Strengthening relational continuity in primary care in Spain: key insights and recommended policy actions: primary health care policy paper series

Overview

Relational continuity in primary care (RCPC) plays a critical role in health system performance. Extensive evidence demonstrates that strong RCPC is associated with lower mortality, reduced emergency department use and hospitalizations, improved chronic disease management, and higher levels of patient and provider satisfaction. These benefits are particularly significant for older adults; people with chronic, mental health or social complexities; and those with lower socioeconomic status. In Spain, key strengths of its primary care model – such as population empanelment to microteams of family doctors and nurses, strong team-based care, and advanced digital infrastructure and population health management capabilities – provide a solid foundation for RCPC. However, structural challenges – such as high turnover linked to contract instability, workforce shortages, mobility rules and limited team autonomy – undermine the capacity to maintain stable patient– provider relationships. Strengthening RCPC in Spain will require targeted policy actions that are organized, in this paper, around four key aims: establishing RCPC as a central dimension of primary care performance; addressing health systems’ features that undermine RCPC; strengthening primary care teams to support RCPC; and taking advantage of untapped opportunities for future-proofing RCPC.