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The School is pleased to announce that, after a very competitive round of applications and external review, the following projects successfully received funding for collaborative research in Funding Round 14. The School awarded £4,643,577 in total for the cross-departmental studies.
Your Voice Matters: Using Participatory Film to Engage People with Chronic Pain in Public Involvement and Research
Background People living with chronic pain (pain ≥ 3-months) often struggle to participate in valued activity (for example, family life, work and in their community) and are under-represented in public involvement and research. We aimed to broaden awareness and encourage engagement in public involvement and research among people living with chronic pain. We outline how we co-produced a film to capture experiences of chronic pain and the potential benefits of engaging in public involvement and research. Methods We undertook a participatory filmmaking project guided by UK Standards for Public Involvement, convening a co-production team of public contributors (n=4) with lived experience of chronic pain, expertise in community outreach and advocacy, a filmmaker, and a physiotherapist-researcher. We worked through five phases, pre-funding, design and production planning, story capture and filming, editing and dissemination in a series of online meetings. Members of the co-production team led outreach through trusted networks to involve an additional group of contributors (n=7) including people with no prior research involvement and non-English speakers (n=2). Reflective discussions were embedded throughout, and impact was documented using the Public Involvement in Research Impact Toolkit (PIRIT). Findings Co-production featured to shape the funding application, the vision for the film, outreach, flexible approaches to story capture, and jointly reviewed edits and supported dissemination. Public contributors within the co-production team were highly involved, shaping priorities, and key decisions about narrative focus, inclusion, and representation. They provided accounts of their experiences of living with pain and their views on public involvement and research, which formed the substantive content of the film. Outreach contributors exercised choice over how their experiences were shared, and their reflections incorporated through iterative team discussion. First‑person reflections from the co-production team illustrated how individuals experienced the project, including increased confidence, connection, and validation. Conclusions These insights illustrate how participatory filmmaking can move involvement beyond consultation toward shared power and meaningful partnership. The co‑produced film which is publicly available, Your Voice Matters: Living with Chronic Pain, Shaping the Future of Research, was a tangible output of this process and a resource to help people make sense of chronic pain and research involvement, and to encourage future engagement.
Operant Approach Activity Pacing Interventions for the Management of Chronic Pain A Systematic Review
Objectives: Operant approach activity pacing (undertaking activities according to quotas, e.g. amount/time/goal rather than according to symptom severity) is advised for chronic pain. There is no standardised intervention that addresses all the components of operant approach activity pacing. This systematic review aimed to identify operant approach activity pacing interventions for chronic pain and explore their components, effectiveness, feasibility and acceptability. Methods: Eligible studies included any type of evaluation (e.g. randomised controlled trials, feasibility/pilot, qualitative) among adults with chronic pain. Ineligible studies included interventions based on energy conservation/envelope theory/adaptive pacing therapy/symptom-contingency, and non-English language. Databases included: MEDLINE, Embase, CINAHL, AMED, PsycINFO, Cochrane CENTRAL, PEDro, OTseeker and Web of Science (from database inception to 26th March 2025). Two independent reviewers extracted data, including descriptions of interventions (TIDieR checklist), appraised risk of bias (Joanna Briggs Institute checklists) and evaluated confidence in the research (GRADE). Findings were synthesised narratively. Results: Nine studies (10 interventions; 11 papers) were included (873 participants). Interventions were heterogeneous in content, length (2-11 sessions) and tailored/untailored to participants’ baseline behaviours. Common intervention components were pre-planning, activity-rest cycling/using rests and alternating activities/positions. Direction of effect (vote counting) was towards improved function, but mixed findings for pain/fatigue. Discussion: Studies showed mixed findings across outcomes, syntheses were limited to vote counting, with very low confidence in the evidence; limiting conclusions about effectiveness. The multiple components of activity pacing can be considered to further develop and test the effectiveness of operant activity pacing for chronic pain. Funder: NIHR School for Primary Care Research. (PROSPERO:CRD42023451469).
