An article examined patient-reported access to English primary care for adults with and without physical disability. It said that adults with physical disability experienced worse physical access into primary care buildings than those without, and that access difficulties were associated with unmet healthcare need.
Source: Nicola Popplewell, Boika Rechel, and Gary Abel, 'How do adults with physical disability experience primary care? A nationwide cross-sectional survey of access among patients in England', BMJ Open, Volume 4 Issue 8
An article examined the effectiveness and cost consequences of family doctor-led and nurse-led telephone triage, compared with usual care, for patients seeking same-day consultations in primary care in the United Kingdom. It said that triage interventions were associated with increased numbers of patient contacts, although the estimated costs over a period of 28 days were similar between all three groups.
Source: John Campbell, Emily Fletcher, Nicky Britten, Colin Green, Tim Holt, Valerie Lattimer, David Richards, Suzanne Richards, Chris Salisbury, Raff Calitri, Vicky Bowyer, Katherine Chaplin, Rebecca Kandiyali, Jamie Murdoch, Julia Roscoe, Anna Varley, Fiona Warren, and Rod Taylor, 'Telephone triage for management of same-day consultation requests in general practice (the ESTEEM trial): a cluster-randomised controlled trial and cost-consequence analysis', The Lancet 4 August 2014
A report examined issues relating to the extension of pharmacy services in hospitals to a seven day per week service, outlining four emerging themes for consideration: joining up hospital and community services; the pharmacy workforce and ways of working; targeted delivery of seven day services; and the business case for extending services.
Source: Seven Day Services in Hospital Pharmacy: Giving patients the care they deserve, Royal Pharmaceutical Society
A think-tank report examined how patients accessed their family doctors in Scotland, and whether it was possible to improve arrangements to encourage better provision of service. It made a range of recommendations, including: for the publication of more, and clearer, information about services; for improved online access and information; for greater choice of family doctor practice, to be aided by allowing new practices to open; to standardize practice regarding ownership by private companies; and for all providers to publish annual accounts.
Source: Ben Thomson, Geoff Mawdsley, and Alison Payne, Examining Access: Survey of GP practices in Scotland, Reform Scotland
A think-tank report examined the scope for partnerships between housing associations and the National Health Service. It said that the existing objectives in health and social care fit well with the capabilities, strengths, and ethos of the social housing sector, and that housing associations providing supported housing could help to deliver the government's health strategy through initiatives such as joint ventures to provide new models of supported housing, step-down and reablement facilities, or extra support and care for people in their own homes. The report was published alongside a further report which discussed the use of surplus National Health Service land for new supported housing provision.
Source: Denise Chevin, Housing Associations and the NHS: New thinking, new partnerships, Smith Institute
A report examined the evidence for successful models of primary care, based on a rapid review of the literature. It said that, in comparison with other countries, the existing primary healthcare system in Wales was good and provided an effective, efficient, and well liked service, but there were areas of concern, including: an unacceptable variation in service provision and quality; difficulties in access to services; signs of a unsustainable imbalance between workload and capacity; and a fall in the percentage of health budgets and health workforce in primary care.
Source: Kathrin Thomas, Paul Myres, Graham Brown, Clare Wilkinson, and Helen Howson, Rapid Review of Primary Care Models and Policy: Discussion paper for Wales, NHS Wales
An audit report said that out of hours family doctor services were variable and although some parts of the National Health Service in England were achieving value for money for their spending on out of hours services, this was not the case across the board and NHS England did little to monitor quality where family doctors retained responsibility for the services. The report said that most patients were positive about their experience of out of hours services, but around one-quarter of people were not aware of their availability.
Source: Out-of-Hours GP Services in England, HC 439 (Session 201415), National Audit Office, TSO
A report examined the role of family doctors for children experiencing maltreatment, or for whom there were 'maltreatment-related concerns'. It said that family doctors were well placed to identify and respond to issues of child neglect and emotional abuse and that the nature of their contact with families gave opportunities for ongoing support and monitoring of the whole family, with direct responses made in tandem with wider child protection systems and other agencies. It said that some family doctors already engaged in some direct response to these issues, and the report called for urgent research to establish whether these models of existing practice were safe and effective for wider implementation across general practice, as well as to identify any system changes necessary for the models to benefit children and families.
