Care In Scotland Research Articles

Estimated impact from the withdrawal of primary care financial incentives on selected indicators of quality of care in Scotland: controlled interrupted time series analysis

ObjectiveTo determine whether the withdrawal of the Quality and Outcomes Framework (QOF) scheme in primary care in Scotland in 2016 had an impact on selected recorded quality of care, compared...

Evaluating primary care transformation: synthesis of findings from UK pilot project reviews.

Pilot 'new models' of primary care have been funded across the UK since 2015, through various national transformation funds. Reflections and syntheses of evaluation findings provide an additional layer of insight into 'what works' in transforming primary care. To identify good practice in policy design, implementation, and evaluation for primary care transformation. A thematic analysis of existing pilot evaluations in England, Wales, and Scotland. Ten studies presenting evaluations of three national pilot studies - the Vanguard programme in England, the Pacesetter programme in Wales, and the National Evaluation of New Models of Primary Care in Scotland - were thematically analysed, and findings synthesised in order to identify lessons learnt and good practice. Common themes emerged across studies in all three countries at project and policy level, which can support or inhibit new models of care. At project level, these included the following: working with all stakeholders, including communities and front-line staff; providing the time, space, and support necessary for the project to succeed; agreeing on clear objectives from the outset; and support for data collection, evaluation, and shared learning. At policy level, more fundamental challenges related to the parameters for pilot projects, in particular, the typically short-term nature of funding, with an expectation of results within 2-3 years. Changing expectations about outcome measures or project guidance part-way through project implementation was also identified as a key challenge. Primary care transformation requires coproduction and a rich, contextual understanding of local needs and complexities. However, a mismatch between policy objectives (care redesign to better meet patient needs) and policy parameters (short timeframes) is often a significant challenge to success.

Challenges in implementing GP clusters in Scotland: a qualitative study comparing the views of senior primary care stakeholders in 2016 with those in 2021.

Formation of GP clusters began in Scotland in April 2016 as part of a new Scottish GP contract. They aim to improve the care quality for local populations (intrinsic role) and the integration of health and social care (extrinsic role). To compare predicted challenges of cluster implementation in 2016 with reported challenges in 2021. Qualitative study of senior national stakeholders in primary care in Scotland. Qualitative analysis of semi-structured interviews with 12 senior primary care national stakeholders in 2016 (n = 6) and 2021 (n = 6). Predicted challenges in 2016 included balancing intrinsic and extrinsic roles, providing sufficient support, maintaining motivation and direction, and avoiding variation between clusters. Progress of clusters in 2021 was perceived as suboptimal and was reported to vary significantly across the country, reflecting differences in local infrastructure. Practical facilitation (data, administrative support, training, project improvement support, and funded time) and strategic guidance from the Scottish Government was felt to be lacking. GP engagement with clusters was felt to be hindered by the significant time and workforce pressures facing primary care. These barriers were considered as collectively contributing to cluster lead 'burnout' and loss of momentum, exacerbated by inadequate opportunities for shared learning between clusters across Scotland. Such barriers preceded, but were perpetuated by, the impact of the COVID-19 pandemic. Apart from the COVID-19 pandemic, many of the challenges reported by stakeholders in 2021 were predicted in 2016. Accelerating progress in cluster working will require renewed investment and support applied consistently across the country.

Interrogating assumptions about the relationship between service providers and recipients: Learning from a new service for survivors of In Care Abuse

Understanding the dynamic relationship between service providers and the people who use their services is key to effective evaluation. This paper presents a practical approach to embedded evaluation that can be used by services to interrogate assumptions about relationships. The approach includes a simple framework for developing theories of change that centres relational aspects of the change process. This framework is complemented by a structured approach to surfacing risks and assumptions. Using the example of the evaluation of Future Pathways, a new and ground breaking service provided to people who experienced abuse or neglect as children In Care in Scotland, the paper describes how this approach was used in practice. Focusing in on assumptions identified by the service around trust, the paper describes the process undertaken to interrogate these assumptions through data collection with people using the service and staff. This process led to rich learning to support the development of the service as well as the identification of new elliptical assumptions. The paper concludes by sharing reflections on the learning from this work for the wider evaluation community highlighting the need for evaluators to take a relational approach to interrogating assumptions about relationships.

