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Eccles A, Bryce C, Driessen A, Pope C, MacLellan J, Gronlund T, Nicholson BD, Ziebland S, Atherton H. Access systems in general practice: a systematic scoping review. Br J Gen Pract 2024; 74:e674-e682. [PMID: 38242712 PMCID: PMC11388093 DOI: 10.3399/bjgp.2023.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 12/11/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Access to GP appointments is increasingly challenging in many high-income countries, with an overstretched workforce and rising demand. Various access systems have been developed and evaluated internationally. AIM To systematically consolidate the current international evidence base related to different types of GP access systems. DESIGN AND SETTING Scoping review examining international literature. METHOD Literature searches were run across relevant databases in May 2022. Title, abstract, and full-text screenings were carried out. Data from included studies were extracted and mapped to synthesise the components and aims within different GP access systems. RESULTS In total, 49 studies were included in the review. The majority of these were set in the UK. Some access systems featured heavily in the literature, such as Advanced Access, telephone triage, and online consultations, and others less so. There were two key strategies adopted by systems that related to either changing appointment capacity or modifying patient pathways. Components related to these strategies are summarised and illustrated as a schematic representation. Most rationales behind access systems were practice, rather than patient, focused. 'Add-on' systems and aims for efficiency have become more popular in recent years. CONCLUSION This synthesis provides a useful tool in understanding access systems' aims, design, and implementation. With focus on alleviating demand, patient-focused outcomes appear to be underinvestigated and potentially overlooked during design and implementation. More recently, digital services have been promoted as offering patient choice and convenience. But a context where demand outweighs resources challenges the premise that extending choice is possible.
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Affiliation(s)
- Abi Eccles
- Warwick Applied Health, Warwick Medical School, University of Warwick, Coventry, UK
| | - Carol Bryce
- Warwick Applied Health, Warwick Medical School, University of Warwick, Coventry, UK
| | - Annelieke Driessen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; post-doctoral researcher, Anthropology Department, University of Amsterdam, Amsterdam, the Netherlands
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Jennifer MacLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Toto Gronlund
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Helen Atherton
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
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Hutchinson J, Gibson J, Kontopantelis E, Checkland K, Spooner S, Parisi R, Sutton M. Trends in full-time working in general practice: a repeated cross-sectional study. Br J Gen Pract 2024; 74:e652-e658. [PMID: 38296357 PMCID: PMC11325444 DOI: 10.3399/bjgp.2023.0432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/03/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND There is little evidence and no agreement on what constitutes full-time working for GPs. This is essential for workforce planning, resource allocation, and accurately describing GP activity. AIM To clarify the definition of full-time working for GPs, how this has changed over time, and whether these changes are explained by GP demographics. DESIGN AND SETTING Data were obtained from repeated cross-sectional national surveys for GPs, which were conducted between 2010 and 2021. METHOD A comparison was undertaken of three measures of working time commitments (hours and sessions per week and hours per session) plus a measure of workload intensity across survey years. Multiple regression was used to adjust the changes over time for age, sex, ethnicity, contract type, area deprivation, and rurality. Unadjusted hours and sessions per week were compared with definitions of full-time working. RESULTS Average hours and sessions per week reduced from 40.5 (95% confidence interval [CI] = 38.5 to 42.5) to 38.0 (95% CI = 36.3 to 39.6) and 7.3 (95% CI = 7.2 to 7.3) to 6.2 (95% CI = 6.2 to 6.3) between 2010 and 2021, respectively. In 2021, 54.6% of GPs worked at least 37.5 hours per week and 9.5% worked at least nine sessions. Hours per session increased from 5.7 (95% CI = 5.7 to 5.7) to 6.2 (95% CI = 6.2 to 6.3) between 2010 and 2021. Partners worked more hours, sessions, and hours per session. Adjustments expanded the increase in hours per session from 0.54 to 0.61. CONCLUSION At the current average duration of sessions, six sessions per week aligns with the NHS definition of full-time hours. However, hours per week is a more consistent way to define full-time work for GPs.
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Affiliation(s)
| | - Jon Gibson
- Centre for Primary Care and Health Services Research
| | | | | | | | - Rosa Parisi
- Division of Informatics, Imaging and Data Science
| | - Matt Sutton
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester
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Dheensa S, Doughty J, Gregory A. Healthcare professionals as domestic abuse survivors: workplace impact and support-seeking. Occup Med (Lond) 2024; 74:514-522. [PMID: 39167918 PMCID: PMC11444377 DOI: 10.1093/occmed/kqae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Healthcare professionals (HCPs) are expected to identify and respond to domestic abuse (DA) among their patients. Although research suggests that a high proportion of HCPs are affected by DA, the impact of their experiences has been under-researched. AIMS To assess UK HCPs' experiences of DA and develop a broad understanding of its impact on work and HCPs' support needs. METHODS An online cross-sectional survey was promoted via multiple professional channels (October to December 2022). We adopted convenience sampling and analysed data descriptively. RESULTS Among the 192 HCP survivors who responded, all abuse subtypes-psychological, sexual, economic and physical-were common. Ninety per cent of abusers were male (ex)partners. Eighty-five per cent reported abusers directly interfered with their work and 92% reported their work and career were affected. Almost all reported physical and mental health consequences. Eighty-nine per cent reported their own experiences shaped their responses to patient survivors. On average, per year, HCP survivors reported they had 13 sick days, 5 days' leave, 10 days' lateness and 6 days' early departure due to DA. Only 20% reported their workplace had a staff DA policy, and over 50% were unsure what workplace support mechanisms were available. Just over half disclosed at work; concerns that others would question their fitness to practice were common. Twenty-two per cent reported aspects of work, for example, long hours, stopped them from seeking support outside work. CONCLUSIONS HCPs face unique barriers to DA disclosure and support-seeking and may benefit from tailored support from specialists who understand both DA and the healthcare context.
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Affiliation(s)
- Sandi Dheensa
- Domestic Violence and Abuse Health Research Group, Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK
| | - Janine Doughty
- School of Dentistry, University of Liverpool, Liverpool, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Alison Gregory
- Domestic Violence and Abuse Health Research Group, Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK
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Pettigrew LM, Petersen I, Mays N, Cromwell D. The changing shape of English general practice: a retrospective longitudinal study using national datasets describing trends in organisational structure, workforce and recorded appointments. BMJ Open 2024; 14:e081535. [PMID: 39227175 PMCID: PMC11404227 DOI: 10.1136/bmjopen-2023-081535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024] Open
Abstract
OBJECTIVE To describe trends in the organisational structure, workforce and recorded appointments by role in English general practice. DESIGN Retrospective longitudinal study. SETTING English general practice. DATA SOURCES AND PARTICIPANTS NHS England, Office for Health Improvement and Disparities and Care Quality Commission national administrative datasets covering between 5 to 10 years from 2013 to 2023. RESULTS Between 2013 and 2023, the number of general practices fell by 20% from 8044 to 6419; the average practice list size increase by 40% from 6967 to 9724 patients. The total population covered by providers with over 100 000 registered patients reached 2.3 million in 2023 compared to 0.5 million in 2017. The proportion of practices under individual ownership decreased from 13% to 11% between 2018 and 2023; there was little change in the proportion owned by partnerships, incorporated companies or NHS bodies, which respectively averaged around 80.3%, 6.9% and 0.7%. Between 2015 and 2022, there was a 20% rise in the total full-time equivalent (FTE) general practice workforce, including Primary Care Network staff, from 1.97 to 2.37 per 1000 patients because of an increase in multidisciplinary other 'Direct Patient Care' (DPC) and administrative roles. The number of nurses remained stable, and the number of qualified general practitioners (GPs) decreased by 15%. In September 2022, there were 0.45 FTE qualified GPs per 1000 patients; GPs and other DPC roles, excluding nurses, each represented 19% of the FTE per 1000 patients workforce; administrative roles represented 51%. The general practice workforce is predominantly female. A quarter of GPs qualified overseas. Between 2018 and 2023, there was no clear upward or downward trend in total appointments per 1000 patients with, on average, half provided by GPs. CONCLUSIONS Since 2013, there has been a shift in general practice towards larger practices with more multidisciplinary teams, alongside a reduction in the number of FTE qualified GPs per 1000 patients. We recommend that the impacts of these changes on access, quality and costs are closely monitored.
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Affiliation(s)
- Luisa M Pettigrew
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, University College London, London, UK
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Nicholas Mays
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David Cromwell
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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McHale L, Wass V. Integrating academic medical education into vocational general practitioner training: how do these combined training posts impact on subsequent career paths? EDUCATION FOR PRIMARY CARE 2024:1-8. [PMID: 39215641 DOI: 10.1080/14739879.2024.2387103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/22/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND In the UK, to encourage academic careers, extended education posts (EEPs) exist, where standard three-year, general practice vocational training is extended, offering trainees dedicated time to spend in another specialty such as medical education (Med Ed). Little is known about whether this impacts positively on their subsequent careers. AIMS To explore general practitioners' (GPs') experiences and career trajectories after undertaking Med Ed EEPs. METHOD Twenty-eight GPs who completed a Med Ed EEP between 2013 and 2021 were invited to participate. Semi-structured interviews were held virtually. Transcripts were coded with NVivo software and underwent thematic analysis using Braun and Clarke's six-phase framework to ensure a reiterative process of internal validation. RESULTS Eight GPs took part. All were working as NHS GPs, alongside other roles. Four themes emerged: 'growing as an academic educator', 'research can be interesting', 'the academic environment' and 'juggling multiple roles is stressful'. Most were still teaching, involved in research and had undertaken formal Med Ed training. Role models and immersion in academic teams were influential. Significant tensions and stresses were experienced when balancing multiple roles. The absence of ongoing academic training tracks contributed to this. CONCLUSION EEPs impact positively on academic career development and the acquisition of appropriate skills. However, managing multiple roles is challenging and stressful. Short-term university contracts, difficulties obtaining flexible working and resultant lack of partnership or salaried clinical work highlight an urgent need to explore fixed academic training pathways after vocational training, if sustainable recruitment into primary care academia is to be achieved.
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Affiliation(s)
- Liam McHale
- North Tees and Hartlepool NHS Foundation Trust, Salaried GP at Havelock Grange Practice, Hartlepool, UK
- Newcastle University, Newcastle-upon-Tyne, UK
| | - Val Wass
- Emeritus Professor of Medical Education, University of Keele, Newcastle-under-Lyme, UK
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Park S, Owen-Boukra E, Burford B, Cohen T, Duddy C, Dunn H, Fadia V, Goodman C, Henry C, Lamb EI, Ogden M, Rapley T, Rees E, Vance G, Wong G. General practitioner workforce sustainability to maximise effective and equitable patient care: a realist review protocol. BMJ Open 2024; 14:e075189. [PMID: 38772888 PMCID: PMC11110576 DOI: 10.1136/bmjopen-2023-075189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 04/29/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION There are not enough general practitioners (GPs) in the UK National Health Service. This problem is worse in areas of the country where poverty and underinvestment in health and social care mean patients experience poorer health compared with wealthier regions. Encouraging more doctors to choose and continue in a GP career is a government priority. This review will examine which aspects of the healthcare system affect GP workforce sustainability, how, why and for whom. METHODS AND ANALYSIS A realist review is a theory-driven interpretive approach to evidence synthesis, that brings together qualitative, quantitative, mixed-methods research and grey literature. We will use a realist approach to synthesise data from the available published literature to refine an evidence-based programme theory that will identify the important contextual factors and underlying mechanisms that underpin observed outcomes relating to GP workforce sustainability. Our review will follow Pawson's five iterative stages: (1) finding existing theories, (2) searching for evidence, (3) article selection, (4) data extraction and (5) synthesising evidence and drawing conclusions. We will work closely with key stakeholders and embed patient and public involvement throughout the review process to refine the focus of the review and enhance the impact and relevance of our research. ETHICS AND DISSEMINATION This review does not require formal ethical approval as it draws on secondary data from published articles and grey literature. Findings will be disseminated through multiple channels, including publication in peer-reviewed journals, at national and international conferences, and other digital scholarly communication tools such as video summaries, X and blog posts. PROSPERO REGISTRATION NUMBER CRD42023395583.
