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Dowling S, Minihan F, Duffy I, McNicholas C, Doran G, Harrold P, Burke J, Cullen W. Benefits and limitations of the transfer online of Irish College of General Practitioners continuing medical education small group learning during the COVID pandemic: a national Delphi study. MEDICAL EDUCATION ONLINE 2024; 29:2396163. [PMID: 39244775 PMCID: PMC11382731 DOI: 10.1080/10872981.2024.2396163] [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: 10/12/2023] [Revised: 03/16/2024] [Accepted: 08/20/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND In Ireland and internationally, small-group learning (SGL) has been shown to be an effective way of delivering continuing medical education (CME) and changing clinical practice. RESEARCH QUESTION This study sought to determine the benefits and limitations, as reported by Irish GPs, of the change of CME-SGL from face-to-face to online learning during COVID. METHODS GPs were invited to participate via email through their respective CME tutors. The first of three rounds of a survey using the Delphi method gathered demographic information and asked GPs about the benefits and/or limitations of learning online in their established small groups. Subsequent rounds obtained a consensus opinion. RESULTS Eighty-eight GPs across Ireland agreed to participate. Response rates varied from 62.5% to 72% in different rounds. These GPs reported that attending their established CME-SGL groups allowed them to discuss the practical implications of applying guidelines in COVID care into practice (92.7% consensus), reviewing new local services and comparing their practice with others (94% consensus); helping them feel less isolated (98% consensus). They reported that online meetings were less social (60% consensus), and informal learning that occurs before and after meetings did not take place (70% consensus). GPs would not like online learning to replace face-to face-CME-SGL after COVID (89% consensus). CONCLUSION GPs in established CME-SGL groups benefited from online learning as they could discuss how to adapt to rapidly changing guidelines while feeling supported and less isolated. They report that face-to-face meetings offer more opportunities for informal learning.
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Affiliation(s)
- Stephanie Dowling
- CME Small Group Tutor Network, Irish College of General Practitioners, Dublin 2, Ireland
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Finola Minihan
- CME Small Group Tutor Network, Irish College of General Practitioners, Dublin 2, Ireland
| | - Ilona Duffy
- CME Small Group Tutor Network, Irish College of General Practitioners, Dublin 2, Ireland
| | - Claire McNicholas
- CME Small Group Tutor Network, Irish College of General Practitioners, Dublin 2, Ireland
| | - Gillian Doran
- CME Small Group Tutor Network, Irish College of General Practitioners, Dublin 2, Ireland
| | - Pat Harrold
- CME Small Group Tutor Network, Irish College of General Practitioners, Dublin 2, Ireland
| | - John Burke
- CME Small Group Tutor Network, Irish College of General Practitioners, Dublin 2, Ireland
| | - Walter Cullen
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
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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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3
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Barnard R, Spooner S, Hubmann M, Checkland K, Campbell J, Swinglehurst D. The hidden work of general practitioners: An ethnography. Soc Sci Med 2024; 350:116922. [PMID: 38713977 DOI: 10.1016/j.socscimed.2024.116922] [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: 10/20/2023] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 05/09/2024]
Abstract
High quality primary care is a foundational element of effective health services. Internationally, primary care physicians (general practitioners (GPs), family doctors) are experiencing significant workload pressures. How non-patient-facing work contributes to these pressures and what constitutes this work is poorly understood and often unrecognised and undervalued by patients, policy makers, and even clinicians engaged in it. This paper examines non-patient-facing work ethnographically, informed by practice theory, the Listening Guide, and empirical ethics. Ethnographic observations (104 h), in-depth interviews (n = 16; 8 with GPs and 8 with other primary care staff) and reflexive workshops were conducted in two general practices in England. Our analysis shows that 'hidden work' was integral to direct patient care, involving diverse clinical practices such as: interpreting test results; crafting referrals; and accepting interruptions from clinical colleagues. We suggest the term 'hidden care work' more accurately reflects the care-ful nature of this work, which was laden with ambiguity and clinical uncertainty. Completing hidden care work outside of expected working hours was normalised, creating feelings of inefficiency, and exacerbating workload pressure. Pushing tasks forward into an imagined future (when conditions might allow its completion) commonly led to overspill into GPs' own time. GPs experienced tension between their desire to provide safe, continuous, 'caring' care and the desire to work a manageable day, in a context of increasing demand and burgeoning complexity.
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Affiliation(s)
- Rachel Barnard
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Sharon Spooner
- Centre for Primary Care & Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - Michaela Hubmann
- Centre for Primary Care & Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - Kath Checkland
- Centre for Primary Care & Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Campbell
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Deborah Swinglehurst
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, 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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Schrimpf A, Scheiwe E, Bleckwenn M. Insights from end-of-career general practitioners on changing working conditions and generational differences: considerations for future strategies. BMC PRIMARY CARE 2024; 25:171. [PMID: 38762452 PMCID: PMC11102275 DOI: 10.1186/s12875-024-02419-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
The landscape of general practice has experienced notable transformations in recent decades, profoundly influencing the working conditions of general practitioners (GPs). This study aimed to examine the most salient changes affecting GPs' daily practices. Through semi-structured qualitative interviews with 15 end-of-career GPs, the study explored how these changes affected work organization, equipment, working hours, work-life balance, job satisfaction, training, patient relationships, and reputation. The interviews revealed that these changes were perceived as barriers, opportunities, or a complex interplay of both for general practice. While the interviewed GPs valued technological advancements and reported positive developments in working conditions, challenges included a gradual reduction in the range of tasks, growing administrative burdens, and less practical training for young physicians. Other changes, such as new doctor-patient dynamics, the transition from single to group practice, and differing professional expectations of the younger generation, were seen as both challenging and strengthening for general practice. By combining these factors and trade-offs observed by end-of-career GPs in our study over the past few decades with general societal changes, we provide ideas for the design of future framework conditions in general practice that might enhance the attractiveness of the profession. These insights offer key considerations that can guide future strategies for general practice and medical education.
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Affiliation(s)
- Anne Schrimpf
- Institute for General Practice, Faculty of Medicine, Leipzig University, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.
| | - Elisabeth Scheiwe
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Markus Bleckwenn
- Institute for General Practice, Faculty of Medicine, Leipzig University, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
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Pearson A, Carrieri D, Melvin A, Bramwell C, Scott J, Hancock J, Papoutsi C, Pearson M, Wong G, Mattick K. Developing a typology of interventions to support doctors' mental health and wellbeing. BMC Health Serv Res 2024; 24:573. [PMID: 38702774 PMCID: PMC11067176 DOI: 10.1186/s12913-024-10884-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/20/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The problem of mental ill-health in doctors is complex, accentuated by the COVID-19 pandemic, and impacts on healthcare provision and broader organisational performance. There are many interventions to address the problem but currently no systematic way to categorise them, which makes it hard to describe and compare interventions. As a result, implementation tends to be unfocussed and fall short of the standards developed for implementing complex healthcare interventions. This study aims to develop: 1) a conceptual typology of workplace mental health and wellbeing interventions and 2) a mapping tool to apply the typology within research and practice. METHODS Typology development was based on iterative cycles of analysis of published and in-practice interventions, incorporation of relevant theories and frameworks, and team and stakeholder group discussions. RESULTS The newly developed typology and mapping tool enable interventions to be conceptualised and/or mapped into different categories, for example whether they are designed to be largely preventative (by either improving the workplace or increasing personal resources) or to resolve problems after they have arisen. Interventions may be mapped across more than one category to reflect the nuance and complexity in many mental health and wellbeing interventions. Mapping of interventions indicated that most publications have not clarified their underlying assumptions about what causes outcomes or the theoretical basis for the intervention. CONCLUSION The conceptual typology and mapping tool aims to raise the quality of future research and promote clear thinking about the nature and purpose of interventions, In doing so it aims to support future research and practice in planning interventions to improve the mental health and wellbeing of doctors.
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Affiliation(s)
- Alison Pearson
- Department of Health & Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
| | - Daniele Carrieri
- Department of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Anna Melvin
- Department of Health & Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Charlotte Bramwell
- Department of Health & Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jessica Scott
- Department of Health & Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Pearson
- Institute of Clinical & Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karen Mattick
- Department of Health & Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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7
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Sinnott C, Alboksmaty A, Moxey JM, Morley KI, Parkinson S, Burt J, Dixon-Woods M. Operational failures in general practice: a consensus-building study on the priorities for improvement. Br J Gen Pract 2024; 74:e339-e346. [PMID: 38621805 PMCID: PMC11044020 DOI: 10.3399/bjgp.2023.0321] [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: 06/29/2023] [Accepted: 09/19/2023] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND System problems, known as operational failures, can greatly affect the work of GPs, with negative consequences for patient and professional experience, efficiency, and effectiveness. Many operational failures are tractable to improvement, but which ones should be prioritised is less clear. AIM To build consensus among GPs and patients on the operational failures that should be prioritised to improve NHS general practice. DESIGN AND SETTING Two modified Delphi exercises were conducted online among NHS GPs and patients in several regions across England. METHOD Between February and October 2021, two modified Delphi exercises were conducted online: one with NHS GPs, and a subsequent exercise with patients. Over two rounds, GPs rated the importance of a list of operational failures (n = 45) that had been compiled using existing evidence. The resulting shortlist was presented to patients for rating over two rounds. Data were analysed using median scores and interquartile ranges. Consensus was defined as 80% of responses falling within one value below and above the median. RESULTS Sixty-two GPs responded to the first Delphi exercise, and 53.2% (n = 33) were retained through to round two. This exercise yielded consensus on 14 failures as a priority for improvement, which were presented to patients. Thirty-seven patients responded to the first patient Delphi exercise, and 89.2% (n = 33) were retained through to round two. Patients identified 13 failures as priorities. The highest scoring failures included inaccuracies in patients' medical notes, missing test results, and difficulties referring patients to other providers because of problems with referral forms. CONCLUSION This study identified the highest-priority operational failures in general practice according to GPs and patients, and indicates where improvement efforts relating to operational failures in general practice should be focused.
