The aim of this paper is to investigate interprofessional collaboration between general practitioners (GPs) and pharmacists involved in the delivery of enhanced pharmacy services under the local pharmaceutical services (LPS) contract in England. Previous research suggests that a number of interprofessional barriers exist between community pharmacists and GPs which hinders the integration of community pharmacists into the primary health care team (PHCT). One of the aims of the LPS contract, introduced in England in 2002 as an alternative to national contractual arrangements, was to enable pharmacists to work more closely with other health care professionals. A two-stage survey was distributed to all pharmacists involved in the first wave of LPS and in-depth interviews undertaken with pharmacists and GPs at six of the LPS sites. Overall the level to which the LPS pharmacists felt integrated into the PHCT did not substantially increase with the introduction of LPS, although co-location was reported to have facilitated integration. New relationships were formed with GPs and existing ones strengthened. A good existing working relationship with GPs was found to be an important factor in the successful operation of the pilots as many were dependent on GPs for patient referrals. The findings suggest that establishing interprofessional collaboration between GPs and pharmacists is a piecemeal process, with a reliance on goodwill and trust-based relationships.

Introduction:Students' perspectives on their learning environment are essential for course development and to enhance the educational experience. In dentistry, there is limited understanding of how students perceive their early clinical training. This study presents students' views on their gradual progression from simulation to patient care and describes the approaches they followed to adapt during this transitioning phase.Methods: A qualitative study design was employed, drawing on focus group discussions conducted with students from the Division of Dentistry at the University of Manchester. The discussions were transcribed verbatim. Data collection and coding process followed the principles of thematic analysis and the inductive approach. Findings:The sample was comprised of 28 undergraduate students, across four focus groups. Thematic analysis generated three key categories: students' immediate perspectives of early clinical training, students' approaches to adapting to the transitioning period and students' suggestions for future improvement. Further, subthemes emerged describing the positive gains which students recognised from their early and gradual clinical involvement and training. Despite experiencing stress and uncertainty, related to insufficient knowledge and immature multitasking skills in the early years of dental training, students were motivated by the clinical environment and identified several ways to adapt to it and enhance their learning. These included additional self-learning resources and simulation opportunities; inter-year group learning activities and further peer support and mentoring. Conclusion:The current study provided insights into students' experiences of learning through early clinical involvement and gradual transitioning between simulation and clinical environments in dentistry. The findings revealed that whilst students appreciated being involved in the clinic at an early stage, they had to adopt a variety of approaches to link their knowledge, learning and skills between the simulation and clinical environments. Students' suggested additional activities to link the learning gap between the two environments and to enrich their learning. K E Y W O R D Sclinical learning, focus group, qualitative research, simulation, students experiences, students learning This study was conducted during 2018 in the Division of Dentistry at the University of Manchester, UK. The teaching philosophy at the Division of Dentistry is based on an Enquiry-Based Learning (EBL) curriculum and student-centreed teaching. This approach integrates theory, skills and clinical teaching vertically and horizontally to achieve the intended learning outcomes defined by the General Dental Council, UK. 10 Students start their clinical learning from early course stage one in parallel with learning using simulation. During the first year, although students are not directly involved in patient care, they are gradually introduced to the complex clinical environment. Students must learn to undertake different competen...

Introduction Guidance from the BOAST helped structure our paediatric orthopaedic service n response to COVID-19. We assessed our compliance with 'BOAST COVID-19 standards', whether it is possible to run a safe and effective paediatric orthopaedic service. Method We performed a prospective audit of clinic and theatre data (16th March to 30th April 2020), from the paediatric orthopaedic department at the BRCH against the 'BOAST COVID-19 standards'. We also performed a retrospective audit. Results Patients booked into acute fracture clinic (AFC) and fracture clinic follow-up (FFO) reduced by 40% and 48% respectively from 2019 to 2020. A virtual fracture clinic (VFC) was implemented with an increasing trend seen. The number of patient initiated follow-up appointments increased in AFC and FFO from 16% to 75% and 12% to 35% respectively. Radiography was reduced; only 17% and 39% of AFC and FFO patients respectively required radiographs. On-call referrals and trauma cases dropped by 50% with similar case mix year-on-year. All elective operating was cancelled in 2020. Conclusions By reducing clinic admissions and theatre throughput, it was possible to run an effective paediatric orthopaedic service in a busy tertiary referral centre. Our aim now is to determine the long-term efficacy, cost, and sustainability of our COVID-19 service.