Missing by omission: the hidden heart of cardiovascular inequity in the UK
Cardiovascular disease (CVD) remains a leading cause of premature mortality in the UK contributing to a quarter of all deaths.1 It is one of the largest drivers of health inequalities nationally, accounting for over one-fifth of the life expectancy gap between most and least deprived communities in males and females.2,3 Data from the Office for Health Improvement and Disparities from 2022–2023 show that in males there were 15 935 excess deaths and in females there were 9707 excess deaths attributable to circulatory disorders in people living in the most socioeconomically deprived quintile when compared to the least deprived quintile (Figure 1 and Figure 2).3 With £50 million investment, the National Institute for Health and Care Research (NIHR) is establishing new research consortia to tackle these stark disparities in cardiovascular health, particularly in higher risk groups such as ethnic minorities and deprived communities; and seeks to address inequalities in CVD outcomes in women and men.4
Optimising the PTSD Hub App Through Co-Production: Enhancing Digital Support for PTSD Management in Primary Care
ABSTRACT Background Post-traumatic stress disorder (PTSD) affects approximately 1 in 20 individuals, with primary care playing a crucial role in early identification and management. However, PTSD is frequently underdiagnosed in primary care settings. The COVID-19 pandemic has exacerbated the incidence of PTSD, leading to an increased demand for accessible mental health services. While NICE guidelines recommend trauma-focused therapies, access remains limited, underscoring the need for alternative strategies to support management within primary care. Aim To optimise and refine through co-production the PTSD Hub app, an existing digital resource, to better support individuals with PTSD in primary care settings, improving usability, clinician engagement, and patient outcomes. Design & Setting A co-production approach was employed with stakeholders, including people with lived experience of PTSD, informal carers, and primary care professionals. Workshops were held online to gather insights on how to enhance the PTSD Hub app for better integration into primary care. Method Two Nominal Group Technique workshops were conducted to identify key barriers to PTSD care in primary care and generate solutions for improving the app. Participants ranked and prioritised features based on relevance to primary care. Results Twenty-six participants attended the workshops, representing a diverse mix of stakeholders. Key barriers identified included stigma, clinician time constraints, and limited access to trauma-focused therapies. Solutions included improving symptom tracking, enhancing customisation features, and raising clinician awareness. Conclusion The study highlights the potential of the PTSD Hub app in improving and supporting PTSD management in primary care. Future research should evaluate the app's effectiveness in real-world primary care settings. Patient and Public Contribution Patients and members of the public were actively involved throughout this study using a co-production approach. A lived experience advisory panel of six individuals with PTSD provided input at all stages, including shaping the study design, reviewing participant materials, and advising on workshop facilitation. Additionally, 26 participants, comprising individuals with lived experience of PTSD, informal carers, and healthcare professionals, contributed to two Nominal Group Technique workshops. A lived experience research partner (NC) was an integral part of the research team, attended all team meetings, co-facilitated workshop sessions and contributed to design, analysis and manuscript preparation.
Family resistance to end-of-life prognosis in hospice care: A conversation analytic single case analysis
Abstract Objectives Some clinicians lack confidence providing prognostic information to families, particularly when they do not accept a short prognosis. This paper aims to understand the communication practices used when the family of a dying patient resist the provision and acceptance of prognostic information, and how a doctor responds to this. Methods Naturally occurring conversations between senior hospice clinicians and families of patients at the end of life were audio-recorded. We present a single-case of a consultation between a doctor and the family of an imminently dying patient. Using conversation analysis, we examine the ways in which prognostic information is resisted by the family and pursued by the doctor. Our analysis contrasts this with practices identified in previously analysed cases where prognostic information was accepted. Results Three practices for resisting prognosis were identified: passive resistance (minimal acknowledgement of prognostic statements), questioning the clinician’s account for the prognosis and their certainty, and providing disaligning responses that do not engage with the prognostic statement. We demonstrate how in response, the doctor pursued prognostic talk, making increasingly explicit prognostic statements. The clinician balanced expressions of certainty that the patient was dying, with honesty about their uncertainty regarding timing. The doctor’s statements more clearly resembled ‘bad news delivery’ than other cases in the dataset. Conclusions The analysis demonstrates how families can resist the provision and acceptance of prognostic information at the end of life. It shows an obligation for doctors to disclose this information and possible strategies to respond to resistance. Practice implications When delivering prognostic information at the end of life, doctors can look for signs of resistance from the family and use strategies to respond, such as expressing certainty where possible while acknowledging uncertainty. These insights may be particularly valuable in acute settings, where prognostic awareness among families may be limited.
