Confused out of care: unanticipated consequences of a ‘Hostile Environment’

2020 ◽  
Vol 46 (3) ◽  
pp. 163-167 ◽  
Author(s):  
Rose Glennerster ◽  
Nathan Hodson
Keyword(s):  
Secondary Care ◽  
Medical Profession ◽  
Free Access ◽  
Hostile Environment ◽  
Patient Health ◽  
Unanticipated Consequences ◽  
Legal Entitlement ◽  
The Uk ◽  
Refugees And Asylum Seekers ◽  
Current Guidelines

The UK’s 2014 Immigration Act aimed to create a ‘Hostile Environment’ for migrants to the UK. One aspect of this was the restriction of access to secondary care for overseas visitors to the UK, although it remains the case that everybody living in the UK has the legal right to access primary care. In this paper, we argue that the effects of this policy extend beyond secondary care, including preventing eligible people from registering with a General Practice (GP), although as an unintended consequence. This problem arises from misinterpretation of policy wording, misleading GP websites and gatekeeping behaviour from front-line staff, even though there are no grounds in the current guidelines or law to support this. Free access to primary healthcare among refugees and asylum seekers living in deprived populations is particularly important in protecting patient health, given the burden of ill-health in this population and the multiple barriers to accessing early intervention they face. The medical profession has a duty to communicate their rights to this patient group—their legal entitlement to access free healthcare, and the vital importance of doing so.

scholarly journals Burnout amongst neurosurgical trainees in the UK and Ireland

2021 ◽  
Author(s):  
Nadia Liber Salloum ◽  
Phillip Correia Copley ◽  
Marco Mancuso-Marcello ◽  
John Emelifeonwu ◽  
Chandrasekaran Kaliaperumal
Keyword(s):  
Risk Factors ◽  
Workplace Bullying ◽  
Online Survey ◽  
Medical Profession ◽  
Leisure Activities ◽  
Attrition Rates ◽  
Workplace Stressors ◽  
Potential Risk Factors ◽  
The Uk ◽  
Enhance Patient Care

Abstract Introduction Burnout is becoming an increasingly recognised phenomenon within the medical profession. This study aims to investigate the presence of burnout amongst neurosurgical trainees in the UK and Ireland as well as investigating potential exacerbating and protective factors. Method An online survey was sent to all neurosurgical trainees in the UK and Ireland via the British Neurosurgical Trainees’ Association (BNTA) mailing list. Responding participants anonymously completed the Copenhagen Burnout Inventory (CBI) and answered questions about known risk factors for burnout including workplace environment, workplace bullying, time spent on leisure activities and sleep and reported likelihood of leaving neurosurgery. We also collated data on responders’ demographics. We compared CBI scores for participants with and without risk factors to determine correlation with CBI. Results There were 75 respondents (response rate 42%) from a range of ages and all training grades, 72% of whom were male. The median CBI score was 38.85 (IQR 17.76). Participants showed a higher degree of personal and workplace burnout (median CBIs of 47.02, IQR 25.00; and 49.14, IQR 19.64, respectively) compared with patient-related burnout (median CBI 18.67, IQR 25.00). Participants with the following self-reported risk factors were significantly more likely to have higher CBIs: workplace bullying (p = 0.01), getting on less well with colleagues (p < 0.05), working longer hours (p < 0.05) and insufficient sleep, exercise and leisure time (all p < 0.01). Those with higher CBI scores were more likely to consider leaving neurosurgical training (p = 0.01). Conclusion We identified a high burnout incidence in a cohort representative of UK neurosurgical trainees, although our results may have been skewed somewhat by selection bias. We determined potential risk factors for burnout related to specific workplace stressors and time for non-work activities. In the future, changes to training curricula should address these issues, aiming to improve training, enhance patient care and reduce attrition rates.

