NHS System Research Articles

A framework to guide the commissioning of healthcare services for people seeking asylum in England

Abstract The increasing number of people seeking asylum (PSA) in England, compounded by delays in processing their cases, has led to an urgent need for tailored practices to overcome barriers to healthcare access. While local examples of excellence in healthcare provision for PSA exist, a national framework to guide healthcare for these groups is lacking, leading to fragmentation and inconsistency in service provision. This collaborative research project with the British Red Cross took a co-production approach, involving three peer researchers with lived experience from the outset. From a literature review of case studies on improving access to healthcare for PSA, a preliminary framework of good practice was developed and explored with participants with lived experience of seeking asylum during three in-person workshops refined this. Finally, two focus groups with policymakers and healthcare professionals (HCPs) explored challenges in commissioning services, ensuring final framework relevance to the policy context. In total, 60 participants with lived experience attended three workshops and 19 policymakers and HCPs attended focus groups. Workshop participants emphasised the critical role of improving communication in healthcare settings and educating HCPs and PSA on entitlements and the NHS system. Policymakers highlighted the importance of robust leadership and a standardised national approach that can be adapted locally. Capacity constraints within the NHS and primary care system were highlighted as barriers to good quality care provision. Findings were collated into a practical framework, describing five pillars of good practice; 1)Working in partnership; 2) Upskilling the healthcare workforce; 3) Including lived experience voices; 4) Improving data on local needs; and 5) Strengthening pathways into healthcare. The framework provides guidance to enhance the accessibility, consistency and quality of healthcare services for PSA, addressing critical gaps in the current system. Key messages • A novel framework to guide commissioning and provision of healthcare for people seeking asylum has been developed, drawing from existing pockets of excellence to aid a consistent national approach. • The framework presents five pillars of systemic good practice, highlighting the importance of strategic partnerships, workforce training and data collection in providing good quality care.

SP6.5 - The NHS's value-based funding model for organ transplantation achieves superior equity and outcomes vs global peers

Abstract Introduction Value-based practice is gaining traction as a way to control costs, improve patient satisfaction, and increase provider accountability. The rising prevalence of end-stage organ disease contrasts with limited donor organs, necessitating maximising equitable access, clinical outcomes, and appropriate cost control. We compare key kidney transplant metrics across the UK, US, and Canada. Methods Parameters analysed from the 2010–2022 national registries include: (1) Policy-components, (2) Transplant rates per million population; (3) 1-5 year survival, (4) Median waiting times, (5) Average cost per patient. Inequality was assessed using the Gini-index and concentration-curves. Results The UK NHS funded >1000 kidney-transplants in 2021 under standardised pricing and coordinated care. This enabled 98% one-year patient survival, 7 percentage points higher than in the US and Canada. The median kidney waiting time is 54% lower than in Canada. The UK transplantation rate per million increased by 25% over the decade, versus a 3% rise in the US and Canada. The Gini index is 0.03 in the UK, indicating highly equitable access, versus 0.11 in the US. Average transplant costs per patient are nearly 85% lower in the UK ($130,000) than in the US ($830,000). Conclusions The integrated funding and oversight model has facilitated access, survival, and sustainability gains on kidney transplantation for the UK NHS system versus lagging peer countries. Continued value optimisation remains necessary to tackle trade-offs. High-Level Structural Comparison ParameterUnited-KingdomUnited-StatesCanadaKey Payer(s)Single: NHSMedicare, Medicaid, PrivateSingle: Provincial-plansUse of Quality-MetricsYesPartialIn ProgressPricing ModelNational-TariffFragmentedProvincialRegulatory-OversightCentralizedVariableProvincial

609 Addressing Fears of Prospective International Medical Graduates (IMGs) Joining the NHS: An Online Course to Improve Equality, Diversity, and Inclusion in the NHS