Measurement and management of adult blood pressure in the peri-operative period: updated guidelines from the Association of Anaesthetists and the British and Irish Hypertension Society
Plain Language Summary Keeping a patient's blood pressure steady during surgery is a very important job for anaesthetists. Some things, like stopping or starting blood pressure medicine, and the types of anaesthetic used, can make blood pressure go up or down a lot – especially in people who already have high blood pressure. This update is based on earlier advice from 2016 made by two groups: the Association of Anaesthetists and the British and Irish Hypertension Society. A team of experts read the newest research and worked together to make clear, updated rules. The new advice explains how to look after adults having planned (non-emergency) surgery; it doesn't cover heart, pregnancy or hormone-related operations. The guidelines explain: when and how to measure blood pressure; what blood pressure numbers mean surgery might need to be delayed; and how to manage blood pressure before, during, and after surgery. Some main points include the following: Hospitals can accept patients for surgery if their blood pressure is below 160/100 when checked at a clinic, or below 155/95 when checked at home in the past year. If someone's blood pressure has not been recently checked by their doctor, they can still go ahead with surgery if their clinic reading is below 180/120, or their home reading is below 175/115. Looking after blood pressure around the time of surgery needs careful balance – doctors must keep patients safe during the operation while also thinking about their long-term heart health. Good communication between GPs, hospital staff and patients is very important to keep everyone informed.
Managing multiple long-term conditions in people experiencing socioeconomic deprivation: a qualitative study of primary care perspectives
Background Multiple long-term conditions (MLTCs) are rising, especially among people experiencing socioeconomic deprivation, who develop MLTCs earlier and face barriers to self-management. Primary healthcare professionals (HCPs) are central to supporting self-management but face systemic challenges, resource inequalities, and emotional strain. Understanding their perspectives is vital to developing effective solutions. Aim To explore how HCPs in general practices in deprived areas support people to self-manage MLTCs, and the barriers to, and facilitators of, providing best levels of care. Design and setting This was a qualitative study with GPs, general practice nurses, advanced nurse practitioners, and allied health professionals working in socioeconomically deprived areas of two cities in England. Method Online semi-structured interviews were conducted with 18 HCPs from 17 general practices. Transcripts were analysed inductively, underpinned by elements of reflexive thematic analysis and grounded-theory methodology. A socioecological framework was applied retrospectively to situate HCP experiences within wider socioecological discourses. Results Four themes were identified: 1) individual factors influencing self-management, such as motivation and health literacy; 2) the role of social connections and community-based support; 3) enhancing primary care through continuity, longer appointments, and culturally sensitive, person-centred care; and 4) the impact of policy and inequitable funding on care provision. Key facilitators included accessible information, community signposting, and support navigating healthcare systems. Conclusion HCPs adapt care to meet patient needs but face systemic barriers, including underfunding and limited resources. Strengthening trust, cultural competence, and continuity of care, alongside policy and funding reform, is essential for delivering effective self-management support.
The use of online consultation tools for common mental health conditions in UK primary care: a qualitative interview study of patient and practitioner perspectives
Background UK general practices are now required to make online consultation tools available during practice hours. Evidence shows patients increasingly use them to access mental health support under the ‘digital first’ approach. Whilst they may increase time-efficiency for practices, we do not know whether practitioners and patients view them as a suitable consultation mode to discuss mental health. Our aim was to explore patients’ and practitioners’ views and experiences of using online consultation tools for mental health, to inform their future use. Method In-depth interviews with 20 primary care practitioners and 21 patients. A topic guide was used to ensure consistency across interviews. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. There was patient and public involvement throughout. Results Patients and practitioners said online consultation tools encouraged reflective thinking about mental health and symptom disclosure. However, patients’ concerns around who might read the output meant they only provided limited information. Patients also reported online tools can be a barrier to accessing care, and those with less mental health literacy may struggle to articulate their concerns. Practitioners noted that continuity of care can be reduced when using online tools, and triage is more challenging if insufficient information is provided to determine if urgent care is needed. Conclusion To ensure that online consultation tools do not increase inequity, they should remain part of a range of options for accessing mental health support in general practice and should not be a mandatory first step to access care. Online consultation tools can provide useful information for practitioners and may be more accessible than a telephone call for patients with anxiety or depression. However, practitioners may struggle to assess patient risk using these tools, which could mean patients do not receive the care they need. Patients might need support when first using online consultation tools and advice on who will access the information provided.