COVID-19 infection and maternal morbidity in critical care units in Scotland: a national cohort study

BackgroundPrevious research has shown that, in comparison with non-pregnant women of reproductive age, pregnant women with COVID-19 are more likely to be admitted to critical care, receive invasive ventilation, and die. At present there are limited data in relation to outcomes and healthcare utilisation following hospital discharge of pregnant and recently pregnant women admitted to critical care. MethodsA national cohort study of pregnant and recently pregnant women who were admitted to critical care in Scotland with confirmed or suspected COVID-19. We examined hospital outcomes as well as hospital re-admission rates. ResultsBetween March 2020 and March 2022, 75 pregnant or recently pregnant women with laboratory-confirmed COVID-19 were admitted to 24 Intensive Care Units across Scotland. Almost two thirds (n=49, 65%) were from the most deprived socio-economic areas. Complete 90-day acute hospital re-admission data were available for 74 (99%) patients. Nine (12%) women required an emergency non-obstetric hospital re-admission within 90 days. Less than 5% of the cohort had received any form of vaccination. ConclusionsThis national cohort study has demonstrated that pregnant or recently pregnant women admitted to critical care with COVID-19 were more likely to reside in areas of socio-economic deprivation, and fewer than 5% of the cohort had received any form of vaccination. More targeted public health campaigning across the socio-economic gradient is urgently required.

Developing social entrepreneurship through public procurement: a wicked problem!

PurposeThis paper explores attempts to deliver socioeconomic benefit by developing social enterprise within the public sector supply chain.Design/methodology/approachA case study approach is adopted which focusses on the implementation of public procurement policy intended to support social entrepreneurs (SEs) in the delivery of social care in Scotland. Socio-technical systems theory (STST) is adopted as a lens through which to explore the case.FindingsWhile acknowledging the contextual limits of the case study, the empirical findings recognise partial implementation of the measures intended to develop social entrepreneurship in the supply chain. The results, however, suggest that both the engagement levels of SEs and the expected socio economic benefits are yet to accrue fully.Social implicationsThe paper concludes that in order to achieve the expected social benefits further progress is required in engaging SEs in formal collaborations with larger, potentially for profit, organisations and also in their increased involvement in the design and commissioning of public services.Originality/valueThe innovative, cross-sectional research design uses a survey based, gap analysis to provide a nuanced comparison between the views of local authority procurement officers and the opinions prevalent within social enterprise care providers and thereby to assesses the effectiveness of public policy.

Educational and health outcomes of schoolchildren in local authority care in Scotland: a retrospective record linkage study.

ObjectivesLooked-after-children are defined as children who are in the care of their local authority. Previous studies have reported that looked-after-children have poorer mental and physical health, increased behavioural problems, and increased self-harm and mortality compared to peers. They also experience poorer educational outcomes yet population wide research into the latter is lacking, particularly in the UK. Education and health share a bidirectional relationship therefore it is important to dually investigate both outcomes. Our study aimed to compare educational and health outcomes for looked-after-children with peers, adjusting for sociodemographic, maternity and comorbidity confounders.
 ApproachLinkage of nine Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, examinations, school absences/exclusions, unemployment, and looked-after-children provided retrospective data on 715,111 children attending Scottish schools between 2009 and 2012.
 ResultsCompared to peers, 13,898 (1.9%) looked-after-children were more likely to be absent and excluded from school, have special educational need and neurodevelopmental multimorbidity, achieve the lowest level of academic attainment, and be unemployed after leaving school. They were more likely to require treatment for epilepsy, attention deficit hyperactivity disorder and depression, be hospitalised overall, for injury and self-harm, and die prematurely. Compared to children looked after at home, children looked after away from home had less absenteeism, less exclusion, less unemployment, and better attainment. Therefore, amongst those in care, being cared for away from home appeared to be a protective factor resulting in better educational outcomes.
 ConclusionsLooked-after-children had poorer health and educational outcomes than peers independent of increased neurodevelopmental conditions and special educational need. Further work is required to understand whether poorer outcomes relate to reasons for entering care, including maltreatment and adverse childhood events, neurodevelopmental vulnerabilities, or characteristics of the care system.

Primary care transformation in Scotland: qualitative evaluation of the views of national senior stakeholders and cluster quality leads.

