Private Provision of ‘outreach’ Clinics to Fundholding General Practices in England

1998 ◽  
Vol 3 (1) ◽  
pp. 20-22 ◽  
Author(s):  
Susan Kerrison ◽  
Roslyn Corney
Keyword(s):  
General Practitioner ◽  
Postal Survey ◽  
Medical Specialist ◽  
Private Provision ◽  
Private Practitioners ◽  
General Practices ◽  
Outreach Clinic ◽  
Set Up ◽  
Second Wave ◽  
Relative Quality

Objectives: To establish the contribution of the private sector in providing outpatient ‘outreach’ clinics in general practitioner fundholding practices. Method: Postal survey of all 13 first-wave fundholders and four of the 13 second-wave fundholders in the former South East Thames Region of the National Health Service in 1995. Results: Fourteen practices responded. Ten practices had set up at least one medical specialist ‘outreach’ clinic and 12 at least one paramedical clinic since becoming fundholders. Eight practices reported their arrangements for consultant ‘outreach’ clinics and ten practices their arrangements for paramedical clinics. Forty-nine per cent of the total medical specialist hours and 46% of total paramedical hours were provided by private practitioners. The largest number of hours provided privately was in gynaecology. Conclusion: This small study identified considerable private provision of fundholders' ‘outreach’ clinics. However, there is no system in the NHS to monitor the extent of this market, the types of activities undertaken or the relative quality and cost of the services provided.

scholarly journals Seeing patients first: creating an opportunity for practice nurse care?

2010 ◽  
Vol 2 (2) ◽  
pp. 136 ◽  
Author(s):  
Tim Kenealy ◽  
Barbara Docherty ◽  
Nicolette Sheridan ◽  
Ryan Gao
Keyword(s):  
New Zealand ◽  
General Practitioner ◽  
Postal Survey ◽  
Working Environment ◽  
Work Organisation ◽  
Practice Nurses ◽  
Telephone Interviews ◽  
General Practices ◽  
Nursing Roles ◽  
Activity Method

INTRODUCTION: Practice nurses see patients in both a planned (i.e. scheduled appointment) and an unplanned (i.e. opportunistic) manner. This study aimed to investigate how often and why New Zealand practice nurses see patients prior to the general practitioner and whether they organise their care to support unplanned, opportunistic activity. METHOD: National postal survey from a random sample of 500 general practices, requesting a response from one nurse per practice. Semi-structured telephone interviews with a purposeful sample of respondents. FINDINGS: Responses came from 225 nurses (51% of practices confirmed to be eligible). Nearly all (92%) said their work role was the same as that of others in their practice. Only 13% of nurses routinely saw patients prior to the doctor, while 24% would choose to do so it they could, and 65% thought it important. Positive and negative aspects of seeing patients first are presented. Constraints included time, their role assisting practice workflow and perceptions of patient expectations. Few organised their work to create opportunities for lifestyle interventions. CONCLUSION: The current working environment of practice nurses in New Zealand does not readily support them routinely seeing patients before the general practitioner. We suggest this is a lost opportunity for patient-centred preventive care. KEYWORDS: Practice nursing roles; opportunistic interventions; work organisation; primary health care; chronic conditions

scholarly journals Standing order use in general practice: the views of medicine, nursing and pharmacy stakeholder organisations

2017 ◽  
Vol 9 (1) ◽  
pp. 47 ◽  
Author(s):  
Robyn Taylor ◽  
Eileen McKinlay ◽  
Caroline Morris
Keyword(s):  
General Practice ◽  
General Practitioner ◽  
Access To Health Care ◽  
Timely Manner ◽  
Face To Face ◽  
Standing Order ◽  
Access To Health ◽  
General Practices ◽  
Pharmacy Data ◽  
The Impact

