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IntroductionBCG vaccination modulates immune responses to unrelated pathogens. This off-target effect could reduce the impact of emerging pathogens. As a readily available, inexpensive intervention that has a well-established safety profile, BCG is a good candidate for protecting healthcare workers (HCWs) and other vulnerable groups against COVID-19.Methods and analysisThis international multicentre phase III randomised controlled trial aims to determine if BCG vaccination reduces the incidence of symptomatic and severe COVID-19 at 6 months (co-primary outcomes) compared with no BCG vaccination. We plan to randomise 10 078 HCWs from Australia, The Netherlands, Spain, the UK and Brazil in a 1:1 ratio to BCG vaccination or no BCG (control group). The participants will be followed for 1 year with questionnaires and collection of blood samples. For any episode of illness, clinical details will be collected daily, and the participant will be tested for SARS-CoV-2 infection. The secondary objectives are to determine if BCG vaccination reduces the rate, incidence, and severity of any febrile or respiratory illness (including SARS-CoV-2), as well as work absenteeism. The safety of BCG vaccination in HCWs will also be evaluated. Immunological analyses will assess changes in the immune system following vaccination, and identify factors associated with susceptibility to or protection against SARS-CoV-2 and other infections.Ethics and disseminationEthical and governance approval will be obtained from participating sites. Results will be published in peer-reviewed open-access journals. The final cleaned and locked database will be deposited in a data sharing repository archiving system.Trial registrationClinicalTrials.gov NCT04327206

Reilly et al ’s article on GP scholarship1 is important and we warmly support it. They rightly state that academic general practice should be ‘integrated and accessible to grass roots GPs’ . Secondary care has long had its teaching hospitals and long trumpeted the academic triad of good service for patients, teaching, and research all in the same place. GPs should seek to replicate …

The benefits associated with continuity of GP care for patients, for GPs, and for the health system have become progressively stronger.1 However, the routine measurement of this continuity in clinical practice has not kept pace with the increasing evidence base. …

Hundreds of studies from various countries and health systems have linked increased continuity to positive outcomes; some show no link and only a few an association with adverse effects.1 To the best of our current knowledge, and on the balance of probabilities, continuity is likely to be beneficial. On this basis it is now important to consider what possible mechanisms can explain the continuity effects.

The negative phrase ‘the worried well’ is being increasingly used, particularly by policymakers and now by some clinicians as well. Usually, it describes a group of patients who are perceived as using health services inappropriately or disproportionately, when other more deserving patients should be given attention. It thus reflects the old idea of the deserving and undeserving poor, and is equally distasteful. There are numerous other reasons why we believe that this term is always inappropriate and should therefore never be used. The ‘worried well’ are not a clearly defined group — the only shared characteristic being that the doctor does not see pathology. Patients with this label could range from someone with a concerning symptom that turns out to be nothing, to someone with severe health anxiety. The term suggests that these patients are well; however, for some patients, the condition of health anxiety, for which the term ‘worried well’ is often used, is a serious and potentially debilitating condition. When investigated, one group labelled as ‘worried well’ were found to have substantial mental illness1 and therefore these patients need medical help.2 For doctors, it is wrong to imply that …

General practice computer systems are remarkably sophisticated but their potential is underused. In contrast many private sector businesses use IT meticulously to measure performance. For example, many retail stores know exactly how sales change according to how they position goods in the shop or even how they alter the lighting. Following Drucker,1 the father of management theory, ‘If you don’t measure it, you can’t manage it.’ Drawing on research and data collection performed at a practice over 30 years, we suggest that there are eight core management statistics that are easily available to every general practice. These make it possible for GPs to understand exactly what is happening in the practice. The core data are: the number, the age/sex structure and the duration of registration of the registered patients, the annual consultation rate, the average duration of face-to-face GP consultations, level of continuity of care, and measures of routine appointment provision and availability. All GPs already understand the importance of knowing the number of patients registered with the practice and this figure is commonly used when describing a general practice. This is available for the population nationally, regionally, and for individual practices. It is particularly helpful to know the proportion of older patients, since they have many more health problems, which helps planning. This is freely available to all practices on the Public Health England Practice Profiles …

Objective To investigate whether the introduction of a named general practitioner (GP, family physician) improved patients’ healthcare for patients aged 75 and over in England. Setting Random sample of 27 500 patients aged 65 to 84 in 2012 within 139 English practices from the Clinical Practice Research Datalink linked with Hospital Episode Statistics. Design Prospective cohort approach, measuring patients’ GP consultations and emergency hospital admissions 2 years before/after the intervention. Patients were grouped in (i) aged over 74 and (ii) younger than 75 in both periods in order to compare who were or were not subject to the intervention. Adjusted associations between the named GP scheme, continuity of care and emergency hospital admission were examined using multilevel modelling. Intervention National Health Service policy to introduce a named accountable GP for patients aged over 74 in April 2014. Main outcome measures (A) Continuity of care index-score, (B) risk of emergency hospital admissions, (C) number of emergency hospital admissions. Results The intervention was associated with a decrease in continuity index-scores of −0.024 (95% CI −0.030 to −0.018, p

