Nurses delivering person-centred multiple long-term condition reviews in primary care: a secondary analysis of qualitative data

Background General practice nurses in England often manage long-term conditions, with more people now living with multiple conditions (MLTC). Evidence on the effectiveness and delivery of person-centred care for MLTC is limited, and the nurse’s role — including necessary training — remains underexplored.

Aim To identify and characterise general practice nurses’ experiences of undertaking person-centred multiple long-term condition reviews in England.

Design & setting Secondary analysis of qualitative data gathered from general practice staff in England.

Method Two-part review consultations for people with three or more long-term conditions (rather than separate single-condition reviews as per usual care) in sixteen English general practices, part of a larger implementation project (PP4M). Empirical qualitative data (healthcare staff interviews and researcher fieldnotes) and theoretical approaches (chronic care model, normalisation process theory) analysed abductively.

Results Two overarching themes identified:

Healthcare professionals’ understanding of MLTC reviews’ purpose. Challenges and opportunities for nurses delivering MLTC reviews.

Some nurses utilised reviews as data-gathering exercises, facilitating collection of nationally set, quality-driven, financial incentives linked to single-conditions. Other nurses used reviews as opportunities for meaningful discussion of complex problems, leading to action.

MLTC reviews allowed nurses a new way of thinking. Some found this empowering, others found it challenging.

Conclusion General practice nurses are central to MLTC care. They value organisational support for training in person-centred MLTC management, but it remains unclear how best to achieve necessary training. Further research is needed on skills and training required for all healthcare professionals caring for people with MLTC.