GP workforce crisis: what can we do now?

Jefferson, Laura; Holmes, Mike

doi:10.3399/bjgp22x719225

Cited by 15 publications

(12 citation statements)

References 8 publications

(13 reference statements)

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“…We found evidence of various strategies used by PCNs to help meet vaccination programme demands, including suspension of regular care. This is unlikely to be sustainable long-term given well-recognised pressures on primary care services [ 23 ] and the disruptive impact of the pandemic on delivery of routine care overall [ 24 – 27 ]. It is also unlikely that any single model will have the capacity to meet national demand alone in a future pandemic, while also ensuring equality in vaccination delivery, and for this reason a mixture of service delivery approaches is likely to be needed.…”

Section: Discussionmentioning

confidence: 99%

Adapting SARS-CoV-2 vaccination delivery in England to population needs: a thematic analysis of providers and commissioner’s perceptions

Ismail

Chantler

Paterson

et al. 2023

BMC Health Serv Res

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Background A national SARS-CoV-2 vaccination programme was implemented in England from 8th December 2020, adopting a series of local level service delivery models to maximise rollout. The evidence base informing service design programme at inception was limited. We examined the real-world implementation of the programme through an assessment of sub-national providers’ and commissioners’ perspectives on the service delivery models used, to strengthen evidence on the acceptability, effectiveness and efficiency of the service delivery approaches used for SARS-CoV-2 vaccination in England or elsewhere. Methods Qualitative, cross-sectional analysis based on semi-structured interviews conducted with 87 stakeholders working in SARS-CoV-2 vaccination delivery across four regions in England. Localities were selected according to geography and population socio-economic status. Participants were purposively sampled from health service providers, commissioners and other relevant bodies. Interviews were conducted between February and October 2021, and transcripts were thematically analysed using inductive and deductive approaches. Results Various service delivery models were implemented over the course of the programme, beginning with hospital hubs and mass vaccination sites, before expanding to incorporate primary care-led services, mobile and other outreach services. Each had advantages and drawbacks but primary care-led models, and to some extent pharmacies, were perceived to offer a better combination of efficiency and community reach for equitable delivery. Common factors for success included availability of a motivated workforce, predictability in vaccine supply chains and strong community engagement. However, interviewees noted a lack of coordination between service providers in the vaccination programme, linked to differing financial incentives and fragmentated information systems, among other factors. Conclusion A range of delivery models are needed to enable vaccine rollout at pace and scale, and to mitigate effects on routine care provision. However, primary care-led services offer a tried-and-trusted framework for vaccine delivery at scale and pace and should be central to planning for future pandemic responses. Mass vaccination sites can offer delivery at scale but may exacerbate inequalities in vaccination coverage and are unlikely to offer value for money. Policymakers in England should prioritise measures to improve collaboration between service providers, including better alignment of IT systems.

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Section: Discussionmentioning

confidence: 99%

Adapting SARS-CoV-2 vaccination delivery in England to population needs: a thematic analysis of providers and commissioner’s perceptions

Ismail

Chantler

Paterson

et al. 2023

BMC Health Serv Res

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“…Combining well-resourced and legitimate participatory practices fosters transparency and builds trust between both patients and staff. Given that trust in the profession is falling and staff feel undervalued 47 , 48 there is a strong case for investment in meaningful patient participation now more than ever.…”

Section: Discussionmentioning

confidence: 99%

Patient influence on general practice service improvement decision making: a participatory research mixed-methods intervention study

