International multimorbidity

At the Society for Academic Primary Care Annual Scientific Meeting held in St Andrews on 24 June 2026, the Special Interest (SIG) Group on Multiple Long-Term Conditions (MLTC) brought together 15 primary care researchers from across the UK.

The meeting began with an introduction to the activities of the SIG and Multimorbidity Blog, hosted by University of Glasgow. Participants then shared their current areas of research interest, which led to a wide-ranging and stimulating discussion on some of the key methodological, clinical, and policy challenges in MLTC research and care.

One of the first topics discussed was the growing use of clustering and sequence analysis in MLTC research. Clustering approaches can be valuable for describing groups of patients with similar patterns of conditions, particularly for identifying populations at higher risk. However, participants also noted that such findings can be difficult for clinicians to apply directly to individual patients in everyday practice.

Sequence-based approaches for analysing MLTC patterns were also discussed. There was broad agreement that the first long-term condition in a patient’s trajectory is important, as it may represent the point at which a person first becomes connected to regular medical care. However, participants also highlighted the need for caution when interpreting subsequent disease sequences. The observed order of diagnoses may be influenced by patterns of healthcare use, clinical review, and investigation. In other words, what appears to be a disease trajectory may partly reflect how, when, and where patients encounter the healthcare system.

Another major theme of discussion was the role of social determinants in shaping MLTC trajectories. Factors such as sex, ethnicity, socioeconomic position, and broader structural inequalities were recognised as central to understanding who develops MLTC, how conditions accumulate, and what kinds of care people receive. The group discussed the challenge of moving beyond description towards research and interventions that can address health inequalities more directly. Throughout the discussion, participants emphasised the importance of keeping patients’ priorities and lived experiences at the centre of MLTC research.

The group also discussed the need to develop and evaluate interventions to improve the quality of care for people living with MLTC. Although there is a growing literature on regular reviews, multidisciplinary care, and other service-level interventions, few have demonstrated large or consistent effects. Participants argued that more attention is needed at the level of the healthcare system, rather than focusing only on individual behaviours or isolated clinical encounters.

Examples were shared from different local contexts, including neighbourhood-based approaches, link workers, and health navigators. These models may offer ways to support people with complex needs beyond traditional consultations. At the same time, participants noted important practical challenges, including limited GP capacity and the risk that involving more professionals may inadvertently increase fragmentation of care.

Finally, the group discussed the importance of developing quality frameworks for MLTC care. Such frameworks could help clarify what good care should look like for people with multiple conditions, support service improvement, and provide a basis for evaluation across different healthcare settings.

Overall, the SIG meeting highlighted both the richness and the complexity of MLTC research. Methodological innovation, consideration of health inequalities, patient-centred perspectives, and system-level thinking will all be essential as the field of MLTC research moves forward. The discussion also reinforced the value of the SIG as a space for MLTC researchers to share ideas, challenge assumptions, and build collaborations across primary care and beyond.

 

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First published: 7 July 2026