Tackling multimorbidity in primary care: is relational continuity the missing ingredient?

Abstract

The GP registration system in the NHS encourages a relationship between a primary care team and a local population over time. Historically, the small size of practice teams and the stability of communities created very strong personal continuity. However, as general practices have become increasingly larger and as people move around and commute more, the likelihood of a strong personal relationship between doctor and patient has been offset against factors such as appointment availability, lead clinicians being responsible for specific conditions, and patients’ choices and priorities. Good and lasting therapeutic relationships flourish when organisations offer sufficient opportunities for a patient to see the same clinician when requested.1,2 However, there is a need for more evidence about how prioritising relational continuity improves overall care outcomes, especially in patients in whom a combination of socioeconomic disadvantage and complex comorbidities prevent effective engagement with health and social services. The term ‘continuity of care’ refers to a complex and multifaceted concept that has been difficult to define.3 Three types of continuity of care are generally accepted: 1) informational continuity, which describes the sharing of patient information between professionals and service providers; 2) management continuity, which describes a timely and complementary delivery of services from different providers; and 3) relational continuity, which describes an ongoing therapeutic relationship between a patient and one or more providers. Relational continuity is associated with improved patient satisfaction, care coordination, and selected patient outcomes.4 It implies a sense of affiliation and mutual commitment between patient and clinician. This affiliation improves reciprocal trust and responsibility, and reduces the ‘collusion of anonymity’, where a succession of clinicians deals only with the most immediately pressing problem. Relational continuity is therefore not only seeing the same …