scholarly journals EP.FRI.422 Over 100,000 COVID-19 deaths calls for a radical reform of health and care system in the UK

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shruti Bodapati ◽  
Raghvinder Gambhir
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Secondary Care ◽  
Face To Face ◽  
Radical Reform ◽  
National Statistics ◽  
The Uk ◽  
Second Wave ◽  
Excess Deaths ◽  
Care System

Abstract Aim With over 100,000 deaths due to COVID 19 and still counting, is it a wake-up call to overhaul our health and care system. Methods Review of NHS England, Office of National Statistics (ONS) and Public Health England (PHE) data to determine where the deaths occurred and what role did the primary care, secondary care, play in delivering the service. Results The data shows that it took 40 weeks to get to the first 50,000 deaths and just another 10 weeks to add another 50,000 deaths. Among the OECD UK ranked number 1 for deaths due to COVID 19.  69.9%   of deaths occurred in hospitals, 24.1% in care homes, while 4.9% occurred at homes. The primary care effectively remained shut for face to face consultation, effectively leaving people to manage themselves at home on their own or reach A & E when things got worse. The hospitals where overwhelmed and coped by shutting out all elective work and converting normal wards to COVID wards and that is where the maximum deaths occurred. There were over 80000 excess deaths above the five-year average. Conclusion We may have been underprepared for the first wave but had the PPE and plans to battle the second wave yet we had the highest mortality in Europe. Is it a price we paid for our disjointed health and care system. There is a need for radical changes to prepare for future disasters.

scholarly journals COVID-19 Pandemic: The Urgent Dental Hub experience from a primary care perspective

2021 ◽  
Vol 10 (3) ◽  
pp. 41-45
Author(s):  
Zohaib Khwaja ◽  
Awais Ali ◽  
Manraj Rai
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Dental Care ◽  
Specialist Care ◽  
Health Message ◽  
Face To Face ◽  
General Dental Practitioner ◽  
Public Health Message ◽  
The Uk

In response to the nationwide lockdown on 23 March 2020 in the UK, urgent dental hubs (UDHs) were established in the community to provide emergency dental care. Consecutive referrals to a primary care UDH were prospectively analysed over a one-month period, from 18 May 2020 to 18 June 2020. Of 400 referrals received, the most common were in relation to pain (87%). In 63% neither a radiograph nor photograph was provided with the referral. Seventy percent of patients were telephone triaged within 24 hours of receipt of referral. Fifty-three percent of referrals were accepted for face-to-face treatment, of which 69% were treated by extraction. Of rejected referrals (n=179; 45%), 79% were due to symptoms having settled or being manageable by the time of triage. A small number of referrals were redirected for specialist care. Referrals that were accepted were more likely to have been prescribed antibiotics and less likely to have been referred by the general dental practitioner (GDP) they regularly saw (p <0.01). Patients that were older and those that identified themselves as not having a regular GDP were less likely to have been referred to an UDH. The quality of referrals was poor and there may be a role for virtual consultations moving forwards. We found pre-referral antimicrobial prescriptions were high and a confused public health message may have been sent.

scholarly journals The potential dangers of not understanding COVID-19 public health restrictions in dementia: “It’s a groundhog day – every single day she does not understand why she can’t go out for a walk”

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Clarissa Giebel ◽  
Kerry Hanna ◽  
Manoj Rajagopal ◽  
Aravind Komuravelli ◽  
Jacqueline Cannon ◽  
...  
Keyword(s):  
Public Health ◽  
Cognitive Deficits ◽  
Third Sector ◽  
Cognitive Capacity ◽  
The Public ◽  
Health Measures ◽  
Third Sector Organisations ◽  
The Uk ◽  
Second Wave

Abstract Background Sudden public health restrictions can be difficult to comprehend for people with cognitive deficits. However, these are even more important for them to adhere to due to their increased levels of vulnerability, particularly to COVID-19. With a lack of previous evidence, we explored the understanding and changes in adherence to COVID-19 public health restrictions over time in people living with dementia (PLWD). Methods Unpaid carers and PLWD were interviewed over the phone in April 2020, shortly after the nationwide UK lockdown, with a proportion followed up from 24th June to 10th July. Participants were recruited via social care and third sector organisations across the UK, and via social media. Findings A total of 70 interviews (50 baseline, 20 follow-up) were completed with unpaid carers and PLWD. Five themes emerged: Confusion and limited comprehension; Frustration and burden; Putting oneself in danger; Adherence to restrictions in wider society; (Un) changed perceptions. Most carers reported limited to no understanding of the public health measures in PLWD, causing distress and frustration for both the carer and the PLWD. Due to the lack of understanding, some PLWD put themselves in dangerous situations without adhering to the restrictions. PLWD with cognitive capacity who participated understood the measures and adhered to these. Discussion In light of the new second wave of the pandemic, public health measures need to be simpler for PLWD to avoid unwilful non-adherence. Society also needs to be more adaptive to the needs of people with cognitive disabilities more widely, as blanket rules cause distress to the lives of those affected by dementia.

