Journal articles on the topic 'Qualitative GP interviews'
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Cheshire, Anna, Damien Ridge, John Hughes, David Peters, Maria Panagioti, Chantal Simon, and George Lewith. "Influences on GP coping and resilience: a qualitative study in primary care." British Journal of General Practice 67, no. 659 (May 8, 2017): e428-e436. http://dx.doi.org/10.3399/bjgp17x690893.
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Background‘Neoliberal’ work policies, austerity, NHS restructuring, and increased GP consultation rates provide the backdrop against increasing reports of GP burnout and an impending shortage of GPs.AimTo explore GPs’ experiences of workplace challenges and stresses, and their coping strategies, particularly focusing on understanding the impact of recent NHS workplace change.Design and settingStudy design was qualitative, with data collected from two focus groups and seven one-to-one telephone interviews.MethodFocus groups and one-to-one telephone interviews explored the experiences of GPs currently practising in England, recruited through convenience sampling. Data were collected using a semi-structured interview approach and analysed using thematic analysis.ResultsThere were 22 GP participants recruited: focus groups (n = 15) and interviews (n = 7). Interviewees understood GPs to be under intense and historically unprecedented pressures, which were tied to the contexts in which they work, with important moral implications for ‘good’ doctoring. Many reported that being a full-time GP was too stressful: work-related stress led to mood changes, sleep disruption, increases in anxiety, and tensions with loved ones. Some had subsequently sought ways to downsize their clinical workload. Workplace change resulted in little time for the things that helped GP resilience: a good work–life balance and better contact with colleagues. Although some GPs were coping better than others, GPs acknowledged that there was only so much an individual GP could do to manage their stress, given the external work issues they faced.ConclusionGPs experience their emotional lives and stresses as being meaningfully shaped by NHS factors. To support GPs to provide effective care, resilience building should move beyond the individual to include systemic work issues.
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van Onna, Marloes, Simone Gorter, Aniek van Meerendonk, and Astrid van Tubergen. "General Practitioners’ Perceptions of Their Ability to Identify and Refer Patients with Suspected Axial Spondyloarthritis: A Qualitative Study." Journal of Rheumatology 41, no. 5 (April 1, 2014): 897–901. http://dx.doi.org/10.3899/jrheum.131293.
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Objective.To explore the knowledge, beliefs, and experiences of general practitioners (GP) about inflammatory back pain (IBP) and axial spondyloarthritis (axSpA) and potential barriers for referral of patients suspected of having axSpA.Methods.A qualitative study involving semistructured interviews with GP was conducted. Transcripts of the interviews were independently read and annotated by 2 readers. Illustrative themes were identified and a coding system to categorize the data was developed.Results.Ten GP (all men; mean age 49 yrs) were interviewed. All could adequately describe “classic” ankylosing spondylitis (AS) and mentioned chronic back pain and/or stiffness as key features. All GP thought that AS is almost exclusively diagnosed in men. Six GP knew that there is a difference between mechanical back pain and IBP, but could recall only a limited number of variables indicative of IBP, such as awakening night pain (4 GP), insidious onset of back pain (1 GP), improvement with movement (1 GP), and (morning) stiffness (2 GP). Two GP mentioned peripheral arthritis as other SpA features, none mentioned dactylitis or enthesitis. GP awareness of associated extraarticular manifestations was low. Most GP expressed that (practical) referral measures would be useful.Conclusion.GP are aware of “classic”, but longterm features of axSpA. Knowledge about the disease spectrum and early detection is, however, limited. Addressing these issues in training programs may improve recognition of axSpA in primary care. This may ultimately contribute to earlier referral, diagnosis, and initiation of effective treatment in patients with axSpA.
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Costa, Marie, Fabienne Marcellin, Marion Coste, Tangui Barré, Sandra Nordmann, Marion Mora, Gwenaëlle Maradan, et al. "Access to care for people with alcohol use disorder in France: a mixed-method cross-sectional study protocol (ASIA)." BMJ Open 8, no. 9 (September 2018): e024669. http://dx.doi.org/10.1136/bmjopen-2018-024669.
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IntroductionAlcohol use disorder (AUD) is a major public health concern worldwide. In France, only 10% of people with AUD (PWAUD) receive medical care. General practitioners (GP) are one of the main entry points for AUD care. The present ongoing study, entitled ASIA (Access to Care and Indifference toward Alcohol,Accès aux Soins et Indifference à l’Alcoolin French), aims to improve knowledge about factors associated with access to care for AUD by exploring related GP and PWAUD practices, experiences and perceptions.Methods and analysisThe ASIA project is an ongoing cross-sectional multisite study based on a complementary mixed-method approach (quantitative and qualitative) using a convergent parallel design. The double-perspective design of the study will enable us to collect and compare data regarding both PWAUD and GP points of view. For the PWAUD quantitative study, 260 PWAUD will be interviewed using a telephone-based questionnaire. For the qualitative study, 36 PWAUD have already been interviewed. The GP quantitative study will include 100 GP in a 15 min survey. Fifteen GP have already participated in semistructured interviews for the qualitative study. Logistic regression will be used to identify predictors for access to care. With respect to data analyses, qualitative interviews will be analysed using semantic analysis while quantitative logistic regression will be used for quantitative interviews.Ethics and disseminationThis study was approved by the CNIL (French National Commission on Informatics and Liberties) (approval reference number: C16-10, date of approval: 17 July 2017), the CCTIRS (Advisory Committee on Information Processing in Material Research in the Field of Health) and the CEEI (Evaluation and Ethics Committee) (approval reference number: 16–312, date of approval: 8 July 2016) of INSERM (French National Institute of Health and Medical Research). Results from ASIA will be disseminated in peer-reviewed publications, conference presentations, reports and in a PhD thesis.
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Augros, Johann, Frédéric Dutheil, Amanda C. Benson, Marie-Pierre Sauvant-Rochat, Gil Boudet, Catherine Laporte, Benoit Cambon, and Guillaume T. Vallet. "Experience of General Practice Residents Caring for Dependent Elderly during the First COVID-19 Lockdown—A Qualitative Study." International Journal of Environmental Research and Public Health 18, no. 23 (November 23, 2021): 12281. http://dx.doi.org/10.3390/ijerph182312281.
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Background: Understanding the experiences of general practice (GP) residents caring for dependent elderly people during the first lockdown as part of the countries COVID-19 pandemic strategy. The aim was to explore themes that could explain the gap between the missions and values at the heart of GP practice during this period of strict isolation. Method: Qualitative study using an iterative approach. Semi-structured interviews were conducted with 13 GP residents using a pre-established interview guide. Audio recordings were transcribed verbatim. Data were analyzed according to a coding grid, developed using Nvivo software (NVivo Qualitative Data Analysis Software; QSR International Pty Ltd. Version Release 1.5.1 (940) 2021), to identify emerging themes. Results: Three themes emerged from this qualitative research: cognitive dissonance, psychosocial risks, and fear. General practice residents have lived in the paradox between care and deprivation of liberty of dependent elderly people. Conclusion: The results suggest that the GP residents experienced a form of work-related suffering in this situation of deprivation of liberty of dependent elderly people. The present research serves as a pilot study to explore how GP residents experienced their care of locked-up dependent elderly people.
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Seamark, David, Deborah Davidson, Angela Ellis-Paine, Jon Glasby, and Helen Tucker. "Factors affecting the changing role of GP clinicians in community hospitals: a qualitative interview study in England." British Journal of General Practice 69, no. 682 (February 25, 2019): e329-e335. http://dx.doi.org/10.3399/bjgp19x701345.
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BackgroundGPs were a key driving force for the development of a network of community hospitals across England, and have provided medical cover for most of them. However, during the past decade there has been a significant shift, with the dominant trend appearing to be one of declining GP involvement.AimTo explore how and why the role of GPs within community hospitals in England is changing.Design and settingQualitative study in a sample of nine diverse community hospitals in England.MethodQualitative interviews with community hospital clinical staff.ResultsIn all, 20 interviews were conducted and two models of medical care observed: GPs employed by a practice and trust-employed doctors. Interviewees confirmed the trend towards declining GP involvement, with the factors driving change identified as being GP workload and recruitment challenges, a change from ‘step-up’ admissions from the community to ‘step-down’ admissions from acute hospitals, fewer local patients being admitted, increased medical acuity of patients admitted, increased burden of medical support required, and inadequate remuneration. The majority of doctors viewed community hospital work in a positive light, welcoming the opportunities for personal development and to acquire new clinical skills. GPs viewed community hospital work as an extension of primary care, adding to job satisfaction.ConclusionMultiple factors have driven changes in the role of GP community hospital clinicians. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital work.
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Leusink, Peter, Renee Steinmann, Merel Makker, Peter L. Lucassen, Doreth Teunissen, Antoine L. Lagro-Janssen, and Ellen T. Laan. "Women’s appraisal of the management of vulvodynia by their general practitioner: a qualitative study." Family Practice 36, no. 6 (May 10, 2019): 791–96. http://dx.doi.org/10.1093/fampra/cmz021.
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Abstract Background Provoked Vulvodynia (PVD) is the most common cause of vulvar pain. General practitioners (GPs) are insufficiently familiar with it, causing a delay in many women receiving correct diagnosis and treatment. Besides patients factors, this delay can partly be explained by the reluctance of GPs to explore the sexual context of PVD and by their negative emotional reactions such as helplessness and frustration when consulted by patients with medically unexplained symptoms like PVD. Objective To gain insight into how women with PVD perceive and evaluate condition management by their GP, in order to support GPs in the consultation of women with PVD. Methods We performed face-to-face in-depth interviews with women diagnosed with PVD. The interviews were recorded, transcribed verbatim and thematically analysed. The Consolidated Criteria for reporting Qualitative Research (COREQ-criteria) were applied. Results Analysis of the interviews generated four interrelated themes: Doctor-patient relationship, Lack of knowledge, Referral process and Addressing sexual issues. Empathy of the GP, involvement in decision-making and referral were important factors in the appreciation of the consultation for women with PVD who were referred to a specialist. Because women were reluctant to start a discussion about sexuality, they expected a proactive attitude from their GP. The communication with and the competence of the GP ultimately proved more important in the contact than the gender of the GP. Conclusion Women with PVD prefer a patient-centred approach and want GPs to acknowledge their autonomy and to address sexuality proactively.
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Cosgriff, David, Jenny Reath, and Penelope Abbott. "Why do people with long-term health needs see more than one GP?: a qualitative study." Australian Journal of Primary Health 26, no. 6 (2020): 514. http://dx.doi.org/10.1071/py20179.
