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Storylines of Family Medicine is a 12-part series of thematically linked essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'V: ways of thinking-honing the therapeutic self', authors present the following sections: 'Reflective practice in action', 'The doctor as drug-Balint groups', 'Cultivating compassion', 'Towards a humanistic approach to doctoring', 'Intimacy in family medicine', 'The many faces of suffering', 'Transcending suffering' and 'The power of listening to stories.' May readers feel a deeper sense of their own therapeutic agency by reflecting on these essays.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'IX: people and places-diverse populations and locations of care', authors address the following themes: 'LGBTQIA+health in family medicine', 'A family medicine approach to substance use disorders', 'Shameless medicine for people experiencing homelessness', '''Difficult" encounters-finding the person behind the patient', 'Attending to patients with medically unexplained symptoms', 'Making house calls and home visits', 'Family physicians in the procedure room', 'Robust rural family medicine' and 'Full-spectrum family medicine'. May readers appreciate the breadth of family medicine in these essays.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'X: standing up for diversity, equity and inclusion', authors address the following themes: 'The power of diversity-why inclusivity is essential to equity in healthcare', 'Medical education for whom?', 'Growing a diverse and inclusive workforce', 'Therapeutic judo-an inclusive approach to patient care', 'Global family medicine-seeing the world "upside down"', 'The inverse care law', 'Social determinants of health as a lens for care', 'Why family physicians should care about human rights' and 'Toward health equity-the opportunome'. May the essays that follow inspire readers to promote change.

Background: Online asynchronous telemedicine platforms are effective and have been implemented in primary care practices, but it is unclear whether implementation was successful. Implementation has not been studied on a large scale in primary care practice. Normalisation Process Theory is a sociological theory used to understand how complex practices can be embedded into routine practice. We aimed to identify and evaluate factors affecting, and make recommendations for, implementation of online asynchronous telemedicine platforms in primary care practice using Normalisation Process Theory. Methods: A systematic search was carried out across four databases. Studies included were empirical research, published between January 2015 and November 2022, of qualitative, quantitative and mixed methods designs, focusing on implementation of online asynchronous telemedicine platforms designed for two-way secure communication between patients and healthcare professionals to give or receive medical advice in primary care. Data extraction was guided by the domains of Normalisation Process Theory: context, mechanisms, outcomes. Results: 25 reports from 21 primary studies were obtained. COVID-19 changed the context in which asynchronous platforms were implemented into primary care, due to restrictions on face-to-face contact. Coherence is supported by online platforms providing benefits for patients. Healthcare staff felt confident using platforms and better teamworking added to cognitive participation, however patient 'misuse' of platforms hindered this. Collective action was negatively affected by poor usability and integration of platforms into practice systems. Reflexive action through large- and small-scale studies had allowed improvements to be made, but poor response rates inhibit this. Outcomes include changed roles and responsibilities for staff and patients and high patient satisfaction. There are concerns regarding confidentiality and health inequities. Conclusions: Increased workload, lack of integration into existing systems and poor usability affect implementation. Widespread implementation of online platforms in primary care practices can be supported by policy-makers through consistent guidelines to improve platforms' content, functionality and compatibility with clinical systems to try to enable improvements in practice. Further research should explore patient groups or needs for which online platforms are most suitable, reasons why online platforms work better for different patients and how different patient groups can be supported to benefit from asynchronous telemedicine. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To reinforce your knowledge of indications and treatment regimens for insulin therapy in type 2 diabetes • To enhance your understanding of psychological insulin resistance and strategies to overcome it • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Supporting adults with type 2 diabetes is an important part of primary care nursing. Insulin therapy is key to managing hyperglycaemia and reducing the risk of long-term diabetes-related complications, so many patients with type 2 diabetes will require insulin therapy as their condition progresses. However, they may have concerns about burdensome side effects such as hypoglycaemia and weight gain or about implications for driving. They may also struggle with concordance with treatment, for example if a suboptimal injection technique leads to pain and lipohypertrophy. This article provides nurses working in primary care with a practical guide to initiating insulin therapy in patients with type 2 diabetes, such as how to determine whether a patient needs insulin therapy, selecting the most appropriate regimen for each patient, supporting patients to overcome psychological insulin resistance and minimising common side effects. [ABSTRACT FROM AUTHOR]

BackgroundAimDesign and settingMethodResultsConclusionRecruiting and retaining International Medical Graduates (IMGs) has been identified as a key component in addressing the ongoing workforce crisis in general practice. However, research shows IMG General Practitioners (GPs) face unique challenges compared to their UK-trained counterparts, impacting their welfare, retention in the workforce, and ability to provide patient care.This study examined the challenges facing early-career IMG GPs, the help and support they access and want to access, and their perceptions and utilisation of the help and support available.A mixed-methods study that collected primary data in an online survey and interviews between March and May 2023.Early-career IMG GPs based in South West England were invited to complete an online survey consisting of 5-point Likert-scale and free-text questions. Interviews were completed with key informants and some survey respondents. Qualitative data were analysed thematically. Data from the survey and interviews were analysed and merged using a convergent parallel design.Based on 29 survey replies and 9 interviews, four interrelated themes were identified: (i) communication and language, (ii) racism, unequal treatment, and developing coping mechanisms (iii), exclusion and being ‘othered’, and (iv) adapting to new ways of living and working. Although some IMG GPs access help and support, many feel this is insufficient and poorly accessible.IMG GPs face interrelated and unique challenges in their personal and professional lives and do not feel adequately supported by the NHS. Addressing this disconnect will be vital to sustaining the general practice workforce. [ABSTRACT FROM AUTHOR]

