scholarly journals Tensions and opportunities in social prescribing. developing a framework to facilitate its implementation and evaluation in primary care: a realist review

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0017
Author(s):  
Sara Calderón-Larrañaga ◽  
Yasmin Milner ◽  
Megan Clinch ◽  
Trisha Greenhalgh ◽  
Sarah Finer
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Best Practice ◽  
Grey Literature ◽  
Good Practice ◽  
Realist Review ◽  
Individual Characteristics ◽  
Quantitative Evidence ◽  
Social Prescribing ◽  
Community Sector

BackgroundSocial prescribing (SP) involves linking patients in primary care with services provided by the voluntary and community sector. Despite growing interest within NHS primary care, it remains unclear how and under what circumstances SP might contribute to good practice.AimTo define ‘good’ practice in SP by identifying context-specific enablers and tensions. To contribute to the development of an evidence-based framework for theorizing and evaluating SP within primary care.Design and settingRealist review of secondary data from primary care-based SP schemes.MethodWe searched for qualitative and quantitative evidence from academic articles and grey literature following the Realist and Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES). We characterised common SP practices in three settings (general practice, link workers and community sector) using archetypes which ranged from best to worst practice.ResultsA total of 140 studies were included for analysis. We characterised common SP practices in three settings (general practice, link workers and community sector) using archetypes which ranged from best to worst practice. We identified resources influencing the type and potential impact of SP practices and outlined four dimensions in which opportunities for good practice arise: 1) individual characteristics (stakeholder’s buy-in, vocation, knowledge); 2) interpersonal relations (trustful, bidirectional, informed, supportive, transparent and convenient interactions within and across sectors); 3) organisational contingencies (the availability of a predisposed practice culture, leadership, training opportunities, supervision, information governance, resource adequacy and continuity and accessibility of care within organisations); and 4) policy structures (bottom-up and coherent policymaking, stable funding and suitable monitoring strategies). Findings where synthesised in a multi-level, dynamic and usable SP Framework.ConclusionOur realist review and resulting framework revealed that SP is not inherently advantageous. Specific individual, interpersonal, organisational and policy resources are needed to ensure SP best practice in primary care.

scholarly journals Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e039809
Author(s):  
Sharon Dixon ◽  
Claire Duddy ◽  
Gabrielle Harrison ◽  
Chrysanthi Papoutsi ◽  
Sue Ziebland ◽  
...  
Keyword(s):  
Primary Care ◽  
Grey Literature ◽  
Relevant Literature ◽  
Theory Development ◽  
Realist Review ◽  
Primary Outcome Measure ◽  
Mandatory Reporting ◽  
Programme Theory ◽  
Genital Mutilation ◽  
The Impact

ObjectivesLittle is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients.SettingPrimary care in England.Data sourcesRealist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients.Primary outcome measureThis realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated.Results124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations.ConclusionsThere is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities’ health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation.PROSPERO registration numberCRD42018091996.

A career in academic general practice

2019 ◽  
Vol 12 (3) ◽  
pp. 149-152
Author(s):  
Jonathan Mills ◽  
Joanne Reeve
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Research And Development ◽  
Best Practice ◽  
Cost Effective ◽  
Academic Community ◽  
Community Or ◽  
Health And Wellbeing ◽  
Effective Part ◽  
And Training

As a GP, you will make a difference to the lives of many thousands of patients over the course of your career, but as an academic GP you could make a difference to hundreds of thousands, even millions of lives. GPs can have an impact, not just in the consulting room or in patients’ homes. Differences can be made to the lives of many through the education and training of doctors, the work of commissioning boards seeking the best services for a community, or through research and development of the latest treatments. Primary care is a highly cost-effective part of NHS healthcare, and has a key role in promoting health and wellbeing. However, these roles would not be possible without contributions from academic general practice; the continuing success of primary care depends on the academic community that supports, researches, and develops best practice.

