In the book that Anatole Broyard wrote about being diagnosed with cancer, he described wishing that his doctor “would brood on my situation for perhaps five minutes, that he would give me his whole mind just once … survey my soul as well as my flesh, to get at my illness, for each man is ill in his own way”. Given the desperate state of the UK’s health services, such appeals for personalised attention might sound like messages beamed in from another world. But a new study from the University of Cambridge offers some of the strongest proof to date that strong doctor-patient relationships contribute positively to health.
The research, which focused on GPs, found that seeing the same one on each visit meant patients chose to wait on average 18% longer between appointments. While this study did not look at outcomes, it treated the frequency of visits as a proxy on the basis that patients in better health are less likely to seek help. An existing body of evidence has highlighted the benefits of continuity of care in primary (non-hospital) settings, including higher patient satisfaction and reduced hospital admissions. This latest study points to the advantages within primary care, as patients leaving longer gaps between visits could free up millions of appointments.
When looking for productivity gains in health services, reformers frequently emphasise technological innovations as well as the urgent need to address the workforce shortages that are a global issue, but particularly acute in the UK. While new medicines and machines are of course vital tools, this study is a timely reminder that the social nature of health and care services can never be separated from the people who give and receive them.
At a gut level, many people take this for granted. Of course, many of us, particularly the growing number who are coping with long-term conditions, prefer to discuss them with someone we know. Since doctors can more rapidly understand the test results of familiar patients, there are associated efficiency gains. But the underresourcing of primary care relative to acute hospital trusts, as well as the emphasis placed on ease of access (the speed at which it is possible to get appointments), mean that these relationships have not been prioritised in recent decades. Data shows that the proportion of patients who “always or almost always” see their preferred GP has been falling since 2009.
Instead, and in common with developments across other public services including education, management systems have tended to incentivise those elements of performance that can most easily be measured. In primary care, that means they skew towards the quantity rather than the quality of appointments. Jonathon Tomlinson, a GP and writer, has written eloquently of his frustration at the ceaseless demands for data entry when his interest and expertise is in people and their problems.
At a time of severe staff shortages, there are no easy fixes. Prof Stefan Scholtes, one of the authors of the new study, notes that every change to a system has unintended consequences. But the prospect of productivity benefits ought to help politicians, including Labour’s Wes Streeting, to win support for policies promoting stronger doctor-patient relationships – at a time when polls show the NHS topping voters’ concerns. Broyard’s longing for a greater share of his doctor’s attention need not be seen as an anachronism after all.
• This article was amended on 27 February 2024 to reflect the fact that Labour plans to offer incentives for GP practices that support continuity of care.
