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A survey of GPs and practice nurses at 22 practices in England in February and August 2007 showed that some GPs view the contract as accelerating a decline in interpersonal continuity of care.

One GP surveyed said that patients presented with the same problems, but added: ‘The difference is that it's more likely that the patient and the doctor won't know each other.'

But nurses are finding they are becoming more involved in continuity of care as they take responsibility for patients with long-term conditions.

Both GPs and nurses said that nurses have become the primary providers of healthcare for those with chronic conditions, with some GPs fearing that their profession was becoming ‘deskilled' as a result.

The quality framework has altered dynamics between GPs and their patients, say the researchers from the National Primary Care Research and Development Centre.

rachel.liddle@haymarket.com

Ann Fam Med 2008; 6:228-34

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