ABSTRACT INTRODUCTION Standing orders are used by many general practices in New Zealand. They allow a practice nurse to assess patients and administer and/or supply medicines without needing intervention from a general practitioner. AIM To explore organisational strategic stakeholders’ views of standing order use in general practice nationally. METHODS Eight semi-structured, qualitative, face-to-face interviews were conducted with participants representing key primary care stakeholder organisations from nursing, medicine and pharmacy. Data were analysed using a qualitative inductive thematic approach. RESULTS Three key themes emerged: a lack of understanding around standing order use in general practice, legal and professional concerns, and the impact on workforce and clinical practice. Standing orders were perceived to extend nursing practice and seen as a useful tool in enabling patients to access medicines in a safe and timely manner. DISCUSSION The variability in understanding of the definition and use of standing orders appears to relate to a lack of leadership in this area. Leadership should facilitate the required development of standardised resources and quality assurance measures to aid implementation. If these aspects are addressed, then standing orders will continue to be a useful tool in general practice and enable patients to have access to health care and, if necessary, to medicines without seeing a general practitioner.

Arthur Conan Doyle and Medical London: Reading the Topography of Round the Red Lamp

2021 ◽  
Vol 11 (3) ◽  
pp. 295-313
Author(s):  
Roger Luckhurst
Keyword(s):  
General Practitioner ◽  
Full Time ◽  
Medical Institutions ◽  
Short Period ◽  
Arthur Conan Doyle ◽  
Set Up

This essay explores the short period of time that Arthur Conan Doyle spent between March and June 1891 when he moved his family into rooms in Bloomsbury and took a consulting room near Harley Street in an attempt to set up as an eye specialist. This last attempt to move up the professional hierarchy from general practitioner to specialist tends to be seen as a final impulsive move before Conan Doyle decided to become a full-time writer in June 1891. The essay aims to elaborate a little on the medical contexts for Conan Doyle’s brief spell in London, and particularly to track the medical topography in which he placed himself, situated between the radical, reformist Bloomsbury medical institutions and the fame and riches of the society doctors of Harley Street. These ambivalences are tracked in the medical fiction he published in Round the Red Lamp, his peculiar collection of medical tales and doctoring in 1894.

scholarly journals Cytokine signature and COVID-19 prediction models in the two waves of pandemics

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Serena Cabaro ◽  
Vittoria D’Esposito ◽  
Tiziana Di Matola ◽  
Silvia Sale ◽  
Michele Cennamo ◽  
...  
Keyword(s):  
Prediction Models ◽  
Regression Tree ◽  
Classification And Regression Tree ◽  
Diagnostic Tools ◽  
Linear Discriminant ◽  
Diagnosis And Prognosis ◽  
Machine Learning Approach ◽  
Set Up ◽  
Definition Of ◽  
Second Wave

AbstractIn Europe, multiple waves of infections with SARS-CoV-2 (COVID-19) have been observed. Here, we have investigated whether common patterns of cytokines could be detected in individuals with mild and severe forms of COVID-19 in two pandemic waves, and whether machine learning approach could be useful to identify the best predictors. An increasing trend of multiple cytokines was observed in patients with mild or severe/critical symptoms of COVID-19, compared with healthy volunteers. Linear Discriminant Analysis (LDA) clearly recognized the three groups based on cytokine patterns. Classification and Regression Tree (CART) further indicated that IL-6 discriminated controls and COVID-19 patients, whilst IL-8 defined disease severity. During the second wave of pandemics, a less intense cytokine storm was observed, as compared with the first. IL-6 was the most robust predictor of infection and discriminated moderate COVID-19 patients from healthy controls, regardless of epidemic peak curve. Thus, serum cytokine patterns provide biomarkers useful for COVID-19 diagnosis and prognosis. Further definition of individual cytokines may allow to envision novel therapeutic options and pave the way to set up innovative diagnostic tools.

scholarly journals Digital Transformation vs COVID-19: the Case of Japan

2020 ◽  
Vol 1 (2) ◽  
pp. 8-16 ◽  
Author(s):  
Junzo Iida
Keyword(s):  
Japanese Society ◽  
Digital Transformation ◽  
Government Agencies ◽  
The Past ◽  
Electronic Contracts ◽  
Court Proceedings ◽  
The Government ◽  
Set Up ◽  
Second Wave ◽  
Business Sectors

