Examining the practice of generalist expertise: a qualitative study identifying constraints and solutions

PubMed Central

Reeve, Joanne; Dowrick, Christopher F; Freeman, George K; Gunn, Jane; Mair, Frances; May, Carl; Mercer, Stewart; Palmer, Victoria; Howe, Amanda; Irving, Greg; Shiner, Alice; Watson, Jessica

2013-01-01

Objectives Provision of person-centred generalist care is a core component of quality primary care systems. The World Health Organisation believes that a lack of generalist primary care is contributing to inefficiency, ineffectiveness and inequity in healthcare. In UK primary care, General Practitioners (GPs) are the largest group of practising generalists. Yet GPs fulfil multiple roles and the pressures of delivering these roles along with wider contextual changes create real challenges to generalist practice. Our study aimed to explore GP perceptions of enablers and constraints for expert generalist care, in order to identify what is needed to ensure health systems are designed to support the generalist role. Design Qualitative study in General Practice. Setting UK primary care. Main outcome measures A qualitative study – interviews, surveys and focus groups with GPs and GP trainees. Data collection and analysis was informed by Normalisation Process Theory. Design and setting Qualitative study in General Practice. We conducted interviews, surveys and focus groups with GPs and GP trainees based mainly, but not exclusively, in the UK. Data collection and analysis were informed by Normalization Process Theory. Participants UK based GPs (interview and surveys); European GP trainees (focus groups). Results Our findings highlight key gaps in current training and service design which may limit development and implementation of expert generalist practice (EGP). These include the lack of a consistent and universal understanding of the distinct expertise of EGP, competing priorities inhibiting the delivery of EGP, lack of the consistent development of skills in interpretive practice and a lack of resources for monitoring EGP. Conclusions We describe four areas for change: Translating EGP, Priority setting for EGP, Trusting EGP and Identifying the impact of EGP. We outline proposals for work needed in each area to help enhance the expert generalist role. PMID:24475347

Five-year clinical evaluation of zirconia-based bridges in patients in UK general dental practices.

PubMed

Burke, F J T; Crisp, R J; Cowan, A J; Lamb, J; Thompson, O; Tulloch, N

2013-11-01

This study reported the results at 5 years of fixed-fixed all-ceramic bridges, constructed in a yttria oxide stabilized tetragonal zirconium oxide polycrystal (Y-TZP) substructure, placed in adult patients in UK general dental practices. Four UK general dental practitioners recruited patients who required fixed bridgework and, after obtaining informed written consent, appropriate clinical and radiographic assessments were completed. The teeth were prepared and bridges constructed in accordance with the manufacturer's instructions. Each bridge was reviewed annually within 3 months of the anniversary of its placement by a calibrated examiner, together with the clinician who had placed the restoration, using modified USPHS criteria. Of the 41 bridges originally placed, 33 bridges were examined at 5 years. All Y-TZP frameworks were intact and no bridge retainers had debonded. Eight chipping fractures in the veneering ceramic were noted over the 5-year period. In five cases the patients were unaware of these and these cases were polished. Of the remaining three cases, in one a repair was attempted but was unsuccessful, but the bridge remained in satisfactory service. However, in the case involving a chipping fracture of the mesial-incisal angle of a central incisor, it was considered that replacement of the bridge was necessary. 97% (n=32) of the 33 Lava Y-TZP fixed-fixed bridges, evaluated in patients attending UK general dental practices, were found to be performing satisfactorily. The use of Y-TZP frameworks holds promise. Copyright © 2013 Elsevier Ltd. All rights reserved.

Career progression of men and women doctors in the UK NHS: a questionnaire study of the UK medical qualifiers of 1993 in 2010/2011

PubMed Central

Svirko, Elena; Goldacre, Michael J

2014-01-01

Summary Objectives To report the career progression of a cohort of UK medical graduates in mid-career, comparing men and women. Design Postal and questionnaire survey conducted in 2010/2011, with comparisons with earlier surveys. Setting UK. Participants In total, 2507 responding UK medical graduates of 1993. Main outcome measures Doctors’ career specialties, grade, work location and working pattern in 2010/2011 and equivalent data in earlier years. Results The respondents represented 72% of the contactable cohort; 90% were working in UK medicine and 7% in medicine outside the UK; 87% were in the UK NHS (87% of men and 86% of women). Of doctors in the NHS, 70.6% of men and 52.0% of women were in the hospital specialties and the great majority of the others were in general practice. Within hospital specialties, a higher percentage of men than women were in surgery, and a higher percentage of women than men were in paediatrics, obstetrics and gynaecology, clinical oncology, pathology and psychiatry. In the NHS, 63% of women and 8% of men were working less-than-full-time (in general practice, 19% of men and 83% of women; and in hospital specialties, 3% of men and 46% of women). Among doctors who had always worked full-time, 94% of men and 87% of women GPs were GP principals; in hospital practice, 96% of men and 93% of women had reached consultant level. Conclusions The 1993 graduates show a continuing high level of commitment to the NHS. Gender differences in seniority lessened considerably when comparing doctors who had always worked full-time. PMID:25408921

The impact of pay-for-performance on professional boundaries in UK general practice: an ethnographic study.

PubMed

Grant, Suzanne; Huby, Guro; Watkins, Francis; Checkland, Kath; McDonald, Ruth; Davies, Huw; Guthrie, Bruce

2009-03-01

The 2004 new General Medical Services (nGMS) contract exemplifies trends across the public services towards increased definition, measurement and regulation of professional work, with general practice income now largely dependent on the quality of care provided across a range of clinical and organisational indicators known collectively as the 'Quality and Outcomes Framework' (QOF). This paper reports an ethnographically based study of the impact of the new contract and the financial incentives contained within it on professional boundaries in UK general practice. The distribution of clinical and administrative work has changed significantly and there has been a new concentration of authority, with QOF decision making and monitoring being led by an internal QOF team of clinical and managerial staff who make the major practice-level decisions about QOF, monitor progress against targets, and intervene to resolve areas or indicators at risk of missing targets. General practitioners and nurses, however, appear to have accommodated these changes by re-creating long established narratives on professional boundaries and clinical hierarchies. This paper is concerned with the impact of these new arrangements on existing clinical hierarchies.

Variation in clinical coding lists in UK general practice: a barrier to consistent data entry?

PubMed

Tai, Tracy Waize; Anandarajah, Sobanna; Dhoul, Neil; de Lusignan, Simon

2007-01-01

Routinely collected general practice computer data are used for quality improvement; poor data quality including inconsistent coding can reduce their usefulness. To document the diversity of data entry systems currently in use in UK general practice and highlight possible implications for data quality. General practice volunteers provided screen shots of the clinical coding screen they would use to code a diagnosis or problem title in the clinical consultation. The six clinical conditions examined were: depression, cystitis, type 2 diabetes mellitus, sore throat, tired all the time, and myocardial infarction. We looked at the picking lists generated for these problem titles in EMIS, IPS, GPASS and iSOFT general practice clinical computer systems, using the Triset browser as a gold standard for comparison. A mean of 19.3 codes is offered in the picking list after entering a diagnosis or problem title. EMIS produced the longest picking lists and GPASS the shortest, with a mean number of choices of 35.2 and 12.7, respectively. Approximately three-quarters (73.5%) of codes are diagnoses, one-eighth (12.5%) symptom codes, and the remainder come from a range of Read chapters. There was no readily detectable consistent order in which codes were displayed. Velocity coding, whereby commonly-used codes are placed higher in the picking list, results in variation between practices even where they have the same brand of computer system. Current systems for clinical coding promote diversity rather than consistency of clinical coding. As the UK moves towards an integrated health IT system consistency of coding will become more important. A standardised, limited list of codes for primary care might help address this need.

Longitudinal study of infectious intestinal disease in the UK (IID2 study): incidence in the community and presenting to general practice

PubMed Central

Rodrigues, Laura C; Viviani, Laura; Dodds, Julie P; Evans, Meirion R; Hunter, Paul R; Gray, Jim J; Letley, Louise H; Rait, Greta; Tompkins, David S; O'Brien, Sarah J

2011-01-01

Objectives To estimate, overall and by organism, the incidence of infectious intestinal disease (IID) in the community, presenting to general practice (GP) and reported to national surveillance. Design Prospective, community cohort study and prospective study of GP presentation conducted between April 2008 and August 2009. Setting Eighty-eight GPs across the UK recruited from the Medical Research Council General Practice Research Framework and the Primary Care Research Networks. Participants 6836 participants registered with the 88 participating practices in the community study; 991 patients with UK-acquired IID presenting to one of 37 practices taking part in the GP presentation study. Main outcome measures IID rates in the community, presenting to GP and reported to national surveillance, overall and by organism; annual IID cases and GP consultations by organism. Results The overall rate of IID in the community was 274 cases per 1000 person-years (95% CI 254 to 296); the rate of GP consultations was 17.7 per 1000 person-years (95% CI 14.4 to 21.8). There were 147 community cases and 10 GP consultations for every case reported to national surveillance. Norovirus was the most common organism, with incidence rates of 47 community cases per 1000 person-years and 2.1 GP consultations per 1000 person-years. Campylobacter was the most common bacterial pathogen, with a rate of 9.3 cases per 1000 person-years in the community, and 1.3 GP consultations per 1000 person-years. We estimate that there are up to 17 million sporadic, community cases of IID and 1 million GP consultations annually in the UK. Of these, norovirus accounts for 3 million cases and 130 000 GP consultations, and Campylobacter is responsible for 500 000 cases and 80 000 GP consultations. Conclusions IID poses a substantial community and healthcare burden in the UK. Control efforts must focus particularly on reducing the burden due to Campylobacter and enteric viruses. PMID:21708822

Prevalence of pain medication prescriptions in France, Germany, and the UK - a cross-sectional study including 4,270,142 patients.

PubMed

Jacob, Louis; Kostev, Karel

2018-01-01

The goal of the present study was to analyze the prevalence of pain medication prescriptions in general practices in France, Germany, and the UK. This study included all patients aged ≥18 years followed in 2016 in general practitioner practices in France, Germany and the UK. The primary outcome was the prevalence of patients receiving prescriptions for pain medications in France, Germany, and the UK in 2016. The following drugs were included in the analysis: anti-inflammatory and antirheumatic products, non-steroids and analgesics including opioids, antimigraine preparations, and other analgesics and antipyretics. Demographic variables included age and gender. This study included 4,270,142 patients. The prevalences of pain medication prescriptions were 57.3% in France, 29.6% in Germany, and 21.7% in the UK. Although this prevalence generally remained consistent between age groups in France (54.3%-60.3%), it increased with age in Germany (18-30 years: 23.8%; >70 years: 35.8%) and in the UK (18-30 years: 9.3%; >70 years: 43.8%). Finally, the prevalence of pain medication prescriptions was higher in women than in men in all three countries. Paracetamol was prescribed to 82.3% and 60.1% of patients receiving pain medication in France and the UK, respectively, whereas ibuprofen was prescribed to 46.5% of individuals in Germany. The prevalence of pain medication prescriptions was higher in France than in Germany and the UK. Further research is needed to gain a better understanding of the differences in the prescription patterns between these three European countries.

Understanding general practice: a conceptual framework developed from case studies in the UK NHS.

PubMed

Checkland, Kath

2007-01-01

General practice in the UK is undergoing a period of rapid and profound change. Traditionally, research into the effects of change on general practice has tended to regard GPs as individuals or as members of a professional group. To understand the impact of change, general practices should also be considered as organisations. To use the organisational studies literature to build a conceptual framework of general practice organisations, and to test and develop this empirically using case studies of change in practice. This study used the implementation of National Service Frameworks (NSFs) and the new General Medical Services (GMS) contract as incidents of change. In-depth, qualitative case studies. The design was iterative: each case study was followed by a review of the theoretical ideas. The final conceptual framework was the result of the dynamic interplay between theory and empirical evidence. Five general practices in England, selected using purposeful sampling. Semi-structured interviews with all clinical and managerial personnel in each practice, participant and nonparticipant observation, and examination of documents. A conceptual framework was developed that can be used to understand how and why practices respond to change. This framework enabled understanding of observed reactions to the introduction of NSFs and the new GMS contract. Important factors for generating responses to change included the story that the practice members told about their practice, beliefs about what counted as legitimate work, the role played by the manager, and previous experiences of change. Viewing general practices as small organisations has generated insights into factors that influence responses to change. Change tends to occur from the bottom up and is determined by beliefs about organisational reality. The conceptual framework suggests some questions that can be asked of practices to explain this internal reality.

The Politics of Childhood and Asylum in the UK

ERIC Educational Resources Information Center

Giner, Clotilde

2007-01-01

This article considers the general treatment of asylum-seeking families with children in the UK, focusing on the government's practices and public reactions to these measures. It first describes both the exclusive asylum framework, based on institutionalised suspicion, welfare restrictions and detention, and the inclusive child policy framework,…

Comparison of anaesthesia 'Day 1 skills' expectations between veterinary anaesthetists and general practitioners.

PubMed

Duncan, J C; Ross, M; Rhind, S; Clutton, E; Shaw, D J

2015-02-28

Day One Skills (DOS) were introduced by the Royal College of Veterinary Surgeons (RCVS) in 2006 as a guideline for minimum skills required by a veterinary graduate. However, the RCVS anaesthesia DOS are broad and do not specify differences in skills required for different species. The aims of this study were: (1) to determine which anaesthesia skills were considered essential for day one practice by UK-based veterinary practitioners (GPs) and anaesthetists; and (2) to explore current opinions on veterinary undergraduate anaesthesia training. Questionnaires for veterinary GPs (QGPs) and veterinary anaesthetists (QVAs) were developed which asked general information on expectations of anaesthesia skills as well as specific expectations for the common veterinary species. Fifty-five UK-based members of the Association of Veterinary Anaesthetists responded, with a random sample of veterinary practices stratified by UK county generating 234 responses and a convenience sample targeted at more specialist veterinary specialities in the UK generating 161 responses. There was close overall agreement between the two groups of GPs and anaesthetists on essential anaesthesia DOS. However, expectations varied with species-greatest in cats and dogs, lowest in exotics. Many respondents commented that new veterinary graduates lack practical skills and should not be expected to be omnicompetent across all species. In conclusion, anaesthesia undergraduate training should prioritise essential practical DOS. British Veterinary Association.

Compiling a register of patients with moderate or severe learning disabilities: experience at one United Kingdom general practice.

PubMed

Lodge, Keri-Michèle; Milnes, David; Gilbody, Simon M

2011-03-01

Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks.Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice.Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed.Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap.Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities.

Compiling a register of patients with moderate or severe learning disabilities: experience at one United Kingdom general practice

PubMed Central

2011-01-01

Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks. Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice. Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed. Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap. Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities. PMID:22479290

Functions of Turkish Complementary Schools in the UK: Official vs. Insider Discourses

ERIC Educational Resources Information Center

Çavusoglu, Çise

2014-01-01

Complementary schools in the United Kingdom (UK) are community organised schools with the general aim of teaching younger generations their "native" languages and cultures. However, the aims and practices of these schools are predominantly dependent on changes in the social and political contexts both in the host country (in this case…

GPs' views of health policy changes: a qualitative 'netnography' study of UK general practice online magazine commentary.

PubMed

Elvey, Rebecca; Voorhees, Jennifer; Bailey, Simon; Burns, Taylor; Hodgson, Damian

2018-06-01

Shifts in health policy since 2010 have brought major structural changes to the English NHS, with government stating intentions to increase GPs' autonomy and improve access to care. Meanwhile, GPs' levels of job satisfaction are low, while stress levels are high. PulseToday is a popular UK general practice online magazine that provides a key discussion forum on news relevant to general practice. To analyse readers' reactions to news stories about health policy changes published in an online general practice magazine. A qualitative 'netnography' was undertaken of readers' comments to PulseToday. METHOD: A sample of readers' comments on articles published in PulseToday was collated and subjected to thematic analysis. Around 300 comments on articles published between January 2012 and March 2016 were included in the analysis, using 'access to care' as a tracer theme. Concern about the demand and strain on general practice was perhaps to be expected. However, analysis revealed various dimensions to this concern: GPs' underlying feelings about their work and place in the NHS; constraints to GPs' control of their own working practices; a perceived loss of respect for the role of GP; and disappointment with representative bodies and GP leadership. This study shows a complex mix of resistance and resignation in general practice about the changing character of GPs' roles. This ambivalence deserves further attention because it could potentially shape responses to further change in primary care in ways that are as yet unknown. © British Journal of General Practice 2018.

Widening access to medicine may improve general practitioner recruitment in deprived and rural communities: survey of GP origins and current place of work.

PubMed

Dowell, J; Norbury, M; Steven, K; Guthrie, B

2015-10-01

Widening access to medicine in the UK is a recalcitrant problem of increasing political importance, with associated strong social justice arguments but without clear evidence of impact on service delivery. Evidence from the United States suggests that widening access may enhance care to underserved communities. Additionally, rural origin has been demonstrated to be the factor most strongly associated with rural practice. However the evidence regarding socio-economic and rural background and subsequent practice locations in the UK has not been explored. The aim of this study was to investigate the association between general practitioners' (GPs) socio-economic and rural background at application to medical school and demographic characteristics of their current practice. The study design was a cross-sectional email survey of general practitioners practising in Scotland. Socio-economic status of GPs at application to medical school was assessed using the self-coded National Statistics Socio-Economic Classification. UK postcode at application was used to define urban-rural location. Current practice deprivation and remoteness was measured using NHS Scotland defined measures based on registered patients' postcodes. A survey was sent to 2050 Scottish GPs with a valid accessible email address, with 801 (41.5 %) responding. GPs whose parents had semi-routine or routine occupations had 4.3 times the odds of working in a deprived practice compared to those with parents from managerial and professional occupations (95 % CI 1.8-10.2, p = 0.001). GPs from remote and rural Scottish backgrounds were more likely to work in remote Scottish practices, as were GPs originating from other UK countries. This study showed that childhood background is associated with the population GPs subsequently serve, implying that widening access may positively affect service delivery in addition to any social justice rationale. Longitudinal research is needed to explore this association and the impact of widening access on service delivery more broadly.

Identification of alkaptonuria in the general population: a United Kingdom experience describing the challenges, possible solutions and persistent barriers.

PubMed

Ranganath, L; Taylor, A M; Shenkin, A; Fraser, W D; Jarvis, J; Gallagher, J A; Sireau, N

2011-06-01

Progress in research into rare diseases is challenging. This paper discusses strategies to identify individuals with the rare genetic disease alkaptonuria (AKU) within the general population. Strategies used included a questionnaire survey of general practitioners, a dedicated website and patient network contact, targeted family screening and medical conference targeting. Primary care physicians of the UK were targeted by a postal survey that involved mailing 11,151 UK GPs; the response rate was 18.2%. We have identified 75 patients in the UK with AKU by the following means: postal survey (23), targeted family screening (11), patient networks and the website (41). Targeting medical conferences (AKU, rare diseases, rheumatology, clinical biochemistry, orthopaedics, general practitioners) did not lead to new identification in the UK but helped identify overseas cases. We are now aware of 626 patients worldwide including newly identified non-UK people with AKU in the following areas: Slovakia (208), the rest of Europe (including Turkey) (79), North America (including USA and Canada) (110), and the rest of the world (154). A mechanism for identifying individuals with AKU in the general population-not just in the UK but worldwide-has been established. Knowledge of patients with AKU, both in the UK and outside, is often confined to establishing their location in a particular GP practice or association with a particular medical professional. Mere identification, however, does not always lead to full engagement for epidemiological research purposes or targeting treatment since further barriers exist.

Palliative care for cirrhosis: a UK survey of health professionals’ perceptions, current practice and future needs

PubMed Central

Low, Joseph; Vickerstaff, Victoria; Davis, Sarah; Bichard, Julia; Greenslade, Lynda; Hopkins, Katherine; Marshall, Aileen; Thorburn, Douglas; Jones, Louise

2016-01-01

Objective To determine the knowledge and practice patterns of a UK cohort of relevant healthcare professionals (HCPs) about delivering palliative care in cirrhosis, and to inform priorities for future research. Design An on-line questionnaire survey with closed and open responses. Setting HCPs identified from the mailing list of special interest groups in hepatology and gastroenterology (liver), general practice and specialist palliative care (SPC) across the UK. Results Of the 6181 potential contacts identified, 517 HCPs responded. Most believed a role exists for SPC in caring for people with cirrhosis, but many SPC HCPs felt ill prepared to provide good care to those facing death. Further training was needed in managing liver-related symptoms, symptom control and end of life issues. All HCP groups wished to increase community provision of palliative care support, but many general practitioners felt unable to manage advanced cirrhosis in the community. There were differences in the optimal trigger for SPC referral with liver HCPs less likely to refer at symptom deterioration. Prognostication, symptom management and service configuration were key areas identified for future research. Conclusions All who responded acknowledged the role of SPC in caring for those dying with cirrhosis and need for further training to improve confidence and enable joint working between SPC, general practice and liver teams. Low response rates make it difficult to generalise these findings, which require further validation. PMID:28839829

When and why do doctors decide to become general practitioners? Implications for recruitment into UK general practice specialty training.

PubMed

Irish, Bill; Lake, Jonathan

2011-01-01

All applicants to round 1 of national recruitment into the general practice specialty recruitment process were surveyed as to the reasons for, and the timing of their career choices. Most applicants reported decision making after completing undergraduate training citing variety, continuity of care and work-life balance as their main drivers for a career in general practice. Applicants were statistically more likely to have undertaken a Foundation placement in general practice than their peers on a Foundation programme. Reasons for choice of deanery were largely related to location and social ties, rather than to the educational 'reputation' of its programmes.

Selecting, training and assessing new general practice community teachers in UK medical schools.

PubMed

Hydes, Ciaran; Ajjawi, Rola

2015-09-01

Standards for undergraduate medical education in the UK, published in Tomorrow's Doctors, include the criterion 'everyone involved in educating medical students will be appropriately selected, trained, supported and appraised'. To establish how new general practice (GP) community teachers of medical students are selected, initially trained and assessed by UK medical schools and establish the extent to which Tomorrow's Doctors standards are being met. A mixed-methods study with questionnaire data collected from 24 lead GPs at UK medical schools, 23 new GP teachers from two medical schools plus a semi-structured telephone interview with two GP leads. Quantitative data were analysed descriptively and qualitative data were analysed informed by framework analysis. GP teachers' selection is non-standardised. One hundred per cent of GP leads provide initial training courses for new GP teachers; 50% are mandatory. The content and length of courses varies. All GP leads use student feedback to assess teaching, but other required methods (peer review and patient feedback) are not universally used. To meet General Medical Council standards, medical schools need to include equality and diversity in initial training and use more than one method to assess new GP teachers. Wider debate about the selection, training and assessment of new GP teachers is needed to agree minimum standards.

Annual Review of Competence Progression (ARCP) performance of doctors who passed Professional and Linguistic Assessments Board (PLAB) tests compared with UK medical graduates: national data linkage study

PubMed Central

Illing, Jan; Kasim, Adetayo S; McLachlan, John C

2014-01-01

Objective To determine whether use of the Professional and Linguistic Assessments Board (PLAB) examination system used to grant registration for international medical graduates results in equivalent postgraduate medical performance, as evaluated at Annual Review of Competence Progression (ARCP), between UK based doctors who qualified overseas and those who obtained their primary medical qualification from UK universities. Design Observational study linking ARCP outcome data from the UK deaneries with PLAB test performance and demographic data held by the UK General Medical Council (GMC). Setting Doctors in postgraduate training for a medical specialty or general practice in the UK and doctors obtaining GMC registration via the PLAB system. Participants 53 436 UK based trainee doctors with at least one competency related ARCP outcome reported during the study period, of whom 42 017 were UK medical graduates and 11 419 were international medical graduates who were registered following a pass from the PLAB route. Main outcome measure Probability of obtaining a poorer versus a more satisfactory category of outcome at ARCP following successful registration as a doctor in the UK. Results International medical graduates were more likely to obtain a less satisfactory outcome at ARCP compared with UK graduates. This finding persisted even after adjustment for the potential influence of sex, age, years of UK based practice, and ethnicity and exclusion of outcomes associated with postgraduate examination failure (odds ratio 1.63, 95% confidence interval 1.30 to 2.06). However, international medical graduates who scored in the highest twelfth at part 1 of the PLAB (at least 32 points above the pass mark) had ARCP outcomes that did not differ significantly from those of UK graduates. Conclusions These findings suggest that the PLAB test used for registration of international medical graduates is not generally equivalent to the requirements for UK graduates. The differences in postgraduate performance, as captured at ARCP, following the two routes to registration might be levelled out by raising the standards of English language competency required as well as the pass marks for the two parts of the PLAB test. An alternative might be to introduce a different testing system. PMID:24742539

Post-marketing studies: the work of the Drug Safety Research Unit.

PubMed

Mackay, F J

1998-11-01

The Drug Safety Research Unit (DSRU) is the centre for prescription-event monitoring (PEM) in England. PEM studies are noninterventional observational cohort studies which monitor the safety of newly marketed drugs. The need for post-marketing surveillance is well recognised in the UK and general practice is an ideal source of data. PEM studies are general practitioner (community)-based and exposure is based on dispensed prescription data in England. To date, 65 PEM studies have been completed with a mean cohort size of 10 979 patients and the DSRU database has clinical information on over 700000 patients prescribed new drugs. Unlike spontaneous reporting schemes, PEM produces incidence rates for events reported during treatment. Comparative studies can be conducted for drugs in the same class. The DSRU aggregates outcome data for pregnancies exposed to new drugs. Data for children and the elderly can also be specifically examined. PEM data have a number of advantages over data from computerised general practice databases in the UK. PEM is the only technique within the UK capable of monitoring newly marketed drugs in such a comprehensive and systematic way.

Understanding general practice: a conceptual framework developed from case studies in the UK NHS

PubMed Central

Checkland, Kath

2007-01-01

Background General practice in the UK is undergoing a period of rapid and profound change. Traditionally, research into the effects of change on general practice has tended to regard GPs as individuals or as members of a professional group. To understand the impact of change, general practices should also be considered as organisations. Aim To use the organisational studies literature to build a conceptual framework of general practice organisations, and to test and develop this empirically using case studies of change in practice. This study used the implementation of National Service Frameworks (NSFs) and the new General Medical Services (GMS) contract as incidents of change. Design of study In-depth, qualitative case studies. The design was iterative: each case study was followed by a review of the theoretical ideas. The final conceptual framework was the result of the dynamic interplay between theory and empirical evidence. Setting Five general practices in England, selected using purposeful sampling. Method Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Results A conceptual framework was developed that can be used to understand how and why practices respond to change. This framework enabled understanding of observed reactions to the introduction of NSFs and the new GMS contract. Important factors for generating responses to change included the story that the practice members told about their practice, beliefs about what counted as legitimate work, the role played by the manager, and previous experiences of change. Conclusion Viewing general practices as small organisations has generated insights into factors that influence responses to change. Change tends to occur from the bottom up and is determined by beliefs about organisational reality. The conceptual framework suggests some questions that can be asked of practices to explain this internal reality. PMID:17244426

The UK Quality and Outcomes Framework pay-for-performance scheme and spirometry: rewarding quality or just quantity? A cross-sectional study in Rotherham, UK

PubMed Central

Strong, Mark; South, Gail; Carlisle, Robin

2009-01-01

Background Accurate spirometry is important in the management of COPD. The UK Quality and Outcomes Framework pay-for-performance scheme for general practitioners includes spirometry related indicators within its COPD domain. It is not known whether high achievement against QOF spirometry indicators is associated with spirometry to BTS standards. Methods Data were obtained from the records of 3,217 patients randomly sampled from 5,649 patients with COPD in 38 general practices in Rotherham, UK. Severity of airflow obstruction was categorised by FEV1 (% predicted) according to NICE guidelines. This was compared with clinician recorded COPD severity. The proportion of patients whose spirometry met BTS standards was calculated in each practice using a random sub-sample of 761 patients. The Spearman rank correlation between practice level QOF spirometry achievement and performance against BTS spirometry standards was calculated. Results Spirometry as assessed by clinical records was to BTS standards in 31% of cases (range at practice level 0% to 74%). The categorisation of airflow obstruction according to the most recent spirometry results did not agree well with the clinical categorisation of COPD recorded in the notes (Cohen's kappa = 0.34, 0.30 – 0.38). 12% of patients on COPD registers had FEV1 (% predicted) results recorded that did not support the diagnosis of COPD. There was no association between quality, as measured by adherence to BTS spirometry standards, and either QOF COPD9 achievement (Spearman's rho = -0.11), or QOF COPD10 achievement (rho = 0.01). Conclusion The UK Quality and Outcomes Framework currently assesses the quantity, but not the quality of spirometry. PMID:19558719

The UK Quality and Outcomes Framework pay-for-performance scheme and spirometry: rewarding quality or just quantity? A cross-sectional study in Rotherham, UK.

PubMed

Strong, Mark; South, Gail; Carlisle, Robin

2009-06-28

Accurate spirometry is important in the management of COPD. The UK Quality and Outcomes Framework pay-for-performance scheme for general practitioners includes spirometry related indicators within its COPD domain. It is not known whether high achievement against QOF spirometry indicators is associated with spirometry to BTS standards. Data were obtained from the records of 3,217 patients randomly sampled from 5,649 patients with COPD in 38 general practices in Rotherham, UK. Severity of airflow obstruction was categorised by FEV1 (% predicted) according to NICE guidelines. This was compared with clinician recorded COPD severity. The proportion of patients whose spirometry met BTS standards was calculated in each practice using a random sub-sample of 761 patients. The Spearman rank correlation between practice level QOF spirometry achievement and performance against BTS spirometry standards was calculated. Spirometry as assessed by clinical records was to BTS standards in 31% of cases (range at practice level 0% to 74%). The categorisation of airflow obstruction according to the most recent spirometry results did not agree well with the clinical categorisation of COPD recorded in the notes (Cohen's kappa = 0.34, 0.30 - 0.38). 12% of patients on COPD registers had FEV1 (% predicted) results recorded that did not support the diagnosis of COPD. There was no association between quality, as measured by adherence to BTS spirometry standards, and either QOF COPD9 achievement (Spearman's rho = -0.11), or QOF COPD10 achievement (rho = 0.01). The UK Quality and Outcomes Framework currently assesses the quantity, but not the quality of spirometry.

GPs’ job satisfaction: doctors who chose general practice early or late

PubMed Central

Lambert, Trevor; Smith, Fay; Goldacre, Michael

2013-01-01

Background In the UK many practising GPs did not choose general practice as their first choice of career when they originally graduated as doctors. Aim To compare job satisfaction of GPs who chose general practice early or later in their career. Design and setting Questionnaires were sent to all UK-trained doctors who graduated in selected years between 1993 and 2000. Method Questionnaires were sent to the doctors 1, 3, 7 and 10 years after graduation. Results Of all 3082 responders working in general practice in years 7 and 10, 38% had first specified general practice as their preferred career when responding 1 year after graduation, 19% by year 3, 21% by year 5, and 22% after year 5. Job satisfaction was high and, generally, there was little difference between the first three groups (although, when different, the most positive responses were from the earliest choosers); but there were slightly lower levels of job satisfaction in the ‘more than 5 years’ group. For example, in response to the statement ‘I find enjoyment in my current post’, the percentages agreeing in the four groups, respectively, were 91.5%, 91.1%, 91.0% and 88.2%. In response to ‘I am doing interesting and challenging work’ the respective percentages were 90.2%, 88.0%, 86.6% and 82.6%. Conclusions Job satisfaction levels were generally high among the late choosers as well as the early choosers. On this evidence, most doctors who turn to general practice, after preferring another specialty in their early career, are likely to have a satisfying career. PMID:24267855

Developing a preliminary 'never event' list for general practice using consensus-building methods.

PubMed

de Wet, Carl; O'Donnell, Catherine; Bowie, Paul

2014-03-01

The 'never event' concept has been implemented in many acute hospital settings to help prevent serious patient safety incidents. Benefits include increasing awareness of highly important patient safety risks among the healthcare workforce, promoting proactive implementation of preventive measures, and facilitating incident reporting. To develop a preliminary list of never events for general practice. Application of a range of consensus-building methods in Scottish and UK general practices. A total of 345 general practice team members suggested potential never events. Next, 'informed' staff (n =15) developed criteria for defining never events and applied the criteria to create a list of candidate never events. Finally, UK primary care patient safety 'experts' (n = 17) reviewed, refined, and validated a preliminary list via a modified Delphi group and by completing a content validity index exercise. There were 721 written suggestions received as potential never events. Thematic categorisation reduced this to 38. Five criteria specific to general practice were developed and applied to produce 11 candidate never events. The expert group endorsed a preliminary list of 10 items with a content validity index (CVI) score of >80%. A preliminary list of never events was developed for general practice through practitioner experience and consensus-building methods. This is an important first step to determine the potential value of the never event concept in this setting. It is now intended to undertake further testing of this preliminary list to assess its acceptability, feasibility, and potential usefulness as a safety improvement intervention.

Exploring the relationship between general practice characteristics, and attendance at walk-in centres, minor injuries units and EDs in England 2012/2013: a cross-sectional study.

PubMed

Tammes, Peter; Morris, Richard W; Brangan, Emer; Checkland, Kath; England, Helen; Huntley, Alyson; Lasserson, Daniel; MacKichan, Fiona; Salisbury, Chris; Wye, Lesley; Purdy, Sarah

2016-10-01

For several years, EDs in the UK NHS have faced considerable increases in attendance rates. Walk-in centres (WiCs) and minor injuries units (MIUs) have been suggested as solutions. We aimed to investigate the associations between practice and practice population characteristics with ED attendance rates or combined ED/WiC/MIU attendance, and the associations between WiC/MIU and ED attendance. We used general practice-level data including 7462 English practices in 2012/2013 and present adjusted regression coefficients from linear multivariable analysis for relationships between patients' emergency attendance rates and practice characteristics. Every percentage-point increase in patients reporting inability to make an appointment was associated with an increase in emergency attendance by 0.36 (95% CI 0.06 to 0.66) per 1000 population. Percentage-point increases in patients unable to speak to a general practitioner (GP)/nurse within two workdays and patients able to speak often to their preferred GP were associated with increased emergency attendance/1000 population by 0.23 (95% CI 0.05 to 0.42) and 0.10 (95% CI 0.00 to 0.19), respectively. Practices in areas encompassing several towns (conurbations) had higher attendance than rural practices, as did practices with more non-UK-qualified GPs. Practice population characteristics associated with increased emergency attendance included higher unemployment rates, higher percentage of UK whites and lower male life expectancy, which showed stronger associations than practice characteristics. Furthermore, higher MIU or WiC attendance rates were associated with lower ED attendance rates. Improving availability of appointments and opportunities to speak a GP/nurse at short notice might reduce ED attendance. Establishing MIUs and WiCs might also reduce ED attendance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

"Cascades, Torrents & Drowning" in Information: Seeking Help in the Contemporary General Practitioner Practice in the UK

ERIC Educational Resources Information Center

Holley, Debbie; Santos, Patricia; Cook, John; Kerr, Micky

2016-01-01

This paper responds to the Alpine Rendez-Vous "crisis" in technology-enhanced learning. It takes a contested area of policy as well as a rapid change in the National Health Service, and documents the responses to "information overload" by a group of general practitioners practices in the North of England. Located between the…

System hazards in managing laboratory test requests and results in primary care: medical protection database analysis and conceptual model.

PubMed

Bowie, Paul; Price, Julie; Hepworth, Neil; Dinwoodie, Mark; McKay, John

2015-11-27

To analyse a medical protection organisation's database to identify hazards related to general practice systems for ordering laboratory tests, managing test results and communicating test result outcomes to patients. To integrate these data with other published evidence sources to inform design of a systems-based conceptual model of related hazards. A retrospective database analysis. General practices in the UK and Ireland. 778 UK and Ireland general practices participating in a medical protection organisation's clinical risk self-assessment (CRSA) programme from January 2008 to December 2014. Proportion of practices with system risks; categorisation of identified hazards; most frequently occurring hazards; development of a conceptual model of hazards; and potential impacts on health, well-being and organisational performance. CRSA visits were undertaken to 778 UK and Ireland general practices of which a range of systems hazards were recorded across the laboratory test ordering and results management systems in 647 practices (83.2%). A total of 45 discrete hazard categories were identified with a mean of 3.6 per practice (SD=1.94). The most frequently occurring hazard was the inadequate process for matching test requests and results received (n=350, 54.1%). Of the 1604 instances where hazards were recorded, the most frequent was at the 'postanalytical test stage' (n=702, 43.8%), followed closely by 'communication outcomes issues' (n=628, 39.1%). Based on arguably the largest data set currently available on the subject matter, our study findings shed new light on the scale and nature of hazards related to test results handling systems, which can inform future efforts to research and improve the design and reliability of these systems. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Experiences of using email for general practice consultations: a qualitative study.

PubMed

Atherton, Helen; Pappas, Yannis; Heneghan, Carl; Murray, Elizabeth

2013-11-01

Reports suggest approximately 21-23% of GPs in the UK have consulted with patients using email, but little is known about the nature of this use and what it means for clinicians and patients in general practice. To understand the use of email consultation in general practice by investigating the experiences of existing users and views of experts. A qualitative study conducted in 2010 using purposive sampling and semi-structured interviews in general practice and community settings in some London boroughs. A maximum variation sample of GPs and patients who had used email for consultation in general practice were recruited, as were policy and/or implementation experts. Interviews continued until saturation was achieved. In total 10 GPs, 14 patients, and six experts were interviewed. Consultation by email was often triggered by logistic or practical issues; motivators for ongoing use were the benefits, such as convenience, for GPs and patients. Both GPs and patients reported concerns about safety and lack of guidance about the 'rules of engagement' in email consultations, with GPs also concerned about workload. In response, both groups attempted to introduce their own rules, although this only went some way to addressing uncertainty. Long term, participants felt there was a need for regulation and guidance. Consultations by email in general practice occur in an unregulated and unstructured way. Current UK policy is to promote consultations by email, making it crucial to consider the responsibility and workload faced by clinicians, and the changes required to ensure safe use; not doing so may risk safety breaches and result in suboptimal care for patients.

Clinical examination & record-keeping: Part 2: History taking.

PubMed

Hadden, A M

2017-12-15

This article is the second part of a BDJ series of Practice papers on the subject of clinical examination and related record keeping. The series is taken from the Faculty of General Dental Practice UK (FGDP[UK]) 2016 Good Practice Guidelines book on this topic, edited by A. M. Hadden. This particular article discusses history taking, where information may be gathered prior to the patient seeing the clinician or, in some cases, this may be carried out chairside by the individual. The information gathered can include a medical history, socio-behavioural history, and patient anxiety levels. It is important to note that throughout this article (and the BDJ series and associated FGDP[UK] book), the specific guidelines will be marked as follows: A: Aspirational, B: Basic, C: Conditional. Further information about this guideline notation system is provided in Part 1 of this series ( 2017; 223: 765-768).

Advance directives in the UK: legal, ethical, and practical considerations for doctors.

PubMed

Kessel, A S; Meran, J

1998-05-01

In the United Kingdom (UK), advance directives have recently received considerable attention from professional and voluntary organizations as well as medical journals and the media. However, despite such exposure, many doctors remain uncertain of the importance or relevance of advance directives with regard to their own clinical practice. This paper addresses these uncertainties by first explaining what advance directives are and then describing the current legal status of such directives in the UK. Examination of the cases underpinning this status reveals several key elements: competence, information, anticipation, applicability, and freedom from duress. Each is discussed. Although this paper focuses on legal issues, it is important that medical law does not dominate medical ethics. Accordingly, the paper also discusses some important philosophical and sociological considerations that have remained largely unexplored in the medical press. Finally, the paper deals with practical matters, including how the general practitioner might be involved.

Current management practices and interventions prioritised as part of a nationwide mastitis control plan

PubMed Central

Bradley, A. J.; Breen, J. E.; Hudson, C. D.; Green, M. J.

2016-01-01

The objectives of this study were to report performance and management data taken from a sample of UK dairy farms that have participated in the Agriculture and Horticulture Development Board Dairy Mastitis Control Plan (DMCP) and to identify important mastitis prevention practices that are not currently widely implemented. A total of 234 UK dairy herds were included in the study from which farm management and udder health data were collected. Herds were grouped according to their mastitis epidemiology and could be classed as (i) environmental dry period (EDP) (i.e. environmental pathogen with majority of infections being acquired during the dry period), (ii) environmental lactation (EL), (iii) contagious dry period (CDP) or (iv) contagious lactation (CL). The results of this study showed that many mastitis-related management practices that are generally considered to be important were not widely performed. A better understanding of those practices not widely adopted by UK dairy farmers at present may aid practitioners in identifying and overcoming potential barriers to improved mastitis control. PMID:26966249

Developing a preliminary ‘never event’ list for general practice using consensus-building methods

PubMed Central

de Wet, Carl; O’Donnell, Catherine; Bowie, Paul

2014-01-01

Background The ‘never event’ concept has been implemented in many acute hospital settings to help prevent serious patient safety incidents. Benefits include increasing awareness of highly important patient safety risks among the healthcare workforce, promoting proactive implementation of preventive measures, and facilitating incident reporting. Aim To develop a preliminary list of never events for general practice. Design and setting Application of a range of consensus-building methods in Scottish and UK general practices. Method A total of 345 general practice team members suggested potential never events. Next, ‘informed’ staff (n =15) developed criteria for defining never events and applied the criteria to create a list of candidate never events. Finally, UK primary care patient safety ‘experts’ (n = 17) reviewed, refined, and validated a preliminary list via a modified Delphi group and by completing a content validity index exercise. Results There were 721 written suggestions received as potential never events. Thematic categorisation reduced this to 38. Five criteria specific to general practice were developed and applied to produce 11 candidate never events. The expert group endorsed a preliminary list of 10 items with a content validity index (CVI) score of >80%. Conclusion A preliminary list of never events was developed for general practice through practitioner experience and consensus-building methods. This is an important first step to determine the potential value of the never event concept in this setting. It is now intended to undertake further testing of this preliminary list to assess its acceptability, feasibility, and potential usefulness as a safety improvement intervention. PMID:24567655

Dentists' perceptions of trends in restorative dentistry in the UK.

PubMed

Randall, Ros C; Vrijhoef, Matthijs M A; Wilson, Nairn H F

2003-04-01

To obtain responses to a questionnaire on likely trends in the clinical practice of restorative dentistry from a national sample of general dental practitioners (GDPs) who were principals of group practices in the UK. A panel of nine experts had been convened previously to define areas of trends in restorative dentistry in the UK and to formulate these into statements. Twenty trends were identified and framed into a 22-item questionnaire based on the trend statements. The questionnaire was sent to a national sample of 2800 principal dentists in group practices. Names of principal dentists were taken from the Yellow Pages directories, a group practice being defined as at least one principal dentist and one other practitioner. Levels of agreement for questionnaire scores of > or = 70% for all segments of a statement were taken as indicating a possible trend. Of the 2800 questionnaires sent out, 1448 were returned, a return rate of 52%. Of these, 1217 questionnaires were usable, an overall response rate of 44%. Good agreement was obtained for 14 statements (64%). The 14 trend statements that scored a level of good agreement were taken as indicating possible trends in dentistry in the UK as perceived by those GDPs who responded to the questionnaire. However, in view of the fact that the 1217 usable questionnaires received reflected the opinions of 10% of the principal dentists in group practice in the UK, this will not be representative of all principal dentists in practice. Nevertheless for the purposes of gaining some insight into trends in restorative dentistry, it could be considered to be of value.

New graduate nurses as knowledge brokers in general practice in New Zealand: a constructivist grounded theory.

PubMed

Hoare, Karen J; Mills, Jane; Francis, Karen

2013-07-01

Practice nursing in New Zealand is not well described in the literature. One survey illustrated that most of the New Zealand practice nurses sampled did not know of the country's two premier evidence-based health websites. A recent review compared general practice in the UK, New Zealand and Australia and found that whereas there had been significant developments in empowering the practice nurse workforce to run nurse-led clinics in the UK, New Zealand and Australia lagged behind. The aim of this reported constructivist grounded theory study was to investigate practice nurses' use of information. Conducted in Auckland, New Zealand, data were collected through ethnographic techniques in one general practice between September 2009 and January 2010 to enhance theoretical sensitivity to the area of information use. Subsequently, six experienced practice nurses (one twice after moving jobs) and five new graduate nurses from five different general practices were interviewed, using open-ended questions, between January 2010 and August 2011. Concurrent data collection and analysis occurred throughout the study period. The use of memos, the constant comparative method, data categorisation and finally, data abstraction resulted in the final theory of reciprocal role modelling. Experienced practice nurses role modelled clinical skills to new graduate nurses. Unexpectedly, new graduate nurses were unconscious experts at sourcing information and role modelled this skill to experienced practice nurses. Once this attribute was acknowledged by the experienced practice nurse, mutual learning occurred that enabled both groups of nurses to become better practitioners. Graduate nurses of the millennial generation were identified as a resource for experienced practice nurses who belong to the baby boomer generation and generation X. © 2013 John Wiley & Sons Ltd.

A survey of current and anticipated use of standard and specialist equipment by UK optometrists.

PubMed

Dabasia, Priya L; Edgar, David F; Garway-Heath, David F; Lawrenson, John G

2014-09-01

To investigate current and anticipated use of equipment and information technology (IT) in community optometric practice in the UK, and to elicit optometrists' views on adoption of specialist equipment and IT. An anonymous online questionnaire was developed, covering use of standard and specialist diagnostic equipment, and IT. The survey was distributed to a random sample of 1300 UK College of Optometrists members. Four hundred and thirty-two responses were received (response rate = 35%). Enhanced (locally commissioned) or additional/separately contracted services were provided by 73% of respondents. Services included glaucoma repeat measures (30% of respondents), glaucoma referral refinement (22%), fast-track referral for wet age-related macular degeneration (48%), and direct cataract referral (40%). Most respondents (88%) reported using non-contact/pneumo tonometry for intra-ocular pressure measurement, with 81% using Goldmann or Perkins tonometry. The most widely used item of specialist equipment was the fundus camera (74% of respondents). Optical Coherence Tomography (OCT) was used by 15% of respondents, up from 2% in 2007. Notably, 43% of those anticipating purchasing specialist equipment in the next 12 months planned to buy an OCT. 'Paperless' records were used by 39% of respondents, and almost 80% of practices used an electronic patient record/practice management system. Variations in responses between parts of the UK reflect differences in the provision of the General Ophthalmic Services contract or community enhanced services. There was general agreement that specialised equipment enhances clinical care, permits increased involvement in enhanced services, promotes the practice and can be used as a defence in clinico-legal cases, but initial costs and ongoing maintenance can be a financial burden. Respondents generally agreed that IT facilitates administrative flow and secure exchange of health information, and promotes a state-of-the-art practice image. However, use of IT may not save examination time; its dynamic nature necessitates frequent updates and technical support; the need for adequate training is an issue; and security of data is also a concern. UK optometrists increasingly employ modern equipment and IT services to enhance patient care and for practice management. While the clinical benefits of specialist equipment and IT are appreciated, questions remain as to whether the investment is cost-effective, and how specialist equipment and IT may be used to best advantage in community optometric practice. © 2014 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.

Case study of an anxious child with extensive caries treated in general dental practice: financial viability under the terms of the UK National Health Service.

PubMed

Shelley, A; Mackie, I

2001-10-01

This case study describes the management of Callum, an anxious 7-year-old boy with extensive caries. Callum's dental care was carried out in a general dental practice in the North of England under the terms of the National Health Service. A preventive programme was carried out in conjunction with the restorative philosophy according to guidelines published by the Dental Practice Board in 1997.

The Health Improvement Network (THIN)

Cancer.gov

The Health Improvement Network is a collaboration between Cegedim Strategic Data EPIC, an expert in the provision of UK primary care patient data that is used for medical research, and In Practice Systems (InPS), who continue to develop and supply the widely-used Vision general practice computer system.

Relationship between quality of care and choice of clinical computing system: retrospective analysis of family practice performance under the UK's quality and outcomes framework.

PubMed

Kontopantelis, Evangelos; Buchan, Iain; Reeves, David; Checkland, Kath; Doran, Tim

2013-08-02

To investigate the relationship between performance on the UK Quality and Outcomes Framework pay-for-performance scheme and choice of clinical computer system. Retrospective longitudinal study. Data for 2007-2008 to 2010-2011, extracted from the clinical computer systems of general practices in England. All English practices participating in the pay-for-performance scheme: average 8257 each year, covering over 99% of the English population registered with a general practice. Levels of achievement on 62 quality-of-care indicators, measured as: reported achievement (levels of care after excluding inappropriate patients); population achievement (levels of care for all patients with the relevant condition) and percentage of available quality points attained. Multilevel mixed effects multiple linear regression models were used to identify population, practice and clinical computing system predictors of achievement. Seven clinical computer systems were consistently active in the study period, collectively holding approximately 99% of the market share. Of all population and practice characteristics assessed, choice of clinical computing system was the strongest predictor of performance across all three outcome measures. Differences between systems were greatest for intermediate outcomes indicators (eg, control of cholesterol levels). Under the UK's pay-for-performance scheme, differences in practice performance were associated with the choice of clinical computing system. This raises the question of whether particular system characteristics facilitate higher quality of care, better data recording or both. Inconsistencies across systems need to be understood and addressed, and researchers need to be cautious when generalising findings from samples of providers using a single computing system.

Experiences of using email for general practice consultations: a qualitative study

PubMed Central

Atherton, Helen; Pappas, Yannis; Heneghan, Carl; Murray, Elizabeth

2013-01-01

Background Reports suggest approximately 21–23% of GPs in the UK have consulted with patients using email, but little is known about the nature of this use and what it means for clinicians and patients in general practice. Aim To understand the use of email consultation in general practice by investigating the experiences of existing users and views of experts. Design and setting A qualitative study conducted in 2010 using purposive sampling and semi-structured interviews in general practice and community settings in some London boroughs. Method A maximum variation sample of GPs and patients who had used email for consultation in general practice were recruited, as were policy and/or implementation experts. Interviews continued until saturation was achieved. Results In total 10 GPs, 14 patients, and six experts were interviewed. Consultation by email was often triggered by logistic or practical issues; motivators for ongoing use were the benefits, such as convenience, for GPs and patients. Both GPs and patients reported concerns about safety and lack of guidance about the ‘rules of engagement’ in email consultations, with GPs also concerned about workload. In response, both groups attempted to introduce their own rules, although this only went some way to addressing uncertainty. Long term, participants felt there was a need for regulation and guidance. Conclusion Consultations by email in general practice occur in an unregulated and unstructured way. Current UK policy is to promote consultations by email, making it crucial to consider the responsibility and workload faced by clinicians, and the changes required to ensure safe use; not doing so may risk safety breaches and result in suboptimal care for patients. PMID:24267859

Relative professional roles in antenatal care: results of a survey in Scottish rural general practice.

PubMed

Farmer, Jane; Stimpson, Paul; Tucker, Janet

2003-11-01

There is evidence of variation and some ambiguity about self-perceived relative professional roles in antenatal care in the UK. There is little information about models of antenatal care provision in UK rural areas. In rural areas, in particular, women have limited choice in accessing health care professionals or alternative primary care delivery settings. In the light of a recent review of Scottish maternity services, it is important and timely to examine models of care and interprofessional working in antenatal care in rural areas. This study explores midwives' and GPs' perceptions about their relative professional roles in remote and rural general practice in Scotland. A questionnaire survey involving all 174 Scottish remote and rural general practices (using one definition of rurality) was conducted, followed by 20 interviews. At least one professional returned a completed questionnaire from 91% of rural practices. A number of areas of dissonance were noted between GPs' and midwives' perceptions of their roles in maternity care and, given the context of service provision, these may impact upon rural patients. Findings are relevant to wider debates on extending the primary care team and strengthening inter-disciplinary working, particularly in rural areas.

The impact of patient record access on appointments and telephone calls in two English general practices: a population-based study

PubMed Central

Fitton, Caroline; Fitton, Richard; Hannan, Amir; Morgan, Lawrie; Halsall, David

2014-01-01

Background Government policy expects all patients who wish to have online record access (RA) by 2015. We currently have no knowledge of the impact of patient record access on practice workload. Setting Two urban general practices in Manchester. Question What is the impact of patient RA on telephone calls and appointments in UK general practice? Method We asked patients in two urban general practices who used RA whether it had increased or decreased their use of the practice over the previous year. Using practice data, we calculated the change in appointments, telephone calls and staff cost. We also estimated the reduction in environmental costs and patient time. Results An average of 187 clinical appointments (of which 87 were with doctors and 45 with nurses) and 290 telephone calls were saved. If 30% of patients used RA at least twice a year, these figures suggest that a 10 000-patient practice would save 4747 appointments and 8020 telephone calls per year. Assuming a consultation rate of 5.3% annually, that equates to a release of about 11% of appointments per year, with significant resource savings for patients and the environment. Discussion This is the first such study in the UK. It shows similar results to a study in the USA. We discuss the study limitations, including the issue of patient recall, nature of the practices studied and nature of early adopter patients. Strengths include combining national data, practice data and local reflection. We are confident that the savings observed are the result of RA rather than other factors. We suggest that RA can be part of continuous practice improvement, given its benefits and the support it offers for patient confidence, self-care and shared decision-making. PMID:25949705

Prescription rates of adrenaline auto-injectors for children in UK general practice: a retrospective cohort study.

PubMed

Diwakar, Lavanya; Cummins, Carole; Ryan, Ronan; Marshall, Tom; Roberts, Tracy

2017-04-01

Adrenaline auto-injectors (AAI) should be provided to individuals considered to be at high risk of anaphylaxis. There is some evidence that the rate of AAI prescription is increasing, but the true extent has not been previously quantified. To estimate the trends in annual GP-issued prescriptions for AAI among UK children between 2000 and 2012. Retrospective cohort study using data from primary care practices that contributed to The Health Improvement Network (THIN) database. Children and young people aged between 0-17 years of age with a prescription for AAIs were identified, and annual AAI device prescription rates were estimated using Stata (version 12). A total of 1.06 million UK children were identified, providing 5.1 million person years of follow-up data. Overall, 23 837 children were deemed high risk by their GPs, and were prescribed 98 737 AAI devices. This equates to 4.67 children (95% confidence interval [CI] = 4.66 to 4.69), and 19.4 (95% CI = 19.2 to 19.5) devices per 1000 person years. Between 2000 and 2012, there has been a 355% increase in the number of children prescribed devices, and a 506% increase in the total number of AAI devices prescribed per 1000 person years in the UK. The number of devices issued per high-risk child during this period has also increased by 33%. The number of children being prescribed AAI devices and the number of devices being prescribed in UK primary care between 2000 and 2012 has significantly increased. A discussion to promote rational prescribing of AAIs in the NHS is needed. © British Journal of General Practice 2017.

Transition to independent practice: a national enquiry into the educational support for newly qualified GPs.

PubMed

Griffin, Ann; Abouharb, Tareq; Etherington, Clare; Bandura, Induja

2010-09-01

The nature of the work that NQGPs are undertaking in their transition to independent practice is changing; current training may not fully prepare them for this new peripatetic role, as indicated by rising numbers of reports of poor performance in this group. Educational support at the time of transition from general practitioner (GP) training to independent practice had previously demonstrated benefits, but many formal schemes have finished. This study aimed to map out the current provision of educational support provided by the UK deaneries for NQGPs and to explore NQGPs' perceptions of the present transition from registrar to independent practitioner. Questionnaire surveys of deanery provision and semi-structured telephone interviews of a purposeful sample of newly qualified GPs across the UK. Interviews were thematically analysed. Deanery provision of educational support to NQGPs varies across the UK. Telephone interviews highlighted the transformation as problematic; NQGPs perceived that independent practice was substantially different from being in a training post - locum work, isolation and accessing educational opportunities were concerns. NQGPs frequently expressed a desire for more formalised relationships with mentors, senior colleagues or peer groups, to support their shift. As NQGPs increasingly find themselves working as locums, lacking the opportunity for stable work-based relationships, and with an increase in medical errors being reported in this group of doctors, it is suggested that there is a need to reconsider the educational support required to facilitate the transition in the early years of independent general practice.

Prostate-specific antigen (PSA) testing of men in UK general practice: a 10-year longitudinal cohort study

PubMed Central

Young, Grace J; Harrison, Sean; Turner, Emma L; Walsh, Eleanor I; Oliver, Steven E; Ben-Shlomo, Yoav; Evans, Simon; Lane, J Athene; Neal, David E; Hamdy, Freddie C; Donovan, Jenny L; Martin, Richard M; Metcalfe, Chris

2017-01-01

Objectives Cross-sectional studies suggest that around 6% of men undergo prostate-specific antigen (PSA) testing each year in UK general practice (GP). This longitudinal study aims to determine the cumulative testing pattern of men over a 10-year period and whether this testing can be considered equivalent to screening for prostate cancer (PCa). Setting, participants and outcome measures Patient-level data on PSA tests, biopsies and PCa diagnoses were obtained from the UK Clinical Practice Research Datalink (CPRD) for the years 2002 to 2011. The cumulative risks of PSA testing and of being diagnosed with PCa were estimated for the 10-year study period. Associations of a man’s age, region and index of multiple deprivation with the cumulative risk of PSA testing and PCa diagnosis were investigated. Rates of biopsy and diagnosis, following a high test result, were compared with those from the programme of PSA testing in the Prostate Testing for Cancer and Treatment (ProtecT) study. Results The 10-year risk of exposure to at least one PSA test in men aged 45 to 69 years in UK GP was 39.2% (95% CI 39.0 to 39.4%). The age-specific risks ranged from 25.2% for men aged 45–49 years to 53.0% for men aged 65–69 years (p for trend <0.001). For those with a PSA level ≥3, a test in UK GP was less likely to result in a biopsy (6%) and/or diagnosis of PCa (15%) compared with ProtecT study participants (85% and 34%, respectively). Conclusion A high proportion of men aged 45–69 years undergo PSA tests in UK GP: 39% over a 10-year period. A high proportion of these tests appear to be for the investigation of lower urinary tract symptoms and not screening for PCa. Trial registration number ISRCTN20141297, NCT02044172. PMID:29084797

Predictors of Treatment with Duloxetine or Venlafaxine XR among Adult Patients Treated for Depression in Primary Care Practices in the United Kingdom

PubMed Central

Shi, Nianwen; Durden, Emily; Torres, Amelito; Cao, Zhun; Happich, Michael

2012-01-01

Background. Knowledge about real-world use of duloxetine and venlafaxine XR to treat depression in the UK is limited. Aims. To identify predictors of duloxetine or venlafaxine XR initiation. Method. Adult depressed patients who initiated duloxetine or venlafaxine XR between January 1, 2006 and September 30, 2007 were identified in the UK's General Practice Research Database. Demographic and clinical predictors of treatment initiation with duloxetine and venlafaxine XR were identified using logistic regression. Results. Patients initiating duloxetine (n = 909) were 4 years older than venlafaxine XR recipients (n = 1286). Older age, preexisting unexplained pain, respiratory disease, and pre-period use of anticonvulsants, opioids, and antihyperlipidemics were associated with increased odds of initiating duloxetine compared to venlafaxine XR. Pre-period anxiety disorder was associated with decreased odds of receiving duloxetine. Conclusion. Initial treatment choice with duloxetine versus venlafaxine XR was primarily driven by patient-specific mental and medical health characteristics. General practitioners in the UK favor duloxetine over venlafaxine XR when pain conditions coexist with depression. PMID:22720149

Letter - Response to 'How to protect general practice from child protection'

PubMed

Lang, Danny

2011-08-18

The bad news is that the BJGP published under such a negative and provocative title without balanced debate, in contrast to the recent BMJ head-to-head debate 'Has child protection become a form of madness'.1,2 One interesting comparison made in that debate is that Sweden and Finland spend 50% more of their gross domestic product on children and families than we do in the UK, we spend 200% more than they do on social problems. In my view these figures help us understand societal attitudes that have knock-on effects through all services for children and families including general practice. The current UK GP contract is certainly not child and family friendly and it is unlikely that current NHS changes will improve matters.Mike Fitzpatrick's latest letter over-emphasises the personal while flagging up the real difficulties for general practice.3 My work as a frontline GP and my statutory role as a named doctor for safeguarding children allows me to understand these difficulties, and indeed the importance of making vulnerable adults safe that he highlights in the same Journal.4The good news is that the great majority of children grow up well and happy in their families and GP practices support them in this. I emphasise this when delivering safeguarding training to GPs. In doing this work GPs can develop a sense of why something is going wrong. With appropriate use of their knowledge, skills, and information, GPs can address the needs of children and their families across the spectrum of vulnerability and need through to abuse and neglect. There is no question that this is challenging, but in the UK all professionals are obliged by statute to fulfil our professional roles and responsibilities. Those specific to general practice are on pages 60-63 of Working Together to Safeguard Children 2012.5GP colleagues in Cornwall show appreciation of the importance of safeguarding, but many feel there is too much guidance and insufficient resources. The majority of the practices value the RCGP/NSPCC Toolkit for Safeguarding Adults and Young People, that being written for GPs by GPs helps practices establish policies and procedures on safeguarding which work.6 I commend the RCGP for grasping the safeguarding nettle, collaborating with the NSPCC to produce this toolkit, and including safeguarding as one of the ten priorities of the RCGP Child Health Strategy for 2012-15.7 Can the BJGP help the College bring this strategy forward? Up to 25% of our patients are children. They are the future of the UK.

Everyday ethics: learning from an ‘ordinary’ consultation in general practice

PubMed Central

2011-01-01

The author uses a constructed case to analyse some of the ethical decisions that UK general practitioners face in everyday settings. A variety of ethical frameworks and empirical primary healthcare literature are used to demonstrate how ethical tools may be used by clinicians in primary healthcare to reflect on their decisions in practice. The GP consultation context can make ‘on the spot’ ethical decisions difficult and varied. PMID:25949652

Relationship between quality of care and choice of clinical computing system: retrospective analysis of family practice performance under the UK's quality and outcomes framework

PubMed Central

Kontopantelis, Evangelos; Buchan, Iain; Reeves, David; Checkland, Kath; Doran, Tim

2013-01-01

Objectives To investigate the relationship between performance on the UK Quality and Outcomes Framework pay-for-performance scheme and choice of clinical computer system. Design Retrospective longitudinal study. Setting Data for 2007–2008 to 2010–2011, extracted from the clinical computer systems of general practices in England. Participants All English practices participating in the pay-for-performance scheme: average 8257 each year, covering over 99% of the English population registered with a general practice. Main outcome measures Levels of achievement on 62 quality-of-care indicators, measured as: reported achievement (levels of care after excluding inappropriate patients); population achievement (levels of care for all patients with the relevant condition) and percentage of available quality points attained. Multilevel mixed effects multiple linear regression models were used to identify population, practice and clinical computing system predictors of achievement. Results Seven clinical computer systems were consistently active in the study period, collectively holding approximately 99% of the market share. Of all population and practice characteristics assessed, choice of clinical computing system was the strongest predictor of performance across all three outcome measures. Differences between systems were greatest for intermediate outcomes indicators (eg, control of cholesterol levels). Conclusions Under the UK's pay-for-performance scheme, differences in practice performance were associated with the choice of clinical computing system. This raises the question of whether particular system characteristics facilitate higher quality of care, better data recording or both. Inconsistencies across systems need to be understood and addressed, and researchers need to be cautious when generalising findings from samples of providers using a single computing system. PMID:23913774

Provision of undergraduate otorhinolaryngology teaching within General Medical Council approved UK medical schools: what is current practice?

PubMed

Khan, M M; Saeed, S R

2012-04-01

Despite longstanding concern, provision of undergraduate ENT teaching has not improved in response to the aims of the UK General Medical Council's initiative Tomorrow's Doctors. Previous studies have demonstrated poor representation of ENT within the undergraduate curriculum. We aimed to identify current practice in order to establish undergraduate ENT experience across UK medical schools, a timely endeavour in light of the General Medical Council's new 2011-2013 education strategy. Questionnaires were sent to ENT consultants, medical school deans and students. All schools with a clinical curriculum were anonymously represented. Our outcome measures were the provision of mandatory or optional ENT placements, and their duration and content. A compulsory ENT placement was available to over half (53 per cent) of the students. Ten of the 26 participating schools did not offer an ENT attachment. The mean mandatory placement was 8 days. Overall, 38 per cent of students reported a satisfactory compulsory ENT placement. Most ENT consultants questioned considered that newly qualified doctors were not proficient in managing common ENT problems that did not require specialist referral. Little improvement in the provision of undergraduate ENT teaching was demonstrated. An increase in the proportion of students undertaking ENT training is necessary. Time and curriculum constraints on medical schools mean that optimisation of available resources is required.

The potential impact of Brexit and immigration policies on the GP workforce in England: a cross-sectional observational study of GP qualification region and the characteristics of the areas and population they served in September 2016.

PubMed

Esmail, Aneez; Panagioti, Maria; Kontopantelis, Evangelos

2017-11-16

The UK is dependent on international doctors, with a greater proportion of non-UK qualified doctors working in its universal health care system than in any other European country, except Ireland and Norway. The terms of the UK exit from the European Union can reduce the ability of European Economic Area (EEA) qualified doctors to work in the UK, while new visa requirements will significantly restrict the influx of non-EEA doctors. We aimed to explore the implications of policy restrictions on immigration, by regionally and spatially describing the characteristics of general practitioners (GPs) by region of medical qualification and the characteristics of the populations they serve. This is a cross-sectional study on 37,792 of 41,865 GPs in England, as of 30 September 2016. The study involved age, sex, full-time equivalent (FTE), country and region of qualification and geography (organisational regions) of individual GPs. Additionally at the practice and geography levels, we studied patient list size by age groups, average patient location deprivation, the overall morbidity as measured by the Quality and Outcomes Framework (QOF) and the average payment made to primary care per patient. Non-UK qualified GPs comprised 21.1% of the total numbers of GPs, with the largest percentage observed in East England (29.8%). Compared to UK qualified GPs, EEA and elsewhere qualified GPs had higher FTE (medians were 0.80, 0.89 and 0.93, respectively) and worked in practices with higher median patient location deprivation (18.3, 22.5 and 25.2, respectively). Practices with high percentages of EEA and elsewhere qualified GPs served patients who resided in more deprived areas, had lower GP-to-patient ratios and lower GP-to-cumulative QOF register ratios. A decrease in pay as the percentage of elsewhere qualified GPs increased was observed; a 10% increase in elsewhere qualified GPs was linked to a £1 decrease (95% confidence interval 0.5-1.4) in average pay per patient. A large percentage of the UK general practice workforce consists of non-UK qualified GPs who work longer hours, are older and serve a larger number of patients in more deprived areas. Following Brexit, difficulties in replacing this valuable workforce will primarily threaten the care delivery in deprived areas.

Quality and content of dental practice websites.

PubMed

Nichols, L C; Hassall, D

2011-04-09

To investigate the quality and content of dental practice websites by constructing an audit framework based on regulations, guidance and expert advice, and applying this framework to a random sample of UK dental practices' websites. An audit framework was constructed and in-depth data collected from a random sample of 150 UK dental practices. Thirty-five percent of dental practices in this study were found to have websites. Compliance with rules and regulations regarding dental practice websites was generally poor. Use of advised content for practice promotion was variable. Many websites were poorly optimised. Eighty-nine percent of the websites advertised tooth whitening, despite the issues surrounding its legality; 25% of the websites advertised Botox even though advertising of prescription only medicines is illegal. Some websites gave misleading information about the specialist status of their dentists. Those responsible for dental practice websites need to be aware of a wide range of regulations and guidance, and are advised to follow expert advice on content and optimisation in order to maximise the potential of their websites.

Doctors' perspectives on PSA testing illuminate established differences in prostate cancer screening rates between Australia and the UK: a qualitative study

PubMed Central

Pickles, Kristen; Carter, Stacy M; Rychetnik, Lucie; Entwistle, Vikki A

2016-01-01

Objectives To examine how general practitioners (GPs) in the UK and GPs in Australia explain their prostate-specific antigen (PSA) testing practices and to illuminate how these explanations are similar and how they are different. Design A grounded theory study. Setting Primary care practices in Australia and the UK. Participants 69 GPs in Australia (n=40) and the UK (n=29). We included GPs of varying ages, sex, clinical experience and patient populations. All GPs interested in participating in the study were included. Results GPs' accounts revealed fundamental differences in whether and how prostate cancer screening occurred in their practice and in the broader context within which they operate. The history of prostate screening policy, organisational structures and funding models appeared to drive more prostate screening in Australia and less in the UK. In Australia, screening processes and decisions were mostly at the discretion of individual clinicians, and varied considerably, whereas the accounts of UK GPs clearly reflected a consistent, organisationally embedded approach based on local evidence-based recommendations to discourage screening. Conclusions The GP accounts suggested that healthcare systems, including historical and current organisational and funding structures and rules, collectively contribute to how and why clinicians use the PSA test and play a significant role in creating the mindlines that GPs employ in their clinic. Australia's recently released consensus guidelines may support more streamlined and consistent care. However, if GP mindlines and thus routine practice in Australia are to shift, to ultimately reduce unnecessary or harmful prostate screening, it is likely that other important drivers at all levels of the screening process will need to be addressed. PMID:27920082

Needle stick injuries: a comparison of practice and attitudes in two UK District General Hospitals.

PubMed

Raghavendran, S; Bagry, H S; Leith, S; Budd, J M

2006-09-01

Hospital staff are at risk from occupational exposure to blood-borne viruses due to needle stick injuries. Occupational health departments have invested considerable resources in the prevention of these injuries, which can be very distressing to the affected individuals. We surveyed health care workers, i.e. doctors, nurses and operating department practitioners, in the operating theatre and critical care units of two UK hospitals located in the Midlands and Merseyside to compare attitudes and experiences. There were significant deficiencies in several aspects of the safe practice of universal precautions. These deficiencies were similar in the two hospitals surveyed and may reflect a national trend. We conclude that every individual, department and trust needs to reflect on their practice and address these deficiencies.

Putting principals back into practice: an evaluation of a re-entry course for vocationally trained doctors.

PubMed Central

Baker, M; Williams, J; Petchey, R

1997-01-01

BACKGROUND: Current recruitment difficulties in general practice have sharpened the interest of the profession in non-principals. No re-entry course for general practice has previously been run in the UK. AIM: To design and evaluate a re-entry course for general practice. METHOD: A re-entry course was developed to help doctors return to general practice as principals. A telephone interview was carried out with each delegate prior to their attendance on the course and was repeated one month and six months after the course to measure any change in career intentions and the perceived benefit of attending the course. RESULTS: Six months after the course, 11 out of 14 delegates had taken positive steps to return to general practice or had increased their time commitment to medicine. This contrasts with only one of the control group having made any steps to change career. CONCLUSION: The course was evaluated and found to be beneficial, particularly in terms of increasing the confidence of the delegates. PMID:9463984

Prostate-specific antigen (PSA) testing of men in UK general practice: a 10-year longitudinal cohort study.

PubMed

Young, Grace J; Harrison, Sean; Turner, Emma L; Walsh, Eleanor I; Oliver, Steven E; Ben-Shlomo, Yoav; Evans, Simon; Lane, J Athene; Neal, David E; Hamdy, Freddie C; Donovan, Jenny L; Martin, Richard M; Metcalfe, Chris

2017-10-30

Cross-sectional studies suggest that around 6% of men undergo prostate-specific antigen (PSA) testing each year in UK general practice (GP). This longitudinal study aims to determine the cumulative testing pattern of men over a 10-year period and whether this testing can be considered equivalent to screening for prostate cancer (PCa). Patient-level data on PSA tests, biopsies and PCa diagnoses were obtained from the UK Clinical Practice Research Datalink (CPRD) for the years 2002 to 2011. The cumulative risks of PSA testing and of being diagnosed with PCa were estimated for the 10-year study period. Associations of a man's age, region and index of multiple deprivation with the cumulative risk of PSA testing and PCa diagnosis were investigated. Rates of biopsy and diagnosis, following a high test result, were compared with those from the programme of PSA testing in the Prostate Testing for Cancer and Treatment (ProtecT) study. The 10-year risk of exposure to at least one PSA test in men aged 45 to 69 years in UK GP was 39.2% (95% CI 39.0 to 39.4%). The age-specific risks ranged from 25.2% for men aged 45-49 years to 53.0% for men aged 65-69 years (p for trend <0.001). For those with a PSA level ≥3, a test in UK GP was less likely to result in a biopsy (6%) and/or diagnosis of PCa (15%) compared with ProtecT study participants (85% and 34%, respectively). A high proportion of men aged 45-69 years undergo PSA tests in UK GP: 39% over a 10-year period. A high proportion of these tests appear to be for the investigation of lower urinary tract symptoms and not screening for PCa. ISRCTN20141297,NCT02044172. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Prevalence of urinary tract infection in acutely unwell children in general practice: a prospective study with systematic urine sampling.

PubMed

O'Brien, Kathryn; Edwards, Adrian; Hood, Kerenza; Butler, Christopher C

2013-02-01

Urinary tract infection (UTI) in children may be associated with long-term complications that could be prevented by prompt treatment. To determine the prevalence of UTI in acutely ill children ≤ 5 years presenting in general practice and to explore patterns of presenting symptoms and urine sampling strategies. Prospective observational study with systematic urine sampling, in general practices in Wales, UK. In total, 1003 children were recruited from 13 general practices between March 2008 and July 2010. The prevalence of UTI was determined and multivariable analysis performed to determine the probability of UTI. Out of 597 (60.0%) children who provided urine samples within 2 days, the prevalence of UTI was 5.9% (95% confidence interval [CI] = 4.3% to 8.0%) overall, 7.3% in those < 3 years and 3.2% in 3-5 year olds. Neither a history of fever nor the absence of an alternative source of infection was associated with UTI (P = 0.64; P = 0.69, respectively). The probability of UTI in children aged ≥3 years without increased urinary frequency or dysuria was 2%. The probability of UTI was ≥5% in all other groups. Urine sampling based purely on GP suspicion would have missed 80% of UTIs, while a sampling strategy based on current guidelines would have missed 50%. Approximately 6% of acutely unwell children presenting to UK general practice met the criteria for a laboratory diagnosis of UTI. This higher than previously recognised prior probability of UTI warrants raised awareness of the condition and suggests clinicians should lower their threshold for urine sampling in young children. The absence of fever or presence of an alternative source of infection, as emphasised in current guidelines, may not rule out UTI in young children with adequate certainty.

Insightful practice: a reliable measure for medical revalidation

PubMed Central

Guthrie, Bruce; Sullivan, Frank M; Mercer, Stewart W; Russell, Andrew; Bruce, David A

2012-01-01

Background Medical revalidation decisions need to be reliable if they are to reassure on the quality and safety of professional practice. This study tested an innovative method in which general practitioners (GPs) were assessed on their reflection and response to a set of externally specified feedback. Setting and participants 60 GPs and 12 GP appraisers in the Tayside region of Scotland, UK. Methods A feedback dataset was specified as (1) GP-specific data collected by GPs themselves (patient and colleague opinion; open book self-evaluated knowledge test; complaints) and (2) Externally collected practice-level data provided to GPs (clinical quality and prescribing safety). GPs' perceptions of whether the feedback covered UK General Medical Council specified attributes of a ‘good doctor’ were examined using a mapping exercise. GPs' professionalism was examined in terms of appraiser assessment of GPs' level of insightful practice, defined as: engagement with, insight into and appropriate action on feedback data. The reliability of assessment of insightful practice and subsequent recommendations on GPs' revalidation by face-to-face and anonymous assessors were investigated using Generalisability G-theory. Main outcome measures Coverage of General Medical Council attributes by specified feedback and reliability of assessor recommendations on doctors' suitability for revalidation. Results Face-to-face assessment proved unreliable. Anonymous global assessment by three appraisers of insightful practice was highly reliable (G=0.85), as were revalidation decisions using four anonymous assessors (G=0.83). Conclusions Unlike face-to-face appraisal, anonymous assessment of insightful practice offers a valid and reliable method to decide GP revalidation. Further validity studies are needed. PMID:22653078

Compassion Is Dissent: The Institute for the Art and Practice of Dissent at Home

ERIC Educational Resources Information Center

Research in Drama Education, 2017

2017-01-01

Following the devastating result of the May 2015 general election in the UK, the Institute for the Art and Practice of Dissent at Home organised "Compassion is dissent: Manifesto Slam." It put out an open call for participants, asking them to bring a three-minute manifesto as means of admission to the event. Here, the Institute showcases…

Management and Prevalence of Long-Term Conditions in Primary Health Care for Adults with Intellectual Disabilities Compared with the General Population: A Population-Based Cohort Study

ERIC Educational Resources Information Center

Cooper, Sally-Ann; Hughes-McCormack, Laura; Greenlaw, Nicola; McConnachie, Alex; Allan, Linda; Baltzer, Marion; McArthur, Laura; Henderson, Angela; Melville, Craig; McSkimming, Paula; Morrison, Jill

2018-01-01

Background: In the UK, general practitioners/family physicians receive pay for performance on management of long-term conditions, according to best-practice indicators. Method: Management of long-term conditions was compared between 721 adults with intellectual disabilities and the general population (n = 764,672). Prevalence of long-term…

Ethnic variations in incidence of asthma episodes in England & Wales: national study of 502,482 patients in primary care.

PubMed

Netuveli, Gopalakrishnan; Hurwitz, Brian; Sheikh, Aziz

2005-10-21

Recent studies have demonstrated marked international variations in the prevalence of asthma, but less is known about ethnic variations in asthma epidemiology within individual countries and in particular the impact of migration on risk of developing asthma. Recent within country comparisons have however revealed that despite originating from areas of the world with a low risk for developing asthma, South Asian and Afro-Caribbean people in the UK are significantly (3x and 2x respectively) more likely to be admitted to hospital for asthma related problems than Whites. Using data from the Fourth National Study of Morbidity Statistics in General Practice, a one-percent broadly representative prospective cohort study of consultations in general practice, we investigated ethnic variations in incident asthma consultations (defined as new or first consultations), and compared consultation rates between those born inside and outside the UK (migrant status). Logistic regression models were used to examine the combined effects of ethnicity and migration on asthma incident consultations. Results showed significantly lower new/first asthma consultation rates for Whites than for each of the ethnic minority groups studied (mean age-adjusted consultation rates per 1000 patient-years: Whites 26.4 (95%CI 26.4, 26.4); South Asians 30.4 (95%CI 30.3, 30.5); Afro-Caribbeans 35.1 (95%CI 34.9, 35.3); and Others 27.8 (27.7, 28.0). Within each of these ethnic groups, those born outside of the UK showed consistently lower rates of incident asthma consultations. Modelling the combined effects of ethnic and migrant status revealed that UK-born South Asians and Afro-Caribbeans experienced comparable risks for incident GP consultations for asthma to UK-born Whites. Non-UK born Whites however experienced reduced risks (adjusted OR 0.82, 95%CI 0.69, 0.97) whilst non-UK born South Asians experienced increased risks (adjusted OR 1.33, 95%CI 1.04, 1.70) compared to UK-born Whites. These findings strongly suggest that ethnicity and migration have significant and independent effects on asthma incidence. The known poorer asthma outcomes in UK South Asians and Afro-Caribbeans may in part be explained by the offspring of migrants experiencing an increased risk of developing asthma when compared to UK-born Whites. This is the first study to find heterogeneity for incident asthma consultations in Whites by migrant status.

Participatory design of a preliminary safety checklist for general practice

PubMed Central

Bowie, Paul; Ferguson, Julie; MacLeod, Marion; Kennedy, Susan; de Wet, Carl; McNab, Duncan; Kelly, Moya; McKay, John; Atkinson, Sarah

2015-01-01

Background The use of checklists to minimise errors is well established in high reliability, safety-critical industries. In health care there is growing interest in checklists to standardise checking processes and ensure task completion, and so provide further systemic defences against error and patient harm. However, in UK general practice there is limited experience of safety checklist use. Aim To identify workplace hazards that impact on safety, health and wellbeing, and performance, and codesign a standardised checklist process. Design and setting Application of mixed methods to identify system hazards in Scottish general practices and develop a safety checklist based on human factors design principles. Method A multiprofessional ‘expert’ group (n = 7) and experienced front-line GPs, nurses, and practice managers (n = 18) identified system hazards and developed and validated a preliminary checklist using a combination of literature review, documentation review, consensus building workshops using a mini-Delphi process, and completion of content validity index exercise. Results A prototype safety checklist was developed and validated consisting of six safety domains (for example, medicines management), 22 sub-categories (for example, emergency drug supplies) and 78 related items (for example, stock balancing, secure drug storage, and cold chain temperature recording). Conclusion Hazards in the general practice work system were prioritised that can potentially impact on the safety, health and wellbeing of patients, GP team members, and practice performance, and a necessary safety checklist prototype was designed. However, checklist efficacy in improving safety processes and outcomes is dependent on user commitment, and support from leaders and promotional champions. Although further usability development and testing is necessary, the concept should be of interest in the UK and internationally. PMID:25918338

Barriers and facilitators to integration of physician associates into the general practice workforce: a grounded theory approach.

