scholarly journals Learning needs, preferred learning methods and learning challenges of first five general practitioners in NHS Scotland: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044859
Author(s):  
David E Cunningham ◽  
Caroline Ward ◽  
John Kyle ◽  
Lynsey Yeoman
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Rural Areas ◽  
Learning Needs ◽  
Independent Practice ◽  
Learning Resources ◽  
Learning Methods ◽  
Travel Costs ◽  
Individual Interviews ◽  
Gp Training

ObjectivesTo identify the learning needs and preferred learning methods of First5 general practitioners (GPs) in National Health Service (NHS) Scotland.DesignQualitative research study using grounded theory methods. First5 GPs were interviewed in small focus groups or individual interviews in-person, or over the telephone depending on their preference.SettingGeneral practice in NHS Scotland.ParticipantsGPs, within the first 5 years of completion of GP training, who were working in NHS Scotland.ResultsThirty-eight First5s were recruited to the study. Participants recognised that gaps in their GP training became apparent in independent practice. Some of this related to NHS appraisal and revalidation, and with the business of general practice. They were interested in learning from an older generation of GPs but perceived that preferred learning methods differed. First5 GPs were less reliant on reading journals to change their practice, preferring to find learning resources that allowed them to gain new knowledge quickly and easily. There were considerations about resilience and of the challenges of learning in remote and rural areas of NHS Scotland. This related to travel costs and time, and to accessibility of learning courses. Participants appreciated collective learning and commented about the logistics and costs of learning.ConclusionsPreferred learning methods and learning resources differ with First5 GPs compared with those who have been in practice for some years. Learning providers need to recognise this and take these differences into account when planning and preparing learning in the future.

Improving the Management of Patients with Schizophrenia in Primary Care: Assessing Learning Needs as a First Step

1996 ◽  
Vol 41 (10) ◽  
pp. 617-622 ◽  
Author(s):  
John Toews ◽  
Jocelyn Lockyer ◽  
Donald Addington ◽  
Gerald McDougall ◽  
Richard Ward ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Family Physician ◽  
Family Physicians ◽  
Learning Needs ◽  
Learning Methods ◽  
Number Of Patients ◽  
Southern Alberta ◽  
Physician Learning ◽  
Teaching Interventions

Objective: To assess family physician learning needs related to the care of patients with schizophrenia. Methods: Questionnaires were mailed to all family physicians and general practitioners practising in southern Alberta. Physicians were asked to indicate the number of patients with schizophrenia cared for, their interest in improving the care they provided, their preferred learning methods, and the content they wished to learn. Results: A total of 539 surveys were returned for a return rate of 43.8%. Over half of the physicians (53.5%) indicated that they saw 1 to 2 patients with schizophrenia each month. Almost half (48.5%) indicated they were somewhat or very interested in increasing the care provided. Primary learning needs included increasing their knowledge of psychopharmacologic agents and monitoring and adjusting medications. Lectures and half-day workshops were the preferred learning methods. Conclusion: Our study was helpful in identifying the types of education that physicians wanted as well as the duration of the programming prior to the development of teaching interventions.

scholarly journals Is There A Role For Paramedics In Primary Care In Ireland: An Exploratory Study

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Fintan Feerick ◽  
Claire Armstrong ◽  
Ray O'Connor ◽  
Mark Dixon
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Rural Communities ◽  
General Practitioners ◽  
Rural Areas ◽  
Significant Risk ◽  
Healthcare Personnel ◽  
Graduate Entry ◽  
Healthcare Needs ◽  
Personnel Shortages

