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 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 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.

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.

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.

Local implementation of AMS initiatives: a mixed-methods study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697025 ◽  
Author(s):  
Rosalie Allison ◽  
Donna Lecky ◽  
Elizabeth Beech ◽  
Ceire Costelloe ◽  
Diane Ashiru-Oredope ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Interviews ◽  
Antibiotic Prescribing ◽  
Out Of Hours ◽  
Face To Face ◽  
E Learning ◽  
General Practices ◽  
Primary Care Practitioners ◽  
Future Work ◽  
Common Infections

BackgroundThe NHS English Quality Premium recommends that inappropriate antibiotic prescribing is reduced; there are a range of national antimicrobial stewardship (AMS) initiatives to support this.AimThe aim of this study is to assess AMS activities in primary care across England. The findings will be used to inform how the RCGP, PHE and NHS can help optimise stewardship activities.MethodQualitative interviews: with AMS leads within Clinical Commissioning Groups’ (CCGs) and Commissioning Support Units’ (CSUs) medicines management teams. Questionnaire: informed by the qualitative data, sent to all 209 CCGs in England in 2017.ResultsIn total, 89% (187/209) of CCGs returned a questionnaire; 82% of AMS leads reported spending only 0.1 whole-time equivalent on AMS activities, as it was only one role within a wider remit, so dedicating time is challenging. 99% (167/169) of CCGs had delivered AMS education in the last 2 years: 140 face-to-face; 121 via e-learning. 99% (184/186) actively promoted the TARGET Antibiotics Toolkit; 94% (175/187) actively promoted TARGET patient leaflets: 92% The Treating Your Infection (TYI) leaflet. 90% (166/185) used the PHE managing common infections guidance: 81% (149/185) modify or localise; 41/185 (22%) signpost directly to it. Eighty-six CCGs reported using CCG audit tools and 82 CCGs reported using TARGET’s audit tools. 85% (142/168) fed back antimicrobial prescribing data to the CCG/CSU board; 100% (169/169) to general practices and 33% (56/169) to out-of-hours providers.ConclusionAlthough CCGs reported promoting these AMS activities, there was little evaluation of uptake by primary care practitioners. Future work should focus on measuring AMS uptake; having staff dedicated solely to AMS could facilitate this.

User Attitudes to E-Government Citizen Services in Europe

2011 ◽  
pp. 2634-2642
Author(s):  
Jeremy Millard
Keyword(s):  
Data Privacy ◽  
The Internet ◽  
Face To Face ◽  
Government Services ◽  
New Information ◽  
User Attitudes ◽  
Potential Demand ◽  
The Uk ◽  
European Union Member States

In 2005, the eUSER project undertook a questionnaire survey covering about 10,000 households in 10 European Union member states, the purpose of which was to provide some of the first systematic evidence in Europe of citizen user behaviour and their attitudes to the use of public services, and particularly the role of e-services in this context. The survey focused on a number of themes — the public’s use of government services, the different channels (or media) employed, the nature of potential future demand for e-government, the barriers and experiences in using e-government, and the socio-economic attributes of e-government users compared with non-users. The results provide important new information on the role that the Internet is now playing in the delivery and take-up of government services by European citizens. Face-to-face contact is still the most important channel for contacting government in Europe. In some countries (e.g., the UK), however, telephone and post have overtaken face-to-face. Results also show that potential demand for e-government services is about 50% of all government users and could be higher. One quarter of individual e-government users have acted as intermediaries for family members or friends, and one quarter have also done so on behalf of their employer. Most barriers that users anticipate they will meet when using e-government relate to difficulty in actually starting, with a feeling that face-to-face is better and the fear about data privacy important. However, once citizens have used e-government services, the barriers appear less, though still important, and relate mainly to the difficulty of feeling left alone with problems or questions.

Why we need to teach leadership skills to medical students: a call to action

BMJ Leader ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 6-10 ◽  
Author(s):  
Simone Jacquelyn Ross ◽  
Tarun Sen Gupta ◽  
Peter Johnson
Keyword(s):  
Medical Students ◽  
Health System ◽  
Leadership Training ◽  
Health Workers ◽  
Leadership Skills ◽  
Leadership Education ◽  
System Reform ◽  
Health System Reform ◽  
The Uk ◽  
Medical Leadership

Health system reform models since the early 1990s have recommended leadership training for medical students, graduates and health workers. Clinicians often have leadership roles thrust on them early in their postgraduate career. Those who are not well trained in leadership and the knowledge that comes with leadership skills may struggle with the role, which can impact patient safety and create unhealthy working environments. While there is some literature published in this area, there appears to be little formal evaluation of the teaching of leadership, with scarcely any discussion about the need to do so in the future. There are clear gaps in the research evidence of how to teach and assess medical leadership teaching. In this paper, three leadership frameworks from Australia, Canada and the UK are compared in terms of leadership capabilities for a global view of medical leadership training opportunities. A literature review of the teaching, assessment and evaluation of leadership education in medical schools in Australia, the UK and America is also discussed and gaps are identified. This paper calls for an education shift to consider practical health system challenges, citing the mounting evidence that health system reform will require the teaching and rigorous evaluation of leadership methods. Opportunities for teaching leadership in the curricula are identified, as well as how to transform leadership education to include knowledge and practice so that students have leadership skills they can use from the time they graduate.

scholarly journals Improving Our Understanding and Practice of Antibiotic Prescribing: A Study on the Use of Social Norms Feedback Letters in Primary Care