PubMed

Jackson, Ben; Marshall, Michelle; Schofield, Susie

2017-11-01

Physician associates (PAs) are described as one solution to workforce capacity in primary care in the UK. Despite new investment in the role, how effective this will be in addressing unmet primary care needs is unclear. To investigate the barriers and facilitators to the integration of PAs into the general practice workforce. A modified grounded theory study in a region unfamiliar with the PA role. No a priori themes were assumed. Themes generated from stakeholder interviews informed a literature review and theoretical framework, and were then tested in focus groups with GPs, advanced nurse practitioners (ANPs), and patients. Recorded data were transcribed verbatim, and organised using NVivo version 10.2.2, with iterative analysis of emergent themes. A reflexive diary and independent verification of coding and analysis were included. There were 51 participants (30 GPs, 11 ANPs, and 10 patients) in eight focus groups. GPs, ANPs, and patients recognised that support for general practice was needed to improve access. GPs expressed concerns regarding PAs around managing medical complexity and supervision burden, non-prescriber status, and medicolegal implications in routine practice. Patients were less concerned about specific competencies as long as there was effective supervision, and were accepting of a PA role. ANPs highlighted their own negative experiences entering advanced clinical practice, and the need for support to counteract stereotypical and prejudicial attitudes CONCLUSION: This study highlights the complex factors that may impede the introduction of PAs into UK primary care. A conceptual model is proposed to help regulators and educationalists support this integration, which has relevance to other proposed new roles in primary care. © British Journal of General Practice 2017.

Domestic violence: knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians

PubMed Central

Ramsay, Jean; Rutterford, Clare; Gregory, Alison; Dunne, Danielle; Eldridge, Sandra; Sharp, Debbie; Feder, Gene

2012-01-01

Background Domestic violence affects one in four women and has significant health consequences. Women experiencing abuse identify doctors and other health professionals as potential sources of support. Primary care clinicians agree that domestic violence is a healthcare issue but have been reluctant to ask women if they are experiencing abuse. Aim To measure selected UK primary care clinicians’ current levels of knowledge, attitudes, and clinical skills in this area. Design and setting Prospective observational cohort in 48 general practices from Hackney in London and Bristol, UK. Method Administration of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), comprising five sections: responder profile, background (perceived preparation and knowledge), actual knowledge, opinions, and practice issues. Results Two hundred and seventy-two (59%) clinicians responded. Minimal previous domestic violence training was reported by participants. Clinicians only had basic knowledge about domestic violence but expressed a positive attitude towards engaging with women experiencing abuse. Many clinicians felt poorly prepared to ask relevant questions about domestic violence or to make appropriate referrals if abuse was disclosed. Forty per cent of participants never or seldom asked about abuse when a woman presented with injuries. Eighty per cent said that they did not have an adequate knowledge of local domestic violence resources. GPs were better prepared and more knowledgeable than practice nurses; they also identified a higher number of domestic violence cases. Conclusion Primary care clinicians’ attitudes towards women experiencing domestic violence are generally positive but they only have basic knowledge of the area. Both GPs and practice nurses need more comprehensive training on assessment and intervention, including the availability of local domestic violence services. PMID:22947586

Learning preferences and learning styles: a study of Wessex general practice registrars.

PubMed Central

Lesmes-Anel, J; Robinson, G; Moody, S

2001-01-01

BACKGROUND: Experienced trainers know that individual registrars react very differently to identical learning experiences generated during the year in practice. This divergence reflects differences in registrars' learning styles. Only one study of United Kingdom (UK) general practitioners' learning styles has been undertaken. Learning style theory predicts that matching learning preference with learning style will enhance learning. This paper researches for the first time the evidence in the setting of UK general practice. AIM: To determine, for the general practice registrars within the Wessex Region, the nature of their learning preferences and learning styles and correlations between them. DESIGN OF STUDY: A descriptive confidential postal questionnaire survey. SETTING: Fifty-seven registrars identified in the Wessex Region with a minimum experience of six months in general practice. METHOD: The questionnaire gathered demographic data (sex, age, experience in general practice, years post-registration, and postgraduate qualifications). Learning preferences were elicited using a six-point Likert scale for learning experiences. The Honey and Mumford Learning Style Questionnaire (LSQ) elicited the registrars' learning styles. A second questionnaire was sent to non-responders. RESULTS: The response rate was 74%. Registrars report that interactive learning with feedback is preferred, but more passive learning formats remain valued. A wide range of learning style scores was found. The Honey and Mumford LSQ mean scores fell within the reflector-theorist quadrant. Evidence for correlations between learning preferences and learning styles was also found, in particular for the multiple choice question and audit components of summative assessment. CONCLUSION: A wide range of registrar learning styles exists in Wessex, and initial correlations are described between learning preferences and learning styles as predicted by style theory. This work sets the stage for a shared understanding and use of learning style theory to enhance professional learning throughout a GP's career. More research is needed in this domain. PMID:11462316

How international medical graduates view their learning needs for UK GP training.

PubMed

Warwick, Christopher

2014-03-01

International medical graduates (IMGs) form a vital group of general practitioners (GPs) in the NHS. They are known to face additional challenges above and beyond those faced by UK medical graduates in the course of their GP training. Whilst they are a heterogeneous group of professionals, their views on what they need to learn, and how they are supported, are often distant from those of the educators responsible for planning their education. This study was undertaken, through narrative-based focus groups, to explore the issues which matter to the IMGs, in an attempt to empower their voices about their experiences in GP training, and to see what lessons could be drawn from these views. The findings confirmed the central importance, and considerable challenge involved, in making an effective transition into the culture of the NHS and UK general practice. The IMGs felt that induction needed to be an on-going, iterative process of learning which continued throughout training, with a more effective individualised learning needs analysis at the start of GP training. Lack of sophisticated language skills was highlighted as a real concern. Recognition that their lack of knowledge about the NHS at the start of training should not be seen as an indicator of deficiency, but a clue to what they needed to learn were also key messages. IMGs also felt the earlier in their training they undertook a GP placement, the quicker they would start to understand the culture of general practice in the UK. Further work following on from this research should include how to manage change in the educational network for these barriers to be overcome.

UK Policy on Doctor Remediation: Trajectories and Challenges.

PubMed

Price, Tristan; Archer, Julian

2017-01-01

Around the world, policy-makers, academics, and health service professionals have become increasingly aware of the importance of remediation, the process by which poor performance is "remedied," as part of the changing landscape of medical regulation. It is, therefore, an opportune time to critique the UK experience with remediation policy. This article frames, for the first time, the UK remediation policy as developing from a central policy aim that was articulated in the 1990s: to accelerate the identification of underperformance and, subsequently, remedy any problems identified as soon as possible. In pursuit of this aim, three policy trajectories have emerged: professionalizing and standardizing remediation provision; linking remediation with other forms of regulation, namely relicensure (known in the UK as medical revalidation); and fostering obligations for doctors to report themselves and others for remediation needs. The operationalization of policy along these trajectories, and the challenges that have arisen, has relevance for anyone seeking to understand or indeed improve remediation practices within any health care system. It is argued here that the UK serves as an example of the more general challenges posed by seeking to integrate remediation policy within broader frameworks of medical governance, in particular systems of relicensure, and the need to develop a solid evidence base for remediation practices.

Doctors' perspectives on PSA testing illuminate established differences in prostate cancer screening rates between Australia and the UK: a qualitative study.

PubMed

Pickles, Kristen; Carter, Stacy M; Rychetnik, Lucie; Entwistle, Vikki A

2016-12-05

To examine how general practitioners (GPs) in the UK and GPs in Australia explain their prostate-specific antigen (PSA) testing practices and to illuminate how these explanations are similar and how they are different. A grounded theory study. Primary care practices in Australia and the UK. 69 GPs in Australia (n=40) and the UK (n=29). We included GPs of varying ages, sex, clinical experience and patient populations. All GPs interested in participating in the study were included. GPs' accounts revealed fundamental differences in whether and how prostate cancer screening occurred in their practice and in the broader context within which they operate. The history of prostate screening policy, organisational structures and funding models appeared to drive more prostate screening in Australia and less in the UK. In Australia, screening processes and decisions were mostly at the discretion of individual clinicians, and varied considerably, whereas the accounts of UK GPs clearly reflected a consistent, organisationally embedded approach based on local evidence-based recommendations to discourage screening. The GP accounts suggested that healthcare systems, including historical and current organisational and funding structures and rules, collectively contribute to how and why clinicians use the PSA test and play a significant role in creating the mindlines that GPs employ in their clinic. Australia's recently released consensus guidelines may support more streamlined and consistent care. However, if GP mindlines and thus routine practice in Australia are to shift, to ultimately reduce unnecessary or harmful prostate screening, it is likely that other important drivers at all levels of the screening process will need to be addressed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Prescription errors in the National Health Services, time to change practice.

PubMed

Hamid, Tahir; Harper, Luke; Rose, Samman; Petkar, Sanjive; Fienman, Richard; Athar, Syed M; Cushley, Michael

2016-02-01

Medication error is a major source of iatrogenic illness. Error in prescription is the most common form of avoidable medication error. We present our study, performed at two, UK, National Health Services Hospitals. The prescription practice of junior doctor's working on general medical and surgical wards in National Health Service District General and University Teaching Hospitals in the UK was reviewed. Practice was assessed against standard hospital prescription charts, developed in accordance with local pharmacy guidance. A total of 407 prescription charts were reviewed in both initial audit and re-audit one year later. In the District General Hospital, documentation of allergy, weight and capital-letter prescription was achieved in 31, 5 and 40% of charts, respectively. Forty-nine per cent of discontinued prescriptions were properly deleted and signed for. In re-audit significant improvement was noted in documentation of the patient's name 100%, gender 54%, allergy status 51% and use of generic drug name 71%. Similarly, in the University Teaching Hospital, 82, 63 and 65% compliance was achieved in documentation of age, generic drug name prescription and capital-letter prescription, respectively. Prescription practice was reassessed one year later after recommendations and changes in the prescription practice, leading to significant improvement in documentation of unit number, generic drug name prescription, insulin prescription and documentation of the patient's ward. Prescription error remains an important, modifiable form of medical error, which may be rectified by introducing multidisciplinary assessment of practice, nationwide standardised prescription charts and revision of current prescribing clinical training. © The Author(s) 2016.

GDPs' self-perceived confidence and anxiety in their clinical and communication skills used when screening for oral cancer: UK variations.

PubMed

Farrand, Paul; Clover, Henry; Hutchison, Iain L

2003-07-01

To compare anxieties of general dental practitioners (GDPs) across the UK in communicating with patients about oral cancer and confidence in clinical skills required to perform soft tissue screening for oral cancer. A questionnaire was sent to 2200 randomly selected GDPs from across the UK. Responses to the questionnaires were analysed using 95% confidence intervals. Dental practitioners in general practice within England, Northern Ireland, Scotland and Wales. The response rate varied between 57% in England and 65% in Northern Ireland. A high percentage of dental practitioners across all UK regions reported performing soft tissue examinations (range 78% to 88%). The number of soft tissue examinations per month varied between 129 (95% CI 109, 148) and 162 (95% CI 154, 170) indicating criteria when selecting patients for screening. Using a nine-point rating scale (1 = not at all, 9 = extremely), confidence in the clinical skills required during oral cancer screening was generally good (ratings varying between 5.4 and 6.7). With the exception of reporting positive findings to patients (rating 4.5 to 5.2), anxiety in communication skills used during oral cancer screening was generally low (ratings varying between 1.8 and 3.9). While concerns over generalizing the results exist, the situation with respect to the clinical and communication skills required by GDPs during oral cancer screening is generally encouraging. An area of concern is discussing positive findings with patients. This may be overcome by developing specialist courses on breaking bad news within undergraduate dental curricula and programmes of continuing professional development.

General practitioners' psychosocial resources, distress, and sickness absence: a study comparing the UK and Finland.

PubMed

Heponiemi, Tarja; Elovainio, Marko; Presseau, Justin; Eccles, Martin P

2014-06-01

Many countries, including the UK and Finland, face difficulties in recruiting GPs and one reason for these difficulties may be due to negative psychosocial work environments. To compare psychosocial resources (job control and participative safety), distress and sickness absences between GPs from the UK and those from Finland. We also examined differences in how psychosocial resources are associated with distress and sickness absence and how distress is associated with sickness absence for both countries. Two independent cross-sectional surveys conducted in general practice in the UK and Finland. Analyses of covariance were used for continuous outcome variables and logistic regression for dichotomized variable (sickness absence) adjusted for gender, qualification year and response format. UK GPs reported more opportunities to control their work and had higher levels of participative safety but were more distressed than Finnish GPs. Finnish GPs were 2.3 (95% confidence interval = 1.8-3.1) times more likely to report sickness absence spells than UK GPs. Among Finnish GPs, job control opportunities and high participative safety were associated with lower levels of distress, but not among UK GPs. Among UK GPs, higher distress was associated with 2.1 (95% confidence interval = 1.3-3.6) times higher likelihood of sickness absence spells, but among Finnish GPs there were no such association. In Finland, primary health care organizations should try to improve participative safety and increase control opportunities of physicians to decrease GP distress, whereas in the UK, other work or private life factors may be more important. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Diagnostic triage and the role of natriuretic peptide testing and echocardiography for suspected heart failure: an appropriateness ratings evaluation by UK GPs

PubMed Central

Campbell, Stephen M; Fuat, Ahmet; Summerton, Nick; Lancaster, Neil; Hobbs, FD Richard

2011-01-01

Background Some UK GPs are acquiring access to natriuretic peptide (NP) testing or echocardiography as diagnostic tests for heart failure. This study developed appropriateness ratings for the diagnostic application of these tests in routine general practice. Aim To develop appropriateness ratings for the diagnostic application of NP testing or echocardiography for heart failure in general practice. Design and setting An appropriateness ratings evaluation in UK general practice. Method Four presenting symptoms (cough, bilateral ankle swelling, dyspnoea, fatigue), three levels of risk of cardiovascular disease (low, intermediate, high), and dichotomous categorisations of cardiovascular/chest examination and electrocardiogram result, were used to create 540 appropriateness scenarios for patients in whom NP testing or echocardiography might be considered. These were rated by a 10-person expert panel, consisting of GPs and GPs with specialist interests in cardiology, in a two-round RAND Appropriateness Method. Results Onward referral for NP testing or echocardiography was rated as an appropriate next step in 217 (40.2%) of the 540 scenarios; in 194 (35.9%) it was rated inappropriate. The ratings also show where NP testing or echocardiography were ranked as equivalent next steps and when one test was seen as the more appropriate than the other. Conclusion NP testing should be the routine test for suspected heart failure where referral for diagnostic testing is considered appropriate. An abnormal electrocardiogram status makes referral to echocardiography an accompanying, or more appropriate, next step alongside NP testing, especially in the presence of dyspnoea. Abnormal NP testing should subsequently be followed up with referral for echocardiography. PMID:21722451

Prescription patterns in asthma patients initiating salmeterol in UK general practice: a retrospective cohort study using the General Practice Research Database (GPRD).

PubMed

DiSantostefano, Rachael L; Davis, Kourtney J

2011-06-01

An association between salmeterol, a long-acting β(2)-agonist (LABA), use and rare serious asthma events or asthma mortality was observed in two large clinical trials. This has resulted in heightened scrutiny of LABAs and comprehensive reviews by regulatory agencies. The aim of this retrospective observational cohort study was to better characterize salmeterol medication use patterns in the UK. We describe asthma prescription patterns in a cohort of patients (n =17,745) in the General Practice Research Database who initiated treatment with salmeterol-containing prescriptions between 2003 and 2006, including salmeterol and salmeterol/fluticasone propionate in a single device. Prescriptions patterns by medication class, including concurrent prescription of salmeterol with inhaled corticosteroids (ICS), were described using 6-month intervals in the 1-year period before and after the salmeterol-containing index prescription. In the 0- to 6-month and 7- to 12-month periods prior to initiation of the salmeterol-containing prescription, the cohort experienced worsening of asthma, measured by an increase in the proportion of patients with prescriptions for short-acting β-agonists [SABA] (73-89%), ICS (70-81%) and systemic corticosteroids (14-28%). Nearly all patients prescribed salmeterol were concurrently prescribed ICS (≥95% within 90 days). In the 12 months following initiation of the salmeterol-containing prescription, a decrease in asthma prescriptions was observed. These results support the appropriate prescribing of salmeterol-containing medications, as per recommendations in asthma treatment guidelines in the UK. Salmeterol was consistently prescribed as an add-on asthma-controller with an ICS for most patients, and was associated with improvements in asthma control, as indicated by decreases in SABA and systemic corticosteroid prescriptions following salmeterol introduction.

Patterns of Warfarin Use in Subgroups of Patients with Atrial Fibrillation: A Cross-Sectional Analysis of 430 General Practices in the United Kingdom

PubMed Central

Mohammed, Mohammed A.; Marshall, Tom; Nirantharakumar, Krishnarajah; Stevens, Andrew; Fitzmaurice, David

2013-01-01

Background Despite the proven efficacy of warfarin, its use in patients with Atrial Fibrillation (AF) is reportedly low. We investigated the underuse and overuse of warfarin in the management of AF in general practices in the United Kingdom (UK) against the National Institute of Clinical Excellence (NICE, UK) guidelines whilst seeking to identify subgroups of AF patients to inform efforts to optimise warfarin use. Methodology A retrospective database analysis to determine warfarin prescribing using tree models based on 50361 patients with AF (classified as low, moderate and high risk of stroke using CHADS2) from 430 general practices in the UK. Results Over one-third (37.0%, 4573/12351) of low risk AF patients were on warfarin, compared with 47.1% (8349/17709) moderate risk AF patients and 54.9% (11142/20301) high risk AF patients. Clinical subgroups (n = 15 low risk subgroups, n = 15 medium risk subgroups, n = 22 high risk subgroups) were identified. Several factors not supported by current guidelines (age, BMI, dementia, gender) were associated with the use of warfarin. Gender and BMI were associated with warfarin use in low and medium risk AF patients but not in high risk AF patients. Conclusion Whilst NICE guidelines suggest that all high risk AF patients should be on warfarin, half of those at moderate risk should be on warfarin and none of those at low risk should be on warfarin, we found evidence of over and under use of warfarin. Interventions to optimise warfarin therapy tailored to and targeting specific subgroups of AF patients identified by the tree models are required. PMID:23658703

The LUCK study: Laxative Usage in patients with GP-diagnosed Constipation in the UK, within the general population and in pregnancy. An epidemiological study using the General Practice Research Database (GPRD)

PubMed Central

Shafe, Anna C. E.; Lee, Sally; Dalrymple, Jamie S. O.; Whorwell, Peter J.

2011-01-01

Background: Despite the high prevalence of constipation and its related public health implications, there is relatively little research available on the condition from large epidemiological studies. The aim of this study was to investigate the epidemiology of general practitioner (GP)-diagnosed constipation and the prescribing trends for laxatives in the UK, within the general population and during pregnancy. Methods: A cohort study for the period from 2005 to 2009 was performed using the UK primary care database (General Practice Research Database), which contains information on over 3 million individuals. Results: The prevalence of GP-diagnosed constipation ranged from 12 per 1000 persons in 2005 (0.012 per person year) to 12.8 per 1000 in 2009 (0.013 per person year). The prevalence was almost twice as high in women as in men, and was higher in older patients. In 2005 the most commonly prescribed laxatives were lactulose (37%), senna (26%), macrogol (19%), ispaghula (6%), docusate sodium (5%), bisacodyl (4%) and glycerol suppositories (2%). By 2009, this pattern had changed: macrogol (31%), lactulose (29%), senna (22%), ispaghula (5%), docusate sodium (6%), bisacodyl (3%) and glycerol suppositories (3%). In pregnancy, lactulose accounted for 81% of laxative use in 2005, falling to 64% by 2009. In contrast, macrogol use in pregnancy rose from 13% in 2005 to 32% in 2009. Conclusions: GP-diagnosed constipation is common, accounting for a large number of consultations. Laxative prescribing trends have changed over the 5-year study period, prescriptions for macrogol becoming increasingly common and prescriptions for lactulose and senna less common. Macrogol also appears to have been replacing lactulose for treating constipation in pregnant women. PMID:22043228

Physical health indicators in major mental illness: data from the Quality and Outcome Framework in the UK.

PubMed

Martin, Julie Langan; Lowrie, Richard; McConnachie, Alex; McLean, Gary; Mair, Frances; Mercer, Stewart; Smith, Daniel

2015-02-26

In the UK, the Quality and Outcome Framework (QOF) has specific targets for general practictioners to record body-mass index (BMI) and blood pressure (BP) in major mental illness, diabetes, and chronic kidney disease. Although incentives are given for aspects of major mental illness (schizophrenia, bipolar disorder, and related psychoses), barriers to care can occur. Our aim was to compare recording of specific targets for BP and BMI in individuals with major mental illness relative to diabetes and chronic kidney disease across the UK. Using 2012 and 2013 QOF data from 9731 general practices across all four countries in the UK, we calculated median payment, population achievement, and exception rates for BP indicators in major mental illness and chronic kidney disease and BMI indicators in major mental illness and diabetes. Differences in unweighted rates between practices in the same UK country were tested with a sign test. Differences in population achievement rate between practices in different countries were compared with those in England by use of a quantile regression analysis. UK payment and population achievement rates for BMI recording in major mental illness were significantly lower than were those in diabetes (payment 92·7% vs 95·5% and population achievement 84·0% vs 92·5%, p<0·0001) and exception rates were higher (8·1% vs 2·0%, p<0·0001). For BP recording, UK payment and population achievement rates were significantly lower for major mental illness than for chronic kidney disease (94·1% vs 97·8% and 87·0% vs 97·1%, p<0·0001), whereas exception rate was higher (6·5% vs 0·0%, p<0·0001). This difference was observed for all UK countries. Median population achievement rates for BMI and BP recording in major mental illness were significantly lower in Scotland than in England (for BMI -1·5%, 99% CI -2·7 to -0·3, and for BP -1·8%, -2·7 to -0·9; p<0·0001 for both). There were no cross-jurisdiction differences for chronic kidney disease and diabetes. We found lower payment rates, higher exception rates, and lower population achievement rates for BMI and BP recording in major mental illness than in diabetes and chronic kidney disease throughout the UK. We also found variation in these rates between countries. This finding is probably multifactorial, reflecting a combination of patient, clinician, and wider organisational factors; however, it might also suggest inequality in access to certain aspects of health care for people with major mental illness. None. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cases relating to anaesthetists handled by the UK General Medical Council in 2009: methodological approach and patterns of referral.

PubMed

Campbell, G; Rollin, A M; Smith, A F

2013-05-01

The General Medical Council is the regulatory body charged with maintaining standards in the medical profession in the UK. We analysed cases relating to anaesthetists handled in 2009 using fitness-to-practise data, comparing them with the profession as a whole and examining patterns of referral. Complaints were made about 105 doctors practising in anaesthesia. The 81 anaesthetists who were investigated further were subject to a total of 225 separate allegations, median (IQR [range]) of 2 (1-3 ) allegations per anaesthetist. Anaesthetists had a lower rate of referral compared with doctors in general (0.095% vs 0.20%, respectively, p = 0.0001). They were less likely than doctors in general to be referred by an individual member of the public (27% vs 64%, respectively, p = 0.0001). As with other specialties, allegations were most commonly made about clinical care, probity and relationships with patients. On the basis of 2009 data, we calculated that a mean (95% CI) of 1 in 120 (1 in 100-145) doctors practising in anaesthesia in the UK will be referred to the General Medical Council every year. We have provided examples of allegations and made recommendations for maintaining good practice in anaesthesia. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

Previous radiographic experience of children referred for dental extractions under general anaesthesia in the U.K.

PubMed

Young, N L; Rodd, H D; Craig, S A

2009-03-01

To determine what proportion of children undergo radiographic assessment prior to referral to a dental hospital for extractions under general anaesthesia. This prospective survey was conducted over a 6-month period. A data sheet was used to record the following information: patient's age; referrer's name and place of work (general dental practice or community dental service); teeth to be extracted (primary dentition and/or permanent dentition) and reported previous radiographic examination. Patients were excluded from the study if, following a clinical examination, radiographs were not actually deemed necessary for diagnosis and treatment planning purposes. Clinical setting A paediatric dentistry clinic within a dental hospital in the North of England. Participants 161 patients with a mean age of six years (SD = 2.2, range = 3-14 years) who were referred to the dental hospital for extractions under general anaesthesia. Overall, 12.4% of children had reportedly undergone a previous radiographic assessment prior to hospital referral. A significantly greater proportion of children referred for permanent tooth extractions had been subject to radiographic examination compared to children referred for primary tooth extractions (46.2% as compared to 6.3%; P = 0.001 chi-squared test). Furthermore, patients referred from the community dental service were significantly more likely to have had previous dental radiographs than children referred from general dental practice (36.9% compared to 9.3%; P = 0.003 chi-squared test). Radiographs do not appear to be routinely employed for caries diagnosis and treatment planning in young children within general dental practice in the U.K.

Preparing dental students for careers as independent dental professionals: clinical audit and community-based clinical teaching.

PubMed

Lynch, C D; Llewelyn, J; Ash, P J; Chadwick, B L

2011-05-28

Community-based clinical teaching programmes are now an established feature of most UK dental school training programmes. Appropriately implemented, they enhance the educational achievements and competences achieved by dental students within the earlier part of their developing careers, while helping students to traverse the often-difficult transition between dental school and vocational/foundation training and independent practice. Dental school programmes have often been criticised for 'lagging behind' developments in general dental practice - an important example being the so-called 'business of dentistry', including clinical audit. As readers will be aware, clinical audit is an essential component of UK dental practice, with the aims of improving the quality of clinical care and optimising patient safety. The aim of this paper is to highlight how training in clinical audit has been successfully embedded in the community-based clinical teaching programme at Cardiff.

Is the faculty of family planning and reproductive health care guidance on emergency contraception being followed in general practice? An audit in the West Midlands, UK.

PubMed

Bannister, Lisa; Macve, Joanna; Pinkey, Benjamin; Webberley, Helen

2007-07-01

In 2003, the Faculty of Family Planning and Reproductive Health Care (FFPRHC) of the Royal College of Obstetricians and Gynaecologists published guidance on emergency contraception (EC). A literature search revealed no published work describing doctors' actions when prescribing EC. In order to assess the extent to which the FFPRHC Guidance is being followed in general practice, an audit of the medical notes of women requesting EC between January 2003 and December 2004 in six general practice surgeries located in the West Midlands, UK was conducted. From the medical notes, discussions between health care professionals and patients requesting EC regarding ongoing contraceptive needs, the risk of sexually transmitted infections (STIs) and the availability of the emergency intrauterine device (IUD) were recorded. A total of 718 emergency contraceptive pill consultations were analysed. The median age for presentation was 24 years. The 20-24 years age group accounted for the most consultations (30.9%). In 40% of consultations there was no evidence of future contraceptive needs having been discussed. Only 20 (2.8%) consultation notes contained evidence that STIs had been discussed. Chlamydia tests were undertaken in only 15/718 (1.7%) consultations. In only 10 (1.4%) of the consultations was the IUD discussed with the patient as an alternative form of EC. This audit suggests that the FFPRHC Guidance on EC is not being followed in general practice, and therefore patients requesting EC may not be receiving the highest standard of care.

The impact of the Quality and Outcomes Framework on practice organisation and service delivery: summary of evidence from two qualitative studies.

PubMed

Checkland, Kath; Harrison, Stephen

2010-01-01

In 2003, the new General Medical Services Contract introduced a pay-for-performance programme know as the Quality and Outcomes Framework (QOF) into UK general practice, with payment for meeting a number of both clinical and organisational quality standards. To investigate in detail the impact of the QOF on practice organisation and service delivery. Two linked qualitative case studies in England and Scotland, using interviews and observation to investigate in depth the impact of the QOF in four general medical practices. A number of significant changes to practice organisation and service delivery were observed, including: changes to practice organisational structures; an increased role for information technology; a move towards a more biomedical form of medical care; and changes to roles and relationships, including the introduction of internal peer-review and surveillance. In spite of this, the practices maintained a narrative of 'no change', arguing that they had 'fitted QOF in' to their routines with little trouble.

Practical barriers to the implementation of early goal directed therapy in the UK: trainee skills and awareness.

PubMed

McNally, S J; MacKinnon, M; Hawkins, M

2009-08-01

The Surviving Sepsis Campaign (SSC) recommends Early Goal Directed Therapy (EGDT) in the treatment of septic shock, which requires key critical care skills and knowledge. This study evaluates the availability of these skills in Specialist Registrars in acute hospital specialities in the UK. A questionnaire was sent to Specialist Registrars in Anaesthetics, General Surgery and General Medicine throughout Scotland. One hundred and eighty five responses were obtained. One hundred percent of anaesthetists, 70% of surgeons and 51% of physicians were aware of EGDT Only 62 trainees (6% of surgeons, 79% of anaesthetists, 19% of physicians) had the full complement of skills and knowledge to implement EGDT. This study demonstrates that non-anaesthetic registrars in the UK lack both knowledge and skills required to provide EGDT. The main deficit was in awareness, demonstrating that knowledge of EGDT is not penetrating into specialities beyond anaesthesia. It is now time for the SSC to specifically target non-anaesthetic specialities.

The effect of recent amblyopia research on current practice in the UK.

PubMed

Newsham, D

2010-10-01

Several studies have recently provided insights into how amblyopia may be most effectively managed. Despite the new evidence, a US study reported that a recent randomised controlled trial had made little influence on clinical practice. The aims of this research are to assess current practice of amblyopia management in the UK and to determine the comparability with the evidence-based recommendations. A questionnaire was constructed to assess current amblyopia management practice, particularly in relation to areas investigated by recent research and emailed to every head orthoptist within the UK. There was a great deal of variability in the amount of occlusion that was prescribed for moderate and severe amblyopia. Sixty per cent of clinicians indicated that the maximum they would prescribe was in excess of the 6 h recommended by research. Atropine was rarely recommended as a first-line treatment, with occlusion generally being considered to be more effective. Despite recommendations regarding education as a means of reducing non-compliance, only 39% of clinicians always gave written information, although various other methods of enhancing compliance were used. A period of refractive adaptation was allowed by most clinicians but often far less than recommended. The uptake of recent research evidence into clinical practice is sporadic and incomplete with one-third of respondents indicating that following the studies, they had made no changes whatsoever to their practice. This is similar to other areas of medicine; the reasons are likely to be varied, and is an area that would benefit from greater attention.

Urban public attitudes to the treatment of psychological problems and depression in general practice.

PubMed

Gavigan, P; Carr, A; McKeon, P

2000-10-01

A previous national study of public attitudes to depression indicated that only 17% spontaneously mentioned their general practitioner as someone who could help with depression, in contrast to 79% of respondents being willing to consult their G.P. in a similar U.K. survey. The present study undertook to examine the public perception of an urban sample to the treatment of depression in general practice and the factors associated with expressed unwillingness to consult. A random sample from the electoral register was drawn and 54 (89%) of 61 subjects selected were interviewed. While 85% of respondents were satisfied with their general practice care, only 24% to 52%, depending on the context and wording of the question, said that they would seek help from their general practitioner for depression. Factors associated with an expressed reluctance to consult were being male, dissatisfied with general practitioner care and believing that general practitioners were not qualified to treat depression.

Representation of people of South Asian origin in cardiovascular outcome trials of glucose-lowering therapies in Type 2 diabetes.

PubMed

Khunti, K; Bellary, S; Karamat, M A; Patel, K; Patel, V; Jones, A; Gray, J; Shepherd, P; Hanif, W

2017-01-01

Our aim was to investigate the proportional representation of people of South Asian origin in cardiovascular outcome trials of glucose-lowering drugs or strategies in Type 2 diabetes, noting that these are among the most significant pieces of evidence used to formulate the guidelines on which clinical practice is largely based. We searched for cardiovascular outcome trials in Type 2 diabetes published before January 2015, and extracted data on the ethnicity of participants. These were compared against expected values for proportional representation of South Asian individuals, based on population data from the USA, from the UK, and globally. Twelve studies met our inclusion criteria and, of these, eight presented a sufficiently detailed breakdown of participant ethnicity to permit numerical analysis. In general, people of South Asian origin were found to be under-represented in trials compared with UK and global expectations and over-represented compared with US expectations. Among the eight trials for which South Asian representation could be reliably estimated, seven under-represented this group relative to the 11.2% of the UK diabetes population estimated to be South Asian, with the representation in these trials ranging from 0.0% to 10.0%. Clinicians should exercise caution when generalizing the results of trials to their own practice, with regard to the ethnicity of individuals. Efforts should be made to improve reporting of ethnicity and improve diversity in trial recruitment, although we acknowledge that there are challenges that must be overcome to make this a reality. © 2016 Diabetes UK.

Does responsibility drive learning? Lessons from intern rotations in general practice.

PubMed

Cantillon, Peter; Macdermott, Maeve

2008-01-01

The intern (or pre-registration) year has been criticised in the past for its emphasis on service delivery at the expense of educational achievement. It is hoped that new approaches to early postgraduate training such as the foundation programmes in the UK, will make clinical education more structured and effective. Intern placements in non-traditional settings such as general practice have been shown in the past to improve the quality of learning. Little is known however about which features of the general practice learning environment contribute most to the perception of improved learning. This aim of this study was to examine the learning environment in general practice from the perspective of interns, (the learners), to determine the factors that contribute most to motivating effective learning in a general practice setting. This study used a qualitative case study approach to explore the effects of two different learning environments, (general practice and hospital) on learner motivation amongst a small group of interns. We found that the biggest difference between the hospital and general practice learning environments was the increased individual responsibility for patient care experienced by interns in general practice. Greater responsibility was associated with greater motivation for learning. Increased intern responsibility for patient care does appear to motivate learning. More work needs to be done on providing interns in hospital posts with greater patient responsibility within an effective supervisory structure.

A survey to assess the provision of conscious sedation by general dental practitioners in the Republic of Ireland.

PubMed

Fisher, Veronica; Stassen, Leo F A; Nunn, June

2011-01-01

To quantify and qualify how conscious sedation was used in general dental practice before the introduction of formal sedation teaching in the Republic of Ireland. 1. To determine the extent of use of oral, inhalational and intravenous sedation; 2. to determine the training and experience of general dental practitioners providing conscious sedation; 3. to determine the perceived barriers to the practice of conscious sedation; and, 4. to gauge the level of interest in a postgraduate course in conscious sedation. Postal questionnaire sent to one general practitioner in seven, selected randomly from the General Dental Council register, in 2007. Seventy six percent of respondents agreed that the provision of conscious sedation in general dental practice is important. However, the current provision of inhalation and intravenous sedation by respondents is low in comparison to provision in the UK. The main barrier to the use of conscious sedation in general dental practice appears to be lack of availability of training. The data from this study indicated the need for postgraduate training in conscious sedation in Ireland and a need for increased awareness of the Dental Council Code of Practice on sedation.

The Great Boundary Crossing: Perceptions on Training Pharmacists as Supplementary Prescribers in the UK

ERIC Educational Resources Information Center

Tann, Jennifer; Blenkinsopp, Alison; Grime, Janet; Evans, Amanda

2010-01-01

Objective: To explore the perceptions of General Medical Practitioners and pharmacist supplementary prescribers of the training provided for qualification as a pharmacist supplementary prescriber, and the experience of pharmacist supplementary prescribers of subsequent continuing professional development in practice. Design: A qualitative study of…

Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey

PubMed Central

Laverty, Anthony A; Harris, Matthew J; Watt, Hilary C; Greaves, Felix; Majeed, Azeem

2017-01-01

Objective To examine associations between the contract and ownership type of general practices and patient experience in England. Design Multilevel linear regression analysis of a national cross-sectional patient survey (General Practice Patient Survey). Setting All general practices in England in 2013–2014 (n = 8017). Participants 903,357 survey respondents aged 18 years or over and registered with a general practice for six months or more (34.3% of 2,631,209 questionnaires sent). Main outcome measures Patient reports of experience across five measures: frequency of consulting a preferred doctor; ability to get a convenient appointment; rating of doctor communication skills; ease of contacting the practice by telephone; and overall experience (measured on four- or five-level interval scales from 0 to 100). Models adjusted for demographic and socioeconomic characteristics of respondents and general practice populations and a random intercept for each general practice. Results Most practices had a centrally negotiated contract with the UK government (‘General Medical Services’ 54.6%; 4337/7949). Few practices were limited companies with locally negotiated ‘Alternative Provider Medical Services’ contracts (1.2%; 98/7949); these practices provided worse overall experiences than General Medical Services practices (adjusted mean difference −3.04, 95% CI −4.15 to −1.94). Associations were consistent in direction across outcomes and largest in magnitude for frequency of consulting a preferred doctor (−12.78, 95% CI −15.17 to −10.39). Results were similar for practices owned by large organisations (defined as having ≥20 practices) which were uncommon (2.2%; 176/7949). Conclusions Patients registered to general practices owned by limited companies, including large organisations, reported worse experiences of their care than other patients in 2013–2014. PMID:29096580

Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey.

PubMed

Cowling, Thomas E; Laverty, Anthony A; Harris, Matthew J; Watt, Hilary C; Greaves, Felix; Majeed, Azeem

2017-11-01

Objective To examine associations between the contract and ownership type of general practices and patient experience in England. Design Multilevel linear regression analysis of a national cross-sectional patient survey (General Practice Patient Survey). Setting All general practices in England in 2013-2014 ( n = 8017). Participants 903,357 survey respondents aged 18 years or over and registered with a general practice for six months or more (34.3% of 2,631,209 questionnaires sent). Main outcome measures Patient reports of experience across five measures: frequency of consulting a preferred doctor; ability to get a convenient appointment; rating of doctor communication skills; ease of contacting the practice by telephone; and overall experience (measured on four- or five-level interval scales from 0 to 100). Models adjusted for demographic and socioeconomic characteristics of respondents and general practice populations and a random intercept for each general practice. Results Most practices had a centrally negotiated contract with the UK government ('General Medical Services' 54.6%; 4337/7949). Few practices were limited companies with locally negotiated 'Alternative Provider Medical Services' contracts (1.2%; 98/7949); these practices provided worse overall experiences than General Medical Services practices (adjusted mean difference -3.04, 95% CI -4.15 to -1.94). Associations were consistent in direction across outcomes and largest in magnitude for frequency of consulting a preferred doctor (-12.78, 95% CI -15.17 to -10.39). Results were similar for practices owned by large organisations (defined as having ≥20 practices) which were uncommon (2.2%; 176/7949). Conclusions Patients registered to general practices owned by limited companies, including large organisations, reported worse experiences of their care than other patients in 2013-2014.

The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial

PubMed Central

Varley, Anna; Warren, Fiona C.; Richards, Suzanne H.; Calitri, Raff; Chaplin, Katherine; Fletcher, Emily; Holt, Tim A.; Lattimer, Valerie; Murdoch, Jamie; Richards, David A.; Campbell, John

2016-01-01

Background Nurse-led telephone triage is increasingly used to manage demand for general practitioner consultations in UK general practice. Previous studies are equivocal about the relationship between clinical experience and the call outcomes of nurse triage. Most research is limited to investigating nurse telephone triage in out-of-hours settings. Objective To investigate whether the professional characteristics of primary care nurses undertaking computer decision supported software telephone triage are related to call disposition. Design Questionnaire survey of nurses delivering the nurse intervention arm of the ESTEEM trial, to capture role type (practice nurse or nurse practitioner), prescriber status, number of years’ nursing experience, graduate status, previous experience of triage, and perceived preparedness for triage. Our main outcome was the proportion of triaged patients recommended for follow-up within the practice (call disposition), including all contact types (face-to-face, telephone or home visit), by a general practitioner or nurse. Settings 15 general practices and 7012 patients receiving the nurse triage intervention in four regions of the UK. Participants 45 nurse practitioners and practice nurse trained in the use of clinical decision support software. Methods We investigated the associations between nursing characteristics and triage call disposition for patient ‘same-day’ appointment requests in general practice using multivariable logistic regression modelling. Results Valid responses from 35 nurses (78%) from 14 practices: 31/35 (89%) had ≥10 years’ experience with 24/35 (69%) having ≥20 years. Most patient contacts (3842/4605; 86%) were recommended for follow-up within the practice. Nurse practitioners were less likely to recommend patients for follow-up odds ratio 0.19, 95% confidence interval 0.07; 0.49 than practice nurses. Nurses who reported that their previous experience had prepared them less well for triage were more likely to recommend patients for follow-up (OR 3.17, 95% CI 1.18–5.55). Conclusion Nurse characteristics were associated with disposition of triage calls to within practice follow-up. Nurse practitioners or those who reported feeling ‘more prepared’ for the role were more likely to manage the call definitively. Practices considering nurse triage should ensure that nurses transitioning into new roles feel adequately prepared. While standardised training is necessary, it may not be sufficient to ensure successful implementation. PMID:27087294

Prevalence of urinary tract infection in acutely unwell children in general practice: a prospective study with systematic urine sampling

PubMed Central

O’Brien, Kathryn; Edwards, Adrian; Hood, Kerenza; Butler, Christopher C

2013-01-01

Background Urinary tract infection (UTI) in children may be associated with long-term complications that could be prevented by prompt treatment. Aim To determine the prevalence of UTI in acutely ill children ≤ 5 years presenting in general practice and to explore patterns of presenting symptoms and urine sampling strategies. Design and setting Prospective observational study with systematic urine sampling, in general practices in Wales, UK. Method In total, 1003 children were recruited from 13 general practices between March 2008 and July 2010. The prevalence of UTI was determined and multivariable analysis performed to determine the probability of UTI. Result Out of 597 (60.0%) children who provided urine samples within 2 days, the prevalence of UTI was 5.9% (95% confidence interval [CI] = 4.3% to 8.0%) overall, 7.3% in those < 3 years and 3.2% in 3–5 year olds. Neither a history of fever nor the absence of an alternative source of infection was associated with UTI (P = 0.64; P = 0.69, respectively). The probability of UTI in children aged ≥3 years without increased urinary frequency or dysuria was 2%. The probability of UTI was ≥5% in all other groups. Urine sampling based purely on GP suspicion would have missed 80% of UTIs, while a sampling strategy based on current guidelines would have missed 50%. Conclusion Approximately 6% of acutely unwell children presenting to UK general practice met the criteria for a laboratory diagnosis of UTI. This higher than previously recognised prior probability of UTI warrants raised awareness of the condition and suggests clinicians should lower their threshold for urine sampling in young children. The absence of fever or presence of an alternative source of infection, as emphasised in current guidelines, may not rule out UTI in young children with adequate certainty. PMID:23561695

Leadership Practices in German and UK Organisations

ERIC Educational Resources Information Center

McCarthy, Grace

2005-01-01

Purpose: The aim of this research was to determine whether leadership practices vary between German and UK organisations. Design/methodology/approach: The author used self-assessment documents submitted by German and UK organisations to the European Foundation for Quality Management (EFQM), to identify leadership practices in both countries. A…

Mortality rates and causes of death in children with epilepsy prescribed antiepileptic drugs: a retrospective cohort study using the UK General Practice Research Database.

PubMed

Ackers, Ruth; Besag, Frank M C; Hughes, Elaine; Squier, Waney; Murray, Macey L; Wong, Ian C K

2011-05-01

Patients with epilepsy, including children, have an increased risk of mortality compared with the general population. Antiepileptic drugs (AEDs) were the most frequent class of drugs reported in a study looking at fatal suspected adverse drug reactions in children in the UK. The objective of the study was to identify cases and causes of death in a paediatric patient cohort prescribed AEDs with an associated epilepsy diagnosis. This was a retrospective cohort study supplemented with general practitioner-completed questionnaires, post-mortem reports and death certificates. The setting was UK primary care practices contributing to the General Practice Research Database. Participants were children and adolescents aged 0-18 years prescribed AEDs between 1993 and 2005. Causality assessment was undertaken by a consensus panel comprising paediatric specialists in neuropathology, neurology, neuropsychiatry, paediatric epilepsy, pharmacoepidemiology and pharmacy to determine crude mortality rate (CMR) and standardized mortality ratios (SMRs), and the likelihood of an association between AED(s) and the event of death. There were 6190 subjects in the cohort (contributing 26,890 person-years of data), of whom 151 died. Median age at death was 8.0 years. CMR was 56.2 per 10,000 person-years and the SMR was 22.4 (95% CI 18.9, 26.2). The majority of deceased subjects had severe underlying disorders. Death was attributable to epilepsy in 18 subjects; in 9 the cause of death was sudden unexpected death in epilepsy (SUDEP) [3.3 per 10 000 person-years (95% CI 1.5, 6.4)]. AEDs were probably (n = 2) or possibly (n = 3) associated causally with death in five subjects. Two status epilepticus deaths were associated causally with AED withdrawal. Children prescribed AEDs have an increased risk of mortality relative to the general population. Most of the deaths were in children with serious underlying disorders. A small number of SUDEP cases were identified. AEDs are not a major cause of death but in a small proportion of cases, a causal relationship between death and AEDs could not be excluded.

Factors associated with differential response to online cognitive behavioural therapy.

PubMed

Button, Katherine S; Wiles, Nicola J; Lewis, Glyn; Peters, Tim J; Kessler, David

2012-05-01

Patients differ in their response to treatments. There is obvious clinical utility in establishing patient characteristics that are associated with differential treatment responses (i.e., are effect modifiers or moderators of treatment response). Factors that moderate response to cognitive behavioural therapy (CBT) remain unclear. This study investigates whether factors prognostic of general depression outcome generally are also moderators of response to online CBT in a sample of depressed patients recruited through U.K. general practices. Secondary analysis of a randomised controlled trial, internet-based psychotherapy for depression. A total of 297 patients referred from 55 U.K. general practices and suffering from depression were randomly allocated to receive either online CBT or waiting list control. Treatment effect was measured by comparing depression score at 4 months between randomization groups. Treatment effect modification was assessed using regression analyses focusing on interactions between treatment effect and putative moderator variables. Pretreatment severity and marital status moderated treatment response. More severe patients, and patients who were separated, widowed, or divorced, benefited most from the intervention. Weak evidence suggested that treatment effectiveness diminished with increasing recent adverse life events. No evidence was found to suggest that educational attainment, age, and history of depression-moderated treatment response. Secondary analyses of trials comparing two or more treatments allow factors that may moderate treatment response to be distinguished from more general prognostic indicators, although caution is needed in interpreting such exploratory analyses.

Optimising value and quality in general practice within the primary health care sector through relationship marketing: a conceptual framework.

PubMed

Bansal, Manjit K

2004-01-01

Discusses the rationale of applying relationship marketing and service quality concepts within the primary health care sector. The use of relational strategies in general practice, by modelling the relationships between practitioners and patients from a marketing perspective, could potentially lead to sustained high quality service being provided, and to more efficient use of resources. This essentially conceptually focused paper addresses an area that has not yet been researched in detail, and furthers understanding of the relationships that facilitate exchange within general practice and service delivery in non-profit, resource-constrained conditions. Deeper understanding of the needs and expectations of patients and the way these can be delivered by general practice can only lead to improvements for all parties involved. The relationship marketing paradigm presents itself as a potentially exciting way of addressing issues associated with ensuring that the highest level of quality is delivered in this area of the UK National Health Service.

Approaches to the vaccination of pregnant women: experience from Stockport, UK, with prenatal influenza.

PubMed

Baxter, David

2013-06-01

For the 2010/11 influenza season the prenatal vaccination program was extended to all women in England and Wales irrespective of gestational age--this was a considerable shift in practice for both pregnant women and healthcare providers where the emphasis previously had been only on targeted vaccination for pregnant women with adverse risk factors for influenza infection. This paper will describe the program's operation in Stockport, UK during this season when uptake was among the highest in the England and Wales. Stockport is situated in the south east of Greater Manchester. It is a generally affluent area with a population of 295,000. Health indicators are generally higher than the regional average. The target population for influenza is just under 50,000 residents (excluding pregnant women).

Conditions for research in general practice. Can the Dutch and British experiences be applied to other countries, for example Spain?

PubMed

van der Zee, Jouke; Kroneman, Madelon; Bolíbar, Bonaventura

2003-06-01

The aim of this study is to identify conditions for research as part of professional development in general practice. Based on the work of Andrew Abbott, who studied the dynamics of professional development, five conditions were identified. These are: the creation of associations among professionals; control of work; the establishment of specialised education; the development of professional knowledge; and the creation of organised structures for professional work. Two countries with a well-established research tradition in general practice (the UK and the Netherlands) and one country where GP research development is still limited (Spain) were evaluated on the basis of these conditions. The conditions identified as favourable were as follows: the existence of a scientific association; a peer-reviewed journal; a defined population resulting in a population denominator for practices; a gatekeeping system; chairs and departments of general practice at universities; the integration of education centres and research centres; GPs working in group practices or health centres; a certain degree of independence from the Ministry of Health; and financial support for practicing GPs to conduct research activities. We showed that most conditions for the successful scientific progress of general practice in Spain are present. However there is still a gap between academia and general practice and a lack of research organisation and support.

Use of atropine penalization to treat amblyopia in UK orthoptic practice.

PubMed

Piano, Marianne; O'Connor, Anna R; Newsham, David

2014-01-01

To compare clinical practice patterns regarding atropine penalization use by UK orthoptists to the current evidence base and identify any existing barriers against use of AP as first-line treatment. An online survey was designed to assess current practice patterns of UK orthoptists using atropine penalization. They were asked to identify issues limiting their use of atropine penalization and give opinions on its effectiveness compared to occlusion. Descriptive statistics and content analysis were applied to the results. Responses were obtained from 151 orthoptists throughout the United Kingdom. The main perceived barriers to use of atropine penalization were inability to prescribe atropine and supply difficulties. However, respondents also did not consider atropine penalization as effective as occlusion in treating amblyopia, contrary to recent research findings. Patient selection criteria and treatment administration largely follow current evidence. More orthoptists use atropine penalization as first-line treatment than previously reported. Practitioners tend to closely follow the current evidence base when using atropine penalization, but reluctance in offering it as first-line treatment or providing a choice for parents between occlusion and atropine still remains. This may result from concerns regarding atropine's general efficacy, side effects, and risk of reverse amblyopia. Alternatively, as demonstrated in other areas of medicine, it may reflect the inherent delay of research findings translating to clinical practice changes. Copyright 2014, SLACK Incorporated.

The predictive validity of selection for entry into postgraduate training in general practice: evidence from three longitudinal studies

PubMed Central

Patterson, Fiona; Lievens, Filip; Kerrin, Máire; Munro, Neil; Irish, Bill

2013-01-01

Background The selection methodology for UK general practice is designed to accommodate several thousand applicants per year and targets six core attributes identified in a multi-method job-analysis study Aim To evaluate the predictive validity of selection methods for entry into postgraduate training, comprising a clinical problem-solving test, a situational judgement test, and a selection centre. Design and setting A three-part longitudinal predictive validity study of selection into training for UK general practice. Method In sample 1, participants were junior doctors applying for training in general practice (n = 6824). In sample 2, participants were GP registrars 1 year into training (n = 196). In sample 3, participants were GP registrars sitting the licensing examination after 3 years, at the end of training (n = 2292). The outcome measures include: assessor ratings of performance in a selection centre comprising job simulation exercises (sample 1); supervisor ratings of trainee job performance 1 year into training (sample 2); and licensing examination results, including an applied knowledge examination and a 12-station clinical skills objective structured clinical examination (OSCE; sample 3). Results Performance ratings at selection predicted subsequent supervisor ratings of job performance 1 year later. Selection results also significantly predicted performance on both the clinical skills OSCE and applied knowledge examination for licensing at the end of training. Conclusion In combination, these longitudinal findings provide good evidence of the predictive validity of the selection methods, and are the first reported for entry into postgraduate training. Results show that the best predictor of work performance and training outcomes is a combination of a clinical problem-solving test, a situational judgement test, and a selection centre. Implications for selection methods for all postgraduate specialties are considered. PMID:24267856

The predictive validity of selection for entry into postgraduate training in general practice: evidence from three longitudinal studies.

PubMed

Patterson, Fiona; Lievens, Filip; Kerrin, Máire; Munro, Neil; Irish, Bill

2013-11-01

The selection methodology for UK general practice is designed to accommodate several thousand applicants per year and targets six core attributes identified in a multi-method job-analysis study To evaluate the predictive validity of selection methods for entry into postgraduate training, comprising a clinical problem-solving test, a situational judgement test, and a selection centre. A three-part longitudinal predictive validity study of selection into training for UK general practice. In sample 1, participants were junior doctors applying for training in general practice (n = 6824). In sample 2, participants were GP registrars 1 year into training (n = 196). In sample 3, participants were GP registrars sitting the licensing examination after 3 years, at the end of training (n = 2292). The outcome measures include: assessor ratings of performance in a selection centre comprising job simulation exercises (sample 1); supervisor ratings of trainee job performance 1 year into training (sample 2); and licensing examination results, including an applied knowledge examination and a 12-station clinical skills objective structured clinical examination (OSCE; sample 3). Performance ratings at selection predicted subsequent supervisor ratings of job performance 1 year later. Selection results also significantly predicted performance on both the clinical skills OSCE and applied knowledge examination for licensing at the end of training. In combination, these longitudinal findings provide good evidence of the predictive validity of the selection methods, and are the first reported for entry into postgraduate training. Results show that the best predictor of work performance and training outcomes is a combination of a clinical problem-solving test, a situational judgement test, and a selection centre. Implications for selection methods for all postgraduate specialties are considered.

Multisource feedback questionnaires in appraisal and for revalidation: a qualitative study in UK general practice

PubMed Central

Hill, Jacqueline J; Asprey, Anthea; Richards, Suzanne H; Campbell, John L

2012-01-01

Background UK revalidation plans for doctors include obtaining multisource feedback from patient and colleague questionnaires as part of the supporting information for appraisal and revalidation. Aim To investigate GPs' and appraisers' views of using multisource feedback data in appraisal, and of the emerging links between multisource feedback, appraisal, and revalidation. Design and setting A qualitative study in UK general practice. Method In total, 12 GPs who had recently completed the General Medical Council multisource feedback questionnaires and 12 appraisers undertook a semi-structured, telephone interview. A thematic analysis was performed. Results Participants supported multisource feedback for formative development, although most expressed concerns about some elements of its methodology (for example, ‘self’ selection of colleagues, or whether patients and colleagues can provide objective feedback). Some participants reported difficulties in understanding benchmark data and some were upset by their scores. Most accepted the links between appraisal and revalidation, and that multisource feedback could make a positive contribution. However, tensions between the formative processes of appraisal and the summative function of revalidation were identified. Conclusion Participants valued multisource feedback as part of formative assessment and saw a role for it in appraisal. However, concerns about some elements of multisource feedback methodology may undermine its credibility as a tool for identifying poor performance. Proposals linking multisource feedback, appraisal, and revalidation may limit the use of multisource feedback and appraisal for learning and development by some doctors. Careful consideration is required with respect to promoting the accuracy and credibility of such feedback processes so that their use for learning and development, and for revalidation, is maximised. PMID:22546590

Multisource feedback questionnaires in appraisal and for revalidation: a qualitative study in UK general practice.

PubMed

Hill, Jacqueline J; Asprey, Anthea; Richards, Suzanne H; Campbell, John L

2012-05-01

UK revalidation plans for doctors include obtaining multisource feedback from patient and colleague questionnaires as part of the supporting information for appraisal and revalidation. To investigate GPs' and appraisers' views of using multisource feedback data in appraisal, and of the emerging links between multisource feedback, appraisal, and revalidation. A qualitative study in UK general practice. In total, 12 GPs who had recently completed the General Medical Council multisource feedback questionnaires and 12 appraisers undertook a semi-structured, telephone interview. A thematic analysis was performed. Participants supported multisource feedback for formative development, although most expressed concerns about some elements of its methodology (for example, 'self' selection of colleagues, or whether patients and colleagues can provide objective feedback). Some participants reported difficulties in understanding benchmark data and some were upset by their scores. Most accepted the links between appraisal and revalidation, and that multisource feedback could make a positive contribution. However, tensions between the formative processes of appraisal and the summative function of revalidation were identified. Participants valued multisource feedback as part of formative assessment and saw a role for it in appraisal. However, concerns about some elements of multisource feedback methodology may undermine its credibility as a tool for identifying poor performance. Proposals linking multisource feedback, appraisal, and revalidation may limit the use of multisource feedback and appraisal for learning and development by some doctors. Careful consideration is required with respect to promoting the accuracy and credibility of such feedback processes so that their use for learning and development, and for revalidation, is maximised.

Predicting the 10-year risk of hip and major osteoporotic fracture in rheumatoid arthritis and in the general population: an independent validation and update of UK FRAX without bone mineral density

PubMed Central

Klop, Corinne; de Vries, Frank; Bijlsma, Johannes W J; Leufkens, Hubert G M; Welsing, Paco M J

2016-01-01

Objectives FRAX incorporates rheumatoid arthritis (RA) as a dichotomous predictor for predicting the 10-year risk of hip and major osteoporotic fracture (MOF). However, fracture risk may deviate with disease severity, duration or treatment. Aims were to validate, and if needed to update, UK FRAX for patients with RA and to compare predictive performance with the general population (GP). Methods Cohort study within UK Clinical Practice Research Datalink (CPRD) (RA: n=11 582, GP: n=38 755), also linked to hospital admissions for hip fracture (CPRD-Hospital Episode Statistics, HES) (RA: n=7221, GP: n=24 227). Predictive performance of UK FRAX without bone mineral density was assessed by discrimination and calibration. Updating methods included recalibration and extension. Differences in predictive performance were assessed by the C-statistic and Net Reclassification Improvement (NRI) using the UK National Osteoporosis Guideline Group intervention thresholds. Results UK FRAX significantly overestimated fracture risk in patients with RA, both for MOF (mean predicted vs observed 10-year risk: 13.3% vs 8.4%) and hip fracture (CPRD: 5.5% vs 3.1%, CPRD-HES: 5.5% vs 4.1%). Calibration was good for hip fracture in the GP (CPRD-HES: 2.7% vs 2.4%). Discrimination was good for hip fracture (RA: 0.78, GP: 0.83) and moderate for MOF (RA: 0.69, GP: 0.71). Extension of the recalibrated UK FRAX using CPRD-HES with duration of RA disease, glucocorticoids (>7.5 mg/day) and secondary osteoporosis did not improve the NRI (0.01, 95% CI −0.04 to 0.05) or C-statistic (0.78). Conclusions UK FRAX overestimated fracture risk in RA, but performed well for hip fracture in the GP after linkage to hospitalisations. Extension of the recalibrated UK FRAX did not improve predictive performance. PMID:26984006

Placebo use in the UK: a qualitative study exploring GPs' views on placebo effects in clinical practice.

PubMed

Bishop, Felicity L; Howick, Jeremy; Heneghan, Carl; Stevens, Sarah; Hobbs, F D Richard; Lewith, George

2014-06-01

Surveys show GPs use placebos in clinical practice and reported prevalence rates vary widely. To explore GPs' perspectives on clinical uses of placebos. A web-based survey of 783 UK GPs' use of placebos in clinical practice. Qualitative descriptive analysis of written responses ('comments') to three open-ended questions. Comments were classified into three categories: (i) defining placebos and their effects in general practice; (ii) ethical, societal and regulatory issues faced by doctors and (iii) reasons why a doctor might use placebos and placebo effects in clinical practice. GPs typically defined placebos as lacking something, be that adverse or beneficial effects, known mechanism of action and/or scientific evidence. Some GPs defined placebos positively as having potential to benefit patients, primarily through psychological mechanisms. GPs described a broad array of possible harms and benefits of placebo prescribing, reflecting fundamental bioethical principles, at the level of the individual, the doctor-patient relationship, the National Health Service and society. While some GPs were adamant that there was no place for placebos in clinical practice, others focused on the clinically beneficial effects of placebos in primary care. This study has elucidated specific costs, benefits and ethical barriers to placebo use as perceived by a large sample of UK GPs. Stand-alone qualitative work would provide a more in-depth understanding of GPs' views. Continuing education and professional guidance could help GPs update and contextualize their understanding of placebos and their clinical effects. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Attitudes to Childhood Overweight and Obesity: The Limits of Cultural Explanations

ERIC Educational Resources Information Center

Chakrabarti, Suparna; Abbott, Stephen

2012-01-01

Objectives: To explore attitudes to and beliefs about childhood overweight and obesity among Bangladeshi mothers and to check maternal perceptions of their children's weight status. Design: Mixed methods cross-sectional study. Setting: A general practice in East London, UK. Methods: Qualitative interviews with 14 mothers; weighing and measuring 22…

Accountability in Further Education: The Impact of UK Government Policy.

ERIC Educational Resources Information Center

Lumby, Jacky

In 1993 the government of the United Kingdom introduced a raft of measures designed to improve practice in postcompulsory, nonadvanced education. A survey of postcompulsory institutions suggests that the same policies have led to different outcomes in the two main types of institution: general further education colleges and sixth form colleges.…

Passing MRCP (UK) PACES: a cross-sectional study examining the performance of doctors by sex and country.

PubMed

Unwin, Emily; Potts, Henry W W; Dacre, Jane; Elder, Andrew; Woolf, Katherine

2018-04-06

There is much discussion about the sex differences that exist in medical education. Research from the United Kingdom (UK) and United States has found female doctors earn less, and are less likely to be senior authors on academic papers, but female doctors are also less likely to be sanctioned, and have been found to perform better academically and clinically. It is also known that international medical graduates tend to perform more poorly academically compared to home-trained graduates in the UK, US, and Canada. It is uncertain whether the magnitude and direction of sex differences in doctors' performance is variable by country. We explored the association between doctors' sex and their performance at a large international high-stakes clinical examination: the Membership of the Royal Colleges of Physicians (UK) Practical Assessment of Clinical Examination Skills (PACES). We examined how sex differences varied by the country in which the doctor received their primary medical qualification, the country in which they took the PACES examination, and by the country in which they are registered to practise. Seven thousand six hundred seventy-one doctors attempted PACES between October 2010 and May 2013. We analysed sex differences in first time pass rates, controlling for ethnicity, in three groups: (i) UK medical graduates (N = 3574); (ii) non-UK medical graduates registered with the UK medical regulator, the General Medical Council (GMC), and thus likely to be working in the UK (N = 1067); and (iii) non-UK medical graduates without GMC registration and so legally unable to work or train in the UK (N = 2179). Female doctors were statistically significantly more likely to pass at their first attempt in all three groups, with the greatest sex effect seen in non-UK medical graduates without GMC registration (OR = 1.99; 95% CI = 1.65-2.39; P < 0.0001) and the smallest in the UK graduates (OR = 1.18; 95% CI = 1.03-1.35; P = 0.02). As found in a previous format of this examination and in other clinical examinations, female doctors outperformed male doctors. Further work is required to explore why sex differences were greater in non-UK graduates, especially those without GMC registration, and to consider how examination performance may relate to performance in practice.

Patients' experiences of continuity in the care of type 2 diabetes: a focus group study in primary care

PubMed Central

Alazri, Mohammed H; Neal, Richard D; Heywood, Phil; Leese, Brenda

2006-01-01

Background Continuity of care is fundamental to general practice and type 2 diabetes is a common chronic disease with major health and social impacts. Nevertheless continuity, as experienced by patients with type 2 diabetes, remains a neglected area. Aim To explore perceptions and experiences of continuity of care in general practice from the perspectives of patients with type 2 diabetes, focusing on the advantages and disadvantages of different types of continuity. Design of study Focus groups with patients. Setting Seven practices with different organisational structures in Leeds, UK. Method Seventy-nine patients with type 2 diabetes were recruited. Focus group interviews were conducted with 79 patients with type 2 diabetes from seven practices in Leeds, UK. Results Patients experienced three different types of continuity: relational (or longitudinal) continuity, cross-boundary (or team) continuity, and continuity of information. Patients' perceptions of continuity were influenced by several factors including a personal relationship between themselves and their healthcare professional, their own beliefs and behaviours, presence of diabetes, and the systems and structures of general practices. Patients identified the advantages and disadvantages of two types of continuity. Relational or longitudinal continuity was important in providing psychosocial care, but with a risk of misdiagnosis. The advantages of cross-boundary or team continuity were to provide physical care, whereas the main disadvantages were the absence of personal care and patient confusion. Conclusion Perceptions of continuity by patients with type 2 diabetes were influenced by several factors; they perceived several advantages and disadvantages associated with different types of continuity. Patients might expect certain healthcare benefits by following certain types of continuity. PMID:16834874

The utility of an online diagnostic decision support system (Isabel) in general practice: a process evaluation.

PubMed

Henderson, Emily J; Rubin, Greg P

2013-05-01

To evaluate the utility of Isabel, an online diagnostic decision support system developed by Isabel Healthcare primarily for secondary medical care, in the general practice setting. Focus groups were conducted with clinicians to understand why and how they used the system. A modified online post-use survey asked practitioners about its impact on their decision-making. Normalization process theory (NPT) was used as a theoretical framework to determine whether the system could be incorporated into routine clinical practice. The system was introduced by NHS County Durham and Darlington in the UK in selected general practices as a three-month pilot. General practitioners and nurse practitioners who had access to Isabel as part of the Primary Care Trust's pilot. General practitioners' views, experiences and usage of the system. Seven general practices agreed to pilot Isabel. Two practices did not subsequently use it. The remaining five practices conducted searches on 16 patients. Post-use surveys (n = 10) indicated that Isabel had little impact on diagnostic decision-making. Focus group participants stated that, although the diagnoses produced by Isabel in general did not have an impact on their decision-making, they would find the tool useful if it were better tailored to the primary care setting. Our analysis concluded that normalization was not likely to occur in its current form. Isabel was of limited utility in this short pilot study and may need further modification for use in general practice.

The PEN&PAD data entry system: from prototype to practical system.

PubMed Central

Kirby, J.; Rector, A. L.

1996-01-01

This paper describes some of the issues addressed in the transition of the PEN&PAD from prototype clinical workstation to practical data entry system for use by general practitioners in the UK. Background and motivation of the PEN&PAD and GALEN projects are presented before the operation of the PEN&PAD user interface is described. A number of issues which have arisen in the development of the PEN&PAD Data Entry System are discussed. PMID:8947757

Increasing awareness of gynaecological cancer symptoms: a GP perspective.

PubMed

Evans, Ruth E C; Morris, Melanie; Sekhon, Mandeep; Buszewicz, Marta; Walter, Fiona M; Waller, Jo; Simon, Alice E

2014-06-01

In the UK there has been an effort, through the National Awareness and Early Diagnosis Initiative (NAEDI), to increase early stage diagnoses and ultimately cancer survival. Encouraging early symptom presentation through awareness-raising activities in primary care is one method to achieve this goal. Understanding GPs' views about this type of activity, however, is crucial prior to implementation. To describe GPs' attitudes to raising public awareness of gynaecological cancers, and their views about the potential impact on primary care services. An online survey with a convenience sample recruited from 1860 UK general practices. An invitation was emailed to GPs via practice managers and included a weblink to a draft education leaflet and an online survey about the impact of sending a leaflet giving information about symptoms associated with gynaecological cancers to all women on GPs' lists. Participants could offer additional free text comments which were coded using content analysis. A total of 621 GPs participated. Most (77%, 477) felt that raising awareness of cancers was important. Only half (50%, 308), however, indicated that they would distribute such a leaflet from their practice. Barriers to implementation included concerns about financial costs; emotional impact on patients; increased demand for appointments and diagnostic services, such as ultrasound. GPs were generally positive about an intervention to improve patients' awareness of gynaecological cancers, but had concerns about increasing rates of presentation. There is a need for research quantifying the benefits of earlier diagnosis against resource costs such as increased consultations, investigations, and referrals. © British Journal of General Practice 2014.

Use of a primary care database to determine trends in genital chlamydia testing, diagnostic episodes and management in UK general practice, 1990–2004

PubMed Central

Hughes, Gwenda; Williams, Tim; Simms, Ian; Mercer, Catherine; Fenton, Kevin; Cassell, Jackie

2007-01-01

Objective To determine the extent of testing, diagnostic episodes and management of genital Chlamydia trachomatis (CT) infection in UK primary care using a large primary care database. Methods The incidence of CT tests, diagnostic episodes, treatments and referrals was measured for all adult patients in the General Practice Research Database between 1990 and 2004. Results Rates of CT testing in those aged 12–64 years in 2004 increased to 1439/100 000 patient years (py) in women but only 74/100 000 py in men. Testing rates were highest among 20–24‐year‐old women (5.5% tested in 2004), followed by 25–34‐year‐old women (3.7% tested in 2004). 0.5% of registered 16–24‐year‐old women were diagnosed as having CT infection in 2004. Three‐quarters of patients with a recorded diagnosis of CT had had an appropriate prescription issued in 2004, a proportion that increased from 1990 along with a decrease in referrals to genitourinary medicine. In 2004, general practitioners treated 25.0% of all recorded diagnoses of CT in women and 5.1% of those in men. Conclusions Testing for and diagnostic episodes of CT in primary care have increased since 1990. Testing continues disproportionately to target women aged >24 years. Extremely low rates of testing in men, together with high positivity, demonstrate a missed opportunity for diagnosis of CT and contact tracing in general practice. PMID:17360731

Playing it safe: addressing the emotional and physical health of lesbian and gay pupils in the U.K.

PubMed

Warwick, I; Aggleton, P; Douglas, N

2001-02-01

Compared to young people in general, young lesbians and gay men can face specific challenges to their physical and emotional well-being. These include discrimination, victimization, homophobic bullying and an elevated suicide risk. Relative to initiatives which attempt to address bullying in general, little has been done in schools in the U.K. to address physical and verbal homophobic bullying. This paper reports on an exploratory study to examine teachers' perceptions of homophobic bullying, the responses made to this form of bullying, and the factors which impact on the provision of education and support to lesbian and gay pupils. Findings suggested that teachers were aware of homophobic bullying but were confused, unable or unwilling to address the needs of lesbian and gay pupils. Implications for policy, practice and research are discussed. While current U.K. Government policy promoting Healthy Schools and Citizenship education offers hope for the future, much remains to be done to ensure that such initiatives are inclusive of all pupils. Copyright 2001 The Association for Professionals in Services for Adolescents.

Health status of Gypsy Travellers.

PubMed

Van Cleemput, P; Parry, G

2001-06-01

Although previous studies suggest that Gypsy Travellers have poorer health status and excess mortality compared with the general population, there is no epidemiological evidence using validated measures in this nomadic ethnic group. The aim of this study was to compare the health status of traditional Gypsy Travellers with norms from the UK population, and with a concurrent comparison group using the Euroqol health status measure (EQ-5D). Eighty-seven adult Gypsy Travellers were matched for age and sex with English or Irish residents, registered with an urban general practice in an area of high social deprivation. Both samples completed the EQ-5D questionnaire by interview. A comparison was also made with normative data from the UK general population. Travellers had poorer health status than their settled counterparts on two of the five dimensions (mobility and activity) but not on the overall summary score. Travellers reported significantly poorer health than the matched comparison group on the EQ-5D visual analogue scale. Both the Travellers and the comparison group had much poorer health status on the EQ-5D index than the UK population norms, even when compared with the lowest socioeconomic group. Health status of Gypsy Travellers was significantly poorer than in the lowest socio-economic UK population group, but was not so markedly different from a concurrent, matched, socially deprived resident group. Gypsy Travellers did have poorer health status than matched comparators in relation to mobility, activity and perception of overall health. Quantitative assessment of health status in the Traveller community is feasible.

Management of hip fractures in older people in Beijing: a retrospective audit and comparison with evidence-based guidelines and practice in the UK.

PubMed

Tian, M; Gong, X; Rath, S; Wei, J; Yan, L L; Lamb, S E; Lindley, R I; Sherrington, C; Willett, K; Norton, R

2016-02-01

Despite the high burden of hip fracture in China, there is limited information on its management. This study investigated the management of hip fractures in a Beijing tertiary hospital and compared practice with that in 180 hospitals in the UK. The findings show a significant gap exists between the countries. The purpose of this study was to determine if the management of older people with hip fractures in a Beijing tertiary hospital is comparable with the UK best practice guidelines for hip fracture management and the UK National Hip Fracture Database 2012, obtained from 180 hospitals. A retrospective audit was undertaken in a large tertiary care hospital in Beijing. Data were compared with the National Hip Fracture Database 2012 collected in 180 hospitals in the UK on the proportion of patients managed according to the UK Blue Book standards. Sixty-six percent of patients were admitted to an orthopaedic ward within 24 h of fracture, while 100 % of patients in the UK were admitted to an orthopaedic ward within 24 h of arrival to an accident and emergency department. Only 8 % of patients received surgery within 48 h of admission compared with 83 % in the UK; 10 % received no surgery compared with 2.5 % in the UK; and 27 % received orthogeriatrician assessment compared with 70 % in the UK. New pressure ulcers developed in 2 % of patients compared with 3.7 % of those in the UK; whereas, 0.3 % of patients were assessed for osteoporosis treatment and 3.8 % received falls assessment, and comparable figures for the UK were 94 and 92 %, respectively. Significant gaps exist in hip fracture management in the Beijing hospital compared with the best practice achieved in 180 UK hospitals, highlighting the need to implement and evaluate proactive strategies to increase the uptake of best practice hip fracture care in China.

Attitudes of newly qualified doctors towards a career in general practice: a qualitative focus group study.

PubMed

Merrett, Alexandra; Jones, Daniel; Sein, Kim; Green, Trish; Macleod, Una

2017-04-01

A key element of the NHS is universal access to a GP. Recently, UK general practice has been described as being in crisis, with training places unfilled and multiple practices reporting vacancies or facing closure. The recruitment of GPs continues to be a key focus for both the Royal College of General Practitioners (RCGP) and the government. To understand the attitudes of newly qualified doctors towards a career in general practice, to appreciate potential reasons for the crisis in GP recruitment, and to recommend ways to improve recruitment. A qualitative study comprising five focus groups with 74 Foundation Year 1 (FY1) doctors from one Yorkshire deanery. Audio recordings were transcribed verbatim and thematic analysis undertaken. Foundation Year 1 doctors' thoughts towards a career in general practice were summarised in four themes: quality of life, job satisfaction, uncertainty surrounding the future of general practice, and the lack of respect for GPs among both doctors and the public. Participants felt that general practice could provide a good work-life balance, fair pay, and job stability. Job satisfaction, with the ability to provide care from the cradle to the grave, and to work within a community, was viewed positively. Uncertainties around future training, skill levels, pay, and workload, together with a perceived stigma experienced in medical schools and hospitals, were viewed as a deterrent to a career in general practice. This study has gathered the opinions of doctors at a critical point in their careers, before they choose a future specialty. Findings highlight areas of concern and potential deterrents to a career in general practice, together with recommendations to address these issues. © British Journal of General Practice 2017.

Education and training in psychiatry in the U.K.

PubMed

Carney, Stuart; Bhugra, Dinesh K

2013-07-01

Recent training and education changes have raised important issues in delivery of psychiatric education at all levels. In this article, the authors describe the current status of mental health education in the training of all doctors and postgraduate training and education in psychiatry in the U.K. The authors explore and describe some of the initiatives that are being used in order to increase exposure to mental health placements in the Foundation Program, and they then describe the existing specific mental health opportunities within general practice and other specialist training programs. After graduation from medical school, a two-year Foundation training program is a must, and, at the end of the first year, trainees become eligible for full registration with the "regulator," the General Medical Council; after finishing the second year, they become eligible to undertake specialist training. Psychiatry training takes up to 6 years, and six specialties are recognized as leading to certificates for completion of training before independent practice. These six specialties are 1) general and community; 2) child and adolescent; 3) medical psychotherapy; 4) forensic psychiatry; 5) psychiatry of old age; and 6) psychiatry of learning disability. Also, three subspecialties-liaison psychiatry, addictions, and rehabilitation-form a part of the training in general and community psychiatry. The authors discuss advantages and disadvantages of such an approach and raise key issues related to ongoing work to improve recruitment, progression, and retention of trainee psychiatrists.

Barriers to medication adherence for the secondary prevention of stroke: a qualitative interview study in primary care.

PubMed

Jamison, James; Graffy, Jonathan; Mullis, Ricky; Mant, Jonathan; Sutton, Stephen

2016-08-01

Medications are highly effective at reducing risk of recurrent stroke, but success is influenced by adherence to treatment. Among survivors of stroke and transient ischaemic attack (TIA), adherence to medication is known to be suboptimal. To identify and report barriers to medication adherence for the secondary prevention of stroke/TIA. A qualitative interview study was conducted within general practice surgeries in the East of England, UK. Patients were approached by letter and invited to take part in a qualitative research study. Semi-structured interviews were undertaken with survivors of stroke, caregivers, and GPs to explore their perspectives and views around secondary prevention and perceived barriers to medication adherence. Key themes were identified using a grounded theory approach. Verbatim quotes describing the themes are presented here. In total, 28 survivors of stroke, including 14 accompanying caregivers and five GPs, were interviewed. Two key themes were identified. Patient level barriers included ability to self-care, the importance people attach to a stroke event, and knowledge of stroke and medication. Medication level barriers included beliefs about medication and beliefs about how pills work, medication routines, changing medications, and regimen complexity and burden of treatment. Patients who have had a stroke are faced with multiple barriers to taking secondary prevention medications in UK general practice. This research suggests that a collaborative approach between caregivers, survivors, and healthcare professionals is needed to address these barriers and facilitate medication-taking behaviour. © British Journal of General Practice 2016.

UK and Italian EIA systems: A comparative study on management practice and performance in the construction industry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bassi, Andrea, E-mail: ab395@bath.co.uk; Howard, Robert, E-mail: robhoward@constcom.demon.co.uk; Geneletti, Davide, E-mail: davide.geneletti@ing.unitn.it

This study evaluates and contrasts the management practice and the performance that characterise Environmental Impact Assessments (EIA) in Italy and in the UK. The methodology relies on the investigation of six carefully selected case studies, critically reviewed by referring to EIA and project design information, as well as collecting the opinion of key project participants. The study focuses on the construction industry and on specific key sectors like infrastructure for transport and renewable energy and commercial and tourism development. A main term of reference for the analyses has been established by critically reviewing international literature so as to outline commonmore » good practice, requirements for the enhancement of sustainability principles and typically incurred drawbacks. The proposed approach enhances transfer of knowledge and of experiences between the analyzed contexts and allows the provision of guidelines for practitioners. Distinctive differences between the UK and the Italian EIA systems have been detected for pivotal phases and elements of EIA, like screening, scoping, analysis of alternatives and of potential impacts, definition of mitigation strategies, review, decision making, public participation and follow up. - Highlights: Black-Right-Pointing-Pointer The Italian and the UK Environmental Impact Assessment systems are compared. Black-Right-Pointing-Pointer The research is centred on the construction industry. Black-Right-Pointing-Pointer Issues and shortcomings are analysed by investigating six case studies. Black-Right-Pointing-Pointer Integration of EIA with sustainability principles is appraised. Black-Right-Pointing-Pointer General guidelines are provided to assist practitioners in the two national contexts.« less

Laboratory Diagnosis and Characterization of Fungal Disease in Patients with Cystic Fibrosis (CF): A Survey of Current UK Practice in a Cohort of Clinical Microbiology Laboratories.

PubMed

Boyle, Maeve; Moore, John E; Whitehouse, Joanna L; Bilton, Diana; Downey, Damian G

2018-03-02

There is much uncertainty as to how fungal disease is diagnosed and characterized in patients with cystic fibrosis (CF). A 19-question anonymous electronic questionnaire was developed and distributed to ascertain current practice in clinical microbiology laboratories providing a fungal laboratory service to CF centres in the UK. Analyses of responses identified the following: (1) current UK laboratory practice, in general, follows the current guidelines, but the scope and diversity of what is currently being delivered by laboratories far exceeds what is detailed in the guidelines; (2) there is a lack of standardization of fungal tests amongst laboratories, outside of the current guidelines; (3) both the UK CF Trust Laboratory Standards for Processing Microbiological Samples from People with Cystic Fibrosis and the US Cumulative Techniques and Procedures in Clinical Microbiology (Cumitech) Guidelines 43 Cystic Fibrosis Microbiology need to be updated to reflect both new methodological innovations, as well as better knowledge of fungal disease pathophysiology in CF; (4) there is a need for clinical medicine to decide upon a stratification strategy for the provision of new fungal assays that will add value to the physician in the optimal management of CF patients; (5) there is also a need to rationale what assays should be performed at local laboratory level and those which are best served at National Mycology Reference Laboratory level; and (6) further research is required in developing laboratory assays, which will help ascertain the clinical importance of 'old' fungal pathogens, as well as 'emerging' fungal pathogens.

Low hepatitis B testing among migrants: a cross-sectional study in a UK city.