<div class="O"><p><strong>Background</strong></p><p>Paramedics are reported to be the most underutilised profession working within rural areas, due to the paucity of service requirements. (O’ Meara et al 2012). Infrequent opportunities to practice particular skills can lead to reduction in levels of confidence and competence that can have significant risk and safety ramifications for practitioners and patients. (Mulholland et al 2014). Traditionally paramedic practice provides emergency care and transport within the community, but current ambulance service models within rural Ireland may be inefficient and  contributing to hospital overcrowding and increased healthcare costs. (Lightfoot, 2015). Alternative models of healthcare are implemented within alternative rural jurisdictions such as Australia and Canada that aims to address issues of practitioner underutilisation, skill retention and healthcare personnel shortages. (Wilson, et al 2009).</p><p><strong>Rationale</strong></p><p>Ireland’s population is ageing, with increased co-morbidities and reports of current and predicted workforce shortages in general practice. (Smyth et al 2017). With rising demands on general practitioners (GPs), measures to increase their supply and retention has become a challenging problem. Potential solutions to this will require immediate change to established work practices, to cater for current and predicted healthcare needs. (H.S.E, 2015). Paramedics with advanced skills (APs) could alleviate some of the shortages identified and enhance paramedic profile by transferring some tasks deemed appropriate from GPs to APs within both urban and rural communities. This process is globally known as task shifting where some competencies are transferred to alternative healthcare practitioners with less training. (WHO, 2007).</p><p><strong>Aim</strong></p><p>To ascertain the attitudes and opinions of paramedics and GPs associated with GEMS - UL, towards a new concept of joint collaboration in primary care that should be of  mutual benefit to both groups, and also to identify potential barriers.</p><p><strong>Methodology</strong></p><p>Questionnaire survey of graduate Paramedics and General Practitioners associated with University of Limerick Graduate Entry Medical School and Paramedic Studies to identify competencies that GPs would deem appropriate to reassign to APs and ascertain both groups’ opinions towards this new concept of joint collaboration and practice.</p><p><strong>Conclusion</strong></p><p>Studies report successful outcomes in similar models of joint collaboration to support shortages of GPs in rural healthcare. (Reaburn, 2017). Collaboration on this scale has been shown to be beneficial for enhancing the paramedic profession within the wider healthcare system while providing essential support within primary care and general practice. Potential benefits have been reported with reduced emergency department admissions and early intervention in the management of chronic disease. (Blacker et al, 2009).</p></div>

scholarly journals Is training policy for general practitioners in China charting the right path forward? a mixed methods analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038173
Author(s):  
Jianwei Shi ◽  
Qingfeng Du ◽  
Xin Gong ◽  
Chunhua Chi ◽  
Jiaoling Huang ◽  
...  
Keyword(s):  
General Practice ◽  
Quantitative Analysis ◽  
Qualitative Analysis ◽  
General Practitioners ◽  
Secondary Outcome ◽  
Chinese Government ◽  
Community Healthcare ◽  
Outpatient Visits ◽  
Training Programmes ◽  
Gp Training

ObjectivesSince 2010, the Chinese government has gradually increased its investment in the training of general practitioners (GPs) to support their role as ‘gatekeepers’ in the healthcare system. However, this training is still organised from the perspective of specialist care. We aimed to assess the appropriateness of the principal GP admission training programme curricula in China, including Residents Training for GPs (RTGP), Residents Training for Assistant GPs (RTAGP) and Training for Specialists with General Practice interest (TSGP).SettingThe study focussed on GP training programmes in Shanghai, China.ParticipantsData on disease competences developed in three GP clinical training programmes (RTGP, RTAGP and TSGP) were derived from official programme training manuals. Data on the proportion of outpatient visits for each disease were taken from the Shanghai community healthcare centres grassroots outpatient database.Primary and secondary outcome measuresWe first conducted a quantitative analysis by comparing the structure of current training curricula with actual outpatient utilisation patterns across all community healthcare institutions in Shanghai from 2014 to 2018. Qualitative analysis was then conducted to evaluate GP training programmes based on Donabedian’s model.ResultsQuantitative analysis showed that the distribution of diseases for which competences were taught did not match the composition of outpatient visits in community healthcare institutions. Concerns identified through qualitative analysis included teachers who were mostly specialists, lack of equipment for differential diagnosis in community healthcare institutions, insufficient teaching of referral standards and GP training in large hospitals that consistently neglected communication skills.ConclusionsThe establishment and implementation of admission training programmes for GPs in China lacks a focus on general practice training and may be improved by adopting an evidence-based general perspective aligned with the medical needs of the community.

scholarly journals New alumni EXperiences of Training and independent Unsupervised Practice (NEXT-UP): protocol for a cross-sectional study of early career general practitioners

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e029585 ◽  
Author(s):  
Parker Magin ◽  
Dominica Moad ◽  
Amanda Tapley ◽  
L Holliday ◽  
Andrew Davey ◽  
...  
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Vocational Training ◽  
Educational Practice ◽  
Cross Sectional Study ◽  
Educational Programme ◽  
Early Career ◽  
Nursing Home Care ◽  
Independent Practice ◽  
Cross Sectional