Background: Gonorrhoea notification rates in Australia have more than doubled between 2014 and 2019. We explored gonorrhoea testing patterns and management of gonorrhoea infection in general practice. Methods: We analysed de-identified electronic medical record data for individuals who attended 73 Australian general practices (72 in the state of Victoria) between January 2018 and December 2020. The 'care cascade' model was utilised to explore gonorrhoea detection and management. Descriptive analysis and logistic regression were used to investigate factors associated with gonorrhoea testing, treatment and retesting. Results: During the study period, there were a total of 1,027,337 clinical episodes. Of these, 5.6% (n = 57,847, 95% confidence interval [CI] 4.5–6.7) involved a gonorrhoea test and 1.1% (n = 637, 95% CI 0.8–1.4) tested positive. Of the 637 gonorrhoea cases, 48.4% (n = 308, 95% CI 29.8–67.0) had an Australian guideline-recommended dual antibiotic prescription (ceftriaxone and azithromycin) recorded. Of 329 cases without a dual antibiotic prescription, 84.2% (n = 277, 95% CI 77.5–90.9) had reattended the clinic. Among the 206 gonorrhoea cases with dual antibiotic prescription recorded in 2018 and 2019, 32.0% (n = 66, 95% CI 25.3–38.8) were retested from 6 weeks to 6 months post-treatment. Of the 140 gonorrhoea cases that were not retested, 54.3% (n = 76, 95% CI 46.8–61.8) reattended the clinic within 6 months of treatment. Conclusion: The low proportion of gonorrhoea cases prescribed recommended antibiotics and retested within recommended timeframes suggests opportunities for integrating Australian STI guidelines into primary care. Further exploration of care pathways is warranted to determine if care was provided but not recorded, provided elsewhere or not provided. Gonorrhoea is the second most common notified sexually transmissible infection in Australia with increased concern of the emergence of antimicrobial resistance strains. Our study found that approximately half of gonorrhoea cases did not have guideline-recommended dual antibiotic prescriptions recorded, and two-thirds of gonorrhoea cases were not retested within the recommended retesting timeframe. Further work in integrating Australian STI guidelines into primary routine care and understanding care pathways for people with gonorrhoea infection is urgently needed. [ABSTRACT FROM AUTHOR]

Background One role of primary care is to support people living with and beyond cancer, the number of whom is increasing worldwide. This study aimed to identify factors affecting cancer care provision within English primary care after the start of the coronavirus pandemic, during high healthcare service demand, and a depleted workforce. Methods An exploratory qualitative descriptive approach was used to collect data via remote semi-structured interviews with primary care staff after gaining informed consent. Interview transcripts were analysed using reflexive thematic analysis. Results Fifteen primary care staff were interviewed (11 general practitioners, 3 practice nurses, and 1 physician associate). Factors affecting cancer care delivery in primary care were: (i) patient level: acceptance of healthcare and understanding of cancer; (ii) clinician level: personal experience with cancer and knowledge; (iii) general practice level: care coordinators and cancer registers, and (iv) system level: lack of healthcare resourcing and political inaction. Conclusions The ability of primary care to deliver cancer care is affected by multiple factors at various levels. Future studies should identify the implementation strategies of local and national policies to better understand how to improve cancer care education, practice-level infrastructure, evidence-based workforce planning, and healthcare resourcing, [ABSTRACT FROM AUTHOR]

Background The Australian National Bowel Cancer Screening Program sends an immunochemical faecal occult blood test to Australians aged 50–74 years to screen for bowel cancer, but uptake is low (40.9%). The SMARTscreen trial demonstrated that sending a short messaging services (SMS) prompt from the participant's general practitioner (GP) increased the proportion of kit returns by 16.5%. This research aimed to determine the acceptability and feasibility of implementing SMARTscreen. Method SMARTscreen was a cluster randomized controlled trial set in 21 Australian general practices in regional Australia. Participants and general practice staff involved in the trial were included in this study. Acceptability and feasibility were measured quantitatively by calculating proportions of the SMS received, viewed, or opted out of, and qualitatively by interviewing people who sent and received the SMS. Results Of 2914 SMS sent, 2645 SMS (91%) were received by participants, 1128 (43%) people opened the weblink, and 59 (2%) people opted out of receiving future SMS. Interviews with general practice staff (n = 17) and participants (n = 18) found that sending and receiving the SMS was acceptable and feasible. The SMS was considered a low-burden activity that easily integrated into the clinic's workflow without impacting clinicians' time. Participants reported an increased intention to participate in screening, but some people worried the weblink was spam, and some suggested sending it out of working hours. Conclusion The SMS-based intervention was widely accepted by GP staff and participants. Future research should test the SMS with and without the weblink, and send the SMS at a more convenient time of the day/week. [ABSTRACT FROM AUTHOR]

Background Relational continuity is a fundamental component of primary care. The 'Quality in General Practice Trial' (EQuIP-GP), was a 12-month cluster randomized trial, designed to investigate whether financial incentives can improve relational continuity in primary care. Aim To examine (i) how financial incentives are perceived and experienced by primary care patients, providers, and practice staff, and (ii) how clinical and organizational routines related to relational continuity are influenced by the introduction of a financial model designed to incentivize relational continuity. Design and setting We used a mixed methods case study approach with six of the intervention arm practices participating in the EQuIP-GP trial. Method Semi-structured interviews were conducted with patients, providers, practice staff, and intervention facilitators. Intervention facilitators kept structured diaries to capture reflective notes. To contextualize results, practices completed a modified practice attributes survey and patients completed the Primary Care Assessment Tool at baseline and 12 months. Results Patient-perceived relational continuity was not impacted by the intervention. Financial incentives were preferred for rewarding, as opposed to incentivizing, quality care; however, they were perceived as a blunt and inflexible instrument. The introduction of the incentive model increased attention to pre-existing organizational routines rather than creating new ones. Conclusion Incentive models should be suitably flexible to accommodate diversity in patient and practice needs. Small changes can be made to existing practice routines that will improve awareness and conscientiousness of relational continuity. Further research should examine how feasible these routine changes would be in practices that do not already focus on continuity. [ABSTRACT FROM AUTHOR]

Dr WG Grace was a general practitioner in Bristol, in the late nineteenth century, but is better remembered as 'the father of cricket'. He showed early promise as a skilled cricket player and was already playing for Gloucester County, by the age of fifteen. However, coming from a well-established medical family, his father wanted him to become a doctor. He trained in Bristol and after qualifying he set up his own practice in the same environs. By this time, he was a superb cricketer with a glittering county and England career, combined with his clinical duties. He has several memorials where he lived and practised in Bristol, which are described and illustrated in this review. These include commemorative plaques in the local church, and near his later residence in Clifton, as well as a large mural at a train station and another at a shopping centre. These are all tributes to one of the most famous sons of Bristol. He is also celebrated at Lord's Cricket Ground, the home of cricket, with eponymous memorial gates and a full-size statue inside the ground. A fine example of a doctor who also had other talents, these memorials reflect his widespread appeal and his long-lasting legacy. [ABSTRACT FROM AUTHOR]

