Hospitals NHS Research Articles

The Impact of Race and Gender-Related Discrimination on the Psychological Distress Experienced by Junior Doctors in the UK: A Qualitative Secondary Data Analysis.

Almost half of NHS doctors are junior doctors, while high proportions are women and/or Black, Asian, and Minority Ethnic (BAME) individuals. Discrimination against this population is associated with poorer career-related outcomes and unequal representation. We aimed to qualitatively explore junior doctors' experience of workplace racial and gender-based discrimination, and its impact on their psychological distress (PD). In this study, we carried out a secondary analysis of data from a UK-based parent study about junior doctors' working cultures and conditions. Interview data was examined using thematic analysis. Transcripts (n = 14) documenting experiences of race and/or gender-based discrimination were sampled and analysed from 21 in-depth interviews conducted with UK junior doctors. Four themes were generated about the experiences and perpetrators of discrimination, the psychological impact of discrimination, and organisational interventions that tackle discrimination. Discrimination in various forms was reported, from racially charged threats to subtle microaggressions. Participants experienced profoundly elevated levels of PD, feeling fearful, undermined, and under-confident. Discrimination is associated with elevated levels of PD, whilst negatively impacting workforce sustainability and retention. This reduces the opportunity for more diversity in NHS medical leadership. We encourage NHS hospitals to review their policies about discrimination and develop in-person workshops that focus on recognising, challenging, and reporting workplace discrimination.

Prosocial voice in the hierarchy of healthcare professionals: the role of emotions after harmful patient safety incidents

PurposeSupporting and nurturing effective communication between healthcare professionals is vital to protect patients from harm. However, not all forms of employee voice are effective. Fear can lead to defensive voice, while the role of other emotions to drive voice behaviour is less well understood. This paper aims to understand what role the broader range of emotions, including compassion and shame, experienced by healthcare professionals following patient safety incidents (PSI) play in the subsequent enactment of prosocial voice, a positive and other-oriented form of communication.Design/methodology/approachThis study is based on data from a single English NHS hospital: interviews with healthcare professionals involved in PSIs (N = 40), observations at quality and risk committees and meetings (N = 26 h) and review of investigative documents (N = 33). Three recent PSIs were selected for cross-case analysis based upon organisational theory related to professional hierarchy, employee voice and literature on emotions.FindingsAmong three cases, the authors found variance in context, emotional experience and voice behaviour. Where professionals feared blame and repercussion, voice was defensive. Meanwhile where they experienced shame and compassion, prosocial voice was enacted to protect patients.Practical implicationsHealthcare organisations seeking to foster prosocial voice should: (1) be more considerate of professionals' emotional experiences post-PSI and ensure adequate support for recovery (2) establish norms for professionals to share their struggles with others (3) reward professionals who demonstrate caring behaviour (4) buffer professionals from workplace pressures.Originality/valueThe authors’ study highlights how emotional experiences, such as shame and compassion, can mediate blame and defensiveness and lead to the enactment of prosocial voice in the professional hierarchy.

Gestational age and hospital admission costs from birth to childhood: a population-based record linkage study in England

ObjectiveTo examine the association between gestational age at birth and hospital admission costs from birth to 8 years of age.DesignPopulation-based, record linkage, cohort study in England.SettingNational Health Service (NHS) hospitals...

The resignations among nurses in the Veneto healthcare institutions. A retrospective study

The phenomenon of large-scale resignations is complex, heterogeneous and cannot be attributed solely to the pandemic crisis, during which many people reconsidered the role of work in their lives. The health system was particularly exposed to the shocks caused by the pandemic. To describe the turnover and analyse the resignations of nurses in the NHS hospitals and districts of the Veneto Region. The hospitals were categorised into 4 types: Hub and Spoke of level 1 and 2. The positions of nurses with permanent contracts between 1 January 2016 and 31 December 2022 were analysed, considering active, nurses on duty for at least one day. The data were extracted from the human resource management database of the Region. Unexpected resignations were considered those occurring before the retirement date (59 years for women and 60 for men). Negative and overall turnover rates were calculated. The risk of unexpected resignations was increased for nurses not resident in Veneto, of male gender and employed at a Hub hospital. The flight from the NHS is in addition to the physiological flow of retirements, due to increase in the coming years. It is necessary to: act on the retention capacity and attractiveness of the profession; implement organisational models based on task sharing and shifting; implement digital tools; favour flexibility and mobility to improve the balance between work and personal life; efficiently integrate professionals quali-fied abroad.

