South East England Research Articles

A novel multisite model to facilitate hepatitis C virus elimination in people experiencing homelessness

Background/aims: Only a handful of countries are on target to achieve hepatitis C virus (HCV) elimination by 2030. People experiencing homelessness (PEH) remain an important HCV reservoir. The END C study evaluated clinical, patient reported and health economic outcomes of a decentralised integrated model. MethodsThis prospective study assessed a decentralised regional service based at multiple homeless sites in southeast England. Novel linkage-care strategies were utilised. We assessed generic and liver specific health-related quality of life (HRQoL) (SF-12v2; EQ-5D-5L and SFLDQol) pre/post HCV treatment and cost per HCV case detected and cured. Primary outcome was intention-to-treat (ITT) sustained virological response (SVR12). ResultsWe recruited 418 individuals, mean age 44.45 ± 10.6, 78% were male, 74% being currently homeless, current injecting drug use/alcohol use being 25% and 65% respectively. Prevalence of cirrhosis (liver stiffness measurement >12kPa) was 12%. Twenty-eight percent (n=116) were HCV PCR positive, of whom n=105 received direct acting antiviral treatment. ITT SVR12 rates were 81% (95% CI 72%-88%), the only predictor of SVR12 being >80% treatment adherence (OR 20.69, 95% CI 6.227-68.772, p<0.001). HRQoL improved significantly after SVR12: SF-12v2 (General Health, Mental Health, Social Functioning, Mental Health Composite Score p<0.049); SFLDQoL (Symptoms/Effects of Liver Disease, Distress, Loneliness p<0.004) and EQ-5D-5L (Index Score, Visual Analog Scale p<0.001). Costs (British pound 2022) per HCV case detected and per case cured were £359 and £257 respectively. Reinfection rates were 6.82/100 person years. ConclusionThe END C study endorses a multisite decentralised service for PEH enabling excellent linkage to care, high SVR12 rates and significant improvements in generic and liver specific HRQoL, all being achieved at modest costs. Such services are paramount to help achieve HCV elimination. Impact and implicationsIn people experiencing homeless, we found a high prevalence of HCV, alcohol and substance misuse including overdoses and mental health issues. Despite this, an integrated and decentralised service resulted in excellent linkage to care with high SVR12 rates. Even in this complex cohort with multiple comorbidities, SVR12 was associated with significant improvements in both generic and liver specific health-related quality of life. This was all achieved at modest costs in a community setting. Such models of care are feasible, easy to replicate and essential if we are to achieve HCV elimination.

Evaluation and comparison of sensitivity of alcohol biomarkers PEth, EtG and EtPa in civil cases in England 2022–2023

This study details trends in direct alcohol biomarker concentrations from civil cases within the United Kingdom (UK). Our subject cohort in this study related to family law litigation, where an individual was subject to an alcohol monitoring order by the court. This monitoring was conducted by quantification of alcohol biomarkers Phosphatidlyethanol (PEth) in dried blood spots (DBS) and Ethyl Glucuronide (EtG) and Ethyl Palmitate (EtPa) from hair segments. In total 298 PEth cases predominantly from the South East of England during the period July 2022 to August 2023 were analysed for alcohol biomarkers in DBS and hair. Subjects alcohol intake was classified as abstinence/low alcohol consumption, moderate or excessive alcohol consumption, based on a combination of Society for Hair Testing and PEth Net guidelines. Our results indicate that 33 % of PEth concentrations were consistent with excessive alcohol use (>200 ng/mL DBS), with 36 % consistent with social or moderate alcohol use (20–200 ng/mL DBS). In relation to EtG and EtPa 23 % and 31 % of subjects were classified as excessive alcohol users respectively. This study indicates that DBS sampling of PEth is a more sensitive predictor of alcohol use, in particular, at differentiating between moderate and excessive alcohol use compared to EtG and EtPa testing in hair. The authors suggest that increased frequency in the sampling of PEth in DBS (multiple occasions per month) may provide a more accurate assessment and simplification of the interpretation criteria of alcohol patterns rather than the combined hair testing and DBS sampling that are typically requested by UK courts.

