Perspectives of GPs working in or alongside emergency departments in England: qualitative findings from the GPs and Emergency Departments Study

Anderson, Helen; Scantlebury, Arabella; Leggett, Heather; Salisbury, Chris; Benger, Jonathan; Adamson, Joy

doi:10.3399/bjgp.2021.0713

Cited by 4 publications

(4 citation statements)

References 17 publications

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“…It was beyond the scope of this study to explore the impact of GP-ED models on local community primary care. Potential effects might include EDs competing for primary care staff from an already limited pool, 176 with a potential increase in workload for the remaining community workforce. They might also see their workload increased by redirection policies.…”

Section: Workforcementioning

confidence: 99%

Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation

Davies,

Edwards,

Price

et al. 2024

Health Soc Care Deliv Res

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Background Emergency healthcare services are under intense pressure to meet increasing patient demands. Many patients presenting to emergency departments could be managed by general practitioners in general practitioner–emergency department service models. Objectives To evaluate the effectiveness, safety, patient experience and system implications of the different general practitioner–emergency department models. Design Mixed-methods realist evaluation. Methods Phase 1 (2017–8), to understand current practice: rapid realist literature review, national survey and follow-up key informant interviews, national stakeholder event and safety data analysis. Phase 2 (2018–21), to collect and analyse qualitative (observations, interviews) and quantitative data (time series analysis); cost–consequences analysis of routine data; and case site data for ‘marker condition’ analysis from a purposive sample of 13 case sites in England and Wales. Phase 3 (2021–2), to conduct mixed-methods analysis for programme theory and toolkit development. Results General practitioners commonly work in emergency departments, but delivery models vary widely in terms of the scope of the general practitioner role and the scale of the general practitioner service. We developed a taxonomy to describe general practitioner–emergency department service models (Integrated with the emergency department service, Parallel within the emergency department, Outside the emergency department on the hospital site) and present a programme theory as principal output of the study to describe how these service models were observed to operate. Routine data were of variable quality, limiting our analysis. Time series analysis demonstrated trends across intervention sites for: increased time spent in the emergency department; increased emergency department attendances and reattendances; and mixed results for hospital admissions. Evidence on patient experience was limited but broadly supportive; we identified department-level processes to optimise the safety of general practitioner–emergency department models. Limitations The quality, heterogeneity and extent of routine emergency department data collection during the study period limited the conclusions. Recruitment was limited by criteria for case sites (time series requirements) and individual patients (with ‘marker conditions’). Pandemic and other pressures limited data collection for marker condition analysis. Data collected and analysed were pre pandemic; new approaches such as ‘telephone first’ and their relevance to our findings remains unexplored. Conclusion Findings suggest that general practitioner–emergency department service models do not meet the aim of reducing the overall emergency department waiting times and improving patient flow with limited evidence of cost savings. Qualitative data indicated that general practitioners were often valued as members of the wider emergency department team. We have developed a toolkit, based on our findings, to provide guidance for implementing and delivering general practitioner–emergency department services. Future work The emergency care data set has since been introduced across England to help standardise data collection to facilitate further research. We would advocate the systematic capture of patient experience measures and patient-reported outcome measures as part of routine care. More could be done to support the development of the general practitioner in emergency department role, including a core set of competencies and governance structure, to reflect the different general practitioner–emergency department models and to evaluate the effectiveness and cost effectiveness to guide future policy. Study registration This study is registered as PROSPERO CRD42017069741. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/145/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 10. See the NIHR Funding and Awards website for further award information.

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Section: Workforcementioning

confidence: 99%

Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation

Davies,

Edwards,

Price

et al. 2024

Health Soc Care Deliv Res

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“…This ability to both retreat and dive into our data was pivotal to our ability to do justice to the data and made it possible for the team to take the lead on separate, more detailed analyses according to their own interests and skillsets. (Anderson et al, 2021(Anderson et al, , 2022 From this point on, the pen portraits became the backbone of our analysis as by including exemplar quotes and detailed synthesis of key themes we largely negated the need to go back to the data that had been coded according to our framework. However, when this was required, because our pen portraits were written using the same thematic structure as our framework, we were able to find quotes with relative ease and avoided having to sift through vast quantities of raw data.…”

