What is the General Practitioner’s understanding of multi-professional teamwork?
There has been a move to increase multidisciplinary working in primary care, driven both by policy changes and by workforce challenges. The perspectives of the General Practitioners have not been widely investigated.
The aim of this project was to explore what general practitioners (GPs) understand by ‘multi-disciplinary, primary healthcare team working’ in the current climate.
Design, Setting and Methods
A descriptive qualitative study, using semi-structured interviews was undertaken to explore the views of six GPs. Transcribed interviews were thematically analysed.
Analysis of the interviews identified six broad themes. These were: practice team structure and function, GPs’ perceptions of their own role within the team, others’ roles within the team, communication issues, constraints impacting upon change and lastly, relationships with external organisations.
General practice multidisciplinary teams are at present in a considerable state of flux due to changes in the workforce, with the introduction of new members, notably paramedic practitioners, extended nursing team roles and physician associates. The extension of the team has implications for increasing the supervisory and leadership role of the GP, without GPs necessarily feeling that they have the skill set for extending that role. The transition from providing physician-only care to team care provision, is seen as inevitable, given the work force strictures on general practice, but this study suggests it is not universally welcomed.
RCGP. General Practice and the Integration of Care. London: RCGP; 2012.
RCGP. The future of GP collaborative working. London: RCGP; 2016.
Dale J, Potter R, Owen K, Parsons N, Realpe A, Leach J. Retaining the general practitioner workforce in England: what matters to GPs? A cross-sectional study. BMC Fam Pract. 2015;16:140.
Kuzel AJ. Keys to high-functioning office teams. Fam Pract Manag. 2011;18(3):15–18.
Bodenheimer T. Primary Care — Will It Survive? N Engl J Med. 2006 Aug 31;355(9):861–4.
Williams A, Sibbald B. Changing roles and identities in primary health care: exploring a culture of uncertainty. J Adv Nurs. 1999 Mar 1;29(3):737–45.
Bramwell D, Peckham S, Allen P, Checkland K. How can GPs and community health services work more effectively together? Br J Gen Pr. 2015;65(636):374–375.
Arksey H, Snape C, Watt I. Roles and expectations of a primary care team. J Interprof Care. 2007 Jan 1;21(2):217–9.
Gerada C, Riley B. The 2022 GP: our profession, our patients, our future. Br J Gen Pr. 2012 Nov 1;62(604):566–7.
NHSEngland. Five Year Forward View [Internet]. London: NHSE; 2014 Oct. Available from: https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
Matteliano MA, Street D. Nurse practitioners’ contributions to cultural competence in primary care settings. J Am Acad Nurse Pract. 2012 Jul;24(7):425–35.
Quinlan E, Robertson S. The communicative power of nurse practitioners in multidisciplinary primary healthcare teams. J Am Acad Nurse Pract. 2013;25(2):91–102.
Stewart KR, Stewart GL, Lampman M, Wakefield B, Rosenthal G, Solimeo SL. Implications of the Patient-Centered Medical Home for Nursing Practice. J Nurs Adm. 2015 Nov;45(11):569–74.
Vail L, Bosley S, Petrova M, Dale J. Healthcare assistants in general practice: a qualitative study of their experiences. Prim Health Care Res Dev. 2011;12(1):29–41.
Mazzaglia G, Lapi F, Silvestri C, Roti L, Giustini SE, Buiatti E. Association between satisfaction and stress with aspects of job and practice management among primary care physicians. Qual Prim Care. 2009 Jun;17(3):215–23.
Tierney E, O’Sullivan M, Hic
key L, Hannigan A, May C, Cullen W, et al. Do primary care professionals agree about progress with implementation of primary care teams: Results from a cross sectional study. BMC Fam Pract [Internet]. 2016;17(1). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85011277095&doi=10.1186%2fs12875-016-0541-9&partnerID=40&md5=c35f62a1c2c8acd61c9631ba9a29d9a9
Kislov R, Walshe K, Harvey G. Managing boundaries in primary care service improvement: A developmental approach to communities of practice. Implement Sci [Internet]. 2012;7(1). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84867386514&doi=10.1186%2f1748-5908-7-97&partnerID=40&md5=f33f0f844676ac5fd7b0c5606e9b3f1c
Pullon S, Morgan S, Macdonald L, McKinlay E, Gray B. Observation of interprofessional collaboration in primary care practice: A multiple case study. J Interprof Care. 2016;30(6):787–94.
