Practitioners In England Research Articles

The science-practice interface of connectivity in England

A disconnect has been identified at the interface between landscape science and practice. More commonly, it is assumed that better or more targeted science would lead to better practice. Others argue that such a view is partial, and propose an understanding that foregrounds how social and political factors shape the science-practice interface. In this study we explore how (the combination of) different conceptualisations, novel governance architectures, and political-economic conditions shape the science-practice interface between landscape ecology and practice, using connectivity conservation and enhancement initiatives in England as a case study. We conducted interviews (n = 36) with practitioners involved in connectivity-related projects (predominantly Nature Improvement Areas and Green Infrastructure initiatives). We transcribed and analysed the interviews using standard methods of qualitative analysis. We also conducted a desk study of green infrastructure strategies (n = 58 documents). Enhancing or maintaining connectivity is perceived positively by conservation and planning practitioners in England. Considering both planning and ecological contexts, quantitative assessments are rare on the ground. Conceptual ambiguity, lack of resources (time, personnel, software and hardware), novel governance architectures, and changing economic and political conditions are implicated. We find that the co-articulation of conceptual ambiguity and resource issues with novel forms of governance in changing economies is diminishing opportunities and creating challenges for (ecological) connectivity conservation. This is particularly true in relation to large scale operationalisation that requires multi-scale and multi-partner coordination.

Identifying \u2018avoidable harm\u2019 in family practice: a RAND/UCLA Appropriateness Method consensus study

BackgroundHealth care-related harm is an internationally recognized threat to public health. The United Kingdom’s national health services demonstrate that upwards of 90% of health care encounters can be delivered in ambulatory settings. Other countries are transitioning to more family practice-based health care systems, and efforts to understand avoidable harm in these settings is needed.MethodsWe developed 100 scenarios reflecting a range of diseases and informed by the World Health Organization definition of ‘significant harm’. Scenarios included different types of patient safety incidents occurring by commission and omission, demonstrated variation in timeliness of intervention, and conditions where evidence-based guidelines are available or absent. We conducted a two-round RAND / UCLA Appropriateness Method consensus study with a panel of family practitioners in England to define “avoidable harm” within family practice. Panelists rated their perceptions of avoidability for each scenario. We ran a k-means cluster analysis of avoidability ratings.ResultsPanelists reached consensus for 95 out of 100 scenarios. The panel agreed avoidable harm occurs when a patient safety incident could have been probably, or totally, avoided by the timely intervention of a health care professional in family practice (e.g. investigations, treatment) and / or an administrative process (e.g. referrals, alerts in electronic health records, procedures for following up results) in accordance with accepted evidence-based practice and clinical governance. Fifty-four scenarios were deemed avoidable, whilst 31 scenarios were rated unavoidable and reflected outcomes deemed inevitable regardless of family practice intervention. Scenarios with low avoidability ratings (1 s or 2 s) were not represented by the categories that were used to generate scenarios, whereas scenarios with high avoidability ratings (7 s 8 s or 9 s) were represented by these a priori categories.DiscussionThe findings from this RAND/UCLA Appropriateness Method study define the characteristics and conditions that can be used to standardize measurement of outcomes for primary care patient safety.ConclusionWe have developed a definition of avoidable harm that has potential for researchers and practitioners to apply across primary care settings, and bolster international efforts to design interventions to target avoidable patient safety incidents that cause the most significant harm to patients.

Awareness of and attitudes towards cervical cancer prevention among migrant Eastern European women in England.

It has been hypothesized that, in England, the rise in incidence of cervical cancer and the fall in screening coverage might be attributable in part to the effect of migration of Eastern European born women. We explored the attitudes and behaviours of these women towards cervical cancer prevention strategies. A mixed methods study using quantitative surveys and in-depth semi-structured qualitative interviews was conducted between April 2015 and December 2016. In total, 331 surveys and 46 interviews were completed. Native English women had greater knowledge that a smear test is a screening test for pre-cancerous cervical cells (90% vs. 71% p≤0.01), whereas migrant Eastern European women believed that it was conducted as part of a full gynaecological examination (46% vs. 21% p≤0.01) and that the screen interval was annual (18% vs. 4% p≤0.01). Distrust of the English healthcare system resulted in some Eastern European women returning to their country of birth for screening. Poor awareness of cervical cancer prior to migration and lack of information at registration with a general practitioner in England were associated with failure to participate in screening. The views and attitudes expressed by the migrant Eastern European women in this study suggest that they are not fully participating in cervical screening in England. Targeted education at the point of contact with healthcare services in England is needed to increase cervical screening participation among these women.

