Closer supervision in Australian general practice training: planning major system change

2020 ◽  
Vol 26 (2) ◽  
pp. 184
Author(s):  
Gerard Ingham ◽  
Kayty Plastow ◽  
Rebecca Kippen ◽  
Nicky White
Keyword(s):  
General Practice ◽  
Focus Groups ◽  
Strong Support ◽  
System Change ◽  
Active Role ◽  
Structured Interviews ◽  
Management Guidelines ◽  
Barriers To Change ◽  
Australian General Practice ◽  
General Practice Training

Major system change involving closer supervision of trainee GP registrars in Australia is warranted. Change management guidelines recommend involving stakeholders in developing change. The views of those involved in general practice training about current and potential supervisory practice were explored. Semi-structured interviews were conducted with a lead medical educator from nine Australian regions. Focus groups were conducted with GP supervisors and GP registrars. Transcripts from the interviews and focus groups were analysed using conventional content analysis, with themes emerging inductively from the data. The findings were that over 1–3 months, a registrar could progress from their supervisor observing all consultations through to the registrar only calling when they identify the need for help. There is strong support from registrars for this change to closer supervision, but less support from supervisors and educators. Barriers to the proposed change include high clinical demand competing with teaching capacity, inadequate payment for closer supervision and supervisors lacking skills or motivation to have a more active role in registrar supervision. If funding and logistic barriers to change are addressed, a change to a closer level of supervision is possible. A pilot study to further refine the change is indicated.

scholarly journals Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jenny Haycock ◽  
Nicole Grivell ◽  
Anne Redman ◽  
Bandana Saini ◽  
Andrew Vakulin ◽  
...  
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Best Practice ◽  
Geographic Location ◽  
Behavioural Therapy ◽  
Chronic Insomnia ◽  
Structured Interviews ◽  
Treatment Pathways ◽  
Falling Asleep ◽  
Australian General Practice

Abstract Background Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend cognitive behavioural therapy for insomnia (CBTi) as first line treatment for insomnia, however research suggests that most general practice consultations for insomnia result in a prescription for hypnotic or sedative medicines. Although the first point of contact for patients experiencing symptoms of insomnia is often general practice, little is known about the current role, experiences and capacity of Australian general practitioners to manage insomnia. This study aimed to address that gap by exploring the attitudes and opinions of general practitioners regarding insomnia management, to inform the development and implementation of new models of best practice insomnia care within general practice. Methods A descriptive, pragmatic qualitative study. Purposive sampling was used to recruit practising Australian general practitioners, varying in age, years of experience and geographic location. Semi-structured interviews were conducted, and data analysed using thematic analysis.  Results Twenty-eight general practitioners participated in the study. Three major themes were identified: 1) Responsibility for insomnia care; 2) Complexities in managing insomnia; and 3) Navigating treatment pathways. Whilst general practitioners readily accepted responsibility for the management of insomnia, provision of care was often demanding and difficult within the funding and time constraints of general practice. Patients presenting with comorbid mental health conditions and insomnia, and decision-making regarding long-term use of benzodiazepines presented challenges for general practitioners. Whilst general practitioners confidently provided sleep hygiene education to patients, their knowledge and experience of CBTi, and access and understanding of specialised referral pathways for insomnia was limited.  Conclusions General practitioners report that whilst assessing and managing insomnia can be demanding, it is an integral part of general practice. Insomnia presents complexities for general practitioners. Greater clarity about funding options, targeted education about effective insomnia treatments, and referral pathways to specialist services, such as benzodiazepine withdrawal support and psychologists, would benefit insomnia management within general practice.

scholarly journals Primary Care Management of Chronic Insomnia: A Qualitative Analysis of the Attitudes and Experiences of Australian General Practitioners

2020 ◽  
Author(s):  
Jenny Haycock ◽  
Nicole Grivell ◽  
Anne Redman ◽  
Bandana Saini ◽  
Andrew Vakulin ◽  
...  
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Best Practice ◽  
Geographic Location ◽  
Behavioural Therapy ◽  
Chronic Insomnia ◽  
Structured Interviews ◽  
Treatment Pathways ◽  
Falling Asleep ◽  
Australian General Practice

Abstract Background Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend Cognitive Behavioural Therapy for insomnia (CBTi) as first line treatment for insomnia however, research suggests that most general practice consultations for insomnia result in a prescription for hypnotic or sedative medicines. Although the first point of contact for patients experiencing symptoms of insomnia is often general practice, little is known about the current role, experiences and capacity of Australian general practitioners to manage insomnia. This study aimed to address that gap by exploring the attitudes and opinions of general practitioners regarding insomnia management, to inform the development and implementation of new models of best practice insomnia care within general practice. Methods A descriptive, pragmatic qualitative study. Purposive sampling was used to recruit practising Australian general practitioners, varying in age, years of experience and geographic location. Semi-structured interviews were conducted, and data analysed using Thematic Analysis. Results Twenty-eight general practitioners participated in the study. Three major themes were identified: 1) Responsibility for insomnia care; 2) Complexities in managing insomnia; and 3) Navigating treatment pathways. Whilst general practitioners readily accepted responsibility for the management of insomnia, provision of care was often demanding and difficult within the funding and time constraints of general practice. Patients presenting with comorbid mental health conditions and insomnia, and decision-making regarding long-term use of benzodiazepines presented challenges for general practitioners. Whilst general practitioners confidently provided sleep hygiene education to patients, their knowledge and experience of CBTi, and access and understanding of specialised referral pathways for insomnia was limited. Conclusions General practitioners report that whilst assessing and managing insomnia can be demanding, it is an integral part of general practice. Insomnia presents complexities for general practitioners, and greater clarity about funding options, targeted education about effective insomnia treatments, and referral pathways to specialist services would benefit insomnia management within general practice.

