A career in academic general practice

2019 ◽  
Vol 12 (3) ◽  
pp. 149-152
Author(s):  
Jonathan Mills ◽  
Joanne Reeve
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Research And Development ◽  
Best Practice ◽  
Cost Effective ◽  
Academic Community ◽  
Community Or ◽  
Health And Wellbeing ◽  
Effective Part ◽  
And Training

As a GP, you will make a difference to the lives of many thousands of patients over the course of your career, but as an academic GP you could make a difference to hundreds of thousands, even millions of lives. GPs can have an impact, not just in the consulting room or in patients’ homes. Differences can be made to the lives of many through the education and training of doctors, the work of commissioning boards seeking the best services for a community, or through research and development of the latest treatments. Primary care is a highly cost-effective part of NHS healthcare, and has a key role in promoting health and wellbeing. However, these roles would not be possible without contributions from academic general practice; the continuing success of primary care depends on the academic community that supports, researches, and develops best practice.

scholarly journals Effectiveness and cost-effectiveness of implementing HIV testing in primary care in East London: protocol for an interrupted time series analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018163 ◽  
Author(s):  
Werner Leber ◽  
Lee Beresford ◽  
Claire Nightingale ◽  
Estela Capelas Barbosa ◽  
Stephen Morris ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
General Practice ◽  
Cost Effectiveness ◽  
Hiv Testing ◽  
Cost Effective ◽  
Interrupted Time Series ◽  
Rapid Hiv Testing ◽  
Post Trial ◽  
Implementation Programme

IntroductionHIV remains underdiagnosed. Guidelines recommend routine HIV testing in primary care, but evidence on implementing testing is lacking. In a previous study, the Rapid HIV Assessment 2 (RHIVA2) cluster randomised controlled trial, we showed that providing training and rapid point-of-care HIV testing at general practice registration (RHIVA2 intervention) in Hackney led to cost-effective, increased and earlier diagnosis of HIV. However, interventions effective in a trial context may be less so when implemented in routine practice. We describe the protocol for an MRC phase IV implementation programme, evaluating the impact of rolling out the RHIVA2 intervention in a post-trial setting. We will use a longitudinal study to examine if the post-trial implementation in Hackney practices is effective and cost-effective, and a cross-sectional study to compare Hackney with two adjacent boroughs providing usual primary care (Newham) and an enhanced service promoting HIV testing in primary care (Tower Hamlets).Methods and analysisService evaluation using interrupted time series and cost-effectiveness analyses. We will include all general practices in three contiguous high HIV prevalence East London boroughs. All adults aged 16 and above registered with the practices will be included. The interventions to be examined are: a post-trial RHIVA2 implementation programme (including practice-based education and training, external quality assurance, incentive payments for rapid HIV testing and incorporation of rapid HIV testing in the sexual health Local Enhanced Service) in Hackney; the general practice sexual health Network Improved Service in Tower Hamlets and usual care in Newham. Coprimary outcomes are rates of HIV testing and new HIV diagnoses.Ethics and disseminationThe chair of the Camden and Islington NHS Research Ethics Committee, London, has endorsed this programme as an evaluation of routine care. Study results will be published in peer-reviewed journals and reported to commissioners.

scholarly journals Assessing Medical Student Basic Otolaryngology Knowledge: A Multi-Institutional Study

2019 ◽  
Vol 98 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Luke J. Pasick ◽  
Daniel Benito ◽  
Philip Zapanta ◽  
Robert T. Sataloff
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Medical Student ◽  
Medical Students ◽  
Head And Neck ◽  
Tracheotomy Tube ◽  
Surgical Specialty ◽  
Student Responses ◽  
Comfort Levels ◽  
And Training

