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This article reports a portion of the findings from a 5-year longitudinal study on child and family social work, commissioned by the Department for Education. The study explored issues relating to child and family practice over the five years, utilising a mixed-methods design, including large-scale surveys, quantitative telephone interviews and semi-structured interviews and culminating in an annual report, published by the Department for Education at the end of each wave. This article focusses on wave four, and on the semi-structured interview phase, which explored how practitioners felt their racial or ethnic identity impacted on their experiences of practice. Five themes were developed across the different topics explored in the interviews; structures and organisations; workforce and colleagues; lack of diversity; working with families and intersectionality. This article presents these themes as part of the challenging context of inclusivity and anti-racism in contemporary social work, and makes recommendations regarding workforce diversity, training needs and reducing the additional burden carried by social workers from minoritized ethnicities, by amending the regulatory requirements of practitioners, education providers and continuing professional development recording. [ABSTRACT FROM AUTHOR]

Practice-based education is an essential component of pre-registration physiotherapy programs, and there is a need for a contemporary review of practice-based educational experiences. The aim of this study was to explore physiotherapy practice educators' experiences of supporting learners to inform considerations for future workforce development. This was a mixed methods sequential explanatory study based in the United Kingdom (UK). Phase one of the study utilized an online survey disseminated via the Chartered Society of Physiotherapy (CSP) professional networks. Phase two consisted of three semi-structured focus group interviews with participants who expressed an interest via completion of the online survey. All were registered or associate CSP members who actively support practice-based education. A total of 208 participants completed the online survey and a sub-set of 15 participated in online focus groups. Quantitative survey data were analyzed using descriptive statistics. Initial thematic analysis of qualitative data from both phases was undertaken by one researcher. Subsequent analyses were carried out independently by the remaining research team, and comparisons were made to agree on codes, categories, and themes. The practice educator is vital in developing the future workforce (30%, n = 61, strongly agree). Identified challenges included supervising more than one learner (34%, n = 67 not at all experienced) and using technology to provide alternative placement models (45%, n = 87 not at all experienced). Practice educators need accessible opportunities for professional development. Practice-based education should be embedded as an integral component of all staff roles. A team approach is essential to developing the future physiotherapy workforce. [ABSTRACT FROM AUTHOR]

Objectives: Ancillary staff – cleaning, catering, housekeeping and laundry workers – play a crucial role in care homes, by promoting infection control, food preparation and hygiene, and contributing to the care home environment. This study sought to understand the experiences of ancillary staff working in English care homes during the COVID-19 pandemic. The results will inform policy makers, employers, care home managers and others, both in England and overseas, as how to best support the ancillary workforce. Methods: Between March and August 2021, video and telephone interviews were conducted with those working or living in care homes in England. Participants comprised ancillary staff (n = 38), care home managers (n = 8), care home residents' family members and friends (n = 7), human resource managers (n = 5) and care home residents (n = 5). Results: Ancillary staff often had increased responsibilities and contributed to pandemic efforts by changing working practices, routines and job roles with the aim of supporting residents and other staff. Teamwork, underpinned by strong leadership, helped ancillary staff feel supported. Conclusions: Ancillary staff should be better recognised as being central to care home care. They are essential workers helping to keep residents safe and well. [ABSTRACT FROM AUTHOR]

Online learning has the potential to improve best practice in substance use treatment by facilitating access to high-quality resources. A user-centered design (UCD) approach can identify the needs, motivating factors, and working contexts of learners. Aim: The aim of this study was to identify ways of improving online learning for people working in substance use treatment services in England. Methods: Semi-structured interviews were conducted with 31 substance use professionals in England and 14 other professionals working in the field. Participants were asked about their training needs, working contexts, and current use of online resources. Data were analyzed according to the principles of UCD via Iterative Categorisation. Results: Participants reported "unmet needs" for training in therapeutic relationships and advanced therapeutic techniques. They enjoyed training that demonstrably improved the quality of life for people who use drugs and that provided career and personal development opportunities. Participants completed many mandatory online courses that were short and unpopular. Access to training was limited by time and financial constraints, with online training partially addressing these barriers. Conclusion: If online learning is to be optimized, the needs of substance use professionals must be accommodated; however, online learning that meets the needs of substance use professionals does not always match the best evidence. [ABSTRACT FROM AUTHOR]

