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Evidence is emerging of the potential of person‐centred approaches to create partnerships between professionals and patients while also containing healthcare costs. This is important for enhancing outcomes in individuals with complex needs, who consistently report poor experiences with care. The shift towards person‐centred care (PCC) is, however, a radical departure from the norm, with increased expectations of both professional and patient. Although there have been studies on the ways in which health care professionals can modify practice to enhance PCC, not all patients welcome changes to their care delivery or understand the aim of the new approach. Without engagement and understanding from the patient, a PCC approach will fail to initiate. Few studies explore how, why and in what circumstances patients become more involved in their care and what professionals can do to enhance participation. We conducted a secondary analysis of qualitative data to examine this issue. Data were collected between 2014 and 2018 from primary care‐based PCC projects across the southwest of England. Supported by people with experience (practitioners and those receiving treatment), theory building workshops developed an explanatory framework that identified contextual factors and mechanisms likely to contribute to effective engagement. Our results show that engagement in a care partnership is achieved through trust and a patient's sense of candidacy. Shared understanding of purpose, clarity of expectations and power sharing were found to facilitate trusted relationships between professional and patient and encourage candidacy. Only then is it possible to develop goals that are meaningful to the patient. Our theory of engagement applies to professionals and patients alike but places the initial burden of responsibility on those who hold the most power: the professional and the system. This theory has the potential to explain patient engagement in PCC and a range of other service interventions, treatments and intervention research. [ABSTRACT FROM AUTHOR]

“Bostin Value” was a pilot scheme aiming to improve fruit and vegetable consumption in a deprived neighborhood in the borough of Dudley, England. Research identified the need to address both supply and demand to encourage the target audience (parents/carers of young children) to consume more fruit and vegetables along with their children. Bostin Value improved supply through commissioning a local greengrocer to sell fresh fruit and vegetables twice a week at a local primary school. Promotions were used to encourage sales, including a loyalty card system, money off vouchers, and recipe cards. To increase demand, educational sessions were run at the school to improve parent’s skills in cooking seasonal produce. Children at the school received tasting workshops to encourage them to try a variety of fruit and vegetables. Results saw the mean portions of fruit consumed weekly by parents significantly increase from 2.4 portions in April 2009 to 3.1 in July 2010. This was mirrored in children whose weekly portions increased from 2.6 to 3.7. The mean number of different fruits and vegetables tasted by children also increased significantly. [ABSTRACT FROM AUTHOR]

The article examines the economic implications of cleaning in response to the flow of visitors through historic houses. The section reflects on work carried out in properties of the National Trust for England, Wales, and Northern Ireland, which is the largest accredited museum authority in the U.K., with 175 furnished properties open to visitors for seven months each year, on average five days per week and four to five hours a day. According to the study, although it describes how control of dust influences property management and housekeeping policies in the National Trust, the outcomes are applicable to historic properties in general and to museums and galleries where significant interiors and collections are exposed to dust.