Social prescribing: A new medicine?

2016 ◽  
Vol 10 (2) ◽  
pp. 90-95 ◽  
Author(s):  
Patrick Hutt
Keyword(s):  
Social Support ◽  
Primary Care ◽  
General Practice ◽  
Health System ◽  
Local Community ◽  
Evidence Base ◽  
Community Services ◽  
Social Prescribing

The concept behind social prescribing is to link patients in primary care with local community services. Social prescribing is increasingly being championed as a key component of a GP’s therapeutic toolkit; it was referenced in the General Practice Forward View 2016 as an example of providing social support for patients and integrating care across the wider health system. This article sets out to describe what constitutes social prescribing, to highlight examples of services that exist, and to discuss the existing evidence base for social prescribing.

Overview of challenges to implementation of good practice in perinatal mental health promotion and management, in universal primary care and community services

2017 ◽  
Vol 16 (3) ◽  
pp. 100-103 ◽  
Author(s):  
Lucy Marks
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Promotion ◽  
Best Practice ◽  
Good Practice ◽  
Community Services ◽  
Mental Health Promotion ◽  
Perinatal Mental Health ◽  
Content Type ◽  
Proactive Management

Purpose The purpose of this paper is to describe some of the barriers and solutions to implementing good practice in perinatal mental health promotion in universal services, and propose some ways forward. Design/methodology/approach This paper describes the rationale and evidence base for proactive management of perinatal mental health in primary care and community services and good practice recommendations. There is considerable evidence that these recommendations have not been implemented nationally in the UK. A range of solutions and proposed ways forward to manage barriers to implementation are set out. Findings It is proposed that a number of factors need to be in place in order to deliver best practice in perinatal mental health. Originality/value The value of this paper is to set out what needs to be in place in order for services to promote good perinatal mental health and secure attachment and change the life chances of children and their parents, by intervening early. This will also ultimately save financial resources for public services, because the quality of early relationships is linked to health and mental health.

scholarly journals Supporting social prescribing in primary care by linking people to local assets: a realist review

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Stephanie Tierney ◽  
Geoff Wong ◽  
Nia Roberts ◽  
Anne-Marie Boylan ◽  
Sophie Park ◽  
...  
Keyword(s):  
Primary Care ◽  
Realist Review ◽  
Social Prescribing

scholarly journals A Framework to Guide the Implementation of Best Practice Clinical Learning Environments in Community General Practice: Australia

2021 ◽  
Vol 18 (4) ◽  
pp. 1482
Author(s):  
Belinda O'Sullivan ◽  
Helen Hickson ◽  
Rebecca Kippen ◽  
Donna Cohen ◽  
Phil Cohen ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Learning Environment ◽  
Learning Environments ◽  
Best Practice ◽  
Clinical Learning ◽  
Limited Information ◽  
Clinical Learning Environment ◽  
Liaison Officer ◽  
Starting Point

Clinical education/training is increasingly being expanded to community general practice settings (primary care clinics led by doctors). This plays an important role in developing a skilled “primary-care ready” workforce. However, there is limited information to guide the implementation of high-quality learning environments suitable for the range of general practices and clinical learners they oversee. We aimed to develop a consensus-based framework to address this. A co-design participatory action research method involved working with stakeholders to agree a project plan, collect and interpret data and endorse a final framework. As a starting point, an initial draft framework was adapted from an existing framework, the Best Practice Clinical Learning Environment (BPCLE) Framework. We gathered feedback about this from a national GP Supervisor Liaison Officer Network (SLON) (experienced GP clinical supervisors) during a 90-minute face-to-face focus group. They rated their agreement with the relevance of objectives and elements, advising on clear terminology and rationale for including/excluding various components. The resulting framework was refined and re-tested with the SLON and wider GP educational stakeholders until a final graphically designed version was endorsed. The resulting “GP Clinical Learning Environment” (GPCLE) Framework is applicable for planning and benchmarking best practice learning environments in general practice.