P633 Choice of first biologic in moderate to severe ulcerative colitis – a decision analysis using time-on-treatment and UK costs

Abstract Background Vedolizumab and anti-TNFα drugs are biologics that are used to treat moderate to severe ulcerative colitis (UC). In the UK, the decision of which drug to use at first-line is often based on a combination of clinical factors and the price of the drug (based on the one-year cost analysis from the NICE appraisal). The cost of the treatment pathway is rarely considered. Therefore, we investigated whether the choice of first-line biologic affects time-on-treatment and the overall treatment pathway costs by creating a cost model for vedolizumab followed by an anti-TNFα (VDZ–anti-TNFα) compared to anti-TNFα followed by vedolizumab (anti-TNFα–VDZ). Methods A targeted literature search identified 19 studies reporting time-on-treatment data for vedolizumab or anti-TNFαs in UC. We pooled data into four categories: 1) vedolizumab in people who were biologic-naïve (VDZ-1L), 2) anti-TNFα in people who were biologic-naïve (anti-TNFα-1L), 3) vedolizumab after first-line anti-TNFα (VDZ-2L) and 4) anti-TNFα after first-line vedolizumab (anti-TNFα-2L). We then fitted parametric curves to inform time-on-treatment estimates for each category. We calculated ‘direct’ treatment costs by considering drug acquisition, drug administration, dose escalation, concomitant use of immunomodulators and drug monitoring; all costs were sourced from four NHS hospital trusts (cost year 2022). As the duration of the anti-TNFα–VDZ pathway was shorter in duration than VDZ–anti-TNFα (62- vs 44-months), we modelled third line options in the shorter pathway using a weighted basket approach. Third line options included colectomy, tofacitinib, ustekinumab or dose escalation of second-line biologic. Results Over the 62-month time horizon (duration of the longer VDZ–anti-TNFα pathway), pathway costs per patient were similar: £41,439 for VDZ–anti-TNFα and £48,027 for anti-TNFα–VDZ (or £8,021 per year and £9,295 per year, respectively). The model predicted that using vedolizumab first-line delayed the time to costly third-line therapies compared to first-line anti-TNFα. This delay resulted from the pooled time-on-treatment data: VDZ-1L median time-on-treatment 43-months (n=585 people) and anti-TNFα-2L 19-months (n=47); anti-TNFα-1L 17-months (n=7690) and VDZ-2L 27-months (n=549). Conclusion When viewed over a longer period and considering all associated direct costs, a biologic treatment pathway that begins with first-line vedolizumab is not more expensive than one beginning with first-line anti-TNFα in treating moderate to severe UC in the UK. The model shows that considering the longer-term costs of a treatment pathway can give a different result compared to considering the short-term costs of single therapies alone.

Kicking the glove habit

British Journal of NursingVol. 32, No. 2 EditorialKicking the glove habitAndrew BartonAndrew Barton(E-mail Address: [email protected])Nurse Consultant, Vascular Access and IV Therapy, Frimley Health NHS Foundation Trust, and Chair, NIVASSearch for more papers by this authorAndrew BartonPublished Online:30 Jan 2023https://doi.org/10.12968/bjon.2023.32.2.S3AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References European Centre for Disease Prevention and Control. Use of gloves in healthcare and non-healthcare settings in the context of the COVID-19 pandemic. 2020. https://tinyurl.com/mwc4suc8 (accessed 16 January 2023) Google ScholarHealth and Safety Executive. The use of gloves. 2022a. https://tinyurl.com/ypwhc5rf (accessed 16 January 2023) Google ScholarHealth and Safety Executive. Safe handling of cytotoxic drugs in the workplace. 2022b. https://tinyurl.com/4s8f374j (accessed 16 January 2023) Google ScholarLoveday HP, Wilson JA, Pratt RJ et al. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2014;86(Suppl 1):S1-70. https://doi.org/10.1016/S0195-6701(13)60012-2 Crossref, Medline, Google ScholarWilson J, Bak A, Loveday HP. Applying human factors and ergonomics to the misuse of nonsterile clinical gloves in acute care. Am J Infect Control. 2017;45(7):779-786. https://doi.org/10.1016/j.ajic.2017.02.019 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 26 January 2023Volume 32Issue 2ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 30 January 2023 Published in print 26 January 2023 Information© MA Healthcare LimitedPDF download

Mental health problems and admissions to hospital for accidents and injuries in the UK military: A data linkage study.

