Examining the practice of generalist expertise: a qualitative study identifying constraints and solutions.
OBJECTIVE
Provision of person-centred generalist care is a core component of quality primary care systems. The World Health Organisation believes that a lack of generalist primary care is contributing to inefficiency, ineffectiveness and inequity in healthcare. In UK primary care, General Practitioners (GPs) are the largest group of practising generalists. Yet GPs fulfil multiple roles and the pressures of delivering these roles along with wider contextual changes create real challenges to generalist practice. Our study aimed to explore GP perceptions of enablers and constraints for expert generalist care, in order to identify what is needed to ensure health systems are designed to support the generalist role.


METHODS
Qualitative study in General Practice.


METHODS
UK primary care.


METHODS
A qualitative study - interviews, surveys and focus groups with GPs and GP trainees. Data collection and analysis was informed by Normalisation Process Theory.


METHODS
Qualitative study in General Practice. We conducted interviews, surveys and focus groups with GPs and GP trainees based mainly, but not exclusively, in the UK. Data collection and analysis were informed by Normalization Process Theory.


METHODS
UK based GPs (interview and surveys); European GP trainees (focus groups).


RESULTS
Our findings highlight key gaps in current training and service design which may limit development and implementation of expert generalist practice (EGP). These include the lack of a consistent and universal understanding of the distinct expertise of EGP, competing priorities inhibiting the delivery of EGP, lack of the consistent development of skills in interpretive practice and a lack of resources for monitoring EGP.


CONCLUSIONS
WE DESCRIBE FOUR AREAS FOR CHANGE: Translating EGP, Priority setting for EGP, Trusting EGP and Identifying the impact of EGP. We outline proposals for work needed in each area to help enhance the expert generalist role.
Department of Health Services Research, University of Liverpool, Liverpool L69 3GB, UK.
Joanne
J
Reeve
Department of Health Services Research, University of Liverpool, Liverpool L69 3GB, UK.
Christopher F
CF
Dowrick
Imperial College London, London SW7 2AZ, UK.
George K
GK
Freeman
University of Melbourne, Melbourne, VIC 3010, Australia.
Jane
J
Gunn
University of Glasgow, Glasgow, Lanarkshire G12 8QQ, UK.
Frances
F
Mair
University of Southampton, Southampton SO17 1BJ, UK.
Carl
C
May
University of Glasgow, Glasgow, Lanarkshire G12 8QQ, UK.
Stewart
S
Mercer
University of Melbourne, Melbourne, VIC 3010, Australia.
Victoria
V
Palmer
University of East Anglia, Norwich, Norfolk NR4 7TJ, UK.
Amanda
A
Howe
Department of Health Services Research, University of Liverpool, Liverpool L69 3GB, UK.
Greg
G
Irving
University of East Anglia, Norwich, Norfolk NR4 7TJ, UK.
Alice
A
Shiner
University of Bristol, Bristol BS8 1TH, UK.
Jessica
J
Watson
generalism; generalist expertise; generalist practice; normalisation process theory; primary care