scholarly journals Advanced Clinical Practitioners in Primary Care in the UK: A Qualitative Study of Workforce Transformation

2020 ◽  
Vol 17 (12) ◽  
pp. 4500 ◽  
Author(s):  
Catrin Evans ◽  
Ruth Pearce ◽  
Sarah Greaves ◽  
Holly Blake
Keyword(s):  
Primary Care ◽  
Qualitative Evaluation ◽  
Support Service ◽  
Full Potential ◽  
Service Demand ◽  
Telephone Interviews ◽  
Healthcare Needs ◽  
Care Systems ◽  
Degree Of Acceptance ◽  
The Uk

Escalating costs and changing population demographics are putting pressure on primary care systems to meet ever more complex healthcare needs. Non-medical ‘advanced clinical practitioner’ (ACP) roles are increasingly being introduced to support service transformation. This paper reports the findings of a qualitative evaluation of nursing ACP roles across General Practices in one region of the UK. Data collection involved telephone interviews with 26 participants from 3 different stakeholder groups based in 9 practice sites: ACPs (n = 9), general practitioners (n = 8) and practice managers (n = 9). The data was analysed thematically. The study found a high degree of acceptance of the ACP role and affirmation of the important contribution of ACPs to patient care. However, significant variations in ACP education, skills and experience led to a bespoke approach to their deployment, impeding system-wide innovation and creating challenges for recruitment and ongoing professional development. In addition, a context of high workforce pressures and high service demand were causing stress and there was a need for greater mentorship and workplace support. System wide changes to ACP education and support are required to enable ACPs to realise their full potential in primary care in the UK.

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.

Explaining the mixed findings of a randomised trial of telehealth with centralised remote support for heart failure: qualitative evaluation

2020 ◽  
Author(s):  
Chrysanthi Papoutsi ◽  
Christine A'Court ◽  
Joseph Wherton ◽  
Sara Shaw ◽  
Trisha Greenhalgh
Keyword(s):  
Heart Failure ◽  
Randomised Trial ◽  
Qualitative Evaluation ◽  
Support Service ◽  
Full Potential ◽  
Variable Degree ◽  
Care Model ◽  
Illness Experiences ◽  
Technological Intervention ◽  
Technical Capacity

Abstract BackgroundCentralised specialist remote support, in which a clinician responds promptly to biomarker changes, could potentially improve outcomes in heart failure. The SUPPORT-HF2 trial compared telehealth technology alone with the same technology combined with centralised remote support. The intervention was implemented differently in different sites; no significant impact was found overall. We sought to explain these findings in a qualitative evaluation. Methods51 people (25 patients, 3 carers, 18 clinicians and 4 additional research staff) were interviewed and observed in 7 SUPPORT-HF sites across UK between 2016 and 2018. We also collected 110 pages of documents. Analysis was informed by sociotechnical theory. ResultsPatients’ experiences of the technology were largely positive; staff engaged with the intervention to a variable degree. Existing services, staffing levels, technical capacity and previous experience with telehealth all influenced how the complex intervention of ‘telehealth technology plus centralised specialist remote support’ was interpreted and the extent to which it was adopted and used to its full potential. In some settings, the intervention was quickly mobilised to fill significant gaps in service provision. In others, it was seen as usefully extending the existing care model for selected patients. However, in some settings, the new care model was actively resisted and the technology little used. In one setting, centralised provision of specialist advice aligned awkwardly with an existing community-based heart failure support service. ConclusionsThe introduction of a telehealth programme rests not only on the technological intervention but also on the individuals involved and numerous subtle aspects of local service design. An iterative approach that attends to patients’ illness experiences, clinicians’ professional values, work practices and care pathways could lead to more effective telehealth support for patients with heart failure.

scholarly journals Primary care consultations in the UK between 2006 and 2015: An analysis of electronic health records

2017 ◽  
Author(s):  
Benjamin Eaton
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Medical Science ◽  
Care Provision ◽  
Health Records ◽  
Healthcare Needs ◽  
Economic Recessions ◽  
The 2008 Financial Crisis ◽  
The Uk ◽  
The Impact

Primary care accounts for the majority of patient contact within the NHS. Over time medical science and healthcare needs change, which may lead to differences in how patients are treated in primary care for good or ill. In this study over 700 million consultations were analysed over a 10 year period between 2006 and 2015 inclusively to examine the trends in how people access primary care. The number of consultations per person per year initially increased in the first two years from 5.81 to 5.92, an increase of 0.11(0.10 to 0.12 95% CI) before declining to 3.7 by 2015, a decrease of 2.21 from the peak in 2008(2.20 to 2.23 95% CI). Consultations were increasingly handled by health care assistants instead of Nurses and GPs, and increased slightly in duration for all types of staff. This reduction in number of consultations is theorized to be a consequence of the 2008 financial crisis and its aftermath, further research is recommended on the impact of economic recessions and austerity policies on health care provision.