The prevalence of otolaryngologic complaints in general practice is disproportionate to the extent of otolaryngology teaching in undergraduate medical education. This is the first multi-institutional validated study used to assess basic otolaryngology knowledge among medical students in order to understand their abilities to recognize and manage these cases. A 9-question, psychometrically validated, multiple-choice quiz was distributed in June 2017 to medical students of 9 US allopathic institutions as an assessment of basic otolaryngology knowledge. A total of 547 medical student responses were used to assess basic otolaryngology knowledge, comfort levels, amount of exposure to otolaryngology, and number of times the head and neck physical examination was taught formally. Comfort in managing otolaryngologic conditions correlated positively with knowledge ( P < .001, R2 = 0.266), in addition to otolaryngology exposure correlating positively with knowledge ( P < .001, R2 = 0.284). Students intending to enter otolaryngology had higher scores ( P = .002), higher comfort levels in managing otolaryngologic cases ( P < .001), and higher comfort levels performing the head and neck examination (χ2 = 21.324, P < .001), compared with students intending to enter primary care or another surgical specialty. Clinical students in third and fourth years entering any surgical specialty (including otolaryngology), more often than students entering primary care ( P = .007), recognized the obturator as the instrument used to guide the insertion of the tracheotomy tube. Additionally, the number of times the head and neck examination was taught correlated positively with comfort in performing the examination ( rs = 0.095, P = .022). Our findings support the need for increased otolaryngologic education and training among all medical students, not only those entering otolaryngology.

scholarly journals Tensions and opportunities in social prescribing. developing a framework to facilitate its implementation and evaluation in primary care: a realist review

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0017
Author(s):  
Sara Calderón-Larrañaga ◽  
Yasmin Milner ◽  
Megan Clinch ◽  
Trisha Greenhalgh ◽  
Sarah Finer
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Best Practice ◽  
Grey Literature ◽  
Good Practice ◽  
Realist Review ◽  
Individual Characteristics ◽  
Quantitative Evidence ◽  
Social Prescribing ◽  
Community Sector

BackgroundSocial prescribing (SP) involves linking patients in primary care with services provided by the voluntary and community sector. Despite growing interest within NHS primary care, it remains unclear how and under what circumstances SP might contribute to good practice.AimTo define ‘good’ practice in SP by identifying context-specific enablers and tensions. To contribute to the development of an evidence-based framework for theorizing and evaluating SP within primary care.Design and settingRealist review of secondary data from primary care-based SP schemes.MethodWe searched for qualitative and quantitative evidence from academic articles and grey literature following the Realist and Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES). We characterised common SP practices in three settings (general practice, link workers and community sector) using archetypes which ranged from best to worst practice.ResultsA total of 140 studies were included for analysis. We characterised common SP practices in three settings (general practice, link workers and community sector) using archetypes which ranged from best to worst practice. We identified resources influencing the type and potential impact of SP practices and outlined four dimensions in which opportunities for good practice arise: 1) individual characteristics (stakeholder’s buy-in, vocation, knowledge); 2) interpersonal relations (trustful, bidirectional, informed, supportive, transparent and convenient interactions within and across sectors); 3) organisational contingencies (the availability of a predisposed practice culture, leadership, training opportunities, supervision, information governance, resource adequacy and continuity and accessibility of care within organisations); and 4) policy structures (bottom-up and coherent policymaking, stable funding and suitable monitoring strategies). Findings where synthesised in a multi-level, dynamic and usable SP Framework.ConclusionOur realist review and resulting framework revealed that SP is not inherently advantageous. Specific individual, interpersonal, organisational and policy resources are needed to ensure SP best practice in primary care.

scholarly journals Exploring the cost–utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups

2012 ◽  
Vol 71 (11) ◽  
pp. 1796-1802 ◽  
Author(s):  
David G T Whitehurst ◽  
Stirling Bryan ◽  
Martyn Lewis ◽  
Jonathan Hill ◽  
Elaine M Hay
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
High Risk ◽  
Best Practice ◽  
Cost Effective ◽  
Cost Utility ◽  
Low Back ◽  
Use Of Resources ◽  
Medium Risk

ObjectivesStratified management for low back pain according to patients' prognosis and matched care pathways has been shown to be an effective treatment approach in primary care. The aim of this within-trial study was to determine the economic implications of providing such an intervention, compared with non-stratified current best practice, within specific risk-defined subgroups (low-risk, medium-risk and high-risk).MethodsWithin a cost–utility framework, the base-case analysis estimated the incremental healthcare cost per additional quality-adjusted life year (QALY), using the EQ-5D to generate QALYs, for each risk-defined subgroup. Uncertainty was explored with cost–utility planes and acceptability curves. Sensitivity analyses were performed to consider alternative costing methodologies, including the assessment of societal loss relating to work absence and the incorporation of generic (ie, non-back pain) healthcare utilisation.ResultsThe stratified management approach was a cost-effective treatment strategy compared with current best practice within each risk-defined subgroup, exhibiting dominance (greater benefit and lower costs) for medium-risk patients and acceptable incremental cost to utility ratios for low-risk and high-risk patients. The likelihood that stratified care provides a cost-effective use of resources exceeds 90% at willingness-to-pay thresholds of £4000 (≈ 4500; $6500) per additional QALY for the medium-risk and high-risk groups. Patients receiving stratified care also reported fewer back pain-related days off work in all three subgroups.ConclusionsCompared with current best practice, stratified primary care management for low back pain provides a highly cost-effective use of resources across all risk-defined subgroups.