Communication during out-of-hours primary care contacts for people with a terminal illness: a scoping review
Abstract Objective To summarise what is known about communication during out-of-hours primary care contacts for people with a terminal illness. Design A scoping review following the Joanna Briggs Institute guidance for scoping reviews and conducted in accordance with Arksey & O’Malley’s methodological framework for scoping reviews. Data sources Searches of MEDLINE, PsycINFO, CINAHL and EMBASE were conducted from inception to 23 July 2024, alongside grey literature searches and hand searching reference lists of relevant reviews. Eligibility criteria Sources were eligible if they provided evidence about communication between people with a terminal condition, their families and/or healthcare professionals during contacts with out-of-hours primary care services. Data extraction and synthesis Data were extracted by two independent researchers following Joanna Briggs Institute guidelines for scoping reviews. Findings were thematically synthesised to create a narrative account of the evidence. Results Of the 1745 records identified, 18 studies were included in the review. Most used qualitative interviews and/or focus groups. Barriers to good communication included a lack of continuity of care, problems relating to remote consultations, the delegitimising of help seeking, and the challenges of conducting specialist palliative care consultations within a generalist out-of-hours system. Facilitators to good communication included the availability of information about patients and families out of hours, an empathetic and confident approach from out-of-hours professionals, and support from colleagues. Conclusions The scoping review showed that there is limited research focusing specifically on end-of-life communication in out-of-hours primary care settings. Further research is needed, particularly using observations or recordings of real interactions. There are several challenges to communication in this setting, but providing clinicians with access to palliative care summaries, alongside training and support in this specialised communication, can facilitate good end-of-life communication with patients and their families.
Digital peer support interventions for people with mental health conditions in outpatient settings: a systematic review and meta-analysis
Background Mental health conditions are a major global challenge with rising demand for accessible, effective, scalable treatments. Digital peer support interventions are a promising way to extend support beyond clinical settings, but their effectiveness requires comprehensive evaluation. Objective To evaluate the effectiveness of digital peer support interventions in improving clinical symptoms, functioning, and treatment engagement among individuals with mental health conditions in outpatient settings. Study selection and analysis We conducted a systematic review and random-effects meta-analysis of controlled interventional studies. Five databases (MEDLINE, CENTRAL, Embase, PsycINFO) were searched up to January 2025. Studies evaluated digital peer support via online platforms, mobile apps or digital communities for people aged ≥16 years with mental health conditions. Outcomes included clinical symptoms (depression, anxiety), functioning (quality of life, social functioning) and treatment engagement. Risk of bias was assessed using Cochrane Risk of Bias 2.0 for randomised controlled trials and ROBINS-I for non-randomised studies. Certainty of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Findings 29 studies including 5825 participants were included. Digital peer support was associated with small-to-moderate improvements in symptoms of depression (standardised mean difference (SMD) −0.28; 95% CI −0.42 to −0.14) and anxiety (SMD −0.47; 95% CI −0.68 to −0.27). Functional outcomes improved modestly: social functioning (SMD 0.18; 95% CI 0.07 to 0.29), quality of life (SMD 0.14; 95% CI 0.02 to 0.26), patient activation (SMD 0.39; 95% CI 0.23 to 0.55) and personal recovery (SMD 0.23; 95% CI 0.11 to 0.35). No significant effects were observed for treatment engagement or satisfaction. Preliminary evidence suggested sustained benefits for depression, anxiety and social functioning. Conclusions and clinical implications Digital peer support offers modest improvements in symptoms and functioning for individuals with mental health conditions and may be considered as an adjunct to usual care to enhance engagement and provide accessible support between clinical contacts. Key priorities include establishing optimal intervention models, clarifying longer-term benefits, and ensuring these approaches can be delivered safely and sustainably within routine outpatient services. PROSPERO registration number CRD42023445194.
