General practice in UK newspapers: an empirical analysis of over 400 articles

UK national newspapers' representation of cancer patients and their care during the early part of the COVID-19 pandemic: Invoking and undermining solidarity?

During the COVID-19 pandemic media narratives of solidarity often cast nations like the UK as if at war, while acclaiming health-care workers as heroic and beloved. However, this solidarity was often fragile and fleeting, as concerns and criticism about workers, citizens and services also circulated. In this article we explore these dynamics of solidarity in more depth, analysing framings of cancer patient suffering, private and public provision of health care in news media during the early part of the COVID-19 pandemic. We explore how cancer patients were positioned as victims of failure and abandonment by the state and its health-care providers, and how the private health-care system was presented in a saviour role. We conclude by reflecting on the implications of new media's alignment of appeals to solidarity with highly individualised forms of care and the consequences for state-based services founded on principles of solidarity.

Cultural Attitudes towards General Practice within Medical Schools: Experiences of GP Curriculum Leaders

INTRODUCTION

UK undergraduate medical curricula are under pressure to become more community-focused and generalist in approach to equip all future doctors with generalist skills and increase recruitment to generalist specialities like general practice. However, the amount of general practice teaching in UK undergraduate curricula is static or falling. Undervaluing, in the form of general practice denigration and undermining, is increasingly recognised from a student perspective. However, little is known about the perspectives of academics working within medical schools.

AIM

To explore the cultural attitudes towards general practice within medical schools as experienced by general practice curriculum leaders.

METHODS

A qualitative study using semi-structured interviews of eight general practice curriculum leaders in UK medical schools. Purposive sampling for diversity was used. Interviews were analysed using reflexive thematic analysis.

FINDINGS

Seven themes were identified covering 'a kaleidoscope of attitudes towards general practice', 'overt everyday denigration of general practice', 'a hidden curriculum of undervaluing general practice', 'valuing general practice: representation, recognition and respect', 'relating to others, relating to oneself', 'power, empowerment and vulnerability', and 'the pandemic as an opportunity'.

CONCLUSIONS

Cultural attitudes towards general practice were diverse: a spectrum varying from valuing general practice to overt denigration, with a 'hidden curriculum' of subtle undervaluing of general practice. Hierarchical, tense relationships between general practice and hospital were a recurring theme. Leadership was identified as important in setting the tone for cultural attitudes, as well as indicating general practice is valued when general practitioners are included within leadership. Recommendations include a shift in narrative from denigration to mutual speciality respect between all doctors.

Patients' experience of accessing support for tics from primary care in the UK: an online mixed-methods survey

BACKGROUND

Tics are common in children and young people and may persist into adulthood. Tics can cause challenges with social, occupational, physical, and academic functioning. The current study explores the perceptions of adults with tics and parents/carers of young people with tics regarding their experience of accessing support from professionals in primary care in the UK.

METHODS

Two online cross-sectional surveys were completed by 33 adults with tics and 94 parents/carers of children with tics. Participants were recruited across three online tic support groups. Tic specialist psychologists, academic researchers, and people with lived experience of tics provided feedback on the surveys before they were made available online. Mixed-method analyses were conducted on the surveys. Qualitative data from the free-text responses were analysed using thematic analysis and triangulated with quantitative findings where appropriate.

RESULTS

While some participants felt supported by general practitioners (GPs), many felt dismissed. The impact of tics was not always explored, nor information on tics provided, during the consultation. Although 78.7% of participants were referred to secondary care for their tics, some struggled to get the referral. Within secondary care, most adult respondents were assessed by neurologists whilst young people were typically assessed by paediatricians or psychiatrists. Most of these secondary care clinicians did not specialise in tic disorders, with only 27.9% of participants being assessed by tic specialists. Mode waitlist time was 3-6 months for young people and longer for adult respondents. Some participants were referred to multiple secondary care services, spanning neurology, paediatrics, and psychiatry, with each stating that they do not provide support for tics. 21% of participants mentioned being discharged from secondary care with no ongoing support. Almost one-third of respondents accessed support within private healthcare.

