Supporting and retaining new to practice GPs through training in advanced generalist medicine: An evaluation of the Catalyst programme

Problem

A workforce crisis in general practice is currently associated with both recruitment and retention issues as more and more GPs in the UK report low morale and intention to leave the job. In this context, new to practice (NTP) GPs are feeling unmotivated as they want a fulfilling career, yet describe gaps in their training. Catalyst, a one year pilot professional development programme, was designed to address this crisis by upskilling NTP GPs in advanced generalist practice while building capacity for the complex work of primary care. This study aims to evaluate Catalyst and describe aspects of the programme that contributed to the participants’ learning experience.

Approach

In order to examine the participants’ understanding and application of the principles of generalist medicine we referred to Normalization Process Theory, which explains how new techniques and approaches are embedded and sustained in everyday practice. We designed a qualitative study and conducted 36 interviews (19 at the start and 17 at the end of the first year) and 6 focus groups (conducted once halfway through the year) with enrolled NTP GPs. Data were analysed using Framework Analysis.

Findings

By establishing a shared language and reframing GP roles, GPs were able to understand and define generalist approaches while affirming their own professional identity in an empowering way. Discussions of both scientific evidence and applied knowledge (e.g., clinical scenarios and experiences) through facilitated interactive learning further legitimised such approaches when GPs had to deviate from clinical guidelines. Finally, structured reflection and monitoring of quality improvement projects improved the participants’ awareness of the system in which they worked.

Consequences

The importance of building a community of practice was evident as the participants valued the peer support they got throughout the programme, along with the opportunities to share and learn from a variety of clinical experiences. This way, and by using evidence to stimulate discussions on generalist medicine, Catalyst enabled knowledge creation activities that led the enrolled GPs to develop confidence in their own generalist skills. Finally, involvement in research informed, comprehensive quality improvement projects, allowed for the reflexive analysis of problems and solutions, improving the participating GPs’ sense of agency and motivation to shape the primary care context.