Continuity of care (CoC) is linked to better outcomes and lower downstream use, yet continuity has declined in some settings. How continuity and primary-care coverage relate to referral behaviour at clinic level remains under-reported. In XXX, we evaluated whether higher continuity and greater primary-care coverage are associated with lower outgoing referral propensity and fewer rejected referrals.(1) Test associations between clinic-level CoC, primary-care coverage, and (a) outgoing referrals and (b) rejected-referral share. (2) Examine structural correlates (centre size, contact intensity). (3) Produce risk-standardised referral rates for fair benchmarking.Cross-sectional, centre-level analysis (year 2021) linking administrative files in XXX. Exposure: clinic CoC index (0–1) and primary-care coverage (share of all visits in primary care). Outcomes: outgoing referrals per 1,000 listed patients and rejected-referral share. Models: Poisson GLM with offset log(list size) for counts (IRR), Binomial GLM for rejected-referral share (OR), and Negative Binomial GLM to compute risk-standardised referral rates (RSR). Partial correlations adjusted for size and activity. N≈40 matched centres.Higher CoC correlated with fewer referrals (r≈−0.40 to −0.44). In count models, CoC predicted lower referrals (IRR≈0.993 per +1 pp; ~6–7% fewer per +10 pp). Coverage correlated negatively with referral propensity (r≈−0.33). CoC was associated with a lower rejected-referral share (OR≈0.989 per +1 pp). Larger centres had lower CoC; RSR identified clinics referring above/below expected given list size and contact mix. Findings were direction-consistent after adjustment.Continuity and coverage appear to shape referrals at clinic level. Mechanistically, relational continuity likely reduces precautionary/duplicative referrals and improves referral acceptability. Scaling pressures threaten continuity, suggesting design countermeasures (empanelment, micro-teams). Limitations include cross-sectional design, centre-level CoC, and incomplete case-mix adjustment.In XXX, higher CoC and stronger primary-care coverage are associated with fewer outgoing referrals and fewer rejections. Preserving continuity while scaling—supported by RSR benchmarking—may reduce avoidable specialist demand and administrative rework.

Traditional healthcare for children and families with complex needs often follows an “estafette model,” where responsibilities are passed from one professional to another. This fragmented approach delays effective support and leaves families navigating complex systems alone. The Wijkwijs project introduces an innovative, neighborhood-based model that integrates general practitioners, pediatricians, youth health physicians, neighborhood social support team, and physiotherapists into one collaborative team.To evaluate Wijkwijs as a care innovation that replaces fragmented pathways with integrated collaboration. The study examines whether families experience improvements across four domains—physical, psychological, social, and existential—and whether the integrated team contributes to clearer, more effective support. It also explores how professionals perceive the added value of working together in a shared responsibility model.A mixed-methods design is used. Quantitative data are collected through a 4D registration tool at intake and six-month follow-up, alongside questionnaires on health, stress, quality of life, and parenting burden. Qualitative insights are gathered through family interviews and professional focus groups. Analyses include pre–post comparisons and thematic coding of experiences.To date, 21 families have been included. Early findings indicate that families experience greater clarity in care, reduced fragmentation, and improved communication across involved professionals. Preliminary follow-up data show notable improvements in the physical and social domains, alongside reduced parental stress. Families report that the team understands the full context of their situation and provides timely, coordinated responses that address underlying concerns rather than isolated symptoms. Professionals describe increased satisfaction, quicker decision-making, and deeper insight into each other’s expertise. Challenges around logistics and documentation remain but are manageable within the collaborative structure.Wijkwijs shows early promise as a care innovation that replaces sequential responsibility transfer with true multidisciplinary collaboration. Preliminary results suggest improved family functioning, stronger continuity of care, and positive professional experiences.These insights will guide further refinement, inform local policy, support scaling to other neighborhoods, and enrich practice-oriented publications.