PubMed

Evlampidou, Iro; Hickman, Matthew; Irish, Charles; Young, Nick; Oliver, Isabel; Gillett, Sophie; Cochrane, Alexandra

2016-06-01

In 2012, hepatitis B virus (HBV) testing of people born in a country with a prevalence of ≥2% was recommended in the UK. Implementation of this recommendation requires an understanding of prior HBV testing practice and coverage, for which there are limited data. To estimate the proportion of migrants tested for HBV and explore GP testing practices and barriers to testing. A cross-sectional study of (a) migrants for whom testing was recommended under English national guidance, living in Bristol, and registered with a GP in 2006-2013, and (b) GPs practising in Bristol. NHS patient demographic data and HBV laboratory surveillance data were linked. A person was defined as 'HBV-tested' if a laboratory result was available. An online GP survey was undertaken, using a structured questionnaire. Among 82 561 migrants for whom HBV testing was recommended, 9627 (12%) were 'HBV-tested'. The HBV testing coverage was: Eastern Africa 20%; Western Africa 15%; South Eastern Asia 9%; Eastern Asia 5%. Of 19 GPs, the majority did not use guidelines to inform HBV testing in migrants and did not believe routine testing of migrants was indicated; 12/17 GPs stated that workload and lack of human, and financial resources were the most significant barriers to increased testing. The majority of migrants to a multicultural UK city from medium-/high-prevalence regions have no evidence of HBV testing. Much greater support for primary care in the UK and increased GP awareness of national guidance are required to achieve adherence to current testing guidance. © British Journal of General Practice 2016.

UK GPs' and practice nurses' views of continuity of care for patients with type 2 diabetes.

PubMed

Alazri, Mohammed H; Heywood, Philip; Neal, Richard D; Leese, Brenda

2007-04-01

Continuity of care is widely regarded as a core value of primary care. Type 2 diabetes is a common chronic disease with major health, social and economic impacts. Primary health care professionals in many countries are involved in the management of patients with type 2 diabetes, but their perspectives on continuity remain neglected in research. To explore UK GPs' and nurses' experiences of continuity of care for patients with type 2 diabetes in primary care settings. Semi-structured individual interviews were conducted with 16 GPs and 18 practice nurses who manage patients with type 2 diabetes recruited from 20 practices with various organizational structures in Leeds, UK. Three types of continuities were identified: relational continuity from the same health care professional, team continuity from a group of health care professionals and cross-boundary continuity across primary-secondary care settings. Relational continuity was influenced by the quality of the patient-health care professional relationship, policy of the National Health Service (NHS) in the UK (new General Medical Services contract), walk-in centres, the behaviour of receptionists and the structure and systems of the practice. Team and cross-boundary continuities were influenced by the relationship between team members and by effective communication. Relational continuity contributed to more 'personal care', but the usual health care professional might know less about diabetes. Team continuity was important in providing 'physical care', but patients could be confused by conflicting advice from different professionals. Cross-boundary continuity helps to provide 'expert advice', but is dependent upon effective communication. GPs and practice nurses dealing with patients with type 2 diabetes identified three types of continuities, each influenced by several factors. Relational continuity deals better with psychosocial care while team continuity promotes better physical care; therefore, imposing one type of continuity may inhibit good diabetic care. Cross-boundary continuity between primary and secondary care is fundamental to contemporary diabetic services and ways should be found to achieve more effective communication.

Images of Childhood in Mothers' Accounts of Contemporary Childrearing

ERIC Educational Resources Information Center

Murphy, Elizabeth

2007-01-01

This article examines how a sample of first-time mothers in the UK constitute childhood in general, and their own children in particular, in and through their talk about the mundane practices of childcare. The data analysed are drawn from a longitudinal qualitative interview study that followed a sample of mothers from late pregnancy until their…

Creating an Inclusive Society… How Close Are We in Relation to Autism Spectrum Disorder? A General Population Survey

ERIC Educational Resources Information Center

Dillenburger, Karola; McKerr, Lyn; Jordan, Julie Ann; Devine, Paula; Keenan, Mickey

2015-01-01

Background: Children with autism spectrum disorder are increasingly educated in mainstream classrooms in the United Kingdom (Wilkinson & Twist, "Autism and Educational Assessment: UK Policy and Practice." NFER, Slough, 2010), and some employers are now specifically seeking out staff on the autism spectrum. Does that mean that we are…

Broken Voices or a Broken Curriculum? The Impact of Research on UK School Choral Practice with Boys

ERIC Educational Resources Information Center

Ashley, Martin R.

2013-01-01

Work such as that of John Cooksey on boys' changing voices has influenced choral practice in the USA and in certain UK youth choirs, but has hitherto had little impact in UK schools where many teachers continue to believe that boys' voices "break". Different practices are found across the independent and maintained sectors of secondary…

Mindful Application of Aviation Practices in Healthcare.

PubMed

Powell-Dunford, Nicole; Brennan, Peter A; Peerally, Mohammad Farhad; Kapur, Narinder; Hynes, Jonny M; Hodkinson, Peter D

2017-12-01

Evidence supports the efficacy of incorporating select recognized aviation practices and procedures into healthcare. Incident analysis, debrief, safety brief, and crew resource management (CRM) have all been assessed for implementation within the UK healthcare system, a world leader in aviation-based patient safety initiatives. Mindful application, in which aviation practices are specifically tailored to the unique healthcare setting, show promise in terms of acceptance and long-term sustainment. In order to establish British healthcare applications of aviation practices, a PubMed search of UK authored manuscripts published between 2005-2016 was undertaken using search terms 'aviation,' 'healthcare,' 'checklist,' and 'CRM.' A convenience sample of UK-authored aviation medical conference presentations and UK-authored patient safety manuscripts were also reviewed. A total of 11 of 94 papers with UK academic affiliations published between 2005-2016 and relevant to aviation modeled healthcare delivery were found. The debrief process, incident analysis, and CRM are the primary practices incorporated into UK healthcare, with success dependent on cultural acceptance and mindful application. CRM training has gained significant acceptance in UK healthcare environments. Aviation modeled incident analysis, debrief, safety brief, and CRM training are increasingly undertaken within the UK healthcare system. Nuanced application, in which the unique aspects of the healthcare setting are addressed as part of a comprehensive safety approach, shows promise for long-term success. The patient safety brief and aviation modeled incident analysis are in earlier phases of implementation, and warrant further analysis.Powell-Dunford N, Brennan PA, Peerally MF, Kapur N, Hynes JM, Hodkinson PD. Mindful application of aviation practices in healthcare. Aerosp Med Hum Perform. 2017; 88(12):1107-1116.

Variations in achievement of evidence-based, high-impact quality indicators in general practice: An observational study

PubMed Central

West, Robert; Rushforth, Bruno; Stokes, Tim; Glidewell, Liz; Carder, Paul; Faulkner, Simon; Foy, Robbie

2017-01-01

Background There are widely recognised variations in the delivery and outcomes of healthcare but an incomplete understanding of their causes. There is a growing interest in using routinely collected ‘big data’ in the evaluation of healthcare. We developed a set of evidence-based ‘high impact’ quality indicators (QIs) for primary care and examined variations in achievement of these indicators using routinely collected data in the United Kingdom (UK). Methods Cross-sectional analysis of routinely collected, electronic primary care data from a sample of general practices in West Yorkshire, UK (n = 89). The QIs covered aspects of care (including processes and intermediate clinical outcomes) in relation to diabetes, hypertension, atrial fibrillation, myocardial infarction, chronic kidney disease (CKD) and ‘risky’ prescribing combinations. Regression models explored the impact of practice and patient characteristics. Clustering within practice was accounted for by including a random intercept for practice. Results Median practice achievement of the QIs ranged from 43.2% (diabetes control) to 72.2% (blood pressure control in CKD). Considerable between-practice variation existed for all indicators: the difference between the highest and lowest performing practices was 26.3 percentage points for risky prescribing and 100 percentage points for anticoagulation in atrial fibrillation. Odds ratios associated with the random effects for practices emphasised this; there was a greater than ten-fold difference in the likelihood of achieving the hypertension indicator between the lowest and highest performing practices. Patient characteristics, in particular age, gender and comorbidity, were consistently but modestly associated with indicator achievement. Statistically significant practice characteristics were identified less frequently in adjusted models. Conclusions Despite various policy and improvement initiatives, there are enduring inappropriate variations in the delivery of evidence-based care. Much of this variation is not explained by routinely collected patient or practice variables, and is likely to be attributable to differences in clinical and organisational behaviour. PMID:28704407

Drugs given by a syringe driver: a prospective multicentre survey of palliative care services in the UK.

PubMed

Wilcock, Andrew; Jacob, Jayin K; Charlesworth, Sarah; Harris, Elayne; Gibbs, Margaret; Allsop, Helen

2006-10-01

The use of a syringe driver to administer drugs by continuous subcutaneous infusion is common practice in the UK. Over time, drug combinations used in a syringe driver are likely to change and the aim of this survey was to obtain a more recent snapshot of practice. On four separate days, at two-week intervals, a questionnaire was completed for every syringe driver in use by 15 palliative care services. Of 336 syringe drivers, the majority contained either two or three drugs, but one-fifth contained only one drug. The median (range) volume of the infusions was 15 (9.5-48) mL, and duration of infusion was generally 24 hours. Only one combination was reported as visually incompatible, and there were 13 site reactions (4% of total). Laboratory physical and chemical compatibility data are available for less than half of the most frequently used combinations.

Pastoral care of mental illness and the accommodation of African Christian beliefs and practices by UK clergy.

PubMed

Leavey, Gerard; Loewenthal, Kate; King, Michael

2017-02-01

Faith-based organisations, especially those related to specific ethnic or migrant groups, are increasingly viewed by secular Western government agencies as potential collaborators in community health and welfare programmes. Although clergy are often called upon to provide mental health pastoral care, their response to such problems remains relatively unexamined. This paper examines how clergy working in multiethnic settings do not always have the answers that people want, or perhaps need, to problems of misfortune and suffering. In the UK these barriers can be attributed, generally, to a lack of training on mental health problems and minimal collaboration with health services. The current paper attempts to highlight the dilemmas of the established churches' involvement in mental health care in the context of diversity. We explore the inability of established churches to accommodate African and other spiritual beliefs and practices related to the etiology and treatment of mental health problems.

Current optometric practices and attitudes in keratoconus patient management.

PubMed

Ortiz-Toquero, Sara; Martin, Raul

2017-08-01

To compare the current optometric practices and attitudes in the management of keratoconus patients in the UK and Spain. An online survey (adapted to optometric practices) was distributed via a newsletter emailed by various professional organizations in the UK and Spain. Four hundred and sixty-four practitioners (126 in the UK; 338 in Spain) who prescribed gas permeable GP contact lenses (CLs) more than once per month (54.8% of UK practitioners and 28.1% of practitioners in Spain; p<0.01) responded to the questionnaire. A combination of multiple factors is considered necessary in the keratoconus detection (79.4% in the UK, 75% in Spain; p=0.68), and the use of classification criteria is considered relevant (67.5% in the UK, 70.7% in Spain; p=0.49). There is a high consensus on the consideration that GP CL fitting is more difficult in keratoconus (79.4% in the UK, 80.5% in Spain; p=0.79) requiring more diagnostic lenses (3.2±1.4 and 3.4±1.2 in the UK and Spain, respectively; p=0.72) than are necessary for healthy eyes. Using corneal topography is uncommon from both countries (38.1% in the UK, 59.8% in Spain; p<0.01), with a similar ophthalmologist referral pattern (at initial diagnosis, 50% in both the UK and Spain; p=1.00). Few cases of co-management with ophthalmologists were noted (no co-management reported by 60.3% in the UK and 72.8% in Spain, p=0.01). This study provides initial observations and evidence regarding keratoconus management by optometrists in the UK and Spain and shows similarity in the professional practices and attitudes of practitioners in these two countries. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Practitioners of Western herbal medicine and their practice in the UK: beginning to sketch the profession.

PubMed

Nissen, Nina

2010-11-01

To profile the profession of Western herbal medicine (WHM) in the UK. A self-completion postal questionnaire sent to a sample of practitioners of WHM in England. A typical practitioner of WHM in the UK is female, aged 41-50, white, and practises part-time from a shared clinic or from home. Motivations to embark on a career in WHM are grounded in an interest in natural healing and the desire to help others. The practice of WHM in the UK responds extensively to women's health needs. Tensions in the practice of WHM are identified between a framework of healthcare that is described as 'traditional' and the influences of evidence-based developments in healthcare. Women, both as practitioners and as patients, and women's health needs play a central role in the contemporary practice of WHM in the UK. Copyright © 2010 Elsevier Ltd. All rights reserved.

The efficiency of cardiovascular risk assessment: do the right patients get statin treatment?

PubMed Central

van Staa, Tjeerd-Pieter; Smeeth, Liam; Ng, Edmond S-W; Goldacre, Ben; Gulliford, Martin

2013-01-01

Objective To evaluate targeting of statin prescribing for primary prevention to those with high cardiovascular disease (CVD) risk. Design Two cohort studies including the general population and initiators of statins aged 35–74 years. Setting UK primary care records in the Clinical Practice Research Datalink. Patients 3.8 million general population patients and 300 914 statin users. Intervention Statin prescribing. Main outcome measures Statin prescribing by CVD risk; observed 5-year CVD risks; variability between practices. Results Statin prescribing increased substantially over time to patients with high 10-year CVD risk (≥20%): 7.0% of these received a statin prior to 2007, and 30.4% in 2007 onwards. Prescribing to patients with low risk (<15%) also increased (from 1.9% to 5.0%). Only about half the patients initiating statin treatment were high risk according to CVD risk score. The 5-year CVD risks, as observed during statin treatment, reduced over calendar time (from 17.0% to 7.1%). There was a large variation between general practices in the percentage of high-risk patients prescribed a statin in 2007 onwards, ranging from 8.2% to 61.5%. For low-risk patients, these varied from 2.1% to 29.1%. Conclusions There appeared to be substantive overuse in low CVD risk and underuse in high CVD risk (600 000 and 850 000 patients, respectively, in the UK since 2007). There is wide variation between practices in statin prescribing to patients at high CVD risk. There is a clear need for randomised trials for the best strategy to target statin treatment and manage CVD risk for primary prevention. PMID:23735939

Council tax valuation band of patient residence and clinical contacts in a general practice

PubMed Central

Beale, Norman; Taylor, Gordon; Straker-Cook, Dawn; Peart, Carole; Gwynne, Mark

2005-01-01

Background There is a dearth of data relating UK general practice workload to personal and social markers of individual patients. Aim To test whether there is a significant association between general practice patient contact rates and the council tax valuation band of their residential address. Design of study Cross-sectional analyses using data recorded, over 1 year, for over 3300 general practice patients. Setting One medium-sized group practice in an industrialised English market town. Method Face-to-face contacts between the patients and the doctors and nurses in the practice were compared by patient age, sex, registration period, distance from surgery, Underprivileged Area 8 (UPA8) score, and council tax valuation band. Results Patient sex, age, recent registration, distance from surgery, and council tax valuation band were each significantly associated with face-to-face contact rate in univariate analyses. UPA8 score was not significantly associated with contact rates. On multivariate testing, sex, age, recent registration, and council tax valuation band remained significantly associated with contact rates. The last is a new finding. Conclusion Council tax valuation bands predict contact rate in general practice; the lower the band, the higher the contact rate. Council tax valuation band could be a useful marker of workload that is linked to socioeconomic status. This is a pilot study and multipractice research is advocated. PMID:15667763

General practices as emergent research organizations: a qualitative study into organizational development.

PubMed

Macfarlane, Fraser; Shaw, Sara; Greenhalgh, Trisha; Carter, Yvonne H

2005-06-01

An increasing proportion of research in primary care is locally undertaken in designated research practices. Capacity building to support high quality research at these grass roots is urgently needed and is a government priority. There is little previously published research on the process by which GP practices develop as research organizations or on their specific support needs at organizational level. Using in-depth qualitative interviews with 28 key informants in 11 research practices across the UK, we explored their historical accounts of the development of research activity. We analysed the data with reference to contemporary theories of organizational development. Participants identified a number of key events and processes, which allowed us to produce a five-phase model of practice development in relation to research activity (creative energy, concrete planning, transformation/differentiation, consolidation and collaboration). Movement between these phases was not linear or continuous, but showed emergent and adaptive properties in which specific triggers and set-backs were often critical. This developmental model challenges previous categorical taxonomies of research practices. It forms a theory-driven framework for providing appropriate support at the grass roots of primary care research, based on the practice's phase of development and the nature of external triggers and potential setbacks. Our findings have important implications for the strategic development of practice-based research in the UK, and could serve as a model for the wider international community.

Nature and governance of veterinary clinical research conducted in the UK.

PubMed

Fordyce, P; Mullan, S

2017-01-21

In order to quantify the amount of clinical research conducted on client-owned animals under the Veterinary Surgeons Act 1966, and the nature and extent of any ethical review of that research, a questionnaire was sent to 6 UK veterinary schools, 1 charity veterinary clinic and 12 private referral clinics. The questionnaire examined whether and how much clinical research respondents undertook, and the composition of any ethical review panels examining research proposals. The questionnaire revealed a substantial amount of clinical research was conducted in the UK, with over 200 veterinary surgeons involved in the year of the survey, with at least 170 academic papers involving clinical research published by respondents in the same year. However, it proved impossible to quantify the full extent of clinical research in the UK. All UK veterinary schools required ethical review of clinical research. The composition and working practices of their ethical review panels generally reflected skill sets in ethical review panels set-up under statute to consider the ethics of non-clinical biomedical research on animals and clinical research conducted on human patients. The process for review of clinical research in the private sector was less clear. British Veterinary Association.

PLAB and UK graduates' performance on MRCP(UK) and MRCGP examinations: data linkage study.

PubMed

McManus, I C; Wakeford, Richard

2014-04-17

To assess whether international medical graduates passing the two examinations set by the Professional and Linguistic Assessments Board (PLAB1 and PLAB2) of the General Medical Council (GMC) are equivalent to UK graduates at the end of the first foundation year of medical training (F1), as the GMC requires, and if not, to assess what changes in the PLAB pass marks might produce equivalence. Data linkage of GMC PLAB performance data with data from the Royal Colleges of Physicians and the Royal College of General Practitioners on performance of PLAB graduates and UK graduates at the MRCP(UK) and MRCGP examinations. Doctors in training for internal medicine or general practice in the United Kingdom. 7829, 5135, and 4387 PLAB graduates on their first attempt at MRCP(UK) Part 1, Part 2, and PACES assessments from 2001 to 2012 compared with 18,532, 14,094, and 14,376 UK graduates taking the same assessments; 3160 PLAB1 graduates making their first attempt at the MRCGP AKT during 2007-12 compared with 14,235 UK graduates; and 1411 PLAB2 graduates making their first attempt at the MRCGP CSA during 2010-12 compared with 6935 UK graduates. Performance at MRCP(UK) Part 1, Part 2, and PACES assessments, and MRCGP AKT and CSA assessments in relation to performance on PLAB1 and PLAB2 assessments, as well as to International English Language Testing System (IELTS) scores. MRCP(UK), MRCGP, and PLAB results were analysed as marks relative to the pass mark at the first attempt. PLAB1 marks were a valid predictor of MRCP(UK) Part 1, MRCP(UK) Part 2, and MRCGP AKT (r=0.521, 0.390, and 0.490; all P<0.001). PLAB2 marks correlated with MRCP(UK) PACES and MRCGP CSA (r=0.274, 0.321; both P<0.001). PLAB graduates had significantly lower MRCP(UK) and MRCGP assessments (Glass's Δ=0.94, 0.91, 1.40, 1.01, and 1.82 for MRCP(UK) Part 1, Part 2, and PACES and MRCGP AKT and CSA), and were more likely to fail assessments and to progress more slowly than UK medical graduates. IELTS scores correlated significantly with later performance, multiple regression showing that the effect of PLAB1 (β=0.496) was much stronger than the effect of IELTS (β=0.086). Changes to PLAB pass marks that would result in international medical graduate and UK medical graduate equivalence were assessed in two ways. Method 1 adjusted PLAB pass marks to equate median performance of PLAB and UK graduates. Method 2 divided PLAB graduates into 12 equally spaced groups according to PLAB performance, and compared these with mean performance of graduates from individual UK medical schools, assessing which PLAB groups were equivalent in MRCP(UK) and MRCGP performance to UK graduates. The two methods produced similar results. To produce equivalent performance on the MRCP and MRGP examinations, the pass mark for PLAB1 would require raising by about 27 marks (13%) and for PLAB2 by about 15-16 marks (20%) above the present standard. PLAB is a valid assessment of medical knowledge and clinical skills, correlating well with performance at MRCP(UK) and MRCGP. PLAB graduates' knowledge and skills at MRCP(UK) and MRCGP are over one standard deviation below those of UK graduates, although differences in training quality cannot be taken into account. Equivalent performance in MRCGP(UK) and MRCGP would occur if the pass marks of PLAB1 and PLAB2 were raised considerably, but that would also reduce the pass rate, with implications for medical workforce planning. Increasing IELTS requirements would have less impact on equivalence than raising PLAB pass marks.

PLAB and UK graduates’ performance on MRCP(UK) and MRCGP examinations: data linkage study

PubMed Central

Wakeford, Richard

2014-01-01

Objectives To assess whether international medical graduates passing the two examinations set by the Professional and Linguistic Assessments Board (PLAB1 and PLAB2) of the General Medical Council (GMC) are equivalent to UK graduates at the end of the first foundation year of medical training (F1), as the GMC requires, and if not, to assess what changes in the PLAB pass marks might produce equivalence. Design Data linkage of GMC PLAB performance data with data from the Royal Colleges of Physicians and the Royal College of General Practitioners on performance of PLAB graduates and UK graduates at the MRCP(UK) and MRCGP examinations. Setting Doctors in training for internal medicine or general practice in the United Kingdom. Participants 7829, 5135, and 4387 PLAB graduates on their first attempt at MRCP(UK) Part 1, Part 2, and PACES assessments from 2001 to 2012 compared with 18 532, 14 094, and 14 376 UK graduates taking the same assessments; 3160 PLAB1 graduates making their first attempt at the MRCGP AKT during 2007-12 compared with 14 235 UK graduates; and 1411 PLAB2 graduates making their first attempt at the MRCGP CSA during 2010-12 compared with 6935 UK graduates. Main outcome measures Performance at MRCP(UK) Part 1, Part 2, and PACES assessments, and MRCGP AKT and CSA assessments in relation to performance on PLAB1 and PLAB2 assessments, as well as to International English Language Testing System (IELTS) scores. MRCP(UK), MRCGP, and PLAB results were analysed as marks relative to the pass mark at the first attempt. Results PLAB1 marks were a valid predictor of MRCP(UK) Part 1, MRCP(UK) Part 2, and MRCGP AKT (r=0.521, 0.390, and 0.490; all P<0.001). PLAB2 marks correlated with MRCP(UK) PACES and MRCGP CSA (r=0.274, 0.321; both P<0.001). PLAB graduates had significantly lower MRCP(UK) and MRCGP assessments (Glass’s Δ=0.94, 0.91, 1.40, 1.01, and 1.82 for MRCP(UK) Part 1, Part 2, and PACES and MRCGP AKT and CSA), and were more likely to fail assessments and to progress more slowly than UK medical graduates. IELTS scores correlated significantly with later performance, multiple regression showing that the effect of PLAB1 (β=0.496) was much stronger than the effect of IELTS (β=0.086). Changes to PLAB pass marks that would result in international medical graduate and UK medical graduate equivalence were assessed in two ways. Method 1 adjusted PLAB pass marks to equate median performance of PLAB and UK graduates. Method 2 divided PLAB graduates into 12 equally spaced groups according to PLAB performance, and compared these with mean performance of graduates from individual UK medical schools, assessing which PLAB groups were equivalent in MRCP(UK) and MRCGP performance to UK graduates. The two methods produced similar results. To produce equivalent performance on the MRCP and MRGP examinations, the pass mark for PLAB1 would require raising by about 27 marks (13%) and for PLAB2 by about 15-16 marks (20%) above the present standard. Conclusions PLAB is a valid assessment of medical knowledge and clinical skills, correlating well with performance at MRCP(UK) and MRCGP. PLAB graduates’ knowledge and skills at MRCP(UK) and MRCGP are over one standard deviation below those of UK graduates, although differences in training quality cannot be taken into account. Equivalent performance in MRCGP(UK) and MRCGP would occur if the pass marks of PLAB1 and PLAB2 were raised considerably, but that would also reduce the pass rate, with implications for medical workforce planning. Increasing IELTS requirements would have less impact on equivalence than raising PLAB pass marks. PMID:24742473

Is the metaphor of 'barriers to change' useful in understanding implementation? Evidence from general medical practice.

PubMed

Checkland, Kath; Harrison, Stephen; Marshall, Martin

2007-04-01

To investigate how general medical practices in the UK react to bureaucratic initiatives, such as National Health Service (NHS) National Service Frameworks (NSFs), and to explore the value of the metaphor of 'barriers to change' for understanding this. Interviews, non-participant observation and documentary analysis within case studies of four practices in northern England. The practices had not actively implemented NSFs. At interview, various 'barriers' that had prevented implementation were listed, including the complexity of the documents and lack of time. Observation suggested that these barriers were constructions used by the participants to make sense of the situation in which they found themselves. The metaphor of 'removing barriers to change' was of limited use in a context where non-implementation of policy was an emergent property of underlying organizational realities, likely to be modifiable only if these realities were addressed.

Medical students' perceptions of general practice as a career; a phenomenological study using socialisation theory.

PubMed

Reid, Katherine; Alberti, Hugh

2018-04-23

The ageing population and push to community care has significantly increased the workload of General Practitioners (GPs) in the UK and internationally. In an attempt to tackle this, NHS England has promised 5000 more GPs by 2020/21; however, recruitment is in crisis with GP training posts remaining unfilled. Little research has been carried out to assess the fundamental questions of what medical students' perceptions of General Practice are and what shapes their perceptions at medical school. We aimed to explore medical students' conceptualisations of being a GP and specifically the role of the medical school in shaping their perceptions. Two focus groups of year one and year four medical students were undertaken using an interpretive phenomenological approach. Our study has revealed that medical students perceive General Practice to lack prestige and challenge. These perceptions come, at least in part, from a process of socialisation within medical school, whereby medical students internalise and adopt their role models' perceptions and values, and the values portrayed by the hidden curriculum in their medical school culture. Perceived external pressures to pursue a career in General Practice can have a negative influence and medical schools should be made aware of this.

Does the private sector receive an excessive return from investments in health care infrastructure projects? Evidence from the UK.

PubMed

Vecchi, Veronica; Hellowell, Mark; Gatti, Stefano

2013-05-01

This paper is concerned with the cost-efficiency of Private Finance Initiatives (PFIs) in the delivery of hospital facilities in the UK. We outline a methodology for identifying the "fair" return on equity, based on the Weighted Average Cost of Capital (WACC) of each investor. We apply this method to assess the expected returns on a sample of 77 contracts signed between 1997 and 2011 by health care provider organisations in the UK. We show that expected returns are in general in excess of the WACC benchmarks. The findings highlight significant problems in current procurement practices and the methodologies by which bids are assessed. To minimise the financial impact of hospital investments on health care systems, a regulatory regime must ensure that expected returns are set at the "fair" rate. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Junior doctor dementia champions in a district general hospital (innovative practice).

PubMed

Wilkinson, Iain; Coates, Anna; Merrick, Sophie; Lee, Chooi

2016-03-01

Dementia is a common condition in the UK with around 25% of patients in acute hospitals having dementia. In the UK, there is national guidance on the assessment of cognitive impairment in acute hospitals. This article is a qualitative study of junior doctors' experiences as part of a dementia and delirium team involved in changing the care of patients with dementia in a hospital in the UK. It draws on data from a focus group and follow-up questionnaire in two hospital trusts. We examine what drives doctors to become involved in such projects and the effects of this experience upon them. We suggest a typology for getting junior doctors involved in projects generating change when working with patients with dementia. Being more actively involved in caring for and developing services for patients with dementia may represent the crossing of an educational threshold for these junior doctors. © The Author(s) 2016.

Are medical educators in general practice untapped potential to increase training capacity in sexual and reproductive healthcare? Results of a survey in London, UK

PubMed Central

Ma, Richard; Shah, Radhika

2016-01-01

Abstract Background Long waiting times for training in sexual and reproductive healthcare (SRH) including long acting reversible contraception (LARC) might lead to attrition from training programmes, leading to reduced capacity for sexual health services, and reduced access to such contraception for women. Setting General practice in London, UK. Question Can medical educators in general practice be used as untapped potential to train other health care professionals in sexual and reproductive healthcare? Method We conducted an online survey to find out the qualifications, skills and willingness of established educators in primary care in London to train other clinicians in sexual and reproductive healthcare, including LARC. Results We received 124 responses from medical educators (10.1% response rate from general practitioner (GP) trainers and 59.0% of clinical supervisors for Foundation Year doctors). 86 (69.9%) had diploma of the Faculty of Sexual and Reproductive Healthcare (DFSRH) qualification and further 18 (14.6%) were interested in obtaining this qualification. Eleven respondents were trained to fit intrauterine contraception only, three for contraceptive implants only and 37 were trained to fit both. 50 (40.3%) of 124 respondents were willing get involved in DFSRH training; 74% of these were willing to teach on any component of DFSRH including LARC. Discussion There is a shortage of training places and long waiting list for clinicians who wish to train in SRH. This survey suggests there is a pool of GP educators with skills and experience in SRH and are willing to train others. This can potentially increase the training capacity and improve overall access to good contraception and LARC for women. PMID:28250840

The adoption of sustainable remediation behaviour in the US and UK: a cross country comparison and determinant analysis.

PubMed

Hou, Deyi; Al-Tabbaa, Abir; Guthrie, Peter

2014-08-15

The sustainable remediation concept, aimed at maximizing the net environmental, social, and economic benefits in contaminated site remediation, is being increasingly recognized by industry, governments, and academia. However, there is limited understanding of actual sustainable behaviour being adopted and the determinants of such sustainable behaviour. The present study identified 27 sustainable practices in remediation. An online questionnaire survey was used to rank and compare them in the US (n=112) and the UK (n=54). The study also rated ten promoting factors, nine barriers, and 17 types of stakeholders' influences. Subsequently, factor analysis and general linear models were used to determine the effects of internal characteristics (i.e. country, organizational characteristics, professional role, personal experience and belief) and external forces (i.e. promoting factors, barriers, and stakeholder influences). It was found that US and UK practitioners adopted many sustainable practices to similar extents. Both US and UK practitioners perceived the most effectively adopted sustainable practices to be reducing the risk to site workers, protecting groundwater and surface water, and reducing the risk to the local community. Comparing the two countries, we found that the US adopted innovative in-situ remediation more effectively; while the UK adopted reuse, recycling, and minimizing material usage more effectively. As for the overall determinants of sustainable remediation, the country of origin was found not to be a significant determinant. Instead, organizational policy was found to be the most important internal characteristic. It had a significant positive effect on reducing distant environmental impact, sustainable resource usage, and reducing remediation cost and time (p<0.01). Customer competitive pressure was found to be the most extensively significant external force. In comparison, perceived stakeholder influence, especially that of primary stakeholders (site owner, regulator, and primary consultant), did not appear to have as extensive a correlation with the adoption of sustainability as one would expect. Copyright © 2014 Elsevier B.V. All rights reserved.

"That's your patient. There's your ventilator": exploring induction to work experiences in a group of non-UK EEA trained anaesthetists in a London hospital: a qualitative study.

PubMed

Snelgrove, Huon; Kuybida, Yuriy; Fleet, Mark; McAnulty, Greg

2015-03-17

European health systems depend increasingly on the services of health professionals who obtained their primary medical qualification from other countries. There has been a significant increase recently in fully qualified specialist doctors arriving from the European Union to provide short term or longer-term solutions to health human resources needs in the UK National Health System. These doctors often take up senior consultant positions. As a result, the NHS has had to learn to deal with both expatriation and repatriation of EU doctors as a constant dynamic characteristic of its own ability to deliver services. We conducted a qualitative study to explore the acclimatisation experience of EU doctors with qualifications in anaesthesia arriving in the United Kingdom to take up clinical employment in the NHS. The question we ask is: how do specialty registered anaesthetists who trained in other European countries experience the process of acclimatisation to practice in the United Kingdom in a large hospital in London? We did individual interviews with non-UK, EU-qualified doctors with Certification of Completion of specialty Training who were registered with the General Medical Council in the UK and could practice in the NHS as specialist anaesthetists. The doctors were all interviewed whilst working in a large NHS teaching hospital in London, UK. We analysed qualitative data from interview transcripts to identity themes and patterns regarding senior doctor's acclimatisation to the British system. Acclimatisation conceived of as transfer of clinical expertise was problematic for doctors who felt they lacked the right kind of support. Doctors sought different opportunities to share wider perspectives on care deriving from their previous experience. Hospital conceptions of acclimatisation as a highly individual process can offer an idealized view of clinical work and learning in the new system. Socio-cultural theories suggest we create regular learning opportunities for international staff to critically reflect on practice with local staff to acclimatise more effectively.

Predicting the 10-year risk of hip and major osteoporotic fracture in rheumatoid arthritis and in the general population: an independent validation and update of UK FRAX without bone mineral density.

PubMed

Klop, Corinne; de Vries, Frank; Bijlsma, Johannes W J; Leufkens, Hubert G M; Welsing, Paco M J

2016-12-01

FRAX incorporates rheumatoid arthritis (RA) as a dichotomous predictor for predicting the 10-year risk of hip and major osteoporotic fracture (MOF). However, fracture risk may deviate with disease severity, duration or treatment. Aims were to validate, and if needed to update, UK FRAX for patients with RA and to compare predictive performance with the general population (GP). Cohort study within UK Clinical Practice Research Datalink (CPRD) (RA: n=11 582, GP: n=38 755), also linked to hospital admissions for hip fracture (CPRD-Hospital Episode Statistics, HES) (RA: n=7221, GP: n=24 227). Predictive performance of UK FRAX without bone mineral density was assessed by discrimination and calibration. Updating methods included recalibration and extension. Differences in predictive performance were assessed by the C-statistic and Net Reclassification Improvement (NRI) using the UK National Osteoporosis Guideline Group intervention thresholds. UK FRAX significantly overestimated fracture risk in patients with RA, both for MOF (mean predicted vs observed 10-year risk: 13.3% vs 8.4%) and hip fracture (CPRD: 5.5% vs 3.1%, CPRD-HES: 5.5% vs 4.1%). Calibration was good for hip fracture in the GP (CPRD-HES: 2.7% vs 2.4%). Discrimination was good for hip fracture (RA: 0.78, GP: 0.83) and moderate for MOF (RA: 0.69, GP: 0.71). Extension of the recalibrated UK FRAX using CPRD-HES with duration of RA disease, glucocorticoids (>7.5 mg/day) and secondary osteoporosis did not improve the NRI (0.01, 95% CI -0.04 to 0.05) or C-statistic (0.78). UK FRAX overestimated fracture risk in RA, but performed well for hip fracture in the GP after linkage to hospitalisations. Extension of the recalibrated UK FRAX did not improve predictive performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The Current Use of Online Services in U.K. Academic Libraries.

ERIC Educational Resources Information Center

Foster, Allan; Akeroyd, John

This update of a survey taken by the authors in April 1978 on the use of online services in British academic libraries (Online Review; v3 n2 p195-204 1979) concentrates on the following areas: (1) general pattern of use; (2) current arguments for charging users for online services; (3) current academic library practice on charging; (4) specific…

Missile Aerodynamics

DTIC Science & Technology

1979-02-01

aimed to emphasize these differences in the aerodynamic design features of both guided and unguided weapons. In addition to treating the component parts...the subject. Lectures generally started with a review of fundamentals and paid particular attention to practical methods of estimation and design and...George G Brebner Aerodynamics Department Royal Aircraft Establishment Farnborough, Hants, GU14 6TD, UK SUMMARY The differences in design objectives and

From Graduate Employability to Employment: Policy and Practice in UK Higher Education

ERIC Educational Resources Information Center

Minocha, Sonal; Hristov, Dean; Reynolds, Martin

2017-01-01

The purpose of this paper is to enrich the current conceptualization of graduate employability and employment through the lens of policy, academia and practice in UK higher education. We examine the UK policy context that is shaping graduate employability and employment debates before enriching this conceptualization through a discussion of key…

Does Council Tax Valuation Band (CTVB) correlate with Under-Privileged Area 8 (UPA8) score and could it be a better 'Jarman Index'?

PubMed Central

Beale, Norman; Taylor, Gordon; Straker-Cook, Dawn

2001-01-01

Background Widespread scepticism persists on the use of the Under-Privileged Area (UPA8) score of Jarman in distributing supplementary resources to so-attributed 'deprived' UK general practices. The search for better 'needs' markers continues. Having already shown that Council Tax Valuation Band (CTVB) is a predictor of UK GP workload, we compare, here, CTVB of residence of a random sample of patients with their respective 'Jarman' scores. Methods Correlation coefficient is calculated between (i) the CTVB of residence of a randomised sample of patients from an English general practice and (ii) the UPA8 scores of the relevant enumeration districts in which they live. Results There is a highly significant correlation between the two measures despite modest study size of 478 patients (85% response). Conclusions The proposal that CTVB is a marker of deprivation and of clinical demand should be examined in more detail: it correlates with 'Jarman', which is already used in NHS resource allocation. But unlike 'Jarman', CTVB is simple, objective, and free of the problems of Census data. CTVB, being household-based, can be aggregated at will. PMID:11716793

Does Council Tax Valuation Band (CTVB) correlate with Under-Privileged Area 8 (UPA8) score and could it be a better 'Jarman Index'?

PubMed

Beale, N; Taylor, G; Straker-Cook, D

2001-01-01

Widespread scepticism persists on the use of the Under-Privileged Area (UPA8) score of Jarman in distributing supplementary resources to so-attributed 'deprived' UK general practices. The search for better 'needs' markers continues. Having already shown that Council Tax Valuation Band (CTVB) is a predictor of UK GP workload, we compare, here, CTVB of residence of a random sample of patients with their respective 'Jarman' scores. Correlation coefficient is calculated between (i) the CTVB of residence of a randomised sample of patients from an English general practice and (ii) the UPA8 scores of the relevant enumeration districts in which they live. There is a highly significant correlation between the two measures despite modest study size of 478 patients (85% response). The proposal that CTVB is a marker of deprivation and of clinical demand should be examined in more detail: it correlates with 'Jarman', which is already used in NHS resource allocation. But unlike 'Jarman', CTVB is simple, objective, and free of the problems of Census data. CTVB, being household-based, can be aggregated at will.

Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007-14.

PubMed

Hobbs, F D Richard; Bankhead, Clare; Mukhtar, Toqir; Stevens, Sarah; Perera-Salazar, Rafael; Holt, Tim; Salisbury, Chris

2016-06-04

Primary care is the main source of health care in many health systems, including the UK National Health Service (NHS), but few objective data exist for the volume and nature of primary care activity. With rising concerns that NHS primary care workload has increased substantially, we aimed to assess the direct clinical workload of general practitioners (GPs) and practice nurses in primary care in the UK. We did a retrospective analysis of GP and nurse consultations of non-temporary patients registered at 398 English general practices between April, 2007, and March, 2014. We used data from electronic health records routinely entered in the Clinical Practice Research Datalink, and linked CPRD data to national datasets. Trends in age-standardised and sex-standardised consultation rates were modelled with joinpoint regression analysis. The dataset comprised 101,818,352 consultations and 20,626,297 person-years of observation. The crude annual consultation rate per person increased by 10·51%, from 4·67 in 2007-08, to 5·16 in 2013-14. Consultation rates were highest in infants (age 0-4 years) and elderly people (≥85 years), and were higher for female patients than for male patients of all ages. The greatest increases in age-standardised and sex-standardised rates were in GPs, with a rise of 12·36% per 10,000 person-years, compared with 0·9% for practice nurses. GP telephone consultation rates doubled, compared with a 5·20% rise in surgery consultations, which accounted for 90% of all consultations. The mean duration of GP surgery consultations increased by 6·7%, from 8·65 min (95% CI 8·64-8·65) to 9·22 min (9·22-9·23), and overall workload increased by 16%. Our findings show a substantial increase in practice consultation rates, average consultation duration, and total patient-facing clinical workload in English general practice. These results suggest that English primary care as currently delivered could be reaching saturation point. Notably, our data only explore direct clinical workload and not indirect activities and professional duties, which have probably also increased. This and additional research questions, including the outcomes of workload changes on other sectors of health care, need urgent answers for primary care provision internationally. Department of Health Policy Research Programme. Copyright © 2016 Hobbs et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

A simple approach to improve recording of concerns about childmaltreatment in primary care records: developing a quality improvement intervention

PubMed Central

Woodman, Jenny; Allister, Janice; Rafi, Imran; de Lusignan, Simon; Belsey, Jonathan; Petersen, Irene; Gilbert, Ruth

2012-01-01

Background Information is lacking on how concerns about child maltreatment are recorded in primary care records. Aim To determine how the recording of child maltreatment concerns can be improved. Design and setting Development of a quality improvement intervention involving: clinical audit, a descriptive survey, telephone interviews, a workshop, database analyses, and consensus development in UK general practice. Method Descriptive analyses and incidence estimates were carried out based on 11 study practices and 442 practices in The Health Improvement Network (THIN). Telephone interviews, a workshop, and a consensus development meeting were conducted with lead GPs from 11 study practices. Results The rate of children with at least one maltreatment-related code was 8.4/1000 child years (11 study practices, 2009–2010), and 8.0/1000 child years (THIN, 2009–2010). Of 25 patients with known maltreatment, six had no maltreatment-related codes recorded, but all had relevant free text, scanned documents, or codes. When stating their reasons for undercoding maltreatment concerns, GPs cited damage to the patient relationship, uncertainty about which codes to use, and having concerns about recording information on other family members in the child’s records. Consensus recommendations are to record the code ‘child is cause for concern’ as a red flag whenever maltreatment is considered, and to use a list of codes arranged around four clinical concepts, with an option for a templated short data entry form. Conclusion GPs under-record maltreatment-related concerns in children’s electronic medical records. As failure to use codes makes it impossible to search or audit these cases, an approach designed to be simple and feasible to implement in UK general practice was recommended. PMID:22781996

Management and prevalence of long-term conditions in primary health care for adults with intellectual disabilities compared with the general population: A population-based cohort study.

PubMed

Cooper, Sally-Ann; Hughes-McCormack, Laura; Greenlaw, Nicola; McConnachie, Alex; Allan, Linda; Baltzer, Marion; McArthur, Laura; Henderson, Angela; Melville, Craig; McSkimming, Paula; Morrison, Jill

2018-01-01

In the UK, general practitioners/family physicians receive pay for performance on management of long-term conditions, according to best-practice indicators. Management of long-term conditions was compared between 721 adults with intellectual disabilities and the general population (n = 764,672). Prevalence of long-term conditions was determined, and associated factors were investigated via logistic regression analyses. Adults with intellectual disabilities received significantly poorer management of all long-term conditions on 38/57 (66.7%) indicators. Achievement was high (75.1%-100%) for only 19.6% of adults with intellectual disabilities, compared with 76.8% of the general population. Adults with intellectual disabilities had higher rates of epilepsy, psychosis, hypothyroidism, asthma, diabetes and heart failure. There were no clear associations with neighbourhood deprivation. Adults with intellectual disabilities receive poorer care, despite conditions being more prevalent. The imperative now is to find practical, implementable means of supporting the challenges that general practices face in delivering equitable care. © 2017 John Wiley & Sons Ltd.

Use of non‐invasive ventilation in UK emergency departments

PubMed Central

Browning, J; Atwood, B; Gray, A

2006-01-01

Aim To describe the current use of non‐invasive ventilation in UK emergency departments. Methods A structured questionnaire was sent to all UK emergency departments assessing 25,000 new patients annually. Results 222 of 233 departments completed the questionnaire. 148 currently use non‐invasive ventilation (NIV). Most used NIV for either cardiogenic pulmonary oedema (n = 128) or chronic obstructive pulmonary disease (n = 115). Only 49 departments have protocols for NIV use and 23 audited practice. Conclusion NIV is commonly used in UK emergency departments. Practices vary significantly. One solution would be the development of guidelines on when and how to use NIV in emergency medicine practice. PMID:17130599

Characteristics of career advisors for general practice--a qualitative study of UK GPs.

PubMed

Thornett, Andrew; Thorley, Judith; Chambers, Ruth

2006-01-01

Career support needs of general practitioners are poorly described in the literature. Semi-structured interviews of 26 practising GPs from two United Kingdom counties. General practitioners believed they would benefit from the provision of career advice and guidance provided by trained peers. They were looking for advisors to whom they could relate and who understood their professional and personal needs, in particular: listening skills, life experience, credibility, protected time, ability to challenge, give careful consideration, trustworthiness, knowledge about GP careers, facilitation skills, and empathy. A strategy put in place in Australia might enable GPs to implement career plans.

Patients' expectations of private osteopathic care in the UK: a national survey of patients.

PubMed

Leach, C M Janine; Mandy, Anne; Hankins, Matthew; Bottomley, Laura M; Cross, Vinette; Fawkes, Carol A; Fiske, Adam; Moore, Ann P

2013-05-31

Patients' expectations of osteopathic care have been little researched. The aim of this study was to quantify the most important expectations of patients in private UK osteopathic practices, and the extent to which those expectations were met or unmet. The study involved development and application of a questionnaire about patients' expectations of osteopathic care. The questionnaire drew on an extensive review of the literature and the findings of a prior qualitative study involving focus groups exploring the expectations of osteopathic patients. A questionnaire survey of osteopathic patients in the UK was then conducted. Patients were recruited from a random sample of 800 registered osteopaths in private practice across the UK. Patients were asked to complete the questionnaire which asked about 51 aspects of expectation, and post it to the researchers for analysis.The main outcome measures were the patients-perceived level of expectation as assessed by the percentage of positive responses for each aspect of expectation, and unmet expectation as computed from the proportion responding that their expectation "did not happen". 1649 sets of patient data were included in the analysis. Thirty five (69%) of the 51 aspects of expectation were prevalent, with listening, respect and information-giving ranking highest. Only 11 expectations were unmet, the most often unmet were to be made aware that there was a complaints procedure, to find it difficult to pay for osteopathic treatment, and perceiving a lack of communication between the osteopath and their GP. The findings reflected the complexity of providing osteopathic care and meeting patients' expectations. The results provided a generally positive message about private osteopathic practice. The study identified certain gaps between expectations and delivery of care, which can be used to improve the quality of care. The questionnaire is a resource for future research.

Is the current standard of care leading to cost-effective outcomes for patients with type 2 diabetes requiring insulin? A long-term health economic analysis for the UK.

PubMed

Valentine, W J; Curtis, B H; Pollock, R F; Van Brunt, K; Paczkowski, R; Brändle, M; Boye, K S; Kendall, D M

2015-07-01

The aim of the analysis was to investigate whether insulin intensification, based on the use of intensive insulin regimens as recommended by the current standard of care in routine clinical practice, would be cost-effective for patients with type 2 diabetes in the UK. Clinical data were derived from a retrospective analysis of 3185 patients with type 2 diabetes on basal insulin in The Health Improvement Network (THIN) general practice database. In total, 48% (614 patients) intensified insulin therapy, defined by adding bolus or premix insulin to a basal regimen, which was associated with a reduction in HbA1c and an increase in body mass index. Projections of clinical outcomes and costs (2011 GBP) over patients' lifetimes were made using a recently validated type 2 diabetes model. Immediate insulin intensification was associated with improvements in life expectancy, quality-adjusted life expectancy and time to onset of complications versus no intensification or delaying intensification by 2, 4, 6, or 8 years. Direct costs were higher with the insulin intensification strategy (due to the acquisition costs of insulin). Incremental cost-effectiveness ratios for insulin intensification were GBP 32,560, GBP 35,187, GBP 40,006, GBP 48,187 and GBP 55,431 per QALY gained versus delaying intensification 2, 4, 6 and 8 years, and no intensification, respectively. Although associated with improved clinical outcomes, insulin intensification as practiced in the UK has a relatively high cost per QALY and may not lead to cost-effective outcomes for patients with type 2 diabetes as currently defined by UK cost-effectiveness thresholds. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Physiotherapy for plantar fasciitis: a UK-wide survey of current practice.

PubMed

Grieve, Rob; Palmer, Shea

2017-06-01

To identify how United Kingdom (UK) physiotherapists currently diagnose, assess and manage plantar fasciitis in routine practice. Online questionnaire survey. Practising physiotherapists across the UK who treat patients with plantar fasciitis. Physiotherapists were approached via 'interactive Chartered Society of Physiotherapy (CSP)' online networks and an email database of clinical educators in South West England. An online questionnaire was developed by reviewing similar existing physiotherapy surveys and consultation with experienced musculoskeletal researchers/clinicians. Descriptive statistics were used to analyse the data. 285 physiotherapists responded, with 257 complete survey responses. Pain on palpation and early morning pain were the most common diagnostic criteria, with some physiotherapists using no formal test criteria. Advice (237/257, 92%), plantar fasciitis pathology education (207/257, 81%) and general stretching exercises (189/257, 74%) were most routinely used. Prefabricated orthotics, custom made orthotics and night splints were seldom always used. For the manual therapy approach, the most frequently used modalities were massage, myofascial release, specific soft tissue mobilisations and myofascial trigger point therapy. Commonly used outcome measures were pain assessment, functional tests and range of movement. Physiotherapists appeared to follow most of the established diagnostic criteria for PF, but have not followed established outcome measure guidelines. Advice as well as education with an emphasis on self-management including calf/hamstring stretching was the most commonly reported treatment approach. There was uncertainty whether this approach accurately reflected clinical practice used throughout the UK, owing to potential response bias/unknown response rate and the low number of patients with PF treated by the respondents. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Assessing the quality of radiographic processing in general dental practice.

PubMed

Thornley, P H; Stewardson, D A; Rout, P G J; Burke, F J T

2006-05-13

To determine if a commercial device (Vischeck) for monitoring film processing quality was a practical option in general dental practice, and to assess processing quality among a group of GDPs in the West Midlands with this device. Clinical evaluation. General dental practice, UK, 2004. Ten GDP volunteers from a practice based research group processed Vischeck strips (a) when chemicals were changed, (b) one week later, and (c) immediately before the next change of chemicals. These were compared with strips processed under ideal conditions. Additionally, a series of duplicate radiographs were produced and processed together with Vischeck strips in progressively more dilute developer solutions to compare the change in radiograph quality assessed clinically with that derived from the Vischeck. The Vischeck strips suggested that at the time chosen for change of processing chemicals, eight dentists had been processing films well beyond the point indicated for replacement. Solutions were changed after a wide range of time periods and number of films processed. The calibration of the Vischeck strip correlated closely to a clinical assessment of acceptable film quality. Vischeck strips are a useful aid to monitoring processing quality in automatic developers in general dental practice. Most of this group of GDPs were using chemicals beyond the point at which diagnostic yield would be affected.

Deficiencies in provision of integrated multidisciplinary podiatry care for patients with inflammatory arthritis: a UK district general hospital experience.

PubMed

Juarez, M; Price, E; Collins, D; Williamson, L

2010-01-01

Foot problems are highly prevalent in inflammatory arthritis (IA), especially rheumatoid arthritis (RA). Chronic inflammation can lead to permanent structural changes, deformity and disability. Early podiatry intervention in RA improves long term outcomes. National guidelines recommend that patients should be treated by a multidisciplinary team with dedicated podiatry services. In clinical practice funding constraints limit availability of these services. To assess prevalence of foot problems and quality and availability of foot care services at a UK district general hospital. 1200 IA patients in Swindon (Wiltshire, UK) were invited to complete an anonymised questionnaire regarding access to foot care services and education/information on foot problems. 448 patients. Prevalence of foot problems: 68%. Only 31% of patients had access to appropriate foot specialist. 24% had received foot assessment within 3 months of diagnosis of IA and 17% yearly review thereafter. Despite high prevalence of foot problems in our population we identified significant deficiencies in provision of integrated multidisciplinary podiatry care. The data we present could be used by others to support business cases to obtain funding to improve the links between rheumatology and podiatry services. Copyright 2010 Elsevier Ltd. All rights reserved.

E-portfolios and personalized learning: research in practice with two dyslexic learners in UK higher education.

PubMed

Hughes, Julie; Herrington, Margaret; McDonald, Tess; Rhodes, Amy

2011-02-01

This paper analyses the use of an e-portfolio system in contributing to the personalized learning of two dyslexic learners at the University of Wolverhampton, UK. The rationale for this research rests at the intersection of generic findings from e-portfolio (and wider e-learning) research and the still challenging project in higher education (HE) of creating inclusive curricula. A qualitative, ethnographic approach was employed in a piece of collaborative research between academic staff and dyslexic learners. Two retrospective learner narratives were constructed and then reviewed by all co-authors in terms of the 'personalized fit' which they allowed with dyslexic thinking, learning and writing experience. The findings suggest a potential refinement of the general pedagogical claims about e-portfolio-based learning when considering dyslexic learners and thence the value of an enhanced prioritization of e-portfolio learning practices within inclusive HE curricula. The review and analysis also allow a 'critical' discussion of the practical and theoretical issues arising within this work. Copyright © 2010 John Wiley & Sons, Ltd.

Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study

PubMed Central

Greenhalgh, Trisha; Russell, Jill; Myall, Michelle

2011-01-01

Objective To describe, explore, and compare organisational routines for repeat prescribing in general practice to identify contributors and barriers to safety and quality. Design Ethnographic case study. Setting Four urban UK general practices with diverse organisational characteristics using electronic patient records that supported semi-automation of repeat prescribing. Participants 395 hours of ethnographic observation of staff (25 doctors, 16 nurses, 4 healthcare assistants, 6 managers, and 56 reception or administrative staff), and 28 documents and other artefacts relating to repeat prescribing locally and nationally. Main outcome measures Potential threats to patient safety and characteristics of good practice. Methods Observation of how doctors, receptionists, and other administrative staff contributed to, and collaborated on, the repeat prescribing routine. Analysis included mapping prescribing routines, building a rich description of organisational practices, and drawing these together through narrative synthesis. This was informed by a sociological model of how organisational routines shape and are shaped by information and communications technologies. Results Repeat prescribing was a complex, technology-supported social practice requiring collaboration between clinical and administrative staff, with important implications for patient safety. More than half of requests for repeat prescriptions were classed as “exceptions” by receptionists (most commonly because the drug, dose, or timing differed from what was on the electronic repeat list). They managed these exceptions by making situated judgments that enabled them (sometimes but not always) to bridge the gap between the idealised assumptions about tasks, roles, and interactions that were built into the electronic patient record and formal protocols, and the actual repeat prescribing routine as it played out in practice. This work was creative and demanded both explicit and tacit knowledge. Clinicians were often unaware of this input and it did not feature in policy documents or previous research. Yet it was sometimes critical to getting the job done and contributed in subtle ways to safeguarding patients. Conclusion Receptionists and administrative staff make important “hidden” contributions to quality and safety in repeat prescribing in general practice, regarding themselves accountable to patients for these contributions. Studying technology-supported work routines that seem mundane, standardised, and automated, but which in reality require a high degree of local tailoring and judgment from frontline staff, opens up a new agenda for the study of patient safety. PMID:22053317

Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study.

PubMed

Swinglehurst, Deborah; Greenhalgh, Trisha; Russell, Jill; Myall, Michelle

2011-11-03

To describe, explore, and compare organisational routines for repeat prescribing in general practice to identify contributors and barriers to safety and quality. Ethnographic case study. Four urban UK general practices with diverse organisational characteristics using electronic patient records that supported semi-automation of repeat prescribing. 395 hours of ethnographic observation of staff (25 doctors, 16 nurses, 4 healthcare assistants, 6 managers, and 56 reception or administrative staff), and 28 documents and other artefacts relating to repeat prescribing locally and nationally. Potential threats to patient safety and characteristics of good practice. Observation of how doctors, receptionists, and other administrative staff contributed to, and collaborated on, the repeat prescribing routine. Analysis included mapping prescribing routines, building a rich description of organisational practices, and drawing these together through narrative synthesis. This was informed by a sociological model of how organisational routines shape and are shaped by information and communications technologies. Results Repeat prescribing was a complex, technology-supported social practice requiring collaboration between clinical and administrative staff, with important implications for patient safety. More than half of requests for repeat prescriptions were classed as "exceptions" by receptionists (most commonly because the drug, dose, or timing differed from what was on the electronic repeat list). They managed these exceptions by making situated judgments that enabled them (sometimes but not always) to bridge the gap between the idealised assumptions about tasks, roles, and interactions that were built into the electronic patient record and formal protocols, and the actual repeat prescribing routine as it played out in practice. This work was creative and demanded both explicit and tacit knowledge. Clinicians were often unaware of this input and it did not feature in policy documents or previous research. Yet it was sometimes critical to getting the job done and contributed in subtle ways to safeguarding patients. Conclusion Receptionists and administrative staff make important "hidden" contributions to quality and safety in repeat prescribing in general practice, regarding themselves accountable to patients for these contributions. Studying technology-supported work routines that seem mundane, standardised, and automated, but which in reality require a high degree of local tailoring and judgment from frontline staff, opens up a new agenda for the study of patient safety.

How do chiropractors manage clinical risk? A questionnaire study.

PubMed

Wangler, Martin; Peterson, Cynthia; Zaugg, Beatrice; Thiel, Haymo; Finch, Rob

2013-06-08

The literature on chiropractic safety tends to focus on adverse events and little is known about how chiropractors ensure safety and manage risk in the course of their daily practice. The purpose of this study was to investigate how chiropractors manage potentially risky clinical scenarios. We also sought to establish how chiropractors perceive the safety climate in their workplace and thus whether there is an observable culture of safety within the profession. An online questionnaire was designed to determine which of nine management options would be chosen by the respondent in response to four defined clinical case scenarios. Safety climate within the respondent's practice setting was measured by seeking the level of agreement with 23 statements relating to six different safety dimensions. 260 licensed chiropractors in Switzerland and 1258 UK members of The Royal College of Chiropractors were invited to complete the questionnaire. Questionnaire responses were analysed quantitatively in respect of the four clinical scenarios and the nine management options to determine the likelihood of each option being undertaken, with results recorded in terms of % likelihood. Gender differences in response to the management options for each scenario were evaluated using the Mann-Whitney U (MWU) test. Positive agreement with elements comprising each of the six safety dimensions contributed to a composite '% positive agreement' score calculated for each dimension. Questionnaire responses were received from 76% (200/260) of Swiss participants and 31% (393/1258) of UK members of The Royal College of Chiropractors. There was a general trend for Swiss and UK chiropractors to manage clinical scenarios where treatment appears not to be successful, not indicated, possibly harmful or where a patient is apparently getting worse, by re-evaluating their care. Stopping treatment and/or incident reporting to a safety incident reporting and learning system were generally found to be unlikely courses of action. Gender differences were observed with female chiropractors appearing to be more risk averse. Swiss and UK chiropractors tend to manage potentially risky clinical scenarios by re-evaluating the case. The unlikeliness of safety incident reporting is probably due to a range of recognised barriers, although Swiss and UK chiropractors are positive about local communication and openness which are important tenets for safety incident reporting. The observed positivity towards key aspects of clinic safety indicates a developing safety culture within the Swiss and UK chiropractic professions.

Perceived future career prospects in general practice: quantitative results from questionnaire surveys of UK doctors

PubMed Central

Lambert, Trevor W; Smith, Fay; Goldacre, Michael J

2016-01-01

Background There are more studies of current job satisfaction among GPs than of their views about their future career prospects, although both are relevant to commitment to careers in general practice. Aim To report on the views of GPs compared with clinicians in other specialties about their future career prospects. Design and setting Questionnaire surveys were sent to UK medical doctors who graduated in selected years between 1974 and 2008. Method Questionnaires were sent to the doctors at different times after graduation, ranging from 3 to 24 years. Results Based on the latest survey of each graduation year of the 20 940 responders, 66.2% of GPs and 74.2% of hospital doctors were positive about their prospects and 9.7% and 8.3%, respectively, were negative. However, with increasing time since graduation and increasing levels of seniority, GPs became less positive about their prospects; by contrast, over time, surgeons became more positive. Three to 5 years after graduation, 86.3% of those training in general practice were positive about their prospects compared with 52.9% of surgical trainees: in surveys conducted 12–24 years after graduation, 60.2% of GPs and 76.6% of surgeons were positive about their prospects. Conclusion GPs held broadly positive views of their career prospects, as did other doctors. However, there was an increase in negativity with increasing time since graduation that was not seen in hospital doctors. Research into the causes of this negativity and policy measures to ameliorate it would contribute to the continued commitment of GPs and may help to reduce attrition. PMID:27578813

A bibliometric analysis of Australian general practice publications from 1980 to 2007 using PubMed.

PubMed

Mendis, Kumara; Kidd, Michael R; Schattner, Peter; Canalese, Joseph

2010-01-01

We analysed Australian general practice (GP) publications in PubMed from 1980 to 2007 to determine journals, authors, publication types, national health priority areas (NHPA) and compared the results with those from three specialties (public health, cardiology and medical informatics) and two countries (the UK and New Zealand). Australian GP publications were downloaded in MEDLINE format using PubMed queries and were written to a Microsoft Access database using a software application. Search Query Language and online PubMed queries were used for further analysis. There were 4777 publications from 1980 to 2007. Australian Family Physician (38.1%) and the Medical Journal of Australia (17.6%) contributed 55.7% of publications. Reviews (12.7%), letters (6.6%), clinical trials (6.5%) and systematic reviews (5%) were the main PubMed publication types. Thirty five percent of publications addressed National Health Priority Areas with material on mental health (13.7%), neoplasms (6.5%) and cardiovascular conditions (5.9%). The comparable numbers of publications for the three specialties were: public health - 80 911, cardiology - 15 130 and medical informatics - 3338; total country GP comparisons were: UK - 14 658 and New Zealand - 1111. Australian GP publications have shown an impressive growth from 1980 to 2007 with a 15-fold increase. This increase may be due in part to the actions of the Australian government over the past decade to financially support research in primary care, as well as the maturing of academic general practice. This analysis can assist governments, researchers, policy makers and others to target resources so that further developments can be encouraged, supported and monitored.

Identification of an updated set of prescribing-safety indicators for GPs

PubMed Central

Spencer, Rachel; Bell, Brian; Avery, Anthony J; Gookey, Gill; Campbell, Stephen M

2014-01-01

Background Medication error is an important contributor to patient morbidity and mortality and is associated with inadequate patient safety measures. However, prescribing-safety tools specifically designed for use in general practice are lacking. Aim To identify and update a set of prescribing-safety indicators for assessing the safety of prescribing in general practice, and to estimate the risk of harm to patients associated with each indicator. Design and setting RAND/UCLA consensus development of indicators in UK general practice. Method Prescribing indicators were identified from a systematic review and previous consensus exercise. The RAND Appropriateness Method was used to further identify and develop the indicators with an electronic-Delphi method used to rate the risk associated with them. Twelve GPs from all the countries of the UK participated in the RAND exercise, with 11 GPs rating risk using the electronic-Delphi approach. Results Fifty-six prescribing-safety indicators were considered appropriate for inclusion (overall panel median rating of 7–9, with agreement). These indicators cover hazardous prescribing across a range of therapeutic indications, hazardous drug–drug combinations and inadequate laboratory test monitoring. Twenty-three (41%) of these indicators were considered high risk or extreme risk by 80% or more of the participants. Conclusion This study identified a set of 56 indicators that were considered, by a panel of GPs, to be appropriate for assessing the safety of GP prescribing. Twenty-three of these indicators were considered to be associated with high or extreme risk to patients and should be the focus of efforts to improve patient safety. PMID:24686882

Barriers encountered using skill-mix to deliver caries prevention in dental practices.

PubMed

Hatim, Eman; Kendall, Nick

2012-04-01

This opinion paper provides an analysis of the barriers and successes experienced when developing and implementing a pilot scheme to deliver caries prevention using skill-mix in the National Health Service (NHS) General Dental Services. A training programme was initiated to develop the skills of extended duties dental nurses to deliver fluoride varnish to patients in selected dental practices in Croydon, London, UK. In the light of the evaluation of this programme, a recommendation is made that similar preventive schemes should be delivered in the future within the NHS dental contract.

Promoting Mental Health and Preventing Mental Illness in General Practice.

PubMed

Thomas, Steve; Jenkins, Rachel; Burch, Tony; Calamos Nasir, Laura; Fisher, Brian; Giotaki, Gina; Gnani, Shamini; Hertel, Lise; Marks, Marina; Mathers, Nigel; Millington-Sanders, Catherine; Morris, David; Ruprah-Shah, Baljeet; Stange, Kurt; Thomas, Paul; White, Robert; Wright, Fiona

2016-01-01

This paper calls for the routine integration of mental health promotion and prevention into UK General Practice in order to reduce the burden of mental and physical disorders and the ensuing pressure on General Practice. The proposals & the resulting document (https://ethicscharity.files.wordpress.com/2015/09/rcgp_keymsg_150925_v5.pdf) arise from an expert 'Think Tank' convened by the London Journal of Primary Care, Educational Trust for Health Improvement through Cognitive Strategies (ETHICS Foundation) and the Royal College of General Practitioners. It makes 12 recommendations for General Practice: (1) Mental health promotion and prevention are too important to wait. (2) Work with your community to map risk factors, resources and assets. (3) Good health care, medicine and best practice are biopsychosocial rather than purely physical. (4) Integrate mental health promotion and prevention into your daily work. (5) Boost resilience in your community through approaches such as community development. (6) Identify people at increased risk of mental disorder for support and screening. (7) Support early intervention for people of all ages with signs of illness. (8) Maintain your biopsychosocial skills. (9) Ensure good communication, interdisciplinary team working and inter-sectoral working with other staff, teams and agencies. (10) Lead by example, taking action to promote the resilience of the general practice workforce. (11) Ensure mental health is appropriately included in the strategic agenda for your 'cluster' of General Practices, at the Clinical Commissioning Groups, and the Health and Wellbeing Board. (12) Be aware of national mental health strategies and localise them, including action to destigmatise mental illness within the context of community development.

Current status of kilovoltage (kV) radiotherapy in the UK: installed equipment, clinical workload, physics quality control and radiation dosimetry.

PubMed

Palmer, Antony L; Pearson, Michael; Whittard, Paul; McHugh, Katie E; Eaton, David J

2016-12-01

To assess the status and practice of kilovoltage (kV) radiotherapy in the UK. 96% of the radiotherapy centres in the UK responded to a comprehensive survey. An analysis of the installed equipment base, patient numbers, clinical treatment sites, quality control (QC) testing and radiation dosimetry processes were undertaken. 73% of UK centres have at least one kV treatment unit, with 58 units installed across the UK. Although 35% of units are over 10 years old, 39% units have been installed in the last 5 years. Approximately 6000 patients are treated with kV units in the UK each year, the most common site (44%) being basal cell carcinoma. A benchmark of QC practice in the UK is presented, against which individual centres can compare their procedures, frequency of testing and acceptable tolerance values. We propose the use of internal "notification" and "suspension" levels for analysis. All surveyed centres were using recommended Codes of Practice for kV dosimetry in the UK; approximately the same number using in-air and in-water methodologies for medium energy, with two-thirds of all centres citing "clinical relevance" as the reason for choice of code. 64% of centres had hosted an external dosimetry audit within the last 3 years, with only one centre never being independently audited. The majority of centres use locally measured applicator factors and published backscatter factors for treatments. Monitor unit calculations are performed using software in only 36% of centres. A comprehensive review of current kV practice in the UK is presented. Advances in knowledge: Data and discussion on contemporary kV radiotherapy in the UK, with a particular focus on physics aspects.

Current status of kilovoltage (kV) radiotherapy in the UK: installed equipment, clinical workload, physics quality control and radiation dosimetry

PubMed Central

Pearson, Michael; Whittard, Paul; McHugh, Katie E; Eaton, David J

2016-01-01

Objective: To assess the status and practice of kilovoltage (kV) radiotherapy in the UK. Methods: 96% of the radiotherapy centres in the UK responded to a comprehensive survey. An analysis of the installed equipment base, patient numbers, clinical treatment sites, quality control (QC) testing and radiation dosimetry processes were undertaken. Results: 73% of UK centres have at least one kV treatment unit, with 58 units installed across the UK. Although 35% of units are over 10 years old, 39% units have been installed in the last 5 years. Approximately 6000 patients are treated with kV units in the UK each year, the most common site (44%) being basal cell carcinoma. A benchmark of QC practice in the UK is presented, against which individual centres can compare their procedures, frequency of testing and acceptable tolerance values. We propose the use of internal “notification” and “suspension” levels for analysis. All surveyed centres were using recommended Codes of Practice for kV dosimetry in the UK; approximately the same number using in-air and in-water methodologies for medium energy, with two-thirds of all centres citing “clinical relevance” as the reason for choice of code. 64% of centres had hosted an external dosimetry audit within the last 3 years, with only one centre never being independently audited. The majority of centres use locally measured applicator factors and published backscatter factors for treatments. Monitor unit calculations are performed using software in only 36% of centres. Conclusion: A comprehensive review of current kV practice in the UK is presented. Advances in knowledge: Data and discussion on contemporary kV radiotherapy in the UK, with a particular focus on physics aspects. PMID:27730839

Experiences from the frontline: An exploration of personal advisers' practice with claimants who have health-related needs within UK welfare-to-work provision.

PubMed

Ceolta-Smith, Jenny; Salway, Sarah; Tod, Angela Mary

2018-04-17

Recent UK welfare reforms have been less successful than expected by the Government in supporting unemployed people with long-term illness into work. Frontline workers remain a core element of the new welfare-to-work machinery, but operate within a changed organisational and policy landscape. These changes raise important questions regarding whether and how claimants' health-related barriers to work are considered. This paper examines the UK welfare-to-work frontline worker's role with claimants who have long-term illness. Fieldwork observations in three not-for-profit employment support services and semi-structured interviews with 29 participants (claimants, frontline workers, healthcare professionals and managers) were conducted between 2011 and 2012. Participant observation of the wider welfare-to-work arena was initiated in 2009 and continued until 2013. A qualitative methodology drawing on ethnographic principles was adopted. Thematic analysis of the data was carried out. The findings show that the frontline worker plays a key role in assessing and addressing claimants' health-related barriers to work. Two important health-related role dimensions were identified: a health promoter role which involved giving health promotional advice to claimants about their general health; and a health monitor role which involved observing and questioning claimants about their general health. Frontline workers' practice approaches were shaped by organisational and individual factors. Integration between the National Health Service and employment support services was limited, and the findings suggested improvements were required to ensure an adequate response to claimants' health-related needs to support their journey into work. © 2018 John Wiley & Sons Ltd.

For society, state and self: juggling the logics of professionalism in general practice appraisal.

PubMed

Entwistle, Tom; Matthews, Elaine

2015-11-01

Sociologists repeatedly appeal to notions of altruism, bureaucratisation and self interest in their efforts to explain the changing place of the professions in contemporary society. We treat these three readings as institutional logics that are key to understanding the way in which doctors respond to the appraisal system at the heart of the UK's approach to revalidation. Our analysis of a survey of 998 general practitioners (GPs) working in Wales finds an altruistic commitment to learning and improvement, bureaucratic demands for reporting information and self-regarding resentment of changes in the occupational package provided by general practice. But the data also demonstrate that the maintenance of the appraisal regime is dependent on the preparedness and capacity of individual GPs to do micro-level institutional work on all fronts. © 2015 Foundation for the Sociology of Health & Illness.

Improving access for patients – a practice manager questionnaire

PubMed Central

Meade, James G; Brown, James S

2006-01-01

Background The administrative and professional consequences of access targets for general practices, as detailed in the new GMS contract, are unknown. This study researched the effect of implementing the access targets of the new GP contract on general practice appointment systems, and practice manager satisfaction in a UK primary health care setting. Methods A four-part postal questionnaire was administered. The questionnaire was modified from previously validated questionnaires and the findings compared with data obtained from the Western Health and Social Services Board (WHSSB) in N Ireland. Practice managers from the 59 general practices in the WHSSB responded to the questionnaire. Results There was a 94.9% response rate. Practice managers were generally satisfied with the introduction of access targets for patients. Some 57.1% of responding practices, most in deprived areas (Odds ratio 3.13 -95% CI 1.01 – 9.80, p = 0.0256) had modified their appointment systems. Less booking flexibility was reported among group practices (p = 0.006), urban practices (p < 0.001) and those with above average patient list sizes (p < 0.001). Receptionists had not received training in patient appointment management in a quarter of practices. Practices with smaller list sizes were more likely than larger ones to utilise nurses in seeing extra patients (p = 0.007) or to undertake triage procedures (p = 0.062). Conclusion The findings demonstrated the ability of general practices within the WHSSB to adjust to a demanding component of the new GP contract. Issues relating to the flexibility of patient appointment booking systems, receptionists' training and the development of the primary care nursing role were highlighted by the study. PMID:16784530

Data Rights Valuation in Software Acquisitions

DTIC Science & Technology

2012-09-01

Practices (A. Krattiger et al.). MIHR (Oxford, UK), PIPRA (Davis, USA), Oswaldo Cruz Foundation (Fiocruz, Rio de Janeiro , Brazil), and bioDevelopments...are generally conveyed with software de - liverables (e.g., government purpose rights may be conveyed instead of only restricted rights to software...needed to purchase C-130J spare parts through competitive procurements. When the prime contractor de - clined to provide a technical data rights package

"Teamwork" or "Working as a Team"? The Theory and Practice of Top Team Working in UK Higher Education

ERIC Educational Resources Information Center

Woodfield, Steve; Kennie, Tom

2008-01-01

This article focuses on the theory and practice of teamwork in "top management teams" in UK higher education institutions. It is informed by some of the key findings from a recent two-year research project sponsored by the Leadership Foundation for Higher Education that investigated the different ways in which UK higher education…

Does radiography advanced practice improve patient outcomes and health service quality? A systematic review.

PubMed

Hardy, Maryann; Johnson, Louise; Sharples, Rachael; Boynes, Stephen; Irving, Donna

2016-06-01

To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. Using the World Health Organization definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs, and data were systematically extracted using electronic data extraction pro forma. 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n = 7) focusing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The articles were generally considered to be of low-to-moderate quality, with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, the included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No articles reported data relating to time to diagnosis, time to recovery or patient mortality. Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality.

Cytotoxic drug use in treatment of dogs and cats with cancer by UK veterinary practices (2003 to 2004).

PubMed

Cave, T A; Norman, P; Mellor, D

2007-07-01

To describe the range and frequency of cytotoxic drugs prescribed within UK veterinary practices to treat dogs and cats with cancer, determine the effect of practice demographic variables on this practice and determine the frequency with which intravenous catheters were used during administration of parenteral cytotoxic drugs. A postal survey of 1838 veterinary practices providing care for dogs and cats within the UK. Prescription of cytotoxic drugs to treat dogs and cats with cancer during the preceding 12 months was reported by 70.8 per cent practices. The most widely prescribed agents were cyclophosphamide (65.4 per cent) and vincristine (63.5 per cent). Twenty-three per cent of responding practices had prescribed an antitumour antibiotic and 8.3 per cent had prescribed a platinum agent. The median frequency of prescription was between once a month and once every three months. Increasing frequency and range of cytotoxic drug prescription were associated with practice employment of higher numbers of veterinary surgeons and increased levels of pet insurance among practice clients. Almost a quarter of practices administering vesicant parenteral cytotoxic drugs failed to always use intravenous catheters to do so. Prescription of cytotoxic drugs, and therefore the potential for occupational exposure of staff, was widespread among UK veterinary practices providing care for dogs and cats.

Improving management and effectiveness of home blood pressure monitoring: a qualitative UK primary care study.

PubMed

Grant, Sabrina; Greenfield, Sheila M; Nouwen, Arie; McManus, Richard J

2015-11-01

Self-monitoring blood pressure (SMBP) is becoming an increasingly prevalent practice in UK primary care, yet there remains little conceptual understanding of why patients with hypertension engage in self-monitoring. To identify psychological factors or processes prompting the decision to self-monitor blood pressure. A qualitative study of patients previously participating in a survey study about SMBP from four general practices in the West Midlands. Taped and transcribed in-depth interviews with 16 patients (6 currently monitoring, 2 used to self-monitor, and 8 had never self-monitored). Thematic analysis was undertaken. Three main themes emerged: 'self' and 'living with hypertension' described the emotional element of living with an asymptomatic condition; 'self-monitoring behaviour and medication' described overall views about self-monitoring, current practice, reasons for monitoring, and the impact on medication adherence; and 'the GP-patient transaction' described the power relations affecting decisions to self-monitor. Self-monitoring was performed by some as a protective tool against the fears of a silent but serious condition, whereas others self-monitor simply out of curiosity. People who self-monitored tended not to discuss this with their nurse or GP, partly due to perceiving minimal or no interest from their clinician about home monitoring, and partly due to fear of being prescribed additional medication. The decision to self-monitor appeared often to be an individual choice with no schedule or systems to integrate it with other medical care. Better recognition by clinicians that patients are self-monitoring, perhaps utilising the results in shared decision-making, might help integrate it into daily practice. © British Journal of General Practice 2015.

Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): a cluster-randomised trial

PubMed Central

Griffin, Simon J; Borch-Johnsen, Knut; Davies, Melanie J; Khunti, Kamlesh; Rutten, Guy EHM; Sandbæk, Annelli; Sharp, Stephen J; Simmons, Rebecca K; van den Donk, Maureen; Wareham, Nicholas J; Lauritzen, Torsten

2011-01-01

Summary Background Intensive treatment of multiple cardiovascular risk factors can halve mortality among people with established type 2 diabetes. We investigated the effect of early multifactorial treatment after diagnosis by screening. Methods In a pragmatic, cluster-randomised, parallel-group trial done in Denmark, the Netherlands, and the UK, 343 general practices were randomly assigned screening of registered patients aged 40–69 years without known diabetes followed by routine care of diabetes or screening followed by intensive treatment of multiple risk factors. The primary endpoint was first cardiovascular event, including cardiovascular mortality and morbidity, revascularisation, and non-traumatic amputation within 5 years. Patients and staff assessing outcomes were unaware of the practice's study group assignment. Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00237549. Findings Primary endpoint data were available for 3055 (99·9%) of 3057 screen-detected patients. The mean age was 60·3 (SD 6·9) years and the mean duration of follow-up was 5·3 (SD 1·6) years. Improvements in cardiovascular risk factors (HbA1c and cholesterol concentrations and blood pressure) were slightly but significantly better in the intensive treatment group. The incidence of first cardiovascular event was 7·2% (13·5 per 1000 person-years) in the intensive treatment group and 8·5% (15·9 per 1000 person-years) in the routine care group (hazard ratio 0·83, 95% CI 0·65–1·05), and of all-cause mortality 6·2% (11·6 per 1000 person-years) and 6·7% (12·5 per 1000 person-years; 0·91, 0·69–1·21), respectively. Interpretation An intervention to promote early intensive management of patients with type 2 diabetes was associated with a small, non-significant reduction in the incidence of cardiovascular events and death. Funding National Health Service Denmark, Danish Council for Strategic Research, Danish Research Foundation for General Practice, Danish Centre for Evaluation and Health Technology Assessment, Danish National Board of Health, Danish Medical Research Council, Aarhus University Research Foundation, Wellcome Trust, UK Medical Research Council, UK NIHR Health Technology Assessment Programme, UK National Health Service R&D, UK National Institute for Health Research, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Novo Nordisk, Astra, Pfizer, GlaxoSmithKline, Servier, HemoCue, Merck. PMID:21705063

The state of UK anaesthesia: a survey of National Health Service activity in 2013.

PubMed

Sury, M R J; Palmer, J H M G; Cook, T M; Pandit, J J

2014-10-01

Details of current UK anaesthetic practice are unknown and were needed for interpretation of reports of accidental awareness during general anaesthesia (GA) within the 5th National Audit Project. We surveyed NHS anaesthetic activity to determine numbers of patients managed by anaesthetists and details of 'who, when, what, and where': activity included GA, local anaesthesia, sedation, or patients managed awake. Anaesthetists in NHS hospitals collected data on all patients for 2 days. Scaling enabled estimation of annual activity. Hospital response rate was 100% with 20,400 returns. The median return rate within departments was 98% (inter-quartile range 0.95-1). Annual numbers (% of total) of general anaesthetics, sedation, and awake cases were 2,766,600 (76.9%), 308,800 (8.6%), and 523,100 (14.5%), respectively. A consultant or career grade anaesthetist was present in more than 87% of cases. Emergency cases accounted for 23.1% of workload, 75% of which were undertaken out of hours. Specialties with the largest workload were orthopaedics/trauma (22.1%), general surgery (16.1%), and gynaecology (9.6%): 6.2% of cases were non-surgical. The survey data describe: who anaesthetized patients according to time of day, urgency, and ASA grade; when anaesthesia took place by day and by weekday; the distribution of patient types, techniques, and monitoring; where patients were anaesthetized. Nine patients out of 15 460 receiving GA died intraoperatively. Anaesthesia in the UK is currently predominantly a consultant-delivered service. The low mortality rate supports the safety of UK anaesthetic care. The survey data should be valuable for planning and monitoring anaesthesia services. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Retrospection and Reflection: The Emerging Influence of an Institutional Professional Recognition Scheme on Professional Development and Academic Practice in a UK University

ERIC Educational Resources Information Center

van der Sluis, Hendrik; Burden, Penny; Huet, Isabel

2017-01-01

Raising the quality and profile of teaching and student learning is something universities across the UK are aspiring to achieve in order to maintain reputations. Currently, the UK Professional Standards Framework (UKPSF) provides a standard by which academic staff can gain professional recognition for their academic practice and many UK…

Dental Health Services Research Unit celebrates 30 years: Report of conference to mark the 30th anniversary of the Dental Health Services Research Unit (DHSRU) at Dundee, held on 1st December 2008.