Primary care transformation in Scotland aims to improve population health, reduce health inequalities, and reduce GP workload. Two key strategies (formalised in April 2018 in the new Scottish GP contract [Scottish General Medical Services contract], although started in early 2016) are the expansion of the multidisciplinary team (MDT) and GP cluster working. To explore progress in the implementation of the GP contract in Scotland in terms of the MDT and cluster working. Qualitative study with key national primary care stakeholders (PCSs) (n = 6) and cluster quality leads (CQLs) in clusters serving urban high deprivation areas (n = 4), urban mixed areas (n = 4), and remote and rural areas (n = 4). Semi-structured interviews with thematic analysis. There was general support for the initial aims of the new GP contract but all interviewees felt that progress on both MDT expansion and cluster working was slow, even before the pandemic. None of the CQLs (and few PCSs) felt that GP workload had reduced significantly, nor that the care of patients with complex needs had improved. Lack of time and poorly developed relationships were key barriers, as was a lack of relevant primary care data, and additional support (including guidance, administration, training, and protected time). Key PCSs and CQLs in different areas of Scotland report limited progress in primary care transformation, only partly related to the pandemic. There is a need for better workforce planning and support if the new GP contract is to succeed in transforming primary care in Scotland.

Associations between declining antibiotic use in primary care in Scotland and hospitalization with infection and patient satisfaction: longitudinal population study.

BackgroundReducing antibiotic use is central to antimicrobial stewardship, but may have unintended consequences.ObjectivesTo examine associations between size of decline in antibiotic prescriptions in general practices and (i) rate of hospitalization for infection and (ii) patient satisfaction.MethodsRoutine data analysis for all general practices in Scotland, quarter one 2012 (Q1 2012) to quarter one 2018 (Q1 2018). Practices were grouped into quartiles of rate of change in prescribing and changes in rates of hospitalization were compared across groups. For satisfaction analysis, associations between practice-level patient satisfaction in 2017–18 (Scottish Health and Care Experience Survey) and prior change in antibiotic prescription were examined.ResultsAntibiotic prescriptions overall fell from 194.1 prescriptions/1000 patients in Q1 2012 to 165.3 in Q1 2018 (14.9% reduction). The first quartile of practices had a non-significant increase in prescriptions [change per quarter = 0.22 (95% CI −0.42 to 0.86) prescriptions/1000 patients], compared with large reductions in the other three groups, largest in quartile four: −2.95 (95% CI −3.66 to −2.24) prescriptions/1000 patients/quarter (29.7% reduction overall). In all quartiles, hospitalizations with infection increased. The increase was smallest in quartile four (the biggest reduction in prescriptions) and highest in quartile one (no significant change in prescriptions): 2.18 (95% CI 1.18 to 3.19) versus 3.68 (95% CI 2.64 to 4.73) admissions/100 000 patients/quarter, respectively [difference = − 1.50 (95% CI −2.91 to −0.10)]. There was no statistically significant association between change in antibiotic prescriptions and patient satisfaction.ConclusionsVery large reductions in antibiotic prescriptions in Scottish general practices have not been associated with increases in hospitalization with infection or changes in patient satisfaction.

Transforming primary care in Scotland: a critical policy analysis.

Transforming primary care in Scotland: a critical policy analysis.

People at the Centre: Designing and Delivering National Engagement on Health and Social Care in Scotland

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Impact on emergency and elective hospital-based care in Scotland over the first 12 months of the pandemic: interrupted time-series analysis of national lockdowns.

COVID-19 has resulted in the greatest disruption to National Health Service (NHS) care in its over 70-year history. Building on our previous work, we assessed the ongoing impact of pandemic-related disruption on provision of emergency and elective hospital-based care across Scotland over the first year of the pandemic. We undertook interrupted time-series analyses to evaluate the impact of ongoing pandemic-related disruption on hospital NHS care provision at national level and across demographics and clinical specialties spanning the period 29 March 2020-28 March 2021. Scotland, UK. Patients receiving hospital care from NHS Scotland. We used the percentage change of accident and emergency attendances, and emergency and planned hospital admissions during the pandemic compared to the average admission rate for equivalent weeks in 2018-2019. As restrictions were gradually lifted in Scotland after the first lockdown, hospital-based admissions increased approaching pre-pandemic levels. Subsequent tightening of restrictions in September 2020 were associated with a change in slope of relative weekly admissions rate: -1.98% (-2.38, -1.58) in accident and emergency attendance, -1.36% (-1.68, -1.04) in emergency admissions and -2.31% (-2.95, -1.66) in planned admissions. A similar pattern was seen across sex, socioeconomic status and most age groups, except children (0-14 years) where accident and emergency attendance, and emergency admissions were persistently low over the study period. We found substantial disruption to urgent and planned inpatient healthcare provision in hospitals across NHS Scotland. There is the need for urgent policy responses to address continuing unmet health needs and to ensure resilience in the context of future pandemics.