Abstract Aim The aim of this project was to identify the biggest fears of IMGs regarding the NHS and address those fears via a locally designed online course, ultimately promoting equality, diversity, and inclusion in the NHS. Method The course was created after consultation with IMGs working in the NHS, and the content was based on the Higher-Level Outcomes (HLOs) of the Foundation Programme. The course was divided into 4 sessions, delivered weekly. Each session had an initial presentation followed by an interactive question answer segment, had 3 faculty personnel, and lasted 2 hours. A good laptop with internet connection was all that was needed for the course. Results In total, 699 participants registered for the course. About 92% of them had never attended similar courses before, and about 73% has never worked in the NHS. Lack of knowledge of the NHS system (32%) and medico-legal issues (25%) were the biggest fears of prospective IMGs regarding working in the NHS. Post course feedback revealed that their confidence about working in the NHS increased by 30% after this course. Their confidence in working on-calls and building portfolio has also increased after the course by almost 26%. 78% participants said their biggest fear was addressed by this course. The question answer segment was rated helpful by 92% of participants. Conclusions This study illustrated that we could promote equality, diversity, and inclusion in the NHS by addressing the biggest fear of IMGs of not knowing the NHS system, using low resource, interactive online courses.

Afghan refugees at risk in the UK: enhancing healthcare access and integration.

Following Kabul's fall in August 2021, there was influx of Afghan refugees in the UK. Southampton's Bridging Hotel provided temporary shelter to 22 families, totaling 116 individuals. The Living Well Partnership (LWP); assumed primary care provision for these vulnerable residents facing health inequalities. Enhancing refugee healthcare access and integration into the NHS system. Improving healthcare education, boosting confidence in appropriate healthcare use, and utilisation of electronic consultations effectively. Working with the local authorities, primary care services were brought to the hotel. Regular 3-hour drop-in sessions with a health and wellbeing coach were established and attended by residents. Non-identifiable data was recorded in individual patient care records and summarised quantitatively. Qualitative data was collected via a pre-established questionnaire during the sessions. RESULTS: Identified issues included language barriers, mental health problems, infectious diseases, contraception, and healthcare access. Language barriers were addressed with interpreters. Fifty-nine patients accessed support services, with 13 benefiting from e-consultations, and nine requiring on-site medical consultations in a 3-month period. Mental health support and infectious disease referrals were facilitated. Access challenges were mitigated by transitioning to e-consultations or face-to-face appointments. Outcomes included improved patient independence, awareness of healthcare processes, familiarity with LWP services, and confidence in navigating the NHS. A multifaceted approach is vital for addressing language and access barriers for refugees. Providing educational resources through facilitated groups empowered refugees and improved healthcare access. This initiative highlights the importance of organised support for vulnerable populations during crises and can be applied more widely.

GIRFT and Measuring Outcomes in MCNs: endodontics in 646 teeth treated in Tier 2 (Primary Care) and Tier 3 (Secondary Care) settings in England.

This paper aims to assess the complexity, quality and outcome of endodontic treatment provided in Managed Clinical Networks (MCNs) in England to understand if we are "getting it right first time" (GIRFT). In a convenient sample of endodontic treatments provided between May 2011 and April 2017, the complexity of teeth treated, the quality of treatment procedure, the radiographic appearance of root fillings, as well as clinical and radiographic healing were retrospectively assessed using records taken as part of treatment. Trained, calibrated examiners independently scored radiographs using previously published scoring systems. 646 teeth were followed up for 24.7 months (standard deviation [SD] 17.08). The average age of those patients treated was 46.7 years (SD 15.38) with 48.3% being male. Of teeth treated, 70.4% were of complexity level 3. 88.2% of teeth were asymptomatic, and 80% demonstrated complete radiographic healing. Procedural errors inhibited achieving correct working length and taper, with more voids within root canal fillings. When patency filing was reported as being carried out, complete radiographic healing was more likely. It is possible to collate outcome data in the NHS system, especially if there is provision for ongoing follow up and time allocated for collection of data. Endodontic treatment provided within primary and secondary care settings are of high quality, with outcomes being better with single operators carrying out high volumes of endodontic treatment.

