scholarly journals Exploring the multiple policy objectives for primary care networks: a qualitative interview study with national policy stakeholders

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038398
Author(s):  
Kath Checkland ◽  
Jonathan Hammond ◽  
Lynsey Warwick-Giles ◽  
Simon Bailey
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Service Delivery ◽  
Service Providers ◽  
National Level ◽  
National Policy ◽  
Document Analysis ◽  
Policy Document ◽  
Qualitative Interview Study ◽  
Policy Objectives

ObjectivesEnglish general practice is suffering a workforce crisis, with general practitioners retiring early and trainees reluctant to enter the profession. To address this, additional funding has been offered, but only through participation in collaborations known as primary care networks (PCNs). This study explored national policy objectives underpinning PCNs and the mechanisms expected to help achieve these, from the perspective of those driving the policy.DesignQualitative semistructured interviews and policy document analysis.Setting and participantsNational-level policy maker and stakeholder interviewees (n=16). Policy document analysis of the Network Contract Direct Enhanced Service draft service specifications.AnalysisInterviews were transcribed, coded and organised thematically according to policy objectives and mechanisms. Thematic data were organised into a matrix so prominent elements can be identified and emphasised accordingly. Themes were considered alongside objectives embedded in PCN draft service delivery requirements.ResultsThree themes of policy objectives and associated mechanisms were identified: (1) supporting general practice, (2) place-based interorganisational collaboration and (3) primary care ‘voice’. Interviewees emphasised and sequenced themes differently, suggesting meeting objectives for one was necessary to realise another. Interviewees most closely linked to primary care emphasised the importance of theme 1. The objectives embedded in draft service delivery requirements primarily emphasised theme 2.ConclusionsThese policy objectives are not mutually exclusive but may imply different approaches to prioritising investment or necessitate more explicit temporal sequencing, with the stabilisation of a struggling primary care sector probably needing to occur before meaningful engagement with other community service providers can be achieved or a ‘collective voice’ is agreed. Multiple objectives create space for stakeholders to feel dissatisfied when implementation details do not match expectations, as the negative reaction to draft service delivery requirements illustrates. Our study offers policy makers suggestions about how confidence in the policy might be restored by crafting delivery requirements so all groups see opportunities to meet favoured objectives.

scholarly journals Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e039674 ◽  
Author(s):  
Veronique Verhoeven ◽  
Giannoula Tsakitzidis ◽  
Hilde Philips ◽  
Paul Van Royen
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Clinical Decision Making ◽  
Core Competencies ◽  
Well Being ◽  
Clinical Decision ◽  
Framework Analysis ◽  
Profound Impact ◽  
The Core ◽  
Qualitative Interview Study

ObjectivesThe current COVID-19 pandemic, as well as the measures taken to control it, have a profound impact on healthcare. This study was set up to gain insights into the consequences of the COVID-19 outbreak on the core competencies of general practice, as they are experienced by general practitioners (GPs) on the frontline.Design, setting, participantsWe performed a descriptive study using semistructured interviews with 132 GPs in Flanders, using a topic list based on the WONCA definition of core competencies in general practice. Data were analysed qualitatively using framework analysis.ResultsChanges in practice management and in consultation strategies were quickly adopted. There was a major switch towards telephone triage and consults, for covid-related as well as for non-covid related problems. Patient-centred care is still a major objective. Clinical decision-making is largely focused on respiratory assessment and triage, and GPs feel that acute care is compromised, both by their own changed focus and by the fact that patients consult less frequently for non-covid problems. Chronic care is mostly postponed, and this will have consequences that will extend and become visible after the corona crisis. Through the holistic eyes of primary care, the current outbreak—as well as the measures taken to control it—will have a profound impact on psychological and socioeconomic well-being. This impact is already visible in vulnerable people and will continue to become clear in the medium and long terms. GPs think that they are at high risk of getting infected. Dropping out and being unable to contribute their part or becoming virus transmitters are reported to be greater concerns than getting ill themselves.ConclusionsThe current times have a profound impact on the core competences of primary care. Although the vast increase in patients soliciting medical help and the necessary separate covid and non-covid flows have been dealt with, GPs are worried about the continuity of regular care and the consequences of the anticovid measures. These may become a threat for the general health of the population and for the provision of primary healthcare in the near and distant future.

