UK Healthcare System Research Articles

Motivational interviewing: a framework for healthcare assistants to improve patient-centred care

Healthcare assistants are integral to patient care in the UK healthcare system, and often the first point of contact for patients to access care. This article explores the application of motivational interviewing as a transformative approach for healthcare assistants to foster patient engagement and wellbeing. Motivational interviewing is a patient-centred and goal-oriented communication method that addresses ambivalence and resistance, empowering patients to make informed health decisions. By embracing the principles of the approach, which are capability, opportunity and motivation, healthcare assistants can shift from directive methods to a collaborative partnership model.

A Comparative Analysis of the UK Physician Associate Curriculum Against the Prescriber Curricula for Pharmacists and Doctors

Background: As the Physician Associate (PA) profession in the UK moves towards statutory regulation with the General Medical Council (GMC), consideration is being given to which, if any, mechanism of prescribing should be granted to PAs. This study examines the alignment between the PA educational curriculum and two pathways to prescribing authority: independent prescribing (IP) from qualification and the non-medical prescribing course. The aim is to determine whether PA education equips graduates for independent prescribing, potentially reducing the need for postqualification training. Methods: A comparative curriculum analysis was conducted by mapping the pre-2023 PA curriculum against the General Pharmaceutical Council (GPhC) standards for pharmacist independent prescribers and the GMC outcomes for newly qualified doctors. The curriculum mapping was performed using an Excel-based comparison tool, identifying areas of direct and oblique alignment between the PA curriculum and the master curricula. Results: The analysis revealed comprehensive alignment between the PA curriculum and the competencies required for independent prescribing by pharmacists and newly qualified doctors. Key areas of alignment include patient-centred care, professional knowledge and skills, and professionalism. However, gaps were identified in the PA curriculum regarding the use of technology in prescribing and the clinical governance of prescribing. Discussion: The findings suggest that the PA curriculum provides a strong foundation for many aspects of prescribing education, supporting the idea that PAs should be granted the use of a mechanism of prescribing. Addressing identified gaps, particularly in technology use and clinical governance, could further enhance PA preparedness for prescribing roles. This could reduce the extent of any postqualification training. Future research should explore variations in clinical experience and individual readiness for independent prescribing among PAs. Collaborative efforts and ongoing curriculum refinement are essential to integrate PAs into prescribing roles while ensuring patient safety in the UK healthcare system.

Considerations for the implementation of a non-pharmacological, patient-centered approach to chronic non-oncological pain treatment in the UK and Chile

Non-oncological chronic pain imposes a significant global burden, and its prevalence is increasing. The World Health Organisation and UK National Institute for Health and Care Excellence promote patient-centered care as an effective approach to treating chronic non-oncological pain. This approach improves long term health outcomes by identifying root causes which impact these conditions, within the framework of the biopsychosocial care model. Within Chile and the United Kingdom, patients advocate for pharmacological interventions, however Centres for Disease Control and Prevention emphasise a preference for non-pharmacological management strategies. As the UK healthcare system actively seeks to reduce reliance on pharmacological treatment modalities, using alternative interventions, Chilean healthcare has also begun to regenerate its approaches to treatment. The objective of this paper is to reflect upon the implementation of these strategies to gain insights into their potential for driving change.

Qualitative research on catch-up vaccination with Russian speaking migrants in the UK: Potential opportunities beyond primary care