scholarly journals A Framework to Guide the Implementation of Best Practice Clinical Learning Environments in Community General Practice: Australia

2021 ◽  
Vol 18 (4) ◽  
pp. 1482
Author(s):  
Belinda O'Sullivan ◽  
Helen Hickson ◽  
Rebecca Kippen ◽  
Donna Cohen ◽  
Phil Cohen ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Learning Environment ◽  
Learning Environments ◽  
Best Practice ◽  
Clinical Learning ◽  
Limited Information ◽  
Clinical Learning Environment ◽  
Liaison Officer ◽  
Starting Point

Clinical education/training is increasingly being expanded to community general practice settings (primary care clinics led by doctors). This plays an important role in developing a skilled “primary-care ready” workforce. However, there is limited information to guide the implementation of high-quality learning environments suitable for the range of general practices and clinical learners they oversee. We aimed to develop a consensus-based framework to address this. A co-design participatory action research method involved working with stakeholders to agree a project plan, collect and interpret data and endorse a final framework. As a starting point, an initial draft framework was adapted from an existing framework, the Best Practice Clinical Learning Environment (BPCLE) Framework. We gathered feedback about this from a national GP Supervisor Liaison Officer Network (SLON) (experienced GP clinical supervisors) during a 90-minute face-to-face focus group. They rated their agreement with the relevance of objectives and elements, advising on clear terminology and rationale for including/excluding various components. The resulting framework was refined and re-tested with the SLON and wider GP educational stakeholders until a final graphically designed version was endorsed. The resulting “GP Clinical Learning Environment” (GPCLE) Framework is applicable for planning and benchmarking best practice learning environments in general practice.

scholarly journals Promoting parkrun to patients using the general practice website: a qualitative exploration of ‘parkrun practice’ websites

BJGP Open ◽  
2020 ◽  
pp. BJGPO.2020.110
Author(s):  
Joanna Fleming ◽  
Rebecca Mensah
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
General Practice ◽  
Content Analysis ◽  
Qualitative Content Analysis ◽  
Low Cost ◽  
Cost Approach ◽  
Health And Wellbeing ◽  
Practical Information ◽  
Qualitative Exploration

Background: The “parkrun practice initiative” is a widely accessible and low cost approach in primary care to promoting patient and staff health and wellbeing through increased physical activity and volunteering opportunities. The parkrun practice Toolkit offers guidance to practices. One recommendation is to ‘include a parkrun page on the practice website, or a link to the parkrun website’. How practices are presenting this information is unknown. Aim: To explore how parkrun practices are using their websites to promote parkrun, including the content and format of information presented and variety of promotion methods used, in order to provide recommendations for inclusion in the Toolkit. Design and Setting: Qualitative content analysis of a sample of parkrun practice websites. Method: The websites of 114 practices who reported using their websites for parkrun promotion were to systematically search and the content analysed. Results: Five main types of content were identified, namely, what parkrun/parkrun practice is; activities and events; addressing patients’ concerns; benefits of parkrun; and practical information. While there were similarities in the information provided, there were variations in presentation. Websites ranged from being extensive and highly informative, to minimal amounts of text or solely images. Conclusion: Findings highlight the variability which currently exists across parkrun practice websites. Including a link on the homepage would assist patients to find information on “parkrun” and clarify the information which would be found. We make suggestions on the type of information and how it could be presented, to be further developed for inclusion in the Toolkit.