In 2023, the UK Government published its long-awaited reform strategy for England's children's social care system. Whilst the strategy set out planned reforms for several aspects of the wider system, an area requiring particular 'priority' was the purported workforce instability seen within child protection social work. However, the strategy has subsequently faced criticism on the basis that the suggested reforms were not satisfactorily informed by the testimonies of practicing social workers. This paper draws from a mixed-method study to report on the lived experiences of a sample of 201 child protection social workers practicing across England, in the context of better understanding the factors which they believed were impacting on workforce stability within England's child protection system. Implications that emerge are the need for an increase in the monetary commitment offered by the UK Government (especially in the context of tackling high caseloads, and improving local authority pay scales to reduce the allure of agency work); a targeted emphasis on challenging local cultures preoccupied with evidencing compliance over time spent with children; and the Government taking a more assertive role in tackling the often-counterproductive commentary perpetuated by politicians and media. [ABSTRACT FROM AUTHOR]

Aim: To explore how nurses working in general practice experienced remote and technology-mediated working during the COVID-19 pandemic. Design: Exploratory qualitative study with nursing team members working in general practices in England and national nurse leaders. Methods: Data were collected between April and August 2022. Forty participants took part in either semi-structured interviews or focus groups. Data were analysed using Framework Analysis informed by the PERCS (Planning and Evaluating Remote Consultation Services) Framework. University of York ethics approval [HSRGC/2021/458/I] and Health Research Authority approval were obtained [IRAS:30353. Protocol number: R23982. Ref 21/HRA/5132. CPMS: 51834]. The study was funded by The General Nursing Council for England and Wales Trust. Results: Participants continued to deliver a significant proportion of patient care inperson. However, remote and technology-mediated care could meet patients' needs and broaden access in some circumstances. When remote and technology-mediated working were used this was often part of a blended model which was expected to continue. This could support some workforce issues, but also increase workload. Participants did not always have access to remote technology and were not involved in decision-making about what was used and how this was implemented. They rarely used video consultations, which were not seen to add value in comparison to telephone consultations. Some participants expressed concern that care had become more transactional than therapeutic and there were potential safety risks. Conclusion: The study explored how nurses working in general practice during the COVID-19 pandemic engaged with remote and technology-mediated working. It identifies specific issues of access to technology, workload, hybrid working, disruption to therapeutic relationships, safety risks and lack of involvement in decision-making. Changes were implemented quickly with little strategic input from nurses. There is now an opportunity to reflect and build on what has been learned in relation to remote and technology-mediated working to ensure the future development of safe and effective nursing care in general practice. Impact: The paper contributes to understanding of remote and technology-mediated working by nurses working in general practice during the COVID-19 pandemic and indicates to employers and policy makers how this can be supported moving forward. Reporting method: Standards for Reporting Qualitative Research (O'Brien et al., 2014). Patient or public contribution: This was a workforce study so there was no patient or public contribution. Implications for the profession and patient care: The paper highlights specific issues which have implications for the development of remote, technology-mediated and blended working for nurses in general practice, care quality and patient safety. These require full attention to ensure the future development of safe and effective nursing care in general practice moving forward. [ABSTRACT FROM AUTHOR]

