Healthwatch response to government’s plans on GP access

via HealthWatch

Health Secretary Thérèse Coffey will unveil government’s NHS plan for this winter to improve access to primary care. As part of the ‘Plan for Patients’, GPs will be able to take on extra staff, including senior nurses, while pharmacists will be asked to take on more work to free up appointments. The plan will also include:

• Same-day GP appointments when needed
• An up to two week-wait for a routine appointment – currently one in five appointments take longer
• Support for ambulances and A&E.

Full article: Healthwatch response to government’s plans on GP access

Policy Paper: Our plan for patients | Dept. for Health and Social Care

Primary care practice and cancer suspicion during the first three COVID-19 lockdowns in the UK: a qualitative study

British Journal of General Practice | Vol. 72, Issue 723

Study (17 interviews) notes some of changes will have been a positive step forward in modernisation of practice, but net impact of pandemic on detection of cancer has been negative, the full effect on stage, treatment intent, & survival may not be fully understood for some time.

Background The COVID-19 pandemic has profoundly affected UK primary care, and as a result the route to cancer diagnosis for many patients.

Aim To explore how the pandemic affected primary care practice, in particular cancer suspicion, referral, and diagnosis, and how this experience evolved as the pandemic progressed.

Design and setting Seventeen qualitative interviews were carried out remotely with primary care staff.

Method Staff from practices in England that expressed an interest in trialling an electronic safety-netting tool were invited to participate. Remote, semi-structured interviews were conducted from September 2020 to March 2021. Data analysis followed a thematic analysis and mind-mapping approach.

Results The first lockdown was described as providing time to make adjustments to allow remote and minimal-contact consultations but caused concerns over undetected cancers. These concerns were realised in summer and autumn 2020 as the participants began to see higher rates of late-stage cancer presentation. During the second and third lockdowns patients seemed more willing to consult. This combined with usual winter pressures, demands of the vaccine programme, and surging levels of COVID-19 meant that the third lockdown was the most difficult. New ways of working were seen as positive when they streamlined services but also unsafe if they prevented GPs from accessing all relevant information and resulted in delayed cancer diagnoses.

Conclusion The post-pandemic recovery of cancer care is dependent on the recovery of primary care. The COVID-19 pandemic has highlighted and exacerbated vulnerabilities in primary care but has also provided new ways of working that may help the recovery.

Full article – Primary care practice and cancer suspicion during the first three COVID-19 lockdowns in the UK: a qualitative study | Claire Friedemann Smith, Brian D Nicholson, Yasemin Hirst, Susannah Fleming, Clare R Bankhead; British Journal of General Practice 2022; 72 (723)

GPs from Doctors’ Association UK call for reform

DAUK’s GP team and GP collaborators have written a letter to the UK Health Secretary, on the urgent need for government action to stabilise primary care | via Doctors’ Association UK (DAUK)

In a letter to the new health secretary, GPs from DAUK and colleagues have warned that the decline in primary care capacity will put doctors and patients at risk.

The letter talks about GP wellbeing and says that, “This job is making us ill. We have entered a downward spiral whereby we can no longer meet the unrealistic demands placed upon us, and the descent down the spiral is accelerating as more find themselves having to leave the profession to preserve what remains of their health.”

The GP team warns that UK general practice could see the emergence of a ‘postcode lottery’. The letter suggests several potential solutions.

Full detail: Letter to Therese Coffey from DAUK’s GP group and Collaborators

Integrating primary care into Integrated Care Systems (ICSs)

Professor Claire Fuller is leading a wide-ranging national stocktake of how primary care can best be supported within the emergent Integrated Care Systems (ICSs) to meet the health needs of people in their local areas. Views are wanted from primary care colleagues about best practice already happening across the country where primary care is fully integrated into ICSs.

Further detail: How can primary care and system partners work together to best meet the health needs of people in their local areas.

Primary care clinical activity in England during the first wave of COVID-19

British Journal of General Practice January 2022; 72 (714): e63-e74. DOI: https://doi.org/10.3399/BJGP.2021.0380

The COVID-19 pandemic has disrupted healthcare activity. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible. The aim of this paper was to describe the volume and variation of coded clinical activity in general practice, taking respiratory disease and laboratory procedures as examples.

An open-source software framework was delivered to describe trends and variation in clinical activity across an unprecedented scale of primary care data. The COVD-19 pandemic led to a substantial change in healthcare activity. Most laboratory tests showed substantial reduction, largely recovering to near-normal levels by September

Full paper: OpenSAFELY NHS Service Restoration Observatory 1: primary care clinical activity in England during the first wave of COVID-19

Managing COVID-19-related mental ill health in primary care

Guidelines in Practice

This article looks at mental health during the pandemic in the primary care setting, with a particular focus on the effect of COVID-19 on the experience and management of mental ill health.

The article looks at:

• the balance of positive and negative factors that contributes to mental wellbeing
• the impacts of the COVID-19 pandemic and its associated restrictions on mental health
• assessing and managing mental ill health in the context of COVID-19.

Full detail: Managing COVID-19-related mental ill health in primary care

How has the COVID-19 pandemic impacted primary care?

The Health Foundation

Since the start of the pandemic the impact of COVID-19 on primary care, and those working within it, has been significant. Staff have been under considerable pressure to maintain services despite social distancing measures, adjusting to virtual consultations and helping to roll out the COVID-19 vaccine. 

In April and May of 2020 – the first months of the UKs first lockdown – the number of appointments booked in general practice plummeted. This led to concerns about unmet need, particularly for people with long-term health conditions, and the potential for delayed diagnoses. However, consultation numbers recovered fast – and by September 2020 total consultations in general practice had recovered to pre-pandemic levels. 

