Is general practice in trouble?

Appleby, John

doi:10.1136/bmj.g6814

Cited by 18 publications

(9 citation statements)

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“…Therefore, the findings of this study support general conclusions from past work that there has been a long history of poor analysis of quality and safety data in primary care. 29 30 This study also supports the growing evidence that the increasing pressures and responsibilities put on GPs and primary care staff are limiting their ability to deal with issues related to patient safety. 13 14 31…”

Section: Discussionsupporting

confidence: 68%

Monitoring patient safety in primary care: an exploratory study using in-depth semistructured interviews

2015

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ObjectivesTo explore how information and data are used to monitor patient safety and quality of primary care by professionals working in, or supporting, primary healthcare.DesignQualitative study of semistructured interviews with a directed content analysis of transcripts.SettingNorth-West London, UK.Participants21 individuals from various levels of the primary healthcare system were recruited, including general practitioners, practice nurses, practice managers, members of Clinical Commissioning Group (CCG) governing bodies, and senior members of regional patient safety teams.ResultsParticipants described being overwhelmed with complicated data which lacked any meaningful analyses about safety and quality. There was also a lack of clarity over which patient safety events are expected to be reported or monitored. Participants also reported uncertainty on whose responsibility it was to act on patient safety information or concerns. At the practice level, there was a range of disincentives for responding to and acting on safety issues and concerns, with few reported benefits. Participants made recommendations to improve future monitoring.ConclusionsThere is a need for clearer information in the form of specific guidelines, policies and procedures with regard to who monitors patient safety in primary care, what is monitored and how it should be monitored.

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Section: Discussionsupporting

confidence: 68%

Monitoring patient safety in primary care: an exploratory study using in-depth semistructured interviews

2015

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“…Clinical commissioning groups (CCGs) replaced primary care trusts (PCTs) in April 2013, and responsibility for Health Checks passed to local authorities. [23][24][25][26][27] Implementation has been highly variable. 28,29 Public Health England is addressing improvements.…”

Section: Introductionmentioning

confidence: 99%

NHS Health Check comorbidity and management: an observational matched study in primary care

et al. 2016

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BackgroundThe NHS Health Check programme completed its first 5 years in 2014, identifying those at highest risk of cardiovascular disease and new comorbidities, and offering behavioural change support and treatment.AimTo describe the coverage and impact of this programme on cardiovascular risk management and identification of new comorbidities.Design and settingObservational 5-year study from April 2009 to March 2014, in 139 of 143 general practices in three clinical commissioning groups (CCGs) in east London.MethodA matched analysis compared comorbidity in NHS Health Check attendees and non-attendees.ResultsA total of 252 259 adults aged 40–74 years were eligible for an NHS Health Check and, of these, 85 122 attended in 5 years. Attendance increased from 7.3% (10 900/149 867) in 2009 to 17.0% (18 459/108 525) in 2013 to 2014, representing increasing coverage from 36.4% to 85.0%. Attendance was higher in the more deprived quintiles and among South Asians. Statins were prescribed to 11.5% of attendees and 8.2% of non-attendees. In a matched analysis, newly-diagnosed comorbidity was more likely in attendees than non-attendees, with odds ratios for new diabetes 1.30 (95% confidence interval [CI] = 1.21 to 1.39), hypertension 1.50 (95% CI = 1.43 to 1.57), and chronic kidney disease 1.83 (95% CI = 1.52 to 2.21).ConclusionThe NHS Health Check programme provision in these CCGs was equitable, with recent coverage of 85%. Statins were 40% more likely to be prescribed to attendees than non-attendees, providing estimated absolute benefits of public health importance. More new cases of diabetes, hypertension, and chronic kidney disease were identified among attendees than a matched group of non-attendees.

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“…There have also been organisational factors that have impacted on implementation of the programme. Major organisational change in the NHS in the context of financial austerity 61 62 led to one-third of staff leaving many PCTs in the transition to CCGs in April 2013 63 and commissioning responsibility for NHS Checks passed to Local Authorities. It is perhaps not surprising that in 2013, 27/151 PCTs nationally offered NHS Health Checks to fewer than 10% of eligible individuals and uptake could be substantially improved.…”

Section: Implications For Practicementioning

confidence: 99%

The NHS Health Check in England: an evaluation of the first 4 years

et al. 2016

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ObjectivesTo describe implementation of a new national preventive programme to reduce cardiovascular morbidity.DesignObservational study over 4 years (April 2009—March 2013).Setting655 general practices across England from the QResearch database.ParticipantsEligible adults aged 40–74 years including attendees at a National Health Service (NHS) Health Check.InterventionNHS Health Check: routine structured cardiovascular check with support for behavioural change and in those at highest risk, treatment of risk factors and newly identified comorbidity.ResultsOf 1.68 million people eligible for an NHS Health Check, 214 295 attended in the period 2009–12. Attendance quadrupled as the programme progressed; 5.8% in 2010 to 30.1% in 2012. Attendance was relatively higher among older people, of whom 19.6% of those eligible at age 60–74 years attended and 9.0% at age 40–59 years. Attendance by population groups at higher cardiovascular disease (CVD) risk, such as the more socially disadvantaged 14.9%, was higher than that of the more affluent 12.3%. Among attendees 7844 new cases of hypertension (38/1000 Checks), 1934 new cases of type 2 diabetes (9/1000 Checks) and 807 new cases of chronic kidney disease (4/1000 Checks) were identified. Of the 27 624 people found to be at high CVD risk (20% or more 10-year risk) when attending an NHS Health Check, 19.3% (5325) were newly prescribed statins and 8.8% (2438) were newly prescribed antihypertensive therapy.ConclusionsNHS Health Check coverage was lower than expected but showed year-on-year improvement. Newly identified comorbidities were an important feature of the NHS Health Checks. Statin treatment at national scale for 1 in 5 attendees at highest CVD risk is likely to have contributed to important reductions in their CVD events.

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Is general practice in trouble?

Abstract: John Appleby unpicks the data on funding of primary care

Cited by 18 publications

References 0 publications

Monitoring patient safety in primary care: an exploratory study using in-depth semistructured interviews

Monitoring patient safety in primary care: an exploratory study using in-depth semistructured interviews

NHS Health Check comorbidity and management: an observational matched study in primary care

The NHS Health Check in England: an evaluation of the first 4 years

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