Accidents are the most common cause of death among UK military personnel. It is a common misconception in the general public that accidental injuries are always the result of random events, however research suggests that mental health problems and the increased levels of risky behaviour in military personnel may play a role. The objective of this study was to further our understanding of injuries and deaths not related to deployment by examining the associations of mental health, alcohol misuse and smoking with inpatient admission to hospital for accidents and injuries, and attendance to accident and emergency (A&E) departments. Data on all hospital admissions for accidents and injuries and A&E attendance at NHS hospitals in England, Scotland and Wales were linked to data on self-reported mental health problems, alcohol misuse and smoking from a large, representative UK military cohort of serving and ex-serving personnel (n = 8,602). Logistic regression was used to examine the associations between having a hospital admission for an accident or injury with self-reported mental health problems, alcohol misuse and smoking. Cox proportional-hazards regression was then conducted to assess the associations of mental health problems, alcohol misuse and smoking with time to hospital admission for an accident or injury. Finally, negative binomial regression was used to examine associations between the number of A&E attendances with mental health problems, alcohol misuse and smoking. Personnel reporting symptoms of common mental disorder (CMD) or probable post-traumatic stress disorder (PTSD) were more likely to have an admission to hospital for an accident or injury (fully adjusted odds ratio 1.39, 95% confidence interval [CI] 1.05-1.84), than those who did not report these symptoms, and also had more attendances to A&E (fully adjusted incidence rate ratio [IRR] 1.32, 95% CI 1.16-1.51). A&E attendances were also more common in personnel who were smokers (fully adjusted IRR 1.21, 95% CI 1.09-1.35) following adjustment for demographic, military and health characteristics. The findings suggest that accidents and injuries among military personnel are not always random events and that there are health and behavioural factors, including poor mental health and smoking, which are associated (with small effect sizes) with an increased risk of being involved in an accident. Clinicians treating individuals attending hospital after an accident should consider their healthcare needs holistically, including issues related to mental health and health damaging behaviours.

Investigating the Relationship between Fear of Failure and the Delivery of End-of-Life Care: A Questionnaire Study

To investigate whether fear of failure (FOF) influences a clinician's perception of how confident and comfortable they are in their delivery of end-of-life (EOL) care. Cross-sectional questionnaire study with recruitment of physicians and nurses across two large NHS hospital trusts in the UK and national UK professional networks. A total of 104 physicians and 101 specialist nurses across 20 hospital specialities provided data that were analysed using a two-step hierarchical regression. The study validated the PFAI measure for use in medical contexts. Number of EOL conversations, gender, and role were shown to impact confidence and comfortableness with EOL care. Four FOF subscales did show a significant relationship with perceived delivery of EOL care. Aspects of FOF can be shown to negatively impact the clinician experience of delivering EOL care. Further study should explore how FOF develops, populations that are more susceptible, sustaining factors, and its impact on clinical care. Techniques developed to manage FOF in other populations can now be investigated in a medical population.

Multiple pathways of SARS-CoV-2 nosocomial transmission uncovered by integrated genomic and epidemiological analyses during the second wave of the COVID-19 pandemic in the UK.

