Examining the practice of generalist expertise: a qualitative study identifying constraints and solutions

Reeve, J. et al. (2013) Examining the practice of generalist expertise: a qualitative study identifying constraints and solutions. JRSM Short Reports, 4(12), (doi:10.1177/2042533313510155)

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Publisher's URL: http://dx.doi.org/10.1177/2042533313510155


<b>Objectives </b>Provision of person-centred generalist care is a core component of quality primary care systems. The World Health Organisation believes that a lack of generalist primary care is contributing to inefficiency, ineffectiveness and inequity in healthcare. In UK primary care, General Practitioners (GPs) are the largest group of practising generalists. Yet GPs fulfil multiple roles and the pressures of delivering these roles along with wider contextual changes create real challenges to generalist practice. Our study aimed to explore GP perceptions of enablers and constraints for expert generalist care, in order to identify what is needed to ensure health systems are designed to support the generalist role. <p></p> <b>Design </b>Qualitative study in General Practice. <p></p> <b>Setting </b>UK primary care. <p></p> <b>Main outcome measures </b>A qualitative study – interviews, surveys and focus groups with GPs and GP trainees. Data collection and analysis was informed by Normalisation Process Theory. <p></p> <b>Design and setting </b>Qualitative study in General Practice. We conducted interviews, surveys and focus groups with GPs and GP trainees based mainly, but not exclusively, in the UK. Data collection and analysis were informed by Normalization Process Theory. <p></p> <b>Participants </b>UK based GPs (interview and surveys). European GP trainees (focus groups). <p></p> <b>Results </b>Our findings highlight key gaps in current training and service design which may limit development and implementation of expert generalist practice (EGP). These include the lack of a consistent and universal understanding of the distinct expertise of EGP, competing priorities inhibiting the delivery of EGP, lack of the consistent development of skills in interpretive practice and a lack of resources for monitoring EGP. <p></p> <b>Conclusions </b>We describe four areas for change: Translating EGP, Priority setting for EGP, Trusting EGP and Identifying the impact of EGP. We outline proposals for work needed in each area to help enhance the expert generalist role.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Mercer, Professor Stewart and Mair, Professor Frances
Authors: Reeve, J., Dowrick, C.F., Freeman, G.K., Gunn, J., Mair, F., May, C., Mercer, S., Palmer, V., Howe, A., Irving, G., Shiner, A., and Watson, J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
Journal Name:JRSM Short Reports
Copyright Holders:Copyright © 2013 The Authors
First Published:First published in JRSM Short Reports 4(12)
Publisher Policy:Reproduced under a Creative Commons License

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