New dental graduates transition into UK professional practice; a longitudinal study of changes in perceptions and behaviours through the lens of evidence-based dentistry

BackgroundThis longitudinal study using qualitative methodology aims to investigate the perceptions, and implementation, of evidence-based guidelines into practice among new dental graduates (NDGs) during their transition from university into professional practice, by identifying factors that influence the adoption of evidence-based practice (EBP) in dental practice.MethodsThe study invited NDGs from one UK dental school (N = 66) and employed longitudinal, multiple qualitative methodologies for data collection, throughout the participants’ Vocational Dental Training (VDT) year. Initial interviews (Interview 1) conducted upon graduation and follow-up interviews (Interview 2) carried out between six and nine months into professional practice were combined with participants longitudinal audio diaries (LADs) recorded between the interviews. The study.ResultsA total of 12 NDGs agreed to participate. For Interview 1, twelve participants were interviewed, seven of whom agreed to participate in Interview 2 and six recorded the LADs. Interview 1 exposed diverse views among NDGs about EBP, acknowledging its significance but facing obstacles in implementation due to time and financial constraints. They intended to use evidence selectively, often aligning with trainers’ or NHS treatment options, while hesitating to fully embrace EBP in a busy dental practice. During VDT, LAD entries showed initial enthusiasm for EBP, but integrating evidence-based guidelines within the NHS system led to pragmatic treatment decisions, balancing gold-standard and cost-effective options. Over time, NDGs became more comfortable with alternative treatments, considering patients’ financial constraints, yet they expressed frustration with external pressures limiting their clinical decision-making autonomy. In Interview 2, after six to nine months in practice, NDGs exhibited mixed attitudes towards EBP. Some actively used dental guidelines like SDCEP, others associated EBP with hi-tech or expensive materials, while others would thought to rely on colleagues’ recommendations. None consistently sought direct evidence for treatment decisions.ConclusionNDGs’ attitudes towards EBP changed and became more negative over their first year in professional practice, leading to challenges in their applying it. It questions the assumption that teaching EBP during undergraduate education ensures its implementation. Further understanding the influences on the development of attitudinal challenges will help to devise effective strategies for fostering lifelong learning and supporting evidence-based practice in dentistry.

Analysis of New 4D Hyperchaotic Systems MACM and Implementation Using Runge-kutta

In general, hyperchaotic system is defined as a chaotic system with more than one positive Lyapunov exponent, this implies that its chaotic dynamics extend in several different directions simultaneously. The discovery of reliable and effective methods for solving hyperchaotic systems is carried out extensively. The aim of this research is to implement nonlinear hyperchaotic using runge-kutta. The NHS system is built by inspecting, modifying and adding one state to the MACM chaotic system. In this study, we use the same initial conditions x_0=y_0=z_0=w_0=1 and the parameters a = 2,b = 2,c = 0.5, and d = 14.5. At first we experiments modified approaches, namely Classic Runge-Kutta Method 3 Order, Runge-Kutta Method Based On Arithmetic Mean, Metode Runge-Kutta Method Based On Geometric Mean, Modified Runge-Kutta Geometric Mean Based Method-1, RKLCM Approaches Instead of RKGM using MAPLE software as a calculation tool. In this work, we observe that the Runge-Kutta Method Based on Arithmetic Mean has the smallest error value with an average variable x of 0.000606953, variable y of 0.009280181, variable z of 0.000378639 and variable w of 0.60781585. Then also in RKLCM Approaches Instead of RKGM it has the largest error value with an average variable x of 0.483789793, variable y of 0.620803849, variable z of 0.92097139, and variable w of 0.596137549.

