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

J. Reeve, C.F. Dowrick, G.K. Freeman, J. Gunn, F. Mair, C. May, S. Mercer, V. Palmer, A. Howe, G. Irving, A. Shiner, J. Watson

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

lt;bgt;Objectives lt;/bgt;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. lt;pgt;lt;/pgt; lt;bgt;Design lt;/bgt;Qualitative study in General Practice. lt;pgt;lt;/pgt; lt;bgt;Setting lt;/bgt;UK primary care. lt;pgt;lt;/pgt; lt;bgt;Main outcome measures lt;/bgt;A qualitative study ? interviews, surveys and focus groups with GPs and GP trainees. Data collection and analysis was informed by Normalisation Process Theory. lt;pgt;lt;/pgt; lt;bgt;Design and setting lt;/bgt;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. lt;pgt;lt;/pgt; lt;bgt;Participants lt;/bgt;UK based GPs (interview and surveys). European GP trainees (focus groups). lt;pgt;lt;/pgt; lt;bgt;Results lt;/bgt;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. lt;pgt;lt;/pgt; lt;bgt;Conclusions lt;/bgt;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.
Original languageEnglish
JournalJRSM short reports
Issue number12
Publication statusPublished - 1 Dec 2013


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