scholarly journals The experience of implementing and delivering group consultations in UK general practice

2021 ◽  
pp. BJGP.2020.0856
Author(s):  
Laura Swaithes ◽  
Zoe Paskins ◽  
Helen Duffy ◽  
Nicola Evans ◽  
Christian Mallen ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
System Level ◽  
Normalisation Process Theory ◽  
Leadership Roles ◽  
Practice Nurses ◽  
Roles And Responsibilities ◽  
Sustaining Change ◽  
Process Outcomes ◽  
Healthcare Assistant

Background: Group consultations are a relatively new concept in UK primary care and are a suggested solution to current workload pressures in general practice. However, little is known about the experience of implementing and delivering this approach from staff and organisational perspectives. Aim: To explore the experience of implementing and delivering group consultations in general practice. Design: Qualitative telephone interview study. Methods: Topic guides explored the perspectives and experiences of general practice staff on the implementation and delivery of group consultations. Data analysis adopted principles of the Framework Method underpinned by Normalisation Process Theory. Results: Interviews were conducted with 8 GPs, 8 Practice Nurses, 1 Nurse Associate, 1 Practice Pharmacist, 1 deputy Practice Manager, 1 Healthcare Assistant. Four themes were identified: sense making of group consultations; the work associated with initiating group consultations; the experiences of operationalising group consultations; and sustaining change. Group consultations made sense to participants as a mechanism to reduce burden on primary care, enhance multi-disciplinary working, and provide patient-centred care. Implementation required strong leadership from a ‘champion’, and a facilitator had a pivotal role in operationalising the approach. The associated workload was often underestimated. Barriers to embedding change included achieving whole practice buy-in, competing practice priorities, and system-level flexibility. Conclusion: General practice clinicians enjoyed group consultations, yet significant work is required to initiate and sustain the approach. An implementation plan considering leadership, roles and responsibilities and wider organisational support is required at the outset. Further research or evaluation is needed to measure process outcomes.

scholarly journals Delivering colon cancer survivorship care in primary care; a qualitative study on the experiences of general practitioners

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Julien A. M. Vos ◽  
Robin de Best ◽  
Laura A. M. Duineveld ◽  
Henk C. P. M. van Weert ◽  
Kristel M. van Asselt
Keyword(s):  
Primary Care ◽  
Colon Cancer ◽  
Cancer Survivorship ◽  
Daily Practice ◽  
System Level ◽  
Normalisation Process Theory ◽  
Survivorship Care ◽  
Structured Interviews ◽  
Delivery Of Care ◽  
Roles And Responsibilities

Abstract Background With more patients in need of oncological care, there is a growing interest to transfer survivorship care from specialist to general practitioner (GP). The ongoing I CARE study was initiated in 2015 in the Netherlands to compare (usual) surgeon- to GP-led survivorship care, with or without access to a supporting eHealth application (Oncokompas). Methods Semi-structured interviews were held at two separate points in time (i.e. after 1- and 5-years of care) to explore GPs’ experiences with delivering this survivorship care intervention, and study its implementation into daily practice. Purposive sampling was used to recruit 17 GPs. Normalisation Process Theory (NPT) was used as a conceptual framework. Results Overall, delivering survivorship care was not deemed difficult and dealing with cancer repercussions was already considered part of a GPs’ work. Though GPs readily identified advantages for patients, caregivers and society, differences were seen in GPs’ commitment to the intervention and whether it felt right for them to be involved. Patients’ initiative with respect to planning, absence of symptoms and regular check-ups due to other chronic care were considered to facilitate the delivery of care. Prominent barriers included GPs’ lack of experience and routine, but also lack of clarity regarding roles and responsibilities for organising care. Need for a monitoring system was often mentioned to reduce the risk of non-compliance. GPs were reticent about a possible future transfer of survivorship care towards primary care due to increases in workload and financial constraints. GPs were not aware of their patients’ use of eHealth. Conclusions GPs’ opinions and beliefs about a possible future role in colon cancer survivorship care vary. Though GPs recognize potential benefit, there is no consensus about transferring survivorship care to primary care on a permanent basis. Barriers and facilitators to implementation highlight the importance of both personal and system level factors. Conditions are put forth relating to time, reorganisation of infrastructure, extra personnel and financial compensation. Trial registration Netherlands Trial Register; NTR4860. Registered on the 2nd of October 2014.