Integrated disease surveillance (IDS) offers the potential for better use of surveillance data to guide responses to public health threats. However, the extent of IDS implementation worldwide is unknown. This study sought to understand how IDS is operationalized, identify implementation challenges and barriers, and identify opportunities for development. Synthesis of qualitative studies undertaken in seven countries. Thirty-four focus group discussions and 48 key informant interviews were undertaken in Pakistan, Mozambique, Malawi, Uganda, Sweden, Canada, and England, with data collection led by the respective national public health institutes. Data were thematically analysed using a conceptual framework that covered governance, system and structure, core functions, finance and resourcing requirements. Emerging themes were then synthesised across countries for comparisons. None of the countries studied had fully integrated surveillance systems. Surveillance was often fragmented, and the conceptualization of integration varied. Barriers and facilitators identified included: 1) the need for clarity of purpose to guide integration activities; 2) challenges arising from unclear or shared ownership; 3) incompatibility of existing IT systems and surveillance infrastructure; 4) workforce and skills requirements; 5) legal environment to facilitate data sharing between agencies; and 6) resourcing to drive integration. In countries dependent on external funding, the focus on single diseases limited integration and created parallel systems. A plurality of surveillance systems exists globally with varying levels of maturity. While development of an international framework and standards are urgently needed to guide integration efforts, these must be tailored to country contexts and guided by their overarching purpose. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To learn about the experiences of nursing students who witness physical restraint on practice placements • To understand how to support these students after episodes of physical restraint • To reflect on the provision for supporting nursing students in your own practice area Background: There is a paucity of research on mental health nursing students' experiences of witnessing physical restraint in practice, despite the fact that they spend half of their time in clinical placements. Aim: To understand the experiences of mental health nursing students who witnessed physical restraint during their clinical placements. Method: Qualitative data were collected through semi-structured interviews conducted remotely with three students from three universities in England. Thematic analysis was used to analyse the data. Findings: Participants found witnessing physical restraint distressing but had positive experiences of the support provided to them by clinical teams. They felt that receiving some education on physical restraint before their first placement could have reduced their distress and feeling of unpreparedness. Conclusion: In placement settings, clinical teams need to be mindful of students' support needs after an incident of physical restraint. At university, enhanced education reinforced by simulation and lived experience accounts could better prepare nursing students for witnessing physical restraint in practice. [ABSTRACT FROM AUTHOR]

The English child protection system continues to be the focus of national commentary in light of several high-profile deaths and the recently published reports from the Review of Children's Social Care, and the Child Safeguarding Practice Review Panel. Whilst narratives of 'failure', 'betrayal', and 'scandalous incompetence' perpetuate, these forgo consideration of the complexity of child protection work, nor do they acknowledge that during the COVID-19 'lockdowns', social workers remained one of the few professional groups visiting vulnerable families at home. Moreover, of the recent accounts of the lived experience of social workers, these have omitted a specific overview of what it means to be a child protection practitioner. Drawing from an original ethnography of a statutory child protection team and supplemented by follow-up interviews, the article seeks to elucidate the long-standing lived experience of a cohort of child protection social workers. It highlights a 'tendency' to be the target of threats and intimidation and identifies other costs in the context of health and personal relationships. The article concludes that these findings could help us better understand child protection workforce instability and the system's reliance on agency staff – both of which continue to be identified as contributory in child death tragedies. [ABSTRACT FROM AUTHOR]

Low‐dose computed tomography lung cancer screening has mortality benefits. Yet, uptake has been low. To inform strategies to better deliver and promote screening, in 2018, we interviewed 27 long‐term smokers immediately following lung cancer screening in Australia, prior to receiving scan results. Existing lung screening studies employ the Health Belief Model. Reflecting growing acknowledgement of the centrality of emotions to screening uptake, we draw on psychological and sociological theories on emotions to thematically and abductively analyse the emotional dimensions of lung cancer screening, with implications for screening promotion and delivery. As smokers, interviewees described feeling stigmatised, with female participants internalising and male participants resisting stigma. Guilt and fear related to lung cancer were described as screening motivators. The screening itself elicited mild positive emotions. Notably, interviewees expressed gratitude for the care implicitly shown through lung screening to smokers. More than individual risk assessment, findings suggest lung screening campaigns should prioritise emotions. Peer workers have been found to increase cancer screening uptake in marginalised communities, however the risk to confidentiality—especially for female smokers—limits its feasibility in lung cancer screening. Instead, we suggest involving peer consultants in developing targeted screening strategies that foreground emotions. Furthermore, findings suggest prioritising humanistic care in lung screening delivery. Such an approach may be especially important for smokers from low socioeconomic backgrounds, who perceive lung cancer screening and smoking as sources of stigma and face a higher risk of dying from lung cancer and lower engagement with screening. [ABSTRACT FROM AUTHOR]