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Affiliation(s)
- Sophie Park
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emily Owen-Boukra
- Department of Primary Care and Population Health, University College London, London, UK
| | - Bryan Burford
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Tanya Cohen
- Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Harry Dunn
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Vacha Fadia
- Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Cecily Henry
- Department of Primary Care and Population Health, University College London, London, UK
| | - Elizabeth I Lamb
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Margaret Ogden
- Department of Primary Care and Population Health, University College London, London, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Eliot Rees
- Department of Primary Care and Population Health, University College London, London, UK
- School of Medicine, Keele University, Keele, UK
| | - Gillian Vance
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Nicodemo C, Orso CE, Tealdi C. Overseas general practitioners (GPs) and prescription behaviour in England. Health Policy 2024; 140:104967. [PMID: 38142570 DOI: 10.1016/j.healthpol.2023.104967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/27/2023] [Accepted: 12/11/2023] [Indexed: 12/26/2023]
Abstract
The UK imports many doctors from abroad, where medical training and experience may differ. This study aims to understand how drug prescription behaviour varies in English GP practices with higher shares of foreign-trained GPs. Results indicate that in general prac- tices with a high proportion of GPs trained outside the UK, there are higher prescriptions for antibiotics, mental health medication, analgesics, antacids, and statins, while controlling for patient and practice characteristics. However, we found no significant impact on pa- tient satisfaction or unplanned hospitalisations, suggesting that this behaviour may be due to over-prescribing. Identifying differences in prescribing habits amongst GPs is crucial in deter- mining best policies for ensuring consistent services across GP practices and reducing health inequalities.
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Affiliation(s)
- Catia Nicodemo
- Department of Primary Health Care, Medical School, Department of Primary Care, University of Oxford, Walton Street OX2 6GG, Oxford, UK; Department of Economics, University of Verona, Via Cantarane 24, Verona 03678, Italy.
| | - Cristina E Orso
- Department of Law, Economics, and Cultures, University of Insubria, Italy
| | - Cristina Tealdi
- Edinburgh Business School, IZA Institute of Labor, Heriot-Watt University, Edinburgh EH14 4AS, UK
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Calderón-Larrañaga S, González-De-La-Fuente Á, Espinosa-González AB, Casado-Vicente V, Brito-Fernandes Ó, Klazinga N, Kringos D. What can we learn from general practitioners who left Spain? A mixed methods international study. HUMAN RESOURCES FOR HEALTH 2024; 22:9. [PMID: 38263243 PMCID: PMC10804741 DOI: 10.1186/s12960-023-00888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND International mobility of health workforce affects the performance of health systems and has major relevance in human resources for health policy and planning. To date, there has been little research exploring the reasons why general practitioners (GPs) migrate. This mixed methods study aimed to investigate the reasons why Spain-trained GPs migrate and develop GP retention and recruitment health policy recommendations relevant to Spanish primary care. METHODS The study followed an explanatory sequential mixed methods study design combining surveys with semi-structured interviews and focus groups with GPs who qualified in Spain and were living overseas at the time of the study. The survey data examined the reasons why GPs left Spain and their intention to return and were analysed using quantitative methods. The transcripts from interviews and focus groups centred on GPs' insights to enhance retention and recruitment in Spain and were analysed thematically. RESULTS The survey had 158 respondents with an estimated 25.4% response rate. Insufficient salary (75.3%), job insecurity and temporality (67.7%), excessive workload (67.7%), poor primary care governance (55.7%), lack of flexibility in the workplace (43.7%) and personal circumstances (43.7%) were the main reasons for leaving Spain. Almost half of the respondents (48.7%) would consider returning to Spanish general practice if their working conditions improved. Interviews and focus groups with respondents (n = 24) pointed towards the need to improve the quality of employment contracts, working conditions, opportunities for professional development, and governance in primary care for effective retention and recruitment. CONCLUSION Efforts to improve GP retention and recruitment in Spain should focus on salary, job security, flexibility, protected workload, professional development, and governance. We draw ten GP retention and recruitment recommendations expected to inform urgent policy action to tackle existing and predicted GP shortages in Spanish primary care.
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Affiliation(s)
- Sara Calderón-Larrañaga
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
- XX Place Health Centre, Bromley By Bow Health Partnership, London, United Kingdom.
| | - Ángel González-De-La-Fuente
- Global Business School for Health, University College London, London, United Kingdom
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ana Belén Espinosa-González
- School of Public Health, Imperial College of London, London, United Kingdom
- Canberra Old Oak Surgery, London, United Kingdom
| | - Verónica Casado-Vicente
- Parquesol Health Centre, SACYL, Valladolid, Spain
- General Practice Teaching Unit, University of Valladolid, Valladolid, Spain
| | - Óscar Brito-Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Loke JC, Lee KW. Additional roles reimbursement to primary care networks: an uplift or downfall of general practice partnership? Br J Gen Pract 2024; 74:38-39. [PMID: 38154941 PMCID: PMC10755975 DOI: 10.3399/bjgp24x736089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Affiliation(s)
- Jennifer Cf Loke
- Prof Sir Ron Cooke International Scholar (HEA), Queen's Nurse, BN, MBA, MSc, PhD, PGD (Research), PGC (CDA), PGC (V300), Adv Dip (Coronary and Critical Care), CPN, CCST, RN, LPE, NMIP, lecturer, University of Hull, Hull, UK; visiting professor, Yangzhou University, Yangzhou, China
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Davidson N, Crowfoot D, Wilkinson G. Nottinghamshire GP Phoenix Programme trainee transition scheme: an innovative education programme supporting GP trainees transition to independent practice. EDUCATION FOR PRIMARY CARE 2024; 35:52-56. [PMID: 38754447 DOI: 10.1080/14739879.2024.2336214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/25/2024] [Indexed: 05/18/2024]
Abstract
It is well-established that GP trainees do not feel confident when transitioning to independent practice. In 2019, the Nottinghamshire GP Phoenix Programme Trainee Transition Scheme (TTS) was established to improve this transition and encourage local retention of newly qualified GPs. The TTS has been evaluated by surveying a total of 344 trainees from August 2022 to August 2023 using an electronic Google Form. Two-thirds of the trainees surveyed felt the mix of TTS-led non-clinical topics and trainee-led clinical topics taught during their locality time were useful for their learning. 72% felt that the TTS would influence their decision to remain working locally after qualification. Based on these positive findings, it is proposed that the TTS should be adopted in other areas to improve both transition and retention of newly qualified GPs.
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Affiliation(s)
| | - Daniel Crowfoot
- Early GP Career Lead, Phoenix Programme, Nottingham, England
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Biddle GJ, Thomas N, Edwardson CL, Clemes SA, Daley AJ. Burnout, psychological wellbeing, and musculoskeletal complaints in UK GPs: an observational study. BJGP Open 2023; 7:BJGPO.2023.0007. [PMID: 37474254 PMCID: PMC11176677 DOI: 10.3399/bjgpo.2023.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/14/2023] [Accepted: 06/29/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Healthcare systems are under unprecedented pressure. GPs are crucial to the health of the population, yet their own health and wellbeing is often overlooked. AIM To investigate feelings of burnout, psychological wellbeing, and musculoskeletal complaints in GPs across the UK and to examine whether these health outcomes vary according to the time GPs spent sitting, their participation in physical activity each day, and the time spent working per day or week. DESIGN & SETTING Observational study involving GPs located across the UK. METHOD An online survey was emailed to working members of the Royal College of General Practitioners and shared on social media between October and December 2020. The survey included questions on burnout, psychological wellbeing, musculoskeletal complaints, sitting time, physical activity, and time spent working. Mean differences were examined for burnout, psychological wellbeing, and musculoskeletal complaints. RESULTS Data from 406 GPs showed a high level of burnout (35.5%) and musculoskeletal complaints (neck, shoulder and back: 81.8%; arms: 28.3%; and legs: 49.8%). Psychological wellbeing was low in 22.9% of GPs. Burnout was lower in GPs who met current physical activity guidelines, while psychological wellbeing was higher in those with >2 breaks in sitting per hour. Musculoskeletal complaints were higher in those spending >50% of sitting time in prolonged bouts (≥30 minutes). CONCLUSION A high proportion of GPs reported experiencing burnout and musculoskeletal complaints, but these health concerns were less evident in GPs who spent less time in prolonged sitting, took more breaks in sitting, and who were more physically active.
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Affiliation(s)
- Gregory Jh Biddle
- The Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Science, Loughborough University, Loughborough, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Nicholas Thomas
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Charlotte L Edwardson
- Research, Royal College of General Practitioners, London, UK
- Sedentary Behaviour and Health, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- Sedentary Behaviour and Health, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Stacy A Clemes
- School of Sport, Exercise and Health Science, Loughborough University, Loughborough, UK
| | - Amanda J Daley
- The Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Science, Loughborough University, Loughborough, UK
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12
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Bartlett S, Bullock A, Morris F. 'It's the stuff they can do better than us': case studies of general practice surgeries' experiences of optimising the skill-mix contribution of practice-based pharmacists in Wales. BMJ Open 2023; 13:e073778. [PMID: 37993155 PMCID: PMC10668294 DOI: 10.1136/bmjopen-2023-073778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/25/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE Pharmacists are increasingly joining the general practice skill-mix. Research is still in relative infancy, but barriers and facilitators to their integration are emerging, as well as indications that pharmacists' skillset remain underutilised. This study explores first-hand experiences and perspectives among general practice teams of the processes that underpin the effective integration and sustained contribution of pharmacists in general practice. DESIGN AND SETTING This research employed a qualitative case study approach involving general practice teams in Wales. Data were collected from eight general practices where each practice represented one case study. Data were collected via online interviews (one-to-one or group) and written feedback. Data were pattern coded and analysed thematically through a constant comparative approach. Data interpretations were confirmed with participants and wider general practice teams. PARTICIPANTS Eight general practice teams across Wales (comprising combinations of practice and business managers, general practitioners (GPs) and general practice pharmacists) represented eight case studies. Cases were required to have had experience of working with a general practice pharmacist. RESULTS Data were yielded from five practice managers, two GPs, three general practice pharmacists and a business manager. A total of 3 hours and 2 min of interview data was recorded as well as 2038 words of written feedback. Three foundations to pharmacists' effective contribution to general practice were identified: defining the role (through identifying the right pharmacist, mapping skillset to demand and utilising the increasing need for specialist skills), appropriate infrastructure and workforce review, and an appropriate employment model. CONCLUSION Pharmacists are becoming increasingly critical to the general practice skill-mix and utilisation of their specialist skillset is crucial. This paper identifies how to enable the effective integration and sustained contribution of pharmacists to general practice.
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Affiliation(s)
- Sophie Bartlett
- Cardiff Unit for Research and Evaluation in Medical and Dental Education, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Felicity Morris
- Cardiff Unit for Research and Evaluation in Medical and Dental Education, School of Social Sciences, Cardiff University, Cardiff, UK
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Song F, Bachmann M, Howe A. Factors associated with the consultation of GPs among adults aged ≥16 years: an analysis of data from the Health Survey for England 2019. BJGP Open 2023; 7:BJGPO.2022.0177. [PMID: 37217212 PMCID: PMC10646211 DOI: 10.3399/bjgpo.2022.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Understanding the factors associated with demands for general practice care is crucial for policy decision makers to appropriately allocate healthcare resources. AIM To investigate factors associated with the frequency of GP consultations. DESIGN & SETTING Data on 8086 adults aged ≥16 years was obtained from cross-sectional Health Survey for England (HSE) 2019. METHOD The primary outcome was the frequency of consultations of a GP in the last 12 months. Multivariable ordered logistic regression analysis was used to evaluate associations between GP consultations and a range of sociodemographic and health-related factors. RESULTS Frequency of GP consultations for all reasons was higher among females (odds ratio [OR] 1.81, 95% confidence interval [CI] = 1.64 to 2.01), those aged ≥75 years (OR 1.48, 95% CI = 1.15 to 1.92), ethnic minority populations (Black: OR 1.42, 95% CI = 1.09 to 1.84; Asian: OR 1.53, 95% CI = 1.25 to 1.87), lowest household income (OR 1.53, 95% CI = 1.29 to 1.83), adults with long-lasting illnesses (OR 3.78, 95% CI = 3.38 to 4.22), former smokers (OR 1.17, 95% CI = 1.04 to 1.22), being overweight (OR 1.14, 95% CI = 1.01 to 1.29), and being obese (OR 1.32, 95% CI = 1.16 to 1.50). Predictors of consultations for physical health problems were similar to predictors of consultations for any health problems. However, younger age was associated with more consultations for mental health problems, or a combination of mental and physical health problems. CONCLUSION The higher frequency of consultation of GPs is associated with female sex, older age, ethnic minority populations, being socioeconomically disadvantaged, existence of lasting illnesses, smoking, being overweight, and being obese. Older age is associated with increased consultations for physical health problems, but associated with reduced consultations for mental health or a combination of mental and physical health problems.