Advancing general practice nursing in Australia: roles and responsibilities of primary healthcare organisations

2017 ◽  
Vol 41 (2) ◽  
pp. 127 ◽  
Author(s):  
Riki Lane ◽  
Elizabeth Halcomb ◽  
Lisa McKenna ◽  
Nicholas Zwar ◽  
Lucio Naccarella ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Leadership Development ◽  
Postgraduate Education ◽  
System Level ◽  
Delphi Consensus ◽  
Practice Nurses ◽  
Care Services ◽  
Primary Care Services ◽  
Australian General Practice

Objectives Given increased numbers and enhanced responsibilities of Australian general practice nurses, we aimed to delineate appropriate roles for primary health care organisations (PHCOs) to support this workforce. Methods A two-round online Delphi consensus process was undertaken between January and June 2012, informed by literature review and key informant interviews. Participants were purposively selected and included decision makers from government and professional organisations, educators, researchers and clinicians from five Australian states and territories Results Of 56 invited respondents, 35 (62%) and 31 (55%) responded to the first and second invitation respectively. Participants reached consensus on five key roles for PHCOs in optimising nursing in general practice: (1) matching workforce size and skills to population needs; (2) facilitating leadership opportunities; (3) providing education and educational access; (4) facilitating integration of general practice with other primary care services to support interdisciplinary care; and (5) promoting advanced nursing roles. National concerns, such as limited opportunities for postgraduate education and career progression, were deemed best addressed by national nursing organisations, universities and peak bodies. Conclusions Advancement of nursing in general practice requires system-level support from a range of organisations. PHCOs play a significant role in education and leadership development for nurses and linking national nursing organisations with general practices. What is known about the topic? The role of nurses in Australian general practice has grown in the last decade, yet they face limited career pathways and opportunities for career advancement. Some nations have forged interprofessional primary care teams that use nurses’ skills to the full extent of their scope of practice. PHCOs have played important roles in the development of general practice nursing in Australia and internationally. What does this paper add? This study delineates organisational support roles for PHCOs in strengthening nurses’ roles and career development in Australian general practice. What are the implications for practitioners? Effective implementation of appropriate responsibilities by PHCOs can assist development of the primary care nursing workforce.

scholarly journals Facilitators and barriers to safer care in Scottish general practice: a qualitative study of the implementation of the trigger review method using normalisation process theory

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029914
Author(s):  
Carl de Wet ◽  
Paul Bowie ◽  
Catherine A O'Donnell
Keyword(s):  
General Practice ◽  
Qualitative Study ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Science Literature ◽  
Leadership Roles ◽  
Structured Interviews ◽  
Theoretical Frameworks ◽  
Practice Nurses ◽  
Healthcare Interventions

ObjectivesPatient safety is a key concern of modern health systems, with numerous approaches to support safety. One, the trigger review method (TRM), is promoted nationally in Scotland as an approach to improve the safety of care in general medical practice. However, it remains unclear which factors are facilitating or hindering its implementation. The aim of this study was to identify the important factors that facilitate or hinder the implementation of the TRM in this setting.DesignQualitative study employing semi-structured interviews. Data analysis was theoretically informed using normalisation process theory (NPT).SettingScottish general practice.ParticipantsWe conducted 28 semistructured interviews with general practitioners (n=12), practice nurses (n=11) and practice managers (n=5) in Scotland.ResultsWe identified four important factors that facilitated or hindered implementation: (1) the amount of time and allocated resources; (2) integration of the TRM into existing initiatives and frameworks facilitated implementation and justified participants’ involvement; (3) the characteristics of the reviewers—implementation was facilitated by experienced, reflective clinicians with leadership roles in their teams; (4) the degree to which participants perceived the TRM as acceptable, feasible and useful.ConclusionsThis study is the first known attempt to investigate how the TRM is implemented and perceived by general practice clinicians and staff. The four main factors that facilitated TRM implementation are comparable with the wider implementation science literature, suggesting that a small number of specific factors determine the success of most, if not all, complex healthcare interventions. These factors can be identified, described and understood through theoretical frameworks such as NPT and are amenable to intervention. Researchers and policymakers should proactively identify and address these factors.

Is the primary care network the answer to increase student nurse capacity in general practice?

2019 ◽  
Vol 30 (12) ◽  
pp. 600-605
Author(s):  
Shaun Heath
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Community Of Practice ◽  
Learning Environments ◽  
Nursing Leadership ◽  
Student Nurse ◽  
Care Network ◽  
Practice Nurses ◽  
Effective Learning ◽  
Effective Learning Environments

Primary care networks have the potential to increase student nurse placements in general practice. Shaun Heath explores how effective learning environments can be created and the concept of the ‘community of practice’ This article explores how the emerging primary care networks (PCNs) could be used to increase student nurse placements in primary care, and how they could facilitate nurses in breaking free from isolative working. Known as a ‘community of practice’, working with our peers and colleagues from neighbouring practices alongside students could facilitate the growth of the network itself, share the educational load with the nurses in the PCN, and create nursing leadership with shared educational advancements. Could PCNs be what general practice nurses need to find their voices and develop their ambitions of becoming leaders?

