Table 5. Suggestions for improvement of personal continuity by GPs and patients (in no particular order)
GP Patient
1. Personal connection
XXOrganise introductory meetingsP: ‘When I visit my GP, he does not look at me and constantly looks at his screen. My husband and I both had this experience. Is my GP really interested in me and my problem?’
XImprove open consultation and listening skills
XPerform home visits
XEnsure the EMR is up to date and is read by GPs
XHave a personal connection between GP and patient
2. GP accessibility and availability
XImplement e-health: consultation by video calls and emailsGP: ‘Personally, I am available to terminal patients directly or via colleagues. If this is not possible due to circumstances, I communicate this with my patient. In my experience, the thought that your expertise is within reach is comforting to these patients.’
XOrganise walk-in hours with own GP
XEnsure direct GP accessibility and availability outside office hours for own patients with complex needs, particularly palliative care needs
XReduce waiting times for own GP
XXReduce part-time employment
3. Communication about (dis)continuity
XXCommunicate GP availability and staff changed to the patients of the practiceP: ‘I would consider it very pleasant if the website showed the office hours of our GP and the availability, that is, holidays. Preferably a notification well ahead of the absence so that I am not unexpectedly confronted with my GP’s absence when I call my practice for an appointment.’
XEncourage patients to ask for their own GP when scheduling appointment
XInform patients about the aim and structure of the out-of-office hours care
4. GP responsibility
XXPromote a proactive GP attitude by periodically, or on occasion, initiating contact instead of depending on patient initiativeP: ‘Unfortunately, we do not have a “total body doctor”. However, an annual check-up combined with a positive consultation experience would be appreciated. In particular for older people, just like a technical examination for cars!’
XStimulate GPs to only prescribe recurrent prescriptions for their own patients
XXInstruct assistants to schedule patients with follow-up consultations with same doctor, barring emergency consultations
5. Triage dependent on severity and urgency
XXInstruct assistants to schedule complex patients with same doctor, barring emergency consultationsP: ‘The role of the practice assistant is crucial in my opinion. She has to compromise between a (too) busy schedule and the (non)importance of seeing your own GP.’
XOptimise the EMR to help assistants with scheduling, that is, preferred GP pop-up
XPlan small medical issues or emergencies with locums or nurse physicians to give regular GP more time for complex cases
6. Time for the patient
XIncrease the compensation per consultationGP: ‘Improve the organisation of out-of-office hours care, in particular with regard to GP with practices. During the day, continuity is essential, emergency care is less continuity-dependent. Enable combining out-of-office hours care with day care, and so create a small workload and provide flexibility.’
XXReduce administrative burden and work load
XReform organisation of out-of-office hours care
XXIncrease the time per consultation
XIncrease GP availability for direct patient care to at least 3 days a week
7. Actions by third parties
XIntroduce a nationwide EMRGP: ‘Sufficient transfer of care between inside and outside office care. For example, by having a nationwide EMR [...] In my opinion, the IT should be adapted drastically to the 21st century.’
XXOptimise collaborations with hospitals and mental healthcare organisations
8. Team continuity
XXPromote small-scale practices: fewer patients and fewer GPs per practices and stimulate regular employmentGP: ‘In a small-scale practice, personal continuity is better ensured, because the assistants know their patients and the lines of communication are shorter. In a large health centre, I supervised several nurse physicians, medical trainees, GP trainees etc. Although I liked these collaborations, the continuity of care was limited.’
XXReduce changes of doctors by stimulating regular employment
XXImprove working atmosphere
XIncrease pay of support staff to improve job attractiveness
XXEnsure a sufficient number of staff
9. GP vocational training
XInclude importance of personal continuity in GP educationGP: ‘[…] More attention in education programmes that being a GP is not ‘just’ a job, that it requires a certain dedication and servitude (like judges). This should be a part of the application procedure.’
  • EMR = electronic medical record.