The Human Connection: Why Relational Continuity Matters in General Practice

What if the key to a more efficient, effective, and resilient NHS wasn't a new technology or a revolutionary drug, but something profoundly human? In the NDPCHS Workforce and Learning Research Group, we believe it is. It’s called relational continuity of care (RCC), the sustained, therapeutic relationship between a patient and their clinician. At its heart, continuity of care means being cared for by someone who knows you — not just your medical history, but your story, your preferences, and what matters to you. While it sounds simple, its impact is anything but. Evidence shows that good continuity of care enhances patient outcomes, reduces healthcare costs, and can even lower mortality rates.

We recently had the pleasure of hosting Professor Denis Pereira Gray, Professor Philip Evans, Dr Nada Khan and Dr Kate Sidaway-Lee from St Leonard's Practice in Exeter. Together, they have spent more than 40 years investigating the impact of RCC. Their insights and our own work point to a clear conclusion: with the NHS under unprecedented pressure and the Government’s 10-year plan shifting care closer to home, the bond between patients and clinicians has never been more vital. In this post, we’ll explore the challenges facing continuity of care, delve into the powerful evidence for its benefits, and share how our new research aims to translate this evidence into practice.

Challenges to Continuity

In recent years, the need for continuity has grown stronger. The COVID-19 pandemic highlighted the importance of a stable patient-provider relationship for managing chronic conditions and navigating a fragmented system. Simultaneously, long-term austerity has stretched healthcare resources thin, while the welcome rise of digital tools and online consultations has, despite its potential convenience, made maintaining a consistent bond more difficult.

This has had a measurable effect. There is strong evidence that patients' perceived continuity with their GP is steadily falling. In fact, the NHS patient survey recently reported that for the first time since 1948, less than half the population felt they had a regular GP. This presents a significant challenge, but also a vital opportunity to reinforce continuity as a core principle of primary care.

Why It Matters: Insights on the Benefits of Continuity

Decades of research show that when patients consistently see the same GP, the effects are felt across the entire health system.

Research shows that good GP continuity is associated with:

• Improved Patient Experience and Adherence: Patients with a trusted GP report higher satisfaction, develop greater trust, and are significantly more likely to follow medical advice and adhere to prescribed medication.
• Enhanced Preventative Care: Continuity is linked to a significantly better uptake of personal preventive measures, such as immunisations and cancer screenings.
• Higher Quality Care and Better Decisions: GPs report they provide better care and make better life-saving decisions for patients they know personally, such as when identifying patients who need statins or diagnosing suspected meningitis in a child.
• Reduced Burden on the NHS: GP continuity is significantly associated with lower rates of attendance at emergency departments, fewer hospital admissions, and lower costs across the whole health system.
• Lower Mortality Rates: Perhaps most strikingly, studies have now established a significant association between better continuity of GP care and a lower death rate in patients.

How Do We Improve It? Personal Lists vs. Pooled Lists

A major factor influencing the level of continuity is the internal organisation of a GP practice. Many practices in England use a "pooled list" system, where all patients are managed as one group and can see any available doctor. In this model, continuity is often low and left to chance.

An alternative is the "personal list" system. Here, the practice list is divided, and each GP is responsible for the overall care of their specific group of patients. Staff actively try to book appointments with the patient's named GP, which fosters a stronger sense of responsibility in the clinician and enables a long-term relationship to build. Practices that focus on personal lists deliver higher continuity, and GPs working in them report higher job satisfaction.

The St Leonard’s team have also developed a practical way to measure how often patients see their named GP. This enables practices to track and improve continuity within existing systems. Their research shows that good continuity can be measured and is achievable even in larger group practices.

Our Research: Building the Evidence with a Realist Review

Our Workforce and Learning Research Group, in collaboration with the incoming President of the Royal College of General Practitioners, Dr Victoria Tzortziou Brown, has recently published a new realist review protocol. Much of the existing research on continuity is observational, meaning it shows strong associations rather than definitive proof of causation. Our project, which is funded as part of the NIHR’s Health and Social Care Delivery Research (HSDR) Programme, uses a realist review methodology to build a detailed, evidence-based theory of how RCC works in different contexts.

Instead of just asking if continuity works, our review asks:

• What strategies can effectively promote RCC in general practice?
• Who benefits most from RCC and under what specific circumstances?

The study will be guided by a stakeholder advisory group including patients, policymakers, and healthcare professionals to ensure our findings are relevant and impactful. This work will also draw upon the findings of a related scoping review, conducted by students supervised by members of the Workforce and Learning Research Group, presented at the recent RCGP Annual Conference and currently under review with Primary Health Care Research & Development. 

The Path to a More Connected Future

The evidence is clear: relational continuity of care is not a nostalgic "nice-to-have" but a cornerstone of high-quality, efficient primary care. It improves patient health, reduces system-wide costs, and makes the job more satisfying for GPs. As the NHS moves forward with its 10-year plan to shift care into the community, we have a unique opportunity to champion relational continuity as the key to a more connected and sustainable healthcare future. By understanding not just that it works, but how it works for different people in different situations, we can develop practical recommendations to strengthen and sustain primary care, reduce health inequalities, and build a more resilient NHS.

To learn more about this work, you can read the full study protocol in BMJ Open. To explore more research from our colleagues, please visit our research group webpage.