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This study aimed to understand what barriers exist or choices are made by patients who access regular care for long-term health issues from multiple GPs. This was a qualitative interview study in Western Sydney community settings consisting of semi-structured interviews and inductive thematic analysis. Twenty participants who accessed GP care were interviewed. Sixteen had seen multiple GPs over the previous twelve months and all had seen multiple GPs over preceding years. Participants valued interpersonal continuity of care. Nevertheless, they made decisions to meet their needs by seeing multiple GPs. They considered waiting times, preference for an individual GP based on their consultation style or perception of their particular area of expertise, experiences with reception staff and the practice model of care. Participants were aware that interpersonal continuity of care was considered important by GPs and were reticent to be seen as ‘doctor shoppers’. Therefore, they did not usually disclose that they saw multiple doctors and were unlikely to discuss continuity of care with a GP. Participants made considered choices about health care. Despite general practice promoting interpersonal continuity of care, it is not always achievable or desired by patients. GPs can promote care continuity through supportive practice models and dialogue about when continuity is desirable.
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Duncan, Polly, Matthew J. Ridd, Deborah McCahon, Bruce Guthrie, and Christie Cabral. "Barriers and enablers to collaborative working between GPs and pharmacists: a qualitative interview study." British Journal of General Practice 70, no. 692 (February 10, 2020): e155-e163. http://dx.doi.org/10.3399/bjgp20x708197.
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BackgroundMany UK GP practices now employ a practice pharmacist, but little is known about how GPs and pharmacists work together to optimise medications for complex patients with multimorbidity.AimTo explore GP and pharmacist perspectives on collaborative working within the context of optimising medications for patients with multimorbidity.Design and settingA qualitative analysis of semi-structured interviews with GPs and pharmacists working in the West of England, Northern England, and Scotland.MethodThirteen GPs and 10 pharmacists were sampled from practices enrolled in the 3D trial (a complex intervention for people with multimorbidity). Participants’ views on collaborative working were explored with interviews that were audiorecorded, transcribed, and analysed thematically. Saturation of data was achieved with no new insights arising from later interviews.ResultsGPs from surgeries that employed a pharmacist tended to value their expertise more than GPs who had not worked with one. Three key themes were identified: resources and competing priorities; responsibility; and professional boundaries. GPs valued pharmacist recommendations that were perceived to improve patient safety, as opposed to those that were technical and unlikely to benefit the patient. Pharmacists who were not known to GPs felt undervalued and wanted feedback from the GPs about their recommendations, particularly those that were not actioned.ConclusionA good working relationship between the GP and pharmacist, where each profession understood the other’s skills and expertise, was key. The importance of face-to-face meetings and feedback should be considered in future studies of interdisciplinary interventions, and by GP practices that employ pharmacists and other allied health professionals.
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Kelly, Dervla, Justin Graffi, Maria Noonan, Philip Green, John McFarland, Peter Hayes, and Liam Glynn. "Exploration of GP perspectives on deprescribing antidepressants: a qualitative study." BMJ Open 11, no. 4 (April 2021): e046054. http://dx.doi.org/10.1136/bmjopen-2020-046054.
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ObjectiveOur aim was to explore general practitioners’ (GPs) perceptions and experiences of discontinuing antidepressants.Study designA qualitative study using semistructured interviews was undertaken between July 2019 and March 2020. The interviews were transcribed and analysed using a thematic analysis framework.SettingGPs affiliated with a university education and research network for general practice in Ireland.ParticipantsA purposive sample of GPs (n=10).ResultsFive themes emerged: shared decision-making; personalised therapy; medication-tapering toolkit; health service factors and concerns around tapering. GPs described being less likely to engage in deprescribing for patients with long-term and/or recurrent depression, older patients and those with comorbidities due to fear of relapse. Access to evidence-based psychological therapies, guidelines, information on rates of relapse, patient leaflets on discontinuing antidepressants and reminder prompts on GP-prescribing software were suggested to optimise appropriate antidepressant discontinuation. There was some suggestion that patients may use antidepressants for longer when talk therapy is not available or taken up.ConclusionsGPs are largely confident in their role of managing mild-to-moderate depression and deprescribing antidepressants. This study provides an insight into factors that influence GPs’ decisions to deprescribe antidepressants. More information on rates of relapse after discontinuation would be helpful to inform decision-making.
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Allison, Rosalie L., Ellie J. Ricketts, Thomas Hartney, Anthony Nardone, Katy Town, Claire Rugman, Kate Folkard, J. Kevin Dunbar, and Cliodna AM McNulty. "Qualitative impact assessment of an educational workshop on primary care practitioner attitudes to NICE HIV testing guidelines." BJGP Open 2, no. 1 (March 6, 2018): bjgpopen18X101433. http://dx.doi.org/10.3399/bjgpopen18x101433.
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BackgroundIn 2013, Public Health England piloted the ‘3Cs (chlamydia, contraception, condoms) and HIV (human immunodeficiency virus)’ educational intervention in 460 GP surgeries. The educational HIV workshop aimed to improve the ability and confidence of staff to offer HIV testing in line with national guidelines.AimTo qualitatively assess the impact of an educational workshop on GP staff’s attitudes to NICE HIV testing guidelines.Design & settingQualitative interviews with GP staff across England before and after an educational HIV workshop.MethodThirty-two GP staff (15 before and 17 after educational HIV workshop) participated in interviews exploring their views and current practice of HIV testing. Interview transcripts were thematically analysed and examined, using the components of the theory of planned behaviour (TPB) and normalisation process theory (NPT) as a framework.ResultsGPs reported that the educational HIV workshop resulted in increased knowledge of, and confidence to offer, HIV tests based on indicator conditions. However, overall participants felt they needed additional HIV training around clinical care pathways for offering tests, giving positive HIV results, and current treatments and outcomes. Participants did not see a place for point-of-care testing in general practice.ConclusionImplementation of national HIV guidelines will require multiple educational sessions, especially to implement testing guidelines for indicator conditions in areas of low HIV prevalence. Additional role-play or discussions around scripts suggesting how to offer an HIV test may improve participants’ confidence and facilitate increased testing. Healthcare assistants (HCAs) may need specific training to ensure that they are skilled in offering HIV testing within new patient checks.
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Seguin, Maureen, Laura Hall, Helen Atherton, Rebecca Barnes, Geraldine Leydon, Elizabeth Murray, Catherine Pope, Sue Ziebland, and Fiona A. Stevenson. "Protocol paper for the ‘Harnessing resources from the internet to maximise outcomes from GP consultations (HaRI)’ study: a mixed qualitative methods study." BMJ Open 8, no. 8 (August 2018): e024188. http://dx.doi.org/10.1136/bmjopen-2018-024188.
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IntroductionMany patients now turn to the internet as a resource for healthcare information and advice. However, patients’ use of the internet to manage their health has been positioned as a potential source of strain on the doctor–patient relationship in primary care. The current evidence about what happens when internet-derived health information is introduced during consultations has relied on qualitative data derived from interview or questionnaire studies. The ‘Harnessing resources from the internet to maximise outcomes from GP consultations (HaRI)’ study combines questionnaire, interview and video-recorded consultation data to address this issue more fully.Methods and analysisThree data collection methods are employed: preconsultation patient questionnaires, video-recorded consultations between general practitioners (GP) and patients, and semistructured interviews with GPs and patients. We seek to recruit 10 GPs practising in Southeast England. We aim to collect up to 30 patient questionnaires and video-recorded consultations per GP, yielding up to 300. Up to 30 patients (approximately three per participating GP) will be selected for interviews sampled for a wide range of sociodemographic characteristics, and a variety of ways the use of, or information from, the internet was present or absent during their consultation. We will interview all 10 participating GPs about their views of online health information, reflecting on their own usage of online information during consultations and their patients’ references to online health information. Descriptive, conversation and thematic analysis will be used respectively for the patient questionnaires, video-recorded consultations and interviews.Ethics and disseminationEthical approval has been granted by the London–Camden & Kings Cross Research Ethics Committee. Alongside journal publications, dissemination activities include the creation of a toolkit to be shared with patients and doctors, to guide discussions of material from the internet in consultations.
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Merriel, Samuel William David, Stephanie Archer, Alice S. Forster, David Eldred-Evans, John McGrath, Hashim Uddin Ahmed, Willie Hamilton, and Fiona M. Walter. "Experiences of ‘traditional’ and ‘one-stop’ MRI-based prostate cancer diagnostic pathways in England: a qualitative study with patients and GPs." BMJ Open 12, no. 7 (July 2022): e054045. http://dx.doi.org/10.1136/bmjopen-2021-054045.
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ObjectivesThis study aimed to understand and explore patient and general practitioner (GP) experiences of ‘traditional’ and ‘one-stop’ prostate cancer diagnostic pathways in England.DesignQualitative study using semi-structured interviews, analysed using inductive thematic analysisSettingPatients were recruited from National Health Service (NHS) Trusts in London and in Devon; GPs were recruited via National Institute for Health Research (NIHR) Clinical Research Networks. Interviews were conducted in person or via telephone.ParticipantsPatients who had undergone a MRI scan of the prostate as part of their diagnostic work-up for possible prostate cancer, and GPs who had referred at least one patient for possible prostate cancer in the preceding 12 months.Results22 patients (aged 47–80 years) and 10 GPs (6 female, aged 38–58 years) were interviewed. Patients described three key themes: cancer beliefs in relation to patient’s attitudes towards prostate cancer;communication with their GP and specialist having a significant impact on experience of the pathway and pathway experience being influenced by appointment and test burden. GP interview themes included: the challenges of dealing with imperfect information in the current pathway; managing uncertainty in identifying patients with possible prostate cancer and sharing this uncertainty with them, and other social, cultural and personal contextual influences.ConclusionsPatients and GPs reported a range of experiences and views of the current prostate cancer diagnostic pathways in England. Patients valued ‘one-stop’ pathways integrating prostate MRI and diagnostic consultations with specialists over the more traditional approach of several hospital appointments. GPs remain uncertain how best to identify patients needing referral for urgent prostate cancer testing due to the lack of accurate triage and risk assessment strategies.
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Dallas, Anthea, Andrew Davey, Katie Mulquiney, Joshua Davis, Paul Glasziou, Mieke Van Driel, and Parker Magin. "Delayed prescribing of antibiotics for acute respiratory infections by GP registrars: a qualitative study." Family Practice 37, no. 3 (November 30, 2019): 406–11. http://dx.doi.org/10.1093/fampra/cmz079.
