Relationship continuity: when and why do primary care patients think it is safer?

Abstract

Background: Doctor-patient continuity is popular with patients and practitioners, and is associated with better outcomes; however, changes in policy and practice organisation have diminished its scope. Although there has been some discussion of safety implications from professionals' perspective, patients' views remain largely unexplored.

Aim: To explore patients' understanding of safety in primary care.

Design and setting: An interview-based study with patients from general practices in the northwest of England.

Method: Patients were recruited from five general practices through patient participation groups and posters in waiting rooms, with further participants recruited through snowballing techniques until no new themes emerged. In-depth interviews were digitally recorded and transcribed. Anonymised transcripts were coded and analysed inductively. Emergent themes were discussed by the team.

Results: For patients, relationship continuity was not simply a matter of service quality but an important safety concern that offered greater psychosocial security than consultations with unfamiliar GPs. Relationship continuity enabled the GP to become a repository of information; acquire specialist knowledge of a patient's condition; become familiar with the patient's consulting behaviour; provide holistic care; and foster the development of trust. Patients were also aware of the risks: a false sense of security and lack of a fresh perspective. Their desire for continuity varied with the nature of their concerns, psychological vulnerability, and perception of GPs' qualities and skills. No one supported a return to imposed continuity.

Conclusion: Relationship continuity and choice of GP were important safety strategies, neither of which is adequately supported by recent policy changes.

Keywords: general practice; patient safety; patients’ perceptions; primary care; systems; trust.