2021 ◽  
Vol 18 (5) ◽  
pp. 2602
Author(s):  
Stephanie Steels ◽  
Natalie Gold ◽  
Victoria Palin ◽  
Tim Chadborn ◽  
Tjeerd Pieter van Staa
Keyword(s):  
Primary Care ◽  
Social Norms ◽  
Medical Officer ◽  
Participatory Approach ◽  
Antibiotic Prescribing ◽  
Behavioural Science ◽  
Face To Face ◽  
Engagement Strategies ◽  
Prescribing Behaviour ◽  
The Uk

In the UK, 81% of all antibiotics are prescribed in primary care. Previous research has shown that a letter from the Chief Medical Officer (CMO) giving social norms feedback to General Practitioners (GPs) whose practices are high prescribers of antibiotics can decrease antibiotic prescribing. The aim of this study was to understand the best way for engaging with GPs to deliver feedback on prescribing behaviour that could be replicated at scale; and explore GP information requirements that would be needed to support prescribing behaviour change. Two workshops were devised utilising a participatory approach. Discussion points were noted and agreed with each group of participants. Minutes of the workshops and observation notes were taken. Data were analysed thematically. Four key themes emerged through the data analysis: (1) Our day-to-day reality, (2) GPs are competitive, (3) Face-to-face support, and (4) Empowerment and engagement. Our findings suggest there is potential for using behavioural science in the form of social norms as part of a range of engagement strategies in reducing antibiotic prescribing within primary care. This should include tailored and localised data with peer-to-peer comparisons.

scholarly journals Factors associated with potentially missed acute deterioration in primary care

2021 ◽  
pp. BJGP.2020.0986
Author(s):  
Elizabeth Cecil ◽  
Alex Bottle ◽  
Azeem Majeed ◽  
Paul Aylin
Keyword(s):  
Primary Care ◽  
Service Use ◽  
Emergency Admission ◽  
Hospital Data ◽  
Long Term Conditions ◽  
Face To Face ◽  
Factors Associated ◽  
Underlying Mechanisms ◽  
The Uk ◽  
Tract Infections

Background: In the UK, the majority of primary care contacts are uncomplicated. However, safety incidents resulting in patient harm occur, such as failure to recognise a patient’s deterioration in health.Aim: We aimed to determine patient and healthcare factors associated with potentially missed deterioration.Design and Setting : A cohort of patients registered with English CPRD general practices between 01-04-2014 and 31-12-2017 with linked hospital data.Methods: We defined a potentially missed deterioration as a patient, seen in primary care by a GP in the three days before hospitalisation, having a self-referred admission. We used generalised estimating equations to investigate factors associated with odds of a self-referred admission. We investigated all diagnoses and subsets of commonly reported missed conditions.Results: There were 116,097 patients who contacted a GP three days prior to an emergency admission. Patients with sepsis or urinary tract infections were more likely to self-refer, adjusted odds ratio 1.10 95%CI(1.02-1.19) and 1.09 (1.04-1.14) respectively. GP appointment durations were associated with self-referral. On average, a 5-minute increase resulted in 10% decrease in odds of self-referred admissions, 0.90 (0.89-0.91). Patients having a telephone (compared with face-to-face) consultation 1.13 (1.09-1.16), previous health service use and health status were also associated with self-referred admission.Conclusions: Differentiating deterioration from self-limiting conditions can be difficult for clinicians, particularly in patients with sepsis, UTI or with long-term conditions. Our findings supports the call for longer GP consultations and cautions reliance on telephone consultations in primary care; however, research is needed to understand the underlying mechanisms.

Assessing mental health in primary care research using standardized scales: can it be carried out over the telephone?

2004 ◽  
Vol 34 (1) ◽  
pp. 157-162 ◽  
Author(s):  
M. EVANS ◽  
D. KESSLER ◽  
G. LEWIS ◽  
T. J. PETERS ◽  
D. SHARP
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
General Health Questionnaire ◽  
Case Definition ◽  
Personal Contact ◽  
Primary Care Research ◽  
Face To Face ◽  
Care Research ◽  
The Uk ◽  
Good Agreement

Background. Telephone interviewing has economic and logistical advantages but has not been widely used in the UK. Most studies comparing face-to-face and telephone psychiatric assessment have been carried out in the US, often restricted to a population with known psychiatric disorder and involving comparisons between two separate sample groups rather than repeat interviews with the same group. The aim of the present study was to compare face-to-face and telephone administration of the 12-item General Health Questionnaire and the Revised Clinical Interview Schedule in a UK general practice sample.Method. Ninety-eight consecutive attenders at two general practices were assessed twice within 48 h. The order of face-to-face and telephone interviews was alternated.Results. There was no evidence that the mode of administration led to a bias in scores on the CIS-R. For the GHQ, those aged over 60 tended to score higher on the telephone. There was good agreement between face-to-face and telephone scores for both GHQ and CIS-R and good agreement for case definition. Participants had a strong preference for face-to-face interviews.Conclusions. Telephone assessment of mental health using the GHQ and CIS-R is a reasonable method to be used in primary care research in the UK with the limitation that telephone responses from older people might be different from face-to-face assessments for the GHQ. However, telephone interviewing appeared less acceptable and should probably be used in the context of established or ongoing personal contact between researcher and subject.

Sign in / Sign up

Export Citation Format

Share Document