Throughout the global COVID-19 pandemic, nosocomial transmission has represented a major concern for healthcare settings and has accounted for many infections diagnosed within hospitals. As restrictions ease and novel variants continue to spread, it is important to uncover the specific pathways by which nosocomial outbreaks occur to understand the most suitable transmission control strategies for the future. In this investigation, SARS-CoV-2 genome sequences obtained from 694 healthcare workers and 1,181 patients were analyzed at a large acute NHS hospital in the UK between September 2020 and May 2021. These viral genomic data were combined with epidemiological data to uncover transmission routes within the hospital. We also investigated the effects of the introduction of the highly transmissible variant of concern (VOC), Alpha, over this period, as well as the effects of the national vaccination program on SARS-CoV-2 infection in the hospital. Our results show that infections of all variants within the hospital increased as community prevalence of Alpha increased, resulting in several outbreaks and super-spreader events. Nosocomial infections were enriched amongst older and more vulnerable patients more likely to be in hospital for longer periods but had no impact on disease severity. Infections appeared to be transmitted most regularly from patient to patient and from patients to HCWs. In contrast, infections from HCWs to patients appeared rare, highlighting the benefits of PPE in infection control. The introduction of the vaccine at this time also reduced infections amongst HCWs by over four-times. These analyses have highlighted the importance of control measures such as regular testing, rapid lateral flow testing alongside polymerase chain reaction (PCR) testing, isolation of positive patients in the emergency department (where possible), and physical distancing of patient beds on hospital wards to minimize nosocomial transmission of infectious diseases such as COVID-19.

Our experience in developing and operating the Airway Intervention Registry for Recurrent Respiratory Papillomatosis (AIR-RRP): national data collection [version 2; peer review: 2 approved

Recurrent respiratory papillomatosis (RRP) is characterised by benign wart-like growths in the respiratory tract caused by the human papillomavirus (HPV). These warts vary in size and grow quickly, causing voice changes and airway obstruction. Whilst the condition is rare, RRP is more common and aggressive in children. There is currently no curative treatment for HPV, therefore RRP is managed by maintaining a safe airway and a serviceable voice by repeated surgery to remove the growths. A lack of specific diagnostic codes prevents reliable case ascertainment of RRP from routine administrative databases such as Hospital Episode Statistics. In 2017 a cross-sectional survey identified 918 RRP patients in the UK, half of whom had received surgical intervention for RRP in the previous 12 months with 16 different interventions. Randomised controlled trials for RRP interventions are difficult due to the rarity of the disease, variation in severity and progression and non-standard care across the NHS. Consequently, there is a lack of definitive efficacy and safety evidence. The only national guidance for RRP interventions is "Radiofrequency cold ablation for respiratory papillomatosis" (NICE IPG434, 2017) which recommended further data collection due to lack of evidence. However, due to the wide variation in RRP management across the NHS, clinical opinion favoured that any data collection should include a comparison of safety and efficacy of all RRP interventions in order to advise which improved patient outcomes and quality of life. To address lack of evidence, and inform the future care of RRP patients, we developed a registry and used it to collect real-world data from patients receiving treatment for RRP in NHS hospitals across the UK. The purpose of this paper is to share lessons learned from this national data collection exercise to inform future clinical registry development.

The perioperative utility of 3D printed models in complex surgical care: feedback from 106 cases.

3D models are an emerging tool for surgical planning, providing an augmented method for the visualisation of a patient's anatomy. As their use increases, more data about the utility of these models is critical to inform budget allocation. This study provides the most comprehensive analysis to date for the use of 3D models in perioperative management. 3D models for complex surgical cases in NHS hospitals were delivered alongside a surgeon feedback survey. The survey on the model's utility had been designed alongside the university data analytical team and focused on five areas: surgical planning and diagnosis, economic impact, impact on intraoperative and preoperative time, effect on communication and direct impact on the patient. There were 106 models used by 63 surgeons for complex surgical cases between May 2020 and March 2021, across multiple surgical specialties. The models were reported to have benefits in all perioperative areas, with 92.5% of responses agreeing that the 3D model was a better method for diagnosis and planning than traditional 2D techniques. Benefits were reported on preoperative planning (92.4%), economic savings due to equipment selection (54.4%), reduction in surgical time (41.5%) and surgeon-to-surgeon communication (92.6%). 3D models were shown to have a wide range of benefits in a surgical setting. The reduction in surgical time could have the potential to help alleviate surgical backlogs. With more widespread use and optimisation of costs the use of 3D models could become the standard for unusual and complex surgical cases.