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Affiliation(s)
- Carol Sinnott
- The Healthcare Improvement Studies (THIS) Institute, Cambridge
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8
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Jerjes W, Kelada M. Revitalising interest in general practice: innovative educational strategies to transform medical student perceptions in the UK. EDUCATION FOR PRIMARY CARE 2024; 35:113-122. [PMID: 38907619 DOI: 10.1080/14739879.2024.2364869] [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: 04/17/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND The UK faces a decline in medical students' interest in general practice (GP), crucial for its healthcare system. This trend endangers primary care sustainability and broader healthcare infrastructure, necessitating innovative educational approaches to improve perceptions of general practice. OBJECTIVE To assess the impact of a pilot programme integrating innovative educational strategies on medical students' perceptions of general practice, aiming to highlight potential reforms for medical education and primary care's future in the UK. METHODS A longitudinal pilot study with eighteen fifth-year medical students from Queen Mary University of London employed a diverse educational approach over thirty-six months. The programme encompassed mentorship, storytelling, community home visits, interactive patient cases, and GP speciality clinics, covering six GP practice domains. Data were collected through mid-placement and end-of-placement questionnaires to evaluate students' perceptions and interest in GP careers. RESULTS The programme significantly improved students' perceptions of general practice. Mentorship and storytelling saw an 83% to 94% increase in appreciation for GP complexities and impact. Community home visits enhanced cultural sensitivity and holistic health views among 67% to 89% of participants. Interactive patient cases and GP speciality clinics notably advanced understanding of GP's multidisciplinary nature. Exposure to GP-led research and business initiatives heightened awareness of entrepreneurial and innovative opportunities within general practice. CONCLUSIONS Innovative educational strategies can substantially influence medical students' perceptions and interest in general practice. The study suggests that enriching medical education with real-world experiences, mentorship, and comprehensive general practice exposure can counter declining interest, showcasing general practice as a dynamic and fulfilling career.
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Affiliation(s)
- Waseem Jerjes
- North End Medical Centre, Hammersmith and Fulham Partnership, London, UK
- Research and Development Unit, Hammersmith and Fulham PCN, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Mary Kelada
- North End Medical Centre, Hammersmith and Fulham Partnership, London, UK
- Research and Development Unit, Hammersmith and Fulham PCN, London, UK
- Faculty of Medicine, Imperial College London, London, 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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Abrams R, Blake S. UK general practice service delivery research priorities: an adapted James Lind Alliance approach. Br J Gen Pract 2024; 74:e9-e16. [PMID: 38154946 PMCID: PMC10755998 DOI: 10.3399/bjgp.2023.0226] [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: 05/09/2023] [Accepted: 07/10/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND General practice is in a state of crisis in a number of countries. In the UK, a range of measures have been introduced to address the situation, including innovations such as practice networks, multidisciplinary roles, and digital technologies. However, identifying what still needs fixing could benefit from more evidence, particularly in relation to day-to-day service delivery. AIM To identify the general practice workforce's top 10 research priorities to improve service delivery. DESIGN AND SETTING This priority-setting study used an adapted James Lind Alliance methodology and involved staff working in general practice across the UK. METHOD The study comprised four phases: an online qualitative survey issued to the general practice workforce (clinical and non-clinical groups); thematic analysis of free-text responses; generation of indicative research questions; and the undertaking of ranking exercises with responders of the original survey. An online workshop was held with participants at the final stage of prioritisation. RESULTS In total, 93 staff completed a survey in Phase 1, from which 20 themes were categorised and developed into research questions. Twenty- two staff responded to the first ranking activity and 11 took part in a second ranking activity to discuss themes that had a tied vote. The final top 10 research priorities were: volume of work; patient behaviour; consultations; employment pay and conditions; workload dumping and care of patients on waiting list; funding; overwhelming pressure; patient health education; complex patient needs; and interfaces with secondary care. However, there was no clear ranking of these 10 priorities; instead, they carried equal weight and were closely interconnected. CONCLUSION Applying a marginal-gains approach, by seeking to explore all 10 priorities simultaneously as opposed to concentrating on one area at a time, may provide more noticeable improvements overall. Systems-based approaches that take account of the marked role that context has may be a particularly useful lens for future research.
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Affiliation(s)
- Ruth Abrams
- School of Health Sciences, University of Surrey, Guildford
| | - Sharon Blake
- School of Health Sciences, University of Surrey, Guildford
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11
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Pathmanathan A, Snelling I. Exploring reasons behind UK doctors leaving the medical profession: a series of qualitative interviews with former UK doctors. BMJ Open 2023; 13:e068202. [PMID: 37739470 PMCID: PMC10533793 DOI: 10.1136/bmjopen-2022-068202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND The retention of doctors is an important issue for the National Health Service; yet evidence suggests that the proportion of doctors wanting to leave UK medicine is increasing. Some of these doctors chose to continue their medical careers in other countries, however, some decided to leave the profession entirely. OBJECTIVES This was the first study to interview a cohort of UK doctors who have left the medical profession to embark on alternative careers. Participants were asked about the reasoning behind their decision to leave medicine. DESIGN Qualitative study using one-to-one, semi-structured virtual interviews. PARTICIPANTS 17 participants, recruited via purposive sampling. SETTING Zoom interviews with 17 former UK doctors who had left medicine to pursue alternative careers were conducted between February and July 2021. FINDINGS Data were analysed using thematic analysis and the theory of work adjustment was applied to findings. The most frequently discussed reasons for leaving were associated with factors preventing participants from providing a desired level of patient care, work-life balance, a lack of support, a lack of control over working lives and the pull of alternative careers. While reasons for leaving varied between participants, all participants reported greater satisfaction in their new careers. CONCLUSION New careers were able to address many of the issues that caused participants to leave UK medicine. Consequently, it is important that some of the key issues raised in this study are addressed to retain more doctors in the UK medical workforce.
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Affiliation(s)
- Arin Pathmanathan
- Birmingham Medical School, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Iain Snelling
- School of Social Policy, University of Birmingham, Birmingham, Birmingham, UK
- Health Services Management Centre, University of Birmingham College of Social Sciences, Birmingham, UK
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12
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Yordanov D, Oxholm AS, Gyrd-Hansen D, Pedersen LB. Mapping GPs' motivation — it's not all about the money: a nationwide cross-sectional survey study from Denmark. Br J Gen Pract 2023; 73:e687-e693. [PMID: 37549995 PMCID: PMC10428006 DOI: 10.3399/bjgp.2022.0563] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/21/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Understanding physicians' motivation may be essential for policymakers if they are to design policies that cater to physicians' wellbeing, job retention, and quality of care. However, physicians' motivation remains an understudied area. AIM To map GPs' work motivation. DESIGN AND SETTING A cross-sectional analysis using registry and survey data from Denmark. METHOD Survey data were used to measure four types of motivation: extrinsic motivation, intrinsic motivation, user orientation, and public service motivation. These were combined with register data on the characteristics of the GP, practice, and area. Using latent profile analysis, the heterogeneity in GPs' motivation was explored; the associations between GPs' motivation and the GP, practice, and area characteristics were estimated using linear regression analyses. RESULTS There was substantial heterogeneity in GPs' motivations. Five classes of GPs were identified with different work motivations: class 1 'it is less about the money' - probability of class membership 53.2%; class 2 'it is about everything' - 26.5%; class 3 'it is about helping others' - 8.6%; class 4 'it is about the work' - 8.2%; and class 5 'it is about the money and the patient' - 3.5%. Linear regression analyses showed that motivation was associated with GP, practice, and area characteristics to a limited extent only. CONCLUSION GPs differ in their work motivations. The finding that, for many GPs, 'it is not all about the money' indicated that their different motivations should be considered when designing new policies and organisational structures to retain the workforce and ensure a high quality of care.
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Affiliation(s)
- Dimitar Yordanov
- Danish Centre for Health Economics, University of Southern Denmark
| | | | | | - Line Bjørnskov Pedersen
- Danish Centre for Health Economics and Research Unit for General Practice, University of Southern Denmark, Odense
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13
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Fisher R, McDermott AM. The battle to retain GPs: why practice culture is critical. BMJ 2023; 380:344. [PMID: 36796838 DOI: 10.1136/bmj.p344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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14
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Schrimpf A, Bleckwenn M, Braesigk A. COVID-19 Continues to Burden General Practitioners: Impact on Workload, Provision of Care, and Intention to Leave. Healthcare (Basel) 2023; 11:320. [PMID: 36766895 PMCID: PMC9914234 DOI: 10.3390/healthcare11030320] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
General practitioners (GPs), already in a profession with a high workload, have been at the frontline of providing COVID-19-related healthcare in addition to routine care. Our study examined the impact of pandemic-related consultations and changes in practice organization on GPs' current workload and provision of healthcare in summer 2021 (May 2021-July 2021) and early 2022 (January 2022-February 2022). In total, 143 German GPs participated in an online survey in the summer of 2021. Of these, 51 GPs participated in the follow-up survey in 2022. Most GPs perceived an increase in consultation frequency, consultation times, and workload since the pandemic outbreak. Increased consultation times were related to the reduced provision of medical care to other patients with chronic diseases. More SARS-CoV-2 vaccination consultations were associated with reduced home visits, acute consultation times, and cancer screenings. A quarter of GPs considered leaving their job. Pandemic-related bureaucracy, restricted access to therapy and rehabilitation services specialized on COVID-19, unreliable vaccine deliveries, mandatory telematics-infrastructure implementation, and frequent changes in official regulations were the main reasons reported for dissatisfaction. Our results provide insights into how the pandemic continues to burden GPs' work routines and how better working conditions in times of high demand could be achieved in future pandemics.
