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PubMed2000

Royal Australian College of Ophthalmologists and Royal Australian College of General Practitioners National GP Eye Skills Workshops: colleges and divisions reskilling general practice.

PURPOSE: Little formal eye skills training has historically been available to Australian general practitioners at undergraduate or postgraduate levels. The development of the National GP Eye Skills Workshop was a joint initiatve of the Royal Australian Colleges of General Practice and Ophthalmology, to enhance the skills of Australian general practitioners in a range of important ocular examination and procedural areas. METHODS: Workshops were run in eight Queensland Divisions of General Practice in 1998. Between two and 10 local ophthalmologists in each divisional area were involved ether in the workshop programme or in the recruitment of patients for the patient assessment module. Workshops were run on weekends and included modules on vision testing and disease screening in children and adults, ophthalmoscopy, assessment for glaucoma and diabetic retinopathy, incision of chalazions, removal of corneal foreign bodies, ocular first aid, implementing eye assessment in busy general practice, and a patient assessment clinic. A questionnaire was administered which was comprised of sections relating to the format of the workshop, new skills and concepts learnt, learning exceptions, and perception of future ability to treat/scan/assess for eye conditions in general practice. The questionnaire was completed by 91% of participants. RESULTS: Participants strongly supported the impact of the workshop on their ability to detect and treat eye problems in their practices, and refer where appropriate to an ophthalmologist. They also rated highly all individual aspects of the programme in terms of impact on their delivery of general practitioner eye care. CONCLUSIONS: The results illustrate the comprehensive success of the workshop programme in format, content, relevance and delivery.

Adult↗
PubMed2004

Implementing the 2-week wait rule for cancer referral in the UK: general practitioners' views and practices.

The 2-week wait rule for cancer referrals became effective in December 2000 for all cancers treated by the National Health Service in the UK. Attainment of this target depends initially on appropriate and timely referral by general practitioners (GPs). General practitioners' views and referral practices under the 2-week wait rule were examined based on a postal survey of 508 GPs in an inner London area (65% response). Data on mode of referral indicated that 90% of GPs used the urgent suspected cancer form, although 38% also sent a letter with further information. General practitioners generally regarded the 2-week wait rule as working well in terms of improving patients' initial access, and 50% thought communication with the hospital had improved. However, 46% expressed some concerns, including problems arising from the different sets of forms required by local cancer networks, the lack of a dedicated referral form for breast cancer, and feelings of a loss of autonomy. General practitioners also acknowledged an element of over-referral under this rule due to the effects of clinical uncertainty and patient pressure and their concerns about increased waiting times for non-target referrals. The survey therefore indicates that GPs are generally positive about the 2-week wait rule but identified some problems of implementation including a need for standardized national cancer referral forms.

Attitude of Health Personnel↗
PubMed1992

General practitioners' management of hypertension in elderly patients.

OBJECTIVE: To assess general practitioners' attitudes to the diagnosis and management of hypertension in elderly patients. DESIGN: Postal questionnaire to all general practitioners in Leicestershire. RESULTS: 360 of 451 general practitioners (80%) responded. 81% (292) reported rechecking an initially high blood pressure on two or three occasions before starting treatment, 56% (202) measured sitting blood pressure only, and just 28% (100) took sitting and standing levels. 36% (128) had no upper age limit for starting anti-hypertensive treatment; of the 58% (206) who did, the median was 80 (range 70-99) years. Blood pressure levels reported for starting treatment in patients aged 70-79 years were 180 (150-240)/106 (90-120) mm Hg. 34% of general practitioners (121) would not treat isolated systolic hypertension. The most popular first line treatment for an elderly hypertensive patient was a thiazide diuretic; only 17% of general practitioners (61) initially tried non-pharmacological methods. 34% (122) would continue anti-hypertensive treatment unchanged in the period immediately after stroke. CONCLUSIONS: The variation among general practitioners in the criteria for the measurement, diagnosis, and treatment of hypertension in elderly patients emphasises the need for clear management guidelines in this age group.

Adrenergic beta-Antagonists↗
PubMed1992

Self-reported health care over the past 10 years: a survey of general practitioners.

