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Background: Primary health care requires new approaches to assist patients with overweight and obesity. This is a particular concern for patients with limited access to specialist or allied health services due to financial cost or location. The Change Program is a toolkit that provides a structured approach for GPs working with patients on weight management., Objective: To assess the acceptability and feasibility of a GP-delivered weight management programme., Methods: A feasibility trial in five Australian general practices with 12 GPs and 23 patients. Mixed methods were used to assess the objective through participant interviews, online surveys and the NOrmalization MeAsure Development (NoMAD) tool based on Normalization Process Theory. Content analysis of interviews is presented alongside Likert scales, free text and the NoMAD tool., Results: The Change Program was acceptable to most GPs and patients. It was best suited to patient-GP dyads where the patient felt a strong preference for GP involvement. Patients' main concerns were the time and possible cost associated with the programme if run outside a research setting. For sustainable implementation, it would have been preferable to recruit a whole practice rather than single GPs to enable activation of systems to support the programme., Conclusion: A GP-delivered weight management programme is feasible and acceptable for patients with obesity in Australian primary health care. The addition of this structured toolkit to support GPs is particularly important for patients with a strong preference for GP involvement or who are unable to access other resources due to cost or location., (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives The aim of the present secondary analysis of data collected in a grounded theory study was to explore the perceptions of Registrars and new Fellows to practice ownership and management. Methods Focus groups and interviews with Registrars and recent Fellows were undertaken to explore the desire to become an owner, facilitators and barriers to practice ownership and delivery models for practice ownership education. A secondary thematic analysis was conducted to understand emerging concepts related to perceptions of general practice ownership. Results A surprisingly strong theme of fear was evident across focus group and interview participants. Expressed fear was specifically related to financial concerns, lack of relevant knowledge and skills and concern over balancing different roles. Moderating factors included previous life and educational experiences, as well as role modelling. Conclusions Graduation of a cohort of new general practitioners (GPs) who express fear towards practice ownership is concerning. Creating more positive learning environments and opportunity for open discussion regarding practice management and ownership is an important step in providing adequate support for new GPs to give serious consideration to career options. What is known about the topic? The traditional model of general practice ownership has been for a doctor to own and/or manage the practice. Fewer new GPs are taking on the role of owning a general practice, and disinterest has been presumed to play a significant role in this trend. It has been reported that current curricula provide insufficient focus on providing learning opportunities for general practice trainees on ownership and management models; however, recent research has shown that general practice trainees have a strong interest in receiving this knowledge during their training. What does this paper add? The present qualitative research evaluated the emotional response that general practice trainees (Registrars) expressed when they considered practice ownership. GP Registrars expressed fear when asked about the prospect of owning their own practice. This may be influenced by the role modelling they receive during their training. What are the implications for practitioners? Supervisors involved in general practice training should ensure their trainees have the opportunity to learn about practice ownership during their training. Supervisors should also be aware that their own behaviour and attitudes towards practice ownership is observed by their trainees and it can colour the emotional response the trainee has when considering owning a practice.

Background: The Prevocational General Practice Placement programme (PGPPP) aims to provide junior doctors with professional, well-supervised, educational rotations in general practice. There is a paucity of literature evaluating the educational effectiveness of the PGPPP. This study aims to compare general practice rotations with hospital rotations, with respect to teaching and support, acquisition of skills and knowledge, and role autonomy., Methods: All junior doctors who participated in a PGPPP rotation were invited to complete a voluntary anonymous online survey using the Postgraduate Hospital Educational Environment Measure (PHEEM) inventory. The PHEEM presents Likert scales grouped into four subscales for participants to rate statements about their rotations. Surveys were completed at the end of the year in which doctors undertook a PGPPP rotation, and covered all rotations. These survey findings were used to compare general practice and hospital rotations., Results: In all four subscales of teaching, clinical skills, social support and role autonomy, the general practice rotation performed as well as, or better than, hospital rotations in the areas of emergency, medicine, and surgery. General practice outperformed all other rotations in 15 out of 20 statements across all subscales., Discussion: This study demonstrates the educational value of a general practice placement in comparison with hospital placements. Expansion of the PGPPP should be considered to provide all junior doctors with the benefits of exposure to generalist skills in the community., (© 2015 John Wiley & Sons Ltd.)

