Not 'just' a GP: a call for action (original) (raw)
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“Only a GP?”: is the solution to the general practice crisis intellectual?
The Medical Journal of Australia, 2003
GENERAL PRACTICE IS IN CRISIS. It has a poor status within the profession, 1 and general practitioners earn less than other medical practitioners 2,3-even for the same services, they command poorer fees than specialists in Australia. 4 Their traditional place is outside the healthcare system (still dominated by hospitals), exerting considerably less influence from the "corner shops" of their private practices. The number of GP registrar applicants is little above the imposed restriction, and is falling (Box 1). Only 392 Australian-trained doctors (about a quarter of the cohort of junior doctors) applied for a GP registrar position for 2003. An additional 35% of applicants were overseastrained, while only 31% were Australian-born (R Coote, General Practice Education and Training Ltd, Canberra, personal communication, May 2003). The picture is similar overseas. 3 The perceived poor state of intellectual activity in general practice is more profound. GPs publish less research than specialists 5-vastly less in relation to their practising numbers. 6 GP journals have lower (if slowly rising) citation indices. Compared with general practice overseas, we seem to be always catching up (Box 2). More important, our patients are losing confidence in their GPs' ability to know them as a whole person (eg, their values and beliefs), to coordinate their care, and to provide it continuously. 8 They commonly ask, "Are you only a GP?"and worse, GPs themselves often reply "yes"! Continuing medical education for GPs is still dominated by specialists. Why does this matter? A competent and self-confident general practice workforce is good for a nation's health. 9 Research comparing nations suggests that a strong, self-sufficient, self-assured, and respected primary healthcare sector leads to both improved quality and more cost-efficient care. 9 For example, the Netherlands has one of the world's highest quality, most cost-effective primary care systems, while Belgium, until
BMJ Open, 2016
Objectives: An increase in patients with long-term conditions and complex care needs presents new challenges to healthcare providers around the developed world. In response, more broad-based training programmes have developed to better prepare trainees for the changing landscape of healthcare delivery. This paper focuses on qualitative elements of a longitudinal, mixed-methods evaluation of the postgraduate, post-Foundation Broad-Based Training (BBT) programme in England. It aims to provide a qualitative analysis of trainees' evaluations of whether the programme meets its intentions to develop practitioners adept at managing complex cases, patient focused care, specialty integration and conviction in career choice. We also identify unintended consequences. Setting: 9 focus groups of BBT trainees were held over a 12-month period. Discussions were audiorecorded and subjected to directed content analysis. Data were collected from trainees across all 7 participating regions: East Midlands; West Midlands; Severn; Northern; North Western; Yorkshire and Humber; Kent, Surry and Sussex. Participants: Focus group participants (61 in total) from the first and second cohorts of BBT. Results: Evidence from trainees indicated that the programme was meeting its aims: trainees valued the extra time to decide on their onward career specialty, having a wider experience and developing a more integrated perspective. They thought of themselves as different and perceived that others they worked alongside also saw them as different. Being different meant benefitting from novel training experiences and opportunities for self-development. However, unintended consequences were feelings of isolation, and uncertainty about professional identity. Conclusions: By spanning boundaries between specialties, trainee generalists have the potential to improve experiences and outcomes for patients with complex health needs. However, the sense of isolation will inhibit this potential. We employ the concept of 'belongingness' to identify challenges related to the implementation of generalist training programmes within existing structures of healthcare provision.
A new competency model for general practice: implications for selection, training, and careers
British Journal of General Practice, 2013
IntroductIon Under the UK government's plans for NHS reform, expectations of policymakers regarding the future role of the GP are a topic of significant debate. 1,2,3 With major structural changes in the UK NHS, 4 there is now more emphasis on exploring the skills and capabilities of GPs outside of the consulting room, relating to leadership, professionalism 5,6 and engagement in commissioning activities. 4,7 These skills are in addition to designing services for their registered patients, with an increasing shift of patient care from hospitals into the community. This suggests that there is a broadening of the UK GP job role from that centred on a 'helping model' in doctorpatient consultations to a role that also emphasises a 'business model', where GPs are increasingly required to consider how their work impacts at a community level and how this fits within the health system as a whole. 4 Furthermore, a recent policy report on the career path of GPs advocates the future importance of generalism as opposed to specialty development. 8 However, there is limited research available to inform the skills and professional attributes required of GPs in future for their expanded role outside of the consulting room. This paper reports on a multisource, multimethod job analysis study of the GP role, replicating a previous job analysis conducted over 12 years ago. 9