scholarly journals Factors influencing recording of drug misuse in primary care: a qualitative study of GPs in England

2018 ◽  
Vol 68 (669) ◽  
pp. e234-e244 ◽  
Author(s):  
Hilary Davies-Kershaw ◽  
Irene Petersen ◽  
Irwin Nazareth ◽  
Fiona Stevenson
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Public Health Problem ◽  
Clinical Decision ◽  
Epidemiological Studies ◽  
Drug Misuse ◽  
Electronic Patient Records ◽  
National Surveys ◽  
Qualitative Interview Study ◽  
Face Complex

BackgroundDrug misuse is a serious public health problem. Evidence from previous epidemiological studies show that GPs are recording drug misuse in electronic patient records (EPR). However, although the recording trends are similar to national surveys, recording rates are much lower.AimTo explore the factors that influence GPs to record drug misuse in the EPR, and to gain a clearer understanding of the gap between the amount of drug misuse recorded in primary care and that in national surveys and other studies.Design and settingA semi-structured qualitative interview study of GPs working in general practices across England.MethodPurposive sampling was employed to recruit 12 GPs, both with and without a special interest in drug misuse, from across England. Semi-structured face-to-face interviews were conducted to consider whether and why GPs record drug misuse, which methods GPs use for recording, GPs’ actions if a patient asks for the information not to be recorded, and GPs’ actions if they think a patient misuses drugs but does not disclose the information. Resulting data were analysed using a combination of inductive and deductive thematic analysis.ResultsThe complexity of asking about drug misuse preceded GPs’ decision to record. They described how the context of the general practice protocols, interaction between GP and patient, and the questioning process affected whether, how, and in which circumstances they asked about drug use. This led to GPs making a clinical decision on whether, who, and how to record in the EPR.ConclusionWhen making decisions about whether or not to record drug misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked and their clinical commissioning group, as well as government policies.

scholarly journals Chlamydia and HIV testing, contraception advice, and free condoms offered in general practice: a qualitative interview study of young adults’ perceptions of this initiative

2017 ◽  
Vol 67 (660) ◽  
pp. e490-e500 ◽  
Author(s):  
Leah Ffion Jones ◽  
Ellie Ricketts ◽  
Katy Town ◽  
Claire Rugman ◽  
Donna Lecky ◽  
...  
Keyword(s):  
General Practice ◽  
Young Adults ◽  
Sexual Health ◽  
Hiv Testing ◽  
Service Providers ◽  
Qualitative Interviews ◽  
Chlamydia Screening ◽  
Routine Practice ◽  
National Guidelines ◽  
Qualitative Interview Study

BackgroundOpportunistic chlamydia screening is actively encouraged in English general practices. Based on recent policy changes, Public Health England piloted 3Cs and HIV in 2013–2014, integrating the offer of chlamydia testing with providing condoms, contraceptive information, and HIV testing (referred to as 3Cs and HIV) according to national guidelines.AimTo determine young adults’ opinions of receiving a broader sexual health offer of 3Cs and HIV at their GP practice.Design and settingQualitative interviews were conducted in a general practice setting in England between March and June 2013.MethodThirty interviews were conducted with nine male and 21 female patients aged 16–24 years, immediately before or after a routine practice attendance. Data were transcribed verbatim and analysed using a thematic framework.ResultsParticipants indicated that the method of testing, timing, and the way the staff member approached the topic were important aspects to patients being offered 3Cs and HIV. Participants displayed a clear preference for 3Cs and HIV to be offered at the GP practice over other sexual health service providers. Participants highlighted convenience of the practice, assurance of confidentiality, and that the sexual health discussion was appropriate and routine. Barriers identified for patients were embarrassment, unease, lack of time, religion, and patients believing that certain patients could take offence. Suggested facilitators include raising awareness, reassuring confidentiality, and ensuring the offer is made in a professional and non-judgemental way at the end of the consultation.ConclusionGeneral practice staff should facilitate patients’ preferences by ensuring that 3Cs and HIV testing services are made available at their surgery and offered to appropriate patients in a non-judgemental way.

