Practitioners In England Research Articles

Aspects of application of digital solutions in primary health care

All over the world, with regard to digitalization in the provision of primary health care, issues of the principles of the cost-effective resource system for the provision of medical services covering all residents (any category of the population), ways to achieve other goals set for the health system at the territorial or regional level are being discussed. Depending on the main goals and principles set out in national legislation, including legislation in the field of health protection, approaches to achieving the Sustainable Development Goals and, accordingly, approaches to organizing the digitalization of medical care differ in different States. The issues of automating the processes of a medical organization and generating relevant information relate to the ways of using artificial intelligence to free up time for doctors, reduce the administrative burden on medical service providers. The level of digital medical literacy, combined with modern possibilities of remote interaction in the patient-medical worker format, can be decisive at the first stage of seeking medical help - with remote patient triage, which is an indispensable tool for determining both the need for assistance and the urgency of providing assistance. The experience of remote triage of patients by non-medical staff provided by the NHS Pathways clinical decision support system, used by the National Health Service of England, has freed up general practitioners (doctors and nurses) to provide other forms of medical care. In 2005, nurses and, to a lesser extent, general practitioners in England accounted for 100% of the staff handling telephone calls in the similar NHS Direct remote consultation system. The foreign experience of patient teletriage in our country will be limited by the legislation of the Russian Federation in the field of health protection, however, some existing restrictions, taking into account the assessment of risks to patients brought by innovative development, may be revised during the implementation of the «Program of experimental legal regime in the field of digital innovations in the field of medical activity, including the use of telemedicine technologies and technologies for collecting and processing information about the state of health and diagnoses of citizens», which will expire on 08/01/2026.

Attitude and readiness of utilizing virtual reality simulations in interprofessional education to facilitate prompt and safe hospital discharges in England

ABSTRACT It can be challenging in England to provide interprofessional education (IPE) in hospitals due to practitioners’ availability, high workload, difficulty to backfill, and training costs. Furthermore, most of the IPE training is facilitated by a didactic teaching strategy in a classroom which fails to engage practitioners to understand each other roles and responsibilities, work procedures, policies, issues related to resources, and their pressure points. Technological innovation, in particular virtual reality has opened up a door to overcome these challenges by enabling practitioners to access IPE virtually, and it provides an immersive experience to them. It is not clear whether health and social care practitioners in England would accept and be ready to embrace this type of technology. Hence, this research study aims to understand attitudes and readiness to access virtual reality simulations (VRS) as a teaching modality and pedagogical tool. Health and social care practitioners (n = 22) attended two focus groups after engaging in a VRS and agreed that it could give them valuable learning experiences where they would be able to learn and practice soft skills in a safe environment to discharge people promptly and safely.

5-year mental health outcomes for children and adolescents presenting with psychiatric symptoms to general practitioners in England: a retrospective cohort study

Little information is available on the clinical trajectories of children and adolescents who attend general practice (GP) with psychiatric symptoms. We aimed to examine 5-year service use in English primary care for children and adolescents with neurodevelopmental or mental health symptoms or diagnoses. In this retrospective cohort study, we used anonymised primary care health records from the Clinical Practice Research Datalink Aurum database (CPRD-Aurum). We identified children and adolescents (aged 3-18 years) presenting to primary care in England between Jan 1, 2000, and May 9, 2016, with a symptom or diagnosis of a mental health, behavioural, or neurodevelopmental condition. Participants were excluded if they had less than 1 year of follow-up. We followed up participants from their index date until either death, transfer out of the practice, or the end of data collection on May 5, 2021, and for trajectory analysis we limited follow-up to 5 years. We used group-based multi-trajectory models to identify clusters with similar trajectories over 5 years of follow-up for three primary outcomes: mental health-related GP contacts, psychotropic medication prescriptions, and specialist mental health-care contact. We did survival analysis to examine the associations between trajectory-group membership and hospital admission for self-harm or death by suicide, as indicators of severe psychiatric distress. We included 369 340 children and adolescents, of whom 180 863 (49·0%) were girls, 188 438 (51·0%) were boys, 39 (<0·1%) were of indeterminate gender, 290 125 (78·6%) were White, 9161 (2·5%) were South Asian, 10 418 (2·8%) were Black, 8115 (2·2%) were of mixed ethnicity, and 8587 (2·3%) were other ethnicities, and the median age at index presentation was 13·6 years (IQR 8·4-16·7). In the best-fitting, seven-group, group-based multi-trajectory model, over a 5-year period, the largest group (low contact; 207 985 [51·2%]) had low rates of additional service contact or psychotropic prescriptions. The other trajectory groups were moderate, non-pharmacological contact (43 836 [13·0%]); declining contact (25 469 [8·7%]); year-4 escalating contact (18 277 [6·9%]); year-5 escalating contact (18 139; 5·2%); prolonged GP contact (32 147 [8·6%]); and prolonged specialist contact (23 487 [6·5%]). Non-White ethnicity and presentation in earlier study years (eg, 2000-2004) were associated with low-contact group membership. The prolonged specialist-contact group had the highest risk of hospital admission for self-harm (hazard ratio vs low-contact group 2·19 [95% CI 2·03-2·36]) and suicide (2·67 [1·72-4·14]). Most children and adolescents presenting to primary care with psychiatric symptoms or diagnoses have low or declining rates of ongoing contact. If these trajectories reflect symptomatic improvement, these findings provide reassurance for children and adolescents and their caregivers. However, these trajectories might reflect an unmet need for some children and adolescents. National Institute for Health and Care Research and the Wellcome Trust.