Widening participation and success in STEM: embedding research-engaged practice to measure impact

There is a systemic shortage in the number of graduates entering the STEM workforce. To address the current graduate shortage (HM Govt, 2017), the widening gap between industry demand, the available skilled workforce (ASE, 2020), and the underrepresentation of key groups within STEM industries and academia requires overhauling the STEM education `pipeline´. However, there is a lack of consensus on how to increase the diversity of students pursuing STEM post-16 and how to tackle the dual challenges of engagement and science capital for the most underrepresented groups. This paper discusses the development of a research-engaged sustained STEM outreach programme working with students from rural and coastal schools in South-East England. Whilst there are numerous STEM programmes that aim to provide academic support, build science capital or improve diversity in post-16 STEM studies, this paper describes how two areas of innovative practice came together in a university-led pre-entry STEM widening participation programme: Inspiring Minds. The first relates to its foundation in a research-engaged pedagogy (the epistemic insight curriculum) that underpinned the programme content and design, and the second to the embedded approach to rigorous evaluation and impact monitoring tracking shifts in both aspirational and attainment measures of participating students.

Tracking the invasive and euryhaline pikeperch Sander lucioperca in the lower River Thames using acoustic telemetry indicates no movements into areas of relatively high salinity.

Native to Central and Eastern Europe, the euryhaline pikeperch Sander lucioperca can acclimatize to elevated salinity levels (e.g., up to 30‰), but it remains unknown whether their invasive populations use this ability to inhabit and/or disperse through brackish waters, such as estuaries and inshore areas. To test whether invasive pikeperch show a propensity to move into areas of relatively high salinity, their spatial use and movement patterns (e.g., home range, distances moved, and movement rates) were assessed using acoustic telemetry in the upper River Thames estuary, southeast England. Analyses revealed that individual pikeperch were capable of moving relatively long distances in a short time (e.g., speeds up to 70 m min-1), with movement patterns associated more with tidal state and elevation at the water surface (both assumed to relate to changes in salinity) than diurnal changes. There were no recorded movements of any pikeperch into the more saline, downstream waters of the estuary where salinity levels were recorded to over 40‰, with the mean salinity in the most downstream area where pikeperch were detected being 1.39‰ (range of logger: 1.22-1.71). The results suggest that these pikeperch did not use high salinity waters when less saline waters were available, and thus the risk that they will use to move through high salinity areas to expand their invasive range appears low. Accordingly, efforts to minimize risks of the further dispersal of invasive pikeperch populations can focus on control and containment programmes within fresh waters.

The role of news and rumour during the Peasants’ Revolt, 1381

Abstract This article uses an interdisciplinary approach to examine the role of news and rumour during the Peasants’ Revolt, an aspect of the rising that has not been the subject of a detailed study. It considers the circulation of news in written and oral form and its importance in driving the rebellion. Sources suggest that the news of the revolt traversed the country quickly, moving at up to sixty-five miles a day, and its transmission is shown through an isopleth map to radiate outwards across the country from its point of origin in south-east England. Rumour is considered by means of a thought experiment using three examples drawn from rebel activities in London in June 1381. It thrived in the absence of news, particularly in a highly stressed environment. It is possible that rumour was used as a tactic by rebel commanders, who were able to generate and manipulate rumours to their own advantage.

‘Hands on’, ‘hands off’ or ‘hands poised’? Exploring intrapartum midwifery decision making through ethnographic research

IssueInjury to the perineal tissues during childbirth is a frequent occurrence with most women likely to experience perineal injury during a first birth which, in some cases, can lead to significant long-term morbidity. The techniques used to minimise perineal injury are frequently termed ‘hands on’ and ‘hands poised’ or ‘hands off’. These terms are often undefined and used inconsistently in the literature, making it difficult to identify the best available evidence to inform midwifery practice. AimThis study aimed to answer the research questions: What do midwives do to minimise perineal injury during birth and what influences their decision-making? MethodsAn ethnographic study was undertaken during 2016 in a maternity unit in the southeast of England. Data were collected through participant-observation, ethnographic and semi-structured interviews and analysed using thematic analysis, informed by the pedagogic theory of threshold concepts. Findings31 midwives participated in the study. Evidence-based decision-making to minimise perineal injury during birth was identified as a complex concept. Within the context of threshold concept theory, three main themes were identified that contributed to the complexity: troublesome language, troublesome knowledge, and troublesome environments. ConclusionsMidwifery decision-making in the context of minimising perineal injury during birth is more varied and conceptually complex than has been previously described. Identification of the various aspects of troublesomeness in this context suggests that this element of practice is a midwifery threshold concept. Addressing this within midwifery curricula and practice education to enable evidence-based decision-making is important.

