Background coded thematically and analysed using Since 2022, general practice has multiple theories of quality. shifted from responding to the acute Results challenges full services of using COVID-19 a hybrid to of restoring remote, Quality occur in efforts the context in UK of general cumulative practice digital, and in-person care. impacts of financial austerity, Aim loss of resilience, increasingly To examine how quality domains are complex patterns of illness and addressed in contemporary UK general need, a diverse and fragmented practice. workforce, material and digital Design and setting infrastructure that is unfit for purpose, and physically distant and Multi-site, mostly qualitative asynchronous ways of working. longitudinal case study, placed in UK Providing the human elements of national policy context. traditional general practice (such as Method relationship-based care, compassion, Data were collected from longitudinal and support) is difficult and ethnographic case studies of sometimes even impossible. Systems 12 general practices (2021–2023), designed to increase efficiency have multi-stakeholder workshops, introduced new forms of inefficiency stakeholder interviews, patient surveys, and have compromised other quality official reports, and publicly accessible domains such as accessibility, patient experience data. Data were 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. Conclusion Contemporary hybrid general practice features changes (digitalisation, physical distancing, extension of roles, and protocolisation) that have had the unintended effect of dehumanising, compromising, and fragmenting care. Policymakers and practices should urgently address the risks to patients and the traditional core values of general practice should be urgently addressed.