Background: Clinical tools are needed in general practice to help identify children who are seriously ill. The Liverpool quick Sequential Organ Failure Assessment (LqSOFA) was validated in an emergency department and performed well. The National Paediatric Early Warning System (PEWS) has been introduced in hospitals throughout England with hopes for implementation in general practice. Aim: To validate the LqSOFA and National PEWS in general practice. Design and setting: Secondary analysis of 6703 children aged <5 years presenting to 225 general practices in England and Wales with acute illnesses, linked to hospital data. Method: Variables from the LqSOFA and National PEWS were mapped onto study data to calculate score totals. A primary outcome of admission within 2 days of GP consultation was used to calculate sensitivity, specificity, negative predictive values (NPVs), positive predictive values (PPVs), and area under the receiver operating characteristic curve (AUC). Results: A total of 104/6703 children were admitted to hospital within 2 days (pre-test probability 1.6%) of GP consultation. The sensitivity of the LqSOFA was 30.6% (95% confidence interval [CI] = 21.8% to 41.0%), with a specificity of 84.7% (95% CI = 83.7% to 85.6%), PPV of 3.0% (95% CI = 2.1% to 4.4%), NPV of 98.7% (95% CI = 98.4% to 99.0%), and AUC of 0.58 (95% CI = 0.53 to 0.63). The sensitivity of the National PEWS was 81.0% (95% CI = 71.0% to 88.1%), with a specificity of 32.5% (95% CI = 31.2% to 33.8%), PPV of 1.9% (95% CI = 1.5% to 2.5%), NPV of 99.1% (95% CI = 98.4% to 99.4%), and AUC of 0.66 (95% CI = 0.59 to 0.72). Conclusion: Although the NPVs appear useful, owing to low pre-test probabilities rather than discriminative ability, neither tool accurately identified admissions to hospital. Unconsidered use by GPs could result in unsustainable referrals. [ABSTRACT FROM AUTHOR]

Background: Safety-netting advice (SNA) can help in the management of acutely ill children. Aim: To assess the effectiveness of different SNA methods on antibiotic prescription and consumption in acutely ill children. Design and setting: Systematic review and network meta-analysis of randomised controlled trials, cluster randomised trials, non-randomised studies of interventions, and controlled before–after studies in ambulatory care in high-income countries. Method: MEDLINE, Embase, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials were searched (22 January 2024). Risk of bias (RoB) was assessed with Cochrane's RoB 2 tool, the Revised Cochrane Tool for Cluster-Randomised Trials, and the Risk Of Bias In Non-randomised Studies — of Interventions tool. Certainty of evidence was assessed using the Confidence in Network Meta-Analysis approach. Sensitivity analyses and network meta-regression were performed. Results: In total, 30 studies (20 interventions) were included. Compared with usual care, paper SNA may reduce: antibiotic prescribing (odds ratio [OR] 0.66, 95% confidence interval [CI] = 0.53 to 0.82, I2 = 92%, very low certainty, three studies, 35 988 participants), especially when combined with oral SNA (OR 0.40, 95% CI = 0.08 to 2.00, P-score = 0.86); antibiotic consumption (OR 0.39, 95% CI = 0.27 to 0.58, low RoB, one study, 509 participants); and return visits (OR 0.74, 95% CI = 0.63 to 0.87). Compared with usual care, video SNA, read-only websites, oral SNA, and web-based SNA (in descending order of effectiveness) may increase parental knowledge (ORs 2.33–4.52), while paper SNA may not (ORs 1.18–1.62). Similarly, compared with usual care, video SNA and web-based modules may improve parental satisfaction (ORs 1.94–4.08), while paper SNA may not (OR 1.85, 95% CI = 0.48 to 7.08). Conclusion: Paper SNA (with oral SNA) may reduce antibiotic use and return visits. Video, oral, and online SNA may improve parental knowledge, whereas video SNA and web-based modules may increase parental satisfaction. [ABSTRACT FROM AUTHOR]

Background: The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) has been implemented in many areas of the UK. It is unclear how ReSPECT is used in primary and community care settings. Aim: To investigate how the ReSPECT process is understood and experienced in the community by clinicians, social care staff, patients, and their relatives, and identify obstacles and enablers to its implementation. Design and setting: A qualitative interview and focus-group study across 13 general practices in three areas of England, between January and December 2022. Method: We interviewed GPs, specialist nurses, patients and relatives, and senior care home staff. Focus groups were conducted with community nurses, paramedics, and home care workers. Questions focused on understanding experiences of, and engagement with, ReSPECT. We analysed data using thematic analysis and a coding framework drawn from normalisation process theory. Results: Participants included n = 21 GPs, n = 5 specialist nurses, n = 9 patients, n = 7 relatives, n = 31 care home staff, n = 9 community nurses, n = 7 home care workers, and n = 2 paramedics. Participants supported ReSPECT, regarding it as a tool to facilitate person-centred care. GPs faced challenges in timing the introduction of ReSPECT and ensuring sufficient time to complete plans with patients. ReSPECT conversations worked best when there was a trusting relationship between the clinician and the patient (and their family). Anticipating future illness trajectories was difficult, yet plans were rarely reviewed. Interpreting recommendations in emergencies was challenging. Conclusion: The ReSPECT process has not translated as well as expected in the community setting. A revised approach is needed to address the challenges of implementation in this context. [ABSTRACT FROM AUTHOR]

Background: Shingles (herpes zoster), caused by reactivation of the varicella-zoster virus, is usually diagnosed and managed in primary care. The lifetime risk of shingles in the general population is approximately 30%, and it can have a detrimental effect on quality of life. There has been little qualitative research about patient experience and understanding of shingles. Aim: To explore patient experiences and understanding of shingles. Design and setting: Qualitative interviews with people with shingles recruited from primary care in England. Method: Qualitative semi-structured remote interviews were undertaken with 29 participants in a randomised controlled trial in primary care in England (ATHENA, ISRCTN14490832). Participants were aged >49 years and were diagnosed within 6 days of shingles rash onset. Interviewees were sampled for diversity in terms of pain, intervention adherence, age, gender, and ethnicity. Data were analysed using reflexive thematic analysis. Results: Interviews took place in November 2022 to April 2023. Participants' understanding of shingles was limited, particularly pre-diagnosis. A common theme was that 'everyone has heard of it, but no one knows what it is'. Television campaigns about the shingles vaccination programme helped some to recognise the rash. Shingles was understood as a disease with a variable prognosis, resulting in a sense of uncertainty about the significance when diagnosed. Participants reported a range of symptoms, which impacted on everyday life. Some people thought their diagnosis was caused by poor mental health or challenging life circumstances, a perception sometimes reinforced by healthcare professionals. Many participants sought meaning in their diagnosis, reflecting on, and sometimes changing, their life and circumstances. Conclusion: Primary care practitioners should be aware of the broad spectrum of patient knowledge, and the potential for better understanding to promote early attendance and treatment to reduce the impact of shingles. [ABSTRACT FROM AUTHOR]