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Abstract Background Antibiotic prescribing for acute self-limiting respiratory tract infections (ARTIs) in Australia is higher than international benchmarks. Antibiotics have little or no efficacy in these conditions, and unnecessary use contributes to antibiotic resistance. Delayed prescribing has been shown to reduce antibiotic use. GP registrars are at a career-stage when long-term prescribing patterns are being established. Aim To explore experiences, perceptions and attitudes of GP registrars and supervisors to delayed antibiotic prescribing for ARTIs. Design and setting A qualitative study of Australian GP registrars and supervisors using a thematic analysis approach. Method GP registrars and supervisors were recruited across three Australian states/territories, using maximum variation sampling. Telephone interviews explored participants’ experience and perceptions of delayed prescribing of antibiotics in ARTIs. Data collection and analysis were concurrent and iterative. Results A total of 12 registrars and 10 supervisors were interviewed. Key themes included the use of delayed prescribing as a safety-net in cases of diagnostic uncertainty or when clinical review was logistically difficult. Delayed prescribing was viewed as a method of educating and empowering patients, and building trust and the doctor–patient relationship. Conversely, it was also seen as a loss of control over management decisions. Supervisors, more so than registrars, appreciated the psychosocial complexity of ARTI consultations and the importance of delayed antibiotic prescribing in this context. Conclusion Better awareness and understanding by GP registrars of the evidence for delayed antibiotic prescription may be a means of reducing antibiotic prescribing. Understanding both registrar and supervisor usage, uncertainties and attitudes should inform educational approaches on this topic.
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Hirst, Victoria, and Fiona Cuthill. "Benefits of GP care in outreach settings for people experiencing homelessness: a qualitative study." British Journal of General Practice 71, no. 709 (February 24, 2021): e596-e603. http://dx.doi.org/10.3399/bjgp.2020.0749.
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BackgroundAlthough people experiencing homelessness (PEH) have the worst health outcomes in society, they have a low uptake of primary care services. GP outreach has developed as a way of increasing their access into primary care but little is known about the experience of patients receiving care in this way.AimTo explore PEHs’ experiences of GP care in community outreach settings in UK; and to seek staff/volunteers’ views on the strengths and weaknesses of GP community outreach services.Design and settingA multi-method qualitative study with PEH and staff/volunteers working in three different community outreach settings in the UK.MethodIndividual semi-structured interviews were carried out with 22 PEH and two focus groups with key staff/volunteers. Data were analysed thematically using framework analysis.ResultsGP outreach services better enabled PEH to access medical care and staff/volunteers valued GP support to promote, and facilitate access to, healthcare services. In particular, the findings illuminate the high value that PEH placed on the organisational environment of the GP outreach service. Valued aspects of GP outreach were identified as comfortable, safe, and engendering a sense of belonging; convenient, opportunistic, and a one-stop shop; and being heard, having more time, and breaking down barriers.ConclusionThe organisational environment is important in enabling PEH to engage with GP services. The physical and organisational environment of the outreach settings were the most important factors; they created a space where professional barriers between the GP and patients were flattened, so facilitating a therapeutic relationship.
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Spooner, Sharon, Louise Laverty, and Kath Checkland. "The influence of training experiences on career intentions of the future GP workforce: a qualitative study of new GPs in England." British Journal of General Practice 69, no. 685 (May 20, 2019): e578-e585. http://dx.doi.org/10.3399/bjgp19x703877.
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BackgroundThe capacity of the UK GP workforce has not kept pace with increasing primary care workloads. Although many doctors successfully complete GP specialty training programmes, some do not progress to work in NHS general practice.AimThis article explores the training experiences and perceptions of newly qualified GPs to understand how their education, training, and early experiences of work influence their career plans.Design and settingA qualitative study of doctors in their final year of GP training (ST3) and within 5 years of completion of GP training (F5).MethodParticipants across England were recruited through training programmes, First5 groups, and publicity using social media and networks. Open narrative interviews were conducted with individuals and focus groups. Audiorecorded interviews were transcribed, and a thematic analysis was supported by NVivo and situational analysis mapping techniques.ResultsFifteen participants engaged in individual interviews and 10 focus groups were carried out with a total of 63 participants. Most doctors reported that training programmes had prepared them to deal confidently with most aspects of routine clinical GP work. However, they felt underprepared for the additional roles of running a practice and in their understanding of wider NHS organisational structures. Doctors wished to avoid unacceptably heavy workloads and voiced concerns about the longer-term sustainability of general practice.ConclusionStrategies to attract and retain enough GPs to support delivery of comprehensive primary care should consider how doctors’ early career experiences influence their career intentions. A coherent plan is needed to improve their preparation and increase confidence that they can achieve a professionally satisfying, effective, and sustainable career in NHS general practice.
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van Bussel, Emma, Leony Reurich, Jeannette Pols, Edo Richard, Eric Moll van Charante, and Suzanne Ligthart. "Hypertension management: experiences, wishes and concerns among older people—a qualitative study." BMJ Open 9, no. 8 (August 2019): e030742. http://dx.doi.org/10.1136/bmjopen-2019-030742.
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ObjectivesSixty-five per cent of older people have hypertension, but little is known about their preferences and concerns regarding hypertension management. Guidelines on hypertension lack consensus on how to treat older people without previous cardiovascular disease (CVD). This asks for explicit consideration of patient preferences in decision making. Therefore, the aim of this study was to explore older peoples’ experiences, preferences, concerns and perceived involvement regarding hypertension management.DesignQualitative interview study.SettingParticipants were selected from 11 general practitioner (GP) practices in the Netherlands and purposively sampled until data saturation was achieved. Semistructured interviews were conducted, audio recorded and analysed by two researchers using thematic analysis.ParticipantsFifteen community dwelling older people aged 74–93 years with hypertension and without previous CVD participated.ResultsInterviewees rarely started the conversation about hypertension management with their GP, although they did have concerns. Reasons for not discussing the subject included low priority of hypertension concerns, reliance on GPs or trust in GPs to make the right decision on their behalf. Also, interviewees anticipated regret of reducing medication, fearing vascular incidents. Interviewees would like to discuss tailoring treatment to their needs, deprescription of medication and ways to reduce side effects. They expected GPs to be more transparent on treatment effects.ConclusionOlder people describe having little involvement in hypertension management, although they have several concerns. Since GPs are also known to be hesitant to bring up this subject, we signal a conspiracy of silence about antihypertensive medication. Through breaking this silence, GPs can facilitate shared decision-making on hypertension management and better tailored care.
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McCallum, Marianne, Sara MacDonald, and John McKay. "GP speciality training in areas of deprivation: factors influencing engagement. A qualitative study." BJGP Open 3, no. 2 (May 14, 2019): bjgpopen19X101644. http://dx.doi.org/10.3399/bjgpopen19x101644.
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BackgroundGP training practices are less likely to be situated in areas of deprivation; little is known about GP views of postgraduate training in such areas.AimTo explore the views of GPs working in deprived areas about GP speciality training (GPST).Design & settingQualitative in-depth interviews with GPs working in practices in deprived areas in Scotland.MethodTen in-depth interviews were conducted with GPs in training and non-training practices, to explore views on training. Interviews were audiotaped and transcribed verbatim, and inductive thematic analysis was undertaken.ResultsThe importance of producing ‘well-rounded’ GPs who are able to work in a variety of environments was highlighted. Trainees need exposure to the specific challenges of deprived contexts (such as early multimorbidity, child protection, and addiction) and the benefit of this for trainees was thought to be invaluable. GPs identified many perceived barriers and benefits to training, some generic but some — such as inspiring the next generation (benefit) or overwhelming workload (barrier) — may be more relevant in areas of high deprivation. Overwhelming workload was the main reason for not becoming a training practice, though some would consider it if supported to develop a training culture. All the GPs, including non-trainers, were involved in optional activities which were felt to be important for resilience.ConclusionGPs in areas of deprivation highlighted specific skills that could be gained by undertaking at least a part placement in deprived areas, with different skills likely to be gained from affluent areas. National education bodies should consider GP training rotations ensure a variety of training environments.
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Dixon, Sharon, Lucy Frost, Gene Feder, Sue Ziebland, and Catherine Pope. "Challenges of safeguarding via remote consulting during the COVID-19 pandemic: a qualitative interview study." British Journal of General Practice 72, no. 716 (January 24, 2022): e199-e208. http://dx.doi.org/10.3399/bjgp.2021.0396.
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BackgroundThe COVID-19 pandemic required general practice to rapidly adapt to remote consultations and assessment of patients, creating new, and exacerbating existing, vulnerabilities for many patients.AimTo explore GP perspectives and concerns about safeguarding practice during the pandemic, focusing on challenges and opportunities created by remote consultation.Design and settingQualitative interview study.MethodEighteen GPs from Oxford, London, Southampton, Liverpool, Manchester, and Reading were interviewed between June and November 2020, using a flexible topic guide and fictional vignettes to explore child and adult safeguarding scenarios. Interviews were audio-recorded, thematically coded, and analysed.ResultsGPs worried about missing observational information during remote consultations and that conversations might not be private or safe. Loss of continuity and pooled triage lists were seen as further weakening safeguarding opportunities. GPs experienced remote consulting as more ‘transactional’, with reduced opportunities to explore ‘other reasons’ including new safeguarding needs. However, they also recognised that remote consulting created opportunities for some vulnerable patients. While supporting known vulnerable patients was difficult, identifying new or unknown vulnerabilities was harder still. Most reported that remote consulting during COVID-19 was harder, riskier, and emotionally draining, contributing to increased GP anxiety and reduced job satisfaction.ConclusionThe GPs interviewed raised important concerns about how to identify and manage safeguarding in the context of remote consultations. Current guidance recommends face-to-face consultation for safeguarding concerns, but pressure to use remote forms of access (within or beyond the pandemic) and the fact that safeguarding needs may be unknown makes this an issue that warrants urgent attention.
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Coste, Sandra, Laetitia Gimenez, Aurélie Comes, Xavier Abdelnour, Julie Dupouy, and Emile Escourrou. "Discussing alcohol use with the GP: a qualitative study." BJGP Open 4, no. 2 (April 28, 2020): bjgpopen20X101029. http://dx.doi.org/10.3399/bjgpopen20x101029.
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BackgroundDespite most GPs recognising their role in the early diagnosis of alcohol use disorder (AUD), only 23% of GPs routinely screen for alcohol use. One reason GPs report for not screening is their relationship with patients; questions regarding alcohol use are considered a disturbance of a relationship built on mutual trust.AimTo analyse the feelings and experiences of patients with AUD concerning early screening for alcohol use by GPs.Design & settingA qualitative study of patients (n = 12) with AUD in remission or treatment, recruited from various medical settings.MethodSemi-structured interviews were conducted, audiorecorded, and transcribed verbatim. The authors conducted an inductive analysis based on grounded theory. The analysis was performed until theoretical data saturation was reached.ResultsThe participants experienced AUD as a chronic, destructive, and shameful disease. The participants expected their GPs to play a primary role in addressing AUD by kind listening, and providing information and support. If the GPs expressed a non-judgmental attitude, the participants could confide in them; this moment was identified as a key milestone in their trajectory, allowing relief and a move toward treatment. The participants thought that any consultation could be an opportunity to discuss alcohol use and noted that such discussions required a psychological and benevolent approach.ConclusionThe participants felt fear or denial from the GPs, even though they felt that discussing alcohol use is part of the GP’s job. The participants requested that GPs adopt non-judgmental attitudes and kindness when approaching the subject of alcohol use.