BackgroundDespite patient preference and many known benefits, continuity of care is in decline in general practice. The most common method of measuring continuity is the Usual Provider of Care (UPC) index. This requires a number of appointments per patient and a relatively long timeframe for accuracy, reducing its applicability for day-to-day performance management.AimTo describe the St Leonard’s Index of Continuity of Care (SLICC) for measuring GP continuity regularly, and demonstrate how it has been used in service in general practice.Design and settingAnalysis of appointment audit data from 2016–2017 in a general practice with 8823–9409 patients and seven part-time partners, in Exeter, UK.MethodThe percentage of face-to-face appointments for patients on each doctor’s list, with the patient’s personal doctor (the SLICC), was calculated monthly. The SLICC for different demographic groupings of patients (for example, sex and frequency of attendance) was compared. The UPC index over the 2 years was also calculated, allowing comparisons between indices.ResultsIn the 2-year study period, there were 35 622 GP face-to-face appointments; 1.96 per patient per year. Overall, 51.7% (95% confidence interval = 51.2 to 52.2) of GP appointments were with the patients’ personal doctor. Patients aged ≥65 years had a higher level of continuity with 64.9% of appointments being with their personal doctor. The mean whole-practice UPC score was 0.61 (standard deviation 0.23), with ‘usual provider’ being the personal GP for 52.8% and a trainee or locum for 8.1% of patients.ConclusionThis method could provide working GPs with a simple way to track continuity of care and inform practice management and decision making.

Continuity of care is a core feature of general practice; it creates multiple benefits for patients, doctors and society. Continuity increases trust, patient satisfaction, disclosure of information, take-up of preventive care, adherence to advice, reduction in socio-economic disadvantage, and reduces deaths. However, the level of continuity is reducing in general practice. About 15 consultations are needed with a patient for a GP to acquire enough ‘accumulated knowledge’ to develop a sense of continuing responsibility. This fosters GP sensitivity and mutual understanding, which enable GPs to provide ‘higher-level’ quality of care. The RCGP curriculum states two high-level aims: that GPs need to ‘enhance continuity of care’ and ‘build long-term relationships with patients’. This article analyses these aims by setting them in the context of international research on continuity of care.

The COVID-19 pandemic has produced the biggest change in consultation patterns in British general practice for at least 200 years. The St Leonard’s Practice in Exeter has for years recorded and analysed consultation data.1,2 After NHS guidance to reduce face-to-face consultations, there was an immediate reduction. During March the number of face-to-face consultations fell from a mean …

Objective Continuity of care is a long-standing feature of healthcare, especially of general practice. It is associated with increased patient satisfaction, increased take-up of health promotion, greater adherence to medical advice and decreased use of hospital services. This review aims to examine whether there is a relationship between the receipt of continuity of doctor care and mortality. Design Systematic review without meta-analysis. Data sources MEDLINE, Embase and the Web of Science, from 1996 to 2017. Eligibility criteria for selecting studies Peer-reviewed primary research articles, published in English which reported measured continuity of care received by patients from any kind of doctor, in any setting, in any country, related to measured mortality of those patients. Results Of the 726 articles identified in searches, 22 fulfilled the eligibility criteria. The studies were all cohort or cross-sectional and most adjusted for multiple potential confounding factors. These studies came from nine countries with very different cultures and health systems. We found such heterogeneity of continuity and mortality measurement methods and time frames that it was not possible to combine the results of studies. However, 18 (81.8%) high-quality studies reported statistically significant reductions in mortality, with increased continuity of care. 16 of these were with all-cause mortality. Three others showed no association and one demonstrated mixed results. These significant protective effects occurred with both generalist and specialist doctors. Conclusions This first systematic review reveals that increased continuity of care by doctors is associated with lower mortality rates. Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors. Many of these articles called for continuity to be given a higher priority in healthcare planning. Despite substantial, successive, technical advances in medicine, interpersonal factors remain important. PROSPERO registration number CRD42016042091.

Objectives To clarify the relationship between social deprivation and age as two factors associated with emergency admissions to hospital. Design Emergency admissions for 12 months were analysed for patients in the NHS NEW Devon CCG. Social deprivation was measured by the Index of Multiple Deprivation (IMD). Logistic regression models estimated the separate and combined effects of social deprivation and age on the risk of emergency admissions for people aged under and over 65. Setting East Devon, UK—area of the NEW Devon CCG. Population 765 861 patients in the CCG database. Main outcome measure Emergency admission to any English hospital. Results Age (p