To investigate how and where doctors receive their health care, 275 general practitioners were given a questionnaire about their health care in the previous 10 years; responses were received from 247 doctors (90%). Thirty nine per cent of the subjects were registered with a general practitioner who was independent of them. All but one of the remainder were registered with a practice partner, close friend or relative. Whatever the relationship of the subjects with their own general practitioner, personal health problems were managed to a great extent by themselves. Most (84%) of the medication taken in the previous five years had been self-prescribed and one third of medical investigations had been self-initiated. Over half of the general practitioners studied had seen a specialist about their health in the preceding 10 years; 51% had referred themselves. A 'jury' of seven general practitioners compared the subjects' referrals to a specialist with the care that would be expected for a non-general practitioner patient. Where the jury reached agreement, 68% of referrals were thought to have been appropriate; self-referrals were significantly more likely to be thought inappropriate (P less than 0.05); and self-treatment prior to self-referral to a specialist was considered inappropriate in 78% of cases. The amount of self-prescribed medication and frequency of consultation was the same, whatever relationship the subject held with the general practitioner. This study shows that most general practitioners manage their own health care. The question of whether this is always appropriate is raised and the provision of an occupational health service for general practitioners is discussed.

Humans↗
PubMed1990

General practitioner response to elderly patients discharged from hospital.

OBJECTIVE: To determine the effect of discharge information given to general practitioners on their management of newly discharged elderly patients. DESIGN: A random sample of 133 elderly patients who had unplanned readmission to a district general hospital within 28 days of discharge was compared with a matched control sample of patients who were not readmitted. Information was gathered from the hospital, the patients, the carers, and the general practitioners about the information that the hospital had sent the general practitioner and the general practitioners' response to this information. SETTING: All specialties in a district general hospital. PATIENTS: 266 Patients aged over 65 representative in the main demographic indices of the population of elderly patients admitted to hospital. RESULTS: Ten weeks after discharge the doctors had received notice of discharge about 169 of the patients, but fewer than half the discharge notices were received within the first week. General practitioners were dissatisfied with the information in 60 cases. A general practitioner visited 174 of the patients after their discharge from hospital and three quarters of the visits took place within two weeks of the discharge. These visits were more likely to have been initiated by patients or families than by the doctor, and this was not influenced by the doctor receiving notice of the patient's discharge. Older patients and those who had carers were the most likely to be visited. Nearly half of the carers were dissatisfied with some aspect of general practitioner care, problems with home visiting being the commonest source of complaint. CONCLUSIONS: Hospital communications to general practitioners about the discharge of elderly patients still cause concern, particularly in the time they take to arrive. Written instruction to vulnerable elderly patients asking them to inform their general practitioner of the discharge might be helpful. Carers complained of lack of support, and it is clearly important for someone (either the general practitioner or another health worker) to visit elderly people shortly after their discharge.

Aged↗
PubMed2002

Identifying and overcoming the barriers to Aboriginal access to general practitioner services in Rural New South Wales.

The Wiradjuri General Practitioners and Aboriginal Health Workers Project aimed to help improve Aboriginal health in central western New South Wales (NSW) by identifying and overcoming the barriers to the Aboriginal population's access to general practitioner services. The central strategy of the project was to convene three rounds of consultative meetings in five towns: Bathurst, Orange, Cowra, Forbes and Condobolin. These meetings brought together Aboriginal community members, general practitioners and Aboriginal health workers to express and define local issues and problems, and to propose solutions. The solutions included general practitioner outreach clinics, a focus on prewinter immunisation, bulk-billing of Aboriginal patients, Aboriginal cultural awareness training for all general practice personnel, employing Aboriginal staff in general practice, and closer professional interaction between general practitioners and Aboriginal health workers. Most participants evaluated the meetings as positive and constructive. The project substantiates the perceived need for alternative models for the funding and delivery of general practitioner services to Aboriginal communities.

Community-Institutional Relations↗
PubMed1991

Role of general practitioners in care of long term mentally ill patients.

