Why You Never See the Same GP - And Why It Matters

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This video touches on a topic that I think about a lot as a GP: continuity of care.

Having completed my GP training in an era and setting where personal lists were not enforced, I feel a sense of longing for what I never got to experience in full force. That longing comes through on the rare occasion where a patient - somehow, despite all the barriers in between - has managed to book into one of my slots. I glance at the notes for a few seconds and the magical GP part of my brain instantly recalls who this patient is, what they came in for before, and a good idea of what they might ask today.

I was trained by GP trainers who, for the most part, had experienced personal lists themselves. I'd debrief the patients I saw with them and look on in wonder at how they seemed to know almost 90% of the patients in the practice - their backstory, their families, their social circumstances. As William Osler put it: "It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has."

My intention with this video is to educate about the value and power of this seemingly old-fashioned model of care.

You may think young, healthy patients don't really need continuity (you may be wrong - more on that below). But the patients who clearly do need it most, the ones who generate the most activity in the healthcare system, are the ones who've been deprived of it the most. We need to move toward a system that prioritises and incentivises continuity of care.

I hope you enjoy this video and my first newsletter (please subscribe if you want more like this!) As always, please share your thoughts in the comments on the video - I try to read through them all.

Until next time,

Katherine

💭 What didn't make it on camera

A number of questions came across my mind whilst making this video, but didn't make it into the final cut:

1. Do I need continuity of care if I'm fit and well?
2. How does continuity of care benefit doctors?
3. Doesn't the workforce shortage mean we can't deliver continuity?
4. Are there any risks to continuity?
5. How far are we from the Health and Social Care Committee's 2022 recommendations?

Do I need continuity of care if I'm fit and well?

This is a really interesting question, and my own assumption before digging into this was, probably not? It seems fine for this population to have less continuity - their care is more transactional, and they might actually prefer quicker access over a relationship.

But here's how Dr Kate Sidaway-Lee, an academic working on continuity in general practice, put it to Parliament: "It is quite hard to predict who is going to have a long-term condition in the future. Ideally, you would have continuity of care established before they had that condition. If you had the chance for the doctor to get to know the patient before they started to have the long-term health condition, it would be much better."

In other words: by the time you know you need continuity, it's harder to build. The ambition should be to offer it to everyone who wants it, with quicker access being a patient choice, not a system default.

How does continuity of care benefit doctors?

I focus on the benefits to patients in my video, but as I alluded to in the intro, there's a huge benefit for doctors too. This is less of a focus in the academic literature, but this article, this research piece on GP registrars, and senior GPs giving evidence to the Health and Social Care Committee all point to the same benefits:

• Learning: following up patients over time lets GPs see how their decisions played out, which is one of the few real feedback loops in primary care
• Effectiveness: knowing the patient saves time, sharpens diagnoses, and makes the consultation itself more efficient
• Meaning: the relationship is a source of personal and job satisfaction

Doesn't the workforce shortage mean we can't deliver continuity?

The most common objection to prioritising continuity is the workforce shortage. We don't have enough GPs, the argument goes, so we can't afford the "luxury" of continuity.

However, as I mentioned in the video, GPs are most productive when there is continuity of care. Patients who see their regular GP re-consult around 18% later, and the Kajaria-Montag study estimates better-targeted continuity could cut total appointment demand by around 5%. That's the equivalent of expanding the workforce by 5%, without hiring anyone.

But we also need to change how GPs work, not just how many of them there are. Continuity can't build if the staff keep changing - it depends on the same GPs being available week after week, which means more permanent contracts.

One practical compromise gaining traction is the micro-team model: small groups of 2-3 GPs sharing a defined patient list. An international systematic review suggests it can deliver meaningfully more continuity than the current default. It's not personal lists - but it's better than nothing.

Are there any risks to continuity?

All medical interventions have downsides, and continuity is no exception. The literature flags four main risks:

• Patients waiting too long to see their preferred GP.
• Patients becoming over-dependent on a single doctor.
• "Collusion" between GP and patient, where familiarity leads to avoiding difficult questions (Kessler et al., 1999).
• Stereotyping a known patient and missing the significance of new symptoms. Ridd et al. (2015) reported a 7-day diagnostic delay for some cancers.

Despite the above, the vast majority of published research, and all five systematic reviews to date, find that continuity's benefits substantially outweigh its risks.

How far are we from the Health and Social Care Committee's 2022 recommendations?

In the video I mention the Committee's recommendation that "NHS England should introduce a national measure of continuity of care to be reported by all GP practices by 2024", which has not translated into practice.