Anticipatory care planning for older adults: a trans-jurisdictional feasibility study

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711197
Author(s):  
Dagmar Corry ◽  
Julie Doherty ◽  
Adrienne McCann ◽  
Frank Doyle ◽  
Christopher Cardwell ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Primary Care ◽  
Action Plan ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Care Planning ◽  
Healthcare Needs ◽  
The Uk

BackgroundAs the population of older adults’ increases, the complexity of care required to support those who choose to remain in the community has also increased. Anticipatory Care Planning (ACP) through earlier identification of healthcare needs is evidenced to improve quality of life, decrease the number of aggressive futile interventions, and even to prolong life.AimTo determine the feasibility of a cluster randomised trial to evaluate the implementation and outcomes of Anticipatory Care Planning (ACP) in primary care to assist older adults identified as at risk for functional decline by developing a personalised support plan.MethodGP practices were randomised into control/intervention groups stratified by jurisdiction [Northern Ireland (UK) and the Republic of Ireland (RoI)], and by setting (urban and rural). Participants were included if they were a) aged ≥70 years, b) 2 or more chronic medical conditions, c) 4 or more prescribed medications. The Anticipatory Care Plan consisted of home visits where the study nurse discussed patients’ goals and plans. An action plan was put in place following consultation with patient’s GPs and study Pharmacist.ResultsEight primary care practices participated; four in the UK and four in the RoI. Sample n = 64. Data was collected pertaining to patient quality of life, mental health, healthcare utilisation, costs, perception of person-centred care, and the use of potentially inappropriate medication.ConclusionUnique insights relating to the trans-jurisdictional delivery of healthcare services in the UK and RoI were observed which has implications on service delivery for older adults.

Satisfaction with Primary Health Care and Confidence in General Practitioners: An Exploratory Comparison of US and UK Students

1993 ◽  
Vol 6 (2) ◽  
pp. 89-98
Author(s):  
Bodo B. Schlegelmilch ◽  
James M. Carman
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Systems ◽  
Primary Care Providers ◽  
Care Providers ◽  
Primary Health ◽  
The Us ◽  
Care Systems ◽  
The Uk ◽  
Oriented System

This paper explores attitudes of university students towards two differently organised health services, ie the National Health Service in the UK and the more market oriented system in the US and analyses the level of confidence placed in primary care providers (GPs/family physicians) in both systems. Although major differences in the perception of the two health care systems are identified, hardly any differences emerge between the two countries in terms of the confidence patients place in their primary care providers.

scholarly journals Management strategies for chronic rhinosinusitis: a qualitative study of GP and ENT specialist views of current practice in the UK

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022643 ◽  
Author(s):  
Jane Vennik ◽  
Caroline Eyles ◽  
Mike Thomas ◽  
Claire Hopkins ◽  
Paul Little ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Treatment ◽  
Chronic Rhinosinusitis ◽  
Secondary Care ◽  
Nasal Polyps ◽  
Patient Choice ◽  
Care Pathways ◽  
Telephone Interviews ◽  
Best Management ◽  
The Uk