Vale of Leven: Britain’s First National Health Service Hospital, 1951–55

ABSTRACTWhile some of the major hospitals built in Britain following the creation of the National Health Service have attracted scholarly attention, Vale of Leven — the first NHS hospital — has been largely overlooked. Erected in 1952–55 at Alexandria, to the northwest of Glasgow, it was built with funds provided by the civil defence budget and was designed as both a potential emergency hospital during wartime and a peacetime general hospital to meet the needs of the local population. The architect, Joseph L. Gleave (1907–65), regarded the project as an opportunity to design a hospital based on the principles of the modern movement and, when it opened, it was applauded as the first ’modern’ hospital built by the NHS. As with the emergency hospitals built at the outset of the second world war, the design was based on a separation between circulation (the ’spine’) and accommodation, which comprised standardised but expandable modular units plugged into the spine, allowing flexibility for future change. Although Vale of Leven Hospital was not replicated, aspects of its planning and design were influential in the short term, and its legacy can be seen in the more compact standardised model of the nucleus hospitals developed in the 1970s.

'Groundbreaking' electronic prescription service rolled out in six NHS hospital trusts

'Groundbreaking' electronic prescription service rolled out in six NHS hospital trusts

How effectively has a Just Culture been adopted? A qualitative study to analyse the attitudes and behaviours of clinicians and managers to clinical incident management within an NHS Hospital Trust and identify enablers and barriers to achieving a Just Culture

ObjectivesJust Culture aims to improve patient safety by examining the organisational and individual factors that contribute to adverse events, enabling corrective action so that errors are not repeated. This qualitative...

Imaginaries of the data-driven hospital in a time of crisis.

This article uses the concept of sociotechnical imaginaries to explore how public hospitals are being reimagined and reconfigured by promissory digital health. Drawing on interviews with 42 senior leaders and staff from a large NHS hospital organisation, the article describes the imaginary of a data-driven hospital and the tensions of its operationalisation. These relate to data quality, data curation and data access, and reflect a discord between the organisation's commitment to immediate patient care and its research aspirations. These tensions, however, serve to invigorate, rather than undermine, the sociotechnical imaginary of a data-driven hospital, as they prompt the translation of a general data-driven imaginary into specific sociotechnical arrangements. The article argues that the potency of the data-driven hospital imaginary must be understood in terms of its enchanting qualities: it has the capacity to excite hospital staff and to align distinct and potentially diverging hopes and expectations regarding the societal role of public hospitals. The article concludes by suggesting that the entrenchment of the data-driven imaginary can be partly explained by its strategic utility for severely resource-constrained healthcare organisations: it provides a means for organisations to position themselves towards a viable future in an otherwise dire health-care context.

Health Resource Utilisation and Disparities: an Ecological Study of Admission Patterns Across Ethnicity in England Between 2017 and 2020

Background and AimThe COVID-19 pandemic highlighted adverse outcomes in Asian, Black, and ethnic minority groups. More research is required to explore underlying ethnic health inequalities. In this study, we aim to examine pre-COVID ethnic inequalities more generally through healthcare utilisation to contextualise underlying inequalities that were present before the pandemic.DesignThis was an ecological study exploring all admissions to NHS hospitals in England from 2017 to 2020.MethodsThe primary outcomes were admission rates within ethnic groups. Secondary outcomes included age-specific and age-standardised admission rates. Sub-analysis of admission rates across an index of multiple deprivation (IMD) deciles was also performed to contextualise the impact of socioeconomic differences amongst ethnic categories. Results were presented as a relative ratio (RR) with 95% confidence intervals.ResultsAge-standardised admission rates were higher in Asian (RR 1.40 [1.38–1.41] in 2019) and Black (RR 1.37 [1.37–1.38]) and lower in Mixed groups (RR 0.91 [0.90–0.91]) relative to White. There was significant missingness or misassignment of ethnicity in NHS admissions: with 11.7% of admissions having an unknown/not-stated ethnicity assignment and ‘other’ ethnicity being significantly over-represented. Admission rates did not mirror the degree of deprivation across all ethnic categories.ConclusionsThis study shows Black and Asian ethnic groups have higher admission rates compared to White across all age groups and when standardised for age. There is evidence of incomplete and misidentification of ethnicity assignment in NHS admission records, which may introduce bias to work on these datasets. Differences in admission rates across individual ethnic categories cannot solely be explained by socioeconomic status. Further work is needed to identify ethnicity-specific factors of these inequalities to allow targeted interventions at the local level.

