Table 1 Assessing capacity for expert generalist practice in the management of multi-morbidity
Patient factors | Practitioner factors | Health system factors | Is investment sustained*? | |
|---|---|---|---|---|
Sense making | Understand illness as a personal challenge [30] in which they are an active partner (rather than passive recipient of technical fix) | Value personalised decision making and the effort of interpretive practice | Policy and strategy recognise | Training of next generation |
Organisational memory | ||||
Engagement | Able and willing to access expert generalist care | Able and willing to make space within working practice to engage in EGP | Policy and organisational systems designed to recognise multi-morbidity as needing personalised care | Continuity of service and care |
Action | Patients with the energy and resource to be active partners | Practitioners have skills and resources for interpretive practice (access to range of knowledge including through communication skills, time and support for interpretation and critical review) | System design creates time, space and resource for actions | Stability of service |
Monitoring | Patient feedback recognises impact of care on health as a resource for living | Personal and collective professional reflection supports the critical analysis of judgements made in personalised decision making | Quality markers and performance management recognise EGP | Feedback integrated into ongoing service development – action learning principles |