title: Cultivation of a learning culture in general practice: an educational intervention.
abstract: BACKGROUND
  Increasing challenges are faced in primary care, including the increase in chronic disease and its management in the community. This paper describes an educational initiative developed to help local general practitioners (GPs) and primary care teams manage chronic conditions and address referral behaviour. The purpose of this study was to evaluate the initiative through the exploration of the experiences of the participants and providers.
  
  
  METHODS
  A variety of methods was used to collect data for the evaluation. These included feedback from participants in the form of workshop evaluation questionnaires, semi-structured interviews of both participants and presenters and focus groups involving participants.
  
  
  RESULTS
  Following analysis of the data, five themes were identified across all the methods used. This paper focuses on the key themes of 'practice change' and 'referral behaviour' as they relate to the specific aims and objectives of the initiative. The data indicated that participants had identified actual changes in practice following their participation in the educational initiative, including changes in individual practice and prescribing behaviour as well as in the provision of healthcare in the community. Changes identified in referral behaviour were evident in feedback from both participants and presenters in secondary care. Participants indicated proposed changes, including an anticipated reduction in referrals for dermatology with greater management of conditions in primary care, as well as a greater awareness of indications for early referral. The use of guidelines in aiding referral decisions was identified and the content and information required from referral letters was also a key area.
  
  
  CONCLUSIONS
  The evaluation of this educational initiative has identified changes in practice in primary care and demonstrates how educational interventions can support and enhance future developments in primary care.
authors.affiliation: NHS Education for Scotland and General Practitioner, Glasgow, UK.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gray
authors.forename: William
authors.initials: W
authors.lastname: Spence
authors.forename: Diane
authors.initials: D
authors.lastname: Kelly
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D004502:Education, Medical, Continuing; D058006:General Practice / Q000193:education*; D006801:Humans; D010818:Practice Patterns, Physicians'; D015397:Program Evaluation; D012017:Referral and Consultation; D006113:United Kingdom