Continuity of care (CoC) is globally recognized as a central value of general practice as it improves health outcomes for patients. Although many general practice curricula acknowledge the importance of CoC, general practice trainees often feel unprepared to deliver it. This suggests a need to better understand how CoC is constructed within the profession and how this shapes what trainees perceive as expected from them.To understand how historical and contemporary ways of talking about CoC shape the professional identities of current and future GPs, and what this means for how trainees learn to enact CoC in practice.We conducted a Foucauldian discourse analysis of policy documents, publications in medical journals and national newspapers (1959–2025) to map the historical discourses through which GPs have talked about CoC. Tracing the development of these discourses allowed us to analyze how their implicit assumptions persist and shape how CoC is understood in present-day general practice.Four CoC discourses were identified: 1 CoC as a moral ideal (North Star), 2. CoC as a long term-and trusting relationship (Cradle-to-Grave), 3. CoC as a system-based effort (Interlocking Systems), and 4. CoC as an entity in decline or lost (Crisis). While each discourse has surfaced at different moments in history, they have now accumulated and coexist.This study illustrates that discourses on CoC have been constructed in multiple ways and have accumulated over time. These coexisting discourses promote multiple, and sometimes incompatible, identity expectations: from moral agent to always-available caregiver, from system-oriented team player to change agent or powerless bystander. This accumulation creates an environment in which GP trainees must reconcile competing demands, making the formation of a coherent professional identity challenging.Recognizing how language shapes CoC can help educators teach it as a living, adaptive practice, enabling GP trainees to take ownership and align CoC with their personal and professional identity.

Patients with persistent somatic symptoms (PSS) account for 20–30% of patients in general practice and can be very burdensome for doctors. Czech general practitioners (GPs) use an original Czech primary care guideline on functional disorders and PSS (2023). Furthermore, Czech GPs can get extra psychosomatic education. Yet, there has been no research focusing on patients with PSS in primary care in the Czech Republic.The aim of our study was to explore the experience of patients with PSS with their GPs, their perception of the role of the GPs and their expectations.We performed individual in-depth semi-structured interviews with 30 patients with PSS (n=30). GPs chose 21 patients who were coming repeatedly to their office with PSS lasting for at least 3 months, with small probability to find a clear organic explanation of the symptoms in the perception of the GP. We used purposive sampling of the GPs, when we included 18 GPs with and without psychosomatic education, from different regions, urban and rural, males and females, younger and older. In the second branch, we recruited 9 patients who come to a psychosomatic clinic in Prague for consultations for PSS lasting at least 3 months.  We performed manual reflexive thematic analysis of the interview transcripts.Our on-going analysis identified the most frequently recurring themes: first-contact doctor, importance of the explanation, relationship with the GP, doctor´s active interest in patient´s life, importance of language/expressions, psychological support, assessment of the results, management of the abnormal findings including those with no significance.Our findings are mostly consistent with the literature. However, in some topics we will bring a deeper insight.The study shows that GPs can play a crucial role in the illness of patients with PSS. Patients are focused on the organic nature of their difficulties and expect solutions from their GP in various forms. A deeper relationship build on mutual trust can help patients to accept bio-psycho-social explanations of their symptoms. We therefore consider it important to focus on GPs’ training in psychology and communication, which could help them to achieve shared understanding even with these patients.

Managing chronic diseases in older adults is a growing challenge in primary care (PC). Multimorbidity, functional decline, and social vulnerability frequently compromise treatment adherence. These interacting factors increase the risk of decompensation, preventable adverse events, and loss of autonomy. An individualized and patient-centred approach, integrating health education, medication review, and social support, is therefore essential.An 80-year-old woman with insulin-dependent type 2 diabetes, hypertension, obesity, chronic kidney disease, chronic coronary syndrome, depressive disorder, and chronic osteoarticular pain. She lived alone in precarious housing with limited social support. She had poor adherence, frequently missed follow-up appointments, and struggled to manage her medication. She presented poor glycaemic control (peak HbA1c 12.8%; occasional glucose >500 mg/dL) and recurrent metabolic decompensation, leading to several unscheduled consultations and emergency visits. Home visits by the PC team revealed that she lived almost entirely confined to one room due to physical limitations, with inadequate hygiene and a highly unbalanced diet mainly composed of soft drinks and industrial porridges. These observations were key to tailoring an appropriate plan. The intervention included glycaemic monitoring, medication reconciliation, activation of social services, and strengthened family involvement. The patient agreed to move in with her daughter, resulting in progressive clinical improvement and adequate glycaemic control within months (HbA1c 8.6%). Strengths and limitations: Strengths included longitudinal follow-up and contextual assessment through home visits. Limitations included difficulty assessing potential cognitive decline and ensuring consistent engagement.Understanding environmental and social determinants is crucial when managing older adults. Early identification of vulnerability, integration of home visits, and structured involvement of family and social services may prevent avoidable complications.This case illustrates how isolation, precarious living conditions, and multimorbidity significantly impair adherence. Tailored intervention improved stability and outcomes.PC teams are crucial for safe and effective chronic disease management in vulnerable elderly. Individualized strategies contribute to better disease control and quality of life.