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.

scholarly journals Knights and Knaves in the English Medical Profession: the Case of Clinical Excellence Awards

2015 ◽  
Vol 45 (1) ◽  
pp. 83-99 ◽  
Author(s):  
MARK EXWORTHY ◽  
PAULA HYDE ◽  
PAMELA MCDONALD-KUHNE
Keyword(s):  
Health Policy ◽  
National Health Service ◽  
Health Service ◽  
Medical Profession ◽  
Clinical Excellence ◽  
Medical Professional ◽  
Policy Makers ◽  
Written Responses ◽  
Private Interests ◽  
The Uk

AbstractWe elaborate Le Grand's thesis of ‘knights and knaves’ in terms of clinical excellence awards (CEAs), the ‘financial bonuses’ which are paid to over half of all English hospital specialists and which can be as much as £75,000 (€92,000) per year in addition to an NHS (National Health Service) salary. Knights are ‘individuals who are motivated to help others for no private reward’ while knaves are ‘self-interested individuals who are motivated to help others only if by doing so they will serve their private interests.’ Doctors (individually and collectively) exhibit both traits but the work of explanation of the inter-relationship between them has remained neglected. Through a textual analysis of written responses to a recent review of CEAs, we examine the ‘knightly’ and ‘knavish’ arguments used by medical professional stakeholders in defending these CEAs. While doctors promote their knightly claims, they are also knavish in shaping the preferences of, and options for, policy-makers. Policy-makers continue to support CEAs but have introduced revised criteria for CEAs, putting pressure on the medical profession to accept reforms. CEAs illustrate the enduring and flexible power of the medical profession in the UK in colonising reforms to their pay, and also the subtle inter-relationship between knights and knaves in health policy.

The National Schools’ Observatory: Access to the Universe for All

2019 ◽  
Vol 15 (S367) ◽  
pp. 28-29
Author(s):  
Sally E. Cooper
Keyword(s):  
Free Access ◽  
Next Generation ◽  
Robotic Telescopes ◽  
The Uk ◽  
Robotic Telescope ◽  
The Universe

AbstractThe National Schools’ Observatory is an educational platform that offers free access to all schools in the UK and Ireland to the world’s largest robotic telescope, the Liverpool Telescope. The website offers activities, resources for teaching and importantly Go Observing, the telescope interface. The website receives 1.5 million visitors a year and has registered users in 80 countries. The next generation of robotic telescopes offer a unique opportunity to build in education, that is open and accessible to all.

scholarly journals Before writing that script: use of antipsychotic medication in patients with dementia in a CMHTOA

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S96-S96
Author(s):  
Adaora Obiekezie ◽  
Roohi Afshan ◽  
Jack Healy
Keyword(s):  
Antipsychotic Medication ◽  
Psychological Symptoms ◽  
Antipsychotic Treatment ◽  
Community Mental Health Team ◽  
Mental Health Team ◽  
Diagnosis Of Dementia ◽  
Independent Review ◽  
The Common ◽  
The Uk ◽  
Current Guidelines

AimsA 2009 independent review commissioned by the UK government to review the use of antipsychotic medication in patients diagnosed with dementia produced the Time for Action report, often referred to as the Banerjee Report. It highlighted the common practise of using antipsychotics in the treatment of Behavioural and Psychological Symptoms of Dementia (BPSD) and the clinical issues this could raise especially when these medications were not being regularly reviewed. The audti was therefore carried out to determine whether patinets with BPSD in a Community Mental Health Team for Older adults (CMHTOA) in Mid Surrey, who had been diagnosed with BPSD, were being adequately assessed and managed in line with the current guidelines.MethodPatients with a diagnosis of dementia open to one of three teams in the CMHTOA during the months of October and November 2019 were identified, those being prescribed antipsychotic medication were selected and data from their electronic records collected and analysed to determine if clinicians: a) identified and documented the target behaviours, b) carried out a structured assessment using an ABC chart before commencing medication, c) reviewed the antipsychotic medication 6 weeks after it was commenced.ResultOf the 87 patients with a diagnosis of Dementia from October to November 2019, 18 were on antipsychotic medication. 100% of these had target behaviours identified and clearly documented, a sixth had a structured assessment prior to starting medication and 61% had been reviewed after the first 6 weeks of starting antipsychotics.ConclusionThe findings showed that a good proprotion of patients did not have the required structured assessment before commencement of treatment and that more needed to be done by way of improving regular reviews after antipsychotic treatment is commenced.

scholarly journals Introduction to the Special Issue “Transnational care: Families confronting borders”