Background: Routine primary care data may be a valuable resource for preconception health research and to inform the provision of preconception care. Aim: To review how primary care data could provide information on the prevalence of preconception indicators and examine associations with maternal and offspring health outcomes. Design and setting: Systematic review of observational studies using UK routine primary care data. Method: Literature searches were conducted in March 2023 using five databases to identify observational studies that used national primary care data from individuals aged 15–49 years. Preconception indicators were defined as medical, behavioural, and social factors that may impact future pregnancies; health outcomes included those that may occur during and after pregnancy. Results: From 5259 screened records, 42 articles were included. The prevalence of 37 preconception indicator measures was described for female patients, ranging from 0.01% for sickle cell disease to >20% for each of advanced maternal age, previous caesarean section (among those with a recorded pregnancy), overweight, obesity, smoking, depression, and anxiety (irrespective of pregnancy). Few studies reported indicators for male patients (n = 3) or associations with outcomes (n = 5). Most studies had a low risk of bias, but missing data may limit generalisability of the findings. Conclusion: The findings demonstrated that routinely collected UK primary care data could be used to identify patients' preconception care needs. Linking primary care data with health outcomes collected in other datasets is underutilised, but could help to quantify how optimising preconception health and care could reduce adverse outcomes for mothers and children. [ABSTRACT FROM AUTHOR]

Background: Strong primary care (PC) services are the foundation of high-performing health care systems and can support effective responses to public health emergencies. Primary care practitioners (PCPs) and PC services played crucial roles in supporting global health system responses to the COVID-19 pandemic. However, these contributions have come at a cost, impacting on PC services and affecting patient care. This secondary analysis of data from an integrative systematic review across international PC settings aimed to identify and describe burdens and challenges experienced by PCPs and PC services in the context of their contributions to COVID-19 pandemic responses. Methods: We conducted an integrative systematic review and narrative analysis, searching PubMed/Medline, Scopus, Proquest Central and Cochrane Database of Systematic Reviews, plus reference lists of key publications. Included studies were published in peer-reviewed English or Chinese language journals, and described collective responses to COVID-19 undertaken in PC settings or by PCPs. Narrative data regarding impacts on PC services and challenges experienced by PCPs were extracted and analysed using inductive coding and thematic analysis. Results: From 1745 screened papers 108, representing 90 countries, were included. Seventy-eight contained data on negative impacts, challenges or issues encountered in PC. Ten 'pressure points' affecting PC during COVID-19 were identified, clustered in four themes: demand to adopt new ways of working; pressure to respond to fluctuating community needs; strain on PC resources and systems; and ambiguity in interactions with the broader health and social care system. Conclusions: PCPs and PC services made critical functional contributions to health system responsiveness during the COVID-19 pandemic. However, both practitioners and PC settings were individually and collectively impacted during this period as a result of changing demands in the PC environment and the operational burden of additional requirements imposed on the sector, offering lessons for future pandemics. This study articulates ten empirically derived 'pressure points' that provide an initial understanding of burdens and demands imposed on the international primary care sector during the COVID-19 pandemic. The impact of these contributions should inform future pandemic planning, guided by involvement of PCPs in public health preparedness and policy design. [ABSTRACT FROM AUTHOR]

Background: The NHS App launched in 2019 as the 'digital front door' to the National Health Service in England with core features including General Practitioner (GP) appointment booking, repeat prescriptions, patient access to records and, later on, COVID-19 vaccination certification. Similar patient portals have been adopted in different formats and with variable levels of success. In this longitudinal study (2021–2023) we examined how the NHS App became implemented in the pandemic context and beyond. Methods: We recruited 88 participants in 62 qualitative interviews and four focus groups. Participants included patients, carers, members of the public, clinical/non-clinical NHS staff from five GP practices (where we also conducted over 60 h of observations) across England, as well as other industry, policy and civil rights stakeholders. Document analysis also contributed to participant recruitment and data interpretation. Data collection and analysis was informed by the Non-Adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework. Results: Our study identified the various ways in which complexity manifested as part of the implementation, use and roll-out of the NHS App. Patients had diverse (positive and negative) user experiences as the app evolved, with some of its features described as more useful than others (e.g. prescription ordering, COVID Pass). As the app primarily provided a gateway to general practice systems and infrastructures, not all features were available by default or consistently to all users, with information often appearing fragmented or system-facing (e.g. coded). NHS staff viewed the app as constituting core NHS infrastructure in the long term which made it appealing, even though initially there was less recognition of its immediate value. There was variable organisational capacity to enable implementation and to put in place processes and staff roles required to support patient adoption. Shifting emphasis towards in-person care, challenges with digital inclusion and controversies related to features such as patient access to own records further complicated roll-out. Conclusions: As the NHS App remains a complex innovation in a shifting landscape, it is clear ongoing work is needed to ensure its potential can be sustained to meet patient, service and policy needs. Clinical study registration: ISRCTN72729780. [ABSTRACT FROM AUTHOR]

AbstractObjectiveDesignSettingSubjectsOutcome measuresResultsConclusionRelative one-year cancer survival rates in the Baltic states are lower than the European mean; in the Nordic countries they are higher than the mean. This study investigated the likelihood of General Practitioners (GPs) investigating or referring patients with a low but significant risk of cancer in these two regions, and how this was affected by GP demographics.A survey of GPs using clinical vignettes.General Practice in Denmark, Estonia, Finland, Latvia, Lithuania, Norway, and Sweden.General Practitioners.A regional comparison of GPs’ stated immediate diagnostic actions (whether or not they would perform a key diagnostic test and/or refer to a specialist) for patients with a low but significant risk of cancer (between 1.2 and 3.6%).Of the 427 GPs that completed the questionnaire, those in the Baltic states, and GPs that were more experienced, were more likely to arrange a key diagnostic test and/or refer their patient to a specialist than those in Nordic Countries or who were less experienced (p < 0.001 for both measures). Neither GP sex nor practice location within a country showed a significant association with these measures.While relative one-year cancer survival rates are lower in the Baltic states than in four Nordic countries, we found no evidence that this is due to their GPs’ reluctance to take immediate diagnostic action, as GPs in the Baltic states were more likely to investigate and/or refer at the first consultation. Research on patient and secondary care factors is needed to explain the survival differences. [ABSTRACT FROM AUTHOR]