Section: The Pen Portrait Methodsmentioning

confidence: 99%

Section: The Pen Portrait Methodsmentioning

confidence: 99%

Conducting a Large, Longitudinal, Multi-Site Qualitative Study Within a Mixed Methods Evaluation of a UK National Health Policy: Reflections From the GPED Study

Scantlebury

Adamson

2022

International Journal of Qualitative Methods

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Over the past decade, there has been a growing trend towards the use of ‘big qualitative data’ in applied health research, particularly when used as part of mixed methods evaluations of health policy in England. These ‘big qualitative’ studies tend to be longitudinal, complex (multi-site and multi-stakeholder) and involve the use of multiple methods (interviews, observations, documents) and large numbers of participants ( n = 100+). Despite their growing popularity, there is no methodological guidance or methodological reflection on how to undertake such studies. Qualitative researchers are therefore faced with a series of unknowns when designing large qualitative studies, particularly in terms of knowing whether existing qualitative sampling and analysis methods are appropriate in this context. In this paper, we use our experience of undertaking a big qualitative study, as part of a national mixed methods evaluation of a health policy in England to reflect on some of the key challenges that we faced in our qualitative study, which broadly related to: sample size, data analysis and the role of patient and public engagement. Underpinning these difficulties was the challenge of being flexible and innovative within the largely positivist research climate of applied health research and being comfortable with uncertainty relating to the three issues outlined. The reflections we present are not to be viewed as a method ‘how to’ guide, but rather as a platform to raise key issues relating to the qualitative methods that we found challenging, in order to stimulate discussion and debate amongst the qualitative community. Through this paper, we therefore hope to demystify what it is like to undertake such a study and hope to spark much needed discussion and innovation to support the future design and conduct of qualitative research at scale.

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“…For the GPs themselves however, working in ED offered an opportunity to enhance their transferable skills and work flexibly as part of a portfolio career when core general practice was seen to be unmanageable. (36)(37)(38) GPs in EMS does seem to offer some clinical benefit, though the reduction in ED conveyance and hospital admission in interventional studies may be due to low acuity case selection rather than the impact of GPs themselves. Once referred, there is limited evidence that specific patient groups benefit more from GP involvement than others.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

GP roles in emergency medical services: a systematic mapping review and narrative synthesis

2023

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BackgroundA significant proportion of Emergency Medical Services (EMS) work is for problems which may be amenable to timely primary care management and could benefit from general practitioner (GP) input. Utilising GPs in EMSs may reduce avoidable emergency department (ED) conveyance, releasing emergency ambulances for higher acuity care, and meeting patient needs earlier in the evolution of an emergency call.AimTo collate and summarise evidence on how GPs are utilised in EMS.Design & settingSystematic mapping review and narrative synthesis.MethodA systematic literature search was conducted using search terms for general practice and emergency care. Primary research articles investigating the utilisation of GPs in non-critical EMS were included. An inductive framework was used to structure the results alongside a narrative synthesis.Results21 papers were included. GPs were embedded in EMS for urgent management of high acuity patients or used as an intervention to avoid unnecessary ED conveyance in selected lower acuity patients. The importance of interprofessional relationships and training for GPs involved in EMS was highlighted. No studies explored patient-reported outcomes. Outcomes measured were predominantly ED non-conveyance and admission avoidance, with GP services as an intervention reducing the likelihood of these.ConclusionEmbedding GPs in EMS might service different purposes depending upon context. There is some evidence that GP EMS services may reduce the likelihood of ED conveyance and hospital admission in selected cases – it is unclear whether this is due to case selection or GP involvement. Future research should incorporate patients’ views and experiences.

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Perspectives of GPs working in or alongside emergency departments in England: qualitative findings from the GPs and Emergency Departments Study

Cited by 4 publications

References 17 publications

Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation

Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation

Conducting a Large, Longitudinal, Multi-Site Qualitative Study Within a Mixed Methods Evaluation of a UK National Health Policy: Reflections From the GPED Study

GP roles in emergency medical services: a systematic mapping review and narrative synthesis

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