OBJECTIVE: To assess general practitioners' involvement with long term mentally ill patients and attitudes towards their care. DESIGN: Postal questionnaire survey. SETTING: General practices in South West Thames region. SUBJECTS: 507 general practitioners, 369 (73%) of whom returned the questionnaire. MAIN OUTCOME MEASURES: The number of adult long term mentally ill patients whom general practitioners estimate they have on their lists and general practitioners' willingness to take responsibility for them. RESULTS: 110 respondents had noticed an effect of the discharge of adult long term mentally ill patients on their practices. Most (225) respondents estimated that they had 10 or fewer such patients each on their lists. Having higher numbers was significantly associated with practising in Greater London or within three miles of a large mental hospital and having contact with a psychiatrist visiting the practice. 333 general practitioners would agree to share the care of long term mentally ill patients with the psychiatrist by taking responsibility for the patients' physical problems. Only 59 would agree to act as a key worker, 308 preferring the community psychiatric nurse to do it. Only nine had specific practice policies for looking after long term mentally ill patients and 287 agreed that such patients often come to their general practitioner's attention only when there is a crisis. CONCLUSIONS: The uneven distribution of long term mentally ill patients suggests that community pyschiatric resources might be better targeted at those practices with higher numbers of such patients. Most general practitioners seem to be receptive to a shared care plan when the consultant takes responsibility for monitoring psychiatric health with the community nurse as key worker. The lack of practice policies for reviewing the care of long term mentally ill patients must limit general practitioners' ability to prevent crises developing in their care.

Attitude of Health Personnel↗
PubMed1980

Usage of information sources by general practitioners.

Questionnaires were sent to approximately 500 general practioners in five areas of one National Health Service Region; there was a 52% response. Certain characteristics of each general practitioner, which were collected from the questionnaire and medical lists, were used to assess how information was used by different `types' of general practitioner. Generally, sources of information emanating from the pharmaceutical industry are used more to introduce the new product, while the `professional' sources such as medical journals are used more to evaluate it. Younger doctors used Drug and Therapeutics Bulletin more than did their colleagues, and single-practice doctors found the representative to be more useful than did joint-practice doctors.

Drug Evaluation↗
PubMed1996

Stresses, coping mechanisms and job satisfaction in general practitioner registrars.

BACKGROUND: There is concern about the morale of general practitioner registrars. There may be stress-provoking factors that could be avoided or minimized. AIMS: The aims of the study were to assess the sources of stress and job satisfaction of general practitioner registrars, to compare registrars' job satisfaction with that of established principals using a recently published survey and to identify registrars' usual responses to stress. METHOD: A postal questionnaire survey was sent to all 143 general practitioner registrars in the West Midlands Region. The main measures were: self-rating scales of stresses associated with work and training; the Warr, Cook and Wall job satisfaction scale; and self-reported responses to stress. RESULTS: A total of 118 (83%) general practitioner registrars responded. The most potent sources of stress were family-job conflict, working for the Membership of the Royal College of General Practitioners, patients' unrealistic expectations and disruption of social life. Registrars practised good coping responses to stress. Registrars in this study had significantly greater job satisfaction than general practitioner principals in a 1993 survey for three out of 10 items measured (responsibility given, hours of work and the job as a whole) and significantly worse scores for three items (recognition for good work, rate of pay and variety of work). CONCLUSIONS: Registrars have additional stresses to those of established principals because they need to study for examinations, learn new tasks in general practice and carry out their service commitments at a stage in life when many are newly married or have a young family. Training in stress management for general practitioner registrars is recommended.

Adaptation, Psychological↗
PubMed1994

Annual assessment of patients aged 75 years and over: general practitioners' and practice nurses' views and experiences.

BACKGROUND: The new contract for general practitioners, introduced in 1990, required them to offer an annual assessment, or 'health check', to patients aged 75 years or more. AIM: A study was undertaken to collect details of practice organization of these assessments, general practitioners' and practice nurses' experience of assessments, and their views of the value of such assessments. METHOD: A nationwide postal survey of 1000 general practitioners and interview surveys with general practitioners and practices nurses from 150 practices were carried out in 1992. RESULTS: The postal survey yielded a response rate of 69% and the interview survey a practice response rate of 76%. Organization of assessments varied enormously between, and often within, practices with a variety of methods of invitation and assessment instruments being used. Of general practitioners 13% did not use a letter of any sort to invite patients to attend, and many doctors excluded certain patients from assessment, particularly those who were seen regularly or had been seen recently. However, 70% of general practitioners estimated that they had assessed over 60% of their elderly patients in the first year (1990-91). A substantial proportion of assessments were estimated to have been conducted on an opportunistic basis and few practices were doing all the assessments of those aged 75 years and over in the patients' homes. In the majority of practices, the general practitioners and practice nurses were the only personnel carrying out assessments. Only 9% of the doctors and 34% of the nurses interviewed had been specially trained to carry out the assessment; 54% of nurses said they would like more training in this area. Both doctors and nurses reported that the assessments did detect previously unknown problems, although over half of doctors reported that they rarely picked up new mental health problems. Increased referrals to social services as a direct result of the assessments were reported by 63% of doctors. The majority of doctors and nurses reported that routine assessments were useful in providing advice and reassurance to elderly people. Two thirds of doctors said they would continue to offer at least selected groups of their elderly patients routine assessments, even if not contractually obliged to do so. CONCLUSION: The findings suggest that the experiences of the first two years of this activity had convinced some general practitioners that routine assessment of elderly patients is worthwhile. However the increased demand for other services must obviously be met by an increase in resources if the effectiveness of these assessments is not to be undermined.