Unnecessarily prolonged stays in hospitals can have negative impacts on patients and present avoidable costs to health and social care systems. This paper presents the qualitative findings of a multi‐methods study of the social care causes of delayed transfers of care (DTOC) for older people in England. The quantitative strand of this study found that DTOC are significantly affected by homecare supply. In this paper, we explore in depth how and why social care capacity factors lead to delays, from the perspectives of those working within the system. We examined the local transfer arrangements in six English local authority (LA) sites that were purposively sampled to include a range of DTOC performance and LA characteristics. Between March and December 2018, 52 professionals involved in arranging or facilitating discharge from hospitals in these sites provided qualitative data, primarily through semi‐structured interviews. Topics included discharge teams and processes, strategic issues and perceived causes of delays. The thematic analysis uncovered the nuances behind the causes of DTOC previously categorised broadly as 'provider capacity' and 'patient choice'. In particular, our analysis highlights the lack of fit between available provision and the needs of people leaving hospital (theme 1); workforce inconsistencies (theme 2) and a myth of patient choice (theme 3). We are now at a turning point in the development of policy to reduce DTOC in the English system, with the full implications of a new national discharge to assess programme yet to be seen. Our research shows the significance of the alignment of service capacity, including the type and location of provision, with the needs and preferences of those leaving hospital. As the new system becomes established, attendance to such nuances behind blockages in the system will be more important than ever. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform future workforce development and planning in a new integrated care system in England. Design/methodology/approach: Semi-structured interviews and focus groups with primary, community, acute care, social care and voluntary care, frontline and managerial staff and with patients and carers receiving these services were undertaken. Data were explored using framework analysis. Findings: Analysis revealed three overarching themes: achieving teamwork and integration, managing demands on capacity and capability and delivering holistic and user-centred care. An organisational development (OD) process was developed as part of the action research process to facilitate the large-scale workforce changes taking place. Research limitations/implications: This study did not consider workforce development and planning challenges for nursing and care staff in residential, nursing care homes or domiciliary services. This part of the workforce is integral to the care pathways for many patients, and in line with the current emerging national focus on this sector, these groups require further examination. Further, data explore service users' and carers' perspectives on workforce skills. It proved challenging to recruit patient and carer respondents for the research due to the nature of their illnesses. Practical implications: Many of the required skills already existed within the workforce. The OD process facilitated collaborative learning to enhance skills; however, workforce planning across a whole system has challenges in relation to data gathering and management. Ensuring a focus on workforce development and planning is an important part of integrated care development. Social implications: This study has implications for social and voluntary sector organisations in respect of inter-agency working practices, as well as the identification of workforce development needs and potential for informing subsequent cross-sector workforce planning arrangements and communication. Originality/value: This paper helps to identify the issues and benefits of implementing person-centred, integrated teamworking and the implications for workforce planning and OD approaches. [ABSTRACT FROM AUTHOR]

Objectives: Health policy and funding initiatives have addressed increasing workloads in general practice through the deployment of clinicians from different disciplinary backgrounds. This study examines how general practices in England operate with increasingly diverse groups of practitioners. Methods: Five general practices were selected for maximum variation of the duration and diversity of skill-mix in their workforce. Individual interviews were recorded with management and administrative staff and different types of practitioner. Patient surveys and focus groups gathered patients' perspectives of consulting with different practitioners. Researchers collaborated during coding and thematic analysis of transcripts of audio recordings. Results: The introduction of a wide range of practitioners required significant changes in how practices dealt with patients requesting treatment, and these changes were not necessarily straightforward. The matching of patients with practitioners required effective categorization of health care patients' reported problem(s) and an understanding of practitioners' capabilities. We identified individual and organizational responses that could minimize the impact on patients, practitioners and practices of imperfections in the matching process. Conclusions: The processes underpinning the redistribution of tasks from GPs to non-GP practitioners are complex. As practitioner employment under the Primary Care Network contracts continues to increase, it is not clear how the necessarily fine-grained adjustments will be made for practitioners working across multiple practices. [ABSTRACT FROM AUTHOR]

