Continuity of care is concerned with the delivery of health care over time and is considered an essential characteristic of primary health care and one of the building blocks of a high performing primary health system. () Traditionally continuity of care has entailed the concept of a strong doctor patient relationship (relational continuity). More recently, discussions about continuity of care has considered the coordination role that is needed to improve the safety and quality of increasingly complex health care (informational or management continuity)() Health reforms in a number of countries (such as the Patient Centred Medical Home initiative in the United States, and Integrated Care initiatives in Australia) have described improved continuity of care as an objective.  These reforms differ (and are often unclear) whether continuity of care is considered at a personal level or at an institutional level. This paper will discuss a conceptual framework for understanding continuity of care at a provider and institutional level.  It is important to differentiate between continuity of care at a provider level, and institutional level continuity of care. Achieving continuity of care at one level only may have different effects on health service usage and care outcomes than achieving continuity at both levels. This has not been considered in much of the existing continuity of care research and consideration of both levels of continuity is need in future research. 1.         Bodenheimer T, Ghorob A, Willard-Grace R, Grumbach K. The 10 building blocks of high-performing primary care. The Annals of Family Medicine. 2014 March 1, 2014;12(2):166-71. 2.         Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of care: A multidisciplinary review. British Medical Journal. 2003;327(7425):1219-21.