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The author comments on the White Paper from the National Health Services (NHS) of Great Britain, titled "Equity and Excellence: Liberating the NHS," which proposes changes in the way decisions about health services are made. The author points out the lack of clarity on how the NHS Commissioning Board will promote involvement in research and the use of research evidence. The author discusses how research is funded and facilitated, topics for research, and the involvement of general practitioners (GPs).

Background: Following a large-scale, pandemic-driven shift to remote consulting in UK general practice in 2020, 2021 saw a partial return to in-person consultations. This occurred in the context of extreme workload pressures because of backlogs, staff shortages, and task shifting. Aim: To study media depictions of remote consultations in UK general practice at a time of system stress. Design and setting: Thematic analysis of national newspaper articles about remote GP consultations from two time periods: 13–26 May 2021, following an NHS England letter, and 14–27 October 2021, following a government-backed directive, both stipulating a return to in-person consulting. Method: Articles were identified through, and retrieved from, LexisNexis. A coding system of themes and narrative devices was developed iteratively to inform data analysis. Results: In total, 25 articles reported on the letter and 75 on the directive. Newspaper coverage of remote consulting was strikingly negative. The right-leaning press in particular praised the return to in-person consultations, depicting remote care as creating access barriers and compromising safety. Two newspapers led national campaigns pressuring the government to require GPs to offer in-person consultations. GPs were quoted as reluctant to return to an 'in-person by default' service (as it would further pressurise a system already close to breaking point). Conclusion: Remote consultations have become associated in the media with poor practice. Some newspapers were actively leading the 'war' on general practice rather than merely reporting on it. Proactive dialogue between practitioners and the media might help minimise polarisation and improve perceptions around general practice. [ABSTRACT FROM AUTHOR]

It is generally believed that the most deprived populations have the worst access to primary care. Lord Darzi's review of the NHS responds to this conventional wisdom and makes a number of proposals for improving the supply of GP services in deprived communities. This paper argues that these proposals are based on an incomplete understanding of inverse care which underestimates the degree to which, relative to their healthcare needs, older populations experience low availability of primary care. Many deprived practices appear to have a better match between need and supply than practices serving affluent but ageing populations. However, practices serving the oldest and most deprived populations have the worst availability of all. [ABSTRACT FROM AUTHOR]

The article focuses on the White Paper "Healthy Lives, Healthy People," which was produced as a response to the work of M. Marmot and to address wider social determinants of health. Several factors contributing to the challenges facing the public health system of Great Britain include policy failures, concerns over communicable disease control, the imminent reorganization of the National Health Service (NHS) and demoralized public health workforce. An extended public health role for general practitioners (GPs) is being offered by the White Paper.

The author discusses the promotion of general practice (GP) commissioning in the White Paper on National Heath Service (NHS) reform in Great Britain. According to the article, the White Paper seeks to give GPs a mediating role between hospitals as corporate entrepreneurs and patients as consumers. He claims that the enhanced public health role of GPs is a reflection of the erosion of boundaries between the public and personal areas.

Background: There is a need for greater understanding of the epidemiology of primary care patient safety in order to generate solutions to prevent future harm.Aim: To estimate the rate of failures in processing actions requested in hospital discharge summaries, and to determine factors associated with these failures.Design and Setting: The authors undertook a retrospective records review. The study population was emergency admissions for patients aged ≥75 years, drawn from 10 practices in three areas of England.Method: One GP researcher reviewed the records for 300 patients after hospital discharge to determine the rate of compliance with actions requested in the discharge summary, and to estimate the rate of associated harm from non-compliance. In cases where GPs documented decision-making contrary to what was requested, these instances did not constitute failures. Data were also collected on time taken to process discharge communications.Results: There were failures in processing actions requested in 46% (112/246) of discharge summaries (95% confidence interval [CI] = 39 to 52%). Medications changes were not made in 17% (124/750) of requests (95% CI = 14 to 19%). Tests were not completed for 26% of requests (95% CI = 16 to 35%), and 27% of requested follow-ups were not arranged (95% CI = 20 to 33%). The harm rate associated with these failures was 8%. Increased risk of failure to process test requests was significantly associated with the type of clinical IT system, and male patients.Conclusion: Failures occurred in the processing of requested actions in almost half of all discharge summaries, and with all types of action requested. Associated harms were uncommon and most were of moderate severity. [ABSTRACT FROM AUTHOR]

