Work In General Practice Research Articles

RCGP chair writes to 20 000 trainees to encourage them to become GPs

The chair of the Royal College of General Practitioners has written to over 20 000 trainee doctors in England to encourage them to become GPs. In her letter Maureen Baker highlighted the benefits of working in general practice. “GP practices are part …

Gaining information about home visits in primary care: methodological issues from a feasibility study.

BackgroundHome visits are part of general practice work in Germany. Within the context of an expanding elderly population and a decreasing number of general practitioner (GPs), open questions regarding the organisation and adequacy of GPs’ care in immobile patients remain. To answer these questions, we will conduct a representative primary data collection concerning contents and organisation of GPs’ home visits in 2014. Because this study will require considerable efforts for documentation and thus substantial involvement by participating GPs, we conducted a pilot study to see whether such a study design was feasible.MethodsWe used a mixed methods design with two study arms in a sample of teaching GPs of the University Halle. The quantitative arm evaluates participating GPs and documentation of home visits. The qualitative arm focuses on reasons for non-participation for GPs who declined to take part in the pilot study.ResultsOur study confirms previously observed reasons for non-response of GPs in the particular setting of home visits including lack of time and/or interest. In contrast to previous findings, monetary incentives were not crucial for GPs participation. Several factors influenced the documentation rate of home visits and resulted in a discrepancy between the numbers of home visits documented versus those actually conducted. The most frequently reported problem was related to obtaining patient consent, especially when patients were unable to provide informed consent due to cognitive deficits.ConclusionsThe results of our feasibility study provide evidence for improvement of the study design and study instruments to effectively conduct a documentation-intensive study of GPs doing home visits. Improvement of instructions and questionnaire regarding time variables and assessment of the need for home visits will be carried out to increase the reliability of future data. One particularly important methodological issue yet to be resolved is how to increase the representativeness of home visit care by including the homebound patient population that is unable to provide informed consent.

International work and leadership in UK general practice

Purpose – The purpose of this paper is to present an exploration of the leadership competencies developed by UK GPs through having undertaken international work and the ability to transfer these competencies back to the UK. Design/methodology/approach – The approach taken is a cross-sectional survey. Findings – A total of 439 UK-based, ranging from GP specialty trainees to retired GPs who had worked overseas, responded to an online survey of UK general practice and international work. Doctors were asked to report competency development through international work using the domains of the Medical Leadership Competency Framework (MLCF). The most common competencies developed, to a “moderate or significant” degree, related to “personal qualities” (89 per cent) and “working in teams” (87 per cent). To a lesser extent Doctors developed competencies in “setting direction” (60 per cent), “managing services” (59 per cent), and “service improvement” (56 per cent), and found these competencies harder to transfer back to the UK. A common reason for limited transfer of competency was the lack of leadership opportunities for Doctors when returning to UK locum roles. Overseas posts were more common in low/middle income countries, and these Doctors reported a greater range of leadership roles, including in health policy, management and teaching, compared to high-income countries. Most doctors felt that they were able to develop their clinical skills overseas whilst relatively few Doctors performed research, especially in high-income countries. Originality/value – To the authors' knowledge this is the first cross-sectional survey exploring the international work of UK GPs and leadership development using the MLCF domains.

Understanding "revolving door" patients in general practice: a qualitative study.

Background‘Revolving door’ patients in general practice are repeatedly removed from general practitioners’ (GP) lists. This paper reports a qualitative portion of the first mixed methods study of these marginalised patients.MethodsWe conducted qualitative semi-structured interviews with six practitioner services staff and six GPs in Scotland, utilizing Charmazian grounded theory to characterise ‘revolving door’ patients and their impact from professionals’ perspectives.Results‘Revolving door’ patients were reported as having three necessary characteristics; they had unreasonable expectations, exhibited inappropriate behaviours and had unmet health needs. A range of boundary breaches were reported too when ‘revolving door’ patients interacted with NHS staff.ConclusionsWe utilise the ‘sensitising concepts’ of legitimacy by drawing on literature about ‘good and bad’ patients and ‘dirty work designations.’ We relate these to the core work of general practice and explore the role that medical and moral schemas have in how health service professionals understand and work with ‘revolving door’ patients. We suggest this may have wider relevance for the problem doctor patient relationship literature.