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Affiliation(s)
- Anne Schrimpf
- Department of General Practice, Faculty of Medicine, Leipzig University, 04109 Leipzig, Germany
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15
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Ocean N, Meyer C. Satisfaction and attrition in the UK healthcare sector over the past decade. PLoS One 2023; 18:e0284516. [PMID: 37053234 PMCID: PMC10101409 DOI: 10.1371/journal.pone.0284516] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
Existing literature has highlighted concerns over working conditions in the UK National Health Service (NHS), with healthcare workers frequently citing work-life balance issues and stress as being drivers of attrition and burnout. However, we do not know whether these problems have become worse over time, particularly over the past decade, during which there have been multiple shocks to the UK healthcare system. To investigate this, we analysed data from NHS monthly workforce statistics and the UK Household Longitudinal Study. Three times as many workers left the NHS in 2021 for work-life balance reasons than in 2011, while estimated satisfaction with one's amount of leisure time for healthcare workers fell by three times the amount that it fell for non-healthcare workers. Both satisfaction with amount of leisure time and satisfaction with income have remained lower for healthcare workers than for other public sector workers. By 2020, a worker that had low satisfaction with their amount of leisure time was as much as 22 percentage points less likely than in 2010 to remain in healthcare in the following year. Overall, working conditions in UK healthcare have deteriorated between 2010 and 2020, especially relative to the private sector. However, overall job satisfaction has fallen faster in other areas of the public sector than it has in healthcare, which may indicate wider issues within the UK public sector as a whole.
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Affiliation(s)
- Neel Ocean
- WMG, University of Warwick, Coventry, United Kingdom
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16
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Verhoef NC, Blomme RJ. Burnout among general practitioners, a systematic quantitative review of the literature on determinants of burnout and their ecological value. Front Psychol 2022; 13:1064889. [PMID: 36591073 PMCID: PMC9798333 DOI: 10.3389/fpsyg.2022.1064889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Burnout is a major social and economic problem, specifically among general practitioners (GPs). The amount of literature on generic determinants of burnout is impressive. However, the size of the library on occupation-specific determinants of burnout among GPs are minimal. With the present study, we aim to gain insight into the existing academic literature on generic and occupation-specific determinants of burnout among GPs. Moreover, we aim to contribute to the ecological validity of this study by emphasizing occupation-specific determinants. We conducted a systematic quantitative literature review in which we followed the PRISMA statement and performed quality assessments according to the AXIS, CASP, MMAT, and 3-MIN procedures. Furthermore, we assessed frequency effect sizes (FES) and intensity effect sizes (IES). By performing Fisher's exact tests, we investigated whether the quality of the studies influenced the outcomes. An extensive literature search revealed 60 eligible studies among which 28 strong studies, 29 moderate studies, and 3 weak studies were identified. Analyzing those studies delivered 75 determinants of burnout, of which 33 were occupation-specific for GPs. According to the average FES, occupation-specific determinants play a significant role in acquiring burnout compared to the generic determinants. The results of the Fisher exact tests provided evidence that the quality of the 60 studies did not affect the outcomes. We conclude that it is surprising that a profession with such an important social position and such a high risk of burnout has been so little researched.
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Affiliation(s)
- Nicolaas Cornelis Verhoef
- Faculty of Management, Open University of the Netherlands, Heerlen, Netherlands,*Correspondence: Nicolaas Cornelis Verhoef,
| | - Robert Jan Blomme
- Faculty of Management, Open University of the Netherlands, Heerlen, Netherlands,Faculty of Leadership and Management, Nyenrode Business University, Breukelen, Netherlands
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17
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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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18
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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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19
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Identifying mental health training needs of general practice pharmacy workforce to advance practice: a training needs analysis survey. Int J Clin Pharm 2022; 44:1454-1463. [DOI: 10.1007/s11096-022-01486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022]
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20
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Stanaway FF, Bell KJL. Challenges of a stratified care approach to musculoskeletal pain. THE LANCET. RHEUMATOLOGY 2022; 4:e578-e579. [PMID: 38288890 DOI: 10.1016/s2665-9913(22)00187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 02/01/2024]
Affiliation(s)
- Fiona F Stanaway
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia.
| | - Katy J L Bell
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
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21
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Johnson CF, Maskrey M, MacBride-Stewart S, Lees A, Macdonald H, Thompson A. New ways of working releasing general practitioner capacity with pharmacy prescribing support: a cost-consequence analysis. Fam Pract 2022; 39:648-655. [PMID: 35016210 DOI: 10.1093/fampra/cmab175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND General practice in the United Kingdom is experiencing a workforce crisis. Greater multidisciplinary working, including more general practice pharmacists, is seen as part of the solution. However, it is unknown what impact and cost-consequences that pharmacists may have in freeing general practitioner (GP) capacity. OBJECTIVE To evaluate the cost-consequences of additional pharmacists in releasing GP capacity. METHODS This cost-consequences evaluation of a prospective observational cohort study in 15 urban practices involving 69 GPs in 1 locality serving a population of 82,000 people. GPs recorded the time they spent addressing key targeted prescribing activities during 5 distinct 2-week audit periods. Pharmacists performed these key prescribing activities to release GP capacity. An additional 225 h of pharmacists' time per week was committed to the locality. Standardized staff costings were used to estimate the financial impact. Prescribing indicator performance was assessed against the other 7 localities within the health board. RESULTS When compared with employing extra nonsalaried GPs this required an estimated additional investment of £16.73 (range £5.97-20.87) per h to free GP capacity. This achieved a sustainable 47% (73 h per week, F(4,56) = 16.05, P < 0.001) reduction in GP time spent on key prescribing activities; equating to 4.9 h (95% confidence interval 3.1-6.7) per practice per week. No significant step changes in locality safety and quality prescribing measures, and no negative effects on locality-level prescribing cost-efficiency work were observed. CONCLUSION Appropriately resourced general practice pharmacy teams delivered prescribing cost-efficiencies as well as sustainably freeing GP capacity by performing key prescribing activities.
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Affiliation(s)
- Chris F Johnson
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Margaret Maskrey
- Inverclyde Health and Social Care Partnership NHS Greater Glasgow and Clyde, Port Glasgow, United Kingdom
| | | | - Ann Lees
- Planning, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Hector Macdonald
- Inverclyde Health and Social Care Partnership NHS Greater Glasgow and Clyde, Port Glasgow, United Kingdom
| | - Audrey Thompson
- Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
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Maben J, Aunger JA, Abrams R, Pearson M, Wright JM, Westbrook J, Mannion R, Jones A. Why do acute healthcare staff engage in unprofessional behaviours towards each other and how can these behaviours be reduced? A realist review protocol. BMJ Open 2022; 12:e061771. [PMID: 35788075 PMCID: PMC9255388 DOI: 10.1136/bmjopen-2022-061771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Unprofessional behaviours encompass many behaviours including bullying, harassment and microaggressions. These behaviours between healthcare staff are problematic; they affect people's ability to work, to feel psychologically safe at work and speak up and to deliver safe care to patients. Almost a fifth of UK National Health Service staff experience unprofessional behaviours in the workplace, with higher incidence in acute care settings and for staff from minority backgrounds. Existing analyses have investigated the effectiveness of strategies to reduce these behaviours. We seek to go beyond these, to understand the range and causes of such behaviours, their negative effects and how mitigation strategies may work, in which contexts and for whom. METHODS AND ANALYSIS This study uses a realist review methodology with stakeholder input comprising a number of iterative steps: (1) formulating initial programme theories drawing on informal literature searches and literature already known to the study team, (2) performing systematic and purposive searches for grey and peer-reviewed literature on Embase, CINAHL and MEDLINE databases as well as Google and Google Scholar, (3) selecting appropriate documents while considering rigour and relevance, (4) extracting data, (5) and synthesising and (6) refining the programme theories by testing the theories against the newly identified literature. ETHICS AND DISSEMINATION Ethical review is not required as this study is a secondary research. An impact strategy has been developed which includes working closely with key stakeholders throughout the project. Step 7 of our project will develop pragmatic resources for managers and professionals, tailoring contextually-sensitive strategies to reduce unprofessional behaviours, identifying what works for which groups. We will be guided by the 'Evidence Integration Triangle' to implement the best strategies to reduce unprofessional behaviours in given contexts. Dissemination will occur through presentation at conferences, innovative methods (cartoons, videos, animations and/or interactive performances) and peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42021255490.