scholarly journals Delegating home visits in general practice: a realist review on the impact on GP workload and patient care

2020 ◽  
Vol 70 (695) ◽  
pp. e412-e420 ◽  
Author(s):  
Ruth Abrams ◽  
Geoff Wong ◽  
Kamal R Mahtani ◽  
Stephanie Tierney ◽  
Anne-Marie Boylan ◽  
...  
Keyword(s):  
General Practice ◽  
Healthcare Professionals ◽  
Hospital Admissions ◽  
Grey Literature ◽  
Home Visits ◽  
Secondary Data ◽  
Realist Review ◽  
Causal Explanations ◽  
New Ways Of Working ◽  
The Impact

BackgroundUK general practice is being shaped by new ways of working. Traditional GP tasks are being delegated to other staff with the intention of reducing GPs’ workload and hospital admissions, and improving patients’ access to care. One such task is patient-requested home visits. However, it is unclear what impact delegated home visits may have, who might benefit, and under what circumstances.AimTo explore how the process of delegating home visits works, for whom, and in what contexts.Design and settingA review of secondary data on home visit delegation processes in UK primary care settings.MethodA realist approach was taken to reviewing data, which aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes. A range of data has been used including news items, grey literature, and academic articles.ResultsData were synthesised from 70 documents. GPs may believe that delegating home visits is a risky option unless they have trust and experience with the wider multidisciplinary team. Internal systems such as technological infrastructure might help or hinder the delegation process. Healthcare professionals carrying out delegated home visits might benefit from being integrated into general practice but may feel that their clinical autonomy is limited by the delegation process. Patients report short-term satisfaction when visited by a healthcare professional other than a GP. The impact this has on long-term health outcomes and cost is less clear.ConclusionThe delegation of home visits may require a shift in patient expectation about who undertakes care. Professional expectations may also require a shift, having implications for the balance of staffing between primary and secondary care, and the training of healthcare professionals.

scholarly journals A systematic literature review of pharmacists in general practice in supporting the implementation of shared care agreements (SCA) in primary care

2021 ◽  
Author(s):  
Naveed Iqbal ◽  
Chi Huynh ◽  
Ian Maidment
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Grey Literature ◽  
Shared Care ◽  
Free Text ◽  
Ageing Population ◽  
Mesh Free ◽  
Free Text Search ◽  
Related Quality ◽  
Successful Execution

Abstract Background Rising demand for healthcare continues to impact on all sectors of the health service. As a result of the growing ageing population and the burden of chronic disease, healthcare has become more complex, the need for more efficient management of specialist medication across the healthcare interface is of paramount importance. With the rising number of pharmacists working in primary care in clinical roles, is this a role that pharmacist could support to ensure the successful execution of Shared Care Agreement (SCA) in primary care for these patients?Aim of the review Systematic review to identify activities and assess interventions provided by pharmacists in primary care on SCA provision and how it affects health-related quality of life (HRQoL) for patients.MethodThe following electronic databases were systematically searched from the date on inception to January 2020: AMED®, CINAHL®, Cochrane Database of Systematic Reviews (CDSR), EMBASE®, EMCARE®, Google Scholar, HMIC®, MEDLINE®, PsycINFO®, Scopus, Web of Science® and grey literature sources were also searched. The search was adapted according to the respective database-specific search tools. It was searched using a combination of medical subject heading terms (MeSH), free-text search terms and Boolean operators.ResultsA total of 6,489 titles/abstracts were screened, and 59 full articles were assessed for eligibility. On examination of full text, no studies met the inclusion criteria for this reviewConclusionThis review highlights the need for further research to evaluate how pharmacists in general practice can support the safe and effective integration of specialist medication in primary care with the use of SCA.

scholarly journals The impact of social prescribing services on service users: a systematic review of the evidence

