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ObjectiveContinuity of care is a long-standing feature of healthcare, especially of general practice. It is associated with increased patient satisfaction, increased take-up of health promotion, greater adherence to medical advice and decreased use of hospital services. This review aims to examine whether there is a relationship between the receipt of continuity of doctor care and mortality.DesignSystematic review without meta-analysis.Data sourcesMEDLINE, Embase and the Web of Science, from 1996 to 2017.Eligibility criteria for selecting studiesPeer-reviewed primary research articles, published in English which reported measured continuity of care received by patients from any kind of doctor, in any setting, in any country, related to measured mortality of those patients.ResultsOf the 726 articles identified in searches, 22 fulfilled the eligibility criteria. The studies were all cohort or cross-sectional and most adjusted for multiple potential confounding factors. These studies came from nine countries with very different cultures and health systems. We found such heterogeneity of continuity and mortality measurement methods and time frames that it was not possible to combine the results of studies. However, 18 (81.8%) high-quality studies reported statistically significant reductions in mortality, with increased continuity of care. 16 of these were with all-cause mortality. Three others showed no association and one demonstrated mixed results. These significant protective effects occurred with both generalist and specialist doctors.ConclusionsThis first systematic review reveals that increased continuity of care by doctors is associated with lower mortality rates. Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors. Many of these articles called for continuity to be given a higher priority in healthcare planning. Despite substantial, successive, technical advances in medicine, interpersonal factors remain important.PROSPERO registration numberCRD42016042091.

Talbot-Smith and colleagues showed that, in the US, the Kaiser highly integrated system was associated with much higher costs than in the NHS. 2 The comment about the new costing system for emergency admissions to hospital needs discussion because it has profound ethical and clinical implications.

After four years as an occupational health physician in Glasgow, he moved in 1952 to Aberdeen University as a lecturer and then reader in public health and social medicine, completing both an MD and a PhD on the health of men in heavy industry. There he was soon taking a lead in the education of medical students and in developing student attachments to general practices, as part of his vision of community based teaching of the subjects of public health and social medicine. In 1966, when the university acquired funding from the Nuffield Provincial Hospitals Trust to create a general practice teaching unit, Ian Richardson was one of an extensive field of applicants, the majority of whom were senior north east general practitioners without academic experience. Ian Richardson was determined to promote a different model and insisted on all posts being fully university funded, with the clinical roles of new staff defined in a way which left adequate academic opportunities. A justice of the peace, he was committed to the work of the Juvenile Court.

University departments of general practice and the postgraduate education system for general practice have developed separately over the past 30 years. This separation is now impeding the academic development of the discipline and causes difficulties with recruitment and career progression. These problems could be eased by the creation of integrated departments. This would establish a critical mass for research and educational development, allow human and other resources to be used more flexibly and effectively, and provide a strong base for undergraduate education, vocational training, higher professional training, and continuing education. It could encourage collaborative ventures with other disciplines and also lead to higher standards of patient care.

To the Editor: Levy and Thom (Sept. 24 issue), 1 in their editorial on rates of death from coronary heart disease (CHD), note an apparent paradox in the declining prevalence of causal risk factors for myocardial infarction and the lack of change or slight increase in the incidence of that disease process from 1987 to 1994, as reported by Rosamond et al. in the same issue. 2 Levy and Thom seek to explain this paradox by looking at the conventional risk factors. I believe this view is too restricted and that, instead of a paradox, there is a failure to look for . . .

Changing priorities in the NHS have underlined the crucial importance of academic general practice in providing quality training and research to underpin developments in general practice. Unfortunately, several problems and constraints mean that the full potential of general practitioners to make a contribution to teaching and research has not been realised. These issues are examined and recommendations for improvements are made. Obstacles to career development for academics in general practice should be removed. The funding of academic general practice should be the same as for other medical disciplines. Vocational training for general practice should be extended to include research and audit methods, particularly for doctors interested in an academic career. Above all, the long term objective should be to integrate undergraduate and postgraduate general practice to increase the overall effectiveness of teaching and research and hence the quality of service general practice.