British Journal of General Practice最新文献

{"title":"Win the crowd.","authors":"Luke Sayers","doi":"10.3399/bjgp25X740973","DOIUrl":"10.3399/bjgp25X740973","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 752","pages":"131"},"PeriodicalIF":5.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Working in a refugee camp on Lesvos.","authors":"Brian Lambert","doi":"10.3399/bjgp25X740901","DOIUrl":"10.3399/bjgp25X740901","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 752","pages":"125"},"PeriodicalIF":5.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Employment and deployment of additional staff roles in general practice: a realist evaluation of what works for whom, how, and why.","authors":"Imelda McDermott, Sharon Spooner, Kath Checkland","doi":"10.3399/BJGP.2024.0562","DOIUrl":"10.3399/BJGP.2024.0562","url":null,"abstract":"<p><strong>Background: </strong>The Additional Roles Reimbursement Scheme (ARRS) was introduced in England in 2019 to alleviate workforce pressures in general practice by funding additional staff such as clinical pharmacists, paramedics, first-contact physiotherapists, and from 1 October 2024 the scheme funds recently qualified GPs. However, the employment and deployment models of ARRS staff present ongoing complexities and challenges that require further exploration.</p><p><strong>Aim: </strong>To explore the decision-making processes behind primary care networks (PCNs) and general practice staffing choices, and how these choices influence the operationalisation of ARRS.</p><p><strong>Design and setting: </strong>This was a qualitative case study across four PCNs in England using a realist evaluation framework.</p><p><strong>Method: </strong>Data collection took place between September 2022 and November 2023. Semi-structured interviews were conducted with PCN clinical directors, GPs, practice managers, and ARRS staff (<i>n</i> = 42). Transcripts were analysed using a realist evaluation framework to identify the context-mechanism-outcome configurations.</p><p><strong>Results: </strong>Direct employment models fostered staff development and retention, contingent on established trust among practices. Subcontracting was favoured to mitigate employment risks but could lead to unintended consequences such as conflicting accountabilities and less integration with existing GP practice staff. The optimal deployment model involved rotations across a limited number of GP practices, ideally two, with one serving as a base, ensuring consistency in training and management.</p><p><strong>Conclusion: </strong>This study provides novel insights into the complexities of different employment and deployment models of ARRS staff. These findings will be invaluable for creating a sustainable GP practice workforce and informing future workforce strategies as the scheme expands to include recently qualified GPs.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e153-e158"},"PeriodicalIF":5.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paramedic or GP consultations in primary care: prospective study comparing costs and outcomes.","authors":"William Hollingworth, Nouf S Gadah-Jeynes, Hazel Taylor, Kirsty Garfield, Sarah Voss, Matthew Booker","doi":"10.3399/BJGP.2024.0469","DOIUrl":"10.3399/BJGP.2024.0469","url":null,"abstract":"<p><strong>Background: </strong>General practice faces pressures because of increased demand and a shortage of GPs. Paramedics in general practice (PGPs) increasingly contribute to managing minor illnesses, conducting home visits, and providing urgent consultations.</p><p><strong>Aim: </strong>To explore the impact of paramedic consultations on patient-reported experience, safe management, and NHS costs.</p><p><strong>Design and setting: </strong>Prospective cohort study comparing PGP with GP consultations at 34 GP sites in England.</p><p><strong>Method: </strong>Eligible participants had a consultation with a PGP (25 PGP sites) or GP (nine non-PGP sites) between May 2022 and February 2023. Questionnaires were provided after the initial consultation and 30 days later. Questionnaires assessed patient experience, outcomes, and perceived safety (PCOQ and PREOS PC), quality of life (EQ-5D-5L), and healthcare use.</p><p><strong>Results: </strong>Of 715 participants recruited, 489 completed the 30-day questionnaire. No evidence was found that PGP consultations resulted in greater improvement/deterioration in patient-reported health and wellbeing (-0.03, 95% confidence interval [CI] = -0.09 to 0.04); confidence in health provision (-0.05, 95% CI = -0.15 to 0.05); health knowledge (0.05, 95% CI = -0.04 to 0.15); or confidence in the health plan (-0.06, 95% CI = -0.11 to -0.01) over the 30-day period. However, the PGP group reported lower confidence in health provision (mean 4.0 versus 4.5; <i>P</i><0.001), poorer perceptions of practice engagement in safety promotion (median 75 versus 88; <i>P</i><0.001), and more communication problems with staff (17% versus 8%; <i>P</i><0.001) immediately after the initial consultation. Patients receiving PGP consultations reported fewer GP appointments during the 30-day period; however, savings to the NHS were offset by higher use of other healthcare professionals.