Designing Absence: The Invisible Bridge and the Ghost Barn

AbstractStraddling the fine line between architecture and art, London‐ based architects ritchie*studio have designed an Invisible Bridge and a Ghost Barn on a private, historic and protected estate in Hampshire, Southeast England. These delicate propositions juggle presence and absence informed by the site's history, by poetry, Charles Darwin, local flint and an intelligent and thoughtful client. Ian Ritchie writes about the concepts for these two interventions and their associated inspirational narratives.

DS16 Incidence and management of pregnancy-associated melanoma in a district general hospital in the Southeast of England

DS16 Incidence and management of pregnancy-associated melanoma in a district general hospital in the Southeast of England

Unleashed: walking dogs off the lead greatly increases habitat disturbance in UK lowland heathlands

Human population growth is associated with increased disturbance to wildlife. This effect is particularly acute in urban and periurban areas, where the area of effective disturbance extends beyond that of human presence by the roaming behaviour of pet dogs. Dogs are globally the dominant companion animal, with a population of ~ 12 million in the UK. As urban areas extend, dogs are exercised in green space close to housing. In southeast and southern England these areas include lowland heath, a habitat of high conservation value. To quantify disturbance caused by dog walkers and their dogs, we used GPS units to track the movement of people and their dogs across four lowland heath sites, used a questionnaire to ask about dog walking habits, and mapped potential areas of disturbance caused by dog walkers. Questionnaires were completed by 798 dog walkers and the walks of 162 owners and their 185 dogs were recorded. Mean (± SE) walk time was 56 ± 23 min, walk distance 3.75 ± 1.68 km and dogs were a median distance of 20 m from the owner during walks. Dogs were walked once (44%) or twice (56%) a day. Most (always: 85%; always or occasionally: 95%) dogs were walked off the lead even when signs were present requesting that dogs were kept on a lead. This resulted in up to a 21% increase in reserve area disturbed. In one reserve (Snelsmore Common), > 90% of the area was disturbed by dogs, greatly eroding its conservation value. This work highlights the importance of considering how dog ownership can exacerbate levels of disturbance in sensitive periurban habitats when housing developments are planned.

Learning disability awareness training for undergraduate midwifery students: Multi-method evaluation of a co-produced and co-delivered educational intervention in England

BackgroundMidwives lack the confidence and competence to identify and support people with learning disabilities, putting this population at risk of inequitable maternity care. ObjectivesTo co-produce, co-deliver and evaluate maternity focused learning disability awareness training for student midwives, in collaboration with experts-by-experience (people with learning disabilities). DesignMulti-methods study evaluating the impact and acceptability of learning disability awareness training. SettingsUniversity in south-east England, UK. Participants83 midwifery students and 7 experts-by-experience. MethodsMidwifery students completed pre-post training surveys and a follow-up survey 3 months post training to substantiate longer-term impact. Experts-by-experience took part in qualitative interviews post training. ResultsStudent-reported learning disability awareness was significantly higher across all domains post training and sustained at follow up. Students reported the most notable aspect of training was learning with and from people with learning disabilities. Three inter-related themes were constructed from interviews with experts-by-experience: reasonable adjustments to training and research processes; a positive social, emotional and learning experience; and perceptions of impact. ConclusionsFindings from this study suggest that co-producing and co-delivering resources and education to an undergraduate midwifery workforce with people with lived experience, can have a profound impact on students and is also a positive experience for people with learning disabilities. The co-produced resources used in this training are free and accessible [https://www.surrey.ac.uk/togetherproject]. Further evaluation will explore acceptability and perceived impact of training and resources on other healthcare professionals working with maternity services.

National myeloma patient survey shows continuing inappropriate imaging and geographical inequalities.

To evaluate the provision of imaging at diagnosis of myeloma from the service user perspective with a specific focus on how the experiences of patients align with the National Institute for Health and Care Excellence (NICE) guidelines (NG35, 2016) on first-line imaging practice for myeloma in the United Kingdom. A national survey was performed to evaluate access to imaging from the patient's perspective. Patients with myeloma who received their diagnosis between 2017 and March 2022 were invited to participate. Data were collected using an online survey from 895 patients and carers between 4 and 14 March 2022. Most patients had more than one imaging test. First-line MRI was used in 69.2% of respondents. First-line skeletal survey (SS, whole body X-rays) remained common (48.7% of respondents). 18F-fluorodexyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was used least often (23.1% of respondents). SS was used more often in East England (57.9%) and Scotland (61.2%) than in South East England (36.3%). Despite NICE recommendations, first-line MRI was not used in a third of patients surveyed, with geographical variation in imaging practice. Patients are still undergoing multiple imaging tests at diagnosis. Healthcare professionals should continue to emphasize the superiority of MRI compared to SS to drive for improvements in care. Current recommendations on first-line imaging for myeloma are not provided consistently across the United Kingdom. There is a need to drive change and support healthcare professionals to deliver guidance-based recommendations to improve experience and outcomes for patients.

