Tensions between policy makers and general practitioners in implementing new genetics: grounded theory interview study

BMJ 1999;319:1410-1413 ( 27 November )

General Practice

Tensions between policy makers and general practitioners in implementing new genetics: grounded theory interview study

Satinder Kumar, clinical research fellow, ^a Madeleine Gantley, senior lecturer. ^b

^a Department of Primary Medical Care, University of Southampton, Southampton SO16 5ST, ^b Department of General Practice and Primary Care, St Bartholomew's and Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS

Correspondence to: S Kumar skk{at}soton.ac.uk

Objective: To explore general practitioners' perceptionsof their role in implementing genetictechnology.
Design: Grounded theory interviewstudy.
Setting: Primarycare.
Subjects: Purposive sample of 30 general practitionerswith a further theoretical sample of14.
Results: Inconsistencies were identified between policymakers' and general practitioners' definitions of general practitioners'role in implementing the new genetics. General practitioners emphasisedthe need to build on current practice, whereas policy makers focusedon transforming practice to include the new specialised rolesand skills. Two core themes were identified: genetics in a generalistcontext, which included appropriate generalist intervention, theethical dilemmas implicit in the "therapeutic gap," the familial-hereditarydistinction in primary care, and the implications for generalistidentity, including the potential marginalisation ofgeneralism.
Conclusion: New technologies such as genetics that requireimplementation in general practice should be integrated withinexisting generalistframeworks.

Key messages

Tensions exist between the role of general practitioners in implementing genetic advances identified by policy makers and that identified by general practitioners themselves
General practitioners' ability to integrate patient experiences with genetic and other biomedical knowledge is a key generalist skill
New genetic technology should be integrated into existing generalist frameworks
General practitioners identified ethical dilemmas associated with the therapeutic gap

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