RESUMO
BACKGROUND: General Practice (GP) is an essential part of healthcare systems in the UK and internationally but continues to struggle with recruitment. Despite these concerns about GP recruitment, few studies have explored factors that influence medical students' career choices around primary care. AIM: We aimed to re-visit factors previously proposed following new ways of working adopted since the COVID-19 pandemic, including the impact of these changes on learning experiences in primary care. DESIGN & SETTING: A qualitative study using focus groups across three English medical schools. METHOD: Eight focus groups involving thirty-three final and penultimate year medical students. Qualitative data analysed using a framework approach. Transcripts coded independently by two researchers from a different institution before themes identified. RESULTS: Six themes were identified: students' prior career aspirations, their experience of the medical school curriculum, conceptualisation of general practice, future career predictions, views on the school's curriculum philosophy and the influence of the COVID-19 pandemic. The curriculum philosophy of each school appeared was important in this journey and changes since the COVID-19 had an impact on all themes. CONCLUSION: Our study has confirmed previous findings that clinical experiences, the perceived narrative of the school, work-life balance and working environment remain important to students in making career plans. However, in addition, we have found the changing landscape in general practice since the covid pandemic, including remote consulting, workload, continuity of care and team-working are additional factors that concern students.
RESUMO
BACKGROUND: General practitioners (GPs) are increasingly pressured to prescribe cost-effectively, due to rising prescribing expenditure and limited budgets. A computerised prescribing substitution application (ScriptSwitch(®)) provides 'pop-ups' of cost-saving drug switches at the point of prescribing. It has been used by some United Kingdom local health commissioning organisations as part of a medicines management strategy. OBJECTIVE: To explore GPs' views on using this prescribing substitution application in their day-to-day clinical practice. METHODS: Qualitative study employing face-to-face semi-structured interviews, undertaken with a convenience sample of eight GPs across five practices within one local health commissioning area in the North of England. Interviews were audio-recorded, transcribed verbatim and thematically analysed. RESULTS: Six themes were identified including: (1) GPs' acceptance, (2) the application's impact, (3) external control, (4) disruption to workflow, (5) GP willingness to switch and (6) patient willingness to switch. CONCLUSIONS: Clinician, patient and organisational factors were identified which were assumed by GPs to affect the engagement with the application. Despite general acceptance of the application to enhance cost-effective prescribing, its impact was perceived to be limited within the context of existing cost-effective prescribing initiatives. The application's perceived lack of 'learning'-e.g. offering the same switch despite the prescriber repeatedly declining this-devalued users' confidence in it. With patients varying in amenability and acceptance to drug switches, GPs appear to experience tension between considering individual patient choice and wider practice population prescribing priorities. Giving GPs more control in adapting the application to their own local prescribing priorities may enhance its success.