Aged↗
PubMed1969

Future role of the general practitioner in the hospital service.

A special subcommittee of the General Practitioner Liaison Committee of the Birmingham Regional Hospital Board used five attitude surveys of groups of general practitioners and a comprehensive study of other publications to determine the future role of the general practitioner in the hospital service.From these and other studies they concluded that, although not all general practitioners wished to participate in hospital work, there was an urgent need to provide suitable facilities and a proper career structure early after qualification for those who did, and that there should be hospital inpatient accommodation in which general practitioners can treat their own patients, preferably in association with consultant beds rather than in separate general-practitioner units.

Attitude of Health Personnel↗
PubMed1993

Iron supplementation in pregnancy. General practitioners' compliance with official recommendations.

UNLABELLED: OBJECTIVE--To compare general practitioners' routines regarding iron supplementation in pregnancy with national recommendations. DESIGN: Mailed questionnaire to general practitioners. SETTING: A county in western Norway. SUBJECTS: 184 general practitioners. MAIN OUTCOME MEASURES: Descriptive registration of reported routines regarding assessment and supplementation of iron. RESULTS: 11% of general practitioners reported complete adherence to the national programme recommending iron supplements for everyone in the second half of pregnancy and use of s-ferritin estimation if Hb falls below 11 g/dl. 36% of the doctors prescribed iron supplements routinely irrespective of iron status. 87% reported use of s-ferritin estimation in antenatal care; usually on indication of low Hb, almost 20% as a routine screening in all pregnancies. CONCLUSION: General practitioners' compliance with national recommendations for iron supplementation in pregnancy is very low and probably reveals a need both for a review of the national recommendations and for an approach to increase compliance with given standards.

Anemia, Hypochromic↗
PubMed1989

Routine treatment of cutaneous warts: a questionnaire survey of general practitioners.

A postal questionnaire was sent to 185 general practitioners to assess their approach to cutaneous warts and their views on the future development of the routine wart treatment service; 159 (85.9%) replied. A wide range of treatments were offered and most patients were given some treatment. The main reasons respondents gave for referring patients to hospital were failure of wart paints (73.6%) and lack of availability of liquid nitrogen (70.4%). Most general practitioners (74.2%) believed that dermatologists should spend less than 5% of their time treating warts. Many general practitioners (61.6%) wanted a practice-based wart clinic offering cryotherapy and 30.8% would like to refer directly to a hospital clinic run by a nurse. A practice clinic was more popular with general practitioners who have a treatment room nurse (P less than 0.01). Most seemed to appreciate the need for training to use liquid nitrogen. We conclude that general practitioners are keen to use cryotherapy and we argue that hospital management should provide the necessary resources for running a community-based service.

Adult↗
PubMed1979

General practitioners and postgraduate education in the Northern Region.