A cohort study of trends in the prevalence of pregestational diabetes in pregnancy recorded in UK general practice between 1995 and 2012
Objective: To describe the characteristics of pregnant women with and without pregestational diabetes and to estimate the prevalence of pregestational diabetes in pregnant women recorded in a UK primary care database. Methods: The data source for this study is The Health Improvement Network (THIN) primary care database. Pregnant women with and without diabetes aged 16 years and over were identified using diagnostic Read codes and prescriptions for antidiabetics from medical records. Data were examined on: age, body mass index (BMI), social deprivation, smoking, ethnicity and glycaemic control. The prevalence of pregestational diabetes was calculated by diabetes type and calendar year between 1995 and 2012. Results: Data from 400 434 pregnancies suggests that women with pregestational diabetes were: older (median 29, 32 vs 29 years for type 1, type 2 and without diabetes, respectively), had higher BMI (median 25.0, 30.4 vs 23.9 k/m2 for type 1, type 2 and without diabetes, respectively) and were registered with a general practice for longer than pregnant women without diabetes. The prevalence of type 1 diabetes in pregnancy increased from 1.56 to 4.09 per 1000 pregnancies between 1995 and 2015. For type 2 diabetes the increase was from 2.34 to 5.09 per 1000 pregnancies between 1995 and 2008 followed by a more rapid increase to 10.62 per 1000 pregnancies by 2012. Conclusions: Pregnant women with pregestational diabetes were older, had higher BMI and were registered for longer than women without diabetes. The prevalence of type 1 and type 2 diabetes increased in pregnancy. The prevalence of type 2 diabetes rose more rapidly with a marked increase after 2008.
‘One man’s medicine is another man’s poison’: a qualitative study of user perspectives on low intensity interventions for Obsessive-Compulsive Disorder (OCD)
Background Low intensity interventions based on cognitive-behavioral therapy (CBT) such as computerized therapy or guided self-help can offer effective and accessible care for mild to moderate mental health problems. However, critics argue that by reducing therapist input and the level of experience of the professionals delivering therapy, low intensity interventions deprive users of critical ‘active ingredients’. Thus, while demand management arguments support the use of low intensity interventions for OCD, their integration into existing mental health services remains incomplete. Studies of user views of low intensity interventions can offer valuable insights to define their role and optimize their implementation in practice. Methods Qualitative interviews (n = 36) in adults with OCD explored user perspectives on the initiation, continuation and acceptability of two low intensity CBT interventions: guided self-help (6 h of professional support) and computerized CBT (1 h of professional support), delivered within the context of a large pragmatic effectiveness trial (ISRCTN73535163). Results While uptake was relatively high, continued engagement with the low intensity interventions was complex, with the perceived limitations of self-help materials impacting on users’ willingness to continue therapy. The addition of professional support provided an acceptable compromise between the relative benefits of self-help and the need for professional input. However, individual differences were evident in the extent to which this compromise was considered necessary and acceptable. The need for some professional contact to manage expectations and personalize therapy materials was amplified in users with OCD, given the unique features of the disorder. However, individual differences were again evident regarding the perceived value of face-to-face support. Conclusions Overall the findings demonstrate the need for flexibility in the provision of low intensity interventions for OCD, responsive to user preferences, as these preferences impact directly on engagement with therapy and perceptions of effectiveness.
Brief pain re-assessment provided more accurate prognosis than baseline information for low-back or shoulder pain
Research investigating prognosis in musculoskeletal pain conditions has only been moderately successful in predicting which patients are unlikely to recover. Clinical decision making could potentially be improved by combining information taken at baseline and re-consultation. Methods: Data from four prospective clinical cohorts of adults presenting to UK and Dutch primary care with low-back or shoulder pain was analysed, assessing long-term disability at 6 or 12 months and including baseline and 4–6 week assessments of pain. Baseline versus short-term assessments of pain, and previously validated multivariable prediction models versus repeat assessment, were compared to assess predictive performance of long-term disability outcome. A hypothetical clinical scenario was explored which made efficient use of both baseline and repeated assessment to identify patients likely to have a poor prognosis and decide on further treatment. Results: Short-term repeat assessment of pain was better than short-term change or baseline score at predicting long-term disability improvement across all cohorts. Short-term repeat assessment of pain was only slightly more predictive of long-term recovery (c-statistics 0.78, 95% CI 0.74 to 0.83 and 0.75, 95% CI 0.69 to 0.82) than a multivariable baseline prognostic model in the two cohorts presenting such a model (c-statistics 0.71, 95% CI 0.67 to 0.76 and 0.72, 95% CI 0.66 to 0.78). Combining optimal prediction at baseline using a multivariable prognostic model with short-term repeat assessment of pain in those with uncertain prognosis in a hypothetical clinical scenario resulted in reduction in the number of patients with an uncertain probability of recovery, thereby reducing the instances where patients may be inappropriately referred or reassured. Conclusions: Incorporating short-term repeat assessment of pain into prognostic models could potentially optimise the clinical usefulness of prognostic information.