Effective palliation of refractory ascites in cirrhosis is challenging.

Palliative care is often suboptimal for patients with end-stage liver disease (ESLD). Ascites remains the most common complication in ESLD. Though long-term abdominal drains (LTAD) are commonly used in refractory malignant ascites, the standard care for ESLD is hospital drainage (large volume paracentesis (LVP)). There is an ongoing National Institute for Health and Care Research (NIHR) funded trial (REDUCe 2 Study) (ISRCTN269936824) comparing palliative LTAD to LVP in ESLD. This 35-site trial is being conducted in England, Scotland and Wales. To understand the views and experience of healthcare professionals (HCP) on the use of palliative LTAD in ESLD. An electronic survey comprised of seven questions with fixed quantitative options and three exploratory questions was used between August-December 2019. The survey was distributed electronically via the British Association for Study of Liver newsletter and to relevant hospital departments in Southeast England and Northeast London. An email reminder was sent at 4 and 8 weeks after the initial invitation to the survey. There were 211 respondents (hepatologists (36.5%), specialist nurses (24.6%), gastroenterologists (16.6%), trainees (17%) and others (5.2%)). All respondents had access to LVP, 86% to a transjugular intrahepatic portosystemic shunt procedure for patients, 67% to LTADs and 10% to other options, such as the automated low-flow ascites (ALFA) pump. The majority of respondents to the survey (68%) reported their experience of using LTAD. Almost all respondents (91%) were willing to consider LTAD in ESLD. However, the main deterrents of this were the perceived risk of infection (90%), followed by LTAD management in community (57%). Some 51% of those with prior experience of using LTAD reported clinical complications for patients (including bleeding, infection and renal impairment), 41% reported technical issues and 35% inadequate community support. Almost all HCPs are willing to consider palliative LTAD in refractory ascites due to ESLD, but the main deterrents are the perceived infection risk and lack of published data to guide community management. The REDUCe 2 trial will clarify if these concerns are real and provide conclusive evidence on role, if any, of palliative LTADs in this vulnerable and under researched cohort with ESLD.

Pressure ulcers: aSSKINg framework study.

Pressure ulcers (PUs) represent a burden to the health economy and patients alike. Despite national and international guidelines regarding the management of risk, the incidence and prevalence across England remains high. Detecting early the risk of PUs is paramount, and requires using a valid risk assessment tool alongside clinical judgement and management of associated risk factors. There is a need to implement prevention strategies. Introducing care bundles for pressure ulcers, for example SKIN, SSKIN and most recently aSSKINg, is designed to guide clinicians and reduce variations in care. This article presents a review of the evidence on compliance with guidelines, frameworks, pathways or care bundles within primary and secondary care settings. This article focuses on the literature review that was conducted to inform a subsequent clinical audit of compliance with the aSSKINg framework in a Community NHS Foundation Trust in the South East of England.

‘Gaming’ in the English primary school: ‘do whatever you need to do to make your data look good’

ABSTRACT In an international policy environment of intensified high-stakes accountability, pupil assessment data are an invaluable commodity and critical indicator of both school and teacher effectiveness. Teachers’ engagement with pupil data and the associated experiences of increased accountability are of great consequence, and highly contentious for perceptions and experiences of policy. In the context of the English primary school, this paper explores the progressively tactical nature of teachers’ enactment of assessment policy, and the impetus to ‘make the data look good’. It draws upon an empirical study of rich qualitative data from 42 interviews with 22 primary teachers employed in the South-East of England. The findings add to an evolving field about ‘gaming’, and particular consequences for teacher identity are discussed. The paper further advances insights about teachers’ experiences of ‘in-school assessment’ as pertinent for understanding gaming. It locates the pupil progress meeting as an iteration of teacher accountability and performativity, and particular site of contestation, and a specific contribution to knowledge in this regard.

