In 2000, a new definition of general practice was proposed.¹ The word continuity was not included in the definition. This caused some debate in the time that followed, and when the European definition was published by WONCA Europe in 2002 it contained the word, continuity.² A recent paper in the BMJ continuing the discussion about the concept of continuity in health care may help to clear up the debate and thus show usefulness for future quality development, teaching and health care planning.³ Three Canadian health services policy and research bodies had commissioned this work with the aim of developing a common understanding of the concept of continuity as a basis for a valid and reliable measurement of continuity in different health care settings. The group identified 2439 unique documents and reviewed 583. The results were discussed at a workshop prior to the publication of the paper.

Initially, the research group emphasised that different health care domains (primary care, mental health care, nursing, different disease management specialties) interpret the concept of continuity in different ways. The group stressed that continuity is an experience and a feeling of an individual and not an attribute of providers and organisations, and so it was meaningless if a specialty, e.g. general practice, saw the concept of continuity as one of its unique features.^1,2 Therefore, the specialty of family medicine has now to find other elements characterising in what ways these give added value to the health care system.^1,4

Three types of continuity can be identified: informational continuity, management continuity and relational continuity:³

Informational continuity describes to which degree the patient experiences that a care provider has sufficient information about earlier healthcare events and that this information forms part of the actual decision-making process. Informational continuity has two aspects, namely information about the disease and information about the patient's wishes, values, and needs.

Management continuity relates to the degree to which patients experience that the total health care system is comprehensive, i.e. the degree to which current care is complementary and timely in relation to previous and future care.

Relational continuity describes the degree to which patients experience a professional relationship with one or more care providers.

General practice/family medicine is uniquely characterised by its awareness of all three types of continuity and by its awareness of the need for informational continuity focusing on both the patient and the disease. It is a challenge to future health care systems to develop methods to ensure continuity not only with respect to the disease, but also with respect to the personal aspects of continuity.

General practice is also characterised by emphasising the importance of relational continuity with patients, and in our teaching we should emphasise ways to establish relational continuity and ways to enable patients to establish good relationships with care providers in other parts of the health care system.

The conceptual clarification of the concept of continuity has several important implications for academic family medicine. First, our teaching of the core elements of continuity should be more specific. Second, we should be more cautious about claiming that continuity is something special to general practice, and the word continuity should not be a constituent part of the definition of the discipline. Third, we should attach more importance to the development of managerial continuity and contribute to the development of a seamless health care organisation where patients experience a comprehensive approach to their needs from the total health care system. Finally we should keep the focus on our bio-psycho-social approach to health care and try to develop ways of making patients' wishes, values and needs so explicit that they can be used by all care providers in a health care system. In time, the conceptual clarification of continuity will enable us to develop valid methods for measuring continuity so that we can develop valid indicators for quality of care that can lead to an enhanced holistic health care system where patients experience continuity.