The mass redeployment of nurses was critical across countries necessitated by the acute health impact of Covid-19. Knowledge was limited regarding how to manage nurse redeployment or the impact that redeployment might have. Redeployment continues, particularly in response to the current staffing crisis and surges such as winter pressures. This study aims to address these gaps in evidence to inform guidance on how best to manage nurse redeployment in practice. First, to understand the processes and underpinning decisions made by managers when managing nurse redeployment prior to and during the Covid-19 pandemic. Second, to identify the lessons that can be learned to improve the management of on-going nurse redeployment. Qualitative study utilising semi-structured interviews and focus groups with nurse managers (ISRCTN: 18172749). Three acute National Health Service (NHS) Trusts in England with geographical and ethnic diversity, and different Covid-19 contexts. Thirty-two nurse managers and four Human Resource advisors responsible for redeploying nurses or receiving and supporting redeployed nurses. Participants took part in face-to-face or virtual semi-structured interviews from February 2021 to November 2021 and virtual focus groups from July to December 2021. Qualitative data were analysed using reflexive thematic analysis. Four themes were evident in the data, capturing four distinctive phases of the redeployment process. There was a fundamental mismatch between how different parts of the nursing and managerial workforce conceived of their decision-making responsibilities across different phases. This led to managers taking inconsistent and sometimes contradictory approaches when redeploying nurses, and a disconnect between nursing staff at all levels of the chain of command. Furthermore, in conjunction with limited guidance in operationalising redeployment and the distressing experiences vocalised by nurses, nurse managers found nurse redeployment logistically and emotionally challenging; and felt 'caught in the middle' of meeting both their managerial and mentoring responsibilities. This became increasingly challenging during subsequent phases of redeployment and remained challenging once the pandemic waned. The approach to nurse redeployment in response to the Covid-19 pandemic prioritised nurse staffing numbers over personal well-being. Key principles of good practice relating to nurse redeployment during the Covid-19 pandemic can be applied to improve future redeployment of nurses and support positive outcomes. Having a planned approach for staff redeployment during normal service delivery comprising operational guidance for those tasked with implementing redeployment, that is scalable in a crisis setting, would be beneficial for the nursing workforce. [ABSTRACT FROM AUTHOR]

Introduction: Sport workforce strategy in the United Kingdom (UK) has identified the occupational therapy profession as being ideally positioned to contribute to public health agendas relating to tackling physical inactivity amongst marginalised populations, such as disabled people and people with experience of mental distress. However, a robust understanding of the enablers, restrictions, and exclusions such groups encounter when seeking to participate in sport and physical activity is currently lacking. Methods: This study aimed to gain an in‐depth understanding of the different ways people with experience of mental distress talked about their participation in a community‐based football league in England, in the UK. Nine people took part in this strand of a larger participatory action research (PAR) study, which used go‐along interviews as the method of data collection. In alignment with PAR seeking to address power imbalances, the data from the go‐along interviews were analysed through a Foucauldian lens using a collaboratively produced analytic framework. Findings Participants constructed the community‐based football league as fostering feelings of purpose and belonging, against a backdrop of them describing experiencing stigma and exclusion when seeking to be active in their wider communities. They used the concept of occupational marginalisation to further interpret their situation. Conclusion: Understanding why and how people participate in football extends beyond seeing it as an individual exercise to shared social lives and occupations. With this perspective, occupational therapists could address occupational marginalisation in partnership with community sports organisations, collaborating for wider social change beyond specialist services. [ABSTRACT FROM AUTHOR]

Background: During the coronavirus disease 2019 (COVID-19) pandemic, support staff working with people with learning disabilities experienced a range of stressors directly related to the effects of the pandemic on themselves and on service users. Supporting staff well-being is crucial given their essential role in the lives of people with learning disabilities. Aim: To investigate the experiences, during the COVID-19 pandemic, of support staff working in residential and supported-living services for people with learning disabilities and understand the stressors staff encountered, the ways in which they managed stress and the support mechanisms they found useful. Method: A qualitative descriptive approach was used and individual semi-structured interviews were conducted with 14 support staff working in residential or supported-living services for people with learning disabilities in the south of England. Findings: The COVID-19 pandemic caused additional stress for staff, including information overload, challenges in providing person-centred, holistic support, and feelings of unfairness or being let down. However, staff derived benefits from timely, practical and non-judgemental support from managers and peers, and from celebrating their own and service users' achievements. Conclusion: A greater focus on non-judgemental listening by managers, celebration of staff's and service users' achievements and awareness of the potential overwhelming effects of email communication could reduce the stress levels support staff are exposed to. [ABSTRACT FROM AUTHOR]