scholarly journals Reaching everyone in general practice? Feasibility of an integrated domestic violence training and support intervention in primary care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Eszter Szilassy ◽  
Jessica Roy ◽  
Emma Williamson ◽  
Katherine Pitt ◽  
Mei-See Man ◽  
...  
Keyword(s):  
Primary Care ◽  
Domestic Violence ◽  
General Practice ◽  
Service Providers ◽  
System Level ◽  
Sources Of Information ◽  
Care Needs ◽  
Post Intervention ◽  
Support Intervention ◽  
Training And Support

Abstract Background Primary care needs to respond effectively to patients experiencing or perpetrating domestic violence and abuse (DVA) and their children, but there is uncertainty about the value of integrated programmes. The aim of the study was to develop and test the feasibility of an integrated primary care system-level training and support intervention, called IRIS+ (Enhanced Identification and Referral to Improve Safety), for all patients affected by DVA. IRIS+ was an adaptation of the original IRIS (Identification and Referral to Improve Safety) model designed to reach female survivors of DVA. Methods Observation of training; pre/post intervention questionnaires with clinicians and patients; data extracted from medical records and DVA agency; semi-structured interviews with clinicians, service providers and referred adults and children. Data collection took place between May 2017 and April 2018. Mixed method analysis was undertaken to triangulate data from various sources to assess the feasibility and acceptability of the intervention. Results Clinicians and service providers believed that the IRIS+ intervention had filled a service gap and was a valuable resource in identifying and referring women, men and children affected by DVA. Despite increased levels of preparedness reported by clinicians after training in managing the complexity of DVA in their practice, the intervention proved to be insufficient to catalyse identification and specialist referral of men and direct identification and referral (without their non-abusive parents) of children and young people. The study also revealed that reports provided to general practice by other agencies are important sources of information about adult and children patients affected by DVA. However, in the absence of guidance about how to use this information in patient care, there are uncertainties and variation in practice. Conclusions The study demonstrates that the IRIS+ intervention is not feasible in the form and timeframe we evaluated. Further adaptation is required to achieve identification and referral of men and children in primary care: an enhanced focus on engagement with men, direct engagement with children, and improved guidance and training on responding to reports of DVA received from other agencies.

scholarly journals Challenges and visions for managing pain-related insomnia in primary care using the hybrid CBT approach: a small-scale qualitative interview study with GPs, nurses, and practice managers

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
V. E. J. Collard ◽  
C. Moore ◽  
V. Nichols ◽  
D. R. Ellard ◽  
S. Patel ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Service Providers ◽  
Care Service ◽  
Primary Care Service ◽  
Care Staff ◽  
Feasibility Trial ◽  
Small Scale ◽  
Qualitative Interview Study ◽  
Patient Reported

Abstract Background Chronic pain and insomnia have a complex, bidirectional relationship – addressing sleep complaints alongside pain may be key to alleviating patient-reported distress and disability. Healthcare professionals have consistently reported wanting to offer psychologically informed chronic pain management at the primary care level. Research in secondary care has demonstrated good treatment efficacy of hybrid CBT for chronic pain and insomnia. However, primary care is typically the main point of treatment entry, hence may be better situated to offer treatments using a multidisciplinary approach. In this study, primary care service providers’ perception of feasibility for tackling pain-related insomnia in primary care was explored. Methods The data corpus originates from a feasibility trial exploring hybrid CBT for chronic pain and insomnia delivered in primary care. This formed three in-depth group interviews with primary care staff (n = 9) from different primary care centres from the same NHS locale. All interviews were conducted on-site using a semi-structured approach. Verbal data was recorded, transcribed verbatim and analysed using the thematic analysis process. Results Eight themes were identified – 1) Discrepant conceptualisations of the chronic pain-insomnia relationship and clinical application, 2) Mismatch between patients’ needs and available treatment offerings, 3) Awareness of psychological complexities, 4) Identified treatment gap for pain-related insomnia, 5) Lack of funding and existing infrastructure for new service development, 6) General shortage of psychological services for complex health conditions, 7) Multidisciplinary team provision with pain specialist input, and 8) Accessibility through primary care. These mapped onto four domains - Current understanding and practice, Perceived facilitators, Perceived barriers, Ideal scenarios for a new treatment service – which reflected the focus of our investigation. Taken together these provide key context for understanding challenges faced by health care professionals in considering and developing a new clinical service. Conclusions Primary care service providers from one locale advocate better, multidisciplinary treatment provision for chronic pain and insomnia. Findings suggest that situating this in primary care could be a feasible option, but this requires systemic support and specialist input as well as definitive trials for success.