Survey to identify research priorities for primary care in Scotland during and following the COVID-19 pandemic

ObjectivesTo identify research priorities for primary care in Scotland following the COVID-19 pandemic.DesignModified James Lind Alliance methodology; respondents completed an online survey to make research suggestions and rank research themes...

P262 The occurrence and characteristics of severe pain in patients with axial spondyloarthritis

Abstract Background/Aims Pharmacological management of axial spondylarthritis (axSpA) seeks to control inflammation. Even if successful, available evidence suggests that many patients continue to experience pain. The aim of the current study was to determine the prevalence and characteristics of severe pain among persons with axSpA. Methods The Scotland Registry for Ankylosing Spondylitis (SIRAS) collected clinical and patient-reported data from adults seen in secondary care in Scotland with a clinical diagnosis of ankylosing spondylitis. Questionnaires asked about severe pain (high pain intensity; high pain interference; and extreme/unbearable pain), lifestyle, and various aspects of health. The relationship between severe pain and clinical/patient-reported factors was assessed using logistic regression. Results 929 participants had pain data available (73% male; median symptom duration 20yrs). High pain intensity and pain interference were more common (57% and 42%) than extreme/unbearable pain (11%). Prevalence did not differ with age, although women were less likely to report severe pain than men (Odds Ratios (ORs) 0.56-0.61) as were those with longer duration of education, and those from more affluent areas. The odds of severe pain increased with every 1 unit increase in BASFI (ORs 1.44-1.56). Strong associations were also seen with disease activity, spinal mobility, fatigue, poor sleep, and worse quality of life. Conclusion In axSpA, severe pain is common, with a clear socio-economic gradient and major impact on quality of life. Rheumatologists need to be aware of the large unmet need in terms of pain management in this patient group with around 1 in 9 patients reporting extreme/unbearable pain. Disclosure G.T. Jones: Grants/research support; Research grant income for biologics registers in axSpA and PsA from the British Society for Rheumatology. The Society receives income from AbbVie, Pfizer, UCB and Amgen to support these registers, current analysis funded by GlaxoSmithKline who were provided with a copy of the results prior to submission. O. Rotariu: None. L.E. Dean: None. A.G. MacDonald: None. G.J. Macfarlane: Grants/research support; Research grant income for biologics registers in axSpA and PsA from the British Society for Rheumatology. The Society receives income from AbbVie, Pfizer, UCB and Amgen to support these registers, current analysis was funded by GlaxoSmithKline who were provided with a copy of the manuscript prior to submission.

A realist evaluation case study of the implementation of advanced nurse practitioner roles in primary care in Scotland.

AimTo evaluate Advanced Nurse Practitioner (ANP) role implementation in primary care across Scotland in contributing to primary care transformation, and establish what works, for whom, why and in what context.DesignA realist evaluation using multiple case studies.MethodsTwo phases, conducted March 2017 to May 2018: (1) multiple case studies of ANP implementation in 15 health boards across Scotland, deductive thematic analysis of interviews, documentary analysis; (2) in‐depth case studies of five health boards, framework analysis of interviews and focus groups.ResultsSixty‐eight informants were interviewed, and 72 documents were reviewed across both phases. ANP roles involved substitution for elements of the GP role for minor illness and injuries, across all ages. In rural areas ANPs undertook multiple nursing roles, were more autonomous and managed greater complexity. Mechanisms that facilitated implementation included: the national ANP definition; GP, primary care team and public engagement; funding for ANP education; and experienced GP supervisors. Contexts that affected mechanisms were national and local leadership; remote, rural and island communities; and workload challenges. Small‐scale evaluations indicated that ANPs: make appropriate decisions; improve patient access and experience.ConclusionsAt the time of the evaluation, the implementation of ANP roles in primary care in Scotland was in early stages. Capacity to train ANPs in a service already under pressure was challenging. Shifting elements of GPs workload to ANPs freed up GPs but did little to transform primary care. Local evaluations provided some evidence that ANPs were delivering high‐quality primary care services and enhanced primary care services to nursing homes or home visits.ImpactANP roles can be implemented with greater success and have more potential to transform primary care when the mechanisms include leadership at all levels, ANP roles that value advanced nursing knowledge, and appropriate education programmes delivered in the context of multidisciplinary collaboration.

