General practitioners' attitudes to professional reaccreditation.

General practitioners (GPs) do not systematically include preventive recommendations in their practice, and some characteristics of health care organization are associated with more systematic prevention. But the characteristics of health care organization may act in a nonuniform manner depending on the type of preventive care. Thus, one characteristic can be positively associated with one type of preventive care and negatively associated with another. Our aim was to investigate the association between health care organization in general practice and different areas of preventive care (immunization and addiction prevention), in search of nonuniform associations. We used a representative survey of 1,813 French GPs conducted in 2009. Four preventive care practices were studied: immunization through flu and HPV vaccination, and prevention of addictive behaviors concerning tobacco and alcohol use.Characteristics of GPs' health care organization and the social context of their practice were collected (spatial accessibility to GPs and socioeconomic level of the area of practice). We constructed mixed models to study associations and interactions between the organization variables and preventive care. Four out of five characteristics of GPs' organization have uneven impacts on different types of preventive care (p-interaction < 10-4). For example, number of daily consultations is associated with better immunization prevention but with poorer prevention counseling in addictive behaviors. In contrast, working with digital medical files is uniformly associated with both types of preventive care (OR = 1.29 [1.15-1.45]; P < 10-4). An approach centered on specific types of preventive care should help deepen our understanding of prevention and possibly help to identify a new typology for preventive care.

BackgroundIn order to provide smoking cessation support to their patients in line with clinical practice guidelines, general practitioners must first ascertain whether their patients’ use tobacco. This study examined (i) the sensitivity, specificity, positive predictive value and negative predictive value of general practitioner detection of smoking, and (ii) the general practitioner and patient characteristics associated with detection of tobacco use.MethodsEligible patients completed a touchscreen computer survey while waiting for an appointment with their general practitioner. Patients self-reported demographic characteristics, medical history, and current smoking status. Following the patient’s consultation, their general practitioner was asked to indicate whether the patient was a current smoker (yes/no/unsure/not applicable). Smoking prevalence, sensitivity, specificity, positive predictive value and negative predictive values (with 95% confidence intervals) were calculated using patient self-report of smoking status as the gold standard. Generalised estimating equations were used to examine the general practitioner and patient characteristics associated with detection of tobacco use.ResultsFifty-one general practitioners and 1,573 patients in twelve general practices participated. Patient self-report of smoking was 11.3% compared to general practitioner estimated prevalence of 9.5%. Sensitivity of general practitioner assessment was 66% [95% CI 59–73] while specificity was 98% [95% CI 97–98]. Positive predictive value was 78% [95% CI 71–85] and negative predictive value was 96% [95% CI 95–97]. No general practitioner factors were associated with detection of smoking. Patients with a higher level of education or who responded ‘Other’ were less likely to be detected as smokers than patients who had completed a high school or below level of education.ConclusionDespite the important role general practitioners play in providing smoking cessation advice and support, a substantial proportion of general practitioners do not know their patient’s smoking status. This represents a significant missed opportunity in the provision of preventive healthcare. Electronic waiting room assessments may assist general practitioners in improving the identification of smokers.

Objective. The risk of being disciplined in connection with a complaint case causes distress to most general practitioners. The present study examined the characteristics of complaint cases resulting in disciplinary action. Material and methods. The Danish Patients’ Complaints Board's decisions concerning general practice in 2007 were examined. Information on the motives for complaining, as well as patient and general practitioner characteristics, was extracted and the association with case outcome (disciplinary or no disciplinary action) was analysed. Variables included complaint motives, patient gender and age, urgency of illness, cancer diagnosis, healthcare settings (daytime or out-of-hours services), and general practitioner gender and professional seniority. Results. Cases where the complaint motives involved a wish for placement of responsibility (OR = 2.35, p = 0.01) or a wish for a review of the general practitioner's competence (OR = 1.95, p = 0.02) were associated with increased odds of the general practitioner being disciplined. The odds of discipline decreased when the complaint was motivated by a feeling of being devalued (OR = 0.39, p = 0.02) or a request for an explanation (OR = 0.46, p = 0.01). With regard to patient and general practitioner characteristics, higher general practitioner professional seniority was associated with increased odds of discipline (OR = 1.97 per 20 additional years of professional seniority, p = 0.01). None of the other characteristics was statistically significantly associated with discipline in the multiple logistic regression model. Conclusion. Complaint motives and professional seniority were associated with decision outcomes. Further research is needed on the impact of professional seniority on performance.

Objectives: To discover the perceived size of pool of doctors considered to be underperforming in general practice in the Northern Deanery and to discover whether these perceptions are based on...