A gendered contribution to play? Perceptions of Early Childhood Education and Care (ECEC) practitioners in England on how their gender influences their approaches to play

ABSTRACT There is a persistent suggestion that the lack of men who choose to work with young children (0–5 years) is detrimental to children’s learning and development. This study analysed whether practitioners believed that men who work with young children adopt specific approaches within a play pedagogy. Practitioner beliefs about how their gender influences their practices were gathered through qualitative surveys and open-ended, photo-based interviews. This paper argues that practitioners use conflicting scripts to discuss their gendered approaches to play; it proposes that opportunities to explore gender critically, through gender sensitivity training, are vital for ECEC practitioners to ensure that a high-quality workforce is developed that can be flexible in its practices and pedagogy.

Estimating local need for mental healthcare to inform fair resource allocation in the NHS in England: cross-sectional analysis of national administrative data linked at person level.

Equitable access to mental healthcare is a priority for many countries. The National Health Service in England uses a weighted capitation formula to ensure that the geographical distribution of resources reflects need. To produce a revised formula for estimating local need for secondary mental health, learning disability (intellectual disability) and psychological therapies services for adults in England. We used demographic records for 43 751 535 adults registered with a primary care practitioner in England linked with service use, ethnicity, physical health diagnoses and type of household, from multiple data-sets. Using linear regression, we estimated the individual cost of care in 2015 as a function of individual- and area-level need and supply variables in 2013 and 2014. We sterilised the effects of the supply variables to obtain individual-need estimates. We aggregated these by general practitioner practice, age and gender to derive weights for the national capitation formula. Higher costs were associated with: being 30-50 years old, compared with 20-24; being Irish, Black African, Black Caribbean or of mixed ethnicity, compared with White British; having been admitted for specific physical health conditions, including drug poisoning; living alone, in a care home or in a communal environment; and living in areas with a higher percentage of out-of-work benefit recipients and higher prevalence of severe mental illness. Longer distance from a provider was associated with lower cost. The resulting needs weights were higher in more deprived areas and informed the distribution of some 12% (£9 bn in 2019/20) of the health budget allocated to local organisations for 2019/20 to 2023/24.

My business is your business: the Court of Appeal’s decision in MN v OP

Abstract This article considers the decision of the Court of Appeal in England in MN v OP [2019] EWCA Civ 679 on the circumstances in which an anonymity order will be made in connection with an application under the Variation of Trusts Act 1958. It looks at the legal framework for the decision, in particular the basis for the contention that an analogy should be drawn with proceedings under Rule 21.10 of the Civil Procedure Rules, with the result that anonymity orders should be the norm. It then sets out the conclusion and reasoning of the Court of Appeal and provides some commentary on the possible ramifications of the decision for practitioners in England and other jurisdictions.

Framing ‘drug prevention’ for young people in contact with the criminal justice system in England: views from practitioners in the field

ABSTRACTDrawing on the work of Rein and Schon (1993. “Reframing Policy Discourse.” In The Argumentative Turn in Policy Analysis and Planning, edited by F. Fischer, and J. Forester, 145–166. London: UCL Press., 1996. “Frame-Critical Policy Analysis and Frame-Reflective Policy Practice.” Knowledge and Policy: the International Journal of Knowledge Transfer and Utilization 9 (1): 85–104), we explore the ways in which ‘young people’, ‘vulnerability’, ‘risk’, ‘prevention’ and ‘prevention practice’ were defined and framed by practitioners engaged in the design, delivery and commissioning of drug prevention interventions for young people in contact with the criminal justice system. We argue that practitioners describe their work in terms of both a preventative frame – based on a ‘deficit’ model – and a transformative praxis frame, more in line with an increasing shift towards ‘positive youth justice’ where practitioners aspire to actively involve the young person in a process of change. The implications of those, often competing, frames are discussed in relation to the development of prevention approaches and the challenges in designing drugs prevention for this group of young people. The paper is based on interviews and focus groups with thirty-one practitioners in England and is part of the EU funded EPPIC project (Exchanging Prevention Practices on Polydrug Use among Youth in Criminal Justice Systems 2017–2020).

