Tackling the crisis in primary care

Paddison, Charlotte; Rosen, Rebecca

doi:10.1136/bmj.o1485

Cited by 7 publications

(7 citation statements)

References 7 publications

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“…Some trans and non-binary people report having excellent GPs with high levels of training and understanding of trans patients while many do not; this may explain our finding of both very positive and very negative experiences. Our findings that trans and non-binary adults in England are more likely to be living with long-term health conditions again highlight the importance of continuity 29. It also highlights that all GPs, regardless of location or special interest, are likely to encounter trans and non-binary patients and will be supporting particular needs relating to long-term health conditions.…”

Section: Discussionmentioning

confidence: 53%

“…Our findings that trans and non-binary adults in England are more likely to be living with longterm health conditions again highlight the importance of continuity. 29 It also highlights that all GPs, regardless of location or special interest, are likely to encounter trans and non-binary patients and will be supporting particular needs relating to long-term health conditions. Where evidence for this work is lacking, further dedicated studies are warranted, with sufficient funding and coproduction with the trans and non-binary community.…”

Section: Open Accessmentioning

confidence: 99%

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Demographic characteristics, long-term health conditions and healthcare experiences of 6333 trans and non-binary adults in England: nationally representative evidence from the 2021 GP Patient Survey

et al. 2023

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ObjectiveIn order to address the lack of data on the health and healthcare needs of trans and non-binary adults, NHS England includes questions asking about both gender and trans status in its surveys to support quality improvement programmes.We used self-reported data from the GP Patient Survey to answer the research question: what are the demographic characteristics, health conditions and healthcare experiences of trans and non-binary adults in England?Design/settingNationally representative, population-based cross-sectional survey in England with survey data collection from January to March 2021.Participants840 691 survey respondents including 6333 trans and non-binary adults.OutcomesWe calculated weighted descriptive statistics, and using logistic regression explored 15 long-term physical and mental health conditions, and 18 patient experience items, covering overall experience, access, communication and continuity.ResultsTrans and non-binary adults were younger, more likely to be from Asian, black, mixed or other ethnic groups and more likely to live in more deprived parts of the country. Age-specific patterns of long-term conditions were broadly similar among trans and non-binary adults compared with all other survey respondents, with some variation by condition. Overall, inequalities in long-term health conditions were largest for autism: OR (95% CI), 5.8 (5.0 to 6.6), dementia: 3.1 (2.5 to 3.9), learning disabilities: 2.8 (2.4 to 3.2) and mental health: 2.0 (1.9 to 2.2), with variation by age. In healthcare experience, disparities are much greater for interpersonal communication (OR for reporting a positive experience, range 0.4 to 0.7 across items) than access (OR range 0.8 to 1.2). Additionally, trans and non-binary adults report much higher preference for continuity 1.7 (1.6 to 1.8), with no evidence of any differences in being able to see or speak to a preferred general practitioner.ConclusionThis research adds up to date evidence about population demographics, health and healthcare needs to support healthcare improvement for trans and non-binary adults.

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Section: Discussionmentioning

confidence: 53%

Section: Open Accessmentioning

confidence: 99%

Demographic characteristics, long-term health conditions and healthcare experiences of 6333 trans and non-binary adults in England: nationally representative evidence from the 2021 GP Patient Survey

et al. 2023

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“… 35 Overall, there is a lack of understanding about how CGA works or what the essential components of this complex intervention are, or which health practitioners are best placed to deliver the intervention. 36 , 37 …”

Section: Discussionmentioning

confidence: 99%

GP-led adapted comprehensive geriatric assessment for frail older people: a multi-methods evaluation of the ‘Living Well Assessment’ quality improvement project in Scotland

et al. 2022

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BackgroundEvidence to support comprehensive geriatric assessment (CGA) in primary care for frail older people is limited.AimTo evaluate a general practitioner (GP) led adapted CGA quality improvement projectDesign & settingMulti-methods evaluation in a large practice in Midlothian in ScotlandMethodThe intervention was conducted by 10 GPs in a practice of approximately 11,000 patients, initially in the patient’s home, and then remotely (by telephone or video consultation) during the COVID-19 pandemic. Evaluation included a patient questionnaire, and qualitative interviews with GPs delivering the LWA, analysed by thematic analysis.Results165/220 (75%) patients responded to the survey of which 86% reported a ‘very good experience’ of the LWA. The method of delivery did not significantly influence this although most (59%) stated a preference for face-to-face consultation. For the 41% who preferred remote LWA, most (33%) preferred telephone to video consultation (8%). Problems in remote consultations related to technical issues (video), poor vision (video) or deafness (telephone/ video). GPs felt that home-based LWAs had real benefits but switching to remote during the pandemic had proven feasible. Concerns included potential increase in GP workload due to the LWA and whether it was an efficient use of GPs’ time.ConclusionsGP-led adapted CGA was feasible in a large practice, even during the pandemic, and highly valued by frail patients. Questions regarding efficient use of GPs’ time, effectiveness in terms of important patient outcomes and impact, and cost-effectiveness, requires further investigation in a larger study.

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“…Complex supply and demand factors govern access to health services and multiple frameworks have been developed, typically defining access as the ability to perceive, seek, reach, pay for and engage with care 2 7–11. Access is increasingly being extended through the use of digital services and remote consultations 12 13. While these services are useful, they come with their own set of barriers and equity issues, and cannot fully replace the central role played by in-person clinical providers 12 14.…”

Section: Introductionmentioning

confidence: 99%

Rapid methods for identifying barriers and solutions to improve access to community health services: a scoping review protocol

et al. 2023

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ObjectivesLow attendance rates for community health services reflect important barriers that prevent people from receiving the care they need. Services and health systems that seek to advance Universal Health Coverage need to understand and act on these factors. Formal qualitative research is the best way to elicit barriers and identify potential solutions, however traditional approaches take months to complete and can be very expensive. We aim to map the methods that have been used to rapidly elicit barriers to accessing community health services and identify potential solutions.Methods and analysisWe will search MEDLINE, Embase, the Cochrane Library and Global Health for empirical studies that use rapid methods (<14 days) to elicit barriers and potential solutions from intended service beneficiaries. We will exclude hospital-based and 100% remotely delivered services. We will include studies conducted in any country from 1978 to present. We will not limit by language. Two reviewers will independently perform screening and data extraction, with disagreements resolved by a third reviewer. We will tabulate the different approaches used and present data on time, skills and financial requirements for each approach, as well as the governance framework and any strengths and weaknesses presented by the study authors. We will follow Joanna Briggs Institute (JBI) scoping review guidance and report the review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.Ethics and disseminationEthical approval is not required. We will share our findings in the peer-reviewed literature, at conferences, and with WHO policymakers working in this space.RegistrationOpen Science Framework (https://osf.io/a6r2m).

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Tackling the crisis in primary care

Abstract: Policy makers must avoid the false dichotomy between continuity and enhanced access

Cited by 7 publications

References 7 publications

Demographic characteristics, long-term health conditions and healthcare experiences of 6333 trans and non-binary adults in England: nationally representative evidence from the 2021 GP Patient Survey

Demographic characteristics, long-term health conditions and healthcare experiences of 6333 trans and non-binary adults in England: nationally representative evidence from the 2021 GP Patient Survey

GP-led adapted comprehensive geriatric assessment for frail older people: a multi-methods evaluation of the ‘Living Well Assessment’ quality improvement project in Scotland

Rapid methods for identifying barriers and solutions to improve access to community health services: a scoping review protocol

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