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Cope, Anwen L., Fiona Wood, Nick A. Francis, and Ivor G. Chestnutt. "Patients’ reasons for consulting a GP when experiencing a dental problem: a qualitative study." British Journal of General Practice 68, no. 677 (October 22, 2018): e877-e883. http://dx.doi.org/10.3399/bjgp18x699749.
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BackgroundThere are approximately 380 000 dental consultations in UK general practice every year.AimTo explore the reasons why patients may consult a GP rather than a dentist when experiencing problems with their teeth or gums.Design and settingA qualitative semi-structured interview study with adults who had consulted a UK GP with a dental problem in the previous 12 months.MethodParticipants were recruited via print and social media; internet adverts; HealthWise Wales, the Welsh national population research cohort; and word of mouth. In total, 39 telephone interviews were conducted, and transcripts thematically analysed.ResultsParticipants’ consultation behaviour was influenced by their interpretation of their symptoms; their perceptions of the scope of practice of primary care practitioners; the comparative ease of navigating medical and dental care systems; previous experiences of dental care, including dental anxiety and dissatisfaction with prior treatment; and willingness and ability to pay for dental care.ConclusionThere are several reasons why patients may consult a GP with a dental problem. Effective interventions will need to break down the barriers preventing access to dental care. Accessible public-facing information on where to seek care for dental problems is required, and general practice teams should be able to signpost patients who present with dental problems, if appropriate. Dental providers should also be encouraged to maintain timely access to urgent care for their patients.
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Lyness, Emily, Jane Louise Vennik, Felicity L. Bishop, Pranati Misurya, Jeremy Howick, Kirsten A. Smith, Mohana Ratnapalan, et al. "Exploring patient views of empathic optimistic communication for osteoarthritis in primary care: a qualitative interview study using vignettes." BJGP Open 5, no. 3 (March 12, 2021): BJGPO.2021.0014. http://dx.doi.org/10.3399/bjgpo.2021.0014.
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BackgroundOsteoarthritis (OA) causes pain and disability. An empathic optimistic consultation approach can improve patient quality of life, satisfaction with care, and reduce pain. However, expressing empathic optimism may be overlooked in busy primary care consultations and there is limited understanding of patients’ views about this approach.AimTo explore patients’ perspectives on clinician communication of empathy and optimism in primary care OA consultations.Design & settingVignette study with qualitative semi-structured interviews. Purposefully sampled patients (n = 33) aged >45 years with hip or knee OA from GP practices in Wessex (Hampshire, Dorest, Wiltshire, and Somerset).MethodFifteen participants watched two filmed OA consultations with a GP, and 18 participants read two case vignettes. In both formats, one GP depicted an empathic optimistic approach and one GP had a ‘neutral’ approach. Semi-structured interviews were conducted with all participants and analysed using thematic analysis.ResultsPatients recognised that empathic communication enhanced interactions, helping to engender a sense of trust in their clinician. They felt it was acceptable for GPs to convey optimism only if it was realistic, personalised, and embedded within an empathic consultation. Discussing patients’ experiences and views with them, and conveying an accurate understanding of these experiences improves the credibility of optimistic messages.ConclusionPatients value communication with empathy and optimism, but it requires a fine balance to ensure messages remain realistic and trustworthy. Increased use of a realistic optimistic approach within an empathic consultation could enhance consultations for OA and other chronic conditions, and improve patient outcomes. Digital training to help GPs implement these findings is being developed.
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Duncan, Polly, Christie Cabral, Deborah McCahon, Bruce Guthrie, and Matthew J. Ridd. "Efficiency versus thoroughness in medication review: a qualitative interview study in UK primary care." British Journal of General Practice 69, no. 680 (February 11, 2019): e190-e198. http://dx.doi.org/10.3399/bjgp19x701321.
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BackgroundMedication reviews may improve the safety of prescribing and the National Institute for Health and Care Excellence (NICE) highlights the importance of involving patients in this process.AimTo explore GP and pharmacist perspectives on how medication reviews were conducted in general practice in the UK.Design and settingAnalysis of semi-structured interviews with GPs and pharmacists working in the South West of England, Northern England, and Scotland, sampled for heterogeneity. Interviews took place between January and October 2017.MethodInterviews focused on experience of medication review. Data saturation was achieved when no new insights arose from later interviews. Interviews were analysed thematically.ResultsIn total, 13 GPs and 10 pharmacists were interviewed. GPs and pharmacists perceived medication review as an opportunity to improve prescribing safety. Although interviewees thought patients should be involved in decisions about their medicines, high workload pressures meant that most medication reviews were conducted with limited or no patient input. For some GPs, a medication review was done ‘in the quickest way possible to say that it was done’. Pharmacists were perceived by both professions as being more thorough but less time efficient than GPs, and few pharmacists were routinely involved in medication reviews even in practices employing a pharmacist. Interviewees argued that it was easier to continue medicines than it was to stop them, particularly because stopping medicines required involving the patient and this generated extra work.ConclusionPractices tended to prioritise being efficient (getting the work done) rather than being thorough (doing it well), so that most medication reviews were carried out with little or no patient involvement, and medicines were rarely stopped or reduced. Time and resource constraints are an important barrier to implementing NICE guidance.
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Fixsen, Alison, Simon Barrett, and Michal Shimonovich. "Weathering the storm: A qualitative study of social prescribing in urban and rural Scotland during the COVID-19 pandemic." SAGE Open Medicine 9 (January 2021): 205031212110291. http://dx.doi.org/10.1177/20503121211029187.
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Objectives: The non-clinical approach known as social prescribing aims to tackle multi-morbidity, reduce general practitioner (GP) workload and promote wellbeing by directing patients to community services. Usual in-person modes of delivery of social prescribing have been virtually impossible under social distancing rules. This study qualitatively examined and compared the responses of three social prescribing schemes in Scotland to the COVID-19 pandemic. Methods: We interviewed a theoretical sample of 23 stakeholders in urban and rural social prescribing schemes at the start of COVID-19 pandemic. Follow-up interviews with a representative sample were conducted around 10 months later. Interviewees included social prescribing coordinators (SPCs) GPs, managers, researchers and representatives of third sector organizations. Interview transcripts were analysed in stages and an inductive approach to coding was supported by NVivo. Results: Findings revealed a complex social prescribing landscape in Scotland with schemes funded, structured and delivering services in diverse ways. Across all schemes, working effectively during the pandemic and shifting to online delivery had been challenging and demanding; however, their priorities in response to the pandemic had differed. With GP time and services stretched to limits, GP practice-attached ‘Link Workers’ had taken on counselling and advocacy roles, sometimes for serious mental health cases. Community-based SPCs had mostly assumed a health education role, and those on the Western Isles of Scotland a digital support role. In both rural or urban areas, combatting loneliness and isolation – especially given social distancing – remained a pivotal aspect of the SPC role. Conclusion: This study highlights significant challenges and shifts in focus in social prescribing in response to the pandemic. The use of multiple digital technologies has assumed a central role in social prescribing, and this situation seems likely to remain. With statutory and non-statutory services stretched to their limits, there is a danger of SPCs assuming new tasks without adequate training or support.
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Cheshire, Anna, John Hughes, George Lewith, Maria Panagioti, David Peters, Chantal Simon, and Damien Ridge. "GPs’ perceptions of resilience training: a qualitative study." British Journal of General Practice 67, no. 663 (September 11, 2017): e709-e715. http://dx.doi.org/10.3399/bjgp17x692561.
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BackgroundGPs are reporting increasing levels of burnout, stress, and job dissatisfaction, and there is a looming GP shortage. Promoting resilience is a key strategy for enhancing the sustainability of the healthcare workforce and improving patient care.AimTo explore GPs’ perspectives on the content, context, and acceptability of resilience training programmes in general practice, in order to build more effective GP resilience programmes.Design and settingThis was a qualitative study of the perspectives of GPs currently practising in England.MethodGPs were recruited through convenience sampling, and data were collected from two focus groups (n = 15) and one-to-one telephone interviews (n = 7). A semi-structured interview approach was used and data were analysed using thematic analysis.ResultsParticipants perceived resilience training to be potentially of value in ameliorating workplace stresses. Nevertheless, uncertainty was expressed regarding how best to provide training for stressed GPs who have limited time. Participants suspected that GPs most likely to benefit from resilience training were the least likely to engage, as stress and being busy worked against engagement. Conflicting views were expressed about the most suitable training delivery method for promoting better engagement. Participants also emphasised that training should not only place the focus on the individual, but also focus on organisation issues.ConclusionA multimodal, flexible approach based on individual needs and learning aims, including resilience workshops within undergraduate training and in individual practices, is likely to be the optimal way to promote resilience.
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Sommer, Jessica, William Macdonald, Caroline Bulsara, and David Lim. "Grunt language versus accent: the perceived communication barriers between international medical graduates and patients in Central Wheatbelt catchments." Australian Journal of Primary Health 18, no. 3 (2012): 197. http://dx.doi.org/10.1071/py11030.
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Due to the chronic shortages of GPs in Australian rural and remote regions, considerable numbers of international medical graduates (IMG) have been recruited. IMG experience many difficulties when relocating to Australia with one of the most significant being effective GP−patient communication. Given that this is essential for effective consultation it can have a substantial impact on health care. A purposive sample of seven practising GPs (five IMG, two Australian-trained doctors (ATD)) was interviewed using a semistructured face-to-face interviewing technique. GPs from Nigeria, Egypt, United Kingdom, India, Singapore and Australia participated. Interviews were transcribed and then coded. The authors used qualitative thematic analysis of interview transcripts to identify common themes. IMG−patient communication barriers were considered significant in the Wheatbelt region as identified by both IMG and ATD. ATD indicated they were aware of IMG−patient communication issues resulting in subsequent consults with patients to explain results and diagnoses. Significantly, a lack of communication between ATD and IMG also emerged, creating a further barrier to effective communication. Analysis of the data generated several important findings that rural GP networks should consider when integrating new IMG into the community. Addressing the challenges related to cross-cultural differences should be a priority, in order to enable effective communication. More open communication between ATD and IMG about GP−patient communication barriers and education programs around GP−patient communication would help both GP and patient satisfaction.
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Banks, Jon, Michelle Farr, Chris Salisbury, Elly Bernard, Kate Northstone, Hannah Edwards, and Jeremy Horwood. "Use of an electronic consultation system in primary care: a qualitative interview study." British Journal of General Practice 68, no. 666 (November 6, 2017): e1-e8. http://dx.doi.org/10.3399/bjgp17x693509.
