Challenges to quality in contemporary, hybrid general practice a multi-site longitudinal case study (

Summary

Since 2022, general practice has shifted from responding to the challenges of Covid-19 to restoring full services using a hybrid of remote, digital and in-person care. This BJGP study aimed to examine how quality domains are addressed in contemporary UK general practice. The authors found that:

• quality efforts in UK general practice occur in the context of combined impacts of financial austerity, loss of resilience, increasingly complex patterns of illness and need, a diverse and fragmented workforce, material and digital infrastructure that is unfit for purpose and physically distant and asynchronous ways of working.
• providing the human elements of traditional general practice, such as relationship-based care, compassion and support, is difficult and sometimes even impossible.
• systems designed to increase efficiency have introduced new forms of inefficiency and have compromised other quality domains such as accessibility, patient-centredness, and equity.
• long-term condition management varies in quality.
• measures to mitigate digital exclusion such as digital navigators are welcome but do not compensate for extremes of structural disadvantage.
• many staff are stressed and demoralised.