Find the Imp

What problem does Find the IMP solve?

General practice trainees are routinely encouraged to explore a patient’s psychosocial context as part of patient-centred care. Most trainees understand that this matters. Many can demonstrate that they know how to ask about work, family, stress, or concerns.

The difficulty arises in what happens next.

In everyday practice — and in training and assessment settings — psychosocial information is often gathered but not meaningfully used. Questions about a patient’s life circumstances, worries, or expectations may be asked appropriately, yet remain disconnected from clinical reasoning, prioritisation, and management planning. The result is that valuable contextual information sits in the background of the consultation rather than shaping decisions.

This gap is rarely due to lack of empathy or effort. More often, trainees struggle with purpose: understanding why they are asking psychosocial questions and how the answers should influence what happens next in the consultation.

Without a clear scaffold, psychosocial enquiry can become:

  • superficial or formulaic

  • detached from prioritisation

  • difficult to translate into a tailored plan

  • vulnerable to feeling performative rather than clinically useful

In complex consultations — involving uncertainty, competing agendas, time pressure, or significant life impact — this disconnect becomes more pronounced. Trainees may focus on clinical priorities and expectations while missing what is most important or most constraining for the patient at that point in time. When this happens, management plans may be clinically sound but poorly aligned with the patient’s reality, leading to resistance, disengagement, or repeated consultations.

Find the IMP was developed to address this specific problem.
It provides a simple, flexible scaffold to help trainees move from eliciting psychosocial information to using it — supporting prioritisation and the development of management plans that are realistic, negotiated, and patient-centred.

What is Find the IMP?

Find the IMP is a practical consultation scaffold designed to support purposeful exploration of a patient’s psychosocial context and its use in clinical decision making.

It helps clinicians move beyond simply eliciting contextual information towards using it to inform prioritisation and management. Rather than treating psychosocial factors as background detail, Find the IMP brings them into the foreground as clinically relevant information.

The framework focuses attention on three linked domains:

  • Impact – how the health problem affects the patient’s daily life, functioning, and responsibilities

  • Meaning – what the problem represents for the patient, including fears, beliefs, and perceived threat

  • Priorities – what matters most to the patient at that point in time, given the impact and meaning of the problem

By exploring impact and meaning with intent, patient priorities often become clearer without needing to be stated explicitly. This supports agenda setting, negotiation, and the development of management plans that are realistic, acceptable, and aligned with the patient’s circumstances.

Find the IMP is designed to be flexible and selective. It can be used lightly within a consultation, drawn on more explicitly in complex encounters, or used retrospectively as a reflective tool in supervision and teaching. The language and depth of exploration should always be adapted to the individual patient and clinical context.

What Find the IMP is not

Find the IMP is not a consultation model. It does not prescribe a sequence for the consultation or replace established approaches to structuring the clinical encounter.

It is not a script or a checklist. Clinicians are not expected to ask fixed questions or to cover all elements in every consultation. Used rigidly, it loses its value.

Find the IMP is not a replacement for existing frameworks such as Ideas, Concerns and Expectations (ICE) or other consultation models commonly taught in general practice. These frameworks continue to play an important role in understanding the patient’s perspective and supporting shared decision making.

Instead, Find the IMP serves a different purpose. It provides a scaffold to help clinicians make sense of psychosocial information once it has been elicited and to connect that understanding to prioritisation and management. It supports thinking rather than performance.

Find the IMP is not required in every consultation. It is particularly useful where complexity, uncertainty, competing agendas, or significant life impact are present, and may be unnecessary in straightforward or transactional encounters.

Used appropriately, Find the IMP complements existing consultation skills by supporting clinicians to translate psychosocial understanding into patient-centred action.

The three domains of Find the IMP

Impact

Impact refers to how a health problem affects a patient’s day-to-day life and functioning.