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Affiliation(s)
- Fujian Song
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Max Bachmann
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Amanda Howe
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
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Burgmann S, Paier-Abuzahra M, Sprenger M, Avian A, Siebenhofer A. Identifying key policy objectives for strong primary care: a cross-sectional study. Prim Health Care Res Dev 2023; 24:e52. [PMID: 37577950 PMCID: PMC10466205 DOI: 10.1017/s1463423623000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 08/15/2023] Open
Abstract
AIM The aim of this study was to identify key policy objectives by investigating the perception of important stakeholders and affected professionals concerning relevance and feasibility of a successful primary care (PC) reform. BACKGROUND Since 2013, the Austrian PC system has been undergoing a reform process to establish multiprofessional primary care units. The reforms have various defined objectives and lack clear priorities. METHODS After the definition and consensus-based selection of 12 policy objectives, a cross-sectional online survey on their relevance and feasibility was distributed via email and social media to PC and public health networks. The survey was conducted in the period from January to February 2020. Results were analyzed descriptively, and further, Pearson Chi-Square Test or Fisher's Exact Test was performed for group comparison regarding respondents' characteristics. Open-ended responses were analyzed using qualitative content analysis. FINDINGS In total, 169 questionnaires were completed. A total of 46.3% of the responders had more than 20 years of professional experience (female: 60.5%). A mandatory internship in general practice, vocational training for general practice, and a modern remuneration system were the three top-rated policy objectives regarding relevance. A mandatory internship in general practice, specialization in general practice, and coding of services and diagnosis were assessed as the most feasible objectives. The group comparisons regarding working field, years of professional experience, age, and sex did not show any meaningful results in the evaluation of relevance and feasibility. DISCUSSION In the view of the study participants, easily obtainable objectives include adapting the duration and setting of internships for medical students, as well as mandatory vocational training for GP trainees. Further efforts are necessary to achieve complex objectives such as the adoption of a modern remuneration scheme and a comprehensive quality assurance program. Building capacity and creating team-oriented environments are also important aspects of a successful PC reform.
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Affiliation(s)
- Sarah Burgmann
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Muna Paier-Abuzahra
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Martin Sprenger
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Andrea Siebenhofer
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
- Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Frankfurt60590, Germany
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15
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Spadaro B, Martin-Key NA, Funnell E, Benáček J, Bahn S. Opportunities for the Implementation of a Digital Mental Health Assessment Tool in the United Kingdom: Exploratory Survey Study. JMIR Form Res 2023; 7:e43271. [PMID: 37549003 PMCID: PMC10442733 DOI: 10.2196/43271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/02/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Every year, one-fourth of the people in the United Kingdom experience diagnosable mental health concerns, yet only a proportion receive a timely diagnosis and treatment. With novel developments in digital technologies, the potential to increase access to mental health assessments and triage is promising. OBJECTIVE This study aimed to investigate the current state of mental health provision in the United Kingdom and understand the utility of, and interest in, digital mental health technologies. METHODS A web-based survey was generated using Qualtrics XM. Participants were recruited via social media. Data were explored using descriptive statistics. RESULTS The majority of the respondents (555/618, 89.8%) had discussed their mental health with a general practitioner. More than three-fourths (503/618, 81.4%) of the respondents had been diagnosed with a mental health disorder, with the most common diagnoses being depression and generalized anxiety disorder. Diagnostic waiting times from first contact with a health care professional varied by diagnosis. Neurodevelopmental disorders (30/56, 54%), bipolar disorder (25/52, 48%), and personality disorders (48/101, 47.5%) had the longest waiting times, with almost half (103/209, 49.3%) of these diagnoses taking >6 months. Participants stated that waiting times resulted in symptoms worsening (262/353, 74.2%), lower quality of life (166/353, 47%), and the necessity to seek emergency care (109/353, 30.9%). Of the 618 participants, 386 (62.5%) stated that they felt that their mental health symptoms were not always taken seriously by their health care provider and 297 (48.1%) were not given any psychoeducational information. The majority of the respondents (416/595, 77.5%) did not have the chance to discuss mental health support and treatment options. Critically, 16.1% (96/595) did not find any treatment or support provided at all helpful, with 63% (48/76) having discontinued treatment with no effective alternatives. Furthermore, 88.3% (545/617) of the respondents) had sought help on the web regarding mental health symptoms, and 44.4% (272/612) had used a web application or smartphone app for their mental health. Psychoeducation (364/596, 61.1%), referral to a health care professional (332/596, 55.7%), and symptom monitoring (314/596, 52.7%) were the most desired app features. Only 6.8% (40/590) of the participants said that they would not be interested in using a mental health assessment app. Respondents were the most interested to receive an overall severity score of their mental health symptoms (441/546, 80.8%) and an indication of whether they should seek mental health support (454/546, 83.2%). CONCLUSIONS Key gaps in current UK mental health care provision are highlighted. Assessment and treatment waiting times together with a lack of information regarding symptoms and treatment options translated into poor care experiences. The participants' responses provide proof-of-concept support for the development of a digital mental health assessment app and valuable recommendations regarding desirable app features.
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Affiliation(s)
- Benedetta Spadaro
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Nayra A Martin-Key
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Erin Funnell
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering, University of Cambridge, Cambridge, United Kingdom
- Psyomics Ltd, Cambridge, United Kingdom
| | - Jiří Benáček
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Sabine Bahn
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering, University of Cambridge, Cambridge, United Kingdom
- Psyomics Ltd, Cambridge, United Kingdom
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Hu PL, Tan CYL, Nguyen NHL, Wu RR, Bahadin J, Nadkarni NV, Tan NC. Integrated care teams in primary care improve clinical outcomes and care processes in patients with non-communicable diseases. Singapore Med J 2023; 64:423-429. [PMID: 35706106 PMCID: PMC10395801 DOI: 10.11622/smedj.2022067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 08/18/2020] [Indexed: 11/18/2022]
Abstract
Introduction Primary care physicians face the increasing burden of managing multimorbidities in an ageing population. Implementing an integrated care team (ICT) with defined roles and accountability to share consultation tasks is an emerging care model to address this issue. This study compared outcomes with ICT versus usual care for patients with multimorbidities in primary care. Methods Data was retrospectively extracted from the electronic medical records (EMRs) of consecutive adult Asian patients empanelled to ICT and those in UC at a typical primary care clinic (polyclinic) in eastern Singapore in 2018. The study population had hypertension, and/or hyperlipidaemia and/or type 2 diabetes mellitus (T2DM). Clinical outcomes included the proportion of patients (ICT vs. UC) who attained their treatment goals after 12 months. Process outcomes included the proportion of patients who completed annual diabetic eye and foot screenings, where applicable. Results Data from 3,302 EMRs (ICT = 1,723, UC = 1,579) from January 2016 to September 2017 was analysed. The ICT cohort was more likely to achieve treatment goals for systolic blood pressure (SBP) (adjusted odds ratio [AOR] = 1.52, 95% confidence interval [CI] = 1.38-1.68), low-density lipoprotein cholesterol (AOR = 1.72, 95% CI = 1.49-1.99), and glycated haemoglobin (AOR = 1.28, 95% CI = 1.09-1.51). The ICT group had higher uptake of diabetic retinal screening (89.1% vs. 83.0%, P < 0.001) and foot screening (85.2% vs. 77.9%, P < 0.001). Conclusion The ICT model yielded better clinical and process outcomes than UC, with more patients attaining treatment goals.
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Affiliation(s)
- Pei Lin Hu
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
| | - Cynthia Yan-Ling Tan
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
| | | | - Rebekah Ryanne Wu
- Department of Medicine, Duke University, Durham, NC, USA
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | | | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
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Evans GF, Brooks J, Collins L, Farrington R, Danquah A. General Practitioner Educators on Clinical Debrief: A Qualitative Investigation into the Experience of Teaching Third-Year Medical Students to Care. TEACHING AND LEARNING IN MEDICINE 2023:1-10. [PMID: 37392155 DOI: 10.1080/10401334.2023.2222314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 04/01/2023] [Accepted: 05/02/2023] [Indexed: 07/03/2023]
Abstract
Phenomenon: There is a paucity of research reporting the experiences of general practitioner clinical educators. Providing education for students could lead to better clinical skills and greater job satisfaction for the educator. However, it could also result in increased stress and mental fatigue, adding to what is an already pressured situation in the current primary care climate. Clinical Debrief is a model of case-based learning with integrated supervision developed to prepare medical students for clinical practice. This study aimed to explore the experiences of general practitioners who facilitate Clinical Debrief. Approach: Eight general practitioner educators with experience of facilitating Clinical Debrief participated in semi-structured qualitative interviews. Results were analyzed using Reflexive Thematic Analysis, and four main themes were developed. Findings: Themes included: Personal enrichment: psychological "respite" and wellbeing; Professional enrichment: Clinical Debrief as a "two-way" door; Becoming a facilitator: a journey; and, Relationships in teaching: blurred boundaries and multiple roles. Insights: Being a Clinical Debrief facilitator had a transformative impact on the personal and professional lives of the GPs who participated in this study. The implications of these findings for individual GPs, their patients, and the wider healthcare system, are discussed.
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Affiliation(s)
- Georgia F Evans
- Division of Psychology and Mental Health School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Joanna Brooks
- Division of Psychology and Mental Health School of Health Sciences, University of Manchester, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lisa Collins
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rebecca Farrington
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Adam Danquah
- Division of Psychology and Mental Health School of Health Sciences, University of Manchester, Manchester, UK
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18
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Rosta J, Rø KI. Changes in weekly working hours, proportion of doctors with hours above the limitations of European Working Time Directive (EWTD) and time spent on direct patient care for doctors in Norway from 2016 to 2019: a study based on repeated surveys. BMJ Open 2023; 13:e069331. [PMID: 37349097 PMCID: PMC10314479 DOI: 10.1136/bmjopen-2022-069331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/01/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES To compare the total weekly working hours, proportions with work hours above the limitations of European working time directive (EWTD) and time spent on direct patient care in 2016 and 2019 for doctors working in different job positions in Norway. DESIGN Repeated postal surveys in 2016 and 2019. SETTING Norway. PARTICIPANTS Representative samples of doctors; the response rates were 73.1% (1604/2195) in 2016 and 72.5% (1511/2084) in 2019. MAIN OUTCOME MEASURES Self-reported weekly working hours, proportions with hours above the limitations of EWTD defined as >48 hours/week and time spent on direct patient care. ANALYSES Linear mixed models with estimated marginal means and proportions. RESULTS From 2016 to 2019, the weekly working hours increased significantly for male general practitioners (GPs) (48.7 hours to 50.9 hours) and male hospital doctors in leading positions (48.2 hours to 50.5 hours), and significantly decreased for female specialists in private practice (48.6 hours to 44.9 hours). The proportion of time spent on direct patient care was noted to be similar between genders and over time. In 2019, it was higher for specialists in private practice (66.4%) and GPs (65.5%) than for doctors in other positions, such as senior hospital consultants (43.5%), specialty registrars (39.8%) and hospital doctors in leading positions (34.3%). Working >48 hours/week increased significantly for both male and female GPs (m: 45.2% to 57.7%; f: 27.8% to 47.0%) and hospital doctors in leading positions (m: 34.4% to 57.1%; f: 17.4% to 46.4%), while it significantly decreased for female specialty registrars (13.2% to 6.9%). CONCLUSIONS Working hours increased significantly for GPs and hospital doctors in leading positions from 2016 to 2019, resulting in increased proportions of doctors with work hours above the EWTD. As work hours above the EWTD can be harmful for health personnel and for safety at work, initiatives to reduce long working weeks are needed.
