Closing the gap between expectations and practice in continuity of care: can we still teach continuity of care?

An educational improvement audit of general practitioner (GP) training in continuity of patient care with special reference to patients with long-term conditions was commissioned by a postgraduate medical and dental deanery. The audit comprised interviews (n = 13) with GP trainers, trainees and GPs who had recently completed their training. These interviews were thematically analysed and the findings discussed in workshops with stakeholders in GP education. The interviews showed that trainers and trainees found considerable difficulty in reconciling the values of continuity of care with recent changes in policy and practice. It was also found that while training practices could demonstrate aspects of continuity of patient care, it was difficult to give trainees practical experience and responsibilities that could underline and reinforce this. Newly qualified GPs found it particularly difficult to maintain and apply their understanding of continuity of care in the realities of practice after moving on from their training practice and before obtaining a long-term GP post. The workshops formulated proposals for a series of measures to make continuity of care, in all its forms, more explicit in every element of training and in support for professional development. These proposals were analysed to develop a phased action programme and to assess their cost and utility. This showed great potential to improve the value of training in continuity of care for GP practices and trainees, and ultimately for patients.