Source: Jenny Woodman, Dawn Hodson, Ruth Gardner, Chris Cuthbert, Andrew Woolley, Janice Allister, Imran Rafi, Simon de Lusignan, and Ruth Gilbert, The GP's Role in Responding to Child Maltreatment: Time for a rethink? An overview of policy, practice and research, National Society for the Prevention of Cruelty to Children
An article examined factors and interventions in primary care that impacted on levels of unscheduled secondary care. It said that there were a range of related patient factors (such as age, prevalence of chronic disease, and socio-economic status), and that patients who saw the same family doctor every time they attended the surgery were less likely to require emergency care. Other factors included: ease of access to family doctor surgeries and primary care providers; the distance between home and the emergency department; and patients' other available options for accessing emergency care.
Source: Alyson Huntley, Daniel Lasserson, Lesley Wye, Richard Morris, Kath Checkland, Helen England, Chris Salisbury, and Sarah Purdy, 'Which features of primary care affect unscheduled secondary care use? A systematic review', BMJ Open, Volume 4 Issue 5
An article examined the contribution of physician assistants (PAs) to the delivery of patient care in primary care services in England. PAs were mid-level practitioners, trained to work under a supervising doctor, and were employed at a small number of general practices in England. The article concluded that PAs were found to be acceptable, effective, and efficient in complementing the work of family doctors, and could provide a flexible addition to the primary care workforce. It said that consideration needed to be given to the appropriate level of regulation and the potential for PAs to prescribe medicines. It called for a range of further research.
Source: Vari Drennan, Mary Halter, Sally Brearley, Wilfred Carneiro, Jonathan Gabe, Heather Gage, Robert Grant, Louise Joly, and Simon de Lusignan, 'Investigating the contribution of physician assistants to primary care in England: a mixed-methods study', Health Services and Delivery Research, Volume 2 Issue 16
A paper said that inadequate capacity in general practice led both to unmet health needs and to increased demand for emergency provision and walk-in centres, but additional provision tended to increase overall service use. It said that the way in which people used unscheduled care services was shaped by their beliefs about health and their expectations of the health services, and that campaigns to change behaviours and expectations needed to be targeted in a variety of ways and sustained over a long period of time. The paper also raised considerations for those evaluating the impact of the Prime Minister's Challenge Fund.
Source: Rebecca Rosen, Meeting Need or Fuelling Demand? Improved access to primary care and supply-induced demand, Nuffield Trust
A report outlined findings from a survey of district nursing staff across the United Kingdom, providing an update on a 2009 survey. The survey asked staff about key elements of the structure, organization, and challenges facing the district nursing service, in the context of rapid change within the National Health Service and a continuing fall in numbers of district nurses. The report said that the survey revealed confusion around job titles, and concerns regarding the methods of service planning, use of technology, communication with other health and social care organizations, and morale. It said that areas for 'cautious optimism' included: the recognition of the value of the specialist practitioner qualification; the growing use of patient outcomes as a service metric; and partnership working with certain key colleagues such as family doctors. The report made recommendations.
Source: 2020 Vision 5 Years On: Reassessing the future of district nursing, The Queen's Nursing Institute
An article examined the relationship between general practitioners (family doctors) and social care professionals. Reflecting on the Home Truths project, that sought to improve joint working between general practice and social care though an action research process, it said that family doctors' knowledge of social care services was poor, they rated their relationship with social workers as poor, and they perceived that social care services were of poor quality. It said that family doctors had expressed a desire to work more closely with social care, but interventions to improve relationships were found to focus on daily practice, rather than introducing new initiatives. The article noted the low response rate of family doctors (10 per cent) and difficulties in outcome measurement.