BackgroundWhile ensuring vaccine access for migrants is a crucial public health goal in the UK and worldwide, migrants remain an under-immunised group. The provision of catch-up vaccination for adult migrants is often faced with institutional, infrastructural, and socio-cultural barriers. This research aims to explore experiences with catch-up vaccination among Russian-speaking migrants in the UK—a group that has been under-represented in research despite its increase since 2022. Methods25 semi-structured interviews were conducted with Russian-speaking migrants in July–August, 2022. A combination of purposive and snowball sampling was used to recruit the participants. All interviews were transcribed verbatim and analysed thematically using Atlas.ti software. Themes for analysis included participants’ experiences with the UK healthcare system, experiences with obtaining vaccination-related information, and practices with catch-up vaccines. FindingsThe majority of participants were from Russia (n=18) with others coming from Latvia (3), Ukraine (2), Belarus (1), and Kazakhstan (1); and most participants were asylum seekers (n=15). 13 participants were males and 12 were females. Seven asylum seekers identified as men who have sex with men (MSM). Apart from language and logistical barriers to access vaccination, participants highlighted lack of centralisation in vaccination provision and difficulty in accessing vaccination within the asylum centres as major challenges. All participants were aware of adult vaccines against COVID-19 and influenza, however, only MSM asylum seekers were familiar with and actively seeking vaccination against hepatitis A and B, HPV and mpox. Importantly, MSM participants highlighted that sexual health clinics are their first point of contact for receiving vaccine-related information and vaccination. InterpretationDespite important barriers to accessing vaccination in the UK, the research participants were proactive in seeking vaccination. Findings from this study indicate that other models of care need to be further explored and evaluated, beyond primary care, for delivering vaccines to diverse migrant groups. FundingAD is funded by the MRC (MR/N013638/1). SH is funded by the NIHR (NIHR300072), the Academy of Medical Sciences (SBF005I1), La Caixa Foundation (LCF/PR/SP21/52930003), Research England, MRC, and WHO. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care and UKHSA.

Evaluating the impact of the Health Access for Refugees Project on people who are refugees or seeking asylum in Northern England.

Evidence demonstrates that people who are seeking asylum and refugees face individual, institutional and system-level barriers when accessing health services. Health Access for Refugees' Project (HARP) is a UK initiative increasing access to health care within this community through a series of interventions. This study explored the impact of HARP on health service access, experiences and outcomes for clients, and how volunteers and staff addressed institutional and system-level barriers. In summer 2020, we conducted qualitative telephone interviews with four HARP clients, eight clients who became volunteers, seven further volunteers and three staff members. The educational aspect of the interventions supported clients navigating the complex UK health care system while promoting independence in accessing health care. Advocacy by volunteers and staff was important in challenging barriers at individual and institutional levels. Staff challenged the asylum system, by improving information around entitlement to health care and addressing barriers to registering with a General Practitioner (GP). Interventions such as those provided by HARP can address different levels of barriers to support people accessing health care provision. This can be achieved through training health professionals and working with peers to support access to care and to develop self-advocacy. However, stable long-term funding is essential to ensure the sustainability of these initiative.

Increasing Internal Medicine Trainees' Satisfaction With Their Formal Teaching Program: A Quality Improvement Project During the NHS Workforce Crisis.

The goal of this quality improvement project was to improve internal medicine trainees' satisfaction with their formal teaching program. Initially, qualitative and quantitative data were collected from trainees, which demonstrated an overall negative attitude towards their teaching. Based on the feedback collected, changes were made to the teaching program, including switching to face-to-face teaching, using study leave in trainees' rosters to allow for higher attendance rates and planning subject-specific "teaching afternoons". After these interventions, trainees' satisfaction with their teaching improved substantially in areas of teaching quality, relevance and reliability. This quality improvement project demonstrates that low-cost interventions based on trainee feedback can improve satisfaction with teaching, which has the potential to alleviate workforce challenges in the UK healthcare system.

Insights gained through exploring UK midwifery care by US midwifery graduate students in a short-term study abroad: A qualitative study.