ObjectivesTo explore general practitioner (GP) and ears, nose and throat (ENT) specialist perspectives of current treatment strategies for chronic rhinosinusitis (CRS) and care pathways through primary and secondary care.DesignSemi-structured qualitative telephone interviews as part of the MACRO programme (Defining best Management for Adults with Chronic Rhinosinusitis)SettingPrimary care and secondary care ENT outpatient clinics in the UK.ParticipantsTwelve GPs and 9 ENT specialists consented to in-depth telephone interviews. Transcribed recordings were managed using NVivo software and analysed using inductive thematic analysis.Main outcome measuresHealthcare professional views of management options and care pathways for CRS.ResultsGPs describe themselves as confident in recognising CRS, with the exception of assessing nasal polyps. In contrast, specialists report common missed diagnoses (eg, allergy; chronic headache) when patients are referred to ENT clinics, and attribute this to the limited ENT training of GPs. Steroid nasal sprays provide the foundation of treatment in primary care, although local prescribing restrictions can affect treatment choice and poor adherence is perceived to be the causes of inadequate symptom control. Symptom severity, poor response to medical treatment and patient pressure drive referral, although there is uncertainty about optimal timing. Treatment decisions in secondary care are based on disease severity, polyp status, prior medical treatment and patient choice, but there is major uncertainty about the place of longer courses of antibiotics and the use of oral steroids. Surgery is regarded as an important treatment option for patients with severe symptoms or with nasal polyps, although timing of surgery remains unclear, and the uncertainty about net long-term benefits of surgery makes balancing of benefits and risks more difficult.ConclusionsClinicians are uncertain about best management of patients with CRS in both primary and secondary care and practice is varied. An integrated care pathway for CRS is needed to improve patient management and timely referral.

scholarly journals Chronic rhinosinusitis: a qualitative study of patient views and experiences of current management in primary and secondary care

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e022644 ◽  
Author(s):  
Jane Vennik ◽  
Caroline Eyles ◽  
Mike Thomas ◽  
Claire Hopkins ◽  
Paul Little ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Rhinosinusitis ◽  
Secondary Care ◽  
Holistic Approach ◽  
Coordinated Care ◽  
Current Management ◽  
Telephone Interviews ◽  
Patient Views ◽  
Appropriate Treatment ◽  
The Uk

ObjectivesTo explore patient views and perspectives of current management of chronic rhinosinusitis (CRS) in primary and secondary care.DesignSemistructured qualitative telephone interviews as part of the MACRO programme (Defining best Management for Adults with Chronic RhinOsinusitis).SettingPrimary care and secondary care ear, nose and throat outpatient clinics in the UK.ParticipantsTwenty-five patients consented to in-depth telephone interviews. Transcribed recordings were managed using NVivo software and analysed using inductive thematic analysis.ResultsCRS has a significant impact on patients’ quality of life, affecting their ability to work effectively, their social interactions and daily living. Patients seek help when symptoms become unmanageable, but can become frustrated with the primary care system with difficulties obtaining an appointment, and lack of continuity of care. Patients perceive that general practitioners can be dismissive of CRS symptoms, and patients often prioritise other concerns when they consult. Health system barriers and poor communication can result in delays in accessing appropriate treatment and referral. Adherence to intranasal steroids is a problem and patients are uncertain about correct technique. Nasal irrigation can be time-consuming and difficult for patients to use. Secondary care consultations can appear rushed, and patients would like specialists to take a more ‘holistic’ approach to their management. Surgery is often considered a temporary solution, appropriate when medical options have been explored.ConclusionsPatients are frustrated with the management of their CRS, and poor communication can result in delays in receiving appropriate treatment and timely referral. Patients seek better understanding of their condition and guidance to support treatments decisions in light of uncertainties around the different medical and surgical options. Better coordinated care between general practice and specialist settings and consistency of advice has the potential to increase patient satisfaction and improve outcomes.

scholarly journals Embedding online patient record access in UK primary care: a survey of stakeholder experiences

2012 ◽  
Vol 3 (5) ◽  
pp. 1-7 ◽  
Author(s):  
Claudia Pagliari ◽  
Tim Shand ◽  
Brian Fisher
Keyword(s):  
Primary Care ◽  
Health Knowledge ◽  
Patient Record ◽  
Daily Lives ◽  
Telephone Interviews ◽  
Negative Beliefs ◽  
Resource Requirements ◽  
Barriers To Implementation ◽  
Set Up ◽  
The Uk

Summary Objectives To explore the integration of online patient Record Access within UK Primary Care, its perceived impacts on workload and service quality, and barriers to implementation. Design Mixed format survey of clinicians, administrators and patients. Telephone interviews with non-users. Setting Primary care centres within NHS England that had offered online record access for the preceding year. Participants Of the 57 practices initially agreeing to pilot the system, 32 had adopted it and 16 of these returned questionnaires. The 42 individual respondents included 14 practice managers, 15 clinicians and 13 patients. Follow-up interviews were conducted with one participant from 15 of the 25 non-adopter practices. Results Most professionals believed that the system is easy to integrate within primary care; while most patients found it easy to integrate within their daily lives. Professionals perceived no increase in the volume of patient queries or clinical consultations as a result of Record Access; indeed some believed that these had decreased. Most clinicians and patients believed that the service had improved mutual trust, communication, patients’ health knowledge and health behaviour. Inhibiting factors included concerns about security, liability and resource requirements. Non-adoption was most frequently attributed to competing priorities, rather than negative beliefs about the service. Conclusions Record access has an important role to play in supporting patient-focused healthcare policies in the UK and may be easily accommodated within existing services. Additional materials to facilitate patient recruitment, inform system set-up processes, and assure clinicians of their legal position are likely to encourage more widespread adoption.