Implementing, embedding and integrating self-management support tools for people with long-term conditions in primary care nursing: A qualitative study

BackgroundAn implementation gap exists between policy aspirations for provision and the delivery of self-management support in primary care. An evidence based training and support package using a whole systems approach implemented as part of a randomised controlled trial was delivered to general practice staff. The trial found no effect of the intervention on patient outcomes. This paper explores why self-management support failed to become part of normal practice. We focussed on implementation of tools which capture two key aspects of self-management support – education (guidebooks for patients) and forming collaborative partnerships (a shared decision-making tool). ObjectivesTo evaluate the implementation and embedding of self-management support in a United Kingdom primary care setting. DesignQualitative semi-structured interviews with primary care professionals. Settings12 General Practices in the Northwest of England located within a deprived inner city area. ParticipantsPractices were approached 3–6 months after undergoing training in a self-management support approach. A pragmatic sample of 37 members of staff – General Practitioners, nurses, and practice support staff from 12 practices agreed to take part. The analysis is based on interviews with 11 practice nurses and one assistant practitioner; all were female with between 2 and 21 years’ experience of working in general practice. MethodsA qualitative design involving face-to-face, semi-structured interviews audio-recorded and transcribed. Normalisation Process Theory framework allowed a systematic evaluation of the factors influencing the work required to implement the tools. FindingsThe guidebooks were embedded in daily practice but the shared decision-making tools were not. Guidebooks were considered to enhance patient-centredness and were minimally disruptive. Practice nurses were reluctant to engage with behaviour change discussions. Self-management support was not formulated as a practice priority and there was minimal support for this activity within the practice: it was not auditable; was insufficiently differentiated from existing content and processes of work to value in its own right, and considered too disruptive and time-consuming. ConclusionSupporting self-management through the encouragement of lifestyle change was problematic to realise with limited evidence of the development of the needed collaborative partnerships between patients and practitioners required by the ethos of self-management support.

Stop penalising UK GPs returning from abroad

I am a UK GP working in general practice and emergency medicine in a remote part of Australia and have been out of the UK for 6 months. I am learning more than I have ever learned before and my clinical skills have improved out of all recognition. As the situation stands, however, should I wish to return to the UK in another 18 months I will be subject to the same blanket requirements for formal re-testing; a lengthy, bureaucratic, and costly process, as an individual who has not worked in clinical medicine at all for this period. Despite repeated private and public requests to clarify their position, the recent data from Morison et al and their colleagues at the Committee of General Practice Education Directors (COGPED) still …

Most GPs say general practice is more stressful than five years ago

Most GPs (93%) think that working in general practice is more stressful than it was five years ago, shows a poll conducted by the Royal College of General Practitioners. The snapshot survey of 258 of the college’s 44 000 members across the UK found that most respondents (84%) believed that their workload had increased substantially over the past five years. …

Weiterbildung zum Hausarzt – ein europäischer Vergleich

As many other European countries, Switzerland is facing a shortage of young general practitioners (GPs). This review summarizes and compares the different characteristics of vocational training programs in Switzerland and other European countries concerning their duration, learning objectives and setting. Countries with a GP-centered healthcare system offer highly structured training programs tailored to the everyday work in general practice, whereas vocational training programs in countries where patients have unlimited access to specialized care are less differentiated. Today, the vocational training of Swiss GPs lacks topically focused learning objectives and seems to be rather underdeveloped when compared to foreign programs. Particularly with regard to the duration and funding of practice-based training periods spent in GP surgeries, Switzerland still has a great development potential.

The Mood Assessment Program is now on the Australian map

To report on the wide uptake and utility of the freely available Mood Assessment Program (MAP) since its introduction as a tool to assist diagnosis and management of mood disorders. By mid-2012, some 16,000 patients had completed the MAP. We analyse data derived from such a sample. The majority of patients utilizing this service were referred by general practitioners, psychologists and psychiatrists from within New South Wales (NSW). The great majority across age bands found the MAP easy to complete and judged that it covers issues relating to their mood disorder very well or completely. The MAP is available for use Australia-wide with ready referral access for patients of mental health practitioners in general practice, psychiatry, psychology and social work. The online availability of the service makes it ideal for use in areas where access to health services is limited.

