scholarly journals Advancing an understanding of access as ‘human fit’: A qualitative participatory case study in general practice

2021 ◽  
pp. BJGP.2021.0375
Author(s):  
Jennifer Voorhees ◽  
Simon Bailey ◽  
Heather Waterman ◽  
Katherine Checkland
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Conceptual Framework ◽  
Care Access ◽  
Healthcare Workforce ◽  
Equal Importance ◽  
Access To Primary Care ◽  
Definition Of ◽  
The Uk

Background: Good access to primary care is an important determinant of population health. Whilst the academic literature on access to care emphasises its complexity, policies aimed at improving access to general practice in the UK have tended to focus on measurable aspects, such as timeliness or number of appointments. Aim: To fill the gap between the complex understanding of primary care access in the literature and the narrow definition of access assumed in UK policies. Design and Setting: Qualitative, community-based participatory case study within the geographic footprint of a Clinical Commissioning Group in northwest England. Method: We applied Levesque et al.’s conceptual framework of patient-centred access and used multiple qualitative methods (interviews, focus groups, observation). Analysis was ongoing, iterative, inductive, and abductive with the theory. Results: The comprehensiveness of Levesque et al.’s access theory resonated with diverse participant experiences. However, while a strength of Levesque et al. was to highlight the importance of people’s abilities to access care, our data suggest equal importance of healthcare workforce abilities to make care accessible. Thus, we present a definition of access as the ‘human fit’ between the needs and abilities of people in the population and the abilities and capacity of people in the healthcare workforce, and provide a modified conceptual framework reflecting these insights. Conclusion: An understanding of access as ‘human fit’ has the potential to address longstanding problems of access within general practice, focusing attention on the need for staff training and support, and emphasising the importance of continuity of care.

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.

scholarly journals Beyond Welfare Chauvinism and Deservingness. Rationales of Belonging as a Conceptual Framework for the Politics and Governance of Migrants’ Rights

2020 ◽  
pp. 1-23
Author(s):  
EMMA CARMEL ◽  
BOŻENA SOJKA
Keyword(s):  
Conceptual Framework ◽  
Social Exclusion ◽  
Social Protection ◽  
Small Scale ◽  
Fine Grained ◽  
Interpretive Analysis ◽  
Alternative Approach ◽  
Migrants Rights ◽  
The Uk

Abstract This article argues that the politics and governance of migrants’ rights needs to be reframed. In particular, the terms “welfare chauvinism”, and deservingness should be replaced. Using a qualitative transnational case study of policymakers in Poland and the UK, we develop an alternative approach. In fine-grained and small-scale interpretive analysis, we tease out four distinct “rationales of belonging” that mark out the terms and practices of social membership, as well as relative positions of privilege and subordination. These rationales of belonging are: temporal-territorial, ethno-cultural, labourist, and welfareist. Importantly, these rationales are knitted together by different framings of the transnational contexts, within which the politics and governance of migration and social protection are given meaning. The rationales of belonging do not exist in isolation, but, in each country, they qualify each other in ways that imply different politics and governance of migrants’ rights. Taken together, these rationales of belonging generate transnational projects of social exclusion, as well as justifications for migrant inclusion stratified by class, gender and ethnicity.

The Impact of Dementia on Oral Health and Dental Care, Part 1: Setting the Scene for Dental Care Provision

2020 ◽  
Vol 9 (2) ◽  
pp. 24-30 ◽  
Author(s):  
Kathryn Kerr ◽  
Charlotte Curl ◽  
Andrew Geddis-Regan
Keyword(s):  
Primary Care ◽  
Oral Health ◽  
Dental Care ◽  
Care Provision ◽  
Care Environment ◽  
Oral Pain ◽  
Key Issues ◽  
Definition Of ◽  
The Uk ◽  
The Impact

There are over 850,000 people living with dementia in the UK and this figure is expected to rise to over a million by 2021. Increasingly, oral healthcare professionals in primary care will see more patients affected by dementia at varying stages of the disease, and it is therefore crucial that they have a basic understanding of the disease and how these patients can be managed in a primary care environment. The first article in this series of two provides a definition of dementia and describes the symptoms of the disease along with the key issues related to oral health, such as oral pain. Oral pain can have far reaching consequences, but identifying it can be problematic, particularly in the latter stages of the disease. This article will therefore cover how to diagnose pain in patients with dementia. Information is also provided about how to make dental surgeries more ‘dementia friendly’.

scholarly journals Experiences of support from primary care and perceived needs of parents bereaved by suicide: a qualitative study