Next steps for student supervision and assessment

2019 ◽  
Vol 30 (10) ◽  
pp. 496-500
Author(s):  
Shaun Heath
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Communities Of Practice ◽  
Student Nurses ◽  
Education Standards ◽  
Student Placement ◽  
Practice Nurses ◽  
Primary Care Settings ◽  
Student Supervision

Student nurses are the future of the profession. Shaun Heath explains how changes to the Nursing and Midwifery Council's education standards will effect those currently acting as mentors and how all practice nurses can get involved and contribute to student placement experiences This article explores the Nursing and Midwifery Council's 2018 education standards and how these will affect the role of general practice nurses in primary care settings. The differing roles found in the standards will be discussed, alongside how primary care and the emerging Primary Care Networks can support learners in general practice through communities of practice.

Behavioural change in primary care professionals undertaking online education in dementia care in general practice

2019 ◽  
Vol 25 (3) ◽  
pp. 244 ◽  
Author(s):  
Michael W. Bentley ◽  
Rohan Kerr ◽  
Margaret Ginger ◽  
Jacob Karagoz
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Online Education ◽  
Behavioural Change ◽  
Dementia Care ◽  
Practice Nurses ◽  
People With Dementia ◽  
General Practices ◽  
Primary Care Professionals ◽  
Systematic Framework

A challenge facing general practice is improving the diagnosis, management and care of people with dementia. Training and education for primary care professionals about knowledge and attitudes about dementia is needed. Online resources can provide educational opportunities for health professionals with limited access to dementia training. An online educational resource (four modules over 3 h) was designed to assist primary care practitioners to develop a systematic framework to identify, diagnose and manage patients with dementia within their practice. Interviews and questionnaires (knowledge, attitudes, confidence and behavioural intentions), with practice nurses and international medical graduates working in general practices, were used to evaluate the resource. Participants’ knowledge, confidence and attitudes about dementia increased after completing the modules. Participants had strong intentions to apply a systematic framework to identify and manage dementia. In post-module interviews, participants reported increased awareness, knowledge and confidence in assessing and managing people with dementia, corroborating the questionnaire results. This project has demonstrated some early changes in clinical behaviour around dementia care in general practice. Promoting the value of applying a systematic framework with colleagues and co-workers could increase awareness of, and participation in, dementia assessment by other primary care professionals within general practices.

Less is more when reducing antimicrobial prescribing

2019 ◽  
Vol 30 (9) ◽  
pp. 452-455
Author(s):  
Gail Haddock
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Decision Making ◽  
General Practice ◽  
Modern Medicine ◽  
Practice Nurses ◽  
Less Is More ◽  
Antimicrobial Prescribing ◽  
The Past ◽  
The Right

As primary care is the main provider of antimicrobial prescriptions, knowing when and what to prescribe, and for how long, is hugely important to public health. Gail Haddock shares useful resources and toolkits to help practice nurses in their decision making Clinicians have reduced their antimicrobial prescribing by 6% in the past 5 years, but this is not enough to overcome the ever-increasing antimicrobial resistance that is a threat to modern medicine. The UK's new target is to reduce prescribing by a further 15% by 2020. This can only be achieved by the commitment of the full general practice team to only prescribe at the right time (ie only if necessary), and the right dose of the right antibiotic for the right length of time. There are numerous excellent resources for patients and clinicians alike on the TARGET website.

Is Accelerated Partner Therapy partner notification for sexually transmissible infections acceptable and feasible in general practice?

Sexual Health ◽  
2011 ◽  
Vol 8 (1) ◽  
pp. 17 ◽  
Author(s):  
Thomas Shackleton ◽  
Lorna Sutcliffe ◽  
Claudia Estcourt
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Partner Notification ◽  
Primary Care Providers ◽  
Health Clinic ◽  
Sex Partners ◽  
Care Providers ◽  
Practice Nurses ◽  
Limited Effectiveness ◽  
Sexually Transmissible Infections

Background: Partner notification in primary care is problematic and of limited effectiveness despite enthusiasm from primary care providers to engage with sexually transmissible infection (STI) management. Innovative partner notification strategies must be relevant to the primary care context. The aim of the present study was to explore the opinions of general practitioners (GP) and practice nurses on the acceptability and feasibility of a new form of partner notification developed in the specialist setting known as Accelerated Partner Therapy (APT), for sex partners of those diagnosed with a bacterial STI in general practice. APT is defined as partner notification strategies that reduce time for sex partners to be treated, and include partner assessment by appropriately qualified health care professionals and here involve telephone and community pharmacy assessment. Methods: Semi-structured qualitative interviews were conducted with a purposive sample of GP and practice nurses in East London, UK. Results: All participants appreciated the importance of partner notification in STI management and felt that APT would improve their practice. They supported prioritising antibiotic provision for the sex partners with provision for future comprehensive STI screening. Although both models were acceptable and feasible, the majority preferred the sexual health clinic telephone assessment over the pharmacy model. Conclusions: GP and practice nurses welcome new strategies for partner notification and believe APT could provide rapid and convenient treatment of sex partners in general practice. This supports further evaluation of APT models as a partner notification strategy in primary care.

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