scholarly journals Evaluation of general practice house officer attachments in Counties Manukau: insights and benefits

2016 ◽  
Vol 8 (4) ◽  
pp. 288 ◽  
Author(s):  
Lyndsay Le Comte ◽  
Brooke Hayward ◽  
David Hughes ◽  
Luis Villa ◽  
Dominic Madell
Keyword(s):  
General Practice ◽  
Focus Groups ◽  
Clinical Skills ◽  
Care Practice ◽  
Medical Council ◽  
Structured Interviews ◽  
Quality Patient Care ◽  
Clinical Support ◽  
Number Of Patients ◽  
Community Attachments

ABSTRACT BACKGROUND The Medical Council of New Zealand requires graduating doctors to have community attachments within their first two years of practice by 2020. Counties Manukau Health has developed a programme where house officers (HOs) are attached to a general practice for three months. AIM This study aimed to establish the value of four HO general practice attachments in Counties Manukau and describe how HOs are being used in these practices. METHODS A mixed-methods design was used to evaluate three attachment runs. Two practices provided the number of patients seen by HOs. Fifty-eight patients were surveyed to assess patient perceptions of the HOs. Six HOs, four supervising general practitioners, two PHO senior staff and one practice manager participated in semi-structured interviews. Focus groups were held with nurses, doctors and administrative staff at all four practices. FINDINGS HOs saw 300–600 patients in one practice and 800–1000 in the other during their attachment. Practices developed their own approach to mentoring and teaching HOs. Most patients reported positive perceptions of the HOs. Themes from interviews and focus groups were consistent among participants and included: improved HO confidence, clinical skills and understanding of general practice; extra capacity and improved quality of care and staff satisfaction among practices. CONCLUSION HOs and practices viewed HO attachments in general practice positively. HOs developed clinical skills and understanding of primary health care. Practice teams enjoyed the energy and enthusiasm of the HOs, while providing clinical support to ensure quality patient care.

Supporting primary care nurses to work at an advanced level through changing practices’ organisational governance

2018 ◽  
Vol 24 (2) ◽  
pp. 171
Author(s):  
Kirsty Forsdike ◽  
Tracy Ann Murphy ◽  
Kelsey Hegarty
Keyword(s):  
General Practice ◽  
Structural Diversity ◽  
Cultural Barriers ◽  
Structured Interviews ◽  
Advanced Level ◽  
Practice Nurses ◽  
Study Approach ◽  
Australian General Practice ◽  
Practice Culture ◽  
Changing Practices

General practice nurses wishing to develop their careers in general practice are often unsupported, relying on the culture of individual practices. Given the structural diversity of Australian general practice, we qualitatively explored staff experiences of organisational governance, what supports are in place and can be used to assist nurses to advance. Semi-structured interviews with 28 staff (including nurses, GPs, receptions and practice managers) were undertaken across three practices, as part of a case-study approach. It was found that general practice staff know little of organisational governance and how it may be harnessed. Practical and flexible organisational governance were the most important factors in supporting general practice nurses to develop and utilise nursing skills, but advocacy from medical colleagues was necessary to support advancement. Barriers include funding structures, non-supportive cultures and inflexible organisational governance structures. Organisation governance has the potential to assist nurses to work at an advanced level, but significant financial, structural and cultural barriers may be too difficult for organisational governance resources alone to overcome. In addition to utilising resources, it may be useful for general practices to undertake a review of how they function as a team and reflect upon their practice culture.

Career development subsequent to general practice training

1983 ◽  
Vol 47 (12) ◽  
pp. 767-770
Author(s):  
SL Handelman ◽  
PM Brunette ◽  
ES Solomon
Keyword(s):  
General Practice ◽  
Career Development ◽  
General Practice Training

A general practice provider federation in a mixed health economy in England: a case study investigation

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696929
Author(s):  
Jill Mitchell
Keyword(s):  
General Practice ◽  
Shared Vision ◽  
Health Economy ◽  
Structured Interviews ◽  
The North ◽  
Common Strategy ◽  
Common Purpose ◽  
Collaborative Working ◽  
The Impact

BackgroundThere is an emerging debate that general practice in its current format is out-dated and there is a requirement to move to a federated model of provision where groups of Practices come together. The emergence of federations has developed over the past 5 years but the factors that influence how federations develop and the impact of this new model is an under researched area.AimThe study explored the rationale around why a group of independent GP practices opted to pursue an alternative business venture and the benefits that this strategy offered.MethodA single organisational case study of a federation in the North of England was conducted between 2011–2016. Mixed methods data collection included individual and group semi-structured interviews and quantitative surveys.ResultsFederations promote collaborative working, relying on strategic coherence of multiple individual GP practices through a shared vision and common purpose. Findings revealed many complexities in implementing a common strategy across multiple independent businesses. The ability of the federation to gain legitimacy was two dimensional – externally and internally. The venture had mixed successes, but their approach to quality improvement proved innovative and demonstrated outcomes on a population basis. The study identified significant pressures that practices were experiencing and the need to seek alternative ways of working but there was no shared vision or inclination to relinquish individual practice autonomy.ConclusionOrganisational development support is critical to reform General Practice. Whether central funding through the GP Five Year Forward View will achieve the scale of change required is yet to be evidenced.

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