2020 ◽  
Vol 32 (3) ◽  
pp. 393-414
Author(s):  
Laura Merla ◽  
Majella Kilkey ◽  
Loretta Baldassar
Keyword(s):  
Latin American ◽  
Asylum Seekers ◽  
Family Relations ◽  
Transnational Families ◽  
Special Issue ◽  
Transnational Family ◽  
Current Scenario ◽  
The Uk ◽  
Refugees And Asylum Seekers ◽  
Migration Regimes

In this article, we introduce the key themes of our Special Issue on "Transnational care: families confronting borders". Central to this collection is the question of how family relations and solidarities are impacted by the current scenario of closed borders and increasingly restrictive migration regimes. This question is examined more specifically through the lens of care dynamics within transnational families and their (re-)configurations across diverse contexts marked by "immobilizing regimes of migration". We begin by presenting a brief overview of key concepts in the transnational families and caregiving literature that provides a foundation for the diverse cases explored in the articles, including refugees and asylum seekers in Germany and Finland, Polish facing Brexit in the UK, Latin American migrants transiting through Mexico, and restrictionist drifts in migration policies in Australia, Belgium and the UK. Drawing on this rich work, we identify two policy tools; namely temporality and exclusion, which appear to be particularly salient features of immobilizing regimes of migration that significantly influence care-related mobilities. We conclude with a discussion of how immobilizing regimes are putting transnational family solidarities in crisis, including in the context of the Covid-19 pandemic, gripping the globe at the time of writing.

The Importance of Convention Status: A Case Study of the UK

2001 ◽  
Vol 6 (1) ◽  
pp. 15-24 ◽  
Author(s):  
Alice Bloch
Keyword(s):  
Asylum Seekers ◽  
Economic Rights ◽  
The United Kingdom ◽  
The Social ◽  
The Status ◽  
The Uk ◽  
Refugees And Asylum Seekers ◽  
Social And Economic Rights

Convention status accords refugees social and economic rights and security of residence in European countries of asylum. However, the trend in Europe has been to prevent asylum seekers reaching its borders, to reduce the rights of asylum seekers in countries of asylum and to use temporary protection as a means of circumventing the responsibility of long-term resettlement. This paper will provide a case study of the United Kingdom. It will examine the social and economic rights afforded to different statuses in the areas of social security, housing, employment and family reunion. It will explore the interaction of social and economic rights and security of residence on the experiences of those seeking protection. Drawing on responses to the crisis in Kosovo and on data from a survey of 180 refugees and asylum seekers in London it will show the importance of Convention status and the rights and security the status brings.

Breast lumps in service women

2014 ◽  
Vol 100 (2) ◽  
pp. 174-178
Author(s):  
S Pengelly ◽  
AW Lambert ◽  
M Khan ◽  
J Groome
Keyword(s):  
Breast Cancer ◽  
Young Population ◽  
Young Females ◽  
Breast Surgeon ◽  
Group A ◽  
Red Flag ◽  
Wait And See ◽  
Breast Lumps ◽  
The Uk ◽  
Current Guidelines

AbstractIntroductionBreast cancer is uncommon in a young population but it does occur. 80% of breast cancer occurs after 50 yrs of age. This article uses current guidelines and evidence to advise military medical staff on how best to investigate and manage servingage women presenting with breast symptoms. Male breast changes will be dealt with in a future article.Differential DiagnosisYoung females presenting with breast lumps are unlikely to have cancer. In order of frequency the causes are likely to be benign breast change; fibroadenoma; abscesses in 20-30 year olds; cysts in 30-40 year olds; and lastly cancer. The UK sees 48,000 new cases of breast cancer in women every year; breast cancer can also occur in men but is very rare.Diagnosis and ManagementManagement in the deployed, primary and secondary care settings are described. It may be reasonable in young women to wait and see if a lump resolves after the patient’s next menstrual cycle before referring the patient. Once referred, current guidelines recommend that all patients are seen by a breast surgeon within two weeks. Within this group, a subgroup of patients with ‘red-flag’ lumps is identified who need to be referred urgently. The remaining patients have lumps that can be considered non-urgent: however, hospitals will still endeavour to see these patients within two weeks..ConclusionsBreast cancer is more difficult to diagnose in the younger patient. In primary care, breast lumps are still simple to manage if the points in this article are followed. Anxious patients can be reassured that cancer is unlikely. However, cancer in this young age group is associated with worse outcomes than breast cancer in older patients.

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