An educational response to the “Prevent duty” in England and Wales

ABSTRACT In 2015, the UK government was the first to introduce a statutory obligation, also known as the “Prevent duty”, on all education institutions, including Higher and Further Education, universities and colleges, in England and Wales, to prevent people from being drawn into terrorism. The duty, promoted by the UK Home Office as another safeguarding measure, acted as an extension to the UK’s Prevent Strategy (CONTEST), first published in 2006. The duty in schools came under scrutiny as national security measures of surveillance and reporting conflict with what education stands for, that is, a space for social, intellectual growth and the formation of one’s identity. There is little literature examining how secondary school teachers attempt to prevent radicalisation through teaching practices. To fill this gap, interviews were carried out with 13 secondary school teachers, teaching different subjects at Key Stage 3/4 in England to investigate their views on what informs their choice of pedagogical methods to prevent radicalisation and how they engage with the curriculum to enact the duty. To contrast teachers’ views, 14 Prevent Practitioners in England were interviewed to examine whether correct interpretation and implementation of the Prevent duty was taking place. Findings show that whilst the duty’s main objective in schools is for teachers to signal and report potential radicalised students, teachers feel that Prevent policy and training requires strengthening to equip them with a sound knowledge of what violent radicalisation entails, and pedagogical tools to help them prevent radicalisation through educational teaching practices and their subject curriculum.

Online Survey to Investigate Asthma Medication Prescription and Adherence from the Perspective of Patients and Healthcare Practitioners in England [Letter

Online Survey to Investigate Asthma Medication Prescription and Adherence from the Perspective of Patients and Healthcare Practitioners in England [Letter

Knowledge Mobilisation in Safeguarding Adults and Children for Healthcare in England

Safeguarding for healthcare involves working together to protect adults, children, and young people at risk of harm. Despite global research and national guidance outlining health professionals’ roles in this regard, there is limited knowledge about the type of strategies used to mobilise safeguarding research to practitioners in England. Our critical interpretive synthesis (CIS) sought to explore how safeguarding knowledge is mobilised to enable practitioners to use research effectively. This synthesis aimed to bridge the theory-practice gap in mobilising safeguarding knowledge to practitioners. Knowledge mobilisation (KMb) is an emerging discipline concerned with moving knowledge across communities to catalyse change. This review aimed to build understanding about how safeguarding knowledge is mobilised for healthcare in England and to synthesise the type of approaches undertaken to protect adults and children from harms, including abuse. A critical interpretive synthesis was undertaken using KMb theory and computer-assisted modelling technologies for secondary thematic analysis of complex literature of relevance, including qualitative research, reviews, and reports. Few papers informed how safeguarding knowledge is mobilised for healthcare in England. Learning from experience dominated the literature in three ways: (i) crisis response, (ii) practice engagement, and (iii) influencing actions (for “best” practice). Embedding safeguarding knowledge and skills in healthcare settings usually followed a crisis response. Learning from experience showed movement between practice engagement and influencing actions for adult and/or child protection. KMb might be useful in supporting the implementation of evidence-based safeguarding for practice. CIS identified a gap in how safeguarding research is mobilised to practitioners for healthcare. KMb theory provided an analytical bridge to computer-assisted modelling of factors associated with moving learning from experience to learning in practice. Future research could build on hybrid synthesising of safeguarding functions and impacts for healthcare, to enable practitioners to protect adults and children from multiple harms, including violence and abuse.