We describe a survey of general practitioners in the Northern Region which was carried out during the summer of 1977 as the result of a commission from the Education Committee of the North of England Faculty of the Royal College of General Practitioners. Seventy-five per cent of a one in two random sample of general practitioner principals returned a postal questionnaire in which their perceptions of postgraduate education were sought and their behaviour measured by the number of sessions they attended during the previous year at their 'usual' and other postgraduate centres. Almost half the respondents had more than a basic qualification and all but three per cent had held full-time hospital appointments, two thirds of them at the level of senior house officer or above. Their experience as general practitioner principals averaged 15 years and 57 per cent held part-time appointments outside their practices. Only four per cent had not attended any postgraduate events during the previous year but the remaining respondents had attended eight sessions on average, six of which were at their usual centres. Those attending more than the average number of sessions tended to have registered between 1950 and 1969, to work in larger practices, to hold additional appointments, or to be trainers or College tutors. Most of the respondents were conservative in their perceptions of teaching methods, the topics discussed at meetings, and the contributors to postgraduate education but the younger general practitioners and a group of established general practitioners affiliated to the Royal College of General Practitioners held more radical views. They agreed about the primacy of traditional clinical topics but were sceptical of the value of ward rounds and formal lectures and favoured the seminar and clinical attachments. They saw a need for more material about practice management and wanted experienced general practitioners and community paramedical staff as teachers in addition to hospital consultants. Most of the respondents believed that their usual centres were well organized and managed but failed to cater for the special requirements of general practitioners in non-clinical aspects of practice. Lunchtime and evenings were seen as the most convenient for weekday meetings and Sunday as the most convenient day of the week. A majority of respondents believed that post-graduate education had altered their practice of clinical medicine but only 15 per cent believed it had caused changes in their practice organization.

Education, Medical, Continuing↗
PubMed1996

Detecting psychological distress: can general practitioners improve their own performance?

BACKGROUND: Many studies have suggested that general practitioners fail to detect a substantial minority of their patients who are psychologically distressed, and there is concern about the possible sequelae of this. Individual patients may suffer unresolved problems, and there are potential costs to the health service in consequent recurrent consultations, inappropriate referrals or treatment. Educational interventions based on small groups led by facilitators have been shown to alter the consultation behaviours of general practitioners that are known to be related to accurate detection of psychological distress. AIM: This controlled study aimed to show that, by utilizing a brief self-directed educational intervention focusing on detection of psychological distress, general practitioners can improve their performance significantly. For this purpose, a new educational intervention was designed: the second aim of the study was thus to assess the effectiveness of this specific intervention. METHOD: An educational intervention was designed which focused on skills relevant to detecting psychological distress, using the principles of reflection on general practitioner performance and consultation skill work. It was designed to be used by individual general practitioners without outside support, using a combination of written background material, feedback on performance and analysis of video material. The effectiveness of the intervention was tested by comparing a trial and control cohort of general practitioners, using detection rates as an outcome measure. RESULTS: The detection rate of the general practitioners who underwent the intervention improved significantly compared with their performance before intervention and with that of the control group. CONCLUSION: General practitioners can improve their ability to detect psychological distress in their patients utilizing this self-directed educational approach.

Adult↗
PubMed2001

Qualitative study of pilot payment aimed at increasing general practitioners' antismoking advice to smokers.

OBJECTIVES: To elicit general practitioners' and practice nurses' accounts of changes in their clinical practice or practice organisation made to claim a pilot health promotion payment. To describe attitudes towards the piloted and previous health promotion payments. DESIGN: Qualitative, semistructured interview study. SETTING: 13 general practices in Leicester. PARTICIPANTS: 18 general practitioners and 13 practice nurses. RESULTS: Health professionals did not report substantially changing their clinical practice to claim the new payments and made only minimal changes in practice organisation. The new health promotion payment did not overcome general practitioners' resistance towards raising the issue of smoking when they felt that doing so could cause confrontation with patients. General practitioners who made the largest number of claims altered the way in which they recorded patients' smoking status rather than raising the topic of smoking more frequently with patients. PARTICIPANTS had strong negative views on the new payment, feeling it would also be viewed negatively by patients. They were, however, more positive about health promotion payments that rewarded "extra" effort-for example, setting up practice based smoking cessation clinics. CONCLUSIONS: General practitioners and practice nurses were negative about a new health promotion payment, despite agreeing to pilot it. Health promotion payments do not automatically generate effective health promotion activity, and policymakers should consider careful piloting and evaluation of future changes in health promotion payments.

Attitude of Health Personnel↗
PubMed1980

General practitioner as psychotherapist.

The importance of general practitioners attending to the emotional problems of their patients is demonstrated. Evidence has been presented concerning the feasibility and cost effectiveness of general practitioners developing the skills required to manage such disorders. A model for training general practitioners in counselling and interviewing skills, and in the more complex psychological therapies, is presented. It is argued that such an integrated approach would produce results superior to the present fragmented approach.

Adult↗