Aims: To understand how COVID‐19 affected nurse staffing in intensive care units (ICUs) in England, and to identify factors that influenced, and were influenced by, pandemic staffing models. Design: Exploratory qualitative study. Methods: Semi‐structured, online interviews conducted July–September 2020 with regional critical care leaders including policy leads (n = 4) and directors/lead nurses (n = 10) across critical care networks in England. Findings: The six themes emerging from the framework analysis illustrate how the pre‐pandemic ICU culture influenced ICU staffing models during the pandemic. Changes in staffing impacted on the workforce and the care delivered, whilst it was necessary to learn from, and adjust to, a rapidly changing situation. Variation across and between networks necessitated variation in responses. The overwhelming outcome was that the pandemic has challenged the central tenets of ICU nurse staffing. Conclusions: Pandemic nurse staffing models resulted in changes to ICU skill‐mix and staffing numbers. Factors such as the impact of nurse staffing on care practices and on the workforce need to be taken into account when developing and testing future nurse staffing models for ICU. The extent to which ICUs will return to former staffing models is not yet known but there seems to be an appetite for change. Impact: In common with many countries, nurse staffing in English ICUs was adapted to address surge requirements during the COVID‐19 pandemic. Findings highlight the challenge COVID‐19 presented to pre‐pandemic ICU nurse staffing guidelines, the impact on patient and staff well‐being and the potential legacy for future staffing models. Study findings have implications for ICU nurse managers, researchers and policy makers: nurse staffing models need to be adaptable to the local context of care and future research should investigate the impact of different models on patients, staff and health service outcomes. [ABSTRACT FROM AUTHOR]

Currently, 78,150 children are in care in England, with 11% of the most vulnerable living in 2,460 residential homes due to multitype traumas. These children require safe and secure trauma‐informed therapeutic care. However, the children's residential care workforce delivering this vital care is an unrepresented, under‐researched and largely unsupported professional group. The workforce undertakes physically and emotionally challenging work in difficult conditions, exacerbated by the COVID‐19 pandemic. Practitioner wellbeing is directly associated with outcomes for children. Therefore, we sought to understand how experiences within the workforce could improve overall working conditions, and thus outcomes for staff and children. Thirty participants took part in a survey, providing feedback on their experiences and the situations they faced during the English lockdown April‐June 2020. Two participants also opted to take part in a teleconference interview, rather than survey, although were asked the same questions. Data were analysed through thematic analysis. A stakeholder advisory board supported the project, including frontline staff, care leavers, service managers and policy researchers. The advisory board assisted in reflecting on the data from the survey and interviews to generate a complete analysis. Overall, staff require facilitated safe spaces for peer‐support, reflective and emotionally supportive supervision. An organisational awareness that staff wellbeing is intrinsically connected to the wellbeing and therapeutic outcomes of the children they care for is essential. Further, staff require a sense of belongingness to feel safe and competent in their role due to a lack of external recognition and professional representation or validation. Based on the findings of the study and an iterative process with the stakeholder advisory board, we created a Wellbeing Charter for adoption within organisations to promote and protect the wellbeing of this vital workforce. The COVID‐19 pandemic has exposed professional, financial and environmental inequalities that affect these frontline workers. Implementing organisational, statutory and policy‐driven initiatives to prioritise their wellbeing are essential for the vulnerable children they care for. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: There are insufficient nurses to meet current demand for mental health care. This is an international concern. Within England, the impact of staff shortages on the quality of patient care in forensic high secure settings has been highlighted by the national regulatory body for hospitals.Forensic hospital nursing is a distinct specialism within mental health. Forensic nurses must negotiate the therapeutic, ethical and practical challenges of caring for high‐risk patients in a locked environment. What this paper adds to existing knowledge?: There has been no previous study to ask frontline high secure forensic nurses, union representatives, senior nurses and workforce leads about what factors may be affecting recruitment and retention in their setting.As well as the specialized and challenging nature of the work, participants identified that workforce sustainability was affected by unequal working terms and conditions, the hospital locations and wider national factors, such as changes to how nurse training was funded.They also identified that some strategies that were employed to address workforce shortages, such as day‐to‐day movement of staff within the hospital and incentive packages for new recruits could be demotivating for established staff. What are the implications for practice?: Forensic high secure nursing workforce strategies should include training, development and career pathways that are specific to the specialism and extend beyond preceptorship for newly qualified staff.There should be clear and equitable employment terms and conditions with remuneration packages that are consistent within and between organizations.Hospital managers should address the effect that movement of staff between wards may have on nurses' morale, therapeutic relationships and safety culture. Introduction: There has been no previous study of stakeholders' views on recruitment and retention concerns in high secure forensic settings. Aim: To identify factors affecting recruitment and retention in high secure hospitals, from the perspectives of stakeholders with experience in forensic mental health nursing. Method: Framework analysis of data from fifteen interviews and three focus groups with frontline nurses, nurse leaders, recruitment leads and union representatives from three high secure hospitals in England. Results: Six themes emerged from the data: (a) the unique nature of high secure nursing; (b) the impact of short staffing; (c) wider factors affecting the high secure nursing workforce; (d) the location; (e) staff being on different terms and conditions of work; (f) recruitment strategies. Discussion: Multiple factors are likely to simultaneously affect high secure hospital recruitment and retention. Findings on the unique nature of high secure work reflect previous qualitative research. The themes of location, working terms and condition and recruitment strategies have not been previously identified in forensic nursing research. Implications for practice: Employers should ensure that employment terms and conditions are equitable and consistent. Furthermore, hospital managers should address the effect that movement of staff between wards may have on morale and therapeutic relationships. [ABSTRACT FROM AUTHOR]