</p><p><strong>Conclusion: </strong>Well-designed training and supervision are needed to ensure PGPs have the right knowledge and can clearly convey healthcare plans to patients. While PGPs may reduce GP workload pressure, they do not necessarily reduce NHS costs.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e166-e172"},"PeriodicalIF":5.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Helping general practice find its groove again.","authors":"Nada Khan","doi":"10.3399/bjgp25X740793","DOIUrl":"10.3399/bjgp25X740793","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 752","pages":"99"},"PeriodicalIF":5.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Books: <i>What Do I Say Next? Everyday Mental Health Conversations in Primary Care: A Practical Guide</i>: Time well spent.","authors":"Hannah Milton","doi":"10.3399/bjgp25X740925","DOIUrl":"https://doi.org/10.3399/bjgp25X740925","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 752","pages":"128"},"PeriodicalIF":5.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed diagnosis of axial spondyloarthritis: the crucial role of primary care - how you can make a difference.","authors":"Thomas A Ingram, Joe Eddison, Karl Gaffney, Raj Sengupta, Daniel Murphy, Toby Wallace, Sampada Bhide, Stephanie Cliffe, Lucy McCann, Jill Hamilton, Clare Clark, Dale Webb","doi":"10.3399/bjgp25X740997","DOIUrl":"10.3399/bjgp25X740997","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 752","pages":"136-139"},"PeriodicalIF":5.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Irresistible and immovable values.","authors":"Ben Hoban","doi":"10.3399/bjgp25X740877","DOIUrl":"10.3399/bjgp25X740877","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 752","pages":"123"},"PeriodicalIF":5.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of integrating social prescribing link workers into primary care in England - bolting on, fitting in, or belonging: a realist evaluation.","authors":"Stephanie Tierney, Debra Westlake, Geoffrey Wong, Amadea Turk, Steven Markham, Jordan Gorenberg, Joanne Reeve, Caroline Mitchell, Kerryn Husk, Sabi Redwood, Catherine Pope, Beccy Baird, Kamal Ram Mahtani","doi":"10.3399/BJGP.2024.0279","DOIUrl":"10.3399/BJGP.2024.0279","url":null,"abstract":"<p><strong>Background: </strong>Following the 2019 NHS Long Term Plan, link workers have been employed across primary care in England to deliver social prescribing.</p><p><strong>Aim: </strong>To understand and explain how the link worker role is being implemented in primary care in England.</p><p><strong>Design and setting: </strong>This was a realist evaluation undertaken in England, focusing on link workers based in primary care.</p><p><strong>Method: </strong>The study used focused ethnographies around seven link workers from different parts of England. As part of this, we interviewed 61 patients and 93 professionals from health care and the voluntary, community, and social enterprise sector. We reinterviewed 41 patients, seven link workers, and a link worker manager 9-12 months after their first interview.</p><p><strong>Results: </strong>We developed four concepts from the codes developed during the project on the topic around how link workers are integrated (or not) within primary care: (or not) within primary care: centralising or diffusing power; forging an identity in general practice; demonstrating effect; and building a facilitative infrastructure. These concepts informed the development of a programme theory around a continuum of integration of link workers into primary care - from being 'bolted on' to existing provision, without much consideration, to 'fitting in', shaping what is delivered to be accommodating, through to 'belonging', whereby they are accepted as a legitimate source of support, making a valued contribution to patients' broader wellbeing.</p><p><strong>Conclusion: </strong>Social prescribing was introduced into primary care to promote greater attention to the full range of factors affecting patients' health and wellbeing, beyond biomedicine. For that to happen, our analysis highlights the need for a whole-system approach to defining, delivering, and maintaining this new part of practice.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e195-e202"},"PeriodicalIF":5.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction.","authors":"","doi":"10.3399/bjgp25X741033","DOIUrl":"10.3399/bjgp25X741033","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 752","pages":"109"},"PeriodicalIF":5.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}