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. 2003 Oct;79(936):553–560. doi: 10.1136/pmj.79.936.553

Future of primary healthcare education: current problems and potential solutions

J Lord 1
PMCID: PMC1742841  PMID: 14612596

Abstract

This review examines the origins of primary care and the pressures currently faced in terms of patient expectation, regulation, accountability, and work force shortages. It recognises the appropriateness of adding to the burden in primary care further by the shift both of more services and more medical education from secondary care. Some conclusions are drawn concerning potential solutions including skill mix changes, centralisation of services, a change in attitudes to professional mistakes, increased protected development time, evidence based education, and academic, leadership, and feedback skills for general practitioners. Six recommendations are offered as a prescription for organisational and educational change.

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Selected References

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  1. Aylin P., Majeed F. A., Cook D. G. Home visiting by general practitioners in England and Wales. BMJ. 1996 Jul 27;313(7051):207–210. doi: 10.1136/bmj.313.7051.207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bonati M. Primary care is natural place for clinical research and practice. BMJ. 2000 Dec 16;321(7275):1529–1529. [PMC free article] [PubMed] [Google Scholar]
  3. Bower Peter, Roland Martin, Campbell John, Mead Nicola. Setting standards based on patients' views on access and continuity: secondary analysis of data from the general practice assessment survey. BMJ. 2003 Feb 1;326(7383):258–258. doi: 10.1136/bmj.326.7383.258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bridge D. T., Gilbert J. An international work exchange: better than a midlife crisis. BMJ. 1998 Dec 19;317(7174):1709–1710. doi: 10.1136/bmj.317.7174.1709. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Brown C. A., Belfield C. R., Field S. J. Cost effectiveness of continuing professional development in health care: a critical review of the evidence. BMJ. 2002 Mar 16;324(7338):652–655. doi: 10.1136/bmj.324.7338.652. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Buchan J., Edwards N. Nursing numbers in Britain: the argument for workforce planning. BMJ. 2000 Apr 15;320(7241):1067–1070. doi: 10.1136/bmj.320.7241.1067. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Campbell S. M., Hann M., Hacker J., Burns C., Oliver D., Thapar A., Mead N., Safran D. G., Roland M. O. Identifying predictors of high quality care in English general practice: observational study. BMJ. 2001 Oct 6;323(7316):784–787. doi: 10.1136/bmj.323.7316.784. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Crawford Mike J., Rutter Deborah, Manley Catherine, Weaver Timothy, Bhui Kamaldeep, Fulop Naomi, Tyrer Peter. Systematic review of involving patients in the planning and development of health care. BMJ. 2002 Nov 30;325(7375):1263–1263. doi: 10.1136/bmj.325.7375.1263. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Davies C. Getting health professionals to work together. BMJ. 2000 Apr 15;320(7241):1021–1022. doi: 10.1136/bmj.320.7241.1021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Davies H. T., Nutley S. M. Developing learning organisations in the new NHS. BMJ. 2000 Apr 8;320(7240):998–1001. doi: 10.1136/bmj.320.7240.998. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Finlayson Belinda, Dixon Jennifer, Meadows Sandra, Blair George. Mind the gap: the extent of the NHS nursing shortage. BMJ. 2002 Sep 7;325(7363):538–541. doi: 10.1136/bmj.325.7363.538. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Freeman George K., Horder John P., Howie John G. R., Hungin A. Pali, Hill Alison P., Shah Nayan C., Wilson Andrew. Evolving general practice consultation in Britain: issues of length and context. BMJ. 2002 Apr 13;324(7342):880–882. doi: 10.1136/bmj.324.7342.880. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Green J. M. The views of singlehanded general practitioners: a qualitative study. BMJ. 1993 Sep 4;307(6904):607–610. doi: 10.1136/bmj.307.6904.607. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hippisley-Cox J., Pringle M., Coupland C., Hammersley V., Wilson A. Do single handed practices offer poorer care? Cross sectional survey of processes and outcomes. BMJ. 2001 Aug 11;323(7308):320–323. doi: 10.1136/bmj.323.7308.320. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Horrocks Sue, Anderson Elizabeth, Salisbury Chris. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ. 2002 Apr 6;324(7341):819–823. doi: 10.1136/bmj.324.7341.819. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Hutchinson L. Evaluating and researching the effectiveness of educational interventions. BMJ. 1999 May 8;318(7193):1267–1269. doi: 10.1136/bmj.318.7193.1267. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Hutchinson L., Marks T., Pittilo M. The physician assistant: would the US model meet the needs of the NHS? BMJ. 2001 Nov 24;323(7323):1244–1247. doi: 10.1136/bmj.323.7323.1244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Jenkins Linda, Britten Nicky, Barber Nick, Bradley Colin P., Stevenson Fiona A. Consultations do not have to be longer. BMJ. 2002 Aug 17;325(7360):388–388. doi: 10.1136/bmj.325.7360.388. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Jones M. Walk-in primary medical care centres: lessons from Canada. BMJ. 2000 Oct 14;321(7266):928–931. doi: 10.1136/bmj.321.7266.928. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Kinnersley P., Anderson E., Parry K., Clement J., Archard L., Turton P., Stainthorpe A., Fraser A., Butler C. C., Rogers C. Randomised controlled trial of nurse practitioner versus general practitioner care for patients requesting "same day" consultations in primary care. BMJ. 2000 Apr 15;320(7241):1043–1048. doi: 10.1136/bmj.320.7241.1043. