Continuity of Care

A major benefit of our primary care system is to be able to provide care continuously over a number of years, building a history of the health of the patient and developing a trusting relationship. In urban practices it is common to have a population of about 30% lifelong patients, 30% staying only a year and the rest staying somewhere in between.

Patients register with a practice, ideally as a family. The records of the patient and the rest of the family are available to all the professionals in the practice. This knowledge of the family can add unique value to the doctor–patient relationship and quality of care. For example, the GP will be attuned to any significant genetic predispositions or be aware of the stresses that may be occurring in family life.

In some practices patients can see the same doctor at each visit, but increasingly there will be several doctors working on a shift system so this may not be possible. Patients are encouraged to see the same doctor for a particular illness or condition, and communication between doctors becomes central to maintaining continuity of care.

Primary Care Team

Primary care doctors work in teams which vary from practice to practice (see Figure 3): nurses, dietitians, counsellors, physiotherapists, phlebotomists and others. They will be supported by a practice manager, receptionists and secretaries. Completing the team are externally employed primary care professionals such as district nurses, including specialist nurses for mental health, palliative care and a range of other specialist services. Effective care depends on good communication through meetings, notes and discussion. In most practices the doctor is the pivotal member of the team. This requires recognition of the skills of all the other members as they all play a vital part in the successful provision of patient care.

Appointments

Most patients are seen by appointment at the practice. Patients will be seen on the same day if their medical condition requires it. The initial appointment may be with a nurse or a doctor. Increasingly, patients are choosing to see a nurse where the request is for a procedure (e.g. a dressing or an injection). Nurses have demonstrated their particular training in developing and adhering to protocols of care. Some nurses have academic qualifications or special training and are recognised as nurse practitioners. They are able to demonstrate a high degree of knowledge and skill, especially in some well-defined areas such as managing minor illness including prescribing certain medications and increasingly in managing chronic illness such as hypertension.

Use of Time

The supreme advantage of primary care is the ability to see a patient as often as necessary. The diagnosis may be unclear at the initial appointment but the patient may be seen again later. It is now easy to organise investigations at the hospital with the results sent back to the practice as rapidly as if requested by a hospital doctor. It has been shown that providing these facilities to primary care is economical.

Preventive Medicine

Primary care is in a prime position to promote the prevention of disease and ill health. This may be by the administration of vaccination programmes or the recognition of early factors leading to chronic ill health such as the management of obesity, smoking or high blood pressure (see Chapter 5).

Special Interests

Some GPs develop an interest and extra training in a particular area of medicine, such as minor surgery, gynaecology, management of drug addiction or diabetic care and accept referrals from other practices or from GPs within their own practice. Most GPs with a special interest (GPSIs) see this as only part of their work.

Chronic Diseases

Chronic conditions are well managed from primary care. Most patients with diabetes or hypertension need not be referred to a hospital clinic. It is in this area the practice team comes into its own (see case study).

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