Friendships for wellbeing?: parents’ and practitioners’ positioning of young children’s friendships in the evaluation of wellbeing factors

ABSTRACTFriendship matters for young children’s development, learning and experience of wellbeing. This paper emphasises the significance of young children’s friendships for their wellbeing, especially in the context of early years settings. Findings are presented from two online questionnaires developed for the project, in which 155 parents/carers and 285 practitioners in England expressed their perceptions of what matters for young children’s wellbeing. Data shows some ambivalence in the views of both parents/carers and practitioners about the importance of friendship in this context. Both groups gave low prioritisation to ‘the company of friends’ for children’s wellbeing. As friendships are of central importance to young children themselves, this could suggests that adults and children may have different priorities, which raises questions about the extent to which young children’s friendships are seen as important by adults. The paper concludes by proposing the need for practitioners in particular, but also parents, to consider their roles and priorities for children’s lives within schools and nurseries, including how they might sensitively support and facilitate children’s friendships in play, activities, transition and everyday life.

Barriers to and facilitators of the identification, management and referral of childhood anxiety disorders in primary care: a survey of general practitioners in England

ObjectivesAlthough anxiety disorders are the most common emotional disorders in childhood and are associated with a broad range of negative outcomes, only a minority of affected children receive professional support....

The Emotional Impacts of Working as an Asylum Lawyer

Asylum practitioners often work with traumatised persons and hear stories of persecution and other traumatic narratives in their everyday work. This study sought to assess the emotional impacts of working as an asylum practitioner, and how these effects could affect a practitioner’s performance in their role or their relationship with their clients. This qualitative study consisted of 10 semi-structured interviews with asylum practitioners in England and the Republic of Ireland. An inductive thematic analysis was used to analyze data. A number of key themes emerged, including participants describing having experienced or witnessed burnout and other negative emotional effects caused by working in this role. Practitioners also described having experienced feelings of detachment from clients, as well as in some cases cynicism and disbelief of their narratives. However, these emotional states were seen to engender positive as well as negative attributes in the delivery of legal representation. Heavy caseloads, the futility of working in a system where some clients have little chance of success, cuts to legal aid, as well as societal stigmatization of claimants were also cited as providing challenges for practitioners. A complex understanding of this role emerged in times of austerity, where anti-immigration sentiment is common within society.

Open government data: critical information management perspectives

PurposeOpen government data and access to public sector information is commonplace, yet little attention has focussed on the essential roles and responsibilities in practice of the information and records management professionals, who enable public authorities to deliver open data to citizens. This paper aims to consider the perspectives of open government and information practitioners in England on the procedural and policy implications of open data across local public authorities.Design/methodology/approachUsing four case studies from different parts of the public sector in England (local government, higher education, National Health Service and hospital trust), the research involved master’s level students in the data collection and analysis, alongside academics, thus enhancing the learning experience of students.FindingsThere was little consistency in the location of responsibility for open government data policy, the range of job roles involved or the organisational structures, policy and guidance in place to deliver this function. While this may reflect the organisational differences and professional concerns, it makes it difficult to share best practice. Central government policy encourages public bodies to make their data available for re-use. However, local practice is very variable and perhaps understandably responds more to local organisational strategic and resource priorities. The research found a lack of common metadata standards for open data, different choices about which data to open, problems of data redundancy, inconsistency and data integrity and a wide variety of views on the corporate and public benefits of open data.Research limitations/implicationsThe research is limited to England and to non-national public bodies and only draws data from a small number of case studies.Originality/valueThe research contributes to the debate about emerging issues around the complexities of open government data and its public benefits, contributing to the discussions around technology-enabled approaches to citizen engagement and governance. It offers new insights into the interaction between open data and public policy objectives, drawing on the experience of local public sectors in England.

A patient consults with an advanced nurse practitioner in England

A patient consults with an advanced nurse practitioner in England

Resource use and cost of annual health checks in primary care for people with intellectual disabilities.

The annual health check (AHC) programme, as part of a Directed Enhanced Service, offers an incentive to general practitioners in England to conduct health checks for people with intellectual disabilities (IDs). The aim of this analysis was to estimate the impact on health care costs of AHCs in primary care to the National Health Service in England by comparing adults with ID who did or did not have AHCs using data obtained from The Health Improvement Network. Two hundred eight records of people with ID from The Health Improvement Network database were analysed. Baseline health care resource use was captured at the time the first AHC was recorded (i.e. index date), or the earliest date after 1 April 2008 for those without an AHC. We examined the volume of resource use and associated costs that occurred at the time AHCs were performed, as well as before and after the index date. We then estimated the impact of AHCs on health care costs. The average cost of AHC was estimated at £142.57 (95%CI £135.41 to £149.74). Primary, community and secondary health care costs increased significantly after the index date in the no AHC group owing to higher increase in resource utilisation. Regression analysis showed that the expected health care cost for those who have an AHC is 56% higher than for those who did not have an AHC. Age and gender were also associated with increase in expected health care cost. The level of resource utilisation increased in both (AHC and no AHC) groups after the index date. Although the level of resource use before index date was lower in the no AHC group, it increased after the index date up to almost reaching the level of resource utilisation in the AHC group. Further research is needed to explore if the AHCs are effective in reducing health inequalities.

