Stakeholders’ views of UK nurse and pharmacist supplementary prescribing

2008 ◽  
Vol 13 (4) ◽  
pp. 215-221 ◽  
Author(s):  
Richard Cooper ◽  
Claire Anderson ◽  
Tony Avery ◽  
Paul Bissell ◽  
Louise Guillaume ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Access To Medicines ◽  
Structured Interviews ◽  
Implementation Barriers ◽  
Framework Analysis ◽  
Independent Prescribing ◽  
Supplementary Prescribing ◽  
Theory Versus ◽  
Barriers And Challenges ◽  
The Uk

Objectives: Supplementary prescribing (SP) by pharmacists and nurses in the UK represents a unique approach to improving patients’ access to medicines and better utilizing health care professionals’ skills. Study aims were to explore the views of stakeholders involved in SP policy, training and practice, focusing upon issues such as SP benefits, facilitators, challenges, safety and costs, thereby informing future practice and policy. Method: Qualitative, semi-structured interviews were conducted with 43 purposively sampled UK stakeholders, including pharmacist and nurse supplementary prescribers, doctors, patient groups representatives, academics and policy developers. Analysis of transcribed interviews was undertaken using a process of constant comparison and framework analysis, with coding of emergent themes. Results: Stakeholders generally viewed SP positively and perceived benefits in terms of improved access to medicines and fewer delays, along with a range of facilitators and barriers to the implementation of this form of non-medical prescribing. Stakeholders’ views on the economic impact of SP varied, but safety concerns were not considered significant. Future challenges and implications for policy included SP being potentially superseded by independent nurse and pharmacist prescribing, and the need to improve awareness of SP. Several potential tensions emerged including nurses’ versus pharmacists’ existing skills and training needs, supplementary versus independent prescribing, SP theory versus practice and prescribers versus non-prescribing peers. Conclusion: SP appeared to be broadly welcomed by stakeholders and was perceived to offer patient benefits. Several years after its introduction in the UK, stakeholders still perceived several implementation barriers and challenges and these, together with various tensions identified, might affect the success of supplementary and other forms of non-medical prescribing.

scholarly journals Transforming community nursing services in the UK; lessons from a participatory evaluation of the implementation of a new community nursing model in East London based on the principles of the Dutch Buurtzorg model

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mirza Lalani ◽  
Jane Fernandes ◽  
Richard Fradgley ◽  
Caroline Ogunsola ◽  
Martin Marshall
Keyword(s):  
The Netherlands ◽  
Patient Experience ◽  
Social Care ◽  
Professional Autonomy ◽  
Community Nursing ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Model Based ◽  
Health And Social Care ◽  
The Uk

Abstract Background Buurtzorg, a model of community nursing conceived in the Netherlands, is widely cited as a promising and evidence-based approach to improving the delivery of integrated nursing and social care in community settings. The model is characterised by high levels of patient and staff satisfaction, professional autonomy exercised through self-managing nursing teams, client empowerment and holistic, patient centred care. This study aimed to examine the extent to which some of the principles of the Buurtzorg model could be adapted for community nursing in the United Kingdom. Methods A community nursing model based on the Buurtzorg approach was piloted from June 2017–August 2018 with a team of nurses co-located in a single general practice in the Borough of Tower Hamlets, East London, UK. The initiative was evaluated using a participatory methodology known as the Researcher-in-Residence model. Qualitative data were collected using participant observation of meetings and semi-structured interviews with nurse team members, senior managers, patients/carers and other local stakeholders such as General Practitioners (GP) and social workers. A thematic framework analysis of the data was carried out. Results Implementation of a community nursing model based on the Buurtzorg approach in East London had mixed success when assessed against its key principles. Patient experience of the service was positive because of the better access, improved continuity of care and longer appointment times in comparison with traditional community nursing provision. The model also provided important learning for developing service integration in community care, in particular, how to form effective collaborations across the care system with other health and social care professionals. However, some of the core features of the Buurtzorg model were difficult to put into practice in the National Health Service (NHS) because of significant cultural and regulatory differences between The Netherlands and the UK, especially the nurses’ ability to exercise professional autonomy. Conclusions Whilst many of the principles of the Buurtzorg model are applicable and transferable to the UK, in particular promoting independence among patients, improving patient experience and empowering frontline staff, the successful embedding of these aims as normalised ways of working will require a significant cultural shift at all levels of the NHS.

