Ask almost anyone over 50 what has changed most about the NHS in their lifetime, and often they will say the same thing: they used to have their own family doctor. Someone who knew their history, knew their family, and noticed when something was not quite right. For millions of people that relationship has quietly disappeared, replaced by whichever clinician happens to be free when the phone lines open at 8 am.
That loss is not just sentimental. It is costing lives.
In the House of Commons last week, I asked the health minister, Dame Diana Johnson, whether she had read a remarkable study published in the British Journal of General Practice. Researchers in Norway followed more than 4.5 million people registered with a named regular GP. They found that patients who had kept the same GP for more than 15 years were 30% less likely to use out-of-hours services, 28% less likely to be admitted to hospital as an emergency and 25% less likely to die, compared with those who had been with their GP for just a year. Crucially, the benefit grew steadily the longer the relationship lasted – exactly what you would expect if continuity itself is doing the work.
Think about what that means. If a new medicine cut mortality by a quarter and emergency admissions by more than a quarter, we would be falling over ourselves to make it available to every patient in the country. Continuity of care is that drug. It costs very little, it has no side effects, and we used to have it.
Why does it work? Because a doctor who knows you spots patterns a stranger misses. They know that you do not usually complain, so when you do, it matters. They do not need to start from scratch every time, so consultations are more efficient. Patients feel more able to raise issues they may be embarrassed about raising with a stranger if they are speaking with someone they know and trust. And a GP who carries personal responsibility for a list of patients has every reason to keep them well and out of hospital.
As health secretary, I reintroduced a named, accountable GP for everyone over 75, because I saw how badly the move away from personal lists had hit older and more vulnerable patients. I thought that would do the trick. But it was me who ended up being tricked. What I hoped would be a major reform ended up being a tick-box exercise. Every patient does now have a “named, accountable clinician” on their medical record. But nothing in the real world changed. Since then, the pressures on general practice have pushed in the opposite direction. Larger practices, more part-time working and the understandable focus on getting people any appointment quickly have all made it harder to see the same person twice.
Labour came to power promising to “bring back the family doctor”. I cheered. Maybe they could pick up where I left off? But two years on, the fundamental structure of general practice has not changed. The minister told the House that the proportion of patients able to see their preferred clinician has risen from 61% to 68%. That is welcome progress, but being able to see a preferred clinician when you happen to ask is not the same as having your own doctor who is responsible for you over years. She said the department has set up a clinical working group to look at how best to support continuity and has kindly offered to read the study and discuss it with me. I will take her up on that. But working groups do not change patient experience. Contracts do.
So here is what I would ask the government to do during the next GP contract negotiations:
- Restore personal lists for everyone. Every patient should have a named GP who is genuinely responsible for their care, not a name on a letter.
- Measure continuity and reward it. What gets measured gets done.
- Practices should report how often patients see their own doctor, and the contract should reward those that deliver it.
- Protect it for those who need it most. Older people, people with long-term conditions and those with complex needs should be guaranteed continuity as a priority.
- Make it compatible with modern practice. Small teams within larger practices, with each GP backed by the same nurses and pharmacists, can keep the personal relationship while sharing the workload.
None of this means turning the clock back on areas where we have made progress. Digital access, extended hours and wider practice teams all have a place. Nor does it mean asking GPs to go back to the old 24/7 on-call duties. But modern general practice should be built around a relationship and not turned into the medical equivalent of Uber.
Continuity of care is one of the rare reforms that is better for patients and better for doctors, who overwhelmingly tell us they find it more rewarding. It also helps hard-pressed NHS budgets because people who are kept well stay out of hospital. The evidence is there. The pledge is there. What is missing is the political will to write it into the contract. Now is the moment.
