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Table 1 Assessing capacity for expert generalist practice in the management of multi-morbidity

From: Generalist solutions to complex problems: generating practice-based evidence - the example of managing 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
  1. * robust enough to last within a changing healthcare context.