ObjectiveThis study aimed to develop a risk prediction model identifying general practices at risk of workforce supply–demand imbalance.DesignThis is a secondary analysis of routine data on general practice workforce, patient experience and registered populations (2012 to 2016), combined with a census of general practitioners’ (GPs’) career intentions (2016).Setting/ParticipantsA hybrid approach was used to develop a model to predict workforce supply–demand imbalance based on practice factors using historical data (2012–2016) on all general practices in England (with over 1000 registered patients n=6398). The model was applied to current data (2016) to explore future risk for practices in South West England (n=368).Primary outcome measureThe primary outcome was a practice being in a state of workforce supply–demand imbalance operationally defined as being in the lowest third nationally of access scores according to the General Practice Patient Survey and the highest third nationally according to list size per full-time equivalent GP (weighted to the demographic distribution of registered patients and adjusted for deprivation).ResultsBased on historical data, the predictive model had fair to good discriminatory ability to predict which practices faced supply–demand imbalance (area under receiver operating characteristic curve=0.755). Predictions using current data suggested that, on average, practices at highest risk of future supply–demand imbalance are currently characterised by having larger patient lists, employing more nurses, serving more deprived and younger populations, and having considerably worse patient experience ratings when compared with other practices. Incorporating findings from a survey of GP’s career intentions made little difference to predictions of future supply–demand risk status when compared with expected future workforce projections based only on routinely available data on GPs’ gender and age.ConclusionsIt is possible to make reasonable predictions of an individual general practice’s future risk of undersupply of GP workforce with respect to its patient population. However, the predictions are inherently limited by the data available.

Background The United Kingdom (UK) is experiencing a general practitioner (GP) workforce retention crisis. Research has focused on investigating why GPs intend to quit, but less is known about the acceptability and effectiveness of policies and strategies to improve GP retention. Using evidence from research and key stakeholder organisations, we generated a set of potential policies and strategies aimed at maximising GP retention and tested their appropriateness for implementation by systematically consulting with GPs. Methods 28 GP Partners and GPs working in national stakeholder organisations from South West England and London were purposively sampled, and asked to take part in a RAND/UCLA Appropriateness Method panel. Panellists were asked to read an evidence briefing summary, and then complete an online survey on two occasions. During each round, participants rated the appropriateness of policies and strategies aimed at improving GP retention using a nine point scale (1 ‘extremely inappropriate’ to 9 ‘extremely appropriate’). Fifty-four potential policies and strategies (equating to 100 statements) were tested, focusing on factors influencing job satisfaction (e.g. well-being, workload, incentives and remuneration, flexible working, human resources systems). Ratings were analysed for panel consensus and categorised based on appropriateness (‘appropriate’, ‘uncertain’, ‘inappropriate’). Results 12/28 GPs approached agreed to take part, 9/28 completed two rounds of the online survey between February and June 2018. Panellists identified 24/54 policy and strategy areas (41/100 statements) as ‘appropriate’. Examples included providing GP practices ‘at risk’ of experiencing GP shortages with a toolkit for managing recruitment and retention, and interventions to facilitate peer support to enhance health and wellbeing, or support portfolio careers. Strategies to limit GP workload, and manage patient demand were also endorsed. Conclusions The panel of experienced GPs identified a number of practical ways to improve GP retention through interventions that might enhance job satisfaction and work-life balance. Future research should evaluate the impact of implementing these recommendations.

The gene SCN9A encodes for the voltage-gated sodium channel Nav1.7, which is highly expressed in pain sensing neurons. Bi-allelic ‘loss of function’ mutations result in a channelopathy associated with insensitivity to pain and anosmia. This is the first report of the labour and postpartum outcomes of two sisters who belong to a non-consanguineous Caucasian family with homozygous SCN9A mutations. Neither sister experienced pain during labour; this had major implications for the staff titrating the syntocinon for labour augmentation and contributed towards their ultimate delivery by caesarean section. During the postpartum period, one of the sisters developed lower limb sensory loss and investigations revealed a spinal haematoma and unrecognized bilateral pelvic fractures. The other sister had an uneventful recovery and both babies are well. These case histories underline the importance of pain in labour management and its function in alerting patients and staff to problems during the puerperium.

Background Nearly two decades after the introduction of the consultant midwife post in the UK, little is understood about where they are and the roles they fulfil within their organisations. Aim A study was undertaken to determine the overall number of consultant midwives, explore the range of clinical specialities and map their location and coverage across the UK, Channel Islands and Isle of Man. Methods A survey and intelligence gathering exercise took place with an online survey being sent to key networks including Heads of Midwifery and consultant midwives in 2016/17. Findings A total of 84 consultant midwives were identified as being employed by around one third of the NHS Trusts and Health Boards. A number of issues were highlighted, including potential retirements and the gradual incorporation of managerial roles in the job description of consultant midwives. Conclusion Given the national imperatives for high quality maternity care, there needs to be a focus on succession planning and growth of the role of consultant midwives across all organisations.

SCN9A codes for the voltage-gated sodium channel Nav1.7, a protein expressed most prominently in sensing pain neurons. Bi-alleleic loss of function mutations in SCN9A results in a severe ‘channelopathy’ associated with insensitivity to acute pain and anosmia. In this report we describe the labour and post-partum outcomes of two sisters with this trait belonging to a non-consanguineous Caucasian family living locally. Both gave a history of life long insensitivity to pain, anosmia and multiple previous unrecognised fractures. Neither sister experienced pain during labour; this had implications for the confidence of the midwifery teams' delivery of intrapartum care. Both delivered by caesarean section. During the post-partum period one of the sisters presented with sensory loss due to a spinal haematoma, a condition not previously associated with SCN9A abnormalities and the ensuing MRI revealed additional undiagnosed bilateral pelvic fractures. Both conditions were managed conservatively. The other sister had an uneventful recovery and both babies were well. These clinical consequences underline the important role of pain in labour management and in the puerperium for alerting staff to problems. This highlights the need for careful pre-pregnancy counselling, antenatal, intra-partum and post-natal management for any other women with this rare condition contemplating pregnancy.