Introduction and Aim: The Australian general practitioner (GP) teaching workforce will need to expand in order to provide for the increasing number of medical students and doctors-in-training. Understanding factors that motivate GPs to become involved in teaching in their clinical practice environments is important for developing recruitment and retention strategies., Method: Thirty-one semi-structured interviews were conducted with a cross section of GP teachers and were subjected to thematic analysis. Themes were identified and further classified as motivations and prerequisites for teaching., Results: The desire to update clinical knowledge was the most frequently mentioned motivation for teaching, and was described as a strategy for GP teachers to preserve clinical competence through the opportunity to learn new aspects of medicine from junior colleagues. Other motivations included personal fulfillment and enjoyment of teaching, the opportunity to pass on general practice skills and knowledge, promoting general practice as a career, and fulfilling a sense of responsibility to the profession and community. Peers, students and patients also influenced the decision to teach. Most GPs identified that time, workload, availability of space and adequate financial remuneration were prerequisites for teaching. Practice owners also often determined the GP teachers' capacity to teach., Discussion: To increase the recruitment and retention of GP teachers, it is recommended that teaching organisations give more recognition to teaching as a clinical professional development activity, place more emphasis on GPs' personal enjoyment, professional responsibility and pride in teaching, and increase engagement with practice owners., (© 2014 John Wiley & Sons Ltd.)

Background: Medical students, junior hospital doctors on rotation and general practice (GP) registrars are undertaking their training in clinical general practices in increasing numbers in Australia. Some practices have four levels of learner. This study aimed to explore how multi-level teaching (also called vertical integration of GP education and training) is occurring in clinical general practice and the impact of such teaching on the learner., Methods: A qualitative research methodology was used with face-to-face, semi-structured interviews of medical students, junior hospital doctors, GP registrars and GP teachers in eight training practices in the region that taught all levels of learners. Interviews were audio-recorded and transcribed. Qualitative analysis was conducted using thematic analysis techniques aided by the use of the software package N-Vivo 9. Primary themes were identified and categorised by the co-investigators., Results: 52 interviews were completed and analysed. Themes were identified relating to both the practice learning environment and teaching methods used.A practice environment where there is a strong teaching culture, enjoyment of learning, and flexible learning methods, as well as learning spaces and organised teaching arrangements, all contribute to positive learning from a learners' perspective.Learners identified a number of innovative teaching methods and viewed them as positive. These included multi-level learner group tutorials in the practice, being taught by a team of teachers, including GP registrars and other health professionals, and access to a supernumerary GP supervisor (also termed "GP consultant teacher"). Other teaching methods that were viewed positively were parallel consulting, informal learning and rural hospital context integrated learning., Conclusions: Vertical integration of GP education and training generally impacted positively on all levels of learner. This research has provided further evidence about the learning culture, structures and teaching processes that have a positive impact on learners in the clinical general practice setting where there are multiple levels of learners. It has also identified some innovative teaching methods that will need further examination. The findings reinforce the importance of the environment for learning and learner centred approaches and will be important for training organisations developing vertically integrated practices and in their training of GP teachers.

Background: Despite low uptake of practice ownership by recent trainees, research has shown that registrars are interested in learning about practice ownership. We aimed to determine how registrars would prefer to learn these skills during general practice training., Methods: A qualitative study using focus groups and semi-structured interviews. Participants were registrars and fellows from the CoastCityCountry General Practice training program. Data was analysed for themes until thematic saturation was achieved., Results: Registrars are interested in learning more about practice ownership in the later stages of training. They need more than just information - they are requesting opportunities to learn from current doctor-owners. Mentorship from doctor-owners was seen to be valuable and could be facilitated through a number of avenues., Discussion: Registrars are keen to learn more about practice ownership. Establishing a mentor relationship with an experienced doctor-owner is essential for this education to succeed.

