IRUS Total

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

Title: Examining the practice of generalist expertise: a qualitative study identifying constraints and solutions
Authors: Reeve, J
Dowrick, CF
Freeman, GK
Gunn, J
Mair, F
May, C
Mercer, S
Palmer, V
Howe, A
Irving, G
Shiner, A
Watson, J
Item Type: Journal Article
Abstract: OBJECTIVES: 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. DESIGN: Qualitative study in General Practice. SETTING: UK primary care. MAIN OUTCOME MEASURES: A qualitative study - interviews, surveys and focus groups with GPs and GP trainees. Data collection and analysis was informed by Normalisation Process Theory. DESIGN AND SETTING: 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. PARTICIPANTS: UK based GPs (interview and surveys); European GP trainees (focus groups). RESULTS: 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. CONCLUSIONS: 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.
Issue Date: 2-Dec-2013
Date of Acceptance: 1-Dec-2013
URI: http://hdl.handle.net/10044/1/64421
DOI: https://dx.doi.org/10.1177/2042533313510155
ISSN: 2042-5333
Publisher: SAGE Publications
Start Page: 1
End Page: 9
Journal / Book Title: JRSM Short Reports
Volume: 4
Issue: 12
Copyright Statement: © 2013 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Non-commercial Attribution License (http://creativecommons.org/licenses/by-nc/2.0/), which permits non-commercial use, distribution and reproduction in any medium, provided the original work is properly cited.
Keywords: generalism
generalist expertise
generalist practice
normalisation process theory
primary care
Publication Status: Published
Conference Place: England
Online Publication Date: 2013-12-02
Appears in Collections:Faculty of Medicine