AbstractAimMethodResultsConclusionTo (1) examine considerations before and experiences with GP contact during the first COronaVIrus Disease 2019 (COVID-19) lockdown among Danish citizens; (2) analyse the associations with sex, age, chronic disease, and socioeconomic factors; and (3) explore changes in healthcare-seeking behaviour post-pandemic.A total of 100,000 Danes aged 20 years or older, randomly selected in the general population, were invited to participate in a survey examining considerations and experiences with healthcare seeking during the first COVID-19 lockdown. Data were collected in spring 2022 and linked to register data on socioeconomic factors. Descriptive statistics and multivariable logistic regression models were applied.Of the 27,369 eligible individuals, 18% reported a need to contact their GP. Being worried about burdening the healthcare system was most frequently reported (45%), followed by being in doubt about acceptable contact reasons (33%), and concern about infection (24%). Although 44% of those who needed to contact their GP found the digital solutions advantageous, individuals frequently found it difficult to discuss symptoms by telehealth (29%) and that they were examined less thoroughly. Generally, women, younger people, and individuals with lower socioeconomic status were more likely to be worried and report difficulties with contact to general practice. Some 86% of the respondents reported no changes in healthcare-seeking behaviour post-pandemic.The results may assist in the organisation of healthcare in case of future lockdowns. Yet, the COVID-19 pandemic has only slightly affected the healthcare-seeking behaviour in the Danish general population. [ABSTRACT FROM AUTHOR]

Background: Health or illness and social issues cannot be viewed in isolation. Social problems can influence well-being and disease. General Practitioners (GPs) are requested to offer counselling opportunities to respond to the social issues of their patients adequately. Counselling on non-medical issues in general practice increases GPs' workload. The study aimed to analyse the occurrence of social problems as well as the strengths and weaknesses of existing working agreements between social services and GPs in primary care. Methods: We carried out a cross-sectional online survey between December 2022 and January 2023 among a sample of Swiss GPs from the Sentinella-Network, the uniham-bb-Network and social workers from the SAGES-Network. Results: Findings come from a sample of 143 GPs (mean age 54 years, 37.8% female) and 41 social workers (mean age 43 years, 75.6% female). GPs face a median of 3 patients with social problems per week (IQR 5.2). They reported encountering patients facing "Finance" issues most frequently, with 78.8% encountering such cases between "more than 3 patients per week" and "1–3 patients per month". "Work" (76.4%) and "Loneliness" (73.7%) were also among the most commonly encountered social problems. When suspecting the problem, GPs more often addressed the issue if it was about "Addiction" (83.2%), "Loneliness" (72.3%), or "Protection" (71.4%). More than half of GPs (56.0%) reported having contact with social workers less than once a month, while approximately half of the social workers reported having contact with GPs 1 to 3 times a month (48.7%). GPs (69.3%) and social workers (76.3%) would like more contact. The most frequently mentioned benefits of an increased collaboration from the GPs' perspective were "improved quality of care (more time for medical issues)" (64.8%) and "improved mental health of patients" (55.6%). Conclusions: Social problems in general practice are common, but the interprofessional cooperation between GPs and social workers is scarce. However, both parties appear to be in favour of closer interprofessional collaboration and seem to be willing to attempt to improve joint patient care in the future. The integration of social workers into general practice is promising for a comprehensive, interprofessional, and preventative patient approach to providing the best healthcare. [ABSTRACT FROM AUTHOR]

AbstractIntroductionObjectiveMethodsResultsConclusionPolypharmacy is widespread. The demographic shift toward older patients receiving multiple medications increases risk and drug-related problems in these patients.To investigate patient perspectives on polypharmacy and the experienced effects of medication reviews by pharmacists in general practice.Twenty-two semi-structured interviews with patients with polypharmacy (>5 medications) from 6 different general practice clinics in the North Denmark region. The interviewees were from the intervention arm of a randomized clinical trial and had received a medication review with a pharmacist in addition to the usual annual check-up in general practice. Participants were interviewed at baseline (no later than 2 weeks after the medication review) and again at follow-up (6 months after the medication review). The interviews were transcribed verbatim and thematically analyzed with an inductive approach.The patients’ narratives show that they face many difficulties in their everyday lives, making it hard for them to live up to society’s ideal of what it is to live a healthy life. The interviewees were generally positive toward the intervention and felt comfortable having a pharmacist conduct the medication review in their usual general practice clinic. Some interviewees gained more insight into their medication from the review.Patient narratives give a comprehensive understanding of the challenges of polypharmacy. Having pharmacists conduct medication reviews in general practice could ensure more time and focus on patients and their medication management. The combined knowledge of physicians, nurses, and pharmacists regarding thorough polypharmacy management is recommended. [ABSTRACT FROM AUTHOR]

Background and Objective: Approximately 7.4% of the German population matched the criteria of impeding, chronic non-cancer-related pain in 2014. Guidelines emphasize the importance of a holistic treatment approach. The project RELIEF aims to develop and evaluate a multifaceted case-management intervention to foster the holistic management of chronic pain in general practice. To inform intervention development, this study explored expectations and perceived role models of general practitioners (GP) and patients regarding chronic non-cancer-related pain management in general practice with a focus on patient expectations of GPs and themselves, as well as GP expectations of patients and their anticipation of patient's expectations. Methods: Data were collected via semi-structured guide-based interviews with general practitioners and patients. Pseudonymized verbatim transcripts were analyzed using an inductive–deductive approach with a structuring qualitative content analysis. The Theoretical Domains Framework served as an analytical framework to explore behavioral aspects associated with expectations and role perceptions. Results:n = 25 interviews were analyzed (GP: n = 10, patient: n = 15). Findings indicate that patients considered themselves as the main actor in the therapy process yet expected guidance and care coordination from their GP. The essential role GPs play in pain management was emphasized. Role models indicated by GPs and some patients represent a care ideal, which was also reflected in discussed expectations. GPs anticipated that patients would place high relevance on pharmacological options. Patients highlighted their preference of non-pharmacological and alternative treatment options. Conclusions: Our findings demonstrate the importance of holistic, individually tailored chronic pain management in general practice. Systematic, multifaceted case management, as planned in the RELIEF project, may contribute to high-quality primary care for affected individuals. [ABSTRACT FROM AUTHOR]