Dietitians’ perspectives on clinical pathways and practice in relation to the dietary management of irritable bowel syndrome in the UK: A qualitative study

Irritable bowel syndrome (IBS) is a chronic and relapsing gastrointestinal condition which negatively impacts quality of life(1). Dietary triggers are common and dietary management is central to the IBS treatment pathway with dietitians being the main education providers for patients(2). The aim of this study was to explore the perceptions of dietitians towards current practices in IBS services in clinical settings across the UK.Qualitative semi-structured interviews were undertaken to explore current practices, barriers, and facilitators to dietetic practice and expected treatment outcomes. Eligible participants were dietitians specialising in IBS and working in the National Health System (NHS) in the UK. Interviews were held virtually. Audio was recorded and transcribed following intelligent transcription. Data were analysed using template analysis (3).Thirteen dietitians (n=12 female) specialising in gastroenterology consented to participate in the study. Dietitians were working in various NHS Trusts across the country (Southeast England n=3; Southwest England n=3; Northwest England n=2; Northeast England n=1; West Midlands n=1; Southwest Wales n=1 and Southcentral Scotland n=2). Ten out of 13 dietitians had more than five years of experience in IBS management. Three main themes emerged: 1) Dietetic services as part of IBS referral pathways; 2) Practices in relation to dietetic services and 3) Implications of services on patients’ expectations and feelings. Each main theme had subthemes to facilitate the description and interpretation of data. The increasing number of IBS referrals to dietitians and the need for accurate and timely IBS diagnosis and specialist IBS dietitians was reported, alongside the use of digital innovation to facilitate practice and access to dietetic care. The use of Internet as a source of (mis)information by patients and the limited time available for educating patients were identified as potential barriers to dietetic practice. Dietitians follow a patient-centred approach to dietary counselling and recognise the negative implications of perceived IBS-related stigma by patients on their feelings and treatment expectations.The study identified areas and practices which can facilitate access to dietetic services and patient- centred care in IBS management as outlined in guidelines (4).

Trajectories of mental health across the primary to secondary school transition

AbstractBackgroundAdolescence is a period of profound developmental change during which the prevalence of mental health problems starts to increase. It also typically coincides with a school transition. Understanding mental health trajectories through school transition is important to inform interventions to support young people's mental health during this period.MethodsIn a longitudinal study with three assessment points spaced six months apart spanning the transition from primary (T1 = end of primary school [Year 6]) to secondary school (T2 = beginning of the first year secondary school [Year 7]; T3 = end of first year of secondary school [Year 7]) we carried out a latent class growth analysis of symptoms of common mental health problems. Young people (mean age at baseline of 11.2 years, standard deviation 0.29; 46.8% female; 53.2% male) from South East England (n = 1861) were included. We modelled emotional problems, conduct problems, hyperactivity and peer problems in parallel over the transition period. Individual‐level variables: socioeconomic status (SES), special educational need(s) (SEN), gender, negative life events (NLEs) and being worried about transition were tested as predictors of trajectory class membership using multinomial logistic regression.ResultsA model with four trajectory classes provided the best fit to the data: ‘persistently elevated’ mental health problems, ‘emotional and peer problems’, ‘hyperactivity and conduct problems’ and ‘persistently low’ mental health problems. Class membership was differentially predicted by the individual‐level variables.ConclusionsYoung people from low SES backgrounds, those with SEN and those who have experienced two or more NLEs are more likely to exhibit trajectories with elevated mental health difficulties through the transition to secondary school. Young people who were worried about transition were more likely to belong to a trajectory class characterised by elevated emotional problems.