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Affiliation(s)
- Judith Rosta
- Institute for Studies of the Medical Profession, Oslo, Norway
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19
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Bartlett S. Practice-based pharmacists: considerations for general practices. Br J Gen Pract 2023; 73:249-250. [PMID: 37230793 PMCID: PMC10229156 DOI: 10.3399/bjgp23x732909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Sophie Bartlett
- Cardiff Unit for Research and Evaluation in Medical and Dental Education, School of Social Sciences, Cardiff University, Cardiff
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20
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Madden S, Martin N, Clements JM, Kirk SJ. 'Factors influencing future career choices of Queen's University Belfast Medical students.'. THE ULSTER MEDICAL JOURNAL 2023; 92:71-76. [PMID: 37649912 PMCID: PMC10464625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Decisions made by medical students on future career choice have demonstrated concordance with subsequent postgraduate career path. This study aimed to understand the factors that impact undergraduate career decision making. METHODS An anonymous voluntary survey consisting of binominal, Likert and free text responses was distributed to all medical students registered at Queen's University Belfast (QUB). Data was collected over 6 weeks in April-May 2021. The primary outcome was future career aspirations. The secondary outcomes were the impact of mentorship on career choice, the likelihood of students completing their medical degree and practicing medicine upon graduation. Local ethical approval was obtained. RESULTS 202 responses were received (response rate 15%). 67% (n = 135) were female. One third of respondents remained undecided about their future career choice. Surgery was both the most popular definite career choice (16.3%) of respondents, butalsothespecialtymarkedmostoftenas'Least preferred Specialty' (33%). Factors positively influencing career choice were academic interest and flexibility in working hours. Negative predictors of career choice were lack of interest in the area, perceived workload, and duration of training schemes. 71% (n=144) of respondents reported that a subspecialty mentor would positively influence their career choice and two-thirds of respondents reported that financial factors would influence their career decision. 11% (n= 22) of respondents were unsure or undecided if they would continue medicine as a career upon graduation. CONCLUSION Uncertainty over future career intention remains common with surgery the least popular speciality. Mentorship, integrating flexibility in training and enhancing academic interest should be considered by educational stakeholders as mechanisms to generating undergraduate interest in a subspecialty. Furthermore, the reported rate of students intention to leave their medical degree prior to graduation by this cohort is concerning, warranting further investigation.
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Affiliation(s)
- S Madden
- School of Medicine, Dentistry & Biomedical Sciences, Queen’s University Belfast
| | - N Martin
- School of Medicine, Dentistry & Biomedical Sciences, Queen’s University Belfast
| | - JM Clements
- School of Medicine, Dentistry & Biomedical Sciences, Queen’s University Belfast
- Ulster Hospital, Dundonald, Belfast
| | - SJ Kirk
- School of Medicine, Dentistry & Biomedical Sciences, Queen’s University Belfast
- Ulster Hospital, Dundonald, Belfast
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Burgmann S, Huter S, Mayerl H, Paier-Abuzahra M, Siebenhofer A. Facilitators and barriers in general practitioners' choice to work in primary care units in Austria: a qualitative study. DAS GESUNDHEITSWESEN 2023; 85:e32-e41. [PMID: 37172594 PMCID: PMC10181885 DOI: 10.1055/a-2011-5362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Recent reforms in Austria have focused on establishing team-based care within multiprofessional primary care units, to enhance amongst others, the work attractiveness of general practice. Nearly 75% of qualified general practitioners are not working as contracted physicians with the social health insurance. This study aims to explore the facilitators of and barriers to non-contracted general practitioners to work in a primary care unit. METHODS We conducted twelve semi-structured, problem-centered interviews among purposively sampled non-contracted general practitioners. To extract categories of facilitators and barriers for working in a primary care unit, transcribed interviews were inductively coded using qualitative content analysis. Subcategories were grouped into factors (facilitators and barriers) of thematic criteria and mapped on the macro-, meso-, micro-, and individual levels. RESULTS We identified 41 categories, including 21 facilitators and 20 barriers. Most facilitators were located at the micro-level, while most barriers were located at the macro-level. Teamwork and associated conditions made primary care units attractive as workplaces and corresponded with individual demands. In contrast, system factors tended to reduce the attractiveness of working as a general practitioner. CONCLUSIONS Multifaceted efforts are needed to address relevant factors at all of the levels mentioned above. These need to be carried out and consistently communicated by all stakeholders. Efforts to strengthen the holistic approach in primary care, like modern remuneration and patient steering mechanisms, are essential. Financial support, consulting services as well as training on entrepreneurship, management, leadership, and team-based care may help to reduce the risk and burden of founding and running a primary care unit.
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Affiliation(s)
- Sarah Burgmann
- Planung und Systementwicklung, Koordination Primärversorgung, Gesundheit Österreich GmbH, Wien, Austria
- Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Graz, Austria
| | - Sebastian Huter
- Institut für Allgemein-, Familien- und Präventivmedizin, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
| | - Hannes Mayerl
- Institut für Sozialmedizin, Medizinische Universität Graz, Graz, Austria
| | - Muna Paier-Abuzahra
- Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Graz, Austria
| | - Andrea Siebenhofer
- Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Graz, Austria
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Smart C, Newman C, Hartill L, Bunce S, McCormick J. Workload effects of online consultation implementation from a Job-Characteristics Model perspective: a qualitative study. BJGP Open 2023; 7:BJGPO.2022.0024. [PMID: 36410768 DOI: 10.3399/bjgpo.2022.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 09/22/2022] [Accepted: 11/10/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Online consultation (OC) was previously promoted by the NHS to solve primary care workload challenges. Its implementation was sped up during the COVID-19 pandemic. Workload effects are widely debated. Using a job design perspective may enhance understandings of workload effect. AIM To qualitatively interrogate the workload experiences of primary care staff involved in OC implementation, using the Job Characteristics Model (JCM) to enable the following: a clearer understanding of the primary care staff psychological experiences; and recommendations informing the design of digital implementations and continued use. DESIGN & SETTING A qualitative interview study of GP practices using OC within South West England. METHOD Thirteen participants representing seven practices completed JCM-based semi-structured telephone interviews. An abductive theoretically driven thematic analysis was completed. RESULTS Participants experienced different tasks pre- and post-implementation of OC, and adapted differently to them. Differences included the following: contact modality change, some administrative staff felt removed from patient contact; and in perceived autonomy, some GPs valued increased workload control. Variation in workload experience was affected by job role and practice context, and the form of and rationale for implementation. Use of a psychological model (the JCM) allowed clearer consideration of the effects of change, as well as OC on workload. CONCLUSION Psychological theory may be helpful in interpreting workload effects of technology implementation such as OC. Designing change to include consideration of technology effects, psychological experiences, differences across roles, and individual and practice contexts may be important for technology implementation and evaluation of its workload effects.
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Affiliation(s)
- Cordet Smart
- Department of Psychology, University of Exeter, Exeter, UK
| | | | | | - Sian Bunce
- Devon Sustainability and Transformation Partnership, Devon, UK
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23
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Granja M, Correia S, Alves L. Access to General Practitioners during the second year of the COVID-19 pandemic in Portugal: a nationwide survey of doctors. BMC PRIMARY CARE 2023; 24:46. [PMID: 36782109 PMCID: PMC9924884 DOI: 10.1186/s12875-023-01994-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The Portuguese National Health System (NHS) provides universal coverage and near-free health care, but the population has high out-of-pocket expenses and unmet care needs. This suggests impaired accessibility, a key dimension of primary care. The COVID-19 pandemic has further affected access to health care. Understanding General Practitioners' (GP) experiences during the pandemic is necessary to reconfigure post-pandemic service delivery and to plan for future emergencies. This study aimed to assess accessibility to GPs, from their perspective, evaluating determinants of accessibility during the second pandemic year in Portugal. METHODS All GPs working in NHS Family Practices in continental Portugal were invited to participate in a survey in 2021. A structured online self-administered anonymous questionnaire was used. Accessibility was assessed through waiting times for consultations and remote contacts and provision of remote access. NHS standards were used to assess waiting times. Descriptive statistics were used to characterize the study sample. Associations between categorical variables were tested using the χ2 statistic and the Student t-test was used to compare means of continuous variables. RESULTS A total of 420 GPs were included (7% of the target population). Median weekly working hours was 49.0 h (interquartile range 42.0-56.8), although only 14% reported a contracted weekly schedule over 40 h. Access to in-person consultations and remote contacts was reported by most GPs to occur within NHS time standards. Younger GPs more often reported waiting times over these standards. Most GPs considered that they do not have enough time for non-urgent consultations or for remote contacts with patients. CONCLUSIONS Most GPs reported compliance with standards for waiting times for most in-person consultations and remote contacts, but they do so at the expense of work overload. A persistent excess of regular and unpaid working hours by GPs needs confirmation. If unpaid overtime is necessary to meet the regular demands of work, then workload and specific allocated tasks warrant review. Future research should focus on younger GPs, as they seem vulnerable to restricted accessibility. GPs' preferences for more in-person care than was feasible during the pandemic must be considered when planning for the post-pandemic reconfiguration of service delivery.
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Affiliation(s)
- Mónica Granja
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal.
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal.
| | - Sofia Correia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
| | - Luís Alves
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
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Gibson J, McBride A, Checkland K, Goff M, Hann M, Hodgson D, McDermott I, Sutton M, Spooner S. General practice managers' motivations for skill mix change in primary care: Results from a cross-sectional survey in England. J Health Serv Res Policy 2023; 28:5-13. [PMID: 35977066 PMCID: PMC9850398 DOI: 10.1177/13558196221117647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The objectives are to determine the factors that motivated GP practice managers in England to employ non-medical roles, and to identify an ideal hypothetical GP practice workforce. METHODS Cross-sectional survey of GP practice managers in England (n = 1205). The survey focused on six non-medical roles: advanced nurse practitioner, specialist nurse, health care assistant, physician associate, paramedic and pharmacist. RESULTS The three most commonly selected motivating factors were: (i) to achieve a better match between what patients need and what the practitioner team can deliver; (ii) to increase overall appointment availability and (iii) to release GP time. Employment of pharmacists and physician associates was most commonly supported by additional funding. Practice managers preferred accessing new non-medical roles through a primary care network or similar, while there was a clear preference for direct employment of additional GPs, advanced nurse practitioners or practice nurses. The ideal practice workforce would comprise over 70% of GPs and nurses, containing, on average, fewer GPs than the current GP practice workforce. CONCLUSION This study confirms that more diverse teams of practitioners are playing an increasing role in providing primary care in England. Managers prefer not to employ all new roles directly within the practice. A more detailed investigation of future workforce requirements is necessary to ensure that health policy supports the funding (whether practice or population based), recruitment, training, deployment and workloads associated with the mix of roles needed in an effective primary care workforce.
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Affiliation(s)
- Jon Gibson
- Research Fellow, Centre for Primary Care and Health Services Research, University of Manchester, UK,Jon Gibson, Centre for Primary Care and Health Services Research, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK.
| | - Anne McBride
- Professor of Employment Relations, Alliance Manchester Business School, University of Manchester, UK
| | - Katherine Checkland
- Professor of Health Policy & Primary Care, Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Mhorag Goff
- Research Associate, Centre for Pharmacy Workforce Studies, University of Manchester, UK
| | - Mark Hann
- Senior Research Fellow, Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Damian Hodgson
- Professor of Organisational Studies, Sheffield University Management School, University of Sheffield, UK
| | - Imelda McDermott
- Research Fellow, Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Matt Sutton
- Research Fellow, Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Sharon Spooner
- Chair in Health Economics, Centre for Primary Care and Health Services Research, University of Manchester, UK
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Khan N. 'Hidden' no more: the real work of the 'part-time' GPs working full-time hours. Br J Gen Pract 2023; 73:26-27. [PMID: 36543544 PMCID: PMC9799354 DOI: 10.3399/bjgp23x731625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Nada Khan
- Nada is an Exeter-based National Institute for Health and Care Research Academic Clinical Fellow in general practice, GPST4/Registrar, and an Associate Editor at the BJGP. @nadafkhan
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Aljohani M, Donnelly M, O’Neill C. Changes in public satisfaction with GP services in Britain between 1998 and 2019: a repeated cross-sectional analysis of attitudinal data. BMC PRIMARY CARE 2022; 23:83. [PMID: 35436843 PMCID: PMC9014779 DOI: 10.1186/s12875-022-01696-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Between 1998 and 2019, the structure and process of general practitioner services in Britain underwent a series of reforms and experienced distinct funding environments. This paper examines changes in satisfaction with GP services over time against this backdrop.
Methods
Data were extracted from the British Social Attitudes Survey for the period 1998–2019. Logistic regression analyses investigated changes in overall satisfaction and among specific population sub-groups differentiated by socio-demographic characteristics whilst taking account of time trend and interaction effects between sub-group membership and time trend.