Background: Like other countries developing standardized general practice training, China faces the challenge of training vast numbers of new general practice faculty. However, little is known about these clinician-teachers' motivations and perceived needs for faculty development. This review intended to explore available published data on Chinese general practice faculty development needs and motivation for ongoing professional development. Methods: A systematic search was conducted using combinations of keyword and MeSH term searches in English in PubMed and in Chinese language CNKI and WanFang databases, followed by a qualitative narrative synthesis of relevant articles identified. Inclusion criteria: English or Chinese publications between 1990 and 2021; qualitative or quantitative research, systematic reviews, literature reviews, review or opinion articles pertaining to faculty development or professional development needs or motivations of general practice or family medicine teachers. Articles pertaining to fields outside of medicine, those with a heavy subspecialty focus or not relevant to primary care were excluded. Results: A total of 88 full text articles were included in this review. Available data on Chinese general practice faculty development needs placed emphasis on fundamental general practice knowledge, principles, and clinical training needs more than teaching and assessment skills. Learning through teaching and a sense of responsibility were potential sources of intrinsic motivation for pursuing faculty development. Potential barriers to participation included busy workloads, inadequate organizational support, and limited finances. Mandatory participation, irrelevant content, lack of teaching experience, lack of motivation to teach, and overall job dissatisfaction appeared to negatively influence motivation to pursue faculty development. Conclusions: Further research should explore the broader continuous professional development needs of this large population of general practice teachers. Qualitative studies are needed to clarify how individual, organizational, and contextual factors influence teachers' motivation to pursue faculty development. Key points: Question: What are the faculty development needs and factors influencing the motivation of Chinese general practice trainers? Findings: A systematic search and qualitative narrative synthesis of English and Chinese published literature found limited data regarding the specific faculty development needs of Chinese general practice trainers, which included clinical knowledge and skills relevant to primary care. Learning through teaching potentially increased intrinsic motivation for pursuing faculty development, whereas busy workloads, inadequate organizational support, mandatory participation, irrelevant content, and overall job dissatisfaction reduced motivation to participate. Meaning: Further mixed-methods research is needed into the specific faculty development needs and motivations of general practice faculty in developing countries such as China. Such research should focus on a broader range of needs beyond clinical content and explore factors influencing internal and external motivation to inform effective program planning. [ABSTRACT FROM AUTHOR]

Background: Women with a history of hypertensive disorders of pregnancy (HDP), including chronic hypertension, gestational hypertension, and preeclampsia have an increased risk of cardiovascular disease (CVD). Current research suggests that general practitioners are unaware of women's HDP history, and although ideally placed to follow-up with these women, there is limited understanding of current CVD prevention practices in women after HDP. Additionally, preeclampsia confers a higher CVD risk compared to other types of HDP, and Australian research suggests that lower socioeconomic status (SES) is associated with a higher incidence of both HDP and CVD. Therefore, the aim of the analysis was to investigate awareness of CVD risk and care received from health professionals among women with a history of HDP and examine differences between type of HDP and SES. Methods: Analysis of a cross-sectional survey of 293 Australian women with a history of HDP (from 2017 onwards). Data were analysed using basic descriptive statistics. To assess differences in HDP type and SES, one-way ANOVA was used to assess continuous variables and χ2 tests for categorical variables, with P < 0.05 considered statistically significant. Results: Most women with a history of HDP were unaware of their increased CVD risk (68%). Women with a history of preeclampsia, gestational hypertension or preeclampsia were more aware of CVD risk compared to those with chronic hypertension (p = 0.02). Regardless of HDP type or SES, women post-HDP were less likely to receive assessment and management of lifestyle CVD risk factors compared to blood pressure. Most women felt supported in managing stress and mental health, but not for managing body weight, smoking and sleep. Conclusions: Women with a history of HDP are unaware of their increased CVD risk and are not receiving recommended CVD preventative care, irrespective of HDP type and/or SES. Findings should be used to inform development of tailored CVD prevention interventions in the primary care setting for women following HDP. [ABSTRACT FROM AUTHOR]

Introduction: Validated patient-reported outcome measures (PROMs) are crucial for assessing patients' experiences in the healthcare system. Both clinically and theoretically, patient-centered consultations are essential in patient-care, and are often suggested as the optimal strategy in caring for patients with multimorbidity. Aim: To either identify or develop and validate a patient-reported outcome measure (PROM) to assess patient-centredness in consultations for patients with multimorbidity in general practice. Methods: We attempted to identify an existing PROM through a systematic literature review. If a suitable PROM was not identified, we planned to (1) construct a draft PROM based on items from existing PROMs, (2) conduct group and individual interviews among members of the target population to ensure comprehensibility, comprehensiveness and relevance, and (3) perform a psychometric validation in a broad sample of patients from primary care. Results: We did not identify an eligible PROM in the literature review. The item extraction and face validity meetings resulted in a new PROM consisting of 47 items divided into five domains: biopsychosocial perspective; 'patient-as-person'; sharing power and responsibility; therapeutic alliance; and coordinated care. The interviews resulted in a number of changes to the layout and phrasing as well as the deletion of items. The PROM used in the psychometric validation consisted of 28 items. Psychometric validation showed high internal consistency, overall high reliability, and moderate fit indices in the confirmatory factor analysis for all five domains. Few items demonstrated differential item functioning concerning variables such as age, sex, and education. Conclusions: This study successfully developed and validated a PROM to measure patient-centredness in consultations for patients with multimorbidity. The five domains demonstrated high reliability and validity, making it a valuable tool for measuring patient-centredness of consultations in general practice. Trial registration: Trial registration number (data for psychometric validation): https://clinicaltrials.gov: NCT05676541 Registration Date: 2022-12-16. [ABSTRACT FROM AUTHOR]

Objectives: Clinical data on the performance of double-crown-retained removable dental prostheses (dcRDPs), especially beyond university studies, are rare. The objective of this retrospective clinical study was to evaluate the survival and complication-freeness probabilities of dcRDPs and to identify risk factors for failure and complications in a dental practice setting. Materials and methods: Anonymized practice data of 174 patients (56.9% female) fitted with a total of 213 dcRDPs (mean of 3.3 abutment teeth per dcRDP) were evaluated up to 11 years after prothesis placement (mean observation time of 3.9 years). Probabilities of survival and complication freeness were calculated on the prosthesis- and abutment level and visualized using the Kaplan–Meier method. Factors influencing failure and complications were computed using Cox regression analyses (R Ver. 7; alpha < 0.05). Results: During our observation period, 39 (18%) of the dcRDPs failed. The mean (95% CI) overall survival was 94% (90–97%) after 2 years and 86% (80–92%) after 5 years. DcRDP survival correlated with lower patient age and more abutment teeth (P < 0.05), while other analyzed factors did not. The probability of absence of prosthesis-related complications was 92% after 2 years and 80% after 5 years. The probability of no technical complications of abutments (teeth/implants) was 85% after 2 years and 78% after 5 years, and the probability of no biological complications was 87% after 2 years and 72% after 5 years. In total, 141 dcRDPs (66.2%) faced at least one complication during the observation period. Conclusions: Double-crown-retained prostheses fitted in a dental practice had acceptable mid-term survival rates and common technical and biological complications that were frequently easily manageable. However, prosthesis performance depended on the quality and number of abutment teeth/implants. Within the limitations of this retrospective analysis, the outcomes we observed in a dental practice are comparable to, albeit slightly worse than, those found in university studies. Clinical relevance. Evaluation of the clinical performance of dcRDPs fitted in a dental practice is important to estimate durability and complication patterns in order to weigh treatment decisions. [ABSTRACT FROM AUTHOR]

