Enablers and barriers to delivering tailored, whole-person care in general practice for people living with multimorbidity: implications for service redesign

Abstract

Background: Growing numbers of people live with multimorbidity. Healthcare needs to change to adequately address the complexity and burden of their needs Research, practice and policy have called for a shift to whole-person, tailored primary care management of multimorbidity. But we still don’t know how best to do that. Our previous research described a theoretical model of tailored primary care. In this new work, we critically examine if and how front-line practice supports and develops our proposed model and so comment on the implications for practice Methods: Focused ethnography of 5 UK GP sites, conducting 100 hours of observations, focus groups and mini-interviews. Two-stage analysis: i) inductive thematic analysis of full data set to describe enablers/barriers to tailored care; ii) normalisation process theory informed analysis of implications to present a new implementation model. Results: We identified three elements needed to enables tailored management : (i) resources for exploration of and practical support for beyond biomedical management of multi-morbidities, (ii) engagement of patients/carers with professional collaboration to co-create tailored management plans, and (iii) the professional training and skills required to confidently work beyond traditional condition-focused models Conclusions: Our work supports and extends our previous work, describing the elements needed for implementation of the complex intervention needed to deliver tailored generalist management of multimorbidity in primary care. We describe our ongoing work to test the assumptions of the model within a new study of care for people living with dementia