But that's only one of several recommendations the government has quietly let slide. Despite the Committee's strong language - that it was "unacceptable that one of the defining standards of general practice has been allowed to erode in this way" - we're three years on, and the gap between recommendation and reality has, if anything, widened.

A few examples:

• The Committee recommended that the government examine limiting list sizes to 2,500 patients per GP, gradually falling to 1,850 over five years as more GPs were recruited. Three years on, the average is over 2,199 patients per GP*.
• The Committee recommended that NHS England set "a stretching ambition" that by 2027, 80% of practices would have returned to personal list continuity, with active support to do so. We're one year out. The 2026/27 GP contract asks practices only to identify patients who would benefit from continuity, with no requirement to actually deliver it.
• The Committee recommended that personal lists be re-implemented in the GP contract from 2030 onwards. We'll see about that one.

*In the video I cite a figure of "over 2,300" - that was based on an older BMA estimate. The most recent figure is around 2,199. Either way, the point stands: we're well above the safe maximum recommended by the 1966 GP Contract (2,000) and the more conservative figure (1,850) recommended by the Health and Social Care Committee in 2022.

🔍 Sources behind the video

The three studies on why continuity matters

Sandvik H, Hetlevik Ø, Blinkenberg J, Hunskaar S (2022) — Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway. British Journal of General Practice, 72(715): e84–e90. 🔗 bjgp.org/content/72/715/e84 The headline Norwegian study of 4.5 million people, showing patients with the same GP for 15+ years had ~25% lower mortality and 28% fewer emergency admissions.

Kajaria-Montag H, Freeman M, Scholtes S (2024) — Continuity of Care Increases Physician Productivity in Primary Care. Management Science, 70(11): 7943–7960. 🔗 pubsonline.informs.org/doi/abs/10.1287/mnsc.2021.02015 The Cambridge/INSEAD study of 10 million UK consultations showing patients re-consult ~18% later when they see their usual GP — and that better-targeted continuity could cut total demand by around 5%.

Leniz J, May P, Gulliford M, Sleeman KE (2026) — Continuity of primary care and end-of-life care costs in dementia: a retrospective cohort study. British Journal of General Practice, 76(763): e116–e123. 🔗 bjgp.org/content/76/763/e116 The King's College London study showing people with dementia who had higher GP continuity had ~£2,100 lower healthcare costs in their final year of life — mainly through fewer hospital admissions.

How continuity is declining in the UK

Levene LS, Baker R, Wilson A et al. (2018) — Predicting declines in perceived relationship continuity using practice deprivation scores: a longitudinal study in primary care. British Journal of General Practice, 68(671): e420–e426. 🔗 bjgp.org/content/68/671/e420 The paper behind the "fell by more than a quarter" figure — relationship continuity in England dropped 27.5% between 2012 and 2017, across all deprivation levels.

Burch et al. (2025) — Relationship between the volume and type of appointments in general practice and patient experience. British Journal of General Practice. 🔗 doi.org/10.3399/BJGP.2024.0276Source for the more recent figure that around a third of patients now regularly see their preferred GP.

GP Patient Survey — Ipsos / NHS England, annual survey of over a million patients. 🔗 gp-patient.co.uk The underlying dataset feeding most UK continuity trend research.

Health Foundation (2023) — Measuring continuity of care in general practice. 🔗 health.org.uk/reports-and-analysis/briefings/measuring-continuity-of-care-in-general-practice A clear briefing on the different ways researchers measure continuity, and why measurement matters for policy.

Why it's declining: workforce and policy

BMA — Safe working in general practice 🔗 bma.org.uk/advice-and-support/gp-practices/managing-workload/safe-working-in-general-practice Source for the "2,300+ patients per GP" figure and the 17% rise since 2015.

NHS England (Feb 2026) — Changes to the GP Contract in 2026/27. 🔗 england.nhs.uk/long-read/changes-to-the-gp-contract-in-2026-27The new GP contract: makes continuity a "core requirement" for PCNs but moves £292m of funding into same-day urgent access.

What needs to change

House of Commons Health and Social Care Committee (Oct 2022) — The future of general practice: Fourth Report of Session 2022–23, HC 113. 🔗 publications.parliament.uk/pa/cm5803/cmselect/cmhealth/113/report.html The cross-party parliamentary report that recommended a national continuity measure by 2024 — a deadline the government allowed to pass.

International comparison

Delalic L, Grøsland M, Godager G, Øien H, Shahid R (2024) — Continuity of care in general practice in Norway. PLOS ONE. 🔗 journals.plos.org/plosone/article?id=10.1371/journal.pone.0305164Population data showing continuity in Norway has remained stable at around 70% since their Regular GP Scheme was introduced in 2001.