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 (LTCs), with more people now living with multiple long-term conditions (MLTC). Evidence on the effectiveness and delivery of person-centred care for MLTCs 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 MLTC 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 LTCs (rather than separate single-condition reviews as per usual care) in 16 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) were analysed abductively. RESULTS: Two overarching themes were identified: healthcare professionals' understanding of MLTC reviews' purpose and the 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, whereas 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.