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General discussion1657a significant contribution to meeting these needs. 21 Practitioners’ support staff can be reminded of this by adequate registration of MID and additional needs in patients’ medical files. To ensure longitudinal continuity, it is desirable for the same practitioner to provide care over time. According to GPs themselves, this is most feasible in small, stable, and familiar teams with two to three usual GPs who share the workload and cover each other’s absences. 20At the organization of healthcare level, some concerning developments in the Netherlands are putting continuity in primary care under pressure. These include an increasing workload in primary care, a reduction in permanent GPs and support staff, and rising expectations from the government, the healthcare domain, and the general population about the accessibility and possibilities of primary healthcare. 25 Without intervention, vulnerable patients for whom continuity of care is of extra importance, like patients with MID and MH problems, will be the first to suffer the consequences. Policymakers should invest in collaboration with healthcare insurers, care professionals, and citizens to secure the sustainability of high-quality, accessible, and affordable primary care.Can task substitution contribute to the continuity of care?Participants in the interview study indicated that longitudinal and relational continuity of care was in some cases easier to achieve with the MHNP rather than with the GP. Patients perceive MHNPs as having more time and giving more attention and as less formal than GPs (Chapter 5). However, an MHNP is focused mainly on MH problems and may not always have experience and affinity with individuals with (M)ID (Chapter 6). This makes me wonder whether the introduction of a new type of nurse practitioner, the ID nurse practitioner (ID-NP), with expertise in the extra communication and domain-transcending needs of patients with MID, could be of added value in primary care practice. This follows the example of ID nurses already working in the United Kingdom and the United States of America. 26, 27 In these countries, these nurses play a role in improving individuals’ physical and MH, reducing barriers to independent living, supporting individuals in leading a fulfilling life, and are strong advocates in fostering improved knowledge about the care of patients with ID in general. They operate in Katrien Pouls sHL.indd 165 24-06-2024 16:26