PubMed

Eaton, Kenneth A; Pitts, Nigel B

2009-04-01

Over the years, several members of the staff of the Dental Health Services Research Unit (DHSRU) at Dundee have published papers in Primary Dental Care. Furthermore, its Director, Professor Nigel Pitts, together with Drs Jan Clarkson and Gail Topping have co-edited a number of the Faculty of General Dental Practice (UK)'s standards manuals and contributed to others. It had been suggested to the Unit by several parties that, having been in funded existence for some 30 years, it would be appropriate to mark this anniversary with a conference to explore 'Dental Health Services Research: After 30 years, what was the impact, what have we learned and where are we going?' So, following a range of consultations, the conference was convened at the West Park Conference Centre in Dundee with a mixed audience representing both dental research and dental practice.

Hijama therapy (wet cupping) - its potential use to complement British healthcare in practice, understanding, evidence and regulation.

PubMed

Sajid, Mohammed Imran

2016-05-01

Wet cupping was used in the nineteenth century for treatment of patients in the United Kingdom (UK) by a few experienced practitioners. Revival Hijama use by practitioners in the UK in recent years has been observed as well as interest from the public, with developments of specific certified training programmes, established businesses providing tailored Hijama therapy Clinical Waste disposal services, provisions of insurance cover, involvement of medical professionals and membership with the General Regulatory Council for Complementary Therapies (GRCCT). However, there has also been noted that there is not much in the way of guidance or regulation. Therefore, we would like to initiate some communication and understanding of Hijama (wet cupping) to benefit medical professionals, discussing recent research undertaken as a basis for potentially more in the future (evidence-based practice), in the likely event that a patient might request to be referred for this therapy during a consultation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Linguistically and Culturally Diverse Students' Perceptions of Successful Classroom Practices in a UK Graduate Program

ERIC Educational Resources Information Center

Rich, Sarah

2005-01-01

In this paper, I present the findings of a longitudinal study into the perceptions of linguistically and culturally diverse practicing teachers in a graduate program in the United Kingdom (UK) with regard to pedagogic practices deemed successful in helping them negotiate access to an academic community of practice. It is argued that an approach…

Alternatives to the face-to-face consultation in general practice: focused ethnographic case study.

PubMed

Atherton, Helen; Brant, Heather; Ziebland, Sue; Bikker, Annemieke; Campbell, John; Gibson, Andy; McKinstry, Brian; Porqueddu, Tania; Salisbury, Chris

2018-04-01

NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives. To understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice. Focused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016. Non-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the 'one sheet of paper' mind-map method to identify the line of argument in each thematic report. Case study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other's practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal. Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team. © British Journal of General Practice 2018.

Predictors of non-use of intrauterine contraception among women aged 18-49 years in a general practice setting in the UK.

PubMed

Walker, Susan H; Newton, Victoria L; Hoggart, Lesley; Parker, Mike J

2016-01-01

Our research examined the barriers to the uptake of intrauterine contraception (IUC) by women in a general practice (GP) setting in the UK. This study reports predictors of non-use of IUC in this context. We used a mixed method Qual/Quant approach in which the initial qualitative research provides a framework for subsequent larger quantitative surveys. Utilizing findings derived from 30 qualitative interviews, a quantitative survey was developed and distributed to a pragmatic sample of 1,195 women, aged 18-49 years, who were recruited through 32 participating GP practices in an area of England, UK. Outcome measures were percentage of attributes or responses in the sample and use or non-use of IUC. Results were analyzed using descriptive statistical analysis and binary logistic regression, using use/non-use as a binary response variable. Attitudinal variables, which were the strongest predictors of non-use of IUC, were an adverse opinion on long-acting aspect of IUC (odds ratio [OR]=8.34), disliking the thought of IUC inside the body (OR=3.138), concerns about IUC causing difficulties becoming pregnant in the future (OR=2.587), concerns about womb damage (OR=2.224), having heard adverse opinions about levonorgestrel-releasing intrauterine system (Mirena ® ) (OR=2.551), having an adverse opinion of having light, irregular periods (OR=2.382) and, having an adverse opinion of having no periods (OR=2.018). Concerns about the long-acting nature of IUC and persisting concerns about the safety of IUC may act as barriers to its use. Information for women, tailored to specifically address these concerns, is needed. Clinicians should provide more reassurance and information to potential users of IUC to increase their confidence about the possibility of removing IUC early or on request. They should also specifically seek to alleviate concerns about internal damage, damage to the womb, or damage to future fertility from using the methods.

MRSA – ‘Bug-Bear’ of a Surgical Practice: Reducing the Incidence of MRSA Surgical Site Infections

PubMed Central

Guyot, Andrea; Layer, Graham

2006-01-01

Adverse publicity (the ‘superbug') has demonstrated that the problem of MRSA (methicillin-resistant Staphylococcus aureus) is prevalent in many of the country's most prestigious hospitals. The results of the mandatory UK Department of Health (DH) surveillance for early surgical site infections in orthopaedic surgery (SSIS) have been published recently for the period April 2004 to March 2005 when 41,242 operations were studied ( 28 October 2005). Infection rates were generally and gratifyingly low but 48% of surgical site infections were caused by Staph. aureus and of those 68% were MRSA. The following article will discuss the aetiology and prevention of MRSA surgical site infection. PMID:16551425

UK-based, multisite, prospective cohort study of small bowel obstruction in acute surgical services: National Audit of Small Bowel Obstruction (NASBO) protocol

PubMed Central

Sayers, Adele E; Drake, Thomas M; Hollyman, Marianne; Bradburn, Mike; Hind, Daniel; Wilson, Timothy R; Fearnhead, Nicola S; Abercrombie, John

2017-01-01

Introduction Small bowel obstruction (SBO) is a common indication for emergency laparotomy in the UK, which is associated with a 90-day mortality rate of 13%. There are currently no UK clinical guidelines for the management of this condition. The aim of this multicentre prospective cohort study is to describe the burden, variation in management and associated outcomes of SBO in the UK adult population. Methods and analysis UK hospitals providing emergency general surgery are eligible to participate. This study has three components: (1) a clinical preference questionnaire to be completed by consultants providing emergency general surgical care to assesses preferences in diagnostics and therapeutic approaches, including laparoscopy and nutritional interventions; (2) site resource profile questionnaire to indicate ease of access to diagnostic services, operating theatres, nutritional support teams and postoperative support including intensive care; (3) prospective cohort study of all cases of SBO admitted during an 8-week period at participating trusts. Data on diagnostics, operative and nutritional interventions, and in-hospital mortality and morbidity will be captured, followed by data validation. Ethics and dissemination This will be conducted as a national audit of practice in conjunction with trainee research collaboratives, with support from patient representatives, surgeons, anaesthetists, gastroenterologists and a clinical trials unit. Site-specific reports will be provided to each participant site as well as an overall report to be disseminated through specialist societies. Results will be published in a formal project report endorsed by stakeholders, and in peer-reviewed scientific reports. Key findings will be debated at a focused national meeting with a view to quality improvement initiatives. PMID:28982819

UK-based, multisite, prospective cohort study of small bowel obstruction in acute surgical services: National Audit of Small Bowel Obstruction (NASBO) protocol.

PubMed

Lee, Matthew J; Sayers, Adele E; Drake, Thomas M; Hollyman, Marianne; Bradburn, Mike; Hind, Daniel; Wilson, Timothy R; Fearnhead, Nicola S

2017-10-05

Small bowel obstruction (SBO) is a common indication for emergency laparotomy in the UK, which is associated with a 90-day mortality rate of 13%. There are currently no UK clinical guidelines for the management of this condition. The aim of this multicentre prospective cohort study is to describe the burden, variation in management and associated outcomes of SBO in the UK adult population. UK hospitals providing emergency general surgery are eligible to participate. This study has three components: (1) a clinical preference questionnaire to be completed by consultants providing emergency general surgical care to assesses preferences in diagnostics and therapeutic approaches, including laparoscopy and nutritional interventions; (2) site resource profile questionnaire to indicate ease of access to diagnostic services, operating theatres, nutritional support teams and postoperative support including intensive care; (3) prospective cohort study of all cases of SBO admitted during an 8-week period at participating trusts. Data on diagnostics, operative and nutritional interventions, and in-hospital mortality and morbidity will be captured, followed by data validation. This will be conducted as a national audit of practice in conjunction with trainee research collaboratives, with support from patient representatives, surgeons, anaesthetists, gastroenterologists and a clinical trials unit. Site-specific reports will be provided to each participant site as well as an overall report to be disseminated through specialist societies. Results will be published in a formal project report endorsed by stakeholders, and in peer-reviewed scientific reports. Key findings will be debated at a focused national meeting with a view to quality improvement initiatives. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The ethics of general practice and advertising.

PubMed

Colman, R D

1989-06-01

UK general practitioners (GPs) are self-employed entrepreneurs running small businesses with commercial considerations. In this situation there is no clear distinction between information, self-promotion and advertising. In response to the growing public demand for more information about medical services, the medical profession should voluntarily accept the notion of soft self-promotion in the form of 'notices' or 'announcements' placed in newspapers. Newspapers are the most effective way of giving easy access to information. The resistance to newspapers may be more concerned with preserving certain medical traditions than consideration of the public interest. The General Medical Council's (GMC's) arguments against soft self-promotion are seen as misguided paternalism, inconsistent and irrational.

Impact of clinical trial findings on Bell's palsy management in general practice in the UK 2001–2012: interrupted time series regression analysis

PubMed Central

Morales, Daniel R; Donnan, Peter T; Daly, Fergus; Staa, Tjeerd Van; Sullivan, Frank M

2013-01-01

Objectives To measure the incidence of Bell's palsy and determine the impact of clinical trial findings on Bell's palsy management in the UK. Design Interrupted time series regression analysis and incidence measures. Setting General practices in the UK contributing to the Clinical Practice Research Datalink (CPRD). Participants Patients ≥16 years with a diagnosis of Bell's palsy between 2001 and 2012. Interventions (1) Publication of the 2004 Cochrane reviews of clinical trials on corticosteroids and antivirals for Bell's palsy, which made no clear recommendation on their use and (2) publication of the 2007 Scottish Bell's Palsy Study (SBPS), which made a clear recommendation that treatment with prednisolone alone improves chances for complete recovery. Main outcome measures Incidence of Bell's palsy per 100 000 person-years. Changes in the management of Bell's palsy with either prednisolone therapy, antiviral therapy, combination therapy (prednisolone with antiviral therapy) or untreated cases. Results During the 12-year period, 14 460 cases of Bell's palsy were identified with an overall incidence of 37.7/100 000 person-years. The 2004 Cochrane reviews were associated with immediate falls in prednisolone therapy (−6.3% (−11.0 to −1.6)), rising trends in combination therapy (1.1% per quarter (0.5 to 1.7)) and falling trends for untreated cases (−0.8% per quarter (−1.4 to −0.3)). SBPS was associated with immediate increases in prednisolone therapy (5.1% (0.9 to 9.3)) and rising trends in prednisolone therapy (0.7% per quarter (0.4 to 1.2)); falling trends in combination therapy (−1.7% per quarter (−2.2 to −1.3)); and rising trends for untreated cases (1.2% per quarter (0.8 to 1.6)). Despite improvements, 44% still remain untreated. Conclusions SBPS was clearly associated with change in management, but a significant proportion of patients failed to receive effective treatment, which cannot be fully explained. Clarity and uncertainty in clinical trial recommendations may change clinical practice. However, better ways are needed to understand and circumvent barriers in implementing clinical trial findings. PMID:23864211

Impact of clinical trial findings on Bell's palsy management in general practice in the UK 2001-2012: interrupted time series regression analysis.

PubMed

Morales, Daniel R; Donnan, Peter T; Daly, Fergus; Staa, Tjeerd Van; Sullivan, Frank M

2013-01-01

To measure the incidence of Bell's palsy and determine the impact of clinical trial findings on Bell's palsy management in the UK. Interrupted time series regression analysis and incidence measures. General practices in the UK contributing to the Clinical Practice Research Datalink (CPRD). Patients ≥16 years with a diagnosis of Bell's palsy between 2001 and 2012. (1) Publication of the 2004 Cochrane reviews of clinical trials on corticosteroids and antivirals for Bell's palsy, which made no clear recommendation on their use and (2) publication of the 2007 Scottish Bell's Palsy Study (SBPS), which made a clear recommendation that treatment with prednisolone alone improves chances for complete recovery. Incidence of Bell's palsy per 100 000 person-years. Changes in the management of Bell's palsy with either prednisolone therapy, antiviral therapy, combination therapy (prednisolone with antiviral therapy) or untreated cases. During the 12-year period, 14 460 cases of Bell's palsy were identified with an overall incidence of 37.7/100 000 person-years. The 2004 Cochrane reviews were associated with immediate falls in prednisolone therapy (-6.3% (-11.0 to -1.6)), rising trends in combination therapy (1.1% per quarter (0.5 to 1.7)) and falling trends for untreated cases (-0.8% per quarter (-1.4 to -0.3)). SBPS was associated with immediate increases in prednisolone therapy (5.1% (0.9 to 9.3)) and rising trends in prednisolone therapy (0.7% per quarter (0.4 to 1.2)); falling trends in combination therapy (-1.7% per quarter (-2.2 to -1.3)); and rising trends for untreated cases (1.2% per quarter (0.8 to 1.6)). Despite improvements, 44% still remain untreated. SBPS was clearly associated with change in management, but a significant proportion of patients failed to receive effective treatment, which cannot be fully explained. Clarity and uncertainty in clinical trial recommendations may change clinical practice. However, better ways are needed to understand and circumvent barriers in implementing clinical trial findings.

Relationship between initial therapy and blood pressure control for high-risk hypertension patients in the UK: a retrospective cohort study from the THIN general practice database.

PubMed

Weir, Sharada; Juhasz, Attila; Puelles, Jorge; Tierney, Travis S

2017-07-28

To examine the UK practice patterns in treating newly diagnosed hypertension and to determine whether subgroups of high-risk patients are more or less likely to follow particular therapeutic protocols and to reach blood pressure goals. Retrospective cohort study. This study examined adults in The Health Improvement Network (THIN) UK general practice medical records database who were initiated on medication for hypertension. 48 131 patients with essential hypertension diagnosed between 2008 and 2010 who were registered with a participating practice for a minimum of 13 months prior to, and 6 months following, initiation of therapy. We excluded patients with gestational hypertension or secondary hypertension. Patients were classified into risk groups based on blood pressure readings and comorbid conditions. Odds of receiving single versus fixed or free-drug combination therapy and odds of achieving blood pressure control were assessed using multivariable logistic regression. The vast majority of patients (95.8%) were initiated on single drug therapy. Patients with high cardiovascular risk (patients with grade 2-3 hypertension or those with high normal/grade 1 hypertension plus at least one cardiovascular condition pretreatment) had a statistically significant benefit of starting immediately on combination therapy when blood pressure control was the desired goal (OR: 1.23; 95% CI: 1.06 to 1.42) but, surprisingly, were less likely than patients with no risk factors to receive combination therapy (OR: 0.53; 95% CI: 0.47 to 0.59). Our results suggest that combination therapy may be indicated for patients with high cardiovascular risk, who accounted for 60.6% of our study population. The National Institute for Health and Care Excellence guideline CG34 of 2006 (in effect during the study period) recommended starting with single drug class therapy for most patients, and this advice does seem to have been followed even in cases where a more aggressive approach might have been considered. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The design and content of orthodontic practise websites in the UK is suboptimal and does not correlate with search ranking.

PubMed

Patel, Annika; Cobourne, Martyn T

2015-08-01

This study investigated standards of ethical advertising; design and content; and information quality associated with UK dental practice websites offering orthodontic treatment. The World Wide Web was searched from a UK-based computer using the Google search engine combined with the term 'orthodontic braces'. The first 100 UK-based dental practice websites were pooled and saved following duplicate removal. Websites were evaluated for compliance with current General Dental Council ethical advertising guidelines; accessibility, usability, and reliability using the LIDA instrument (a validated outcome tool for healthcare website design and content evaluation); and quality of information using the DISCERN toolkit (a validated method of quality assessment for online written patient information). Nine per cent of websites demonstrated full compliance with current guidelines on ethical advertising. Mean total LIDA score was 110/144 (76%) [range: 51-135; 35-94%]. Eleven websites reached a gold standard of 90% or more for total LIDA score. Mean total DISCERN score was 48/75 (64%) [range: 19-73; 25-97%]. Five websites achieved a total DISCERN score above 90%. Spearman's rank correlation coefficients demonstrated no significant correlations between LIDA (0.1669; P = 0.4252, confidence interval [CI]: -0.2560 to 0.5362) or DISCERN (0.3572; P = 0.0796, CI: -0.0565 to 0.663) score and ranking amongst the 25 highest ranked websites. Most UK websites offering orthodontic services are not fully compliant with national guidelines relating to ethical advertising. Validated measures of website design (LIDA) and information quality (DISCERN) showed wide variation amongst sites. No correlation existed between ranking amongst the highest 25 sites and either of these measures. This investigation was limited to a subsample of UK-only websites; and whilst not representative of European-wide sites, it does suggest that in the UK at least website quality can be improved. © The Author 2014. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Promoting Mental Health and Preventing Mental Illness in General Practice

PubMed Central

Thomas, Steve; Jenkins, Rachel; Burch, Tony; Calamos Nasir, Laura; Fisher, Brian; Giotaki, Gina; Gnani, Shamini; Hertel, Lise; Marks, Marina; Mathers, Nigel; Millington-Sanders, Catherine; Morris, David; Ruprah-Shah, Baljeet; Stange, Kurt; Thomas, Paul; White, Robert; Wright, Fiona

2016-01-01

Abstract This paper calls for the routine integration of mental health promotion and prevention into UK General Practice in order to reduce the burden of mental and physical disorders and the ensuing pressure on General Practice. The proposals & the resulting document (https://ethicscharity.files.wordpress.com/2015/09/rcgp_keymsg_150925_v5.pdf) arise from an expert ‘Think Tank’ convened by the London Journal of Primary Care, Educational Trust for Health Improvement through Cognitive Strategies (ETHICS Foundation) and the Royal College of General Practitioners. It makes 12 recommendations for General Practice: (1) Mental health promotion and prevention are too important to wait. (2) Work with your community to map risk factors, resources and assets. (3) Good health care, medicine and best practice are biopsychosocial rather than purely physical. (4) Integrate mental health promotion and prevention into your daily work. (5) Boost resilience in your community through approaches such as community development. (6) Identify people at increased risk of mental disorder for support and screening. (7) Support early intervention for people of all ages with signs of illness. (8) Maintain your biopsychosocial skills. (9) Ensure good communication, interdisciplinary team working and inter-sectoral working with other staff, teams and agencies. (10) Lead by example, taking action to promote the resilience of the general practice workforce. (11) Ensure mental health is appropriately included in the strategic agenda for your ‘cluster’ of General Practices, at the Clinical Commissioning Groups, and the Health and Wellbeing Board. (12) Be aware of national mental health strategies and localise them, including action to destigmatise mental illness within the context of community development. PMID:28250821

In retrospect--a reflection on a 50-year research journey.

PubMed

Howie, John G R

2014-02-01

This essay is a personal review of a research journey extending over 50 years during which time the understanding of medical practice has changed out of all recognition and the quality and standing of the discipline of general practice has improved substantially. Three main bodies of work are reviewed and set against the reasons why they were undertaken. The first, on the pathology of the appendix and the management of possible appendicitis, was carried out almost entirely in the hospital setting. The second, about the prescribing of antibiotics for respiratory illnesses, and the third, about the determinants of good consulting practice, were carried out in general practice. The essay concludes with a reflection on the relevance of the work to some contemporary academic and health service issues. Although the work was carried out in the UK in the context of its National Health Service (NHS), the conclusions are widely generalizable and have contributed to health service and academic developments in many other countries.

Having diabetes and having to fast: a qualitative study of British Muslims with diabetes.

PubMed

Patel, Neesha R; Kennedy, Anne; Blickem, Christian; Rogers, Anne; Reeves, David; Chew-Graham, Carolyn

2015-10-01

There are approximately 2.7 million Muslims in the UK, constituting 4.8% of the population. It is estimated that 325,000 UK Muslims have diabetes. Whilst dietary practices of Muslims with diabetes have been explored, little work has described the beliefs and decisions to fast during Ramadan, whereby Muslims with diabetes refrain from eating, drinking and taking medication between sunrise and sunset. To explore beliefs and experiences of fasting during Ramadan of Muslim respondents with diabetes and their perceptions of the role played by their general practitioner (GP) and/or practice nurse (PN) in supporting them. Qualitative study. General practices and community groups located in Greater Manchester. 23 South Asian Muslims. Semi-structured interviews were conducted as part of the Collaboration of Applied Health Research and Care (CLAHRC) programme, Greater Manchester. Respondents were recruited using random and purposive sampling techniques. Interviews were analysed thematically using a constant comparison approach. Thirteen respondents reported they fasted and altered diabetes medication and diet during Ramadan. The decision to fast was influenced by pressures from the family and the collective social aspect of fasting, and respondents made limited contact with primary care during fasting. Tensions exist between the respondent's personal desire to fast or not fast and their family's opinion on the matter, with a strong reluctance to disclose fasting to GP and/or PN. Future research needs to explore whether GPs or PNs feel competent enough to support patients who wish to fast. © 2014 John Wiley & Sons Ltd.

Evaluation of effect on skills of GP trainees taking time out of programme (OOP) in developing countries.

PubMed

Kiernan, Patrick; O'Dempsey, Tim; Kwalombota, Kwalombota; Elliott, Lynne; Cowan, Lesley

2014-03-01

The London School of General Practice Time Out of Programme (OOP) provides general practice (GP) trainees with an opportunity to enhance clinical experience and develop a range of skills and competencies, which are often not achievable in a three-year training programme, that are relevant and transferable to their practice in the UK. The programme offers one-year posts in the developing world to trainees between years ST2/3. This study builds on the work of the International Health Links Centre and London Deanery report (2011) and is designed to assess the skills and competencies of GP trainees on an OOP scheme. The study evaluated the impact of the OOP scheme on: • GP trainees? clinical skills • GP trainees' decision-making, management and leadership skills • Any other competencies. London GP trainees and trainers. Data were gathered using structured interview schedules developed for GP trainees and GP trainers and mapped against the RCGP Trainee e-portfolio Competence Areas. Our findings show that trainees and trainers reported an increase in skill levels in the more generic competencies. The study shows that the OOP scheme provides GP trainees with an excellent opportunity to develop clinical skills and more generic skills such as leadership, management and decision-making, as well as effective use of resources. However, not all clinical skill improvements were directly transferable to trainees' clinical work on return to the UK.

Evaluation of the status of canine hydrotherapy in the UK.

PubMed

Waining, M; Young, I S; Williams, S B

2011-04-16

To establish the current status of canine hydrotherapy in the UK and to ascertain information regarding the current use of hydrotherapy, a questionnaire was sent to 152 hydrotherapy centres throughout the UK, from which 89 responded. Hydrotherapy was found to be a rapidly growing business. Stand-alone centres were in existence; however, many centres were connected to other businesses, including boarding kennels and general practice veterinary surgeries. The dogs using the facility were mainly pedigree breeds, particularly labrador retrievers (30 per cent), and the most commonly encountered conditions were rupture of the cranial cruciate ligament (25 per cent), hip dysplasia (24 per cent) and osteoarthritis (18 per cent). The proportion of qualified versus unqualified staff varied between centres, highlighting a need for improved regulation of this aspect of the industry. However, all the dogs treated by the hydrotherapy centres surveyed were direct veterinary referrals, suggesting a good degree of professionalism in the field and a high regard for the benefits of hydrotherapy.

Addressing long-term physical healthcare needs in a forensic mental health inpatient population using the UK primary care Quality and Outcomes Framework (QOF): an audit.

PubMed

Ivbijaro, Go; Kolkiewicz, LA; McGee, Lsf; Gikunoo, M

2008-03-01

Objectives This audit aims to evaluate the effectiveness of delivering an equivalent primary care service to a long-term forensic psychiatric inpatient population, using the UK primary care national Quality and Outcomes Framework (QOF).Method The audit compares the targets met by the general practitioner with special interest (GPwSI) service, using local and national QOF benchmarks (2005-2006), and determines the prevalence of chronic disease in a long-term inpatient forensic psychiatry population.Results The audit results show that the UK national QOF is a useful tool for assessment and evaluation of physical healthcare needs in a non-community based population. It shows an increased prevalence of all QOF-assessed long-term physical conditions when compared to the local East London population and national UK population, confirming previously reported elevated levels of physical healthcare need in psychiatric populations.Conclusions This audit shows that the UK General Practice QOF can be used as a standardised instrument for commissioning and monitoring the delivery of physical health services to in-patient psychiatric populations, and for the evaluation of the effectiveness of clinical interventions in long-term physical conditions. The audit also demonstrates the effectiveness of using a GPwSI in healthcare delivery in non-community based settings. We suggest that the findings may be generalisable to other long-term inpatient psychiatric and prison populations in order to further the objective of delivering an equivalent primary care service to all populations.The QOF is a set of national primary care audit standards and is freely available on the British Medical Association website or the UK Department of Health website. We suggest that primary care workers in health economies who have not yet developed their own national primary care standards can access and adapt these standards in order to improve the clinical standards of care given to the primary care populations that they serve.

Addressing long-term physical healthcare needs in a forensic mental health inpatient population using the UK primary care Quality and Outcomes Framework (QOF): an audit

PubMed Central

2008-01-01

Objectives This audit aims to evaluate the effectiveness of delivering an equivalent primary care service to a long-term forensic psychiatric inpatient population, using the UK primary care national Quality and Outcomes Framework (QOF). Method The audit compares the targets met by the general practitioner with special interest (GPwSI) service, using local and national QOF benchmarks (2005–2006), and determines the prevalence of chronic disease in a long-term inpatient forensic psychiatry population. Results The audit results show that the UK national QOF is a useful tool for assessment and evaluation of physical healthcare needs in a non-community based population. It shows an increased prevalence of all QOF-assessed long-term physical conditions when compared to the local East London population and national UK population, confirming previously reported elevated levels of physical healthcare need in psychiatric populations. Conclusions This audit shows that the UK General Practice QOF can be used as a standardised instrument for commissioning and monitoring the delivery of physical health services to in-patient psychiatric populations, and for the evaluation of the effectiveness of clinical interventions in long-term physical conditions. The audit also demonstrates the effectiveness of using a GPwSI in healthcare delivery in non-community based settings. We suggest that the findings may be generalisable to other long-term inpatient psychiatric and prison populations in order to further the objective of delivering an equivalent primary care service to all populations. The QOF is a set of national primary care audit standards and is freely available on the British Medical Association website or the UK Department of Health website. We suggest that primary care workers in health economies who have not yet developed their own national primary care standards can access and adapt these standards in order to improve the clinical standards of care given to the primary care populations that they serve. PMID:22477846

Current practice of usual clinic blood pressure measurement in people with and without diabetes: a survey and prospective ‘mystery shopper’ study in UK primary care

PubMed Central

2018-01-01

Objectives Hypertension trials and epidemiological studies use multiple clinic blood pressure (BP) measurements at each visit. Repeat measurement is also recommended in international guidance; however, little is known about how BP is measured routinely. This is important for individual patient management and because routinely recorded readings form part of research databases. We aimed to determine the current practice of BP measurement during routine general practice appointments. Design (1) An online cross-sectional survey and (2) a prospective ‘mystery shopper’ study where patients agreed to report how BP was measured during their next appointment. Setting Primary care. Participants Patient charity/involvement group members completing an online survey between July 2015 and January 2016. 334 participants completed the prospective study (51.5% male, mean age=59.3 years) of which 279 (83.5%) had diabetes. Primary outcome Proportion of patients having BP measured according to guidelines. Results 217 participants with (183) and without diabetes (34) had their BP measured at their last appointment. BP was measured in line with UK guidance in 63.7% and 60.0% of participants with and without diabetes, respectively. Initial pressures were significantly higher in those who had their BP measured more than once compared with only once (p=0.016/0.089 systolic and p<0.001/p=0.022 diastolic, in patients with/without diabetes, respectively). Conclusions Current practice of routine BP measurement in UK primary care is often concordant with guidelines for repeat measurement. Further studies are required to confirm findings in broader populations, to confirm when a third repeat reading is obtained routinely and to assess adherence to other aspects of BP measurement guidance. PMID:29654037

Understanding the delayed prescribing of antibiotics for respiratory tract infection in primary care: a qualitative analysis.

PubMed

Ryves, R; Eyles, C; Moore, M; McDermott, L; Little, P; Leydon, G M

2016-11-18

To identify general practitioner (GP) views and understanding on the use of delayed prescribing in primary care. Qualitative semistructured telephone interview study. Primary care general practices in England. 32 GPs from identified high-prescribing and low-prescribing general practices in England. Semistructured telephone interviews were conducted with GPs identified from practices within clinical commissioning groups with the highest and lowest prescribing rates in England. A thematic analysis of the data was conducted to generate themes. All GPs had a good understanding of respiratory tract infection (RTI) management and how the delayed prescribing approach could be used in primary care. However, GPs highlighted factors that were influential as to whether delayed prescribing was successfully carried out during the consultation. These included the increase in evidence of antimicrobial resistance, and GPs' prior experiences of using delayed prescribing during the consultation. The patient-practitioner relationship could also influence treatment outcomes for RTI, and a lack of an agreed prescribing strategy within and between practices was considered to be of significance to GPs. Participants expressed that a lack of feedback on prescribing data at an individual and practice level made it difficult to know if delayed prescribing strategies were successful in reducing unnecessary consumption. GPs agreed that coherent and uniform training and guidelines would be of some benefit to ensure consistent prescribing throughout the UK. Delayed prescribing is encouraged in primary care, but is not always implemented successfully. Greater uniformity within and between practices in the UK is needed to operationalise delayed prescribing, as well as providing feedback on the uptake of antibiotics. Finally, GPs may need further guidance on how to answer the concerns of patients without interpreting these questions as a demand for antibiotics, as well as educating the patient about antimicrobial resistance and supporting a good patient-practitioner relationship. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Adjusting for case mix and social class in examining variation in home visits between practices.

PubMed

Sullivan, Caoimhe O; Omar, Rumana Z; Forrest, Christopher B; Majeed, Azeem

2004-08-01

The purpose of this study was to investigate whether adjusting for clinical case mix and social class explains more of the variation in home visits between general practices than adjusting for age and sex alone. The setting was 60 general practices in England and Wales taking part in the 1 year Fourth National Morbidity Survey. The participants comprised 349 505 patients who were registered with one of the participating general practices for at least 180 days, and who had at least one consultation during the period. The outcome measure is whether or not a patient received a home visit in that year. A clinical case mix category (morbidity class) based on 1 year's diagnostic information was assigned to each patient using the Johns Hopkins Adjusted Clinical Groups (ACG) Case Mix System. The social class measure was derived from occupation and employment status and is similar to that of the 1991 UK census. Variations in home visits between practices were examined using multilevel logistic regression models. The variability between practices before and after adjusting for clinical case mix and social class was estimated using the intracluster correlation coefficient (ICC). The overall percentage of patients receiving a home visit over the 1 year study period was 17%, and this varied from 7 to 31% across the 60 practices. The percentage of the total variation in home visits attributable to differences between practices was 2.5% [95% confidence interval (CI) 1.4-3.2%] after adjusting for age and sex. This reduced to 1.6% (95% CI 1.1-2.4%) after taking into account morbidity class. The results were similar when social class was included instead of morbidity class. Morbidity and social class together reduced variation in home visits between practices to 1.5% (95% CI 1.1-2.2%). Age, sex, social class and clinical case mix are strong determinants of home visits in the UK. Adjusting for morbidity and social class results in a small improvement in explaining the variability in home visits between practices compared with adjusting for age and sex alone. There is far more variation between patients within practices; however, it is not straightforward to examine the factors influencing this variation. In addition to morbidity and social class, there could also be other unmeasured factors such as varying patient demand for home visits, disability or differences in GP home visiting practice style that could influence the large within-practice variability observed in this study.

Scope of practice and supervision of orthodontic therapists in the United Kingdom: Part 2: a national cross-sectional survey of orthodontic therapists.

PubMed

Ahmed, Farooq; Dugdale, Charlotte; Malik, Ovais; Waring, David

2018-03-01

Orthodontic therapists (OTs) are the most recent addition to the orthodontic clinical team. The General Dental Council (GDC) and the British Orthodontic Society have formulated guidance and guidelines relating to their scope of practice and level of supervision, however there has been no contemporary UK-based research investigating practice and supervision of OTs. The aim of this study was to investigate the scope of practice and level of supervision of OTs working in the UK. Ethical approval was received from the University of Manchester Research Ethics Committee. An anonymous postal questionnaire was dispatched using postal details acquired through the British Orthodontic Societies mailing list. Three mailings of the questionnaire were conducted. A 74% response rate was achieved. OTs routinely conducted 16 of the 20 procedures from their scope of practice. Uncommon procedures included fitting headgear (24%), lingual appliances (27%), inserting or removing temporary anchorage devices (20%), and taking facebow record (18%). A total of 62% of OTs took patient consent for treatment. 59% were supervised through a written prescription with no direct supervision. OTs were directly supervised for only a quarter of their clinical practice. Orthodontists viewing frequency for OTs varied significantly, and was found to be the following: every 2-4 visits (36%), every other visit (35%), and every visit (26%). OTs mostly carried out the scope of practice as permitted by the GDC. Procedures uncommon to routine orthodontic practice were also uncommon to Orthodontic therapist clinical practice. OTs work mostly through written prescription with no direct supervision.

The costs of care in general practice: patients compared by the council tax valuation band of their home address.

PubMed

Beale, Norman; Hollinghurst, Sandra; Taylor, Gordon; Gwynne, Mark; Peart, Carole; Straker-Cook, Dawn

2005-06-01

It is difficult to measure and compare workload in UK general practice. A GP/health economist team recently proposed a means of calculating the unit cost of a GP consulting. It is therefore now possible to extrapolate to the costs of other clinical tasks in a practice and then to compare the workloads of caring for different patients and compare between practices. The study aims were: (i) to estimate the relative costs of daily clinical activities within a practice (implying workload); and (ii) to compare the costs of caring for different types of patients categorized by gender, by age, and by socio-economic status as marked by the Council Tax Valuation Band (CTVB) of home address. The study design was a cross-sectional cost comparison of all clinical activity aggregated, by patient, over one year in an English semi-rural general practice. The subjects were 3339 practice patients, randomly selected. The main outcome measures were costs per clinical domain and overall costs per patient per year; both then compared by gender, age group and by CTVB. CTVB is as significant a predictor of patient care cost (workload) as is patient gender and age (both already known). It is now possible to estimate the cost of care of different patients in such a way that NHS planning and especially resource allocation to practices could be improved.

Qualitative evaluation of an educational intervention to reduce medicolegal risks for medical doctors experiencing significantly more cases than their peers in the UK and Ireland

PubMed Central

Jolly, John; Bowie, Paul; Price, Julie; Mason, Matt; Dinwoodie, Mark

2018-01-01

Objectives The Medical Protection Society (MPS) is a leading protection organisation for healthcare professionals worldwide. In the UK and Ireland, a small minority of MPS members experience significantly more medicolegal cases than their peers and are invited to participate in a risk education (RE) remediation process. To understand more about this educational intervention, we sought to explore participating doctors’ views of their experiences of this process and identify self-reported performance improvements and what elements of the intervention could be improved. Design Qualitative semistructured telephone interviews with a convenience sample of doctors with significantly more medicolegal cases than their peers identified by MPS. Setting UK and Ireland MPS members. Participants A convenience sample of 20 general medical practitioners and hospital specialists from a total of 79 who completed the RE process (25.3% response rate), with a particular focus on the Member Risk Review programme, between November 2013 and October 2015. Results 19 participants were male and 16 were based in general medical (office) practice. Three key themes were generated: personal and professional impacts and actions (eg, member has taken action to reduce clinical workload); comprehension and validity of RE interventions (eg, risks were related to wider patient management); and feedback and proposals (eg, the supportive nature of the educational interventions should be clear from the start). A number of recommendations were made by participants to improve the RE process and enhance the educational experience. Conclusions The RE process was largely valued by participants with many reporting that participation led to some positive professional behaviour changes and improvements in practice processes and personal well-being. PMID:29678988

An observational descriptive study of the epidemiology and treatment of neuropathic pain in a UK general population

PubMed Central

2013-01-01

Background This study updated our knowledge of UK primary care neuropathic pain incidence rates and prescribing practices. Methods Patients with a first diagnosis of post-herpetic neuralgia (PHN), painful diabetic neuropathy (PDN) or phantom limb pain (PLP) were identified from the General Practice Research Database (2006 – 2010) and incidence rates were calculated. Prescription records were searched for pain treatments from diagnosis of these conditions and the duration and daily dose estimated for first-line and subsequent treatment regimens. Recording of neuropathic back and post-operative pain was investigated. Results The study included 5,920 patients with PHN, 5,340 with PDN, and 185 with PLP. The incidence per 10,000 person-years was 3.4 (95% CI 3.4, 3.5) for PHN; and 0.11 (95% CI 0.09, 0.12) for PLP. Validation of the PDN case definition suggested that was not sensitive. Incident PHN increased over the study period. The most common first-line treatments were amitriptyline or gabapentin in the PDN and PLP cohorts, and amitriptyline or co-codamol (codeine-paracetamol) in PHN. Paracetamol, co-dydramol (paracetamol-dihydrocodeine) and capsaicin were also often prescribed in one or more condition. Most first-line treatments comprised only one therapeutic class. Use of antiepileptics licensed for neuropathic pain treatment had increased since 2002–2005. Amitriptyline was the only antidepressant prescribed commonly as a first-line treatment. Conclusion The UK incidence of diagnosed PHN has increased with the incidence of back-pain and post-operative pain unclear. While use of licenced antiepileptics increased, prescribing of therapy with little evidence of efficacy in neuropathic pain is still common and consequently treatment was often not in-line with current guidance. PMID:23442783

An observational descriptive study of the epidemiology and treatment of neuropathic pain in a UK general population.

PubMed

Hall, Gillian C; Morant, Steve V; Carroll, Dawn; Gabriel, Zahava L; McQuay, Henry J

2013-02-26

This study updated our knowledge of UK primary care neuropathic pain incidence rates and prescribing practices. Patients with a first diagnosis of post-herpetic neuralgia (PHN), painful diabetic neuropathy (PDN) or phantom limb pain (PLP) were identified from the General Practice Research Database (2006 - 2010) and incidence rates were calculated. Prescription records were searched for pain treatments from diagnosis of these conditions and the duration and daily dose estimated for first-line and subsequent treatment regimens. Recording of neuropathic back and post-operative pain was investigated. The study included 5,920 patients with PHN, 5,340 with PDN, and 185 with PLP. The incidence per 10,000 person-years was 3.4 (95% CI 3.4, 3.5) for PHN; and 0.11 (95% CI 0.09, 0.12) for PLP. Validation of the PDN case definition suggested that was not sensitive. Incident PHN increased over the study period. The most common first-line treatments were amitriptyline or gabapentin in the PDN and PLP cohorts, and amitriptyline or co-codamol (codeine-paracetamol) in PHN. Paracetamol, co-dydramol (paracetamol-dihydrocodeine) and capsaicin were also often prescribed in one or more condition. Most first-line treatments comprised only one therapeutic class. Use of antiepileptics licensed for neuropathic pain treatment had increased since 2002-2005. Amitriptyline was the only antidepressant prescribed commonly as a first-line treatment. The UK incidence of diagnosed PHN has increased with the incidence of back-pain and post-operative pain unclear. While use of licensed antiepileptics increased, prescribing of therapy with little evidence of efficacy in neuropathic pain is still common and consequently treatment was often not in-line with current guidance.

Statin use is associated with reduced risk of histologic subtypes of esophageal cancer: a nested case-control analysis.

PubMed

Alexandre, Leo; Clark, Allan B; Bhutta, Hina Y; Holt, Sean; Lewis, Michael P N; Hart, Andrew R

2014-03-01

Most patients with esophageal adenocarcinoma (EAC) or squamous cell cancer (ESCC) present with advanced, incurable disease. Statins have reported anti-carcinogenic effects and may be chemoprotective. We investigated the association between regular use of statins and the main histologic subtypes of esophageal malignancy (EAC, esophagogastric junctional adenocarcinoma, and ESCC) in the UK general population. We identified all individuals in the UK General Practice Research Database diagnosed with esophageal cancer from 2000 through 2009. Patients were linked to the National Cancer Registry to confirm histologic subtypes. Each patient was matched with up to 4 controls for age, sex, and practice. We performed a nested case-control analysis using conditional logistic regression to estimate the risk of each subtype with regular statin use, adjusted for body mass index, smoking, alcohol intake, and concomitant use of medications. In total, 581 participants with EAC, 213 with esophagogastric junctional adenocarcinoma, and 332 with ESCC were matched to 2167, 783, and 1242 controls, respectively. Regular statin use was inversely associated with development of EAC (odds ratio = 0.58; 95% confidence interval: 0.39-0.87) (with significant dose and duration responses) and esophagogastric junctional adenocarcinoma (odds ratio = 0.29; 95% confidence interval: 0.09-0.92) (with high-dose use only). Statin use for 1-4 years was inversely associated with ESCC (odds ratio = 0.51; 95% confidence interval: 0.27-0.98). In a nested case-control analysis of a UK population-based cohort, statin use was inversely associated with histologic subtypes of esophageal cancer. Randomized controlled trials are warranted to determine whether statins have chemopreventive effects in high-risk groups. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

Why is the General Ophthalmic Services (GOS) Contract that underpins primary eye care in the U.K. contrary to the public health interest?

PubMed

Shickle, D; Davey, C J; Slade, S V

2015-07-01

The model for delivery of primary eye care in Europe varies from country to country with differing reliance on ophthalmologists, optometrists and dispensing opticians. Comparative analysis of models has tended to focus on interprofessional working arrangements, training and regulatory issues, rather than on whether a particular model is effective for delivering public health goals for that country. National Health Service (NHS) primary eye care services in the UK are predominantly provided under a General Ophthalmic Services (GOS) Contract between the NHS and practice owners (Contractors). Over two-thirds of sight tests conducted in England, Wales and Northern Ireland and all in Scotland are performed under a GOS Contract, however many people entitled to a GOS sight test do not take up their entitlement. The fee paid for sight tests conducted under a GOS Contract in England, Wales and Northern Ireland does not cover the full cost of conducting the examination. The shortfall must be made up through profits of sale of optical appliances but this business model can be a deterrent to establishing practices within socioeconomically deprived communities, and can also be a barrier to uptake of sight tests, even though many people are entitled to a NHS optical voucher towards the cost of spectacles or contact lenses. This paper critiques the GOS Contracts within the UK. We argue that aspects of the way the GOS Contract is implemented are contrary to the public health interest and that different approaches are needed to address eye health inequalities and to reduce preventable sight loss. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Applying animal-based welfare assessments on New Zealand dairy farms: feasibility and a comparison with United Kingdom data.

PubMed

Laven, R A; Fabian, J

2016-07-01

To assess the feasibility of applying animal-based welfare assessments developed for use in Europe on New Zealand dairy farms; in particular, to identify measures which could be evaluated during a single visit at milking time alongside whole herd locomotion scoring. A protocol for animal welfare assessment, developed in the United Kingdom (UK), was evaluated. Measures that were suitable for use on pasture-based dairy farms in New Zealand were then assessed for practicability on 59 farms across New Zealand, during and immediately after milking, alongside whole herd locomotion scoring. Where data were collected the results were compared to those from a UK study of 53 dairy farms. Thirteen observations of the physical condition of cows were considered suitable for measurement, excluding observations related to hock lesions as they are rarely observed on pasture-based farms. Five of these measures were not assessed as there was not time to do so during milking alongside whole herd locomotion scoring. Thus, the prevalence of dirty flanks, hind limbs and udders, dull coat, thick hairy coat, significant hair loss, very fat cows (body condition score (BCS) ≥7 on 1-10 scale) and very thin cows (BCS≤3), were recorded. Three measures of behaviour were considered suitable for measurement on-farm, but only locomotion score was practicable and was measured. Farmer-estimates for the incidence of mastitis, lameness, sudden death, milk fever and other diseases were also obtained.Overall, dirty flanks, dirty udders and estimated milk fever incidence were more prevalent in this study than in the UK. The prevalence of thin and fat cows, lame cows and estimated mastitis incidence were much lower in the present study than on UK farms. Animal-based assessments can be used on dairy farms in New Zealand, but need to be modified from those developed for housed cows.Welfare on these farms was generally good compared to those in the UK, but these results need to be confirmed on more farms using a wider range of assessments than proved practicable in this study.

Creating an Inclusive Society… How Close are We in Relation to Autism Spectrum Disorder? A General Population Survey.

PubMed

Dillenburger, Karola; McKerr, Lyn; Jordan, Julie Ann; Devine, Paula; Keenan, Mickey

2015-07-01

Children with autism spectrum disorder are increasingly educated in mainstream classrooms in the United Kingdom (Wilkinson & Twist, Autism and Educational Assessment: UK Policy and Practice. NFER, Slough, 2010), and some employers are now specifically seeking out staff on the autism spectrum. Does that mean that we are living in an 'inclusive society' [United Nations Department of Economic and Social Affairs (UNDESA), Creating an Inclusive Society: Practical Strategies to Promote Social Integration 2008], in the sense that inequalities are reduced and full economic, social and cultural participation is advanced for individuals with autism? A general population survey was conducted to assess how close we, as a society, are to an inclusive society for individuals with autism in Northern Ireland. Public attitudes were examined to (i) visibility and social interaction, (ii) aetiology, needs and interventions, and (iii) rights and resources. A stratified, representative sample of 1204 adults took part in the survey; of these, 989 were aware of autism and their attitudes and behavioural projections reflected a mix of acceptance and denunciation. The level of confusion with regard to interventions reflected the general uncertainty within UK policy regarding meeting the needs of individuals on the autism spectrum (International Journal of Disability, Development and Education 61, 134, 2014a). Therefore, it seems that inclusion is working to an extent, but more clarity is needed with regard to adequate education, intervention and support for individuals with autism. © 2015 John Wiley & Sons Ltd.

UK Parents' Beliefs about Applied Behaviour Analysis as an Approach to Autism Education

ERIC Educational Resources Information Center

Denne, Louise D.; Hastings, Richard P.; Hughes, J. Carl

2017-01-01

Research into factors underlying the dissemination of evidence-based practice is limited within the field of Applied Behaviour Analysis (ABA). This is pertinent, particularly in the UK where national policies and guidelines do not reflect the emerging ABA evidence base, or policies and practices elsewhere. Theories of evidence-based practice in…

Delivering Communication Strategy Training for People with Aphasia: What Is Current Clinical Practice?

ERIC Educational Resources Information Center

Beckley, Firle; Best, Wendy; Beeke, Suzanne

2017-01-01

Background: Communication strategy training (CST) is a recognized part of UK speech and language therapists' (SLTs) role when working with a person with aphasia. Multiple CST interventions have been published but, to date, there are no published studies exploring clinical practice in this area. Aims: To investigate UK SLTs' current CST practices.…

Clinical roles in clinical biochemistry: a national survey of practice in the UK.

PubMed

Choudhury, Sirazum M; Williams, Emma L; Barnes, Sophie C; Alaghband-Zadeh, Jamshid; Tan, Tricia M; Cegla, Jaimini

2017-05-01

Background Using an online survey, we collected data to present a picture of how clinical authorization is performed in the UK. Methods A 21-question survey was uploaded to www.surveymonkey.com , and responses were invited via the mail base of the Association for Clinical Biochemistry and Laboratory Medicine. The questionnaire examined the intensity and function of the duty biochemist role and how different types of authorization are used to handle and release results. Results Of 70 responses received, 60 were suitable for analysis. Responses were received from every region of the UK. A typical duty biochemist shift started on average at 8:50, and finished at 17:25. The mean duration was 8 h 58 min. Clinical scientists are the most abundantly represented group on duty biochemist rotas. Higher banded clinical scientists and chemical pathologists covered out-of-hours shifts. Results were handled differently depending on the level of abnormality and the requesting area. Normal results tended to be released either directly from the analyser or after technical then autoauthorization (90%). A greater preference for clinical authorization was seen for abnormal and critical results originating from outpatients (49% and 69%, respectively) or general practice (51% and 71%) than for inpatients (33% and 53%) or A&E (25% and 37%). Conclusions The handling and authorization of biochemistry results varies greatly between laboratories. The role is clearly heterogeneous in the UK. Guidance from the Association for Clinical Biochemistry and Royal College of Pathologists may help to clarify the essential roles of the duty biochemist.

Advance care planning for cancer patients in primary care: a feasibility study

PubMed Central

Boyd, Kirsty; Mason, Bruce; Kendall, Marilyn; Barclay, Stephen; Chinn, David; Thomas, Keri; Sheikh, Aziz; Murray, Scott A

2010-01-01

Background Advance care planning is being promoted as a central component of end-of-life policies in many developed countries, but there is concern that professionals find its implementation challenging. Aim To assess the feasibility of implementing advance care planning in UK primary care. Design of study Mixed methods evaluation of a pilot educational intervention. Setting Four general practices in south-east Scotland. Method Interviews with 20 GPs and eight community nurses before and after a practice-based workshop; this was followed by telephone interviews with nine other GPs with a special interest in palliative care from across the UK. Results End-of-life care planning for patients typically starts as an urgent response to clear evidence of a short prognosis, and aims to achieve a ‘good death’. Findings suggest that there were multiple barriers to earlier planning: prognostic uncertainty; limited collaboration with secondary care; a desire to maintain hope; and resistance to any kind of ‘tick-box’ approach. Following the workshop, participants' knowledge and skills were enhanced but there was little evidence of more proactive planning. GPs from other parts of the UK described confusion over terminology and were concerned about the difficulties of implementing inflexible, policy-driven care. Conclusion A clear divide was found between UK policy directives and delivery of end-of-life care in the community that educational interventions targeting primary care professionals are unlikely to address. Advance care planning has the potential to promote autonomy and shared decision making about end-of-life care, but this will require a significant shift in attitudes. PMID:21144189

Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice.

PubMed

Apekey, Tanefa A; McSorley, Gerry; Tilling, Michelle; Siriwardena, A Niroshan

2011-04-01

Leadership and innovation are currently seen as essential elements for the development and maintenance of high-quality care. Little is known about the relationship between leadership and culture of innovation and the extent to which quality improvement methods are used in general practice. This study aimed to assess the relationship between leadership behaviour, culture of innovation and adoption of quality improvement methods in general practice. Self-administered postal questionnaires were sent to general practitioner quality improvement leads in one county in the UK between June and December 2007. The questionnaire consisted of background information, a 12-item scale to assess leadership behaviour, a seven-dimension self-rating scale for culture of innovation and questions on current use of quality improvement tools and techniques. Sixty-three completed questionnaires (62%) were returned. Leadership behaviours were not commonly reported. Most practices reported a positive culture of innovation, featuring relationship most strongly, followed by targets and information but rated lower on other dimensions of rewards, risk and resources. There was a significant positive correlation between leadership behaviour and the culture of innovation (r = 0.57; P < 0.001). Apart from clinical audit and significant event analysis, quality improvement methods were not adopted by most participating practices. Leadership behaviours were infrequently reported and this was associated with a limited culture of innovation in participating general practices. There was little use of quality improvement methods beyond clinical and significant event audit. Practices need support to enhance leadership skills, encourage innovation and develop quality improvement skills if improvements in health care are to accelerate. © 2010 Blackwell Publishing Ltd.

Economic influences on GPs' decisions to provide out-of-hours care.

PubMed

Geue, Claudia; Skåtun, Diane; Sutton, Matt

2009-01-01

Introduction of the new general medical services contract offered UK general practices the option to discontinue providing out-of-hours (OOH) care. This aimed to improve GP recruitment and retention by offering a better work-life balance, but put primary care organisations under pressure to ensure sustainable delivery of these services. Many organisations arranged this by re-purchasing provision from individual GPs. To analyse which factors influence an individual GP's decision to re-provide OOH care when their practice has opted out. Cross-sectional questionnaire survey. Rural and urban general practices in Scotland, UK. A postal survey was sent to all GPs working in Scotland in 2006, with analyses weighted for differential response rates. Analysis included logistic regression of individuals' decisions to re-provide OOH care based on personal characteristics, work and non-work time commitments, income from other sources, and contracting primary care organisation. Of the 1707 GPs in Scotland whose practice had opted out, 40.6% participated in OOH provision. Participation rates of GPs within primary care organisations varied from 16.7% to 74.7%. Males with young children were substantially more likely to participate than males without children (odds ratio [OR] 2.44, 95% confidence interval [CI] = 1.36 to 4.40). GPs with higher-earning spouses were less likely to participate. This effect was reinforced if GPs had spouses who were also GPs (OR 0.52, 95% CI = 0.37 to 0.74). GPs with training responsibilities (OR 1.36, 95% CI = 1.09 to 1.71) and other medical posts (OR 1.38, 95% CI = 1.09 to 1.75) were more likely to re-provide OOH services. The opportunity to opt out of OOH care has provided flexibility for GPs to raise additional income, although primary care organisations vary in the extent to which they offer these opportunities. Examining intrinsic motivation is an area for future study.

Practice nursing in Australia: A review of education and career pathways

PubMed Central

Parker, Rhian M; Keleher, Helen M; Francis, Karen; Abdulwadud, Omar

2009-01-01

Background Nurses in Australia are often not educated in their pre registration years to meet the needs of primary care. Careers in primary care may not be as attractive to nursing graduates as high-tech settings such as intensive or acute care. Yet, it is in primary care that increasingly complex health problems are managed. The Australian government has invested in incentives for general practices to employ practice nurses. However, no policy framework has been developed for practice nursing to support career development and post-registration education and training programs are developed in an ad hoc manner and are not underpinned by core professional competencies. This paper reports on a systematic review undertaken to establish the available evidence on education models and career pathways with a view to enhancing recruitment and retention of practice nurses in primary care in Australia. Methods Search terms describing education models, career pathways and policy associated with primary care (practice) nursing were established. These search terms were used to search electronic databases. The search strategy identified 1394 citations of which 408 addressed one or more of the key search terms on policy, education and career pathways. Grey literature from the UK and New Zealand internet sites were sourced and examined. The UK and New Zealand Internet sites were selected because they have well established and advanced developments in education and career pathways for practice nurses. Two reviewers examined titles, abstracts and studies, based on inclusion and exclusion criteria. Disagreement between the reviewers was resolved by consensus or by a third reviewer. Results Significant advances have been made in New Zealand and the UK towards strengthening frameworks for primary care nursing education and career pathways. However, in Australia there is no policy at national level prepare nurses to work in primary care sector and no framework for education or career pathways for nurses working in that sector. Conclusion There is a need for national training standards and a process of accreditation for practice nursing in Australia to support the development of a responsive and sustainable nursing workforce in primary care and to provide quality education and career pathways. PMID:19473493

Practice nursing in Australia: A review of education and career pathways.

PubMed

Parker, Rhian M; Keleher, Helen M; Francis, Karen; Abdulwadud, Omar

2009-05-27

Nurses in Australia are often not educated in their pre registration years to meet the needs of primary care. Careers in primary care may not be as attractive to nursing graduates as high-tech settings such as intensive or acute care. Yet, it is in primary care that increasingly complex health problems are managed. The Australian government has invested in incentives for general practices to employ practice nurses. However, no policy framework has been developed for practice nursing to support career development and post-registration education and training programs are developed in an ad hoc manner and are not underpinned by core professional competencies. This paper reports on a systematic review undertaken to establish the available evidence on education models and career pathways with a view to enhancing recruitment and retention of practice nurses in primary care in Australia. Search terms describing education models, career pathways and policy associated with primary care (practice) nursing were established. These search terms were used to search electronic databases. The search strategy identified 1394 citations of which 408 addressed one or more of the key search terms on policy, education and career pathways. Grey literature from the UK and New Zealand internet sites were sourced and examined. The UK and New Zealand Internet sites were selected because they have well established and advanced developments in education and career pathways for practice nurses.Two reviewers examined titles, abstracts and studies, based on inclusion and exclusion criteria. Disagreement between the reviewers was resolved by consensus or by a third reviewer. Significant advances have been made in New Zealand and the UK towards strengthening frameworks for primary care nursing education and career pathways. However, in Australia there is no policy at national level prepare nurses to work in primary care sector and no framework for education or career pathways for nurses working in that sector. There is a need for national training standards and a process of accreditation for practice nursing in Australia to support the development of a responsive and sustainable nursing workforce in primary care and to provide quality education and career pathways.

Universal coverage and cost control: the United Kingdom National Health Service.

PubMed

Maynard, A; Bloor, K

1998-01-01

The UK NHS has a number of important strengths. Its costs are relatively low compared to the health care systems of other developed countries due in part to cash limited central budgeting. It is extremely popular with the electorate and surveys show overall satisfaction with the NHS despite some dissatisfaction with waiting lists and a public perception of underfunding. The NHS model of general medical care provided by independent contractors has been acclaimed as "a British success" (General Medical Services Council, 1983). The role of the UK GP combines providing primary care and acting as a gatekeeper to secondary care. This increases equitable access to care for the population and assists in cost containment. As a model, it is currently being emulated in other countries including Sweden and US Health Maintenance Organizations but, as in these countries, the UK primary care model has been evaluated poorly. There are of course continuing weaknesses in the UK health care system. There is insufficient knowledge upon which to base health care services and increase efficiency. In the future, if a knowledge-based health care service is to be created, a considerable amount of research and evaluation is required to identify "what works" in health care (i.e., what is effective) and also the cost effective ways of altering provider behaviour to maximise the amount of health gain which can be achieved using a limited budget. The NHS reforms created a lot of enthusiasm and energy but its effects are difficult to disentangle from the simultaneous increases in funding. There is little evidence from the UK or elsewhere that competition in health care produces efficiency or improvements in resource allocation. Evaluation is required to identify which of the reforms are increasing efficiency. Competition needs to be used with caution and recognised as a mean and not an end in itself. It is remarkable how both clinical practice and health policy reform, in the UK and elsewhere, is poorly evaluated. Medical practice varies substantially locally, regionally, and internationally, e.g., patients with similar age and stage of cancer receive very different levels of radiotherapy across Europe. For most interventions, the appropriate level of treatment may be asserted but is not based on cost effectiveness knowledge. Health policy analysts, like clinicians, make assertions about competition and other health care reforms which are value- rather than knowledge-based. Both groups of decision-makers should be more cautious, informing their choices with research rather than relying on unsubstantiated optimism!

Changing hearts and minds: examining student nurses' experiences and perceptions of a general practice placement through a 'community of practice' lens.

PubMed

Lewis, Robin; Kelly, Shona

2018-04-05

The recent UK Government paper 'Five year forward view' describes the need to move much patient management from secondary to primary care, and this will require a significant increase in the numbers of General Practice Nurses (GPNs). Until recently, there has been no clear recruitment strategy to address this. There have however been a number of proposed solutions to address the impending GPN recruitment crisis and to increase the numbers of new GPNs in post. General Practitioners (GPs) working in the Advanced Training Practice Scheme (ATPS) have been commissioned by Health Education England to provide placements for student nurses. This paper reports upon the findings of a study evaluating the South Yorkshire ATPS network in relation to nursing students' perceptions of general practice as a placement and a potential career option post-graduation. Data were collected using semi-structured interviews with 18 nursing students. Qualitative data analysis used a framework approach and themes were cross-checked within the team. The research had ethical approval and anonymity and confidentiality were maintained throughout. Using the Communities of Practice (CoP) framework as a theoretical lens, two main themes emerged from the data: 'Myths and misunderstandings' outlined some of the misconceptions that abounded in the absence of an established CoP in general practice. These included perceptions of what constitutes a 'good' placement, an apparent lack of relevant content in the curriculum, and the widespread use of social media by students as a means of information gathering. 'Changing hearts and minds' referred to the need to positively influence the culture within general practice by addressing some of the longstanding myths. Through the fledgling CoP, the students' perceptions of the GPN role in particular were positively revised, as was the prospect of a career in general practice upon graduation. The CoP that is emerging through the ATPS placements appear to be gradually changing the socio-cultural landscape within general practice by enabling student nurses to experience the reality of life in general practice nursing, and to view the GPN role as a viable career option upon graduation.

A cross sectional study of surgical training among United Kingdom general practitioners with specialist interests in surgery.

PubMed

Ferguson, H J M; Fitzgerald, J E F; Reilly, J; Beamish, A J; Gokani, V J

2015-04-08

Increasing numbers of minor surgical procedures are being performed in the community. In the UK, general practitioners (family medicine physicians) with a specialist interest (GPwSI) in surgery frequently undertake them. This shift has caused decreases in available cases for junior surgeons to gain and consolidate operative skills. This study evaluated GPwSI's case-load, procedural training and perceptions of offering formalised operative training experience to surgical trainees. Prospective, questionnaire-based cross-sectional study. A novel, 13-item, self-administered questionnaire was distributed to members of the Association of Surgeons in Primary Care (ASPC). A total 113 of 120 ASPC members completed the questionnaire, representing a 94% response rate. Respondents were general practitioners practising or intending to practice surgery in the community. Respondents performed a mean of 38 (range 5-150) surgical procedures per month in primary care. 37% (42/113) of respondents had previously been awarded Membership or Fellowship of a Surgical Royal College; 22% (25/113) had completed a surgical certificate or diploma or undertaken a course of less than 1 year duration. 41% (46/113) had no formal British surgical qualifications. All respondents believed that surgical training in primary care could be valuable for surgical trainees, and the majority (71/113, 63%) felt that both general practice and surgical trainees could benefit equally from such training. There is a significant volume of surgical procedures being undertaken in the community by general practitioners, with the capacity and appetite for training of prospective surgeons in this setting, providing appropriate standards are achieved and maintained, commensurate with current standards in secondary care. Surgical experience and training of GPwSI's in surgery is highly varied, and does not yet benefit from the quality assurance secondary care surgical training in the UK undergoes. The Royal Colleges of Surgery and General Practice are well placed to invest in such infrastructure to provide long-term, high-quality service and training in the community. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Digital communication between clinician and patient and the impact on marginalised groups: a realist review in general practice.

PubMed

Huxley, Caroline J; Atherton, Helen; Watkins, Jocelyn Anstey; Griffiths, Frances

2015-12-01

Increasingly, the NHS is embracing the use of digital communication technology for communication between clinicians and patients. Policymakers deem digital clinical communication as presenting a solution to the capacity issues currently faced by general practice. There is some concern that these technologies may exacerbate existing inequalities in accessing health care. It is not known what impact they may have on groups who are already marginalised in their ability to access general practice. To assess the potential impact of the availability of digital clinician-patient communication on marginalised groups' access to general practice in the UK. Realist review in general practice. A four-step realist review process was used: to define the scope of the review; to search for and scrutinise evidence; to extract and synthesise evidence; and to develop a narrative, including hypotheses. Digital communication has the potential to overcome the following barriers for marginalised groups: practical access issues, previous negative experiences with healthcare service/staff, and stigmatising reactions from staff and other patients. It may reduce patient-related barriers by offering anonymity and offers advantages to patients who require an interpreter. It does not impact on inability to communicate with healthcare professionals or on a lack of candidacy. It is likely to work best in the context of a pre-existing clinician-patient relationship. Digital communication technology offers increased opportunities for marginalised groups to access health care. However, it cannot remove all barriers to care for these groups. It is likely that they will remain disadvantaged relative to other population groups after their introduction. © British Journal of General Practice 2015.

Why do GPs leave direct patient care and what might help to retain them? A qualitative study of GPs in South West England

PubMed Central

Sansom, Anna; Terry, Rohini; Fletcher, Emily; Salisbury, Chris; Long, Linda; Richards, Suzanne H; Aylward, Alex; Welsman, Jo; Sims, Laura; Campbell, John L; Dean, Sarah G

2018-01-01

Objective To identify factors influencing general practitioners’ (GPs’) decisions about whether or not to remain in direct patient care in general practice and what might help to retain them in that role. Design Qualitative, in-depth, individual interviews exploring factors related to GPs leaving, remaining in and returning to direct patient care. Setting South West England, UK. Participants 41 GPs: 7 retired; 8 intending to take early retirement; 11 who were on or intending to take a career break; 9 aged under 50 years who had left or were intending to leave direct patient care and 6 who were not intending to leave or to take a career break. Plus 19 stakeholders from a range of primary care-related professional organisations and roles. Results Reasons for leaving direct patient care were complex and based on a range of job-related and individual factors. Three key themes underpinned the interviewed GPs’ thinking and rationale: issues relating to their personal and professional identity and the perceived value of general practice-based care within the healthcare system; concerns regarding fear and risk, for example, in respect of medical litigation and managing administrative challenges within the context of increasingly complex care pathways and environments; and issues around choice and volition in respect of personal social, financial, domestic and professional considerations. These themes provide increased understanding of the lived experiences of working in today’s National Health Service for this group of GPs. Conclusion Future policies and strategies aimed at retaining GPs in direct patient care should clarify the role and expectations of general practice and align with GPs’ perception of their own roles and identity; demonstrate to GPs that they are valued and listened to in planning delivery of the UK healthcare; target GPs’ concerns regarding fear and risk, seeking to reduce these to manageable levels and give GPs viable options to support them to remain in direct patient care. PMID:29326195

Factors influencing career intentions on completion of general practice vocational training in England: a cross-sectional study

PubMed Central

Russell, Rachel; Scott, Emma; Owen, Katherine

2017-01-01

Objectives General practice is experiencing a growing crisis with the numbers of doctors who are training and then entering the profession in the UK failing to keep pace with workforce needs. This study investigated the immediate to medium term career intentions of those who are about to become general practitioners (GPs) and the factors that are influencing career plans. Design Online questionnaire survey, with quantitative answers analysed using descriptive statistics and free text data analysed using a thematic framework approach. Setting and participants Doctors approaching the end of 3-year GP vocational training in the West Midlands, England. Results 178 (57.2%) doctors completed the survey. Most participants planned to work as salaried GPs or locums rather than entering a general practice partnership for at least the first 5 years post-completion of training; others failed to express a career plan or planned to leave general practice completely or work overseas. Many were interested in developing portfolio careers. The quality of general practice experience across undergraduate, foundation and vocational training were reported as influencing personal career plans, and in particular perceptions about workload pressure and morale within the training practices in which they had been placed. Experience of a poor work–life balance as a trainee had a negative effect on career intentions, as did negative perceptions about how general practice is portrayed by politicians and the media. Conclusion This study describes a number of potentially modifiable factors related to training programmes that are detrimentally influencing the career plans of newly trained GPs. In addition, there are sociodemographic factors, such as age, gender and having children, which are also influencing career plans and so need to be accommodated. With ever-increasing workload in general practice, there is an urgent need to understand and where possible address these issues at national and local level. PMID:28819069

Factors influencing career intentions on completion of general practice vocational training in England: a cross-sectional study.

PubMed

Dale, Jeremy; Russell, Rachel; Scott, Emma; Owen, Katherine

2017-08-17

General practice is experiencing a growing crisis with the numbers of doctors who are training and then entering the profession in the UK failing to keep pace with workforce needs. This study investigated the immediate to medium term career intentions of those who are about to become general practitioners (GPs) and the factors that are influencing career plans. Online questionnaire survey, with quantitative answers analysed using descriptive statistics and free text data analysed using a thematic framework approach. Doctors approaching the end of 3-year GP vocational training in the West Midlands, England. 178 (57.2%) doctors completed the survey. Most participants planned to work as salaried GPs or locums rather than entering a general practice partnership for at least the first 5 years post-completion of training; others failed to express a career plan or planned to leave general practice completely or work overseas. Many were interested in developing portfolio careers.The quality of general practice experience across undergraduate, foundation and vocational training were reported as influencing personal career plans, and in particular perceptions about workload pressure and morale within the training practices in which they had been placed. Experience of a poor work-life balance as a trainee had a negative effect on career intentions, as did negative perceptions about how general practice is portrayed by politicians and the media. This study describes a number of potentially modifiable factors related to training programmes that are detrimentally influencing the career plans of newly trained GPs. In addition, there are sociodemographic factors, such as age, gender and having children, which are also influencing career plans and so need to be accommodated. With ever-increasing workload in general practice, there is an urgent need to understand and where possible address these issues at national and local level. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A nurse-led clinic for patients consulting with osteoarthritis in general practice: development and impact of training in a cluster randomised controlled trial.

PubMed

Healey, Emma L; Main, Chris J; Ryan, Sarah; McHugh, Gretl A; Porcheret, Mark; Finney, Andrew G; Morden, Andrew; Dziedzic, Krysia S

2016-12-21

Despite a lack of service provision for people with osteoarthritis (OA), each year 1 in 5 of the general population consults a GP about a musculoskeletal condition such as OA. Consequently this may provide an opportunity for practice nurses to take an active role in helping patients manage their condition. A nurse led clinic for supporting patients with OA was developed for the MOSAICS study investigating how to implement the NICE 2014 OA Guideline core recommendations. This paper has two main objectives, firstly to provide an overview of the nurse-led OA clinic, and secondly to describe the development, key learning objectives, content and impact of the training to support its delivery. A training programme was developed and delivered to provide practice nurses with the knowledge and skill set needed to run the nurse-led OA clinic. The impact of the training programme on knowledge, confidence and OA management was evaluated using case report forms and pre and post training questionnaires. The pre-training questionnaire identified a gap between what practice nurses feel they can do and what they should be doing in line with NICE OA guidelines. Evaluation of the training suggests that it enabled practice nurses to feel more knowledgeable and confident in supporting patients to manage their OA and this was reflected in the clinical management patients received in the nurse-led OA clinics. A significant gap between what is recommended and what practice nurses feel they can currently provide in terms of OA management was evident. The development of a nurse training programme goes some way to develop a system in primary care for delivering the core recommendations by NICE. The cluster trial linked to this training was conducted from May 2012 through February 2014 by the Arthritis Research UK Primary Care Centre, Keele University, UK (Trial registration number ISRCTN06984617 ).

Recent migrants' perspectives on antibiotic use and prescribing in primary care: a qualitative study.

PubMed

Lindenmeyer, Antje; Redwood, Sabi; Griffith, Laura; Ahmed, Shazia; Phillimore, Jenny

2016-11-01

Currently there is great interest in antibiotic prescribing practices in the UK, but little is known about the experiences of the increasing numbers of recent migrants (those present in the UK for >1 year but <5 years) registered at GP practices. Qualitative research has suggested that reasons for not prescribing antibiotics may not be clearly communicated to migrants. This study aimed to explore the factors that shape migrants' experiences of and attitudes to antibiotics, and to suggest ways to improve effective communication around their use. A qualitative study on recent migrants' health beliefs, values, and experiences in a community setting in primary care. Twenty-three recent migrants were interviewed in their preferred language by trained community researchers. The research team conducted a thematic analysis, focusing on health beliefs, engaging with health services, transnational medicine, and concepts of fairness. Experiences around antibiotics were a strong emerging theme. Three reasons were identified for antibiotics seeking: first, holding an 'infectious model' of illness implying that antibiotics are required quickly to avoid illness becoming worse or spreading to others; second, reasoning that other medications will be less effective for people 'used to' antibiotics'; and third, perceiving antibiotic prescription as a sign of being taken seriously. Some participants obtained antibiotics from their country of origin or migrant networks in the UK; others changed their mind and accepted alternatives. Primary care professionals should aim to understand migrants' perspectives to improve communication with patients. Further research is needed to identify different strategies needed to respond to the varying understandings of antibiotics held by migrants. © British Journal of General Practice 2016.

Learning the law: practical proposals for UK medical education.

PubMed

Margetts, J K

2016-02-01

Ongoing serious breaches in medical professionalism might be avoided if UK doctors rethink their approach to law. UK medical education has a role in creating a climate of change by re-examining how law is taught to medical students. Adopting a more insightful approach in the UK to the impact of The Human Rights Act and learning to manipulate legal concepts, such as conflict of interest, need to be taught to medical students now if UK doctors are to manage complex decision-making in the NHS of the future. The literature is reviewed from a unique personal perspective of a doctor and lawyer, and practical proposals for developing medical education in law in the UK are suggested. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Patients’ expectations of private osteopathic care in the UK: a national survey of patients

PubMed Central

2013-01-01

Background Patients’ expectations of osteopathic care have been little researched. The aim of this study was to quantify the most important expectations of patients in private UK osteopathic practices, and the extent to which those expectations were met or unmet. Methods The study involved development and application of a questionnaire about patients’ expectations of osteopathic care. The questionnaire drew on an extensive review of the literature and the findings of a prior qualitative study involving focus groups exploring the expectations of osteopathic patients. A questionnaire survey of osteopathic patients in the UK was then conducted. Patients were recruited from a random sample of 800 registered osteopaths in private practice across the UK. Patients were asked to complete the questionnaire which asked about 51 aspects of expectation, and post it to the researchers for analysis. The main outcome measures were the patients-perceived level of expectation as assessed by the percentage of positive responses for each aspect of expectation, and unmet expectation as computed from the proportion responding that their expectation “did not happen”. Results 1649 sets of patient data were included in the analysis. Thirty five (69%) of the 51 aspects of expectation were prevalent, with listening, respect and information-giving ranking highest. Only 11 expectations were unmet, the most often unmet were to be made aware that there was a complaints procedure, to find it difficult to pay for osteopathic treatment, and perceiving a lack of communication between the osteopath and their GP. Conclusions The findings reflected the complexity of providing osteopathic care and meeting patients’ expectations. The results provided a generally positive message about private osteopathic practice. The study identified certain gaps between expectations and delivery of care, which can be used to improve the quality of care. The questionnaire is a resource for future research. PMID:23721054

Genetics, lifestyle and environment. UK Biobank is an open access resource following the lives of 500,000 participants to improve the health of future generations.

PubMed

Trehearne, Andrew

2016-03-01

UK Biobank is a long-term prospective epidemiology study having recruited and now following the lives of 500,000 people in England, Scotland and Wales, aged 40-69 years when they joined the study (Sudlow et al., PLoS Med 12(3):e1001779, 2015). Participants were recruited by letter and asked to attend one of 22 assessment centres in towns and cities across Britain, where they provided consent, answered detailed questions about their health and lifestyle, had body measures taken and donated blood, urine and saliva. Participants provided consent for the long-term follow-up of their health via medical records, such as general practice and hospital records, cancer and death records. Samples are being stored long term for a wide range of analyses, including genetic. The resource is open to all bona fide scientists from the UK and overseas, academic and industry who register via its access management system. Summary of UK Biobank data can be viewed via its Data Showcase and the resource will be strengthened over time as the results of new analyses and studies are returned, health links and participants provide additional information about themselves. Some will attend full repeat assessment visits. UK Biobank is open for business, and it hopes researchers will find it a valuable tool to improve the health of future generations.

The ethics of general practice and advertising.

PubMed Central

Colman, R D

1989-01-01

UK general practitioners (GPs) are self-employed entrepreneurs running small businesses with commercial considerations. In this situation there is no clear distinction between information, self-promotion and advertising. In response to the growing public demand for more information about medical services, the medical profession should voluntarily accept the notion of soft self-promotion in the form of 'notices' or 'announcements' placed in newspapers. Newspapers are the most effective way of giving easy access to information. The resistance to newspapers may be more concerned with preserving certain medical traditions than consideration of the public interest. The General Medical Council's (GMC's) arguments against soft self-promotion are seen as misguided paternalism, inconsistent and irrational. PMID:2746609

Nurse prescribing in general practice: a qualitative study of job satisfaction and work-related stress.

PubMed

Cousins, Rosanna; Donnell, Christine

2012-04-01

Studies examining the impact nurse prescribing have largely focused on the efficacy of the service. It was suggested in pro-prescribing policy arguments that extending the nursing role to include prescribing would increase job satisfaction. This assertion has not been fully explored. To investigate the impact of independent prescribing for experienced nurse practitioners (NPs) working in general practice. In-depth interviews were conducted with six NPs who each had at least 3 years experience of independent prescribing in a busy inner city general practice. Analysis of interview data yielded two main themes: as independent prescribers NPs experienced increased levels of both job satisfaction and work-related stress. Increased satisfaction was associated with having greater autonomy and being able to provide more holistic care. Increased work-related stress emerged from greater job demands, perceived insufficient support and perceived effort-reward imbalance that centred upon the enhanced role not being recognized in terms of an increase in grade and pay. Independent prescribing increases job satisfaction for NPs in general practice, but there is also evidence of stressors associated with the role. It is important that NPs in general practice are encouraged and supported towards providing the effective patient-centred care in the community envisaged by current UK government. We acknowledge that the results presented in this paper are based on a sample limited to one city; however, it provides information that has important implications for the well being of NPs and ultimately patient care.

Oncological screening for Bilateral Breast Reduction: a survey of practice variations in UK Breast and Plastics surgeons 2009.

PubMed

Hennedige, Anusha A; Kong, Tze Yean; Gandhi, Ashu

2011-07-01

Bilateral Breast Reduction (BBR) is a common procedure performed by Breast and Plastic surgeons in the UK. No consensus exists regarding preoperative screening for malignancy or for selective criteria for such screening. Preoperative BBR screening practices among UK Breast and Plastic surgeons are unknown. Ascertain the preoperative and postoperative BBR screening practices of UK Breast and Plastic surgeons. A questionnaire was posted to all 434 Breast and 335 Plastic surgeons in the UK. All results were analysed with relevant statistical methods. 64% of Breast surgeons and 72% of Plastic surgeons responded. 40% of Breast surgeons and 91% of Plastic surgeons perform BBR. Routine radiological screening: 92% Breast 41% Plastic (p < 0.05). Routine breast examination prior to BBR: 98% Breast 91% Plastic. Routine histology for BBR specimens: 96% Breast 90% Plastic. Selective screening of patients aged 30-40 years old: Breast 38% Plastic 10%. Selective screening of patients aged 40-50: Breast 78%, Plastic 53%. Selective screening of patients with strong family history of breast cancer: Breast 72%, Plastic 91%. Selective screening of patients with previous breast cancer: Breast 77%, Plastic 93%. There are significant differences in practice between UK Breast surgeons and Plastic surgeons in preoperative oncological screening for BBR. The large discrepancy in preoperative radiological screening, reflects a ubiquitous pro-screening ideology among Breast surgeons not prevalent among Plastic surgeons. These results will provoke debate towards the direction of consensus to ultimately reflect best practice. Copyright © 2010. Published by Elsevier Ltd.

Developing a framework of, and quality indicators for, general practice management in Europe.

PubMed

Engels, Yvonne; Campbell, Stephen; Dautzenberg, Maaike; van den Hombergh, Pieter; Brinkmann, Henrik; Szécsényi, Joachim; Falcoff, Hector; Seuntjens, Luc; Kuenzi, Beat; Grol, Richard

2005-04-01

To develop a framework for general practice management made up of quality indicators shared by six European countries. Two-round postal Delphi questionnaire in the setting of general practice in Belgium, France, Germany, The Netherlands, Switzerland and the United Kingdom. Six national expert panels, each consisting of 10 members, primarily primary care practitioners and experts in the field of quality in primary care participated in the study. The main outcome measures were: (a) a European framework with indicators for the organization of primary care; and (b) ratings of the face validity of the usefulness of the indicators by expert panels in six countries. Agreement was reached about a definition of practice management across five domains (infrastructure, staff, information, finance, and quality and safety), and a common set of indicators for the organization of general practice. The panellist response rate was 95%. Sixty-two indicators (37%) were rated face valid by all six panels. Examples include out of hours service, accessibility, the content of doctors' bags and staff involvement in quality improvement. No indicators were rated invalid by all six panels. It proved to be possible to develop a European set of indicators for assessing the quality of practice management, despite the differences in health care systems and cultures in the six different countries. These indicators will now be used in a quality assessment procedure of practice management in nine European countries. While organizational indicators are part of the new GMS contract in the UK, this research shows that many practice management issues within primary care are also of relevance in other European countries.