CONCLUSIONS

Generally, more negative than positive experiences were reported. Possible contributing factors included a lack of clear tic referral pathways, long waitlists, a lack of information about tics provided in primary care appointments and a lack of support offered following diagnosis by secondary care services, together with poor access to tic specialist clinicians. This study highlights areas where improvements to UK services for tics can be made.

Recruitment of general practitioners in China: a scoping review of strategies and challenges

Background

China is rapidly expanding its general practitioner (GP) workforce as part of recent healthcare reform, with an extra 400,000 GPs by 2030. This scoping review identifies the published strategies for GP recruitment that are being implemented and the challenges encountered.

Methods

We searched six English and three Chinese databases from 2015 to April 2022, following Arksey and O’Malley’s framework and the PRISMA ScR reporting guidelines.

Results

A total of 40 Chinese-language and 5 English-language records were included. We identified multiple policies, pathways and programmes focused on expanding GP recruitment. Twenty-two evaluations of these initiatives show varying degrees of effectiveness. Selecting general practice as a career is affected by many factors, including individual’s background, remuneration and benefits, career prospects, working environment, self-fulfilment, and current national developments and reorganisations of primary care. The challenge most frequently reported was the adequate provision of qualified GP in rural regions. The targeting of students from rural areas and provision of free education in return for an obligatory six-years’ working in their hometown upon graduation appears to be effective. Extracted records mostly studied views of trainees in a defined locality, and we identified a paucity of studies which explored the perspectives of organisations and institutions, similarly there were areas of China not contributing to the literature and there were no records taking a national perspective.

Conclusions

Long-term monitoring is required to assess policy changes and to systematically evaluate the effectiveness of the interventions nationally. The monitoring of the challenges influencing GP recruitment can be used to inform the design of future initiatives.

Development of a minimum agreed standardised set of outcomes used to measure and report evaluations will help assess the relative contributions and cost effectiveness of different approaches being used to boost GP numbers. We provide suggestions for improving the benefits and rewards for GPs and how to promote recruitment to the more rural or less attractive areas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01854-0.

Impact of covid-19 on primary care contacts with children and young people aged 0-24 years in England; longitudinal trends study 2015-2020

Background: The NHS response to covid-19 altered provision and access to primary care. Aim: To examine the impact of covid-19 on general practitioner (GP) contacts with children and young people in England. Design and Setting: Longitudinal trends analysis using electronic health records from the Clinical Practice Research Datalink Aurum database. Methods: We included all children and young people younger than 25 years registered with a GP. We compared the number of total, remote and face-to-face contacts during the first UK lockdown (March to June 2020) with the mean contacts for comparable weeks from 2015 to 2019. Results: We examined 47 607 765 GP contacts with 4 307 120 million children and young people. GP contacts fell 41% during the first lockdown compared with previous years. Children aged 1-14 had greater falls in total contacts (>50%) compared with infants and 15-24s. Face-to-face contacts fell by 88% with the greatest falls occurring among children aged 1-14 (> 90%). Remote contacts more than doubled, increasing most in infants (over 2.5 fold). Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote, mitigating the total fall (31%). Conclusion: During the covid-19 pandemic, children and young people’s contact with GPs fell, particularly for face-to-face assessment. This may be explained by a lower prevalence of respiratory illnesses due to fewer social contacts and changing health care seeking behaviour. The large shift to remote contacts mitigated total falls in contacts for some age groups and for common non-transmissible conditions.

Community perspectives and engagement in sustainable solid waste management (SWM) in Fiji: A socioecological thematic analysis

Improper waste disposal and low rates of household waste diversion through material and organic waste recycling are a global concern. Understanding community perspectives on solid waste management services, outreach activities, and regulatory measures, and the barriers to sustainable practices, is crucial for designing effective waste management programmes. Longitudinal content analysis of archival data, such as newspapers, is a cost-effective, yet underutilised, research method to identify the viewpoints of diverse civic groups and examine the developments and challenges associated with the waste management sector. This paper investigates divergent stakeholders' perspectives and priorities using the Socio-Ecological Model (SEM) to examine the micro-system (intrapersonal and interpersonal), meso- and exo-system (community and institutional), and macro-system (policy level) factors that influence sustainable SWM practices. Using specific keywords, the authors searched online archives of a national newspaper in Fiji with a weekday circulation of over 20,000. Data from 482 newspaper articles, dated 2009-2020, were reviewed and dual-coded by two researchers using QDA Miner Lite. Findings indicate that poor waste management behaviour is linked to all factors within the Socio-Ecological system. While micro-level factors such as negligence, personal responsibility, lack of civic pride, and lack of awareness are causes of anti-environmental behaviour, structural factors such as inadequate waste collection services and recycling infrastructure contribute to low recycling rates. Civic education has been highlighted as a solution to encouraging pro-environmental behaviour (PEB), but there is a need to identify the type of educational tools and the frequency and impact of education workshops. This paper further discusses about the implications of community-based strategies and regulatory measures.