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Affiliation(s)
- Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Justin Avery Aunger
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Ruth Abrams
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
| | - Judy M Wright
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Earle-Payne K, Forsyth P, Johnson CF, Harrison H, Robertson S, Weidmann AE. The standards of practice for delivery of polypharmacy and chronic disease medication reviews by general practice clinical pharmacists: a consensus study. Int J Clin Pharm 2022; 44:663-672. [PMID: 35320485 PMCID: PMC8941365 DOI: 10.1007/s11096-022-01387-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/15/2022] [Indexed: 01/05/2023]
Abstract
Background General practice in the UK is experiencing a crisis. Greater multidisciplinary working is a potential solution. The new general practice contract in Scotland encourages this and includes a new pharmacotherapy service to be delivered by General Practice Clinical Pharmacists (GPCPs). Consensus is lacking for the standards of practice for delivery of pharmacotherapy medication reviews (which are polypharmacy and chronic medication reviews) as part of this service. Aim To identify and validate standards of practice for polypharmacy and chronic disease medication (pharmacotherapy level 3) reviews conducted by GPCPs. Method A two-phased mixed-methods consensus methodology was used. Phase 1: An expert group of GPCPs (n = 4) and clinical pharmacist managers (n = 2) responsible for delivering the pharmacotherapy service used a Modified Nominal Group Technique to generate potential standards. Phase 2: Two-round Delphi survey involving GPCPs with ≥ 1 year of experience of working in general practice (n = 159). Results The expert group identified 44 potential standards of practice for polypharmacy and chronic disease reviews. Practicing GPCPs indicated during the Delphi phase that the 44 standards were applicable to practice. The standards of practice covered seven main categories: skills, environment, qualifications, qualities and behaviours, knowledge, process and experience. Conclusion Practicing GPCPs indicated that the standards identified by the expert group are acceptable and valid for current practice and the delivery of polypharmacy and chronic medication reviews. The application of these standards to practice may help GPCPs and general practices to ensure equitable delivery of patient care.
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Affiliation(s)
- Katie Earle-Payne
- NHS Greater Glasgow & Clyde, Renfrew Health and Social Care Centre, 10 Ferry Road, Renfrew, PA4 8RU United Kingdom
- School of Pharmacy and Life Sciences, Robert Gordon University, Sir Ian Wood Building, Robert Gordon University, Garthdee Road, Aberdeen, United Kingdom
| | - Paul Forsyth
- NHS Greater Glasgow & Clyde, Clarkston Court, 56 Busby Road, Glasgow, G76 7AT United Kingdom
| | - Chris F. Johnson
- NHS Greater Glasgow & Clyde, Clarkston Court, 56 Busby Road, Glasgow, G76 7AT United Kingdom
| | - Heather Harrison
- NHS Greater Glasgow & Clyde, Clarkston Court, 56 Busby Road, Glasgow, G76 7AT United Kingdom
| | - Susan Robertson
- NHS Greater Glasgow & Clyde, Renfrew Health and Social Care Centre, 10 Ferry Road, Renfrew, PA4 8RU United Kingdom
| | - Anita E. Weidmann
- Faculty of Chemistry and Pharmacy, University Innsbruck, Innrain 80-82, Innrain 52c., 6020 Innsbruck, Austria
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Wilson HC, Abrams S, Simpkin Begin A. Drexit: Understanding why junior doctors leave their training programs to train overseas: An observational study of UK physicians. Health Sci Rep 2021; 4:e419. [PMID: 34646946 PMCID: PMC8499680 DOI: 10.1002/hsr2.419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Drexit ("Doctor-Exit") is the exponentially growing trend for junior doctors in the UK to walk away from their jobs in the National Health Service (NHS). Our objective was to identify the reasons why junior doctors in the UK leave their NHS training programs to train overseas. MATERIALS AND METHODS A simultaneous and convergent mixed-methods study was performed to analyze both an online survey and semi-structured interviews from junior doctors who had left the NHS. Social media, online professional media, and networks of junior doctors were used to recruit doctors. All were UK medical school graduates who had left the NHS within the last 15 years (2003-2018). RESULTS 96.1% (149/155) of respondents reported not being offered an exit interview on leaving the NHS. 94.8% (147/155) of respondents did not regret quitting the NHS. Participants were more satisfied with their pay and work life balance in their overseas posts when compared to training in the NHS (P < 0.05). Burnout was variably defined and was prominent in doctors who left 53.8% (113/210) but was reversed when they practiced medicine overseas in 89.2% (74/83) of cases. Qualitative data identified four key themes which were categorized into push factors, which were lack of interest in retention and bleak outlook; and pull factors, which were financial vs social capital and things are different overseas. CONCLUSION Listening to the frontline junior doctors' voices lend insights into a better understanding of the push and pull factors that appear to be exacerbating the exodus of junior doctors from the NHS. Our results indicate that exit interviews should be performed routinely. There needs to be a shift to focus on the training of doctors rather than service provision, with efforts to support, appreciate, and value junior doctors. Further exploration is needed to identify what is happening in training programs overseas to improve retention within the NHS. Furthermore, identifying issues perceived by junior doctors in the UK in the context of workforce planning may be applicable to healthcare systems across the globe.
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Affiliation(s)
- Hannah C.P. Wilson
- Department of Medical EducationHarvard Medical SchoolBostonMassachusettsUSA
| | - Sarah Abrams
- School of MedicineImperial College LondonLondonUK
| | - Arabella Simpkin Begin
- Department of Medical EducationHarvard Medical SchoolBostonMassachusettsUSA
- Department of MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of PharmacologyUniversity of OxfordOxfordUK
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Muldoon D, Seenan C. The introduction of advanced paramedics into primary care in Northern Ireland: a qualitative descriptive study of the experiences of general practitioners. Br Paramed J 2021; 6:1-6. [PMID: 34970077 DOI: 10.29045/14784726.2021.12.6.3.1] [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: 11/11/2022] Open
Abstract
Background Primary care is dealing with an ever-increasing workload. The causes are multi-factorial but include a decreasing number of General Practitioners (GPs), combined with increased numbers of patients with multiple co-morbidities and an ageing population. As a result of these pressures, nursing and allied health professionals are now working within a growing number of advanced practice roles delivering community-based care. One such example is paramedics taking up advanced roles within General Practice settings in Northern Ireland. What is not known, however, is what GPs' experiences are of these developments. Aims To examine the experiences of GPs who have introduced an advanced paramedic into their primary care team in Northern Ireland. Design A qualitative descriptive design was chosen as the most suitable approach to allow participants to relay their experiences in their own words within the loose confines of a semi-structured interview. Methods Semi-structured interviews were conducted with a group of four purposively selected GPs who had direct experience of the phenomena of interest. These interviews were transcribed verbatim, anonymised and then analysed thematically. Results The thematic analysis produced three superordinate themes of alleviating pressure, acceptance and psychological well-being. These were underpinned by seven ordinate themes that were supported using verbatim quotes. These were then discussed and contextualised with themes from existing literature. Conclusion Generally, there was widespread support from the GPs for the introduction of advanced paramedics into primary care teams. The reasons were multi-factorial but the reduction in GP workload featured prominently. The participants reported benefits in terms of increased resilience and work-life balance. The capacity to provide a clinician with experience of dealing with acute and emergency presentations, in combination with managing routine procedures, was also reported to be of great importance.
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Ooi SZY, Ooi R, Godoi A, Foo EF, Woo T, Li C, Ganesananthan S. Motivations of medical students and doctors leaving the NHS explored in a residency training application webinar series. Postgrad Med J 2021; 98:942-947. [PMID: 34675115 DOI: 10.1136/postgradmedj-2021-140795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/08/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Recent reports show that about 10% of UK-graduate doctors leave the country to pursue specialty training elsewhere. Our article aims to evaluate the motivating factors for UK graduates to leave the National Health Service (NHS), especially during the COVID-19 pandemic and Brexit. STUDY DESIGN Cross-sectional study. METHOD A novel 22-item questionnaire was disseminated at a webinar series regarding the application process to pursue residency training in six different countries/regions from 2 August 2020 to 13 September 2020. The data was analysed using Kruskal-Wallis rank-sum with post-hoc Wilcoxon test to compare the difference in significance among the motivating factors. RESULTS 1118 responses from the UK medical students and doctors were collected; of which, 1001 (89.5%) were medical students, and 88 (7.9%) were junior doctors. There was a higher propensity for leaving after the Foundation Programme compared with other periods (p<0.0001 for all comparisons). There was no difference between desire for leaving after core surgical/medical training and specialty training (p=0.549). However, both were significantly higher than leaving the NHS after medical school (p<0.0001). Quality of life and financial prospects (both p<0.0001) were the most agreed reasons to leave the NHS, followed by clinical and academic opportunities and, subsequently, family reasons. CONCLUSION Future work on the quality of life for doctors in the UK should be explored, especially among those considering leaving the NHS. Policymakers should focus on assessing the difference in working hours, on-call hours and wages that may differ among healthcare systems.
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Affiliation(s)
| | - Rucira Ooi
- Cardiff University School of Medicine, Cardiff, UK
| | - Amanda Godoi
- Cardiff University School of Medicine, Cardiff, UK
| | - Eu Fang Foo
- Cardiff University School of Medicine, Cardiff, UK
| | - Timothy Woo
- Cardiff University School of Medicine, Cardiff, UK
| | - Chunhei Li
- Cardiff University School of Medicine, Cardiff, UK
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Identifying how GPs spend their time and the obstacles they face: a mixed-methods study. Br J Gen Pract 2021; 72:e148-e160. [PMID: 34844920 PMCID: PMC8813099 DOI: 10.3399/bjgp.2021.0357] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background Although problems that impair task completion — known as operational failures — are an important focus of concern in primary care, they have remained little studied. Aim To quantify the time GPs spend on different activities during clinical sessions; to identify the number of operational failures they encounter; and to characterise the nature of operational failures and their impact for GPs. Design and setting Mixed-method triangulation study with 61 GPs in 28 NHS general practices in England from December 2018 to December 2019. Method Time–motion methods, ethnographic observations, and interviews were used. Results Time–motion data on 7679 GP tasks during 238 hours of practice in 61 clinical sessions suggested that operational failures were responsible for around 5.0% (95% confidence interval [CI] = 4.5% to 5.4%) of all tasks undertaken by GPs and accounted for 3.9% (95% CI = 3.2% to 4.5%) of clinical time. However, qualitative data showed that time–motion methods, which depend on pre-programmed categories, substantially underestimated operational failures. Qualitative data also enabled further characterisation of operational failures, extending beyond those measured directly in the time–motion data (for example, interruptions, deficits in equipment/supplies, and technology) to include problems linked to GPs’ coordination role and weaknesses in work systems and processes. The impacts of operational failures were highly consequential for GPs’ experiences of work. Conclusion GPs experience frequent operational failures, disrupting patient care, impairing experiences of work, and imposing burden in an already pressurised system. This better understanding of the nature and impact of operational failures allows for identification of targets for improvement and indicates the need for coordinated action to support GPs.