Research on the Aging of Global Workforce and Solutions

The twenty-first century has seen significant shifts in fertility attitudes and demographics, leading to an aging global workforce. This paper explores how different regions - the United States, Western Europe, Japan, and China - address the challenges and opportunities posed by their aging populations in terms of healthcare, social security, and employment. The main findings reveal diverse strategies. The United States combines public and private healthcare components through Medicare and private insurance. Western Europe emphasizes publicly funded healthcare, exemplified by the UKs NHS and Germanys multi-layered pension system. Japans universal coverage and pioneering Long-Term Care Insurance stand out, while China adapts healthcare for both urban and rural elderly residents. Social security systems range from Germanys multi-faceted pensions to Japans comprehensive structure, and China is working to bridge urban-rural disparities. Employment trends vary, with the United States witnessing older adults extending work lives, the Netherlands introducing innovative retirement schemes, Japan promoting active aging, and China focusing on skill enhancement. The study suggests cross-country learning and adaptation. Each nation can benefit from the best practices of others to enhance its own strategies. Collaborative approaches can drive innovative solutions for aging populations, fostering resilient healthcare systems, inclusive social security, and age-friendly employment environments. This comparative analysis offers insights for creating a harmonious and sustainable future for aging populations globally.

Evaluation of the Design and Development of the HeLe Newborn Hearing Screening Tele-Audiology Systems for the Philippines.

There is increasing interest in innovation development and management in the Philippines, especially in the last decade. In the advocacy for universal hearing health, the HeLe, "Hearing for Life'' Research Program was implemented. HeLe developed novel telehealth technologies and field tested a proof-of-concept service delivery model to improve provision of newborn hearing screening and intervention services in the Philippines. As the HeLe research period concludes, this appraisal was organized to document and assess the health information technology systems of the HeLe. The evaluation follows the elements of the Centers for Disease Control and Prevention (CDC) guidelines for evaluation of public health surveillance systems. It centers on the status of the eHealth-based components of the HeLe NHS interventions: HeLe NHS module in the Community Health Information Tracking System (CHITS) electronic medical records system, the Tele-Audiology module in National Telehealth System (NTS), and the HeLe NHS registry. The evaluation is based on interviews of key HeLe research staff and documentation review. The HeLe system has a stable, SQL-Server-based architecture. It is a secure, web-based system with clean separation of back-end database and front-end Web, using Secure Socket Layer (SSL) technology. Standardization of data via mapping ensures reliable, comparable measures. HeLe demonstrates that NHS data collected by the HeLe NHS device can be sent to, stored in, and extracted from the CHITS electronic medical record system and exchanged across platforms. Where actual patient and NHS data were available, this HeLe system is validated to be efficacious to capture and seamlessly exchange data across various eHealth platforms. These eHealth technologies are described to be at Technology Readiness Level 5, "technologies are validated in a relevant environment". The HeLe program, however, needs to address completeness in documentation as a standard practice, if only to ensure better management of risks introduced by novel eHealth systems in patient care. The CDC public health surveillance checklist used for this assessment is useful in identifying gaps in research management for the HeLe inventors. It is recommended to be incorporated to be standard and implemented early in the next iteration of the HeLe research. Overall, the HeLe technologies, in this initial stage of research, have achieved the purpose for which they were developed. As a novel technology-based NHS system, HeLe is a potentially powerful tool to assist in monitoring newborn hearing disease caseloads by community-based primary care clinics, NHS facilities, and hospitals that provide definitive medical services. As other health systems strengthening reforms take root in the Philippines, secure exchange of data electronically across the country would depend on sound technologies, including those used in hearing health. This paper can be instructive to the emerging research community in the eHealth and biomedical development space especially in resource-challenged settings. Likewise, lessons can reinforce institutional support from research agencies, clinicians, and state/ county or subnational health departments for policy and resource mobilization to better manage those identified with congenital hearing loss.

Dental practice workforce challenges in rural England: survey into recruitment and retention in Devon and Cornwall.