'From disaster, miracles are wrought': a narrative analysis of UK media depictions of remote GP consulting in the COVID-19 pandemic using Burke's pentad

During crises (major events characterised by uncertainty, urgency and threat), society must make sense of rapidly unfolding events. This happens mainly through narrativising-depicting a setting, characters and a meaningful sequence of events and actions unfolding over time. In the early months of the pandemic, UK general practice shifted from face-to-face consultations to a remote-by-default model (telephone, video or e-consultation). This shift was initially widely accepted by press and public, but support waned after a politician declared that the change would be permanent. We invoke Burke's dramatistic pentad of act, scene, agent, agency and purpose to theorise findings from a detailed analysis of media coverage of the remote-by-default policy and reactions to it. We consider the 12 weeks from March to June 2020 (first lockdown, when remote-by-default services had just been introduced) and 1 week from late July 2020 (following the ministerial announcement). The initial introduction of remote consulting had strong narrative coherence in which all parts of the pentad were balanced: scene (a deadly virus threatening the country) aligned with act (lockdown, including avoiding face-to-face appointments unless essential), agents (the National Health Service and digital technology as heroic macro-actors), agency (general practitioners 'deployed') and purpose (to control the pandemic). The later period, however, was characterised by a mismatch between scene (a country emerging from lockdown and resuming normal life), act (imposition of the remote model), agent (a politician known for his enthusiasm for technology), agency (top-down directive) and purpose (modernisation). Whereas media narratives in the first period aligned with the genre of heroic adventure (suggesting a worthy battle, bravely fought), those of the second had characteristics of farce (something both comic and grotesque). We conclude that close reading of media narratives may surface potential misalignments between policy decisions and the context in which they must be implemented.

Impact of changes to national guidelines on hypertension-related workload: an interrupted time series analysis in English primary care

BACKGROUND

In 2011, National Institute for Health and Care Excellence (NICE) guidelines recommended the routine use of out-of-office blood pressure (BP) monitoring for the diagnosis of hypertension. These changes were predicted to reduce unnecessary treatment costs and workload associated with misdiagnosis.

AIM

To assess the impact of guideline change on rates of hypertension-related consultation in general practice.

DESIGN AND SETTING

A retrospective open cohort study in adults registered with English general practices contributing to the Clinical Practice Research Datalink between 1 April 2006 and 31 March 2017.

METHOD

The primary outcome was the rate of face-to-face, telephone, and home visit consultations related to hypertension with a GP or nurse. Age- and sex-standardised rates were analysed using interrupted time-series analysis.

RESULTS

In 3 937 191 adults (median follow-up 4.2 years) there were 12 253 836 hypertension-related consultations. The rate of hypertension-related consultation was 71.0 per 100 person-years (95% confidence interval [CI] = 67.8 to 74.2) in April 2006, which remained flat before 2011. The introduction of the NICE hypertension guideline in 2011 was associated with a change in yearly trend (change in trend -3.60 per 100 person-years, 95% CI = -5.12 to -2.09). The rate of consultation subsequently decreased to 59.2 per 100 person-years (95% CI = 56.5 to 61.8) in March 2017. These changes occurred around the time of diagnosis, and persisted when accounting for wider trends in all consultations.

CONCLUSION

Hypertension-related workload has declined in the last decade, in association with guideline changes. This is due to changes in workload at the time of diagnosis, rather than reductions in misdiagnosis.

