scholarly journals Factors affecting the changing role of GP clinicians in community hospitals: a qualitative interview study in England

2019 ◽  
Vol 69 (682) ◽  
pp. e329-e335
Author(s):  
David Seamark ◽  
Deborah Davidson ◽  
Angela Ellis-Paine ◽  
Jon Glasby ◽  
Helen Tucker

BackgroundGPs were a key driving force for the development of a network of community hospitals across England, and have provided medical cover for most of them. However, during the past decade there has been a significant shift, with the dominant trend appearing to be one of declining GP involvement.AimTo explore how and why the role of GPs within community hospitals in England is changing.Design and settingQualitative study in a sample of nine diverse community hospitals in England.MethodQualitative interviews with community hospital clinical staff.ResultsIn all, 20 interviews were conducted and two models of medical care observed: GPs employed by a practice and trust-employed doctors. Interviewees confirmed the trend towards declining GP involvement, with the factors driving change identified as being GP workload and recruitment challenges, a change from ‘step-up’ admissions from the community to ‘step-down’ admissions from acute hospitals, fewer local patients being admitted, increased medical acuity of patients admitted, increased burden of medical support required, and inadequate remuneration. The majority of doctors viewed community hospital work in a positive light, welcoming the opportunities for personal development and to acquire new clinical skills. GPs viewed community hospital work as an extension of primary care, adding to job satisfaction.ConclusionMultiple factors have driven changes in the role of GP community hospital clinicians. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital work.

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696713
Author(s):  
David Seamark ◽  
Deborah Davidson ◽  
Helen Tucker ◽  
Angela Ellis-Paine ◽  
Jon Glasby

BackgroundIn 2000 20% of UK GPs had admitting rights to community hospitals. In subsequent years the number of GPs engaged in community hospital clinical care has decreased.AimWhat models of medical care exist in English community hospitals today and what factors are driving changes?MethodInterviews with community hospital clinical staff conducted as part of a multimethod study of the community value of community hospitals.ResultsSeventeen interviews were conducted and two different models of medical care observed: GP led and Trust employed doctors. Factors driving changes were GP workload and recruitment challenges; increased medical acuity of patients admitted; fewer local patients being admitted; frustration over the move from ‘step-up’ care from the local community to ‘step-down’ care from acute hospitals; increased burden of GP medical support; inadequate remuneration; and GP admission rights removed due to bed closures or GP practices withdrawing from community hospital work.ConclusionMultiple factors have driven changes in the role of GP community hospital clinicians with a consequent loss of GP generalist skills in the community hospital setting. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital care.


2018 ◽  
Vol 32 (9) ◽  
pp. 1465-1473 ◽  
Author(s):  
Sarah Hoare ◽  
Michael P Kelly ◽  
Larissa Prothero ◽  
Stephen Barclay

Background: Hospital admissions for end-of-life patients, particularly those who die shortly after being admitted, are recognised to be an international policy problem. How patients come to be transferred to hospital for care, and the central role of decisions made by ambulance staff in facilitating transfer, are under-explored. Aim: To understand the role of ambulance staff in the admission to hospital of patients close to the end of life. Design: Qualitative interviews, using particular patient cases as a basis for discussion, analysed thematically. Participants/setting: Ambulance staff ( n = 6) and other healthcare staff (total staff n = 30), involved in the transfer of patients (the case-patients) aged more than 65 years to a large English hospital who died within 3 days of admission with either cancer, chronic obstructive pulmonary disease or dementia. Results: Ambulance interviewees were broadly positive about enabling people to die at home, provided they could be sure that they would not benefit from treatment available in hospital. Barriers for non-conveyance included difficulties arranging care particularly out-of-hours, limited available patient information and service emphasis on emergency care. Conclusion: Ambulance interviewees fulfilled an important role in the admission of end-of-life patients to hospital, frequently having to decide whether to leave a patient at home or to instigate transfer to hospital. Their difficulty in facilitating non-hospital care at the end of life challenges the negative view of near end-of-life hospital admissions as failures. Hospital provision was sought for dying patients in need of care which was inaccessible in the community.


BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030243
Author(s):  
Angela Ellis Paine ◽  
Daiga Kamerāde ◽  
John Mohan ◽  
Deborah Davidson

ObjectiveTo examine the forms, scale and role of community and voluntary support for community hospitals in England.DesignA multimethods study. Quantitative analysis of Charity Commission data on levels of volunteering and voluntary income for charities supporting community hospitals. Nine qualitative case studies of community hospitals and their surrounding communities, including interviews and focus groups.SettingCommunity hospitals in England and their surrounding communities.ParticipantsCharity Commission data for 245 community hospital Leagues of Friends. Interviews with staff (89), patients (60), carers (28), volunteers (35), community representatives (20), managers and commissioners (9). Focus groups with multidisciplinary teams (8 groups across nine sites, involving 43 respondents), volunteers (6 groups, 33 respondents) and community stakeholders (8 groups, 54 respondents).ResultsCommunities support community hospitals through: human resources (average=24 volunteers a year per hospital); financial resources (median voluntary income = £15 632); practical resources through services and activities provided by voluntary and community groups; and intellectual resources (eg, consultation and coproduction). Communities provide valuable supplementary resources to the National Health Service, enhancing community hospital services, patient experience, staff morale and volunteer well-being. Such resources, however, vary in level and form from hospital to hospital and over time: voluntary income is on the decline, as is membership of League of Friends, and it can be hard to recruit regular, active volunteers.ConclusionsCommunities can be a significant resource for healthcare services, in ways which can enhance patient experience and service quality. Harnessing that resource, however, is not straight forward and there is a perception that it might be becoming more difficult questioning the extent to which it can be considered sustainable or ‘renewable’.


2022 ◽  
Author(s):  
Balazs Adam ◽  
Richard Keers

Abstract BackgroundThe Mental Health Act 1983 was amended in 2007 introducing the role of the Approved Clinician (AC) which could be assumed by individuals from several professional groups. Although the role of mental health pharmacists have undergone significant transformation over the past few decades, pharmacists remain ineligible to train and practise as an AC. There is a paucity of research on non-medical ACs and there are currently no known studies exploring the potential of mental health pharmacists to be considered for the role of AC in future.AimThis qualitative research explored the views and attitudes of a range of healthcare professionals towards the role of the mental health pharmacist, and whether they could and/or should be enabled, via a legislative change, to become ACs in the future.MethodRecruitment based on systematic purposive sampling principles took place at one mental health trust in England. Six pharmacists, five medical ACs and two experienced mental health nurses participated in digitally audio-recorded semi-structured interviews between June-November 2020. The recordings were transcribed verbatim before being inductively coded and thematically analysed.ResultsNotwithstanding the wide recognition among participants of several key skills possessed by mental health pharmacists, various obstacles were also identified to their becoming ACs in future, including prevalent conventional models of pharmacy services delivery restricting adequate patient access, as well as insufficient training opportunities to acquire advanced clinical skills particularly in diagnosis and assessment. Participants also highlighted wider concerns with current uptake of the non-medical AC role which could influence the success of pharmacists’ involvement, including legislative restrictions and a lack of perceived training support.ConclusionChanges to the skill mix within multidisciplinary mental health teams as well as to the training of staff may be required to equip pharmacists with essential skills to be able to transition towards the AC role. Further research is required to gain a better understanding of the challenges facing the clinical development and enhanced utilisation of highly specialised mental health pharmacists across services.


2017 ◽  
Vol 5 (19) ◽  
pp. 1-220 ◽  
Author(s):  
Emma Pitchforth ◽  
Ellen Nolte ◽  
Jennie Corbett ◽  
Céline Miani ◽  
Eleanor Winpenny ◽  
...  

BackgroundThe notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential.ObjectivesThis study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care.MethodsA multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland.ResultsThe evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented.LimitationsThe use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth.ConclusionsAt a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s).FundingThe National Institute for Health Research Health Services and Delivery Research programme.


