Lanre Daodu, Yogini Raste, Judith E Allgrove, Francesca Arrigoni, Reem Kayyali
While national guidelines provide best practices, this study uniquely captures the systemic bottlenecks that occur when operationalising these standards locally. The mapped pathway reveals a pressing need for the standardisation of functional assessment tools, genuinely integrated interdisciplinary clinics and robust post-discharge tracking to mitigate the burden of coordination on primary care.
OBJECTIVES: To explore the operational reality of the long covid care pathway from the perspective of National Health Service (NHS) professionals, addressing the gap between national guidelines and frontline implementation.
DESIGN: A qualitative study using single-timepoint, semi-structured interviews. Data were collected between July and October 2024. Data were analysed using reflexive thematic analysis.
SETTING: Primary and secondary NHS care settings in a diverse South London Borough (Croydon), UK.
PARTICIPANTS: 12 NHS healthcare professionals managing adult patients, comprising general practitioners (GPs, n=5), respiratory consultants (n=2), specialist nurses (n=3), a respiratory physiotherapist (n=1) and a clinical psychologist (n=1).
RESULTS: The operational reality of long covid care was constructed around four central themes. First, lacking definitive biomarkers, clinicians navigated diagnostic uncertainty using pragmatic, exclusionary testing and subjective severity assessments. Second, GPs acted as administrative linchpins, compelled to triage patients into fragmented, symptom-driven specialist silos. Third, treatment demonstrated therapeutic pragmatism, relying heavily on non-pharmacological rehabilitation rather than medicalised cures. Finally, variable monitoring practices across secondary services created a post-discharge 'continuity gap', placing the burden of re-initiating care on the patient. These systemic frictions were synthesised into an eight-step operational care pathway map.
CONCLUSIONS: While national guidelines provide best practices, this study uniquely captures the systemic bottlenecks that occur when operationalising these standards locally. The mapped pathway reveals a pressing need for the standardisation of functional assessment tools, genuinely integrated interdisciplinary clinics and robust post-discharge tracking to mitigate the burden of coordination on primary care.