Paramedic independent prescribing: a qualitative study of early adopters in the UK

2021 ◽  
Vol 6 (1) ◽  
pp. 30-37
Author(s):  
Karen Stenner ◽  
Suzanne van Even ◽  
Andy Collen
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
High Volume ◽  
Urgent Care ◽  
Multidisciplinary Teams ◽  
Framework Analysis ◽  
Early Adopters ◽  
Independent Prescribing ◽  
Controlled Drugs ◽  
The Uk

Background: Paramedics working in advanced practice roles in the UK can now train to prescribe medicine. This is anticipated to benefit patient access to medicines and quality of care where there is a national shortage of doctors, particularly in primary care.Aim: To explore the experience of paramedics who are early adopters of independent prescribing in a range of healthcare settings in the UK.Design and setting: A qualitative study involving interviews between May and August 2019, with paramedics in the UK who had completed a prescribing programme.Methods: Individual interviews with a purposive sample of paramedics recruited via social media and regional paramedic networks. Interviews covered experiences, benefits and challenges of the prescribing role. A framework analysis approach was used to identify key themes.Results: Participants were 18 advanced paramedics working in primary care, emergency departments, urgent care centres and rapid response units. All participants reported being adequately prepared to prescribe. Key benefits of prescribing included improving service capacity, efficiency and safety, and facilitating advanced clinical roles. Challenges included technological problems, inability to prescribe controlled drugs and managing expectations about the prescribing role. Concerns were raised about support and role expectations, particularly in general practice.Conclusion: Paramedic prescribing is most successful in settings with a high volume of same-day presentations and urgent and emergency care. It facilitated advanced roles within multidisciplinary teams. Concerns indicate that greater consideration for support infrastructure and workforce planning is required within primary care to ensure paramedics meet the entry criteria for a prescribing role.

Failure Mode and Effects Analysis: Views of Hospital Staff in the UK

2012 ◽  
Vol 17 (1) ◽  
pp. 37-43 ◽  
Author(s):  
Nada Shebl ◽  
Bryony Franklin ◽  
Nick Barber ◽  
Susan Burnett ◽  
Anam Parand
Keyword(s):  
Health Care ◽  
High Risk ◽  
Failure Mode ◽  
Health Care Professionals ◽  
Hospital Staff ◽  
Validity And Reliability ◽  
Structured Interviews ◽  
Framework Analysis ◽  
National Quality ◽  
Risk Areas

Objective To explore health care professionals' experiences and perceptions of Failure Mode and Effects Analysis (FMEA), a team-based, prospective risk analysis technique. Methods Semi-structured interviews were conducted with 21 operational leads (20 pharmacists, one nurse) in medicines management teams of hospitals participating in a national quality improvement programme. Interviews were transcribed, coded and emergent themes identified using framework analysis. Results Themes identified included perceptions and experiences of participants with FMEA, validity and reliability issues, and FMEA's use in practice. FMEA was considered to be a structured but subjective process that helps health care professionals get together to identify high risk areas of care. Both positive and negative opinions were expressed, with the majority of interviewees expressing positive views towards FMEA in relation to its structured nature and the use of a multidisciplinary team. Other participants criticised FMEA for being subjective and lacking validity. Most likely to restrict its widespread use were its time consuming nature and its perceived lack of validity and reliability. Conclusion FMEA is a subjective but systematic tool that helps identify high risk areas, but its time consuming nature, difficulty with the scores and perceived lack of validity and reliability may limit its widespread use.

scholarly journals Living life in limbo: experiences of healthcare professionals during the HCPC fitness to practice investigation process in the UK

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jill Maben ◽  
Linda Hoinville ◽  
Dawn Querstret ◽  
Cath Taylor ◽  
Magdalena Zasada ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Psychological Impact ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Individual Level ◽  
Healthcare Settings ◽  
Lack Of Information ◽  
The Uk ◽  
The Impact ◽  
Investigation Process