This includes, but is not limited to:

  • work, finances and education

  • caring responsibilities

  • family and relationships

  • daily activities and independence

  • emotional and psychological wellbeing

Exploring impact helps clinicians understand how illness is lived, not just how it is diagnosed. It highlights constraints and pressures that may influence what is feasible within a management plan, such as the ability to attend follow-up, adhere to treatment, or tolerate ongoing symptoms.

Importantly, impact is clinically relevant information. Understanding how a problem affects a patient’s life provides context for decision making, risk tolerance, and prioritisation within the consultation.

Meaning

Meaning refers to what the health problem represents for the patient.

Patients often interpret symptoms through personal beliefs, past experiences, cultural understanding, or perceived threat. This may include fears about serious illness, concerns about future consequences, or assumptions about why symptoms have occurred now.

Exploring meaning helps clinicians understand why a patient has sought help at this moment and what may be driving anxiety, urgency, or resistance. It legitimises the patient’s perspective and supports more accurate interpretation of their concerns, even when these are not stated directly.

Attention to meaning can reveal factors that strongly influence engagement with care, such as fear of diagnosis, previous negative healthcare experiences, or beliefs about treatment.

Priorities

Priorities reflect what matters most to the patient at that point in time, given the impact and meaning of the problem.

Rather than being a separate line of questioning, priorities often become clearer through understanding impact and meaning. Pressures related to work, finances, caring roles, or emotional burden may shape what the patient is able or willing to address within the consultation.

Recognising patient priorities supports:

  • agenda setting in consultations with multiple issues

  • negotiation when clinical and patient priorities differ

  • realistic planning within time and resource constraints

Priorities act as the bridge between understanding the patient’s context and taking action. They enable management plans to be tailored in a way that is both clinically appropriate and acceptable to the patient.

Impact and Meaning inform Priorities.


Priorities guide negotiation and management.

Using the domains together

The domains of Impact, Meaning, and Priorities are linked and dynamic, not sequential steps to be completed.

In practice:

  • exploration may move back and forth between domains

  • not all domains need equal emphasis in every consultation

  • depth should be guided by clinical context and patient cues

Find the IMP supports clinicians to hold these domains in mind as part of their clinical reasoning, using psychosocial understanding to inform prioritisation and management rather than treating it as background information.

From understanding to action: why priorities matter

Understanding a patient’s context is only clinically useful if it informs what happens next in the consultation.

Find the IMP places priorities at the centre of this transition from understanding to action. By exploring impact and meaning with intent, clinicians are better able to recognise what the patient is most able, willing, or motivated to address at that point in time.

This has practical implications for everyday general practice. Insight into patient priorities can shape:

  • which problems are addressed within a single consultation

  • how agendas are negotiated when there are competing concerns

  • the feasibility of investigations, treatment options, or follow-up

  • the acceptability of risk, watchful waiting, or staged management

In many consultations, management plans fail not because they are clinically inappropriate, but because they do not fit the patient’s circumstances. Pressures related to work, finances, caring responsibilities, or emotional burden may limit what is realistically achievable, even when clinical need is clear.

Recognising priorities allows clinicians to tailor management in a way that balances clinical judgement with patient context. This may involve adapting the plan, agreeing staged goals, or explicitly acknowledging and negotiating differences between clinical and patient priorities.

Find the IMP supports this process by making prioritisation a visible and legitimate part of clinical reasoning. Rather than treating psychosocial understanding as background information, it becomes an active driver of decision making, enabling management plans that are both clinically sound and patient-centred.

Where Find the IMP fits in GP consultations

Find the IMP is designed to sit within general practice consultations, not to structure them.

It does not prescribe a sequence or require explicit signposting during the consultation. Instead, it provides a way of thinking that clinicians can draw on flexibly, depending on the clinical context and the needs of the patient.

Find the IMP is particularly helpful in consultations where:

  • there is complexity or uncertainty

  • multiple problems or competing agendas are present

  • psychosocial factors significantly influence feasibility or risk

  • there is tension between clinical priorities and patient preferences

In these settings, the framework helps clinicians make sense of contextual information and use it purposefully, rather than attempting to address everything or defaulting to purely clinical priorities.