Reassurance of population immunity to diphtheria in England: Results from a 2021 national serosurvey

BackgroundDiphtheria is rare in England because of an effective national immunisation schedule that includes 5 doses of a diphtheria-containing vaccine at 2, 3, 4 months, preschool and adolescent boosters. However, in recent years there has been a notable increase in cases due to Corynebacterium ulcerans among older adults and evidence of endemic transmission of C. diphtheriae (normally associated with travel to endemic countries). We aimed to update 2009 estimates of diphtheria immunity considering the evolving epidemiology. MethodsResidual sera collected from diagnostic laboratories and general practitioners in England in 2021 were randomly selected and tested for diphtheria antibody, to estimate proportions protected per age group. Diphtheria antibody levels were defined as susceptible (<0.01 IU/mL), basic protection (0.01–0.099 IU/mL) and full protection (≥0.1 IU/mL). Immunity estimates were standardised to the England population and compared to 2009. ResultsBased on 3,745 residual sera tested, 89% (95%CI: 87%–90%) of the 2021 England population had at least basic diphtheria protection (vs. 90% [88%–92%] in 2009) and 50% (48%–52%) full protection (vs. 41% [38%–44%]). Higher antibody levels were observed in those aged 1 and under, 10–11, 12–15, 25–34 and 35–44 years compared to 2009. The largest proportion susceptible were observed in those aged 70+, 26% (21%–31%) vs 12% (7%–18%) in 2009. ConclusionsBasic diphtheria protection is comparable between 2021 and 2009. The increase in immunity in working age adults is likely due to the school leaver booster introduced in 1994. The current vaccination schedule is maintaining sufficient population immunity. However, we recommend clinicians remain vigilant to severe diphtheria outcomes in older adults, because of their observed susceptibility.

Online Survey to Investigate Asthma Medication Prescription and Adherence from the Perspective of Patients and Healthcare Practitioners in England.

High short-acting β2-agonist (SABA) use and/or inhaled corticosteroid (ICS) underuse are common and are associated with poor asthma outcomes. This study explored patients' and healthcare practitioners' (HCPs') perspectives to contextualize asthma treatment patterns observed in real-world studies. Data were collected using online surveys from HCPs and people with asthma (≥18 years old with a confirmed asthma diagnosis of any severity) who had consented to research participation through the Clinical Practice Research Datalink. Data were analysed using descriptive statistics. In total, 76 HCPs and 63 patients were invited to take part. Of 48 valid HCP responders, 54.2% (n=26) reported scheduling an annual asthma treatment review with their patients and 83.3% of general practitioners (n=40) had prescribed repeated inhalers at the patient's request. Of 47 valid patient responders, 57.4% (n=27) reported using their reliever (SABA) inhaler daily and 55.3% of patients (n=26) reported being prescribed a preventer inhaler. Of the total patient responders, 31.9% (n=15) reported that they never used their preventer inhaler. Consistent annual adherence with preventer inhalers was reported by 44.7% of all valid responders (n=21), while other patients admitted to using preventers intermittently. SABA and ICS prescription patterns are driven by a combination of HCP and patient factors. Opportunities exist to improve asthma control and behaviours around inhaler use.

Understanding Measurement of postural hypotension: a nationwide survey of primary care practice in England.