Background: 'Neoliberal' work policies, austerity, NHS restructuring, and increased GP consultation rates provide the backdrop against increasing reports of GP burnout and an impending shortage of GPs.Aim: To explore GPs' experiences of workplace challenges and stresses, and their coping strategies, particularly focusing on understanding the impact of recent NHS workplace change.Design and Setting: Study design was qualitative, with data collected from two focus groups and seven one-to-one telephone interviews.Method: Focus groups and one-to-one telephone interviews explored the experiences of GPs currently practising in England, recruited through convenience sampling. Data were collected using a semi-structured interview approach and analysed using thematic analysis.Results: There were 22 GP participants recruited: focus groups (n = 15) and interviews (n = 7). Interviewees understood GPs to be under intense and historically unprecedented pressures, which were tied to the contexts in which they work, with important moral implications for 'good' doctoring. Many reported that being a full-time GP was too stressful: work-related stress led to mood changes, sleep disruption, increases in anxiety, and tensions with loved ones. Some had subsequently sought ways to downsize their clinical workload. Workplace change resulted in little time for the things that helped GP resilience: a good work-life balance and better contact with colleagues. Although some GPs were coping better than others, GPs acknowledged that there was only so much an individual GP could do to manage their stress, given the external work issues they faced.Conclusion: GPs experience their emotional lives and stresses as being meaningfully shaped by NHS factors. To support GPs to provide effective care, resilience building should move beyond the individual to include systemic work issues. [ABSTRACT FROM AUTHOR]

An essay is presented which considers the possible effects of the commissioning of general practitioners (GP) in Great Britain in 2010. Under the proposal in the government's White Paper, all GP are required to join a commissioning consortium by 2011 and 2012, and primary care trusts (PCT) will be terminated in 2013. It argues that the move will take up a lot of GP time and for doctors who are already involved in patient care and management to devote time to patient care. It ponders whether physician assistants will be tasked to handle routine care.

The author discusses whether general practitioners (GPs) in Great Britain is need of occupational therapy intervention. He is critical on the impact of un-rostered working hours and poor work-life balance on GPs which are linked to several health problems including stress, anxiety and gastrointestinal disorders. He also discusses some issues surrounding the National Health Service (NHS).

The article presents the author's insights on the hassle brought by general practitioners' (GP) repeat prescribing system in Great Britain. The author is critical on the disadvantage of repeat prescribing system in GP's workload. Moreover, she relates the qualitative study conducted by P. M. Wilson and colleagues on the patient and carer experience of having repeat medications in the National Health Service in England.

Background: Laboratory tests are extensively used for diagnosis and monitoring in UK primary care. Test usage by GPs, and associated costs, have grown substantially in recent years. Aim: This study aimed to quantify temporal growth and geographic variation in utilisation of laboratory tests. Design and setting: Retrospective cohort study using data from general practices in the UK. Method: Data from the General Practice Research Database, including patient demographics, clinical details, and laboratory test results, were used to estimate rates of change in utilisation between 2005 and 2009, and identify tests with greatest inter-regional variation, by fitting random-effects Poisson regression models. The study also investigated indications for test requests, using diagnoses and symptoms recorded in the 2 weeks before each test. Results: Around 660 000 tests were recorded in 230 000 person-years of follow-up. Test use increased by 24.2%, from 23 872 to 29 644 tests per 10 000 person-years, between 2005 and 2009. Tests with the largest increases were faecal occult blood (121%) and C-reactive protein (86%). There was substantial geographic variation in test utilisation; GPs in some regions requested tests such as plasma viscosity and cardiac enzymes at a rate more than three times the national average. Conclusion: Increases in the use of laboratory tests have substantial resource implications. Rapid increases in particular tests may be supported by evidence-based guidelines, but these are often vague about who should be tested, how often, and for how long. Substantial regional variation in test use may reflect uncertainty about diagnostic accuracy and appropriate indications for the laboratory test. There is a need for further research on the diagnostic accuracy, therapeutic impact, and effect on patient health outcomes of the most rapidly increasing and geographically variable tests. [ABSTRACT FROM AUTHOR]

The article discusses ethics in general practice. The author presents issues considered by general practitioners (GPs) every day including if needs of patient conflicts with primary care trust (PCT) policies or Department of Health, judging between needs of patient and needs of the physician's family, and how far to go in prioritizing patient's needs. The "British Journal of General Practice" is calling for papers on the issue of medical ethics for GPs.

The author comments on a white paper issued by Great Britain's National Health Service regarding a practice-based commissioning (PBC) consortium committee. The author presents several scenarios that will show the impact of PBC consortia to primary care. According to the author, the PBC plans is a conflict of interest for general practitioners to commission services in which they have a financial stake.

The author discusses the increase in workload of general practitioners in Great Britain. Topics discussed include decrease in funding for general practice and call for sophisticated staffing models and resource allocation formulae; moving of general practitioners from direct clinical care due to less job satisfaction; and commitment of National Health Service for funding allocations and reducing inequalities in funding.

The article discusses the Sustainability and Transformation Plans (STPs) brought in the planning guidance of Great Britain National Health Service (NHS) in December 2015, and mentions the role of physiotherapists and occupational therapists to general practitioners (GPs). Topics include the significance of rehabilitation agenda within the STPs, the opportunities to enhance the rehabilitation, and occupational therapy cost benefits.

The article focuses on the extension of general practice (GP) training in urgent and emergency primary care in Great Britain to reduce cost and meet the training needs in the country. Topics include the detailed case for the extension of GP training published by the Royal College of General Practitioners (RCGP), how to achieve the Five Year Forward View objectives of the National Health Service (NHS) England, and the importance of better training in acute and urgent primary medical care.