scholarly journals A qualitative exploration of patients’ experiences, needs and expectations regarding online access to their primary care record

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044221
Author(s):  
Brian McMillan ◽  
Gail Davidge ◽  
Lindsey Brown ◽  
Moira Lyons ◽  
Helen Atherton ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Groups ◽  
Negative Consequences ◽  
Face To Face ◽  
Primary Care Record ◽  
Online Access ◽  
Additional Support ◽  
The Uk ◽  
Records Access ◽  
Qualitative Exploration

ObjectivesPrimary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need.DesignFocus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach.SettingFocus groups and interviews were conducted in community settings in the UK.ParticipantsFifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else.ResultsParticipants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated.ConclusionsDiscussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service.

scholarly journals Referrals to Urgent Dental Centres During the COVID-19 Pandemic: A Multi-Site Analysis Research Project

2021 ◽  
Vol 10 (1) ◽  
pp. 40-45
Author(s):  
Adam Shathur ◽  
Samuel Reeves ◽  
Faizal Sameja ◽  
Vishal Patel ◽  
Allan Jones
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Easy Access ◽  
Dental Services ◽  
Care Services ◽  
Dental Practitioners ◽  
Consultation And Referral ◽  
Care Systems ◽  
Access To Primary Care ◽  
The Uk

Introduction: The COVID-19 pandemic enforced the cessation of routine dentistry and the creation of local urgent dental care systems in the UK. General dental practices are obligated by NHS guidance to remain open and provide remote consultation and referral where appropriate to patients having pain or problems. Aims: To compare two urgent dental centres with different triage and referral systems with regard to quality and appropriateness of referrals, and patient management outcomes. Methods: 110 consecutive referrals received by a primary care urgent dental centre and a secondary care urgent dental centre were assessed. It was considered whether the patients referred had access to remote primary care dental services, fulfilled the criteria required to be deemed a dental emergency as mandated by NHS guidance, and what the outcomes of referrals were. Results: At the primary care centre, 100% of patients were referred by general dental practitioners and had access to remote primary care dental services. 95.5% of referrals were deemed appropriate and were seen for treatment. At the secondary care site, 94.5% of referrals were direct from the patient by contacting NHS 111. 40% had received triaging to include ‘advice, analgesia and antimicrobial’ from a general dental practitioner, and 25.5% were deemed appropriate and resulted in treatment. Conclusion: Urgent dental centres face many issues, and it would seem that easy access to primary care services, collaboration between primary care clinicians and urgent dental centres, and training of triaging staff are important in operating a successful system.

The context of healthcare

2020 ◽  
pp. 1-34
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Northern Ireland ◽  
Healthcare Services ◽  
Health Profile ◽  
Long Term Conditions ◽  
Key Concepts ◽  
The Uk

This chapter begins by covering the UK health profile, then defines the key concepts in primary care and public health, and outlines the generic long-term conditions model. It provides a brief overview of the National Health Service, including differences in England, Northern Ireland, Scotland, and Wales. It covers current NHS entitlements for people from overseas, commissioning of services, and public health in a broader context. It also describes health needs assessment, and provides an overview of the services in primary care, the role of general practice, and other primary healthcare services. Further services, including those to prevent unplanned hospital admission, aid hospital discharge, those that support children and families, housing, social support, and care homes are all covered.