Postural hypotension (PH), the drop in blood pressure (BP) on standing, is associated with falls, all-cause mortality and cognitive decline. PH diagnostic criteria require lying-to-standing BP measurements. PH Prevalence in older adults is 20%, however, it is infrequently recorded in primary care records, suggesting PH testing and/or recording is under-utilised in this setting. To understand current PH measurement and management by primary care practitioners in England. Clinical Research Networks circulated an online survey to primary care clinicians involved in measurement of BP. Demographics and responses were summarised as percentages, or median and inter-quartile ranges (IQR), as appropriate. The survey remains open until 30 November 2022; full results will be presented at the conference. To date, there are 669 replies (341 doctors, 179 nurses, 70 healthcare assistants, 23 pharmacists, 56 other roles); median age 45 (IQR 38 to 53), 72% female. Overall, 597 (89%) responders check for PH, predominantly when symptoms are present (98%). Less common reasons to check include patients being over 80 (24%), Parkinson's disease (21%), hypertension reviews (18%), medication reviews (12%) or diabetes reviews (11%). Sitting-to-standing BP measurements are common (77%); only 22% use lying-to-standing. Only 64% ensure a rest period before sitting or lying BP measurement and only 1 (IQR 1 to 2) standing BP measurement is made, usually (66%) within the first minute of standing. Interim findings suggest that most PH assessments in primary care do not meet current guideline criteria. Full findings from this survey are expected to inform and influence future national guidelines.

Children, Sexual Abuse and the Emotions of the Community Health Practitioner in England and Wales, 1970-2000.

A survivor of child sexual abuse felt that doctors missed opportunities to notice her distress when, at fourteen, she had an unexplained illness that lasted for a year. The cause, she wrote, was "explained by Doctors as psychological, but nobody questioned further. WHY??? … If adults don't listen[,] then we have no one to turn to." For decades, community health practitioners have been identified as an important group in protecting children from maltreatment, but survivor testimony and agency statistics demonstrate that they rarely receive verbal disclosures or recognize the physical or behavioural warning signs of sexual abuse. The accounts we have of the 1980s tell of swiftly heightening professional awareness, followed by a visceral backlash in the latter part of the decade that discouraged practitioners from acting on their concerns. This article uses trade and professional journals, training materials, textbooks, and new oral histories to consider why community-based doctors and nurses have struggled to notice and respond to the sexually abused child. It will argue that the conceptual model of child sexual abuse that community health practitioners encountered in the workplace encouraged a mechanical and procedural response to suspicions of abuse. In a highly gendered and contested workplace, practitioners' feelings about how survivors, non-abusing family members, and perpetrators should be understood were rarely debated in training or in practice. The emotional cost to the practitioners of engagement with sexual abuse, and their need for spaces of reflexivity and structures of support, were ignored.

Dynamic data-enabled stratified sampling for trial invitations with application in NHS-Galleri.

Participants of health research studies such as cancer screening trials usually have better health than the target population. Data-enabled recruitment strategies might be used to help minimise healthy volunteer effects on study power and improve equity. A computer algorithm was developed to help target trial invitations. It assumes participants are recruited from distinct sites (such as different physical locations or periods in time) that are served by clusters (such as general practitioners in England, or geographical areas), and the population may be split into defined groups (such as age and sex bands). The problem is to decide the number of people to invite from each group, such that all recruitment slots are filled, healthy volunteer effects are accounted for, and equity is achieved through representation in sufficient numbers of all major societal and ethnic groups. A linear programme was formulated for this problem. The optimisation problem was solved dynamically for invitations to the NHS-Galleri trial (ISRCTN91431511). This multi-cancer screening trial aimed to recruit 140,000 participants from areas in England over 10 months. Public data sources were used for objective function weights, and constraints. Invitations were sent by sampling according to lists generated by the algorithm. To help achieve equity the algorithm tilts the invitation sampling distribution towards groups that are less likely to join. To mitigate healthy volunteer effects, it requires a minimum expected event rate of the primary outcome in the trial. Our invitation algorithm is a novel data-enabled approach to recruitment that is designed to address healthy volunteer effects and inequity in health research studies. It could be adapted for use in other trials or research studies.

Rescheduling gabapentinoids had negligible effects on prescribing behaviour by general practitioners in England.

