title: Personal continuity and access in UK general practice: a qualitative study of general practitioners' and patients' perceptions of when and how they matter.
abstract: BACKGROUND
  Personal continuity is a core value for family practice, but policy and performance targets emphasise other aspects of care, particularly waiting times for consultation. This study examined patient and general practitioner (GP) perceptions of the value of personal continuity and rapid access, and the relationship between them.
  
  
  METHODS
  Qualitative analysis of semi-structured interviews with a purposive sample of 16 GPs and 32 patients in the Lothian region of Scotland, to identify whether, how, why and in which circumstances personal continuity and rapid access were valued.
  
  
  RESULTS
  From the patients' perspective, what mattered was 'access to appropriate care' depending on the problem to be dealt with. For a few patients, rapid access was the only priority. For most, rapid access was balanced against greater involvement in the consultation when seeing 'their' trusted doctor, which was particularly valued for chronic, complex and emotional problems. GPs focused on the value of personal continuity in the consultation for improving the diagnosis and management of the same kinds of problem. GPs did not perceive enabling access to be a core part of their work. There was little evidence that GPs routinely discussed with patients when or how personal continuity and access should be balanced.
  
  
  CONCLUSIONS
  'Access to appropriate care' from the patients' perspective is not fully addressed by GPs' focus on personal continuity, nor by performance targets focused only on speed of access. GPs need to make enabling access as much a part of their core values as personal continuity, and access targets need to be based on less simplistic measures that account for the appropriateness of care as well as speed of access.
authors.affiliation: Tayside Centre for General Practice, University of Dundee, Dundee DD2 4BF, UK. b.guthrie@chs.dundee.ac.uk
authors.forename: Bruce
authors.initials: B
authors.lastname: Guthrie
authors.forename: Sally
authors.initials: S
authors.lastname: Wyke
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D036301:Qualitative Research; D019984:Quality Indicators, Health Care; D012606:Scotland; D013997:Time Factors