Keywords: continuity, digital, remote, general practice

Background:

Continuity is a cornerstone of general practice. Traditional continuity i.e., the one-to-one doctor-patient relationship, is declining within the UK. This is driven by policies promoting complex and fragmentary systems, workforce alterations, and remote and digital practices. It is therefore timely to reconsider continuity’s relational, organisational, sociotechnical, and professional/ethical characteristics and roles within contemporary practice.

Research questions:

What is continuity in contemporary general practice? How is it enacted and performed? What is continued? What characteristics/features enable continuity to play out in different clinical, social, and technological contexts and to what extent are these in tension or require trade-offs?

Method:

As part of a multi-case study, Remote-by-Default 2, data was generated from 11 UK general practices during their introduction of remote and digital services between 2021-2023. Collection included strategic, immersive ethnography, narrative interviews, stakeholder engagements, and material analyses of technologies. Thematic analysis identified granular subthemes, with combination and contrast between data sources, and interdisciplinary/sense-checking team discussions. Emergent analytical themes prompted engagement with theoretical literature and subsequent theory development.

Results:

Continuity was valued but differently defined across practices. It was situated and effortful, influenced by a range of contextual factors, values, and practices. It was often labour intensive, necessitating deliberate articulation by individuals. Remote and digital modalities extended possible continuity across space and time but added additional complexities. Enactment of continuity enabled one or more of four ontological forms: interpersonal, continuing psychodynamic features; biomedical, continuing features of the disease or illness; sociotechnical, continuing the distributed work of healthcare; or ethical/professional, continuing ethical or professional values.

Conclusions:

Continuity is effortfully and situationally enacted to enable a quadripartite ontology of continued elements. The diverse practice contexts and case-study depth here offered analytical strength but are limited to UK settings. This study will support how we conceptualize and achieve continuity in contemporary general practice.

Points for discussion:

How can policy makers/system leaders consider the different ontologies of continuity to better support its achievement in practice?

How can continuity be better embedded into systems/organisations/practices to reduce the effort on individuals that is currently required to achieve it?

How can we evaluate the wider (often hidden) benefits of the different forms of continuity to better inform policy decisions?