Table 4 Challenges and enablers to GCs’ new roles in the specialties.

 Medical specialists’ hesitancy in engaging with the project

[S]ome of our specialist colleagues are feeling a bit resistant to this project, and that they feel like they might not have the capacity to include this as part of their usual clinical workload, which is, I think, understandable. I think everyone in public health they [are] overworked… (#05)

 Lacking the interaction to ascertain the level of genomics-related knowledge of medical specialists

Some of the specialists just aren’t reaching out that much, and so I’m not sure if it’s because they don’t think their patients would benefit from genetic testing, and it’s not useful for them, so they’re not asking. Or if it’s because they [do] not feel confident, or they might have some concerns, but they don’t feel comfortable bringing it up. I don’t know. (#05)

 Differences in professional views and practice between the genetic and medical specialists

[A] huge gap between how a genetic health professional would interpret a result and explain that result to a patient, and then use that result with a family compared to a specialist’s interpretation and understanding of a result. (#04)

 Tension for clinician education due to the differences between the two professions

I think education about result, interpretation, and how to use it in your clinical practice is going to be a challenge because I think that there’s nuance that can be missed, and if you miss it, you might never know that you’ve missed it because you just accept the thing that’s evolved or as the result. (#04)

 The feeling of isolation

I’m a little silo. I feel like I’m a little bit separate from the specialty and genetics, waving the flag for specialty genetics on my own and I think that’s not gonna go away, because even when I’m in the specialist clinics regularly, I’m the only genetics person there.” (#07)

 Inter-professional collaboration

I think that I would like them to learn what a genetic counsellor actually does and the value of genetic counsellors in a service like this so they could appreciate the skillset we bring and the level of support we can give. (#10)

 A clear scope of roles for both GC and medical specialists involved in mainstreaming

[I]t’s really important that they also recognize this separate role that would remain for the genetics clinic what’s appropriate for mainstreaming, and when to refer on and that I wouldn’t expect a specialist to offer predictive testing to unaffected family members. (#05)

[E]veryone knows that you are there to work together… not be a gatekeeper for genetic testing… but more there to enrich the experience with family and the patient. (#01)

 Medical specialists showing momentum in orienting the delivery of a new model of care

It might be that the clinicians need to determine when the best timing is for an appointment. And hopefully, that’s something that can be done and not just relying on my availability kind of thing. (#02)

 Leadership endorsement conducive to forging the connection between a genetic counsellor and a team of medial specialists

[T]he head [of a clinic] has sort of attended those [introductory meetings], and reiterated their belief that this [mainstreaming model] is important, which I think has been really integral to the [specialists] who don’t know who I am. Most of them they don’t know who I am, but their head feels this is important, so hopefully [that] helps keep them on side, keep them interested. (#07)

 Easy access to the project leaders and supervisors in the specialist clinic

[T]o be able to speak with the geneticists and specialists about complex cases is really important. [Name of the project lead] is running the project across many different sites. And so, making sure these people I can go to… [H]aving people I can contact with complex cases, both complex genetics and medically, but also complex psychosocially as well, is really important. (#08)

 Peer connection

I think implementation isn’t something that genetic counsellors naturally think about… So they’re really having to draw on different skills. And so I think it’s nice to have a community you can come to and talk about that sort of stuff. (#12)

I want to connect to the genetic counsellors that are on this project to create a chat thing as well, so that there is that connection between the counsellors to support each other, and also to discuss anything that works and doesn’t work so that we can then take that away to our site. (#09)