Patient-reported quality indicators for osteoarthritis: a patient and public generated self-report measure for primary care.

PubMed

Blackburn, Steven; Higginbottom, Adele; Taylor, Robert; Bird, Jo; Østerås, Nina; Hagen, Kåre Birger; Edwards, John J; Jordan, Kelvin P; Jinks, Clare; Dziedzic, Krysia

2016-01-01

People with osteoarthritis desire high quality care, support and information. However, the quality of care for people with OA in general practice is not routinely collected. Quality Indicators can be used to benefit patients by measuring whether minimum standards of quality care are being met from a patient perspective. The aim of this study was to describe how a Research User Group (RUG) worked alongside researchers to co-produce a set of self-reported quality indicators for people with osteoarthritis when visiting their general practitioner or practice nurse (primary care). These were required in the MOSAICS study, which developed and evaluated a new model of supported self-management of OA to implement the NICE quality standards for OA. This article describes the public involvement in the MOSAICS study. This was 1) the co-development by RUG members and researchers of an Osteoarthritis Quality Indicators United Kingdom (OA QI (UK)) questionnaire for use in primary care, and 2) the comparison of the OA QI (UK) with a similar questionnaire developed in Norway. This study shows how important and effective a research user group can be in working with researchers in developing quality care indicators for osteoarthritis for use in a research study and, potentially, routine use in primary care. The questionnaire is intended to benefit patients by enabling the assessment of the quality of primary care for osteoarthritis from a patient's perspective. The OA QI (UK) has been used to examine differences in the quality of osteoarthritis care in four European countries. Background People with osteoarthritis (OA) desire high quality care, support and information about OA. However, the quality of care for people with OA in general practice is not routinely collected. Quality Indicators (QI) can be used to benefit patients by measuring whether minimum standards of quality care (e.g. NICE quality standards) are being met from a patient perspective. A Research User Group (RUG) worked with researchers to co-produce a set of self-report, patient-generated QIs for OA. The QIs were intended for use in the MOSAICS study, which developed and evaluated a new model of supported self-management of OA to implement the NICE guidelines. We report on 1) the co-development of the OA QI (UK) questionnaire for primary care; and 2) the comparison of the content of the OA QI (UK) questionnaire with a parallel questionnaire developed in Norway for the Musculoskeletal Pain in Ullensaker (MUST) study. Methods Researchers were invited to OA RUG meetings. Firstly, RUG members were asked to consider factors important to patients consulting their general practitioner (GP) for OA and then each person rated their five most important. RUG members then discussed these in relation to a systematic review of OA QIs in order to form a list of OA QIs from a patient perspective. RUG members suggested wording and response options for a draft OA QI (UK) questionnaire to assess the QIs. Finally RUG members commented on draft and final versions of the questionnaire and how it compared with a translated Norwegian OA-QI questionnaire. Results RUG members (5 males, 5 females; aged 52-80 years) attended up to four meetings. RUG members ranked 20 factors considered most important to patients consulting their GP for joint pain. Following discussion, a list of eleven patient-reported QIs for OA consultations were formed. RUG members then suggested the wording and response options of 16 draft items - four QIs were split into two or more questionnaire items to avoid multiple dimensions of care quality within a single item. On comparison of this to the Norwegian OA-QI questionnaire, RUG members commented that both questionnaires contained seven similar QIs. The RUG members and researchers agreed to adopt the Norwegian OA-QI wording for four of these items. RUG members also recommended adopting an additional seven items from the Norwegian OA-QI with some minor word changes to improve their suitability for patients in the UK. One other item from the draft OA QI (UK) questionnaire was retained and eight items were excluded, resulting in a 15-item final version. Conclusions This study describes the development of patient-reported quality indicators for OA primary care derived by members of a RUG group, working in partnership with the research team throughout the study. The OA QI (UK) supports the NICE quality standards for OA and they have been successfully used to assess the quality of OA consultations in primary care in the MOSAICS study. The OA QI (UK) has the potential for routine use in primary care to assess the quality of OA care provided to patients. Ongoing research using both the UK and Norwegian OA-QI questionnaires is assessing the self-reported quality of OA care in different European populations.

Practical Methods for the Compensation and Control of Multivariable Systems.

DTIC Science & Technology

1982-04-01

a constant gain element gji . To be more specific, let us consider a linear multivariable system whose dynamical behavior is specified by a (pxm...controllable via uk if Yi is fed back to uj via an arbitrary gain gji , as depicted in the figure below? It might be noted that only the outputs and inputs...modes controllable via uk(s) before feedback will remain -19- controllable via uk(s) irrespective of gji (although certain of these uk controllable

Alternatives to the face-to-face consultation in general practice: focused ethnographic case study

PubMed Central

Atherton, Helen; Brant, Heather; Ziebland, Sue; Bikker, Annemieke; Campbell, John; Gibson, Andy; McKinstry, Brian; Porqueddu, Tania; Salisbury, Chris

2018-01-01

Background NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives. Aim To understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice. Design and setting Focused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016. Method Non-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the ‘one sheet of paper’ mind-map method to identify the line of argument in each thematic report. Results Case study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other’s practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal. Conclusion Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team. PMID:29378697

'Personal Care' and General Practice Medicine in the UK: A qualitative interview study with patients and General Practitioners.

PubMed

Adam, Rachel

2007-08-31

Recent policy and organisational changes within UK primary care have emphasised graduated access to care, speed of access to the first available general practitioner (GP) and care being provided by a range of healthcare professionals. These trends have been strengthened by the current GP contract and Quality and Outcomes Framework (QOF). Concern has been expressed that the potential for personal care is being diminished as a result and that this will reduce quality standards. This paper presents data from a study that explored with patients and GPs what personal care means and whether it has continuing importance to them. A semi-structured questionnaire was used to interview participants and Framework Analysis supported analysis of emerging themes. Twenty-nine patients, mainly women with young children, and twenty-three GPs were interviewed from seven practices in Lothian, Scotland, ranged by practice size and relative deprivation score. Personal care was defined mainly, though not exclusively, as care given within the context of a continuing relationship in which there is an interpersonal connection and the doctor adopts a particular consultation style. Defined in this way, it was reported to have benefits for both health outcomes and patients' experience of care. In particular, such care was thought to be beneficial in attending to the emotions that can be elicited when seeking and receiving health care and in enabling patients to be known by doctors as legitimate seekers of care from the health service. Its importance was described as being dependent upon the nature of the health problem and patients' wider familial and social circumstances. In particular, it was found to provide support to patients in their parenting and other familial caring roles. Personal care has continuing salience to patients and GPs in modern primary care in the UK. Patients equate the experience of care, not just outcomes, with high quality care. As it is mainly conceptualised and experienced as care within the context of a continuing relationship, policies and organisational arrangements that support and give incentives to this must be in place. These preferences are not strongly reflected in the QOF. Specific questions need to be addressed by future audit and research on the impact of the contract on these aspects of service.

Unwrapping the diagnosis of tuberculosis in primary care: a qualitative study.

PubMed

Metcalf, Elizabeth P; Davies, Joanne C; Wood, Fiona; Butler, Christopher C

2007-02-01

Although tuberculosis (TB) is relatively rare in the UK, its diagnosis is important because diagnostic delays can result in worse outcomes for patients and expose others to the risk of infection. Atypical presentations may be common, and patients' help-seeking behaviour may influence the diagnostic process in primary care. Little is known about the process of diagnosing TB in primary care in developed countries. To understand the process of diagnosing TB in UK primary care. Qualitative inductive study with paired semi-structured interviews. Communities and general practices in south-east Wales. Interviews were conducted with 17 patients diagnosed with TB in the previous 6 months and 16 GPs involved with their care. Data were analysed thematically. In response to expected classical features, GPs generally ordered specific tests. Both GPs and patients reported atypical presentations, and then the diagnostic and referral net was appropriately widened in most cases. Identified barriers to prompt diagnosis included atypical presentations and low clinical suspicion of TB, lack of continuity of care, workload demands that limit time with patients, and suboptimal clinician-patient communication. GPs recognised the growing problem of TB nationally and the need for improved education among health professionals. GPs' and patients' accounts about the process of diagnosing TB suggest that delays can occur, although they are not typical. Where diagnosis is clear, GPs generally test specifically and refer appropriately; where diagnosis is less clear, the diagnostic net is cast further. It is only when certain core values of general practice are not applied (including continuity of care, considering context appropriately, and eliciting and responding appropriately to patients' explanatory models) that clinicians and patients identify a suboptimal diagnostic process.

Effectiveness of UK provider financial incentives on quality of care: a systematic review.

PubMed

Mandavia, Rishi; Mehta, Nishchay; Schilder, Anne; Mossialos, Elias

2017-11-01

Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency. To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care. Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as 'positive', those that were 'intermediate' showed improvement in some measures, and those classified as 'negative' showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist. Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points. The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives - if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK. © British Journal of General Practice 2017.

Increasing awareness of gynaecological cancer symptoms: a GP perspective

PubMed Central

Evans, Ruth EC; Morris, Melanie; Sekhon, Mandeep; Buszewicz, Marta; Walter, Fiona M; Waller, Jo; Simon, Alice E

2014-01-01

Background In the UK there has been an effort, through the National Awareness and Early Diagnosis Initiative (NAEDI), to increase early stage diagnoses and ultimately cancer survival. Encouraging early symptom presentation through awareness-raising activities in primary care is one method to achieve this goal. Understanding GPs’ views about this type of activity, however, is crucial prior to implementation. Aim To describe GPs’ attitudes to raising public awareness of gynaecological cancers, and their views about the potential impact on primary care services. Design and setting An online survey with a convenience sample recruited from 1860 UK general practices. Method An invitation was emailed to GPs via practice managers and included a weblink to a draft education leaflet and an online survey about the impact of sending a leaflet giving information about symptoms associated with gynaecological cancers to all women on GPs’ lists. Participants could offer additional free text comments which were coded using content analysis. Results A total of 621 GPs participated. Most (77%, 477) felt that raising awareness of cancers was important. Only half (50%, 308), however, indicated that they would distribute such a leaflet from their practice. Barriers to implementation included concerns about financial costs; emotional impact on patients; increased demand for appointments and diagnostic services, such as ultrasound. Conclusions GPs were generally positive about an intervention to improve patients’ awareness of gynaecological cancers, but had concerns about increasing rates of presentation. There is a need for research quantifying the benefits of earlier diagnosis against resource costs such as increased consultations, investigations, and referrals. PMID:24868075

INVESTIGATING THE MANAGEMENT OF CARIOUS PRIMARY TEETH IN GENERAL DENTAL PRACTICE: AN OVERVIEW OF THE DEVELOPMENT AND CONDUCT OF THE FICTION TRIAL.

PubMed

Stewart, Matthew; Keightley, Alexander; Maguire, Anne; Chadwick, Barbara; Vale, Luke; Homer, Tara; Douglas, Gail; Deery, Chris; Marshman, Zoe; Ryan, Vicky; Innes, Nicola

2015-11-01

The management of carious primary teeth is a challenge for patients, parents and clinicians. Most evidence supporting different management strategies originates from a specialist setting and therefore its relevance to the primary care setting is questionable. The UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) has commissioned the FiCTION (Filling Children's Teeth: Indicated Or Not?) trial; a multi-centre primary dental care randomised controlled trial (RCT) to determine the most clinically and cost- effective approach to managing caries in the primary dentition in the UK. This large trial began in 2012, is due to be completed in late 2017 and involves 72 practices and 1,124 children initially aged three to seven years with dentine caries, following randomisation to one of three caries management strategies. Clinical, radiographic, quality of life, treatment acceptability and health economics data are collected during the three-year follow up period. This article provides an overview of the development and conduct of FiCTION and discusses some approaches adopted to manage challenges and achieve the patient recruitment target.

Combined horizontal and vertical integration of care: a goal of practice-based commissioning.

PubMed

Thomas, Paul; Meads, Geoffrey; Moustafa, Ahmet; Nazareth, Irwin; Stange, Kurt C; Donnelly Hess, Gertrude

2008-01-01

Practice-based commissioning (PBC) in the UK is intended to improve both the vertical and horizontal integration of health care, in order to avoid escalating costs and enhance population health. Vertical integration involves patient pathways to treat named medical conditions that transcend organisational boundaries and connect community-based generalists with largely hospital-sited specialists, whereas horizontal integration involves peer-based and cross-sectoral collaboration to improve overall health. Effective mechanisms are now needed to permit ongoing dialogue between the vertical and horizontal dimensions to ensure that medical and nonmedical care are both used to their best advantage. This paper proposes three different models for combining vertical and horizontal integration - each is a hybrid of internationally recognised ideal types of primary care organisation. Leaders of PBC should consider a range of models and apply them in ways that are relevant to the local context. General practitioners, policy makers and others whose job it is to facilitate horizontal and vertical integration must learn to lead such combined approaches to integration if the UK is to avoid the mistakes of the USA in over-medicalising health issues.

The journals of importance to UK clinicians: a questionnaire survey of surgeons

PubMed Central

Jones, Teresa H; Hanney, Steve; Buxton, Martin J

2006-01-01

Background Peer-reviewed journals are seen as a major vehicle in the transmission of research findings to clinicians. Perspectives on the importance of individual journals vary and the use of impact factors to assess research is criticised. Other surveys of clinicians suggest a few key journals within a specialty, and sub-specialties, are widely read. Journals with high impact factors are not always widely read or perceived as important. In order to determine whether UK surgeons consider peer-reviewed journals to be important information sources and which journals they read and consider important to inform their clinical practice, we conducted a postal questionnaire survey and then compared the findings with those from a survey of US surgeons. Methods A questionnaire survey sent to 2,660 UK surgeons asked which information sources they considered to be important and which peer-reviewed journals they read, and perceived as important, to inform their clinical practice. Comparisons were made with numbers of UK NHS-funded surgery publications, journal impact factors and other similar surveys. Results Peer-reviewed journals were considered to be the second most important information source for UK surgeons. A mode of four journals read was found with academics reading more than non-academics. Two journals, the BMJ and the Annals of the Royal College of Surgeons of England, are prominent across all sub-specialties and others within sub-specialties. The British Journal of Surgery plays a key role within three sub-specialties. UK journals are generally preferred and readership patterns are influenced by membership journals. Some of the journals viewed by surgeons as being most important, for example the Annals of the Royal College of Surgeons of England, do not have high impact factors. Conclusion Combining the findings from this study with comparable studies highlights the importance of national journals and of membership journals. Our study also illustrates the complexity of the link between the impact factors of journals and the importance of the journals to clinicians. This analysis potentially provides an additional basis on which to assess the role of different journals, and the published output from research. PMID:16762051

Paediatric rheumatology: clinical practice review. Physiotherapy and occupational therapy for juvenile chronic arthritis: custom and practice in five centres in the UK, USA and Canada

PubMed

Hackett; Johnson; Parkin; Southwood

1996-07-01

Physiotherapy and occupational therapy are widely accepted as being of central importance for the treatment of juvenile chronic arthritis (JCA). However, these approaches have rarely been subject to critical scrutiny. The aims of this report are to highlight some of the inter-centre similarities and differences observed in the implementation of physical and occupational therapy for JCA, and to emphasize the need for scientifically controlled research in this area. During a series of visits to several paediatric rheumatology units in the UK, USA and Canada, three aspects of the service were noted: treatment philosophy, physical interventions used for the treatment of JCA and quality-of life and independence training activities. There was general consensus with the philosophy that early physical intervention was a vital part of the treatment plan for JCA, although all therapists were concerned that compliance with treatment modalities was poor. Differences between units in the approach to acute arthritis, the use of foot othoses and wrist splints, the treatment of joint contractures and the use of general quality-of-life training activities were noted. Although it was widely recognized that controlled research into the efficacy of physical intervention was needed, no centre had a co-ordinated plan for such investigations. Keywords: Juvenile chronic arthritis, Physiotherapy, Occupational therapy

Primary care quality and safety systems in the English National Health Service: a case study of a new type of primary care provider.

PubMed

Baker, Richard; Willars, Janet; McNicol, Sarah; Dixon-Woods, Mary; McKee, Lorna

2014-01-01

Although the predominant model of general practice in the UK National Health Service (NHS) remains the small partnership owned and run by general practitioners (GPs), new types of provider are emerging. We sought to characterize the quality and safety systems and processes used in one large, privately owned company providing primary care through a chain of over 50 general practices in England. Senior staff with responsibility for policy on quality and safety were interviewed. We also undertook ethnographic observation in non-clinical areas and interviews with staff in three practices. A small senior executive team set policy and strategy on quality and safety, including a systematic incident reporting and investigation system and processes for disseminating learning with a strong emphasis on customer focus. Standardization of systems was possible because of the large number of practices. Policies appeared generally well implemented at practice level. However, there was some evidence of high staff turnover, particularly of GPs. This caused problems for continuity of care and challenges in inducting new GPs in the company's systems and procedures. A model of primary care delivery based on a corporate chain may be useful in standardizing policies and procedures, facilitating implementation of systems, and relieving clinical staff of administrative duties. However, the model also poses some risks, including those relating to stability. Provider forms that retain the long term, personal commitment of staff to their practices, such as federations or networks, should also be investigated; they may offer the benefits of a corporate chain combined with the greater continuity and stability of the more traditional general practice.

Pharmacist independent prescribing in critical care: results of a national questionnaire to establish the 2014 UK position.

PubMed

Bourne, Richard S; Whiting, Paul; Brown, Lisa S; Borthwick, Mark

2016-04-01

Clinical pharmacist practice is well established in the safe and effective use of medicines in the critically ill patient. In the UK, independent pharmacist prescribers are generally recognised as a valuable and desirable resource. However, currently, there are only anecdotal reports of pharmacist-independent prescribing in critical care. The aim of this questionnaire was to determine the current and proposed future independent prescribing practice of UK clinical pharmacists working in adult critical care. The questionnaire was distributed electronically to UK Clinical Pharmacy Association members (closed August 2014). There were 134 responses to the questionnaire (response rate at least 33%). Over a third of critical care pharmacists were practising independent prescribers in the specialty, and 70% intended to be prescribers within the next 3 years. Pharmacists with ≥5 years critical care experience (P < 0.001) or worked in a team (P = 0.005) were more likely to be practising independent prescribers. Pharmacists reported significant positives to the use of independent prescribing in critical care both in patient care and job satisfaction. Independently, prescribing was routine in: dose adjustment for multi-organ failure, change in route or formulation, correction prescribing errors, therapeutic drug monitoring and chronic medication. The majority of pharmacist prescribers reported they spent ≤5% of their clinical time prescribing and accounted for ≤5% of new prescriptions in critical care patients. Most critical care pharmacists intend to be practising as independent prescribers within the next 3 years. The extent and scope of critical care pharmacist prescribing appear to be of relatively low volume and within niche prescribing areas. © 2015 Royal Pharmaceutical Society.

Smoke-free legislation and the incidence of paediatric respiratory infections and wheezing/asthma: interrupted time series analyses in the four UK nations

PubMed Central

Been, Jasper V.; Szatkowski, Lisa; van Staa, Tjeerd-Pieter; Leufkens, Hubert G.; van Schayck, Onno C.; Sheikh, Aziz; de Vries, Frank; Souverein, Patrick

2015-01-01

We investigated the association between introduction of smoke-free legislation in the UK (March 2006 for Scotland, April 2007 for Wales and Northern Ireland, and July 2007 for England) and the incidence of respiratory diseases among children. We extracted monthly counts of new diagnoses of wheezing/asthma and RTIs among children aged 0–12 years from all general practices in the Clinical Practice Research Datalink during 1997–2012. Interrupted time series analyses were performed using generalised additive mixed models, adjusting for underlying incidence trends, population size changes, seasonal factors, and pandemic influenza, as appropriate. 366,642 new wheezing/asthma diagnoses and 4,324,789 RTIs were observed over 9,536,003 patient-years. There was no statistically significant change in the incidence of wheezing/asthma after introduction of smoke-free legislation in England (incidence rate ratio (IRR) 0.94, 95% CI 0.81–1.09) or any other UK country (Scotland: IRR 0.99, 95% CI 0.83–1.19; Wales: IRR 1.09, 95% CI 0.89–1.35; Northern Ireland: IRR 0.96, 95% CI 0.76–1.22). Similarly no statistically significant changes in RTI incidence were demonstrated (England: IRR 0.95, 95% CI 0.86–1.06; Scotland: IRR 0.96, 95% CI 0.83–1.11; Wales: IRR 0.97, 95% CI 0.86–1.09; Northern Ireland: IRR 0.90, 95% CI 0.79–1.03). There were no demonstrable reductions in the incidence of paediatric wheezing/asthma or RTIs following introduction of smoke-free legislation in the UK. PMID:26463498

Design and preliminary recruitment results of the Cluster randomised triAl of PSA testing for Prostate cancer (CAP).

PubMed

Turner, E L; Metcalfe, C; Donovan, J L; Noble, S; Sterne, J A C; Lane, J A; Avery, K N; Down, L; Walsh, E; Davis, M; Ben-Shlomo, Y; Oliver, S E; Evans, S; Brindle, P; Williams, N J; Hughes, L J; Hill, E M; Davies, C; Ng, S Y; Neal, D E; Hamdy, F C; Martin, R M

2014-06-10

Screening for prostate cancer continues to generate controversy because of concerns about over-diagnosis and unnecessary treatment. We describe the rationale, design and recruitment of the Cluster randomised triAl of PSA testing for Prostate cancer (CAP) trial, a UK-wide cluster randomised controlled trial investigating the effectiveness and cost-effectiveness of prostate-specific antigen (PSA) testing. Seven hundred and eighty-five general practitioner (GP) practices in England and Wales were randomised to a population-based PSA testing or standard care and then approached for consent to participate. In the intervention arm, men aged 50-69 years were invited to undergo PSA testing, and those diagnosed with localised prostate cancer were invited into a treatment trial. Control arm practices undertook standard UK management. All men were flagged with the Health and Social Care Information Centre for deaths and cancer registrations. The primary outcome is prostate cancer mortality at a median 10-year-follow-up. Among randomised practices, 271 (68%) in the intervention arm (198,114 men) and 302 (78%) in the control arm (221,929 men) consented to participate, meeting pre-specified power requirements. There was little evidence of differences between trial arms in measured baseline characteristics of the consenting GP practices (or men within those practices). The CAP trial successfully met its recruitment targets and will make an important contribution to international understanding of PSA-based prostate cancer screening.

Survey of current practice in clinical transvaginal ultrasound scanning in the UK

PubMed Central

Shaw, Adam; Lees, Christoph

2015-01-01

During transvaginal ultrasound scanning, the fetus and other sensitive tissues are placed close to the transducer. Heating of these tissues occurs by direct conduction from the transducer and by absorption of ultrasound in the tissue. The extent of any heating will depend on the equipment and settings used, the duration of the scan, imaging modes and other aspects of scanning practice. To ensure that scans are performed with minimum risk, staff should have an appropriate knowledge of safety and follow guidelines issued by professional bodies. An online survey aiming to document current practice in transvaginal ultrasound in the UK was created and distributed to individuals performing this type of scanning. The survey posed questions about the respondents, the departments where scans were performed, the equipment used, knowledge of ultrasound safety, scanning practice and the frequency, duration and mode of transvaginal ultrasound scans for gynaecology, obstetrics and fertility applications. In all, 294 responses were obtained, mostly from sonographers (94%). From the analysis of the responses, it was clear that there was a good understanding of the general meaning of thermal and mechanical index and high awareness of guidelines issued by professional bodies. However, 40% of respondents stated that they rarely or never monitor Thermal or Mechanical indices during scanning. Scanning practice was consistent in terms of the duration of scans, scan protocols followed and use of imaging modes. The results highlight the importance of continued ultrasound safety training and promotion of safety guidelines to users. PMID:27433250

General practitioners' perceptions of the barriers and solutions to good-quality palliative care in dementia.

PubMed

Carter, Gillian; van der Steen, Jenny T; Galway, Karen; Brazil, Kevin

2015-04-16

The general practitioner (GP) is in a pivotal position to initiate and adapt care for their patients living with dementia. This study aimed to elicit GPs' perceptions of the potential barriers and solutions to the provision of good-quality palliative care in dementia in their practices. A postal survey of GPs across Northern Ireland was conducted with open-ended items soliciting for barriers in their practices and possible solutions; 40.6% (138/340) were returned completed. Barriers to palliative care in dementia were perceived to be a dementia knowledge deficit for healthcare staff and the public, a resource shortfall within the GP practice and community, poor team coordination alongside inappropriate dementia care provision, and disagreements from and within families. These findings have significant implications for educators and clinicians as enhanced dementia education and training were highlighted as a strong agenda for GPs with the suggestions of dementia awareness programmes for the public. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

The barriers to clinical coding in general practice: a literature review.

PubMed

de Lusignan, S

2005-06-01

Clinical coding is variable in UK general practice. The reasons for this remain undefined. This review explains why there are no readily available alternatives to recording structured clinical data and reviews the barriers to recording structured clinical data. Methods used included a literature review of bibliographic databases, university health informatics departments, and national and international medical informatics associations. The results show that the current state of development of computers and data processing means there is no practical alternative to coding data. The identified barriers to clinical coding are: the limitations of the coding systems and terminologies and the skill gap in their use; recording structured data in the consultation takes time and is distracting; the level of motivation of primary care professionals; and the priority within the organization. A taxonomy is proposed to describe the barriers to clinical coding. This can be used to identify barriers to coding and facilitate the development of strategies to overcome them.

Variation in assessment and standard setting practices across UK undergraduate medicine and the need for a benchmark.

PubMed

MacDougall, Margaret

2015-10-31

The principal aim of this study is to provide an account of variation in UK undergraduate medical assessment styles and corresponding standard setting approaches with a view to highlighting the importance of a UK national licensing exam in recognizing a common standard. Using a secure online survey system, response data were collected during the period 13 - 30 January 2014 from selected specialists in medical education assessment, who served as representatives for their respective medical schools. Assessment styles and corresponding choices of standard setting methods vary markedly across UK medical schools. While there is considerable consensus on the application of compensatory approaches, individual schools display their own nuances through use of hybrid assessment and standard setting styles, uptake of less popular standard setting techniques and divided views on norm referencing. The extent of variation in assessment and standard setting practices across UK medical schools validates the concern that there is a lack of evidence that UK medical students achieve a common standard on graduation. A national licensing exam is therefore a viable option for benchmarking the performance of all UK undergraduate medical students.

Availability and use of capnography for in-hospital cardiac arrests in the United Kingdom.

PubMed

Turle, Sarah; Sherren, Peter B; Nicholson, Stuart; Callaghan, Thomas; Shepherd, Stephen J

2015-09-01

Airway complications occur more frequently outside the operating theatre and in emergency situations. Capnography remains the gold standard for confirming correct endotracheal tube placement, retaining high sensitivity and specificity in cardiac arrest. The 2010 European Resuscitation Council guidelines for adult advanced life support recommended waveform capnography in this setting. We investigated current UK practice relating to the availability and use of this technology during cardiac arrest. Between June and November 2014, a study was conducted of all UK acute hospitals with both a level three adult intensive care unit (ICU) and an emergency department (ED). A telephone questionnaire was administered examining intubation practice and utilisation of capnography within the ED, ICU and general wards. Two hundred and eleven hospitals met the inclusion criteria. The response rate was 100%. Arrests were mainly attended by anaesthesia (48%) and ICU physicians (38%) of registrar grade (56%). The ability to measure end tidal carbon dioxide (ETCO2) was available in all but 4 EDs; most used in waveform devices. Most ICUs were similar. However, in 67% of hospitals surveyed, it was not possible to measure ETCO2 in general wards. Where available, 87% used capnography to confirm ETT placement with less than 50% using ETCO2 to determine CPR effectiveness and 8% to prognosticate. We believe this is the first study of its kind to fully investigate the availability and use of capnography during cardiac arrest throughout the hospital. Whilst equipment provision appears adequate in critical care areas, it is insufficient in general wards. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

"Always paracetamol, they give them paracetamol for everything": a qualitative study examining Eastern European migrants' experiences of the UK health service.

PubMed

Madden, Hannah; Harris, Jane; Blickem, Christian; Harrison, Rebecca; Timpson, Hannah

2017-08-29

The enlargement of the European Union since 2004 has led to an increase in the number of Eastern European migrants living in the UK. The health of this group is under-researched though some mixed evidence shows they are at higher risk of certain physical health conditions such as heart attacks, strokes, HIV and alcohol use and have poorer mental health. This is compounded by poor or insecure housing, low pay, isolation and prejudice. We aimed to understand the health needs and health service experiences of the Eastern European population in a town in Northern England. Five semi structured one-to-one and small group interviews and five focus groups were conducted with 42 Eastern European participants between June and September 2014. The majority of participants were Polish and other participants were from Belarus, Hungary, Latvia, Russia, Slovakia and Ukraine. The data were analysed using thematic framework analysis. Key findings included a good understanding the UK health service structure and high registration and use of general practice/primary care services. However, overall, there were high levels of dissatisfaction, frustration and distrust in General Practitioners (GP). The majority of participants viewed the GP as unhelpful and dismissive; a barrier to secondary/acute care; reluctant to prescribe antibiotics; and that GPs too often advised them to take paracetamol (acetaminophen) and rest. Overwhelmingly participants had strong opinions about access to primary care and the role of the general practitioners. Although the design of the UK health service was well understood, participants were unhappy with the system of GP as gatekeeper and felt it inferior to the consumer-focused health systems in their country of origin. More work is needed to promote the importance of self-care, reduce antibiotic and medication use, and to increase trust in the GP.

Quality of recording of diabetes in the UK: how does the GP's method of coding clinical data affect incidence estimates? Cross-sectional study using the CPRD database

PubMed Central

Tate, A Rosemary; Dungey, Sheena; Glew, Simon; Beloff, Natalia; Williams, Rachael; Williams, Tim

2017-01-01

Objective To assess the effect of coding quality on estimates of the incidence of diabetes in the UK between 1995 and 2014. Design A cross-sectional analysis examining diabetes coding from 1995 to 2014 and how the choice of codes (diagnosis codes vs codes which suggest diagnosis) and quality of coding affect estimated incidence. Setting Routine primary care data from 684 practices contributing to the UK Clinical Practice Research Datalink (data contributed from Vision (INPS) practices). Main outcome measure Incidence rates of diabetes and how they are affected by (1) GP coding and (2) excluding ‘poor’ quality practices with at least 10% incident patients inaccurately coded between 2004 and 2014. Results Incidence rates and accuracy of coding varied widely between practices and the trends differed according to selected category of code. If diagnosis codes were used, the incidence of type 2 increased sharply until 2004 (when the UK Quality Outcomes Framework was introduced), and then flattened off, until 2009, after which they decreased. If non-diagnosis codes were included, the numbers continued to increase until 2012. Although coding quality improved over time, 15% of the 666 practices that contributed data between 2004 and 2014 were labelled ‘poor’ quality. When these practices were dropped from the analyses, the downward trend in the incidence of type 2 after 2009 became less marked and incidence rates were higher. Conclusions In contrast to some previous reports, diabetes incidence (based on diagnostic codes) appears not to have increased since 2004 in the UK. Choice of codes can make a significant difference to incidence estimates, as can quality of recording. Codes and data quality should be checked when assessing incidence rates using GP data. PMID:28122831

Text messaging reminders for influenza vaccine in primary care: protocol for a cluster randomised controlled trial (TXT4FLUJAB).

PubMed

Herrett, Emily; van Staa, Tjeerd; Free, Caroline; Smeeth, Liam

2014-05-02

The UK government recommends that at least 75% of people aged under 64 with certain conditions receive an annual influenza vaccination. Primary care practices often fall short of this target and strategies to increase vaccine uptake are required. Text messaging reminders are already used in 30% of practices to remind patients about vaccination, but there has been no trial addressing their effectiveness in increasing influenza vaccine uptake in the UK. The aims of the study are (1) to develop the methodology for conducting cluster randomised trials of text messaging interventions utilising routine electronic health records and (2) to assess the effectiveness of using a text messaging influenza vaccine reminder in achieving an increase in influenza vaccine uptake in patients aged 18-64 with chronic conditions, compared with standard care. This cluster randomised trial will recruit general practices across three settings in English primary care (Clinical Practice Research Datalink, ResearchOne and London iPLATO text messaging software users) and randomise them to either standard care or a text messaging campaign to eligible patients. Flu vaccine uptake will be ascertained using routinely collected, anonymised electronic patient records. This protocol outlines the proposed study design and analysis methods. This study will determine the effectiveness of text messaging vaccine reminders in primary care in increasing influenza vaccine uptake, and will strengthen the methodology for using electronic health records in cluster randomised trials of text messaging interventions. This trial was approved by the Surrey Borders Ethics Committee (13/LO/0872). The trial results will be disseminated at national conferences and published in a peer-reviewed medical journal. The results will also be distributed to the Primary Care Research Network and to all participating general practices. This study is registered at controlled-trials.com ISRCTN48840025, July 2013.

The Flying Classroom--A Cost Effective Integrated Approach to Learning and Teaching Flight Dynamics

ERIC Educational Resources Information Center

Bromfield, Michael A.; Belberov, Aleksandar

2017-01-01

In the UK, the Royal Aeronautical Society recommends the inclusion of practical flight exercises for accredited undergraduate aerospace engineering programmes to enhance learning and student experience. The majority of academic institutions teaching aerospace in the UK separate the theory and practice of flight dynamics with students attending a…

Parental feeding behaviours and motivations: a qualitative study in mothers of UK pre-schoolers

PubMed Central

Carnell, S; Cooke, L; Cheng, R; Robbins, A; Wardle, J

2011-01-01

Parental feeding behaviours are considered major influences on children’s eating behaviour. However, many questionnaire studies of feeding neglect subtle distinctions between specific feeding strategies and practices in favour of eliciting general feeding goals, and do not take account of the context provided by parents’ motivations. These factors may be critical to understanding child outcomes and engaging parents in child obesity prevention. The present study obtained interview and diary data on specific feeding behaviours and underlying motivations from 22 mothers of predominantly healthy weight 3–5 y olds in the UK. Parents described a wide range of efforts to promote or restrict intake that were largely motivated by practical and health considerations and only rarely by concern about weight. There was also evidence for instrumental feeding, rules surrounding meal-time, child involvement, and parental flexibility in relation to feeding. Almost all parents described responding to children’s appetitive traits, consistent with growing evidence for genetically-influenced individual differences in children’s appetite. These findings suggest that in order to engage parents of currently healthy weight children, obesity prevention advice should aim to satisfy their primary motivations (practicality, health), and be framed as helping parents to respond sensitively and appropriately to different children’s characteristics. PMID:21884741

"Who's on the team today?" The status of briefing amongst operating theatre practitioners in one UK hospital.

PubMed

Allard, Jon; Bleakley, Alan; Hobbs, Adrian; Vinnell, Tina

2007-03-01

Accidents in health care are mainly due to systemic communication errors. Errors occur more frequently in the operating theatre (OT) than other clinical settings. Hence, it is important that preventive communication practices are adopted in OT teams. Formal team pre-briefing has been shown to improve safety in high risk settings such as aviation, but such briefing is not common practice in OT teams. This paper reviews key literature demonstrating the value of briefing in high-risk practices; presents and analyses the results of a questionnaire survey on the status of briefing after its introduction to OT teams in one UK hospital; and analyses processes that frustrate widespread adoption of briefing. In comparison with other OT practitioners, surgeons generally reported differing perceptions of the meaning and value of briefing, often holding broad notions of what constitutes a "brief", but also showing scepticism towards briefing. However, surgeons who had introduced briefing reported positive results such as greater efficiency, shared understanding, and increased team morale. Collaborative briefing that extends beyond the technical to include the interpersonal could be initiated in principle by any member of the OT team, but a number of factors inhibit this, and surgeons play a pivotal role in establishing briefing.

Dentistry as a business: in search of the moral high ground.

PubMed

Holt, Vernon P

2010-07-01

This paper has been developed from a version originally submitted as an assignment for the Faculty of General Dental Practice (UK) Certificate in Health Services Leadership and Management Course. It has been revised in the light of the independent review led by Professor Jimmy Steele into National Health Service dental services in England (generally referred to as the Steele Report), which has commented on many of the points dealt with here. The paper addresses issues arising from a moral tension often experienced by dentists between the professional desire to serve patients well and the necessity, as practice owners running a business, to survive financially. The need for honest and open recognition of what is truly achievable from the public purse is stressed. Rights and responsibilities are discussed in relation to professional practitioners, their patients, and society in general, in seeking the moral high ground under different funding arrangements. The paper concludes by stressing the need to offer improved health rather than palliation of disease.

Nutrient cycles in agricultural systems at sub-catchment scale within the UK and China

NASA Astrophysics Data System (ADS)

Bellarby, Jessica; Surridge, Ben; Haygarth, Philip M.; Lai, Xin; Zhang, Guilong; Song, Xiaolong; Zhou, Jianbin; Meng, Fanqiao; Shen, Jianbo; Rahn, Clive; Smith, Laurence; Burke, Sean

2015-04-01

Diffuse water pollution from agriculture (DWPA) represents a significant challenge in both the UK and China. The UK has developed policies and practices which seek to mitigate DWPA, yet the risks and adverse impacts of DWPA remain widespread. In contrast, China's past priorities have largely focussed on food security, with an emphasis on increasing food production through high fertiliser application rates with little attention being paid to enhanced nutrient export from land to water and to air. This has contributed to severe environmental problems which are only now beginning to be recognised and addressed. We have prepared nutrient balances (phosphorus and nitrogen) in contrasting agricultural production systems at sub-catchment scale within China and the UK. These draw from a variety of sources ranging from general yearly statistics collected by the respective government to farm surveys. Our aim is to use the resulting nutrient balances to underpin the sharing of knowledge and innovation to mitigate DWPA in both nations. In the UK, the case studies focus on the three Demonstration Test Catchment locations, covering a range of livestock and arable production systems across England. Here, the high frequency monitoring of phosphorus river loads enables the cross-validation of the simple nutrient budget approaches applied in this study. In China, our case studies span kiwi orchard, fruit and vegetable solar greenhouse systems, double cropped rice-wheat and wheat-maize production systems. Substantial differences in nutrient stocks and flows exist between individual production systems both across and within the two countries. These differences will be expressed along the source-mobilisation-delivery-impact continuum that underpins our budgets for both phosphorus and nitrogen. We will present the phosphorus cycles of some case studies and highlight their challenges and relevance at sub-catchment scale. Based on our nutrient budgets, general recommendations can be formulated to mitigate DWPA from farm to policy levels.

Extended opening hours and patient experience of general practice in England: multilevel regression analysis of a national patient survey

PubMed Central

Cowling, Thomas E; Harris, Matthew; Majeed, Azeem

2017-01-01

Background The UK government plans to extend the opening hours of general practices in England. The ‘extended hours access scheme’ pays practices for providing appointments outside core times (08:00 to 18.30, Monday to Friday) for at least 30 min per 1000 registered patients each week. Objective To determine the association between extended hours access scheme participation and patient experience. Methods Retrospective analysis of a national cross-sectional survey completed by questionnaire (General Practice Patient Survey 2013–2014); 903 357 survey respondents aged ≥18 years old and registered to 8005 general practices formed the study population. Outcome measures were satisfaction with opening hours, experience of making an appointment and overall experience (on five-level interval scales from 0 to 100). Mean differences between scheme participation groups were estimated using multilevel random-effects regression, propensity score matching and instrumental variable analysis. Results Most patients were very (37.2%) or fairly satisfied (42.7%) with the opening hours of their general practices; results were similar for experience of making an appointment and overall experience. Most general practices participated in the extended hours access scheme (73.9%). Mean differences in outcome measures between scheme participants and non-participants were positive but small across estimation methods (mean differences ≤1.79). For example, scheme participation was associated with a 1.25 (95% CI 0.96 to 1.55) increase in satisfaction with opening hours using multilevel regression; this association was slightly greater when patients could not take time off work to see a general practitioner (2.08, 95% CI 1.53 to 2.63). Conclusions Participation in the extended hours access scheme has a limited association with three patient experience measures. This questions expected impacts of current plans to extend opening hours on patient experience. PMID:27343274

Extended opening hours and patient experience of general practice in England: multilevel regression analysis of a national patient survey.

PubMed

Cowling, Thomas E; Harris, Matthew; Majeed, Azeem

2017-05-01

The UK government plans to extend the opening hours of general practices in England. The 'extended hours access scheme' pays practices for providing appointments outside core times (08:00 to 18.30, Monday to Friday) for at least 30 min per 1000 registered patients each week. To determine the association between extended hours access scheme participation and patient experience. Retrospective analysis of a national cross-sectional survey completed by questionnaire (General Practice Patient Survey 2013-2014); 903 357 survey respondents aged ≥18 years old and registered to 8005 general practices formed the study population. Outcome measures were satisfaction with opening hours, experience of making an appointment and overall experience (on five-level interval scales from 0 to 100). Mean differences between scheme participation groups were estimated using multilevel random-effects regression, propensity score matching and instrumental variable analysis. Most patients were very (37.2%) or fairly satisfied (42.7%) with the opening hours of their general practices; results were similar for experience of making an appointment and overall experience. Most general practices participated in the extended hours access scheme (73.9%). Mean differences in outcome measures between scheme participants and non-participants were positive but small across estimation methods (mean differences ≤1.79). For example, scheme participation was associated with a 1.25 (95% CI 0.96 to 1.55) increase in satisfaction with opening hours using multilevel regression; this association was slightly greater when patients could not take time off work to see a general practitioner (2.08, 95% CI 1.53 to 2.63). Participation in the extended hours access scheme has a limited association with three patient experience measures. This questions expected impacts of current plans to extend opening hours on patient experience. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The information sources and journals consulted or read by UK paediatricians to inform their clinical practice and those which they consider important: a questionnaire survey

PubMed Central

Jones, Teresa H; Hanney, Steve; Buxton, Martin J

2007-01-01

Background Implementation of health research findings is important for medicine to be evidence-based. Previous studies have found variation in the information sources thought to be of greatest importance to clinicians but publication in peer-reviewed journals is the traditional route for dissemination of research findings. There is debate about whether the impact made on clinicians should be considered as part of the evaluation of research outputs. We aimed to determine first which information sources are generally most consulted by paediatricians to inform their clinical practice, and which sources they considered most important, and second, how many and which peer-reviewed journals they read. Methods We enquired, by questionnaire survey, about the information sources and academic journals that UK medical paediatric specialists generally consulted, attended or read and considered important to their clinical practice. Results The same three information sources – professional meetings & conferences, peer-reviewed journals and medical colleagues – were, overall, the most consulted or attended and ranked the most important. No one information source was found to be of greatest importance to all groups of paediatricians. Journals were widely read by all groups, but the proportion ranking them first in importance as an information source ranged from 10% to 46%. The number of journals read varied between the groups, but Archives of Disease in Childhood and BMJ were the most read journals in all groups. Six out of the seven journals previously identified as containing best paediatric evidence are the most widely read overall by UK paediatricians, however, only the two most prominent are widely read by those based in the community. Conclusion No one information source is dominant, therefore a variety of approaches to Continuing Professional Development and the dissemination of research findings to paediatricians should be used. Journals are an important information source. A small number of key ones can be identified and such analysis could provide valuable additional input into the evaluation of clinical research outputs. PMID:17224061

Adherence to guidelines for creatinine and potassium monitoring and discontinuation following renin–angiotensin system blockade: a UK general practice-based cohort study

PubMed Central

Schmidt, Morten; Bhaskaran, Krishnan; Nitsch, Dorothea; Sørensen, Henrik Toft; Smeeth, Liam; Tomlinson, Laurie A

2017-01-01

Objectives To examine adherence to serum creatinine and potassium monitoring and discontinuation guidelines following initiation of treatment with ACE inhibitors (ACEI) or angiotensin receptor blockers (ARBs); and whether high-risk patients are monitored. Design A general practice-based cohort study using electronic health records from the UK Clinical Practice Research Datalink and Hospital Episode Statistics. Setting UK primary care, 2004–2014. Subjects 223 814 new ACEI/ARB users. Main outcome measures Proportion of patients with renal function monitoring before and after ACEI/ARB initiation; creatinine increase ≥30% or potassium levels >6 mmol/L at first follow-up monitoring; and treatment discontinuation after such changes. Using logistic regression models, we also examined patient characteristics associated with these biochemical changes, and with follow-up monitoring within the guideline recommendation of 2 weeks after treatment initiation. Results 10% of patients had neither baseline nor follow-up monitoring of creatinine within 12 months before and 2 months after initiation of an ACEI/ARB, 28% had monitoring only at baseline, 15% only at follow-up, and 47% both at baseline and follow-up. The median period between the most recent baseline monitoring and drug initiation was 40 days (IQR 12–125 days). 34% of patients had baseline creatinine monitoring within 1 month before initiating therapy, but <10% also had the guideline-recommended follow-up test recorded within 2 weeks. Among patients experiencing a creatinine increase ≥30% (n=567, 1.2%) or potassium level >6 mmol/L (n=191, 0.4%), 80% continued treatment. Although patients with prior myocardial infarction, hypertension or baseline potassium >5 mmol/L were at high risk of ≥30% increase in creatinine after ACEI/ARB initiation, there was no evidence that they were more frequently monitored. Conclusions Only one-tenth of patients initiating ACEI/ARB therapy receive the guideline-recommended creatinine monitoring. Moreover, the vast majority of the patients fulfilling postinitiation discontinuation criteria for creatinine and potassium increases continue on treatment. PMID:28069618

Current training provision and training needs in oral health for UK general practice trainees: survey of General Practitioner Training Programme Directors.

PubMed

Ahluwalia, Aneeta; Crossman, Tim; Smith, Helen

2016-05-11

In the UK the incidence of oral cancers has risen by a third in the last decade, and there have been minimal improvements in survival rates. Moreover, a significant proportion of the population no longer access dental health services regularly, instead presenting their oral health concerns to their General Medical Practitioner. Therefore, General Practitioners (GP) have an important role in the diagnosis of oral health pathologies and the earlier detection of oral cancers. This study aims to understand the current provision of training in oral health and cancer for GP trainees and to identify how unmet training needs could be met. A cross-sectional survey of GP Training Programme Directors using an online questionnaire asking about current oral health education training (hospital placements and structured teaching), the competencies covered with trainees and ways to improve oral health training. Quantitative data were analysed using descriptive statistics and content analysis was undertaken of free text responses. We obtained responses from 132 GP Training Programme Directors (GPTPDs), from 13 of the 16 UK medical deaneries surveyed. The majority of respondents (71.2%) indicated that their programmes did not provide any structured oral health training to GP trainees and that ≤ 10% of their trainees were undertaking hospital posts relevant to oral health. GPTPDs were of the view that the quality of oral health training was poor, relative to the specified competencies, and that teaching on clinical presentations of 'normal' oral anatomy was particularly poor. It was envisaged that oral health training could be improved by access to specialist tutors, e-learning programmes and problem-based-learning sessions. Respondents highlighted the need for training sessions to be relevant to GPs. Barriers to improving training in oral health were time constraints, competing priorities and reluctance to taking on the workload of dentists. This UK-wide survey has identified important gaps in the training of GP trainees in relation to oral health care and cancer detection. Addressing these knowledge and skill gaps, particularly in the identification of oral cancers, will help to improve oral health and, more importantly, the timely diagnosis of oral cancer.

Contemporary chiropractic practice in the UK: a field study of a chiropractor and his patients in a suburban chiropractic clinic

PubMed Central

2013-01-01

Background Two recent surveys of chiropractors in Great Britain suggest that there are discrepancies between chiropractic practice as defined in regulatory guidelines and day-to-day chiropractic clinical practice and there is in general a paucity of information regarding the characteristics of contemporary chiropractic practice in the United Kingdom. This field study describes the daily practice of a contemporary British UK-trained chiropractor. Methods The fieldwork took place during the spring and summer of 2008 when the author spent one day per week observing consultations and interviewing patients in a chiropractic clinic. The chiropractor was subjected to interviews on two occasions. The author also registered as a patient. Field notes were taken by the author, interviews were recorded and the transcripts were corrected and analysed by the author. Results A total of 25 patients took part in the study. The interaction that took place between patients and staff in reception could be considered as a prelude to consultation facilitating the transformation from individual to patient and back to individual. Coupled with the continuous physical contact between the chiropractor and each patient there was a substantial amount of verbal and non-verbal communication throughout treatment visits. The patients presented with predominantly musculo-skeletal pain and the majority had consulted the chiropractor as a result of recommendations from others in their close social environment. The majority of the interviewed patients had either an inaccurate or at best rudimentary understanding of the mechanisms of chiropractic treatment. A few of the interviewed patients indicated that they had at first experienced concerns about the nature of chiropractic treatment or getting undressed. The author was able to gain some insight into how the chiropractor's experiences, opinions and beliefs had shaped his approach to chiropractic treatment and how this formed the basis of his clinical modus operandi. Conclusion Although no robust conclusions should be drawn from this small scale field study it does show that the clinical chiropractic practice as carried out by this UK trained British chiropractor contains a number of elements described in earlier qualitative studies in the United States, Canada, and Australia. PMID:23927011

The prevalence of PFS and prevalence and characteristics of reported food allergy; a survey of UK adults aged 18-75 incorporating a validated PFS diagnostic questionnaire.

PubMed

Skypala, I J; Bull, S; Deegan, K; Gruffydd-Jones, K; Holmes, S; Small, I; Emery, P W; Durham, S R

2013-08-01

Pollen-food syndrome (PFS), a food allergy affecting pollen-sensitized individuals, is likely to be the most prevalent food allergy in adults, estimated to affect 50-90% of people allergic to birch tree pollen. A validated PFS diagnostic questionnaire (PFSDQ2) was used to determine the prevalence of PFS and also to characterize those who report reactions to foods. Five UK General practices each sent the PFSDQ2 by post to 2000 patients aged 18-75 years randomly selected from their practice database. The validated questionnaire was accompanied by an additional set of questions to ascertain the demographic of the population, the foods involved and the age of onset. There were 3590 subjects who returned completed questionnaires, with an average return rate from each practice of 36% (range 22-47%). Of these, 73 were diagnosed with PFS according to the questionnaire (PFS+ve) giving a population prevalence of 2%. A further 482 subjects reported reactions to foods but did not fulfil the diagnostic criteria for PFS. The greatest prevalence of PFS was in the Croydon (SE England) urban practice (4.1%) and the lowest in the Aberdeen (Scotland) urban practice (0.8%) (P < 0.001).The most frequently reported trigger foods were apples, hazelnuts and kiwifruit and the majority of those with PFS first experienced symptoms below the age of 20 years. PFS+ve subjects were also more likely to be female and have a higher socio-economic status than those who did not report reactions to foods. The UK prevalence of PFS was 2%, although this varied according to the location of the practice population. The majority of PFS+ve subjects first reported symptoms in their teens. The reported age of onset has important implications for the diagnosis of primary and cross-reactive peanut and tree nut allergies in teenagers and young adults. The continuing rise in aeroallergen sensitization is likely to result in an increased frequency of PFS presenting in both primary and secondary care. © 2013 Blackwell Publishing Ltd.

Contemporary chiropractic practice in the UK: a field study of a chiropractor and his patients in a suburban chiropractic clinic.

PubMed

Hennius, Bjorn J

2013-08-08

Two recent surveys of chiropractors in Great Britain suggest that there are discrepancies between chiropractic practice as defined in regulatory guidelines and day-to-day chiropractic clinical practice and there is in general a paucity of information regarding the characteristics of contemporary chiropractic practice in the United Kingdom. This field study describes the daily practice of a contemporary British UK-trained chiropractor. The fieldwork took place during the spring and summer of 2008 when the author spent one day per week observing consultations and interviewing patients in a chiropractic clinic. The chiropractor was subjected to interviews on two occasions. The author also registered as a patient. Field notes were taken by the author, interviews were recorded and the transcripts were corrected and analysed by the author. A total of 25 patients took part in the study. The interaction that took place between patients and staff in reception could be considered as a prelude to consultation facilitating the transformation from individual to patient and back to individual. Coupled with the continuous physical contact between the chiropractor and each patient there was a substantial amount of verbal and non-verbal communication throughout treatment visits. The patients presented with predominantly musculo-skeletal pain and the majority had consulted the chiropractor as a result of recommendations from others in their close social environment. The majority of the interviewed patients had either an inaccurate or at best rudimentary understanding of the mechanisms of chiropractic treatment. A few of the interviewed patients indicated that they had at first experienced concerns about the nature of chiropractic treatment or getting undressed. The author was able to gain some insight into how the chiropractor's experiences, opinions and beliefs had shaped his approach to chiropractic treatment and how this formed the basis of his clinical modus operandi. Although no robust conclusions should be drawn from this small scale field study it does show that the clinical chiropractic practice as carried out by this UK trained British chiropractor contains a number of elements described in earlier qualitative studies in the United States, Canada, and Australia.

Paediatric home care in the UK.

PubMed Central

Tatman, M A; Woodroffe, C

1993-01-01

Paediatric home care services in the UK were ascertained in 1991 and 1992. Respondents from 209 (97%) UK health districts and boards identified 62 general and 124 specialist paediatric home care services by January 1993, 15% having opened in the previous year. Of all UK children, 30% lived in a district with a general home care service. Five health regions had only specialist services. Districts differed widely in the availability of home care for different disorders. The home care services were small, general services employing a mean (SD) of 2.5 (1.6) whole time equivalent (WTE) nurses, and specialist services 1.3 (0.8) WTE nurses. Few services were available 24 hours a day. Funding arrangements were diverse and some services had difficulties in obtaining consumables and equipment for home use. Despite rapid growth there remains considerable scope for the development of paediatric home care throughout the UK. PMID:8285782

Ethnic disparities in coronary heart disease management and pay for performance in the UK.

PubMed

Millett, Christopher; Gray, Jeremy; Wall, Martin; Majeed, Azeem

2009-01-01

Few pay for performance schemes have been subject to rigorous evaluation, and their impact on disparities in chronic disease management is uncertain. To examine disparities in coronary heart disease management and intermediate clinical outcomes within a multiethnic population before and after the introduction of a major pay for performance initiative in April 2004. Comparison of two cross-sectional surveys using electronic general practice records. Thirty-two family practices in south London, United Kingdom (UK). Two thousand eight hundred and ninety-one individuals with coronary heart disease registered with participating practices in 2003 and 3,101 in 2005. Percentage achievement by ethnic group of quality indicators in the management of coronary heart disease The proportion of patients reaching national treatment targets increased significantly for blood pressure (51.2% to 58.9%) and total cholesterol (65.7% to 73.8%) after the implementation of a major pay for performance initiative in April 2004. Improvements in blood pressure control were greater in the black group compared to whites, with disparities evident at baseline being attenuated (black 54.8% vs. white 58.3% reaching target in 2005). Lower recording of blood pressure in the south Asian group evident in 2003 was attenuated in 2005. Statin prescribing remained significantly lower (p < 0.001) in the black group compared with the south Asian and white groups after the implementation of pay for performance (black 74.8%, south Asian 83.8%, white 80.2% in 2005). The introduction of pay for performance incentives in UK primary care has been associated with better and more equitable management of coronary heart disease across ethnic groups.

Validation of chronic obstructive pulmonary disease recording in the Clinical Practice Research Datalink (CPRD-GOLD)

PubMed Central

Quint, Jennifer K; Müllerova, Hana; DiSantostefano, Rachael L; Forbes, Harriet; Eaton, Susan; Hurst, John R; Davis, Kourtney; Smeeth, Liam

2014-01-01

Objectives The optimal method of identifying people with chronic obstructive pulmonary disease (COPD) from electronic primary care records is not known. We assessed the accuracy of different approaches using the Clinical Practice Research Datalink, a UK electronic health record database. Setting 951 participants registered with a CPRD practice in the UK between 1 January 2004 and 31 December 2012. Individuals were selected for ≥1 of 8 algorithms to identify people with COPD. General practitioners were sent a brief questionnaire and additional evidence to support a COPD diagnosis was requested. All information received was reviewed independently by two respiratory physicians whose opinion was taken as the gold standard. Primary outcome measure The primary measure of accuracy was the positive predictive value (PPV), the proportion of people identified by each algorithm for whom COPD was confirmed. Results 951 questionnaires were sent and 738 (78%) returned. After quality control, 696 (73.2%) patients were included in the final analysis. All four algorithms including a specific COPD diagnostic code performed well. Using a diagnostic code alone, the PPV was 86.5% (77.5–92.3%) while requiring a diagnosis plus spirometry plus specific medication; the PPV was slightly higher at 89.4% (80.7–94.5%) but reduced case numbers by 10%. Algorithms without specific diagnostic codes had low PPVs (range 12.2–44.4%). Conclusions Patients with COPD can be accurately identified from UK primary care records using specific diagnostic codes. Requiring spirometry or COPD medications only marginally improved accuracy. The high accuracy applies since the introduction of an incentivised disease register for COPD as part of Quality and Outcomes Framework in 2004. PMID:25056980

A 5-year retrospective audit of prescribing by a critical care outreach team.

PubMed

Wilson, Mark

2018-05-01

UK prescribing legislation changes made in 2006 and 2012 enabled appropriately qualified nurses to prescribe any licensed medication, and all controlled drugs in schedule 2-5 of the Misuse of Drugs Regulations 2001, for any medical condition within their clinical competence. Critical Care Outreach nurses who are independent nurse prescribers are ideally placed to ensure that acutely ill patients receive treatment without delay. The perceived challenge was how Critical Care Outreach nurses would be able to safely prescribe for a diverse patient group. This study informs this developing area of nurse prescribing in critical care practice. The aims of the audit were to: identify which medications were prescribed; develop a critical care outreach formulary; identify the frequency, timing and number of prescribing decisions being made; identify if prescribing practice changed over the years and provide information for our continuing professional development. This article reports on data collected from a 5-year retrospective audit; of prescribing activity undertaken by nine independent nurse prescribers working in a 24/7 Critical Care Outreach team of a 600-bedded district general hospital in the UK. In total, 8216 medication items were prescribed, with an average of 2·6 prescribed per shift. The most commonly prescribed items were intravenous fluids and analgesia, which were mostly prescribed at night and weekends. The audit has shown that Critical Care Outreach nurse prescribing is feasible in a whole hospital patient population. The majority of prescribing occurred after 16:00 and at night. Further research would be beneficial, particularly looking at patient outcomes following reviews from prescribing critical care outreach nurses. The audit is one of the only long-term studies that describes prescribing practice in Critical Care Outreach teams in the UK. © 2017 British Association of Critical Care Nurses.

Fifty years of longitudinal continuity in general practice: a retrospective observational study.

PubMed

White, Eleanor S; Pereira Gray, Denis; Langley, Peter; Evans, Philip H

2016-04-01

Continuity of care has been defined as relational continuity between patient and doctor and longitudinal continuity describing the duration of the relationship. Measurement of longitudinal continuity alone is associated with outcomes including patient satisfaction, medical costs, hospital admissions and mortality. In one UK general practice, records were searched for patients with continuous registration for 50 or more years. Characteristics of these patients were analysed for age, gender, social deprivation, partner registration and length of registration. Trends in numbers and proportions of this group over the previous 14 years were determined. A comparison group of patients, aged 50 or more, and registered in the same practice within the last 2-4 years, was identified. Patients registered for 50 years or more with a median registration of 56.2 years numbered 190 out of a population of 8420 (2.3%). These patients increased in number by 35.3% (1.7-2.3%) over 14 consecutive years. There were no differences between groups for GP consultation rate, number of repeat medications and hospital use, despite the significantly higher prevalence of multi-morbidity, depression and diabetes in patients with high continuity. This is the first report of 50-year continuity in general practice. Numbers of such patients and proportions are increasing. Longitudinal continuity is easily measured in general practice and associated with important clinical outcomes. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Prevalence of dementia in African-Caribbean compared with UK-born White older people: two-stage cross-sectional study.

PubMed

Adelman, Simon; Blanchard, Martin; Rait, Greta; Leavey, Gerard; Livingston, Gill

2011-08-01

Preliminary studies in the UK, all using screening instruments of unknown cultural validity, indicate that there may be an increased prevalence of dementia in African-Caribbean people, possibly related to vascular risk factors and potentially amenable to preventative measures. To determine the prevalence of dementia in older people of African-Caribbean country of birth compared with their White UK-born counterparts. A total of 218 people of African-Caribbean country of birth and 218 White UK-born people aged ≥60 years were recruited from five general practices in North London. Those who screened positive for cognitive impairment using a culturally valid instrument were offered a standardised diagnostic interview. Two independent assessors diagnosed dementia according to standard operationalised criteria. African-Caribbean participants were 2 years younger, and those with dementia nearly 8 years younger than their White counterparts. The prevalence of dementia was significantly higher in the African-Caribbean (9.6%) than the White group (6.9%) after adjustment for the confounders age and socioeconomic status (odds ratio (OR) = 3.1, 95%CI 1.3-7.3, P = 0.012). There is an increased prevalence of dementia in older people of African-Caribbean country of birth in the UK and at younger ages than in the indigenous White population. These findings have implications for service provision and preventive interventions. Further research is needed to explore the role of vascular risk factors and social adversity in the excess of dementia in this population.

The state of primary care in the United States of America and lessons for primary care groups in the United Kingdom.

PubMed

Koperski, M

2000-04-01

The health care system of the United States of America (USA) is lavishly funded and those with adequate insurance usually receive excellent attention. However, the system is fragmented and inequitable. Health workers often find it difficult to separate vocational roles from business roles. Care tends to focus on the acute rather than the chronic, on 'episodes of illness' rather than 'person-centred' care, on short-term fixes rather than long-term approaches, on scientific/technical solutions rather than discourse or the 'art of healing', and on individual health rather than population health. The majority of US doctors are trained in the 'hightech' hospital paradigm and there is no equivalent of the United Kingdom (UK) general practitioner (GP), who lies at the hub of a primary health care team (PHCT) and who is charged with taking a long-term view, co-ordinating health care for individual patients, and acting as patient advocate without major conflicting financial incentives. However, primary care groups/trusts (PCGs) could learn from US management and training techniques, case management, NHS Direct equivalents, and the effects of poorly developed PHCTs. PCGs could develop the UK's own version of utilisation management. A cash-limited, unified budget within an underfunded National Health Service poses threats to general practice. In both the USA and the UK, primary care is a prominent tool in new attempts at cost control. PCGs offer the opportunity of better integration with public health and social services, but threaten GPs' role as independent advocates by giving them a rationing role. Managed care has forced a similar role onto our US counterparts with consequent public displeasure and professional disillusion. UK GPs will have to steer a careful course if they are to avoid a similar fate.

UK Renal Registry 16th annual report: chapter 9 adequacy of haemodialysis in UK adult patients in 2012: national and centre-specific analyses.

PubMed

Shaw, Catriona; Steenkamp, Retha; Davenport, Andrew

2013-01-01

Outcomes in patients treated with haemodialysis (HD) are influenced by the delivered dose of dialysis. The UK Renal Association (RA) publishes clinical practice guidelines which include recommendations for dialysis dose. The urea reduction ratio (URR) is a widely used measure of dialysis dose and has historically been the measure of adequacy reported by the UKRR. This chapter aims to determine the extent to which patients achieved the recommended UK target. All 71 UK renal centres submitted data to the UK Renal Registry (UKRR). Two groups of patients were included in the analyses: the prevalent HD patient population on 30st September 2012 and the incident HD patient population for 2011. Centres returning data on <50% of their patient population or centres with <20 patients were excluded from centrespecific comparisons. Data regarding URR were available from 63 renal centres in the UK. Forty nine centres provided URR data on more than 90% of prevalent HD patients. The proportion of patients in the UK who met the UK clinical practice guideline for URR (>65%) increased from 69% in 2000 to 88% in 2012. There was persistent variation observed between centres, with 21 centres attaining the RA clinical practice guideline in >90% of patients, 38 centres attaining the guideline in 70-90% of patients and one centre in less than 70% of patients. The overall proportion of prevalent HD patients with a URR >65% has continued to improve over time. The delivered dose of HD, as measured by URR for patients with established renal failure, has increased over the last decade. Whilst the majority of UK patients achieved the target URR there was considerable variation between centres in the percentage of patients achieving the current guideline. © 2014 S. Karger AG, Basel.

Impact of omalizumab on treatment of severe allergic asthma in UK clinical practice: a UK multicentre observational study (the APEX II study)

PubMed Central

Niven, Robert M; Saralaya, Dinesh; Chaudhuri, Rekha; Masoli, Matthew; Clifton, Ian; Mansur, Adel H; Hacking, Victoria; McLain-Smith, Susan; Menzies-Gow, Andrew

2016-01-01

Objective To describe the impact of omalizumab on asthma management in patients treated as part of normal clinical practice in the UK National Health Service (NHS). Design A non-interventional, mixed methodology study, combining retrospective and prospective data collection for 12 months pre-omalizumab and post-omalizumab initiation, respectively. Setting Data were collected in 22 UK NHS centres, including specialist centres and district general hospitals in the UK. Participants 258 adult patients (aged ≥16 years; 65% women) with severe persistent allergic asthma treated with omalizumab were recruited, of whom 218 (84.5%) completed the study. Primary and secondary outcome measures The primary outcome measure was change in mean daily dose of oral corticosteroids (OCS) between the 12-month pre-omalizumab and post-omalizumab initiation periods. A priori secondary outcome measures included response to treatment, changes in OCS dosing, asthma exacerbations, lung function, employment/education, patient-reported outcomes and hospital resource utilisation. Results The response rate to omalizumab at 16 weeks was 82.4%. Comparing pre-omalizumab and post-omalizumab periods, the mean (95% CIs) daily dose of OCS decreased by 1.61 (−2.41 to −0.80) mg/patient/day (p<0.001) and hospital exacerbations decreased by 0.97 (−1.19 to −0.75) exacerbations/patient (p<0.001). Compared with baseline, lung function, assessed by percentage of forced expiratory volume in 1 s, improved by 4.5 (2.7 to 6.3)% at 16 weeks (p<0.001; maintained at 12 months) and patient quality of life (Asthma Quality of Life Questionnaire) improved by 1.38 (1.18 to 1.58) points at 16 weeks (p<0.001, maintained at 12 months). 21/162 patients with complete employment data gained employment and 6 patients lost employment in the 12-month post-omalizumab period. The mean number of A&E visits, inpatient hospitalisations, outpatient visits (excluding for omalizumab) and number of bed days/patient decreased significantly (p<0.001) in the 12-month post-omalizumab period. Conclusions These data support the beneficial effects of omalizumab on asthma-related outcomes, quality of life and resource utilisation in unselected patients treated in ‘real-world’ clinical practice. PMID:27507234

Evaluating UK research in speech and language therapy.

PubMed

Lewison, Grant; Carding, Paul

2003-01-01

There has been a steady growth in recent years in British higher-degree training in speech and language therapy. But what is the standing of UK research in the subject and its component areas which should underpin and inform such training? How can such research be evaluated? The intention was to compare UK publications relevant to speech and language therapy with those of other countries, both quantitatively and qualitatively. We sought then to examine the UK papers in more detail to analyse their sources of funding, their geographical distribution and the ways in which they could appropriately be evaluated. Papers were selectively retrieved from the Science Citation Index and the Social Sciences Citation Index for 1991-2000 by means of a filter based on journal names and paper title words. They were subsequently checked to remove many false positives. The papers were classified into one of seven subject areas and by their research level (from clinical to basic). Their importance was estimated through their potential impact on other researchers, as determined by the citation score of their journals, by the numbers of citations they actually received and by the subjective esteem in which the various journals were held by UK speech and language researchers. World output of speech and language therapy papers has averaged 1000 papers per year during the 1990s, and has grown by half over the period. UK output has been about 12% of the total, compared with 10% in biomedicine, and is published in high impact journals relative to the norm for the field, which is quite a low rate compared with biomedicine overall. Almost half the UK papers had no funding acknowledgements, with the private-non-profit and industrial sectors playing less of a role than in other biomedical areas. Papers in seven subject areas showed substantial differences in their performance on the four criteria selected. The state of British speech and language research appears to be satisfactory, with an above average output in both quantity and quality. However, it is not attracting funding from some types of sponsors and is not being published in general medical journals where it might have a wider influence on general clinical practice. It is also not clear how best such research can be evaluated, although conventional citation counts may be relevant for some subject areas.

Digital communication between clinician and patient and the impact on marginalised groups: a realist review in general practice

PubMed Central

Huxley, Caroline J; Atherton, Helen; Watkins, Jocelyn Anstey; Griffiths, Frances

2015-01-01

Background Increasingly, the NHS is embracing the use of digital communication technology for communication between clinicians and patients. Policymakers deem digital clinical communication as presenting a solution to the capacity issues currently faced by general practice. There is some concern that these technologies may exacerbate existing inequalities in accessing health care. It is not known what impact they may have on groups who are already marginalised in their ability to access general practice. Aim To assess the potential impact of the availability of digital clinician–patient communication on marginalised groups’ access to general practice in the UK. Design and setting Realist review in general practice. Method A four-step realist review process was used: to define the scope of the review; to search for and scrutinise evidence; to extract and synthesise evidence; and to develop a narrative, including hypotheses. Results Digital communication has the potential to overcome the following barriers for marginalised groups: practical access issues, previous negative experiences with healthcare service/staff, and stigmatising reactions from staff and other patients. It may reduce patient-related barriers by offering anonymity and offers advantages to patients who require an interpreter. It does not impact on inability to communicate with healthcare professionals or on a lack of candidacy. It is likely to work best in the context of a pre-existing clinician–patient relationship. Conclusion Digital communication technology offers increased opportunities for marginalised groups to access health care. However, it cannot remove all barriers to care for these groups. It is likely that they will remain disadvantaged relative to other population groups after their introduction. PMID:26622034

Online data on opening hours of general practices in England: a comparison with telephone survey data

PubMed Central

Richards, Emma C; Cowling, Thomas E; Gunning, Elinor J; Harris, Matthew J; Soljak, Michael A; Nowlan, Naomi; Dharmayat, Kanika; Johari, Nur; Majeed, Azeem

2015-01-01

Background The NHS Choices website (www.nhs.uk) provides data on the opening hours of general practices in England. If the data are accurate, they could be used to examine the benefits of extended hours. Aim To determine whether online data on the opening times of general practices in England are accurate regarding the number of hours in which GPs provide face-to-face consultations. Design and setting Cross-sectional comparison of data from NHS Choices and telephone survey data reported by general practice staff, for a nationally representative sample of 320 general practices (December 2013 to September 2014). Method GP face-to-face consultation times were collected by telephone for each sampled practice for each day of the week. NHS Choices data on surgery times were available online. Analysis was based on differences in the number of surgery hours (accounting for breaks) and the times of the first and last consultations of the day only between the two data sources. Results The NHS Choices data recorded 8.8 more hours per week than the survey data on average (40.1 versus 31.2; 95% confidence interval [CI] = 7.4 to 10.3). This was largely accounted for by differences in the recording of breaks between sessions. The data were more similar when only the first and last consultation times were considered (mean difference = 1.6 hours; 95% CI = 0.9 to 2.3). Conclusion NHS Choices data do not accurately measure the number of hours in which GPs provide face-to-face consultations. They better record the hours between the first and last consultations of the day. PMID:26622033

Musculoskeletal training: are GP trainees exposed to the right case mix for independent practice?

PubMed

Goff, Iain; Wise, Elspeth Mary; Coady, David; Walker, David

2016-02-01

Musculoskeletal conditions are common in general practice, but clinicians express poor self confidence in dealing with them. Training in general practice relies on clinical exposure to a range of presentations in order to gain competence. It has been suggested that trainees are exposed to a different case mix from qualified general practices (GPs), due to seeing more minor illness and less chronic disease and that this may be responsible in part for their subsequent lack of confidence. The aims of this study were to analyse the case mix of musculoskeletal conditions encountered by general practice trainees and to compare this to the overall population consulting behaviour. This is a prospective observational study. Thirteen general practices in North East England were recruited. Musculoskeletal disorders encountered by 13 GP trainees (7 junior and 6 senior) were prospectively recorded using a handheld diary. Disorders were classified according to working diagnosis or body region if diagnosis was unclear. Musculoskeletal (MSK) disorders comprised 17 % of consultations, and the distribution of diagnoses of these was in proportion to epidemiological studies of MSK disorders in the UK as they present in primary care. Back pain was the most frequent label with 141 (29 %) consultations with a further 43 (9 %) for neck pain. Inflammatory arthritis accounted for the same number 43 (9 %). Individual joint problems were 115 (24 %) with knee being most common. A specific diagnosis was more likely to be applied when symptoms were more distal and less likely when axial. Trainees are exposed to the same spectrum of MSK disorders as are present in the population as a whole. Case mix does not appear to be a significant factor in low confidence levels in dealing with MSK disorders.

Staffing UK University Campuses Overseas: Lessons from MNE Practice

ERIC Educational Resources Information Center

Salt, John; Wood, Peter

2014-01-01

This article suggests that as their internal labor markets become more multinational in scope, UK universities may acquire similar staffing characteristics to commercial multinational enterprises (MNEs). Comparing evidence from four UK universities with several surveys of MNEs it concludes that, although there are broad similarities in the…

Use of structured musculoskeletal examination routines in undergraduate medical education and postgraduate clinical practice - a UK survey.

PubMed

Baker, Kenneth F; Jandial, Sharmila; Thompson, Ben; Walker, David; Taylor, Ken; Foster, Helen E

2016-10-21

Structured examination routines have been developed as educational resources for musculoskeletal clinical skills teaching, including Gait-Arms-Legs-Spine (GALS), Regional Examination of the Musculoskeletal System (REMS) and paediatric GALS (pGALS). In this study, we aimed to assess the awareness and use of these examination routines in undergraduate medical teaching in UK medical schools and UK postgraduate clinical practice. Electronic questionnaires were distributed to adult and paediatric musculoskeletal teaching leads at UK medical schools and current UK doctors in training. Responses were received from 67 tutors representing teaching at 22/33 [67 %] of all UK medical schools, and 70 trainee doctors across a range of postgraduate training specialities. There was widespread adoption, at responding medical schools, of the adult examination routines within musculoskeletal teaching (GALS: 14/16 [88 %]; REMS: 12/16 [75 %]) and assessment (GALS: 13/16 [81 %]; REMS: 12/16 [75 %]). More trainees were aware of GALS (64/70 [91 %]) than REMS (14/67 [21 %]). Of the 39 trainees who used GALS in their clinical practice, 35/39 [90 %] reported that it had improved their confidence in musculoskeletal examination. Of the 17/22 responding medical schools that included paediatric musculoskeletal examination within their curricula, 15/17 [88 %] used the pGALS approach and this was included within student assessment at 4 medical schools. We demonstrate the widespread adoption of these examination routines in undergraduate education and significant uptake in postgraduate clinical practice. Further study is required to understand their impact upon clinical performance.

Lecturers' Attitudes to Inclusive Teaching Practice at a UK University: Will Staff "Resistance" Hinder Implementation?

ERIC Educational Resources Information Center

Smith, Maria

2010-01-01

Higher education institutions in the UK are required, by law, to make "anticipatory" reasonable adjustments for students with disabilities. Inclusive teaching practice, if adopted across the sector, would ensure that the needs of students with disabilities are considered and provided for, before they even arrive on campus. This paper…

Developing Competence Frameworks in UK Healthcare: Lessons from Practice

ERIC Educational Resources Information Center

Mitchell, Lindsay; Boak, George

2009-01-01

Purpose: The purpose of this article is to review the use of competence frameworks in the UK healthcare sector and to explore characteristics of the sector that may influence the success of projects to develop new frameworks. Design/methodology/approach: The paper draws on project reports and evaluations of practice in a range of recent projects…

Exploring Transition to Postgraduate Study: Shifting Identities in Interaction with Communities, Practice and Participation

ERIC Educational Resources Information Center

Tobbell, Jane; O'Donnell, Victoria; Zammit, Maria

2010-01-01

There has been relatively little research to date that has explored the transition to postgraduate study. This paper reports findings from a project (funded by the UK's Higher Education Academy) that sought to address this gap. The research project was ethnographic and explored university practice and student participation in five UK universities.…

Theory, Practice and Policy: A Longitudinal Study of University Knowledge Exchange in the UK

ERIC Educational Resources Information Center

Zhang, Qiantao

2018-01-01

This article examines the progress of university knowledge exchange in the United Kingdom over a decade, linking theory, practice and policy. As indicated by the literature, the performance of university knowledge exchange is influenced by institutional and locational characteristics. Data on 133 UK universities between 2003-2004 and 2012-2013 are…

Americanization and UK Higher Education: Towards a History of Transatlantic Influence on Policy and Practice.

ERIC Educational Resources Information Center

Smith, David; Baston, Lewis; Bocock, Jean; Scott, Peter

2002-01-01

Investigates history of US influence on UK higher education policy and practice during the second half of the 20th century within broader context of cultural and policy encounters between the two nations during these years and considers relevance of the contested concept of "Americanization." Concludes that US exercised an important but…

Evaluation, or Just Data Collection? An Exploration of the Evaluation Practice of Selected UK Environmental Educators

ERIC Educational Resources Information Center

West, Sarah Elizabeth

2015-01-01

Little is known about the evaluation practices of environmental educators. Questionnaires and discussion groups with a convenience sample of UK-based practitioners were used to uncover their evaluation methods. Although many report that they are evaluating regularly, this is mainly monitoring numbers of participants or an assessment of enjoyment.…

Patient information materials in general practices and promotion of health literacy: an observational study of their effectiveness.

PubMed

Protheroe, Joanne; Estacio, Emee Vida; Saidy-Khan, Sirandou

2015-03-01

Government policy in the UK emphasises providing patients with good health information to encourage participation in their health care. Patient information leaflets (PILs) form part of this policy and have been shown to affect patient health outcomes; however, many are poorly written. To describe the PILs in general practice surgeries in Stoke-on-Trent in terms of readability and variety of content. An observational study of randomly selected GP practices (n = 17) across Stoke-on-Trent. PILs were assessed for readability (Flesch Reading Ease and Flesch-Kincaid Grade Level) and compared with national skills level data and with the recommended level for medical information. The PILs were also categorised for content using the Rudd (2007) health material classification framework. A total of 345 PILs were collected and assessed. Only 24.3% meet recommended reading-level criteria. Compared with national skills levels, over 75% of the PILs collected were too complex for at least 15% of the English population. Of the PILs, 47.8% were classified as 'systems navigation' (information regarding services); 22.9% were disease prevention (screening and immunisations); 14.2% personal and public safety; and less than 10% were for managing illness or health promotion. Current PILs in general practices do not all promote health literacy. Information only accessible to a proportion of higher skilled patients may increase inequalities in health. Less than 10% of PILs promote managing illness or healthy lifestyles. Processes must be put in place to improve the readability and variety of content of PILs in GP practices. © British Journal of General Practice 2015.

Using the electronic health record to build a culture of practice safety: evaluating the implementation of trigger tools in one general practice.

PubMed

Margham, Tom; Symes, Natalie; Hull, Sally A

2018-04-01

Identifying patients at risk of harm in general practice is challenging for busy clinicians. In UK primary care, trigger tools and case note reviews are mainly used to identify rates of harm in sample populations. This study explores how adaptions to existing trigger tool methodology can identify patient safety events and engage clinicians in ongoing reflective work around safety. Mixed-method quantitative and narrative evaluation using thematic analysis in a single East London training practice. The project team developed and tested five trigger searches, supported by Excel worksheets to guide the case review process. Project evaluation included summary statistics of completed worksheets and a qualitative review focused on ease of use, barriers to implementation, and perception of value to clinicians. Trigger searches identified 204 patients for GP review. Overall, 117 (57%) of cases were reviewed and 62 (53%) of these cases had patient safety events identified. These were usually incidents of omission, including failure to monitor or review. Key themes from interviews with practice members included the fact that GPs' work is generally reactive and GPs welcomed an approach that identified patients who were 'under the radar' of safety. All GPs expressed concern that the tool might identify too many patients at risk of harm, placing further demands on their time. Electronic trigger tools can identify patients for review in domains of clinical risk for primary care. The high yield of safety events engaged clinicians and provided validation of the need for routine safety checks. © British Journal of General Practice 2018.

What do we really know about UK paediatric dental general anaesthesia services?

PubMed

Robertson, S; Ní Chaollaí, A; Dyer, T A

2012-02-24

Dental general anaesthesia (DGA) is only permitted within a hospital setting where critical care facilities are available. Recently, concern has been expressed about the number of hospital admissions for the dental care of children following the publication of a high profile paper which highlighted an apparent increase in children being admitted for extractions due to caries under DGA. Coincidentally new best practice standards for paediatric DGA services have been published. An evaluation of DGA services in Yorkshire and the Humber suggested that existing monitoring was inadequate and is unlikely to represent true levels of activity and that any apparent increase may reflect the method of remuneration for services. In fact, recent changes in service structure and changes to improve quality have reduced DGA activity in some areas. In addition, the evaluation revealed that many services were not meeting standards of best practice.