Introduction Devon and Cornwall have been identified as 'dental deserts' with limited NHS dental access and high levels of oral health inequality. Challenges around recruitment and retention of the dental workforce have been acknowledged as an important contributory factor.Aims The aim of this research was to explore the experiences of dental practices within Devon and Cornwall in relation to recruitment and retention of the dental workforce.Method A self-administered, online questionnaire was used to explore various aspects of workforce recruitment and retention. The questionnaire included categorical rating scale and free-text question formats providing quantitative and qualitative data.Results In total, 106 dental practices responded to the survey, providing a response rate of 36%. The vast majority of respondents (94%) considered recruitment and retention to be a major barrier to delivering NHS services. Additionally, 77% of practices had a current staff vacancy, 57% had a dentist vacancy and 48% had a vacancy for dental nurses. Thematic analysis led to identification of four main themes which were considered to influence recruitment and retention: NHS system; economic challenges; logistics; and support networks.Conclusion A large number of dental practices in Devon and Cornwall are failing to operate at capacity due to workforce shortages, which is affecting access to services in both NHS and private practices. Recruitment and retention of dentists and dental nurses appears to be the most challenging factor, with NHS practices affected more than the private sector.

Staff Members' Experience of Italian Shelters for LGBTQIA+ Homeless and Runaway People: An Exploratory Study.

Some LGBTQIA+ people, after coming out, experience marginalization and homelessness due to rejection and discrimination from their family and community. The increase in support requests led to the creation of LGBTQIA+ temporary shelter homes worldwide. This study aims to explore the functioning and effectiveness of shelters, analyzing the experiences of staff members in Italy. Focus groups were held with a total of 15 staff members (age range: 32-53) working in three shelters for LGBTQIA+ people. Data were analyzed qualitatively through the grounded theory methodology. Data coding showed five final core categories: (1) user characteristics; (2) staff characteristics; (3) community relations; (4) activities carried out by services; (5) criteria for intervention assessment and staff satisfaction. Results revealed some criticalities in the effectiveness of these services, particularly the difficulty in achieving autonomy for users, a weakness attributable to the non-exhaustive training of staff members and the funding discontinuity. To improve the efficacy of shelters, this study emphasizes the necessity to (a) carry out an analysis of the vulnerability of the local LGBTQIA+ community, (b) establish a stable network with local services (NHS system), and (c) implement staff members' psychological training.

Ethnically diverse communities and their priorities for cancer research.

e18602 Background: Ethnic minorities in the UK tend to have poorer access to healthcare, outcomes and experiences than the majority population. They are often underrepresented in health research. Experiencing disparities compounded by the lack of involvement in research widens the inequalities gap. Methods: Targeted community engagement was implemented in the highest areas of deprivation in the South West. The project team designed a series of questions and data was collected during outreach health checks and community events by members of the team based in the community. Information was collected from individuals and from groups. Results: Forty people, from culturally and linguistically diverse communities participated. We sought help from interpreters to ensure inclusivity and information was gathered in a cultural sensitive way. This was especially important due to the sensitivity in this topic area. Demographic information was collected from those that participated. The majority were women (n = 33), men (n = 7). In terms of ethnicity the majority described themselves as Black African/Caribbean (n = 31), Arab (n = 9) and Asian (n = 3). The age range was 25 - 64 years. Twelve people identified that their actual age was different to their recorded age on the NHS system. Fourteen people had been in the UK for less than 5 years and included those identifying themselves as refugees and asylum seekers. We conducted content analysis to identify and categorise the cancer research needs identified. Key themes identified included: Easier access to screening programmes; earlier diagnosis and how to initiate onward referral; research into cancer prevention and a more holistic approach to cancer care. Only one patient had clinical trials discussed. Conclusions: Community engagement offers the opportunity to identify cancer research priorities and discuss access to cancer prevention, cancer screening programmes, therapies and clinical trials. Through actively listening to our communities and the voices seldom heard about their experience of health and cancer care, we raise awareness and provide ongoing education to health care teams, on the delivery of care that is culturally sensitive, inclusive and more tailored to an individual. Increasing the diversity of the workforce may increase representation and greater advocacy of the communities. Engaging patients more in their own cancer care and decision-making may empower them to be more involved in their health. Our findings suggest that community engagement with people from diverse communities identify areas for improvement in their cancer care and experience. This includes how we might better engage with people from diverse backgrounds on clinical trials. Addressing the priorities identified from these communities is a first step in addressing the existing inequalities. Organisations need to actively engage, listen to and empower the communities that we serve.