Sharing success stories and celebrating carers

Nursing and Residential CareVol. 24, No. 12 EditorialSharing success stories and celebrating carersAdrian AshurstAdrian AshurstCorrespondence to: Adrian Ashurst; E-mail Address: [email protected]Consultant Editor, Nursing and Residential Care, London, UKSearch for more papers by this authorAdrian AshurstPublished Online:27 Dec 2022https://doi.org/10.12968/nrec.2022.0063AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Thomas R. Nurses strikes: Full list of NHS hospitals where 100,000 staff have voted for industrial action. 2022. https://www.independent.co.uk/news/health/nurse-strikes-2022-nhs-hospitals-b2238907.html (accessed 12 December 2022) Google Scholar FiguresReferencesRelatedDetails 2 December 2022Volume 24Issue 12ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 27 December 2022 Published in print 2 December 2022 Information© MA Healthcare LimitedPDF download

Preventing cardiotoxicity in patients with breast cancer and lymphoma: protocol for a multicentre randomised controlled trial (PROACT)

IntroductionAnthracyclines are included in chemotherapy regimens to treat several different types of cancer and are extremely effective. However, it is recognised that a significant side effect is cardiotoxicity; anthracyclines can...

42. Intra-operative CT scanning for mid face fracture fixation – Can we improve outcomes and introduce costs savings?

Intra-operative CT scanning is the international standard for treating mid-face fractures as it allows immediate assessment of reduction and plate positioning. To our knowledge no NHS hospital in the UK has this facility yet due to perceived cost and logistical burdens.

Are scrubs the new white coat? An exploration of MPharm students’ experiences of wearing scrubs

Abstract Introduction Many healthcare professionals and students wear uniforms while working in clinical environments which help develop professional identity, however, there is limited data regarding uniforms for pharmacy professionals in the UK.1 Historically, pharmacists and some pharmacy students wore white coats which increased professionalism, yet they are not practical with clinical roles.2 In September 2021, one UK School of Pharmacy introduced scrubs as a uniform for MPharm students for work-based learning (WBL) at several NHS hospital trusts. Aim To explore the experiences of MPharm students wearing scrubs during WBL. Methods MPharm students in years 2-4 (n=311) were invited to participate in a 5-item anonymous online questionnaire which consisted of open-ended and closed-ended questions to explore perceptions of wearing scrubs. Years 3 and 4 were asked additional questions to compare wearing scrubs with their prior WBL where they had to dress ‘’professionally’’. The data underwent descriptive and content analysis. This project received institutional ethical approval (17759-2021). Results 75 responses from years 2-4 were analysed (17%, 52%, and 31% respectively across the year groups, 24% overall response rate). Students were predominantly female (85%; n=64) and White British (52%; n=39). When asked how happy they were to wear scrubs on a Likert scale from ‘5-extremely happy’ to ‘1- not at all’, 92% (n=69) indicated they were extremely or moderately happy to wear scrubs (median=5; IQR 1). The accompanying free-text responses showed reoccurring groups of positive comments concerning: professionalism (21%), acceptance (24%), and identity (26%). Students viewed themselves as having a “shared identity, sense of professionalism and purpose and maturity” [P40]. More negative comments pertained to the sizing (13%), changing facilities (6%) and being mistaken for other professionals (9%). 44% (n=27) of year 3 and 4 students perceived a change in patients’ attitudes since wearing scrubs with 20% (n=13) citing patients as appearing more comfortable: ‘’Patients take us much more seriously - they see us as healthcare professionals rather than just students. I think it gives us greater confidence in ourselves.’’[P11]. Additionally, 39% (n=24) perceived a change in treatment from staff, with 10% of these students sharing that staff were more open to them being on the wards. ‘’we are taken more seriously by staff… there are no questions about why we are on the ward’’[P22]. Discussion/Conclusion The introduction of scrubs had a positive impact on student experience and contributed to a sense of belonging to the profession and within the ward environment. There were practical issues around sizing and changing facilities which should be considered at a local level but with mindfulness so as not to discriminate against individuals. Further data should be sought exploring the patient perspective and from students at other institutions. It should be noted that three NHS Trusts hosted placements and so there is some transferability. Scrubs are an appropriate and well-liked uniform for pharmacy students. Introducing scrubs across other Schools of Pharmacy could increase the professionalism, confidence, and socialisation of MPharm students whilst also creating a shared identity between pharmacy students, like that of the historic white coat.