Prescribing of medication to prevent glucocorticoid harms in patients with Polymyalgia Rheumatica: a cross-sectional study and two emulated target trials in the Clinical Practice Research Datalink Aurum
Abstract Objectives Polymyalgia rheumatica (PMR) is a common indication for long-term glucocorticoid (GC) treatment. Bone- and gastro-protective medications are recommended for those at high-risk of adverse events from GCs but no trials have evaluated their effectiveness in PMR. We describe bone-/gastro-protective medicine prescribing in people with PMR and evaluate its impact on adverse GC outcomes using a target trial approach. Methods A sample of >40,000 individuals aged ≥50 years, with a coded PMR diagnosis from January 2010-March 2022, prescribed GCs within 21 days of first PMR diagnosis code, was constructed in CPRD Aurum. Prescriptions were defined as prevalent (pre-PMR diagnosis), incident (at diagnosis), or late (post-diagnosis, still GC-treated), reported stratified by age/gender/deprivation. A target-trial approach assessed the effect of: a) bisphosphonates on fragility fractures and b) proton-pump inhibitors/H2-receptor antagonists (PPIs/H2RAs) on gastrointestinal (GI) ulceration/bleeding. Treatment effect, adjusted for confounders, was modelled using targeted maximum likelihood estimation. Results 67.2% were co-prescribed bisphosphonates and 78.6% PPIs/H2RAs. Males and those in more deprived areas were less likely to receive bisphosphonates. 1.40% (95%CI 1.10%,1.70%) of those prescribed vs 2.32% (2.12%,2.52%) of those not prescribed bisphosphonates for 12 months experienced a fracture (risk difference 0.92% points [0.56%,1.27%], NNT 109). Prescribing gastro-protective medications was not associated with serious GI events. Conclusion Rates of prescribing to mitigate GC harms are higher than previously reported. Bisphosphonates are associated with approximately one less fragility fracture per year for every 100 people treated. Gastro-prophylaxis is not associated with reduced risk of GI ulceration/bleeding, suggesting potential to reduce prescribing for this indication.
Health visitor and community health nurse perspectives of supporting parents caring for unsettled babies: a qualitative interview study
Abstract Objectives: The aims of this study were to explore how health visitors (HVs) and community health nurses (CHNs) assess unsettled baby behaviours, how their perceptions of these behaviours influence decisions about support offered, and how able they feel to deliver support to families of unsettled babies. Design: Qualitative semi-structured interviews were conducted, recorded and transcribed. Data were analysed using Reflexive Thematic Analysis. Setting: Potential participants were invited nationally via social media and via Health Visiting Service managers from an NHS Trust. Interviews took place remotely. Participants: 17 HVs and 3 CHNs were purposively selected to include a wide range of perspectives. Results: Three themes were developed, (1) HVs' perceptions of parents' sense-making which explains how HVs/CHNs understand parents' beliefs around unsettled babies; (2) care pathway which highlights the importance HVs place on creating emotional space for the baby, the parent and the health visitor within the pathway (containment); and (3) service delivery decline, which outlines the impact of funding cuts to the services on the HVs' ability to provide support for families. Lastly, a new concept - the Tipping Point model - was created to holistically conceptualise the experiences of HVs providing support for unsettled babies in the UK. Conclusions: Policy makers need to organise services to value and support the role of the health visiting team in 'containment'. HVs identified a training need around assessing and advising about unsettled babies to place them in a stronger position to support families. Further research is needed into different models of support for families of unsettled babies from the wider primary care team and/or from digital services.
