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Purpose of the study Increasing pressure on general practice prompts innovative change in service organisation. This study sought to evaluate the impact of introducing a telephone-first consultation system in a socioeconomically deprived population. Study design An interrupted time series of preplanned outcomes for 2 years before and 1 year postintroduction of a telephone-first system was used to measure the volume and type of general practitioner (GP) consultations and the number of patients consulted per year. Emergency department (ED) and GP out-of-hours attendances, the number of outpatient referrals, and the number of requests for laboratory tests were measured as secondary outcomes. Results The telephone-first system was associated with a 20% increase in total GP consultations (telephone and face-to-face, effect estimate at 12 months, p=0.001). Face-to-face consultations decreased by 39% (p Conclusions A telephone-first system in a deprived urban general practice can decrease delays to GP–patient contacts. The number of patients seeking a medical intervention did not differ irrespective of the consultation system used. The telephone-first system did not affect GP out-of-hours, laboratory investigations or secondary care contacts.

ObjectivesTo assess the acceptability and use of a low-cost patient-held communication tool.DesignLongitudinal qualitative interviews at three time points over 18 months and document content analysis.SettingPrimary and community services.ParticipantsTwenty-eight dyads: People living with dementia in Northern Ireland and their informal carers.InterventionsA patient-held healthcare ‘passport’ for people living with dementia.Primary and secondary outcomesAcceptability and use of the passport—barriers and facilitators to successful engagement.ResultsThere was a qualified appreciation of the healthcare passport and a much more nuanced, individualistic or personalised approach to its desirability and use. How people perceive it and what they actually do with it are strongly determined by individual contexts, dementia stage and other health problems, social and family needs and capacities. We noted concerns about privacy and ambivalence about engaging with health professionals.ConclusionSuch tools may be of use but there is a need for demanding, thoughtful and nuanced programme delivery for future implementation in dementia care. The incentivisation and commitment of general practitioners is crucial. Altering the asymmetrical relationship between professionals and patients requires more extensive attention.

Enhanced Day Hospice is a pilot project in Northern Ireland funded by the local Integrated Care Partnership for End of Life Care. This service comprises four designated sessions of medical cover for day hospice including provision of specialist palliative medicine input, working alongside and with support from a staff nurse as well as additional support from the day hospice nurse manager and day hospice volunteers. It enables a holistic assessment of patients affected by any life-limiting illness. Provided they are well enough to attend, they are also likely to be in the last year (or years) of life, undergoing rapid change in health status, wish to live independently for as long as possible, learning how to manage and minimise the symptoms of their condition(s) with the help (potentially) of family, carers and healthcare staff. Day hospice is a well-established model of outpatient hospice care and was identified as a key aspect of specialist palliative care delivery in the Living Matters Dying Matters strategy for Northern Ireland in 2010. Patient surveys undertaken across hospices in Northern Ireland indicate that patients greatly value this service and in particular having access to a dedicated day hospice service, whilst carers value the respite time. Anticipated outcomes of Enhanced Day Hospice: Improve ability to manage illness related change for patients, families, carers Reduce risks of social isolation Anticipate and plan for potential crises Improve experience of end-of-life for patients, carers, families Reduce reliance on primary and secondary care services during time of intense health challenge. Other benefits: Reduction in hospital deaths Improved discharge planning and capacity Improved support for Home Care Nursing Team – Increased domiciliary visits Improved palliative medicine outpatient capacity Reduction in need by patients for other services.

Background During strategy consultation in Northern Ireland an “End of Life Care Passport” was suggested as a way to address myriad communication difficulties involved in living with evolving illness. Aim To build a patient-owned communication tool to facilitate important conversations and capture key information as health changes. Methods Participatory action methods used to engage service users, carers, patient advocates, and healthcare professionals. Views harnessed via: face to face, email, telephone, via series of workshops. Iterative process of drafting, dissemination, evaluation, re drafting. Pilot version launched (350 disseminated): used for a 3 month evaluative period by 3 groups: living with dementia, with motor neurone disease, with advanced respiratory illness. Feedback widely sought from participating individuals and groups. Results The emergent tool 1 very different from originally envisaged. Key issues include widespread rejection of “End of Life Care Passport” (felt to be professionally based perspective); very high level of engagement with the process, imperative to develop a tool which focusses on language and communication needs of patient and carers rather than professionals. Emergent tool contains ten sections and brief explanatory content. Housed as A5 portable ring binder (e-version suggested), updated collaboratively by patient, carers, key supporters, professionals. Conclusion Patients and carers face multiple communication difficulties negotiating changing health. At particular risk are those with rare illness and those whose capacity is limited due to illness, language or cultural barriers. There is a role for a communication tool which houses key evolving information, is completed collaboratively and patient owned and controlled. Reference http://www.rcgp.org.uk/rcgp-near-you/rcgp-northern-ireland/my-healthcare-passport.aspx

Background There is an urgent need for the development of simple communication tools that convey the strengths, assets, and healthcare needs of people living with dementia. A Healthcare Passport may improve communication with range of health and social support services, enhancing quality and continuity of care, and to permit a consideration of the challenges and how these might be managed effectively and compassionately. This study aims to evaluate the acceptability and use of this type of intervention for people living with dementia and their carers. Methods/Design This is a qualitative longitudinal study informed by a critical realist review. The participants will be individuals identified as having mild-moderate dementia and informal carers. The in-depth interviews will occur at three points over the course of 18 months as they use the passport. This will be supplemented by analysis of the content of the passports and information from health and social care providers on the daily practicalities of using the passport in a range of healthcare settings. Discussion By using a critical realist review and a qualitative, longitudinal approach, the study allows for the assessment of a complex intervention in a manner which goes beyond evaluating the basic efficacy of the passport, but looking more deeply at how it worked, for whom, and in what context. It has the potential to develop new data on how interventions improve communication across a range of service providers, while encouraging health and social care professionals to respect and encourage the development of self-management and retention of personhood throughout the progression of life-limiting illnesses.