What do patients and clinicians think about continuity in general practice in England? a qualitative study

Background: Relational continuity - an ongoing therapeutic relationship between a patient and a clinician - has long been a hallmark of general practice. However, its prevalence in England has declined over the past decade amid increasing demand, workforce shortages, and structural changes in primary care delivery.

Aim: To explore patient and clinician views on continuity in general practice, and understand the factors influencing these perspectives.

Design and setting: A qualitative study using interviews and focus groups conducted in England between July 2024 and February 2025.

Method: Semi-structured interviews were conducted with 17 primary care staff, and six focus groups were held with 40 patients. Staff were recruited through team contacts and snowballing. Patients were recruited through adverts in general practices. Inductive thematic analysis was informed by theoretical models of continuity, Reeve and Byng's United Model of Generalism, and the biopsychosocial model of care. Data were coded using NVivo software.

Results: Four themes were identified: many patients lack experience of continuity and struggle to understand its value; patients and clinicians often prioritise other elements of care, such as quick access, over continuity; views on the value of continuity are shaped by beliefs about the role of general practice; and there is scepticism about the feasibility of restoring continuity within current system constraints.

Conclusion: We may be reaching a tipping point, whereby a critical mass of patients views general practice solely as a method of accessing biomedical services from whichever staff member is available. If we want to improve continuity, we need to act before changes in attitudes and care delivery make change an impossibility.