Should general practices open for longer?

Kingsland, James; Swinyard, Peter W

doi:10.1136/bmj.f6832

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…Limited access to healthcare services is a well-known barrier to help-seeking. 21 Increased GP practice opening hours, 22 community-based health clinics 23 and telephone consultations, 24 may prove effective at meeting need, particularly in London where access can be more challenging than in the rest of England. 25 Further, opportunities to educate first generation Black African women about the importance of early diagnosis or to refer them directly onto breast specialists may have been missed by A&E staff.…”

Section: Discussionmentioning

confidence: 99%

Barriers to early diagnosis of symptomatic breast cancer: a qualitative study of Black African, Black Caribbean and White British women living in the UK

et al. 2015

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ObjectivesUnderstanding barriers to early diagnosis of symptomatic breast cancer among Black African, Black Caribbean and White British women in the UK.DesignIn-depth qualitative interviews using grounded theory methods to identify themes. Findings validated through focus groups.Participants94 women aged 33–91 years; 20 Black African, 20 Black Caribbean and 20 White British women diagnosed with symptomatic breast cancer were interviewed. Fourteen Black African and 20 Black Caribbean women with (n=19) and without (n=15) breast cancer participated in six focus groups.SettingEight cancer centres/hospital trusts in London (n=5), Somerset (n=1), West Midlands (n=1) and Greater Manchester (n=1) during 2012–2013.ResultsThere are important differences and similarities in barriers to early diagnosis of breast cancer between Black African, Black Caribbean and White British women in the UK. Differences were influenced by country of birth, time spent in UK and age. First generation Black African women experienced most barriers and longest delays. Second generation Black Caribbean and White British women were similar and experienced fewest barriers. Absence of pain was a barrier for Black African and Black Caribbean women. Older White British women (≥70 years) and first generation Black African and Black Caribbean women shared conservative attitudes and taboos about breast awareness. All women viewed themselves at low risk of the disease, and voiced uncertainty over breast awareness and appraising non-lump symptoms. Focus group findings validated and expanded themes identified in interviews.ConclusionsFindings challenged reporting of Black women homogenously in breast cancer research. This can mask distinctions within and between ethnic groups. Current media and health promotion messages need reframing to promote early presentation with breast symptoms. Working with communities and developing culturally appropriate materials may lessen taboos and stigma, raise awareness, increase discussion of breast cancer and promote prompt help-seeking for breast symptoms among women with low cancer awareness.

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Section: Discussionmentioning

confidence: 99%

Barriers to early diagnosis of symptomatic breast cancer: a qualitative study of Black African, Black Caribbean and White British women living in the UK

et al. 2015

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“…Concerns about rising emergency department visits and short-stay admissions have sparked calls for a reversal of policy reform, suggesting UK primary care physicians should extend access to primary care outside of core hours, and controversial pilot schemes for 24/7 care are now proposed in many areas. 38 Such changes, however, have huge implications for the primary care physician workforce and UK health system budgets. We recommend further research to model clinical and costeffectiveness and survey parental attitudes to weigh best options for avoiding admissions in children.…”

Section: Implications and Future Researchmentioning

confidence: 99%

Impact of UK Primary Care Policy Reforms on Short-Stay Unplanned Hospital Admissions for Children With Primary Care-Sensitive Conditions

Cecil

Bottle

Saxena

2015

The Annals of Family Medicine

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PURPOSE We aimed to assess the impact of UK primary care policy reforms implemented in April 2004 on potentially avoidable unplanned short-stay hospital admissions for children with primary care-sensitive conditions. METHODSWe conducted an interrupted time series analysis of hospital admissions for all children aged younger than 15 years in England between April 2000 and March 2012 using data from National Health Service public hospitals in England. The main outcomes were annual short-stay (<2-day) unplanned hospital admission rates for primary care-sensitive infectious and chronic conditions. RESULTS There were 7.8 million unplanned admissions over the study period. More than one-half (4,144,729 of 7,831,633) were short-stay admissions for potentially avoidable infectious and chronic conditions. The primary care policy reforms of April 2004 were associated with an 8% increase in short-stay admission rates for chronic conditions, equivalent to 8,500 additional admissions, above the 3% annual increasing trend. Policy reforms were not associated with an increase in short-stay admission rates for infectious illness, which were increasing by 5% annually before April 2004. The proportion of primary care-referred admissions was falling before the reforms, and there were further sharp reductions in 2004. CONCLUSIONSThe introduction of primary care policy reforms coincided with an increase in short-stay admission rates for children with primary care-sensitive chronic conditions, and with more children being admitted through emergency departments. Short-stay admission rates for primary care-sensitive infectious illness increased more steadily and could be related to lowered thresholds for hospital admission.

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“…When this scheme was first announced, the government stated that the pilot was seen as ‘the first step’ to rolling the policy out across the country, expecting that it could reduce utilisation of A&E services 5. These proposals have been controversial6 and may not be feasible without significant improvements in funding for general practice services 7. The Official Opposition to the current government, the Labour Party, have pledged to ensure patients are able to see a GP within 48 hours if elected, again presuming that this will relieve pressure on A&E departments 8…”

Section: Introductionmentioning

confidence: 99%

Access to general practice and visits to accident and emergency departments in England: cross-sectional analysis of a national patient survey

et al. 2014

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BackgroundThe annual number of unplanned attendances at accident and emergency (A&E) departments in England increased by 11% (2.2 million attendances) between 2008–2009 and 2012–2013. A national review of urgent and emergency care has emphasised the role of access to primary care services in preventing A&E attendances.AimTo estimate the number of A&E attendances in England in 2012–2013 that were preceded by the attending patient being unable to obtain an appointment or a convenient appointment at their general practice.Design and settingCross-sectional analysis of a national survey of adults registered with a GP in England.MethodThe number of general practice consultations in England in 2012–2013 was estimated by extrapolating the linear trend of published data for 2000–2001 to 2008–2009. This parameter was multiplied by the ratio of attempts to obtain a general practice appointment that resulted in an A&E attendance to attempts that resulted in a general practice consultation estimated using the GP Patient Survey 2012–2013. A sensitivity analysis varied the number of consultations by ±12% and the ratio by ±25%.ResultsAn estimated 5.77 million (99.9% confidence interval = 5.49 to 6.05 million) A&E attendances were preceded by the attending patient being unable to obtain a general practice appointment or a convenient appointment, comprising 26.5% of unplanned A&E attendances in England in 2012–2013. The sensitivity analysis produced values between 17.5% and 37.2% of unplanned A&E attendances.ConclusionA large number of A&E attendances are likely to be preceded by unsuccessful attempts to obtain convenient general practice appointments in England each year.

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Should general practices open for longer?

Cited by 5 publications

References 5 publications

Barriers to early diagnosis of symptomatic breast cancer: a qualitative study of Black African, Black Caribbean and White British women living in the UK

Barriers to early diagnosis of symptomatic breast cancer: a qualitative study of Black African, Black Caribbean and White British women living in the UK

Impact of UK Primary Care Policy Reforms on Short-Stay Unplanned Hospital Admissions for Children With Primary Care-Sensitive Conditions

Access to general practice and visits to accident and emergency departments in England: cross-sectional analysis of a national patient survey

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