Pharmacists in primary care in Scotland: a mixed-methods exploration of pharmacists’ perceptions of a national educational resource package

Abstract Introduction There is growing pressure on primary care, which has resulted in an increased number of clinical pharmacists working within the setting. To help support this growing workforce in their role and with their development, several countries have created educational resources. Within Scotland, an educational resource package was created for pharmacists working in General Practice, containing a Competency and Capability Framework, an online platform and educational and clinical supervision. The implementation of these resources in Scotland has not been evaluated thus far, therefore it is unclear to what extent they may support and facilitate pharmacists in their professional role. Aim The aim of this project was to assess pharmacists’ perceptions of the educational resource package available to General Practice pharmacists in Scotland. Methods A mixed-methods study comprising an online questionnaire and semi-structured telephone interviews was undertaken between July and October 2019. The questionnaire sought to provide a more representative overview, with the interviews designed to gain an in-depth understanding, to support the development of recommendations to improve the educational resource package. A previously validated, online questionnaire (1) was used to explore pharmacists’ view on the adoption, acceptability, appropriateness, and feasibility of the educational resources based on Proctor’s model of implementation outcomes (2); similarly, the semi-structured telephone interviews explored pharmacists’ experiences with the resources, in addition to inquiring about its adoption, acceptability, appropriateness, and feasibility. The questionnaire included a Likert scale and free-text questions; quantitative responses were summarised, whereas the qualitative answers underwent a content analysis directed by Proctor’s implementation outcomes. The interview results were structured using the framework approach, with the data undergoing a thematic or summative content analysis. Results Overall, 52 pharmacists completed the questionnaire and 12 participated in the interviews. The results indicated widespread adoption and acceptance of the educational resource package. The level of acceptance was influenced by the perceived purpose of completing the resources, such as if they believed it provided development opportunities. Its appropriateness depended on the pharmacist’s individual situation since previous experiences and current job role differed. Additionally, several barriers complicated the feasibility of the resources, such as insufficient support and guidance. Conclusion The adoption and acceptance of the educational resource package for General Practice pharmacists in Scotland indicated its suitability for supporting their role; however, further facilitation would enhance their engagement with the resources, and potentially improve their perception of its appropriateness and feasibility. Despite the limited sample size, the study provided an in-depth understanding of general practice pharmacists perceptions of the educational recourse package, based on an established model. References (1) Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65-76. (2) Weiner BJ, Lewis CC, Stanick C, et al. Psychometric assessment of three newly developed implementation outcome measures. Implement Sci. 2017; 12(1): 108.

Pharmacists in primary care in Scotland: an exploration of competencies required for the provision of pharmacy services within general practice

Abstract Introduction Efforts are increasingly being made to implement pharmacists working in General Practice to support General Practitioners and alleviate pressure, mainly by providing pharmacotherapy services such as medication reviews and authorising prescribing requests (1). While there is wide interest in the contributions pharmacists can make within primary care, there is limited research exploring the competencies pharmacists need to safely and effectively provide care in this area. Aim The aim of this project was to identify competencies required for pharmacists providing pharmacotherapy services in General Practice. Methods Modified eDelphi study (2), comprising a series of online questionnaires conducted between July 2019 and January 2020. Participants were pharmacists working in General Practice in Scotland. The first questionnaire consisted of open-ended questions aimed at generating a list of competencies; competency categories and individual competency items relating to pharmacotherapy service tasks were identified based on the free text responses using content analysis. Subsequently, the second questionnaire aimed to establish consensus regarding the importance of the collected competencies, using a rating scale from 1 (“not important”) to 10 (“very important”); participants’ scores were aggregated using modes and medians, and the level of agreement among participants with regards to the importance of competencies was evaluated by calculating the percentage of scores between 8 and 10. Due to the novelty of this work and the resultant uncertainty surrounding participants’ responses, no cut-off point for agreement was pre-specified. Results Overall, 10 pharmacists completed the first questionnaire, and 11 completed the second. Building on the findings from the first questionnaire, a framework of competencies necessary to provide pharmacotherapy services in General Practice was developed, comprising eight competency categories, with a total of 31 individual competency items: General Skills (e.g. ability to record patient information); IT Skills (e.g. ability to use GP computer system to update documentation); Legal & Professional Frameworks (e.g. understanding of clinical guidelines); Procedural Skills (e.g. ability to arrange follow-up); Multidisciplinary Team Communication Skills (e.g. ability to communicate with others within the GP practice); Consultation Skills (e.g. ability to take a complete history); Clinical Knowledge (e.g. knowledge related to conditions being treated); and Clinical Skills (e.g. ability to interpret clinical information). All eight competency categories were considered important across the pharmacotherapy service, with high agreement (between 71 and 85%) among participants. Conclusion Using a bottom-up, exploratory approach, this study confirmed that practicing within the General Practice setting requires a wide set of competencies, including – but not limited to – advanced clinical and consultation skills. Nevertheless, findings should be interpreted cautiously due to the limited sample size; although results have tentatively been validated using a paper-based version of the second online questionnaire during an in-person event with General Practice pharmacists, results might not be reflective of all pharmacists working in this setting. References (1) Scottish Government. (2017). The 2018 General Medical Services Contract in Scotland. Retrieved from https://www.glasgowlmc.co.uk/download/contract%20and%20contractural%20Issues/The-2018-General-Medical-Services-Contract-in-Scotland.pdf (2) Hsu, C. C., & Sandford, B. A. (2007). The Delphi technique: Making sense of consensus. Practical Assessment, Research & Evaluation, 12, Article10. https://doi.org/10.7275/pdz9-th90

