It’s the relationships, stupid.

I was in the midst of writing a blog on PIEs and Housing First, for the Housing First England website (now also here), when into my letter box – the real, physical one – pops a weekly magazine with an article[i] by Dr Phil Whittaker.

Dr Whittaker is a regular columnist at the New Statesman, and a consistently humane and grounded voice in that weekly political melee. Dr Phil writes here about the overlooked significance of continuity in care, and specifically in the relationship a family GP has with their patients.  

He writes powerfully and from experience. But he also has the research to back him. A new study from Norway shows that:

‘(W)hat they discovered was little short of astounding . Patients who’d had the same family doctor for many years were 30% less likely to use out-of-hour services; 30% less likely to be admitted to hospital as an emergency; and 25% less likely to die then people registered with their GP for under a year.’

‘…. (T)here are other benefits: patients are more likely to follow lifestyle advice, attend screening and vaccination appointments and stick with treatment. Continuity reduces prescribing costs, results in fewer referrals, and protects the health service against litigation costs..’ 

But if this is true of patients with mainly physical health needs in primary care, how much more true is it likely to be of services for those most at risk of social exclusion, stigma and marginalisation?   With those for whom daring to trust any authority or care figure at all is already quite a challenge, the investment we make in a relationship of trust is gold dust.

Then blow me down, in October 2020 the Daily Mail – no less –  also ran an article on the same subject[i].  So you don’t have to be a left winger to know this; it’s one of those immediately, intuitively obvious things that are so easy, therefore, to overlook. 

But the really sad and worrying thing is the title of Dr Whittaker’s article: “The last days of the family doctor”. He explains how current NHS policy, in a totally misguided attempt at ‘economy’ in healthcare, is actively creating mega-practices with multiple GPs and a ‘taxi rank’ system for appointments. By ignoring the importance of continuity of care, and of the 1-1 relationship, the evidence suggests that this is a hugely wasteful system

Sounds familiar? What counts is not just what’s counted; and the business models we expect of services for the people with the most complex needs can often overlook the bindingly obvious: to paraphrase Bill Clinton, it’s the relationship, stupid.

[i] Michael Dixon, Why the demise of the family doctor will be the death of us, Daily Mail, 19/10/2020, at:

[i] Phil Whittaker, The last days of the family doctor : New Statesman, 10th December 2021, pp 68-73.


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