In Norway, health care services are largely a public responsibility, where specialized health care services are provided by the state and primary care by the municipalities. General practitioners (GPs) are fundamental providers of primary care and are gatekeepers for the specialist services, which overall requires referral.

In 2001, Norway initiated the Regular GP Scheme. Under this scheme, every GP has a contract with a municipality that specifies the maximum number of patients that GP can serve, called a “patient list”. People choose their regular GP, may change GP twice a year, and will be assigned to the patient list of their preferred GP in their home municipality, provided the list is not complete. On the other hand, when a GP ends their contract with a municipality, their list patients will be randomly assigned to other GPs with contracts and capacity in the same municipality.

The regular GP Scheme aimed to assure good and equal medical care, anchored the role of gatekeeping, and the value of continuity in primary care. The scheme facilitates interpersonal continuity, an ongoing relationship between a patient and one physician, responsible for the patient’s overall health care(1). However, most GPs take part in mandatory, out-of-office public medical tasks, including out-of-hours services, resulting in absence from regular practice. In case patients require medical care when their regular GP is away, informational and “one medical home” continuity(1), is normally maintained, since most GPs work in group practices sharing electronic journal system, support staff and location and serve each other’s patients as required.

In addition to being a core value in primary care, research on GP-patient relation continuity, show associations to positive health outcomes, such as lower mortality(2) and lower specialist health care utilization(3–6). However, personal continuity is associated with practice and GP characteristics, such as number of GPs(7), list size(7,8) and perception of continuity(7), as well as patients age(7,8), sex(7,8), conditions(7,8) and number of contacts(7). These factors may also affect health outcomes, thus confounding the relationship of GP-patient continuity to health outcomes.

Breaks in continuity is less explored, but impact patients emotional stress(9). In Norway, sudden, short-term breaks showed modest changes in health care utilization, with overall less regular GP and increased out-of-hours contacts during the break, and a prolonged increase in hospital admissions for ambulatory care sensitive conditions among elderly(10).

The Regular GP Scheme has been popular, with less than 0,5% of the population opting out (11). However, the workload for GPs has increased over time, considered partly causing more GPs quitting than recruited. The GP Scheme is currently severely challenged, as one third of the municipalities do not have any available list capacity and in October 2022, more than 200 000 people lack a regular GP (3.9 % of the total population) (12). Patient ombudsmen across the country reports patients fearing lack of follow up(13) and missing a regular GP is shown to threaten basic informational continuity (14). This amplifies the need for more knowledge on health outcomes related to the definite loss of a regular GP in Norway.

We will add to former studies on GP-patient continuity, using events where original regular GPs end their contract, prompting an ended relation that is not patient-driven, aiming to avoid confounding of continuity. We will use a difference-in-difference design to compare health outcomes and health care use among the patients whose GP-relation ended to patients with a continuous GP-relation. We will further explore these effects for characteristics of the patients, the transition, and the municipalities, which may impact the outcomes, such as for patients with assumed complex needs(15), an abrupt versus gradual ended relation, and between municipalities with varying GP coverage.