Drinkwater,

MacFarlane,

Twiddy

et al. 2023

Br J Gen Pract

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Background: Health policy promotes patient participation in decision-making about service organisation. In English general practice this happens through contractually required patient participation groups (PPGs). However, there are problems with the enactment of PPGs which have not been systematically addressed. Aim: To observe how a co-designed theory-informed intervention can increase representational legitimacy and facilitate power-sharing to support PPGs to influence decision-making about general practice service improvement. Design and Setting: Participatory action research to implement the intervention in two general practices in the North of England. The intervention combined two different participatory practices; partnership working involving externally facilitated meetings with PPG members and staff, and consultation with the wider patient population using a bespoke discrete choice experiment (DCE). Method: To illustrate decision-making in PPGs qualitative data is presented from participant observation notes and photographed visual data generated through participatory methods. The DCE results are summarised to illustrate how wider population priorities contributed to overall decision-making. Observational data was thematically analysed using Normalisation Process Theory with support from a multi-stakeholder co-research group. Results: In both practices, patients influenced decision-making during PPG meetings and through the DCE, resulting in bespoke patient-centred action plans for service improvement. Power asymmetries were addressed through participatory methods, clarification of PPG roles in decision-making, and addressing representational legitimacy through wider survey consultation. Conclusion: Combining participatory practices and facilitated participatory methods enabled patients to influence decision-making about general practice service improvement. The policy of mandatory PPGs needs updating to recognise the need to resource participation in a meaningful way.

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“…Research and surveys undertaken by others in 2021-2022 affirmed a number of findings of this familiarisation phase, including problems of accessing primary care 29 ; substantially increased workload in UK primary care 30 ; perceptions by GPs of increased clinical risk with some remote consultations 31 , 32 or when patients are encouraged to monitor their own chronic conditions such as blood pressure and report by telephone 33 ; exacerbation of inequities, especially among the most vulnerable groups, as services went digital 34 – 40 ; a primary care workforce that is increasingly stressed and underconfident 41 – 44 ; multiple infrastructural challenges to establishing remote services during the pandemic 45 – 48 ; and challenges to patient input to research efforts during the pandemic 49 .…”

Section: Discussionmentioning

confidence: 99%

Remote care in UK general practice: baseline data on 11 case studies

et al. 2022

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Background: Accessing and receiving care remotely (by telephone, video or online) became the default option during the coronavirus disease 2019 (COVID-19) pandemic, but in-person care has unique benefits in some circumstances. We are studying UK general practices as they try to balance remote and in-person care, with recurrent waves of COVID-19 and various post-pandemic backlogs. Methods: Mixed-methods (mostly qualitative) case study across 11 general practices. Researchers-in-residence have built relationships with practices and become familiar with their contexts and activities; they are following their progress for two years via staff and patient interviews, documents and ethnography, and supporting improvement efforts through co-design. In this paper, we report baseline data. Results: Reflecting our maximum-variety sampling strategy, the 11 practices vary in size, setting, ethos, staffing, population demographics and digital maturity, but share common contextual features—notably system-level stressors such as high workload and staff shortages, and UK’s technical and regulatory infrastructure. We have identified both commonalities and differences between practices in terms of how they: 1] manage the ‘digital front door’ (access and triage) and balance demand and capacity; 2] strive for high standards of quality and safety; 3] ensure digital inclusion and mitigate wider inequalities; 4] support and train their staff (clinical and non-clinical), students and trainees; 5] select, install, pilot and use technologies and the digital infrastructure which support them; and 6] involve patients in their improvement efforts. Conclusions: General practices’ responses to pandemic-induced disruptive innovation appear unique and situated. We anticipate that by focusing on depth and detail, this longitudinal study will throw light on why a solution that works well in one practice does not work at all in another. As the study unfolds, we will explore how practices achieve timely diagnosis of urgent or serious illness and manage continuity of care, long-term conditions and complex needs.

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GP workforce crisis: what can we do now?

Cited by 15 publications

References 8 publications

Adapting SARS-CoV-2 vaccination delivery in England to population needs: a thematic analysis of providers and commissioner’s perceptions

Adapting SARS-CoV-2 vaccination delivery in England to population needs: a thematic analysis of providers and commissioner’s perceptions

Patient influence on general practice service improvement decision making: a participatory research mixed-methods intervention study

Remote care in UK general practice: baseline data on 11 case studies

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