scholarly journals Understanding people who self-referred in an emergency department with primary care problems during office hours: a qualitative interview study at a Daytime General Practice Cooperative in two hospitals in The Hague, The Netherlands

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e029853 ◽  
Author(s):  
Rosa Naomi Minderhout ◽  
Pien Venema ◽  
Hedwig M M Vos ◽  
Jojanneke Kant ◽  
Marc Abraham Bruijnzeels ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
General Practice ◽  
The Netherlands ◽  
Motivational Factors ◽  
Lack Of Information ◽  
Qualitative Interview Study ◽  
The Hague ◽  
Straightforward Solution ◽  
The Right

ObjectiveTo provide insight into the motives for hospital self-referral during office hours and the barriers deterring general practitioner (GP) consultation with a primary care request.SettingPeople who self-referred at a Daytime General Practice Cooperative (GPC) in two hospitals in The Hague, The Netherlands.ParticipantsA total of 44 people who self-referred were interviewed in two hospitals. The average age of interviewees was 35 years (range 19 months to 83 years), a parent of a young patient was interviewed, but the age of patients is shown here. There were more male patients (66%) than female patients (34%). Patients were recruited using a sampling method after triage. Triage was the responsibility of an emergency department (ED) nurse in one hospital and of a GP in the other. Those excluded from participation included (a) children under the age of 18 years and not accompanied by a parent or legal guardian, (b) foreign patients not resident in the Netherlands, (c) patients unable to communicate in Dutch or English and (d) patients directly referred to the ED after triage by the GP (in one hospital).ResultsPeople who self-referred generally reported several motives for going to the hospital directly. Information and awareness factors played an important role, often related to a lack of information regarding where to go with a medical complaint. Furthermore, many people who self-referred mentioned hospital facilities, convenience and perceived medical necessity as motivational factors. Barriers deterring a visit to the own GP were mainly logistical, including not being registered with a GP, the GP was too far away, poor GP telephone accessibility or a waiting list for an appointment.ConclusionInformation and awareness factors contribute to misperceptions among people who self-referred concerning the complaint, the GP and the hospital. As a range of motivational factors are involved, there is no straightforward solution. However, better dissemination of information might alleviate misconceptions and contribute to providing the right care to the right patient in the right setting.

Facilitators and barriers to general practitioner and general practice nurse participation in end-of-life care: systematic review

2020 ◽  
pp. bmjspcare-2019-002109 ◽  
Author(s):  
Joel J Rhee ◽  
Matthew Grant ◽  
Hugh Senior ◽  
Leanne Monterosso ◽  
Peta McVey ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
End Of Life ◽  
Low Income ◽  
End Of Life Care ◽  
National Level ◽  
Aged Care ◽  
Life Care ◽  
Structural Barriers ◽  
Facilitators And Barriers

BackgroundGeneral practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide palliative care (PC) or end-of-life care (EoLC) as the population ages. To enhance primary EoLC, the facilitators and barriers to their provision need to be understood.ObjectiveTo provide a comprehensive description of the facilitators and barriers to GP and GPN provision of PC or EoLC.MethodSystematic literature review. Data included papers (2000 to 2017) sought from Medline, PsycInfo, Embase, Joanna Briggs Institute and Cochrane databases.ResultsFrom 6209 journal articles, 62 reviewed papers reported the GP’s and GPN’s role in EoLC or PC practice. Six themes emerged: patient factors; personal GP factors; general practice factors; relational factors; co-ordination of care; availability of services. Four specific settings were identified: aged care facilities, out-of-hours care and resource-constrained settings (rural, and low-income and middle-income countries). Most GPs provide EoLC to some extent, with greater professional experience leading to increased comfort in performing this form of care. The organisation of primary care at practice, local and national level impose numerous structural barriers that impede more significant involvement. There are potential gaps in service provision where GPNs may provide significant input, but there is a paucity of studies describing GPN routine involvement in EoLC.ConclusionsWhile primary care practitioners have a natural role to play in EoLC, significant barriers exist to improved GP and GPN involvement in PC. More work is required on the role of GPNs.