The composition and distribution of the legal profession, and the use of law in Britain and Ireland, c.1500-c.1850

Summary The geography of the legal profession and legal culture, and the possibility that there were major regional differences in the use of law and legal institutions across historic Europe have been little studied by historians. This article compares England and Wales with Scotland, whose private law was different, and Ireland, where English common law worked alongside indigenous law traditions. Lawyers can be divided between those who pleaded and those who prepared documents, but the nomenclature and professional development of ‘men of law’ differed considerably within the component parts of Britain and Ireland. The article brings out these differences and, in so doing, hopes to provide a framework for comparing the place of the legal profession and the use of law over space and time. It is in two parts. The first explores the changing numbers of different sorts of legal practitioner in England and Wales, Scotland, and Ireland: barristers, solicitors/attorneys, advocates, writers, and notaries. From an early date, England and Wales had many more lawyers per head of population than other parts of what became the United Kingdom of Great Britain and Ireland; the legal profession was dominated by attorneys, who far outnumbered barristers, whereas in Scotland and Ireland those who pleaded formed a significant proportion of all men of law. The second part seeks to explain this difference, by examining how different societies related to the formal practices of law and to alternative forms of dispute resolution. The component parts of the British Isles had distinctive social structures, economic compositions, religious emphases, and cultural forms, which meant that the place of law and lawyers in their societies varied considerably. The argument is that, as well as having different legal institutions and professional structures, Scottish and Irish people used the law more selectively than their English (and perhaps also Welsh) equivalents.

Stop Smoking Practitioners’ understanding of e-cigarettes’ use and efficacy with particular reference to vapers’ socioeconomic status

Introduction: We have undertaken four online surveys of Stop Smoking Service (SSS) practitioners in England, between 2011 and 2016, in order to enhance our understanding of e-cigarettes: a fast moving new phenomenon. It is important to understand whether e-cigarettes can ameliorate or exacerbate health inequalities given that smoking is one of the most serious causes of excessive mortality and morbidity among disadvantaged groups globally. Aims: To update findings of previous surveys and examine socioeconomic status differences in e-cigarette use and efficacy. Methods: Analysis was undertaken of electronic surveys, particularly, the most recent 2016 survey (n = 514) and 2015/16 SSS client routine monitoring data. Results: SSS practitioners were becoming more positive about e-cigarettes: 42% agreed that e-cigarettes were a good thing compared with 15% in 2011. Reported use of e-cigarettes among SSS clients was low (about 3%) despite higher quit rates (63% of clients reported being quit at four week follow-up, compared with 51% overall). Where socioeconomic differences in e-cigarettes' efficacy for quitting were identified, affluent and working smokers were advantaged. Conclusions: Low use of e-cigarettes by clients and practitioner opinions suggest that further education of SSS staff is needed if they are to adopt the current service recommendations about e-cigarettes.

From “Learning disability to intellectual disability”—Perceptions of the increasing use of the term “intellectual disability” in learning disability policy, research and practice

Accessible summary: “Learning disability” replaced the outdated term, “mentally handicapped” in the UK over 20 years ago. Recently, some services and professionals have been using the term “intellectual disability” instead. In America, “intellectual disability” has been chosen to replace the old term, “mental retardation.” There has been lots of explanation why this has happened. In the UK, there has not been much explanation. It is important to know what terms mean and why they are being used because their use affects the lives of people with learning disabilities. This article looks at what different people in the UK think about term “intellectual disability.” AbstractBackgroundThe term “intellectual disability” is increasingly used to refer to people with learning disabilities in British learning disability policy, practice and research. This change is undoubtedly a reflection of the changing international context. The inclusion of the term “intellectual disability” has been particularly pronounced in countries such as the USA. By contrast, this change has been relatively silent in England.MethodsIn light of this, the paper explores the discussions of 12 focus groups conducted with professional and lay groups working in or influencing learning disability research and practice in England. Each focus group was asked the following two questions: Have you heard of the term “intellectual disability” and how do you feel about the term “intellectual disability?.”Discussion and ConclusionThematic analysis of the discussions identified four dominant themes: dislike and disbelief; ambiguity; tautology; and fear. It is concluded that more explanation is required in order for researchers and practitioners in England to understand this semantic change.