A study of the impact of teaching undergraduate medical students in general practice as part of a new clinical skills course was carried out in Newcastle Medical School in the United Kingdom. The evaluation was based on analysis of a pre and post course postal questionnaire sent to the lead general practitioner and practice manager in all 52 participating practices; log diaries which were kept by sixteen of the practices; and a postal questionnaire sent to all patients used in the teaching in three practices. The paper presents and discusses the results of the questionnaire survey. There was an 83% response rate. The impact of the teaching on the practices was significant in terms of real costs incurred, and organisational issues such as use of space, administration of the teaching, disruption of normal routines and so on. How ever, the costs appeared to be outweighed by a range of perceived benefits including a positive effect on team spirit. The impact on individual general practitioners was also substantial, for example encroachment on personal time. However, as with the practices, the negative effects were offset by perceived benefits which included the opportunity to revise basic clinical skills, developing teaching skills, taking a fresh look at things and so on. Overall, the benefits seemed to outweigh the disadvantages. However, there may be a ‘honeymoon’ effect which could mean that disadvantages are felt to outweigh advantages if, for instance, teacher enthusiasm wanes. Furthermore, some of the potential impacts on general practice based teaching, such as effects on the doctor patient relationship, and on quality of care will probably take several years to develop. There is thus a need for long term monitoring and evaluation of such innovations.

General practitioner referrals to exercise physiologists during routine practice: A prospective study

# GPs to produce a strategy for the future {#article-title-2} The General Medical Services Committee will begin to discuss its strategy for the future of general practice at its September meeting. This will be the first stage of the GMSC's response to the government's document Primary Care: The Future (15 June, p 1500). Dr Ian Bogle, who was re-elected unopposed as chairman but said that it would be the last year that he stood, said last week that he and the negotiators planned a weekend meeting to draft the strategy. This would be wide-ranging and cover a definition of core services, contractual options, recruitment, workload, and funding. Welcoming the move Dr Tony Stanton, secretary of the inner London local medical committees, said that the committee needed to debate all the issues urgently. General practitioners' wish to recruit more doctors and reduce list sizes might not be achievable. He did not believe that they wanted to see the hospital service depleted further to pay for additional primary care services. The GMSC has set up a task group to examine how it conducts its business. Dr John Ball will chair the group, and its other members are Dr Lawrence Buckman, Dr John Canning, Dr Grant Kelly, and Dr Fay Wilson. Dr Ball, a former chairman of the GMSC, told the committee that there was a wealth of talent on the committee that was never tapped and he wondered whether concentrating so much work and responsibility on a few people was the right way …

Managing the growing number of oldest-old patients with multimorbidity and polypharmacy in primary health care poses an increasing public health challenge. Since inappropriate polypharmacy can harm patients’ health, general practitioners (GPs) should regularly review patients’ medications and, if necessary, deprescribe. This case vignette study evaluates the deprescribing decisions of GPs from 31 countries and compares the factors influencing GPs’ deprescribing decisions. We invited GPs to participate in an online survey, containing a) three cases of increasingly dependent oldest-old multimorbid patients with potentially inappropriate polypharmacy and b) Likert-scale questions assessing the importance of factors influencing deprescribing. We presented each case with and without history of cardiovascular disease (CVD). For each case, we asked whether GPs would deprescribe any medication and, if so, which one(s). We calculated percentages of GPs deprescribing at least one medication in each case, compared cases with/without CVD history and different levels of dependency in activities of daily living, and calculated the percentage of factors rated as important or very important. Of 3175 invited GPs from 31 countries, 53% responded (N = 1’706) with a mean age of 50 years and 60% females. Results are preliminary, but despite some differences across GP characteristics (male/female, age) and across countries, GPs generally showed a high willingness to deprescribe in oldest-old patients (&amp;gt;80 years) with polypharmacy. GPs were more likely to deprescribe in patients with a higher level of dependency, in the absence of history of CVD, and when patients are on statins, proton-pump inhibitors or potentially inappropriate pain medication. Factors GPs rated as important or very important for the deprescribing decision were patients’ quality of life, risks and benefits of medications, patients’ life expectancy, and potential negative health outcomes resulting from deprescribing. Key messages Despite international differences, most GPs report they would deprescribe in older multimorbid patients with polypharmacy. The results will facilitate the development of interventions supporting general practitioners to deprescribe.

