Supporting expert generalist practice: the SAGE consultation model.

Abstract

Consultation models are core to GP training. Current models provide an excellent basis for sharing the key elements needed for safe and effective consultations in a front-line, first-contact setting: where any problem can walk through the door, and where the consultation is an integral part of a therapeutic relationship. They support an all-rounder view of the generalist. But the ‘expert generalist’ is more than an all-rounder: someone who knows a little bit about a lot of things, and is able to navigate a patient through multiple protocols and disease pathways.1 Rather, the distinct expertise of the generalist is in providing personalised illness care.1 We know from patients that individually-tailored care requires more than just good personal care; it requires good communication skills and empathy.2 It also needs personalised decision making;3 that is, the interpretive practice which goes beyond the application of guideline(s) to this individual, to the co-creation of a new, individualised explanation of illness experience. GPs have told us their training has not developed skills and/or confidence in individually-tailored decision making; in going beyond a protocol.4 Existing consultation models do not pay enough attention to the specific practice of individually-tailored decision making. The School for Advancing Generalist Expertise (SAGE) is an international collaboration that aims to support the development and delivery of generalist solutions to complex problems. The group has previously described the principles underpinning interpretive generalist practice and how it differs from other approaches. We have been working with GPs to understand and address whole-system barriers and enablers to expert generalist practice (EGP).4 GPs have consistently identified extended consultation skills as one area of need.4 Colleagues have highlighted …