Current practice of usual clinic blood pressure measurement in people with and without diabetes: a survey and prospective 'mystery shopper' study in UK primary care.

PubMed

Stevens, Sarah L; McManus, Richard J; Stevens, Richard John

2018-04-12

Hypertension trials and epidemiological studies use multiple clinic blood pressure (BP) measurements at each visit. Repeat measurement is also recommended in international guidance; however, little is known about how BP is measured routinely. This is important for individual patient management and because routinely recorded readings form part of research databases. We aimed to determine the current practice of BP measurement during routine general practice appointments. (1) An online cross-sectional survey and (2) a prospective 'mystery shopper' study where patients agreed to report how BP was measured during their next appointment. Primary care. Patient charity/involvement group members completing an online survey between July 2015 and January 2016. 334 participants completed the prospective study (51.5% male, mean age=59.3 years) of which 279 (83.5%) had diabetes. Proportion of patients having BP measured according to guidelines. 217 participants with (183) and without diabetes (34) had their BP measured at their last appointment. BP was measured in line with UK guidance in 63.7% and 60.0% of participants with and without diabetes, respectively. Initial pressures were significantly higher in those who had their BP measured more than once compared with only once (p=0.016/0.089 systolic and p<0.001/p=0.022 diastolic, in patients with/without diabetes, respectively). Current practice of routine BP measurement in UK primary care is often concordant with guidelines for repeat measurement. Further studies are required to confirm findings in broader populations, to confirm when a third repeat reading is obtained routinely and to assess adherence to other aspects of BP measurement guidance. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Prevalence, incidence, indication, and choice of antidepressants in patients with and without chronic kidney disease: a matched cohort study in UK Clinical Practice Research Datalink.

PubMed

Iwagami, Masao; Tomlinson, Laurie A; Mansfield, Kathryn E; McDonald, Helen I; Smeeth, Liam; Nitsch, Dorothea

2017-07-01

People with chronic kidney disease (CKD) have an increased prevalence of depression, anxiety, and neuropathic pain. We examined prevalence, incidence, indication for, and choice of antidepressants among patients with and without CKD. Using the UK Clinical Practice Research Datalink, we identified patients with CKD (two measurements of estimated glomerular filtration rate < 60 mL/min/1.73m 2 for ≥3 months) between April 2004 and March 2014. We compared those with CKD to a general population cohort without CKD (matched on age, sex, general practice, and calendar time [index date]). We identified any antidepressant prescribing in the six months prior to index date (prevalence), the first prescription after index date among non-prevalent users (incidence), and recorded diagnoses (indication). We compared antidepressant choice between patients with and without CKD among patients with a diagnosis of depression. There were 242 349 matched patients (median age 76 [interquartile range 70-82], male 39.3%) with and without CKD. Prevalence of antidepressant prescribing was 16.3 and 11.9%, and incidence was 57.2 and 42.4/1000 person-years, in patients with and without CKD, respectively. After adjusting for confounders, CKD remained associated with higher prevalence and incidence of antidepressant prescription. Regardless of CKD status, selective serotonin reuptake inhibitors were predominantly prescribed for depression or anxiety, while tricyclic antidepressants were prescribed for neuropathic pain or other reasons. Antidepressant choice was similar in depressed patients with and without CKD. The rate of antidepressant prescribing was nearly one and a half times higher among people with CKD than in the general population. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd.

Understanding the treatment of attention deficit hyperactivity disorder in newly diagnosed adult patients in general practice: a UK database study

PubMed Central

Bushe, Christopher; Wilson, Bernard; Televantou, Foula; Belger, Mark; Watson, Louise

2015-01-01

Background Adult attention deficit hyperactivity disorder (ADHD) has been largely ignored in psychiatric and general practice guidance until recently. Adult ADHD has a high social and medical burden, but health care is not well described in the UK. The main study objective was to evaluate a primary care adult ADHD population in terms of prescribing and health care contact rates. Methods This was a retrospective observational study using data from the Clinical Practice Research Database from January 1, 2002 to July 31, 2011. Adult patients with an incident ADHD diagnosis or ADHD medication were identified as having been free of ADHD medication or diagnoses in the previous 2 years. Patients were followed for 12–24 months after diagnosis. Results Of the 663 patients with ADHD in the cohort, 54.1% were prescribed ADHD medication during the observation period. During the first 6 months, 34.2% of patients initiated methylphenidates and 14.0% atomoxetine. In total, 36.3% patients were referred to secondary care psychiatry during observation, with the remaining population (63.7%) never having a referral. Most of the referrals were before diagnosis in primary care. At the end of the observation period, 16.2% of patients were on antipsychotics, 17.3% hypnotics, and 34.8% antidepressants or anxiolytics; however, some patients appeared to be prescribed antipsychotic or antidepressant medications even if they did not have an observable diagnosis in their records. Health care contact rates (general practitioner or hospital) increased by 39.2% post-diagnosis (incidence rate ratio: 1.39; 95% confidence interval: 1.32, 1.47), which may be related to the need for medication monitoring and titration. Conclusion This study has shown in primary care that there is relatively low use of ADHD medication, low referrals into secondary care, high rates of usage of psychiatric non-ADHD medications for different indications, and an increasing burden in terms of health care contacts in adult ADHD patients post-diagnosis. PMID:27774030

Engaging the oldest old in research: lessons from the Newcastle 85+ study.

PubMed

Davies, Karen; Collerton, Joanna C; Jagger, Carol; Bond, John; Barker, Sally A H; Edwards, June; Hughes, Joan; Hunt, Judith M; Robinson, Louise

2010-09-17

Those aged 85 and over, the oldest old, are now the fastest growing sector of the population. Information on their health is essential to inform future planning; however, there is a paucity of up-to-date information on the oldest old, who are often excluded from research. The aim of the Newcastle 85+ Study is to investigate the health of a cohort of 85-year-olds from a biological, medical and psychosocial perspective. This paper describes the methods employed for the successful recruitment, retention and evaluation of this cohort. Participants were all individuals born in 1921 and registered with a participating general practice in Newcastle and North Tyneside, UK. Involvement comprised detailed health assessments, by a nurse, in their usual place of residence and/or review of their general practice medical records. Of the 1453 individuals eligible to participate, 72% (n = 1042) were recruited; 59% (n = 851) consented to both health assessment and review of general practice records. Key factors for successful involvement included protected time to engage with family and other key gatekeepers, minimising participant burden, through for example home based assessment, and flexibility of approach. Cognitive impairment is a significant issue; due consideration should be given to the ethical and legal issues of capacity and consent. Interim withdrawal rates at phase 2 (18 month post baseline), show 88 out of 854 participants (10%) had withdrawn with approval for continued use of data and materials and a further 2 participants (0.2%) had withdrawn and requested that all data be destroyed. Attrition due to death of participants within this same time frame was 135 (16%). Our recruitment rates were good and compared favourably with other similar UK and international longitudinal studies of the oldest old. The challenges of and successful strategies for involving, recruiting and retaining the oldest old in research, including those in institutions, are described to facilitate adequate representation of this growing population in future research into ageing.

Health surveillance for occupational asthma in the UK.

PubMed

Fishwick, D; Sen, D; Barker, P; Codling, A; Fox, D; Naylor, S

2016-07-01

Periodic health surveillance (HS) of workers can identify early cases of occupational asthma. Information about its uptake and its content in the UK is lacking. To identify the overall levels of uptake and quality of HS for occupational asthma within three high-risk industry sectors in the UK. A telephone survey of employers, and their occupational health (OH) professionals, carried out in three sectors with exposures potentially capable of causing occupational asthma (bakeries, wood working and motor vehicle repair). A total of 457 organizations participated (31% response rate). About 77% employed <10 people, 17% between 10 and 50 and 6% >50. Risk assessments were common (67%) and 14% carried out some form of HS for occupational asthma, rising to 19% if only organizations reporting asthma hazards and risks were considered. HS was carried out both by in-house (31%) and external providers (69%). Organizational policies were often used to define HS approaches (80%), but infrequently shared with the OH provider. OH providers described considerable variation in practice. Record keeping was universal, but worker-held records were not reported. HS tools were generally developed in-house. Lung function was commonly measured, but only limited interpretation evident. Referral of workers to local specialist respiratory services was variable. This study provided new insights into the real world of HS for occupational asthma. We consider that future work could and should define simpler, more practical and evidence-based approaches to HS to ensure maximal consistency and use of high-quality approaches. © Crown copyright 2016.

Patient experience of general practice and use of emergency hospital services in England: regression analysis of national cross-sectional time series data.

PubMed

Cowling, Thomas E; Majeed, Azeem; Harris, Matthew J

2018-01-22

The UK Government has introduced several national policies to improve access to primary care. We examined associations between patient experience of general practice and rates of visits to accident and emergency (A&E) departments and emergency hospital admissions in England. The study included 8124 general practices between 2011-2012 and 2013-2014. Outcome measures were annual rates of A&E visits and emergency admissions by general practice population, according to administrative hospital records. Explanatory variables included three patient experience measures from the General Practice Patient Survey: practice-level means of experience of making an appointment, satisfaction with opening hours and overall experience (on 0-100 scales). The main analysis used random-effects Poisson regression for cross-sectional time series. Five sensitivity analyses examined changes in model specification. Mean practice-level rates of A&E visits and emergency admissions increased from 2011-2012 to 2013-2014 (310.3-324.4 and 98.8-102.9 per 1000 patients). Each patient experience measure decreased; for example, mean satisfaction with opening hours was 79.4 in 2011-2012 and 76.6 in 2013-2014. In the adjusted regression analysis, an SD increase in experience of making appointments (equal to 9 points) predicted decreases of 1.8% (95% CI -2.4% to -1.2%) in A&E visit rates and 1.4% (95% CI -1.9% to -0.9%) in admission rates. This equalled 301 174 fewer A&E visits and 74 610 fewer admissions nationally per year. Satisfaction with opening hours and overall experience were not consistently associated with either outcome measure across the main and sensitivity analyses. Associations between patient experience of general practice and use of emergency hospital services were small or inconsistent. In England, realistic short-term improvements in patient experience of general practice may only have modest effects on A&E visits and emergency admissions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The perceived benefits of a two-year period of extended specialty training in general practice: the trainees' perspective.

PubMed

Agius, Steven; Lewis, Barry; Kirk, Bob; Hayden, Jacky

2014-01-01

Evidence suggests that, in the UK, the current three-year specialty training period in general practice is inadequate for equipping newly qualified GPs with mastery in all the necessary clinical and generic skills that would allow them to respond with optimum effect to the complexities and uncertainties of the generalist workplace. The North Western Deanery initiated an innovative pilot programme of extended (by 24 months) specialty training in general practice (GPST4-5). Nine ST3 trainees who had just 'graduated' from GPST, holding nMRCGP, were recruited, thereby formally deferring their application for a Certificate of Completion of Training (CCT). The programme was evaluated using established qualitative research techniques. Semi-structured interviews were conducted at fixed points and data were analysed for recurring discourses and themes using a framework thematic analysis. We obtained evidence of the benefits of extended specialty training in encouraging the development of clinical mastery alongside additional specialist skills, generalist and leadership competencies. We also identified the enabling factors for beneficial extended training, including workplace-based training under educational mentorship, combined with a blended learning programme and sustained expert- and peer-support.

Biomedicine, holism and general medical practice: responses to the 2004 General Practitioner contract.

PubMed

Checkland, Kath; Harrison, Stephen; McDonald, Ruth; Grant, Suzanne; Campbell, Stephen; Guthrie, Bruce

2008-07-01

In 2004 a new contract was introduced for General Practitioners in the UK, which introduced a significant element of 'pay-for-performance', including both clinical and organisational targets. The introduction of this contract has caused interest across the world, particularly amongst those responsible for commissioning primary care services. It can be argued that the clinical targets in the contract (known as the Quality and Outcomes Framework, QOF) represent a move towards a more biomedical model of health and illness, which is contrary to the ideal of providing holistic (or biopsychosocial) care that has been traditionally espoused by GPs. This paper reports results from two linked studies (in England and Scotland) investigating the early stages of the new contract. We describe the way in which four practices with different organisational approaches and espoused identities have all changed their practice structures, consultations and clinical care in response to QOF in ways which will result in patients receiving a more biomedical type of care. In spite of these observed changes, respondents continued to maintain discursive claims to holism. We discuss how this disconnection between rhetoric and reality can be maintained, and consider its implications for the future development of GPs' claims to a professional identity.

Variation in assessment and standard setting practices across UK undergraduate medicine and the need for a benchmark

PubMed Central

2015-01-01

Objectives The principal aim of this study is to provide an account of variation in UK undergraduate medical assessment styles and corresponding standard setting approaches with a view to highlighting the importance of a UK national licensing exam in recognizing a common standard. Methods Using a secure online survey system, response data were collected during the period 13 - 30 January 2014 from selected specialists in medical education assessment, who served as representatives for their respective medical schools. Results Assessment styles and corresponding choices of standard setting methods vary markedly across UK medical schools. While there is considerable consensus on the application of compensatory approaches, individual schools display their own nuances through use of hybrid assessment and standard setting styles, uptake of less popular standard setting techniques and divided views on norm referencing. Conclusions The extent of variation in assessment and standard setting practices across UK medical schools validates the concern that there is a lack of evidence that UK medical students achieve a common standard on graduation. A national licensing exam is therefore a viable option for benchmarking the performance of all UK undergraduate medical students. PMID:26520472

Benchmarking of venous thromboembolism prophylaxis practice with ENT.UK guidelines.

PubMed

Al-Qahtani, Ali S

2017-05-01

The aim of this study was to benchmark our guidelines of prevention of venous thromboembolism (VTE) in ENT surgical population against ENT.UK guidelines, and also to encourage healthcare providers to utilize benchmarking as an effective method of improving performance. The study design is prospective descriptive analysis. The setting of this study is tertiary referral centre (Assir Central Hospital, Abha, Saudi Arabia). In this study, we are benchmarking our practice guidelines of the prevention of VTE in the ENT surgical population against that of ENT.UK guidelines to mitigate any gaps. ENT guidelines 2010 were downloaded from the ENT.UK Website. Our guidelines were compared with the possibilities that either our performance meets or fall short of ENT.UK guidelines. Immediate corrective actions will take place if there is quality chasm between the two guidelines. ENT.UK guidelines are evidence-based and updated which may serve as role-model for adoption and benchmarking. Our guidelines were accordingly amended to contain all factors required in providing a quality service to ENT surgical patients. While not given appropriate attention, benchmarking is a useful tool in improving quality of health care. It allows learning from others' practices and experiences, and works towards closing any quality gaps. In addition, benchmarking clinical outcomes is critical for quality improvement and informing decisions concerning service provision. It is recommended to be included on the list of quality improvement methods of healthcare services.

A survey of UK practice patterns in the delivery of intravitreal injections.

PubMed

Samia-Aly, Emma; Cassels-Brown, Andrew; Morris, Daniel S; Stancliffe, Rachel; Somner, John E A

2015-07-01

To assess UK practice patterns related to the prescription of antibiotics before, during and after intravitreal injections, the location where injections are carried out and the qualifications of those administering the injections. Every ophthalmology unit featured in the Royal College of Ophthalmologists (UK) training directory was contacted. A healthcare professional involved in giving intravitreal injections at each institution completed a questionnaire regarding local practice patterns. A response rate of 85% (115/136) was achieved. Seventy four percent of hospitals (85/115) gave take home antibiotics post intravitreal injection. Twenty three percent (26/115) of hospitals employed non-medical healthcare professionals to administer injections and 83% (96/115) administered intravitreal injections in a dedicated clean room as opposed to an operating theatre. Practice patterns for intravitreal injection vary considerably. Guidelines alone do not appear to be effective in reducing practices which are considered wasteful and other approaches need to be developed. © 2015 The Authors Ophthalmic & Physiological Optics © 2015 The College of Optometrists.

Respiratory pharmacotherapy use in patients newly diagnosed with chronic obstructive pulmonary disease in a primary care setting in the UK: a retrospective cohort study.

PubMed

Wurst, Keele E; Shukla, Amit; Muellerova, Hana; Davis, Kourtney J

2014-09-01

This retrospective cohort study aimed to analyze the prescribing practices of general practitioners treating patients with newly diagnosed chronic obstructive pulmonary disease (COPD), and to assess characteristics associated with initial pharmacotherapy. Patients were identified in the General Practice Research Database, a population-based UK electronic medical record (EMR) with data from January 1, 2008 to December 31, 2009. Patient characteristics, prescribed COPD pharmacotherapies (≤12 months before diagnosis and within 3 months following diagnosis), co-morbidities, hospitalizations, and events indicative of a possible COPD exacerbation (≤12 months before diagnosis) were analyzed in 7881 patients with newly diagnosed COPD. Most patients (64.4%) were prescribed COPD pharmacotherapy in the 12 months before diagnosis. Following diagnosis, COPD pharmacotherapy was prescribed within 3 months in 85.0% of patients. Short-acting bronchodilators alone (22.9%) or inhaled corticosteroids + long-acting beta-2 agonists (ICS+LABA, 22.1%) were prescribed most frequently. Compared with other pharmacotherapies, the prevalence of severe airflow limitation was highest in patients prescribed ICS+LABA+long-acting muscarinic antagonists (LAMA). Moderate-to-severe dyspnea was identified most frequently in patients prescribed a LAMA-containing regimen. Patients prescribed an ICS-containing regimen had a higher prevalence of asthma or possible exacerbations recorded in the EMR than those not prescribed ICS. In conclusion, pharmacotherapy prescribed at initial COPD diagnosis varied by disease severity indicators as assessed by airflow limitation, dyspnea, history of asthma, and possible exacerbations. Frequent prescription of COPD pharmacotherapies before the first-recorded COPD diagnosis indicates a delay between obstructive lung disease presentation in primary care practice and assignment of a medical diagnosis.

Evaluating candidate reactions to selection practices using organisational justice theory.

PubMed

Patterson, Fiona; Zibarras, Lara; Carr, Victoria; Irish, Bill; Gregory, Simon

2011-03-01

This study aimed to examine candidate reactions to selection practices in postgraduate medical training using organisational justice theory. We carried out three independent cross-sectional studies using samples from three consecutive annual recruitment rounds. Data were gathered from candidates applying for entry into UK general practice (GP) training during 2007, 2008 and 2009. Participants completed an evaluation questionnaire immediately after the short-listing stage and after the selection centre (interview) stage. Participants were doctors applying for GP training in the UK. Main outcome measures were participants' evaluations of the selection methods and perceptions of the overall fairness of each selection stage (short-listing and selection centre). A total of 23,855 evaluation questionnaires were completed (6893 in 2007, 10,497 in 2008 and 6465 in 2009). Absolute levels of perceptions of fairness of all the selection methods at both the short-listing and selection centre stages were consistently high over the 3years. Similarly, all selection methods were considered to be job-related by candidates. However, in general, candidates considered the selection centre stage to be significantly fairer than the short-listing stage. Of all the selection methods, the simulated patient consultation completed at the selection centre stage was rated as the most job-relevant. This is the first study to use a model of organisational justice theory to evaluate candidate reactions during selection into postgraduate specialty training. The high-fidelity selection methods are consistently viewed as more job-relevant and fairer by candidates. This has important implications for the design of recruitment systems for all specialties and, potentially, for medical school admissions. Using this approach, recruiters can systematically compare perceptions of the fairness and job relevance of various selection methods. © Blackwell Publishing Ltd 2011.

Cost-effectiveness of intensive multifactorial treatment compared with routine care for individuals with screen-detected Type 2 diabetes: analysis of the ADDITION-UK cluster-randomized controlled trial

PubMed Central

Tao, L; Wilson, E C F; Wareham, N J; Sandbæk, A; Rutten, G E H M; Lauritzen, T; Khunti, K; Davies, M J; Borch-Johnsen, K; Griffin, S J; Simmons, R K

2015-01-01

Aims To examine the short- and long-term cost-effectiveness of intensive multifactorial treatment compared with routine care among people with screen-detected Type 2 diabetes. Methods Cost–utility analysis in ADDITION-UK, a cluster-randomized controlled trial of early intensive treatment in people with screen-detected diabetes in 69 UK general practices. Unit treatment costs and utility decrement data were taken from published literature. Accumulated costs and quality-adjusted life years (QALYs) were calculated using ADDITION-UK data from 1 to 5 years (short-term analysis, n = 1024); trial data were extrapolated to 30 years using the UKPDS outcomes model (version 1.3) (long-term analysis; n = 999). All costs were transformed to the UK 2009/10 price level. Results Adjusted incremental costs to the NHS were £285, £935, £1190 and £1745 over a 1-, 5-, 10- and 30-year time horizon, respectively (discounted at 3.5%). Adjusted incremental QALYs were 0.0000, – 0.0040, 0.0140 and 0.0465 over the same time horizons. Point estimate incremental cost-effectiveness ratios (ICERs) suggested that the intervention was not cost-effective although the ratio improved over time: the ICER over 10 years was £82 250, falling to £37 500 over 30 years. The ICER fell below £30 000 only when the intervention cost was below £631 per patient: we estimated the cost at £981. Conclusion Given conventional thresholds of cost-effectiveness, the intensive treatment delivered in ADDITION was not cost-effective compared with routine care for individuals with screen-detected diabetes in the UK. The intervention may be cost-effective if it can be delivered at reduced cost. PMID:25661661

Individual efforts to reduce salt intake in China, Japan, UK, USA: what did people achieve? The INTERMAP Population Study.

PubMed

Okuda, Nagako; Stamler, Jeremiah; Brown, Ian J; Ueshima, Hirotsugu; Miura, Katsuyuki; Okayama, Akira; Saitoh, Shigeyuki; Nakagawa, Hideaki; Sakata, Kiyomi; Yoshita, Katsushi; Zhao, Liancheng; Elliott, Paul

2014-12-01

Habitual high-salt intake raises blood pressure and risk of cardiovascular diseases. To prevent/control these risks, reduced salt diet (RSD) is recommended in many countries and some people report practicing it; however, little is known about actual achievement. This population-based study assessed level of 24-h dietary sodium intake of participants reporting RSD and others. Participants were 4680 men and women ages 40-59 years randomly selected from 17 populations in People's Republic of China (PRC), Japan, UK and USA, for an observational study on diet and blood pressure (INTERMAP). Daily sodium intake was determined by two timed 24-h urine collections. Antihypertensive treatment status and RSD were ascertained by questionnaire. Participants reporting RSD were few; 3.1% (Japan), 1.3% (PRC), 2.5% (UK), 7.2% (USA); 15.1, 7.9, 16.7 and 16.8% of people with treated hypertension. For those reporting RSD, 24-h urinary sodium excretion was significantly, but only modestly lower than for others, by 17.9 mmol/day (Japan), 56.7 (PRC) and 14.7 (USA), but higher by 10.5 in UK. Sodium intakes for participants reporting RSD remained higher than recommended; 181.0 mmol/day (Japan), 171.5 (PRC), 155.2 (UK) and 148.9 (USA). For these people, as for others, main sources of salt were processed foods in Japan, UK and USA; in PRC, salt added in preparation at home. Enhanced sustained efforts are needed to raise general awareness of the harmful effects of salt on health and the benefits of salt reduction. Population approaches are needed to reduce salt content of processed foods and restaurant meals.

The use of equipment and training practices and the prevalence of owner-reported ridden behaviour problems in UK leisure horses.

PubMed

Hockenhull, J; Creighton, E

2013-01-01

UK leisure horses are owned primarily for riding. Ridden behaviour problems may compromise the use of the horse in this role and lead to harsh redress or relinquishment of the horse. Despite the consequences of these problems little is known about their prevalence or the working lives of UK leisure horses. To generate data on the work undertaken by leisure horses, the equipment and training practices used with them and prevalence of ridden behaviour problems. An internet survey was used to generate horse-level data from a convenience sample of leisure horse carers. Respondents were asked to report on their practices in the week prior to the survey's completion to minimise recall bias. The survey was online for one year to allow for seasonal variation in practices. Data were collected on the tack and equipment used on the horse, the regularity that professional services (e.g. farriers) were used, type of training employed and frequency the owner reported that horse displayed 15 ridden behaviour problems. The survey generated data on 1326 individual horses. Data describing practices relating to the horse's working life are presented. Ridden behaviour problems were reported in 91% of horses in the week preceding data collection. Descriptive data on the working lives of UK leisure horses provides valuable baseline statistics for this largest section of the UK horse population. High prevalence of owner-reported ridden behaviour problems represents a concern in such leisure horses and may indicate significant rider safety and horse welfare concerns. © 2012 EVJ Ltd.

Practice patterns for the radical treatment of nasopharyngeal cancer by head and neck oncologists in the United Kingdom.

PubMed

Petkar, Imran; Bhide, Shreerang; Newbold, Kate; Harrington, Kevin; Nutting, Chris

2018-05-01

Advances in radiation delivery, imaging techniques, and chemotherapy have significantly improved treatment options for non-metastatic nasopharyngeal cancers (NPC). However, their impact on the practice in the United Kingdom (UK), where this tumour is rare, is unknown. This study examined the current attitudes of UK head and neck oncologists to the treatment of NPC. UK head and neck oncologists representing 19/23 cancer networks were sent an invitation email with a personalised link to a web-based survey designed to identify the influence of tumour and nodal staging on current NPC management practices. 26/42 (61%) of clinicians responded. Induction chemotherapy followed by concomitant chemoradiation was the treatment of choice for Stage III (69%) and IVa/b (96%), with cisplatin and 5-fluorouracil combination being the most commonly used induction chemotherapy regimen (88%). 16 centres (61%) used a geometric approach, adding variable margins of 0-10 mm to the gross tumour volume to define their therapeutic dose clinical target volume. 54% of respondents used 3 radiotherapy (RT) prescription doses to treat NPC. Retropharyngeal nodal region irradiation policy was inconsistent, with nearly one-quarter treating the entire group to a radical dose. Significant heterogeneity currently exists in the RT practice of NPC in the UK. A consensus regarding the optimal curative, function-sparing treatment paradigm for NPC is necessary to ensure cancer survivors have satisfactory long-term health-related quality of life. Advances in knowledge: This is the first study to highlight the significant variation in RT practice of NPC in the UK.

Herpes zoster as a risk factor for stroke and TIA: a retrospective cohort study in the UK.

PubMed

Breuer, Judith; Pacou, Maud; Gautier, Aline; Brown, Martin M

2014-07-08

Stroke and TIA are recognized complications of acute herpes zoster (HZ). Herein, we evaluate HZ as a risk factor for cerebrovascular disease (stroke and TIA) and myocardial infarction (MI) in a UK population cohort. A retrospective cohort of 106,601 HZ cases and 213,202 controls, matched for age, sex, and general practice, was identified from the THIN (The Health Improvement Network) general practice database. Cox proportional hazard models were used to examine the risks of stroke, TIA, and MI in cases and controls, adjusted for vascular risk factors, including body mass index >30 kg/m(2), smoking, cholesterol >6.2 mmol/L, hypertension, diabetes, ischemic heart disease, atrial fibrillation, intermittent arterial claudication, carotid stenosis, and valvular heart disease, over 24 (median 6.3) years after HZ infection. Risk factors for vascular disease were significantly increased in cases of HZ compared with controls. Adjusted hazard ratios for TIA and MI but not stroke were increased in all patients with HZ (adjusted hazard ratios [95% confidence intervals]: 1.15 [1.09-1.21] and 1.10 [1.05-1.16], respectively). However, stroke, TIA, and MI were increased in cases whose HZ occurred when they were younger than 40 years (adjusted hazard ratios [95% confidence intervals]: 1.74 [1.13-2.66], 2.42 [1.34-4.36], and 1.49 [1.04-2.15], respectively). Subjects younger than 40 years were significantly less likely to be asked about vascular risk factors compared with older patients (p < 0.001). HZ is an independent risk factor for vascular disease in the UK population, particularly for stroke, TIA, and MI in subjects affected before the age of 40 years. In older subjects, better ascertainment of vascular risk factors and earlier intervention may explain the reduction in risk of stroke after HZ infection. © 2014 American Academy of Neurology.

Incidence of Community-Acquired Lower Respiratory Tract Infections and Pneumonia among Older Adults in the United Kingdom: A Population-Based Study

PubMed Central

Millett, Elizabeth R. C.; Quint, Jennifer K.; Smeeth, Liam; Daniel, Rhian M.; Thomas, Sara L.

2013-01-01

Community-acquired lower respiratory tract infections (LRTI) and pneumonia (CAP) are common causes of morbidity and mortality among those aged ≥65 years; a growing population in many countries. Detailed incidence estimates for these infections among older adults in the United Kingdom (UK) are lacking. We used electronic general practice records from the Clinical Practice Research Data link, linked to Hospital Episode Statistics inpatient data, to estimate incidence of community-acquired LRTI and CAP among UK older adults between April 1997-March 2011, by age, sex, region and deprivation quintile. Levels of antibiotic prescribing were also assessed. LRTI incidence increased with fluctuations over time, was higher in men than women aged ≥70 and increased with age from 92.21 episodes/1000 person-years (65-69 years) to 187.91/1000 (85-89 years). CAP incidence increased more markedly with age, from 2.81 to 21.81 episodes/1000 person-years respectively, and was higher among men. For both infection groups, increases over time were attenuated after age-standardisation, indicating that these rises were largely due to population aging. Rates among those in the most deprived quintile were around 70% higher than the least deprived and were generally higher in the North of England. GP antibiotic prescribing rates were high for LRTI but lower for CAP (mostly due to immediate hospitalisation). This is the first study to provide long-term detailed incidence estimates of community-acquired LRTI and CAP in UK older individuals, taking person-time at risk into account. The summary incidence commonly presented for the ≥65 age group considerably underestimates LRTI/CAP rates, particularly among older individuals within this group. Our methodology and findings are likely to be highly relevant to health planners and researchers in other countries with aging populations. PMID:24040394

UK Higher Education Institutions' Technology-Enhanced Learning Strategies from the Perspective of Disruptive Innovation

ERIC Educational Resources Information Center

Flavin, Michael; Quintero, Valentina

2018-01-01

The publication of institutional strategies for learning, teaching and assessment in UK higher education is practically ubiquitous. Strategies for technology-enhanced learning are also widespread. This article examines 44 publicly available UK university strategies for technology-enhanced learning, aiming to assess the extent to which…

Artistry and Analysis: Student Experiences of UK Practice-Based Doctorates in Art and Design

ERIC Educational Resources Information Center

Collinson, Jacquelyn Allen

2005-01-01

During the last decade, doctoral education has been the focus of much international academic attention. This period has also witnessed the rapid growth of practice-based research degrees in art and design in the UK. To date, however, there has been no extensive empirical research on the subjective experiences of students undertaking this form of…

Globalisation and Education: A Review of Conflicting Perspectives and their Effect on Policy and Professional Practice in the UK

ERIC Educational Resources Information Center

Kelly, Anthony

2009-01-01

Many disparate groups have written about the effects of globalisation on education. Some have promoted its benefits; others have warned against its ill-effects. This paper is an attempt at coalescing and juxtaposing the respective arguments as they relate to schooling policy and practice in the UK. The growing international pressures of…

Written Assessment and Feedback Practices in Postgraduate Taught Courses in the UK: Staff and International Students' Perspectives

ERIC Educational Resources Information Center

Guillen Solano, Victor

2016-01-01

In recent years UK universities have attracted an increasing number of international students. Their socialisation into different academic practices greatly depends on their ability to write in English since writing is the main way in which students demonstrate their learning at university. This paper looks into the widely-shared view that tutor…

Overcoming the Barriers of Distance: Using Mobile Technology to Facilitate Moderation and Best Practice in Initial Teacher Training

ERIC Educational Resources Information Center

Leggatt, Simon

2016-01-01

This case study describes the development process of a model using readily-available technology to facilitate collaboration, moderation and the dissemination of best practice in initial teacher training in the UK. Students, mentors, tutors and external examiners from a number of educational institutions in a UK, higher education-led Lifelong…

A UK and Ireland Survey of Educational Psychologists' Intervention Practices for Students with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Robinson, Lee; Bond, Caroline; Oldfield, Jeremy

2018-01-01

Although evidence-based interventions (EBIs) for autism spectrum disorder (ASD) have been identified in recent systematic literature reviews, the extent to which the practice of educational psychologists (EPs) in the UK and Ireland is informed by these is unknown. This study presents the results of a questionnaire that surveyed 146 EP…

Why do GPs leave direct patient care and what might help to retain them? A qualitative study of GPs in South West England.

PubMed

Sansom, Anna; Terry, Rohini; Fletcher, Emily; Salisbury, Chris; Long, Linda; Richards, Suzanne H; Aylward, Alex; Welsman, Jo; Sims, Laura; Campbell, John L; Dean, Sarah G

2018-01-10

To identify factors influencing general practitioners' (GPs') decisions about whether or not to remain in direct patient care in general practice and what might help to retain them in that role. Qualitative, in-depth, individual interviews exploring factors related to GPs leaving, remaining in and returning to direct patient care. South West England, UK. 41 GPs: 7 retired; 8 intending to take early retirement; 11 who were on or intending to take a career break; 9 aged under 50 years who had left or were intending to leave direct patient care and 6 who were not intending to leave or to take a career break. Plus 19 stakeholders from a range of primary care-related professional organisations and roles. Reasons for leaving direct patient care were complex and based on a range of job-related and individual factors. Three key themes underpinned the interviewed GPs' thinking and rationale: issues relating to their personal and professional identity and the perceived value of general practice-based care within the healthcare system; concerns regarding fear and risk, for example, in respect of medical litigation and managing administrative challenges within the context of increasingly complex care pathways and environments; and issues around choice and volition in respect of personal social, financial, domestic and professional considerations. These themes provide increased understanding of the lived experiences of working in today's National Health Service for this group of GPs. Future policies and strategies aimed at retaining GPs in direct patient care should clarify the role and expectations of general practice and align with GPs' perception of their own roles and identity; demonstrate to GPs that they are valued and listened to in planning delivery of the UK healthcare; target GPs' concerns regarding fear and risk, seeking to reduce these to manageable levels and give GPs viable options to support them to remain in direct patient care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Survey of UK and New Zealand gastroenterologists’ practice regarding dietary advice and food exclusion in irritable bowel syndrome and inflammatory bowel disease

PubMed Central

Inns, Stephen James; Emmanuel, Anton V

2013-01-01

Background This study aimed to assess the dietary advice practice of UK and New Zealand (NZ) adult gastroenterologists in inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Methods A questionnaire regarding dietary advice practice was emailed or mailed to all members of the British Society of Gastroenterology (n=983) and the NZ Society of Gastroenterology (n=54). Results 363 questionnaires were returned in the UK (response rate 37%) and 51 in NZ (94%). More respondents gave specific dietary advice to more than 25% of their patients on IBS than IBD (84% vs 27% UK, 90% vs 55% NZ; p=0.001 for both) and gave advice about dietary exclusions to more than 25% of patients on IBS than IBD (61% vs 13% UK, 77% vs 14% NZ; p<0.001 for both). They were most likely to provide dietary advice to patients with small bowel Crohn's disease, difficult to control IBD, diarrhoea predominant IBS and difficult to control IBS. The majority of respondents agreed strongly or a little that dietary exclusion was effective in the treatment of IBS, compared to the minority in IBD (71% vs 39% UK, 84% vs 43% p<0.05 for both). Conclusions UK and NZ gastroenterologists give dietary advice more commonly to IBS than IBD patients. The majority of gastroenterologists have some confidence in the use of dietary exclusion in IBS, the converse is true in IBD. However, the advice given is largely empiric and mostly comprises the exclusion of fibre, dairy and wheat. PMID:28839699

Experience with the United Kingdom examinations in neurosurgery.

PubMed

Pickard, J D

1997-01-01

The UK Intercollegiate Specialty Board examination in Surgical Neurology was established in 1991 based on the experience of the original Royal College of Surgeons of Edinburgh Assessment in Surgical Neurology, an exit examination that was originally opposed both by surgery in general and by the younger neurosurgical community. Criteria for eligibility encompass both UK, EC and non-EC overseas graduates. Candidates must have completed satisfactorily their 4th year of a 6 year training programme, have personal experience with the more straightforward benign tumours, aneurysms and posterior fossa explorations, and be able to safely manage a conventional neurosurgical practice. The examination consists of a multiple choice question paper, clinical examination and three Vivas. A curriculum is under construction. Examinations are held twice per annum, and rotate between the four colleges. There are strict guidelines for the examiners. The pass rate is about 70%. All aspects of the examination continue to evolve and are carefully audited.

Validity of the Perceived Health Competence Scale in a UK primary care setting.

PubMed

Dempster, Martin; Donnelly, Michael

2008-01-01

The Perceived Health Competence Scale (PHCS) is a measure of self-efficacy regarding general health-related behaviour. This brief paper examines the psychometric properties of the PHCS in a UK context. Questionnaires containing the PHCS, the SF-36 and questions about perceived health needs were posted to 486 patients randomly selected from a GP practice list. Complete questionnaires were returned by 320 patients. Analyses of these responses provide strong evidence for the validity of the PHCS in this setting. Consequently, we conclude that the PHCS is a useful addition to measures of global self-efficacy and measures of self-efficacy regarding specific behaviours in the toolkit of health psychologists. This range of self-efficacy assessment tools will ensure that psychologists can match the level of specificity of the measure of expectancy beliefs to the level of specificity of the outcome of interest.

Developing consumer involvement in primary dental care. Report of a half-day seminar held at the Royal College of Surgeons of England on 15th September 2008.

PubMed

Eaton, Kenneth A; Batchelor, Paul; Johns, David J

2009-01-01

The seminar on developing consumer involvement in primary dental care, held during the morning of 15th September 2008, was a collaboration between the Lay Advisory Group and Research Committee of the Faculty of General Dental Practice (UK) (FGDP[UK]). As Professor Mike Mulcahy (immediate past Dean of the Faculty) remarked during his address of welcome, it marked a new and exciting development in the Faculty's role in setting and maintaining professional standards for the benefit of patients. It brought together nearly 50 representatives of national bodies, such as the National Audit Office, consumer groups, the Faculty's Lay Advisory Group and Research Committee, the media and others. Many of the national bodies represented at the seminar had published reports on primary dental care during the last five years.

The North West London Integrated Care Pilot: innovative strategies to improve care coordination for older adults and people with diabetes.

PubMed

Harris, Matthew; Greaves, Felix; Patterson, Sue; Jones, Jessica; Pappas, Yannis; Majeed, Azeem; Car, Josip

2012-01-01

The North West London Integrated Care Pilot (ICP) was launched in June 2011 and brings together more than 100 general practices, 2 acute care trusts, 5 primary care trusts, 2 mental health care trusts, 3 community health trusts, 5 local authorities, and 2 voluntary sector organizations (Age UK and Diabetes UK) to improve the coordination of care for a pilot population of 550 000 people. Specifically, the ICP serves people older than 75 years and those with diabetes. Although still in the early stages of implementation, the ICP has already received national awards for its innovations in design and delivery. This article critically describes the ICP objectives, facilitating processes, and planned impact as well as the organizational and financial challenges that policy makers are facing in the implementation of the pilot program.

The U.K.'s "Dash for Gas".

PubMed

Watterson, Andrew; Dinan, William

2017-05-01

The evidence on public health regulation of the unconventional gas extraction (fracking) industry was examined using a rapid evidence assessment of fifteen case studies from multiple countries. They included scientific and academic papers, professional reports, government agency reports, industry and industry-funded reports, and a nongovernment organization report. Each case study review was structured to address strengths and weaknesses of the publication in relation to our research questions. Some case studies emphasized inherent industry short-, medium-, and long-term dangers to public health directly and through global climate change impacts. Other case studies argued that fracking could be conducted safely assuming industry best practice, "robust" regulation, and mitigation, but the evidence base for such statements proved generally sparse. U.K. regulators' own assessments on fracking regulation are also evaluated. The existing evidence points to the necessity of a precautionary approach to protect public health from unconventional gas extraction development.

Investigation of the effect of a countywide protected learning time scheme on prescribing rates of ramipril: interrupted time series study.

PubMed

Siriwardena, A N; Fairchild, P; Gibson, S; Sach, T; Dewey, M

2007-02-01

Protected learning time (PLT) schemes have been set up in primary care across the UK. There is little published evidence of their effectiveness. To investigate the effect of a PLT intervention for general practice to increase prescribing of ramipril for prevention of cardiovascular outcomes. Quasi-experimental, interrupted time series. Lincolnshire, UK. Prescribing data were analysed one year before and after the education for change in rate of increase of prescribing of ramipril, whether change in prescribing was related to postulated explanatory variables and to determine intervention costs. The primary outcome was the rate of change of ramipril (10 mg) prescription items 12 months after compared with before the educational intervention. Secondary outcomes included cost. Ramipril prescribing at therapeutic dosage increased significantly (odds ratio 1.50, 95% CI 1.07-1.93) following education by 52,345 items (31,132 items at 10 mg) at a cost of pound 292k to pound 460k depending on formulation. This occurred despite a background of secular change. Most practices were represented by GPs, nurses or both during the education. Single-handed GPs were less likely to attend. Practices showed considerable variation in response to the educational intervention. The only predictor of whether practices increased in prescribing rate after the education was whether a practice nurse had undertaken specific diabetes training. Total list size, dispensing, training or single-handed status and GP attendance did not predict a change in prescribing. PLT schemes can contribute to beneficial changes in prescribing across a large geographical area.

The relationships among work stress, strain and self-reported errors in UK community pharmacy.

PubMed

Johnson, S J; O'Connor, E M; Jacobs, S; Hassell, K; Ashcroft, D M

2014-01-01

Changes in the UK community pharmacy profession including new contractual frameworks, expansion of services, and increasing levels of workload have prompted concerns about rising levels of workplace stress and overload. This has implications for pharmacist health and well-being and the occurrence of errors that pose a risk to patient safety. Despite these concerns being voiced in the profession, few studies have explored work stress in the community pharmacy context. To investigate work-related stress among UK community pharmacists and to explore its relationships with pharmacists' psychological and physical well-being, and the occurrence of self-reported dispensing errors and detection of prescribing errors. A cross-sectional postal survey of a random sample of practicing community pharmacists (n = 903) used ASSET (A Shortened Stress Evaluation Tool) and questions relating to self-reported involvement in errors. Stress data were compared to general working population norms, and regressed on well-being and self-reported errors. Analysis of the data revealed that pharmacists reported significantly higher levels of workplace stressors than the general working population, with concerns about work-life balance, the nature of the job, and work relationships being the most influential on health and well-being. Despite this, pharmacists were not found to report worse health than the general working population. Self-reported error involvement was linked to both high dispensing volume and being troubled by perceived overload (dispensing errors), and resources and communication (detection of prescribing errors). This study contributes to the literature by benchmarking community pharmacists' health and well-being, and investigating sources of stress using a quantitative approach. A further important contribution to the literature is the identification of a quantitative link between high workload and self-reported dispensing errors. Copyright © 2014 Elsevier Inc. All rights reserved.

Unrecognised bipolar disorder among UK primary care patients prescribed antidepressants: an observational study.

PubMed

Hughes, Tom; Cardno, Alastair; West, Robert; Marino-Francis, Federica; Featherstone, Imogen; Rolling, Keeley; Locker, Alice; McLintock, Kate; House, Allan

2016-02-01

Bipolar disorder is not uncommon, is associated with high disability and risk of suicide, often presents with depression, and can go unrecognised. To determine the prevalence of unrecognised bipolar disorder among those prescribed antidepressants for depressive or anxiety disorder in UK primary care; whether those with unrecognised bipolar disorder have more severe depression than those who do not; and the accuracy of a screening questionnaire for bipolar disorder, the Mood Disorder Questionnaire (MDQ), in this setting. Observational primary care study of patients on the lists of 21 general practices in West Yorkshire aged 16-40 years and prescribed antidepressant medication. Participants were recruited using primary care databases, interviewed using a diagnostic interview, and completed the screening questionnaire and rating scales of symptoms and quality of life. The prevalence of unrecognised bipolar disorder was 7.3%. Adjusting for differences between the sample and a national database gives a prevalence of 10.0%. Those with unrecognised bipolar disorder were younger and had greater lifetime depression. The predictive value of the MDQ was poor. Among people aged 16-40 years prescribed antidepressants in primary care for depression or anxiety, there is a substantial proportion with unrecognised bipolar disorder. When seeing patients with depression or anxiety disorder, particularly when they are young or not doing well, clinicians should review the life history for evidence of unrecognised bipolar disorder. Some clinicians might find the MDQ to be a useful supplement to non-standardised questioning. © British Journal of General Practice 2016.

Perceptions of good medical practice in the NHS: a survey of senior health professionals.

PubMed

Hutchinson, A; Williams, M; Meadows, K; Barbour, R S; Jones, R

1999-12-01

To categorize senior health professionals' experience with poor medical practice in hospitals and in general practice, to describe perceptions which senior NHS staff have of good medical practice, and to describe how problems of poor medical practice are currently managed. A postal questionnaire survey. The questionnaire sought perceptions of good medical practice, asked participants to characterise deviations from good practice, and to describe experience with managing poor performance at the time of the introduction of the General Medical Council (GMC) performance procedures. A range of NHS settings in the UK: hospital trusts, health authorities/boards, local medical committees, community health councils. Senior health professionals involved in the management of medical professional performance. Perceptions of what constitutes good medical practice. Most respondents considered that persistent problems related to clinical practice (diagnosis, management, and outcome and prescribing) would require local management and, possibly, referral to the GMC performance procedures. Informal mechanisms, including informal discussion, education, training, and work shifting, were the most usual means of handling a doctor whose performance was poor. Many took a less serious view of deficiencies in performance on manner and attitude and communication, although consultation skills rather than technical skills comprised the greatest number of complaints about doctors. Senior NHS professionals seem reluctant to consider persistently poor consultation skills in the same critical light as they do persistently poor technical practice. These attitudes may need to change with the implementation of clinical governance and updated guidance from the GMC on what constitutes good medical practice.

Understanding long-term opioid prescribing for non-cancer pain in primary care: a qualitative study.

PubMed

McCrorie, Carolyn; Closs, S José; House, Allan; Petty, Duncan; Ziegler, Lucy; Glidewell, Liz; West, Robert; Foy, Robbie

2015-09-11

The place of opioids in the management of chronic, non-cancer pain is limited. Even so their use is escalating, leading to concerns that patients are prescribed strong opioids inappropriately and alternatives to medication are under-used. We aimed to understand the processes which bring about and perpetuate long-term prescribing of opioids for chronic, non-cancer pain. We held semi-structured interviews with patients and focus groups with general practitioners (GPs). Participants included 23 patients currently prescribed long-term opioids and 15 GPs from Leeds and Bradford, United Kingdom (UK). We used a grounded approach to the analysis of transcripts. Patients are driven by the needs for pain relief, explanation, and improvement or maintenance of quality of life. GPs' responses are shaped by how UK general practice is organised, available therapeutic choices and their expertise in managing chronic pain, especially when facing diagnostic uncertainty or when their own approach is at odds with the patient's wishes. Four features of the resulting transaction between patients and doctors influence prescribing: lack of clarity of strategy, including the risk of any plans being subverted by urgent demands; lack of certainty about locus of control in decision-making, especially in relation to prescribing; continuity in the doctor-patient relationship; and mutuality and trust. Problematic prescribing occurs when patients experience repeated consultations that do not meet their needs and GPs feel unable to negotiate alternative approaches to treatment. Therapeutic short-termism is perpetuated by inconsistent clinical encounters and the absence of mutually-agreed formulations of underlying problems and plans of action. Apart from commissioning improved access to appropriate specialist services, general practices should also consider how they manage problematic opioid prescribing and be prepared to set boundaries with patients.

Gender identity and the management of the transgender patient: a guide for non-specialists.

PubMed

Joseph, Albert; Cliffe, Charlotte; Hillyard, Miriam; Majeed, Azeem

2017-04-01

In this review, we introduce the topic of transgender medicine, aimed at the non-specialist clinician working in the UK. Appropriate terminology is provided alongside practical advice on how to appropriately care for transgender people. We offer a brief theoretical discussion on transgenderism and consider how it relates to broader understandings of both gender and disease. In respect to epidemiology, while it is difficult to assess the exact size of the transgender population in the UK, population surveys suggest a prevalence of between 0.2 and 0.6% in adults, with rates of referrals to gender identity clinics in the UK increasing yearly. We outline the legal framework that protects the rights of transgender people, showing that is not legal for physicians to deny transgender people access to services based on their personal beliefs. Being transgender is often, although not always, associated with gender dysphoria, a potentially disabling condition in which the discordance between a person's natal sex (that assigned to them at birth) and gender identity results in distress, with high associated rates of self-harm, suicidality and functional impairment. We show that gender reassignment can be a safe and effective treatment for gender dysphoria with counselling, exogenous hormones and surgery being the mainstay of treatment. The role of the general practitioner in the management of transgender patients is discussed and we consider whether hormone therapy should be initiated in primary care in the absence of specialist advice, as is suggested by recent General Medical Council guidance.

Incidence of fatigue symptoms and diagnoses presenting in UK primary care from 1990 to 2001.

PubMed

Gallagher, Arlene M; Thomas, Janice M; Hamilton, William T; White, Peter D

2004-12-01

Little is known about whether the incidence of symptoms of fatigue presented in primary care, and the consequent diagnoses made, change over time. The UK General Practice Research Database was used to investigate the annual incidence of both fatigue symptoms and diagnoses recorded in UK primary care from 1990 to 2001. The overall incidence of all fatigue diagnoses decreased from 87 per 100 000 patients in 1990 to 49 in 2001, a reduction of 44%, while postviral fatigue syndromes decreased from 81% of all fatigue diagnoses in 1990 to 60% in 2001. Chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME) together increased from 9% to 26% of all fatigue diagnoses. The incidence of fibromyalgia increased from less than 1 per 100 000 to 35 per 100 000. In contrast, there was no consistent change in the incidence of all recorded symptoms of fatigue, with an average of 1503 per 100 000, equivalent to 1.5% per year. CFS/ME and fibromyalgia were rarely diagnosed in children and were uncommon in the elderly. All symptoms and diagnoses were more common in females than in males. The overall incidence of fatigue diagnoses in general has fallen, but the incidence rates of the specific diagnoses of CFS/ME and fibromyalgia have risen, against a background of little change in symptom reporting. This is likely to reflect fashions in diagnostic labelling rather than true changes in incidence.

Increasing antimicrobial resistance in clinical isolates of Staphylococcus intermedius group bacteria and emergence of MRSP in the UK.

PubMed

Beever, L; Bond, R; Graham, P A; Jackson, B; Lloyd, D H; Loeffler, A

2015-02-14

Frequencies of antimicrobial resistance were determined amongst 14,555 clinical Staphylococcus intermedius group (SIG) isolates from UK dogs and cats to estimate resistance trends and quantify the occurrence of meticillin-resistant Staphylococcus pseudintermedius (MRSP). Reports from two diagnostic laboratories (13,313 general submissions, 1242 referral centre only submissions) were analysed retrospectively (2003/2006-2012). MRSP were defined by phenotypic resistance to meticillin and concurrent broad β-lactam resistance; a subset was confirmed genetically (SIG-specific nuc and mecA). Trends were analysed by Cochran-Armitage test. Resistance remained below 10 per cent for cefalexin, amoxicillin-clavulanic acid and the fluoroquinolones. Increasing resistance trends were seen in both laboratories for ampicillin/amoxicillin (both P<0.001), cefovecin (both P<0.046) and enrofloxacin (both P<0.02). Resistance to cefalexin increased over time in referral hospital isolates (P<0.001) to clindamycin (P=0.01) and trimethoprim-sulfamethoxazole (P=0.001) amongst general laboratory submissions. Overall, 106 MRSP were isolated (0.7 per cent of submissions) including 32 (2.6 per cent of submissions, all genetically confirmed) from the referral centre population (inter-laboratory difference P<0.001). Against a background of widely susceptible SIG isolates, a new trend of increasing resistance to important antimicrobials was identified overtime and the emergence of MRSP from UK clinical cases was confirmed. Attention to responsible use of antibacterial therapy in small animal practice is urgently needed. British Veterinary Association.

Human Immunodeficiency Virus (HIV) and migrant "risk environments": the case of the Ethiopian and Eritrean immigrant community in the West Midlands of the UK.

PubMed

Barrett, Hazel R; Mulugeta, Betselot

2010-05-01

The flow of migrants from high human immunodeficiency virus (HIV) prevalence regions such as sub-Saharan Africa to western countries is changing the profile of HIV infection in host countries, with immigrants from these countries accounting for the majority of heterosexually acquired HIV infection. Few studies have been conducted on the sexual culture and practices of different migrant African communities living in western countries including the UK. Significant gaps therefore exist in our knowledge of the HIV/AIDS prevention needs of culturally diverse communities, particularly those from sub-Saharan Africa living in the UK. Based on empirical research undertaken in 2007, this article explores the knowledge and practices concerning HIV amongst the Ethiopian and Eritrean immigrant community living in the West Midlands of the UK. Using in-depth qualitative methods, the study investigated the HIV "risk environment" of this immigrant community. The research found that the group had little knowledge or understanding of the HIV epidemic in the UK and this resulted in serious misconceptions which led to risky sexual practice. Whilst the group had good knowledge and understanding of the disease and its transmission which had been acquired in their country of origin, this was not translated into practice. The perceived "low-risk environment" of HIV in the UK, as well as traditional male domination concerning sexual issues goes some way in explaining the low usage of the male condom amongst this group. Promoting the use of the female condom could empower women within this community to practice safe sex, which is acceptable to their male partners. The study identified a number of issues relevant to this immigrant group that could be easily tackled, empowering them to make informed decisions and take actions commensurate with the real, rather than perceived, HIV "risk environment" of their new home.

Quality of recording of diabetes in the UK: how does the GP's method of coding clinical data affect incidence estimates? Cross-sectional study using the CPRD database.

PubMed

Tate, A Rosemary; Dungey, Sheena; Glew, Simon; Beloff, Natalia; Williams, Rachael; Williams, Tim

2017-01-25

To assess the effect of coding quality on estimates of the incidence of diabetes in the UK between 1995 and 2014. A cross-sectional analysis examining diabetes coding from 1995 to 2014 and how the choice of codes (diagnosis codes vs codes which suggest diagnosis) and quality of coding affect estimated incidence. Routine primary care data from 684 practices contributing to the UK Clinical Practice Research Datalink (data contributed from Vision (INPS) practices). Incidence rates of diabetes and how they are affected by (1) GP coding and (2) excluding 'poor' quality practices with at least 10% incident patients inaccurately coded between 2004 and 2014. Incidence rates and accuracy of coding varied widely between practices and the trends differed according to selected category of code. If diagnosis codes were used, the incidence of type 2 increased sharply until 2004 (when the UK Quality Outcomes Framework was introduced), and then flattened off, until 2009, after which they decreased. If non-diagnosis codes were included, the numbers continued to increase until 2012. Although coding quality improved over time, 15% of the 666 practices that contributed data between 2004 and 2014 were labelled 'poor' quality. When these practices were dropped from the analyses, the downward trend in the incidence of type 2 after 2009 became less marked and incidence rates were higher. In contrast to some previous reports, diabetes incidence (based on diagnostic codes) appears not to have increased since 2004 in the UK. Choice of codes can make a significant difference to incidence estimates, as can quality of recording. Codes and data quality should be checked when assessing incidence rates using GP data. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Foundation doctors and dyslexia: a qualitative study of their experiences and coping strategies.

PubMed

Newlands, Freda; Shrewsbury, Duncan; Robson, Jean

2015-03-01

Dyslexia is the most common form of specific learning difficulty affecting approximately 6% of the general UK population and believed to affect approximately 2% of UK medical students. The impact of dyslexia on early practice has not been studied. To develop an understanding of the challenges faced by doctors with dyslexia in the first year of practice and their support requirements. Semistructured telephone interviews were conducted with seven foundation year 1 doctors with dyslexia from Scottish hospitals between March 2013 and August 2013. Foundation doctors indicated that due to their dyslexia, they experience difficulty with all forms of communication, time management and anxiety. There were concerns about disclosure of their dyslexia to colleagues and supervisors. Coping strategies used frequently were safety-netting and planning; technology solutions did offer some assistance. Although technological interventions have the potential to offer benefits to foundation doctors with dyslexia, increased openness about a diagnosis of dyslexia with discussion between doctor and supervisors about the challenges and anxieties is likely to provide the most benefit. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Exclusion of patients from pay-for-performance targets by English physicians.

PubMed

Doran, Tim; Fullwood, Catherine; Reeves, David; Gravelle, Hugh; Roland, Martin

2008-07-17

In the English pay-for-performance program, physicians use a range of criteria to exclude individual patients from the quality calculations that determine their pay. This process, which is called exception reporting, is intended to safeguard patients against inappropriate treatment by physicians seeking to maximize their income. However, exception reporting may allow physicians to inappropriately exclude patients for whom targets have been missed (a practice known as gaming). We analyzed data extracted automatically from clinical computing systems for 8105 family practices in England (96% of all practices), data from the U.K. Census, and data on practice characteristics from the U.K. Department of Health. We determined the rate of exception reporting for 65 clinical activities and the association between this rate and the characteristics of patients and medical practices. From April 2005 through March 2006, physicians excluded a median of 5.3% of patients (interquartile range, 4.0 to 6.9) from the quality calculations. Physicians were most likely to exclude patients from indicators that were related to providing treatments and achieving target levels of intermediate outcomes; they were least likely to exclude patients from indicators that were related to routine checks and measurements and to offers of treatment. The characteristics of patients and practices explained only 2.7% of the variance in exception reporting. We estimate that exception reporting accounted for approximately 1.5% of the cost of the pay-for-performance program. Exception reporting brings substantial benefits to pay-for-performance programs, providing that the process is used appropriately. In England, rates of exception reporting have generally been low, with little evidence of widespread gaming. 2008 Massachusetts Medical Society

Advanced nursing practice.

PubMed

Carroll, Mark

Mark Carroll examines the concept of advanced nursing practice and highlights a number of the difficulties in assessing and defining different levels of practice. Some of the differences and similarities between advanced practice in the US and UK are compared and contrasted. Issues of élitism and the lack of correlation between the needs of the healthcare system and professional self-interest prevent the advancement of specialist roles in the UK. The continuing focus of local trusts on the medicalisation of roles to meet the demands of the healthcare system appears to ignore the need for nursing to expand from within the profession.

Between demarcation and discretion: The medical-administrative boundary as a locus of safety in high-volume organisational routines.

PubMed

Grant, Suzanne; Guthrie, Bruce

2018-04-01

Patient safety is an increasing concern for health systems internationally. The majority of administrative work in UK general practice takes place in the context of organisational routines such as repeat prescribing and test results handling, where high workloads and increased clinician dependency on administrative staff have been identified as an emerging safety issue. Despite this trend, most research to date has focused on the redistribution of the clinical workload between doctors, nurses and allied health professionals within individual care settings. Drawing on Strauss's negotiated order perspective, we examine ethnographically the achievement of safety across the medical-administrative boundary in key high-volume routines in UK general practice. We focus on two main issues. First, GPs engaged in strategies of demarcation by defining receptionist work as routine, unspecialised and dependent upon GP clinical knowledge and oversight as the safety net to deal with complexity and risk. Receptionists consented to this 'social closure' when describing their role, thus reinforcing the underlying inter-occupational relationship of medical domination. Second, in everyday practice, GPs and receptionists engaged in informal boundary-blurring to safely accommodate the complexity of everyday high-volume routine work. This comprised additional informal discretionary spaces for receptionist decision-making and action that went beyond the routine safety work formally assigned to them. New restratified intra-occupational hierarchies were also being created between receptionists based on the complexity of the safety work that they were authorised to do at practice level, with specialised roles constituting a new form of administrative 'professional project'. The article advances negotiated order theory by providing an in-depth examination of the ways in which medical-administrative boundary-making and boundary-blurring constitute distinct modes of safety in high-volume routines. It also provides the basis for further research and safety improvement to maximise team-level understandings of the pivotal role of medical-administrative negotiations in achieving safety and mitigating risk. Copyright © 2018 Elsevier Ltd. All rights reserved.

Meeting the needs of people in emergencies: a review of UK experiences and capability

PubMed Central

Eyre, A

2008-01-01

This article summarises the key findings of two research studies conducted for the UK Government in 2006–2007. The first was a literature review of evidence about provisions and interventions to meet the needs of people affected by ‘emergencies’ as defined within the Civil Contingencies Act (2004). Drawing on both historical and contemporary research and practice, the literature review presented an assessment of people's psychosocial needs after events such as natural disasters, terrorism, and other major incidents. Although some reference was made about the needs of and consequences on disaster workers responding to these events, the main emphasis was on those directly affected as bereaved people and/or injured survivors. The review offered best practice guidelines based on the most effective methods of humanitarian assistance in the immediate, short-term, and long-term aftermath of major emergencies. The second report was a follow-up study conducted in 2007. This was a piece of primary research focusing on the UK's current capability in humanitarian assistance in terms of the extent of planning, training, exercising, and experience relating to meeting people's needs in emergencies. A variety of methods were used to gather quantitative and qualitative evidence of the nature and status of such activity across the UK, including questionnaires, focus groups, and a review of literature and documentary evidence. The report included a number of good practice case studies and made recommendations for the development of best practice in humanitarian assistance within the UK. PMID:22460218

The rationale for simple approaches for sustainability assessment and management in contaminated land practice.

PubMed

Bardos, R Paul; Bone, Brian D; Boyle, Richard; Evans, Frank; Harries, Nicola D; Howard, Trevor; Smith, Jonathan W N

2016-09-01

The scale of land-contamination problems, and of the responses to them, makes achieving sustainability in contaminated land remediation an important objective. The Sustainable Remediation Forum in the UK (SuRF-UK) was established in 2007 to support more sustainable remediation practice in the UK. The current international interest in 'sustainable remediation' has achieved a fairly rapid consensus on concepts, descriptions and definitions for sustainable remediation, which are now being incorporated into an ISO standard. However the sustainability assessment methods being used remain diverse with a range of (mainly) semi-quantitative and quantitative approaches and tools developed, or in development. Sustainability assessment is site specific and subjective. It depends on the inclusion of a wide range of considerations across different stakeholder perspectives. Taking a tiered approach to sustainability assessment offers important advantages, starting from a qualitative assessment and moving through to semi-quantitative and quantitative assessments on an 'as required' basis only. It is also clear that there are a number of 'easy wins' that could improve performance against sustainability criteria right across the site management process. SuRF-UK has provided a checklist of 'sustainable management practices' that describes some of these. This paper provides the rationale for, and an outline of, and recently published SuRF-UK guidance on preparing for and framing sustainability assessments; carrying out qualitative sustainability assessment; and simple good management practices to improve sustainability across contaminated land management activities. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

Parliamentary privilege--mortality in members of the Houses of Parliament compared with the UK general population: retrospective cohort analysis, 1945-2011.

PubMed

Dennis, John; Crayford, Tim

2015-12-14

To examine mortality in members of the two UK Houses of Parliament compared with the general population, 1945-2011. Retrospective cohort analysis of death rates and predictors of mortality in Members of Parliament (MPs) and members of the House of Lords (Lords). UK. 4950 MPs and Lords first joining the UK parliament in 1945-2011. Standardised mortality ratios, comparing all cause death rates of MPs and Lords from first election or appointment with those in the age, sex, and calendar year matched general population. Between 1945 and 2011, mortality was lower in MPs (standardised mortality ratio 0.72, 95% confidence interval 0.67 to 0.76) and Lords (0.63, 0.60 to 0.67) than in the general population. Over the same period, death rates among MPs also improved more quickly than in the general population. For every 100 expected deaths, 22 fewer deaths occurred among MPs first elected in 1990-99 compared with MPs first elected in 1945-49. Labour party MPs had 19% higher death rates compared with the general population than did Conservative MPs (relative mortality ratio 1.19, 95% confidence interval 1.01 to 1.40). The effect of political party on mortality disappeared when controlling for education level. From 1945 to 2011, MPs and Lords experienced lower mortality than the UK general population, and, at least until 1999, the mortality gap between newly elected MPs and the general population widened. Even among MPs, educational background was an important predictor of mortality, and education possibly explains much of the mortality difference between Labour and Conservative MPs. Social inequalities are alive and well in UK parliamentarians, and at least in terms of mortality, MPs are likely to have never had it so good. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Who attends a UK diabetes screening programme? Findings from the ADDITION-Cambridge study.

PubMed

Sargeant, L A; Simmons, R K; Barling, R S; Butler, R; Williams, K M; Prevost, A T; Kinmonth, A L; Wareham, N J; Griffin, S J

2010-09-01

One of the factors influencing the cost-effectiveness of population screening for Type 2 diabetes may be uptake. We examined attendance and practice- and individual-level factors influencing uptake at each stage of a diabetes screening programme in general practice. A stepwise screening programme was undertaken among 135, 825 people aged 40-69 years without known diabetes in 49 general practices in East England. The programme included a score based on routinely available data (age, sex, body mass index and prescribed medication) to identify those at high risk, who were offered random capillary blood glucose (RBG) and glycosylated haemoglobin tests. Those screening positive were offered fasting capillary blood glucose (FBG) and confirmatory oral glucose tolerance tests (OGTT). There were 33 539 high-risk individuals invited for a RBG screening test; 24 654 (74%) attended. Ninety-four per cent attended the follow-up FBG test and 82% the diagnostic OGTT. Seventy per cent of individuals completed the screening programme. Practices with higher general practitioner staff complements and those located in more deprived areas had lower uptake for RBG and FBG tests. Male sex and a higher body mass index were associated with lower attendance for RBG testing. Older age, prescription of antihypertensive medication and a higher risk score were associated with higher attendance for FBG and RBG tests. High attendance rates can be achieved by targeted stepwise screening of individuals assessed as high risk by data routinely available in general practice. Different strategies may be required to increase initial attendance, ensure completion of the screening programme, and reduce the risk that screening increases health inequalities.

Providing end-of-life care in general practice: findings of a national GP questionnaire survey.

PubMed

Mitchell, Sarah; Loew, Joelle; Millington-Sanders, Catherine; Dale, Jeremy

2016-09-01

With increasing numbers of people living with complex life-limiting multimorbidity in the community, consideration must be given to improving the organisation and delivery of high-quality palliative and end-of-life care (EOLC). To provide insight into the experience of GPs providing EOLC in the community, particularly the facilitators and barriers to good-quality care. A web-based national UK questionnaire survey circulated via the Royal College of General Practitioners, NHS, Marie Curie, and Macmillan networks to GPs. Responses were analysed using descriptive statistics and an inductive thematic analysis. Responses were received from 516 GPs, who were widely distributed in terms of practice location. Of these, 97% felt that general practice plays a key role in the delivery of care to people approaching the end of life and their families. Four interdependent themes emerged from the data: continuity of care - which can be difficult to achieve because of resource concerns including time, staff numbers, increasing primary care workload, and lack of funding; patient and family factors - with challenges including early identification of palliative care needs and recognition of the end of life, opportunity for care planning discussions, and provision of support for families; medical management - including effective symptom-control and access to specialist palliative care services; and expertise and training - the need for training and professional development was recognised to enhance knowledge, skills, and attitudes towards EOLC. The findings reveal enduring priorities for policy, commissioning, practice development, and research in future primary palliative care. © British Journal of General Practice 2016.

Influence of training changes on the stability of specialty choices of UK medical graduates: surveys of the graduates of 2002 and 2008.

PubMed

Svirko, Elena; Lambert, Trevor W; Goldacre, Michael J

2015-01-01

To explore the impact of Modernising Medical Careers (MMC) training on the stability of medical career choices in the UK. Graduates of 2002 and 2008 from all UK medical schools, 1 and 3 years postgraduation. Questionnaire surveys were conducted of 2002 and 2008 graduates from all UK medical schools 1 and 3 years post graduation. Doctors gave their specialty choice(s) and rated the influence of each of 11 factors on their career choice. 2008 graduates were a little more likely than graduates of 2002 to retain their year 1 choice in year 3 (77.3% vs. 73.3%; p = 0.002). Among 2008 graduates, the percentage retaining their year 1 choice varied between 42% (clinical oncology) and 79% (general practice). Enthusiasm for a specialty, student experience and inclinations before medical school were associated with choice retention; consideration of domestic circumstances and hours/working conditions were associated with changes of choice. 2008 graduates were more likely than 2002s to be influenced by enthusiasm for a specialty, self-appraisal of their skills, working hours and their domestic circumstances; and less likely to be influenced by their experience of jobs, a particular teacher/department or eventual financial prospects. Post-MMC, graduates were less likely to change their career choice and more likely to be motivated by personal factors and self-assessment of their suitability to a particular area of work. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Current UK dental sedation practice and the 'National Institute for Health and Care Excellence' (NICE) guideline 112: sedation in children and young people.

PubMed

Coulthard, P; Craig, D; Holden, C; Robb, N D; Sury, M; Chopra, S; Holroyd, I

2015-04-24

Describe current dental sedation practice for under 19-year-olds in the UK and compare it with the recommendations of NICE guidance 112. Members of the Society for the Advancement of Anaesthesia in Dentistry and members of the Dental Sedation Teachers Group were invited to participate in an online survey. Two hundred and sixty-six dentists and doctors completed the survey. Eighty-two percent were operator and sedationist (operator-sedationist). Ninety-five percent provided written information and 94% obtained written consent. Eighty-four percent kept a written or electronic sedation record. Eighty-six percent complied with life support training expectations. Eighty-six percent had immediate access to resuscitation equipment. Sixty-seven percent of sedationists reported that treatment could not be completed under sedation for <10% of cases during the previous year. When sedation was unsuccessful, 61% said they would schedule general anaesthesia and 54.5% would schedule advanced sedation care. Forty-nine percent believed that a dentist was an appropriate person to provide advanced sedation for 12-18 years. Only 24% thought a dentist should provide advanced sedation for children<12 years, with 75% preferring an anaesthetist. The appropriate setting for advanced sedation was thought to be primary care by 33% and secondary care by 68%. We found good agreement between the current practice of sedation and the recommendations of the NICE guidance 112.

The collection and utilisation of patient ethnicity data in general practices and hospitals in the United Kingdom: a qualitative case study.

PubMed

Morrison, Zoe; Fernando, Bernard; Kalra, Dipak; Cresswell, Kathrin; Robertson, Ann; Sheikh, Aziz

2014-01-01

Although the collection of patient ethnicity data is a requirement of publicly funded healthcare providers in the UK, recording of ethnicity is sub-optimal for reasons that remain poorly understood. We sought to understand enablers and barriers to the collection and utilisation of ethnicity data within electronic health records, how these practices have developed and what benefit this information provides to different stakeholder groups. We undertook an in-depth, qualitative case study drawing on interviews and documents obtained from participants working as academics, managers and administrators within the UK. Information regarding patient ethnicity was collected and coded as administrative patient data, and/or in narrative form within clinical records. We identified disparities in the classification of ethnicity, approaches to coding and levels of completeness due to differing local, regional and national policies and processes. Most participants could not identify any clinical value of ethnicity information and many did not know if and when data were shared between services or used to support quality of care and research. Findings highlighted substantial variations in data classification, and practical challenges in data collection and usage that undermine the integrity of data collected. Future work needs to focus on explaining the uses of these data to frontline clinicians, identifying resources that can support busy professionals to collect standardised data and then, once collected, maximising the utility of these data.

Does a higher 'quality points' score mean better care in stroke? An audit of general practice medical records.

PubMed

Williams, Peter Huw; de Lusignan, Simon

2006-01-01

The Royal College of Physicians (RCP) have produced guidelines for stroke management in primary care; this guidance is taken to be the gold standard for the care of people with stroke. UK general practitioners now have a quality-based contract which includes a Quality and Outcomes Framework (QOF). This consists of financially remunerated 'quality points' for specific disease areas, including stroke. Achievement of these quality points is measured by extracting a limited list of computer codes from practice computer systems. To investigate whether a high stroke quality score is associated with adherence to RCP guidelines. Examination of computer and written medical records of all patients with a diagnosis of stroke. Two general practices, one in southwest London, one in Surrey, with a combined practice population of over 20 000. Both practices had a similar age-sex profile and prevalence of stroke. One practice scored 93.5% (29/31) of the available stroke quality points. The other practice achieved 73.4% (22.75/31), and only did better in one stroke quality target. However, the practice scoring fewer quality points had much better adherence to RCP guidance: 96% of patients were assessed in secondary care compared with 79% (P=0.001); 64% of stroke patients were seen the same day, compared with 44%; 56% received rehabilitation compared with 37%. Higher quality points did not reflect better adherence to RCP guidance. This audit highlights a gap between relatively simplistic measures of quality in the QOF, dependent on the recording of a narrow range of computer codes, and the actual standard of care being delivered. Research is needed to see whether this finding is generalisable and how the Quality and Outcomes Framework might be better aligned with delivering best practice.

The use of fixed appliances in the UK: a survey of specialist orthodontists.

PubMed

Banks, Phil; Elton, Victoria; Jones, Yvonne; Rice, Peter; Derwent, Serena; Odondi, Lang'o

2010-03-01

To investigate the use of fixed appliances in the UK. Prospective postal questionnaire. UK. All members of the General Dental Council Specialist List in Orthodontics still in active practice and not in training posts. A preemptive letter of explanation was sent inviting orthodontists to participate in the survey. The questionnaire was subsequently posted to 935 specialists. Data analysis investigated differences in clinical practice related to varying provider groups, level of operator experience and geographical region. The response rate achieved was 66.3%. A majority of orthodontists routinely used the 0.022 inch pre-adjusted edgewise system, standard size Siamese pattern stainless steel brackets, conventionally ligated and bonded using standard etch and light cured composite. Nickel titanium and stainless steel were the most popular archwire materials. Anchorage was supported routinely by palatal and lingual arches in up to 25% and by headgear in over a third of respondents. Newer innovations showed variable popularity. Self-etching primer was used routinely by one-third of respondents with 11% use of self-ligating brackets. Banding of first molars was preferred by over 60% of clinicians. Bone screw implants were used by only 0.2% of respondents. Clinicians with less than 10 years experience used more headgear, light curing, MBT prescription and molar bonding. Operators with over 20 years experience used more chemically cured bonding, Roth prescription, banded first molars, 0.018 inch slot size and Tip-Edge(TM), with less use of headgear. Fixed appliance use differed from that reported in the US with lower use in the UK of standard edgewise and Roth systems, aesthetic, miniaturised and 0.018 inch slot brackets and rapid maxillary expansion. Most UK orthodontic specialists routinely used the 0.022 inch pre-adjusted edgewise system with standard size Siamese steel brackets bonded using standard etch and light cured composite with conventional ligation. Variations were seen between different provider groups, types of treatment funding, levels of operator seniority and geographical regions. Differences were noted particularly in the use of bracket prescription and design, types of molar attachment and anchorage control.

The frequency and characteristics of chronic widespread pain in general practice: a case-control study.

PubMed

Rohrbeck, Jens; Jordan, Kelvin; Croft, Peter

2007-02-01

Chronic widespread pain is common in the community but is not often diagnosed in primary care. One explanation may be that widespread pain is presented and treated in primary care as multiple episodes of regional pain. To determine whether patients who consult with multiple regional pain syndromes have characteristics consistent with chronic widespread pain. Case-control study. One general practice in North Staffordshire, UK. Participants were 148 cases who consulted regularly with different musculoskeletal pains over 5 years, and 524 controls who had not consulted for musculoskeletal pain during the same period. A postal questionnaire survey and medical record review were undertaken. Cases with musculoskeletal pain reported more health problems and higher levels of fatigue than controls, and significantly worse general health and greater sleep disturbance (odds ratios 3.3. and 3.1, respectively). They generally reported more severe symptoms and consulted more frequently for a range of problems, but this was not explained by a general propensity to consult. Patients who consult in primary care with multiple regional pain syndromes have similar characteristics to those associated with chronic widespread pain and fibromyalgia. Recognising the need for general approaches to pain management, rather than treating each syndrome as a regional problem of pain, may improve the outcome in such patients.

Autoclave performance and operator knowledge of autoclave use in primary care: a survey of UK practices.

PubMed

Coulter, W A; Chew-Graham, C A; Cheung, S W; Burke, F J

2001-07-01

Changes in the delivery of health care have increased the demand for minor surgical and screening procedures in general practice. This has increased the risk of cross-infection with blood-borne viruses and the demand for sterile instruments. The aim of this study was to investigate the knowledge and training of medical personnel in England and Wales on aspects of autoclave use, and to test the effectiveness of their practice autoclaves. An anonymous postal questionnaire and autoclave performance survey using biological indicators was made of 700 general medical practitioners selected at random from FHSA lists from 12 Health Authorities in England and Wales. The overall response rate was 53.1% (N= 372) comprising 10% general practitioners and 90% practice nurses. Eighty-two percent of respondents used autoclaves with a mean age of 2.5 years, of which 91% had been serviced in the past year. While 35% of respondents made daily observation of gauges, 19% did not routinely monitor autoclave effectiveness. Six autoclaves failed to sterilize the spore test ampoules. Fourteen percent of respondents did not autoclave instruments after every patient. Only 33.1% reported wearing gloves during minor operations. Fifty five percent had training in cross-infection prevention. It was concluded that although there has been improvement in instrument decontamination procedures in general practice compared with previous surveys, further education of medical practitioners and practice nurses in the use of autoclaves and infection prevention and control is indicated. The failure of 2% of the autoclaves to kill spores suggests the need for increased monitoring of autoclave performance. Two-thirds of practitioners exposed themselves to increased risk of infection by carrying out minor surgery without the protection of gloves. Copyright 2001 The Hospital Infection Society.

Using the Theoretical Domains Framework (TDF) to understand adherence to multiple evidence-based indicators in primary care: a qualitative study.

PubMed

Lawton, Rebecca; Heyhoe, Jane; Louch, Gemma; Ingleson, Emma; Glidewell, Liz; Willis, Thomas A; McEachan, Rosemary R C; Foy, Robbie

2016-08-08

There are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier screened clinical guideline recommendations to derive a set of 'high-impact' indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. Here, we explore health professionals' perceived determinants of adherence to these indicators, examining the degree to which determinants were indicator-specific or potentially generalisable across indicators. We interviewed 60 general practitioners, practice nurses and practice managers in West Yorkshire, the UK, about adherence to four indicators: avoidance of risky prescribing; treatment targets in type 2 diabetes; blood pressure targets in treated hypertension; and anticoagulation in atrial fibrillation. Interview questions drew upon the Theoretical Domains Framework (TDF). Data were analysed using framework analysis. Professional role and identity and environmental context and resources featured prominently across all indicators whilst the importance of other domains, for example, beliefs about consequences, social influences and knowledge varied across indicators. We identified five meta-themes representing more general organisational and contextual factors common to all indicators. The TDF helped elicit a wide range of reported determinants of adherence to 'high-impact' indicators in primary care. It was more difficult to pinpoint which determinants, if targeted by an implementation strategy, would maximise change. The meta-themes broadly underline the need to align the design of interventions targeting general practices with higher level supports and broader contextual considerations. However, our findings suggest that it is feasible to develop interventions to promote the uptake of different evidence-based indicators which share common features whilst also including content-specific adaptations.

State-of-the-art techniques in operative dentistry: contemporary teaching of posterior composites in UK and Irish dental schools.

PubMed

Lynch, C D; Frazier, K B; McConnell, R J; Blum, I R; Wilson, N H F

2010-08-14

Advances of composite systems and their application have revolutionised the management of posterior teeth affected by caries, facilitating a minimally invasive approach. Previous surveys have indicated that the teaching of posterior composites within dental schools was developing, albeit not keeping pace with clinical evidence and the development of increasingly predictable techniques and materials. Concurrently, surveys of dental practice indicate that dental amalgam still predominates as the 'material of choice' for the restoration of posterior teeth within UK general dental practice. In light of such considerations, the aim of this study was to investigate current teaching of posterior composites in Irish and UK dental schools. An online questionnaire which sought information in relation to the current teaching of posterior composites was developed and distributed to the 17 established Irish and UK dental schools with undergraduate teaching programmes in late 2009. Completed responses were received from all 17 schools (response rate = 100%). All 17 schools taught the placement of occlusal and two-surface occlusoproximal composites in premolar and permanent molar teeth. Two schools did not teach placement of three-surface occlusoproximal composites in either premolars or molars. In their preclinical courses, ten schools taught posterior composites before teaching dental amalgams. Fifty-five percent of posterior restorations placed by dental students were of composite (range = 10-90%) and 44% amalgam (range = 10-90%), indicating an increase of 180% in the numbers of posterior composites placed over the past five years. Diversity was noted in the teaching of clinical techniques and students at different schools are trained with different composites and bonding systems. Some cause for concern was noted in the teaching of certain techniques that were not in keeping with existing best evidence, such as the teaching of transparent matrix bands and light-transmitting wedges for occluso-proximal composites (eight schools) and the teaching of bevels on the cavosurface enamel margins of both the occlusal and proximal box margins (three schools). The teaching of posterior composites in the Irish and UK dental schools has substantially increased over the last five years. Dental students in these schools often gain more experience in the placement of posterior composites than amalgam. However, practice trends indicate that a majority of GDPs continue to place amalgam in preference to composite, thereby suggesting a source of tension as current dental students emerge into the dental workforce over the coming years. There is, as a consequence, a challenge to the dental profession and its funding agencies in the UK to encourage more of a shift towards the minimally interventive use of composite systems in the restoration of posterior teeth, in particular among established practitioners.

Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey.

PubMed

Scobbie, Lesley; Duncan, Edward A; Brady, Marian C; Wyke, Sally

2015-01-01

We investigated the nature of services providing community-based stroke rehabilitation across the UK, and goal setting practice used within them, to inform evaluation of a goal setting and action planning (G-AP) framework. We designed, piloted and electronically distributed a survey to health professionals working in community-based stroke rehabilitation settings across the UK. We optimised recruitment using a multi-faceted strategy. Responses were analysed from 437 services. Services size, composition and input was highly variable; however, most were multi-disciplinary (82%; n = 335/407) and provided input to a mixed diagnostic group of patients (71%; n = 312/437). Ninety one percent of services (n = 358/395) reported setting goals with "all" or "most" stroke survivors. Seventeen percent (n = 65/380) reported that no methods were used to guide goal setting practice; 47% (n = 148/315) reported use of informal methods only. Goal setting practice varied, e.g. 98% of services (n = 362/369) reported routinely asking patients about goal priorities; 39% (n = 141/360) reported routinely providing patients with a copy of their goals. Goal setting is embedded within community-based stroke rehabilitation; however, practice varies and is potentially sub-optimal. Further evaluation of the G-AP framework is warranted to inform optimal practice. Evaluation design will take account of the diverse service models that exist. Implications for Rehabilitation Community-based stroke rehabilitation services across the UK are diverse and tend to see a mixed diagnostic group of patients. Goal setting is implemented routinely within community-based stroke rehabilitation services; however, practice is variable and potentially sub-optimal. Further evaluation of the G-AP framework is warranted to assess its effectiveness in practice.

Antimicrobial prescribing practice in UK equine veterinary practice.

PubMed

Hughes, L A; Pinchbeck, G; Callaby, R; Dawson, S; Clegg, P; Williams, N

2013-03-01

Antimicrobial use is known to select for the emergence of resistant strains of bacteria; therefore prudent use in both human and veterinary medicine is essential to preserve their efficacy. To characterise antimicrobial prescribing patterns in UK equine practice and evaluate factors associated with prescribing. A postal questionnaire including 4 clinical scenarios was sent to 740 veterinary surgeons that treat horses. Data were collected on the clinician, their practice and sources of information regarding antimicrobials and their use. Multivariable logistic regression analysis was used to ascertain factors associated with 5 outcomes; prescribing off-licence drugs; prescribing at incorrect doses; prescribing 3rd or 4th generation cephalosporins; prescribing fluoroquinolones and prescribing potentiated sulphonamides. Questionnaires were completed by 38% of veterinary surgeons who were sent questionnaires. Less than 1% of practices had antimicrobial use guidelines. Trimethoprim-sulphonamides were most commonly prescribed in each clinical scenario. Eleven percent of prescriptions were for antimicrobial drugs not licensed for use in horses in the UK. Five percent of prescriptions for licensed antimicrobials were under the recommended dose rate and 56% over the recommended dose rate. Fluoroquinolones and 3rd and 4th generation cephalosporins accounted for 1 and 3% of prescriptions, respectively. Veterinary surgeons working at referral practices were more likely to prescribe 3rd and 4th generation cephalosporins and fluoroquinolones and off-licence antimicrobials whereas those working in first-opinion practices were more likely to prescribe potentiated sulphonamides. Sources of information regarding antimicrobials also had an effect on prescribing. Prescription of antimicrobials at inappropriate doses was common even when provided with the weight of the animal. It is uncommon for UK equine veterinary practices to have guidelines for antimicrobial use. The introduction of such guidelines could lead to more prudent use of antimicrobials. © 2012 EVJ Ltd.

Variable implementation of good practice recommendations for the assessment and management of UK children with neurodisability.

PubMed

Gray, L; Gibbs, J; Jolleff, N; Williams, J; McConachie, H; Parr, J R

2015-11-01

The aims of this study were to determine whether UK child development teams (CDTs) have implemented good practice recommendations for the co-ordinated assessment and support of children with neurodisability and to explore some of the factors associated with variations in good practice implementation. Surveys were sent to every UK CDT in 2009/2010. Responses about CDT provision and ways of working were compared with good practice recommendations from national policy documents and professional organizations. The extent to which CDTs in England and Wales met 11 selected good practice recommendations was scored; teams in Scotland and Northern Ireland were given a score out of 9 to reflect the optional use of the common assessment framework and early support materials in these countries. Responses were received from 225/240 (94%) UK CDTs. Thirty-seven per cent of CDTs in England and Wales had implemented nine or more of the 11 recommendations. Fifty-nine per cent of teams in Scotland and 78% of teams in Northern Ireland met between six and nine recommendations of good working practice. Higher levels of implementation of recommendations were found when the CDT had a Child Development Centre base and for teams who had received increased funding in the 5 years preceding the survey. There was considerable variability in the degree to which CDTs implemented good practice recommendations for the diagnosis and management of children with neurodisability. Evidence about child and parent satisfaction, and the effectiveness of CDT practices and provision, is required, so policymakers, healthcare commissioners and clinicians can provide the most appropriate services to children with neurodisability and their families. © 2015 John Wiley & Sons Ltd.

A theoretical and practical test of geographical profiling with serial vehicle theft in a U.K. context.

PubMed

Tonkin, Matthew; Woodhams, Jessica; Bond, John W; Loe, Trudy

2010-01-01

Geographical profiling is an investigative methodology sometimes employed by the police to predict the residence of an unknown offender from the locations of his/her crimes. The validity of geographical profiling, however, has not been fully explored for certain crime types. This study, therefore, presents a preliminary test of the potential for geographical profiling with a sample of 145 serial vehicle thieves from the U.K. The behavioural assumptions underlying geographical profiling (distance decay and domocentricity) are tested and a simple practical test of profiling using the spatial mean is presented. There is evidence for distance decay but not domocentricity among the spatial behaviour of car thieves from the U.K. A degree of success was achieved when applying the spatial mean on a case-by-case basis. The level of success varied, however, and neither series length in days nor number of crimes could account for the variation. The findings question previously held assumptions regarding geographical profiling and have potential theoretical and practical implications for the study and investigation of vehicle theft in the U.K. 2009 John Wiley & Sons, Ltd.

Parental Discussion of Child Sexual Abuse: Is It Associated with the Parenting Practices of Involvement, Monitoring, and General Communication?

PubMed

Rudolph, Julia; Zimmer-Gembeck, Melanie J; Shanley, Dianne C; Walsh, Kerrryann; Hawkins, Russell

2018-01-01

We investigated whether parents who reported more positive parenting practices (i.e., monitoring, involvement, and communication) reported more discussion of child sexual abuse (CSA) with their children. Parents from Australia and the UK (N = 248), with children aged 6 to 11 years, completed an online survey. About half of parents reported directly discussing CSA, whereas 35% reported telling their children that CSA perpetrators may be family members. Rates of discussion were higher for other CSA-related topics such as body integrity and abduction. Correlational analyses showed that parents who reported speaking to their children about CSA also reported more positive parenting practices, more discussion of other sensitive topics, and assessed CSA risk for children (in general) to be higher. Discussion of CSA risk was not associated with parents' CSA knowledge, confidence or appraisal of own-child risk. Parents higher in positive parenting believed their children to be at less CSA risk. Parents who appraised higher own-child risk reported less positive parenting practices and were less confident about their parenting and their ability to protect their children from CSA. The findings are the first to report on the associations of parenting practices with parents' CSA discussion with their children.

Knowledge Exchange between Universities and the Creative Industries in the UK: A Case Study of Current Practice

ERIC Educational Resources Information Center

Ferguson, Morag

2014-01-01

The importance to the economy of knowledge exchange between universities and industry has long been recognized, and in the UK a number of initiatives are in place to support such activities. These initiatives have helped to stimulate engagement between universities and the creative industries, a sector of increasing importance to the UK economy.…

Interpretation of medical information acts by UK occupational physicians.

PubMed

Batty, Lucia; Glozier, Nick; Holland-Elliott, Kevin

2009-05-01

Difficulties arise in applying the Data Protection Act 1998 and the Access to Medical Reports Act 1988 in occupational health practice. There is no guidance on detailed aspects of applying these Acts in practice and consistent advice has proved difficult to obtain. To audit the understanding and practice of UK occupational physicians to see if a consensus view existed. A postal questionnaire sent to all UK-based Society of Occupational Medicine (SOM) members between December 2005 and June 2006. Responses were analysed using the SPSS 13.0 software. Responses were received from 726 SOM members, a response rate of 48%. The study revealed wide variation and a limited consensus in practice. Significant differences existed between doctors with a Diploma in Occupational Medicine and those with higher Faculty qualifications, between part-time and full-time practitioners and between doctors who qualified pre- and post-1974. The audit revealed wide variation in responding to clinical scenarios in relation to both the Access to Medical Reports and the Data Protection Acts. The findings have implications for clinical practice, policy and research. The majority of respondents reported that national guidance is needed.

Identifying individuals for primary cardiovascular disease prevention in UK general practice: priorities and resource implications

PubMed Central

Holt, Tim A; Thorogood, Margaret; Griffiths, Frances; Munday, Stephen; Stables, David

2008-01-01

Targeted cardiovascular disease prevention relies on risk-factor information held in primary care records. A risk algorithm, the ‘e-Nudge’, was applied to data from a population of ≥50-year-olds in 19 West Midlands practices, to identify those individuals at risk of cardiovascular disease. Altogether, 5.9% were identified aged 50–74 years at ≥20% 10-year risk based on existing data, and a further 26.4% were potentially at risk but had missing risk-factor information; 9.2% of patients aged over 50 years with established cardiovascular disease had at least one modifiable risk factor outside the audit target of the Quality and Outcomes Framework. Implications for resource allocation are discussed. PMID:18611316

University Knowledge Exchange (KE) Framework: Good Practice in Technology Transfer. Report to the UK Higher Education Sector and HEFCE by the McMillan Group

ERIC Educational Resources Information Center

Higher Education Funding Council for England, 2016

2016-01-01

As part of its commitment to keeping the UK at the leading edge as a global knowledge-based economy, the last Government asked the Higher Education Funding Council for England (HEFCE) in 2014 to develop a knowledge exchange (KE) performance framework that would secure effective practice in universities on key productive elements in the…

Provision and practice of specialist preterm labour clinics: a UK survey of practice.

PubMed

Sharp, A N; Alfirevic, Z

2014-03-01

To identify the current status of specialist preterm labour (PTL) clinic provision and management within the UK. Postal survey of clinical practice. All consultant-led obstetric units within the UK. A questionnaire was sent by post to all 210 NHS consultant-led obstetric units within the UK. Units that had a specialist PTL clinic were asked to complete a further 20 questions defining their protocol for risk stratification and management. Current practice in specialist preterm labour clinics. We have identified 23 specialist clinics; the most common indications for attendance were previous PTL (100%), preterm prelabour rupture of membranes (95%), two large loop excisions of the transformation zone (95%) or cone biopsy (95%). There was significant heterogeneity in the indications for and method of primary treatment for short cervix, with cervical cerclage used in 45% of units, progesterone in 18% of units and Arabin cervical pessary in 5%. A further 23% used multiple treatment modalities in combination. A significant heterogeneity in all topics surveyed suggests an urgent need for networking, more evidence-based guidelines and prospective comparative audits to ascertain the real impact of specialist PTL clinics on the reduction in preterm birth and its sequelae. © 2013 Royal College of Obstetricians and Gynaecologists.

Satisfying the patient in primary care: a postal survey following a recent consultation.

PubMed

Long, Sarah; Jiwa, Moyez

2004-05-01

Factors over and above the skills of the health care professional appear to impact on how well patients can cope with an illness following a consultation in general practice. These other factors appear to relate to the organisation and fabric of the doctor's practice. This study reports a systematic analysis of responses to a questionnaire survey of patients following a telephone consultation in a general practice setting. This study aims to explore how views on specific aspects of a general practice service contrast among patients. A structured anonymised postal questionnaire was sent to 916 patients within 24 h of a telephone consultation with a doctor or nurse in five general practices in North Trent, UK. No reminders were sent. Included on the questionnaire were free-text questions that invited opinions on areas for improvement for the patients' registered practice. These were analysed qualitatively using content analysis by two independent researchers. The overall response rate was 52% although responses from young men were under-represented in the survey. One in three responders expressed a need for improvements in the appointments, more access and less delay before practice. Five themes and a number of sub-themes were identified. Patients wanted more appointments. Other themes included a desire for better communication, more patient friendly policies and facilities. Analysis suggests that it would be very difficult to satisfy the contrasting and divergent needs of all patients. Communication with patients in general practice is influenced by the fabric, policies and reception staff in the practice as much as by the skills and resources of the care provider. Seeking patients' opinions about the practice within the context of a recent telephone consultation unearthed conflicting desires that cannot be satisfied given existing resources in the National Health Service (NHS). Patients favour a speedy, convenient and above all, tailored service. This may be impossible to deliver universally. Attention to the non-doctor aspects of the service may enhance the ability of practitioners to enable patients to cope with illness. The data suggest that patients are not universally satisfied with the service provided and that it would be naive to attempt to please them all.

Training on domestic violence and child safeguarding in general practice: a mixed method evaluation of a pilot intervention.

PubMed

Lewis, Natalia V; Larkins, Cath; Stanley, Nicky; Szilassy, Eszter; Turner, William; Drinkwater, Jessica; Feder, Gene S

2017-03-04

Children's exposure to domestic violence is a type of child maltreatment, yet many general practice clinicians remain uncertain of their child safeguarding responsibilities in the context of domestic violence. We developed an evidence-based pilot training on domestic violence and child safeguarding for general practice teams. The aim of this study was to test and evaluate its feasibility, acceptability and the direction of change in short-term outcome measures. We used a mixed method design which included a pre-post questionnaire survey, qualitative analysis of free-text comments, training observations, and post-training interviews with trainers and participants. The questionnaire survey used a validated scale to measure participants' knowledge, confidence/ self-efficacy, and beliefs/ attitudes towards domestic violence and child safeguarding in the context of domestic violence. Eleven UK general practices were recruited (response rate 55%) and 88 clinicians attended the pilot training. Thirty-seven participants (42%) completed all pre-post questionnaires and nine were interviewed. All training sessions were observed. All six trainers were interviewed. General practice clinicians valued the training materials and teaching styles, opportunities for reflection and delivery by local trainers from both health and children's social services. The training elicited positive changes in total outcome score and knowledge and confidence/ self-efficacy sub scores which remained at 3-month follow up. However, the mean sub score of beliefs and attitudes did not change and the qualitative results were mixed. Two interviewees described changes in their clinical practice. Participants' suggestions for improving the training included incorporating more ethnic and class diversity in the material, using cases with multiple socio economic disadvantages, and addressing multi-agency collaboration in the context of changing and under-resourced services for children. The pilot training for general practice on child safeguarding in the context of domestic violence was feasible and acceptable. It elicited positive changes in clinicians' knowledge and confidence/ self-esteem. The extent to which clinical behaviour changed is unclear, but there are indications of changes in practice by some clinicians. The pilot training requires further refinement and evaluation before implementation.

Practical skills teaching in contemporary surgical education: how can educational theory be applied to promote effective learning?

PubMed

Sadideen, Hazim; Kneebone, Roger

2012-09-01

Teaching practical skills is a core component of undergraduate and postgraduate surgical education. It is crucial to optimize our current learning and teaching models, particularly in a climate of decreased clinical exposure. This review explores the role of educational theory in promoting effective learning in practical skills teaching. Peer-reviewed publications, books, and online resources from national bodies (eg, the UK General Medical Council) were reviewed. This review highlights several aspects of surgical education, modeling them on current educational theory. These include the following: (1) acquisition and retention of motor skills (Miller's triangle; Fitts' and Posner's theory), (2) development of expertise after repeated practice and regular reinforcement (Ericsson's theory), (3) importance of the availability of expert assistance (Vygotsky's theory), (4) learning within communities of practice (Lave and Wenger's theory), (5) importance of feedback in learning practical skills (Boud, Schon, and Endes' theories), and (6) affective component of learning. It is hoped that new approaches to practical skills teaching are designed in light of our understanding of educational theory. Copyright © 2012 Elsevier Inc. All rights reserved.

The evidence-based practice profiles of academic and clinical staff involved in pre-registration nursing students' education: a cross sectional survey of US and UK staff.

PubMed

Upton, Penney; Scurlock-Evans, Laura; Williamson, Kathleen; Rouse, Joanne; Upton, Dominic

2015-01-01

Competency in evidence-based practice (EBP) is a requirement for graduate nurses. Despite a growing body of research exploring the EBP profiles of students, little research has explored the EBP profiles of nurse educators. To explore: the differences/similarities in the EBP profiles of US and UK clinical and academic faculty; the barriers nurse educators experience when teaching EBP; the impact of postgraduate education on EBP profile and; what nurse educators perceive "success" in implementing and teaching EBP to be. A cross-sectional online survey design was employed. Two Universities delivering undergraduate nursing education in the US and UK, in partnership with large hospital systems, small community hospitals, community settings, and independent sector health organisations. Eighty-one nurse educators working in academic and clinical contexts in the US and UK (US academic=12, US clinical=17, UK academic=9, UK clinical=43) were recruited opportunistically. Participants were emailed a weblink to an online survey, comprising demographic questions, the Evidence-Based Practice Questionnaire and open-ended questions about EBP barriers, facilitators and successes. Quantitative results indicated that academic faculty scored significantly higher on knowledge and skills of EBP, than clinical faculty, but revealed no other significant differences on EBP use or attitudes, or between US and UK professionals. Participants with postgraduate training scored significantly higher on EBP knowledge/skills, but not EBP attitudes or use. Qualitative findings identified key themes relating to EBP barriers and facilitators, including: Evidence-, organisational-, and teaching-related issues. Perceptions of successes in EBP were also described. Nurse educators working in the UK and US face similar EBP barriers to teaching and implementation, but view it positively and use it frequently. Clinical staff may require extra support to maintain their EBP knowledge and skills in comparison to staff working in academic contexts. Copyright © 2014 Elsevier Ltd. All rights reserved.

Randomised controlled trial of exercise to prevent shoulder problems in women undergoing breast cancer treatment: study protocol for the prevention of shoulder problems trial (UK PROSPER)

PubMed Central

Williamson, Esther; Lait, Clare; Richmond, Helen; Betteley, Lauren; Lall, Ranjit; Petrou, Stavros; Rees, Sophie; Withers, Emma J; Lamb, Sarah E; Thompson, Alastair M

2018-01-01

Musculoskeletal shoulder problems are common after breast cancer treatment. Early postoperative exercises targeting the upper limb may improve shoulder function. This protocol describes a National Institute for Health Research-funded randomised controlled trial (RCT) to evaluate the clinical and cost-effectiveness of an early supervised structured exercise programme compared with usual care, for women at high risk of developing shoulder problems after breast cancer surgery. Methods This pragmatic two-armed, multicentre RCT is underway within secondary care in the UK. PRevention Of Shoulder ProblEms tRial (PROSPER) aims to recruit 350 women from approximately 15 UK centres with follow-up at 6 weeks, 6 and 12 months after randomisation. Recruitment processes and intervention development were optimised through qualitative research during a 6-month internal pilot phase. Participants are randomised to the PROSPER intervention or best practice usual care only. The PROSPER intervention is delivered by physiotherapists and incorporates three main components: shoulder-specific exercises targeting range of movement and strength; general physical activity and behavioural strategies to encourage adherence and support exercise behaviour. The primary outcome is upper arm function assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at 12 months postrandomisation. Secondary outcomes include DASH subscales, acute and chronic pain, complications, health-related quality of life and healthcare resource use. We will interview a subsample of 20 participants to explore their experiences of the trial interventions. Discussion The PROSPER study is the first multicentre UK clinical trial to investigate the clinical and cost-effectiveness of supported exercise in the prevention of shoulder problems in high-risk women undergoing breast cancer surgery. The findings will inform future clinical practice and provide valuable insight into the role of physiotherapy-supported exercise in breast cancer rehabilitation. Protocol version Version 2.1; dated 11 January 2017 Trial registration number ISRCTN35358984; Pre-results. PMID:29574439

Mentoring overseas nurses: barriers to effective and non-discriminatory mentoring practices.

PubMed

Allan, Helen

2010-09-01

In this article it is argued that there are barriers to effective and non-discriminatory practice when mentoring overseas nurses within the National Health Service (NHS) and the care home sector. These include a lack of awareness about how cultural differences affect mentoring and learning for overseas nurses during their period of supervised practice prior to registration with the UK Nursing and Midwifery Council. These barriers may demonstrate a lack of effective teaching of ethical practice in the context of cultural diversity in health care. This argument is supported by empirical data from a national study. Interviews were undertaken with 93 overseas nurses and 24 national and 13 local managers and mentors from six research sites involving UK health care employers in the NHS and independent sectors in different regions of the UK. The data collected showed that overseas nurses are discriminated against in their learning by poor mentoring practices; equally, from these data, it appears that mentors are ill-equipped by existing mentor preparation programmes to mentor overseas-trained nurses from culturally diverse backgrounds. Recommendations are made for improving mentoring programmes to address mentors' ability to facilitate learning in a culturally diverse workplace and thereby improve overseas nurses' experiences of their supervised practice.

Declining incidence of chickenpox in the absence of universal childhood immunisation

PubMed Central

Lowe, G; Salmon, R; Thomas, D; Evans, M

2004-01-01

Objective: To examine the epidemiology of chickenpox in Wales from 1986 to 2001. Design: Descriptive analysis of chickenpox consultations reported by the Welsh general practice sentinel surveillance scheme for infectious diseases, compared with annual shingles consultation rates from the same scheme to exclude reporting fatigue and data from a general practice morbidity database to validate results. Setting: A total of 226 884 patients registered with one of 30 volunteer general practices participating in the sentinel surveillance scheme. Main outcome measures: Age standardised and age specific incidence of chickenpox. Results: Crude and age standardised consultation rates for chickenpox declined from 1986 to 2001, with loss of epidemic cycling. Rates remained stable in 0–4 year olds but declined in all older age groups, particularly those aged 5–14 years. Shingles consultation rates remained constant over the same period. Data from the morbidity database displayed similar trends. Conclusion: General practitioner consultation rates for chickenpox are declining in Wales except in pre-school children. These findings are unlikely to be a reporting artefact but may be explained either by an overall decline in transmission or increased social mixing in those under 5 years old, through formal child care and earlier school entry, and associated increasing rates of mild or subclinical infection in this age group. Further investigation, particularly by serological surveillance, is necessary before universal varicella immunisation can be considered in the UK. PMID:15383443

On-Demand Testing and Maintaining Standards for General Qualifications in the UK Using Item Response Theory: Possibilities and Challenges

ERIC Educational Resources Information Center

He, Qingping

2012-01-01

Background: Although on-demand testing is being increasingly used in many areas of assessment, it has not been adopted in high stakes examinations like the General Certificate of Secondary Education (GCSE) and General Certificate of Education Advanced level (GCE A level) offered by awarding organisations (AOs) in the UK. One of the major issues…

Perceptions of the benefits and challenges of the role of advanced practice nurses in nurse-led out-of-hours care in Hong Kong: a questionnaire study.

PubMed

Christiansen, Angela; Vernon, Veronica; Jinks, Annette

2013-04-01

The aim of the study was to identify the factors that nurses perceive may facilitate or hinder the development of advanced practice nurse roles in Hong Kong. Advanced practice nurses are increasingly prominent in nurse-led out-of-hours care in Hong Kong in response to changes to junior doctors' hours of work. Three five-day workshops for Hong Kong-based advanced practice nurses were offered in partnership with UK clinicians. The aim of the workshops was to share UK experiences of implementation of the 'Hospital at Night' model of care delivery. The questionnaire study undertaken was not part of the workshop programme. However, the workshops gave the authors a unique opportunity to access relatively large numbers of Hong Kong-based advanced practice nurses. The workshops were attended by experienced nurses who had been or were about to be appointed as advanced practice nurses. All nurses who attended one of the three workshops (n=120) agreed to participate in the study. Responses to two open questions posed in the questionnaire were the subject of a content analysis. A prominent finding of the study was that respondents viewed the benefits of introducing advanced practice nurse roles in Hong Kong as outweighing any challenges. One of the main features of the perceived benefits relates to improving the quality and safety of patient care. The greatest challenges associated with the role related to acceptance of the role by other healthcare professionals, and difficulties associated with the general public's traditional attitudes to healthcare provision in Hong Kong. Education of the public concerning the implementation of such roles is of crucial importance. Findings from this study enhance understanding of the factors that hinder or facilitate advanced practice roles in out-of-hours care in Hong Kong. © 2012 Blackwell Publishing Ltd.

Stroke care conference.

PubMed

Watkins, Caroline

2016-10-28

The 11th UK Stroke Forum Conference, hosted by the Stroke Association, is the largest stroke conference in the UK. It aims to provide nurses and other healthcare professionals with opportunities to share learning and best practice in stroke care and rehabilitation.

Food hygiene training in the UK: time for a radical re-think?

PubMed

MacAuslan, E

2001-12-01

Training food handlers in the hospitality industry has been recommended by various organisations as a means of improving food handling practices and thus the safety of food for consumers. It is nearly 20 years since the first examinations for basic level food hygiene certificates were made available to food handlers in the UK. Since then little has changed in the syllabuses and in the way the questions are worded. However, the range of languages spoken by food handlers working in the UK has increased substantially since more employers are recruiting those who speak English as a second language. Training can be an unwelcome expense for managers where there is a high turnover of employees, especially amongst those for whom English is not a first language. To improve practical implementation of food hygiene theory it is time to develop a radical strategy concerning the way training is targeted and delivered in the UK, and perhaps Europe.

Lessons from America? US magnet hospitals and their implications for UK nursing.

PubMed

Buchan, J

1994-02-01

This paper examines possible implications of the US 'magnet hospital' concept for the UK nursing labour market. Magnet hospitals have been researched in the US and have been demonstrated to exhibit lower nurse turnover and higher levels of reported job satisfaction than other hospitals. Key characteristics include a decentralized organizational structure, a commitment to flexible working hours, an emphasis on professional autonomy and development, and systematic communication between management and staff. The paper examines the labour market characteristics of UK nurses and US nurses and finds many similarities. Detailed case studies of employment practice in 10 US hospitals and 10 Scottish hospitals are reported, with specific attention to remuneration practice, methods of organizing nursing care, establishment-setting and flexible hours. The paper concludes that there are features of the magnet hospital concept which are of relevance and applicable to the UK nursing labour market, but that piecemeal importation of ideas is unlikely to be beneficial.

Adherence to guidelines for creatinine and potassium monitoring and discontinuation following renin-angiotensin system blockade: a UK general practice-based cohort study.

PubMed

Schmidt, Morten; Mansfield, Kathryn E; Bhaskaran, Krishnan; Nitsch, Dorothea; Sørensen, Henrik Toft; Smeeth, Liam; Tomlinson, Laurie A

2017-01-09

To examine adherence to serum creatinine and potassium monitoring and discontinuation guidelines following initiation of treatment with ACE inhibitors (ACEI) or angiotensin receptor blockers (ARBs); and whether high-risk patients are monitored. A general practice-based cohort study using electronic health records from the UK Clinical Practice Research Datalink and Hospital Episode Statistics. UK primary care, 2004-2014. 223 814 new ACEI/ARB users. Proportion of patients with renal function monitoring before and after ACEI/ARB initiation; creatinine increase ≥30% or potassium levels >6 mmol/L at first follow-up monitoring; and treatment discontinuation after such changes. Using logistic regression models, we also examined patient characteristics associated with these biochemical changes, and with follow-up monitoring within the guideline recommendation of 2 weeks after treatment initiation. 10% of patients had neither baseline nor follow-up monitoring of creatinine within 12 months before and 2 months after initiation of an ACEI/ARB, 28% had monitoring only at baseline, 15% only at follow-up, and 47% both at baseline and follow-up. The median period between the most recent baseline monitoring and drug initiation was 40 days (IQR 12-125 days). 34% of patients had baseline creatinine monitoring within 1 month before initiating therapy, but <10% also had the guideline-recommended follow-up test recorded within 2 weeks. Among patients experiencing a creatinine increase ≥30% (n=567, 1.2%) or potassium level >6 mmol/L (n=191, 0.4%), 80% continued treatment. Although patients with prior myocardial infarction, hypertension or baseline potassium >5 mmol/L were at high risk of ≥30% increase in creatinine after ACEI/ARB initiation, there was no evidence that they were more frequently monitored. Only one-tenth of patients initiating ACEI/ARB therapy receive the guideline-recommended creatinine monitoring. Moreover, the vast majority of the patients fulfilling postinitiation discontinuation criteria for creatinine and potassium increases continue on treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Receptionists' role in new approaches to consultations in primary care: a focused ethnographic study.

PubMed

Brant, Heather Dawn; Atherton, Helen; Bikker, Annemieke; Porqueddu, Tania; Salisbury, Chris; McKinstry, Brian; Campbell, John; Gibson, Andy; Ziebland, Sue

2018-06-04

The receptionist is pivotal to the smooth running of general practice in the UK, communicating with patients and booking appointments. The authors aimed to explore the role of the receptionist in the implementation of new approaches to consultations in primary care. The authors conducted a team-based focused ethnography. Three researchers observed eight general practices across England and Scotland between June 2015 and May 2016. Interviews were conducted with 39 patients and 45 staff in the practices, all of which had adopted one or more methods (telephone, email, e-consultation, or internet video) for providing an alternative to face-to-face consultation. Receptionists have a key role in facilitating patient awareness regarding new approaches to consultations in primary care, while at the same time ensuring that patients receive a consultation appropriate to their needs. In this study, receptionists' involvement in implementation and planning for the introduction of alternative approaches to face-to-face consultations was minimal, despite the expectation that they would be involved in delivery. A shared understanding within practices of the potential difficulties and extra work that might ensue for reception staff was lacking. This might contribute to the low uptake by patients of potentially important innovations in service delivery. Involvement of the wider practice team in planning and piloting changes, supporting team members through service reconfiguration, and providing an opportunity to discuss and contribute to modifications of any new system would ensure that reception staff are suitably prepared to support the introduction of a new approach to consultations. © British Journal of General Practice 2018.

Identifying patients with undetected colorectal cancer: an independent validation of QCancer (Colorectal).

PubMed

Collins, G S; Altman, D G

2012-07-10

Early identification of colorectal cancer is an unresolved challenge and the predictive value of single symptoms is limited. We evaluated the performance of QCancer (Colorectal) prediction model for predicting the absolute risk of colorectal cancer in an independent UK cohort of patients from general practice records. A total of 2.1 million patients registered with a general practice surgery between 01 January 2000 and 30 June 2008, aged 30-84 years (3.7 million person-years) with 3712 colorectal cancer cases were included in the analysis. Colorectal cancer was defined as incident diagnosis of colorectal cancer during the 2 years after study entry. The results from this independent and external validation of QCancer (Colorectal) prediction model demonstrated good performance data on a large cohort of general practice patients. QCancer (Colorectal) had very good discrimination with an area under the ROC curve of 0.92 (women) and 0.91 (men), and explained 68% (women) and 66% (men) of the variation. QCancer (Colorectal) was well calibrated across all tenths of risk and over all age ranges with predicted risks closely matching observed risks. QCancer (Colorectal) appears to be a useful tool for identifying undetected cases of undiagnosed colorectal cancer in primary care in the United Kingdom.

Prescribing for pain--how do nurses contribute? A national questionnaire survey.

PubMed

Stenner, Karen; Carey, Nicola; Courtenay, Molly

2012-12-01

To provide information on the profile and practice of nurses in the UK who prescribe medication for pain. Pain is widely under-reported and under-treated and can have negative consequences for health and psychosocial well-being. Indications are that nurses can improve treatment and access to pain medications when they prescribe. Whilst nurses working in many practice areas treat patients with pain, little is known about the profile, prescribing practice or training needs of these nurses. A descriptive questionnaire survey. An online questionnaire was used to survey 214 nurses who prescribed for pain in the UK between May and July 2010. Data were analysed using descriptive statistics and non-parametric tests. Half the participants (50%) worked in primary care, 32% in secondary care and 14% worked across care settings. A range of services were provided, including general practice, palliative care, pain management, emergency care, walk-in-centres and out-of-hours. The majority (86%) independently prescribed 1-20 items per week. Non-opioid and weak opioids analgesics were prescribed by most (95%) nurses, whereas fewer (35%) prescribed strong opioids. Training in pain had been undertaken by 97% and 82% felt adequately trained, although 28% had problems accessing training. Those with specialist training prescribed a wider range of pain medications, were more likely to prescribe strong opioids and were more often in pain management roles. Nurses prescribe for pain in a range of settings with an emphasis on the treatment of minor ailments and acute pain. A range of medications are prescribed, and most nurses have access to training. The nursing contribution to pain treatment must be acknowledged within initiatives to improve pain management. Access to ongoing training is required to support nurse development in this area of practice to maximise benefits. © 2012 Blackwell Publishing Ltd.

Cataloguing E-Books in UK Higher Education Libraries: Report of a Survey

ERIC Educational Resources Information Center

Belanger, Jacqueline

2007-01-01

Purpose: The purpose of this paper is to discuss the results of a 2006 survey of UK Higher Education OPACs in order to provide a snapshot of cataloguing practices for e-books. Design/methodology/approach: The OPACs of 30 UK HE libraries were examined in July/August 2006 to determine which e-books were catalogued, and the level of cataloguing…

The Impact of Peer Mentoring on Levels of Student Wellbeing, Integration and Retention: A Controlled Comparative Evaluation of Residential Students in UK Higher Education

ERIC Educational Resources Information Center

Collings, R.; Swanson, V.; Watkins, R.

2014-01-01

Peer mentoring is becoming increasingly popular in UK higher education, however, there remains little good quality, theoretically driven and evaluative research. The current study aims to bridge the gap between theory, practice and evaluation by providing a controlled evaluation of a peer mentoring scheme within UK universities. 109 first year…

Non-face-to-face consultations and communications in primary care: the role and perspective of general practice managers in Scotland.

PubMed

Hanna, Lisa; May, Carl; Fairhurst, Karen

2011-01-01

Practice managers play an important role in the organisation and delivery of primary care, including uptake and implementation of technologies. Little is currently known about practice managers' attitudes to the use of information and communication technologies, such as email or text messaging, to communicate or consult with patients. To investigate practice managers' attitudes to non-face-to-face consultation/communication technologies in the routine delivery of primary care and their role in the introduction and normalisation of these technologies. We carried out a mixed-methods study in Scotland, UK. We invited all practice managers in Scotland to take part in a postal questionnaire survey. A maximum variation sample of 20 survey respondents participated subsequently in in-depth qualitative interviews. Practice managers supported the use of new technologies for routine tasks to manage workload and maximise convenience for patients, but a range of contextual factors such as practice list size, practice deprivation area and geographical location affected whether managers would pursue the introduction of these technologies in the immediate future. The most common objections were medico-legal concerns and lack of perceived patient demand. Practice managers are likely to play a central role in the introduction of new consultation/communication technologies within general practice. They hold varying views on the appropriateness of these technologies, influenced by a complex mix of contextual characteristics. Managers from areas in which the ethos of the practice prioritises personalised care in service delivery are less enthusiastic about the adoption of remote consultation/communication technologies.

A Comparative Review of Policy and Practice for Education for Sustainable Development/Education for Global Citizenship (ESD/GC) in Teacher Education across the Four Nations of the UK

ERIC Educational Resources Information Center

Bamber, Philip; Bullivant, Andrea; Glover, Alison; King, Betsy; McMcCann, Gerard

2016-01-01

The early 21st century has seen a period of extreme turbulence in education at all levels in the UK. Although education policy was administrated on a territorial basis before 1999, the 1998-1999 devolution settlement has amplified the complexity of education policy and practice across England, Wales, Scotland, and Northern Ireland. Through a…

The impact of General Dental Council registration and continuing professional development on UK dental care professionals: (1) dental nurses.

PubMed

Turner, S; Ross, M K; Ibbetson, R J

2012-07-27

To investigate the impact of GDC registration and mandatory CPD on dental nurses' views, job satisfaction and intention to leave. Postal/online survey, conducted in parallel with a survey of dental technicians. UK private and NHS practices, community services, dental hospitals. Representative sample of General Dental Council registrants. Job satisfaction; intention to leave profession (dependent variable in regression analysis). Eleven were ineligible (left profession, moved abroad); 267 (44% of those eligible) responded, all female. Respondents' mean age was 38.2 years (sd 10.74). The general principle of registration was endorsed by 67%, and compulsory registration by 51%, but the fee level by only 6%. Most nurses did not feel that registration had affected their view of dental nursing as a career (56%), their role (74%) or status (86%) within the dental team, or that CPD helped them to do their job better (76%). Fifty-six percent were not satisfied with their job, and 22% intended to leave the profession. Intention to leave was predicted by younger age and greater dissatisfaction with physical working conditions and opportunities to progress. Widely held criticisms regarding the costs and relevance of registration and CPD coupled with a potentially high level of attrition from the profession suggest a review of the fee and salary structure and greater financial support for CPD is warranted.

Instrument development, data collection, and characteristics of practices, staff, and measures in the Improving Quality of Care in Diabetes (iQuaD) Study.

PubMed

Eccles, Martin P; Hrisos, Susan; Francis, Jill J; Stamp, Elaine; Johnston, Marie; Hawthorne, Gillian; Steen, Nick; Grimshaw, Jeremy M; Elovainio, Marko; Presseau, Justin; Hunter, Margaret

2011-06-09

Type 2 diabetes is an increasingly prevalent chronic illness and an important cause of avoidable mortality. Patients are managed by the integrated activities of clinical and non-clinical members of primary care teams. This study aimed to: investigate theoretically-based organisational, team, and individual factors determining the multiple behaviours needed to manage diabetes; and identify multilevel determinants of different diabetes management behaviours and potential interventions to improve them. This paper describes the instrument development, study recruitment, characteristics of the study participating practices and their constituent healthcare professionals and administrative staff and reports descriptive analyses of the data collected. The study was a predictive study over a 12-month period. Practices (N = 99) were recruited from within the UK Medical Research Council General Practice Research Framework. We identified six behaviours chosen to cover a range of clinical activities (prescribing, non-prescribing), reflect decisions that were not necessarily straightforward (controlling blood pressure that was above target despite other drug treatment), and reflect recommended best practice as described by national guidelines. Practice attributes and a wide range of individually reported measures were assessed at baseline; measures of clinical outcome were collected over the ensuing 12 months, and a number of proxy measures of behaviour were collected at baseline and at 12 months. Data were collected by telephone interview, postal questionnaire (organisational and clinical) to practice staff, postal questionnaire to patients, and by computer data extraction query. All 99 practices completed a telephone interview and responded to baseline questionnaires. The organisational questionnaire was completed by 931/1236 (75.3%) administrative staff, 423/529 (80.0%) primary care doctors, and 255/314 (81.2%) nurses. Clinical questionnaires were completed by 326/361 (90.3%) primary care doctors and 163/186 (87.6%) nurses. At a practice level, we achieved response rates of 100% from clinicians in 40 practices and > 80% from clinicians in 67 practices. All measures had satisfactory internal consistency (alpha coefficient range from 0.61 to 0.97; Pearson correlation coefficient (two item measures) 0.32 to 0.81); scores were generally consistent with good practice. Measures of behaviour showed relatively high rates of performance of the six behaviours, but with considerable variability within and across the behaviours and measures. We have assembled an unparalleled data set from clinicians reporting on their cognitions in relation to the performance of six clinical behaviours involved in the management of people with one chronic disease (diabetes mellitus), using a range of organisational and individual level measures as well as information on the structure of the practice teams and across a large number of UK primary care practices. We would welcome approaches from other researchers to collaborate on the analysis of this data.

Utilizing research in practice and generating evidence from practice.

PubMed

Learmonth, A M

2000-12-01

This paper gives an overview of evidence-based practice in health promotion, with reference mainly to the National Health Service (NHS) context within the UK, but with wider international relevance. It starts by looking at the tensions raised at the interface of the two activities of research and health promotion. It goes on to explore two aspects of evidence-based practice: incorporating research evidence into health promotion activity and developing robustly evaluated practice in such a way as to feed the developing research agenda. Each of these two aspects is explored using a specific example, from within the UK. Finally, the paper goes on to make eight recommendations that taken together would help create an iterative process contributing to the development of health promotion theory and practice.

Accuracy of SIAscopy for pigmented skin lesions encountered in primary care: development and validation of a new diagnostic algorithm.

PubMed

Emery, Jon D; Hunter, Judith; Hall, Per N; Watson, Anthony J; Moncrieff, Marc; Walter, Fiona M

2010-09-25

Diagnosing pigmented skin lesions in general practice is challenging. SIAscopy has been shown to increase diagnostic accuracy for melanoma in referred populations. We aimed to develop and validate a scoring system for SIAscopic diagnosis of pigmented lesions in primary care. This study was conducted in two consecutive settings in the UK and Australia, and occurred in three stages: 1) Development of the primary care scoring algorithm (PCSA) on a sub-set of lesions from the UK sample; 2) Validation of the PCSA on a different sub-set of lesions from the same UK sample; 3) Validation of the PCSA on a new set of lesions from an Australian primary care population. Patients presenting with a pigmented lesion were recruited from 6 general practices in the UK and 2 primary care skin cancer clinics in Australia. The following data were obtained for each lesion: clinical history; SIAscan; digital photograph; and digital dermoscopy. SIAscans were interpreted by an expert and validated against histopathology where possible, or expert clinical review of all available data for each lesion. A total of 858 patients with 1,211 lesions were recruited. Most lesions were benign naevi (64.8%) or seborrhoeic keratoses (22.1%); 1.2% were melanoma. The original SIAscopic diagnostic algorithm did not perform well because of the higher prevalence of seborrhoeic keratoses and haemangiomas seen in primary care. A primary care scoring algorithm (PCSA) was developed to account for this. In the UK sample the PCSA had the following characteristics for the diagnosis of 'suspicious': sensitivity 0.50 (0.18-0.81); specificity 0.84 (0.78-0.88); PPV 0.09 (0.03-0.22); NPV 0.98 (0.95-0.99). In the Australian sample the PCSA had the following characteristics for the diagnosis of 'suspicious': sensitivity 0.44 (0.32-0.58); specificity 0.95 (0.93-0.97); PPV 0.52 (0.38-0.66); NPV 0.95 (0.92-0.96). In an analysis of lesions for which histological diagnosis was available (n = 111), the PCSA had a significantly greater Area Under the Curve than the 7-point checklist for the diagnosis of melanoma (0.83; 95% CI 0.71-0.95 versus 0.61; 95% CI 0.44-0.78; p = 0.02 for difference). The PCSA could have a useful role in improving primary care management of pigmented skin lesions. Further work is needed to develop and validate the PCSA in other primary care populations and to evaluate the cost-effectiveness of GP management of pigmented lesions using SIAscopy.

Rise in antiobesity drug prescribing for children and adolescents in the UK: a population-based study

PubMed Central

Viner, Russell M; Hsia, Yingfen; Neubert, Antje; Wong, Ian C K

2009-01-01

AIMS The international childhood obesity epidemic has driven increased use of unlicensed antiobesity drugs, whose efficacy and safety are poorly studied in children and adolescents. We investigated the use of unlicensed antiobesity drugs (orlistat, sibutramine and rimonabant) in children and adolescents (0–18 years) in the UK. METHODS Population-based prescribing data from the UK General Practice Research Database between 1 January 1999 and 31 December 2006. RESULTS A total of 452 subjects received 1334 prescriptions during the study period. The annual prevalence of antiobesity drug prescriptions rose significantly from 0.006 per 1000 [95% confidence interval (CI) 0.0007, 0.0113] in 1999 to 0.091 per 1000 (95% CI 0.07, 0.11) in 2006, a 15-fold increase, with similar increases seen in both genders. The majority of prescriptions were made to those ≥14 years old, although 25 prescriptions were made for children <12 years old. Orlistat accounted for 78.4% of all prescriptions; only one patient was prescribed rimonabant. However, approximately 45% of the patients ceased orlistat and 25% ceased sibutramine after only 1 month. The estimated mean treatment durations for orlistat and sibutramine were 3 and 4 months, respectively. CONCLUSIONS Prescribing of unlicensed antiobesity drugs in children and adolescents has dramatically increased in the past 8 years. The majority are rapidly discontinued before patients can see weight benefit, suggesting they are poorly tolerated or poorly efficacious when used in the general population. Further research into the effectiveness and safety of antiobesity drugs in clinical populations of children and adolescents is needed. PMID:20002078

Increasing chlamydia screening tests in general practice: a modified Zelen prospective Cluster Randomised Controlled Trial evaluating a complex intervention based on the Theory of Planned Behaviour.

PubMed

McNulty, Cliodna A M; Hogan, Angela H; Ricketts, Ellie J; Wallace, Louise; Oliver, Isabel; Campbell, Rona; Kalwij, Sebastian; O'Connell, Elaine; Charlett, Andre

2014-05-01

To determine if a structured complex intervention increases opportunistic chlamydia screening testing of patients aged 15-24 years attending English general practitioner (GP) practices. A prospective, Cluster Randomised Controlled Trial with a modified Zelen design involving 160 practices in South West England in 2010. The intervention was based on the Theory of Planned Behaviour (TPB). It comprised of practice-based education with up to two additional contacts to increase the importance of screening to GP staff and their confidence to offer tests through skill development (including videos). Practical resources (targets, posters, invitation cards, computer reminders, newsletters including feedback) aimed to actively influence social cognitions of staff, increasing their testing intention. Data from 76 intervention and 81 control practices were analysed. In intervention practices, chlamydia screening test rates were 2.43/100 15-24-year-olds registered preintervention, 4.34 during intervention and 3.46 postintervention; controls testing rates were 2.61/100 registered patients prior intervention, 3.0 during intervention and 2.82 postintervention. During the intervention period, testing in intervention practices was 1.76 times as great (CI 1.24 to 2.48) as controls; this persisted for 9 months postintervention (1.57 times as great, CI 1.27 to 2.30). Chlamydia infections detected increased in intervention practices from 2.1/1000 registered 15-24-year-olds prior intervention to 2.5 during the intervention compared with 2.0 and 2.3/1000 in controls (Estimated Rate Ratio intervention versus controls 1.4 (CI 1.01 to 1.93). This complex intervention doubled chlamydia screening tests in fully engaged practices. The modified Zelen design gave realistic measures of practice full engagement (63%) and efficacy of this educational intervention in general practice; it should be used more often. The trial was registered on the UK Clinical Research Network Study Portfolio database. UKCRN number 9722.

Functions and responsibilities of organizations dealing with surrogate motherhood in the UK.

PubMed

van Den Akker, Olga B. A.

1998-01-01

The separation of maternity from social motherhood and progress in reproductive technology raise many social, psychological, medical and legal issues (van den Akker, 1994). The most recent British Medical Association report (BMA, 1996) acknowledged the practice of surrogacy and issued new guidelines for good practice and support for those involved. Surrogate motherhood services have increased around the country over the last decade, even before the formal British Medical Association acknowledgement of their necessity and existence (BMA, 1996). The present survey investigated the incidence, accessibility, and functions of such organizations, specifically, the legal, medical and psychological problems encountered and how they were dealt with, to discover what advice and support is given. Ten centres were interviewed. The incidence of surrogacy conducted through these organizations is widespread, but the processes involved and therefore the implications of the types of surrogacy dealt with are very different. The two major surrogacy agencies deal primarily with partial surrogacy, whereas the clinics are concerned almost exclusively with full (IVF) surrogacy. Information about the procedures involved appears to rely on experience; screening is generally carried out 'in house', and psychological factors are dealt with by counsellors on request by the couples. In general, although the roles of the organizations are disparate and clearly defined, no holistic or long-term care is provided by any of the organizations involved with surrogacy in the UK. The reasons for this are clear cut and stem from the nature of the organizations, and the behaviour of the clients. The data indicate that the current procedures used by the organizations are adequate but could be improved and standardized.

A Mixed-Methods Evaluation of a Community-Based Glaucoma Check Service in Hackney, London, UK.

PubMed

Holdsworth, Elizabeth; Datta, Jessica; Marks, Dalya; Kuper, Hannah; Lee, Helen; Leamon, Shaun; Lindfield, Robert; Wormald, Richard; Clarke, Jonathan; Elkarmouty, Ahmed; Macdowall, Wendy

2017-08-01

To evaluate the uptake, feasibility and acceptability of a general practice-based optometrist-led glaucoma check service. The service targeted people of black Caribbean and black African descent aged 40-65 years, resident in Hackney, London, United Kingdom. The study used a mixed-method design, including analysis of service data, prospective audit of secondary care referrals patient survey, cost-consequence analysis, and interviews with staff involved in developing and implementing the service. A total of 3040 patients were invited to undergo the free check; 595 (19.6%) booked an appointment and 461 (15.2%) attended. Overall, 31 patients (6.8%) were referred to secondary care, of whom 22 attended and were assessed for glaucoma. Four were diagnosed with glaucoma and eight with suspected glaucoma, i.e. 2.6% of patients who underwent the check. The cost per patient identified with suspected or confirmed glaucoma was £9,013. Staff who were interviewed suggested that patients who attended might be those who routinely attended optometrist appointments, however only 62.4% of survey respondents reported having had an eye examination in the previous two years, and 11.4% of women and 16.0% of men reported never having had an eye examination. This study represents one possible configuration for a glaucoma case-finding service, and it contributes to a wider debate about whether screening, targeted or otherwise, should be offered in the UK. Our findings suggest that general practice is an acceptable setting and that such a service may reach some people not previously engaged with primary eye care services.

International developments in revenues and incomes of general practitioners from 2000 to 2010

PubMed Central

2013-01-01

Background The remuneration system of General Practitioners (GPs) has changed in several countries in the past decade. The aim of our study was: to establish the effect of these changes on the revenues and income of GPs in the first decade of the 21st century. Methods Annual GP revenue and practice costs were collected from national institutes in the eight countries included in our study (Belgium, Denmark, Finland, France, Germany, The Netherlands, Sweden, The United Kingdom (UK)) from 2000–2010. The data were corrected for inflation and purchasing power. Data on the remuneration systems and changes herein were collected from the European Observatory Health Systems Reviews and country experts. Results Comprehensive changes in the remuneration system of GPs were associated with considerable changes in GP income. Incremental changes mainly coincided with a gradual increase in income after correction for inflation. Average GP income was higher in countries with a strong primary care structure. Conclusions The gap between the countries where GPs have a lower income (Belgium, Sweden, France and Finland) and the countries where GPs have a higher income (Netherlands, Germany and the UK) continues to exist over time and appeared to be related to dimensions of primary care, such as governance and access. New payment forms, such as integrated care payment systems, and new health care professionals that are working for GPs, increasingly blur the line between practice costs and income, making it more and more important to clearly define expenditures on GPs, to remain sight on the actual income of GPs. PMID:24152337

Supporting self-care in general practice

PubMed Central

Greaves, Colin J; Campbell, John L

2007-01-01

There is both a clear need and a political will to improve self-care in long-term conditions: demand for self-care support interventions is rising. This article discusses current approaches to supporting self-care in primary care, evidence in favour of self-care support, and issues for GPs to consider in planning self-care support systems. In planning care pathways, important choices need to be made about whether to use individual or group-based approaches and what intensity of intervention is appropriate to match patient needs. Investment may also be needed in both health professional competences and practice systems to optimise their ability to support patient self-care. Self-care support is a key approach for the future of UK health care. Practices that are well trained and well organised to support self-care will respond better to the complex challenges of achieving improvements in the outcomes of long-term conditions. PMID:17925140

The ultrasound unit and infection control – Are we on the right track?

PubMed Central

Westerway, Susan C

2017-01-01

Best practice guidelines for the disinfection of ultrasound transducers and infection prevention in ultrasound departments are generally recommended by either government health groups or the ultrasound societies of individual countries. The literature shows a wide variance in not only transducer cleaning methods but basic hygiene practices in the ultrasound workplace. This paper describes results from a UK survey of disinfection of ultrasound transducers and hygiene practice in the workplace. The survey revealed that some ultrasound practitioners did not follow current guidelines with regard to the correct disinfection method of transducers, cords or ultrasound machine keyboards. Furthermore, the survey exposed the lack of training from the product manufacturers on how to use the disinfection product appropriately. These inconsistencies may be responsible for compliance issues and highlight the need for an awareness campaign and a unified approach to infection control by ultrasound practitioners. PMID:28228825

Paediatric rheumatology practice in the UK benchmarked against the British Society for Paediatric and Adolescent Rheumatology/Arthritis and Musculoskeletal Alliance Standards of Care for juvenile idiopathic arthritis.

PubMed

Kavirayani, Akhila; Foster, Helen E

2013-12-01

To describe current clinical practice against the BSPAR/ARMA Standards of Care (SOCs) for children and young people (CYP) with incident JIA. Ten UK paediatric rheumatology centres (including all current centres nationally accredited for paediatric rheumatology higher specialist training) participated in a retrospective case notes review using a pretested pro forma based on the SOC. Data collected per centre included clinical service configuration and the initial clinical care for a minimum of 30 consecutive new patients seen within the previous 2 years and followed up for at least 6 months. A total of 428 CYP with JIA (median age 11 years, range 1-21 years) were included, with complete data available for 73% (311/428). Against the key SOCs, 41% (175/428) were assessed ≤10 weeks from symptom onset, 60% (186/311) ≤4 weeks from referral, 26% (81/311) had eye screening at ≤6 weeks, 83% (282/341) had joint injections at ≤6 weeks, 59% (184/311) were assessed by a nurse specialist at ≤4 weeks and 45% (141/311) were assessed by a physiotherapist at ≤8 weeks. A median of 6% of patients per centre participated in clinical trials. All centres had access to eye screening and prescribed biologic therapies. All had access to a nurse specialist and physiotherapist. Most had access to an occupational therapist (8/10), psychologist (8/10), joint injection lists (general anaesthesia/inhaled analgesia) (9/10) and designated transitional care clinics (7/10). This first description of UK clinical practice in paediatric rheumatology benchmarked against the BSPAR/ARMA SOCs demonstrates variable clinical service delivery. Considerable delay in access to specialist care is evident and this needs to be addressed in order to improve clinical outcomes.

Regional differences in insulin therapy regimens in five European countries
.

PubMed

Rathmann, Wolfgang; Czech, Marcin; Franek, Edward; Kostev, Karel

2017-05-01

The purpose of this study was to investigate differences of insulin therapy regimens in five European countries. Proportions of basal bolus therapy (intensified insulin therapy (ICT), basal insulin supported oral therapy (BOT), conventional therapy (CT), and short-acting prandial insulin (SIT) among insulin-treated diabetes patients in Germany (n = 64,055), the UK (n = 6,740), and France (n = 4,779) were estimated using representative general medicine practice databases (Disease Analyzer: 2014). Insulin regimens in Hungary (n = 40,769) and Poland (n = 68,136) were analyzed based on nationwide prescription databases (LRx: 2014). ICT was the most frequent insulin regimen (46 - 81%) in all countries except France (BOT > ICT). SIT showed the lowest use, ranging from 2.5% in the UK to 11.2% in Germany. BOT was more frequently used than CT in Germany and Hungary, which was just the opposite in the UK and Poland. The share of insulin analogs among all prescriptions was higher in Germany, the UK, and France (short-acting insulins: 59 - 98%; basal insulins: 70 - 93%) than in Hungary and Poland (short-acting insulins: 41 - 57%; basal insulins: 23 - 46%) (all p < 0.001). Despite national and international guidelines, insulin regimens differ substantially between European countries. Our results most likely reflect differences in regulations and reimbursement systems, national diabetes care systems as well as patient characteristics and expectations.
.

New undergraduate curricula in the UK and Australia.

PubMed

Lumsden, M A; Symonds, I M

2010-12-01

There are many challenges facing undergraduate education in the smaller specialities such as obstetrics and gynaecology (O&G). These are similar throughout the world, although the emphasis may vary according to geography and the approach of those involved in medical education in general. The number of medical students has increased because of the greater number of doctors required, the gender balance and also because it provides revenue for the universities. This means that strategies must be developed to include more teaching units in both primary and secondary care as well as those at a distance from the main teaching provider. Australia and the UK both have this problem but, obviously, the distances involved in Australia are much greater. One of the drivers for the change in undergraduate medical education in the UK was factual overload and the need to teach basic competencies to the students. National curricula that take this into account are being developed and that in the UK has been taken up by a majority of the medical schools. The opportunities offered by O&G to provide basic skills and competencies difficult to find elsewhere in the curriculum are unparalleled. These include issues such as communication in situations where great sensitivity is required and also the impact of cultural beliefs and ethnicity on clinical practice. However, factual knowledge of medical science is also essential and ways of achieving a balance are discussed. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

Ethnic and geographic variations in the epidemiology of childhood fractures in the United Kingdom.

PubMed

Moon, Rebecca J; Harvey, Nicholas C; Curtis, Elizabeth M; de Vries, Frank; van Staa, Tjeerd; Cooper, Cyrus

2016-04-01

Fractures are common in childhood, and there is considerable variation in the reported incidence across European countries, but few data relating to ethnic and geographic differences within a single country. We therefore aimed to determine the incidence of childhood fractures in the United Kingdom (UK), and to describe age-, ethnicity- and region- specific variations. The Clinical Practice Research Datalink (CPRD) contains anonymised electronic health records for approximately 7% of the UK population. The occurrence of a fracture between 1988 and 2012 was determined from the CPRD for all individuals <18years of age, and used to calculate fracture incidence rates for age, sex and ethnicity. Regional fracture incidence rates were also calculated based on general practitioner location within 14 Strategic Health Authorities (SHA) within the UK. The overall fracture incidence rate was 137 per 10,000 person-years (py). This was higher in boys (169 per 10,000 py) than girls (103 per 10,000 py) and white children (150 per 10,000 py) compared to those of black (64 per 10,000 py) and South Asian (81 per 10,000 py) ethnicity. Marked geographic variation in incidence was observed. The highest fracture rates were observed in Wales, where boys and girls had 1.82 and 1.97 times greater incidence, respectively, than those residing in Greater London. In the period 1988-2012, there was marked geographic and ethnic variation in childhood fracture incidence across the UK. These findings also implicate lifestyle and socio-economic differences associated with location and ethnicity, and are relevant to policy makers in the UK and internationally. Copyright © 2016 Elsevier Inc. All rights reserved.

Teachers of the Alexander Technique in the UK and the people who take their lessons: A national cross-sectional survey.

PubMed

Eldred, J; Hopton, A; Donnison, E; Woodman, J; MacPherson, H

2015-06-01

Given the rising profile of the Alexander Technique in the UK, there is a need for a comprehensive description of its teachers and of those who currently take lessons. In a national survey of Alexander teachers, we set out to address this information gap. A cross-sectional survey of 871 UK members of three main Alexander Technique teachers' professional associations was conducted. A questionnaire requested information about their professional background, teaching practice and methods, and about the people who attend lessons and their reasons for seeking help. With an overall response rate of 61%, 534 teachers responded; 74% were female with median age of 58 years, 60% had a higher education qualification, and 95% were self-employed, many with additional non-Alexander paid employment. The majority (87%) offered lessons on their own premises or in a privately rented room, and 19% provided home visits; both individual and group lessons were provided. People who took lessons were predominantly female (66%) with a median age of 48 years, and 91% paid for their lessons privately. Nearly two-thirds (62%) began lessons for reasons related to musculoskeletal conditions, including back symptoms, posture, neck pain, and shoulder pain. Other reasons were general (18%, including well-being), performance-related (10%, including voice-, music-, and sport-related), psychological (5%) and neurological (3%). We estimate that Alexander teachers in the UK provide approximately 400,000 lessons per year. This study provides an overview of Alexander Technique teaching in the UK today and data that may be useful when planning future research. Copyright © 2015 Elsevier Ltd. All rights reserved.

Assessment and management of the communication difficulties of children with cerebral palsy: a UK survey of SLT practice

PubMed Central

Mary Watson, Rose; Pennington, Lindsay

2015-01-01

Background Communication difficulties are common in cerebral palsy (CP) and are frequently associated with motor, intellectual and sensory impairments. Speech and language therapy research comprises single-case experimental design and small group studies, limiting evidence-based intervention and possibly exacerbating variation in practice. Aims To describe the assessment and intervention practices of speech–language therapist (SLTs) in the UK in their management of communication difficulties associated with CP in childhood. Methods & Procedures An online survey of the assessments and interventions employed by UK SLTs working with children and young people with CP was conducted. The survey was publicized via NHS trusts, the Royal College of Speech and Language Therapists (RCSLT) and private practice associations using a variety of social media. The survey was open from 5 December 2011 to 30 January 2012. Outcomes & Results Two hundred and sixty-five UK SLTs who worked with children and young people with CP in England (n = 199), Wales (n = 13), Scotland (n = 36) and Northern Ireland (n = 17) completed the survey. SLTs reported using a wide variety of published, standardized tests, but most commonly reported assessing oromotor function, speech, receptive and expressive language, and communication skills by observation or using assessment schedules they had developed themselves. The most highly prioritized areas for intervention were: dysphagia, alternative and augmentative (AAC)/interaction and receptive language. SLTs reported using a wide variety of techniques to address difficulties in speech, language and communication. Some interventions used have no supporting evidence. Many SLTs felt unable to estimate the hours of therapy per year children and young people with CP and communication disorders received from their service. Conclusions & Implications The assessment and management of communication difficulties associated with CP in childhood varies widely in the UK. Lack of standard assessment practices prevents comparisons across time or services. The adoption of a standard set of agreed clinical measures would enable benchmarking of service provision, permit the development of large-scale research studies using routine clinical data and facilitate the identification of potential participants for research studies in the UK. Some interventions provided lack evidence. Recent systematic reviews could guide intervention, but robust evidence is needed in most areas addressed in clinical practice. PMID:25652139

Assessment and management of the communication difficulties of children with cerebral palsy: a UK survey of SLT practice.

PubMed

Watson, Rose Mary; Pennington, Lindsay

2015-01-01

Communication difficulties are common in cerebral palsy (CP) and are frequently associated with motor, intellectual and sensory impairments. Speech and language therapy research comprises single-case experimental design and small group studies, limiting evidence-based intervention and possibly exacerbating variation in practice. To describe the assessment and intervention practices of speech-language therapist (SLTs) in the UK in their management of communication difficulties associated with CP in childhood. An online survey of the assessments and interventions employed by UK SLTs working with children and young people with CP was conducted. The survey was publicized via NHS trusts, the Royal College of Speech and Language Therapists (RCSLT) and private practice associations using a variety of social media. The survey was open from 5 December 2011 to 30 January 2012. Two hundred and sixty-five UK SLTs who worked with children and young people with CP in England (n = 199), Wales (n = 13), Scotland (n = 36) and Northern Ireland (n = 17) completed the survey. SLTs reported using a wide variety of published, standardized tests, but most commonly reported assessing oromotor function, speech, receptive and expressive language, and communication skills by observation or using assessment schedules they had developed themselves. The most highly prioritized areas for intervention were: dysphagia, alternative and augmentative (AAC)/interaction and receptive language. SLTs reported using a wide variety of techniques to address difficulties in speech, language and communication. Some interventions used have no supporting evidence. Many SLTs felt unable to estimate the hours of therapy per year children and young people with CP and communication disorders received from their service. The assessment and management of communication difficulties associated with CP in childhood varies widely in the UK. Lack of standard assessment practices prevents comparisons across time or services. The adoption of a standard set of agreed clinical measures would enable benchmarking of service provision, permit the development of large-scale research studies using routine clinical data and facilitate the identification of potential participants for research studies in the UK. Some interventions provided lack evidence. Recent systematic reviews could guide intervention, but robust evidence is needed in most areas addressed in clinical practice. © 2015 The Authors International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.

Implications of aligning full registration of doctors with medical school graduation: a qualitative study of stakeholder perspectives.

PubMed

Mattick, K L; Kaufhold, K; Kelly, N; Cole, J A; Scheffler, G; Rees, C E; Bullock, A; Gormley, G J; Monrouxe, L V

2016-02-23

The Shape of Training report recommended that full registration is aligned with medical school graduation. As part of a General Medical Council-funded study about the preparedness for practice of UK medical graduates, we explored UK stakeholders' views about this proposal using qualitative interviews (30 group and 87 individual interviews) and Framework Analysis. Four UK study sites, one in each country. 185 individuals from eight stakeholder groups: (1) foundation year 1 (F1) doctors (n=34); (2) fully registered trainee doctors (n=33); (3) clinical educators (n=32); (4) undergraduate/postgraduate Deans, and Foundation Programme Directors (n=30); (5) other healthcare professionals (n=13); (6) employers (n=7); (7) policy and government (n=11); (8) patient and public representatives (n=25). We identified four main themes: (1) The F1 year as a safety net: patients were protected by close trainee supervision and 'sign off' to prevent errors; trainees were provided with a safe environment for learning on the job; (2) Implications for undergraduate medical education: if the proposal was accepted, a 'radical review' of undergraduate curricula would be needed; undergraduate education might need to be longer; (3) Implications for F1 work practice: steps to protect healthcare team integration and ensure that F1 doctors stay within competency limits would be required; (4) Financial, structural and political implications: there would be cost implications for trainees; clarification of responsibilities between undergraduate and postgraduate medical education would be needed. Typically, each theme comprised arguments for and against the proposal. A policy change to align the timing of full registration with graduation would require considerable planning and preliminary work. These findings will inform policymakers' decision-making. Regardless of the decision, medical students should take on greater responsibility for patient care as undergraduates, assessment methods in clinical practice and professionalism domains need development, and good practice in postgraduate supervision and support must be shared. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

When politics meets science: What impact might Brexit have on organ donation and transplantation in the United Kingdom?

PubMed

Shapey, Iestyn M; Summers, Angela M; Simkin, Iain J; Augustine, Titus; van Dellen, David

2018-06-21

Brexit may lead to major political, societal, and financial changes-this has significant implications for a tax revenue funded healthcare system such as the United Kingdom's (UK) National Health Service. The complex relationship between European Union (EU) legislation and clinical practice of organ donation and transplantation is poorly understood. However, it is unclear what impact Brexit may have on organ donation and transplantation in the UK and EU. This work aims to describe the current legislative interactions affecting organ donation and transplantation regulation and governance within the UK and EU. We consider the potential impact of Brexit on the practical aspects of transplantation such organ-sharing networks, logistics, and the provision of health care for transplant patients when traveling to the EU from the UK and vice versa, as well as personnel, and research. Successful organ donation and transplantation practices rely on close collaboration and co-operation across Europe and throughout the United Kingdom. The continuation of such relationships, despite the proposed legislative change, will remain a vital and necessary component for the ongoing success of transplantation programs. © 2018 The Authors. Clinical Transplantation Published by John Wiley & Sons Ltd.

Investigating the Impact of Working in Multi-Agency Service Delivery Settings in the UK on Early Years Practitioners' Beliefs and Practices

ERIC Educational Resources Information Center

Anning, Angela

2005-01-01

In the UK Centres of Excellence were funded by the DfES to model high quality, multi-agency, early years services for young children and their families. They were precursors to Children's Centres to be established across the UK. Early Excellence Centres were evaluated at national and local levels. This article will draw on data from local…

Low attendance at structured education for people with newly diagnosed type 2 diabetes: General practice characteristics and individual patient factors predict uptake.

PubMed

Winkley, Kirsty; Stahl, Daniel; Chamley, Mark; Stopford, Rosanna; Boughdady, Monica; Thomas, Stephen; Amiel, Stephanie A; Forbes, Angus; Ismail, Khalida

2016-01-01

The aims were to determine the association between individual and neighbourhood factors and attendance at structured education amongst people with newly diagnosed type 2 diabetes (T2DM). Multi-level analysis of questionnaire data from a prospective cohort of adults newly diagnosed T2DM. Setting was primary care, London, UK. Main outcome was attendance at structured education within 2 years. Of 1790 people recruited, attendance data were available for 1626 (91%). Only 22.4% (n=365/1626) attended education. Attendance was independently associated with female gender (OR 1.28, 95% CI 1.05-1.46), lower HbA1c (OR 0.98 mmol/mol 95% CI 0.97-0.99) and non-smoker status (OR 1.36, 95% CI 1.07-1.55). General practice covariates, achievement of primary care targets for glycaemic control (OR 1.05, 95% C.I. 1.01-1.08) and recording of retinal screening (OR 0.96, 95% C.I. 0.93-0.99) were independently associated with attendance but unexplained general practice clustering accounted for 17% of the variance. Education uptake is low amongst people with new onset T2DM. Attenders are more likely to be female, non-smokers with better HbA1c. General practices achieving glycaemic targets are more likely to have patients who attend education. Strategies are needed to improve attendance at structured diabetes education particularly amongst hard to reach groups. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Inter-professional work based learning within an MSc in Advanced Practice: lessons from one UK higher education programme.

PubMed

Gaskell, Lynne; Beaton, Susan

2010-09-01

This paper will describe the implementation of inter-professional work based education (IPE) in one postgraduate Advanced Practitioner programme in the UK. The concept of Advanced Practice has developed as a response of a number of drivers including change in junior doctor training; government policy and increasing demands on the central government funded UK health service (the NHS). The programme was commissioned by the then greater Manchester Strategic Health Authority (now NHS North West) to meet service needs. The educational philosophy underpinning the MSc Advanced Practice (health and social care) provided by the University of Salford is IPE linked to work based learning. The process of work based learning (WBL) and inter-professional learning underpinning the programme will be discussed in relation to feedback from university staff, Advanced Practitioner (AP) students and employer feedback taken from programme and module evaluations. We argue that IPE at this level facilitates a greater understanding of the connectivity between professionals working in the health care system in the UK; a better understanding of the skills and knowledge base of colleagues; more inter-professional working and appropriate referrals in the work place. This has raised the profile of Advanced Practice (AP) in the region and ultimately resulted in better patient care with more effective and efficient use of resources (Acton Shapiro, 2006, 2008). (c) 2009 Elsevier Ltd. All rights reserved.

Criteria used by nurses to evaluate practice-related information on the World Wide Web.

PubMed

Cader, Raffik; Campbell, Steve; Watson, Don

2003-01-01

Existing criteria used to evaluate information on the World Wide Web often are not related to nursing, especially in relation to clinical and evidence-based practice. Published criteria have been found orientated to the health-consumer, medicine, or general information. In this study, the process by which nurses evaluate practice-related information and the associated evaluative nursing criteria were investigated using a grounded theory approach. In the first stage of this ongoing investigation, semistructured interviews were used to collect data from UK postregistration nursing students. The findings from this initial study provided indications of the process and the criteria for evaluating information on the World Wide Web. Participating students identified intuition as part of the evaluative process. They identified some criteria similar to existing standards, but critically, with additional criteria that are nursing practice related. Because these new criteria are significant for evaluating nursing information, further refinement of these findings is being undertaken through the next stage of the research program.

Getting the right balance? A mixed logit analysis of the relationship between UK training doctors’ characteristics and their specialties using the 2013 National Training Survey

PubMed Central

Chalkley, Martin

2017-01-01

Objective To analyse how training doctors’ demographic and socioeconomic characteristics vary according to the specialty that they are training for. Design Descriptive statistics and mixed logistic regression analysis of cross-sectional survey data to quantify evidence of systematic relationships between doctors’ characteristics and their specialty. Setting Doctors in training in the United Kingdom in 2013. Participants 27 530 doctors in training but not in their foundation year who responded to the National Training Survey 2013. Main outcome measures Mixed logit regression estimates and the corresponding odds ratios (calculated separately for all doctors in training and a subsample comprising those educated in the UK), relating gender, age, ethnicity, place of studies, socioeconomic background and parental education to the probability of training for a particular specialty. Results Being female and being white British increase the chances of being in general practice with respect to any other specialty, while coming from a better-off socioeconomic background and having parents with tertiary education have the opposite effect. Mixed results are found for age and place of studies. For example, the difference between men and women is greatest for surgical specialties for which a man is 12.121 times more likely to be training to a surgical specialty (relative to general practice) than a woman (p-value<0.01). Doctors who attended an independent school which is proxy for doctor’s socioeconomic background are 1.789 and 1.413 times more likely to be training for surgical or medical specialties (relative to general practice) than those who attended a state school (p-value<0.01). Conclusions There are systematic and substantial differences between specialties in respect of training doctors’ gender, ethnicity, age and socioeconomic background. The persistent underrepresentation in some specialties of women, minority ethnic groups and of those coming from disadvantaged backgrounds will impact on the representativeness of the profession into the future. Further research is needed to understand how the processes of selection and the self-selection of applicants into specialties gives rise to these observed differences. PMID:28801397

Is council tax valuation band a predictor of mortality?

PubMed Central

Beale, Norman R; Taylor, Gordon J; Straker-Cook, Dawn MK

2002-01-01

Background All current UK indices of socio-economic status have inherent problems, especially those used to govern resource allocation to the health sphere. The search for improved markers continues: this study proposes and tests the possibility that Council Tax Valuation Band (CTVB) might match requirements. Presentation of the hypothesis To determine if there is an association between CTVB of final residence and mortality risk using the death registers of a UK general practice. Testing the hypothesis Standardised death rates and odds ratios (ORs) for groups defined by CTVB of dwelling (A – H) were calculated using one in four denominator samples from the practice lists. Analyses were repeated three times – between number of deaths and CTVB of residence of deceased 1992 – 1994 inclusive, 1995 – 1997 inc., 1998 – 2000 inc. In 856 deaths there were consistent and significant differences in death rates between CTVBs: above average for bands A and B residents; below average for other band residents. There were significantly higher ORs for A, B residents who were female and who died prematurely (before average group life expectancy). Implications of the hypothesis CTVB of final residence appears to be a proxy marker of mortality risk and could be a valuable indicator of health needs resource at household level. It is worthy of further exploration. PMID:12207828

Current UK practices in the management of subacromial impingement.

PubMed

Bryceland, James K; Drury, Colin; Tait, Gavin R

2015-07-01

Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections.

Current UK practices in the management of subacromial impingement

PubMed Central

Drury, Colin; Tait, Gavin R

2015-01-01

Background Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. Methods BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Results Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Conclusions Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections. PMID:27582972

Prepared for practice? Law teaching and assessment in UK medical schools.

PubMed

Preston-Shoot, Michael; McKimm, Judy

2010-11-01

A revised core curriculum for medical ethics and law in UK medical schools has been published. The General Medical Council requires medical graduates to understand law and ethics and behave in accordance with ethical and legal principles. A parallel policy agenda emphasises accountability, the development of professionalism and patient safety. Given the renewed focus on teaching and learning law alongside medical ethics and the development of professional identity, this survey aimed to identify how medical schools are responding to the preparation of medical students for practice in the future. Questions were asked about the location, content and methods of teaching and assessment of law in undergraduate medical education. Examples of course documentation were requested to illustrate the approaches being taken. A 76% response rate was achieved. Most responding schools integrate law teaching with medical ethics, emphasising both the acquisition of knowledge and its application in a clinical context. Teaching, learning and assessment of law in clinical attachments is much less formalised than that in non-clinical education. Coverage of recommended topic areas varies, raising questions about the degree to which students can embed their knowledge and skills in actual practice. More positively, teaching does not rely on single individuals and clear descriptions were offered for problem-based and small group case-based learning. Further research is required to explore whether there are optimum ways of ensuring that legal knowledge, and skills in its use, form part of the development of professionalism among doctors in training.

Understanding continuous professional development participation and choice of mid-career general dental practitioners.

PubMed

Brown, T; Wassif, H S

2017-02-01

Participating in continuing professional development (CPD) activities is a requirement for dental practitioners to keep their skills and knowledge up to date. Understanding the ways dental practitioners engage with professional development and the impact on practice is not fully known (Eaton et al. 2011, http://www.gdc-uk.org/Aboutus/policy/Documents/Impact%20Of%20CPD%20In%20Dentistry.pdf). The aim of this study was to gain insights into the ways that dentists reflect on their professional development and what may be influencing their choices. Empirical qualitative data were collected by semi-structured interviewing of five mid-career dentists. Using grounded theory, the data were analysed for themes about CPD choice and participation. Three themes were identified as influences to dentists' choices of CPD with pragmatic considerations of how new learning could benefit their patients and their practices. Dental practitioners were influenced by the requirements of external regulatory bodies which they did not consider to necessarily improve practice. Dentists working in primary care in the UK are undertaking CPD which is influenced by the pragmatic requirements of running a small business and to meet regulatory requirements. In this sample, dentists are not critically reflecting on their education needs when choosing their CPD activity. Protected learning time and organisational feedback and support are recommended as a way to promote more meaningful reflection on learning and to improve professional development. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Preventive medical care in remote Aboriginal communities in the Northern Territory: a follow-up study of the impact of clinical guidelines, computerised recall and reminder systems, and audit and feedback.

PubMed

Bailie, Ross S; Togni, Samantha J; Si, Damin; Robinson, Gary; d'Abbs, Peter H N

2003-07-30

Interventions to improve delivery of preventive medical services have been shown to be effective in North America and the UK. However, there are few studies of the extent to which the impact of such interventions has been sustained, or of the impact of such interventions in disadvantaged populations or remote settings. This paper describes the trends in delivery of preventive medical services following a multifaceted intervention in remote community health centres in the Northern Territory of Australia. The intervention comprised the development and dissemination of best practice guidelines supported by an electronic client register, recall and reminder systems and associated staff training, and audit and feedback. Clinical records in seven community health centres were audited at regular intervals against best practice guidelines over a period of three years, with feedback of audit findings to health centre staff and management. Levels of service delivery varied between services and between communities. There was an initial improvement in service levels for most services following the intervention, but improvements were in general not fully sustained over the three year period. Improvements in service delivery are consistent with the international experience, although baseline and follow-up levels are in many cases higher than reported for comparable studies in North America and the UK. Sustainability of improvements may be achieved by institutionalisation of relevant work practices and enhanced health centre capacity.

A holistic approach to managing a patient with heart failure.

PubMed

Duncan, Alison; Cunnington, Colin

2013-03-01

Despite varied and complex therapeutic strategies for managing patients with heart failure, the prognosis may remain poor in certain groups. Recognition that patients with heart failure frequently require input from many care groups formed the basis of The British Society of Heart Failure Annual Autumn Meeting in London (UK), in November 2012, entitled: 'Heart failure: a multidisciplinary approach'. Experts in cardiology, cardiac surgery, general practice, care of the elderly, palliative care and cardiac imaging shared their knowledge and expertise. The 2-day symposium was attended by over 500 participants from the UK, Europe and North America, and hosted physicians, nurses, scientists, trainees and representatives from the industry, as well as patient and community groups. The symposium, accredited by the Royal College of Physicians and the Royal College of Nursing, focused on the multidisciplinary approach to heart failure, in particular, current therapeutic advances, cardiac remodeling, palliative care, atrial fibrillation, heart rate-lowering therapies, management of acute heart failure and the management of patients with mitral regurgitation and heart failure.

Use of educational games in the health professions: a mixed-methods study of educators' perspectives in the UK.

PubMed

Blakely, Gillian; Skirton, Heather; Cooper, Simon; Allum, Peter; Nelmes, Pam

2010-03-01

Educational games have been shown to be effective in supporting learning, especially to reinforce knowledge, and students are generally positive about the use of games. The aim of this mixed-methods study that was conducted in the UK was to explore educators' views towards the use of educational games in the health sciences. The data were collected via semistructured interviews with 13 health educators and an online survey that was completed by 97 health educators. Three factors influence the use of classroom games: reflective practice, the impact of games on students, and the impact of logistical factors. Educators assess their own performance and the impact of the games on students when planning their use; however, large classes and the need for preparation time have a negative impact on educators' willingness to use games. Similar constraints might restrict the use of active learning strategies, such as simulation, that are crucial for enabling health professionals to develop competence. These issues require consideration when planning educational methods.

Epidemiology of fractures in the United Kingdom 1988-2012: Variation with age, sex, geography, ethnicity and socioeconomic status.