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BackgroundThe level of demand on primary care continues to increase. Electronic or e-consultations enable patients to consult their GP online and have been promoted as having potential to improve access and efficiency.AimTo evaluate whether an e-consultation system improves the ability of practice staff to manage workload and access.Design and settingA qualitative interview study in general practices in the West of England that piloted an e-consultation system for 15 months during 2015 and 2016.MethodPractices were purposefully sampled by location and level of e-consultation use. Clinical, administrative, and management staff were recruited at each practice. Interviews were transcribed and analysed thematically.ResultsTwenty-three interviews were carried out across six general practices. Routine e-consultations offered benefits for the practice because they could be completed without direct contact between GP and patient. However, most e-consultations resulted in GPs needing to follow up with a telephone or face-to-face appointment because the e-consultation did not contain sufficient information to inform clinical decision making. This was perceived as adding to the workload and providing some patients with an alternative route into the appointment system. Although this was seen as offering some patient benefit, there appeared to be fewer benefits for the practices.ConclusionThe experiences of the practices in this study demonstrate that the technology, in its current form, fell short of providing an effective platform for clinicians to consult with patients and did not justify their financial investment in the system. The study also highlights the challenges of remote consultations, which lack the facility for real time interactions.
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Abbott, Penelope, Kelly Watt, Parker Magin, Joyce Davison, and Wendy C. Y. Hu. "Welcomeness for people with substance use disorders to general practice: a qualitative study." Family Practice 39, no. 2 (November 18, 2021): 257–63. http://dx.doi.org/10.1093/fampra/cmab151.
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Abstract Background Good primary care for people with substance use disorders (SUDs) is crucial given the high prevalence of SUDs and overdose deaths. Objective To explore general practice care for people with a history of SUDs from the perspectives of women involved with the criminal justice system. Methods Qualitative interview study with pre- and postrelease interviews, undertaken in Australian prisons and community settings. We utilized thematic analysis informed by constructivist grounded theory. Results We undertook 65 interviews with 39 women. Access to and experience of general practitioner (GP) care was affected by perceived welcomeness, decisions around disclosure, and consultation experiences related to medication prescription. Participants reported that they were not as welcome as other patients, welcome could be conditional on not disclosing SUDs or only requesting unrelated healthcare, and GPs did not always differentiate between past and current drug use. Participants perceived difficulty finding general practices where the potential benefit of disclosing SUDs outweighed the risks of stigmatized reactions and lack of GP skills and interest. Participants did not always recognize that care beyond physical health could occur in general practice. The pejorative implications of labelling patients as “doctor shoppers” were challenged by participants, as they considered it could be necessary to attend multiple GPs to find a welcoming practice. Conclusions People with histories of SUDs do not uniformly experience welcomeness in general practice, perpetuating poor engagement in healthcare and poor outcomes related to SUDs. Programmes targeting prescription drug misuse through general practice should also promote welcomeness for people with SUDs.
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Dixon, Sharon, Abigail McNiven, Amelia Talbot, and Lisa Hinton. "Navigating possible endometriosis in primary care: a qualitative study of GP perspectives." British Journal of General Practice 71, no. 710 (May 4, 2021): e668-e676. http://dx.doi.org/10.3399/bjgp.2021.0030.
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BackgroundEndometriosis affects approximately 6–10% of women, with well documented delays between initial presentation with symptoms and diagnosis. In England, women typically seek help first in primary care, making this setting pivotal in women’s pathways to diagnosis and treatment. English GP perspectives on managing possible endometriosis have not been previously reported.AimTo explore what GPs identify as important considerations when caring for women with symptoms that raise the possibility of endometriosis.Design and settingQualitative study in English primary care.MethodSemi-structured scenario-based telephone interviews with 42 GPs from April 2019 to January 2020, based around a fictional scenario of a woman presenting to primary care with symptoms suggesting possible endometriosis. Interviews were thematically coded and analysed.ResultsManaging possible endometriosis in primary care brings challenges. While knowledge and awareness were prerequisites for considering endometriosis, other important considerations were raised. Symptoms suggestive of endometriosis are non-specific, making endometriosis one possible consideration of many. GPs move through a diagnostic hierarchy to exclude sinister causes and utilise trials of treatment as both therapeutic interventions and diagnostic tools; processes which take time. An endometriosis label or diagnosis has advantages and risks. GPs reported sharing decisions about investigation and referral while holding women’s priorities as pivotal. These conversations were underpinned by their knowledge of uncertainties and unknowns, including the wide spectrum and unpredictability of endometriosis.ConclusionGPs considerations are more complex than simply lacking awareness. The unknowns surrounding endometriosis matter to GPs. Further research and tailored resources for primary care, where women present with undifferentiated symptoms, are needed.
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Deslandes, R., E. Mantzourani, K. Hodson, and L. Taylor. "Views of independent prescribing pharmacists on the community pharmacy pilot independent prescribing service: a qualitative study." International Journal of Pharmacy Practice 30, Supplement_1 (April 1, 2022): i34—i35. http://dx.doi.org/10.1093/ijpp/riac019.048.
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Abstract Introduction Independent Prescribing Pharmacists (IPPs) can prescribe autonomously within their scope of practice. Their role is increasing within the community setting (1). The Welsh Pharmaceutical Committee has a vision to have at least one IPP in every community pharmacy by 2030 (1). In 2020, an Independent Prescribers’ Service (IPS) pilot was delivered in 13 pharmacies across six of the seven Health Boards in Wales (2), via Choose Pharmacy (CP), an IT platform that provides access to patients’ General Practitioner (GP) medical record. IPS allowed patients to access advice, and, where relevant, be treated in the community pharmacy setting, rather than the GP surgery. The consultation is recorded on CP and the patient’s GP informed of the outcome. As the IPS is a recent development there is little research on this service. Aim To explore the views of community IPPs delivering the IPS. Methods A qualitative methodology was utilised with semi-structured interviews, via telephone or MS Teams. Only thirteen pharmacies were commissioned to deliver the service. Purposive sampling was used to identify IPPs in these premises, who had completed at least one IPS consultation. Participants were informed of the study and written; informed consent obtained. An interview schedule utilised open questions to explore participants’ experiences of the service. Interviews were recorded, transcribed and analysed via deductive and inductive thematic analysis. Analysis was quality assured through discussion with the research team. All identifiable information in the transcripts were removed to ensure anonymity. Results Nine interviews were conducted, including participants from all Health Boards in the pilot. Interviewees had varied prescribing experience with some only prescribing since the roll out of the pilot. The IPPs’ scope of practice included acute minor ailments, contraception, urinary tract infections and asthma. Four themes were identified: 1.Impact of the IPS: Participants believed the service had impacted on the wider healthcare setting, patients and themselves. Patients had improved convenience and accessibility to a healthcare professional to manage their condition. Patient safety was of a high standard with access to patient notes ensuring informed, appropriate clinical decisions. 2.Relationship with GP: Positive relationships with local GPs was believed to be critical to the pilot’s success. 3.Future delivery: This will rely on support, funding, and ongoing review. A ‘blended approach’ whereby patients are seen with or without an appointment was believed to provide the flexibility that patients want. 4.Remote consultations: Can have an impact on patient safety, making non-verbal communication and language barriers more challenging. After nine interviews, no new information was gathered. Conclusion Participants were supportive of the service which will potentially benefit IPPs, patients and GPs, and improve patient care. Pharmacists, by providing a high quality, accessible service, ensures that forward thinking healthcare is delivered in a manner which makes use of the skills of those working in the community. The study, albeit small scale, explored the thoughts of the majority of IPPs conducting the IPS service at that time. More information is needed to understand the impact of the service and effect on practice, from the practitioner and patient perspective. References (1) Walsh A. All Welsh pharmacies to have independent prescribers. Wales; 2019 [accessed 5 February 2021]. Available from: http://www.pharmacymagazine.co.uk/all-welsh-pharmacies-to-have-independent-prescribers (2) NHS Wales Informatics Service. Choose Pharmacy. Wales; 2021 [accessed 5 Feb 2021]. Available from: http://www.nwis.nhs.wales/systems-and-services/in-the-community/choose-pharmacy/
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James, Oscar, Karen Cardwell, Frank Moriarty, Susan M. Smith, and Barbara Clyne. "Pharmacists in general practice: a qualitative process evaluation of the General Practice Pharmacist (GPP) study." Family Practice 37, no. 5 (May 7, 2020): 711–18. http://dx.doi.org/10.1093/fampra/cmaa044.
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Abstract Background There is some evidence to suggest that pharmacists integrated into primary care improves patient outcomes and prescribing quality. Despite this growing evidence, there is a lack of detail about the context of the role. Objective To explore the implementation of The General Practice Pharmacist (GPP) intervention (pharmacists integrating into general practice within a non-randomized pilot study in Ireland), the experiences of study participants and lessons for future implementation. Design and setting Process evaluation with a descriptive qualitative approach conducted in four purposively selected GP practices. Methods A process evaluation with a descriptive qualitative approach was conducted in four purposively selected GP practices. Semi-structured interviews were conducted, transcribed verbatim and analysed using a thematic analysis. Results Twenty-three participants (three pharmacists, four GPs, four patients, four practice nurses, four practice managers and four practice administrators) were interviewed. Themes reported include day-to-day practicalities (incorporating location and space, systems and procedures and pharmacists’ tasks), relationships and communication (incorporating GP/pharmacist mode of communication, mutual trust and respect, relationship with other practice staff and with patients) and role perception (incorporating shared goals, professional rewards, scope of practice and logistics). Conclusions Pharmacists working within the general practice team have potential to improve prescribing quality. This process evaluation found that a pharmacist joining the general practice team was well accepted by the GP and practice staff and effective interprofessional relationships were described. Patients were less clear of the overall benefits. Important barriers (such as funding, infrastructure and workload) and facilitators (such as teamwork and integration) to the intervention were identified which will be incorporated into a pilot cluster randomized controlled trial.
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Ahmed, Raja Adnan, Rugiyya Saeed, and Michal Tombs. "GP Trainees' perceptions and experiences of the training placement in Psychiatry - A qualitative study." BJPsych Open 7, S1 (June 2021): S232. http://dx.doi.org/10.1192/bjo.2021.618.