2019 ◽  
pp. 22-29
Author(s):  
Н. В. Фрадкіна

The purpose and tasks of the work are to analyze the contemporary Ukrainian mass culture in terms of its value and humanistic components, as well as the importance of cultural studies and Ukrainian studies in educational disciplines for the formation of a holistic worldview of modern youth.Analysis of research and publications. Scientists repeatedly turned to the problems of the role of spirituality in the formation of society and its culture. This problem is highlighted in the publications by O. Losev, V. Lytvyn, D. Likhachev, S. Avierintsev, M. Zakovych, I. Stepanenko and E. Kostyshyn.Experts see the main negative impact of mass culture on the quality approach, which determines mass culture through the market, because mass culture, from our point of view, is everything that is sold and used in mass demand.One of the most interesting studies on this issue was the work by the representatives of Frankfurt School M. Horkheimer and T. Adorno «Dialectics of Enlightenment» (1947), devoted to a detailed analysis of mass culture. Propaganda at all socio-cultural levels in the form is similar in both totalitarian and democratic countries. It is connected, according to the authors, with the direction of European enlightenment. The tendency to unify people is a manifestation of the influence of mass culture, from cinema to pop. Mass culture is a phenomenon whose existence is associated with commerce (accumulation in any form – this is the main feature of education), in general, the fact that it exists in this form is related to the direction of the history of civilization.Modern mass culture, with its externally attractive and easily assimilated ideas and symbols, appealing to the trends of modern fashion, becomes a standard of prestigious consumption, does not require intense reflection, allows you to relax, distract, not teach, but entertains, preaches hedonism as the main spiritual value. And as a consequence, there are socio-cultural risks: an active rejection of other people, which leads to the formation of indifference; cruelty as a character trait; increase of violent and mercenary crime; increase in the number of alcohol and drug addicts; anti-patriotism; indifference to the values of the family and as a result of social orphanhood and prostitution.Conclusions, perspectives of research. Thus, we can conclude that modern Ukrainian education is predominantly formed by the values of mass culture. Namely, according to the «Dialectic» by Horkheimer and Adorno, «semi-enlightenment becomes an objective spirit» of our modern society.It is concluded that only high-quality education can create the opposite of the onset of mass culture and the destruction of spirituality in our society. It is proved that only by realizing the importance of cultivating disciplines in the educational process and the spiritual upbringing of the nation, through educational reforms, humanitarian knowledge will gradually return to student audiences.Formation of youth occurs under the influence of social environment, culture, education and self-education. The optimal combination of these factors determines both the process of socialization itself and how successful it will be. In this context, one can see the leading role of education and upbringing. It turns out that the main task of modern education is to spread its influence on the development of spiritual culture of the individual, which eventually becomes a solid foundation for the formation of the individual. Such a subject requires both philosophical and humanitarian approaches in further integrated interdisciplinary research, since the availability of such research will provide the theoretical foundation for truly modern educational and personal development.


Author(s):  
Do Huy Thuong ◽  
Nguyen Thi Phuong Hong

Improving the quality in order to keep up with the trend in the world is the vital task of training institutions today. Training institutions need to grasp market needs and satisfy the requirements of customers - learners. Nadiri, H., Kandampully, J & Hussain, K. (2009) argue that the managers in education need to apply market strategies that are being used by manufacturing and business enterprises and need to be aware that the role of training institutions is a service industry which is responsible for satisfying learner needs (Elliott & Shin, 2002). Currently, there have been many researches on students’ satisfaction. However, each research has its own objectives and is conducted on different scales. This study is implemented to provide information about the factors affecting master students’ satisfaction with the training service at VNU School of Interdisciplinary Studies (VNU SIS). Through it, the research offers a number of solutions to improving the satisfaction level of the master students at VNU SIS in the coming time.


2020 ◽  
Vol 26 (1) ◽  
pp. 86-93
Author(s):  
D. V. Slivinsky ◽  
I. A. Fomina ◽  
D. G. Menshikh

The presented study determines the role of business aviation in the modern economy and examines the specific features of its development in Russia.Aim. The study aims to analyze the development of business aviation in Russia and its correlation with economic development in general.Tasks. The authors determine the benefits of business aviation as a business tool, examine the specific features of the Russian business aviation market and problems of its development, and identify factors that affect the development of business aviation in Russia.Methods. This study uses the methods of comparative and retrospective analysis, cross-country comparison, systems approach, and expert analytics.Results. Business aviation is a new segment of civil aviation for Russia. Therefore, it is advisable to rely on foreign practices in the management of its development. In many countries, business aviation is a separate industry that specializes in providing transport services to a wide range of corporate clients and/or individuals. The development of this industry is associated with the economic growth rate and the development level of the national economy, and also depends on the national institutional specifics. This study describes the specific features of development of business aviation in Russia and problems arising in the organization and management of this type of business.Conclusions. The authors develop a system of factors affecting the development of business aviation in Russia, describe the major problems of this industry, and propose solutions. The results of this study can be used in the development (adjustment) of business aviation development strategies in Russia both at the industrial and corporate level, and in the implementation of the national policy in this field.


Author(s):  
E. M. Ratnikov ◽  
D. O. Milko

Annotation Purpose. Development of a program and methods for conducting experimental studies of the extrusion process with the definition of parameters and modes of operation of the extruder to improve its energy performance. Methods. Methods of mathematical statistics, synthesis, analysis, description and modeling were used. Results. The application of mathematical methods, in particular mathematical planning, reduces the number of experiments several times, and allows to evaluate the role of influencing factors, obtain a mathematical model of the process and determine the optimal conditions for its parameters and modes, etc. Conclusions. The methodology for experimental studies of a screw extruder is presented with the necessary equipment and methodology for processing the obtained experimental data. A mathematical method of planning, which reduces the number of experiments several times, allows us to evaluate the role of factors affecting productivity and energy intensity is presented. Keywords: extruder, auger, nutrients, research methodology, extrusion, processing, feed.


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