Abstract Background It is the responsibility of healthcare regulators to ensure healthcare professionals remain fit for practice in healthcare settings. If there are concerns about an individual healthcare professional they may undergo a fitness to practice investigation. This process is known to be hugely stressful for doctors and social workers, but little is known about the impact of this experience on other professions. This study explores the experiences of registrants going through the process of being reported to the UK’s Health and Care Professions Council (HCPC) and attending fitness to practice (FTP) hearings. We discuss the implications of this process on registrants’ wellbeing and, from our findings, present recommendations based on registrants experiences. In doing so we articulate the structural processes of the HCPC FTP process and the impact this has on individuals. Methods This study uses semi-structured interviews and framework analysis to explore the experiences of 15 registrants who had completed the FTP process. Participants were sampled for maximum variation and were selected to reflect the range of possible processes and outcomes through the FTP process. Results The psychological impact of undergoing a FTP process was significant for the majority of participants. Their stories described influences on their wellbeing at both a macro (institutional/organisational) and micro (individual) level. A lack of information, long length of time for the process and poor support avenues were macro factors impacting on the ability of registrants to cope with their experiences (theme 1). These macro factors led to feelings of powerlessness, vulnerability and threat of ruin for many registrants (theme 2). Suggested improvements (theme 3) included better psychological support (e.g. signposting or provision); proportional processes to the incident (e.g. mediation instead of hearings); and taking context into account. Conclusions Findings suggest that improvements to both the structure and conduct of the FTP process are warranted. Implementation of better signposting for support both during and after a FTP process may improve psychological wellbeing. There may also be value in considering alternative ways of organising the FTP process to enable greater consideration of and flexibility for registrants’ context and how they are investigated.

scholarly journals PP14  Improving access to, and experience of, ambulance care for eastern european migrants: a paramedic interview study

2020 ◽  
Vol 37 (10) ◽  
pp. e8.1-e8
Author(s):  
Viet-Hai Phung ◽  
Zahid Asghar ◽  
Milika Matiti ◽  
Niro Siriwardena
Keyword(s):  
Service Providers ◽  
Ambulance Service ◽  
Eastern European ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Quality Healthcare ◽  
European Languages ◽  
East Midlands ◽  
The Uk ◽  
Key Terms

BackgroundThe UK has experienced significant immigration from Eastern Europe following European Union (EU) expansion in 2004. Lincolnshire is a predominantly rural county in the East Midlands region of the UK with a large Eastern European migrant population requiring healthcare, including urgent ambulance care. The Equality Act 2010 requires public bodies such as health services to provide access to high quality healthcare, while the Equality Delivery System seeks to ensure that NHS organisations comply with the legislation. This study aimed to explore the perceptions and experiences of ambulance staff attending Eastern European migrants in Lincolnshire.MethodsQualitative semi-structured interviews were conducted with 15 ambulance staff at locations across Lincolnshire. Purposive and maximum variation sampling ensured that participants were knowledgeable about Eastern European migrants’ use of ambulance care and covered a range of demographic characteristics. The data were analysed using framework analysis.ResultsDifficulty in accessing professional interpreters meant that some patients relied instead on family members. Some Eastern European migrants brought back foreign language medication, which ambulance staff could not understand. It was common for patients to not be registered with GPs because they were temporarily resident, did not understand how the UK healthcare system worked or preferred to go to their home country for treatment. By not registering with GPs, patients were sometimes transported to the Emergency Department for primary care conditions.ConclusionsThe practical recommendations for service delivery improvements may be valuable for service providers and could be incorporated into future protocols. These include: having a glossary of key terms in Eastern European languages; simple packs explaining how and when to use the ambulance service translated into different languages where necessary; encouraging patients to register with GPs; and face-to-face meetings where the ambulance service inform the Eastern European communities about how to use their services.

scholarly journals Barriers to home bowel screening test in South Asians in the UK

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Smith ◽  
S Howcutt ◽  
P Saini ◽  
J Brett ◽  
C Henshall ◽  
...  
Keyword(s):  
Screening Test ◽  
South Asians ◽  
Theoretical Domains Framework ◽  
Target Population ◽  
Bowel Cancer ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Home Test ◽  
Early Results ◽  
The Uk

Abstract Background Bowel cancer is common and accounts for 10% of all cancer mortality. Early detection significantly reduces mortality. In the UK, the NHS Bowel Cancer Screening Programme invites adults aged 60-74 years to carry out a home screening test biennially. The national target for test completion is 60%; completion is substantially lower (∼30%) amongst South Asian populations. Our aim was to develop a community-based intervention to increase completion of the home bowel screening test in South Asians. Methods Multi-methods comprising two stages: 1) group and individual interviews with South Asians aged 50-74 years purposively sampled from community groups for maximum variation. Semi-structured interviews based on the Theoretical Domains Framework (TDF) investigated determinants of bowel screening completion. Interviews were recorded, transcribed, and analysed using framework analysis and findings mapped onto the COM-B Behaviour Change Wheel; 2) Co-production of intervention during two workshops with key stakeholders and target population. Results To-date 25 adults recruited of Indian, Pakistani and Bangladeshi ethnicity with variation in age, gender, first language, faith, and compliance with bowel screening. Key barriers and TDF domains that they mapped to were: - lack of knowledge about bowel cancer and screening; lack of language, literacy and physical ability (skills) to carry out the home test; confidence to carry it out correctly (belief about capabilities); appropriate space and time to carry out the test (environmental context and resources); putting off undertaking the test (memory attention and decision processes); risk perception and fear of cancer (emotions). Enablers were: social influences from peers; goals and motivations. Conclusions Early results suggest an intervention comprising education, persuasion, modelling and enablement functions could increase completion of the home test. Key messages Community engagement and working with community leaders enhanced the success of recruitment. The TDF was a useful framework for identifying barriers to home bowel screening test by South Asians in the South East of England.