Periglacial landforms and landscape development in southern England

The south-central and south-east England Geological Conservation Review region is unique in Britain in lying completely outside the margins of Quaternary ice sheets. In view of this, the area has been described as a ‘relict periglacial landscape’. This implies that the region has evolved its current form substantially under the influence of seasonal and/or perennial frost. In fact, modern research has demonstrated that permafrost, either continuous or discontinuous, likely existed across probably the whole of the region at different times during the Quaternary. This has important implications for ground permeability and the strength of sediments and soils and this has, without doubt, influenced landscape development. Whilst the whole region appears to have experienced cold environmental conditions, the landforms, structures and sediments of some sites are particularly associated with periglacial processes. Allington Quarry, Spot Lane Quarry, Oaken Wood, Chiddingly Wood (known locally as Chiddinglye Wood), High Rocks and Rusthall Common have exhibited typical cambering structures with open or closed gulls. The latter three sites also display a fine range of surface weathering features. Hubbard's Hill is characterised by solifluction and active-layer detachment slides and associated subsurface shear structures, whilst the sarsen trains at Fyfield Down and Valley of Stones are also attributed to solifluction processes. Birling Gap and Pegwell Bay exhibit spectacular sediment brecciation and involutions. Pegwell Bay is also known for its thick layer of periglacial loess, a sediment that is also a feature of North Cliff, Broadstairs. Unfortunately, the dating of these landscape features has, so far, proved possible only at Hubbard's Hill and Pegwell Bay. Nevertheless, the sites reviewed here provide exceptional, and in some cases internationally important, indications of landscape development in cold, often permafrost, environments which justifies their status as GCR sites.

Prospects for a Megacity Region Transition in Australia: A Preliminary Examination of Transport and Communication Drivers

Australian governments continue to search for a model capable of planning future urban settlements at an extended spatial scale (the mega-metropolitan region) to accommodate high population growth more sustainably. Attempts at decentralisation over the past half century have failed, as state capital cities continue to sprawl in an unsustainable manner and increase their primacy at the expense of regional cities. This paper examines how two technologies, broadband and fast rail—both infrastructures capable of re-shaping space–time relationships—could underpin a transition of Australia’s largest capital cities into megacity regions by functionally integrating regional cities into their core metropolitan agglomerations. With the Melbourne megacity region as a spatial framework, changes in population and economic development are examined for Melbourne and several regional cities in Victoria following the introduction of regional fast rail (RFR) and broadband. The impact of high-speed rail (HSR) for intercity corridors in southeast England is analysed as a possible analogue for future application in Victoria. The results revealed that RFR primarily served to extend capital city suburban development. Only HSR had the capacity to ‘punch through’ and boost growth for ‘basic’ new economy industries in ‘on-line’ urban centres in corridors linked to London. High-speed broadband proved most attractive to Melbourne’s agglomeration of high-skilled information workers. Lower speed broadband services were more uniformly taken up across all centres. This discussion speculates on the impacts of these and other green economy and digitalisation drivers on prospects for a future megacity region transition in Victoria.

Experiences and management of uncertainty following treatment for prostate cancer

This article explores men’s experiences and management of uncertainty following treatment for prostate cancer. Qualitative interviews with 29 men, recruited from two prostate cancer support groups (PCSGs) in the Southeast of England, explored prostate cancer and post-treatment experiences of uncertainty. Data were analysed thematically using a constructivist grounded theory approach. Four common uncertainties were identified: (1) fear of cancer recurrence from continued biomedical monitoring following treatment; (2) fear of cancer recurrence from unexplained bodily symptoms; (3) concerns about post-treatment side effects; and (4) concern with having made the ‘right’ treatment choice. Three strategies for how men managed these uncertainties were also identified: (1) interpreting biomedical knowledge; (2) planning for future uncertain events; and (3) engaging with support groups that served as vigilance networks. Nuanced strategies of vigilance are identified, of reinterpreted pasts and imagined futures to manage uncertainties. These strategies temporally displace the uncertain present and are employed individually and communally as part of vigilance networks. This article adds to theoretical resources for understanding uncertainty management and evidences the chronicity of men’s post-treatment experiences of prostate cancer.

A quantitative and qualitative investigation into the management of carious primary molars by foundation dentists in primary care in the South East of England.

Introduction Dental caries is the most common reason for hospital admission of children aged 5-9 in the UK. Better management of caries in primary molars would reduce the number of children requiring treatment in hospitals; however, little research has been done into why primary care clinicians do not use an evidence-based approach to caries management for deciduous molars.Aims The aim of this paper is to identify the rationale behind caries management techniques used in primary care, as well as the choice of materials and long-term success of restorations placed.Materials and methods Use of a retrospective audit and a focus group with primary care clinicians to provide an insight into the management of carious primary molars and the barriers to achieving gold standard care.Results Glass ionomer cements (GICs) were the restoration of choice in primary care. Lack of time, equipment availability and clinician inexperience were cited as to why Hall crowns were not commonly placed.Conclusions The barriers to gold standard management of carious primary molars in practice are wide-ranging but tend to focus on the limitations of NHS care under the units of dental activity system. Lack of time and cost of materials encouraged clinicians to adopt a 'quick fix' approach in GIC.