Background: The impact of the COVID‐19 pandemic on the mental health of children and young people (CYP) has been widely reported. Primary care electronic health records were utilised to examine trends in the diagnosing, recording and treating of these common mental disorders by ethnicity and social deprivation in Greater Manchester, England. Methods: Time‐series analyses conducted using Greater Manchester Care Record (GMCR) data examined all diagnosed episodes of anxiety disorders and depression and prescribing of anxiolytics and antidepressants among patients aged 6–24 years. The 41‐month observation period was split into three epochs: Pre‐pandemic (1/2019–2/2020); Pandemic Phase 1 (3/2020–6/2021); Pandemic Phase 2 (7/2021–5/2022). Rate ratios for all CYP specific to sex, age, ethnicity, and neighbourhood‐level Indices of Multiple Deprivation (IMD) quintile were modelled using negative binomial regression. Results: Depression and anxiety disorder rates were highest in females, CYP aged 19–24, and White and 'Other' ethnic groups. During Pandemic Phase 1, rates for these diagnoses fell in all demographic subgroups and then rose to similar levels as those recorded pre‐pandemic. In Pandemic Phase 2, rates in Black and Mixed‐ethnicity females rose to a significantly greater degree (by 54% and 62%, respectively) than those in White females. Prescribing rates increased throughout the study period, with significantly greater rises observed in non‐White females and males. The temporal trends were mostly homogeneous across deprivation quintiles. Conclusion: The observed fluctuations in frequency of recorded common mental illness diagnoses likely reflect service accessibility and patients' differential propensities to consult as well as changing levels of distress and psychopathology in the population. However, psychotropic medication prescribing increased throughout the observation period, possibly indicating a sustained decline in mental health among CYP, and also clinicians' responses to problems presented. The comparatively greater increases in frequencies of diagnosis recording and medication prescribing among ethnic minority groups warrants further investigation. [ABSTRACT FROM AUTHOR]

Background Sexual health communication between general practitioners (GPs) and individuals with chronic diseases is well documented as an important component of sexual well-being. However, a notable gap exists in understanding factors that contribute to sexual health communication in the endometriosis context. Endometriosis-related research has focused on the assessment of sexual functioning and its role in influencing health-related quality of life, with a limited understanding of the management of sexual well-being in primary healthcare settings. Aim To explore how individuals with endometriosis perceive their experiences of sexual health communication with GPs to understand the barriers and facilitators of this communication in general practice. Methods This study formed part of a larger online quantitative survey measuring psychological and sexual well-being in individuals with endometriosis. In total 141 participants provided responses via open-ended unlimited free-text questions focused on their experiences of sexual health communication with GPs, including their perspectives on barriers and facilitators. Results Four overarching themes regarding barriers to sexual health communication were identified through thematic template analysis: (1) systemic factors; (2) practitioner factors; (3) patient factors; and (4) interpersonal factors. Facilitators mirrored strategies to address these barriers. Additionally, participants offered recommendations for developing resources to improve sexual health communication. Clinical Implications Despite patients' interest, sexual health concerns in endometriosis are commonly overlooked in general practice due to various barriers, which individuals suggest could be addressed through comprehensive GP education and practical aids including communication tools. Strengths and Limitations Although the sample is large for a qualitative study, the potential selection bias—stemming from participants' high levels of sexual dysfunction and motivation to discuss sexual health with a GP—may limit the diversity of perspectives. GP perspectives were not evaluated, precluding any assessment of the accuracy of individuals' perceptions of practitioner factors. Conclusions Individuals with endometriosis encounter various systematic, practitioner, personal, and interpersonal factors that hinder or facilitate sexual health communication in general practice. Future research should prioritize strategies to improve sexual health communication for both GPs and patients. [ABSTRACT FROM AUTHOR]

Background: Many practitioners have highlighted the value in being given protected time to undertake supervision practice as it offers the opportunity of sharing knowledge and provides feedback around good clinical practice leading to high quality patient care delivery (Rothwell et al, 2021 & Goode et al, 2024). As healthcare policies evolve, supervision practices can adapt and become embedded as part of the regulatory requirement (NHS England, 2022). However, many practitioners struggle to either embed and/or sustain core clinical supervision practices. If left to drift a workforce may become poor functioning and non-concordant with the latest regulations and standards in primary care. Therefore, general practice practitioners require guidance and support to be increasingly creative and resourceful whilst managing clinical demands. Methodology/Methods: An explorative hermeneutic phenomenology approach, using semi structured interviews was utilised to explore themes and experiences around implementing and facilitating core clinical supervision in practice. Findings: Four key themes arose from the study. Identifying resources needed to implement core clinical supervision; Leading and managing clinical sessions; professional and personal development and quality improvement indicators. Recommendations and Conclusion: Several recommendations are offered from the study to initiate and embed core clinical supervision in practice with emphasis on quality indicators, utilising some change management strategies and ensuring core supervision is sustainable in practice. [ABSTRACT FROM AUTHOR]

Background/Aim: Pharmacotherapy is vital in medicine, but inappropriate and inadequate use of medications significantly impacts global mortality and morbidity. Increased prescribing may indicate irrational use or prolonged illness, while decreased prescribing could suggest undertreatment, supply shortages, or the availability of safer and, more effective treatments. The COVID-19 pandemic disrupted health systems, potentially altering prescribing patterns. This study examined its impact on the prescribing patterns of common therapeutic categories and high-risk medicines in general practice in England. Materials and Methods: Common therapeutic categories were identified from English General Practice prescription data, and high-risk medicines were identified by mapping the UK pharmacovigilance data onto the English prescribing data. A retrospective analysis compared monthly prescription data pre-pandemic, during the pandemic, and postpandemic. Significant changes in the prescribing volumes of therapeutic categories and high-risk medicines were tracked to determine persistence, intensification, or diminution postpandemic. Linear regression models analysed prescribing trends. Results: Among 220 therapeutic categories, 16 experienced significant changes: 14 increased and two decreased during the pandemic. Of 78 high-risk medicines, six showed significant changes: two increased and three decreased. Only three therapeutic categories and two highrisk medicines returned to pre-pandemic levels. Conclusion: Despite a reduction in general practice appointments during the pandemic, prescribing for several therapeutic categories and certain high-risk medicines surged, indicating increased treatment, prolonged illness or stockpiling. Post-pandemic downward trends suggest long-term under-treatment or reduced stockpiling. Continuous monitoring, strategic healthcare planning, and regulatory interventions are needed to optimise prescribing. Future research is needed to assess the long-term effects on disease management. [ABSTRACT FROM AUTHOR]