2019 ◽  
Vol 30 (4) ◽  
pp. 664-673 ◽  
Author(s):  
Julia V Pescheny ◽  
Gurch Randhawa ◽  
Yannis Pappas
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Grey Literature ◽  
Evidence Base ◽  
Service Users ◽  
Health And Wellbeing ◽  
Medical Needs ◽  
Social Prescribing ◽  
Health And Social Care ◽  
The Impact

Abstract Background Social prescribing initiatives are widely implemented in the UK National Health Service to integrate health and social care. Social prescribing is a service in primary care that links patients with non-medical needs to sources of support provided by the community and voluntary sector to help improve their health and wellbeing. Such programmes usually include navigators, who work with referred patients and issue onward referrals to sources of non-medical support. This systematic review aimed to assess the evidence of service user outcomes of social prescribing programmes based on primary care and involving navigators. Methods We searched 11 databases, the grey literature, and the reference lists of relevant studies to identify the available evidence on the impact of social prescribing on service users. Searches were limited to literature written in English. No date restrictions were applied, and searches were conducted to June 2018. Findings were synthesized narratively, employing thematic analysis. The Mixed Methods Appraisal Tool Version 2011 was used to evaluate the methodological quality of included studies. Results Sixteen studies met the inclusion criteria. The evidence base is mixed, some studies found improvements in health and wellbeing, health-related behaviours, self-concepts, feelings, social contacts and day-to-day functioning post-social prescribing, whereas others have not. The review also shows that the evaluation methodologies utilized were variable in quality. Conclusion In order to assess the success of social prescribing services, more high quality and comparable evaluations need to be conducted in the future. International Prospective Register of Systematic Reviews number: CRD42017079664

scholarly journals The challenges of integrating signposting into general practice: qualitative stakeholder perspectives on care navigation and social prescribing in primary care

2021 ◽  
Author(s):  
Lisa Brunton ◽  
Abigail Tazzyman ◽  
Jane Ferguson ◽  
Damian Hodgson ◽  
Pauline A Nelson
Keyword(s):  
Primary Care ◽  
General Practice ◽  
National Policy ◽  
Professional Services ◽  
Structured Interviews ◽  
Practice Staff ◽  
Social Prescribing ◽  
Stakeholder Perspectives ◽  
Wide Range ◽  
The Right

Abstract Background A national policy focus in England to address general practice workforce issues has led to a commitment to employ significant numbers of non-GP roles to redistribute workload. This paper focuses on two such roles: the care navigation (CN) and social prescribing link worker (SPLW) roles, which both aim to introduce ‘active signposting’ into primary care, to direct patients to the right professional/services at the right time and free up GP time. There is a lack of research exploring staff views of how these roles are being planned and operationalised into general practice and how signposting is being integrated into primary care. Methods The design uses in-depth qualitative methods to explore a wide range of stakeholder staff views. We generated a purposive sample of 34 respondents who took part in 17 semi-structured interviews and one focus group (service leads, role holders and host general practice staff). We analysed data using a Template Analysis approach. Results Three key themes highlight the challenges of operationalising signposting into general practice: 1) Role perception – signposting was made challenging by the way both roles were perceived by others (e.g. among the public, patients and general practice staff) and highlighted inherent tensions in the expressed aims of the policy of active signposting.; 2) Role preparedness – a lack of training meant that some receptionist staff felt unprepared to take on the CN role as expected and raised patient safety issues; for SPLW staff, training affected the consistency of service offer across an area; 3) Integration and co-ordination of roles – a lack of planning and co-ordination across components of the health and care system challenged the success of integrating signposting into general practice. Conclusions This study provides new insights from staff stakeholder perspectives into the challenges of integrating signposting into general practice, and highlights key factors affecting the success of signposting in practice. Clarity of role purpose and remit (including resolving tensions inherent the dual aims of ‘active signposting’), appropriate training and skill development for role holders and adequate communication and engagement between stakeholders/partnership working across services, are required to enable successful integration of signposting into general practice.

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