scholarly journals COVID-19 Vaccination in Lower-Middle Income Countries: National Stakeholder Views on Challenges, Barriers, and Potential Solutions

2021 ◽  
Vol 9 ◽  
Author(s):  
Eunice Twumwaa Tagoe ◽  
Nurnabi Sheikh ◽  
Alec Morton ◽  
Justice Nonvignon ◽  
Abdur Razzaque Sarker ◽  
...  
Keyword(s):  
National Level ◽  
Immunisation Programme ◽  
Health Providers ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Middle Income ◽  
Vaccination Programs ◽  
Middle Income Countries ◽  
Short Period ◽  
Barriers And Challenges

The development of COVID-19 vaccines does not imply the end of the global pandemic as now countries have to purchase enough COVID-19 vaccine doses and work towards their successful rollout. Vaccination across the world has progressed slowly in all, but a few high-income countries (HICs) as governments learn how to vaccinate their entire populations amidst a pandemic. Most low- and middle-income countries (LMICs) have been relying on the COVID-19 Vaccines Global Access (COVAX) Facility to obtain vaccines. COVAX aims to provide these countries with enough doses to vaccinate 20% of their populations. LMICs will likely encounter additional barriers and challenges rolling out vaccines compared HICs despite their significant experience from the Expanded Programme on Immunisation (EPI). This study explores potential barriers that will arise during the COVID-19 vaccine rollout in lower-middle-income countries and how to overcome them. We conducted sixteen semi-structured interviews with national-level stakeholders from Ghana and Bangladesh (eight in each country). Stakeholders included policymakers and immunisation programme experts. Data were analysed using a Framework Analysis technique. Stakeholders believed their country could use existing EPI structures for the COVID-19 vaccine rollout despite existing challenges with the EPI and despite its focus on childhood immunisation rather than vaccinating the entire population over a short period of time. Stakeholders suggested increasing confidence in the vaccine through community influencers and by utilising local government accredited institutions such as the Drug Authorities for vaccine approval. Additional strategies they discussed included training more health providers and recruiting volunteers to increase vaccination speed, expanding government budgets for COVID-19 vaccine purchase and delivery, and exploring other financing opportunities to address in-country vaccine shortages. Stakeholders also believed that LMICs may encounter challenges complying with priority lists. Our findings suggest that COVID-19 vaccination is different from previous vaccination programs, and therefore, policymakers have to expand the EPI structure and also take a systematic and collaborative approach to plan and effectively rollout the vaccines.

scholarly journals Accreditation and professional integration experiences of internationally qualified dentists working in the United Kingdom

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Latha S. Davda ◽  
David R. Radford ◽  
Sasha Scambler ◽  
Jennifer E. Gallagher
Keyword(s):  
Health Care ◽  
United Kingdom ◽  
Dental Care ◽  
Health Care Professionals ◽  
European Economic Area ◽  
The European Union ◽  
Framework Analysis ◽  
Professional Integration ◽  
The United Kingdom ◽  
The Uk