Loved or listened to? Parent and practitioner perspectives on young children’s well-being

ABSTRACTWell-being is a significant concept in research, policy and practice in education, but consensus about what it is is challenging. In addition, the well-being of children under eight is under-researched. Using online surveys, this paper looks at the perspectives of 155 parent/carers and 285 practitioners in England on young children’s well-being. In many areas, there were high levels of agreement: the importance of fun and laughter, feeling good about oneself, feeling listened to, good family relationships, time and space to play and opportunities to express thoughts and feelings. Parents/carers emphasized ‘love’ whilst practitioners emphasized listening to children. Practitioners also strongly emphasized the importance of their relationships with children and parents/carers. The paper concludes that, whilst the perspectives of parents/carers and practitioners are valuable, a full understanding of young children’s well-being needs to include their voices as well as those of adults.

Clinical oral microbiology and antimicrobial susceptibility – does it matter?

ABSTRACTLittle surveillance data is undertaken on the antimicrobial susceptibility of isolates from acute dento-alveolar infections. We present data collated from routine diagnostic microbiology specimens submitted over a 27 year period in Glasgow, UK. Over the study period isolates were identified using the API system, VITEK 2 and MALDI-TOF. Antimicrobial susceptibility tests were undertaken using combinations of Stokes method and/or E-tests. Baseline data based on Lewis et al., (JAC 23,69-77 1989) and compared to isolates from 1998-2015. From 621 specimens, we isolated Anginosus group streptococci (n = 196), Mitis group Streptococci (n = 448), anaerobic streptococci (n = 116), Fusobacteria (n = 121) and Prevotella (n = 140) species. No discernable increase in resistance patterns over the 27 year time period of analysis was observed. A 6 month audit (May-Oct 2016) in Glasgow recorded 37 patients hospital admissions for 142 bed days (mean 3.5 days) to incise and drain severe odontogenic infections. But, dental practitioners in England (2015) prescribed 10,717 items of cephalosporins and 18, 630 items of augmentin (Source: Health and Social Care Information Centre) – why?Diagnostic oral microbiology matters in guiding antimicrobial stewardship programs but more collaborative working on processing methods and routine susceptibility data would help overcome limited data from single centers.

Pay for performance and contractual choice: the case of general practitioners in England

The Quality and Outcomes Framework (QOF) is a Pay-for-Performance scheme introduced in England in 2004 to reward primary care providers. This incentive scheme provides financial incentives that reward the overall performance of a practice, not individual effort. Consequently, an important question is how the QOF may affect contractual choices, quality provision and doctor mobility in the primary healthcare labour market. The paper provides a simple theoretical model that shows that the introduction and further strengthening of the scheme may have induced practices to compete for the best doctors and modified their choices in terms of contractual agreements with practitioners. We test the implications of this model using a linkage between Doctors Census data and practices’ characteristics from 2003 to 2007. We use linear multilevel models with random intercept and we account for sample selection. We find that after the introduction of the QOF efficient doctors are more likely to become partners and mobility among doctors has increased. The strengthening of the scheme in 2005 is associated with an increase in the quality of primary care and a reduction in access to the market for new doctors.

A dermatological questionnaire for general practitioners in England with a focus on melanoma; misdiagnosis in black patients compared to white patients.

Malignant melanoma presents a significant health burden in the UK in terms of mortality and financial cost. This aggressive and often fatal disease is under-diagnosed among patients with darker skin tones (type 5 and 6) such as Afro-Caribbean patients. A lack of both patient and practitioner awareness leads to a later diagnosis in patients with black compared to white skin. There is currently a paucity of literature looking at the diagnosis rates of melanoma between patients of different ethnicities in the UK and the reasons behind these differences. The primary aim was to obtain data on the diagnosis rate of melanoma in the primary care setting, with particular attention to white vs. black skin types. An online questionnaire was sent to 2975 general practitioner (GP) practices in England and 287 responses were received. The questionnaire contained 20 high-quality picture questions of differing common skin conditions. The participants were asked to choose their diagnosis from 20 potential diagnoses. Only 4/20 questions were melanomas, two on white and two on black skin. No accompanying histories were provided. The mean score for the questionnaire was 11.6/20 (58%) with a range from 5% to 100%. Of the two black skin melanoma pictures, 177/287 (62%) and 90/287 (31%) responses were incorrectly identified, compared to 37/287 (13%) and 19/287 (7%) in the white skin melanoma pictures. The questionnaire results show a clear increased misdiagnosis of melanoma in black patients in primary care vs. white. The results suggest that vigilance is needed when diagnosing possible melanoma in black patients and better quality melanoma teaching is required in GP training concentrating on pigmented skin. This pilot study should encourage more research into ethnic skin inequalities in the UK.