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

Area of Science:

• General Practice
• Healthcare Quality
• Health Services Research

Background:

• Post-2022, UK general practice shifted to hybrid care models (remote, digital, in-person).
• This transition aimed to restore services after the acute phase of COVID-19.

Purpose of the Study:

• To examine how quality domains are addressed in contemporary UK general practice.
• To identify challenges and unintended consequences of hybrid care models.

Main Methods:

• Multi-site, qualitative longitudinal case study design.
• Data collection included ethnographic studies, workshops, interviews, patient surveys, and public data (2021-2023).
• Thematic coding and analysis using multiple quality theories were employed.

Main Results:

• Quality efforts are impacted by austerity, workforce fragmentation, and inadequate infrastructure.
• Hybrid models struggle to provide relationship-based care, leading to dehumanization.
• Efficiency systems compromised accessibility, patient-centeredness, and equity; staff are stressed.

Conclusions:

• Contemporary hybrid general practice has unintended consequences of dehumanizing and fragmenting care.
• Urgent policy and practice interventions are needed to address risks and preserve core values.
• Digitalization and protocolization require careful management to avoid compromising care quality.