True believers? Characteristics of general practitioners in Victorian community health centres

We aimed to ascertain how frequently Australian general practitioners (GPs) test patients for chlamydia and to determine GP, patient and encounter characteristics where tests occurred. We identified all GP, patient and encounter characteristics associated with higher testing rates, April 2000 to March 2007, using the Bettering the Evaluation and Care of Health data. Multiple logistic regression was used to measure the effect of each GP, patient and encounter characteristic. Data were available for 689 000 encounters from 6890 GPs, of which 2236 were test encounters. Testing rates increased significantly between 2000 and 2007 (P < 0.0001). The rate of testing was higher for female patients (4.2 per 1000, 95% confidence interval (CI): 3.8-4.5) than males (2.0; 95% CI: 1.8-2.2). Predictors of higher chlamydia testing were: female GP (adjusted odds ratio (AOR): 1.84; 95% CI: 1.60-2.1); GP age (<35 v. 55+, 2.17; 95% CI: 1.65-2.85); practice in a major city (1.34; 95% CI: 1.18-1.52); large practice (5+ GP practice v. solo, 1.69; 95% CI: 1.27-2.25); graduated in Australia (1.22; 95% CI: 1.04-1.44); patient sex and younger age, being new to the practice (1.65; 95% CI: 0.47-1.86), Indigenous (3.46; 95% CI: 2.64-4.54), late in the study (twice as likely in 2006-07 than in 2000-01) and 'opportunity to test' (AOR: 32.25; 95% CI: 27.25-38.16). Chlamydia testing rates have increased in general practice in Australia, with higher rates in females. Initiatives to overcome barriers to testing (especially for male patients and older male GPs) need to be established and evaluated.

Former secretary inner London local medical committees (b Batley 1931; q Leeds 1955; OBE, DA, FRCGP), died from carcinomatosis on 16 July 2004.​2004. Figure 1 After serving overseas in the...

Recruitment and retention of General Practitioners (GPs) is a global challenge in primary care. Traditionally, GPs in the UK have worked as self-employed partners. However, policy changes in England have allowed for salaried GP positions within primary care partnerships. The effects of these different employment models on recruitment and retention remain unclear. This study investigates the impact of partnership vs. salaried employment models on GP job satisfaction, job pressures, and intentions to reduce working hours in England. Data from nine waves of the national GP Worklife Survey (2001-2019) were analysed using multivariate regression models. The analysis adjusted for several GP characteristics, including age, gender, ethnicity, marital status, and number of children. Salaried GPs reported higher satisfaction with working hours but lower satisfaction with income compared to partner GPs. Partner GPs experienced higher job pressures and were more likely to intend to reduce their working hours within five years. Flexible working arrangements, such as salaried positions, may enhance job satisfaction and retention among GPs, helping to address workforce challenges in primary care. Targeted policies are needed to mitigate job pressures and improve satisfaction, particularly among partner GPs.

Intercultural effectiveness in GPs' communication and clinical assessment: An experimental study

ABSTRACTBackground People with an intellectual disability (ID) have complex healthcare needs yet experience barriers to participation in primary care. Further research is required to examine if the characteristics of general practitioners (GPs) and their practices influence their delivery of care to people with ID.Methods Data from the Bettering the Evaluation and Care of Health program was used to determine if there are significant differences in the ID-GP and Non ID-GP group. Analysis included characteristic-specific rates, chi-square, and odds ratios.Results This study found that GPs who were Australian medical graduates, practising in rural areas, in accredited practices, and in some states of Australia were significantly more likely to be classified to the ID-GP than the Non ID-GP group.Conclusions This research suggests that certain GP and practice characteristics may present barriers to primary care participation for people with ID and supports the need for a comprehensive national action framework.

Since April 1993 general practice fundholders have been able to provide some secondary care services in their practices. The BMA's Central Consultants and Specialists Committee has consulted the medical royal colleges and the General Medical Services Committee and prepared guidelines on the levels of training and experience that might be appropriate. Fundholders have to obtain regional consent in writing before providing any services or seeking reimbursement, but the CCSC has found that in many cases regional health authorities have not established appropriate approval mechanisms. The committee believes that consultants in the relevant specialties and general practitioners should be involved in all stages of the approval mechanism. Applicants should be able to show their training and competence in each procedure and give numbers of procedures undertaken of a similar nature and current specialist commitments. The Association of Anaesthetists is preparing guidelines on the provision of general anaesthesia outside hospital. In the meantime, the CCSC believes that fundholders should adhere to the guidelines in the Royal College of Surgeons' booklet Guidelines for Sedation by Non- Anaesthetists. The guidelines cover procedures in gynaecology; ear, nose, and throat; urology; pathology; ophthalmology; general surgery; and orthopaedics. In many instances the guidelines emphasise that resuscitation facilities and staff trained in life support must be available, particularly if the procedure is carried out under sedation. Copies of the guidelines are available from the CCSC secretariat, BMA, BMA House, Tavistock Square, London WC1H 9JP. There should be a campaign to warn the public of the dangers in the Department of Health's code for safeguarding confidentiality in the NHS, the BMA's medical ethics committee believes. The government issued its draft code (20-27 August, p 499) a week …