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2.  Examining the practice of generalist expertise: a qualitative study identifying constraints and solutions 
JRSM Short Reports  2013;4(12):2042533313510155.
Provision of person-centred generalist care is a core component of quality primary care systems. The World Health Organisation believes that a lack of generalist primary care is contributing to inefficiency, ineffectiveness and inequity in healthcare. In UK primary care, General Practitioners (GPs) are the largest group of practising generalists. Yet GPs fulfil multiple roles and the pressures of delivering these roles along with wider contextual changes create real challenges to generalist practice. Our study aimed to explore GP perceptions of enablers and constraints for expert generalist care, in order to identify what is needed to ensure health systems are designed to support the generalist role.
Qualitative study in General Practice.
UK primary care.
Main outcome measures
A qualitative study – interviews, surveys and focus groups with GPs and GP trainees. Data collection and analysis was informed by Normalisation Process Theory.
Design and setting
Qualitative study in General Practice. We conducted interviews, surveys and focus groups with GPs and GP trainees based mainly, but not exclusively, in the UK. Data collection and analysis were informed by Normalization Process Theory.
UK based GPs (interview and surveys); European GP trainees (focus groups).
Our findings highlight key gaps in current training and service design which may limit development and implementation of expert generalist practice (EGP). These include the lack of a consistent and universal understanding of the distinct expertise of EGP, competing priorities inhibiting the delivery of EGP, lack of the consistent development of skills in interpretive practice and a lack of resources for monitoring EGP.
We describe four areas for change: Translating EGP, Priority setting for EGP, Trusting EGP and Identifying the impact of EGP. We outline proposals for work needed in each area to help enhance the expert generalist role.
PMCID: PMC3899736  PMID: 24475347
generalism; generalist practice; normalisation process theory; primary care; generalist expertise
3.  A Novel Electronic Data Collection System for Large-Scale Surveys of Neglected Tropical Diseases 
PLoS ONE  2013;8(9):e74570.
Large cross-sectional household surveys are common for measuring indicators of neglected tropical disease control programs. As an alternative to standard paper-based data collection, we utilized novel paperless technology to collect data electronically from over 12,000 households in Ethiopia.
We conducted a needs assessment to design an Android-based electronic data collection and management system. We then evaluated the system by reporting results of a pilot trial and from comparisons of two, large-scale surveys; one with traditional paper questionnaires and the other with tablet computers, including accuracy, person-time days, and costs incurred.
Principle Findings
The electronic data collection system met core functions in household surveys and overcame constraints identified in the needs assessment. Pilot data recorders took 264 (standard deviation (SD) 152 sec) and 260 sec (SD 122 sec) per person registered to complete household surveys using paper and tablets, respectively (P = 0.77). Data recorders felt a lack of connection with the interviewee during the first days using electronic devices, but preferred to collect data electronically in future surveys. Electronic data collection saved time by giving results immediately, obviating the need for double data entry and cross-correcting. The proportion of identified data entry errors in disease classification did not differ between the two data collection methods. Geographic coordinates collected using the tablets were more accurate than coordinates transcribed on a paper form. Costs of the equipment required for electronic data collection was approximately the same cost incurred for data entry of questionnaires, whereas repeated use of the electronic equipment may increase cost savings.
Conducting a needs assessment and pilot testing allowed the design to specifically match the functionality required for surveys. Electronic data collection using an Android-based technology was suitable for a large-scale health survey, saved time, provided more accurate geo-coordinates, and was preferred by recorders over standard paper-based questionnaires.
PMCID: PMC3774718  PMID: 24066147
4.  Motivation and satisfaction in GP training: a UK cross-sectional survey 
The British Journal of General Practice  2011;61(591):e645-e649.
Recruitment to general practice has had periods of difficulty, but is currently going through a phase of relative popularity in the UK.
To explore motivators for career choice and career satisfaction among UK GP trainees and newly qualified GPs.
Design and setting
Cross-sectional web-based questionnaire of GP trainees and GPs within the first 5 years of qualification in the UK.
All 9557 UK GP trainees and 8013 GPs who were within the first 5 years of qualification were invited to participate by email. Further publicity was conducted via general practice publications and the internet.
Overall, there were 2178 responses to the questionnaire (12.4% response rate, 61.5% women, 61.8% trainees). Levels of satisfaction were high, with 83% of responders stating that they would choose to be a doctor again; of these, 95% would choose to be a GP again. The most frequently cited reason for choosing general practice was ‘compatibility with family life’, which was chosen by 76.6% of women and 63.2% of men (P<0.001). Other reasons given were: ‘challenging medically diverse discipline’ (women 59.8%, men 61.8%, P = 0.350), ‘the one-to-one care general practice offers’ (women 40.0%, men 41.2%, P = 0.570), ‘holistic approach’ (women 41.4%, men 30.1%, P<0.001), ‘autonomy and independence’ (women 18.0%, men 34.8%, P<0.001), ‘communication’ (women 20.6%, men 12.2%, P<0.001), ‘negative experiences in hospital’ (women 12.8%, men 9.8%, P= 0.036), and ‘good salary’ (women 7.8%, men 14.9%, P<0.001).
The most important reason for both women and men choosing general practice as a career in the UK is its compatibility with family life. As such, changes to UK primary care that decrease family compatibility could negatively impact on recruitment.
PMCID: PMC3177133  PMID: 22152846
career choice; family practice; job satisfaction; medical education; motivation; questionnaires
7.  Fractured: picking up the pieces 
BMJ : British Medical Journal  2007;334(7606):1275.
An author's fractured arm led to a book on the intrusive surveillance of doctors, finds Jessica Watson
PMCID: PMC1892509
8.  Fas-mediated elimination of antigen-presenting cells and autoreactive T cells contribute to prevention of autoimmunity 
Immunity  2007;26(5):629-641.
Fas (Apo-1, CD95) receptor has been suggested to control T cell expansion by triggering T cell-autonomous apoptosis. This paradigm is based on the extensive lymphoproliferation and systemic autoimmunity in mice and humans lacking Fas or its ligand. However, with systemic loss of Fas, it is unclear whether T cell-extrinsic mechanisms contribute to autoimmunity. We found that tissue-specific deletion of Fas in mouse antigen presenting cells (APC) was sufficient to cause systemic autoimmunity, implying that normally APC are destroyed during immune responses via a Fas-mediated mechanism. Fas expression by APC was increased by exposure to microbial stimuli. Analysis of mice with Fas loss restricted to T cells revealed that Fas indeed controls autoimmune T cells, but not T cells responding to strong antigenic stimulation. Thus, Fas-dependent elimination of APC is a major regulatory mechanism curbing autoimmune responses and acts in concert with Fas-mediated regulation of chronically activated autoimmune T cells.
PMCID: PMC2575811  PMID: 17509906

Results 1-8 (8)