Is general practice in the wrong PLACE?

Baird, Anne

doi:10.3399/bjgp16x686329

Cited by 8 publications

(12 citation statements)

References 4 publications

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“…This has instigated a trend towards increased registered patient lists in each General Practice 2,3 . The belief is that larger interdisciplinary teams can improve access and provide more cost-effective services to patients [4][5][6][7][8][9] . With this expansion of registered patient numbers in each General Practice, there is a potential threat that the continuity of care (i.e.…”

Section: Introductionmentioning

confidence: 99%

Primary care micro-teams: an international systematic review of patient and healthcare professional perspectives

et al. 2023

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Background: There has been a recent trend, both in the UK and internationally, towards creating larger primary care practices with the assumption that interdisciplinary teams can increase patient accessibility and provide more cost-effective, efficient services. Micro-teams have been proposed to mitigate some of the potential challenges with practice expansion, including continuity of care. Aim: Review the available literature to examine how micro-teams are described and the opportunities which primary care micro-teams can provide for practice staff and patients and limitations to their introduction and implementation. Design and setting: International Systematic review of studies published in English. Method: A Framework analysis was used to synthesise the literature. Databases and grey literature were searched. Studies were included if they provided evidence regarding the implementation of micro-teams in primary care. We worked with a PPI co-author and conducted stakeholder discussions to those with and without experience in micro-team implementation. Results: The majority of the 24 included studies discussed empirical data from healthcare professionals, describing the implementation of micro-teams. Results include the characteristics of the literature; how micro-teams have been described; the range of ways micro-teams have been implemented; reported outcomes and experiences of patients and staff. Conclusion: The organisation of primary care has the potential to impact the nature and quality of patient care, safety and outcomes. This review contributes to current debates surrounding care delivery and how this can impact the experiences and outcomes of patients and staff. The analysis identifies several key opportunities and challenges for future research, policy and practice.

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Section: Introductionmentioning

confidence: 99%

Primary care micro-teams: an international systematic review of patient and healthcare professional perspectives

et al. 2023

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“…The policy perspective recognizes the need to transform primary healthcare, not just shift workload from one practitioner to another. Nurses face similar workforce challenges to doctors (Baird et al, 2016), therefore transformation will require new ways of working (HEE, 2017). This case study aimed to evaluate Advanced Nurse Practitioner (ANP) role implementation in primary care across Scotland in contributing to primary care transformation, and establish what works, for whom, why and in what context.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…Their scope of practice includes assessment, diagnosis, ordering tests, prescribing, health promotion and education, administration and working with marginalized groups. Unfortunately, the existence of a range of different advanced nursing roles causes some confusion in terminology, as the following titles all describe nurses working in advanced roles: nurse practitioner, nurse consultant, advanced practice nurse, clinical nurse specialist, nurse specialist (Baird et al, 2016). While the ANP title is not recordable or registered with the UK Nursing and Midwifery Council, a nationally agreed definition and criteria exists in Scotland and was therefore used in this study (Sottish Government, 2017).…”

Section: Backg Rou N Dmentioning

confidence: 99%

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A realist evaluation case study of the implementation of advanced nurse practitioner roles in primary care in Scotland

Strachan

Hoskins

Wells

et al. 2022

Journal of Advanced Nursing

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Aim: To evaluate Advanced Nurse Practitioner (ANP) role implementation in primary care across Scotland in contributing to primary care transformation, and establish what works, for whom, why and in what context. Design: A realist evaluation using multiple case studies. Methods: Two phases, conducted March 2017 to May 2018: (1) multiple case studies of ANP implementation in 15 health boards across Scotland, deductive thematic analysis of interviews, documentary analysis; (2) in-depth case studies of five health boards, framework analysis of interviews and focus groups.Results: Sixty-eight informants were interviewed, and 72 documents were reviewed across both phases. ANP roles involved substitution for elements of the GP role for minor illness and injuries, across all ages. In rural areas ANPs undertook multiple nursing roles, were more autonomous and managed greater complexity. Mechanisms that facilitated implementation included: the national ANP definition; GP, primary care team and public engagement; funding for ANP education; and experienced GP supervisors. Contexts that affected mechanisms were national and local leadership; remote, rural and island communities; and workload challenges. Small-scale evaluations indicated that ANPs: make appropriate decisions; improve patient access and experience. Conclusions:At the time of the evaluation, the implementation of ANP roles in primary care in Scotland was in early stages. Capacity to train ANPs in a service already under pressure was challenging. Shifting elements of GPs workload to ANPs freed up GPs but did little to transform primary care. Local evaluations provided some evidence that ANPs were delivering high-quality primary care services and enhanced primary care services to nursing homes or home visits.Impact: ANP roles can be implemented with greater success and have more potential to transform primary care when the mechanisms include leadership at all levels, ANP roles that value advanced nursing knowledge, and appropriate education programmes delivered in the context of multidisciplinary collaboration.

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“…By providing an in-depth exploration of trainees’ progression and the factors that have an impact on this progression our study may ultimately contribute to achieving a better understanding of successful completion of training programmes in psychiatry and other specialties facing similar challenges such as general practice. 9 …”

Section: Aimsmentioning

confidence: 99%

Uncovering trends in training progression for a national cohort of psychiatry trainees: discrete-time survival analysis

2021

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Background The global rise in mental health issues calls for a strong psychiatry workforce. Yet, psychiatry training worldwide is facing recruitment challenges, causing unfilled consultant posts and possibly threatening the quality of patient care. An in-depth understanding of trainees’ progression through training is warranted to explore what happens to recruited trainees during training. Aims To uncover current trends in psychiatry trainees’ progression through training in the UK. Method This national retrospective cohort study with data from the UK Medical Education Database used discrete-time survival analysis to analyse training progression for those trainees who started their core psychiatry post in 2012–2017 (2820 trainees; 59.6% female, 67.6% UK graduates (UKGs)). The impact of sociodemographic characteristics on training progression were also investigated. Results The overall probability of completing training in 6 years (minimum years required to complete psychiatry training in the UK) was 17.2% (ranging from 4.8% for non-UKG females to 29% for UKG males). The probability to not progress was highest (57.1%) from core to specialty training. For UKGs, trainees from ethnicities other than White, trainees with a disability, and trainees who had experienced childhood social deprivation (measured as entitlement to free school meals) had a significantly (P ≤ 0.02) lower probability of completing training in 6 years. Conclusions Less than one in five psychiatry trainees are likely to complete training in 6 years and this probability varies across groups of doctors. Completing psychiatry training in 6 years is, therefore, the exception rather than the norm and this has important implications for trainees, those planning psychiatry workforces or responsible for psychiatry training.

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Is general practice in the wrong PLACE?

Cited by 8 publications

References 4 publications

Primary care micro-teams: an international systematic review of patient and healthcare professional perspectives

Primary care micro-teams: an international systematic review of patient and healthcare professional perspectives

A realist evaluation case study of the implementation of advanced nurse practitioner roles in primary care in Scotland

Uncovering trends in training progression for a national cohort of psychiatry trainees: discrete-time survival analysis

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