Creswell JW. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Third Edition edition. Thousand Oaks, Calif: SAGE Publications, Inc; 2008. 296 p.
Miller P, Cannell C. Interviewing for social research. In: Educational research, methodology and measurement: An international handbook. 2nd ed. Oxford: Elsevier Science; 1997. p. 361–70.
Kvale S. InterViews: An Introduction to Qualitative Research Interviewing. 1 edition. Thousand Oaks, Calif: SAGE Publications, Inc; 1996. 344 p.
Bengtsson M. How to plan and perform a qualitative study using content analysis. NursingPlus Open. 2016 Jan 1;2:8–14.
Fischer CT. Bracketing in qualitative research: Conceptual and practical matters. Psychother Res. 2009;19(4–5):583–90.
Gray CP, Harrison MI, Hung D. Medical Assistants as Flow Managers in Primary Care: Challenges and Recommendations. J Healthc Manag Am Coll Healthc Exec. 2016;61(3):181–91.
Vegesna A, Coschignano C, Hegarty SE, Karagiannis T, Polenzani L, Messina E, et al. Attitudes towards physician-nurse collaboration in a primary care team-based setting: Survey-based research conducted in the chronic care units of the Tuscany region of Italy. J Interprof Care. 2016;30(1):65–70.
Harrod M, Weston LE, Robinson C, Tremblay A, Greenstone CL, Forman J. “It goes beyond good camaraderie”: A qualitative study of the process of becoming an interprofessional healthcare “teamlet”. J Interprof Care. 2016 May;30(3):295–300.
Patterson C, Arthur H, Peachey G, Vohra J, Price D, Pearson D, et al. Planning for interprofessional change in primary health care: exploring the use of the Interprofessional Resource Centre. Adv Med Educ Pract. 2013;4:117–25.
Irvine R, Kerridge I, McPhee J, Freeman S. Interprofessionalism and ethics: consensus or clash of cultures? J Interprof Care. 2002 Jan 1;16(3):199–210.
Pullon S. Competence, respect and trust: key features of successful interprofessional nurse-doctor relationships. J Interprof Care. 2008 Mar;22(2):133–47.
Macdonald MB, Bally JM, Ferguson LM, Lee Murray B, Fowler-Kerry SE, Anonson JMS. Knowledge of the professional role of others: a key interprofessional competency. Nurse Educ Pract. 2010 Jul;10(4):238–42.
Lawn S, Lloyd A, King A, Sweet L, Gum L. Integration of primary health services: being put together does not mean they will work together. BMC Res Notes. 2014;7:66.
Soubhi H, Bayliss EA, Fortin M, Hudon C, van den Akker M, Thivierge R, et al. Learning and Caring in Communities of Practice: Using Relationships and Collective Learning to Improve Primary Care for Patients with Multimorbidity. Ann Fam Med. 2010 Mar;8(2):170–7.
Croxson CH, Ashdown HF, Hobbs FR. GPs’ perceptions of workload in England: a qualitative interview study. Br J Gen Pr. 2017 Feb 1;67(655):e138–47.
Grumbach K, Bodenheimer T. Can Health Care Teams Improve Primary Care Practice? JAMA. 2004 Mar 10;291(10):1246–51.
Shaw EK, Howard J, Etz RS, Hudson SV, Crabtree BF. How Team-Based Reflection Affects Quality Improvement Implementation: A Qualitative Study. Qual Manag Health Care. 2012;21(2):104–13.
Bidwell S, Thompson L. GPs, community pharmacists and shifting professional boundaries - New Zealand Medical Journal [Internet]. 2015 [cited 2017 May 14]. Available from: https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2015/vol-128-no-1414-15-may-2015/6533
Naccarella L. General practitioner networks matter in primary health care team service provision. Aust J Prim Health. 2009;15(4):312–8.
Jaruseviciene L, Liseckiene I, Valius L, Kontrimiene A, Jarusevicius G, Lapão LV. Teamwork in primary care: perspectives of general practitioners and community nurses in Lithuania. BMC Fam Pract. 2013 Aug 15;14:118.
Brown JS, Duguid P. Organizational learning and communities-of-practice: Toward a unified view of working, learning, and innovation. Organ Sci. 1991;2(1):40–57.
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