Objectives To compare the quality of clinical care in walk-in centres with that provided in general practice and by NHS Direct. Design Observational study involving assessment of clinicians by standardised patients. Setting 20 walk-in centres, 20 general practices, and 11 NHS Direct sites. Participants 297 consultations with standardised patients, 99 in each setting, carried out by professional role players trained to play five clinical scenarios (postcoital contraception, chest pain, sinusitis, headache, and asthma). Main outcome measures Primary outcomes were mean scores on consensus derived checklists of essential items for the management of the clinical scenarios. Data were also collected on access to and referral by walk-in centres, general practices, and NHS Direct. Results Walk-in centres achieved a significantly greater mean score for all scenarios combined than general practices (difference between groups 8.2, 95% confidence interval 1.7 to 14.6) and NHS Direct (10.8, 5.5 to 16.1). There was considerable between scenario variation, with walk-in centres performing particularly well on postcoital contraception and asthma scenarios. In contrast to general practices, walk-in centres and NHS Direct referred a higher proportion of patients (26% and 82%, respectively). Conclusion Walk-in centres perform adequately and safely compared with general practices and NHS Direct for the range of conditions under study, but the impact of referrals on workload of other healthcare providers requires further research.
Understanding what the current generation of trainees want to achieve is the key to understanding the future of the workforce Introduction Reform to surgical training over the last three decades has significantly affected the surgical workforce, career planning and progression. Despite changes to consultant job plans, there are no published data on trainees' aspirations and priorities for their future practice. In order to inform the design and structure of consultant job plans, this study sought to produce a trainee consensus statement regarding essential and desirable aspirations for their future professional practice as consultant surgeons. Methods This study used qualitative methodology with an initial survey to define themes, followed by an open invitation to a consensus session held at the Association of Surgeons in Training annual conference in Belfast in 2019. Results Fourteen essential and eight desirable aspirations for consultant practice were voted in and ratified at a formal consensus session. Essential aspirations included: regular theatre lists of cases in the clinician's subspecialty area of interest; regular theatre lists for teaching; regular ward rounds of the clinician's own patients; regular involvement in multidisciplinary team meetings, and morbidity and mortality meetings; a fixed elective schedule; specialty specific procedural lists; flexible working; dedicated time for administration, teaching, education and continuing professional development; options for sabbatical leave; and working in a supportive department. Conclusions This is the first formal national consensus process used to identify what surgical trainees deem as essential and desirable aspirations for their future practice as consultants. Healthcare employers should consider these aspirations when creating job plans and posts to attract trainees, encourage job satisfaction, improve workforce retention, and ultimately improve service delivery and patient care.
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