Continuity of care is a workforce strategy, not just a quality indicator

One respondent captured the issue succinctly:

"When I started it was an amazing career; now the aspects that I like such as continuity of care are being eroded."

This reflects a broader change in the way general practice has been organised. As continuity has become harder to provide, many GPs have lost one of the main sources of satisfaction in their work.

Two decades of prioritising access

The evidence that continuity is good for patients is long established. Seeing the same doctor over time is linked with lower mortality, fewer emergency admissions, lower costs and higher patient satisfaction.

Despite this evidence, policy since the early 2000s has largely prioritised rapid access. The introduction of Advanced Access increased same-day availability but reduced opportunities for advance booking with a preferred GP. More recently, the Government's 10-Year Health Plan has emphasised ‘instant access’ and ‘a doctor in their pocket’, while continuity is absent as an explicit policy objective. There are no national continuity metrics, few contractual incentives and little evidence that workforce planning takes continuity into account. In 2023, the House of Commons Health and Social Care Committee concluded that continuity of care is no longer the norm in general practice.

What our research found

As part of the PATHWAYS study examining GP career decisions, we asked practising GPs across the UK what they had found most rewarding about their careers. Nearly half identified continuity of care, making it the most frequently cited source of professional satisfaction by a considerable margin. It ranked well ahead of other positive aspects of the job, including flexibility and the variety of clinical work. These findings have now been published in BMJ Leader.

Continuity as a workforce issue

There has been some progress. The 2024/25 GP contract included £29.2 million of dedicated funding for continuity of care, the first specific investment since the NHS was founded. However, the policy approach remains entirely patient-centred and targeted: use risk stratification to identify the patients who would benefit most, and provide continuity to them, at that point in time.

Given current workforce pressures, this targeted approach is understandable. Universal personal lists are difficult for many practices to sustain. However, it also reflects an implicit assumption that continuity is primarily a clinical intervention for selected patients, rather than a feature of general practice that benefits both patients and clinicians.

Our findings suggest that this distinction matters. If continuity is also the aspect of practice that GPs value most highly, then its decline has implications beyond quality of care. It may also affect recruitment, retention and long-term workforce sustainability.

These issues are increasingly pressing. England is projected to face a shortfall of around 15,000 GPs by 2036/37, while a 2024 survey found that more than 40% of GPs expected to leave the profession within five years.

What this means for policy and practice

Recognising continuity as a workforce strategy would require a broader policy approach. Alongside access, continuity should become a defined objective for general practice, supported by routine measurement and contractual incentives. National policy on access and digital triage should also be designed to strengthen, rather than weaken, ongoing relationships between patients and clinicians.

Many practices are already finding practical ways to support continuity within existing constraints. These include:

• appointment systems that allow patients to book with their usual GP, including dedicated follow-up slots;
• personal or micro-team lists, supported by buddy arrangements where full personal lists are not feasible;
• routine measurement of continuity using established indices such as the St Leonard's Index or the Bice–Boxerman Index;
• digital triage systems that direct follow-up requests to the patient's usual GP or clinical team; and
• better integration of regular locum GPs through induction, shared systems and participation in team communication.

Re-establishing continuity within modern primary care means embedding relationship-based care as a core priority within the systems practices already run, in ways that fit flexible and part-time careers.

The full paper is open access in BMJ Leader: Continuity of care matters to GPs: implications for leadership and workforce planning. If your practice or ICB is working on continuity, or has hit barriers trying, I would like to hear about it: catharina.savelkoul@trinity.ox.ac.uk.

Catharina Savelkoul is a DPhil researcher in the Health Economics and Policy Evaluation Research Group at the Nuffield Department of Primary Care Health Sciences, University of Oxford, and an Oxford–MRC Enterprise iCASE Scholar. The survey forms part of the PATHWAYS study of GP career decisions.