Student midwives exposed to effective systems of midwifery care in other countries can consider how aspects of this knowledge can translate into their healthcare system to improve maternal and infant perinatal outcomes. An optional short-term study abroad (STSA) experience was developed for US midwifery graduate students to expose them to the UK healthcare system, where midwives are considered the primary professionals for the care of the childbearing family. This qualitative study explored the influence of an STSA experience on US midwifery graduate students' learning of midwifery in the UK. Ten midwife student participants wrote pre- and post-trip narratives in the US and daily diary entries during their week in the UK. A grounded theory approach guided the content analysis. The themes were derived from the NVivo software data by three midwife researchers who value global health learning experiences. Analysis was shared with participants to ensure its trustworthiness. Themes that emerged included: 'Another viewpoint', encapsulating curiosity and comparison of US and UK midwifery; 'Eye-opening', capturing surprise at noted differences between US and UK midwifery practice; and 'Goals met and influenced', expressing how their learning is anticipated to shape their professional identities and career trajectories going forward. US student midwives exposed to functional systems in countries where midwifery care is fully integrated, broadened their views of midwifery care and practice. They became inspired to make positive changes in the US. Educational opportunities for midwifery students, such as STSA experiences, can positively influence self-confidence and professional identity.

Moving from psychiatric practice in the UK to Australia: some personal reflections.

In this article, we reflect on factors which may tempt psychiatrists to move from working in the UK to Australia. A comparison between the UK and Australian healthcare systems is presented. Following this, G.W. offers personal reflections on his transition between working in the UK and Australia, including an experience of being a patient, the benefits of working and training in the respective countries, and personal sacrifices which must be considered. We conclude that individual clinicians must weigh up the positives and negatives of the system which they want to work within, with the best option for each person being specifically individual to them.

WP6.13 - REINVENT- Robotic SurgEry: INnoVation for EfficieNt Training- A qualitative study assessing training in RAS (Robotic Assisted Surgery) and future implementation

Abstract Introduction Despite the rise in use of RAS in UK surgical practice, concerns have been reported regarding the lack of standardisation in training. Little is known on the current exposure to RAS training in the UK and thoughts on how training should be delivered in the future. Methods Semi-structured interviews were completed in person/online with four stakeholder groups:(1) pan speciality surgical trainees; (2) robotic trainers; (3) leads in curriculum development; (4) RAS industry leads. Respondents were pan-speciality and from across the UK. Topic guides focussed on personal perspectives on RAS training, current barriers to accessing training and views on how RAS training can be optimally delivered in the future. Data collection ceased upon saturation in themes and were analysed thematically. Results Twenty-seven informants were interviewed, including 8 trainees, 7 curriculum developers, 6 robotic surgeons and 6 industry leads. Respondents reported multiple challenges in training including barriers to accessing the robot such as the geographical location of the systems; the consultant RAS learning needs; equality and diversity issues and challenges with delivering platform agnostic training. However, respondents reported an anticipated growth in RAS and a need for the surgical training bodies to invest in structured RAS training which should be implemented earlier in surgical training. Discussion RAS training in the UK requires overcoming several barriers to deliver equitable, standardised training. A further study is required to reach a consensus amongst stakeholders on how RAS should be delivered within the current infrastructure of both the UK health care system and surgical training climate.

Clinical Exercise Physiologists in the United Kingdom: Multi-stakeholder Perspectives

ABSTRACT Background In the UK Academy of Healthcare Science, registered clinical exercise physiologists (CEPs) receive specialist, master’s-level education and training in the knowledge and skills required to work with chronic and complex medical conditions based on a curriculum that was benchmarked against Australian standards. The aim of this study was to explore the perspectives of multiple stakeholders to identify the key knowledge and skills required for a registered CEP to work effectively in the United Kingdom and inform future iterations of the accredited curriculum. Methods Semistructured interviews of academics (n = 5), CEPs (n = 5) and service users (n = 5) explored perspectives of the key knowledge and skills required of a CEP in UK health care. Reflexive thematic analysis was performed to identify the key knowledge and skills of a UK-registered CEP that all the stakeholders deemed important. Results Six themes were identified from the interviews. The CEP-specific themes were identified as pathophysiology, physiological assessments, exercise prescription, exercise delivery, and behavior change and education. Clinical practice was recognized as the overarching concept that linked all the CEP-specific themes together. Conclusion This study provides the first understanding of the knowledge and skills required for a CEP to work effectively in the UK health care system, in addition to providing research evidence and insight to the next iterations of the Clinical Exercise Physiology UK (CEP-UK) curriculum framework. Future research should focus on establishing a more comprehensive, definitive list of the knowledge and skills of a UK CEP that will contribute to subsequent versions of the CEP-UK curriculum framework.