Background: With a declining Australian general practice workforce, succession planning for practice owners is a pertinent concern. Limited previous research and anecdotal evidence suggests there is minimal interest from general practice registrars in practice ownership., Objective: We conducted a web based survey to investigate the interest of general practice registrars in the Australian Capital Territory and southeast New South Wales in practice ownership, perceived barriers to becoming an owner-operator, and preferred educational activities on this subject., Discussion: We found more interest in practice ownership than previous research suggests. Insufficient knowledge, workload, bureaucracy and finance issues were perceived as barriers to ownership. The registrars favourably rated mentoring, release workshops, and an extended skills post as educational activities through which they prefer to attain skills in this field. Further investigation into effective practice ownership education delivery is warranted.

Background: General practitioners (GPs) have played an integral role in Australia's coronavirus disease 2019 (COVID-19) pandemic response. However, little is known about how GPs themselves have been impacted by the COVID-19 pandemic. This study aimed to increase our understanding of the experiences of GPs working during the COVID-19 pandemic. Methods: A qualitative study was conducted using semi-structured interviews. Using purposive sampling, 15 GPs from South-Eastern Australia were asked to reflect on their experiences during the first year of the COVID-19 pandemic. Interview transcripts underwent thematic analysis. Results: Five main themes were identified: fear of infection; uncertainty and information overload; impacts on the government–GP relationship; impacts on the patient–doctor relationship; and teamwork within practices and among GPs. Conclusions: The 15 GPs interviewed in this study provided valuable insights into their experiences working during the first year of the COVID-19 pandemic. From these insights, four recommendations propose what could be done to help support GPs to respond to a pandemic while continuing to deliver primary health care. Although general practitioners (GPs) have played a crucial role in Australia's COVID-19 pandemic response, few studies have explored the impact of the COVID-19 pandemic on GPs themselves. In this qualitative study, 15 GPs from South-Eastern Australia were asked to reflect on their experiences working during the first year of the COVID-19 pandemic in semi-structured interviews. Their reflections enhance our understanding of the experience of GPs working during the COVID-19 pandemic and may help guide future research and work to support GPs. [ABSTRACT FROM AUTHOR]

Background: Relational aspects of primary care are important, but we have no standard measure for assessment. The 'working alliance' incorporates elements of the therapeutic relationship, shared decision-making, goal setting and communication skills. The Working Alliance Inventory (short form) (WAI-SF) has been used in adult psychology, and a high score on the survey is associated with improved outcomes for clients.Objective: To adapt the WAI-SF for use between GPs and patients and to test its concurrent validity with measures of shared decision-making and the doctor-patient relationship and discriminant validity with measures of social desirability.Methods: Two rounds of online survey feedback from 55 GPs and 47 patients were used to adapt the WAI-SF-the WAI-GP. The tool was then completed by 142 patients in waiting rooms after seeing their GP and by 16 GPs at the end of their session. Concurrent validity with measures of shared decision-making and patient-doctor depth of relationship was determined using Spearman Rho correlations. Patients also completed two social desirability surveys, and discriminant validity with WAI-GP was assessed.Results: Following feedback, the survey was re-worded to remove phrases that were perceived as judgmental or irrelevant. The patient measure of the WAI-GP was strongly correlated with Dyadic OPTION (rho = 0.705, P = 0.0001) and Patient-Doctor Depth of Relationship scale (rho = 0.591, P = 0.0001) and not with measures of social desirability.Conclusion: The psychometric properties of the WAI-GP support its use for measuring GP-patient alliance. Possibilities for use include assessing the influence of therapeutic alliance on the effectiveness of interventions. [ABSTRACT FROM AUTHOR]