Exclusive:Our bond of trust with patients is being undermined, Scottish GPs warn
The Royal College of General Practitioners called for continuity of care to be prioritised by the Scottish Government
The trusting relationship between GPs and their patients is being undermined by the focus on faster access to appointments, ministers have been warned.
The Royal College of General Practitioners (RCGP) Scotland said continuity of care must be seen as "a critical measure of quality" and not "a nostalgic ideal".
It came as the body renewed its criticism of SNP plans to adopt GP walk-in centres in Scotland, arguing this will duplicate and fragment care.
First Minister John Swinney announced the move at the SNP conference in October, insisting it will deliver more than one million additional GP and nurse appointments.
But Dr Chris Provan, chair of the RCGP Scotland, said there was “clear evidence from other parts of the UK that GP walk-in centres fail to reduce pressure on core services”.
He added: “Instead, they duplicate and fragment care, incur higher costs than in-hours general practice, worsen health inequalities, and undermine continuity of care.
"It is essential that the pilot is accompanied with a rigorous evaluation to assess the impact on patients, staff, the wider health system, and existing services.
“Should the pilot prove ineffective in reducing demand on core general practice - as we anticipate - we urge the Scottish Government to implement a clear exit strategy.
"This will ensure that no further public funds are wasted and that resources are reinvested where they are already proven to deliver the greatest benefit: core in-hours general practice."
A new paper by RCGP Scotland highlights the importance of “relational continuity of care”, which it describes as “ongoing, trusting relationships between patients and their GPs”. It says this has been deprioritised in favour of speed and convenience.
“Relational continuity of care is not a luxury—it is a foundational element of safe, effective, and person-centred general practice,” the paper argues.
“The weight of evidence is clear: patients who have an ongoing, trusted relationship with their GP experience better health outcomes, higher satisfaction, fewer hospital admissions, and reduced healthcare costs.
“Yet in the face of growing system pressures, continuity has been deprioritised in favour of speed and convenience, particularly to the detriment of those who would benefit from it most.
“To reverse this trend, continuity must be reframed as a critical measure of quality in modern general practice, not a nostalgic ideal. It is incumbent on all stakeholders; the Scottish Government, policy makers and healthcare leaders, to respond and create the conditions needed to embed continuity into the fabric of general practice.”
RCGP Scotland called for a number of changes, including growing the GP workforce and “identifying, celebrating, and learning from flagship practices”, as well as enhancing data collection and digital infrastructure to effectively measure continuity of care.
“Ongoing, trusting relationships between patients and their GPs, or relational continuity of care, is a cornerstone of effective general practice in Scotland,” the paper says.
“Despite strong evidence linking continuity to better health outcomes, patient satisfaction, professional satisfaction and reduced healthcare consumption, especially in unscheduled care settings, it has been in decline due to a number of factors.
“Declining GP workforce capacity, increasing workload pressures, and changing models of care, and the emphasis on rapid access have all created challenges to providing continuity of care for patients.
“As Scotland’s population health needs become more complex and patient expectations for convenience rise, prioritising speed of access, regardless of the urgency of the healthcare need, risks undermining care quality and safety.”
The paper says continuity of GP care is linked to lower death rates and reduced admissions to hospital, as well as lower costs across the whole health system and better patient satisfaction.
It argues this is especially valuable for patients with long-term conditions, mental health challenges and complex care needs such as trauma or substance misuse, as well as for older people, those requiring palliative care, and individuals experiencing socio-economic deprivation and health inequalities.
Dr Provan said: "Illness is a profoundly human experience, and in my 25 years as a GP, I have seen how much patients value being cared for by a trusted doctor when they need it most.
"The honour of knowing my patients is one of the main reasons I chose to become a GP. But continuity is not a luxury. It must be a core principle in how we organise and deliver healthcare, because of the significant benefits it offers to patients, practitioners, and the wider system.
"The evidence is clear: relational continuity reduces mortality, improves adherence to medical advice, lowers hospital admissions and A&E attendances, and delivers higher patient satisfaction.
“For GPs, it means greater job satisfaction and fewer complaints or litigation. For the health system, it reduces repeat attendances and overall costs.
"I share in my patients’ frustration with difficulties in accessing GP appointments. However, efforts to improve speed of access can come at the expense of continuity of care.
“By expanding the GP workforce, providing tools to support clinicians, improving data collection and digital infrastructure, and exploring contractual opportunities, the Scottish Government can ensure patients benefit from relational continuity while accessing their trusted GP in a timely manner."
The warning comes after resident doctors in Scotland - formerly known as junior doctors - voted in favour of strike action in a dispute over pay.
BMA Scotland confirmed resident doctors will strike from 7am on Tuesday, January 13, to 7am on Saturday, January 17. It said the Scottish Government cannot expect to “brazenly renege” on its commitments without being “held to account.”
Resident doctors make up almost half of the medical workforce in Scotland. They can be newly qualified or have up to 10 years’ experience.
Health Secretary Neil Gray previously said resident doctors in Scotland had received a 4.25 per cent pay uplift this year – as part of a two-year deal – the same as accepted by nurses and other NHS staff.
“This means by 2027, we will have delivered a cumulative pay rise of 35 per cent in four years,” he said.
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