Racial microaggressions within the UK Healthcare System: a narrative review.

Racial microaggressions are subtle and everyday actions that communicate derogatory messages or assumptions based on an individual's race. These seemingly minor acts, often unintended, can accumulate to undermine patient well-being and contribute to healthcare disparities. They are the unnoticed comments, gestures, or attitudes that carry significant impact. Through a systematic analysis of the literature, we highlight the insidious nature of racial microaggressions and their impact on healthcare outcomes. The objectives of this paper are to: • Present real-life instances from research to showcase the tangible effects of racial microaggressions. • Identify the everyday scenarios within healthcare interactions where racial microaggressions often occur. • Emphasise the need for recognition and understanding of these biases for fostering better patient-provider relationships. Also, by analysing the fundamental elements underpinning racial microaggressions such as systems, interactions, vulnerabilities and consequences, we explore the implications it has on healthcare policy and management. Most importantly, we address the importance of identifying and tackling racial microaggressions in order to create a more inclusive healthcare environment.

'There's Nothing Wrong With You; You Just Need to Lose Weight'-A Qualitative Exploration of Pelvic Floor Dysfunction Among Women With Multiple Sclerosis and Their Interaction in Seeking Pelvic Healthcare.

Within 10 years of multiple sclerosis (MS) progression, nearly all women will have experienced symptoms associated with bladder, bowel and/or sexual health. Yet despite the impact these symptoms have on physical, psychological and social well-being, it remains an underserved area within the UK healthcare system. This research employs a participatory research approach framed within the principles of intersectional feminism to collaboratively investigate the lived experiences of pelvic floor dysfunction (PFD) and healthcare interactions among UK-based women with MS. Women residing in the United Kingdom with MS were invited to participate in online interviews facilitated by the primary author. A thematic framework analysis offering a structured yet adaptable approach to data collection and interpretation. One focus group involving four women with MS and seven individual, one-to-one interviews with women with MS provided insights into the challenges associated with navigating both MS and PFD. Four main themes included: Navigating MS and PFD; Cycles of Control; Mind, Mobility and Bladder Embodiment; Silenced Voices: The Impact of Taboos/Stigma/Dismissal on Preventing Access and Resistance through Collective Community. Six subthemes were also identified. Taken together, these themes cumulatively reflect PFD as an unmet healthcare need. Our findings underscore negative healthcare experiences, inadequate information provisionand unmet needs related to PFD, emphasising the compounding effects of gender and disability biases. We hope that these insights can lay the groundwork for developing tailored therapeutic interventions and improved PFD healthcare for women with MS. Potential solutions include using existing MS support communities. Women with MS were actively involved in co-producing interview scripts for one-to-one interviews. The primary author shared study findings at an MS group event, engaging in discussions with over 30 individuals, including people with MS and their loved ones. MS advocates played a pivotal role in contextualising the study within the broader lived experience of MS.

Journeys Through Genomics: Co-Producing Visual Resources to Communicate Patient Experiences

Journeys through Genomics is a series of illustrations co-produced with patients and families to communicate their experiences of seeking genomic explanations for a health condition and the wider impact on their lives. The resources are embedded within qualitative longitudinal research exploring patient’s experiences of genomic medicine. This research takes place as genomic medicine becomes an integral part of mainstream care within the UK healthcare system. The depiction of genomic medicine often focuses on its technological components and the speed by which genetic code can be analysed, but here, we present a dynamic and situated understanding of the challenges genomic testing presents for patients and families. We describe the process of working with research participants and an artist to co-produce visual resources that illustrate the complexity of participant’s journeys, situating genomic testing within the broader context of their lives. These resources are designed to help future patients, families, and healthcare professionals understand the process, opportunities, and challenges they may face.

