What do patients and clinicians think about interventions which prioritise continuity for certain patients in primary care?

backgroundRelational continuity of care is associated with improved patient outcomes, yet continuity in UK general practice is declining. This is despite the UK requiring patients to register/enrol with a general practice to access routine healthcare. Several methods to improve continuity within an enrolled population have been suggested and piloted, some of these prioritise continuity for selected patient groups rather than for all patients. However, little is known about how patients and clinicians perceive targeted continuity schemes. This study explored attitudes towards implementing systems that prioritise continuity for specific groups within general practice.

methodsA qualitative study using semi-structured interviews with primary care professionals and six focus groups with adult patients was conducted across England (July 2024–February 2025). Clinicians were purposively recruited; patients responded to advertisements in GP practices. Sessions were recorded, transcribed verbatim, and analysed thematically using NVivo. Coding was iterative, supported by team discussion and public and patient involvement input. Analysis focused on views about interventions that allocate continuity to selected patient groups.

resultsForty patients and 17 healthcare staff participated. Both groups broadly accepted that some patients may benefit more from continuity than others. However, views differed on whether schemes to improve continuity should be targeted at particular patients and, if so, who should be prioritised. Clinicians tended to emphasise medical or psychosocial complexity, while patients highlighted the need for flexibility and personal choice. Participants expressed concern about equity, the risk of poorer care for “non-continuity” patients, and challenges in assigning patients to categories. Practical uncertainties included how acute issues should be managed for continuity-assigned patients, the role of allied health professionals, and the potential for clinician burnout if complex patients were disproportionately assigned to specific GPs. Both groups worried about reduced autonomy and mismatches between patient and GP preference if allocation was rigid.

conclusionsThese findings suggest that, targeting continuity improvement schemes to selected patient groups is not simply a technical service redesign but raises fundamental questions about equity, professional roles, and patient autonomy in general practice. Continuity improvement schemes should therefore avoid a rigid, one-size-fits-all approach and instead support locally tailored approaches that balance relational care, access, and workforce sustainability. Further research is needed to identify which clinical and social characteristics truly modify the benefits of relational continuity, and to test models that preserve choice and fairness while operating within constrained primary care capacity.