Results
Sustained and significant changes in satisfaction coincided closely with changes to the funding environment. Distinct patterns were evident among sub-groups. Satisfaction appeared to fall more sharply during austerity for low income groups, older people and people who had fewer formal qualifications/years in education.
Conclusion
While a series of policy initiatives were adopted over the period examined, public satisfaction seemed to move in a manner consistent with levels of government expenditure rather than exhibiting distinct breaks that coincided with policy initiatives. As services recover from the pandemic it will be necessary to invest in a significant and sustained way to rebuild public satisfaction.
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Fang Y, Soljak M, Tan SLL, Peckham S, Tan TL, Smith HE. General practitioners’ views on retaining Singapore’s primary care doctors: a cross-sectional survey and qualitative analysis. BMC PRIMARY CARE 2022; 23:168. [PMID: 35773647 PMCID: PMC9247956 DOI: 10.1186/s12875-022-01774-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
To support its ageing population and the increasing need for chronic care in the community, Singapore needs to boost the number of doctors in its primary care workforce. To better understand how to improve doctor retention and build a more robust primary care system, we conducted a cross-sectional survey with doctors in general practice and family medicine to explore their career satisfaction, their career plans, factors related to their plans to leave, and their view on retaining GPs in primary care.
Methods
An anonymous online survey was distributed to general practitioners working in the public and private sectors. The survey contained questions on career satisfaction, career plans in the next 5 years, and factors important for retaining doctors in primary care. In addition, there were open-ended questions for respondents to elaborate on retention initiatives and other factors that may improve engagement among primary care doctors. Quantitative data was analyzed with descriptive statistics, principal component analysis, χ2 tests, t-tests, and Pearson’s correlations; qualitative data was analyzed thematically.
Results
The survey was attempted by 355 general practitioners and completed in full by 303. The respondents were most satisfied with rapport with patients and their current professional role; they were least satisfied with the amount of paperwork and the status of general practice in society. In terms of their career plans in the next 5 years, 49/341 (14.4%) of the respondents plan to leave general practice permanently, 43/341 (12.6%) plan to take a career break, and 175/341 (51.3%) plan to reduce their clinical hours. Higher remuneration, recognizing general practice and family medicine as a medical specialty, and reducing the litigious pressures on medical practice were rated as the most important factors for retaining primary care. Free-text responses also revealed a growing dissatisfaction with the Third-Party Administrators that manage insurance arrangements.
Conclusion
While the proportion of doctors who intend to leave is smaller than that reported in overseas studies, our findings highlight an urgent need for targeted interventions to engage and retain primary care doctors. Increasing recognition and support for general practitioners and their professional practice may contribute to strengthening community care for the ageing population.
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Roberts R, DaSilva D. Do fellowships for newly qualified GPs improve retention? Evaluation of London's SPIN New to Practice Fellowships. EDUCATION FOR PRIMARY CARE 2022; 33:342-346. [PMID: 36170443 DOI: 10.1080/14739879.2022.2120832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND We explored whether having a variety of work roles and extra support during the first 2 years after qualifying would retain general practitioners (GPs) in London. Newly qualified GPs were offered a Fellowship comprising permanent salaried positions, part-time (portfolio) roles outside general practice and peer support for 1-2 years. METHODS We surveyed newly qualified GPs taking part in the Fellowship near the beginning of their Fellowship (91) and again after 8-10 months (93). We interviewed 34 newly qualified GPs taking part in the Fellowship and 20 who were not. We surveyed and interviewed representatives from employing practices (171), organisations hosting portfolio roles (20), those facilitating the Fellowship (10) and other stakeholders (43). FINDINGS Over a 2.5-year period, employers recruited and retained 425 newly qualified GPs to salaried posts using the Fellowship. Eighty-eight per cent of the newly qualified GPs taking part said they intended to stay working in local practices. They said that undertaking a portfolio role helped them feel valued, had more variety and integration with the wider professional community. Those with two or more portfolio sessions per week were the most positive. CONCLUSIONS Portfolio roles and peer support may increase newly qualified GPs intention to stay working in salaried posts, however it is too early to say whether these intentions will translate into behaviour. WHAT THIS EVALUATION ADDS TO CURRENT KNOWLEDGE Portfolio roles and monthly peer support helped newly qualified GPs feel supported and valued, which may influence their intention to stay working in general practice locally.
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Stigwood A, Maru D, Hadley E, Molloy A, Benneyworth R, Owolabi B. Responding to the systemic inequalities experienced by ethnic minority-led GP providers. BMJ LEADER 2022:leader-2022-000621. [DOI: 10.1136/leader-2022-000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022]
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Peter L, Stumm J, Wäscher C, Kümpel L, Heintze C, Döpfmer S. COMPASS II-Coordination of Medical Professions Aiming at Sustainable Support Protocol for a feasibility study of cooperation between general practitioner practices and community care points. PLoS One 2022; 17:e0273212. [PMID: 36067167 PMCID: PMC9447866 DOI: 10.1371/journal.pone.0273212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION General practitioners (GP) increasingly face the challenge of meeting the complex care needs of multi-morbid patients. Previous studies show that GP practices would like support from other institutions in advising on social aspects of care for multi-morbid patients. Already existing counselling services, like community care points, are not sufficiently known by both GPs and patients. The aim of COMPASS II is to investigate the feasibility of cooperation between GP practices and community care points. METHODS AND ANALYSIS During the intervention, GPs send eligible multi-morbid patients with social care needs to a community care point. The community care points report the consultation results back to the GPs. In preparation for the intervention, in a moderated process, GP practices meet with the community care points to agree on information exchange. The primary outcome is the feasibility of the cooperation: Questionnaires will be sent to GPs, medical practice assistances and community care point personnel (focus: practicality, acceptability). Data will be collected on frequency and reasons for GP-initiated consultations at community care points (focus: demand). Qualitative interviews will be conducted with all participating groups (focus: acceptability, satisfaction). The secondary outcome is the assessment of changes in health-related quality of life, social support and satisfaction with care: participating patients complete a questionnaire before and three to six months after their counselling. The results of the study will be incorporated into a manual in which the experiences of the cooperation will be made available to other GP practices and community care points. DISCUSSION In COMPASS II, GP practices establish cooperation with community care points. The latter are already existing institutions that provide independent and free advice on social matters. By using an existing institution, the established cooperation and experiences from the study can be used beyond the end of the study. TRIAL REGISTRATION The trial is registered with DRKS-ID: DRKS00023798, Coordination of Medical Professions Aiming at Sustainable Support II.
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Affiliation(s)
- Lisa Peter
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Judith Stumm
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Cornelia Wäscher
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lisa Kümpel
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christoph Heintze
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Susanne Döpfmer
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Greenhalgh T, Shaw SE, Alvarez Nishio A, Booth A, Byng R, Clarke A, Dakin F, Davies R, Faulkner S, Hemmings N, Husain L, Kalin A, Ladds E, Moore L, Rosen R, Rybczynska-Bunt S, Wherton J, Wieringa S. Protocol: Remote care as the 'new normal'? Multi-site case study in UK general practice. NIHR OPEN RESEARCH 2022; 2:46. [PMID: 37881300 PMCID: PMC10593351 DOI: 10.3310/nihropenres.13289.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 10/27/2023]
Abstract
Background Following a pandemic-driven shift to remote service provision, UK general practices offer telephone, video or online consultation options alongside face-to-face. This study explores practices' varied experiences over time as they seek to establish remote forms of accessing and delivering care. Methods This protocol is for a mixed-methods multi-site case study with co-design and national stakeholder engagement. 11 general practices were selected for diversity in geographical location, size, demographics, ethos, and digital maturity. Each practice has a researcher-in-residence whose role is to become familiar with its context and activity, follow it longitudinally for two years using interviews, public-domain documents and ethnography, and support improvement efforts. Research team members meet regularly to compare and contrast across cases. Practice staff are invited to join online learning events. Patient representatives work locally within their practice patient involvement groups as well as joining an online patient learning set or linking via a non-digital buddy system. NHS Research Ethics Approval has been granted. Governance includes a diverse independent advisory group with lay chair. We also have policy in-reach (national stakeholders sit on our advisory group) and outreach (research team members sit on national policy working groups). Results anticipated We expect to produce rich narratives of contingent change over time, addressing cross-cutting themes including access, triage and capacity; digital and wider inequities; quality and safety of care (e.g. continuity, long-term condition management, timely diagnosis, complex needs); workforce and staff wellbeing (including non-clinical staff, students and trainees); technologies and digital infrastructure; patient perspectives; and sustainability (e.g. carbon footprint). Conclusion By using case study methods focusing on depth and detail, we hope to explain why digital solutions that work well in one practice do not work at all in another. We plan to inform policy and service development through inter-sectoral network-building, stakeholder workshops and topic-focused policy briefings.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Amy Booth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Aileen Clarke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Francesca Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Stuart Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Asli Kalin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | | | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
- Centre for Sustainable Health Education, University of Oslo, Oslo, Norway
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Stigwood A, Ashmore AA, Maru D, Soni L. Review of literature for ethnic minority-led GP practices: impact and experience of CQC regulation. BMJ LEADER 2022; 7:12-15. [PMID: 37013878 DOI: 10.1136/leader-2022-000606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/18/2022] [Indexed: 11/04/2022]
Abstract
AbstractBackground/aimThe Care Quality Commissions’ (CQC) recent report into the impact and experience of CQC regulation for ethnic minority-led general practitioner (GP) practices found that ethnic minority-led practices are disproportionately situated in areas of deprivation, working single-handedly and without adequate systems of support. These challenges are not always accounted for in CQC’s processes or methodology (CQC, 2022).This study summarises a review of literature carried out as part of research by the CQC, which was published in January 2022.MethodsSearch terms included ‘GP’, ‘CQC’, ‘Black and Ethnic Minority GPs’ combined with Boolean operators. Grey literature was reviewed, and searches were undertaken of known authors in the field. Backwards and forwards reference harvesting was performed on identified literature. Limitations included the capacity and subjectivity of the reviewer, as well as the availability of studies with a focus on ethnic minority GPs as opposed to doctors whose place of primary medical qualification was outside of the UK.Results20 evidence sources were identified and included. The literature review found that many ethnic minority-led GP practices are in complex cycle of inequality, which starts with recruitment and thereafter followed by deprivation, isolation, poor funding and low morale. The symptom of these factors is often poor regulatory outcomes and ratings. When these poor ratings are received, GP providers often struggle to recruit, which serves to perpetuate the cycle of inequality.ConclusionWhen CQC rates an ethnic minority-led practice as requires improvement or inadequate, this can perpetuate a cycle of inequality.
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Affiliation(s)
| | - Ayisha Adeeba Ashmore
- ST4 Registrar, University Hospitals of Leicester, Obstetrics and Gynaecology Department, Leicester, UK
| | - Devina Maru
- National Medical Director's Clinical Fellow, Primary Medical Services and Integrated Care Directorate, GP Specialty Registrar, London, UK
| | - Lakshya Soni
- Junior Doctor, Queen Elizabeth Woolwich, London, UK
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Robinson T, Lefroy J. How do medical students' experiences inform their opinions of general practice and its potential as a future career choice? EDUCATION FOR PRIMARY CARE 2022; 33:156-164. [PMID: 35438598 DOI: 10.1080/14739879.2022.2045229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Recruitment of general practitioners (GPs) in the UK has been suboptimal. There is a wealth of literature exploring recruitment into general practice and opinions of general practice, set in many contexts. This paper aims to synthesise all the elements and extract mechanisms to explain what works, for whom in what circumstances, to create a comprehensive understanding and highlight potential target areas for improvement to improve understanding and fuel interest in general practice careers. A realist review of literature and contemporary data was conducted in line with RAMESES standards. Analysis and synthesis were aided by NVivo. An initial program theory was developed following discussion with expert informers. Sections of text from included literature relating to program theory were extracted and synthesised into a final program theory using a realist logic of analysis in which recurring Context-Mechanism-Outcome configurations (CMOCs) were identified. Searches identified 27 relevant documents. Twenty recurring CMOCs were extracted, explaining how student perceptions of General Practice were influenced by placement experiences, comments from hospital doctors, medical school faculty, peers, GPs, student perceptions of lifestyle and the media. The GP placement environment plays an important role in the formation of opinions about the speciality. The impact of social influence varies depending on the student's desire to belong to a reference group and their level of self-monitoring behaviour. The 'GP lifestyle' was judged to be compatible with many students' needs. This realist review provides recommendations on how curricula can adapt to provide an accurate insight into general practice.