To determine whether the rescheduling of gabapentinoids in England as Schedule 3 Controlled Substances in April 2019, changed prescribing behaviour for gabapentinoids by general practitioners. Data on the monthly number of prescription items and the monthly average dose per prescription item were analysed for the period April 2017 to April 2021 under three models: (i) a simple linear regression, (ii) a linear spline with a knot at April 2019, and (iii) a parallel slopes model with time before and after the rescheduling as a covariate. Best fit models were selected based on them having the lowest corrected Akaike's information criterion. Auto-regressive integrated moving average (ARIMA) models were also generated. For gabapentin, the best fit model for the number of prescription items was the simple linear model, and for the dose per prescription item it was the parallel slopes model. For pregabalin, the best fit model was the linear spline for the number of prescription items and the dose per prescription item. For all models, the interval estimates for the slopes were consistent with no change or no meaningful change in prescribing behaviour after April 2019. Forecasts from ARIMA models for gabapentin and pregabalin were consistent with no change in the number of prescription items per month. However, forecasts for the dose per prescription item for gabapentin or pregabalin did not fully capture the post-April 2019 trajectories. The reclassification of gabapentinoids did not materially change the prescribing behaviour of these drugs by general practitioners in England.

‘Rocky road’ &amp; ‘brick walls’ – Multiple meanings of resilience in a social work context through the lens of critical realist Informed grounded theory

This study seeks to build an explanation of the multiple meanings of resilience in a social work context, centralising the interplay between human agency (meaning-making, motivations and intentionality) and social structures (enduring patterns, social rules, norms and laws). Specifically, this research provides insight into how care-experienced people (aged 17–50 years old) and social workers and affiliated practitioners in England make sense of ‘resilience’ and ‘resilient’ behaviours. Critical realist informed grounded theory (CRGT) provides unique opportunities here, with critical realist’s primacy of ontology as the starting point and grounded theory providing the epistemological force, contextualising research and imbedding this more firmly into practice. Drawing on the four stages of retroductive argumentation proposed by Kempster and Parry (2014) and developed by us, we identify a number of key themes, namely, ‘Having/Building an Ability’ – ‘Rocky Road’ and ‘Brick Walls’ – Resilience as Resistance – ‘Compliance’, as well as causal factors impacting upon the themes (such as traumatic life experiences, protective factors, external support systems, political agendas, structure-agency relationships and stigma, discrimination and marginalisation). The research highlights how multiple causal mechanisms, including interpretations of situations by individuals (in this case care-experienced individuals and social workers/affiliated practitioners) interact and generate multiple meaning in relation to process and outcomes of resilience. The research thus provides insight into deeply embedded interpretations of resilience, which should be viewed in light of the stratified non-linear dynamics of embodied experiences, material/institutional forces and social relationships, that co-constitute subjectivity, as well as having an ongoing influence on body–brain systems.

The development of digital dentistry in the UK: An overview.

The COVID-19 pandemic has highlighted the benefits which digital technology offers to all aspects of dental practice and education. This paper provides an overview of how digital technology has enhanced clinical and administrative procedures within dental practice, including computer-aided design/computer-aided manufacture (CAD/CAM), digital radiography, 3D printing, patient records, electronic patient referrals and electronic communications from dental practices. It then considers the development of teledentistry (mHealth) and its benefits in enabling distant consultations with patients, who for one reason or another are unable to visit dental practices easily. It then goes on to consider how and why digital dental distance learning materials were provided to general dental practitioners in England by the Department of Health (DoH) (England) and how they evolved. Finally, this paper considers the use of digital technology in dental education by dental schools.

From Robert Keayne to Angola, Richard, and Grace: Bernard Bailyn and New England's Place in an Atlantic World

From Robert Keayne to Angola, Richard, and Grace: Bernard Bailyn and New England's Place in an Atlantic World

Impact of the Covid pandemic on health care equity in NHS General Dental Practice.

Oral health inequalities existed before Covid, but the pandemic presented an unprecedented challenge for health services. Our aim was to determine whether patient groups at risk of health care inequality due to the pandemic could be identified from NHS dental claims. Secondary analysis of routinely collected NHS Business Services Authority data for patients treated by General Dental Practitioners in England and Wales between April 2019 and January 2022 to assess the effect of the Covid pandemic on claims for patients attending general dental practices. Data for treatment items claimed after the start of the first lockdown were compared to the pre-lockdown period. The proportion of claims for child fillings, child extractions and child fluoride varnish application after March 2020 were lower than equivalent proportions for adults, in both England and Wales. Similarly, there were consistently fewer claims for fillings and extractions for patients claiming pension credit guarantee credit than all pensioners in both England and Wales. The Covid pandemic may have caused health care inequality for children and patients claiming pension credit guarantee credit. This may compound the inequality in oral health for these patients.

