by Dr Steve McCabe

DR J. MATTHEW Duncan is described in the British Medical Journal (BMJ) of 1887 as ‘a physicianaccoucher (i.e. an obstetrician) and lecturer in midwifery at St Bartholomew’s Hospital, London. On October 3rd 1887 he gave an address to the first medical students entering the new Medical Department of the Yorkshire College in Leeds. Entitled ‘On the Continuity of Medical Life’ his address described the idea of continuity as ‘a doctrine of the highest importance’ and he traced this notion all the way back to the life and times of Hippocrates.

The principle of continuity of care provided by family doctors lay at the heart of the Highlands and Islands Medical Scheme of 1913, the Cathcart Report of 1936 and the four National Health Service Acts of 1948 and it’s a principle that remains important today.

The Royal College of General Practitioners (RCGP) has defined continuity of care as ‘as the extent to which a person experiences an ongoing relationship with a clinical team or member of a clinical team and the coordinated clinical care that progresses smoothly as the patient moves between different parts of the health service. Continuity of care is a critical element of general practice, particularly, continuity of the personal relationship between patients and their general practitioner. Many patients are looking to general practice as the keepers of their story, the clinician or team of clinicians that know them and their circumstances’ A paper published in the BMJ in 1973 looked at a domiciliary outreach service provided by the St Christopher’s Hospice, London and reviewed hundreds of cases over three years. The conclusion was blunt – ‘the most important factors contributing to the success of the service are continuity of care and good communication – without this the whole thing falls’