Exploring the experiences of GPs in establishing and operating the chronic disease management programme in clinical practice in Ireland. A qualitative study.

Background: The management of chronic diseases, in the context of an ageing population and increasing life expectancy, is one of the major challenges facing the Irish health system. In 2020, a chronic disease management programme [CDM] was introduced in Irish general practice as part of a transformation in health policy to meet the changing needs of the population.

Objectives: To explore GPs' experiences and perceptions of the impact of the introduction of CDM on general practice in Ireland.

Methods: 18 semi-structured interviews were conducted with GPs in clinical practice from across Ireland. GPs were purposefully recruited to capture the differing experiences faced by GPs in large and small practices in both urban and rural settings. Interviews were analysed using reflexive thematic analysis.

Results: GPs were enthusiastic about aspects of CDM, which they felt provided an improved framework for their approach to the management of chronic diseases. However, they described several challenges to implementation, especially around capacity constraints. CDM could have unintended consequences for aspects of routine GP care. GPs described how practice nurses had taken on a central role in both clinical and administrative aspects of the programme.

Conclusions: GPs value the framework provided by CDM for their approach to the management of chronic disease. However, challenges around practice capacity and its impact both on the delivery of CDM and aspects of routine care highlight the importance for policy makers to provide continued support to strengthen the general practice infrastructure.