2020 ◽  
Vol 70 (691) ◽  
pp. e102-e110 ◽  
Author(s):  
Verity Wainwright ◽  
Lis Cordingley ◽  
Carolyn A Chew-Graham ◽  
Nav Kapur ◽  
Jenny Shaw ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Qualitative Study ◽  
Support Needs ◽  
Structured Interviews ◽  
Perceived Needs ◽  
The North ◽  
Suicide Bereavement ◽  
Additional Support ◽  
The Uk

BackgroundPeople bereaved by suicide are a vulnerable group, also at risk of dying by suicide. The importance of postvention support (intervention after suicide) has recently been highlighted; however, little is known about the support needs of parents bereaved by suicide in the UK, and the role played by general practice.AimTo explore the perspectives, experiences, and support needs of parents bereaved by suicide.Design and settingThis was a qualitative study, with semi-structured interviews conducted between 2012 and 2014 in the north of England and the Midlands, with parents bereaved by their son or daughter’s suicide.MethodInterviews explored parents’ experiences of suicide bereavement following the death of their son or daughter, with a focus on their experiences of support from primary care. Interviews were analysed thematically using constant comparison.ResultsTwenty-three interviews were conducted. Three themes were identified from the data: the importance of not feeling alone; perceived barriers to accessing support; and the need for signposting for additional support. Some parents reported having experienced good support from their general practice; others described a number of barriers to accessing help, including triage processes. Primary care was considered to be an important avenue of support but GPs were often perceived as uncertain how to respond. The need for information, signposting to avenues of support, and the helpfulness of group support were also highlighted.ConclusionParents believed it was important that people working in general practice have an awareness of suicide bereavement and understanding of their needs, including knowledge of where to direct people for further support.

Student paramedics' views on placements in general practice as part of a degree

2019 ◽  
Vol 11 (12) ◽  
pp. 519-525
Author(s):  
Alyesha Proctor
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Care Pathway ◽  
Structured Interviews ◽  
Learning And Development ◽  
Alternative Care ◽  
Face To Face ◽  
The Uk ◽  
University Degree

Background: Frontline paramedics are increasingly attending to non-emergency problems and calls that could be managed by a primary care provider. Alongside this, there is a growing pressure to manage patients at home or use an alternative care pathway and reduce hospital conveyance. Student paramedic training, including both placement and taught elements at university, should therefore reflect this. However, placement opportunities for student paramedics in primary care settings is variable across the UK. Aim: To explore student paramedics' views on incorporating a placement within general practice as part of their degree and its effects on their learning and development as an autonomous paramedic. Method: A small pedagogic study as part of a postgraduate certificate in academic practice for higher education, involving a case study, qualitative approach using face-to-face, semi-structured interviews and thematic analysis, was carried out. Findings: Student paramedics feel that incorporating a placement in general practice as part of their degree will significantly help in their learning and development as autonomous paramedics. Specifically, they feel it: will help them understand the role of the GP and what the GP expects of them; will help them to focus their assessments and improve confidence in decisions not to convey patients; may lead to better knowledge of alternative care pathways; and, finally, may provide an insight into the role of the paramedic in general practice as a future career opportunity. There are a few reservations about whether students would be able to use the skills and knowledge gained in this setting, as they feel they do not have access to the tools or the authority in a frontline ambulance service. Students would prefer to have a placement in a GP surgery in the final year of their university degree. Conclusion: Placement within a GP surgery for student paramedics should be included as part of a paramedic science degree as a priority. This is necessary, particularly given the changing role of the contemporary paramedic who attends to non-emergency problems.

scholarly journals Help Seeking and Access to Primary Care for People from “Hard-to-Reach” Groups with Common Mental Health Problems

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
K. Bristow ◽  
S. Edwards ◽  
E. Funnel ◽  
L. Fisher ◽  
L. Gask ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Help Seeking ◽  
Mental Health Problems ◽  
Health Problems ◽  
Structured Interviews ◽  
Care Givers ◽  
Common Mental Health Problems ◽  
Access To Primary Care ◽  
The Uk

Background. In the UK, most people with mental health problems are managed in primary care. However, many individuals in need of help are not able to access care, either because it is not available, or because the individual's interaction with care-givers deters or diverts help-seeking. Aims. To understand the experience of seeking care for distress from the perspective of potential patients from “hard-to-reach” groups. Methods. A qualitative study using semi-structured interviews, analysed using a thematic framework. Results. Access to primary care is problematic in four main areas: how distress is conceptualised by individuals, the decision to seek help, barriers to help-seeking, and navigating and negotiating services. Conclusion. There are complex reasons why people from “hard-to-reach” groups may not conceptualise their distress as a biomedical problem. In addition, there are particular barriers to accessing primary care when distress is recognised by the person and help-seeking is attempted. We suggest how primary care could be more accessible to people from “hard-to-reach” groups including the need to offer a flexible, non-biomedical response to distress.