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AimsThis qualitative study aims to explore the leaning needs of the GP trainees for their psychiatry placements.MethodIn this qualitative study, semi-structured interviews of eight former GP trainees were conducted. Data were transcribed and analysed using thematic analysis. Triangulation through multiple analysts” was used to improve the validity of the studyResultThis study identified six key areas of learning needs for GP trainees during their psychiatry placement. i) the on-call experience which enabled the participants to learn how to manage acutely unwell patients in psychiatry, ii) learning the self-harm and suicidal risk assessment which is an important skill for a GP practising in primary care, iii) training in relation to psychiatric medication which enabled GPs to prescribe more confidently in the community, iv) exposure to the community psychiatry which was helpful in getting exposure to community-based clinical practice, v) learning from formal teaching activities which can be tailored to cover the relevant primary care related clinical topics and finally, vi) getting the opportunity to improve the communications skills during the psychiatry placement which is useful for all doctor in training.ConclusionWe recommend that detailed induction of the service setup is required before GP trainees start on-calls and a well-defined support network should be provided and explained to the training doctors. Risk assessment teaching should be delivered by formal training, regular supervision and discussions. Training on psychiatric medication especially in the context of GP prescribing should be considered as part of formal teaching experience. Opportunities to work with community mental health teams and outpatient clinics should be generated and offered to the trainees. Formal teaching sessions should be set up with an understanding of the GP training curriculum and their learning needs. Improvement of communications skills with exposure to difficult communication scenarios under supervision during psychiatric placement should be identified as an important area of learning for the GP trainees.
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Moore, Abigail, Caroline Croxson, Sara McKelvie, Dan Lasserson, and Gail Hayward. "General practitioners’ attitudes and decision making regarding admission for older adults with infection: a UK qualitative interview study." Family Practice 36, no. 4 (September 14, 2018): 493–500. http://dx.doi.org/10.1093/fampra/cmy083.
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Abstract Background The world has an ageing population. Infection is common in older adults; serious infection has a high mortality rate and is associated with unplanned admissions. In the UK, general practitioners (GPs) must identify which older patients require admission to hospital and provide appropriate care and support for those staying at home. Objectives To explore attitudes of UK GPs towards referring older patients with suspected infection to hospital, how they weigh up the decision to admit against the alternatives and how alternatives to admission could be made more effective. Methods. Qualitative study using semi-structured interviews. GPs were purposively sampled from across the UK to achieve maximum variation in terms of GP role, experience and practice population. Interview transcripts were coded and analysed using a modified framework approach. Results GPs’ key influences on decision making were grouped into patient, GP and system factors. Patient factors included clinical factors, social factors and shared decision making. GP factors included gut instinct, risk management and acknowledging an associated personal emotional burden. System factors involved weighing up the pressure on secondary care beds against increasing GP workload. GPs described that finding an alternative to admission could be more time consuming, complex to arrange or were restricted by lack of capacity. Conclusion GPs need to be empowered to make safe decisions about place of care for older adults with suspected infection. This may mean developing strategies to support decision making as well as improving the ease of access to, and capacity of, any alternatives to admission.
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Huang, Huayi, Emily R. Jefferson, Mark Gotink, Carol Sinclair, Stewart W. Mercer, and Bruce Guthrie. "Collaborative improvement in Scottish GP clusters after the Quality and Outcomes Framework: a qualitative study." British Journal of General Practice 71, no. 710 (April 1, 2021): e719-e727. http://dx.doi.org/10.3399/bjgp.2020.1101.
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BackgroundScotland abolished the Quality and Outcomes Framework (QOF) in April 2016, before implementing a new Scottish GP contract in April 2018. Since 2016, groups of practices (GP clusters) have been incentivised to meet regularly to plan and organise quality improvement (QI) as part of this new direction in primary care policy.AimTo understand the organisation and perceived impact of GP clusters, including how they use quantitative data for improvement.Design and settingThematic analysis of semi-structured interviews with key stakeholders (n = 17) and observations of GP cluster meetings (n = 6) in two clusters.MethodThis analytical strategy was combined with a purposive (variation) sampling approach to the sources of data, to try to identify commonalities across diverse stakeholder experiences of working in or on the idea of GP clusters. Variation was sought particularly in terms of stakeholders’ level of involvement in improvement initiatives, and in their disciplinary affiliations.ResultsThere was uncertainty as to whether GP clusters should focus on activities generated internally or externally by the wider healthcare system (for example, from Scottish Health Boards), although the two observed clusters generally generated their own ideas and issues. Clusters operated with variable administrative/managerial and data support, and variable baseline leadership experience and QI skills. Qualitative approaches formed the focus of collaborative learning in cluster meetings, through sharing and discussion of member practices’ own understandings and experiences. Less evidence was observed of data analytics being championed in these meetings, partly because of barriers to accessing the analytics data and existing data quality.ConclusionCluster development would benefit from more consistent training and support for cluster leads in small-group facilitation, leadership, and QI expertise, and data analytics access and capacity. While GP clusters are up and running, their impact is likely to be limited without further investment in developing capacity in these areas.
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Croxson, Caroline HD, Helen F. Ashdown, and FD Richard Hobbs. "GPs’ perceptions of workload in England: a qualitative interview study." British Journal of General Practice 67, no. 655 (January 16, 2017): e138-e147. http://dx.doi.org/10.3399/bjgp17x688849.
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BackgroundGPs report the lowest levels of morale among doctors, job satisfaction is low, and the GP workforce is diminishing. Workload is frequently cited as negatively impacting on commitment to a career in general practice, and many GPs report that their workload is unmanageable.AimTo gather an in-depth understanding of GPs’ perceptions and attitudes towards workload.Design and settingAll GPs working within NHS England were eligible. Advertisements were circulated via regional GP e-mail lists and national social media networks in June 2015. Of those GPs who responded, a maximum-variation sample was selected until data saturation was reached.MethodSemi-structured, qualitative interviews were conducted. Data were analysed thematically.ResultsIn total, 171 GPs responded, and 34 were included in this study. GPs described an increase in workload over recent years, with current working days being long and intense, raising concerns over the wellbeing of GPs and patients. Full-time partnership was generally not considered to be possible, and many participants felt workload was unsustainable, particularly given the diminishing workforce. Four major themes emerged to explain increased workload: increased patient needs and expectations; a changing relationship between primary and secondary care; bureaucracy and resources; and the balance of workload within a practice. Continuity of care was perceived as being eroded by changes in contracts and working patterns to deal with workload.ConclusionThis study highlights the urgent need to address perceived lack of investment and clinical capacity in general practice, and suggests that managing patient expectations around what primary care can deliver, and reducing bureaucracy, have become key issues, at least until capacity issues are resolved.
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Rajabzadeh, Vian, Nicola Thomas, and Sally Hull. "Evaluating the use of CKD trigger tools across practices in east London: a qualitative study in primary care." British Journal of General Practice 69, suppl 1 (June 2019): bjgp19X703133. http://dx.doi.org/10.3399/bjgp19x703133.
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BackgroundEarly identification of people with chronic kidney disease (CKD) in primary care, enables proactive clinical management. CKD trigger tools designed as patient safety tools, alert GP practices when falling estimated glomerular filtration rates (eGFR) are identified from the patient record. The tool’s aim is to alert clinicians to possible CKD progression, and invites written reflection by the GP of the ‘referral’ or ‘non-referral’ outcomes of patients identified.AimTo evaluate how the CKD trigger tool is used across practices in east London. To examine how the differences in the practitioner use and perceived value of the tool is characterised by interview transcripts, compared with the written reflections.MethodEight semi-structured interviews were undertaken with six GPs, one pharmacist, and one practice manager. The reflection free-text data were organised into categories, of ‘yes’ and ‘no’ referrals, dividing further each category by ‘young’ and ‘old’ cases. Thematic analysis was applied to the interview transcripts. Arising themes were supplemented by the descriptive analysis of the reflection.ResultsIn total 1921 reflection comments were examined, 1770 ‘No’ referrals (935 aged <60 years) and 151 ‘Yes’ referrals (81 aged <60 years), covering a 2-year period. Four themes emerged from the interviews: ‘Getting started …’, ‘Workflow’, ‘Trigger tool as a learning tool’, and ‘Patient safety’.ConclusionThe study highlights that administratively well organised practices found that the tool could be readily embedded into their workflow. Reflection data highlighted cases of poorly controlled diabetes and/or hypertension for the ‘yes–young’ referrals. Generally, ‘No’ referrals emphasised the implementation of a clinical management plan.
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Pennington, Andrew V. R., Sharleen L. O'Reilly, Doris Young, and James A. Dunbar. "Improving follow-up care for women with a history of gestational diabetes: perspectives of GPs and patients." Australian Journal of Primary Health 23, no. 1 (2017): 66. http://dx.doi.org/10.1071/py15177.
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This paper investigates factors influencing women’s engagement with diabetes preventative care after a pregnancy with gestational diabetes (GDM) from the perspectives of GPs and women and explores the role of the GP in that care. Qualitative research using semi-structured interviews with women who had experienced GDM (n=16) and GPs (n=18) were conducted and a thematic content analysis conducted. Women’s interviews explored their experience of GDM, factors influencing, and engagement with, follow-up care for diabetes prevention and role of the GP in that care. GP interviews explored postnatal care provided to women with GDM, the role of the GP in that care and perceived factors influencing a mother’s engagement in her self-care. Three themes were identified: (1) advice and testing; (2) role of the GP; and (3) barriers and enablers to care. Significant consensus about the role of the GP and barriers and enablers to care existed. Both groups believed post GDM follow-up is best done by GPs and suggested recall and reminders would improve care. GPs gave consistent exercise advice, but lacked consensus on follow-up testing, dietary and weight-loss advice. Women’s health literacy influenced how they viewed their GPs role. Consensus guidelines on follow-up testing and diabetes prevention advice, tailored advice according to health literacy and addressing barriers to care would likely improve the capacity of GPs to prevent unnecessary conversion to type 2 diabetes in these at-risk women.
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Prathivadi, Pallavi, Chris Barton, and Danielle Mazza. "Qualitative insights into the opioid prescribing practices of Australian GP." Family Practice 37, no. 3 (November 26, 2019): 412–17. http://dx.doi.org/10.1093/fampra/cmz083.
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Abstract Background Over the last three decades, Australian opioid-prescribing rates and related morbidity and mortality have dramatically increased. Opioids are frequently prescribed by general practitioners (GPs) to manage chronic non-cancer pain, despite evidence-based recommendations from the Centre for Disease Control, National Institute for Health and Care Excellence and World Health Organization widely cautioning their use. Little is known about the factors influencing the opioid prescribing decisions of Australian GPs, especially when not evidence based. Objective To explore the opioid prescribing knowledge, attitudes and practices of Australian GPs. Methods Semi-structured interviews with 20 GPs recruited from the Monash University practice-based research network in metropolitan, southeastern Melbourne. Thematic analysis was used to identify emergent themes. Data were managed using QSR NVivo. Ethics approval was granted by Monash University. Results Three key themes emerged. GP attitudes towards opioid use for chronic pain varied by age of patient and goals for therapy. Use of opioids for elderly patients was positively perceived. GPs were reluctant to use opioids in younger patients due to fears of addiction and difficulty weaning. GPs felt obliged to prescribe opioids recommended by specialists, even if they believed the opioids were unsafe. Conclusion This study identified and described the patient-centred nature of GP opioid prescribing decisions. Patient age and perceived age-related opioid harm were important factors influencing prescribing decisions. Future work should inform interventions that value GP autonomy while still encouraging a collaborative inter-speciality approach to managing chronic pain patients with opioids.