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Kmietowicz Z. Quarter of GPs want to quit, BMA survey shows. BMJ. 2001 Oct 20;323(7318):887–887. doi: 10.1136/bmj.323.7318.887. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Lattimer V., Sassi F., George S., Moore M., Turnbull J., Mullee M., Smith H. Cost analysis of nurse telephone consultation in out of hours primary care: evidence from a randomised controlled trial. BMJ. 2000 Apr 15;320(7241):1053–1057. doi: 10.1136/bmj.320.7241.1053. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Mayor Susan. England short of 970 GPs. BMJ. 2003 Feb 1;326(7383):243–243. doi: 10.1136/bmj.326.7383.243/a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. McNiece R., Majeed A. Socioeconomic differences in general practice consultation rates in patients aged 65 and over: prospective cohort study. BMJ. 1999 Jul 3;319(7201):26–28. doi: 10.1136/bmj.319.7201.26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Mittman David E., Cawley James F., Fenn William H. Physician assistants in the United States. BMJ. 2002 Aug 31;325(7362):485–487. doi: 10.1136/bmj.325.7362.485. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Norman Geoff. Research in medical education: three decades of progress. BMJ. 2002 Jun 29;324(7353):1560–1562. doi: 10.1136/bmj.324.7353.1560. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. O'Neil E. Leading to well-being: the 5 key elements of healthy leadership. West J Med. 2001 Jan;174(1):34–36. doi: 10.1136/ewjm.174.1.34. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Petersen S. Time for evidence based medical education. BMJ. 1999 May 8;318(7193):1223–1224. doi: 10.1136/bmj.318.7193.1223. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Prideaux David. Researching the outcomes of educational interventions: a matter of design. RTCs have important limitations in evaluating educational interventions. BMJ. 2002 Jan 19;324(7330):126–127. doi: 10.1136/bmj.324.7330.126. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Puddester D. The Canadian Medical Association's Policy on Physician Health and Well-being. West J Med. 2001 Jan;174(1):5–7. doi: 10.1136/ewjm.174.1.5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Reason J. Human error: models and management. BMJ. 2000 Mar 18;320(7237):768–770. doi: 10.1136/bmj.320.7237.768. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Richards David A., Meakins Joan, Tawfik Jane, Godfrey Lesley, Dutton Evelyn, Richardson Gerald, Russell Daphne. Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs. BMJ. 2002 Nov 23;325(7374):1214–1214. doi: 10.1136/bmj.325.7374.1214. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Shum C., Humphreys A., Wheeler D., Cochrane M. A., Skoda S., Clement S. Nurse management of patients with minor illnesses in general practice: multicentre, randomised controlled trial. BMJ. 2000 Apr 15;320(7241):1038–1043. doi: 10.1136/bmj.320.7241.1038. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Sibbald Bonnie, Bojke Chris, Gravelle Hugh. National survey of job satisfaction and retirement intentions among general practitioners in England. BMJ. 2003 Jan 4;326(7379):22–22. doi: 10.1136/bmj.326.7379.22. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Smith R. Why are doctors so unhappy? There are probably many causes, some of them deep. BMJ. 2001 May 5;322(7294):1073–1074. doi: 10.1136/bmj.322.7294.1073. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Squires Ben, Learmonth Ian. Empowerment of patients---fact or fiction? BMJ. 2003 Mar 29;326(7391):710–710. doi: 10.1136/bmj.326.7391.710. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Timmins N. The jewel in welfare's crown. The NHS will glisten still if it retains middle class support. BMJ. 1998 Jul 4;317(7150):2–3. doi: 10.1136/bmj.317.7150.2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Venning P., Durie A., Roland M., Roberts C., Leese B. Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care. BMJ. 2000 Apr 15;320(7241):1048–1053. doi: 10.1136/bmj.320.7241.1048. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Walshe Kieran. The rise of regulation in the NHS. BMJ. 2002 Apr 20;324(7343):967–970. doi: 10.1136/bmj.324.7343.967. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Watkins S. J. Conviction by mathematical error? Doctors and lawyers should get probability theory right. BMJ. 2000 Jan 1;320(7226):2–3. doi: 10.1136/bmj.320.7226.2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. White C. Doctor referred to GMC after inquiry into epilepsy diagnoses. BMJ. 2001 Dec 8;323(7325):1323–1323. doi: 10.1136/bmj.323.7325.1323. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Wilkes M., Bligh J. Evaluating educational interventions. BMJ. 1999 May 8;318(7193):1269–1272. doi: 10.1136/bmj.318.7193.1269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Williams M., Neal R. D. Time for a change? The process of lengthening booking intervals in general practice. Br J Gen Pract. 1998 Nov;48(436):1783–1786. [PMC free article] [PubMed] [Google Scholar]
  44. Williams W. O. A survey of doctorates by thesis among general practitioners in the British Isles from 1973 to 1988. Br J Gen Pract. 1990 Dec;40(341):491–494. [PMC free article] [PubMed] [Google Scholar]
  45. Wilson S., Delaney B. C., Roalfe A., Roberts L., Redman V., Wearn A. M., Hobbs F. D. Randomised controlled trials in primary care: case study. BMJ. 2000 Jul 1;321(7252):24–27. doi: 10.1136/bmj.321.7252.24. [DOI] [PMC free article] [PubMed] [Google Scholar]

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