ID-5184 Wonca Abstracts supplement L-Z 13-10-23 - Flipbook - Page 9
WONCA 2023 Supplement 2: WONCA 2023 abstracts (L–Z)
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Towards a contemporary theory of continuity in general
practice: ‘Following the story’ in a digital age
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Dr Emma Ladds1, Richard Byng2, Aileen Clark1, Sarah Rybczynska-Bunt2, Prof Trish Greenhalgh1
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University of Oxford, 2University of Plymouth
Background
Continuity is a long-established and fiercely defended value in general practice. Traditionally referring
to longevity and consistency within the individual doctor–patient relationship, its value for patients,
professionals and systems has been repeatedly demonstrated. However, in recent years, UK general
practice has seen the introduction of new staff roles and remote and digital approaches to patient
access (online platforms and triage-first) and clinical encounters (telephone, video and electronic
consultations). These changes may require an extension of how we conceptualise continuity.
Methods
As part of a longitudinal case study between 2021 and 2023, we used strategic, immersive
ethnography and semistructured and narrative interviews to explore continuity in differing
geographical, organisational and technological contexts among 11 UK general practices as they
introduced (or chose not to introduce) digital and remote forms of access and clinical care. We
analysed the data using a narrative approach and used this to develop and extend existing theory
about continuity.
Results
Different practices variably defined continuity and achieved it to differing degrees. Its attainment
required additional effort and work by individuals and was influenced by aspects of the locality,
practice, technical infrastructure and wider healthcare system. Remote and digital modalities provided
opportunities for extending continuity across time and space and for achieving (some) continuity of
the record and shared team understanding of a patient and illness episode. The nature and degree of
continuity influenced the coherence and witnessing of patients’ illness narratives. Impaired continuity
disrupted coherence and fragmented stories, impacting health outcomes, experiences of care and
subsequent interactions with the healthcare system.
Conclusion
Continuity remains crucial within general practice. However, practices should consider how remote
and digital approaches can be used, and individuals supported, to widen how it is conceptualised and
operationalised to encourage the coherence of individual narratives.
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