Imperial College London

Emeritus ProfessorGeorgeFreeman

Faculty of MedicineSchool of Public Health

Emeritus Professor of General Practice
 
 
 
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Contact

 

+44 (0)1189 841 401g.freeman

 
 
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Location

 

Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

95 results found

Freeman G, Baker R, Levene L, Newby Cet al., 2023, Does shortage of general practitioners matter? Life expectancy in English general practices, British Journal of General Practice, ISSN: 0960-1643

Journal article

Howie JG, Freeman GK, 2022, Parity at last: a new funding model for undergraduate primary care education in England, British Journal of General Practice, Vol: 72, Pages: 317-317, ISSN: 0960-1643

Journal article

Baker R, Freeman GK, Haggerty JL, Bankart MJ, Nockels KHet al., 2020, Primary medical care continuity and patient mortality: a systematic review, British Journal of General Practice, Vol: 70, Pages: e600-e611, ISSN: 0960-1643

BACKGROUND: A 2018 review into continuity of care with doctors in primary and secondary care concluded that mortality rates are lower with higher continuity of care. AIM: This association was studied further to elucidate its strength and how causative mechanisms may work, specifically in the field of primary medical care. DESIGN AND SETTING: Systematic review of studies published in English or French from database and source inception to July 2019. METHOD: Original empirical quantitative studies of any design were included, from MEDLINE, Embase, PsycINFO, OpenGrey, and the library catalogue of the New York Academy of Medicine for unpublished studies. Selected studies included patients who were seen wholly or mostly in primary care settings, and quantifiable measures of continuity and mortality. RESULTS: Thirteen quantitative studies were identified that included either cross-sectional or retrospective cohorts with variable periods of follow-up. Twelve of these measured the effect on all-cause mortality; a statistically significant protective effect of greater care continuity was found in nine, absent in two, and in one effects ranged from increased to decreased mortality depending on the continuity measure. The remaining study found a protective association for coronary heart disease mortality. Improved clinical responsibility, physician knowledge, and patient trust were suggested as causative mechanisms, although these were not investigated. CONCLUSION: This review adds reduced mortality to the demonstrated benefits of there being better continuity in primary care for patients. Some patients may benefit more than others. Further studies should seek to elucidate mechanisms and those patients who are likely to benefit most. Despite mounting evidence of its broad benefit to patients, relationship continuity in primary care is in decline - decisive action is required from policymakers and practitioners to counter this.

Journal article

Freeman GK, 2016, Commentary on 'Continuity of care (CoC) in general practice vocational training: prevalence, associations and implications for training', EDUCATION FOR PRIMARY CARE, Vol: 27, Pages: 37-38, ISSN: 1473-9879

Journal article

Reeve J, Dowrick CF, Freeman GK, Gunn J, Mair F, May C, Mercer S, Palmer V, Howe A, Irving G, Shiner A, Watson Jet al., 2013, Examining the practice of generalist expertise: a qualitative study identifying constraints and solutions, JRSM Short Reports, Vol: 4, Pages: 1-9, ISSN: 2042-5333

OBJECTIVES: Provision of person-centred generalist care is a core component of quality primary care systems. The World Health Organisation believes that a lack of generalist primary care is contributing to inefficiency, ineffectiveness and inequity in healthcare. In UK primary care, General Practitioners (GPs) are the largest group of practising generalists. Yet GPs fulfil multiple roles and the pressures of delivering these roles along with wider contextual changes create real challenges to generalist practice. Our study aimed to explore GP perceptions of enablers and constraints for expert generalist care, in order to identify what is needed to ensure health systems are designed to support the generalist role. DESIGN: Qualitative study in General Practice. SETTING: UK primary care. MAIN OUTCOME MEASURES: A qualitative study - interviews, surveys and focus groups with GPs and GP trainees. Data collection and analysis was informed by Normalisation Process Theory. DESIGN AND SETTING: Qualitative study in General Practice. We conducted interviews, surveys and focus groups with GPs and GP trainees based mainly, but not exclusively, in the UK. Data collection and analysis were informed by Normalization Process Theory. PARTICIPANTS: UK based GPs (interview and surveys); European GP trainees (focus groups). RESULTS: Our findings highlight key gaps in current training and service design which may limit development and implementation of expert generalist practice (EGP). These include the lack of a consistent and universal understanding of the distinct expertise of EGP, competing priorities inhibiting the delivery of EGP, lack of the consistent development of skills in interpretive practice and a lack of resources for monitoring EGP. CONCLUSIONS: WE DESCRIBE FOUR AREAS FOR CHANGE: Translating EGP, Priority setting for EGP, Trusting EGP and Identifying the impact of EGP. We outline proposals for work needed in each area to help enhance the expert generalist role.