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Affiliation(s)
- Toni Robinson
- School of Medicine, Keele University, Newcastle-under-Lyme, United Kingdom
| | - Janet Lefroy
- School of Medicine, Keele University, Newcastle-under-Lyme, United Kingdom
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Anderson H, Scantlebury A, Leggett H, Salisbury C, Benger J, Adamson J. Perspectives of GPs working in or alongside emergency departments in England: qualitative findings from the GPs and Emergency Departments Study. Br J Gen Pract 2022; 72:BJGP.2021.0713. [PMID: 35879107 PMCID: PMC9328803 DOI: 10.3399/bjgp.2021.0713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/12/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Around 43% of emergency department (ED) attendances can be managed in general practice. Strategies to address this include directing appropriate patients to GPs working in or alongside EDs (GPED). Views of GPs choosing to work in GPED roles may inform planning and implementation of GPED services as well as wider general practice provision. AIM To explore the experiences and motivations of GPs choosing to work in GPED services in England, and to identify factors that may support or hinder GPs working in GPED roles. DESIGN AND SETTING Thematic analysis of 42 semi-structured interviews of GPs working in 10 GPED case sites across England. METHOD Qualitative GP interviews from a mixed-methods study of GPs in GPED roles were thematically analysed in relation to research aims. RESULTS Four themes were generated: the 'pull' of a portfolio career; the 'push' of disillusionment with general practice; professional reciprocity; sustainability of GPED services and core general practice. Flexible, favourable working conditions, collaboration, and professional development made GPED an attractive workplace, often as part of a portfolio career or after retiring from core general practice. Working in GPED services was largely driven by disillusionment with core general practice. Both GPED and core general practice were thought to benefit from GPED GPs' skills. There were concerns about GPED sustainability and destabilisation of core general practice. CONCLUSION GPED may extend the clinical careers of experienced GPs and support recruitment and retention of more recently qualified GPs. Despite some benefits, GPED may destabilise core general practice and increase pressure on both environments.
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Affiliation(s)
- Helen Anderson
- York Trials Unit, Department of Health Sciences, University of York, York
| | | | - Heather Leggett
- York Trials Unit, Department of Health Sciences, University of York, York
| | - Chris Salisbury
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, Bristol
| | - Jonathan Benger
- School of Health and Social Wellbeing, University of the West of England, Bristol
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York
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Hall LH, Thorneloe R, Rodriguez-Lopez R, Grice A, Thorat MA, Bradbury K, Kamble MW, Okoli GN, Powell D, Beeken RJ. Delivering brief physical activity interventions in primary care: a systematic review. Br J Gen Pract 2022; 72:e209-e216. [PMID: 34782318 PMCID: PMC8597771 DOI: 10.3399/bjgp.2021.0312] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/02/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Physical activity (PA) brief interventions (BIs) involving screening and/or advice are recommended in primary care but frequency of delivery is unknown. AIM To examine the extent to which PA BIs are delivered in primary care, and explore factors associated with delivery, receipt, and patient receptivity. DESIGN AND SETTING A mixed-methods systematic review of studies conducted worldwide, with a narrative synthesis of results. METHOD CINAHL, EMBASE, MEDLINE, and APA PsycINFO index databases were searched for qualitative and quantitative studies, dating from January 2012 to June 2020, that reported the level of delivery and/or receipt of PA BIs in primary care, and/or factors affecting delivery, receipt, and patient receptivity. Quality was assessed using the Mixed Methods Appraisal Tool. Attitudes towards and barriers to delivery were coded into the Theoretical Domains Framework and the Capability, Opportunity, and Motivation Behaviour model. RESULTS After screening a total of 13 066 records, 66 articles were included in the review. The extent of PA screening and advice in primary care varied widely (2.4%-100% and 0.6%-100%, respectively). PA advice was delivered more often to patients with a higher body mass index, lower PA levels, and/or more comorbidities. Barriers - including a lack of time and training/guidelines - remain, despite recommendations from the World Health Organization and National Institute for Health and Care Excellence that PA advice should be provided in primary care. Few studies explored patients' receptivity to advice. CONCLUSION PA BIs are not delivered frequently or consistently in primary care. Addressing barriers to delivery through system-level changes and training programmes could improve and increase the advice given. Understanding when patients are receptive to PA interventions could enhance health professionals' confidence in their delivery.
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Affiliation(s)
- Louise H Hall
- National Institute for Health Research (NIHR) in-practice fellow
| | - Rachael Thorneloe
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield
| | | | - Adam Grice
- National Institute for Health Research (NIHR) in-practice fellow
| | - Mangesh A Thorat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London
| | - Katherine Bradbury
- NIHR Southampton Biomedical Research Centre, NIHR Applied Research Collaboration Wessex, Southampton
| | | | - Grace N Okoli
- Institute of Population Health Sciences, Barts, and The London School of Medicine and Dentistry, Queen Mary University of London, London
| | - Daniel Powell
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen
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Lang J, Graffy H, Reeve J. An evaluation of community placements for GP registrars in Yorkshire and the Humber: 'a home visit… not to a patient but to the community'. EDUCATION FOR PRIMARY CARE 2022; 33:199-206. [PMID: 35098898 DOI: 10.1080/14739879.2022.2027274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND GP registrars are required to demonstrate capabilities in 'community orientation', reflecting skills in developing and working with services that respond to community needs. These skills have sometimes been seen as vague and difficult to obtain. In the Yorkshire and the Humber Deanery of Health Education England we developed a novel programme of community placements to overcome this. Registrars spent two half-days with a community organisation of their choosing, working in their practice area. AIM To evaluate if and how community placements enabled registrars to develop capabilities in community orientation. METHODS All registrars completing placements were invited to participate in the evaluation; 13 (7%) accepted. Semi-structured, face-to-face and telephone interviews explored registrars' perceptions and experiences of the programme. Interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS The majority of participants reported that placements enabled them to attain a range of capabilities in community orientation. Registrars described an improved understanding of their practice community and the social determinants of health. Placements impacted their clinical practice by stimulating a holistic approach to the assessment and management of health needs. Our analysis described five key mechanisms for this learning: building confidence, building communities and networks of practice, gaining novel perspectives, generating a hunger for general practice and experiential learning. CONCLUSION Community placements enabled GP registrars to attain capabilities in community orientation. Further research is required to determine the transferability of our findings and further evaluate mechanisms of learning through placements outside of training and their role in the development of professional practice.
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Affiliation(s)
- Jennifer Lang
- Future Leaders Programme, Health Education England, Yorkshire, UK
| | - Hilary Graffy
- Future Leaders Programme, Health Education England, Yorkshire, UK
| | - Joanne Reeve
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull, UK
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O'Regan A, O'Doherty J, Green J, Hyde S. Symbiotic relationships through longitudinal integrated clerkships in general practice. BMC MEDICAL EDUCATION 2022; 22:64. [PMID: 35081951 PMCID: PMC8793267 DOI: 10.1186/s12909-022-03119-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/12/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND Longitudinal integrated clerkships (LICs) are an innovation in medical education that are often successfully implemented in general practice contexts. The aim of this study was to explore the experiences and perspectives of general practitioner (GP)-tutors on the impact of LICs on their practices, patients and the wider community. METHODS GPs affiliated with the University of Limerick School of Medicine- LIC were invited to participate in in-depth interviews. Semi-structured interviews were conducted in person and over the phone and were based on a topic guide. The guide and approach to analysis were informed by symbiosis in medical education as a conceptual lens. Data were recorded, transcribed and analysed using an inductive thematic approach. RESULTS Twenty-two GPs participated. Two main themes were identified from interviews: 'roles and relationships' and 'patient-centred physicians'. Five subthemes were identified which were: 'GP-role model', 'community of learning', and 'mentorship', 'student doctors' and 'serving the community'. CONCLUSION LICs have the potential to develop more patient-centred future doctors, who have a greater understanding of how medicine is practised in the community. The LIC model appears to have a positive impact on all stakeholders but their success hinges on having adequate support for GPs and resourcing for the practices.
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Affiliation(s)
- Andrew O'Regan
- School of Medicine, Health Research Institute, Faculty of Education and Health Sciences University of Limerick, Limerick, Ireland
| | - Jane O'Doherty
- School of Medicine, Health Research Institute, Faculty of Education and Health Sciences University of Limerick, Limerick, Ireland
| | - James Green
- School of Allied Health, Health Research Institute,, Faculty of Education and Health Sciences University of Limerick, Limerick, Ireland
| | - Sarah Hyde
- School of Medicine, Health Research Institute, Faculty of Education and Health Sciences University of Limerick, Limerick, Ireland.
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Kierkegaard P, Hicks T, Allen AJ, Yang Y, Hayward G, Glogowska M, Nicholson BD, Buckle P. Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel. Implement Sci Commun 2021; 2:139. [PMID: 34922624 PMCID: PMC8684208 DOI: 10.1186/s43058-021-00242-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/17/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study is to develop a theory-driven understanding of the barriers and facilitators underpinning physicians' attitudes and capabilities to implementing SARS-CoV-2 point-of-care (POC) testing into primary care practices. METHODS We used a secondary qualitative analysis approach to re-analyse data from a qualitative, interview study of 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify the barriers to implementing SARS-CoV-2 POC testing and identified strategies to address these challenges. RESULTS Several factors underpinned primary care physicians' attitudes and capabilities to implement SARS-CoV-2 POC testing into practice. First, limited knowledge of the SARS-CoV-2 POC testing landscape and a demanding workload affected physicians' willingness to use the tests. Second, there was scepticism about the insufficient evidence pertaining to the clinical efficacy and utility of POC tests, which affected physicians' confidence in the accuracy of tests. Third, physicians would adopt POC tests if they were prescribed and recommended by authorities. Fourth, physicians required professional education and training to increase their confidence in using POC tests but also suggested that healthcare assistants should administer the tests. Fifth, physicians expressed concerns about their limited workload capacity and that extra resources are needed to accommodate any anticipated changes. Sixth, information sharing across practices shaped perceptions of POC tests and the quality of information influenced physician perceptions. Seventh, financial incentives could motivate physicians and were also needed to cover the associated costs of testing. Eighth, physicians were worried that society will view primary care as an alternative to community testing centres, which would change perceptions around their professional identity. Ninth, physicians' perception of assurance/risk influenced their willingness to use POC testing if it could help identify infectious individuals, but they were also concerned about the risk of occupational exposure and potentially losing staff members who would need to self-isolate. CONCLUSIONS Improving primary care physicians' knowledgebase of SARS-CoV-2 POC tests, introducing policies to embed testing into practice, and providing resources to meet the anticipated demands of testing are critical to implementing testing into practice.
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Affiliation(s)
- Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
- CRUK Convergence Science Center, Institute for Cancer Research & Imperial College London, Roderic Hill Building, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK.
| | - Timothy Hicks
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Peter Buckle
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
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Cleland Jennifer A, Porteous T, Ourega-Zoé E, Mandy R, Skåtun D. Won't you stay just a little bit longer? A discrete choice experiment of UK doctors' preferences for delaying retirement. Health Policy 2021; 126:60-68. [PMID: 34887102 DOI: 10.1016/j.healthpol.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/21/2021] [Accepted: 11/12/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION AND AIMS Health systems around the world face difficulties retaining their workforce, which is exacerbated by the early retirement of experienced clinicians. This study aims to determine how to incentivise doctors to delay their retirement. METHODS We used a discrete choice experiment to estimate the relative importance of job characteristics in doctors' willingness to delay retirement, and the number of extra years they were willing to delay retirement when job characteristics improved. 2885 British Medical Association members aged between 50 and 70 years, registered with the General Medical Council, practising in Scotland (in December 2019), and who had not started to draw a pension were invited. We compared the preferences of hospital doctors (HDs) and general practitioners (GPs). RESULTS The response rate was 27.4% (n = 788). The number of extra years expected to work was the most important job characteristic for both respondents, followed by work intensity for GPs, whereas working hours and on-call were more important for HDs. Personalised working conditions and pension taxation were the least important characteristics for both groups. Setting all characteristics to their BEST levels, GPs would be willing to delay retirement by 4 years and HDs by 7 years. CONCLUSIONS Characteristics related to the job rather than pension could have the greatest impact on delaying retirement among clinicians.
