The evidence in favour of care continuity in primary medical services gets stronger and harder to ignore as each year passes. If a patient sees their usual GP then it leads to improved patient outcomes, reduced use of secondary care, and improved working conditions for GPs.  The latest evidence suggests that it also reduces demand for primary care, by lengthening the interval to the patient’s next appointment. Surely this is the holy grail? 

Nobody seems to deny the benefits of care continuity and it used to be the norm; yet we seem to have constructed a system that makes it almost impossible to deliver.  Levels of care continuity have been declining for many years and the latest GP Patient Survey suggests it has reached a new low.

In our recent paper we explore why this is the case and what might be done to turn things around.  Spoiler alert: it won’t be easy and would require significant policy changes.

One (of many) trends that seems to be at odds with continuity of care, is the increasing prevalence of part-time working amongst GPs.  I have no doubt that part-time staff work as hard, if not harder, than their full-time counterparts.  And part-time working is a central part of NHS efforts to offer flexible working arrangements.  But it is also true, that, all other things being equal, it is harder for a part-time GP to offer continuity of care than it is for a full-time GP. 

The trend towards more part-time working is often described through a demographic lens.  The argument typically goes that women make up an increasing proportion of the GP workforce, and women are more likely to work part-time, so this leads to an increase in part-time working overall. 

It is an argument with little explanatory power. The change in the sex-distribution of the GP workforce explains only a small part of the trend towards part-time working.  The main effect, is that both male and female GPs are more likely to work part-time now than their counterparts were in the past. 

One potential explanation for this is the incessant, and highly pressured working environment of modern general practice, where productivity is king and demand always seems to exceed supply. Faced with this, and equipped with choice, GPs are voting with their feet.  

GPs crave the opportunity to build meaningful relationships with their patients as they did in the past.  Perhaps part-time working is a way for GPs to wrestle back control over their working week.  Seen this way, part-time working is a symptom of dwindling care continuity, not a cause of it.