title: Identifying future models for delivering genetic services: a nominal group study in primary care.
abstract: BACKGROUND
  To enable primary care medical practitioners to generate a range of possible service delivery models for genetic counselling services and critically assess their suitability.
  
  
  METHODS
  Modified nominal group technique using in primary care professional development workshops.
  
  
  RESULTS
  37 general practitioners in Wales, United Kingdom too part in the nominal group process. The practitioners who attended did not believe current systems were sufficient to meet anticipated demand for genetic services. A wide range of different service models was proposed, although no single option emerged as a clear preference. No argument was put forward for genetic assessment and counselling being central to family practice, neither was there a voice for the view that the family doctor should become skilled at advising patients about predictive genetic testing and be able to counsel patients about the wider implications of genetic testing for patients and their family members, even for areas such as common cancers. Nevertheless, all the preferred models put a high priority on providing the service in the community, and often co-located in primary care, by clinicians who had developed expertise.
  
  
  CONCLUSIONS
  There is a need for a wider debate about how healthcare systems address individual concerns about genetic concerns and risk, especially given the increasing commercial marketing of genetic tests.
authors.affiliation: Centre for Health Sciences Research, Cardiff University, 56 Park Place, Cardiff, CF10 3AT, Wales. glyn.elwyn@btinternet.com
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
authors.forename: Rachel
authors.initials: R
authors.lastname: Iredale
authors.forename: Peter
authors.initials: P
authors.lastname: Davies
authors.forename: Jonathon
authors.initials: J
authors.lastname: Gray
mesh_terms: D005194:Family Practice / Q000193:education / Q000458:organization & administration*; D005260:Female; D005544:Forecasting; D033142:Genetic Services / Q000458:organization & administration*; D006126:Group Processes; D006301:Health Services Needs and Demand / Q000639:trends; D006801:Humans; D008297:Male; D017146:Models, Organizational; D011320:Primary Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D006113:United Kingdom