Keywords: GP / FD, Primary Healthcare, Multidisciplinary Team, Oncology, Prostate cancer

Background:

Continuity of care is fundamental to the effective management of complex conditions such as prostate cancer, where patients frequently transition across multiple levels of the healthcare system. GPs play a central role in ensuring continuity; however, systemic fragmentation can impede coordinated and effective care.

Research questions:

What strategies do postgraduate GP trainees propose to prevent patients from becoming “lost” in the healthcare system during prostate cancer management?

Method:

A qualitative study was conducted among 86 postgraduate GP trainees. Participants were presented with a vignette depicting an informal multidisciplinary interaction involving a patient with prostate cancer and provided written responses to the question: “What strategies can be implemented to prevent patients from becoming ‘lost’ as they navigate the healthcare system?” Data were analysed using reflexive thematic analysis following Braun and Clarke’s six-step approach. Inductive coding with repeated reading and comparison across responses was used to identify recurring strategy-focused themes, ensuring analytical rigour through transparent theme development.

Results:

Three categories of strategies were identified. First, trainees proposed active GP-led follow-up, including systematic recall, monitoring of referrals, and re-engagement after specialist encounters. Second, structured communication mechanisms were emphasised, such as clear referral pathways, direct GP–specialist contact, and shared access to relevant clinical information beyond electronic health records. Third, trainees highlighted patient and family empowerment strategies, including clear explanation of care pathways, shared decision-making, and involving relatives to support continuity. Overall, trainees stressed that continuity requires intentional organisational actions rather than informal solutions.

Conclusions:

GP trainees propose concrete, practice-oriented strategies to prevent patient discontinuity, centred on proactive GP coordination, structured interprofessional communication, and patient engagement. Embedding these strategies within GP education and healthcare systems may reduce the risk of patients becoming “lost” in complex cancer care pathways.

Points for discussion:

Which of these trainee-proposed strategies could be realistically implemented in everyday General Pracitce healthcare systems?

How can GP training programmes operationalise proactive follow-up as a core competency?

How can patient and family engagement be formally integrated to support continuity of care?