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Continuity is a long-established and fiercely-defended value in primary care. Traditional continuity, based on a one-to-one doctor-patient relationship, has declined in recent years. Contemporary general practice is organisationally and technically complex, with multiple staff roles and technologies supporting patient access (e.g. electronic and telephone triage) and clinical encounters (e.g. telephone, video and electronic consultations). Re-evaluation of continuity's relational, organisational, socio-technical and professional characteristics is therefore timely. We developed theory in parallel with collecting and analysing data from case studies of 11 UK general practices followed from 2021 to 2023 as they introduced (or chose not to introduce) remote and digital services. We used strategic, immersive ethnography, interviews, and material analysis of technologies (e.g. digital walk-throughs). Continuity was almost universally valued but differently defined across practices. It was invariably situated and effortful, influenced by the locality, organisation, technical infrastructure, wider system and the values and ways of working of participating actors, and often requiring articulation and 'tinkering' by staff. Remote and digital modalities provided opportunities for extending continuity across time and space and for achieving—to a greater or lesser extent—continuity of digital records and shared understandings of a patient and illness episode across the clinical team. Delivering continuity for the most vulnerable patients was sometimes labour-intensive and required one-off adaptations. Building on earlier work by Haggerty et al. we propose a novel ontology of four analytically distinct but empirically overlapping kinds of continuity—of the therapeutic relationship (based on psychodynamic and narrative paradigms), of the illness episode (biomedical-interpretive paradigm), of distributed work (sociotechnical paradigm), and of the practice's commitment to a community (political economy and ethics of care paradigm). This ontology allowed us to theorise and critique successes (continuity achieved) and failures (breaches of continuity and fragmentation of care) in our dataset. • We propose a quadripartite ontology of continuity in general practice today. • These include psychodynamic, biomedical, sociotechnical, and political economy. • We empirically explore the manifestation of these continuities in practice. • This will help conceptualise 'continuity' and its achievement in practice. [ABSTRACT FROM AUTHOR]

The Philippines remains the world's largest exporter of nurses, with over 22,000 employed in the NHS (Baker, 2020). In this article, we analyse the migratory rationales and choices of Filipino nurses either about to embark or already working in the UK's National Health Service (NHS), through an ontological security framework. Qualitative interviews and focus groups were undertaken with 24 nurses in the Philippines and UK one element of which set out to understand why, in the context of high global demand for overseas nurses the nurses had chosen the UK as their destination. Findings highlight how collective imageries of 'home' and of different overseas destinations are rooted in shared understandings of underlying social structures, and their perceived capacity to generate ontological security for their citizens. Social and institutional pressures in the Philippines engendered a generalised insecurity that was corrosive to the nurses' identity and sense of agency and undermined the ability to meet cultural norms of family support. The nurses favoured the UK due to the comparative ease of moving there; a prevailing perception of social stability and of its political and institutional structures as being based on transparency and meritocracy, facilitating professional development and social mobility. The findings extend 'culture of migration' perspectives by illuminating why nurses migrate to where they do by emphasising place as a source of ontological security, with migratory preferences influenced by the perceived capacity of different national systems to minimise social risks. This also implies that as global social risks and volatilities intensify, plugging nursing gaps in the economically developed world with nurses from the developing world will become increasingly unpredictable as the ability of governments in destination countries to guarantee ontological security becomes more uncertain. • Explores why Filipino nurses move to the UK given high global demand for nurses. • Images of migratory destinations reflect shared understandings of its society. • Perceptions of comparative ontological security shapes migratory choices. [ABSTRACT FROM AUTHOR]