Relational continuity of care (RCC) refers to the sustained therapeutic relationship between a patient and healthcare professionals, which fosters trust, communication, and clinical responsibility. ¹RCC in general practice is linked to improved patient outcomes, reduced hospital admissions, lower mortality rates, decreased healthcare costs, and enhanced patient experience. ^{2, 3, 4} Despite these benefits, there is little consensus on how to deliver RCC effectively and for whom it should be prioritised.

NHS reorganisations, workforce shortages, and the expansion of multidisciplinary teams have contributed to a fragmented healthcare system, resulting in reduced RCC. Policies that prioritise timely access over continuity have further eroded RCC, with only 16% of patients in 2023 consistently able to see their preferred GP. ⁵ Calls for incentivising RCC through contractual changes have emerged, ⁶ but it remains unclear how to achieve this within the current general practice framework.

Although RCC has demonstrated significant benefits, its impact varies across patient groups.⁷ For example, for patients with chronic conditions, such as diabetes or hypertension, greater continuity of care has been associated with reduced hospitalisation and mortality rates.⁸ However, it is unclear whether these benefits are similar for patients with other long-term conditions. Additionally, patients with cancer receiving RCC are more likely to be able to understand and manage their condition, experience greater feelings of control, and have higher overall well-being⁹. But there is a lack of clarity regarding the benefits of maintaining such RCC after cancer remission and recovery. A recent study showed that the productivity benefit of continuity of care seems to be greater for older patients, those with multiple chronic conditions, and individuals with mental health conditions. ¹⁰ However, the evidence on the differential benefits of continuity across various patient groups has not yet been synthesised.¹¹

RCC may also enhance patient safety by reducing diagnostic delays, particularly for complex cases. ¹²However, while RCC fosters trust and holistic care, there are potential downsides, including diagnostic bias, patient collusion, and increased GP workload, which may contribute to clinician burnout.^{13, 14, 15}

Evidence suggests that RCC is less accessible to patients from non-white ethnic backgrounds and socioeconomically deprived communities, despite their higher preference for continuity. ^16,17 Older individuals also experience reduced RCC, highlighting systemic inequalities in access. ¹⁸ The implementation of RCC can be more challenging in practices situated in areas of high deprivation. This is because general practice in deprived areas is underfunded and under-doctored relative to need. ¹⁹ Evidence suggests a negative association between larger practice sizes and continuity, ²⁰ with single-handed practices having higher patient-reported access, continuity and overall satisfaction, while higher levels of practice deprivation are associated with lower RCC. ²¹

There is an urgent need to identify effective care models that balance RCC with the realities of modern general practice. Understanding which patients benefit most, under what circumstances, and how RCC can be implemented in a multidisciplinary setting is crucial for informing policy and practice. By addressing these gaps, RCC can be optimised to improve patient outcomes, reduce health inequalities, and support the sustainability of primary care.