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Fisher, Rebecca FR, Caroline HD Croxson, Helen F. Ashdown, and FD Richard Hobbs. "GP views on strategies to cope with increasing workload: a qualitative interview study." British Journal of General Practice 67, no. 655 (January 16, 2017): e148-e156. http://dx.doi.org/10.3399/bjgp17x688861.
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BackgroundThe existence of a crisis in primary care in the UK is in little doubt. GP morale and job satisfaction are low, and workload is increasing. In this challenging context, finding ways for GPs to manage that workload is imperative.AimTo explore what existing or potential strategies are described by GPs for dealing with their workload, and their views on the relative merits of each.Design and settingSemi-structured, qualitative interviews with GPs working within NHS England.MethodAll GPs working within NHS England were eligible. Of those who responded to advertisements, a maximum-variation sample was selected and interviewed until data saturation was reached. Data were analysed thematically.ResultsResponses were received from 171 GPs, and, from these, 34 were included in the study. Four main themes emerged for workload management: patient-level, GP-level, practice-level, and systems-level strategies. A need for patients to take greater responsibility for self-management was clear, but many felt that GPs should not be responsible for this education. Increased delegation of tasks was felt to be key to managing workload, with innovative use of allied healthcare professionals and extended roles for non-clinical staff suggested. Telephone triage was a commonly used tool for managing workload, although not all participants found this helpful.ConclusionThis in-depth qualitative study demonstrates an encouraging resilience among GPs. They are proactively trying to manage workload, often using innovative local strategies. GPs do not feel that they can do this alone, however, and called repeatedly for increased recruitment and more investment in primary care.
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Walton, Elizabeth, Anam Ahmed, Chris Burton, and Nigel Mathers. "Influences of socioeconomic deprivation on GPs’ decisions to refer patients to cardiology: a qualitative study." British Journal of General Practice 68, no. 677 (October 22, 2018): e826-e834. http://dx.doi.org/10.3399/bjgp18x699785.
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BackgroundVariation in GP referral practice may be a factor contributing to the lower uptake of cardiology specialist services for people living in socioeconomic deprivation. Cardiology referrals were chosen for this study due to higher rates of premature death and emergency admissions resulting from coronary heart disease for patients living in more deprived areas.AimTo find out how socioeconomic deprivation influences GP referral practice.Design and settingA qualitative study of GPs working in affluent and deprived areas of one large city in the UK.MethodThe authors used purposive and snowball sampling to recruit 17 GP participants to interviews and a focus group. Participants were asked to reflect on their own experience of making referrals. The authors used a framework approach to the analysis, with differences in themes for GPs working in least and most deprived areas being highlighted.ResultsThe authors identified four main themes by which socioeconomic deprivation influenced GP referral practice: identifying problems; making decisions about referral; navigating the healthcare system; and external pressures. Using a published framework of consultation complexity, the authors then examined the data in relation to a fifth theme of complexity. Referrals from areas of high socioeconomic deprivation involved greater complexity in the majority of the domains of this framework.ConclusionSocioeconomic deprivation influences GP referral decisions and navigation of the healthcare system in multiple ways. Referral practice for GPs working in deprived areas is more complex than for their peers working in more affluent areas.
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Khan, Nadia, and Tim Usherwood. "'We are not invincible': a qualitative study of self-care practices by Australian general practice registrars." Australian Journal of Primary Health 25, no. 4 (2019): 380. http://dx.doi.org/10.1071/py18169.
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Doctors are not well known to look after their own health. The barriers and enablers that doctors face in staying healthy and managing ill health are not fully understood. This study aimed to explore these issues among general practice registrars (trainee general practitioners (GPs)). Semistructured interviews conducted with 14 GP registrars were audio-recorded, transcribed and analysed thematically. Participants noted the benefits of healthy lifestyle and the major barrier of competing priorities. Barriers to having their own GP included uncertainty about colleagues’ clinical abilities and about their respect for professional boundaries. Nearly all the participants had self-prescribed and many reported informal consultations with colleagues, although they noted the limitations of these. The participants identified their professional responsibility to maintain a healthy lifestyle and need for a regular GP, the importance of support for these responsibilities by training practices and regional training organisations and the value of training organisations incorporating such support into curriculum and policies.
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White, Isabella, Jill Benson, Taryn Elliott, and Lucie Walters. "Australian general practice registrars’ experiences of training, well-being and support during the COVID-19 pandemic: a qualitative study." BMJ Open 12, no. 6 (June 2022): e060307. http://dx.doi.org/10.1136/bmjopen-2021-060307.
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ObjectivesProviding well-supported general practice (GP) training is fundamental to strengthen the primary health workforce. Research into the unique needs of GP registrars during disasters is limited. Registrar burnout and insufficient support have been associated with personal and professional detrimental effects. This study aims to explore the experiences of Australian GP registrars with learning, well-being and support from their training organisation during the COVID-19 pandemic, and to guide training organisation efforts to support registrars through future disasters.SettingInterviews were conducted via Zoom.ParticipantsFifteen GP registrars from South Australia, Victoria and New South Wales who had experienced community-based GP training in both 2019 (prepandemic) and 2020 (early pandemic).Outcome measuresTraining, well-being and support experiences were explored. Interviews were recorded and transcribed and themes analysed.ResultsDiverse experiences were reported: changes included telehealth, online tutorials, delayed examinations and social restrictions. Social and professional connections strongly influenced experiences. Personal and training factors were also important. Additional GP training organisation support was minimally needed when strong connections were in place.ConclusionsThis study identifies aspects of support which shaped registrars’ diverse experiences of COVID-19, particularly regarding professional and social connections. Findings illustrate the importance of broad principles around supporting registrar well-being. Particularly significant aspects of support include connection to educational mentors such as supervisors and medical educators; connection and culture within practices; opportunities to share clinical experiences; and connection to personal social supports. Participation in this global disaster contributed to registrars’ developing professionalism. GP training organisations are positioned to implement monitoring and supports for registrars through disasters. Although registrars may not require significant GP training organisation intervention where powerful professional and personal connections exist, strong foundational GP training organisation supports can be established and augmented to support registrars in need before and during future disasters. These findings contribute to the global developing field of knowledge of registrar training and well-being needs during crises.
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Jamison, James, Stephen Sutton, Jonathan Mant, and Anna De Simoni. "Online stroke forum as source of data for qualitative research: insights from a comparison with patients’ interviews." BMJ Open 8, no. 3 (March 2018): e020133. http://dx.doi.org/10.1136/bmjopen-2017-020133.
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ObjectiveTo determine the appropriateness of an online forum compared with face-to-face interviews as a source of data for qualitative research on adherence to secondary prevention medications after stroke.DesignA comparison of attributes of two data sources, interviews and a forum, using realistic evaluation; a comparison of themes around adherence according to the Perceptions and Practicalities Approach (PAPA) framework.SettingInterviews were conducted in UK GP practices in 2013 and 2014; online posts were written by UK stroke survivors and family members taking part in the online forum of the Stroke Association between 2004 and 2011.Participants42 interview participants: 28 stroke survivors (age range 61–92 years) and 14 caregivers (85% spouses). 84 online forum participants: 49 stroke survivors (age range 32–72 years) and 33 caregivers (60% sons/daughters).Results10 attributes were identified within the two data sources and categorised under three domains (context, mechanisms and outcomes). Participants’ characteristics of forum users were often missing. Most forum participants had experienced a stroke within the previous 12 months, while interviewees had done so 1–5 years previously.All interview themes could be matched with corresponding themes from the forum. The forum yielded three additional themes: influence of bad press on taking statins, criticisms of clinicians’ prescribing practices and caregiver burden in assisting with medications and being advocates for survivors with healthcare professionals.ConclusionsAn online forum is an appropriate source of data for qualitative research on patients’ and caregivers’ issues with adherence to secondary prevention stroke medications and may offer additional insights compared with interviews, which can be attributed to differences in the approach to data collection.
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McNulty, Cliodna, Ellie J. Ricketts, Hans Fredlund, Anneli Uusküla, Katy Town, Claire Rugman, Anna Tisler-Sala, et al. "Qualitative interviews with healthcare staff in four European countries to inform adaptation of an intervention to increase chlamydia testing." BMJ Open 7, no. 9 (September 2017): e017528. http://dx.doi.org/10.1136/bmjopen-2017-017528.
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ObjectiveTo determine the needs of primary healthcare general practice (GP) staff, stakeholders and trainers to inform the adaptation of a locally successful complex intervention (Chlamydia Intervention Randomised Trial (CIRT)) aimed at increasing chlamydia testing within primary healthcare within South West England to three EU countries (Estonia, France and Sweden) and throughout England.DesignQualitative interviews.SettingEuropean primary healthcare in England, France, Sweden and Estonia with a range of chlamydia screening provision in 2013.Participants45 GP staff, 13 trainers and 18 stakeholders.InterviewsThe iterative interview schedule explored participants’ personal attitudes, subjective norms and perceived behavioural controls around provision of chlamydia testing, sexual health services and training in general practice. Researchers used a common thematic analysis.ResultsFindings were similar across all countries. Most participants agreed that chlamydia testing and sexual health services should be offered in general practice. There was no culture of GP staff routinely offering opportunistic chlamydia testing or sexual health advice, and due to other priorities, participants reported this would be challenging. All participants indicated that the CIRT workshop covering chlamydia testing and sexual health would be useful if practice based, included all practice staff and action planning, and was adequately resourced. Participants suggested minor adaptations to CIRT to suit their country’s health services.ConclusionsA common complex intervention can be adapted for use across Europe, despite varied sexual health provision. The intervention (ChlamydiA Testing Training in Europe (CATTE)) should comprise: a staff workshop covering sexual health and chlamydia testing rates and procedures, action planning and patient materials and staff reminders via computer prompts, emails or newsletters, with testing feedback through practice champions. CATTE materials are available at: www.STItraining.eu.
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Lindemann, Roberta F., Gordon Robson, and David Edward Cunningham. "Commercial business and partnership aspects of general practice: the learning needs of First5 general practitioners in NHS Scotland–a qualitative study." BMJ Open 12, no. 9 (September 2022): e056188. http://dx.doi.org/10.1136/bmjopen-2021-056188.
