Gunner, E., et al. | 2019| Provision and accessibility of primary healthcare services for people who are homeless: a qualitative study of patient perspectives in the UK British Journal of General Practice | bjgp19X704633| DOI: https://doi.org/10.3399/bjgp19X704633
Research that sought the views of 22 homeless people and explored their experiences and access to primary care services, report that homeless people perceived inequality in access, and mostly faced negative experiences, in their use of mainstream services.
Background Anecdotal reports of people who are homeless being denied access and facing negative experiences of primary health care have often emerged. However, there is a dearth of research exploring this population’s views and experiences of such services.
Aim To explore the perspectives of individuals who are homeless on the provision and accessibility of primary healthcare services.
Design and setting A qualitative study with individuals who are homeless recruited from three homeless shelters and a specialist primary healthcare centre for the homeless in the West Midlands, England.
Method Semi-structured interviews were audiorecorded, transcribed verbatim, and analysed using a thematic framework approach. The Theoretical Domains Framework (TDF) was used to map the identified barriers in framework analysis.
Results A total of 22 people who were homeless were recruited. Although some participants described facing no barriers, accounts of being denied registration at general practices and being discharged from hospital onto the streets with no access or referral to primary care providers were described. Services offering support to those with substance misuse issues and mental health problems were deemed to be excluding those with the greatest need. A participant described committing crimes with the intention of going to prison to access health care. High satisfaction was expressed by participants about their experiences at the specialist primary healthcare centre for people who are homeless (SPHCPH).
Conclusion Participants perceived inequality in access, and mostly faced negative experiences, in their use of mainstream services. Changes are imperative to facilitate access to primary health care, improve patient experiences of mainstream services, and to share best practices identified by participants at the SPHCPH.
The King’s Fund | June 2019 | Insights from the spread of the primary care home
The King’s Fund has published Insights from the spread of the primary care home, a report that looks at the factors that contributed to the spread of the ‘primary care home’, a type of primary care network, from concept to more than 200 sites in a few years. The King’s Fund draw on a series of interviews with staff from the National Association of Primary Care (NAPC, who curated the primary care home concept for use in England in 2015), NHS England (who supported the work) and local sites (who delivered changes on the ground).
The report identifies factors that enabled the spread of primary care homes, as well as the factors that made the spread harder. It provides insights for the NAPC and others that can inform their health and care transformation efforts (Source: The King’s Fund).
Nuffield Trust | May 2019 | Improving access out of hours: Evaluation of extended-hours primary care access hubs
The Nuffield Trust was commissioned by Barking, Havering and Redbridge CCGs to evaluate the impact of access programmes in these boroughs.
The schemes aimed to improve the quality of primary care services and to improve patients’ experience and outcomes over a two-year period.
The schemes involved:
improving public access to primary care by providing additional capacity outside of core hours
the development of a new integrated care hub for the management of people with complex care needs.
Most of the patients we interviewed told us that they had chosen to attend the hubs because they found it difficult to attend in-hours primary care services. Others said that they had wanted a speedy clinical assessment for themselves or their children.
Patients particularly liked the appointment-based system at the hubs and this was what they highlighted when distinguishing between the hubs and other services such as walk-in centres and A&E departments.
Since the hubs opened, there has been an increase in the use of A&E services across the boroughs. However, during our research the size of this increase appeared to be associated with hub attendance in that it was significantly lower in areas where hub attendance was highest by approximately 4.5%. This suggests that the presence of the hubs may have been diverting some people who would otherwise choose to attend A&E, or who may have been sent to A&E by NHS 111, away from this service.
However, from a commissioning perspective, such reductions in A&E attendance would not be enough to offset the local cost of providing the hub service.
During the study, a call centre had been introduced to improve the appointment booking process. By 2016, between 80% and 90% of patients attending the hubs were recorded as self-referrals, presumably because they had used the call centre. The number of referrals from NHS 111 had remained more stable and generally not increased as new hubs opened.