The views and experiences of female GPs on professional practice and career support

National GP demographic data demonstrate an increasing 'feminisation' of the workforce. With female GP specialty trainees continuing to outnumber males, this trend is set to continue. The changing composition of the workforce presents challenges in terms of how best to support the long-term career and educational development needs of this sector of the workforce in an evolving healthcare context. The aim of this work was to capture female GPs' experiences of working in general practice and their expectations concerning their career and educational development. Participants were surveyed and completed a semi-structured questionnaire, which generated qualitative and quantitative data. The sample comprised GP registrars, principals and sessionals. This study has generated an important dataset on working patterns, educational experiences and long-term career intentions of female GPs. Despite increased representation in the GP workforce, female GPs (particularly those with young children) appear less likely to be involved in education and training than their male counterparts, and even less likely to be involved in roles linked to primary care trusts, medico-political issues, hospital service delivery, special clinical interests or deanery education management. younger GPs reported significantly more difficulties in managing their childcare needs than older colleagues. Marital status, number of children and employment status did not moderate the effect of these difficulties. Female GPs reported working more hours with increasing age, but were not necessarily represented in a range of educational and/or training posts as a consequence.

Risk Reduction Technologies in General Practice and Social Work

General practitioners (GPs) and social workers (SWs) are professions whose professional autonomy and discretion have changed in the so-called risk and audit society. The aim of this article is to compare GPs’ and SWs’ responses to Evidence-Based and Organizational Risk Reduction Technologies (ERRT and ORRT). It is based on a content analysis of 54 peer-reviewed empirical articles. The results show that both professions held ambivalent positions towards ERRT. The response towards ORRT differed in that GPs were sceptical whilst SWs took a more pragmatic view. Furthermore the results suggest that SWs might experience professional benefits by adopting an adherent approach to the increased dissemination of risk reduction technologies (RRT). GPs, however, did not seem to experience such benefits. Keywords: Profession, risk, social worker, general practitioner, risk reduction technologies, evidence-based practice/medicine

Risk Reduction Technologies in General Practice and Social Work

General practitioners (GPs) and social workers (SWs) are professions whose professional autonomy and discretion have changed in the so-called risk and audit society. The aim of this article is to compare GPs’ and SWs’ responses to Evidence-Based and Organizational Risk Reduction Technologies (ERRT and ORRT). It is based on a content analysis of 54 peer-reviewed empirical articles. The results show that both professions held ambivalent positions towards ERRT. The response towards ORRT differed in that GPs were sceptical whilst SWs took a more pragmatic view. Furthermore the results suggest that SWs might experience professional benefits by adopting an adherent approach to the increased dissemination of risk reduction technologies (RRT). GPs, however, did not seem to experience such benefits. Keywords: Profession, risk, social worker, general practitioner, risk reduction technologies, evidence-based practice/medicine  

Risk Reduction Technologies in General Practice and Social Work

General practitioners (GPs) and social workers (SWs) are professions whose professional autonomy and discretion have changed in the so-called risk and audit society. The aim of this article is to compare GPs’ and SWs’ responses to Evidence-Based and Organizational Risk Reduction Technologies (ERRT and ORRT). It is based on a content analysis of 54 peer-reviewed empirical articles. The results show that both professions held ambivalent positions towards ERRT. The response towards ORRT differed in that GPs were sceptical whilst SWs took a more pragmatic view. Furthermore the results suggest that SWs might experience professional benefits by adopting an adherent approach to the increased dissemination of risk reduction technologies (RRT). GPs, however, did not seem to experience such benefits. Keywords: Profession, risk, social worker, general practitioner, risk reduction technologies, evidence-based practice/medicine &nbsp

Combining general practice with international work: online survey of experiences of UK GPs

ObjectivesTo conduct an exploratory study to learn about the experiences of GPs who have undertaken international work.DesignCross-sectional surveySettingOnline survey of UK-based GPs. Members of all UK RCGP faculties were invited to participate by email and the survey was publicised on the RCGP websiteParticipantsAll UK-based GPsMain outcome measuresTypes of UK and international work undertaken, barriers, competencies gained, influence on career and future plans.ResultsThe study identified 439 respondents, in a variety of GP roles at all career stages, who had undertaken international work in their role as a doctor. GPs are undertaking international work in both high and low/middle-income countries, engaging in a wide range of clinical and non-clinical activities. Respondents reported gaining a range of competencies from international work, which could be transferred back to the UK setting to a variable degree. Commonly cited barriers to international work were having to leave friends and family, and concerns regarding future employment and pension. Most reported that engaging in international work had influenced the direction of their career, with the largest proportion stating that they wish to work predominantly in the UK, with some international work in the future.ConclusionThe study highlights the variety of ways in which UK GPs are combining UK general practice and international work, competencies gained with such work, and ability to transfer these back to the UK setting. Historical barriers to international work still exist and future research could further examine the value of such work.

