Over a billion NHS prescription medicines are issued by pharmacists in England every year – at a cost of over £9 billion. Many of these are prescribed by GPs to manage long-term health conditions, such as diabetes or cardiovascular disease.
The current “repeat prescription” system allows patients to request a further supply of medicines without the inconvenience of another doctor’s appointment.
The UK Department of Health advises that the frequency of repeat prescriptions should “balance patient convenience with clinical appropriateness, cost-effectiveness and patient safety”.
However, it does not recommend a specific time period. As a result, local health service commissioners have developed their own guidance, with many encouraging GPs to issue short-term supplies of repeat medications, typically 28 days in length. This is supported by … Read more
Person-centred healthcare is accepted as desirable on moral grounds and because it potentially leads to better health outcomes, greater efficiency and less waste. It means both involvement of individuals in their healthcare and individualisation of care.
The NHS has been chasing the goal of person-centred care planning for several years and there are many good examples of innovation. The ‘House of Care’ describes what it might mean in practice for people with long-term conditions. At its heart is personalised care planning, taking account of patients’ expressed needs and priorities. The national new models of care programme, involving 50 vanguard sites, is also pursuing this goal and recently reported on lessons learnt. Many of the vanguards have invested in health coaching and communication skills training for clinicians.
I recently worked on a large research project, … Read more
Clinician intuition and gut feelings are often talked about in health care but are largely mysterious. Clinicians describe just knowing that there was something wrong with a patient but not exactly how they came to that conclusion.
In a recent study we aimed to unpick how clinicians form their gut feelings, how they use them to influence treatment decisions, and whether their gut feeling was good at predicting whether a child with infectious cough would get sicker in the 30 days after seeing them.
Using gut feeling to predict outcome in children with infectious cough
Infectious cough in children is the most common problem managed by health services internationally. Although the majority of children get better on their own, a small proportion end up hospital with a serious illness. Clinicians do not always find it easy to … Read more
As winter continues, so does the usual soul searching about the state of the UK’s National Health Service (NHS). Images of ambulances backing up outside emergency departments and patients lying on trolleys in corridors haunt politicians and the public alike.
Demand on the NHS, which is always high, increases over the coldest of seasons, when threats to health are greatest. Generally, more than 20,000 extra deaths occur from December to March than in any other four-month period in England and Wales. That number varies considerably, however – from 17,460 in 2013-4 to 43,850 in 2014-5 (which was not even a particularly cold winter). And there has been no evidence of a decreasing trend since the early 1990s, despite the national flu immunisation programme.
The percentage increase in deaths seen each winter in England and Wales … Read more
“How important are informal supporters of women experiencing domestic violence?”: “Very” – a simple answer to a complicated question. The bottom line, in terms of statistics, is that if survivors disclose their situation to anyone, it will most likely be to informal supporters (friends, relatives, neighbours and colleagues) rather than professionals.1 And this is true across the world, with research indicating that sometimes a disclosure to an informal supporter happens alongside a disclosure to a professional, but frequently this is not the case.2-5 In addition, it is not unusual for informal supporters to witness abusive behaviours, but commonly they are uncertain about what exactly it is that they are seeing, in particular, what it means, and what their role in the situation should be.6 ,7
Have you ever planned to do some writing, only to find yourself distracted by emails and ‘urgent’ tasks? Do you find you have a growing list of unpublished papers and grant proposals to write? Does it feel as if there is never enough time to get going with your writing?
As academics, writing is arguably our most important task. The mantra ‘publish or perish’ is not just a matter of prestige and a means to academic career progression. Nor is it simply about keeping our University rankings within the Research Excellence Framework. It is an ethical imperative.
Most medical research is funded either through taxpayers’ money or through charitable donations and relies on the trust and goodwill of voluntary research participants. This is both a privilege and responsibility. We must ensure that money … Read more
Assisted dying can be a divisive and polarising subject. But there is one aspect on which most people probably agree – the need to improve the conversations people have about death.
At the moment, there is uncertainty in the UK regarding what people – especially health professionals – can and cannot say when the topic of assisted dying comes up. Conversation can become especially stilted when it turns to patients obtaining the medical documentation required for an assisted death abroad.
The situation requires clarification. Currently, if a doctor in the UK writes a specific report to help with an assisted death abroad (three organisations in Switzerland accept UK citizens), the General Medical Council (GMC) may view this as a “fitness to practice” issue.
However, if a doctor provides copies of medical records, even with the knowledge that … Read more
Image credit: Doctor and patient – Government of Alberta. Creative Commons License 2.0 (Non-commercial No Derivatives). Source: Flickr: https://www.flickr.com/photos/governmentofalberta/21221196734
In a systematic review published this month, we identified 153 communication skills training interventions for generalists in end of life care. In randomised controlled trials, training improved showing empathy and discussing emotions in simulated interactions (i.e. with actor patients) but evidence of effect on clinician behaviours during real patient interactions, and on patient-reported outcomes, was inconclusive.
The global increase in the proportion of older people and length of life means providing end of life care is now increasingly the responsibility of generalist as well as specialist palliative care providers. But many clinicians find communicating about end of life issues challenging: how do you best discuss imminent mortality, limited treatment options, what to … Read more
When I first became a health researcher, I felt that people would see taking part in research as a bother, a pain, or a waste of their time and that, by association, they would see me as akin to a nuisance caller, intent on coercing them into some unwanted activity. Thankfully, after 10 years doing research, it’s become apparent to me that this is far from the truth.
For a start, the tentativeness with which most of the researchers I know proceed as they recruit participants is anything but a hard-sell. In fact, due to necessarily stringent ethics and governance processes and practices, strict eligibility criteria, and a healthy dose of ‘only wanting to do what’s best for people’, we are possibly more in danger of being talked out of … Read more
A partnership and panel event to support NIHR School for Primary Care Research (SPCR) FR15/16 applications
Pre-grant public involvement is vital to relevant and successful research. It is considered the gold-standard approach. In practice, the issue is that before the grant is awarded, there are often no resources available to conduct high quality public and patient involvement (PPI).
With SPCR funding for pre-grant PPI supporting FR15/16 applications, we developed an event to carry out and promote early PPI at the Centre for Academic Primary Care. This served to achieve PPI for these rounds of SPCR applications, foster links between members of the public and researchers and establish early PPI as achievable and accepted culture.
The event comprised a public panel and parallel sessions of Partneropoly – an interactive game … Read more