This blog was first published by the Innovation Research Board on the Royal College of General Practitioners website in 2019
Guidelines play an important role for GPs, but they can’t give answers on how to care for an individual. GPs use generalist wisdom to deliver personal care, but do those outside (or even inside) the general practice profession fully understand what that is? Professor Joanne Reeve, WiseGP lead and Professor of Primary Care Research, Hull York Medical School, discusses WiseGP, a new initiative championing the wisdom of daily practice.
The WiseGP programme is a joint initiative between the RCGP and the Society for Academic Primary Care (SAPC) to champion the distinct clinical scholarship that lies at the heart of person-centred general practice.
WiseGP recognises the need for everyone – professionals, the public, policy makers and patients - to understand the distinct intellectual work that GPs do, to ensure that practice, policy, workforce and workload solutions are designed to optimally support and use the expertise of GPs.
Research suggests that there is work to be done this area. Medical students do not see general practice as intellectually stimulating[1]. Yet practising professionals report that the work is, at times, overly intellectually demanding[2] . Observation of professional practice in action[3] describes the skilled and complex process by which GPs generate explanations of individual illness to guide tailored management plans. Professional accounts of being a ‘jack of all trades’[4] also reveal the skill and complexity of practice but plans such as those for ‘digitally enabled primary care’[5] don’t, as yet, seem to recognise these challenges.
Clinical guidelines offer evidence of best care for management of specific conditions. In a consultation, GPs combine these with information from patients and from professionally constructed ‘mindlines’[6] to generate new knowledge about this individual in their context. This means GPs must use the skills of clinical scholarship[7] to generate explanations of individual illness to guide a tailored management plan.
The distinct intellectual skill of general practice lies not in knowing a little about a lot, but in being able to use that knowledge to generate tailored interpretations of illness.
The WiseGP programme describes this as the Bananarama Principle – it ain’t what you know, it’s the way that you use it (that gets results…).
But GPs tell us – both in research studies[8], and through informal conversations – that health services are not designed to adequately support this model of practice. Barriers[9],[10] include a perceived lack of permission to work beyond guidelines, failure to prioritise this challenging task within a busy workload, insufficient professional training to develop the skills as well as the confidence to use them, and performance management processes that at best ignore – and at worst inhibit – this form of practice. These problems extend beyond the clinical management of individual patients to GPs’ work to support practice development and quality improvement[11].
WiseGP aims to tackle these barriers through three activities.
Raising the profile and understanding of the intellectual work of general practice – to guide conversations across the board about how to revitalise general practice.
Delivering a new Skills Academy – resources to develop skills and confidence in all GPs, and access to advisors and experts from within the SAPC community.
Supporting and championing new teams of GPs championing scholarship, such as the PACT initiative led by Dr Polly Duncan.
If you would like to know more about the WiseGP programme, or to access any of the resources being developed, explore this website, sign up for our newsletter and follow us on Twitter (@wisgpcouk)
[1] https://bjgp.org/content/69/683/309/tab-article-info [2] https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-017-0705-2 [3] https://www.tandfonline.com/doi/full/10.3109/13814788.2013.805197 [4] https://www.gponline.com/generalist-medicine-gps-celebrated-jack-trades/article/1417502 [5] https://bjgp.org/content/69/686/420 [6] Gabbay J, Le May A (2010) Practice-based evidence for healthcare: clinical mindlines (Routledge, Abingdon) [7] https://bjgp.org/content/67/659/266.long [8] https://www.publish.csiro.au/PY/PY18019 Open access version: https://hull-repository.worktribe.com/OutputFile/981617 [9] https://bmcfampract.biomedcentral.com/track/pdf/10.1186/s12875-017-0705-2 [10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899736/pdf/10.1177_2042533313510155.pdf [11] https://bjgpopen.org/content/2/1/bjgpopen18X101421