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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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Mughal Z, Maharjan R. Cross-sectional analysis of hospital tasks handed over to general practitioners: workload delegation or dumping? Postgrad Med J 2021; 98:e14. [PMID: 33790035 DOI: 10.1136/postgradmedj-2020-139641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/14/2021] [Accepted: 03/24/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE OF THE STUDY New requirements for hospital clinicians to follow up and act on hospital-initiated investigations were introduced in 2016 in the National Health Service standard contract. We aimed to evaluate the tasks handed over from hospital clinicians to general practitioners (GPs). STUDY DESIGN A retrospective observation of all tasks in a random sample of electronic discharge summaries at a university teaching hospital over a 1 month period was conducted. A single-best-answer questionnaire was circulated among hospital clinicians over 3 months to gain an understanding of their follow-up and referral practices. RESULTS The total number of tasks found on discharge summaries (n=178) were 227, of which 39% were directed at GPs and 61% at the hospital team. Of 89 tasks delegated to GPs, 33% were inappropriate. Some tasks on discharge summaries were delegated more frequently to GPs such as blood tests (73%) and endoscopy requests (67%). While others were undertaken more often by hospitals clinicians including imaging requests (88%), follow-up appointments (87%) and onward referrals (71%). Surveyed doctors (n=72) admitted to asking GPs to follow up blood tests (52%), imaging and endoscopy (16%) and make onward referrals for related conditions (14%) and unrelated conditions (70%). CONCLUSION The majority of outstanding tasks in the hospital setting were followed up by hospital clinicians. A considerable volume of tasks were delegated to GPs, of which a significant proportion were inappropriate. An increase in awareness and understanding among hospital clinicians of their responsibility to follow up hospital-initiated investigations is needed.
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Affiliation(s)
- Zahir Mughal
- Department of General Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Rajib Maharjan
- Department of General Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Brickley B, Williams LT, Morgan M, Ross A, Trigger K, Ball L. Putting patients first: development of a patient advocate and general practitioner-informed model of patient-centred care. BMC Health Serv Res 2021; 21:261. [PMID: 33743709 PMCID: PMC7981870 DOI: 10.1186/s12913-021-06273-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 03/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Patients, providers and health care organisations benefit from an increased understanding and implementation of patient-centred care (PCC) by general practitioners (GPs). This study aimed to evaluate and advance a theoretical model of PCC developed in consultation with practising GPs and patient advocates. Methods Qualitative description in a social constructivist/interpretivist paradigm. Participants were purposively sampled from six primary care organisations in south east Queensland/northern New South Wales, Australia. Participants engaged in focus group discussions where they expressed their perceptions, views and feelings of an existing PCC model. Data was analysed thematically using a constant-comparison approach. Results Three focus groups with 15 patient advocates and three focus groups with 12 GPs were conducted before thematic saturation was obtained. Three themes emerged: i) the model represents the ideal, ii) considering the system and collaborating in care and iii) optimising the general practice environment. The themes related to participants’ impression of the model and new components of PCC perceived to be experienced in the ‘real world’. The data was synthesised to produce an advanced model of PCC named, “Putting Patients First: A Map for PCC”. Conclusions Our revised PCC model represents an enhanced understanding of PCC in the ‘real world’ and can be used to inform patients, providers and health organisations striving for PCC. Qualitative testing advanced and supported the credibility of the model and expanded its application beyond the doctor-patient encounter. Future work could incorporate our map for PCC in tool/tool kits designed to support GPs and general practice with PCC. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06273-y.
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Affiliation(s)
- Bryce Brickley
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | | | - Alyson Ross
- Gold Coast Primary Health Network, Gold Coast, QLD, Australia
| | - Kellie Trigger
- Gold Coast Primary Health Network, Gold Coast, QLD, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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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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Mackie E, Alberti H. Longitudinal GP placements - inspiring tomorrow's doctors? EDUCATION FOR PRIMARY CARE 2020; 32:149-156. [PMID: 33228461 DOI: 10.1080/14739879.2020.1846142] [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: 10/22/2022]
Abstract
General practice worldwide is facing a severe recruitment crisis, with significantly fewer medical students choosing to pursue careers in primary care than are required to meet society's growing demands. The role of GP placements and GP tutors has been highlighted as having a significantly positive influence on medical students' perceptions of general practice. However, how students perceive these experiences to have influenced their subsequent career preferences remains poorly understood.We sought to explore how a longitudinal GP placement influences medical students' preferences regarding a career in general practice, in order to gain a deeper understanding of the significance of such placements. Semi-structured interviews were undertaken with five fourth-year medical students using Interpretive Phenomenological Analysis methodology.Four overarching concepts were identified, with nine superordinate themes, to describe how a longitudinal placement had influenced medical students' preference regarding a career in general practice. There appears to have been a matching process between an expanding knowledge of the realities of being a GP and an increasing understanding of self. The GP tutor and 'authentic' experiences to consult patients themselves developed a growing sense of self-efficacy within students, all of which resulted in a significant internal desire to become future GPs.
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Affiliation(s)
- Emily Mackie
- School of Medical Education, The Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Hugh Alberti
- Subdean for Primary and Community Care, School of Medical Education, The Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Stoye G, Zaranko B, Shipley M, McKee M, Brunner EJ. Educational Inequalities in Hospital Use Among Older Adults in England, 2004-2015. Milbank Q 2020; 98:1134-1170. [PMID: 33022084 PMCID: PMC7772637 DOI: 10.1111/1468-0009.12479] [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] [Indexed: 11/30/2022] Open
Abstract
Policy Points US policymakers considering proposals to expand public health care (such as “Medicare for all”) as a means of reducing inequalities in health care access and use could learn from the experiences of nations where well‐funded universal health care systems are already in place. In England, which has a publicly funded universal health care system, the use of core inpatient services by adults 65 years and older is equal across groups defined by education level, after controlling for health status. However, variation among these groups in the use of outpatient and emergency department care developed between 2010 and 2015, a period of relative financial austerity. Based on England's experience, introducing universal health care in the United States seems likely to reduce, but not entirely eliminate, inequalities in health care use across different population groups.
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Affiliation(s)
- George Stoye
- Institute for Fiscal Studies and Department of Economics, University College London
| | - Ben Zaranko
- Institute for Fiscal Studies and Department of Economics, University College London
| | - Martin Shipley
- University College London Institute of Epidemiology and Health Care
| | | | - Eric J Brunner
- University College London Institute of Epidemiology and Health Care
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Cowdell F, Ahmed T, Layfield C. Knowledge mobilisation: a UK co-creation study to devise strategies to amend lay and practitioner atopic eczema mindlines to improve consultation experiences and self-management practices in primary care. BMJ Open 2020; 10:e036520. [PMID: 32988943 PMCID: PMC7523205 DOI: 10.1136/bmjopen-2019-036520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/17/2020] [Accepted: 08/19/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To devise strategies to amend lay and practitioner atopic eczema mindlines 'collectively reinforced, internalised tacit guidelines', to improve consultation experiences and self-management practices in primary care. DESIGN Co-creation workshops informed by the Co:Create Coproduction Matrix. SETTING Conference centre in central England and via remote communication. PARTICIPANTS Lay people with, and parents of children with, atopic eczema, practitioners, a researcher and a facilitator (n=22). RESULTS Eczema mindline amendment needs to address people and parents of children with the condition, practitioners and wider society in parallel. For lay people trust and 'realness' of amendment activity was vital and practitioners wanted practical, locally relevant, hints and tips, tailored, 'no faff' approaches. To improve consultation experiences and self-management practices, five key, consistent, evidence-based messages need to be instilled into eczema mindlines: (1) eczema is more than just dry skin, (2) eczema does not just go away, (3) moisturisers are for every day, (4) steroid creams are okay when you need them and (5) you know your child's eczema best. CONCLUSION This co-creation study provides original insights into what eczema knowledge should be mobilised, who needs to have this knowledge, how this should be achieved to amend existing mindlines to improve consultation experiences and self-management practices in primary care.The remaining challenge is to refine, implement and evaluate the effectiveness of strategies developed to instil the five core messages and erase outdated or inaccurate information.
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Affiliation(s)
- Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Taheeya Ahmed
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Carron Layfield
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Abstract
Intended as a contribution to the
Waiting in Pandemic Times project Collection in response to COVID-19, this short theoretical paper views the coronavirus crisis in terms of its unpredictable effects on the interior life of the National Health Service (NHS) workforce. Written immediately following the suspension (due to the pandemic) of an ethnographic investigation of waiting in a general practice in London, it tracks the first signs that working definitions of time would struggle to survive the onset of a temporality of acute crisis in the NHS. The paper considers what it might mean for healthcare practitioners at this particular moment in the NHS’s history to be living through an experience of ‘the ordinary’ breaking down. It also follows hints of new temporal modes of care appearing during this same period when one kind of crisis in the NHS has been put on hold, and another (the crisis of coronavirus) is just getting underway.