Background: The growing number of people living with multiple long-term conditions is increasing demand on Global Health Systems at a time of fiscal constraint [1]. To meet this challenge, new models of primary care aiming at enhanced coordination and person centred care have been proposed to improve efficiency and patient outcomes by breaking with paternalistic models of health and encouraging increased self-management within the community [2]. Lack of implementable evidence and guidance has led to the development of local 'implementation experiments'. We evaluated a number of these 'experiments' across southwest England against four routines for practice developed by the Gothenburg centre for person centred care [3]. Methods: To develop theory about how best to engage people in new interventions for the development of person centred coordinated care we conducted a secondary, inductive analysis of qualitative data. This comprised of data generated from structured interviews, focus groups and observations with patients and practitioners that formed part of our service evaluations. Theory was co-produced in workshops involving patients and practitioners. Results: Our data revealed that initially some patients were suspicious of the motives for their inclusion in novel interventions, or did not understand the new model's rationale. In these cases participants found it difficult to develop a narrative routine one and some individuals declined participation. This was due to underdevelopment of programme theory and inexperience of practitioners in articulating programme aims when introducing the intervention. Evidence suggested that older individuals with more complex care needs may find it more difficult to engage with the new approach, resulting in lack of shared decision making during subsequent goal setting and care planning routines two and three. Co-production was an unintended consequence of bringing participant groups together which produced mechanisms reframing interactions and further developing participants' narratives. Developing a trusting relationship with practitioners over time also promoted engagement and was more likely to result in development of authentic, holistic narratives and goals. Discussion: Evidence shows that person centred care increases wellbeing and self-management in patients and co-production supports personalised practice [4]. This study gives exemplars of how these principles operate in practice. Personal narrative development is a significant departure from traditional health service encounters in which topics and solutions are defined by practitioners. It may be challenging for patients and practitioners. Conclusions: The establishment of a meaningful patient narrative depends on clear explanations of new interventions and the formation of relationships with practitioners trained in eliciting these conversations. This 'pre-context' is fundamental to person centred care since it establishes rules of engagement for the subsequent routines of decision-making and care planning. Lessons learned: Clarity of programme theory and staff training on effective communication and narrative development are imperative to the delivery of person centred care. Limitations: Data was limited to those agreeing to be interviewed, observed, or take part in focus groups; the views and experiences used to develop theory may not be wholly representative of more marginalised individuals. Suggestions for future research: Testing the developed theory in controlled or other welldesigned research programmes. [ABSTRACT FROM AUTHOR]

Background: Measuring patient experiences of healthcare is increasingly emphasized as a mechanism to measure, benchmark and drive quality improvement, clinical effectiveness and patient safety at both national and local NHS level. Person-centred coordinated care (P3C) is the conjunction of two constructs; person-centred care and care coordination. It is a complex intervention requiring support for changes to organizational structure and the behaviour of professionals and patients. P3C can be defined as: 'care and support that is guided by and organized effectively around the needs and preferences of individuals'. Despite the vast array of PRMS available, remarkably few tools have been designed that efficiently probe the core domains of P3C. This paper presents the psychometric properties of a newly developed PREM to evaluate P3C from a patient perspective., Methods: A customized EMIS search was conducted at 72 GP practices across the South West (Somerset, Devon and Cornwall) to identify 100 patients with 1 or more LTCs, and are frequent users of primary healthcare services. Partial Credit Rasch Modelling was conducted to identify dimensionality and internal consistency. Ecological validity and sensitivity to change were assessed as part of intervention designed to improve P3C in adults with multiple long-term conditions; comparisons were drawn between the P3CEQ and qualitative data., Results: Response rate for the P3CEQ was 32.82%. A two-factor model was identified. Rasch analysis confirmed unidimensionality of each factor (using infit MSQ values between 0.5 and 1.5). High internal consistency was established for both factors; For the Person-centred scale Cronbach's Alpha = 0.829, Person separation = 0.756 and for the coordination scale Cronbach's alpha = 0.783, person separation = 0.672., Conclusions: The P3CEQ is a valid and reliable measure of P3C. The P3C is considered to have strong face, construct and ecological validity, with demonstrable sensitivity to change in a primary healthcare intervention., (© The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care.)