PubMed

Curtis, Elizabeth M; van der Velde, Robert; Moon, Rebecca J; van den Bergh, Joop P W; Geusens, Piet; de Vries, Frank; van Staa, Tjeerd P; Cooper, Cyrus; Harvey, Nicholas C

2016-06-01

Rates of fracture worldwide are changing. Using the Clinical Practice Research Datalink (CPRD), age, and gender, geographical, ethnic and socioeconomic trends in fracture rates across the United Kingdom were studied over a 24-year period 1988-2012. Previously observed patterns in fracture incidence by age and fracture site were evident. New data on the influence of geographic location, ethnic group and socioeconomic status were obtained. With secular changes in age- and sex-specific fracture incidence observed in many populations, and global shifts towards an elderly demography, it is vital for health care planners to have an accurate understanding of fracture incidence nationally. We aimed to present up to date fracture incidence data in the UK, stratified by age, sex, geographic location, ethnicity and socioeconomic status. The Clinical Practice Research Datalink (CPRD) contains anonymised electronic health records for approximately 6.9% of the UK population. Information comes from General Practitioners, and covers 11.3 million people from 674 practices across the UK, demonstrated to be representative of the national population. The study population consisted of all permanently registered individuals aged ≥18years. Validated data on fracture incidence were obtained from their medical records, as was information on socioeconomic deprivation, ethnicity and geographic location. Age- and sex-specific fracture incidence rates were calculated. Fracture incidence rates by age and sex were comparable to those documented in previous studies and demonstrated a bimodal distribution. Substantial geographic heterogeneity in age- and sex adjusted fracture incidence was observed, with rates in Scotland almost 50% greater than those in London and South East England. Lowest rates of fracture were observed in black individuals of both sexes; rates of fragility fracture in white women were 4.7 times greater than in black women. Strong associations between deprivation and fracture risk were observed in hip fracture in men, with a relative risk of 1.3 (95% CI 1.21-1.41) in Index of Multiple Deprivation category 5 (representing the most deprived) compared to category 1. This study presents robust estimates of fracture incidence across the UK, which will aid decisions regarding allocation of healthcare provision to populations of greatest need. It will also assist the implementation and design of strategies to reduce fracture incidence and its personal and financial impact on individuals and health services. Copyright © 2016 Elsevier Inc. All rights reserved.

Cross-Cultural Study of Information Processing Biases in Chronic Fatigue Syndrome: Comparison of Dutch and UK Chronic Fatigue Patients.

PubMed

Hughes, Alicia M; Hirsch, Colette R; Nikolaus, Stephanie; Chalder, Trudie; Knoop, Hans; Moss-Morris, Rona

2018-02-01

This study aims to replicate a UK study, with a Dutch sample to explore whether attention and interpretation biases and general attentional control deficits in chronic fatigue syndrome (CFS) are similar across populations and cultures. Thirty eight Dutch CFS participants were compared to 52 CFS and 51 healthy participants recruited from the UK. Participants completed self-report measures of symptoms, functioning, and mood, as well as three experimental tasks (i) visual-probe task measuring attentional bias to illness (somatic symptoms and disability) versus neutral words, (ii) interpretive bias task measuring positive versus somatic interpretations of ambiguous information, and (iii) the Attention Network Test measuring general attentional control. Compared to controls, Dutch and UK participants with CFS showed a significant attentional bias for illness-related words and were significantly more likely to interpret ambiguous information in a somatic way. These effects were not moderated by attentional control. There were no significant differences between the Dutch and UK CFS groups on attentional bias, interpretation bias, or attentional control scores. This study replicated the main findings of the UK study, with a Dutch CFS population, indicating that across these two cultures, people with CFS demonstrate biases in how somatic information is attended to and interpreted. These illness-specific biases appear to be unrelated to general attentional control deficits.

The current cost of angina pectoris to the National Health Service in the UK

PubMed Central

Stewart, S; Murphy, N; Walker, A; McGuire, A; McMurray, J J V

2003-01-01

Objective: To calculate the cost of angina pectoris to the UK National Health Service (NHS) in the year 2000. Methods: Calculation of the cost of hospital admissions, revascularisation procedures, hospital outpatient consultations, general practice (GP) consultations, and prescribed drug treatment. Results: 634 000 individuals (1.1% of the UK population) consulted GPs 2.35 million times, costing £60.5 million. They required 16.0 million prescriptions (cost £80.7 million) and 254 000 hospital outpatient referrals (cost £30.4 million). There were 149 000 hospital admissions, 117 000 coronary angiograms, 21 400 coronary artery bypass operations, 17 700 percutaneous coronary interventions, and 516 000 outpatient visits, at a cost of £208.4 million, £69.9 million, £106.2 million, £60.7 million, and £52.2 million, respectively. The direct cost of angina was therefore £669 million (1.3% of total NHS expenditure), with hospital bed occupancy and procedures accounting for 32% and 35% of this total, respectively. Conclusions: Angina is a common and costly public health problem. It consumed over 1% of all NHS expenditure in the year 2000, mainly because of hospital bed occupancy and revascularisation procedures. This is likely to be a conservative estimate of its true cost. PMID:12860855

Diversity in Family Medicine: The Art of Thinking Independently Together – Reflections on the RCGP exchange 2016

PubMed Central

Figueiredo, Ana Beatriz; Pesolillo, Gabriella; Kanwal, Sidra; Tezen, Amelia

2017-01-01

This narrative summarizes the reflections of a UK conference exchange experience of four young general practitioners (GPs) from Peru, Portugal, Italy, and Pakistan. This article was written after participating in a RCGP exchange program in October 2016. This consisted of 2 days of observation in a GP practice in Liverpool followed by attendance at the RCGP preconference and annual conference. The exchange was organized by the RCGP Junior International Committee, which links to the Vasco da Gama Movement, a European network of new and future GPs. PMID:29564249

Emergency medical conference South Africa, October 1998--a report on proceedings and clinical visits.

PubMed

Hodgetts, T J

1999-06-01

The South Africans are keen to adopt the Major Incident Medical Management and Support course, developed in the UK. South Africa can provide an excellent training ground for military personnel in the triage, resuscitation and surgical management of the patient with penetrating trauma. Johannesburg General Hospital has a high quality training system under the direction of Dr Ken Boffard. The nearby Baragwaneth Hospital is the closest to military surgical practice one can probably get in a civilian setting. There is an unprecedented opportunity for clinical skills training, and a wealth of research opportunities.

Allergy in the elderly: case note review.

PubMed

Gray, N J; Redshaw, E L; Isaacs, D; Tarzi, M D; Smith, H E; Frew, A J

2018-05-19

The prevalence of IgE-mediated disease increased significantly during the 20th century. In developed countries, about 20% of people have atopic disease, which consumes significant amounts of healthcare funding. For example, in UK general practice, allergic conditions account for 6% of consultations and ~10% of prescribing costs [1]. Whilst most studies of allergy focus on children and adolescents, relatively little has been written about allergy in older people, although food allergy may be increasingly common in this group [2]. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Demography and disorders of the French Bulldog population under primary veterinary care in the UK in 2013.

PubMed

O'Neill, Dan G; Baral, Lauren; Church, David B; Brodbelt, Dave C; Packer, Rowena M A

2018-01-01

Despite its Gallic name, the French Bulldog is a breed of both British and French origin that was first recognised by The Kennel Club in 1906. The French Bulldog has demonstrated recent rapid rises in Kennel Club registrations and is now (2017) the second most commonly registered pedigree breed in the UK. However, the breed has been reported to be predisposed to several disorders including ocular, respiratory, neurological and dermatological problems. The VetCompass™ Programme collates de-identified clinical data from primary-care veterinary practices in the UK for epidemiological research. Using VetCompass™ clinical data, this study aimed to characterise the demography and common disorders of the general population of French Bulldogs under veterinary care in the UK. French Bulldogs comprised 2228 (0.49%) of 445,557 study dogs under veterinary care during 2013. Annual proportional birth rates showed that the proportional ownership of French Bulldog puppies rose steeply from 0.02% of the annual birth cohort attending VetCompass™ practices in 2003 to 1.46% in 2013. The median age of the French Bulldogs overall was 1.3 years (IQR 0.6-2.5, range 0.0-13.0). The most common colours of French Bulldogs were brindle (solid or main) (32.36%) and fawn (solid or main) (29.9%). Of the 2228 French Bulldogs under veterinary care during 2013, 1612 (72.4%) had at least one disorder recorded. The most prevalent fine-level precision disorders recorded were otitis externa (14.0%, 95% CI: 12.6-15.5), diarrhoea (7.5%, 95% CI: 6.4-8.7), conjunctivitis (3.2%, 95% CI: 2.5-4.0), nails overlong (3.1%, 95% CI% 2.4-3.9) and skin fold dermatitis (3.0%, 95% CI% 2.3-3.8). The most prevalent disorder groups were cutaneous (17.9%, 95% CI: 16.3-19.6), enteropathy (16.7%, 95% CI: 15.2-18.3), aural (16.3%, 95% CI: 14.8-17.9), upper respiratory tract (12.7%, 95% CI: 11.3-14.1) and ophthalmological (10.5%, 95% CI: 9.3-11.9). Ownership of French Bulldogs in the UK is rising steeply. This means that the disorder profiles reported in this study reflect a current young UK population and are likely to shift as this cohort ages. Otitis externa, diarrhoea and conjunctivitis were the most common disorders in French Bulldogs. Identification of health priorities based on VetCompass™ data can support evidence-based reforms to improve health and welfare within the breed.

Diagnosis of airway obstruction in primary care in the UK: the CADRE (COPD and Asthma Diagnostic/management REassessment) programme 1997-2001.

PubMed

Pearson, Mike; Ayres, Jon G; Sarno, Maria; Massey, Dan; Price, David

2006-01-01

Asthma and COPD require different management strategies, but differentiation in primary care is difficult. This primary care support initiative observed the impact of spirometry and clinical assessment on the diagnosis of airway disease. Of 61,191 patients aged > or =40 years being treated for respiratory conditions within 1003 UK primary care practices, 43,203 underwent a diagnostic review including standardized spirometric assessment. The proportion of patients in whom the diagnosis was changed by the additional information was determined. The relationship of various patient characteristics was compared with the baseline and review diagnoses and with any change in diagnosis. Asthma was initially diagnosed in 43% of patients, COPD in 35%, mixed disease in 9%, and other respiratory condition in 13%. Patients initially diagnosed with asthma, mixed disease, or another condition were more likely to have their diagnosis changed at review (54%, 46%, and 63%, respectively) than those initially diagnosed with COPD (14%). A change from asthma to COPD was associated with male gender, smoking, older age, and reduced lung function, the opposite being associated with a change from COPD to asthma. In this study, a clinical review supplemented by additional information including spirometry highlights apparent mislabeling of significant numbers of patients with chronic obstructive disease in general practice with significant implications for individual treatment and healthcare provision. This study shows that the addition of more clinical information can have a major effect on diagnostic tendency in patients with airway disease. An initial diagnosis of COPD seems less likely to change following review than an asthma diagnosis. While it is likely that greater information leads to a more accurate diagnosis, the differential effect of new information on diagnostic labeling highlights the insecurity of the diagnostic process in primary care in the UK.

Childhood obesity trends from primary care electronic health records in England between 1994 and 2013: population-based cohort study.

PubMed

van Jaarsveld, Cornelia H M; Gulliford, Martin C

2015-03-01

This study aimed to use primary care electronic health records to evaluate the prevalence of overweight and obesity in 2-15-year-old children in England and compare trends over the last two decades. Cohort study of primary care electronic health records. 375 general practices in England that contribute to the UK Clinical Practice Research Datalink. Individual participants were sampled if they were aged between 2 and 15 years during the period 1994-2013 and had one or more records of body mass index (BMI). Prevalence of overweight (including obesity) was defined as a BMI equal to or greater than the 85th centile of the 1990 UK reference population. Data were analysed for 370 544 children with 507 483 BMI records. From 1994 to 2003, the odds of overweight and obesity increased by 8.1% per year (95% CI 7.2% to 8.9%) compared with 0.4% (-0.2% to 1.1%) from 2004 to 2013. Trends were similar for boys and girls, but differed by age groups, with prevalence stabilising in 2004 to 2013 in the younger (2-10 year) but not older (11-15 year) age group, where rates continued to increase. Primary care electronic health records in England may provide a valuable resource for monitoring obesity trends. More than a third of UK children are overweight or obese, but the prevalence of overweight and obesity may have stabilised between 2004 and 2013. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

How Do Physical Therapists in the United Kingdom Manage Patients With Hip Osteoarthritis? Results of a Cross-Sectional Survey.

PubMed

Holden, Melanie A; Bennell, Kim L; Whittle, Rebecca; Chesterton, Linda; Foster, Nadine E; Halliday, Nicola A; Spiers, Libby N; Mason, Elizabeth M; Quicke, Jonathan G; Mallen, Christian D

2018-06-01

Hip osteoarthritis (OA) is common, painful, and disabling. Physical therapists have an important role in managing patients with hip OA; however, little is known about their current management approach and whether it aligns with clinical guideline recommendations. The objective of this study is to describe United Kingdom (UK) physical therapists' current management of patients with hip OA and to determine whether it aligns with clinical guidelines. The design is a cross-section questionnaire. A questionnaire was mailed to 3126 physical therapists in the UK that explored physical therapists' self-reported management of a patient with hip OA using a case vignette and clinical management questions. The response rate was 52.7% (n = 1646). In total, 1148 (69.7%) physical therapists had treated a patient with hip OA in the last 6 months and were included in the analyses. A treatment package was commonly provided incorporating advice, exercise (strength training 95.9%; general physical activity 85.4%), and other nonpharmacological modalities, predominantly manual therapy (69.6%), and gait retraining (66.4%). There were some differences in reported management between physical therapists based in the National Health Service (NHS) and non-NHS-based physical therapists, including fewer treatment sessions being provided by NHS-based therapists. Limitations include the potential for nonresponder bias and, in clinical practice, physical therapists may manage patients with hip OA differently. UK-based physical therapists commonly provide a package of care for patients with hip OA that is broadly in line with current clinical guidelines, including advice, exercise, and other nonpharmacological treatments. There were some differences in clinical practice between NHS and non-NHS-based physical therapists, but whether these differences impact on clinical outcomes remains unknown.

Examining trends in type 2 diabetes incidence, prevalence and mortality in the UK between 2004 and 2014.

PubMed

Zghebi, Salwa S; Steinke, Douglas T; Carr, Matthew J; Rutter, Martin K; Emsley, Richard A; Ashcroft, Darren M

2017-11-01

Contemporary data describing type 2 diabetes prevalence, incidence and mortality are limited. We aimed to (1) estimate annual incidence and prevalence rates of type 2 diabetes in the UK between 2004 and 2014, (2) examine relationships between observed rates with age, gender, socio-economic status and geographic region, and (3) assess how temporal changes in incidence and all-cause mortality rates influence changes in prevalence. Type 2 diabetes patients aged ≥16 years between January 2004 and December 2014 were identified using the Clinical Practice Research Datalink (CPRD). Up to 5 individuals without diabetes were matched to diabetes patients based on age, gender and the general practice. Annual incidence, prevalence and mortality rates were calculated per 10 000 person-years at risk (95% CI). Survival models compared mortality rates in patients with and without type 2 diabetes. Prevalence rates of type 2 diabetes increased from 3.21% (3.19; 3.22) in 2004 to 5.26% (5.24; 5.29) in 2014. Incidence rates remained stable, overall, throughout the study period. Higher incidence and prevalence rates were related to male gender and deprivation. Individuals with type 2 diabetes were associated with higher risk of mortality (Hazard ratio 1.26 [1.20; 1.32]). Mortality rates declined in patients with and without diabetes throughout the study period. The incidence and prevalence of type 2 diabetes in patients aged 16 to 34 years increased over time. The rising prevalence of type 2 diabetes in the UK over the last decade is probably explained by patients living longer rather than by increasing incidence of type 2 diabetes. © 2017 John Wiley & Sons Ltd.

Creating and facilitating change for Person-Centred Coordinated Care (P3C): The development of the Organisational Change Tool (P3C-OCT).

PubMed

Horrell, Jane; Lloyd, Helen; Sugavanam, Thavapriya; Close, James; Byng, Richard

2018-04-01

Person Centred Coordinated Care (P3C) is a UK priority for patients, carers, professionals, commissioners and policy makers. Services are developing a range of approaches to deliver this care with a lack of tools to guide implementation. A scoping review and critical examination of current policy, key literature and NHS guidelines, together with stakeholder involvement led to the identification of domains, subdomains and component activities (processes and behaviours) required to deliver P3C. These were validated through codesign with stakeholders via a series of workshops and cognitive interviews. Six core domains of P3C were identified as follows: (i) my goals, (ii) care planning, (iii) transitions, (iv) decision making (v), information and communication and (vi) organizational support activities. These were populated by 29 core subdomains (question items). A number of response codes (components) to each question provide examples of the processes and activities that can be actioned to achieve each core subdomain of P3C. The P3C-OCT provides a coherent approach to monitoring progress and supporting practice development towards P3C. It can be used to generate a shared understanding of the core domains of P3C at a service delivery level, and support reorganization of care for those with complex needs. The tool can reliably detect change over time, as demonstrated in a sample of 40 UK general practices. It is currently being used in four UK evaluations of new models of care and being further developed as a training tool for the delivery of P3C. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

The quality of orthodontic practice websites.

PubMed

Parekh, J; Gill, D S

2014-05-01

To evaluate orthodontic practice websites for the reliability of information presented, accessibility, usability for patients and compliance to General Dental Council (GDC) regulations on ethical advertising. World Wide Web. The term 'orthodontic practice' was entered into three separate search engines. The 30 websites from the UK were selected and graded according to the LIDA tool (a validated method of evaluating healthcare websites) for accessibility, usability of the website and reliability of information on orthodontic treatment. The websites were then evaluated against the GDC's Principles for ethical advertising in nine different criteria. On average, each website fulfilled six out of nine points of the GDC's criteria, with inclusion of a complaints policy being the most poorly fulfilled criteria. The mean LIDA score (a combination of usability, reliability and accessibility) was 102/144 (standard deviation 8.38). The websites scored most poorly on reliability (average 43% SD 11.7), with no single website reporting a clear, reliable method of content production. Average accessibility was 81% and usability 73%. In general, websites did not comply with GDC guidelines on ethical advertising. Furthermore, practitioners should consider reporting their method of information production, particularly when making claims about efficiency and speed of treatment in order to improve reliability.

Epidural analgesia in children. A survey of current opinions and practices amongst UK paediatric anaesthetists.

PubMed

Williams, D G; Howard, R F

2003-11-01

Despite the widespread use of epidural analgesia in children its place in paediatric pain management has not been clearly established. In order to investigate the current practice of paediatric epidural analgesia in the UK paediatric anaesthetists and paediatric pain management teams were surveyed. Questionnaires were sent to the members of the Association of Paediatric Anaesthetists (APA) working within the UK and to lead clinicians and clinical nurse specialists for acute pain in the 26 designated major paediatric centres. The response rate was 72%. There was little consensus regarding drugs and drug combinations used for epidural analgesia. A total of 36% of paediatric centres did not audit their epidural practice, and of those that did the reported incidences of side-effects showed wide variation. Important differences in practice were also identified in the areas of patient selection, informed consent, the use of epidural test doses, drug delivery systems, monitoring and the management of side-effects. Twelve per cent of specialist paediatric hospitals did not have an acute pain team and elsewhere the provision was often limited to staff with few or no specialist skills. There is wide variation in the practice of paediatric epidural analgesia in the UK. Inconsistencies are likely to be related to the poor evidence base available to guide clinical decision making and the lack of a specialized paediatric acute pain service in some centres. More research is required to determine the optimal management of epidural analgesia, and suitable clinical support for paediatric pain control should be more widely available.

Marked variation in newborn resuscitation practice: A national survey in the UK☆

PubMed Central

Mann, Chantelle; Ward, Carole; Grubb, Mark; Hayes-Gill, Barrie; Crowe, John; Marlow, Neil; Sharkey, Don

2012-01-01

Background Although international newborn resuscitation guidance has been in force for some time, there are no UK data on current newborn resuscitation practices. Objective Establish delivery room (DR) resuscitation practices in the UK, and identify any differences between neonatal intensive care units (NICU), and other local neonatal services. Methods We conducted a structured two-stage survey of DR management, among UK neonatal units during 2009–2010 (n = 192). Differences between NICU services (tertiary level) and other local neonatal services (non-tertiary) were analysed using Fisher's exact and Student's t-tests. Results There was an 89% response rate (n = 171). More tertiary NICUs institute DR CPAP than non-tertiary units (43% vs. 16%, P = 0.0001) though there was no significant difference in frequency of elective intubation and surfactant administration for preterm babies. More tertiary units commence DR resuscitation in air (62% vs. 29%, P < 0.0001) and fewer in 100% oxygen (11% vs. 41%, P < 0.0001). Resuscitation of preterm babies in particular, commences with air in 56% of tertiary units. Significantly more tertiary units use DR pulse oximeters (58% vs. 29%, P < 0.01) and titrate oxygen based on saturations. Almost all services use occlusive wrapping to maintain temperature for preterm infants. Conclusions In the UK, there are many areas of good evidence based DR practice. However, there is marked variation in management, including between units of different designation, suggesting a need to review practice to fulfil new resuscitation guidance, which will have training and resource implications. PMID:22245743

A qualitative study of advanced nurse practitioners' use of physical assessment skills in the community: shifting skills across professional boundaries.

PubMed

Raleigh, Mary; Allan, Helen

2017-07-01

To explore multiple perspectives on the use of physical assessment skills by advanced nurse practitioners in the UK. Physical assessment skills practices are embedded in advanced nursing practice roles in the UK. There is little evidence on how these skills are used by advanced nurse practitioners in the community. Case study. A qualitative interpretative single-embedded case study of 22 participants from South of England. A framework method analysed interview data collected by the researcher between March-August 2013. Participants included nurses, doctors, nurse educators and managers. Physical assessment skills education at universities is part of a policy shift to develop a flexible workforce in the UK. Shared physical assessment practices are less to do with role substitution and more about preparing practitioners with skills that are fit for purpose. Competence, capability and performance with physical assessment skills are an expectation of advanced nursing practice. These skills are used successfully by community advanced nurse practitioners to deliver a wide range of services in response to changing patient need. The introduction of physical assessment skills education to undergraduate professional preparation would create a firm foundation to develop these skills in postgraduate education. Physical assessment education prepares nurses with the clinical competencies to carry out healthcare reforms in the UK. Shared sets of clinical assessment competencies between disciplines have better outcomes for patients. Levels of assessment competence can depend on the professional attributes of individual practitioners. Unsupportive learning cultures can hinder professional development of advanced nursing practice. © 2016 John Wiley & Sons Ltd.

Boosting uptake of influenza immunisation: a randomised controlled trial of telephone appointing in general practice.

PubMed Central

Hull, Sally; Hagdrup, Nicola; Hart, Ben; Griffiths, Chris; Hennessy, Enid

2002-01-01

BACKGROUND: Immunisation against influenza is an effective intervention that reduces serologically confirmed cases by between 60% and 70%. Almost all influenza immunisation in the UK is done within general practice. Current evidence on the effectiveness of patient reminders for all types of immunisation programmes is largely based on North American studies. AIM: To determine whether telephone appointments offered bygeneral practice receptionists increase the uptake of irfluenza immunisation among the registered population aged over 65 years in east London practices. DESIGN OF STUDY: Randomised controlled trial. SETTING: Three research general practices within the East London and Essex network of researchers (ELENoR). METHOD: Participants were 1,820 low-risk patients aged 65 to 74 years who had not previously been in a recall system for influenza immunisation at their general practice. The intervention, during October 2000, was a telephone call from the practice receptionist to intervention group households, offering an appointment for influenza immunisation at a nurse-run. clinic Main outcome measures were the numbers of individuals in each group receiving immunisation, and practice costs of a telephone-appointing programme. RESULTS: intention to treat analysis showed an immunisation rate in the control group of 44%, compared with 50% in the intervention group (odds ratio = 1.29, 95% confidence interval = 1.03 to 1.63). Of the patients making a telephone appointment, 88% recieved immunisation, while 22% of those not wanting an appointment went on to be immunised. In the controlgroup, income generated was 11.35 pounds per immunisation, for each additional immunisation in the intervention group the income was 5.20 pounds. The 'number needed to telephone' was 17. CONCLUSION: Uptake of influenza immunisation among the low-risk older population in inner-city areas can be boosted by around 6% using a simple intervention by receptionists. Immunisation rates in this low-risk group fell well short of the 60% government target. Improving immunisation rates will require a sustained public health campaign. Retaining the item-of-service payments to practices should support costs of practice-based interventions. PMID:12236273

Ecological assessment of the direct and indirect effects of routine rotavirus vaccination in Merseyside, UK using data from multiple health systems: a study protocol.

PubMed

Hungerford, Daniel; Vivancos, Roberto; French, Neil; Iturriza-Gomara, Miren; Cunliffe, Nigel

2014-11-25

Rotavirus is the most common cause of severe gastroenteritis in infants and young children worldwide. Currently 67 countries include rotavirus vaccine in childhood immunisation programmes, but uptake in Western Europe has been slow. In July 2013, rotavirus vaccine was introduced into the UK's routine childhood immunisation programme. Prior to vaccine introduction in the UK, rotavirus was estimated to result in 750,000 diarrhoea episodes and 80,000 general practice (GP) consultations each year, together with 45% and 20% of hospital admissions and emergency department attendances for acute gastroenteritis, in children under 5 years of age. This paper describes a protocol for an ecological study that will assess rotavirus vaccine impact in the UK, to inform rotavirus immunisation policy in the UK and in other Western European countries. In Merseyside, UK, we will conduct an ecological study using a 'before and after' approach to examine changes in gastroenteritis and rotavirus incidence following the introduction of rotavirus vaccination. Data will be collected on mortality, hospital admissions, nosocomial infection, emergency department attendances, GP consultations and community health consultations to capture all healthcare providers in the region. We will assess both the direct and indirect effects of the vaccine on the study population. Comparisons of outcome indicator rates will be made in relation to vaccine uptake and socioeconomic status. The study has been approved by NHS Research Ethics Committee, South Central-Berkshire REC Reference: 14/SC/1140. Study outputs will be disseminated through scientific conferences and peer-reviewed publications. The study will demonstrate the impact of rotavirus vaccination on the burden of disease from a complete health system perspective. It will identify key areas that require improved data collection tools to maximise the usefulness of this surveillance approach and will provide a template for vaccine evaluations using ecological methods in the UK. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Norms and Values in UK Science Engagement Practice

ERIC Educational Resources Information Center

Jensen, Eric; Holliman, Richard

2016-01-01

In recent years, there has been a rhetorical shift from "deficit" to "dialogue" and "engagement" in UK policy and institutional discourse about science communication. Past efforts to reduce public scientific literacy deficits have been overshadowed by calls for dialogue between scientists, science communicators and…

Abortion and neonaticide: ethics, practice, and policy in four nations.

PubMed

Gross, Michael L

2002-06-01

Abortion, particularly later-term abortion, and neonaticide, selective non-treatment of newborns, are feasible management strategies for fetuses or newborns diagnosed with severe abnormalities. However, policy varies considerably among developed nations. This article examines abortion and neonatal policy in four nations: Israel, the US, the UK and Denmark. In Israel, late-term abortion is permitted while non-treatment of newborns is prohibited. In the US, on the other hand, later-term abortion is severely restricted, while treatment to newborns may be withdrawn. Policy in the UK and Denmark bridges some of these gaps with liberal abortion and neonatal policy. Disparate policy within and between nations creates practical and ethical difficulties. Practice diverges from policy as many practitioners find it difficult to adhere to official policy. Ethically, it is difficult to entirely justify perinatal policy in these nations. In each nation, there are elements of ethically sound policy, while other aspects cannot be defended. Ethical policy hinges on two underlying normative issues: the question of fetal/newborn status and the morality of killing and letting die. While each issue has been the subject of extensive debate, there are firm ethical norms that should serve as the basis for coherent and consistent perinatal policy. These include 1) a grant of full moral and legal status to the newborn but only partial moral and legal status to the late-term fetus 2) a general prohibition against feticide unless to save the life of the mother or prevent the birth of a fetus facing certain death or severe pain or suffering and 3) a general endorsement of neonaticide subject to a parent's assessment of the newborn's interest broadly defined to consider physical harm as well as social, psychological and or financial harm to related third parties. Policies in each of the nations surveyed diverging from these norms should be the subject of public discourse and, where possible, legislative reform.

Problematising the `Career Academic' in UK construction and engineering education: does the system want what the system gets?

NASA Astrophysics Data System (ADS)

Pilcher, Nick; Forster, Alan; Tennant, Stuart; Murray, Mike; Craig, Nigel

2017-11-01

'Career Academics' are principally research-led, entering academia with limited or no industrial or practical experience. UK Higher Education Institutions welcome them for their potential to attain research grant funding and publish world-leading journal papers, ultimately enhancing institutional reputation. This polemical paper problematises the Career Academic around three areas: their institutional appeal; their impact on the student experience, team dynamics and broader academic functions; and current strategic policy to employ them. We also argue that recent UK Government teaching-focused initiatives will not address needs to employ practical academics, or 'Pracademics' in predominantly vocational Construction and Engineering Education. We generate questions for policy-makers, institutions and those implementing strategy. We argue that research is key, but partial rebalancing will achieve a diverse academic skill base to achieve contextualised construction and engineering education. In wider European contexts, the paper resonates with issues of academic 'drift' and provides reflection for others on the UK context.

National audit of cerebrospinal fluid testing.

PubMed

Holbrook, Ian; Beetham, Robert; Cruickshank, Anne; Egner, William; Fahie-Wilson, Mike; Keir, Geoff; Patel, Dina; Watson, Ian; White, Peter

2007-09-01

UK National External Quality Assessment Service (NEQAS) Specialist Advisory Group for EQA of CSF Proteins and Biochemistry was interested in current practice for the biochemical investigation of cerebrospinal fluid (CSF) in the UK. A questionnaire was sent to laboratories via regional audit committees and the results collated. Most laboratories were analysing CSF in a satisfactory manner. There was some variation in the reference ranges used for glucose, protein and lactate. There was concern about the rejection policies of some laboratories on these unrepeatable samples and the wavelengths used to measure bilirubin. The survey revealed the lack of spectrophotometric scanning for haem pigments and bilirubin in some hospitals. The current practice for the measurement of CSF samples in the UK is satisfactory in most laboratories responding to the questionnaire. National agreement on reference ranges for glucose, protein and lactate should be achievable. Those performing spectrophotometric scanning of the CSF were doing so in concordance with the national guidelines. Some hospitals in the UK may not have responded to the questionnaire because they did not offer spectrophotometric scanning.

Catchments of general practice in different countries– a literature review

PubMed Central

2014-01-01

The purpose of this paper is to review the current research on catchment areas of private general practices in different developed countries because healthcare reform, including primary health care, has featured prominently as an important political issue in a number of developed countries. The debates around health reform have had a significant health geographic focus. Conceptually, GP catchments describe the distribution, composition and profile of patients who access a general practitioner or a general practice (i.e. a site or facility comprising one or more general practitioners). Therefore, GP catchments provide important information into the geographic variation of access rates, utilisation of services and health outcomes by all of the population or different population groups in a defined area or aggregated area. This review highlights a wide range of diversity in the literature as to how GP catchments can be described, the indicators and measures used to frame the scale of catchments. Patient access to general practice health care services should be considered from a range of locational concepts, and not necessarily constrained by their place of residence. An analysis of catchment patterns of general practitioners should be considered as dynamic and multi-perspective. Geographic information systems provide opportunities to contribute valuable methodologies to study these relationships. However, researchers acknowledge that a conceptual framework for the analysis of GP catchments requires access to real world data. Recent studies have shown promising developments in the use of real world data, especially from studies in the UK. Understanding the catchment profiles of individual GP surgeries is important if governments are serious about patient choice being a key part of proposed primary health reforms. Future health planning should incorporate models of GP catchments as planning tools, at the micro level as well as the macro level, to assist policies on the allocation of resources so that opportunities for good health outcomes for all groups within society, especially those who have been systematically denied equitable access, are maximised. PMID:25174719

Risk Assessment in the UK Health and Safety System: Theory and Practice.

PubMed

Russ, Karen

2010-09-01

In the UK, a person or organisation that creates risk is required to manage and control that risk so that it is reduced 'So Far As Is Reasonably Practicable' (SFAIRP). How the risk is managed is to be determined by those who create the risk. They have a duty to demonstrate that they have taken action to ensure all risk is reduced SFAIRP and must have documentary evidence, for example a risk assessment or safety case, to prove that they manage the risks their activities create. The UK Health and Safety Executive (HSE) does not tell organisations how to manage the risks they create but does inspect the quality of risk identification and management. This paper gives a brief overview of where responsibility for occupational health and safety lies in the UK, and how risk should be managed through risk assessment. The focus of the paper is three recent major UK incidents, all involving fatalities, and all of which were wholly avoidable if risks had been properly assessed and managed. The paper concludes with an analysis of the common failings of risk assessments and key actions for improvement.

Crooked Timber: The life of Calvin Wells (1908–1978)

PubMed Central

2014-01-01

Calvin Wells was the leading palaeopathologist in the UK between the later 1950s and the early 1970s. He studied medicine at University College London but failed in anatomy and qualified in 1933 with the Conjoint Diploma (MRCS, LRCP). After qualification he began to study obstetrics and after war service in the RAMC he settled in Norfolk (UK), established a small general practice and took up palaeopathology. Although he was usually conservative in diagnosis he tended to over-interpret signs in the skeleton, often publishing descriptions that were more fiction than science. He held firm views on the way in which palaeopathology should be undertaken and in particular he resented the entry into the field of anthropologists without medical training. His major contributions to palaeopathology were related to the study of cremations and the introduction of the notion of pseudopathology, and his writings on these subjects have scarcely been improved upon since. He was extremely well read, warm and encouraging to those with archaeological or medical qualifications, but vituperative about those he disliked. His bone reports, which are a major proportion of his published output, generally were highly regarded but his writing is often marred by sexual innuendo and vulgarity which does his memory little credit. PMID:24585588

Physiotherapy and occupational therapy for juvenile chronic arthritis: custom and practice in five centres in the UK, USA and Canada.

PubMed

Hackett, J; Johnson, B; Parkin, A; Southwood, T

1996-07-01

Physiotherapy and occupational therapy are widely accepted as being of central importance for the treatment of juvenile chronic arthritis (JCA). However, these approaches have rarely been subject to critical scrutiny. The aims of this report are to highlight some of the inter-centre similarities and differences observed in the implementation of physical and occupational therapy for JCA, and to emphasize the need for scientifically controlled research in this area. During a series of visits to several paediatric rheumatology units in the UK, USA and Canada, three aspects of the service were noted: treatment philosophy, physical interventions used for the treatment of JCA and quality-of-life and independence training activities. There was general consensus with the philosophy that early physical intervention was a vital part of the treatment plan for JCA, although all therapists were concerned that compliance with treatment modalities was poor. Differences between units in the approach to acute arthritis, the use of foot orthoses and wrist splints, the treatment of joint contractures and the use of general quality-of-life training activities were noted. Although it was widely recognized that controlled research into the efficacy of physical intervention was needed, no centre had a co-ordinated plan for such investigations.

Inaccurate Dental Charting in an Audit of 1128 General Dental Practice Records.

PubMed

Brown, Nathan L; Jephcote, Victoria E L

2017-03-01

Fourteen dentists at different practices in the UK assessed the dental charts of 1128 patients who were new to the dentist but not new to the practice; 44% of the dental charts were found to be inaccurate. Inaccuracy of the individual practice-based charts ranged between 16% for the best performing practices to 83% for the worst: 5% of dental charts had too many teeth charted and 5% had too few teeth charted; 13% of charts had missed amalgam restorations and 18% had missed tooth-coloured restorations; 5% of charts had amalgam restorations recorded but with the surfaces incorrect (eg an MO restoration charted but a DO restoration actually present); 9% of charts had tooth-coloured restoration surfaces incorrectly recorded. For 7.5% of charts, amalgams were charted but not actually present. Other inaccuracies were also noted. The authors reinforce the requirements of the GDC, the advice of defence organizations, and the forensic importance of accurate dental charts. Clinical relevance: Dental charting forms part of the patient’s dental records, and the GDC requires dentists to maintain complete and accurate dental records.

Retrospective examination of lipid-lowering treatment patterns in a real-world high-risk cohort in the UK in 2014: comparison with the National Institute for Health and Care Excellence (NICE) 2014 lipid modification guidelines.

PubMed

Steen, Dylan L; Khan, Irfan; Ansell, David; Sanchez, Robert J; Ray, Kausik K

2017-02-17

In 2014, guidelines from the National Institute for Health and Care Excellence (NICE) provided updated recommendations on lipid-modifying therapy (LMT). We assessed clinical practice contemporaneous to release of these guidelines in a UK general practice setting for secondary and high-risk primary-prevention populations, and extrapolated the findings to UK nation level. Patients from The Health Improvement Network database with the following criteria were included: lipid profile in 2014 (index date); ≥20 years of age; ≥2 years representation in database prior to index; ≥1 statin indication either for atherosclerotic cardiovascular disease (ASCVD) or the non-ASCVD conditions high-risk diabetes mellitus and/or chronic kidney disease. Overall, 183 565 patients met the inclusion criteria (n=91 479 for ASCVD, 92 086 for non-ASCVD). In those with ASCVD, 79% received statin treatment and 31% received high-intensity statin. In the non-ASCVD group, 62% were on a statin and 57% received medium-intensity or high-intensity statin. In the ASCVD and non-ASCVD cohorts, 6% and 15%, respectively, were already treated according to dosing recommendations as per updated NICE guidelines. Extrapolation to the 2014 UK population indicated that, of the 3.3 million individuals with ASCVD, 2.4 million would require statin uptitration and 680 000 would require statin initiation (31% de novo initiation, 60% reinitiation, 9% addition to non-statin LMT) to achieve full concordance with updated guidelines. Of the 3.5 million high-risk non-ASCVD individuals, 1.6 million would require statin uptitration and 1.4 million would require statin initiation (59% de novo initiation, 36% reinitiation, 5% addition to non-statin LMT). A large proportion of UK individuals with ASCVD and high-risk non-ASCVD received statin treatment (79% and 62%, respectively) during the year of NICE 2014 guidelines release. Up to 94% of patients with ASCVD and 85% of high-risk non-ASCVD individuals, representing ∼3 million individuals in each group, would require statin uptitration or initiation to achieve full concordance with updated guidelines. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The Development of the Special Educational Needs Coordinator Role in a Higher Education Setting

ERIC Educational Resources Information Center

Taylor, Mark

2005-01-01

UK higher education appears to have generally been slow to adopt an organised means of provision for special educational needs for its students. This may be due to the fact that, historically, relatively few disabled students entered UK higher education. However, there is a growing number of disabled students entering UK higher education…

Communication on Safety of Medicines in Europe: Current Practices and General Practitioners' Awareness and Preferences.

PubMed

de Vries, Sieta T; van der Sar, Maartje J M; Cupelli, Amelia; Baldelli, Ilaria; Coleman, Anna Marie; Montero, Dolores; Šipić, Ivana; Andrić, Adriana; Wennberg, Annika; Ahlqvist-Rastad, Jane; Denig, Petra; Mol, Peter G M

2017-08-01

National competent authorities (NCAs) for medicines coordinate communication relating to the safety of medicines in Europe. The effectiveness of current communication practices has been questioned, particularly with regard to reaching general practitioners (GPs). The aim of this study was to assess current European NCA safety communication practices and to investigate European GPs' awareness of and preferences for safety communications on medicines. Web-based surveys were distributed among European NCAs and healthcare professionals (HCPs). The survey among regulators was emailed to a representative of each of the 27 European countries participating in the Strengthening Collaboration for Operating Pharmacovigilance in Europe (SCOPE) Joint Action. HCPs from nine European countries (Denmark, Spain, Croatia, Ireland, Italy, The Netherlands, Norway, Sweden, and the UK) were asked about their preferences through a link to the survey on websites, in newsletters, and/or in a direct email. From this survey, data from GPs were used and descriptive analyses were conducted. Current NCA practices were reported for 26 countries. In 23 countries (88%), NCAs published direct healthcare professional communications (DHPCs, i.e. urgent communication letters for serious safety issues) on their website in addition to distribution to individual HCPs. Educational materials were available on the NCA's website in 10 countries (40%), and 21 NCAs (81%) indicated they had their own bulletin/newsletter, which is often presented on the NCA's website (15 countries; 60%). More than 90% of the 1766 GPs who completed the survey were aware of DHPCs. The most preferred senders of safety information were NCAs and professional bodies, while the preferred channels for keeping up to date with safety information were medicines reference books and clinical guidelines. GPs found the repetition of safety issues useful (range of 80% in the UK to 97% in Italy). Preference for an electronic copy rather than a hardcopy varied per country (36% in Sweden to 72% in Spain). NCAs use similar methods for safety communications on medicines. Most GPs were aware of urgent communications and preferred similar senders of safety communications; however, their preferences towards the format differed per country.

The INCENTIVE protocol: an evaluation of the organisation and delivery of NHS dental healthcare to patients—innovation in the commissioning of primary dental care service delivery and organisation in the UK

PubMed Central

Pavitt, Sue H; Baxter, Paul D; Brunton, Paul A; Douglas, Gail; Edlin, Richard; Gibson, Barry J; Godson, Jenny; Hall, Melanie; Porritt, Jenny; Robinson, Peter G; Vinall, Karen; Hulme, Claire

2014-01-01

Introduction In England, in 2006, new dental contracts devolved commissioning of dental services locally to Primary Care Trusts to meet the needs of their local population. The new national General Dental Services contracts (nGDS) were based on payment for Units of Dental Activity (UDAs) awarded in three treatment bands based on complexity of care. Recently, contract currency in UK dentistry is evolving from UDAs based on volume and case complexity towards ‘blended contracts’ that include incentives linked with key performance indicators such as quality and improved health outcome. Overall, evidence of the effectiveness of incentive-driven contracting of health providers is still emerging. The INCENTIVE Study aims to evaluate a blended contract model (incentive-driven) compared to traditional nGDS contracts on dental service delivery in practices in West Yorkshire, England. Methods and analysis The INCENTIVE model uses a mixed methods approach to comprehensively evaluate a new incentive-driven model of NHS dental service delivery. The study includes 6 dental surgeries located across three newly commissioned dental practices (blended contract) and three existing traditional practices (nGDS contracts). The newly commissioned practices have been matched to traditional practices by deprivation index, age profile, ethnicity, size of practice and taking on new patients. The study consists of three interlinked work packages: a qualitative study to explore stakeholder perspectives of the new service delivery model; an effectiveness study to assess the INCENTIVE model in reducing the risk of and amount of dental disease and enhance oral health-related quality of life in patients; and an economic study to assess cost-effectiveness of the INCENTIVE model in relation to clinical status and oral health-related quality of life. Ethics and dissemination The study has been approved by NRES Committee London, Bromley. The results of this study will be disseminated at national and international conferences and in international journals. PMID:25231492

Attitudes and perceptions of health professionals towards management of hypothyroidism in general practice: a qualitative interview study

PubMed Central

Dew, Rosie; King, Kathryn; Okosieme, Onyebuchi E; Pearce, Simon H; Donovan, Gemma; Taylor, Peter N; Hickey, Janis; Dayan, Colin M; Leese, Graham; Razvi, Salman; Wilkes, Scott

2018-01-01

Objective To explore the attitudes and perceptions of health professionals towards management of hypothyroidism that contributes to the suboptimal treatment of hypothyroidism in general practice. Design A qualitative interview study using semistructured interviews. Participants Sixteen participants were interviewed between March and August 2016 comprising nine general practitioners (GPs), four pharmacists, two practice nurses and one nurse practitioner. Setting General practice and community pharmacies in the counties of Northumberland, Tyne and Wear, Stockton-on-Tees and North Cumbria, North of England, UK. Method A grounded-theory approach was used to generate themes from interviews, which were underpinned by the theory of planned behaviour to give explanation to the data. Results Although health professionals felt that hypothyroidism was easy to manage, GPs and nurses generally revealed inadequate knowledge of medication interactions and levothyroxine pharmacokinetics. Pharmacists felt limited in the advice that they provide to patients due to lack of access to patient records. Most GPs and nurses followed local guidelines, and relied on blood tests over clinical symptoms to adjust levothyroxine dose. The information exchanged between professional and patient was usually restricted by time and often centred on symptoms rather than patient education. Health professionals felt that incorrect levothyroxine adherence was the main reason behind suboptimal treatment, although other factors such as comorbidity and concomitant medication were mentioned. Enablers perceived by health professionals to improve the management of hypothyroidism included continuity of care, blood test reminders, system alerts for interfering medications and prescription renewal, and accessible blood tests and levothyroxine prescriptions for patients. Conclusion There is a significant health professional behavioural component to the management of hypothyroidism. Addressing the differences in patient and professional knowledge and perceptions could reduce the barriers to optimal treatment, while continuity of care and increased involvement of pharmacists and practice nurses would help to promote optimal thyroid replacement. PMID:29467136

Leading Change in Higher Education

ERIC Educational Resources Information Center

McRoy, Ian; Gibbs, Paul

2009-01-01

This article considers the situation in the UK higher education system and investigates specifically the leadership practice in a cluster of UK institutions as they changed their status. The research goes further to advocate a form of contextualized leadership that is relevant to higher institutions under change. (Contains 1 figure.)

Cluster randomized trials utilizing primary care electronic health records: methodological issues in design, conduct, and analysis (eCRT Study).

PubMed

Gulliford, Martin C; van Staa, Tjeerd P; McDermott, Lisa; McCann, Gerard; Charlton, Judith; Dregan, Alex

2014-06-11

There is growing interest in conducting clinical and cluster randomized trials through electronic health records. This paper reports on the methodological issues identified during the implementation of two cluster randomized trials using the electronic health records of the Clinical Practice Research Datalink (CPRD). Two trials were completed in primary care: one aimed to reduce inappropriate antibiotic prescribing for acute respiratory infection; the other aimed to increase physician adherence with secondary prevention interventions after first stroke. The paper draws on documentary records and trial datasets to report on the methodological experience with respect to research ethics and research governance approval, general practice recruitment and allocation, sample size calculation and power, intervention implementation, and trial analysis. We obtained research governance approvals from more than 150 primary care organizations in England, Wales, and Scotland. There were 104 CPRD general practices recruited to the antibiotic trial and 106 to the stroke trial, with the target number of practices being recruited within six months. Interventions were installed into practice information systems remotely over the internet. The mean number of participants per practice was 5,588 in the antibiotic trial and 110 in the stroke trial, with the coefficient of variation of practice sizes being 0.53 and 0.56 respectively. Outcome measures showed substantial correlations between the 12 months before, and after intervention, with coefficients ranging from 0.42 for diastolic blood pressure to 0.91 for proportion of consultations with antibiotics prescribed, defining practice and participant eligibility for analysis requires careful consideration. Cluster randomized trials may be performed efficiently in large samples from UK general practices using the electronic health records of a primary care database. The geographical dispersal of trial sites presents a difficulty for research governance approval and intervention implementation. Pretrial data analyses should inform trial design and analysis plans. Current Controlled Trials ISRCTN 47558792 and ISRCTN 35701810 (both registered on 17 March 2010).

Cluster randomized trials utilizing primary care electronic health records: methodological issues in design, conduct, and analysis (eCRT Study)

PubMed Central

2014-01-01

Background There is growing interest in conducting clinical and cluster randomized trials through electronic health records. This paper reports on the methodological issues identified during the implementation of two cluster randomized trials using the electronic health records of the Clinical Practice Research Datalink (CPRD). Methods Two trials were completed in primary care: one aimed to reduce inappropriate antibiotic prescribing for acute respiratory infection; the other aimed to increase physician adherence with secondary prevention interventions after first stroke. The paper draws on documentary records and trial datasets to report on the methodological experience with respect to research ethics and research governance approval, general practice recruitment and allocation, sample size calculation and power, intervention implementation, and trial analysis. Results We obtained research governance approvals from more than 150 primary care organizations in England, Wales, and Scotland. There were 104 CPRD general practices recruited to the antibiotic trial and 106 to the stroke trial, with the target number of practices being recruited within six months. Interventions were installed into practice information systems remotely over the internet. The mean number of participants per practice was 5,588 in the antibiotic trial and 110 in the stroke trial, with the coefficient of variation of practice sizes being 0.53 and 0.56 respectively. Outcome measures showed substantial correlations between the 12 months before, and after intervention, with coefficients ranging from 0.42 for diastolic blood pressure to 0.91 for proportion of consultations with antibiotics prescribed, defining practice and participant eligibility for analysis requires careful consideration. Conclusions Cluster randomized trials may be performed efficiently in large samples from UK general practices using the electronic health records of a primary care database. The geographical dispersal of trial sites presents a difficulty for research governance approval and intervention implementation. Pretrial data analyses should inform trial design and analysis plans. Trial registration Current Controlled Trials ISRCTN 47558792 and ISRCTN 35701810 (both registered on 17 March 2010). PMID:24919485

Intensive care discharge summaries for general practice staff: a focus group study

PubMed Central

Bench, Suzanne; Cornish, Jocelyn; Xyrichis, Andreas

2016-01-01

Background Understanding how patients and relatives can be supported after hospital discharge is a UK research priority. Intensive Care Unit (ICU) discharge summaries are a simple way of providing GPs with the information they require to coordinate ongoing care, but little evidence is available to guide best practice. Aim This study aimed at better understanding the information needs of GP staff (GPs and practice nurses) supporting former patients of ICUs and their families following discharge from hospital, and identifying the barriers/facilitators associated with ICU–primary care information transfer. Design and setting This was a qualitative exploratory study of practices and participants throughout the UK. Method Audiotaped focus group discussions, complemented by small-group/individual interviews, were conducted with 15 former patients of ICUs, four relatives, and 20 GP staff between June and September 2015. Demographic data were captured by questionnaire and qualitative data were thematically analysed. Results Findings suggest variability in discharge information experiences and blurred lines of responsibility between hospital and GP staff, and patients/relatives. Continuity of care was affected by delayed or poor communication from the hospital; GPs’ limited contact with patients from critical care; and a lack of knowledge of the effects of critical illness or resources available to ameliorate these difficulties. Time pressures and information technology were, respectively, the most commonly mentioned barrier and facilitator. Conclusion Effective rehabilitation after a critical illness requires a coordinated and comprehensive approach, incorporating the provision of well-completed, timely, and relevant ICU–primary care discharge information. Health professionals need an improved understanding of critical illness, and patients and families must be included in all aspects of the information-sharing process. PMID:27872086

Exploring the training and scope of practice of GPs in England, Germany and Spain.

PubMed

Glonti, Ketevan; Struckmann, Verena; Alconada, Alvaro; Pettigrew, Luisa M; Hernandez-Santiago, Virginia; Minue, Sergio; Risso-Gill, Isabelle; McKee, Martin; Legido-Quigley, Helena

2018-03-22

To explore general practitioner (GP) training, continuing professional development, scope of practice, ethical issues and challenges in the working environment in three European countries. Qualitative study of 35 GPs from England, Germany and Spain working in urban primary care practices. Participants were recruited using convenience and snowball sampling techniques. Semi-structured interviews were recorded, transcribed and analysed by four independent researchers adopting a thematic approach. Entrance to and length of GP training differ between the three countries, while continuing professional development is required in all three, although with different characteristics. Key variations in the scope of practice include whether there is a gatekeeping role, whether GPs work in multidisciplinary teams or singlehandedly, the existence of appraisal processes, and the balance between administrative and clinical tasks. However, similar challenges, including the need to adapt to an ageing population, end-of-life care, ethical dilemmas, the impact of austerity measures, limited time for patients and gaps in coordination between primary and secondary care are experienced by GPs in all three countries. Primary health care variations have strong historical roots, derived from the different national experiences and the range of clinical services delivered by GPs. There is a need for an accessible source of information for GPs themselves and those responsible for safety and quality standards of the healthcare workforce. This paper maps out the current situation before Brexit is being implemented in the UK which could see many of the current EU arrangements and legislation to assure professional mobility between the UK and the rest of Europe dismantled. Copyright © 2017. Publicado por Elsevier España, S.L.U.

Primary goals, information-giving and men’s understanding: a qualitative study of Australian and UK doctors’ varied communication about PSA screening

PubMed Central

Pickles, Kristen; Rychetnik, Lucie; McCaffery, Kirsten; Entwistle, Vikki A

2018-01-01

Objectives (1) To characterise variation in general practitioners’ (GPs’) accounts of communicating with men about prostate cancer screening using the prostate-specific antigen (PSA) test, (2) to characterise GPs’ reasons for communicating as they do and (3) to explain why and under what conditions GP communication approaches vary. Study design and setting A grounded theory study. We interviewed 69 GPs consulting in primary care practices in Australia (n=40) and the UK (n=29). Results GPs explained their communication practices in relation to their primary goals. In Australia, three different communication goals were reported: to encourage asymptomatic men to either have a PSA test, or not test, or alternatively, to support men to make their own decision. As well as having different primary goals, GPs aimed to provide different information (from comprehensive to strongly filtered) and to support men to develop different kinds of understanding, from population-level to ‘gist’ understanding. Taking into account these three dimensions (goals, information, understanding) and building on Entwistle et al’s Consider an Offer framework, we derived four overarching approaches to communication: Be screened, Do not be screened, Analyse and choose, and As you wish. We also describe ways in which situational and relational factors influenced GPs’ preferred communication approach. Conclusion GPs’ reported approach to communicating about prostate cancer screening varies according to three dimensions—their primary goal, information provision preference and understanding sought—and in response to specific practice situations. If GP communication about PSA screening is to become more standardised in Australia, it is likely that each of these dimensions will require attention in policy and practice support interventions. PMID:29362252

Primary goals, information-giving and men's understanding: a qualitative study of Australian and UK doctors' varied communication about PSA screening.

PubMed

Pickles, Kristen; Carter, Stacy M; Rychetnik, Lucie; McCaffery, Kirsten; Entwistle, Vikki A

2018-01-23

(1) To characterise variation in general practitioners' (GPs') accounts of communicating with men about prostate cancer screening using the prostate-specific antigen (PSA) test, (2) to characterise GPs' reasons for communicating as they do and (3) to explain why and under what conditions GP communication approaches vary. A grounded theory study. We interviewed 69 GPs consulting in primary care practices in Australia (n=40) and the UK (n=29). GPs explained their communication practices in relation to their primary goals. In Australia, three different communication goals were reported: to encourage asymptomatic men to either have a PSA test, or not test, or alternatively, to support men to make their own decision. As well as having different primary goals, GPs aimed to provide different information (from comprehensive to strongly filtered) and to support men to develop different kinds of understanding, from population-level to 'gist' understanding. Taking into account these three dimensions (goals, information, understanding) and building on Entwistle et al' s Consider an Offer framework, we derived four overarching approaches to communication: Be screened , Do not be screened , Analyse and choose , and As you wish . We also describe ways in which situational and relational factors influenced GPs' preferred communication approach. GPs' reported approach to communicating about prostate cancer screening varies according to three dimensions-their primary goal, information provision preference and understanding sought-and in response to specific practice situations. If GP communication about PSA screening is to become more standardised in Australia, it is likely that each of these dimensions will require attention in policy and practice support interventions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Leadership and the everyday practice of Consultant Radiographers in the UK: Transformational ideals and the generation of self-efficacy.

PubMed

Booth, L; Henwood, S; Miller, P K

2017-05-01

This paper outlines findings from a broader, two-year project investigating the role of Consultant Radiographers (CRs) in the UK, focussing specifically on the leadership aspect of that role. Using a qualitative-thematic approach, the leadership-related experiences of a purposive sample of six participating CRs are explored, alongside the systems through which they evaluated how successful they had been as leaders. It is evidenced that many of the ways in which participants describe their own leadership practice, particularly in the intra-team domain, is consistent with the precepts of the Transformational Leadership Model. For example, they highlight how they have asserted positive influence and encouraged collective action and decision-making. However, the experiential focus of the analysis reveals that in specific examples of practice, the transformational approach was not always seen as the most useful route to a productive outcome given constrictions on time and other resources within real professional environments. More 'direct' managerial approaches were sometimes deemed necessary, and at others leadership was reduced to simply 'solving other people's problems'. It was also found that the manner in which participants evaluated their own success as leaders was a practical concern, based in part upon having satisfied 'hard' institutional goals, but also on the more personal business of having affirmatively 'surprised' oneself, or a general sense of feeling trusted by colleagues. These findings may help support CRs in the business of real leadership, not least through better understanding how even apparently mundane outcomes can have significant impacts on professional self-efficacy. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Preparticipation medical evaluation in professional sport in the UK: theory or practice?

PubMed

Fuller, C W; Ojelade, E O; Taylor, A

2007-12-01

To determine the level of pre-employment, pre-season, and post-injury medical evaluation of players undertaken within UK professional team sports. A postal, whole population survey. Elite professional sports teams in England. Six groups comprising the following clubs: professional football (Premiership, 15 of 20; Championship, 22 of 24), rugby union (Premiership, 9 of 12; Division 1, 11 of 14), rugby league (Super League, 6 of 11) and cricket (County, 12 of 18). Number (percentage) of clubs recording players' medical history and undertaking medical examinations of players' cardiovascular, respiratory, neurological, and musculoskeletal systems at pre-employment, pre-season and post-injury. The overall response to the survey was 74%, with a range from 55% to 92% among groups. Almost 90% of football (Premiership and Championship) and rugby union (Premiership) clubs took a pre-employment history of players' general health, cardiovascular, respiratory, neurological, and musculoskeletal systems, but fewer than 50% of cricket and rugby union (Division 1) clubs recorded a history. The majority of football (Premiership and Championship) and rugby union (Premiership) clubs implemented both cardiovascular and musculoskeletal examinations of players before employment. Fewer than 25% of clubs in any of the groups implemented neurological examinations of players at pre-employment, although 100% of rugby union (Premiership) and rugby league clubs implemented neurological testing during pre-season. None of the sports implemented best practice guidelines for the preparticipation evaluation of players at all stages of their employment. Departures from best practice guidelines and differences in practices between clubs within the same sport leave club physicians vulnerable if their players sustain injuries or ill health conditions that could have been identified and avoided through the implementation of a preparticipation examination.

Tinnitus referral pathways within the National Health Service in England: a survey of their perceived effectiveness among audiology staff

PubMed Central

2011-01-01

Background In the UK, audiology services deliver the majority of tinnitus patient care, but not all patients experience the same level of service. In 2009, the Department of Health released a Good Practice Guide to inform commissioners about key aspects of a quality tinnitus service in order to promote equity of tinnitus patient care in UK primary care, audiology, and in specialist multi-disciplinary centres. The purpose of the present research was to evaluate utilisation and opinions on pathways for the referral of tinnitus patients to and from English Audiology Departments. Methods We surveyed all audiology staff engaged in providing tinnitus services across England. A 36-item questionnaire was mailed to 351 clinicians in all 163 National Health Service (NHS) Trusts identified as having a tinnitus service. 138 clinicians responded. The results presented here describe experiences and opinions of the current patient pathways to and from the audiology tinnitus service. Results The most common referral pathway was from general practice to a hospital-based Ear, Nose & Throat department and from there to a hospital-based audiology department (64%). Respondents considered the NHS tinnitus referral process to be generally effective (67%), but expressed needs for improving GP referral and patients' access to services. 'Open access' to the audiology clinic was rarely an option for patients (9%), nor was the opportunity to access specialist counselling provided by clinical psychology (35%). To decrease the number of inappropriate referrals, 40% of respondents called for greater awareness by referrers about the audiology tinnitus service. Conclusions Respondents in the present survey were generally satisfied with the tinnitus referral system. However, they highlighted some potential targets for service improvement including 1] faster and more appropriate referral from GPs, to be achieved through education on tinnitus referral criteria, 2] improved access to psychological services through audiologist training, and 3] ongoing support from tinnitus support groups, national charities, or open access to the tinnitus clinic for existing patients. PMID:21733188

Tinnitus referral pathways within the National Health Service in England: a survey of their perceived effectiveness among audiology staff.

PubMed

Gander, Phillip E; Hoare, Derek J; Collins, Luke; Smith, Sandra; Hall, Deborah A

2011-07-06

In the UK, audiology services deliver the majority of tinnitus patient care, but not all patients experience the same level of service. In 2009, the Department of Health released a Good Practice Guide to inform commissioners about key aspects of a quality tinnitus service in order to promote equity of tinnitus patient care in UK primary care, audiology, and in specialist multi-disciplinary centres. The purpose of the present research was to evaluate utilisation and opinions on pathways for the referral of tinnitus patients to and from English Audiology Departments. We surveyed all audiology staff engaged in providing tinnitus services across England. A 36-item questionnaire was mailed to 351 clinicians in all 163 National Health Service (NHS) Trusts identified as having a tinnitus service. 138 clinicians responded. The results presented here describe experiences and opinions of the current patient pathways to and from the audiology tinnitus service. The most common referral pathway was from general practice to a hospital-based Ear, Nose & Throat department and from there to a hospital-based audiology department (64%). Respondents considered the NHS tinnitus referral process to be generally effective (67%), but expressed needs for improving GP referral and patients' access to services. 'Open access' to the audiology clinic was rarely an option for patients (9%), nor was the opportunity to access specialist counselling provided by clinical psychology (35%). To decrease the number of inappropriate referrals, 40% of respondents called for greater awareness by referrers about the audiology tinnitus service. Respondents in the present survey were generally satisfied with the tinnitus referral system. However, they highlighted some potential targets for service improvement including 1] faster and more appropriate referral from GPs, to be achieved through education on tinnitus referral criteria, 2] improved access to psychological services through audiologist training, and 3] ongoing support from tinnitus support groups, national charities, or open access to the tinnitus clinic for existing patients.

‘You can't be a person and a doctor’: the work–life balance of doctors in training—a qualitative study

PubMed Central

Viney, Rowena; Needleman, Sarah; Griffin, Ann

2016-01-01

Objectives Investigate the work–life balance of doctors in training in the UK from the perspectives of trainers and trainees. Design Qualitative semistructured focus groups and interviews with trainees and trainers. Setting Postgraduate medical training in London, Yorkshire and Humber, Kent, Surrey and Sussex, and Wales during the junior doctor contract dispute at the end of 2015. Part of a larger General Medical Council study about the fairness of postgraduate medical training. Participants 96 trainees and 41 trainers. Trainees comprised UK graduates and International Medical Graduates, across all stages of training in 6 specialties (General Practice, Medicine, Obstetrics and Gynaecology, Psychiatry, Radiology, Surgery) and Foundation. Results Postgraduate training was characterised by work–life imbalance. Long hours at work were typically supplemented with revision and completion of the e-portfolio. Trainees regularly moved workplaces which could disrupt their personal lives and sometimes led to separation from friends and family. This made it challenging to cope with personal pressures, the stresses of which could then impinge on learning and training, while also leaving trainees with a lack of social support outside work to buffer against the considerable stresses of training. Low morale and harm to well-being resulted in some trainees feeling dehumanised. Work–life imbalance was particularly severe for those with children and especially women who faced a lack of less-than-full-time positions and discriminatory attitudes. Female trainees frequently talked about having to choose a specialty they felt was more conducive to a work–life balance such as General Practice. The proposed junior doctor contract was felt to exacerbate existing problems. Conclusions A lack of work–life balance in postgraduate medical training negatively impacted on trainees' learning and well-being. Women with children were particularly affected, suggesting this group would benefit the greatest from changes to improve the work–life balance of trainees. PMID:27913563

Promoting excellence in care.

PubMed

2004-07-01

Welcome to Nurse Researcher. This year's annual RCN International Nursing Research Conference was held recently in Cambridge, UK. The event, which attracted over 500 delegates from a range of diverse and academic settings across the world, brought together nurses and other healthcare professionals to promote and develop nursing knowledge. Over 200 papers and poster presentations covered a wide range of topics in nursing and healthcare research, including: issues in research methodology; education; theoretical perspectives; transcultural nursing; evidence-based practice; employment issues; and research governance. In addition to concurrent sessions and posters, many symposia, workshops and other fringe and networking events offered opportunities for sharing good practice and research collaboration. Next year's conference will be held in Belfast, Northern Ireland, UK from Tuesday 8 to Friday 11 March 2005. For more information visit: www.man.ac.uk/rcn/research2005.

Contemporary management of acute coronary syndromes: does the practice match the evidence? The global registry of acute coronary events (GRACE).

PubMed

Carruthers, K F; Dabbous, O H; Flather, M D; Starkey, I; Jacob, A; Macleod, D; Fox, K A A

2005-03-01

To determine to what extent evidence based guidelines are followed in the management of acute coronary syndromes (ACS) in the UK, elsewhere in Europe, and multinationally, and what the outcomes are. Multinational, prospective, observational registry (GRACE, global registry of acute coronary events) with six months' follow up. Patients presenting to a cluster of hospitals. The study was designed to collect data representative of the full spectrum of ACS in specific geographic populations. Patients admitted with a working diagnosis of unstable angina or suspected myocardial infarction (MI). Death during hospitalisation and at six months' follow up (adjusted for baseline risks). In ST elevation MI, reperfusion was applied more often in the UK (71%) than in Europe (65%) and multinationally (59%) (p < 0.01). However, this was almost entirely by lytic treatment, in contrast with elsewhere (primary percutaneous coronary intervention 1%, 29%, 16%, respectively). Statins were applied more frequently in the UK for all classes of patients with ACS (p < 0.0001). In contrast there was lower use of revascularisation procedures in non-ST MI (20% v 37% v 28%, respectively) and glycoprotein IIb/IIIa antagonists (6% v 25% v 26%, respectively). In-hospital death rates, adjusted for baseline risk, were not significantly different but six month death rates were higher in the UK for ST elevation MI (7.2% UK, 4.3% Europe, 5.3% multinationally; p < 0.0001) and non-ST elevation MI (7.5%, 6.2%, and 6.7%, respectively; p = 0.012, UK v Europe). Current management of ACS in the UK more closely follows the recommendations of the National Service Framework than British or European guidelines. Differences in practice may account for the observed higher event rates in the UK after hospital discharge.

Children and young adults with CF in the USA have better lung function compared with the UK.

PubMed

Goss, Christopher H; MacNeill, Stephanie J; Quinton, Hebe B; Marshall, Bruce C; Elbert, Alexander; Knapp, Emily A; Petren, Kristofer; Gunn, Elaine; Osmond, Joanne; Bilton, Diana

2015-03-01

People with cystic fibrosis (CF) are managed differently in the USA and UK providing an opportunity to learn from differences in practice patterns. To compare cross-sectional demographics, practice patterns and clinical outcomes between US and UK CF patients. This was a cross-sectional study using 2010 data from patients in the US Cystic Fibrosis Foundation and the UK Cystic Fibrosis patient registries. The a priori outcome measures of interest were lung function and nutritional status. Descriptive statistics and two sample comparisons were performed. Stratification and multivariable linear regression were used to adjust for confounding. The study cohort included 13 777 children and 11 058 adults from the USA and 3968 children and 3965 adults from the UK. In children, mean body mass index centiles were similar. Lung function (FEV1 and FVC% predicted) was significantly higher in US patients ages 6-25 years of age. In a regression model adjusted for only age, FEV1% predicted was on average 3.31% of predicted (95% CI 2.65 to 3.96) higher in the USA compared with the UK. When adjusted for age, age at diagnosis, gender, pancreatic insufficiency and genotype, FEV1% predicted was on average 3.03% of predicted (95% CI 2.37 to 3.69) higher in the USA compared with the UK These differences persisted despite adjustment for possible confounders. Hypertonic saline and dornase alfa were much more commonly prescribed in US children. Children and young adults with CF have better lung function in the USA compared with the UK despite similar nutritional status. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Primary care Identification and Referral to Improve Safety of women experiencing domestic violence (IRIS): protocol for a pragmatic cluster randomised controlled trial

PubMed Central

2010-01-01

Background Domestic violence, which may be psychological, physical, sexual, financial or emotional, is a major public health problem due to the long-term health consequences for women who have experienced it and for their children who witness it. In populations of women attending general practice, the prevalence of physical or sexual abuse in the past year from a partner or ex-partner ranges from 6 to 23%, and lifetime prevalence from 21 to 55%. Domestic violence is particularly important in general practice because women have many contacts with primary care clinicians and because women experiencing abuse identify doctors and nurses as professionals from whom they would like to get support. Yet health professionals rarely ask about domestic violence and have little or no training in how to respond to disclosure of abuse. Methods/Design This protocol describes IRIS, a pragmatic cluster randomised controlled trial with the general practice as unit of randomisation. Our trial tests the effectiveness and cost-effectiveness of a training and support programme targeted at general practice teams. The primary outcome is referral of women to specialist domestic violence agencies. Forty-eight practices in two UK cities (Bristol and London) are randomly allocated, using minimisation, into intervention and control groups. The intervention, based on an adult learning model in an educational outreach framework, has been designed to address barriers to asking women about domestic violence and to encourage appropriate responses to disclosure and referral to specialist domestic violence agencies. Multidisciplinary training sessions are held with clinicians and administrative staff in each of the intervention practices, with periodic feedback of identification and referral data to practice teams. Intervention practices have a prompt to ask about abuse integrated in the electronic medical record system. Other components of the intervention include an IRIS champion in each practice and a direct referral pathway to a named domestic violence advocate. Discussion This is the first European randomised controlled trial of an intervention to improve the health care response to domestic violence. The findings will have the potential to inform training and service provision. Trial registration ISRCTN74012786 PMID:20122266

Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review.

PubMed

Ford, Elizabeth; Shakespeare, Judy; Elias, Fatin; Ayers, Susan

2017-02-01

Perinatal anxiety and depression are widespread, with up to 20% of women affected during pregnancy and after birth. In the UK, management of perinatal mental health falls under the remit of general practitioners (GPs). We reviewed the literature on GPs' routine recognition, diagnosis and management of anxiety and depression in the perinatal period. A systematic search of Embase, Medline, PsycInfo, Pubmed, Scopus and Web of Science was conducted. Studies were eligible if they reported quantitative measures of GPs' or Family Physicians' assessment, recognition and management of anxiety or depression in pregnancy or post-partum. Thirteen papers, reporting 10 studies, were identified from the United States, Australia, UK, Netherlands and Canada. All reported on depression; two included anxiety disorders. Reported awareness and ability to diagnose perinatal depression among GPs was high. GPs knew about and used screening tools in the UK but less so in US settings. Antidepressants were the first line of treatment, with various SSRIs considered safest. Counseling by GPs and referrals to specialists were common in the post-natal period, less so in pregnancy. Treatment choices were determined by resources, attitudes, knowledge and training. Data on GPs' awareness and management of perinatal depression were sparse and unlikely to be generalizable. Future directions for research are proposed; such as exploring the management of anxiety disorders which are largely missing from the literature, and understanding more about barriers to disclosure and recognition in primary care. More standardized training could help to improve recognition and management practices. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Hydrotherapy in burn care: a survey of hydrotherapy practices in the UK and Ireland and literature review.

PubMed

Langschmidt, Jenna; Caine, Paul L; Wearn, Christopher M; Bamford, Amy; Wilson, Yvonne T; Moiemen, Naiem S

2014-08-01

Hydrotherapy is widely used in burns management however there are risks associated with its use, in particular cross-infection. Data regarding indications and techniques in common use is deficient. This study aimed to investigate hydrotherapy practices in the UK and Ireland. A survey of the hydrotherapy practice of major burn care providers was performed by e mail and where necessary, follow up telephone contact. The survey included 28 burn care providers. 27 reported using hydrotherapy. Only 11 (41%) had defined indication criteria with 4 (15%) implementing a specific protocol. Variations in hydrotherapy practice were seen. Hydrotherapy is used nationwide, however considerable variation in practice exists. One area worthy of further consideration is the need for appropriate standards of infection control. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

GP preferences for information systems: conjoint analysis of speed, reliability, access and users.

PubMed

Wyatt, Jeremy C; Batley, Richard P; Keen, Justin

2010-10-01

To elicit the preferences and trade-offs of UK general practitioners about key features of health information systems, to help inform the design of such systems in future. A stated choice study to uncover implicit preferences based on a binary choice between scenarios presented in random order. were all 303 general practice members of the UK Internet service provider, Medix who were approached by email to participate. The main outcome measure was the number of seconds delay in system response that general practitioners were willing to trade off for each key system feature: the reliability of the system, the sites from which the system could be accessed and which staff are able to view patient data. Doctors valued speed of response most in information systems but would be prepared to wait 28 seconds to access a system in exchange for improved reliability from 95% to 99%, a further 2 seconds for an improvement to 99.9% and 27 seconds for access to data from anywhere including their own home compared with one place in a single health care premises. However, they would require a system that was 14 seconds faster to compensate for allowing social care as well as National Health Service staff to read patient data. These results provide important new evidence about which system characteristics doctors value highly, and hence which characteristics designers need to focus on when large scale health information systems are planned. © 2010 Blackwell Publishing Ltd.

Comparison of Sociodemographic and Health-Related Characteristics of UK Biobank Participants With Those of the General Population

PubMed Central

Fry, Anna; Littlejohns, Thomas J; Sudlow, Cathie; Doherty, Nicola; Adamska, Ligia; Sprosen, Tim; Collins, Rory; Allen, Naomi E

2017-01-01

Abstract The UK Biobank cohort is a population-based cohort of 500,000 participants recruited in the United Kingdom (UK) between 2006 and 2010. Approximately 9.2 million individuals aged 40–69 years who lived within 25 miles (40 km) of one of 22 assessment centers in England, Wales, and Scotland were invited to enter the cohort, and 5.5% participated in the baseline assessment. The representativeness of the UK Biobank cohort was investigated by comparing demographic characteristics between nonresponders and responders. Sociodemographic, physical, lifestyle, and health-related characteristics of the cohort were compared with nationally representative data sources. UK Biobank participants were more likely to be older, to be female, and to live in less socioeconomically deprived areas than nonparticipants. Compared with the general population, participants were less likely to be obese, to smoke, and to drink alcohol on a daily basis and had fewer self-reported health conditions. At age 70–74 years, rates of all-cause mortality and total cancer incidence were 46.2% and 11.8% lower, respectively, in men and 55.5% and 18.1% lower, respectively, in women than in the general population of the same age. UK Biobank is not representative of the sampling population; there is evidence of a “healthy volunteer” selection bias. Nonetheless, valid assessment of exposure-disease relationships may be widely generalizable and does not require participants to be representative of the population at large. PMID:28641372

Effect of health literacy on the quality of life of older patients with long-term conditions: a large cohort study in UK general practice.

PubMed

Panagioti, Maria; Skevington, Suzanne M; Hann, Mark; Howells, Kelly; Blakemore, Amy; Reeves, David; Bower, Peter

2018-05-01

The levels of health literacy in patients with long-term conditions (LTCs) are critical for better disease management and quality of life (QoL). However, the impact of health literacy on QoL in older adults with LTCs is unclear. This study examined the association between health literacy and domains of QoL in older people with LTCs, investigating key socio-demographic and clinical variables, as confounders. A prospective cohort study was conducted on older adults (n = 4278; aged 65 years and over) with at least one LTC, registered in general practices in Salford, UK. Participants completed measures of health literacy, QoL, multi-morbidity, depression, social support, and socio-demographic characteristics. Multivariate linear regressions were performed to examine the effects of health literacy on four QoL domains at baseline, and then changes in QoL over 12 months. At baseline, poor health literacy was associated with lower scores in all four QoL domains (physical, psychological, social relationships and environment), after adjusting for the effects of multi-morbidity, depression, social support and socio-demographic factors. At 12-month follow-up, low health literacy significantly predicted declines in the physical, psychological and environment domains of QoL, but not in social relationships QoL. This is the largest, most complete assessment of the effects of health literacy on QoL in older adults with LTCs. Low health literacy is an independent indicator of poor QoL older patients with LTCs. Interventions to improve health literacy in older people with LTCs are encouraged by these findings.

Characteristics, resource utilization and safety profile of patients prescribed with neuropathic pain treatments: a real-world evidence study on general practices in Europe - the role of the lidocaine 5% medicated plaster.

PubMed

Katz, Pablo; Pegoraro, Valeria; Liedgens, Hiltrud

2017-08-01

To identify characteristics, resource utilization, and safety profile of patients prescribed with lidocaine 5% medicated plaster, pregabalin, gabapentin, amitriptyline and duloxetine when experiencing pain in the real-world setting of general practitioners (GPs) in Europe. Retrospective analysis on real world data from IMS Health Longitudinal Patient Database. Patients with at least one prescription of the drugs of interest during 2014 were selected and those with a non-neuropathic pain-related diagnosis were excluded. Patients' demographic and clinical characteristics, resource utilization data and adverse drug reactions (ADRs) as described in the leaflet were extracted. The association between treatments and ADR occurrence was evaluated applying multivariate logistic models. A total of 70,515 patients were selected from Italy, Germany, the UK, Spain and Belgium. Lidocaine 5% medicated plaster patients were the oldest in Italy, the UK and Spain and the most health impaired in Italy, Spain and Belgium. No relevant differences in the number of co-prescriptions, specialist visits, examinations and hospitalizations were found. Significantly less lidocaine 5% plasters patients experienced ADRs, with odds ratios in favor of lidocaine 5% medicated plasters ranging from 3.41 (p = .036) to 52.33 (p < .001). Evidence from daily clinical practice in GP settings agrees with the findings from more controlled clinical-trial settings, with lidocaine 5% medicated plaster patients showing a better safety profile, but also a comparable level of resource utilization. A possible re-evaluation of the scientific value coming from this retrospective study in building up a diagnostic as well as a therapeutic algorithm is suggested.

Walking Away from Type 2 diabetes: a cluster randomized controlled trial.

PubMed

Yates, T; Edwardson, C L; Henson, J; Gray, L J; Ashra, N B; Troughton, J; Khunti, K; Davies, M J

2017-05-01

This study aimed to investigate whether an established behavioural intervention, Walking Away from Type 2 Diabetes, is effective at promoting and sustaining increased walking activity when delivered within primary care. Cluster randomized controlled trial involving 10 general practices recruited from Leicestershire, UK, in 2009-2010. Eight hundred and eight (36% female) individuals with a high risk of Type 2 diabetes mellitus, identified through a validated risk score, were included. Participants in five practices were randomized to Walking Away from Type 2 Diabetes, a pragmatic 3-h group-based structured education programme incorporating pedometer use with annual follow-on refresher sessions. The primary outcome was accelerometer assessed ambulatory activity (steps/day) at 12 months. Longer term maintenance was assessed at 24 and 36 months. Results were analysed using generalized estimating equation models, accounting for clustering. Complete accelerometer data for the primary outcome were available for 571 (71%) participants. Increases in ambulatory activity of 411 steps/day [95% confidence interval (CI): 117, 704] and self-reported vigorous-intensity physical activity of 218 metabolic equivalent min/week (95% CI: 6, 425) at 12 months were observed in the intervention group compared with control; differences between groups were not sustained at 36 months. No differences between groups were observed for markers of cardiometabolic health. Replacing missing data with multiple imputation did not affect the results. A pragmatic low-resource group-based structured education programme with pedometer use resulted in modest increases in ambulatory activity compared with control conditions after 12 months when implemented within a primary care setting to those at high risk of Type 2 diabetes mellitus; however, the results were not maintained over 36 months. © 2016 Diabetes UK.

The use of standard contracts in the English National Health Service: a case study analysis.

PubMed

Petsoulas, Christina; Allen, Pauline; Hughes, David; Vincent-Jones, Peter; Roberts, Jennifer

2011-07-01

The use of contracts is vital to market transactions. The introduction of market reforms in health care in the U.K. and other developed countries twenty years ago meant greater use of contracts. In the U.K., health care contracting was widely researched in the 1990s. Yet, despite the changing policy context, the subject has attracted less interest in recent years. This paper seeks to fill a gap by reporting findings from a study of contracting in the English National Health Service (NHS) after the introduction of the national standard contract in 2007. By using economic and socio-legal theories and two case studies we examine the way in which the new contract was implemented in practice and the extent to which implementation conformed to policy intentions and to our theoretical predictions. Data were collected using non-participant observation of 36 contracting meetings, 24 semi-structured interviews, and analysis of documents. We found that despite efforts to introduce a more detailed ('complete') contract, in practice, purchasers and providers often reverted to a more relational style of contracting. Frequently reliance on the NHS hierarchy proved to be indispensable; in particular, formal dispute resolution was avoided and financial risk was re-allocated in compromises that sometimes ignored contractual provisions. Serious data deficiencies and shortages of skilled personnel still caused major difficulties. We conclude that contracting for health care continues to raise serious problems, which may be exacerbated by the impending transfer of responsibility to groups of general practitioners (GPs) who generally lack experience and expertise in large-scale, secondary care contracting. Copyright © 2011 Elsevier Ltd. All rights reserved.

Using Applied Behaviour Analysis as Standard Practice in a UK Special Needs School

ERIC Educational Resources Information Center

Foran, Denise; Hoerger, Marguerite; Philpott, Hannah; Jones, Elin Walker; Hughes, J. Carl; Morgan, Jonathan

2015-01-01

This article describes how applied behaviour analysis can be implemented effectively and affordably in a maintained special needs school in the UK. Behaviour analysts collaborate with classroom teachers to provide early intensive behaviour education for young children with autism spectrum disorders (ASD), and function based behavioural…