scholarly journals Processing discharge summaries in general practice: a qualitative interview study with GPs and practice managers

BJGP Open ◽  
2019 ◽  
Vol 3 (1) ◽  
pp. bjgpopen18X101625 ◽  
Author(s):  
Rachel A Spencer ◽  
Sarah Rodgers ◽  
Ndeshi Salema ◽  
Stephen M Campbell ◽  
Anthony J Avery
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Hospital Discharge ◽  
Secondary Care ◽  
Human Error ◽  
Transitions Of Care ◽  
Care Staff ◽  
Geographical Regions ◽  
Qualitative Interview Study ◽  
Discharge Summaries

BackgroundDischarge summaries are essential for communicating patient information from secondary care to general practice on hospital discharge. Although there has been extensive research into their design and completion in secondary care, very little is known about primary care processing of these documents.AimTo explore what general practice staff think are the factors associated with failure to respond to actions requested in discharge summaries and what practices do to mitigate this.Design & settingSemi-structured interviews were undertaken with primary care staff in three geographical regions of England.MethodInterviews with 10 practice managers and 10 GPs (one of each at each of the 10 practices) were undertaken to explore management of discharge summaries.ResultsFive themes emerged from the interviews. The 'secondary care factors' theme describes participants’ perspectives on the design of summaries, which are inconsistent and often require improvement. The 'safety features of processing systems' theme focuses on document handling in primary care. A theme devoted to 'medicines reconciliation' followed. 'Error and harm as a result of faulty processing' is a theme describing ‘human error’ and other factors that participants believed contributed to failure to respond to requested actions. Finally, the 'strategies for safety improvement' theme describes initiatives to prevent failures of safer transitions of care.ConclusionCorrect processing of discharge summaries is essential to ensure patients experience a safe transition of care and not just a hospital discharge. Based on the interview findings, strategies to mitigate against faults in the processing of discharge summaries have been suggested to enhance safer transitions of care.

scholarly journals Investigating the impact of distance on the use of primary care extended hours

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Jen Murphy ◽  
Mark Elliot ◽  
William Whittaker ◽  
Rathi Ravindrarajah
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Negative Binomial ◽  
Service Providers ◽  
Unmet Need ◽  
Area Deprivation ◽  
Home Practice ◽  
Extended Access ◽  
Gp Services ◽  
The Impact

IntroductionPoor access to general practice services has been attributed to increasing pressure on the health system more widely and low satisfaction among patients. Recent initiatives in England have sought to expand access by the provision of appointments in the evening and at weekends. Services are provided using a hub model. NHS national targets mandate extended opening hours as a mechanism for increasing access to primary care, based on the assumption that unmet need is caused by a lack of appointments at the right time. However, research has shown that other factors affect access to healthcare and it may not simply be appointment availability that limits an individual's ability to access general practice services. ObjectivesTo determine whether distance and deprivation impact on the uptake of extended hours GP services that use a hub practice model. MethodsWe linked a dataset (N = 25,408) concerning extended access appointments covering 158 general practice surgeries in four Clinical Commissioning Groups (CCGs) to the General Practice Patient Survey (GPPS) survey, deprivation statistics and primary care registration data. We used negative binomial regression to estimate associations between distance and deprivation on the uptake of extended hours GP services in the Greater Manchester City Region. Distance was defined as a straight line between the extended hours provider location and the patient's home practice, the English Indices of Multiple Deprivation were used to determine area deprivation based upon the home practice, and familiarity was defined as whether the patient's home practice provided an extended hours service. ResultsThe number of uses of the extended hours service at a GP practice level was associated with distance. After allowing for distance, the number of uses of the service for hub practices was higher than for non-hub practices. Deprivation was not associated with rates of use. ConclusionThe results indicate geographic inequity in the extended hours service. There may be many patients with unmet need for whom the extension of hours via a hub and spoke model does not address barriers to access. Findings may help to inform the choice of hub practices when designing an extended access service. Providers should consider initiatives to improve access for those patients located in practices furthest away from hub practices. This is particularly of importance in the context of closing health inequality gaps.

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