A new vision for general practice: WISE GP

Two staff in a GP surgery in discussion

General practice manages some of the most complex problems in modern healthcare. Every day, GPs consult growing numbers of people whose healthcare needs are complex, varied and changing.

Dr Annabelle Machin and Professor Joanne Reeve

Dr Annabelle Machin and Professor Joanne Reeve, who are driving change in general practice

Dr Annabelle Machin and Professor Joanne Reeve, who are driving change in general practice

Understanding and addressing such complexity requires clinicians with the skills and confidence to work beyond single disease guidelines, so that they can deliver tailored healthcare.

GPs work to explore multiple perspectives on a problem, use what they see to develop tailored explanations of a problem and management plans, and so evaluate the outcome. This is known as the ‘knowledge work’ of expert generalist practice.

However, current healthcare is rooted in a model designed to treat specific diseases, and as such often struggles to meet the complex demands faced by patients seen in today’s everyday practice.

Recognising this shift in clinical need, researchers at Hull York Medical School have developed WiseGP, a programme of work which champions the ‘knowledge work’ of modern general practice, to overcome these challenges and reclaim whole-person healthcare.

Led by Professor Joanne Reeve, Professor of Primary Care, the WiseGP initiative is a pioneering effort aimed at reclaiming the very essence of general practice.

Challenges in traditional healthcare: A need for transformation

Professor Reeve recognises the traditional model of primary healthcare falls short in addressing the dynamic healthcare needs faced by today’s patients.

Professor Reeve explains, “Each day, GPs engage with a diverse range of patients, each presenting their unique healthcare challenges. This complexity demands clinicians with the skills and confidence to move beyond rigid disease guidelines and tailor healthcare to individual needs.

"This nuanced approach, referred to as 'knowledge work,' involves evaluating multiple perspectives and outcomes to provide tailored comprehensive care.”

The WiseGP programme seeks to bridge this gap by promoting, advancing, and sustaining the distinct knowledge work of primary healthcare.

WiseGP recognises that change is needed, as the current model of primary care is contributing to clinician burnout, patient dissatisfaction, and an overwhelmed system, as practices attempt to navigate nearly 31 million consultations a month.

Dr Annabelle Machin, a portfolio GP and WiseGP fellow, emphasises the complexity of being a general practitioner.

“While the public often perceives GPs as diagnosing simple problems and offering quick solutions, the reality is actually very nuanced"
Dr Annabelle Machin

“WiseGP aims to shift this way of working, encouraging a more profound understanding of healthcare complexities and fostering patient-centred care.”

How WiseGP works in practice

WiseGP isn't just an abstract vision - it's a comprehensive support system designed to empower front-line clinicians and transform the landscape of primary healthcare.

With the aim of boosting clinicians’ confidence in handling complex issues and fostering continuous learning, WiseGP offers an array of resources and tools tailored to the challenges faced by modern healthcare professionals.

The crux of WiseGP's offerings lies in recognising the limitations of traditional guidelines and care pathways when dealing with the intricate healthcare issues of today. Many patient scenarios simply can't be neatly packaged into a single directive.

Instead, GPs must engage in the distinct knowledge work of primary medical care/general practice to navigate complex problems and provide effective solutions for their patients.

To overcome these challenges, WiseGP provides a range of resources on the WiseGP website, carefully curated to address the unique barriers faced by GPs in transcending guidelines.

The initial funding for WiseGP came from the Society for Academic Primary Care and the NIHR School for Primary Care Research. These organisations played a pivotal role in setting up the foundational framework for the initiative, including the establishment of the dedicated website for WiseGP.

This website served as a platform to articulate the vision behind WiseGP and began hosting essential resources to support the initiative's objectives. Further development of the website has been supported by funding from Hull York Medical School.