Source: Catherine Mangan and Robin Miller, 'Time for some home truths – exploring the relationship between GPs and social workers', Journal of Integrated Care, Volume 22 Number 2
An article examined a project in Tower Hamlets, a disadvantaged area in East London, that grouped family doctor practices into local networks for cardiovascular care. The 34 practices were allocated to geographical networks of four to five practices, to deliver financially-incentivized attainment targets in four care packages, of which cardiovascular disease (CVD) comprised one. The article concluded that the managed geographical practice networks delivered a 'step-change' in improvements in key CVD performance indicators, compared with England, London, or similar PCT/CCGs.
Source: John Robson, Sally Hull, Rohini Mathur, and Kambiz Boomla, 'Improving cardiovascular disease using managed networks in general practice: an observational study in inner London', British Journal of General Practice, Volume 64 Number 622
A report examined the accessibility of primary care (family doctors) for women in the United Kingdom. It considered the barriers to access, including key issues for women from a range of minority groups. It made recommendations for improvements in various areas, including: the appointments system; registration (particularly with regard to personal identification); effective use of the appointment, including the right to see a female doctor, allowing sufficient time for sensitive issues, and making the process more accessible through providing assistance such as translation and advocacy; addressing prejudice and discrimination; engagement with issues related to gender-based violence; and awareness of, and services for, mental health.
Source: Annah Psarros, Women's Voices On Health: Addressing barriers to accessing primary care, Maternity Action/Women's Health and Equality Consortium
An article examined how young men recognized and sought help with eating disorders, and their experiences of initial contacts with primary care.
Source: Ulla Raisanen and Kate Hunt, 'The role of gendered constructions of eating disorders in delayed help-seeking in men: a qualitative interview study', BMJ Open, Volume 4 Issue 4
A report provided an outline of the government's plans for changes to primary care in England. This would include some surgeries opening longer hours and greater use of technology, as well as the Proactive Care Programme, which would provide patients with the most complex health and care needs with a personal care and support plan, a named family doctor, a professional to co-ordinate their care, and same-day telephone consultations. The plan outlined in general terms how the relevant organizations were working to implement the changes, which would be introduced from mid 2014.
Source: Transforming Primary Care: Safe, proactive, personalised care for those who need it most, Department of Health
Links: Report | Equality analysis | DH press release | Age UK press release | Independent Age press release | RCGP press release | RCPsych press release | BBC report | Guardian report | Telegraph report
A report outlined the view of NHS England on the role to be played by general practice (family doctors) in wider local systems of primary care, and progress made to date.
Source: Improving General Practice: A call to action ï¿½ Phase One report, NHS England
A report examined funding for family doctor practices in England and called for a new approach to combine funding for general practice with that for other services, to create integrated 'family care networks'. It said that this would require new forms of commissioning and that practices would need new skills in areas such as: understanding risk stratification of the population; quality improvement; collaborative working; and managing financial and clinical risks.
Source: Rachael Addicott and Chris Ham, Commissioning and Funding General Practice: Making the case for family care networks, Kingï¿½s Fund
The regulator for National Health Service services in England published a report that summarized issues raised following a call for evidence in July 2013. The call had sought to understand how well the arrangements for commissioning and providing general practice (family doctor) services were working for patients. The report summarized responses under three headings: access and quality; the ability of new or existing providers to develop the scope of their offer to the National Health Service; and providers' ability and incentives to work together to benefit patients. It outlined work currently being undertaken in the sector to address those issues and identified areas where the regulator could provide support to improve services for patients.
Source: Discussion Document Following Monitor's Call for Evidence on GP Services, Monitor
A report examined the changes needed to realize the full potential of community services, based on contributions from a working group of community providers. The report said that: services should be simplified, to remove unnecessary complexity; there should be larger multidisciplinary teams based around primary care and natural geographies, offering rapid and accessible response and better outreach; new ways were needed to contract and pay for services; and changes were needed to the infrastructure and workforce, with community services more closely connected to other parts of the health and social care system.
Source: Nigel Edwards, Community Services: How they can transform care, Kingï¿½s Fund
A paper examined levels of trust held by patients in their family doctors, and considered possible explanations for the lower levels of trust found to be associated with certain health conditions.
Source: Rose Wiles, Trust in GPs: Findings from focus groups, Working paper 1/14, National Centre for Research Methods (University of Southampton)