Can general practice help address youth mental health? A retrospective cross‐sectional study in Dublin's south inner city

With general practice potentially having an important role in early intervention of mental and substance use disorders among young people, we aim to explore this issue by determining the prevalence of psychological problems and general practice/health service utilization among young people attending general practice. A retrospective cross-sectional study of patients attending three general practices in Dublin city. Among a sample of young people (mostly women, 44% general medical services (GMS) eligible), we observed considerable contact with general practice, both lifetime and for the 2 years of the study. The mean consultation rate was 3.9 consultations in 2 years and psychosocial issues (most commonly stress/anxiety and depression) were documented in 35% of cases. Identification of psychosocial issues was associated with GMS eligibility, three or more doctor consultations, and documentation of smoking and drinking status. Psychosocial issues are common among young people attending general practice and more work on their epidemiology and further identification in general practice are advocated.

Does the positive influence of an undergraduate rural placement persist into postgraduate years?

Medical schools worldwide are playing a role in addressing the shortage of rural health practitioners. Selection of rural-origin students and long-term rural undergraduate placements have been shown to have a positive influence on a subsequent career choice of rural health. Evidence for the impact of short-term rural placements is less clear. In New Zealand, the Otago University Faculty of Medicine introduced a 7 week rural undergraduate placement at the Dunedin School Of Medicine, one of its three clinical schools, in 2000. A study of the first two annual cohorts showed a positive influence of the course on student attitudes to rural health and their intention to practise in a rural setting. The purpose of this study was to test whether or not these effects persisted into postgraduate years. The original study cohorts were posted a questionnaire (questions worded identically to the original survey) in 2009 (5th and 6th postgraduate years). Non-responders were followed up after 2 months. Graduates from the same year cohort at the two other Otago clinical schools (Christchurch and Wellington) were also surveyed. In addition to analysis by question, principal component analysis (PCA) identified 3 questions which represented the influence of the medical undergraduate program on students' attitudes towards rural general practice. This was used as an index of influence of the undergraduate curriculum. There was a statistically significant difference among graduates from Dunedin and the other two schools in reporting a positive influence towards rural practice from the undergraduate course.When asked how the medical undergraduate program influenced their attitude towards a career in rural practice, 56% of respondents from Dunedin reported a positive influence compared with 24% from Christchurch and 15% Wellington. This effect was less strong than that obtained immediately after the rural placement where 70% of Dunedin based students reported a positive influence. The index value for positive effect on attitudes was significantly higher for respondents who studied at Dunedin than at Wellington (mean index value 0.552 for Dunedin, -0.374 for Wellington t=4.172, p=0.000) or Christchurch (mean index value -0.083 for Christchurch t=2.606, p=0.011). There was no significant difference between Christchurch and Wellington (t=1.420, p=0.160). There was no significant difference among schools in the proportion of graduates who had worked or intended to work in rural general practice at any point in their career (24% Dunedin, 31% Christchurch, 16% Wellington (Phi=0.160, p=0.178). Most of the literature on the influence of rural undergraduate placements, especially short term placements, examines immediate changes. This study adds to the evidence by showing that positive effects from a rural undergraduate placement persist into the postgraduate years, although that in isolation is unlikely to result in a significant workforce effect. Further investigation is warranted into which features of the undergraduate placement result in an extended positive effect on student attitudes.

P119 Integrated care in sexual health: a novel training programme to engender culture change for trainees in primary and secondary care specialties

BackgroundChanges in the NHS dictate that staff in general practice (GP), public health (PH), SRH and GUM work closely together. This integration cannot be achieved by processes and structures alone....

Editorial introductions

Editorial introductions

In‐practice and distance consultant on‐call general practitioner supervisors for Australian general practice?

Increasing numbers of medical students and junior doctors learn and work in general practice. Increased supervisory responsibilities for general practitioners threaten the quality of care provided to patients and the income thus derived. Incremental changes to infrastructure and funding are welcome, but insufficient. Alternative models must be funded, trialled and evaluated. One such model, involving consultant on-call GP supervisors, is proposed.

General practice and social service partnership for better clinical outcomes, patient self efficacy and lifestyle behaviours of diabetic care: randomised control trial of a chronic care model

BackgroundThe International Diabetes Attitudes, Wishes, and Needs (DAWN) programmes have shown the existence of a critical gap in self management support and access to the support system. This study aims...