UK top in primary care co-ordination according to international survey

The UK emerges as the first of 11 countries in an international survey of care co-ordination in primary care settings | The Commonwealth Fund

In a survey of health care experiences in 11 high-income countries, the rate of poor primary care coordination was 5.2 percent overall and 9.8 percent in the United States, the highest rate. Patients who have a positive, established relationship with their provider were less likely to report poor primary care coordination. Being young or having a chronic illness was associated with poor care coordination.

care coordination gaps

Image source: The Commonwealth Fund

The dimensions of care coordination assessed for this study were:

  • access to medical records or test results;
  • receiving conflicting information;
  • use of diagnostic tests that the patient felt were unnecessary; sharing of information between primary care doctor and specialist.

The UK had the highest percentage of patients reporting no care coordination gaps within primary care.

Full results can be accessed here

 

General practice nursing

Health Education England has published The General Practice Nursing Workforce Development Plan.

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Image source: http://www.hee.nhs.uk

This report aims to offers guidance and steps that can be taken to improve general practice nursing recruitment and retention, and encourage nurses to return to the profession by setting out how best to respond to the current and anticipated workforce challenges at both strategic and local levels.

Key report recommendations include:

  • improving training capacity for the general practice nurse workforce by providing access to accredited training to equip them for each level of their role;
  • raising the profile of general practice nursing, to increase the uptake of the role as a first-destination career;
  • developing GPN educator roles to cover all CCG areas, including the promotion of mentor training for all GPNs  to retain the knowledge and expertise of existing GPNs; and
  • the development of a sustainable and easily accessible ‘how-to’ toolkit and web based resource to support the implementation of general practice nursing workforce initiatives.
  • a nationwide standardised general practice nursing ‘return to practice’ education programme which includes a general practice placement, mentorship and appropriate support to meet the NMC requirements for ‘return to practice’.

Full report is available here

Reducing hospital admissions by improving continuity of care in general practice

This briefing summarises research that analysed data from over 230,000 anonymised patient records for older people aged 62 – 82 years | The Health Foundation

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Image source: The Health Foundation

  • Continuity of care is an aspect of general practice valued by patients and GPs alike. However, it seems to be in decline in England.
  • Our analysis, published in The BMJ and summarised in this briefing, looks at the link between continuity of care and hospital admissions for older patients in England. We looked specifically at admissions for conditions that could potentially be prevented through effective treatment in primary care.
  • We found there to be fewer hospital admissions – both elective and emergency – for these conditions for patients who experience higher continuity of care (ie those who see the same GP a greater proportion of the time). Controlling for patient characteristics, we estimate that if patients saw their most frequently seen GP two more times out of every 10 consultations, this would be associated with a 6% decrease in admissions.
  • To improve continuity for patients, general practices who are not already doing so could set prompts on their booking systems and encourage receptionists to book patients to their usual GP. Patients could also be encouraged to request their usual GP.
  • Clinical commissioning groups and NHS England Area Teams could work with general practices to support quality improvement initiatives that maintain or improve continuity of care.
  • Future national initiatives should have a well developed understanding of how and why the policy will impact on continuity in a particular context.

Read the full overview here

Read the full report here

Medical school tripled GP trainee output after raising exposure to general practice

The University of Cambridge medical school more than tripled its output of GP trainees in 2016 after implementing measures to give students and F2 doctors greater exposure to general practice | GP Online

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Giving medical students and junior doctors more exposure to general practice placements could give a real boost to interest in GP careers, the outcome suggests.

For F2 leavers in 2016, almost a quarter (22%) of those who graduated from the University of Cambridge and went directly into further training opted to begin GP training, according to official data.

Just one year before, in 2015, the university had the lowest proportion of F2s entering GP training in the England, at just 7%.

Read the full news article here

Changes to General Practice contract 2017/18

NHS England has issued a letter setting out the key changes to the GMS contract for 2017/18

The new agreement includes an increased focus on tailored annual reviews offered to frail pensioners, and an increase in the number of health checks for people with learning disabilities.  The new contract also includes provisions to encourage practices to expand access and not to close for half-a-day a week.

The contract, to take effect from 01 April 2017, will see investment of around £238 million going into the contract for 2017/18. In addition, £157 million from a previous earmarked scheme will be transferred into core GP funding so that family doctors can be more flexible in how they care for the most frail.

Revalidation and appraisal of General Practitioners

The General Medical Council has published Sir Keith Pearson’s review of revalidation Taking Revalidation Forward: improving the process of relicensing for doctors

 

The report highlights evidence that patients expect there to be systems in place for checking that doctors continue to be safe to practise, but they are not generally aware of the important role they can play in this process.  The report includes recommendations for easing the burden on doctors engaging in the revalidation and appraisal process.

Additional links:

Extended hours in primary care linked to reductions in minor A&E attendances

National Institute for Health Research Signal
Published: Associations between Extending Access to Primary Care and Emergency Department Visits: A Difference-In-Differences Analysis, Whittaker, W.,Anselmi, L.,Kristensen, S. R. PLoS One Volume 13 Issue 9 , 2016

Practices which offered additional appointments showed a reduction in the number of their patients attending emergency departments (also known as A&E) for minor conditions. There was no overall reduction in emergency visits. Costs were reduced for emergency departments but by less than the cost of the additional appointments. The study did not evaluate whether or not this is cost saving to the health service as a whole nor if health outcomes were improved.

Emergency departments are increasingly busy and patients are waiting longer to be treated. Commissioners and providers have been interested in interventions which may help to reduce these hospital pressures.

This NIHR-funded study funded 56 general practices in Manchester to offer extra appointments during evenings and weekends as part of a larger programme to improve primary care. There was a 26.4% relative reduction in “minor” A&E visits (10,933 fewer visits), compared to 469 practices which did not offer additional appointments.

Nationally, policy-makers aim to encourage patients with minor conditions to attend alternative services, including primary care. These findings suggest additional appointments may help reduce minor A&E visits but may be more costly overall.