The British journal of general practice : the journal of the Royal College of General Practitioners
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There has been a lack of discussion and consensus as to what the role of the general practitioner should be in the care of patients with chronic diseases. Should general practitioners concentrate on the disease or should their remit include the resultant disability and handicap? General practitioners have tended to concentrate on the disease, but this may be inappropriate. ⋯ Greater knowledge among doctors of the functional and social aspects of disease would therefore improve the quality of care for patients, and should be assessed through clinical audit. Ways are described in which general practitioners, working together with their patients with chronic diseases and with other health professionals, can improve aspects of the care of these patients.
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Primary health care services are the most frequently used in the health care system. Consumer feedback on these services is important. Research in this area relates mainly to doctor-patient relationships which fails to reflect the multidisciplinary nature of primary health care. ⋯ The pilot study showed that it is possible to use the consultation satisfaction questionnaire for both general practitioners and community nurses. Comparison between health professional groups should be undertaken with caution as data were available for only a small number of consultations with some of the groups of health professionals studied.
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The present postgraduate education allowance structure for general practitioners is unacceptable and inadequate on a number of counts. Improvements could be made in continuing medical education by involving learners more actively, through giving them greater ownership of their continuing medical education aims and by integrating it with the current moves towards reaccreditation. ⋯ It would be more sensitive to current attitudes, more practical, a better use of existing facilities and more logical to improve continuing medical education by linking its improvement to the evaluation of reaccreditation in as acceptable and simple a way as possible. A framework is proposed, based on an annual educational general practitioner assessment visit in which a personal learning plan is developed as a focus for an individual's continuing medical education needs.
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With the advent of general practitioner fundholding, there has been growth in outreach clinics covering many specialties. The benefits and costs of this model of service provision are unclear. ⋯ The model of ophthalmic outreach care in this pilot study was popular with patients and general practitioners and appeared to act as an effective filter of demand for care in the hospital setting. However, the educational impact of the scheme was limited. Although the unit costs (per patient) of the outreach scheme compared unfavourably with those of conventional outpatient treatment, potential health gains from this more accessible model of care require further exploration.