Changing media depictions of remote consulting in COVID-19: analysis of UK newspapers

BACKGROUND

Remote consulting was introduced quickly into UK general practice in March 2020 as an emergency response to COVID-19. In July 2020, 'remote-first' became long-term government policy.

AIM

To explore how this change was portrayed in national newspapers and how depictions changed over time.

DESIGN AND SETTING

Thematic analysis of newspaper articles referring to remote GP consultations from two time periods: 2 March-31 May 2020 (period 1) and 30 July-12 August 2020 (period 2).

METHOD

Articles were identified through, and extracted from, LexisNexis Academic UK. A coding system of themes and narrative devices was developed and applied to the data. The analysis was developed iteratively, amending the coding structure as new data were added.

RESULTS

Remote consulting was widely covered in newspapers. Articles in period 1 depicted it positively, equating digital change with progress and linking novel technological solutions with improved efficiency and safety (for example, infection control) in a service that was overdue for modernisation. Articles in period 2 questioned the persistence of a remote-first service now that the pandemic was waning, emphasising, for example, missed diagnoses, challenges to the therapeutic relationship, and digital inequalities.

CONCLUSION

As the first wave of the pandemic came and went, media depictions of remote consulting evolved from an 'efficiency and safety' narrative to a 'risks, inequalities, and lack of choice' narrative. To restore public trust in general practice, public communication should emphasise the wide menu of consulting options now available to patients and measures being taken to assure safety and avoid inequity.

Look who's talking now: Cancer in primary care on Twitter. An observational study

Background

Twitter is a microblogging platform that helps share information. It is a dynamic tool that has been embraced by many user types including consumers and healthcare professionals (HCPs). Currently, there are no data on how cancer in primary care features on Twitter.

Aim

To explore the type of users and information shared about cancer in primary care on Twitter.

Design & setting

A descriptive exploratory study took place of publicly available Twitter data.

Method

Tweets were searched between July 2015 and June 2017 for ‘GP’, ‘general practice’, ‘primary care’, or ‘general practitioner’ in conjunction with ‘cancer’. A 20% random sample was coded for geographic location, user type, type of tweet, and theme. Tweet sentiment was analysed using R package sentimentr. Content that gained traction was compared by combining original tweets, retweets, favourites, and duration.

Results

There were a total of 3413 tweets from 1611 users in 44 countries. Consumers were the largest user group followed by health organisations, healthcare professionals, and the media. The most common theme across user types was diagnostic delay. Other themes that emerged included cancer screening, symptom awareness, and early diagnosis. Consumers published more negative tweets, particularly in relation to diagnostic delay. Health organisations focused on symptom awareness and screening. Over half of media tweets were stories that featured delayed diagnosis or screening.

Conclusion

A broad range of users engage with Twitter to share information about cancer in primary care. Content is different between user groups, but diagnostic delay and symptom awareness are common themes. Healthcare and professional organisations may need to consider approaches to counter negative messages about diagnostic delay.

Patient experiences of the urgent cancer referral pathway-Can the NHS do better? Semi-structured interviews with patients with upper gastrointestinal cancer

Background

Timeliness is viewed as a key feature of health‐care quality. Internationally, this is challenging. In England, cancer waiting time targets are currently not being met. For example, between 2015 and 2018 only 71% of patients with upper gastrointestinal (UGI) cancer started treatment within the recommended 62 days of referral.

Objective

We explored patients’ experiences to identify areas for service improvement.

Design

Semi‐structured interviews were conducted.

Setting and participants

Twenty patients who were referred through the urgent (two‐week) GP referral route and were within six months of receiving first treatment were recruited.

Data analysis

Data from the interviews were analysed thematically.

Results

Four themes were developed: organization of care; diagnosis; support; and views and expectations of the NHS. Patients described cross‐cutting issues such as complex and varied pathways and uncertainty about what would happen next. They felt daunted by the intensity and speed of investigations. They were presented with a recommended course of action rather than options and had little involvement in decision making. They were grateful for care, reluctant to complain and resigned to the status quo.

Discussion and conclusions

In order to meet patient needs, the NHS needs to improve communication and streamline pathways. Future cancer pathways also need to be designed to support shared decision making, be truly person‐centred and informed by patient experience.