This article presents three charts which explore the impact of the pandemic on primary care in more detail. The charts cover regional trends in the number of primary care appointments, trends in the number of primary care appointments with GPs and the shifting balance between face-to-face and phone appointments.

Key points

• In total, 31 million fewer primary care appointments were booked between April 2020 and March 2021 compared to the previous 12 months – a fall from 310 million to 279 million.
• London had the lowest drop in total number of appointments, with North East and Yorkshire, East of England and Midlands all seeing a drop in appointments twice as big percentage wise.
• The way that appointments take place has also shifted. March 2021 saw the highest ever number of telephone appointments in general practice; 11.4 million compared to 6.6 million in March 2020 and 3.5 million in March 2019. Between April 2020 and March 2021, 54% of appointments were face-to-face, compared with 79% in the previous year.

Full article: How has the COVID-19 pandemic impacted primary care?

See also: Rising patient numbers threaten to overwhelm GPs | BBC News

Promoting physical activity in primary care: a systematic review and meta-analysis

British Journal of General Practice | May 2021

Background Promoting physical activity is an important part of patient care in primary care and has been investigated in many studies with a wide range of intervention characteristics, often including external support. It is unclear, however, if promoting physical activity is effective.

Aim To investigate the effectiveness of behaviour change interventions to promote physical activity in primary care.

Design and setting This is a systematic review and meta-analysis to evaluate physical activity promotion in a primary care setting.

Method EMBASE, MEDLINE, PsycInfo, and the Joanna Briggs Institute Database were searched for ‘physical activity’, ‘interview’, ‘motivation’, ‘primary care’, and equivalent words to identify randomised controlled trials with physical activity as the outcome at patient level.

Results The review identified 24 eligible studies. The quality appraisal showed that most studies reported insufficient details regarding randomisation, group allocation, blinding, and fidelity of intervention delivery. The included studies reported a wide range of interventions with varying numbers of follow-up visits or phone calls. The overall effect size for interventions with a 6-month follow-up interval was 0.04 (95% confidence interval [CI] = −0.06 to 0.14), and for interventions with a 12-month follow-up interval it was 0.20 (95% CI = 0.04 to 0.36). Only one intervention based on three motivational interviewing sessions achieved a moderate effect.

Conclusion Counselling to promote physical activity in primary care has a limited effect on patients’ behaviour and it might not, on its own, be enough to change physical activity behaviour.

Full article: Promoting physical activity in primary care: a systematic review and meta-analysis

Effect of the OPTIMAL programme on self-management of multimorbidity in primary care: a randomised controlled trial

British Journal of General Practice | April 2021

Background Effective primary care interventions for multimorbidity are needed.

Aim To evaluate the effectiveness of a group-based, 6-week, occupational therapy-led self-management support programme (OPTIMAL) for patients with multimorbidity.

Design and setting A pragmatic parallel randomised controlled trial across eight primary care teams in Eastern Ireland with 149 patients with multimorbidity, from November 2015 to December 2018. Intervention was OPTIMAL with a usual care comparison.

Method Primary outcomes were health-related quality of life (EQ-5D-3L) and frequency of activity participation (Frenchay Activities Index [FAI]). Secondary outcomes included independence in activities of daily living, occupational performance and satisfaction, anxiety and depression, self-efficacy, and healthcare utilisation. Complete case linear regression analyses were conducted. Age (<65/≥65 years) and the number of chronic conditions (<4/≥4) were explored further.

Results A total of 124 (83.2%) and 121 (81.2%) participants had complete data at immediate and 6-month post-intervention follow-up, respectively. Intervention participants had significant improvement in EQ-VAS (visual analogue scale) at immediate follow-up (adjusted mean difference [aMD] = 7.86; 95% confidence interval [CI] = 0.92 to 14.80) but no difference in index score (aMD = 0.04; 95% CI = −0.06 to 0.13) or FAI (aMD = 1.22; 95% CI = −0.84 to 3.29). At 6-month follow-up there were no differences in primary outcomes and mixed results for secondary outcomes. Pre-planned subgroup analyses suggested participants aged <65 years were more likely to benefit.

Conclusion OPTIMAL was found to be ineffective in improving health-related quality of life or activity participation at 6-month follow-up. Existing multimorbidity interventions tend to focus on older adults; preplanned subgroup analyses results in the present study suggest that future research should target younger adults (<65 years) with multimorbidity.

Full article: Effect of the OPTIMAL programme on self-management of multimorbidity in primary care: a randomised controlled trial

Effect of Behavioral Therapy With In-Clinic or Telephone Group Visits vs In-Clinic Individual Visits on Weight Loss Among Patients With Obesity in Rural Clinical Practice

Question  Does behavioral obesity treatment delivered in rural primary care settings via in-clinic group visits or telephone group visits improve weight loss compared with the fee-for-service model with in-clinic individual visits?

Findings  In this cluster randomized trial that included 1407 participants, in-clinic group visits, compared with in-clinic individual visits, resulted in significantly greater mean weight loss at 24 months (–4.4 kg vs –2.6 kg, respectively), and the difference between telephone-based group visits and in-clinic individual visits was not significantly different (–3.9 kg vs –2.6 kg).

Meaning  In rural primary care practices, behavioral weight loss therapy delivered via in-clinic group visits resulted in statistically significantly greater weight loss than in-clinic individual visits, although the difference was small and of uncertain clinical importance.

Reference: JAMA. 2021;325(4):363-372.