Abstract Introduction Regulatory processes for Oral health care professionals are considered essential for patient safety and to ensure health workforce quality. The global variation in their registration and regulation is under-reported in the literature. Regulatory systems could become a barrier to their national and international movement, leading to loss of skilled human resources. The General Dental Council is the regulatory authority in the UK, one of the nine regulators of health care overseen by the Professional Standards Authority. Aim The aim of this paper is to present the professional integration experiences of internationally qualified dentists (IQDs) working in the UK, against the background of regulation and accreditation nationally. Methods Registration data were obtained from the General Dental Council to inform the sampling and recruitment of research participants. Semi-structured interviews of 38 internationally qualified dentists working in the United Kingdom were conducted between August 2014 and October 2017. The topic guide which explored professional integration experiences of the dentists was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis to detect themes. Results Internationally qualified dentist’s professional integration was influenced by factors that could be broadly classified as structural (source country training; registration and employment; variation in practising dentistry) and relational (experiences of discrimination; value of networks and support; and personal attributes). The routes to register for work as a dentist were perceived to favour UK dental graduates and those qualifying from the European Economic Area. Dentists from the rest of the world reported experiencing major hurdles including succeeding in the licensing examinations, English tests, proving immigration status and succeeding in obtaining a National Health Service performer number, all prior to being able to practice within state funded dental care. Conclusion The pathways for dentists to register and work in state funded dental care in UK differ by geographic type of registrant, creating significant inconsistencies in their professional integration. Professional integration is perceived by an individual IQD as a continuum dictated by host countries health care systems, workforce recruitment policies, access to training, together with their professional and personal skills. The reliance of the UK on internationally qualified dentists has increased in the past two decades, however, it is not known how these trends will be affected by UK’s exit from the European Union and the COVID-19 pandemic.

scholarly journals A school-commissioned model of speech and language therapy

2018 ◽  
Vol 34 (2) ◽  
pp. 141-153 ◽  
Author(s):  
Sarah White ◽  
Sarah Spencer
Keyword(s):  
Special Educational Needs ◽  
Speech And Language ◽  
Structured Interviews ◽  
Language Therapy ◽  
Framework Analysis ◽  
Speech And Language Therapy ◽  
Outcomes For Children ◽  
Communication Needs ◽  
Uk National Health Service ◽  
The Uk

Many speech and language therapy (SLT) services have limited capacity for providing school-based input. Some offer commissioned SLT input, to enhance the service provided by the UK National Health Service (NHS), giving schools the option to increase the amount and scope of SLT intervention. This two-tiered model of service provision is relatively new and has not been researched. This study investigated the experiences of schools who had commissioned input from the local SLT service, in terms of (1) describing how this was utilized and (2) exploring perceptions of its value. Semi-structured interviews were carried out with special educational needs co-ordinators (SENCos) from 11 schools and were thematically analysed using Framework Analysis. SENCos reported many positive aspects of the commissioned model, including better communication with Speech and Language Therapists (SLTs) and improved outcomes for children. SENCos felt that the numbers of children with speech, language and communication needs (SLCN) had reduced following commissioned input. Very few disadvantages of the model were identified. SLTs delivered a range of activities, including training staff and providing direct input for children. SENCos would recommend the service, and perceived the cost to be moderate. These data suggest that SENCos place a high value on SLT in schools, and welcome the opportunity to purchase additional input.

scholarly journals Transforming community nursing services in the UK: lessons from a participatory evaluation of the implementation of a new model of community nursing in East London

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703385
Author(s):  
Mirza Lalani ◽  
Jane Fernandes ◽  
Richard Fradgley ◽  
Caroline Ogunsola ◽  
Martin Marshall
Keyword(s):  
The Netherlands ◽  
Patient Experience ◽  
Participant Observation ◽  
Community Nursing ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Frontline Staff ◽  
Team Members ◽  
Nursing Services ◽  
The Uk

BackgroundBuurtzorg, a model of community nursing conceived in the Netherlands, is widely cited as a promising and evidence-based approach to improving the delivery of integrated nursing and social care in community settings.AimThis study aimed to examine the transferability of some of the principles of the Buurtzorg model to community nursing in the UK NHS.MethodA community nursing model based on the Buurtzorg approach was piloted between June 2017 and August 2018 with a team of nurses co-located in a single general practice in the Borough of Tower Hamlets, East London. The initiative was evaluated using a qualitative approach within the participatory Researcher-in-Residence model. Participant observation of meetings and semi-structured interviews with team members, patients/carers, and other local stakeholders were undertaken. A thematic framework analysis of the data was carried out.ResultsPatient experience of the service was positive, in particular because of the better access, improved continuity of care and longer appointment times in comparison with traditional district nursing provision. However, certain aspects of the Buurtzorg model were difficult to put into practice in the NHS because of significant cultural, human resource, and regulatory differences between The Netherlands and the UK.ConclusionWhile many of the principles of the Buurtzorg model are applicable and transferable to the UK, in particular promoting independence among patients, improving patient experience, and empowering frontline staff, the successful embedding of these aims as normalised ways of working will require a significant cultural shift at all levels of the NHS.

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