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Affiliation(s)
- Anne Cleland Jennifer
- Centre for Healthcare Education Research Innovation (CHERI), School of Medicine, Medical Sciences & Nutrition, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD, UK; Lee Kong Chian School of Medicine (LKCMedicine), Nanyang Technological University Singapore, 308232, Singapore.
| | - Terry Porteous
- Centre for Healthcare Education Research Innovation (CHERI), School of Medicine, Medical Sciences & Nutrition, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD, UK; Health Economics Research Unit (HERU), School of Medicine, Medical Sciences & Nutrition, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD, UK
| | - Ejebu Ourega-Zoé
- School of Health Sciences, University Road, University of Southampton, SO17 1BJ, UK
| | - Ryan Mandy
- Health Economics Research Unit (HERU), School of Medicine, Medical Sciences & Nutrition, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD, UK
| | - Diane Skåtun
- Centre for Healthcare Education Research Innovation (CHERI), School of Medicine, Medical Sciences & Nutrition, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD, UK; Health Economics Research Unit (HERU), School of Medicine, Medical Sciences & Nutrition, Polwarth Building, Foresterhill, University of Aberdeen, AB25 2ZD, UK
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Tudor Car L, Teng YS, How JW, Nazri NNBM, Tan ALX, Quah J, Peckham S, Smith H. Priorities for family physician and general practitioner recruitment and retention in Singapore: a PRIORITIZE study. BMC FAMILY PRACTICE 2021; 22:229. [PMID: 34784892 PMCID: PMC8596925 DOI: 10.1186/s12875-021-01570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/20/2021] [Indexed: 11/28/2022]
Abstract
Background A shortage of primary care physicians has been reported in many countries. Primary care systems are diverse and the challenges leading to a decline in workforce are at times context-specific and require tailored solutions. Inviting frontline clinicians to share their insights can help identify optimal strategies for a particular setting. To determine priorities for family physicians’ and general practitioners’ recruitment and retention in Singapore, we invited primary care physicians to rank pertinent strategies using PRIORITIZE, a transparent, systematic priority-setting approach. Methods The study advisory board, consisting of representatives of Singapore’s key primary care stakeholders, determined the criteria for prioritising of general practitioners (GPs) and family physicians (FPs) recruitment and retention strategies in Singapore. A comprehensive list of GPs and FPs recruitment and retention strategies was extracted from a recent systematic review of the relevant literature. A questionnaire listing the strategies and the scoring criteria was administered online to doctors practicing in public and private sector in Singapore. Respondents’ scores were combined to create a ranked list of locally most relevant strategies for improving GPs and FPs recruitment and retention. Results We recruited a diverse sample of 50 GPs and FPs practicing in a variety of primary care settings, many with a range of additional professional responsibilities. Around 60 and 66% of respondents thought that there was a problem with recruitment and retention of GPs and FPs in Singapore, respectively. Strategies focusing on promoting primary care by emphasizing the advantages and enhancing the status of the profession as well as training-related strategies, such as sub-specialisation and high-quality rotations were considered priorities for improving recruitment. For retention of GPs and FPs, improving working conditions by increasing GPs’ and FPs’ salary and recognition, as well as varying or reducing time commitment, were seen as the most important strategies. The ranking between physicians working in public and private sector was mostly similar, with nine out of the top ten recruitment and retention strategies being the same. Conclusion Primary care physicians’ ranking of recruitment and retention strategies for GPs and FPs in Singapore provide important insight into the challenges and the solutions as seen by the members of the profession themselves. This information can guide future policy and decision making in this area. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01570-1.
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Affiliation(s)
- Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, Singapore. .,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
| | - Yee Sean Teng
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, Singapore
| | - Jin Wei How
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, Singapore
| | | | - Amy Li Xian Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, Singapore
| | - Joanne Quah
- SingHealth Polyclinics, Singapore, Singapore
| | - Stephen Peckham
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Helen Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, Singapore
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Preston K, Weir NM, Mueller T, Newham R, Bennie M. Implementation of pharmacist-led services in primary care: A mixed-methods exploration of pharmacists' perceptions of a national educational resource package. Pharm Pract (Granada) 2021; 19:2440. [PMID: 34621453 PMCID: PMC8456343 DOI: 10.18549/pharmpract.2021.3.2440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background: To help alleviate the global pressure on primary care, there has been an
increase in the number of clinical pharmacists within primary care.
Educational resources are necessary to support this workforce and their
development within this role. An educational resource package was developed
in Scotland to support the General Practice Clinical Pharmacists (GPCPs),
containing a hard copy Competency and Capability Framework (CCF), an online
platform (TURAS) and both clinical and educational supervisors in 2016. Objective: To examine the implementation of a competency-based educational resource
package through the exploration of pharmacists’ perceptions of its
adoption, acceptability, appropriateness, and feasibility. Methods: Participants were GPCPs who had been part of a national training event
between 2016 and 2018. The participants were given the opportunity to
complete an online questionnaire or a semi-structured telephone interview.
Both data collection tools were based on Proctor’s model of
implementation outcomes: adoption, acceptability, appropriateness and
feasibility. Areas covered included GPCPs’ perceptions and level of
adoption of the educational resource package developed to support them in
their role. Results: Of a potential 164 participants, 52 (31.7%) completed the
questionnaire and 12 (7.3%) completed the interview. GPCPs indicated
widespread adoption and were accepting of the resources; however, it was
suggested that its value was undermined, as it was not associated with a
qualification. The appropriateness and feasibility of the resources depended
on GPCPs’ individual situation (including current role, previous job
experience, time available, support received from peers and supervisors, and
perceptions of resources available). Conclusions: The suitability of the CCF was evidenced by participants’ adoption and
acceptance of the resource, indicating the necessity of a competence-based
framework to support the GPCPs’ role. However, its suitability was
hindered in terms of varied perceptions of appropriateness and feasibility.
Despite the limited sample size, the results indicate that the value of
these resources should be promoted across primary care; nevertheless further
facilitation is required to allow GPCPs to fully engage with the
resources.
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Affiliation(s)
- Kate Preston
- BA (Hons), MSc. Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde. Glasgow (United Kingdom).
| | - Natalie M Weir
- MPharm, PhD. Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde. Glasgow (United Kingdom).
| | - Tanja Mueller
- MPharm (equiv), MPH, PhD. Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde. Glasgow (United Kingdom).
| | - Rosemary Newham
- BA (Hons), MRes, PhD. Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde. Glasgow (United Kingdom).
| | - Marion Bennie
- BSc, MSc (Clin Pharm). Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde. Glasgow (United Kingdom).
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Lenoir AL, Leconte S, Cayn M, Ketterer F, Duchesnes C, Fraipont B, Richelle L. Exploring the diverse career trajectories of general practice graduates in the French-speaking part of Belgium: An interview study. Eur J Gen Pract 2021; 27:111-118. [PMID: 34132619 PMCID: PMC8211135 DOI: 10.1080/13814788.2021.1933938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Several European countries face a shortage of general practitioners (GPs), in part due to GP attrition. Most studies of GP attrition have focussed on why GPs decide to leave. Yet understanding why GPs decide to remain may also elicit potential interventions to reduce attrition. Objectives This study examined GP graduates’ career trajectories and underlying decisions to elucidate the factors influencing GP attrition. Methods We conducted semi-structured interviews of early to mid-career general practice graduates having completed training in Belgian French-speaking universities between 1999 and 2013. We sampled participants from three categories: full-time GPs, part-time GPs, no longer working as GPs. We analysed each participant’s career trajectory and broke it down into major phases. We performed thematic analysis of the factors influencing participants’ trajectories. We compared and contrasted trajectories to develop a typology of career trajectories. Results We identified six types of career trajectories: ‘stable’ (never considered leaving general practice), ‘reaffirmed’ (had considered leaving but made substantial changes whilst remaining), ‘reactional reorientations’ (had left to escape the challenges of general practice), ‘inspired reorientations’ (had left to pursue a different job), ‘reorientations out of loyalty’ (had never wanted to practice as GPs and had remained true to their original professional aspirations) and ‘mobiles’ (valued change and did not want to set-up practice). Conclusion Reasons GPs leave the profession are multiple. The typology that emerged indicates that only some of the career trajectories would benefit from interventions to reduce attrition such as improving working conditions and providing psychological support for GPs.
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Affiliation(s)
- Anne-Laure Lenoir
- Department of General Practice, Université de Liège, University hospital of Sart-Tilman, Liège, Belgium
| | - Sophie Leconte
- Academic Centre of General Practice, Université catholique de Louvain, Louvain, Belgium
| | - Marion Cayn
- Department of General Practice, Université Libre de Bruxelles, Erasme Campus, Brussels, Belgium
| | - Frédéric Ketterer
- Department of General Practice, Université de Liège, University hospital of Sart-Tilman, Liège, Belgium
| | - Christiane Duchesnes
- Department of General Practice, Université de Liège, University hospital of Sart-Tilman, Liège, Belgium
| | - Béatrice Fraipont
- Academic Centre of General Practice, Université catholique de Louvain, Louvain, Belgium
| | - Lou Richelle
- Department of General Practice, Université Libre de Bruxelles, Erasme Campus, Brussels, Belgium
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Cunningham DE, Ward C, Kyle J, Yeoman L. Learning needs, preferred learning methods and learning challenges of first five general practitioners in NHS Scotland: a qualitative study. BMJ Open 2021; 11:e044859. [PMID: 33986054 PMCID: PMC8126297 DOI: 10.1136/bmjopen-2020-044859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To identify the learning needs and preferred learning methods of First5 general practitioners (GPs) in National Health Service (NHS) Scotland. DESIGN Qualitative research study using grounded theory methods. First5 GPs were interviewed in small focus groups or individual interviews in-person, or over the telephone depending on their preference. SETTING General practice in NHS Scotland. PARTICIPANTS GPs, within the first 5 years of completion of GP training, who were working in NHS Scotland. RESULTS Thirty-eight First5s were recruited to the study. Participants recognised that gaps in their GP training became apparent in independent practice. Some of this related to NHS appraisal and revalidation, and with the business of general practice. They were interested in learning from an older generation of GPs but perceived that preferred learning methods differed. First5 GPs were less reliant on reading journals to change their practice, preferring to find learning resources that allowed them to gain new knowledge quickly and easily. There were considerations about resilience and of the challenges of learning in remote and rural areas of NHS Scotland. This related to travel costs and time, and to accessibility of learning courses. Participants appreciated collective learning and commented about the logistics and costs of learning. CONCLUSIONS Preferred learning methods and learning resources differ with First5 GPs compared with those who have been in practice for some years. Learning providers need to recognise this and take these differences into account when planning and preparing learning in the future.
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Affiliation(s)
| | - Caroline Ward
- Medicine Directorate, NHS Education for Scotland, Glasgow, UK
| | - John Kyle
- Medicine Directorate, NHS Education for Scotland, Glasgow, UK
| | - Lynsey Yeoman
- Medicine Directorate, NHS Education for Scotland, Glasgow, UK
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Lay-Flurrie SL, Sheppard JP, Stevens RJ, Mallen C, Heneghan C, Hobbs FR, Williams B, Mant J, McManus RJ. Impact of changes to national guidelines on hypertension-related workload: an interrupted time series analysis in English primary care. Br J Gen Pract 2021; 71:e296-e302. [PMID: 33753350 PMCID: PMC7997675 DOI: 10.3399/bjgp21x714281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/02/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In 2011, National Institute for Health and Care Excellence (NICE) guidelines recommended the routine use of out-of-office blood pressure (BP) monitoring for the diagnosis of hypertension. These changes were predicted to reduce unnecessary treatment costs and workload associated with misdiagnosis. AIM To assess the impact of guideline change on rates of hypertension-related consultation in general practice. DESIGN AND SETTING A retrospective open cohort study in adults registered with English general practices contributing to the Clinical Practice Research Datalink between 1 April 2006 and 31 March 2017. METHOD The primary outcome was the rate of face-to-face, telephone, and home visit consultations related to hypertension with a GP or nurse. Age- and sex-standardised rates were analysed using interrupted time-series analysis. RESULTS In 3 937 191 adults (median follow-up 4.2 years) there were 12 253 836 hypertension-related consultations. The rate of hypertension-related consultation was 71.0 per 100 person-years (95% confidence interval [CI] = 67.8 to 74.2) in April 2006, which remained flat before 2011. The introduction of the NICE hypertension guideline in 2011 was associated with a change in yearly trend (change in trend -3.60 per 100 person-years, 95% CI = -5.12 to -2.09). The rate of consultation subsequently decreased to 59.2 per 100 person-years (95% CI = 56.5 to 61.8) in March 2017. These changes occurred around the time of diagnosis, and persisted when accounting for wider trends in all consultations. CONCLUSION Hypertension-related workload has declined in the last decade, in association with guideline changes. This is due to changes in workload at the time of diagnosis, rather than reductions in misdiagnosis.
