Background: Risk of harm from drinking is heightened in later life, due to age-related sensitivities to alcohol. Primary care services have a key role in supporting older people to make healthier decisions about alcohol. Aim: To examine primary care practitioners’ perceptions of factors that promote and challenge their work to support older people in alcohol risk-reduction. Design and Setting: Qualitative study consisting of semi-structured interviews and focus groups with primary care practitioners in Northern England. Method: Thirty-five practitioners (general practitioners, practice/district nurses, pharmacists, dentists, social care practitioners, domiciliary carers) participated in eight interviews and five focus groups. Data were analysed thematically, applying principles of constant comparison. Results: Practitioners highlighted particular sensitivities amongst older people to discussing alcohol, and reservations about older people’s resistance to making changes in old age; given drinking practices could be established, and promote socialisation and emotional wellbeing in later life. Age-related health issues increased older people’s contact with practitioners; but management of older people’s long-term conditions was prioritised over discussion of alcohol. Dedicated time to address alcohol in routine consultations with older people, and training in alcohol intervention facilitated practitioners; particularly pharmacists and practice nurses. Conclusion: There are clear opportunities to support older people in primary care to make healthier decisions about alcohol. Dedicated time to address alcohol, training in identification of alcohol-related risks, particularly those associated with old age; and tailored interventions for older people, feasible to implement in practice settings, would support primary care practitioners to address older people’s alcohol use.

BackgroundDelivering the “right care, at the right time, in the right place, by the right people” is a challenge for all healthcare services [1], but particularly so for subspecialties such as paediatric and adolescent rheumatology, where inequities in access to specialist care are known to exist [2]. In the United Kingdom (UK), to help address this there is support for the development of clinical networks. A number of paediatric and adolescent rheumatology clinical networks are now evolving across the UK: their effect and role in the transition process between paediatric and adult services is unknown.ObjectivesWe explored the experiences of those involved to try and understand this further.MethodsHealth professionals, young people with Juvenile Idiopathic Arthritis and their families were recruited via five National Health Service paediatric and adolescent rheumatology specialist centres and networks across the UK. Seventy participants took part in focus groups and one-to-one interviews. Data was analysed using coding, memoing and mapping techniques to identify features of transitional services across the sectorResultsVariation and inequities in transitional care exist. Although transition services in networks are evolving, development has lagged behind other areas with network establishment focusing more on access to paediatric rheumatology multidisciplinary teams. Challenges include workforce shortfalls, differences in service priorities, standards and healthcare infrastructures, and managing the legacy of historic encountersConclusionsProviding equitable high quality clinically effective services for transition across the UK has a long way to go. There is a call for more protected time, staff and resources to develop transition roles and services, as well as streamlining of local referral pathways between paediatric and adult healthcare services. In addition, there is a need to support professionals in developing their understanding of transitional care in clinical networks, particularly around service design, organizational change and the interpersonal skills required for collaborative working.ReferencesRCPCH. Facing the Future: Standards for Paediatric Services. Secondary Facing the Future: Standards for Paediatric Services 2011. (accessed 21 Nov 2014).Foster H, Rapley T. Access to pediatric rheumatology care - a major challenge to improving outcome in juvenile idiopathic arthritis. The Journal of rheumatology 2010;37(11):2199-202 doi: 10.3899/jrheum.100910.AcknowledgementsOur thanks go to patients and their families, and healthcare professionals who have participated in the project, without whom this work would not have been possible.This work was supported by Arthritis Research UK Educational Research Fellowship Grant (number: 20123)Disclosure of InterestNone declared