EE199 Budget Impact Analysis of the Anti-Vegfs Injections for Treating Diabetic Macular Oedema: Assessing Their Affordability in the UK Healthcare System

EE199 Budget Impact Analysis of the Anti-Vegfs Injections for Treating Diabetic Macular Oedema: Assessing Their Affordability in the UK Healthcare System

Decentralized Colorectal Cancer Care: Benefit or Burden in the Pandemic? – An International Comparative Study in two Health Care Systems (DCCC Study)

Abstract Background Beneficial effects of centralization could be shown. During SARS-CoV2 pandemic however, the centralization in the UK healthcare system led to cessation of screening colonoscopies and oncological resections. In the decentralized healthcare system of Switzerland, a high frequency of colonoscopies could be maintained. Aims The aim of this international study is to evaluate if a decentralized health care systems can prevent the threatening unmet needs of colorectal cancer patients under pandemic conditions. Methods This observational trial was performed in the south-east of Scotland and in the extended northwest of Switzerland with a catchment area of 1.5 Mio. inhabitants each. Patients with colorectal cancer diagnosed during January 2019 and December 2022 were included. Results Six thousand six hundred and eighty patients were included in this preliminary analysis (4059 in the NHS group and 2621 in the Swiss group). In Scotland the median number of diagnosed patients per quarter was 258 pre-pandemics, 218 during lockdown and 258 after lockdown (p=0.56). There was no significant alteration of the median diagnosed patients per quarter during different phases in Switzerland (165 pre-pandemic vs. 187 during lockdown vs. 162 post-lockdown, p=0.56). In Scotland the median number of all performed tumor treatments per quarter were lower during lockdown (83 pre-pandemic vs. 75 during lockdown vs. 93 post-lockdown, p<0.01). In Switzerland the median treatment numbers per quarter didn´t differ during different phases (56 pre-pandemic vs. 62 during lockdown vs. 60 post-lockdown, p=0.51). The number of patients diagnosed with a T4 tumor during pandemic was higher in Scotland than in Switzerland (28% vs. 19%, p<0.01). The 30-day mortality under pandemic condition was 7.5% (65 of 859) in Scotland compared to 3.7% (14 of 374) in Switzerland (p=0.01). Conclusion SARS-CoV2 pandemic led to a reduction in performed cancer treatments in Scotland. In Switzerland's decentralized healthcare system, cancer treatments were maintained during pandemic.

Challenges for international medical graduates in the US and the UK graduate medical education and health care system environment: A comprehensive review

A comprehensive review of past research and statistical data is necessary to understand the significant obstacles encountered by International Medical Graduates (IMGs) in the healthcare systems of the USA and UK. A careful review of the literature shows that financial, cultural, and linguistic barriers are worsened by the intricate USA licensing processes overseen by the ECFMG. The BMJ and the AAMC's research statistics demonstrate the prevalence of these difficulties and their impact on the career trajectories and well-being of IMGs. The study assesses the impact of professional networks, mentoring programs, and support systems in addressing challenges faced by IMGs in the healthcare sectors of the US and UK, emphasizing the significance of evidence-based interventions in developing inclusion and equality. International Medical Graduates (IMGs) play an important role in graduate medical education and broad medical settings, but their integration present challenges that need thoughtful evaluation of many concerns they face.

The Nitrous Oxide Project: assessment of advocacy and national directives to deliver mitigation of anaesthetic nitrous oxide.

The environmental emissions attributed to anaesthetic nitrous oxide across the NHS are comparable to the carbon dioxide released by 135,000 flights from Frankfurt to New York. Much of these emissions are attributable to cumbersome and inadequately managed piped systems, resulting in excessive loss and waste. Since 2020, multiple hospital sites have been engaging with the Nitrous Oxide Project, a quality improvement method supporting a 'lean systems' approach to the provision of nitrous oxide. This review considers the frameworks supporting medical gas management in UK healthcare systems, and the impact of professional advocacy and medical gas stewardship to drive anaesthetic nitrous oxide mitigation in the NHS. Nitrous oxide mitigation efforts by grassroots and professional advocacy networks are enhanced through national centralised emission monitoring, distribution of data, technical information and provision of quality analysis. Given the climate harms of nitrous oxide, concerted efforts should be made to rationalise its use, and resources should be committed to supporting this at local, regional and national levels.