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Affiliation(s)
- Stephanie Davies
- Department of Psychosocial Studies, Birkbeck University of London, London, WC1B 5DT, UK
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36
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Abstract
Intended as a contribution to the Waiting in Pandemic Times project Collection in response to COVID-19, this short theoretical paper views the coronavirus crisis in terms of its unpredictable effects on the interior life of the National Health Service (NHS) workforce. Written immediately following the suspension (due to the pandemic) of an ethnographic investigation of waiting in a general practice in London, it tracks the first signs that working definitions of time would struggle to survive the onset of a temporality of acute crisis in the NHS. The paper considers what it might mean for healthcare practitioners at this particular moment in the NHS's history to be living through an experience of 'the ordinary' breaking down. It also follows hints of new temporal modes of care appearing during this same period when one kind of crisis in the NHS has been put on hold, and another (the crisis of coronavirus) is just getting underway.
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Affiliation(s)
- Stephanie Davies
- Department of Psychosocial Studies, Birkbeck University of London, London, WC1B 5DT, UK
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37
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Spiers J, Buszewicz M, Chew-Graham CA, Riley R. The experiences of general practitioner partners living with distress: An interpretative phenomenological analysis. J Health Psychol 2020; 25:1439-1449. [PMID: 29468904 PMCID: PMC7479991 DOI: 10.1177/1359105318758860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Doctors, including general practitioners, experience higher levels of mental illness than the general population. General practitioners who are partners in their practices may face heightened stress. In total, 10 general practitioner partners living with work-related distress were interviewed, and transcripts were analysed using interpretative phenomenological analysis. Three major themes arose: (1) extreme distress, (2) conflicted doctor identity and (3) toxic versus supportive workplace relationships. Participants detailed symptoms of depression, anxiety and burnout; reported conflicted identities; and discussed the impact of bullying partnerships. We recommend that organisational interventions tackling issues such as bullying be implemented and opportunities to debrief be offered as protected time activities to general practitioner partners.
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Affiliation(s)
- Johanna Spiers
- University of Bristol, UK,Johanna Spiers, 2 The Old Byre, East Dundry
Lane, East Dundry, Bristol BS41 8NH, UK.
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A real-time measurement of general practice workload in the Republic of Ireland: a prospective study. Br J Gen Pract 2020; 70:e489-e496. [PMID: 32482628 PMCID: PMC7274543 DOI: 10.3399/bjgp20x710429] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/09/2019] [Indexed: 12/05/2022] Open
Abstract
Background Demand for GP services in the Republic of Ireland (RoI) is increasing, and the resultant escalation in workload demands is an issue of growing concern. Accordingly, the accurate measurement and description of GP workload is essential to inform future healthcare planning. Aim To provide a real-time measurement of GP workload with respect to hours worked and of proportional time expenditure on typical workload activities. Design and setting A prospective study among GPs in the RoI that took place from January 2019 to March 2019. Method Participants were invited to enrol in the study by direct email invitation and via notifications posted within GP-specific monthly journals; online forums; and a social media platform. Participants used a time-management software program to self-record workload activity in real time over 6 weeks. Results In total, 123 GPs were included for final analyses with a total of 8930 hours of activity recorded. The mean duration of a two-session day (excluding break-time) was 9.9 hours (95% confidence interval [CI] = 9.7 to 10.0; interquartile range [IQR] 7.9 to 13.9). Of this time, 64% was spent on clinical consultations. In total, 25.4% of activity was recorded outside the hours of 9.00 am and 5.00 pm. An average of 12.4 face-to-face consultations were completed per session of activity. The mean duration of a 10-session week was greatest for the partner (50.8 hours; 95% CI = 49.8 to 51.9) and >55-year-old (50.8 hours; 95% CI = 49.3 to 52.2) demographics, relative to their respective colleagues. Conclusion To the authors’ knowledge, this is the first study to provide an objective, accurate, and granular real-time measurement of GP workload in the RoI, demonstrating the significant volume and variety of work undertaken by GPs in the RoI.
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Fixsen A, Seers H, Polley M, Robins J. Applying critical systems thinking to social prescribing: a relational model of stakeholder "buy-in". BMC Health Serv Res 2020; 20:580. [PMID: 32580718 PMCID: PMC7312116 DOI: 10.1186/s12913-020-05443-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social prescribing (SP) allows health professionals to refer primary care patients toward health and wellbeing interventions and activities in the local community. Now widely implemented across the UK and adopted in other nations, questions arise concerning the modelling of present and future schemes, including challenges to full engagement encountered by stakeholders, which lie beyond the scope of traditional evaluations. Critical Systems Thinking (CST) allows for holistic analysis of fields where multiple stakeholders hold diverse interests and unequal power. METHODS We use CST to (a) critically examine a developing rural social prescribing scheme from multiple stakeholder perspectives and (b) present a relational model for local social prescribing schemes. Our fieldwork included 24 in-depth interviews, regular planning meetings with key stakeholders, and discussions with those involved with national and international SP landscaping. A modified grounded theory approach was used for the analysis, and to consider the core elements of social prescribing sustainability. RESULTS Our study confirms that local social prescribing schemes must operate with numerous stakeholder interests in mind, seeking to address real life social complexity and offer integrated solutions to multifaceted issues. Three main areas are discussed: holistic vision and boundary judgments; barriers and facilitators; relational issues and "emotional buy in". Problems for staff include selecting suitable clients, feedback and technological issues and funding and evaluation pressures. Barriers for clients include health, transport and expense issues, also lack of prior information and GP involvement. Emotional "buy-in" emerged as essential for all stakeholders, but hard to sustain. Based on our findings we propose a positive relational model comprising shared vision, confidence and commitment; motivation and encouragement, support and wellbeing focus, collaborative relationships, communication and feedback, access to information /resources, learning in and from action, with emotional "buy-in" at its heart. CONCLUSION Those implementing social prescribing in different localities inevitably face hard choices about what and whom to include. Research on the sustainability of social prescribing remains limited, studies are required to ascertain which "holistic" models of social prescribing work best for which communities, who are the main beneficiaries of these approaches and how "buy-in" is best sustained.
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Affiliation(s)
- Alison Fixsen
- University of Westminster, School of Social Sciences (Psychology), 115 New Cavendish Street, London, W1W 6UW UK
| | - Helen Seers
- University of Westminster, School of Social Sciences (Psychology), 115 New Cavendish Street, London, W1W 6UW UK
| | - Marie Polley
- University of Westminster, School of Social Sciences (Psychology), 115 New Cavendish Street, London, W1W 6UW UK
| | - Jo Robins
- Shropshire Public Health, Shirehall, Abbey Foregate, SY2 6ND UK
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Pedersen LB, Allen T, Waldorff FB, Andersen MKK. Does accreditation affect the job satisfaction of general practitioners? A combined panel data survey and cluster randomised field experiment. Health Policy 2020; 124:849-855. [PMID: 32540210 DOI: 10.1016/j.healthpol.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/24/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
A critical question for policy makers in health care is whether external interventions have unintended consequences such as lowering professionals' job satisfaction. We investigate whether a non-monetary incentive, in the form of mandatory accreditation, affects the job satisfaction of Danish GPs. Accreditation of general practice in Denmark was introduced as a cluster randomised stepwise implementation from 2016 to 2018. We measure job satisfaction at three time points: before the randomisation took place, one year into the accreditation process and two years into the accreditation process. We use a balanced panel of GPs who have completed all three waves of the survey (n = 846) and estimate a series of random and mixed effects ordered logit models. Despite many GPs having negative attitudes towards accreditation, we find no evidence of accreditation affecting GP job satisfaction. However, there are negative associations between job satisfaction and perceiving accreditation as a tool for external control. Policy makers are therefore encouraged to carefully inform about new interventions and identify barriers to diminish pre-existing negative perceptions about the incentive.
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Affiliation(s)
- Line Bjørnskov Pedersen
- DaCHE - Danish Centre for Health Economics, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9B, 5000 Odense C, Denmark; Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9A, 5000 Odense C, Denmark.
| | - Thomas Allen
- Manchester Centre for Health Economics, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Frans Boch Waldorff
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9A, 5000 Odense C, Denmark
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Long L, Moore D, Robinson S, Sansom A, Aylward A, Fletcher E, Welsman J, Dean SG, Campbell JL, Anderson R. Understanding why primary care doctors leave direct patient care: a systematic review of qualitative research. BMJ Open 2020; 10:e029846. [PMID: 32404383 PMCID: PMC7228506 DOI: 10.1136/bmjopen-2019-029846] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND UK general practitioners (GPs) are leaving direct patient care in significant numbers. We undertook a systematic review of qualitative research to identify factors affecting GPs' leaving behaviour in the workforce as part of a wider mixed methods study (ReGROUP). OBJECTIVE To identify factors that affect GPs' decisions to leave direct patient care. METHODS Qualitative interview-based studies were identified and their quality was assessed. A thematic analysis was performed and an explanatory model was constructed providing an overview of factors affecting UK GPs. Non-UK studies were considered separately. RESULTS Six UK interview-based studies and one Australian interview-based study were identified. Three central dynamics that are key to understanding UK GP leaving behaviour were identified: factors associated with low job satisfaction, high job satisfaction and those linked to the doctor-patient relationship. The importance of contextual influence on job satisfaction emerged. GPs with high job satisfaction described feeling supported by good practice relationships, while GPs with poor job satisfaction described feeling overworked and unsupported with negatively impacted doctor-patient relationships. CONCLUSIONS Many GPs report that job satisfaction directly relates to the quality of the doctor-patient relationship. Combined with changing relationships with patients and interfaces with secondary care, and the gradual sense of loss of autonomy within the workplace, many GPs report a reduction in job satisfaction. Once job satisfaction has become negatively impacted, the combined pressure of increased patient demand and workload, together with other stress factors, has left many feeling unsupported and vulnerable to burn-out and ill health, and ultimately to the decision to leave general practice.