The expanding backlog of mental health patients and the continued toll of zero-COVID policy on healthcare settings

Aim and Scope: Prior research has shown that isolation measures implemented to contain previous pandemics had led to negative impacts on mental health. There has been increased awareness of mental health issues over the past few years with more patients encouraged to seek help. Nevertheless, operational restrictions imposed on the health services to contain COVID-19 have resulted in reduced capacity in the health service. We have aimed to measure the combined effects of increased demand and reduction in capacity on the backlog of patients awaiting access to specialist care in Scotland. Design: To quantify the effect that the present pandemic has had on access to specialist care, comprehensive data on referrals by general practitioners (GPs) for specialist mental health support was obtained for 2016-2020 period following Freedom of Information (FOI) requests to all 14 health boards of National Health Service (NHS) Scotland. Results: Monthly GP referral counts accumulated across all health boards revealed the extent of demand for specialist mental health support. Prior to the pandemic there was a 4-5% annual rise in the number of mental health related GP referrals in Scotland. Pandemic related restrictions imposed to curb infections has led to a higher incidence of mental health problems. However, there was a 27% drop in referrals in 2020 alone, affecting an estimated 43,522 patients. The reduction on mental health provisions is similar in profile to the drop in number of planned hospital admissions. Conclusions: Policies to combat COVID-19 resulted in significant negative impacts on the mental health of the population. The continued restrictions on healthcare settings limit their operations, resulting in long waiting lists for accessing specialist care. Despite some easing for restrictions on public, restrictions on healthcare settings place strict limits on their operations and therefore are detrimental to public health.

P-OGC77 Why curative treatment rates are so low for stage I/II Oesophago-gastric cancer in the West of Scotland? – A five year review

Abstract Background Over the last decade, quality performance indicators (QPIs) have been used to drive improvements in cancer care in Scotland. QPI-11 targets curative treatment rates for oesophago-gastric (OG) cancer and this target has been consistently missed. This study aimed to investigate why patients with potentially curable Stage I and II OG cancer did not receive curative treatment. Methods The West of Scotland MCN database was interrogated for patients with newly diagnosed stage I and II OG cancer between January 2015 and December 2019 to identify those patients who did not have curative treatment. Electronic records were then analyzed and the reason for the non curative treatment recorded. Results 260 patients (mean age 78.3 ± 9 years; 114 (43.8%) female) were identified. Median Scottish Index of Multiple Deprivation was 4 (IQR 2-7). There were 159 (61.2%) oesophageal cancers, 196 (75.4%) adenocarcinomas and 174 (66.9%) were Stage II cancers. Formal CPEX fitness was assessed in only 20 patients (7.7%). Reasons for curative treatment not being received were as follows: not clinically fit (n = 216 (83.1%)); patient declined curative treatment (n = 17 (6.5%)); disease progression (n = 16 (6.2%)) and identification of synchronous cancers (n = 9 (3.5%)). Conclusions Lack of fitness for radical treatment is the predominant reason for Stage I and II OG cancer patients in the West of Scotland not being treated with curative intent. This may be related to the previously described “West of Scotland” effect on health comorbidities.

Front door admission avoidance

Purpose: The six Essential Actions of Improving Unscheduled Care in Scotland focuses on developing the relationships between Health and Social Care Partnerships, by reducing hospital admissions and to ensure a timely discharge of patients from hospital.