Developing a competency framework for integrated care working across healthcare, social care and allied professions

Background/Aims For integrated care to truly become embedded in the UK health and social care system, there is need for a shared understanding of what integrated care looks like at the local level. This study aimed to identify the competencies and behaviours required for working across the full range of health and social care services in the Bedfordshire, Luton and Milton Keynes Integrated Care System. Methods A multi-method approach was used to develop and refine the competency framework. An extensive evidence review of academic and practitioner literature was used to create the initial framework by synthesising previous frameworks. Four multi-agency focus groups were held to conduct utility testing and refine the framework. Quantitative testing was carried out using an 89-item online survey, including questions on the framework, a range of personal and work-related outcomes, and demographic characteristics. The survey was distributed to staff working across 13 different agencies within the integrated care system. Associations between variables were assessed using Spearman's Rho, using the Statistical Package for the Social Sciences. Results The evidence review identified 21 relevant competency frameworks, originating from nine different countries, which were used to create the integrated care competency framework. A total of 91 staff members completed the survey, with results showing acceptable reliability and validity of the final framework (item total correlation >0.2; inter-item correlation ≤0.9). Differences were found between agencies and occupational groups in terms of their integrated care competencies. Those with shorter tenure described greater use of integrated care competencies. Those who demonstrated more integrated care competencies also saw their work as more meaningful and enjoyed greater levels of support from their peers. Conclusions This is the first UK framework of integrated care competencies to be subjected to empirical testing. Initial testing supports the validity and reliability of the framework, as well as showing the positive outcomes associated with integrated working. This framework could be developed and rolled out on a wider scale to support integrated care working.

A Case Study on The Effects of Human Resource Shortages on Project Management in The Uk Health Sector: Focusing on Achieve Care Solutions Agency

The healthcare sector, one of the most in-demand sectors in the UK, is currently facing a shortage of human resources. This shortage is due to several factors, including a high turnover rate, an aging workforce, and a lack of younger staff entering the sector. This study explores the impact of human resource shortages on project management within the UK healthcare sector, focusing on Achieve Care Solutions Agency. To understand the context of this shortage, we surveyed 50 professionals from Achieve Care Solutions Agency. Out of the questions asked, 85% of the responses were properly returned. The data was then analyzed using graphical statistics to create averages, tables, and graphs showing frequency and percentages. The findings of the study suggest that training has a positive effect on the motivation of Achieve Care's human resources. The current workforce in social care is experienced, and compassionate, and values their work, primarily because they feel appreciated and well-trained. However, the critical shortage of human resources is negatively impacting the UK's healthcare system and organizations like Achieve Care. This study highlights the need for a healthcare delivery system adequately staffed with human resources. It emphasizes the importance of providing everyone with access to the guidance, support, and care they need to live fulfilling lives. Despite the challenges posed by human resource shortages, the healthcare sector presents a promising career path with a bright future, especially as other industries contract due to increased automation.

Perceptions of healthcare provision throughout the menopause in the UK: a mixed-methods study

The UK healthcare system faces a shortage of high-quality menopausal care. The objective of this study was to understand perspectives of menopause care in the UK. An online survey was delivered. Data from 952 respondents were analysed. Descriptive statistics were calculated for quantitative data overall and per menopause stage. Thematic analysis was calculated on qualitative data. 74.47% sought help for the menopause. Oral (68.83%) and topical medication (17.21%) and lifestyle changes (17.21%) were the most common treatment approaches. Consistent integration of mental health screening into menopausal care was lacking. Open-ended data from women who reported poor care quality revealed six themes: consequences of poor care, dismissive or negative attitudes from healthcare professionals (HCPs), poor treatment management, symptom information and misattribution, poor HCP knowledge, and the need for self-advocacy. The findings underscore the importance of improving HCP knowledge, providing empathetic and supportive care, and involving women in decision-making.