Whilst the DX policy of the Japanese government started in 2001, then called the E-Japan Strategy and being replaced a few years later by the i-Japan Strategy, in the 20 years since then IT has not been a success in Japan’s administrative system. On the other hand, the private sector, concerned about Japan’s lagging in its adoption of information technology, has been gradually moving forward to DX measures, such as electronic contracts. Then, this year, the COVID-19 pandemic broke out. Japan is (as of July 2020) about to experience a second wave of this disease. The need for DX has become imperative in all aspects of Japanese society, especially the government and business sectors. In the first half of 2020, the government set up DX policy rapidly; for example, civil court proceedings, the traditional carve seals custom, and the submission of administrative documents to government agencies have also been forced to move forward to DX due to COVID-19. It might be said that the crisis has been the catalyst for Japan’s shift to DX. However, it will be at least a few years before it can be known whether Japan’s DX will succeed, looking at the past examples within the Japanese bureaucratic system and politicians’ attitudes towards DX.

scholarly journals Setting up a methadone maintenance clinic in a hostel in London's West End

2006 ◽  
Vol 30 (9) ◽  
pp. 337-339
Author(s):  
John Dunn ◽  
David Robertson ◽  
Paul Davis ◽  
Babak Khosrawan ◽  
Suneel Christian
Keyword(s):  
Treatment Outcomes ◽  
Substance Misuse ◽  
Methadone Maintenance ◽  
Homeless People ◽  
Clinical Implications ◽  
Original Cohort ◽  
Heroin Use ◽  
The Past ◽  
Outreach Clinic ◽  
Set Up

Aims and MethodA satellite methadone prescribing service was set up in a hostel in London's West End. The aim was to investigate if it were feasible to engage and retain these hard-to-reach, chaotic, polydrug users in treatment. A basic needs assessment was undertaken with staff and clients at the hostel. Treatment outcomes were assessed at 16 weeks using the Maudsley Addiction Profile.ResultsAt 16 weeks 87% of the original cohort (26 out of 30) were still in treatment. There were also significant reductions in mean heroin use (from 29.7 to 14.5 out of the past 30 days, P<0.001) and in the frequency of injecting (from 25.9 to 15.9 days, P<0.001).Clinical ImplicationsThis outreach clinic offers a model for developing services to homeless people with substance misuse problems.

scholarly journals Evaluation of a community based service for urgent psychiatric assessment

1996 ◽  
Vol 20 (10) ◽  
pp. 592-595 ◽  
Author(s):  
M. J. Crawford ◽  
D. Kohen ◽  
J. Dalton
Keyword(s):  
General Practitioner ◽  
Initial Assessment ◽  
Medical Professionals ◽  
Hospital Services ◽  
Community Based ◽  
Psychiatric Assessment ◽  
Assessment And Treatment ◽  
Set Up

The Urgent Assessment Service (UAS) was set up to provide community based urgent psychiatric assessment to a range of referrers. The work of the service was assessed over a six month period. Results show that it was popular with a broad range of medical and non-medical professionals. Patients generally presented with depression or psychotic illnesses and those referred from non-medical sources were more likely to be suffering from schizophrenia and assessed as being at least as unwell as those referred by GPs and hospital based doctors. Rates or referral to hospital services were low with the vast majority of patients being referred back to their general practitioner after initial assessment and treatment.

Introduction

2017 ◽  
Author(s):  
Emily Anne Parker ◽  
Anne van Leeuwen
Keyword(s):  
Critical Dialogue ◽  
Contested Space ◽  
Feminist Theories ◽  
Set Up ◽  
Second Wave

This volume returns to Beauvoir, to Irigaray, and to a critical dialogue between their projects. The motivation is not to produce dutiful interpretations that ignore their limits; rather the task here is to identify the most incisive moments of these bodies of work to articulate the trajectories that we find in these projects, ones that they set up as well as ones that they did not and could not have anticipated. We return to Beauvoir and Irigaray because the richness of their thought far exceeds the reductive parameters of a largely white, Eurocentric, bourgeois second-wave debate and because the fecundity these projects as well as an adequate critique of their work remains largely still to be elaborated. We hope that positioning them in critical dialogue will open up one possible richly complex and contested space for multiplicitous contemporary feminist theories.

scholarly journals Couple relationship problems—a task for the general practitioner? A cross-sectional survey from Norway