An extended role being explored globally is the advanced clinical practitioner (ACP). In England this is an extended role for allied health professions, nurses and midwives in a range of settings. This paper focuses on three research questions: 1) What is the role of ACPs in England? 2) What are the barriers and facilitators to implementing the role? and 3) What is the contribution of ACPs to health services in England? A qualitative, exploratory study to explore perspectives on the ACP role in a range of clinical settings. We recruited 63 stakeholders, including 34 nurses, working in a ACP role or ACP education. A purposive snowball sampling technique identified participants meeting inclusion criteria. One-to-one semi-structured interviews throughout 2020, recorded and transcribed verbatim, anonymised and thematically analysed. The ACP role in England was undertaken in a broad range of clinical contexts. In England 'advanced clinical practitioner' was not a protected title. There were high levels of variability and ambiguity of understanding and deployment of the ACP role in England. Facilitators to the implementation process included training and education, clinical supervision and organisational support. Lack of protection for the role and variances in experience were barriers. Employer support facilitated development of the ACP role, however where support was limited, at either an individual or organisation level, this was a barrier. Our study highlighted the wide range of ways the ACP role benefitted patient outcomes and workforce development. This study outlines the contribution that ACPs can make to health services, contributing factors and key barriers and facilitators to implementing this role. The work showed the positive contribution ACPs can make to service redesign, workforce development and patient outcomes, whilst accepting there is much work to do to ensure protected status and parity across all professions and clinical contexts [ABSTRACT FROM AUTHOR]

Good patient access to medicines at home during the last 12 months of life is critical for effective symptom control, prevention of distress and avoidance of unscheduled and urgent care. To undertake an evaluation of patient and carer access to medicines at end-of-life within the context of models of service delivery. Evaluative, mixed method case studies of service delivery models, including cost analysis. The unit of analysis was the service delivery model, with embedded sub-units of analysis. (i) General Practitioner services (ii) Palliative care clinical nurse specialist prescribers (iii) a 24/7 palliative care telephone support line service. Healthcare professionals delivering end-of-life care; patients living at home, in the last 12 months of life, and their carers. Within each case: Patients/carers completed a structured log on medicines access experiences over an 8-week period. Logs were used as an aide memoire to sequential, semi-structured interviews with patients/carers at study entry, and at four and eight weeks. Healthcare professionals took part in semi-structured interviews focused on their experiences of facilitating access to medicines, including barriers, and facilitating factors. Data on prescribed medicines were extracted from patient records. Detailed contextual data on each case were also collected from a range of documents. Patient, carer and healthcare professional interview data were analysed using Framework Analysis to identify main themes. We estimated prescription costs and budget impact analysis of the different service models. Data were triangulated within each case. Cross-case comparison and logic models were employed to enable systematic comparisons across service delivery types. Accessing medicines is a process characterised by complexity and systems inter-dependency requiring considerable co-ordination work by patients, carers and healthcare professionals. Case studies highlighted differences in speed and ease of access to medicines across service delivery models. Key issues were diversifying the prescriber workforce, the importance of continuity of relationships and team integration, access to electronic prescribing systems, shared records and improved community pharmacy stock. Per patient prescription cost differentials between services were modest but were substantial when accounting for the eligible population over the medium term. Experiences of medicines access would be improved through increasing numbers of nurse and pharmacist prescribers, and improving shared inter-professional access to electronic prescribing systems and patient records, within care delivery systems that prioritise continuity of relationships. Community pharmacy stock of palliative care medicines also needs to become more reliable. [ABSTRACT FROM AUTHOR]