PURPOSEWe determined the reported value general practitioners/family physicians in 3 different health care systems place on the various types of continuity of care. METHODSWe conducted a postal questionnaire survey in England and Wales, the United States, and the Netherlands. The participants were 1,523 general practitioners/family physicians (568 from England and Wales, 453 from the United States and 502 from the Netherlands). Our main outcome measures were the perceived importance of the types of continuity of care and doctor or practice characteristics that may infl uence attitudes toward personal continuity of care. RESULTSThe response rates were England and Wales 60% (568/946), United States 47% (453/963) and Netherlands 76% (502/660). The doctors in all 3 countries felt strongly that personal continuity remained an important aspect of goodquality care to their patients. Within a given health care system, doctors' personal and practice characteristics explained only a small part of the variance in attitudes toward the provision of personal continuity of care (England and Wales and the Netherlands r 2 = 0.04, United States r 2 = 0.01). The doctors in all 3 countries felt that they were currently able to provide all 3 types of continuity of care, although doctors in England and Wales were least positive about the provision of informational and management continuity across the primary-secondary care divide.CONCLUSIONS General practitioners/family physicians from 3 differing health care systems all place high value on being able to provide personal continuity of care to patients. Personal continuity of care remains a core value of general practice/ family medicine and should be taken account of by policy makers when redesigning health care systems. INTRODUCTIONC ontinuity of care is an important element of the delivery and organization of primary health care. 1 It has consistently been shown to be associated with increased patient and doctor satisfaction and may positively affect other health outcomes, such as adherence to treatment, uptake of preventive services, and decreased hospitalizations. 2,3Continuity can be understood as the degree to which a series of discrete encounters with health care clinicians is experienced as coherent, connected, and consistent with the patient's medical needs and personal context. 4 Three distinct means of providing continuity have been identifi ed: personal continuity (provision of care through an ongoing clinician-patient relationship), continuity of information (the use of information on past events and personal circumstances to make current care appropriate), and management continuity (a consistent and coherent approach to the management of a health problem). 2,4 There has, however, been increasing concern in many countries that the changing nature of general practice/family medicine in the last 30 years has led to a reduction in the extent to which physicians can offer personal continuity despite recent research that shows patients want personal continuity from ...

New nursing services should incorporate patients' views on continuity of care provider when developing models of care delivery. Patient information leaflets in general practices should be used to explain the roles of general practitioners and nurse practitioners/practice nurses. As these roles develop further, more research is needed into all aspects of their implementation and patients' views should particularly be evaluated.

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Primary care plays an important role in delivering care to people who are dying. However, providing palliative care to people dying with conditions other than cancer may be more problematic, because it may be more difficult to establish an exact prognosis or to identify their needs. This article draws on qualitative research, which explored the views of health professionals, patients and their carers about care provided at the end of life. Differences between the care of people with cancer and those with end-stage cardiorespiratory disease were found in four main areas: management and progression of disease, communication and information, health care in the community and awareness of dying. The research shows that even in PHCTs (primary health care teams) committed to the delivery of palliative care, people dying with end-stage cardiorespiratory disease are less likely than those with cancer to receive full, and easily understood, information, to be aware that they are dying or to receive district nursing care. There is an increasing call for palliative care to be extended to all, but further work is needed to develop appropriate packages of care for those dying with conditions other than cancer.