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In her landmark Lancet article ‘Is primary care essential?’1 Barbara Starfield described primary health care as being first-contact care that is comprehensive, coordinated, and continuous. To this could be added something about accessibility and effectiveness and, in the UK context at least, care that is provided locally and personally. In these changing times, most of these attributes of good primary care have come under pressure. Comprehensiveness can be threatened by inequalities in access, fragmentation of primary care teams, discrimination, and the effects of the inverse care law.2 Continuity is increasingly difficult to deliver, for well-rehearsed reasons, and coordination is often more of an aspiration than an achievement because of dysfunctional communication across the primary–secondary care interface. Finally, access, a crucial dimension of primary care, has become a political and professional battlefield in recent years. In last month’s issue of the BJGP Simpson and colleagues3 called for a policy rethink on access, and for a more nuanced debate to take us beyond the simple metrics of waiting times and capacity. This month, Access to Care is the major theme of the journal, with articles on the research evidence related to access,4 the controversy about 7-day NHS opening,5 and the persistent, pernicious influences of deprivation on equity and equality.6 The need for a more sophisticated discussion of access is emphasised by Campbell and Salisbury’s Research Into Practice article,4 in which they review the evidence on new opportunities to measure and improve access, as well as providing a useful model of the various factors and forces at play. Their careful review serves to show that the evidence base for much organisational thinking and policy rhetoric is based on very thin evidence or no evidence at all, although it is clear that good ideas may work well …

A continuing patient–doctor relationship has achieved the status of a core value and feature of primary care.1 In this issue of the BJGP , two papers by Salisbury et al 2 and Ridd et al 3 add to the large body of primary care research seeking to improve the definition and measurement of the continuing patient–doctor relationship. The aim is to understand and defend it as a core feature. It has been under pressure as primary health care moves away from autonomous single-handed practices to multidisciplinary group practices with common accountability to central authority. For primary care and family medicine the continuing patient–doctor relationship has been subsumed under the broader concept of continuity of care.4 Clinicians from other health disciplines recognise the importance of the relationship with the patient but use the term ‘continuity of care’ to refer to the delivery of services in a coordinated and timely manner by more than one health professional. Salisbury and colleagues call this coordinated care, as would most primary care clinicians. Both Salisbury et al and Ridd et al use the label ‘longitudinal continuity’ to describe the primary care model of continuity of care, a tribute to Barbara Starfield who proposed this term to distinguish it from that of continuity of care used in other disciplines.5 Ridd et al synthesize what qualitative research tells us about the nature of the patient–doctor relationship, where the regularity of good experiences with the doctor over time leads …