Primary care depends on the effective communication between service user and practitioner. This study proposes that people with communication difficulties serve as a litmus test for whether practitioners are truly sensitised to the impact of their own communication skills. It is based on interviews with service users and carers. Three key themes emerged, namely inclusion , the process of communication , and continuity . Inclusion is concerned with effective participation in society in general and access to health care in particular. The communication process describes the way in which health issues are raised and addressed. Continuity refers to the way in which time interacts with the relationship between user and provider. The paper concludes that effective communication is not simply a set of taught behaviours but reflects a set of values that create the conditions for improving both communication and clinical outcomes
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