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ObjectivesTo identify the learning needs of recently qualified general practitioners (GPs) (First5) in National Health Service (NHS) Scotland concerning GP partnership and the commercial business aspects of general practice. It aimed to identify learning opportunities during General Practice Specialty Training and the first 5 years of work, and to explore their suggestions of additional resources that would improve their sense of preparedness for partnership. A secondary aim was to explore what influenced their current choice of employment model and place of work.DesignQualitative research study using grounded theory methods. Recruitment was stratified to include First5 GPs from a range of NHS boards in Scotland including remote and rural areas. Participants were interviewed in small focus groups or individual interviews in person, or over the telephone depending on their preference. Interviews were audio-recorded and transcribed. Transcriptions were coded and codes developed into themes using Charmazian grounded theory methods. Data saturation was achieved and verified by the researchers.SettingGeneral practice in NHS Scotland. Participant GPs, within the first 5 years of completion of General Practice Specialty Training, who were working in NHS Scotland.ResultsTwenty-seven recently qualified GPs participated in the study. Three main themes were constructed: preparedness for partnership from experiential learning in General Practice Specialty Training; perceived commercial business learning needs and preferred learning styles (with learning needs arranged into five topic areas); considerations that inform decision-making about choice of employment model and of practice. Factors that influenced the decision to enter into specific employment models were identified.ConclusionLengthening the time spent in specialty training may help GP trainees gain more knowledge, skills and confidence about the commercial business aspects of general practice and of GP partnership.
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Walter, Fiona M., Clarissa Penfold, Alexis Joannides, Smiji Saji, Margaret Johnson, Colin Watts, Andrew Brodbelt, et al. "Missed opportunities for diagnosing brain tumours in primary care: a qualitative study of patient experiences." British Journal of General Practice 69, no. 681 (March 11, 2019): e224-e235. http://dx.doi.org/10.3399/bjgp19x701861.
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BackgroundBrain tumours are uncommon, and have extremely poor outcomes. Patients and GPs may find it difficult to recognise early symptoms because they are often non-specific and more likely due to other conditions.AimTo explore patients’ experiences of symptom appraisal, help seeking, and routes to diagnosis.Design and settingQualitative study set in the East and North West of England.MethodIn-depth interviews with adult patients recently diagnosed with a primary brain tumour and their family members were analysed thematically, using the Model of Pathways to Treatment as a conceptual framework.ResultsInterviews were carried out with 39 patients. Few participants (n = 7; 18%) presented as an emergency without having had a previous GP consultation; most had had one (n = 15; 38%), two (n = 9; 23%), or more (n = 8; 21%) GP consultations. Participants experienced multiple subtle ‘changes’ rather than ‘symptoms’, often noticed by others rather than the patient, which frequently led to loss of interest or less ability to engage with daily living activities. The most common changes were in cognition (speaking, writing, comprehension, memory, concentration, and multitasking), sleep, and other ‘head feelings’ such as dizziness. Not all patients experienced a seizure, and few seizures were experienced ‘out of the blue’. Quality of communication in GP consultations played a key role in patients’ subsequent symptom appraisal and the timing of their decision to re-consult.ConclusionMultiple subtle changes and frequent GP visits often precede brain tumour diagnosis, giving possible diagnostic opportunities for GPs. Refined community symptom awareness and GP guidance could enable more direct pathways to diagnosis, and potentially improve patient experiences and outcomes.
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Bayley, Sarah A., Parker J. Magin, Jennifer M. Sweatman, and Catherine M. Regan. "Effects of compulsory rural vocational training for Australian general practitioners: a qualitative study." Australian Health Review 35, no. 1 (2011): 81. http://dx.doi.org/10.1071/ah09853.
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Background. Increasing the recruitment of doctors, including general practitioners (GPs), to rural areas is recognised as a health priority internationally. Australian GP trainees (registrars) complete a mandatory minimum of 6 months training in a rural area. The rationale for this includes the expectation of increased likelihood of a future choice of rural practice location. Method. A qualitative study employing semistructured in-depth interviews and a modified grounded methodology. Participants were 15 registrars from an Australian GP postgraduate training program. Results. Though generally a rewarding clinical learning experience, negative aspects of the rural placement included the disruption to personal lives of rural relocation and the stresses involved in higher levels of clinical responsibility. These stressors could undermine rather than enhance clinical confidence. Anxiety and depression were accompaniments for some registrars. Intention to practice rurally was little influenced by this compulsory placement. Conclusions. Findings of positive effects on rural practice destination in studies of medical undergraduates should not be generalised to GP registrars. The positive clinical learning experience of most registrars in rural terms must be balanced with the social dislocation involved in rural relocation and the adverse effects of the rural experience, for some registrars, on professional confidence and psychological well being. What is known about the topic? The rationale for compulsory rural placements during general practitioner vocational training includes an assumption that this will increase rural GP workforce. Undergraduate training in rural environments is known to enhance recruitment to rural practice. What does this paper add? Despite considerable positive educational and training outcomes for many registrars, compulsory rural training placements cause significant social dislocation for many registrars and were in this study associated with psychological morbidity in some registrars. Placements are unlikely to significantly increase rural GP workforce. What are the implications for practitioners? Compulsory rural placements can be a negative experience for GP registrars. Findings of positive effects of rural training experience on career intentions and rural workplace destination in studies of medical undergraduates should not be generalised to compulsory rural placements for general practice registrars.
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Ashman, Freya, Elizabeth Sturgiss, and Emily Haesler. "Exploring Self-Efficacy in Australian General Practitioners Managing Patient Obesity: A Qualitative Survey Study." International Journal of Family Medicine 2016 (May 4, 2016): 1–8. http://dx.doi.org/10.1155/2016/8212837.
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Background. Obesity is a leading cause of morbidity and mortality in the Australian community, and general practitioners (GPs) are commonly approached by patients for assistance in losing weight. Previous studies have shown that GPs have low self-efficacy and low outcome expectation when it comes to managing overweight and obese patients, which affects their willingness to initiate and continue with weight counselling. This qualitative survey study aimed to explore the factors influencing confidence and behaviour in obesity management in GPs. Method. Twelve GPs recruited to deliver a pilot of an obesity management program participated in semistructured interviews, and interpretive analysis underpinned by social cognitive theory was performed on the transcripts. Results. Analysis identified five main themes: (1) perceived knowledge and skills, (2) structure to management approach, (3) the GP-patient relationship, (4) acknowledged barriers to weight loss and lifestyle change, and (5) prior experience and outcome expectation. Conclusions. GPs are likely to welcome tools which provide a more structured approach to obesity management. Shifting away from weight and BMI as sole yardsticks for success or failure and emphasising positive lifestyle changes for their own sake may improve GP self-efficacy and allow for a more authentic GP-patient interaction.
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Butterworth, Jo, Anna Sansom, Laura Sims, Mark Healey, Ellie Kingsland, and John Campbell. "Pharmacists’ perceptions of their emerging general practice roles in UK primary care: a qualitative interview study." British Journal of General Practice 67, no. 662 (July 3, 2017): e650-e658. http://dx.doi.org/10.3399/bjgp17x691733.
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BackgroundUK general practice is experiencing a workload crisis. Pharmacists are the third largest healthcare profession in the UK; however, their skills are a currently underutilised and potentially highly valuable resource for primary health care. This study forms part of the evaluation of an innovative training programme for pharmacists who are interested in extended roles in primary care, advocated by a UK collaborative ‘10-point GP workforce action plan’.AimTo explore pharmacists’ perceptions of primary care roles including the potential for greater integration of their profession into general practice.Design and settingA qualitative interview study in UK primary care carried out between October 2015 and July 2016.MethodPharmacists were purposively sampled by level of experience, geographical location, and type of workplace. Two confidential semi-structured telephone interviews were conducted — one before and one after the training programme. A constant comparative, inductive approach to thematic analysis was used.ResultsSixteen participants were interviewed. The themes related to: initial expectations of the general practice role, varying by participants’ experience of primary care; the influence of the training course with respect to managing uncertainty, critical appraisal skills, and confidence for the role; and predictions for the future of this role.ConclusionThere is enthusiasm and willingness among pharmacists for new, extended roles in primary care, which could effectively relieve GP workload pressures. A definition of the role, with examples of the knowledge, skills, and attributes required, should be made available to pharmacists, primary care teams, and the public. Training should include clinical skills teaching, set in context through exposure to general practice, and delivered motivationally by primary care practitioners.
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Stoddart, Hannah, Emily Hansen, and Mark Nelson. "Australian Parents' Reasons for Attending a GP when their Child has Upper Respiratory Tract Symptoms: An Exploratory Pilot Study." Australian Journal of Primary Health 12, no. 1 (2006): 27. http://dx.doi.org/10.1071/py06005.
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Upper respiratory tract infections (URTIs) in children are a frequent presentation in Australian general practice. However, there is limited Australian evidence about why parents decide to consult a doctor for childhood URTIs. Our objective was to design a qualitative pilot study aiming to explore this issue using semi-structured interviews. Interviews were conducted with nine parents. We found that cough, fever and abnormal behaviour of the child prompted a consultation with the general practitioner (GP). Parents sought an examination of their child (in particular "hidden areas" such as ears and throat) and reassurance, rather than antibiotics. They also wanted the GP to suggest practical ways to help alleviate their child's symptoms. The results provide a greater understanding of the fears, concerns and beliefs of parents of children with URTIs and hence may improve the GP - parent consultation. Health providers may be encouraged to address the specific parental concerns emerging from this study.
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Lambert, Alice Kate, Alison Jayne Doherty, Neil Wilson, Umesh Chauhan, and Dushyanthan Mahadevan. "GP perceptions of community-based children’s mental health services in Pennine Lancashire: a qualitative study." BJGP Open 4, no. 4 (September 1, 2020): bjgpopen20X101075. http://dx.doi.org/10.3399/bjgpopen20x101075.
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BackgroundGP satisfaction with specialist Child & Adolescent Mental Health Services (CAMHS) is often reported as low in the UK, and internationally.AimTo explore GP perceptions of local children’s mental health services and to understand their experiences of a novel GP-attached Primary Mental Health Worker (PMHW) service.Design & settingQualitative research involving GPs in Pennine Lancashire.MethodSemi-structured face-to-face interviews of GPs (n = 9) were carried out. Thematic analysis was undertaken.ResultsThemes identified included: 1) The role of the GP: most GPs perceived their role to be signposting and referring patients with mental health issues to specialist services, rather than offering care directly; 2) Clarity on help available: GPs were unclear about specialist CAMHS referral criteria and alternative resources available. GPs experienced communication challenges with specialist CAMHS; 3) Getting advice and support: PMHWs enabled GPs to have informal discussions, and to seek advice about children. Some GPs felt they could recognise problems earlier and were able to access help more quickly; and 4) Development needs: some GPs felt they required increased training in supporting children with mental health problems, and identified a need for further collaboration with schools and specialist CAMHS.ConclusionThe study identified challenges that GPs face with accessing and utilising specialist CAMHS. GPs who had PMHWs based in their practices expressed increased satisfaction with these services. GP-attached PMHWs can potentially reduce the challenges faced by GPs in primary care by offering timely and accessible advice, and improving access to specialist CAMHS.