Navigating change and crisis: an ethnographic case study of the digitalisation of general practice work between 2020-2024

Since 2020, changes in the organisation and delivery of UK general practice have been extensive and far-reaching. The widespread scale-up of remote and digital forms of working in UK general practice during the COVID-19 pandemic has driven the development of new routines and working styles, affecting how work is done, and the conditions in which it is completed, with repercussions for the wellbeing of the workforce. In the work reported here, I aim to build a more nuanced understanding of the impact of digitalisation on the kinds of work performed by patients and staff in UK GP practices, the impact thereof on staff wellbeing, and ascertain what further learning could be gleaned about how change and crisis are navigated in practice teams. I conducted a narrative literature synthesis and a multi-sited ethnographic case study of UK GP practice, informed by the Eisenhardt method. To do so, I employed multiple qualitative methods to collect data from two in-depth ethnographic case study sites. I also collected and reanalysed previously collected qualitative data from eight comparative case study sites. I analysed these data at three sequential levels: inductively, thematically, and abductively, to build and extend theory in conversation with my data. In this thesis, I make several novel contributions to empirical, methodological, and theoretical literature. I split my results on the impact of digitalisation during 2020-24 across four chapters. The first outlines the work that patients must now perform to achieve digital candidacy and craft a digital facsimile to access their GP practice successfully. The second looks at the impact on the work and wellbeing of support staff, highlighting the unique translational work they perform. The third describes the impacts on the whole practice team, and identifies new risks to their wellbeing: technostress, technosuffering, and relational strain. Finally, the fourth results chapter illustrates the organisational conditions that are most protective of staff wellbeing when navigating these kinds of change and crisis events and suggests a model for how these conditions can be constructed, maintained, or slip away. I have disseminated these findings to academic, public, policy, and practice audiences.