In more straightforward or transactional encounters, Find the IMP may play a minimal role or none at all. Its value lies in selective use, supporting judgement rather than replacing it.

Used in this way, Find the IMP complements established consultation skills and clinical reasoning processes. It supports clinicians to respond to the realities of general practice — balancing time, complexity, and uncertainty — while maintaining patient-centred care.

Find the IMP in GP training and assessment

Find the IMP is particularly relevant in GP training, where trainees are expected not only to gather information, but to demonstrate that they can use it to inform clinical reasoning and management.

In training and assessment settings, psychosocial enquiry can sometimes become performative. Trainees may ask appropriate questions about context, concerns, or expectations, yet struggle to show how this information influences prioritisation or the plan. Find the IMP provides a scaffold to support trainees in making this connection explicit.

By encouraging purposeful exploration of impact and meaning, Find the IMP helps trainees identify patient priorities that are directly relevant to:

  • agenda setting

  • negotiation

  • tailoring management

  • follow-up and safety-netting

This supports consultation performance that feels coherent rather than formulaic. Management decisions are easier to justify when they are clearly grounded in an understanding of the patient’s circumstances and priorities.

Find the IMP also aligns well with the capabilities assessed in GP training and the Simulated Consultation Assessment (SCA). It supports:

  • meaningful data gathering that extends beyond biomedical detail

  • interpretation of contextual information

  • management planning that is patient-centred, negotiated, and realistic

  • global consultation performance that integrates clinical and contextual understanding

Used appropriately, Find the IMP can help trainees move from demonstrating isolated consultation behaviours to showing integrated, thoughtful clinical practice. For educators, it offers a shared language to discuss consultation quality and to support trainees who “ask the right questions” but struggle to translate answers into action.

Using Find the IMP in teaching and supervision

Find the IMP can be used flexibly as a teaching and supervision tool across a range of GP training contexts.

For educators, it offers a shared language to support feedback that moves beyond checklist behaviours. Rather than focusing solely on whether psychosocial questions were asked, Find the IMP supports discussion of how contextual understanding influenced prioritisation and management.

In teaching sessions, Find the IMP can be introduced briefly and then applied through:

  • case-based discussion

  • simulated consultations or role play

  • review of recorded or observed consultations

Educators may prompt trainees to reflect on how impact and meaning shaped the plan, or to consider how patient priorities influenced what was addressed within the consultation and what was deferred. This can help trainees recognise why a management plan felt difficult to negotiate or failed to land, even when it was clinically appropriate.

In supervision, Find the IMP can support reflective conversations about complex or unsatisfactory consultations. It provides a way to explore whether patient context was sufficiently understood and whether priorities were made explicit in the clinician’s reasoning.

Some educators use Find the IMP selectively, drawing on it when trainees:

  • gather psychosocial information but struggle to use it

  • default to clinically driven plans that meet resistance

  • find prioritisation difficult in complex consultations

Used in this way, Find the IMP supports learning that is practical and transferable. Over time, trainees often internalise the thinking behind the scaffold, using it more fluidly and less explicitly as their confidence and judgement develop.

Evidence & Development

Find the IMP has been informed by established consultation theory and by experience in GP education and supervision. It has been developed and refined through use in teaching, simulated consultations, and reflective practice with GP trainees.

It is intended as a practical educational scaffold rather than a prescriptive model, and continues to evolve in response to feedback from training contexts and clinical practice.

Find the IMP in summary

Find the IMP is a flexible consultation scaffold designed to support purposeful exploration of psychosocial context and its use in clinical decision making.

By focusing on Impact, Meaning, and Priorities, it helps clinicians move from understanding the patient’s situation to developing management plans that are realistic, negotiated, and patient-centred.

Used selectively, Find the IMP complements existing consultation skills and supports trainees and educators in translating contextual understanding into clinical action.