BackgroundEmergency services are facing increasing workload pressures, and new models of care are needed. We evaluate the impact of a service development involving a partnership between emergency ambulance crews and general practitioners (GPs) on reducing conveyance rates to the Hospital Emergency Department(ED) .MethodsThe service model was implemented in the West Midlands of England. Call handlers identified patients with needs that could be addressed by a GP using locally agreed criteria. GPs supported the assessment of such patients either at scene or by telephone. Routine data were collected from October 2012 to November 2013, from the ambulance service computer-aided dispatch system. Logistic regression models were used to determine the likelihood for patients being transported to ED.ResultsOf 23 395 emergency contacts during the evaluation period, 1903 (8.1 %) patients were triaged to GP supported assessment. Mean age (SD) was 61.8 (27.9) years; 42.9 % were aged 75 years and over. 1221 (64.2%) had face-to-face GP assessment and 682 (35.8%) via telephone. 1500 (78%) of those who received GP support were not transported to hospital. After controlling for confounders, those aged greater than 75 years (OR 0.67; 95% CI 0.52 to 0.86), and females (OR 0.64; 95% CI 0.51 to 0.82) were less likely to be transported, while those who received GP telephone input rather than face-to-face assessment were more likely to be transferred to an ED (OR 2.14; 95% CI 1.69 to 2.72).ConclusionSupport of the paramedic service by GPs enabled patients to avoid transfer to an ED, potentially avoiding subsequent hospital admission, reducing costs and improving quality of care for patients that are not in need of hospital services. However, use of services in the days following the call was not assessed, and hence the overall impact and safety requires further evaluation.

Background Early career general practitioners are known to be at high risk of burnout. There is a need for widely applicable, cost-effective evidence-based interventions to develop trainees’ protective skills and strategies. Results Of 120 eligible trainees, 23 (19.2%) expressed interest in participating, 17 subsequently started the course, and 15 completed at least 5 out of its 6 sessions. All psychological measures were stable for the six-week period prior to commencing the course. Following the course, there were statistically significant (p < 0.05) improvements in wellbeing, resilience, mindfulness, emotional exhaustion, disengagement, and stress scores. Participants described numerous benefits, and most stated that they would recommend it to colleagues. Conclusion Including mindful practice within general practice vocational training is feasible, and in this study it benefited the psychological wellbeing of participants. Further research is needed to explore ways of increasing uptake and course completion, the sustainability of its effects, and the wider applicability of this approach.

BackgroundTrainee GPs are at risk of developing burnout as a result of high stress levels. Improving resilience may prevent the negative effects of stress on wellbeing, morale, and patient care, thereby supporting recruitment to general practice.AimTo explore experiences of stress and burnout among GP trainees, and their level of interest in undertaking a mindfulness programme.Design & settingA qualitative study was performed with a cohort of GP trainees in Coventry and Warwickshire.MethodThis mixed-methods study utilised a survey with validated measures to investigate the prevalence of burnout, state of wellbeing, and resilience in GP trainees. Focus groups were also used to explore experiences of stress and burnout, and perceptions of mindfulness practice.ResultsIn total, 47 (response rate 39%) trainees completed the survey and 14 participated in focus groups. There was a high prevalence of disengagement (n = 36; 80%) and emotional exhaustion (n = 35; 77%), with 29 (64%) scoring above the cut-off value for both. While 16 (34%) reported already practising mindfulness, 39 (83%) described interest in engaging in mindfulness practice. The focus groups identified a range of issues relating to how trainees recognise stress and burnout, their help-seeking and coping strategies, the perceived barriers to practising self-care, and motivations for participating in mindfulness training.ConclusionThis study confirms the degree of stress and burnout that GP trainees experience, and their desire for greater wellbeing and resilience support. It identified a high level of interest in attending a mindfulness programme, but also barriers to engagement. Results of this research shaped the Mindful Practice Curriculum programme, which was later provided to this cohort of trainees.