2020 ◽  
Author(s):  
Siri Dalsmo Berge ◽  
Eivind Meland ◽  
Mette Brekke ◽  
Gunnar Tschudi Bondevik ◽  
Frode Thuen ◽  
...  
Keyword(s):  
General Practice ◽  
General Practitioner ◽  
Regression Models ◽  
Good Health ◽  
Couple Relationship ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Relationship Problems ◽  
Logistic Regression Models ◽  
General Practices

Abstract Background A healthy couple relationship is a predictor of good health. There is a lack of knowledge about what role family and couples counselling should have in general practice. Objectives To identify the prevalence of patients who have talked, or want to talk, with their general practitioner (GP) about their couple relationship, to investigate what characterizes these patients and to explore whether they believe that couple relationship problems should be dealt with in general practice. Methods We conducted a cross-sectional survey in 70 general practices in Norway during spring 2019. A questionnaire was answered by 2178 consecutive patients (response rate 75%) in GP waiting rooms. Data were examined using frequencies and linear and logistic regression models. Results We included 2097 responses. Mean age was 49.0 years and 61.3% were women. One in four (25.0%) had already talked with their GP about couple relationship problems, while one in three (33.5%) wanted to talk with their GP about their couple relationship problems. These patients more frequently had experience of divorce, poor self-rated health, an opinion that their couple relationship had a significant impact on their health and lower couple relationship quality when adjusted for age, sex, present marital status and children living at home. We found that 46.4% of patients believed that GPs should be interested in their couple relationship problems. Conclusion Relationship problems are frequently addressed in general practice. GPs should be prepared to discuss this issue to facilitate help for couples earlier than they might otherwise expect.

scholarly journals Building a Multi-centre Clinical Research Facilitation Network: The ARC Experience

2017 ◽  
Vol 2 (2) ◽  
Author(s):  
Ian Nicholson
Keyword(s):  
General Practitioner ◽  
Clinical Research ◽  
Animal Health ◽  
Data Gathering ◽  
Small Animal ◽  
Multi Centre Study ◽  
Statistical Planning ◽  
Set Up ◽  
Randomised Controlled ◽  
Soft Tissue Surgery

<p>Introduction: In order to practice evidence-based veterinary medicine, good quality clinical evidence needs to be produced, in order that it can be apprasied systematically by the EBVM network, and used by vets. There is very little good-quality veterinary evidence for most of the veterinary procedures carried out every day across the world. Very few, if any, individuals have all the necessary qualities (case-load, time, research expertise, financial support) to be able to systematically produce good-quality, and relevant, clinical research on their own, in a timely manner. The Association for Veterinary Soft Tissue Surgery (AVSTS) www.avsts.org.uk is an affiliate group with the British Small Animal Veterinary Association (BSAVA), and functions as a clinical network of like-minded individuals. In 2013 AVSTS sought to create a role for itself in facilitating the production (by its members) of multi-centre clinical research of relevance to its members.</p><p>Materials and methods: Members of AVSTS were asked to join the AVSTS Research Cooperative (ARC), with a veterinary epidemiologist and an experienced multi-centre veterinary clinical researcher (to help with study design and statistical planning), and the Animal Health Trust clinical research ethics committee. An email list was established, and a page was set up on the AVSTS website, to allow information to be disseminated. The AVSTS spring and autumn meetings were used as a regular forum by ARC, to discuss its direction, to generate interest, to create and promote specific studies (in order to widen participation amongst different centres), and to update members about previous studies.</p><p>Results: Membership of ARC has grown to 224 people, although the epidemiologist left. One multi-centre study has been published, two have been presented and await publication, one has been accepted for presentation, two other studies are gathering data at present, and further studies are in the pipeline. There has been interest from general practitioner members but as yet no studies of general practice procedures have been forthcoming.</p><p>Discussion: Vets want to be involved with clinical research. ARC has had early successes and will continue to grow - though more work is needed to encourage general practitioner members. Multi-centre research allows more cases to be recruited more quickly, adding weight to studies and shortening the period of data-gathering. These initial retrospective studies have generated a committed core of individuals seeking to create prospective studies together. An online tool is planned, to facilitate real-time case-recruitment<br />for prospective multi-centre studies including randomised controlled trials. Anyone can join ARC, please email [email protected].</p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" />

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