Lifting the lid on Pandora’s box: Putting professional curiosity into practice

Professional curiosity has recently become a ‘buzzword’ in the field of probation and social work. However, little research has sought to understand what professional curiosity means definitionally, conceptually or operationally. In this article, we analyse interview data from 49 probation practitioners in England and Wales to explore what professional curiosity means in the context of probation and what the main barriers are to enacting professional curiosity. We argue that professional curiosity is primarily used to assess risk and that practitioners face multiple barriers to its enactment which are rarely acknowledged or dealt with in policy and practice guides. These barriers fall into three groups: structural, relational and emotional. We conclude the article by examining the findings through the lens of neo-liberalism and probation values. The article therefore extends knowledge of professional curiosity operationally while also seeking to explain its position in a neo-liberal policy context. This research has important implications for policy and practice. Rather than simply asking practitioners to ask questions and be on the lookout for disguised compliance, probation providers should recognise and acknowledge these barriers to practice.

‘It’s a hard balance to find’: the perspectives of youth justice practitioners in England on the place of ‘risk’ in an emerging ‘child first’ world

‘It’s a hard balance to find’: the perspectives of youth justice practitioners in England on the place of ‘risk’ in an emerging ‘child first’ world

A safe place of one’s own? Exploring practice and policy dilemmas in child welfare practice with families waiting for adequate and secure housing

ABSTRACT As in many European states, a shortage of housing in England has resulted in some families who are ‘waiting for’ adequate and secure housing in England while also having the ‘weight of’ their children being placed outside their care hanging over them. This paper reports on the development of a practice guidance document that included an online survey with 38 children’s social services practitioners in England regarding their practice experiences of responding to family homelessness. Findings suggest the complexity of the issue of family homelessness and implicitly highlight its neglect within contemporary research and policy in the UK. Homeless families are caught between the constraints of housing shortages and the complexity of the needs underpinning their homelessness. Despite these constraints, social work practice has an important role to play in providing, or facilitating families’ pathway to, housing advocacy and advice. Most importantly of all, social work practice can maximise families’ access to statutory family support provision so that families can be helped to remain together wherever this is safely possible. Suggestions for practice, policy, and research development are outlined.

Characteristics of New Users of Single- and Multiple-Inhaler Triple Therapy for COPD in Primary Care in England.

PurposeInhaled triple therapy is recommended for patients with chronic obstructive pulmonary disease (COPD) who have poorly controlled symptoms and to reduce the risk of exacerbations. This study assessed the clinical characteristics of new users of single- and multiple-inhaler triple therapy (SITT and MITT) treated in a primary care setting in England.Patients and MethodsThis cross-sectional, observational study used data from an electronic health record database (CPRD Aurum) of COPD patients registered with a primary care practice in England, with linkage to a secondary care database. Patients were required to have initiated a new triple therapy (index) between November 2017 and November 2018 and have ≥12 months of available medical history prior to the index date.ResultsIn total, 3536 patients initiated fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) SITT for the first time: 65% had a Medical Research Council (MRC) dyspnea score ≥3, 45% had forced expiratory volume in 1 second (FEV1)% predicted <50%, and 64% had a moderate or severe exacerbation in the previous 12 months. The majority (83%) of new FF/UMEC/VI users had a history of MITT use. Immediately prior to FF/UMEC/VI initiation, 46% received MITT, 25% received an inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA), 12% received long-acting muscarinic antagonist (LAMA)/LABA, and 14% stepped up directly from LAMA monotherapy. A second cohort of 6540 patients initiated triple therapy (SITT or MITT) for the first time. COPD severity (airflow limitation, exacerbation history) was worse among patients initiating SITT versus MITT. In the 12 months before triple-therapy initiation, ICS/LABA was the most common treatment; a step up from LAMA/LABA was more common among patients initiating FF/UMEC/VI (34%) or beclomethasone/formoterol/glycopyrronium bromide SITT (25%) than MITT (14%).ConclusionFirst-time triple therapy was frequently initiated in patients with COPD inadequately controlled on maintenance therapy. General practitioners in England generally identify appropriate patients who require initiation of triple therapy.