THUR 121 Identifying participants with parkinson’s disease in uk biobank

2018 ◽  
Vol 89 (10) ◽  
pp. A13.2-A13
Author(s):  
Bush Kathryn ◽  
Rannikmae Kristiina ◽  
Schnier Christian ◽  
Wilkinson Timothy ◽  
Nolan John ◽  
...  
Keyword(s):  
Primary Care ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Secondary Care ◽  
Large Population ◽  
Free Text ◽  
Uk Biobank ◽  
Predictive Values ◽  
Diagnostic Codes ◽  
The Uk

BackgroundLinkage to routinely collected NHS data from primary, secondary care and death certificates enables identification of participants with Parkinson’s Disease (PD) within the UK Biobank cohort of 5 00 000 adults. Validation of the accuracy of this data is required prior to their use in research studies.MethodIn this validation study participants (n=125) with a code indicating PD were identified from a sample of 17 000 participants in the cohort. Diagnoses were validated by expert adjudicators, based on free text electronic medical records. Positive predictive values (PPV,% of cases identified that are true cases) were calculated.ResultsPrimary care diagnostic codes identified 93% of PD cases, with a PPV of 95%. Combined secondary care and death data identified 42% of PD cases with a PPV of 84%.Combining diagnostic and medication codes identified more participants, but did not increase the PPV.ConclusionsThis study suggests that linkage to routinely collected healthcare data is a reliable method for identifying participants with PD in the UK Biobank cohort.Primary care diagnostic codes identified the highest proportion of participants and had the highest PPV, demonstrating the value of using primary care data to identify cases of disease in large population based cohort studies.

View from the top: a thematic analysis of interviews with top healthcare leaders in the UK about leadership and how UK GPs should prepare for it

BMJ Leader ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. 136-139
Author(s):  
Veronica Wilkie ◽  
Kay Mohanna
Keyword(s):  
Primary Care ◽  
Leadership Training ◽  
Work Force ◽  
Senior Leaders ◽  
Face To Face ◽  
New Information ◽  
Personal Qualities ◽  
The Uk ◽  
Medical Leadership ◽  
Future Work

IntroductionLeadership is often quoted as being a solution to future work force problems . This study looks at the views of leaders within the NHS to find out what they think should be done, how and when for GPs in training.MethodsA series of interviews were carried out with senior leaders within the NHS, within primary care, NHS England and Health Education England. All the participants were involved in primary care either assenior general practitioners, senior educators, or clinical and non clinical managers. The interviews were face to face or via a telephone and recorded before being transcribed and analysed. The interviews were carried out until no new information was forthcoming.ResultsAll of the participants agreed that leadership was necessary. Non clinicians tended to think that the training was best done once a GP had arrived at a senior leadership position, clinicians tended to think leadership training should happen from the start of the career. The competences identified fitted within those originally identified from the Medical Leadership Competency Framework.DiscussionLeadership training is still regarded as important and overall the senior leaders recognised the need for personal qualities, the ability to lead and work in teams, how to manage and improve services and how to set direction for change. The difficulties of organizing this and how to fit this in with the needs of service delivery and current curriculum was highlighted.

scholarly journals Cross-sectional observation study to investigate the impact of risk-based stratification on care pathways for patients with chronic kidney disease: protocol paper

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027315 ◽  
Author(s):  
Harjeet Kaur Bhachu ◽  
Paul Cockwell ◽  
Anuradhaa Subramanian ◽  
Krishnarajah Nirantharakumar ◽  
Derek Kyte ◽  
...  
Keyword(s):  
Primary Care ◽  
Kidney Disease ◽  
Secondary Care ◽  
Health Improvement ◽  
Cross Sectional ◽  
Risk Equation ◽  
Failure Risk ◽  
The Health Improvement Network ◽  
The Uk ◽  
The Impact

IntroductionChronic kidney disease (CKD) management in the UK is usually primary care based, with National Institute for Health and Care Excellence (NICE) guidelines defining criteria for referral to secondary care nephrology services. Estimated glomerular filtration rate (eGFR) is commonly used to guide timing of referrals and preparation of patients approaching renal replacement therapy. However, eGFR lacks sensitivity for progression to end-stage renal failure; as a consequence, the international guideline group, Kidney Disease: Improving Global Outcomes has recommended the use of a risk calculator. The validated Kidney Failure Risk Equation may enable increased precision for the management of patients with CKD; however, there is little evidence to date for the implication of its use in routine clinical practice. This study will aim to determine the impact of the Kidney Failure Risk Equation on the redesignation of patients with CKD in the UK for referral to secondary care, compared with NICE CKD guidance.Method and analysisThis is a cross-sectional population-based observational study using The Health Improvement Network database to identify the impact of risk-based designation for referral into secondary care for patients with CKD in the UK. Adult patients registered in primary care and active in the database within the period 1 January 2016 to 31 March 2017 with confirmed CKD will be analysed. The proportion of patients who meet defined risk thresholds will be cross-referenced with the current NICE guideline recommendations for referral into secondary care along with an evaluation of urinary albumin–creatinine ratio monitoring.Ethics and disseminationApproval was granted by The Health Improvement Network Scientific Review Committee (Reference number: 18THIN061). Study outcomes will inform national and international guidelines including the next version of the NICE CKD guideline. Dissemination of findings will also be through publication in a peer-reviewed journal, presentation at conferences and inclusion in the core resources of the Think Kidneys programme.