Journal article

Reeve J, Blakeman T, Freeman GK, Green LA, James PA, Lucassen P, Martin CM, Sturmberg JP, van Weel Cet al., 2013, Generalist solutions to complex problems: generating practice-based evidence - the example of managing multi-morbidity, BMC Family Practice, Vol: 14, ISSN: 1471-2296

BackgroundA growing proportion of people are living with long term conditions. The majority have more than one. Dealing with multi-morbidity is a complex problem for health systems: for those designing and implementing healthcare as well as for those providing the evidence informing practice. Yet the concept of multi-morbidity (the presence of >2 diseases) is a product of the design of health care systems which define health care need on the basis of disease status. So does the solution lie in an alternative model of healthcare?DiscussionStrengthening generalist practice has been proposed as part of the solution to tackling multi-morbidity. Generalism is a professional philosophy of practice, deeply known to many practitioners, and described as expertise in whole person medicine. But generalism lacks the evidence base needed by policy makers and planners to support service redesign. The challenge is to fill this practice-research gap in order to critically explore if and when generalist care offers a robust alternative to management of this complex problem.We need practice-based evidence to fill this gap. By recognising generalist practice as a ‘complex intervention’ (intervening in a complex system), we outline an approach to evaluate impact using action-research principles. We highlight the implications for those who both commission and undertake research in order to tackle this problem.SummaryAnswers to the complex problem of multi-morbidity won’t come from doing more of the same. We need to change systems of care, and so the systems for generating evidence to support that care. This paper contributes to that work through outlining a process for generating practice-based evidence of generalist solutions to the complex problem of person-centred care for people with multi-morbidity.

Journal article

Haggerty JL, Roberge D, Freeman GK, Beaulieu Cet al., 2013, Experienced Continuity of Care When Patients See Multiple Clinicians: A Qualitative Metasummary, ANNALS OF FAMILY MEDICINE, Vol: 11, Pages: 262-271, ISSN: 1544-1709

Journal article

Gallagher N, MacFarlane A, Murphy AW, Freeman GK, Glynn LG, Bradley CPet al., 2013, Service Users' and Caregivers' Perspectives on Continuity of Care in Out-of-Hours Primary Care, QUALITATIVE HEALTH RESEARCH, Vol: 23, Pages: 407-421, ISSN: 1049-7323

Journal article

Haggerty JL, Roberge D, Freeman GK, Beaulieu C, Breton Met al., 2012, Validation of a Generic Measure of Continuity of Care: When Patients Encounter Several Clinicians, ANNALS OF FAMILY MEDICINE, Vol: 10, Pages: 443-451, ISSN: 1544-1709

Journal article

Freeman GK, 2012, Progress with relationship continuity 2012, a British perspective, International Journal of Integrated Care, Vol: 12, ISSN: 1568-4156

This perspective paper makes a brief conceptual review of continuity and argues that relationship continuity is the most controversial type. Plentiful evidence of association with better satisfaction and outcomes urgently needs to be supplemented by studies of causation.The scope of these has been outlined in this paper. Evidence strongly suggests that patients generally want more relationship continuity than they are getting and that relationship continuity is linked with better patient and staff satisfaction. This is reason enough to justify improving relationship continuity for patients.

Journal article

Breton M, Haggerty J, Roberge D, Freeman GKet al., 2012, Management continuity in local health networks, International Journal of Integrated Care, Vol: 12, Pages: 1-9, ISSN: 1568-4156

Introduction: Patients increasingly receive care from multiple providers in a variety of settings. They expect management continuity that crosses boundaries and bridges gaps in the healthcare system. To our knowledge, little research has been done to assess coordination across organizational and professional boundaries from the patients' perspective. Our objective was to assess whether greater local health network integration is associated with management continuity as perceived by patients.Method: We used the data from a research project on the development and validation of a generic and comprehensive continuity measurement instrument that can be applied to a variety of patient conditions and settings. We used the results of a cross-sectional survey conducted in 2009 with 256 patients in two local health networks in Quebec, Canada. We compared four aspects of management continuity between two contrasting network types (highly integrated vs. poorly integrated).Results: The scores obtained in the highly integrated network are better than those of the poorly integrated network on all dimensions of management continuity (coordinator role, role clarity and coordination between clinics, and information gaps between providers) except for experience of care plan.Conclusion: Some aspects of care coordination among professionals and organizations are noticed by patients and may be valid indicators to assess care coordination.