IntroductionGeneral practice in Australia, as in many countries, faces challenges in the areas of workforce capacity and workforce distribution. General practice vocational training in Australia not only addresses the training of competent independent general practitioners (GPs) but also addresses these workforce issues. This study aims to establish the prevalence and associations of early career (within 2 years of completion of vocational training) GPs’ practice characteristics; and also to establish their perceptions of utility of their training in preparing them for independent practice.Methods and analysisThis will be a cross-sectional questionnaire study. Participants will be former registrars (‘alumni’) of three regional training organisations (RTOs) who achieved general practice Fellowship (qualifying them for independent practice) between January 2016 and July 2018 inclusive. The questionnaire data will be linked to data collected as part of the participants’ educational programme with the RTOs. Outcomes will include alumni rurality of practice; socioeconomic status of practice; retention within their RTO’s geographic footprint; workload; provision of nursing home care, after-hours care and home visits; and involvement in general practice teaching and supervision. Associations of these outcomes will be established with logistic regression. The utility of RTO-provided training versus in-practice training in preparing the early career GP for unsupervised post-Ffellowship practice in particular aspects of practice will be assessed with χ2tests.Ethics and disseminationEthics approval is by the University of Newcastle Human Research Ethics Committee, approval numbers H-2018-0333 and H-2009-0323. The findings of this study will be widely disseminated via conference presentations and publication in peer-reviewed journals, educational practice translational workshops and the GP Synergy Research subwebsite.

scholarly journals Clinical activity of overseas-trained doctors practising in general practice in Australia

2007 ◽  
Vol 31 (3) ◽  
pp. 440 ◽  
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Rural Areas ◽  
Patient Characteristics ◽  
National Study ◽  
Clinical Activity ◽  
Alternative Pathways ◽  
Royal Australian College ◽  
Practice Style ◽  
Tract Infections

Introduction: Medical workforce shortages in Australia have led to increasing reliance on overseas- trained doctors (OTDs) to work in general practice in areas of need, particularly in rural areas. These OTDs do not have Australian postgraduate training in general practice, and we know little about how they practise. Objective: To determine differences in practice style between a self-selected group of overseastrained general practitioners undertaking the Alternative Pathways Program and GPs who are Fellows of the Royal Australian College of General Practitioners (FRACGP), and whether such differences can be explained by other practitioner, practice and patient characteristics. Method: A self-selected sample of 89 OTDs from the Alternative Pathways Program were compared with FRACGPs in a continuous national study of GP activity (n = 1032). Each GP provided details about themselves and their practice and recorded data about patients, morbidity and treatments for 100 encounters. Results: OTDs were younger, less experienced, worked more sessions per week, in smaller practices. OTDs saw fewer children and elderly patients, more new patients, health concession card holders and Indigenous people. OTDs managed less general, urological, social, skin and pregnancy problems, and more cardiovascular problems, urinary tract infections, tonsillitis and conjunctivitis. They provided more medications, other treatments and referrals, and ordered more pathology and imaging tests. Conclusion: This study suggests that OTDs see a different patient mix and range of morbidity and provide different management to that of FRACGPs, generating higher costs of care. Regular study of the clinical activities of a representative sample of overseas-trained GPs is needed.

General Practice in Australia

1972 ◽  
Vol 2 (2) ◽  
pp. 273-284
Author(s):  
J. G. P. Ryan
Keyword(s):  
General Practice ◽  
General Practitioner ◽  
General Practitioners ◽  
Rural Areas ◽  
Community Health Centers ◽  
Work Load ◽  
Medical Community ◽  
Personal View ◽  
Royal Australian College ◽  
Urban And Rural Areas

A personal view of the state of general practice in Australia and likely trends in the future is presented in this article. The effects of falling recruitment and increasing community demand for service have not yet produced serious effects in this country. A comparison of the effects on urban and rural areas is made. The general practitioner must relinquish some of his traditional roles, especially in surgery and anesthesia, and adopt new ones. To cope with an increasing work load more use must be made by general practitioners of associated health personnel. Community health centers should be developed in Australia and they may be the key to the viability of general practice. The National Health Service as it applies to general practice is discussed especially in relation to the recent introduction of the most common fee concept. The Royal Australian College of General Practitioners is active in preparing a vocational training program. Excerpts from the preliminary report of the Australian Medical Association Study Group on Medical Planning are given. Future medical manpower should be adequate to maintain present standards if recruitment to general practice can be maintained at a satisfactory level. The general practitioner must redefine his role in the medical community. Departments of general practice or community medicine should be established in all universities.