Exploring the barriers and facilitators to discussing social media in primary care for young adults with mental health concerns: a qualitative study
Background Social media is a pervasive part of young peoples’ lives and may influence their mental health. Primary care is often the first point of care when seeking help for mental health problems. However, little is known about how young adults with mental health problems experience and perceive primary care support for managing social media. Aim To explore young adults’ views on help-seeking for social media use in primary care in relation to mental health problems. Design & setting Qualitative interview study with 28 young adults aged 18–25 with self-reported mental health problems across England. Method Semi-structured interviews were analysed thematically to identify barriers and facilitators to help-seeking. Themes were organised using the Theory of Planned Behaviour - attitudes, social norms and perceived behavioural control. Results Barriers for help-seeking included attitudes that social media was a secondary issue and low expectations of meaningful support; perceived negative attitudes and limited understanding of social media by primary care clinicians, communities and families; and constrained ability to seek help due to limited consultation time and uncertainty around how to seek help. Facilitators included clinicians offering practical strategies, raising the topic non-judgmentally, receiving training to better understand young people’s digital lives, longer appointment times, and clearer information about support in primary care for social media-related concerns. Conclusion Young adults with mental health concerns face multiple barriers to discussing social media in primary care, shaped by attitudes and structural challenges. Addressing these through clinician training, communication, and service adaptations may enhance engagement and support.
Teamwork and relational infrastructure: a qualitative study of modern UK general practice
Abstract Background Clinical and support staff in modern general practice must work across in-person and digital modalities to deliver high-quality, safe care in a context of high workload, constant change and intermittent crisis. Navigating this environment is cognitively and emotionally demanding and requires complex teamwork. Staff morale is often low, and staff turnover high. Aims 1. To understand how the context of modern UK general practice affects staff wellbeing and teamwork. 2. To develop our understanding of how to improve these aspects of work culture. Design and Setting Multi-site case study of 10 GP practices across England, Wales, and Scotland. Method Mixed qualitative methods, incorporating ethnographic observations, interviews, and focus groups, to develop case studies. First, we conducted an in-depth longitudinal study of two practices focused on developing theory, which we cross-compared with eight others. Our analysis was informed by theories from organisational research, including psychological safety, relational coordination and attentional infrastructure. Results Staff wellbeing and effective teamwork depended on positive team relations. Practices in which such relations were valued and nurtured (i.e. those with a strong relational infrastructure) appeared to have stronger team identities, better coordination of work tasks, and higher overall staff wellbeing than those in which team relations were not actively nurtured. Staff relations were built and sustained through various individual actions and organisational routines. Conclusion This study has identified elements of 'relational infrastructure' with the potential to improve team relations, communication, and coordination, which may also enhance practices' resilience to withstand change and crises.
Understanding the retention and support needs of UK first contact practitioner physiotherapists in primary care; a realist review
Background First Contact Practitioner Physiotherapists (FCPPs) have been widely implemented in UK general practice through the Additional Roles Reimbursement Scheme to improve access to musculoskeletal (MSK) care and reduce GP workload. While evidence suggests clinical and economic benefits, concerns are emerging regarding practitioner burnout and turnover. Understanding how contextual factors contribute to these outcomes is essential for sustainable workforce planning. Aim To explore how the UK based FCPP role interacts with workplace contexts to influence practitioner wellbeing, burnout, and turnover intentions, and to identify implications for support and service design. Methods A realist review of UK-based literature examining the implementation and experiences of FCPPs and comparable primary care roles was conducted in line with RAMESES standards. Initial programme theories were developed through stakeholder consultation and iteratively refined using published evidence. Data were synthesised into context–mechanism–outcome configurations (CMOCs), organised across four domains: role characteristics, personal characteristics, caseload complexity, and working environment. Results Thirty-three CMOCs were synthesised. Role ambiguity and poorly defined boundaries contributed to inappropriate referrals and role overload, intensifying an already complex caseload. These pressures were exacerbated by limited supervision and organisational support, leading to emotional strain, professional isolation, and increased burnout risk. Although practitioner experience and resilience could mitigate some effects, reliance on individual coping without adequate structural support undermined sustainability and contributed to turnover intentions. Conclusion Burnout and turnover intentions among FCPPs arise primarily from systemic and organisational factors rather than individual shortcomings. Addressing role clarity, supervision, interprofessional integration, and workload alignment is essential to support practitioner wellbeing and ensure the long-term sustainability of FCPP roles.