Journal article

Freeman GK, 2011, Holding relationships in general practice: What are they? How do they work? Are they worth having?, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 61, Pages: 487-488, ISSN: 0960-1643

Journal article

Freeman G, Hughes J, 2010, Continuity of care and the patient experience, Continuity of care and the patient experience, London, Publisher: The King's Fund

Continuity of care contributes importantly to patient experience, whether it's continuity of a relationship, by seeing the same GP, or management continuity, that coordinates an individual’s care across the wider health care system. However, continuity is not monitored or incentivised in the same way as other aspects of good practice.

Report

Guthrie B, Saultz J, Freeman GK, Haggerty Jet al., 2008, Continuity of care matters: relationships between doctors and patients are central to good care., British Medical Journal, Vol: 337

Journal article

Freeman GK, 2008, Urban continuity of general practice care in the new century, New Zealand Family Physician, Vol: 35, Pages: 5-7

Journal article

Freeman GK, Woloshynowych M, Baker R, Boulton M, Guthrie B, Car J, Haggerty J, Tarrant Cet al., 2007, Continuity of care 2006: What have we learned since 2000 and what are policy imperatives now? Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO).

Report

Baker R, Boulton M, Windridge K, Tarrant C, Bankart J, Freeman GKet al., 2007, Interpersonal continuity of care: a cross-sectional survey of primary care patients' preferences and their experiences, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 57, Pages: 283-289, ISSN: 0960-1643

Journal article

Gill N, Freeman GK, 2007, Continuity of care and rapid access: the potential impact of appointment systems, Primary Care Research & Development, Vol: 8, Pages: 235-242

Journal article

Turner D, Tarrant C, Windridge K, Bryan S, Boulton M, Freeman G, Baker Ret al., 2007, Do patients value continuity of care in general practice? An investigation using stated preference discrete choice experiments?, J Health Serv Res Policy, Vol: 12, Pages: 132-137

Journal article

Freeman GK, Woloshynowych M, Baker R, Boulton M, Guthrie B, Haggerty J, Car J, Tarrant Cet al., 2007, Continuity of care 2006: what have we learned since 2000 and what are policy imperatives now?, Continuity of care 2006: what have we learned since 2000 and what are policy imperatives now?, London, Publisher: National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO)

Report

Boulton M, Tarrant C, Windridge K, Baker R, Freeman GKet al., 2006, How are different types of continuity achieved? A mixed methods longitudinal study, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 56, Pages: 749-755, ISSN: 0960-1643

Journal article

van Baar JD, Joosten H, Car J, Freeman GK, Partridge MR, van Weel C, Sheikh Aet al., 2006, Understanding reasons for asthma outpatient (non)-attendance and exploring the role of telephone and e-consulting in facilitating access to care: exploratory qualitative study, QUALITY & SAFETY IN HEALTH CARE, Vol: 15, Pages: 191-195, ISSN: 1475-3898

Journal article

Ferlie E, Freeman G, McDonnell J, Petsoulas C, Rundle-Smith Set al., 2006, Introducing choice in the public services: Some supply-side issues, PUBLIC MONEY & MANAGEMENT, Vol: 26, Pages: 63-72, ISSN: 0954-0962

Journal article

Freeman GK, 2006, Up close and personal? Continuing pressure on the doctor-patient relationship in the QOF era., British Journal of General Practice, Vol: 56, Pages: 483-484

Journal article

Baker R, Freeman G, Boulton M, Windridge K, Preston C, Low J, Turner D, Hutton E, Bryan Set al., 2006, Continuity of care: patients’ and carers’ views and choices in their use of primary care services, Continuity of care: patients’ and carers’ views and choices in their use of primary care services, London, Publisher: National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NHSCCSDO)

Report

McKinstry B, Ashcroft RE, Car J, Freeman GK, Sheikh Aet al., 2006, Interventions for improving patients' trust in doctors and groups of doctors, COCHRANE DATABASE OF SYSTEMATIC REVIEWS, ISSN: 1469-493X

Journal article

David L, Freeman G, 2006, Improving consultation skills using cognitive-behavioural therapy: a new ‘cognitive-behavioural model’ for general practice, Education for Primary Care, Pages: 443-453

Journal article

McKInstry B, Ashcroft R, Car J, Freeman G, Sheikh Aet al., 2006, Interventions for improving patients' trust in doctors and groups of doctors., Publisher: Cochrane database Jul 19;3:CD004134 PMID: 16856033

Cochrane Database Syst Rev

Working paper

Rhodes M, Ashcroft M, Atun RA, Freeman GK, Jamrozik Ket al., 2006, Teaching evidence-based medicine to undergraduate medical students: a course integrating ethics, audit, management and clinical epidemiology, Medical teacher, Vol: 28, Pages: 313-317, ISSN: 0142-159X

Journal article

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