Ideally, a general practitioner (GP) and their team know their patients well and follow their care pathways within both primary care and other healthcare settings. This is called continuity of care (COC). Although COC is a core value of general practice - with benefits including fewer hospital admissions, reduced healthcare costs, and better quality of life - it has shown a sharp decline in the Western world over the past decades. Moreover, it is expected COC will further decline in the future due to fragmentation and changes in availability of care. Given the decline in COC, there is a risk that patients with complex or less predictable illness trajectories experience inequities in access to coherent, person-centred care at the end of life. In the Netherlands, most palliative care takes place in a primary care setting, and there is little evidence on how patients in the palliative phase experience and value COC.Our study explores the perspectives of palliative patients on COC across three illness trajectories: cancer, heart failure, and multimorbidity.We conduct a longitudinal interview study with approximately 20 patients in the palliative phase (identified by a negative answer to the surprise question) across the three illness groups to capture their experiences and perceptions of continuity of palliative care, supplemented with the Nijmegen Continuity of Care Questionnaire and the Patient Satisfaction Index. We will analyze the data using thematic analysis.Data collection and analysis are ongoing. The first results that we present at the conference will focus on initial interviews conducted with patients.Topics discussed in the interviews include availability of care, coordination and oversight, and transfer of information between different care providers.To estimate the value of COC in palliative care and come to practical recommendations, it is crucial to investigate patients’ perspectives on COC at the end of life. This study will contribute to a deeper understanding of COC in the primary care setting at the end of life in different illness trajectories.

Continuity in UK general practice has clear benefits but is difficult to achieve. The 2025-26 GP Contract advocates for incentivised identification of people who may particularly benefit from continuity, for example those with a terminal illness. Mesothelioma is an incurable disease caused by asbestos exposure and people with this diagnosis potentially derive significant benefit from continuity. However, there is little research exploring continuity in general practice for these individuals.This study aimed to provide detailed understanding of the experiences of continuity in UK general practice among people with mesothelioma, their close persons, and their healthcare professionals (HCPs); how they achieve this (or not); and how it affects their healthcare service use.Qualitative data obtained from longitudinal interviews with people with mesothelioma, their close persons, and their HCPs, was used to construct detailed case studies. Reflexive thematic analysis was undertaken. Five individuals participated in a patient and public involvement capacity.Data from 54 interviews formed nine case studies. Findings are presented in relation to five overarching themes: 1) People with mesothelioma experience unique challenges in achieving continuity; 2) Patient/close person capacity to facilitate continuity in general practice; 3) HCP capacity to facilitate continuity in general practice; 4) MDT approach differs from traditional family doctor model; and 5) ‘NHS general practice is broken’.Despite its well-evidenced benefits, continuity is under-represented in UK general practice service design, contract, and policy. Participants described the intense burden of living with and dying from a rare cancer with a poor prognosis, exposure-related legal and financial complications, and a lack of awareness among the public and HCPs. Ultimately, the needs of people with mesothelioma may not be addressed if they are not supported by both relevant mesothelioma-focused services, and generalist services that can provide holistic care. Integration and continuity are imperative.This research deepens understanding of continuity in general practice for people with mesothelioma, with a specific focus on their ability to achieve continuity. Although focused on people with mesothelioma in the UK, findings are relevant to other international patient populations, particularly those with other rare conditions or palliative care needs.