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

scholarly journals How to set up a postmortem facility in a farm animal practice

Livestock ◽  
2021 ◽  
Vol 26 (4) ◽  
pp. 196-201
Author(s):  
John F Mee ◽  
Rhona Ley
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Diagnostic Tool ◽  
Small Ruminants ◽  
Farm Animal ◽  
Small Animals ◽  
Animal Medicine ◽  
Set Up ◽  
Postmortem Examinations

Postmortem examinations can be a useful diagnostic tool in farm animal medicine; however, they are often avoided in general practice because of a lack of appropriate facilities and expertise/familiarity with techniques. This article describes the setting up of a basic facility to allow general practitioners to perform postmortem examinations of calves, small ruminants and other small animals, e.g. poultry.

scholarly journals Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers

2021 ◽  
Vol 10 (2) ◽  
pp. e001309
Author(s):  
Jennifer Gosling ◽  
Nicholas Mays ◽  
Bob Erens ◽  
David Reid ◽  
Josephine Exley
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
General Practitioners ◽  
Service Improvement ◽  
Protected Time ◽  
Routine Work ◽  
Professional Interest ◽  
Quality And Outcomes ◽  
Nationally Representative ◽  
The Uk

BackgroundThis paper presents the results of the first UK-wide survey of National Health Service (NHS) general practitioners (GPs) and practice managers (PMs) designed to explore the service improvement activities being undertaken in practices, and the factors that facilitated or obstructed that work. The research was prompted by growing policy and professional interest in the quality of general practice and its improvement. The analysis compares GP and PM involvement in, and experience of, quality improvement activities.MethodsThis was a mixed-method study comprising 26 semistructured interviews, a focus group and two surveys. The qualitative data supported the design of the surveys, which were sent to all 46 238 GPs on the Royal College of General Practitioners (RCGP) database and the PM at every practice across the UK (n=9153) in July 2017.ResultsResponses from 2377 GPs and 1424 PMs were received and were broadly representative of each group. Ninety-nine per cent reported having planned or undertaken improvement activities in the previous 12 months. The most frequent related to prescribing and access. Key facilitators of improvement included ‘good clinical leadership’. The two main barriers were ‘too many demands from external stakeholders’ and a lack of protected time. Audit and significant event audit were the most common improvement tools used, but respondents were interested in training on other quality improvement tools.ConclusionGPs and PMs are interested in improving service quality. As such, the new quality improvement domain in the Quality and Outcomes Framework used in the payment of practices is likely to be relatively easily accepted by GPs in England. However, if improving quality is to become routine work for practices, it will be important for the NHS in the four UK countries to work with practices to mitigate some of the barriers that they face, in particular the lack of protected time.

scholarly journals ABC of prescribing exercise as medicine: a narrative review of the experiences of general practitioners and patients

2021 ◽  
Vol 7 (2) ◽  
pp. e001050
Author(s):  
Andrew O'Regan ◽  
Michael Pollock ◽  
Saskia D'Sa ◽  
Vikram Niranjan
Keyword(s):  
Physical Activity ◽  
General Practice ◽  
General Practitioners ◽  
Exercise Prescription ◽  
Narrative Review ◽  
System Support ◽  
Physician Characteristics ◽  
Cochrane Reviews ◽  
Type Of Exercise ◽  
User Friendly

BackgroundExercise prescribing can help patients to overcome physical inactivity, but its use in general practice is limited. The purpose of this narrative review was to investigate contemporaneous experiences of general practitioners and patients with exercise prescribing.MethodPubMed, Scopus, Science Direct and Cochrane reviews were reviewed using the terms ‘exercise prescription’, ‘exercise prescribing’, ‘family practice’, ‘general practice’, ‘adults’ and ‘physical activity prescribing’.ResultsAfter screening by title, abstract and full paper, 23 studies were selected for inclusion. Qualitative, quantitative and mixed-methods studies revealed key experiences of general practitioners and patients. Barriers identified included: physician characteristics, patients’ physical and psychosocial factors, systems and cultural failures, as well as ambiguity around exercise prescribing. We present a synthesis of the key strategies to overcome these using an ABC approach: A: assessment of physical activity: involves asking about physical activity, barriers and risks to undertaking an exercise prescription; B: brief intervention: advice, written prescription detailing frequency, intensity, timing and type of exercise; and C: continued support: providing ongoing monitoring, accountability and progression of the prescription. Multiple supports were identified: user-friendly resources, workshops for doctors, guidelines for specific illnesses and multimorbidity, electronic devices, health system support and collaboration with other healthcare and exercise professionals.DiscussionThis review has identified levers for facilitating exercise prescribing and adherence to it. The findings have been presented in an ABC format as a guide and support for general practitioners to prescribe exercise.

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