Living with multiple health problems

Continuity of Care

“Continuity of care” describes the way in which different aspects of people’s health care are joined up or follow on from each other. People with more than one health problem might be seeing doctors in different departments and hospitals who may or may not communicate with each other or the person’s GP. Even with one condition alone there might be disagreement between different doctors. When people spoke about the continuity of care it was often about whether they were satisfied with care. The main issues in care continuity people spoke about were:

•    seeing different health professionals, 
•    the transfer of medical information between departments, and 
•    whether people were followed-up and monitored or not.

The issue that most concerned people was whether they always saw the same GP (at their local doctor’s surgery) or the same consultant or other health worker (in hospital departments). Seeing the same professional at every visit was highly valued. Derrick said he trusted his GP completely and felt he could talk to him as if he was one of the family. Barry felt his GP knew him well; he appreciated that when he phoned the surgery for help the GP would call him back promptly. Nigel was very satisfied with his GP when she paid close attention and made a speedy referral. Anne Y felt that her epilepsy management had improved since she had been seeing the same consultant for a long period of time.
Aspects of some people’s care might be joined up better than others. For example, Tammy complained about always seeing different consultants for diabetes but she found good continuity with the specialist nurses. She also found it useful that the neurologist she sees about her epilepsy is based in the same hospital she attends for diabetes appointments.
People said that it can be difficult to develop trust when constantly seeing new (or different) health professionals. This can also mean having to repeat their story over and over again. Farza’s practice appeared to be staffed entirely by short-term locum doctors, which prevented the development of long-term relationships. Others had changed GP practice after moving house; Michael X had left behind a GP with whom he had got on very well and had so far seen four different GPs at his new practice. 

A related issue was why health professionals in different services or departments seemingly cannot all access the relevant parts of a patient’s medical history. Farza was seeing a psychiatrist in a different town, which seemed to create problems in GP communication. Val was told she did not need to take copies of her test results from one hospital to another, but when she arrived she was instead told they couldn’t access them because they had been done in a different county. Val had sought help from a private specialist while waiting for an appointment with an NHS rheumatologist; she doubted that the two consultants would talk to each other. Andrew said that being referred to a physician and a surgeon at the same time about his appendix problem was “a bit of a muddle”. However, he also said that having to tell his story repeatedly to different doctors, each time he attended the endocrinology clinic, meant that on one occasion he met a doctor who took a greater interest in his history.
Trying to make sure they always saw the same GP was a common way of trying to avoid the kinds of problems mentioned above. However, getting a timely appointment with their chosen GP wasn’t always easy. Amy’s GP got around access problems by always inviting her to book her next appointment after each visit. Pat felt privileged that her GP had given her his email address but she was wary of abusing it. Being able to see the same GP every time was valued, not just because of developing a trusting relationship, but also if they were perceived as knowing a lot about a particular medical condition or were good at giving emotional support and practical advice. Continuity of care from specialist doctors and nurses was also valued.
In contrast to those people who were careful to always try and see the same GP, others did not mind seeing different ones. Loraine made sure she saw either of two whom she preferred at her local surgery. Anne Y didn’t mind who she saw about her asthma but wanted to see the same GP about her epilepsy as she considered it the more serious condition. Others did not mind who they saw. Some even saw it as beneficial to see different doctors as you could get a range of opinions. Steve said he had a good relationship with all the GPs at his local surgery. 

Different people had different opinions and experiences of the value of always seeing the same doctors. When people spoke about not minding which doctor they saw they also talked about the availability or transfer of medical records between different doctors. Val believed that some GPs don’t refer on to specialists quickly enough.
Disagreement between health professionals also affected continuity in people’s care; partly as it could involve going back and forth between doctors before a treatment plan was finalised. Disagreement between health professionals is also considered in other topics (see particularly ‘Impact on medical care’) although it related mainly to single medical conditions.

Another key issue for the people we spoke to was whether they were seen by anybody at all for follow-up and monitoring. Once again, people’s experiences varied widely. Some complained that they were never recalled by hospital departments (e.g. following major treatment for a stroke or heart attack). Others reported regular (e.g. 6 monthly) check-ups with specialists; this seemed to be a feature more seen in the interviews with people with diabetes or epilepsy. Angela wasn’t personally sure whether she wanted more or less follow-up, but thought that everything was driven by doctors. Fred had been in and out of hospital and complained about the lack of follow-up after being discharged.


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