Off with Her Head! Who Dares May Lose? NHS Fit for Purpose

This article attempts to define, analyse, and resolve a problem. The problem is complex and multi-faceted. it involves an amalgam of intricately connected. bio-psychosocial and political economic factors.  Added to which are issues of traditions, reliance, and the emotional familiarity of a well treasured comforter The National Health Service.   If the NHS is viewed as a system, the input is inaugurated by the patient who offers symptoms. The general practitioner (GP) makes a diagnosis, a degree of agreement and acceptance is reached, and various options are available to treat the presenting symptoms.  However, what if we dig beneath the presenting symptoms and unearth foundational causes perhaps unknown facts of which the practitioner is unaware? Lifestyle causes but which the patient medicalises.  Such as reckless spending or driving, — partying, drinking, overeating. Alternatively, maybe the patient, by choosing a career which is beyond the necessary ability, or personality characteristics demanded, by the job or career. Lacking the necessary characteristics such as robustness and tenacity and the ability to cope, without suffering from stress-related diseases.  Or living lifestyles beyond sustainable economic means?   Originally back in the early days of the NHS, the GP knew the patient more intimately from the cradle onwards, however nowadays the relationship is usually more transparent. Patients cannot count on seeing the same GP for every consultation. And furthermore, the notes written by the GP are less personal and less revealing. In an effort towards transparency patients can read their notes. In the present climate of victimization and litigation, it is perhaps only for the more robust clinicians to use blatant language or face to face confrontation clinically and confront behaviour related to causation.    Can the sufferers plead being a victim of ignorance and blame the educational or the welfare system? Medicalization of the results of breakdown and these unsustainable choices then falls on the NHS to care but not notice longer cure?   With the word cure, now removed from the aim of the National Health System which some cynics will label as an economic based subtle nevertheless intentional dumbing down of provision. (Harries, Elliott, & Higgins, 1999) NHS England, 2017.  This article aims to focus on the dilemma which begs the question: Is it the responsibility of the clinician to alleviate the symptoms or to treat the cause and prevent recurrence or both? Furthermore, is the NHS system too antiquated, to deal with the present-day situation is it no longer fit for purpose.

O.R. Contributes to the Covid-19 Response in the Bristol Nhs System

O.R. Contributes to the Covid-19 Response in the Bristol Nhs System

Implications of Migration Patterns and Sex Work on Access to Health Services and Key Health Outcomes: A Qualitative Study on Male Migrant Sex Workers in London

Objectives This paper describes migration toward the UK, sex work involvement, use of health services, and health issues. Methods This qualitative study interviewed twenty-five men. The data were analyzed using thematic analysis. Results Five main themes emerged: emigration, migration routes, sex work entrance, use of health services, and main health outcomes. Conclusions Discrimination and social exclusion were identified before and during migration. Participants had used the NHS system and told positive experiences. They reported STI-HIV, recreational drugs and mental health issues. Findings suggest the influence of migration and sex work on their vulnerabilities and health outcomes.

A COVID-19 vaccine—dare to dream

The global desire to produce and deploy a safe and effective vaccine to protect against SARS-CoV-2 infection and the morbidity and mortality subsequent to COVID-19 is unprecedented. The unparalleled speed of research development and access to funding is perhaps equally unique in the history of therapeutic achievement. This article, the third in a series of dedicated to exploring the origins and developments of SARS-CoV-2 within the context of the strategies of infection prevention and control, investigates the theatre behind the extraordinary efforts underpinning the research for therapeutic interventions to halt the COVID-19 pandemic. The Chair of the UK Vaccine Taskforce has stated that the exit strategy depends on a vaccine that is effective in reducing mortality, improving population health by reducing serious disease and protecting the NHS and social care system. This article introduces the major COVID-19 vaccine contenders and considers the challenges and opportunities of an effective global vaccination strategy.