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Affiliation(s)
- Sarah L Lay-Flurrie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - James P Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Richard J Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Christian Mallen
- School for Primary, Community and Social Care, Keele University, Staffordshire
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Bryan Williams
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, Institute of Cardiovascular Science, University College London, London
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
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Exploring commissioners' understandings of early primary care network development: qualitative interview study. Br J Gen Pract 2021; 71:e711-e718. [PMID: 33690149 PMCID: PMC8252856 DOI: 10.3399/bjgp.2020.0917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background Primary care networks (PCNs) are financially incentivised groupings of general practices in the English NHS. Their purpose is to deliver a number of policy goals set out in The NHS Long Term Plan. Clinical commissioning groups (CCGs) have a role in their establishment, support, and oversight. Aim To explore commissioners’ perspectives on the early development of PCNs. Design and setting Qualitative study of CCG staff using telephone interviews. Method Semi-structured interviews were carried out with 37 CCG employees involved in PCN establishment. Interviewees were asked about local PCNs’ characteristics, factors shaping development and form, activities to date, challenges and benefits, and their CCGs’ relationship with PCNs. Interviewee responses were summarised within a matrix and analysed thematically. Results Three meta-themes were identified: the multifaceted role of the commissioner, tensions between PCN policy and locally commissioned services, and engaging the broader system. Interviewees reported that the policy potentially favours those PCNs working from a ‘blank slate’ and does not sufficiently account for the fact some GP practices and wider system organisations have been doing similar work already. The prescriptive, contractual nature of the policy has led to local challenges, trying to ensure that local good practices are not lost during implementation. Interviewees also considered an important part of their work to be protecting PCNs from the weight of expectations placed on them. Conclusion CCGs are well placed to understand the complexities of local systems and to facilitate PCNs and working practices between wider system partners. It is important that this local role is not lost as CCGs continue to merge and cover larger geographical populations.
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Understanding the impact of professional motivation on the workforce crisis in medicine: a rapid review. BJGP Open 2021; 5:BJGPO.2021.0005. [PMID: 33653705 PMCID: PMC8170605 DOI: 10.3399/bjgpo.2021.0005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background The NHS is facing a workforce crisis. Responses to date have focused on improving recruitment of staff, but less attention has been paid to retention. Aim To conduct a rapid review using Rosabeth Moss Kanter’s three Ms model of workforce motivation as a sensitising framework to examine the current medical workforce crisis. The work considers how insights from research in other professions offers new thinking for understanding what motivates doctors to continue working. Design & setting Rapid literature review with secondary analysis of existing research examining reasons for leaving medicine. Method A systematic search strategy was developed with the aid of an information specialist. The search terms used were: medical professionals, retention, and NHS. The exclusions were: commentaries, non-medical professionals, non-English language, and it was limited to post-1990. The search was applied to three electronic databases, MEDLINE, Embase, and Healthcare Management Information Consortium (HMIC). This produced a dataset describing study design, and factors related to motivation for leaving the medical profession. Comparative thematic analysis distilled core themes explaining the reasons for leaving and their relation to the three Ms model. Results Of 3389 abstracts identified, screening and assessment produced 82 articles included in the final analysis. Thematic analysis identified four key themes: low morale, disconnect, unmanageable change, and lack of personal and professional support. The themes of mastery, membership, and meaning were substantially present within the dataset. Conclusion Kanter's three Ms model of motivation can be applied to the medical workforce to understand retention issues. This work supports the development of targeted solutions to tackle the worsening workforce crisis.
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Mazuquin B, Sunemi MMDO, E Silva MPP, Sarian LOZ, Williamson E, Bruce J. Current physical therapy care of patients undergoing breast reconstruction for breast cancer: a survey of practice in the United Kingdom and Brazil. Braz J Phys Ther 2021; 25:175-185. [PMID: 32605886 PMCID: PMC7990737 DOI: 10.1016/j.bjpt.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/12/2020] [Accepted: 05/25/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In both the United Kingdom (UK) and Brazil, women undergoing mastectomy should be offered breast reconstruction. Patients may benefit from physical therapy to prevent and treat muscular deficits. However, there are uncertainties regarding which physical therapy program to recommend. OBJECTIVE The aim was to investigate the clinical practice of physical therapists for patients undergoing breast reconstruction for breast cancer. A secondary aim was to compare physical therapy practice between UK and Brazil. METHODS Online survey with physical therapists in both countries. We asked about physical therapists' clinical practice. RESULTS 181 physical therapists completed the survey, the majority were from Brazil (77%). Respondents reported that only half of women having breast reconstruction were routinely referred to physical therapy postoperatively. Contact with patients varied widely between countries, the mean number of postoperative sessions was 5.7 in the UK and 15.1 in Brazil. The exercise programs were similar for different reconstruction operations. Therapists described a progressive loading structure over time: range of motion (ROM) was restricted to 90° of arm elevation in the first two postoperative weeks; by 2-4 weeks ROM was unrestricted; at 1-3 months muscle strengthening was initiated, and after three months the focus was on sports-specific activities. CONCLUSION Only half of patients having a breast reconstruction are routinely referred to physical therapy. Patients in Brazil have more intensive follow-up, with up to three times more face-to-face contact with a physical therapist than in the UK. Current practice broadly follows programs for mastectomy care rather than being specific to reconstruction surgery.
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Affiliation(s)
- Bruno Mazuquin
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, United Kingdom.
| | | | | | - Luís Otávio Zanatta Sarian
- Centre for Integral Attention to Women's Health, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Esther Williamson
- Nuffield Department of Orthopedics Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - Julie Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, United Kingdom
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Malau-Aduli BS, Alele FO, Heggarty P, Reeve C, Teague PA. Key elements of effective postgraduate GP educational environments: a mixed methods study. BMJ Open 2021; 11:e041110. [PMID: 33589449 PMCID: PMC7887342 DOI: 10.1136/bmjopen-2020-041110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Evidence in the literature suggests that satisfaction with postgraduate general practice (GP) training is associated with the quality of the educational environment. This study aimed to examine GP registrars' level of satisfaction with a distributed model of training in a regional educational environment and investigate the relationship between satisfaction and academic performance. STUDY DESIGN A longitudinal 3-year study was conducted among GP registrars at James Cook University using a sequential explanatory mixed methods research design. GP registrars' satisfaction was obtained using the scan of postgraduate educational environment domains tool. A focus group discussion was conducted to explore GP registrars' perceptions of satisfaction with the educational environment. SETTING James Cook University General Practice Training (JCU GPT) programme. PARTICIPANTS Six hundred and fifty one (651) GP registrars enrolled between 2016 and 2018 at JCU GPT programme. RESULTS 651 registrars completed the satisfaction survey between 2016 and 2018. Overall, 92% of the registrars were satisfied with the educational training environment. Registrars who had become fellows reported higher satisfaction levels compared with those who were still in training (mean=4.39 vs 4.20, p=0.001). However, academic performance had no impact on level of satisfaction with the educational environment. Similarly, practice location did not influence registrars' satisfaction rates. Four themes (rich rural/remote educational environment, supportive learning environment, readiness to continue with rural practice and practice culture) emerged from the thematic data analysis. CONCLUSION A clinical learning environment that focuses on and supports individual learning needs is vital for effective postgraduate medical training. This study suggests that JCU GPT programme's distributed model fostered a satisfying and supportive training environment with rich educational experiences that enhance retention of GP registrars in rural/remote North Queensland, Australia. The findings of this study may be applicable to other settings with similar training models.
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Affiliation(s)
- Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Faith O Alele
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Paula Heggarty
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Carole Reeve
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Peta-Ann Teague
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
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Recovery, restoration, and risk: a cross-sectional survey of the impact of COVID-19 on GPs in the first UK city to lock down. BJGP Open 2020; 5:BJGPO.2020.0151. [PMID: 33199303 PMCID: PMC7960523 DOI: 10.3399/bjgpo.2020.0151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/01/2020] [Indexed: 12/17/2022] Open
Abstract
Background The COVID-19 pandemic has impacted GPs immensely. Work patterns have changed, risk stratification has been proposed, and the mental health of clinicians has been adversely affected. The COVID-19 prevalence among GPs is unknown. This study focuses on assessing the impact of COVID-19 on GPs in Leicestershire, the first UK city to lock down locally. Aim This survey assessed the prevalence of COVID-19 in GPs and explored GP work patterns in comparison with national guidance. It used a validated perceived stress tool to evaluate the impact of COVID-19 on GP stress perception. Design & setting The cross-sectional retrospective survey was sent to all the GPs in Leicestershire. Method A total of 111 GPs in Leicestershire took part voluntarily in an anonymised questionnaire-based study. A 29-item survey using SmartSurvey software was designed with multiple choice and Likert response scale questions. Results COVID-19 prevalence in GPs in Leicestershire was 8.1%; 70.3% of GPs were of Black, Asian, and minority ethnic (BAME) origin; 91.9% of GPs had undergone risk stratification; and 79.3% of GPs felt supported by their practice, but only 59.5% felt supported with mental health. GPs described feeling more stressed during the COVID-19 pandemic than they had been previously. Conclusion This is the first study evaluating COVID-19 prevalence among GPs in Leicestershire. Despite government interventions, GPs felt less supported with their mental health compared with pre-COVID-19 times. Thus, the NHS in England should focus on GP stress and wellbeing as they work towards the restoration and recovery of primary care while battling the second wave.
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Hayes H, Gibson J, Fitzpatrick B, Checkland K, Guthrie B, Sutton M, Gillies J, Mercer SW. Working lives of GPs in Scotland and England: cross-sectional analysis of national surveys. BMJ Open 2020; 10:e042236. [PMID: 33127639 PMCID: PMC7604859 DOI: 10.1136/bmjopen-2020-042236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/23/2020] [Accepted: 10/06/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The UK faces major problems in retaining general practitioners (GPs). Scotland introduced a new GP contract in April 2018, intended to better support GPs. This study compares the career intentions and working lives of GPs in Scotland with GPs in England, shortly after the new Scotland contract was introduced. DESIGN AND SETTING Comparison of cross-sectional analysis of survey responses of GPs in England and Scotland in 2017 and 2018, respectively, using linear regression to adjust the differences for gender, age, ethnicity, urbanicity and deprivation. PARTICIPANTS 2048 GPs in Scotland and 879 GPs in England. MAIN OUTCOME MEASURES Four intentions to reduce work participation (5-point scales: 1='none', 5='high'): reducing working hours; leaving medical work entirely; leaving direct patient care; or continuing medical work but outside the UK. Four domains of working life: job satisfaction (7-point scale: 1='extremely dissatisfied', 7='extremely satisfied'); job stressors (5-point-scale: 1='no pressure', 5='high pressure); positive and negative job attributes (5-point scales: 1='strongly disagree', 5='strongly agree'). RESULTS Compared with England, GPs in Scotland had lower intention to reduce work participation, including a lower likelihood of reducing work hours (2.78 vs 3.54; adjusted difference=-0.52; 95% CI -0.64 to -0.41), a lower likelihood of leaving medical work entirely (2.11 vs 2.76; adjusted difference=-0.32; 95% CI -0.42 to -0.22), a lower likelihood of leaving direct patient care (2.23 vs 2.93; adjusted difference=-0.37; 95% CI -0.47 to -0.27), and a lower likelihood of continuing medical work but outside of the UK (1.41 vs 1.61; adjusted difference=-0.2; 95% CI -0.28 to -0.12). GPs in Scotland reported higher job satisfaction, lower job stressors, similar positive job attributes and lower negative job attributes. CONCLUSION Following the introduction of the new contract in Scotland, GPs in Scotland reported significantly better working lives and lower intention to reduce work participation than England.
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Affiliation(s)
- Helen Hayes
- Health Organisation, Policy and Economics Research Group, Centre for Primary Care & Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jonathan Gibson
- Health Organisation, Policy and Economics Research Group, Centre for Primary Care & Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - Kath Checkland
- Health Organisation, Policy and Economics Research Group, Centre for Primary Care & Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - Bruce Guthrie
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics Research Group, Centre for Primary Care & Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Gillies
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Stewart W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
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