Practice nurse involvement in general practice clinical care: policy and funding issues need resolution

2014 ◽  
Vol 38 (3) ◽  
pp. 301 ◽  
Author(s):  
Hossein Haji Ali Afzali ◽  
Jonathan Karnon ◽  
Justin Beilby ◽  
Jodi Gray ◽  
Christine Holton ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Chronic Conditions ◽  
Practice Nurse ◽  
Clinical Care ◽  
Cost Effective ◽  
Clinical Role ◽  
Practice Nurses ◽  
General Practices ◽  
Diabetes And Obesity

In Australia, primary care-based funding initiatives have been implemented to encourage general practices to employ practice nurses. The aim of this paper is to discuss limitations of the current funding and policy arrangements in enhancing the clinical role of practice nurses in the management of chronic conditions. This paper draws on the results of a real-world economic evaluation, the Primary Care Services Improvement Project (PCSIP). The PCSIP linked routinely collected clinical and resource use data to undertake a risk-adjusted cost-effectiveness analysis of increased practice nurse involvement in clinical-based activities for the management of diabetes and obesity. The findings of the PCSIP suggested that the active involvement of practice nurses in collaborative clinical-based activities is cost-effective, as well as addressing general practice workforce issues. Although primary healthcare organisations (e.g. Medicare Locals) can play a key role in supporting enhanced practice nurse roles, improvements to practice nurse funding models could further encourage more efficient use of an important resource. What is known about the topic? There is evidence that the increased involvement of practice nurses in clinical-based activities in the management of patients with chronic conditions (e.g. diabetes and obesity) is cost-effective. The Australian Government has implemented financial incentives to encourage general practices to recruit nurses and to expand nursing roles within collaborative models of care. There is currently insufficient engagement of practice nurses in clinical care. What does this paper add? This paper summarises evidence regarding the value of an enhanced practice nurse role in Australian general practice, and discusses refinements to current funding arrangements for practice nurses. What are the implications for practitioners? Delegating clinical role (e.g. patient education and monitoring clinical progress) to practice nurses in the management of patients with chronic conditions can improve clinical outcomes without adversely affecting general practice business models.

How professional identity shapes youth healthcare

2015 ◽  
Vol 29 (3) ◽  
pp. 317-342 ◽  
Author(s):  
Ann Dadich ◽  
Carmen Jarrett ◽  
Fiona Robards ◽  
David Bennett
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Professional Identity ◽  
Considerable Change ◽  
Youth Health ◽  
Content Type ◽  
Clinician Training ◽  
Primary Care Sector ◽  
And Training ◽  
Practical Implications

Purpose – The primary care sector is experiencing considerable change. How change and uncertainty are accommodated by the professional identity of medicine has not been examined. The purpose of this paper is to address the youth healthcare as an exemplar as this field is often a source of uncertainty for general practitioners (GPs). Design/methodology/approach – Using heterogeneity sampling, 22 GPs participated in focus groups to explore perceptions of youth healthcare, factors that help and hinder it, and training needs. Analysis of the research material was guided by a theoretical model on professional identity. Findings – GPs described tensions that challenged their professional identity – the challenges of working with young people and their complex issues, the extent to which youth healthcare sits within the purview of general practice, and the scope of training required. These tensions appeared to destabilise professional identity. Some participants had customised their identity by enriching understandings of and approach to general practice. Participants also reported work customisation as a way of managing the complex demands of the general practice role. Deepened insight appeared to bolster perceived capacity to support a complex patient cohort. Research limitations/implications – Participants are not representative of the primary care sector – furthermore, the methodology limits the generalisability of the findings. Practical implications – To bolster youth health, mere clinician training is insufficient. Youth health requires explicit support from governments and training providers to be incorporated into the healthcare landscape. Originality/value – This study extends current research on professional identity by examining youth healthcare within the changing context of primary care.

scholarly journals A systematic review of postgraduate training programmes directed at pharmacists entering primary care

2020 ◽  
Author(s):  
Anna Groen ◽  
Cherie Lucas ◽  
Helen Benson ◽  
Mohammed Alsubaie ◽  
Matthew J Boyd
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
General Practice ◽  
Web Of Science ◽  
Postgraduate Training ◽  
Postgraduate Education ◽  
Disease States ◽  
Training Courses ◽  
Training Programmes ◽  
And Training

This systematic review explores the international postgraduate education and training programmes designed to provide or develop knowledge or skills focused on enabling pharmacists to work in a general practice setting. Four thousand, eight hundred and seventy-one (4,871) articles were identified from database searches of SCOPUS, EMBASE, Medline, CINAHL, IPA, Web of Science and ERIC. After removal of duplicates and article screening, seven articles were included. Educational content, setting, contact time and methods of assessment varied across all studies. There is paucity of published literature relating to the development and evaluation of education programmes directed at pharmacists entering into general practice. A combination of work and classroom-based education provided by general practitioners and pharmacists already working in primary care is deemed most beneficial coupled with systematic debriefing sessions at the completion of training courses. The findings suggest future training should focus on specific disease states.

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