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Creating mindlines – can this help us deal with the everyday challenges of front-line practice?

It is hard, working in general practice at the moment. The workload is huge, and can seem never ending. The problems we are dealing with feel ever more complex. The tools we have to deliver safe, effective and manageable person-centred healthcare don’t feel good enough for the job. All of which adds to the workload and work pressure. So where can we turn for help and inspiration?

We set up WiseGP as one source of help. Our goal is to help front-line clinicians feel more confident in making sense of, managing, and learning from the complex problems we see in everyday practice. WiseGP recognises that a lot of what we are dealing with everyday can’t be explained or managed by a simple guideline or care pathway. Instead, we have to use our critical creative knowledge work skills to help our patients. Our WiseGP resources are designed to tackle the specific barriers you have told us you face in working beyond guidelines and simple pathways. Our WiseStories and short animations offer an understanding of knowledge work as a legitimate part of your everyday professional practice. Our Wise Newsletter and WiseGEMs both offer ideas and resources to help you get started in, or further develop, your knowledge work skills. Our Wise Blog invites you to share your stories of knowledge work in action with your wider general practice community.

This new book from Professors John Gabbay and Andrée le May also looks at the knowledge work of everyday practice. It builds on their research, first published in the BMJ in 2004, in which they challenged the view that a GP’s job involves simply passively following published guidelines and pathways. Instead they described the skilled and complex (knowledge) work that front-line clinicians do every day to convert generic (simple) guidelines into a nuanced understanding of practice better suited to their local context and population. They described this work as the generation of “mindlines”.

In this latest book, they offer eleven examples of mindlines in action – of clinicians working together to critically create new understanding-in-context and new ways of working for everyday practice through the generation of mindlines. Examples come from across clinical disciplines, including dentistry, physiotherapy, palliative care and general practice – though interestingly, most are community based; and across health service delivery, including guideline development and responses to the COVID pandemic. All describe clinicians taking ownership and control of managing real world challenges by creating the new tools they need for their daily work. We see clinicians creating and using the collective local wisdom they need to work safely and effectively within complex and uncertain situations.

So what can this book offer to the time-poor, overworked front-line clinician? As Gabbay states, it is intentionally not a book that tells you what to do. It instead looks to legitimate and so support the work to generate and use collective wisdom at, and from, the front-line. First and foremost it is perhaps a resource for those involved in enabling practice redesign – clinical leaders, ICB members, educators, policy makers and academics. It challenges them to recognise that traditional research (such as that summarised in guidelines) is an important form of knowledge for practice – but is also insufficient. It highlights why and how we need to redesign practice to recognise and enable local knowledge generation as a crucial part of everyday professional practice.

But it also describes the work done by front-line clinicians to address the real-world challenges they face every day. It is written by those clinicians and tells their stories. It shines a light on the practical work they are doing to change practice at the coalface. For me, this is an inspiring set of stories that remind us things can get better.

If you feel inspired too, we’d love to hear your reflections – the ideas you have, the work you are doing to create the mindlines that can make your job better. Send us a blog with your thoughts and we’ll share them with the WiseGP community on here.

Joanne Reeve

GP, Professor of Primary Care and founder of WiseGP


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