Managing epilepsy in primary care. A qualitative study and logic model.

Problem

Epilepsy management in primary care is a good example of care for chronic conditions, balancing the need for good quality primary care, which also must support the profound social and psychological impact of the condition, with the need for communication with specialists in secondary care. To the best of our knowledge, the GPs with an extended role (GPwER), formerly known as GPs with a special interest (GPwSI), have never been compared to GPs for the delivery of care for people with epilepsy (PWE) until this ongoing research project.

Approach

This qualitative interview study informed by a scoping review of literature recruited GPs and GPwERs (target sample size of 15-20 participants per group) analysing and comparing their responses separately . Questions were developed using the European Service Mappin Schedule to describe the service, the availability of care, resource use and service characteristics (Romero-Lopez-Alperca et al., 2019) combined with theoretical propositions jointly developed from the scoping review findings and a framework for primary care ‘the united model of generalism’ (Reeve and Byng, 2017). Results from individual interviews were collectively used to produce logic models representing outcomes for people with epilepsy.

Findings

We identified system level conditions facilitating training to become a GPwER: exposure to neurology after qualifying as a doctor, research opportunities to explore epilepsy and epilepsy management, and a strong, continuing professional relationships with neurologists. for opting to act as a GPwER in epilepsy, rather than a standard GP. Without these preconditions, GPs typically were unable to build the required epilepsy specific knowledge and epilepsy related professional networks to become a GPwER. The importance of the generalist skill set of a GP was relevant for epilepsy management and engaging in ‘whole person care’. While both groups held these skills, GPwER were more adept at navigating demand management during consultations, while GPs were often limited to referrals to secondary care. Participants attributed the low uptake of GPwER roles across the country to a lack of personal relationships and experiences with neurology, but GPwERs who did participate were able to demonstrate several examples of service models which are highly appreciated by patients and specialists alike.

Consequences

The role of GPwERs in epilepsy is not widespread across the country, but benefits from strong support from the International League Against Epilepsy’s British Branch. It is hoped that the logic model produced from the research will demonstrate the strengths in providing primary care for people with epilepsy can lead to better outcomes for: complex cases, those at risk of experiencing poor outcomes and also for all people with epilepsy who require ‘whole person care’ as opposed to fragmented treatment of their condition between primary care and secondary care.