The hubs had adapted to lower demand on Sundays by reducing opening hours and staffing, thus ensuring that Sunday usage rates were comparable to usage rates on other days of the week.
Some staff working at the hubs raised concerns about their lack of access to patients’ medical records and their inability to refer patients on for further treatment. Both these areas require effective systems to be in place to avoid the potential of increased clinical risk.
Survey responses from staff working at the hubs revealed a largely positive attitude towards working at the hubs, with 59% of staff saying that working at the hubs was better than their other or previous work.
It is possible that the hub scheme may have had an effect on the locum market in the area: some staff not working at the hubs suggested that higher locum rates being paid to hub staff might reduce the availability of locums for in-hours work.
The newly emerging primary care networks provide an opportunity to tackle health inequalities in England but, as Rebecca Fisher and Beccy Baird explain, they will have to be careful to avoid perpetuating the problem | via BMJ
In the face of a growing health gap between rich and poor in England, the NHS long-term plan explicitly commits to a focus on “health inequality reduction.” The roots of socioeconomic inequalities lie deep within communities, and general practice—itself rooted in communities—is key to addressing the problem. As practices scrabble to organise themselves into primary care networks, making meaningful progress towards reducing health inequalities requires these networks to be part of the solution. But unless a combination of quirks, oversights, and loopholes in their design and contracting are addressed, there is a risk that they could perpetuate the problem.
NICE | May 2019 | Lead-I ECG devices for detecting symptomatic atrial fibrillation using single time point testing in primary care
Evidence-based recommendations on lead-I electrocardiogram (ECG) devices (imPulse, Kardia Mobile, MyDiagnostick and Zenicor-ECG) for detecting symptomatic atrial fibrillation using single time point testing in primary care.
This guidance covers devices that are used to record and analyse a single time point lead-I ECG for people in primary care with symptoms of atrial fibrillation and an irregular pulse. Using the devices for taking ECGs other than a single time point lead-I ECG reading, or for screening for atrial fibrillation in people without symptoms, was outside the scope of the assessment.
The British Journal of General Practice has published research where physiotherapists have been the first point of contact for musculoskeletal conditions, rather than GPs.
The evaluation of two years’ data suggests that patients with musculoskeletal conditions may be assessed and managed independently and effectively by physiotherapists instead of GPs. Most of patients in the study, were managed within primary care, with low referral rates and highly appropriate referrals to orthopaedics. Patients reported positive views regarding the service.
Background Physiotherapists are currently working in primary care as first contact practitioners (FCP), assessing and managing patients with musculoskeletal conditions instead of GPs. There are no published data on these types of services.
Aim To evaluate a new service presenting the first 2 years of data.
Design and setting Analysis of 2 years’ data of patient outcomes and a patient experience questionnaire from two GP practices in Forth Valley NHS, UK. The service was launched in November 2015 in response to GP shortages.
Method Data were collected from every patient contact in the first 2 years. This included outcomes of appointments, GP support, capacity of the service, referral rates to physiotherapy and orthopaedics, numbers of steroid injections, and outcomes from orthopaedic referrals. A patient experience questionnaire was also conducted.
Results A total of 8417 patient contacts were made, with the majority managed within primary care (n = 7348; 87.3%) and 60.4% (n = 5083) requiring self-management alone. Referrals to orthopaedics were substantially reduced in both practices. Practice A from 1.1 to 0.7 per 1000 patients; practice B from 2.4 to 0.8 per 1000 patients. Of referrals to orthopaedics, 86% were considered ‘appropriate’. Extended scope physiotherapists (ESPs) asked for a GP review in 1% of patients.
Conclusion The results suggest that patients with musculoskeletal conditions may be assessed and managed independently and effectively by physiotherapists instead of GPs. This has the potential to significantly reduce workload for GPs as the service requires minimal GP support. The majority of patients were managed within primary care, with low referral rates and highly appropriate referrals to orthopaedics. Patients reported positive views regarding the service.
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