Regions for health case study: Turning Welsh legislation for sustainable development into everyday practice

Abstract In 1998, Wales became one of the first nations in the world to have a legal requirement in relation to sustainable development. The introduction of the Well-being of Future Generations (Wales) Act 2015 bolstered previous schemes, by providing an enabling framework for thinking and working differently, and embedding a Health in All Policies approach. With seven well-being goals which aim to make Wales a healthier place, where the social, economic, environmental and cultural well-being of Wales is improved, the Act impacts on public bodies, including local authorities, to make sure that when making their decisions they take into account the impact they could have on people's well-being, that they involve citizens, and they look to the future as well as focusing on the now. Wales also became one of the first nations in the world to establish a legislative link to the international SDGs. A new report gives practical examples and case studies demonstrating how organizations can respond to the legislation. Informed by a review of the international evidence, the report makes five key recommendations for practical implementation of sustainable development principles. Although the report reflects the Welsh public sector context, the findings can act as a go-to guide for any organization seeking to address global issues such as climate change, biodiversity and de-carbonization, as well as to implement the globally agreed Sustainable Development Goals (SDG). The report is positive about the Welsh legislative approach; suggesting it could make a significant and long-lasting difference to the people living in Wales, with the potential to set an example globally. The presentation will provide examples on how this is translating into practical action for the Welsh NHS system change including collective action on a de-carbonization pathway and how staff and the wider public are being motivated and engaged to 'Be The Change'. to create a network of champions will be given.

Fiddling while Rome burns? Conducting research with healthcare staff when the NHS is in crisis

PurposeHealth research in the UK is being impeded by a stretched NHS system. The purpose of this paper is to use the Great Fire of Rome as an allegory to understand the difficulties encountered by health researchers when attempting to conduct research within a healthcare system that is currently in crisis.Design/methodology/approachThe paper draws on both the authors’ own and other research teams’ experiences from the published literature in order to demonstrate that this difficulty is a widespread problem for the health research community in the UK.FindingsRecruitment and engagement issues across different research studies and clinical environments are often ascribed as being related to individual contexts or settings. Rather, the authors propose that these problems are actually writ large across nearly the entire NHS. The authors offer ideas for what can be done to alleviate the worst of this situation – a change in culture and ways of working alongside employing more pragmatic, rapid methods to engage exceptionally busy healthcare staff.Originality/valueThe paper offers a provocative viewpoint that instead of seeking to individualise recruitment and engagement issues in relation to the local context, the research community should publicly acknowledge the universality of this problem in order to bring about meaningful change.

Clinical and academic recommendations for primary dental care prosthodontics.

Prosthodontic practice includes a large proportion of dental care provision, mostly undertaken in primary dental care (PDC) in the UK. However, there is limited research evidence in prosthodontic practice, necessary to tackle key questions to improve oral and dental health. In addition, many overarching challenges exist within the NHS system relevant to prosthodontics. For example, demands on healthcare services from increasing patient expectations, the ever-ageing and growing population, risks of litigation, availability of appropriate care, difficulties with access to care, rapidly emerging treatments and technologies, and ongoing needs for education. This article develops clinical and academic recommendations to improve oral health improvements in PDC prosthodontics, further to recommendations determined by the James Lind Alliance, a non-profit making initiative to tackle treatment 'uncertainties' (http://www.jla.nihr.ac.uk/), and the overarching challenges, which are mentioned above. Considerable clinical and academic author experiences from primary, secondary and tertiary care as well as education and research in prosthodontics are employed. We consider management of networks involving patients, carers, healthcare professionals, industry and academics, in order to increase access to improve oral and general health and help drive dental research, education and communication. We investigate how to manage dental disease and intervene to improve the longevity of restorations and the dentition. Finally, we review how rapidly developing digital technologies can best be utilised, in conjunction with industry, in order to improve oral health.

We can't afford to lose more nurses.

With the current focus on NHS funding and system pressures, campaigning for a pay rise may seem insignificant. But it has never been so important, with 24,000 vacancies, the unknown effect of Brexit and student funding changes.