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Affiliation(s)
- Linda Long
- ESMI (Evidence Synthesis & Modelling for Health Improvement), University of Exeter Medical School, Exeter, Devon, UK
| | - Darren Moore
- Graduate School of Education, University of Exeter, Exeter, UK
| | - Sophie Robinson
- ESMI (Evidence Synthesis & Modelling for Health Improvement), University of Exeter Medical School, Exeter, Devon, UK
| | - Anna Sansom
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Alex Aylward
- Patient and Public Involvement Group, PenCLAHRC, University of Exeter Medical School, Exeter, UK
| | - Emily Fletcher
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Jo Welsman
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, Devon, UK
| | | | - John L Campbell
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Rob Anderson
- ESMI (Evidence Synthesis & Modelling for Health Improvement), University of Exeter Medical School, Exeter, Devon, UK
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GPs' understanding of the benefits and harms of treatments for long-term conditions: an online survey. BJGP Open 2020; 4:bjgpopen20X101016. [PMID: 32127362 PMCID: PMC7330197 DOI: 10.3399/bjgpopen20x101016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background GPs prescribe multiple long-term treatments to their patients. For shared clinical decision-making, understanding of the absolute benefits and harms of individual treatments is needed. International evidence shows that doctors’ knowledge of treatment effects is poor but, to the authors knowledge, this has not been researched among GPs in the UK. Aim To measure the level and range of the quantitative understanding of the benefits and harms of treatments for common long-term conditions (LTCs) among GPs. Design & setting An online cross-sectional survey was distributed to GPs in the UK. Method Participants were asked to estimate the percentage absolute risk reduction or increase conferred by 13 interventions across 10 LTCs on 17 important outcomes. Responses were collated and presented in a novel graphic format to allow detailed visualisation of the findings. Descriptive statistical analysis was performed. Results A total of 443 responders were included in the analysis. Most demonstrated poor (and in some cases very poor) knowledge of the absolute benefits and harms of treatments. Overall, an average of 10.9% of responses were correct allowing for ±1% margin in absolute risk estimates and 23.3% allowing a ±3% margin. Eighty-seven point seven per cent of responses overestimated and 8.9% of responses underestimated treatment effects. There was no tendency to differentially overestimate benefits and underestimate harms. Sixty-four point eight per cent of GPs self-reported ‘low’ to ‘very low’ confidence in their knowledge. Conclusion GPs’ knowledge of the absolute benefits and harms of treatments is poor, with inaccuracies of a magnitude likely to meaningfully affect clinical decision-making and impede conversations with patients regarding treatment choices.
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Carrieri D, Pearson M, Mattick K, Papoutsi C, Briscoe S, Wong G, Jackson M. Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The growing incidence of mental ill-health in health professionals, including doctors, is a global concern. Although a large body of literature exists on interventions that offer support, advice and/or treatment to sick doctors, it has not yet been synthesised in a way that takes account of the complexity and heterogeneity of the interventions, and the many dimensions (e.g. individual, organisational, sociocultural) of the problem.
Objectives
Our aim was to improve understanding of how, why and in what contexts mental health services and support interventions can be designed to minimise the incidence of doctors’ mental ill-health. The objectives were to review interventions to tackle doctors’ mental ill-health and its impact on the clinical workforce and patient care, drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives to produce actionable theory; and recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts.
Design
Realist literature review consistent with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.
Data sources
Bibliographic database searches were developed and conducted using MEDLINE (1946 to November week 4 2017), MEDLINE In-Process and Other Non-indexed Citations (1946 to 6 December 2017) and PsycINFO (1806 to November week 2 2017) (all via Ovid) and Applied Social Sciences Index and Abstracts (1987 to 6 December 2017) (via ProQuest) on 6 December 2017. Further UK-based studies were identified by forwards and author citation searches, manual backwards citation searching and hand-searching relevant journal websites.
Review methods
We included all studies that focused on mental ill-health; all study designs; all health-care settings; all studies that included medical doctors/medical students; descriptions of interventions or resources that focus on improving mental ill-health and minimising its impacts; all mental health outcome measures, including absenteeism (doctors taking short-/long-term sick leave); presenteeism (doctors working despite being unwell); and workforce retention (doctors leaving the profession temporarily/permanently). Data were extracted from included articles and the data set was subjected to realist analysis to identify context–mechanism–outcome configurations.
Results
A total of 179 out of 3069 records were included. Most were from the USA (45%) and had been published since 2009 (74%). More included articles focused on structural-level interventions (33%) than individual-level interventions (21%), but most articles (46%) considered both levels. Most interventions focused on prevention, rather than treatment/screening, and most studies referred to doctors/physicians in general, rather than to specific specialties or career stages. Nineteen per cent of the included sources provided cost information and none reported a health economic analysis. The 19 context–mechanism–outcome configurations demonstrated that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job, and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote well-being. Interventions creating a people-focused working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors needed to have confidence in an intervention for the intervention to be effective.
Limitations
Variable quality of included literature; limited UK-based studies.
Future work
Use this evidence synthesis to refine, implement and evaluate interventions.
Study registration
This study is registered as PROSPERO CRD42017069870.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Daniele Carrieri
- College of Medicine and Health, University of Exeter, Exeter, UK
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, UK
| | - Karen Mattick
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Briscoe
- Exeter HSDR Evidence Synthesis Centre, Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Jackson
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
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Johnson CF, Smith J, Harrison H, Hassett R. Exploring learning needs for general practice based pharmacist: Are behavioural and influencing skills needed? Pharm Pract (Granada) 2020; 18:1814. [PMID: 32477433 PMCID: PMC7243743 DOI: 10.18549/pharmpract.2020.2.1814] [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] [Received: 01/21/2020] [Accepted: 04/26/2020] [Indexed: 11/14/2022] Open
Abstract
Background Embedding pharmacists in general practice has been shown to create cost efficiencies, improve patient care and free general practitioner capacity. Consequently, there is a drive to recruit additional pharmacists to work within general practices. However, equipping pharmacists with behaviour and influencing skills may further optimise their impact. Key elements which may enhance behaviour and influencing skills include self-efficacy and resilience. Objective This study aimed to: 1) Assess general practice pharmacists' self-efficacy and resilience. 2) Explore differences primarily between pharmacists reporting lower and higher self-efficacy, secondarily for those reporting lower and higher scores for resilience. Methods All 159 NHS Greater Glasgow and Clyde general practice pharmacists were invited to complete an online survey in May 2019. The survey captured anonymised data covering: demographics; professional experience; qualifications, prescribing status and preferred learning styles. Unconscious learning needs for behavioural and influencing skills were assessed using validated tools: the new general self-efficacy scale (GSES) and short general resilience scale (GRIT). Participants' responses were differentiated by the lowest quartile and higher quartiles of GSES and GRIT scores, and analysed to identify differences. Results The survey was completed by 57% (91/159) of eligible pharmacists; mean age 38 (range 24-60) years; 91% were of white ethnicity and 89% female. The median time qualified was 14 (1-38) years and 3 (1-22) years working in general practices. Overall pharmacists scored well on the GSES, mean 25 (SD 3; 95%CI 24.4-25.6), and GRIT, mean 30 (SD 4; 95%CI 29.6-30.4), out of a maximum 32 and 40 respectively. A significant positive correlation between GSES and GRIT scores was found (Pearson's r=0.284, p=0.006). However, no significant differences were identified between pharmacists scoring in the lower and upper quartiles by GSES or GRIT. Overall respondents reported their preferred learning styles were activists (46%) or pragmatists (29%). The majority (91%) preferred blended learning methods as opposed to 38% or less for a range of online methods. Conclusions General practice pharmacists on average scored highly for self-efficacy and resilience. Higher scores did not appear to be associated with demographic, years of practice, professional or educational experience. Prospective interventions to support those with lower scores may enhance and optimise pharmacists' effectiveness in general practice.
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Affiliation(s)
- Chris F Johnson
- MRes, MSc, BSc (Hons), PGCert Psych Pharm. Specialist Mental Health and Advanced Prescribing Support Pharmacist Primary Care. Pharmacy Services, NHS Greater Glasgow and Clyde, Clarkston Court. Glasgow (United Kingdom).
| | - Jan Smith
- CPsychol, PhD, MSc, MSc, BSc (Hons), PGCert. Researcher and Chartered Health Psychologist. Pharmacy Services, NHS Greater Glasgow and Clyde, Clarkston Court. Glasgow (United Kingdom).
| | - Heather Harrison
- MPC, BSc (Hons), PGDip. Senior Prescribing Advisor. Pharmacy Services, NHS Greater Glasgow and Clyde, Clarkston Court. Glasgow (United Kingdom).
| | - Richard Hassett
- BA (Hons). Senior Information & Prescribing Analyst. Pharmacy Services, NHS Greater Glasgow and Clyde, Clarkston Court. Glasgow (United Kingdom).
