Geographical and organisational variation in the structure of primary care services: implications for study design

2003 ◽  
Vol 8 (2) ◽  
pp. 87-93 ◽  
Author(s):  
Geoffrey Adams ◽  
Martin Gulliford ◽  
Obioha Ukoumunne ◽  
Susan Chinn ◽  
Michael Campbell
Keyword(s):  
Primary Care ◽  
Health Authority ◽  
Regional Level ◽  
Total Variance ◽  
Care Group ◽  
Practice List ◽  
Components Of Variance ◽  
Care Services ◽  
Primary Care Services ◽  
General Practices

Aims: To evaluate the extent to which structural variation between English general practices is accounted for at higher organisational levels in the National Health Service (NHS). Methods: We analysed data for 11 structural characteristics of all general practices in England. These included characteristics of general practitioners (GPs), the practice list and the services provided by practices. A four-level random effects model was used for analysis and components of variance were estimated at the levels of practice, primary care group (PCG), health authority and region. Results: The proportion of single-handed practices ranged from 0% to 74% at PCG level and from 14% to 43% in different regions. The proportion of practices providing diabetes services ranged from 0% to 100% at PCG level and from 71% to 96% in different regions. The list size per GP ranged from 1314 to 2704 patients per GP at PCG level and from 1721 to 2225 at regional level. Across the 11 variables analysed, components of variance at general practice level accounted for between 43% and 95% of the total variance. The PCG level accounted for between 1% and 29%, the health authority level for between 2% and 15% and the regional level for between 0% and 13% of the total variance. Adjusting for an index of deprivation and the supply of GPs gave a median 8% decrease in the sum of variance components. Conclusion: Geographical and organisational variation in the structure of primary care services should be considered in designing studies in health systems such as the English NHS. Stratified designs may be used to increase study efficiency, but variation between areas may sometimes compromise generalisability.

scholarly journals Out-of-hours primary care services: Demands and patient referral patterns in a Veneto region (Italy) Local Health Authority

Health Policy ◽  
2015 ◽  
Vol 119 (4) ◽  
pp. 437-446 ◽  
Author(s):  
Alessandra Buja ◽  
Roberto Toffanin ◽  
Stefano Rigon ◽  
Paolo Sandonà ◽  
Daniela Carraro ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Authority ◽  
Local Health Authority ◽  
Local Health ◽  
Veneto Region ◽  
Referral Patterns ◽  
Out Of Hours ◽  
Patient Referral ◽  
Care Services ◽  
Primary Care Services

scholarly journals Setting the scene for paramedics in general practice: What can we expect?

2018 ◽  
Author(s):  
Kamal Mahtani ◽  
Georgette Eaton ◽  
Matthew Catterall ◽  
Alice Ridley
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Models Of Care ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Care Workforce ◽  
Clinical Complexity ◽  
Or Practice ◽  
General Practices ◽  
Gp Care

Primary care services in England may be reaching saturation point. Demands to see a GP or practice nurse have increased substantially. Clinical complexity has also increased; patients are living longer, but with more multimorbidity.(1) These demands are mirrored by a decline in the GP workforce, despite political pledges to reverse this.(2) New strategies are needed to tackle the current pressures in general practice and reduce the risks of harm to patients. The NHS England GP Forward View advocates investing and developing new models of care, including expansion of a multidisciplinary, integrated primary care team.(3) These recommendations reflect the findings of the Primary Care Workforce Commission, who highlighted the potential roles for clinical pharmacists, physician associates, and physiotherapists, all substituting into current GP care pathways.(4) The Commission also recommended that general practices should consider more opportunities to use the skills of paramedics in primary care. Specific roles may include running clinics, triaging and managing minor illnesses, as well as provide continuity for patients with complex health needs. Further roles may include assessment and management of requests for same-day urgent home visits, as well as regular visits to homebound patients with long-term conditions.The commision highlighted that these innovative roles should be subject to further evaluation. Nevertheless, historical and current perspectives allow us to model how the role could be fully used.

scholarly journals Setting the scene for paramedics in general practice: What can we expect?

2018 ◽  
Author(s):  
Kamal Mahtani ◽  
Georgette Eaton ◽  
Matthew Catterall ◽  
Alice Ridley
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Models Of Care ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Care Workforce ◽  
Clinical Complexity ◽  
Or Practice ◽  
General Practices ◽  
Gp Care

Primary care services in England may be reaching saturation point. Demands to see a GP or practice nurse have increased substantially. Clinical complexity has also increased; patients are living longer, but with more multimorbidity.(1) These demands are mirrored by a decline in the GP workforce, despite political pledges to reverse this.(2) New strategies are needed to tackle the current pressures in general practice and reduce the risks of harm to patients. The NHS England GP Forward View advocates investing and developing new models of care, including expansion of a multidisciplinary, integrated primary care team.(3) These recommendations reflect the findings of the Primary Care Workforce Commission, who highlighted the potential roles for clinical pharmacists, physician associates, and physiotherapists, all substituting into current GP care pathways.(4) The Commission also recommended that general practices should consider more opportunities to use the skills of paramedics in primary care. Specific roles may include running clinics, triaging and managing minor illnesses, as well as provide continuity for patients with complex health needs. Further roles may include assessment and management of requests for same-day urgent home visits, as well as regular visits to homebound patients with long-term conditions.The commision highlighted that these innovative roles should be subject to further evaluation. Nevertheless, historical and current perspectives allow us to model how the role could be fully used.

scholarly journals Screening Neurocognitive Disorders in Primary Care Services: The Quick Mild Cognitive Impairment Approach

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 158-158
Author(s):  
Constanca Paul ◽  
Susana Sousa ◽  
Pedro Santos ◽  
Rónán O’Caoimh ◽  
William Molloy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Cognitive Impairment ◽  
Community Sample ◽  
Neurocognitive Disorders ◽  
Cognitive Status ◽  
Health Concerns ◽  
Care Services ◽  
Primary Care Services ◽  
Mental Health Concerns

Abstract Neurocognitive Disorders (NCD) is an increasingly common condition in the community. The General Practitioner (GP) in Primary Care Services (PCS), have a crucial role in early detection of NCD and is usually the first professional to detect the signs of MCI. The objective of this study was to test the feasibility and utility of the cognitive screening instrument QMCI in Primary Care. A community sample of 436 people 65+ living in the community was randomly selected from a larger group of old people with mental health concerns (N=2734), referred by their GPs. The mean age of the sample was 75.2 years (sd 7.2), with 41.3% men and 58.7% women; 60.4% married followed by 28.7% widows. The education level was low with 21% illiterate and 69,8% people with 4 years education. The QMCI mean was 37.1/100 (sd 16.2). The amount of people screening positive for cognitive impairment QMCI (<62/100) was 94.2%. In the distribution of people with cognitive impairment by Global Deterioration Scale (GDS) three recoded categories, of the 286 people 76,1% where classified as having very mild or mild impairment, 19,4% moderate or moderately serious and 4,5% severe or very severe impairment. These results confirm the perception of GPs about their clients having mental health concerns and the ability of QMCI accurately discriminate MCI. The QMCI is very brief (3-5mins) fitting the short time of GPs to assess cognitive status and timely refer clients to nonpharmacological interventions that could postpone NCD symptoms.

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