A recommitment to continuity of care is central to reviving primary care

The UK in 2024: general practices setting up food banks, doctors writing prescriptions for over-the-counter drugs to help patients save money, and staff giving people cash handouts to alleviate poverty (doi:10.1136/bmj.q1339).1 In London, primary care services specialise in providing care for homeless people who invariably present with complex physical and mental health conditions (doi:10.1136/bmj.q778).2 Around the country, demands on primary care continue to outstrip staffing levels. Against the backdrop of a fractured society, patients’ needs aren’t being met (doi:10.1136/bmj.q1152),3 and staff, unable to deliver the care they know they should, are struggling to prop up the health service.

Yet funding for primary care has barely moved. A funding increase of 1.9% is below inflation (doi:10.1136/bmj.q1114) and forces general practices to adopt the twisted logic of employing lesser trained staff to replace doctors, to provide suboptimal care when baseline health is suboptimal.4 The number of full time equivalent GPs has fallen over a decade. These malign levers of power—the funding restrictions and the workforce machinations (doi:10.1136/bmj.q1191)—have damaged relations between professional groups and eroded primary care’s gatekeeper function.5 Innovations, a constant of progress, are viewed as another oppression driven by distorted priorities (doi:10.1136/bmj.q1332).6 The result is that primary care is collapsing and private healthcare is booming.

This is a mess we need to get out of, but how? How do you redress the chronic destabilisation of primary care in the twinkle of a political cycle? How do you avoid the US trap of spending 20% of GDP on health, within a decade, with a barely discernible impact on health outcomes (doi:10.1136/bmj.q1333)?7 The fix will be a long one, but it begins with a clear understanding of and commitment to the value of primary care: how that commitment leads to better population health—from tackling polypharmacy (doi:10.1136/bmj-2023-074892) to diagnosing skin lesions (doi:10.1136/bmj-2023-077845)—how spending on primary care is a cost effective investment, and how an appreciation of the place of primary care supports the lives of communities and their struggles with the social determinants of health (doi:10.1136/bmj-2024-079259).8910

Seeking succour in election manifestos is a fool’s errand. Health is a common theme, but promises are generally unsubstantiated, usually end up being unfulfilled, or ignore deliverable benefits (doi:10.1136/bmj.q1286).11 The fact that each of the main political parties does promise some action to increase primary care staffing or access (doi:10.1136/bmj.q1360) shows that they do, at least tacitly, accept that a deep crisis exists (doi:10.1136/bmj.q1320 doi:10.1136/bmj.q1326).121314 Our NHS Commission has proposed the health manifesto that any political party that is serious about population health and the NHS should adopt (doi:10.1136/bmj.q1307).15

Might the way ahead be to focus on one principle and construct the service around it? On a recent flight I sat next to two fellow graduates of Leeds Medical School. They had continued to work in Yorkshire, met at their general practice decades ago, and loved their work. They were united in condemning the damage being done to people’s health and wellbeing by the drip-drip destruction of continuity of care. It is a regret shared by every doctor I’ve spoken to about primary care. It is the gripe that won’t settle. Patients and staff prefer continuity of care. The data support that the concept works.

A revival is long overdue for primary care, the jewel in the crown of the NHS. John Launer (doi:10.1136/bmj.q1323) laments that continuity of care is collateral damage: “Narratives have yielded to numbers. Dialogue has given way to data.”16 Numbers and data have their place, in every era, but a commitment to continuity of care is the foundation of reviving a primary care service that is now battered and no longer bejewelled.