These resources include:

  • WiseStories and short animations: These tools offer a deep dive into the concept of knowledge work, highlighting its integral role in everyday professional practice. By showcasing real-life instances of successful knowledge work, WiseStories and animations inspire clinicians to embrace this approach and incorporate it into their own practice.
  • WiseGP newsletter and Wise GEMs: Keeping clinicians at the forefront of innovative practice, the WiseGP newsletter and Wise GEMs deliver valuable insights, ideas, and resources. Designed to catalyse the development of knowledge work skills, these resources offer a practical starting point for clinicians looking to expand their capabilities.
  • WiseGP blog: The blog serves as a platform for clinicians to share their first-hand experiences of knowledge work in action. By contributing to this collective knowledge pool, clinicians not only enrich the general practice community but also inspire others to explore and apply knowledge work principles.
  • WISDOM: practical training in everyday knowledge work of modern practice – developed with financial support from Health Education England Yorkshire
Stethoscope

How WiseGP came about

The seeds of WiseGP were sown during a pivotal workshop held at the Royal College of General Practitioners conference in 2017.

The event gathered an overwhelming turnout, with around 120 participants filling the room.

At the heart of the workshop was a candid discussion about the formidable challenges faced by GPs in their roles. This led to the realisation that a shift was necessary – a new way of thinking about practice. The notion of ‘clinical scholarship’ began to emerge as a focal point in the discussions, with attendees recognising the need for GPs to take ownership of their professional practice and development.

The participants, determined to bridge the gap between the daily experiences of practicing GPs and academic scholarship, felt that an initiative was needed to empower GPs themselves to develop the tools and insights they needed to thrive in their roles.

Through subsequent dialogues with various stakeholders, including GPs, the Royal College of General Practitioners, the Society for Academic Primary Care, and university colleagues, WiseGP was born.

The term WiseGP not only encapsulated the essence of wise general practice but also resonated more effectively with the GP community. WiseGP came to symbolise the collective effort of GPs and their general practice colleagues to navigate the intricate landscape of modern healthcare with wisdom, practical insights, and a commitment to continuous learning.

The journey from that packed workshop in 2017 to the inception of WiseGP was a testament to the collaborative spirit, the willingness to challenge established norms, and the determination to equip GPs with the tools and mindset needed to thrive in an ever-evolving healthcare landscape.

Dr Machin shed light on the Wise GEMs initiative, outlining its purpose within the context of time constraints faced by busy GPs.

She explained, “The GEMs library highlights research that doctors can apply in practice. The thought behind GEMs was that often busy GPs don't have the time to read detailed research articles, so we have made it really easy to find and use the latest research.”

Professor Reeve related the alignment between the Wise GEMs initiative and the feedback received during the initial workshop back in 2017.

She explained, “It relates back to that very first workshop, where GPs said research is something somebody else does, and they don’t have the time or the skills to do it.

“The Wise GEMs initiative, however, empowers GPs by portraying research as a practical tool that can be used in everyday practice.”

The ripple effect of WiseGP

Dr Machin shared her perspective on the transformative impact of her involvement in the WiseGP initiative, stating, “I found it inspiring working with Professor Reeve. Being involved in it made me think differently about my practice and be a better GP, and I think I also have a positive influence on the trainees I work with in practice.”

Her experience working alongside Professor Reeve and contributing to WiseGP led her to view her own practice through a fresh lens, resulting in personal growth as a GP. This transformation not only benefited her individual practice but also had a ripple effect on students and colleagues she mentors, in addition to collaborators, enhancing their approaches to patient care.

Professor Reeve echoed these sentiments and shared her personal journey and motivation behind her involvement in the WiseGP initiative.

She reflected, "Chaos crisis creates an opportunity for something different and so that's what it is for me, is the chance to actually make a difference.”

Professor Reeve's words reflected her profound drive in seizing the chance presented by challenges and disruptions to bring about transformation in healthcare. While she acknowledged that her phrasing might sound grand, her underlying message was clear: WiseGP represents an avenue for her to enact impactful change and steer healthcare in a more positive direction.

For more information visit the WiseGP website, or contact Professor Joanne Reeve, Director of the Academy of Primary Care.