Objectives: To evaluate a county-wide deincentivisation of the Quality and Outcomes Framework (QOF) payment scheme for UK General Practice (GP)., Setting: In 2014, National Health Service England signalled a move towards devolution of QOF to Clinical Commissioning Groups. Fifty-five GPs in Somerset established the Somerset Practice Quality Scheme (SPQS)-a deincentivisation of QOF-with the goal of redirecting resources towards Person Centred Coordinated Care (P3C), especially for those with long-term conditions (LTCs). We evaluated the impact on processes and outcomes of care from April 2016 to March 2017., Participants and Design: The evaluation used data from 55 SPQS practices and 17 regional control practices for three survey instruments. We collected patient experiences ('P3C-EQ'; 2363 returns from patients with 1+LTC; 36% response rate), staff experiences ('P3C-practitioner'; 127 professionals) and organisational data ('P3C-OCT'; 36 of 55 practices at two time points, 65% response rate; 17 control practices). Hospital Episode Statistics emergency admission data were analysed for 2014-2017 for ambulatory-sensitive conditions across Somerset using interrupted time series., Results: Patient and practitioner experiences were similar in SPQS versus control practices. However, discretion from QOF incentives resulted in time savings in the majority of practices, and SPQS practice data showed a significant increase in P3C oriented organisational processes, with a moderate effect size (Wilcoxon signed rank test; p=0.01; r=0.42). Analysis of transformation plans and organisational data suggested stronger federation-level agreements and informal networks, increased multidisciplinary working, reallocation of resources for other healthcare professionals and changes to the structure and timings of GP appointments. No disbenefits were detected in admission data., Conclusion: The SPQS scheme leveraged time savings and reduced administrative burden via discretionary removal of QOF incentives, enabling practices to engage actively in a number of schemes aimed at improving care for people with LTCs. We found no differences in the experiences of patients or healthcare professionals between SPQS and control practices., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To understand the experiences of students and problem-based learning (PBL) facilitators during an evidence-based curriculum change to a PBL programme within an undergraduate medical course in South West England., Methods: Four novel PBL cases were designed and implemented, based on educational theory and evidence. Eight focus groups were undertaken with Year-1 and -2 students (n = 18) and PBL facilitators (n = 14) to explore the experiences of participants. Thematic analysis and conceptual abstraction led to insights into the intended and unintended consequences of the change., Results: Participant responses to the change process were influenced by the perceived relevance and value of the change (e.g. benefit to student learning), which was shaped by individual beliefs and preferences (e.g. presumed purpose of PBL, relative value placed on different curriculum topics, and desire for uniform educational experience), and the wider education context (e.g. expectations of assessment). It appears that the three distinct elements must align for the changes to be received positively. We updated our PBL curriculum in response to new evidence DISCUSSION: This study describes how we updated our PBL curriculum in response to new evidence, and demonstrates the importance of communicating the pedagogic rationale behind changes, and meticulous planning, preparation and alignment, even in distant parts of the curriculum. Engaging with existing views and attitudes is an essential requirement for successful curriculum change., (© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Context: Second-generation (atypical) antipsychotics (SGAs) are more expensive than first-generation (typical) antipsychotics (FGAs) but are perceived to be more effective, with fewer adverse effects, and preferable to patients. Most evidence comes from short-term efficacy trials of symptoms., Objective: To test the hypothesis that in people with schizophrenia requiring a change in treatment, SGAs other than clozapine are associated with improved quality of life across 1 year compared with FGAs., Design: A noncommercially funded, pragmatic, multisite, randomized controlled trial of antipsychotic drug classes, with blind assessments at 12, 26, and 56 weeks using intention-to-treat analysis., Setting: Fourteen community psychiatric services in the English National Health Service., Participants: Two hundred twenty-seven people aged 18 to 65 years with DSM-IV schizophrenia and related disorders assessed for medication review because of inadequate response or adverse effects., Interventions: Randomized prescription of either FGAs or SGAs (other than clozapine), with the choice of individual drug made by the managing psychiatrist., Main Outcome Measures: Quality of Life Scale scores, symptoms, adverse effects, participant satisfaction, and costs of care., Results: The primary hypothesis of significant improvement in Quality of Life Scale scores during the year after commencement of SGAs vs FGAs was excluded. Participants in the FGA arm showed a trend toward greater improvements in Quality of Life Scale and symptom scores. Participants reported no clear preference for either drug group; costs were similar., Conclusions: In people with schizophrenia whose medication is changed for clinical reasons, there is no disadvantage across 1 year in terms of quality of life, symptoms, or associated costs of care in using FGAs rather than nonclozapine SGAs. Neither inadequate power nor patterns of drug discontinuation accounted for the result.