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
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
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
Two individuals are supported by the NIHR School for Primary Care Research (NIHR SPCR) to attend the Oxford Leadership Programme every year. This year researchers Drs Alyson Huntley from the Centre for Academic Primary Care, University of Bristol and Sarah Tonkin-Crine, from the Nuffield Department of Primary Care Health Sciences, University of Oxford attended the first week of events at St Hughs’ College, Oxford.
As cohort#12 of the International Primary Care Research Leadership Programme we were lucky to stay at St Hugh’s College, Oxford during a very hot and sunny week in July. After arriving at the college on Sunday afternoon we were given our timetable and a list of our cohort members spanning the UK, Catalonia and … Read more
For 25 years, I have been a frustrated researcher. Like many, I came into the field of research to make a difference. But as the years passed, I realised that research had little influence on healthcare policy making or practice. I wanted to do something, so in 2009 I applied for a NIHR post-doctoral fellowship to skill up research teams to make a bigger impact. The feedback on my (unsuccessful) application was that researchers just had to publish in the BMJ and things would change (if only!).
Imagine my delight when a few short years later, the NIHR Knowledge Mobilisation Research Fellowship scheme was launched. Its aim was to create a “cadre of knowledge mobilisers”, proficient both in the practice and research of knowledge mobilisation (or ways of sharing knowledge). In 2014, I became one of them.
I know this from working in both general practice and as a hospital doctor in A&E.
During the early stages of an illness it can be difficult for even the most experienced healthcare professionals to determine whether a patient has a minor self-limiting illness or is harbouring a more serious condition. In addition, growing problems such as antibiotic resistance and multimorbidity mean that sometimes even when a doctor makes a correct diagnosis, patients do not always get better with the first round of treatment and may require further medical help.
We cannot, and it is not clinically appropriate, to admit everyone to hospital to observe them until they feel 100% better.
That is why it is important that healthcare professionals provide patients with safety-netting advice. Safety-netting … Read more
With ninety percent of patient interaction with health services going through primary care, it’s not surprising that primary care clinicians and researchers try to figure out ways to improve primary care services. Interventions are many and varied, and result in important questions about their effectiveness. Do electronic consultations offer a good service to patients? If GPs introduce advice on healthy lifestyles into the consultation, does it make patients healthier? What about increasing the duration of GP appointments to ten minutes – does this improve outcomes for patients? Or ensuring that patients always see the same named doctor? Or painting the waiting room green?
Questions like these are normally answered by administration of a generic patient-reported questionnaire. By comparing the responses of groups of patients (say those with eight minute consultations and those with ten minute consultations), researchers can … Read more
I have a problem with gambling. There’s not enough of it.
That was the admission from billionaire Steve Wynn, a major figure in the casino industry, speaking at a recent gambling research conference in (where else?) Las Vegas. And sure, it made for a good quote. But it’s also a rather glib dismissal of a serious issue that affects many thousands of people across the world.
The UK certainly has a problem with gambling. At least it has since 2007, when laws were changed to allow for huge growth in gambling opportunities and exposure. It has been hard to ignore the subsequent explosion in industry advertising, which increased by around 500% between 2007 and 2013. By contrast, you may have missed the increased numbers of high intensity electronic gambling … Read more