scholarly journals Explaining the mixed findings of a randomised controlled trial of telehealth with centralised remote support for heart failure: multi-site qualitative study using the NASSS framework

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Chrysanthi Papoutsi ◽  
Christine A’Court ◽  
Joseph Wherton ◽  
Sara Shaw ◽  
Trisha Greenhalgh
Keyword(s):  
Heart Failure ◽  
Randomised Controlled Trial ◽  
Complex Intervention ◽  
Controlled Trial ◽  
New Technology ◽  
Scale Up ◽  
Qualitative Evaluation ◽  
Support Service ◽  
Full Potential ◽  
Randomised Controlled

Abstract Background The SUPPORT-HF2 randomised controlled trial compared telehealth technology alone with the same technology combined with centralised remote support, in which a clinician responds promptly to biomarker changes. The intervention was implemented differently in different sites; no overall impact was found on the primary endpoint (proportion of patients on optimum treatment). We sought to explain the trial’s findings in a qualitative evaluation. Methods Fifty-one people (25 patients, 3 carers, 18 clinicians, 4 additional researchers) were interviewed and observed in 7 UK trial sites in 2016–2018. We collected 110 pages of documents. The analysis was informed by the NASSS framework, a multi-level theoretical lens which considers non-adoption and abandonment of technologies by individuals and challenges to scale-up, spread and sustainability. In particular, we used NASSS to tease out why a ‘standardised’ socio-technical intervention played out differently in different sites. Results Patients’ experiences of the technology were largely positive, though influenced by the nature and severity of their illness. In each trial site, existing services, staffing levels, technical capacity and previous telehealth experiences influenced how the complex intervention of ‘telehealth technology plus centralised specialist remote support’ was interpreted and the extent to which it was adopted and used to its full potential. In some sites, the intervention was quickly mobilised to fill significant gaps in service provision. In others, it was seen as usefully extending the existing care model for selected patients. Elsewhere, the new model was actively resisted and the technology little used. In one site, centralised provision of specialist advice aligned awkwardly with an existing community-based heart failure support service. Conclusions Complex socio-technical interventions, even when implemented in a so-called standardised way with uniform inclusion and exclusion criteria, are inevitably implemented differently in different local settings because of how individual staff members interpret the technology and the trial protocol and because of the practical realities and path dependencies of local organisations. Site-specific iteration and embedding of a new technology-supported complex intervention may be required (in addition to co-design of the user interface) before such interventions are ready for testing in clinical trials. Trial registration BMC ISRCTN Registry 86212709. Retrospectively registered on 5 September 2014

scholarly journals Primary care consultations in the UK between 2006 and 2015: An analysis of electronic health records

2017 ◽  
Author(s):  
Benjamin Eaton
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Medical Science ◽  
Care Provision ◽  
Health Records ◽  
Healthcare Needs ◽  
Economic Recessions ◽  
The 2008 Financial Crisis ◽  
The Uk ◽  
The Impact

Primary care accounts for the majority of patient contact within the NHS. Over time medical science and healthcare needs change, which may lead to differences in how patients are treated in primary care for good or ill. In this study over 700 million consultations were analysed over a 10 year period between 2006 and 2015 inclusively to examine the trends in how people access primary care. The number of consultations per person per year initially increased in the first two years from 5.81 to 5.92, an increase of 0.11(0.10 to 0.12 95% CI) before declining to 3.7 by 2015, a decrease of 2.21 from the peak in 2008(2.20 to 2.23 95% CI). Consultations were increasingly handled by health care assistants instead of Nurses and GPs, and increased slightly in duration for all types of staff. This reduction in number of consultations is theorized to be a consequence of the 2008 financial crisis and its aftermath, further research is recommended on the impact of economic recessions and austerity policies on health care provision.

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