Background: Clinical coding allows for structured and standardised recording of patients' electronic healthcare records. How clinical and non-clinical staff in general practice approach clinical coding is poorly understood. Aim: To explore primary care staff's experiences and views on clinical coding. Design and setting: Qualitative, semi-structured interview study among primary care staff across Wales. Method: All general practices within Wales were invited to participate via NHS health boards. Semi-structured questions guided interviews, conducted between February 2023 and June 2023. Audio-recorded data were transcribed and analysed using reflexive thematic analysis. Results: A total of 19 participants were interviewed and six themes were identified: coding challenges, motivation to code, making coding easier, daily task of coding, what and when to code, and coding through COVID. Conclusion: This study demonstrates the complexity of clinical coding in primary care. Clinical and non-clinical staff spoke of systems that lacked intuitiveness, and the challenges of multimorbidity and time pressures when coding in clinical situations. These challenges are likely to be exacerbated in socioeconomically deprived areas, leading to underreporting of disease in these areas. Challenges of clinical coding may lead to implications for data quality, particularly the validity of research findings generated from studies reliant on clinical coding from primary care. There are also consequences for patient care. Participants cared about coding quality and wanted a better way of using coding. There is a need to explore technological and non-technological solutions, such as artificial intelligence, training, and education to unburden people using clinical coding in primary care. [ABSTRACT FROM AUTHOR]

Background: Long-term use of antipsychotics confers increased risk of cardiometabolic disease. Ongoing need should be reviewed regularly by psychiatrists. Aim: To explore trends in antipsychotic management in general practice, and the proportions of patients prescribed antipsychotics receiving psychiatrist review. Design and setting: Serial cross-sectional study using linked general practice and hospital data in Wales (2011–2020). Method: Participants were adults (aged ≥18 years) registered with general practices in Wales. Outcome measures were prevalence of patients receiving ≥6 antipsychotic prescriptions annually, the proportion of patients prescribed antipsychotics receiving annual psychiatrist review, and the proportion of patients prescribed antipsychotics who were registered on the UK serious mental illness, depression, and/or dementia registers, or not on any of these registers. Results: Prevalence of adults prescribed long-term antipsychotics increased from 1.055% (95% confidence interval [CI] = 1.041 to 1.069) in 2011 to 1.448% (95% CI = 1.432 to 1.464) in 2020. The proportion receiving annual psychiatrist review decreased from 59.6% (95% CI = 58.9 to 60.4) in 2011 to 52.0% (95% CI = 51.4 to 52.7) in 2020. The proportion of overall antipsychotic use prescribed to patients on the serious mental illness register decreased from 50.0% (95% CI = 49.4 to 50.7) in 2011 to 43.6% (95% CI = 43.0 to 44.1) by 2020. Conclusion: Prevalence of long-term antipsychotic use is increasing. More patients are managed by GPs without psychiatrist review and are not on monitored disease registers; they thus may be less likely to undergo cardiometabolic monitoring and miss opportunities to optimise or deprescribe antipsychotics. These trends pose risks for patients and need to be addressed urgently. [ABSTRACT FROM AUTHOR]

Background: Research activity usually improves outcomes by being translated into practice; however, there is developing evidence that research activity itself may improve the overall performance of healthcare organisations. Evidence that these relationships represent a causal impact of research activity is, however, less clear. Additionally, the bulk of the existing evidence relates to hospital settings, and it is not known if those relationships would also be found in general practice, where most patient contacts occur. Aim: To test 1) whether there are significant relationships between research activity in general practice and organisational performance; and 2) whether those relationships are plausibly causal. Design and setting: National data were analysed between 2008 and 2019, using cross-sectional and longitudinal analyses on general practices in England. Method: Cross-sectional, panel, and instrumental variable analyses were employed to explore relationships between research activity (including measures from the National Institute for Health and Care Research Clinical Research Network and the Royal College of General Practitioners) and practice performance (including clinical quality of care, patient-reported experience of care, prescribing quality, and hospital admissions). Results: In cross-sectional analyses, different measures of research activity were positively associated with several measures of practice performance, but most consistently with clinical quality of care and accident and emergency attendances. The associations were generally modest in magnitude; however, longitudinal analyses did not support a reliable causal relationship. Conclusion: Similar to findings from hospital settings, research activity in general practice is associated with practice performance. There is less evidence that research is causing those improvements, although this may reflect the limited level of research activity in most practices. No negative impacts were identified, suggesting that research activity is a potential marker of quality and something that high-quality practices can deliver alongside their core responsibilities. [ABSTRACT FROM AUTHOR]

Background: The Additional Roles Reimbursement Scheme (ARRS) was introduced by NHS England in 2019 alongside primary care networks (PCNs), with the aims of increasing the workforce and improving patient outcomes. Aim: To describe the uptake of direct patient care (DPC)-ARRS roles and its impact on patients' experiences. Design and setting: An ecological study using 2020–2023 PCN and practice workforce data, registered patient characteristics, the General Practice Patient Survey, and the Quality and Outcomes Framework (QOF). Method: Descriptive statistics with associations were examined using quantile and linear regression. Results: By March 2023, 17 588 full-time equivalent (FTE) DPC-ARRS roles were commissioned by 1223 PCNs. PCNs with fewer constituent practices had more DPC-ARRS roles per population (P<0.001), as did PCNs with more FTE GPs per population (P = 0.005). DPC-ARRS commissioning did not vary with age, sex, or deprivation characteristics of practice populations. DPC-ARRS roles were associated with small increases in patient satisfaction (0.8 percentage points increase in patients satisfied per one DPC-ARRS FTE) and perceptions of access (0.7 percentage points increase in patients reporting 'good' experience of making an appointment per one DPC-ARRS FTE), but not with overall QOF achievement. Conclusion: The commissioning of DPC-ARRS roles was associated with small increases in patient satisfaction and perceptions of access, but not with QOF achievement. DPC-ARRS roles were employed in areas with more GPs rather than compensating for a shortage of doctors. Single-practice PCNs commissioned more roles per registered population, which may be advantageous to single-practice PCNs. Further evaluation of the scheme is warranted. [ABSTRACT FROM AUTHOR]