First contact in the primary care setting and the development of a gatekeeping system are crucial for the implementation of a hierarchical medical system. Additionally, the implementation of first contact in the primary care setting depends on the serving capacities of primary care practitioners.

This study aims to assess the capabilities of primary care general practitioners in diagnosing and managing common diseases, referral practices, and evidence-based practice; and to explore their training needs to inform demand-driven training programs in Hunan Province.

From April to May 2023, a convenience sampling method was used to recruit primary care general practitioners who participated in the residency training or general practitioner transfer training at Xiangya Hospital, Central South University. A self-developed questionnaire consisting of four sections was used, covering basic characteristics, self-assessment of the capabilities for common diseases diagnosis and treatment, and evidence-based practice, and demands for capabilities improvement. Questionnaire Star platform was used to collect data, and descriptive analysis was used to present the results.

A total of 337 valid questionnaires were collected from each prefecture-level city and autonomous prefecture in Hunan Province, with 128 coming from community health service centers and 209 from township health institutions. The differences in gender, age, professional title, years of service at the grassroots level, and staffing status between general practitioners in township health institutions and community health service centers are all statistically significant (P<0.05). The results show that 75.1% (253/337) of participants consider themselves competent in the diagnosis and treatment of common diseases; 16.6% (56/337) of participants reported a lack of competence in certain diseases, with the top six including depression[89.3% (50/56) ], stress incontinence[69.6% (39/56) ], dementia[66.1% (37/56) ], stroke[53.6% (30/56) ], co-morbidities[51.8% (29/56) ]and tuberculosis[46.4% (26/56) ]. These findings consistent between community and township respondents. Furthermore, 71.8% (242/337) of participants reported being unfamiliar with referral practices. 73.0% (246/337) of participants indicated limited knowledge of evidence-based practice, and 85.8% (247/288) of participants have limited use of evidence-based practice. Additionally, 77.2% (260/337) of participants lacked sufficient knowledge of clinical practice guidelines; 90.8% (306/337) of participants rarely consulted guidelines when facing decision-making difficulties, mainly because they felt guidelines could not address complex cases[50.0% (153/306) ], were unclear on how to search for guidelines[43.1% (132/306) ]and the resources available for retrieving guidelines[34.3% (105 /306) ]; participants mainly obtain the guidelines through the WeChat official account[72.5% (237/327) ] and databases such as the China National Knowledge Infrastructure [50.2% (164/327) ]. 97.0% (327/337) of participants expressed a demand for training to improve their capabilities, suggesting that training should be tailored to the specific needs of primary care institutions[60.8% (205/337) ]; the preferred approaches are advanced training in higher-level hospitals[71.3% (233/327) ]and primary care institutions with high diagnostic and treatment capabilities[56.3% (184/327) ]; the preferred training programs are on standardized treatment of common diseases[78.0% (263/337) ]and multiple coexisting diseases[69.4% (234/337) ].

The majority of primary care general practitioners in Hunan Province consider themselves competent in the treatment of common diseases, but some are relatively incompetent in diseases such as depression, stress urinary incontinence, dementia, stroke, co-morbidities and tuberculosis; the majority of participants need to improve their capabilities in standardized referral, evidence-based practice, retrieval and application of clinical practice guidelines, suggesting that these items could be focus of training. The primary care general practitioners have a high demand for training, they prefer to engage in advanced training in high level institutions, and training in standardized treatment of common diseases and multiple coexisting diseases is needed. The training programs should be individualized based on the demands of primary care institutions.