scholarly journals Provider perspectives on general practice in Henan, China: a mixed-methods study

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e036240
Author(s):  
Jiming Zhu ◽  
Proochista Ariana
Keyword(s):  
Public Health ◽  
Primary Care ◽  
General Practice ◽  
Mixed Methods ◽  
Central Government ◽  
Point Of Care ◽  
Primary Care System ◽  
Common People ◽  
Provider Perspectives ◽  
Care System

ObjectiveSince 2011 China’s central government has committed to establishing a new ‘general practitioner’ (GP)-centred primary care system. To this end there have been great efforts to train an additional 300 000 GPs by 2020. This paper examines the perspective of practitioners in Henan, China, regarding general practice.DesignA mixed-methods approach using focus group discussions (FGD), and structured questionnaires.Setting/participantsSeven FGDs and responses to 1887 questionnaires included medical students, primary care doctors and GP residents in Henan.ResultsThe three surveyed medical groups have some awareness of the attributes of general practice (eg, comprehensiveness, first contact and coordination), but often misinterpret what being a GP entails. Five themes were identified through the FGDs and tested quantitatively for their prevalence with structured questionnaires. First, the GPs’ role as a comprehensive care provider was (mis)interpreted as an ‘all-round doctor’. Second, the GP’s responsibility as the first point of care was understood in two conflicting ways: private personal doctors of the rich and the powerful or village doctors for common people. Third, referral was understood as simply guiding patients to appropriate departments within the hospital while the gatekeeping role was interpreted to involve GPs being peoples’ health protectors rather than being also gatekeepers of specialty services. Traditional Chinese medicine now further complicates the understanding of GPs. And lastly, the GPs’ main responsibility was considered to be public health work.ConclusionThe misunderstandings of the roles and responsibilities of GPs render problematic the policy foundation of China’s GP-centred primary care system. Pursuing the quantity of GPs on its own is meaningless, since the number needed depends on the delineated role of GPs. Top priority is to establish clarity about the GP role, which requires reforming the health delivery system to address issues with fragmented care, strategically taking into account the development of GPs with work delegation and substitution and providing more clarity on the distinction between general practice and public health.

Student paramedics' views on placements in general practice as part of a degree

2019 ◽  
Vol 11 (12) ◽  
pp. 519-525
Author(s):  
Alyesha Proctor
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Care Pathway ◽  
Structured Interviews ◽  
Learning And Development ◽  
Alternative Care ◽  
Face To Face ◽  
The Uk ◽  
University Degree

Background: Frontline paramedics are increasingly attending to non-emergency problems and calls that could be managed by a primary care provider. Alongside this, there is a growing pressure to manage patients at home or use an alternative care pathway and reduce hospital conveyance. Student paramedic training, including both placement and taught elements at university, should therefore reflect this. However, placement opportunities for student paramedics in primary care settings is variable across the UK. Aim: To explore student paramedics' views on incorporating a placement within general practice as part of their degree and its effects on their learning and development as an autonomous paramedic. Method: A small pedagogic study as part of a postgraduate certificate in academic practice for higher education, involving a case study, qualitative approach using face-to-face, semi-structured interviews and thematic analysis, was carried out. Findings: Student paramedics feel that incorporating a placement in general practice as part of their degree will significantly help in their learning and development as autonomous paramedics. Specifically, they feel it: will help them understand the role of the GP and what the GP expects of them; will help them to focus their assessments and improve confidence in decisions not to convey patients; may lead to better knowledge of alternative care pathways; and, finally, may provide an insight into the role of the paramedic in general practice as a future career opportunity. There are a few reservations about whether students would be able to use the skills and knowledge gained in this setting, as they feel they do not have access to the tools or the authority in a frontline ambulance service. Students would prefer to have a placement in a GP surgery in the final year of their university degree. Conclusion: Placement within a GP surgery for student paramedics should be included as part of a paramedic science degree as a priority. This is necessary, particularly given the changing role of the contemporary paramedic who attends to non-emergency problems.

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