Social and Ethical Aspects of Remote and Hybrid Care in the Special Allocation Scheme in general practice (SEARCH): A mixed methods feasibility study protocol
Home Browse Social and Ethical Aspects of Remote and Hybrid Care in the Special... ALL Metrics 154 Views 11 Downloads Get PDF Get XML Cite Export Track Share ▬ Study Protocol Social and Ethical Aspects of Remote and Hybrid Care in the Special Allocation Scheme in general practice (SEARCH): A mixed methods feasibility study protocol [version 1; peer review: 3 approved with reservations] Natassia Brenman https://orcid.org/0000-0002-6567-21291, Jackie van Dael1, Francesca Dakin https://orcid.org/0000-0002-4105-46171, Kelly Howells2, Jessica Drinkwater https://orcid.org/0000-0003-1034-07812, Anne-Laure Donskoy3, Clive Rowe4, Nicky Pyper5, Sara Shaw https://orcid.org/0000-0002-7014-47931 Author details Abstract Background Despite the growing body of research on remote primary care and access for (digitally) excluded groups, very little is known about care for patients who have been deliberately excluded from mainstream services. The ‘Special Allocation Scheme’ (SAS) in England provides GP services to patients who have been excluded from their GP practice after being reported for violent behaviour. Patients registered on SAS are likely to be offered remote services, in part because patients are often placed in an ‘out-of-area’ SAS practice. Our aim is to find out more about the needs of patients on the SAS, whether and when it is appropriate to offer remote options, and who these options might benefit or disadvantage. We also aim to develop safe, ethical, and meaningful ways to involve patients with experience on the scheme in research and service development. Methods Workstream 1 includes a national scoping survey of SAS provision across England. Workstream 2 comprises of three ethnographic case studies of SAS services, including observation and interviews with patients, NHS staff and national/regional decision makers. Workstream 3 involves two codesign workshops with patients, researchers, clinicians, support staff and third sector care providers to co-produce a set of reflections and best practices to inform future research and service redesign in this context. An iterative and participatory-informed PPIE approach is adopted throughout, involving patients and other stakeholders from early conceptualisation to study design, analysis and codesign of outputs. Conclusions Whilst remote solutions can improve access to primary care for some, they are not suitable for every patient population and can widen health inequalities. This is a novel study in a critically under-researched area of service delivery with clear practical and ethical implications for practice. Findings will develop understanding and transferable learning for SAS delivery and inform the design of a future study.
Methods to establish a Pregnancy Register in the QResearch Database
Abstract Background: Electronic health records are increasingly used to conduct pregnancy-related research as pregnant women are under-represented in research. Creating a register of pregnancies by combining data from primary and secondary care will further facilitate research in pregnancy. This work describes the construction of an algorithm to create a unified pregnancy cohort in the QResearch database during the emergency phase of the COVID-19 pandemic. Methods: National primary care records in the QResearch® database were linked to patient-level data from Hospital Episode Statistics (HES) datasets. Females aged 15-50 years with a pregnancy outcome recorded between 30 December 2020 and 30 September 2022 were included. Pregnancy (delivery/loss) episodes were identified and cohort demographics reported using a three-stage algorithm. Pregnancy start dates were derived using a combination of HES and primary care data, or individually estimated where no corresponding date could be identified. Results: 266,758 women with 279,027 pregnancies are captured in the register. 232,673 pregnancies (83.4%) are deliveries (99.5% livebirths and 0.5% stillbirths) and 46,354 (16.6%) pregnancies are pregnancy losses. Pregnancy losses are highest amongst those of Caribbean (23.1%; n = 781) ethnicity and lowest in those of Pakistani ethnicity (13.9%, n = 1,579). 82.4% of pregnancies are derived from HES maternity records, 10.6% from primary care records, 3.4% from HES Admissions, and 3.6% from HES Procedures. Conclusion: The construction of a pregnancy register in QResearch® offers a valuable resource for future research. Its methodology can be adapted to construct new cohorts over any period, providing a comprehensive resource on pregnancy outcomes and events.