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Brickley B, Sladdin I, Williams LT, Morgan M, Ross A, Trigger K, Ball L. A new model of patient-centred care for general practitioners: results of an integrative review. Fam Pract 2020; 37:154-172. [PMID: 31670759 DOI: 10.1093/fampra/cmz063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND GPs providing patient-centred care (PCC) is embedded in international health care policies due to its positive impact on patients and potential to lower health care costs. However, what is currently known about GP-delivered PCC is unknown. OBJECTIVE To synthesize literature investigating GP-delivered PCC and address 'what is currently known about GP-delivered PCC?' METHOD A systematic literature search was conducted between June and July 2018. Eligible articles were empirical, full-text studies published in English between January 2003 and July 2018, related to at least three of the four dimensions of PCC described by Hudon et al. (2011), and related to preventative, acute, and/or chronic care by GPs. Following screening, full-text articles were independently assessed for inclusion by two investigators. Data were extracted and quality assessed by two researchers. Findings on PCC were analysed thematically (meta-synthesis). RESULTS Thirty medium- to high-quality studies met the inclusions criteria. Included studies utilized varied designs, with the most frequent being quantitative, cross-sectional. A theoretical model of PCC was synthesized from included studies and contained four major components: (i) understanding the whole person, (ii) finding common ground, (iii) experiencing time and (iv) aiming for positive outcomes. Harms of PCC were rarely reported. CONCLUSIONS Four overarching theoretical components of PCC relate to elements of the consultation and experience of time. These components can be used to inform the development of toolkits to support GPs and general practice organizations in pursuit of PCC as well as tools to measure patient-centredness.
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Affiliation(s)
- Bryce Brickley
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Ishtar Sladdin
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Mark Morgan
- Bond University, Gold Coast, Queensland, Australia
| | - Alyson Ross
- Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Kellie Trigger
- Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Skarshaug LJ, Kaspersen SL, Bjørngaard JH, Pape K. Changes in General Practitioners' consultation frequency over time for patients with hypertension or anxiety/depression symptoms: a 10-year follow-up of the Norwegian HUNT study. Fam Pract 2020; 37:248-254. [PMID: 31690941 DOI: 10.1093/fampra/cmz070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND General Practitioners' (GPs') workload has been suggested to increase in many countries; how does this impact patient follow-up? OBJECTIVE To investigate trends in GP consultation patterns for adults according to baseline hypertension and anxiety/depression symptoms and attribution of the GP to trend differences. METHODS Prospective cohort study, linking survey data and clinical measurements from the Norwegian HUNT3 study (2006-08) with national administrative data on GP list assignment and consultations with GP services. We grouped participants aged 40-59 years according to sex and their baseline status regarding hypertension and anxiety/depression symptoms. We registered GP consultations in 2007-16 and used general estimation equation models to estimate the level of GP consultations per month per year during follow-up. We used multilevel models with participants nested in their assigned regular GP to calculate GP-level intra-class correlation coefficients, reflecting to what extent patients' consultation patterns could be attributed to the individual GP. RESULTS In total, 47 550 HUNT3 participants were registered with 102 different GPs in Nord-Trøndelag County, Norway, in 2007. Adjusted for age, we observed an overall increase in GP consultations in 2007-16, particularly in those with a better health status at baseline. About 2% of the variance of patient consultations could be attributed to differences between GPs and 10% to the use of lengthy consultations. Out-of-hours consultations did not change much in the study period 2007-16. CONCLUSION Increased use of GP consultations, mainly among the healthiest participants, encourage further research into whether these patients displace patients with heavier and more complex needs.
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Affiliation(s)
- Lena J Skarshaug
- Department of Public Health and Nursing at the Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Silje L Kaspersen
- Department of Public Health and Nursing at the Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,SINTEF Digital, SINTEF, Trondheim, Norway
| | - Johan H Bjørngaard
- Department of Public Health and Nursing at the Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Nord University, Faculty of Nursing and Health Sciences, Levanger, Norway
| | - Kristine Pape
- Department of Public Health and Nursing at the Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Ansell S, Read J, Bryce M. Challenges to well-being for general practice trainee doctors: a qualitative study of their experiences and coping strategies. Postgrad Med J 2020; 96:325-330. [PMID: 32144118 DOI: 10.1136/postgradmedj-2019-137076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/17/2020] [Accepted: 02/07/2020] [Indexed: 12/27/2022]
Abstract
PURPOSES OF THE STUDY To identify the challenges to well-being experienced by general practice postgraduate trainees and to explore how the trainees respond to those challenges. STUDY DESIGN Qualitative focus group study with doctors in their final year of general practice training (n=16). The participants in the study were recruited from one training scheme in South West England. Data were thematically analysed. RESULTS Participants reported challenges to well-being relating to dysfunctional relationships with colleagues and patients, their workload, a perceived lack of support at work and also physical environmental challenges. They identified response strategies focused on cognitive processing, physical self-care, focusing on their professional purpose, building supportive relationships and adapting their working environment where possible. Additionally, there were factors that could support trainee well-being, including personal factors such as adaptability and self-awareness, but also external and organisational factors, such as culture, supportive colleagues and organisational adaptability in relation to workload management. The importance to trainees of the idea of being a 'good doctor' arose repeatedly in the data, as did the importance of the organisational environment. Participants reported finding their training placements in secondary care environments particularly challenging. CONCLUSION This research highlights the strategies that general practice trainees use in response to challenges, but also that the responsibility for maintaining well-being cannot be borne by individuals alone. This study identifies that supportive approaches by healthcare organisations and educators are vitally important to general practitioner trainees' well-being.
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Affiliation(s)
- Sarah Ansell
- Peninsula Postgraduate Medical Education School of Primary Care, Health Education England South West, Plymouth, UK
| | - James Read
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Marie Bryce
- Faculty of Health, University of Plymouth, Plymouth, UK
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Fisher SJ, Margerison LN, Jonker L. Development and cohort study of an audit approach to evaluate patient management in family practice in the UK: the 7S tool. Fam Pract 2020; 37:98-102. [PMID: 31529031 DOI: 10.1093/fampra/cmz053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the UK, there is increased pressure on general practitioners' time due to an increase in (elderly) population and a shortage of general practitioners. This means that time has to be used efficiently, whilst optimizing adherence to consistent, appropriate and timely provision of care. OBJECTIVE(S) Create an audit tool that assists general practitioners and family practice staff to evaluate if patients are managed as effectively as possible, and to test the usefulness of this tool in a family practice. METHODS The '7S' audit tool has seven outcome elements; these broadly stand for what the actual and desired patient contact outcome was, or should have been. Terms include 'surgery', 'speak' and 'specific other' for an appointment at the practice, by telephone or with a dedicated specialist such as a practice nurse or phlebotomist, respectively. RESULTS A very small, rural, general practice in the UK was audited using the 7S tool. Five hundred patient contacts were reviewed by an independent general practitioner and the decision made if the mode of contact was appropriate or not for each case; in one of the three cases, the choice of care provision was inappropriate and chronic disease cases contributed most to this. General practitioners instigated the majority of poor patient management choices, and chronic disease patients were frequently seen in suboptimal settings. CONCLUSIONS Inefficiencies in the management of patients in family practice can be identified with the 7S audit tool, thereby producing evidence for staff education and service reconfiguration.
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Affiliation(s)
| | | | - Leon Jonker
- Science and Innovation Manager, Cumbria Partnership NHS Foundation Trust, Carlisle, UK
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Koh MYH, Hum AYM, Khoo HS, Ho AHY, Chong PH, Ong WY, Ong J, Neo PSH, Yong WC. Burnout and Resilience After a Decade in Palliative Care: What Survivors Have to Teach Us. A Qualitative Study of Palliative Care Clinicians With More Than 10 Years of Experience. J Pain Symptom Manage 2020; 59:105-115. [PMID: 31465787 DOI: 10.1016/j.jpainsymman.2019.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/04/2019] [Accepted: 08/07/2019] [Indexed: 11/27/2022]
Abstract
CONTEXT Burnout is common among palliative care clinicians (PCCs). Resilience helps to reduce burnout, compassion fatigue, and is associated with longevity in palliative care. OBJECTIVES We aimed to study PCCs who have remained in the field for longer than 10 years to deepen our understanding on their views on burnout and resilience. METHODS We conducted a qualitative study using semistructured interviews and purposive sampling on 18 PCCs - five doctors, 10 nurses, and three social workers who worked in various palliative care settings (hospital palliative care team, home hospice, and inpatient hospice). The mean age of the interviewees was 52 years, and the mean number of years practicing palliative care was 15.7 years (range 10-25). The interviews were recorded verbatim, transcribed, and analyzed using a grounded theory approach. RESULTS Four major themes emerged from our analysis - struggling, changing mindset, adapting, and resilience. Intervening conditions, such as self-awareness, reflection, and evolution, were also important factors. The core phenomenon of our study was that of transformational growth - a process that PCCs have to go through before they achieve resilience. We also further classified resilience into both personal and collective resilience. CONCLUSION Our findings highlight the evolving process of transformational growth that PCCs must repeatedly undergo as they strive toward sustained resilience and longevity. It also stresses the importance of taking individual and collective responsibility toward building a culture of personal and team resilience.
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Affiliation(s)
- Mervyn Y H Koh
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore.
| | - Allyn Y M Hum
- Palliative Care Centre for Excellence in Research and Education (PalC), Singapore
| | - Hwee Sing Khoo
- Health Outcomes and Medical Education Research, National Healthcare Group, Singapore
| | - Andy H Y Ho
- School of Social Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | | | | | - Patricia S H Neo
- Division of Supportive and Palliative Care, National Cancer Centre, Singapore
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