scholarly journals An evaluation of the clinical skills and experience within an orthopaedic Integrated Clinical Assessment and Treatment Service

BJGP Open ◽  
2017 ◽  
Vol 1 (4) ◽  
pp. bjgpopen17X101217
Author(s):  
Simon Feist-Wilson ◽  
Neil Heron
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Northern Ireland ◽  
Clinical Assessment ◽  
Clinical Skills ◽  
Treatment Service ◽  
Exercise Medicine ◽  
Assessment And Treatment ◽  
The Uk ◽  
High Level

BackgroundGeneral practice in the UK is ‘in crisis’. With 20% of GP workload relating to musculoskeletal (MSK) problems, an orthopaedic Integrated Clinical Assessment and Treatment Service (ICATS) could help support assessment of these patients in primary care, alleviating pressure on GPs. However, practitioners in ICATS must be trained appropriately to ensure its effectiveness.AimThis evaluation aimed to identify the training levels of doctors in one Northern Ireland orthopaedic ICATS system, what their future training needs are, and suggestions for how this service could be improved to better support general practice.Design & settingA questionnaire study in an orthopaedic ICATS, Northern Ireland.MethodAll seven doctors working within the Southern Trust orthopaedic ICATS were asked to complete a questionnaire detailing their training and experience in MSK medicine. Their views on how the service could be improved were elicited.ResultsSix of seven questionnaires were returned. All responders were Members of the Royal College of General Practitioners (MRCGP), while five of six held a Diploma in Sports and Exercise Medicine (Dip SEM). Half of responders suggested that MSK ultrasound could be beneficial within ICATS. However, it was viewed that extensive training would be required before paediatric MSK patients could be included.ConclusionHigh levels of training and experience were reported by responders, suggesting ICATS provides a high-level MSK service. Furthermore, it was noted that inclusion of MSK ultrasound and paediatric patients into this service could be beneficial but not without undertaking further training. With appropriate funding and support the ICATS service has the potential to expand the clinical services it offers to general practice, helping to reduce work pressures in primary care at this time of crisis for UK general practice.

scholarly journals Rhetoric, Evidence and Policymaking: a Case Study of Priority Setting in Primary Care*

2011 ◽  
Author(s):  
JILL RUSSELL ◽  
TRISHA GREENHALGH
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Social Interaction ◽  
Priority Setting ◽  
Meaning Making ◽  
Primary Care Trust ◽  
Rhetorical Theory ◽  
Micro Level ◽  
The Uk

This chapter describes a study undertaken as part of the UCL Evidence programme to explore how policymakers talk about and reason with evidence. Specifically, researchers were interested in the micro-processes of deliberation and meaning-making practices of a group of people charged with prioritising health care in an NHS Primary Care Trust in the UK. The chapter describes how the research study brought together ideas from rhetorical theory and methods of discourse analysis to develop an innovative approach to exploring how evidence is constituted at the micro-level of social interaction and communication. It presents empirical data to illuminate the representation and meaning of evidence within one particular policymaking forum, and to highlight contrasting constructions of the policymaking process.

Primary care

2016 ◽  
pp. 466-533
Author(s):  
Andrew Baldwin ◽  
Nina Hjelde ◽  
Charlotte Goumalatsou ◽  
Gil Myers
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Social Class ◽  
Sleep Problems ◽  
Care Home ◽  
Medically Unexplained Symptoms ◽  
Drug Misuse ◽  
Independent Practice ◽  
And Performance ◽  
The Uk

This chapter explores primary care and general practice. It outlines primary care (general practice in the UK and worldwide, primary care, intermediate care and self-care, primary health care teams, and pressures of primary care), consulting and certifying (the consultation and patient centred care, consultation models, complex decision making, managing uncertainty, what to do for the best, continuity of care, home visits, telephone consulting, chronic disease, approaching minor illness, medically unexplained symptoms, time off work and fit notes, fitness to drive, fitness to fly, UK benefits, certification of death) health and healthy living (health and social class, social class and health inequalities, prevention, screening, health education, smoking cessation, managing alcohol and drug misuse, managing obesity, managing sleep problems, exercise, healthy eating and alternative medicine, domestic violence), and practice management and performance (GPs as business managers and commissioners, independent practice vs commercial companies, clinical governance, significant events, audit and complaints, appraisal, revalidation and performance, prescribing and referring, patient groups).

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