by Peter Tammes, Mairead Murphy and Chris Salisbury, Centre for Academic Primary Care, University of Bristol
Decreasing trend of continuity of care
Seeing the same GP over time is highly valued by most patients and GPs in the UK. This is known as ‘continuity of care’ and it is linked with lower healthcare costs, more satisfied patients, fewer emergency hospital admissions and even with reduced mortality.
Given these multiple benefits, one would expect it to be highly prioritised. However, our recently published study in the British Journal of General Practice shows that continuity of care declined steadily between 2012 and 2017. On average, the percentage of patients who reported to have a preferred GP declined by nine percentage points and the percentage who can usually see their preferred GP declined by 10 percentage points.
Is decreasing continuity of care a concern?
Decreasing continuity is … Read more
by Dr Lucy Pocock, GP Career Progression Fellow, Centre for Academic Primary Care, University of Bristol
Before COVID-19, there were around 10,000 deaths in care homes in England and Wales every month. Then, between March 27 and April 24 2020, the number more than doubled to 23,113.
The Office for National Statistics (ONS) later reported 17,422 deaths of care home residents from COVID-19 between the end of March and June 5, accounting for 47% of the total number of deaths caused by the virus.
So it is unsurprising that the pandemic has led to much greater interest in what happens inside care homes. As well as the significant increase in the number of residents dying, concerns have been raised about a lack of access to testing and personal protective equipment (PPE), the discharge of coronavirus-positive patients from hospital to care homes, rationalisation of the health … Read more
by Chris Salisbury, Mairead Murphy and Polly Duncan, Centre for Academic Primary Care, University of Bristol
Because of the COVID-19 pandemic, general practices have rapidly shifted to offering consultations remotely by telephone, video or online messaging rather than face-to-face. Many general practices are considering whether they should continue these new ways of working into the future and some commentators are arguing that general practice will be changed forever. Remote consultations could be more convenient for patients and reduce workload pressures on general practices.
Just before the COVID-19 pandemic we wrote a paper which modelled how an increasing use of online, video and telephone consultations would affect GPs’ workload. Our conclusion was that a reduction in workload should not be assumed, and remote consulting could instead lead to an increase in GP workload over time. It all depends on how remote consultations are used.
The paper … Read more
by Dr Sophie Turnbull, Senior Research Associate, Centre for Academic Primary Care, University of Bristol
Digital interventions have become increasingly popular due to their potential to increase access to healthcare for people with chronic conditions and reduce the burden on a stretched healthcare system.
This has been amplified during the COVID-19 crisis, where much face-to-face support has been reduced or is no longer available. However, there are concerns that digital health provision may exacerbate existing health inequalities.
Chronic or long-term conditions, such as diabetes, are estimated to account for 87% of deaths and have a significant impact on an individual’s quality of life. Even in high-income countries, people with lower socioeconomic status experience chronic illness more commonly and with greater severity than average for the rest of the population.
We also know that people with existing health conditions, in low paid or insecure work and … Read more
by Dr Eszter Szilassy, Research Fellow, Centre for Academic Primary Care, University of Bristol
GPs and other primary health care professionals play a vital role in addressing domestic violence and abuse (DVA). This is especially true during the current coronavirus pandemic, when individuals and families are isolated from potential sources of help and support.
Home during lockdown may not be a safe place for those affected. In England, the National Domestic Abuse Helpline, run by Refuge, has seen a 50 per cent increase in calls compared to pre-COVID-19, along with a 400 per cent increase in web traffic.
We know that the pandemic is having a detrimental impact on the health and wellbeing of people affected by DVA and their children. Extensive periods of self-isolation and social distancing compounded by increasing uncertainty over jobs and financial security for families may be a dangerous and profoundly … Read more
by Dr Jessica Watson, GP and NIHR Doctoral Senior Clinical Research Fellow, Centre for Academic Primary Care, University of Bristol and Dr Penny Whiting, Associate Professor in Clinical Epidemiology, NIHR ARC West and University of Bristol
Coronavirus testing has been the subject of huge interest, frustration and confusion. The UK has come under worldwide criticism for its lack of mass testing, despite the director general of WHO encouraging countries to “test, test, test”. Health Secretary Matt Hancock announced that the UK now aims to test 100,000 people a dayfor COVID-19 by the end of April.
There are two main types of COVID-19 tests. Swab tests, which usually take a sample from the throat or nose, to detect viral RNA. These determine if you currently have COVID-19. Blood tests, which detect antibodies, can determine if you have had COVID-19, and are therefore immune.
No test … Read more
Dr Lucy Selman, Senior Research Fellow, Centre for Academic Primary Care, University of Bristol
As I write this, the UK government has just announced that 13,729 people have died in hospitals from COVID-19. Care England estimates more than 1,400 people have now died in care homes. As you read this, those appalling figures will have grown. The national medical director, Stephen Powis, has said that if the UK death tally comes in below 20,000, “we will have done very well”.
As a result, a wave of grief will swell in the coming months, with more and more people experiencing a close bereavement related to COVID-19. The disease brings new challenges in caring for patients and supporting their family and friends. A particularly cruel one is that patients must be isolated to control the spread of infection.
Since a patient’s loved ones are often unable to accompany … Read more
by Dr Rupert Payne, Consultant Senior Lecturer in Primary Health Care, Centre for Academic Primary Care, University of Bristol
Boots pharmacies made the mainstream news headlines in May this year when it became apparent that some prescriptions which were being prepared using an automated centralised system were being distributed using plastic bags. Lloyds pharmacies have a similar process in place.
The argument is that the centralised assembly process is more efficient and safer than the old-fashioned local approach which used paper bags. The bags can be recycled but, as many of us know, that isn’t necessarily straightforward. Given the backlash against plastic that has been seen recently, and particularly given the fact that pharmacies have always been well known for using paper bags, it is unsurprising that this change has been received negatively by consumers.
But the impact of prescribing on the environment is not just … Read more
by Dr Yvette Pyne, Academic Clinical Fellow, Centre for Academic Primary Care, University of Bristol
The breadth of conditions doctors are expected to manage continues to grow as people and society become ever more complex and it is in GP surgeries up and down the country where this is most starkly seen. The volume of work expected of GPs is taking its toll on individual doctors and the service as a whole.
My previous career designing and developing information technology (IT) systems gives me insight into the huge potential computers and machine learning have to help us in this increasingly challenging environment. Artificial Intelligence (AI) can enable us to provide the best evidence-based medicine to our patients while also freeing us from mundane administration to spend more time connecting with the human beings in front of us.
In the UK, Primary Care is already leading … Read more
by Dr Jason Sarfo-Annin, Honorary Research Fellow, Centre for Academic Primary Care, University of Bristol
Debate surrounding the future of general practice is usually rooted in the context of the primary care workforce, the introduction of new roles and developing practitioners with a new skill-mix.
Such solutions are rooted in the medical model of health. I share the Marmotian view that health care is just one dimension of improving individual and population health.
As GPs, we often consult with patients who cannot be helped by our services. We are also often unable to effectively signpost patients or help navigate them to services that can support them. Consequently, I believe the future involves working as part of a collaboration of services – delivered optimally by co-location. Provision of these services would be based on the geographical location of patients and include amenities already provided by local authorities … Read more