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This article explores the experiences of those who lead undergraduate education-related programmes in further education (FE) colleges in England. Questionnaire and interview fieldwork with 14 further education-based programme leaders were supplemented by a comparison survey of equivalent professionals from higher education institutions (HEIs). Drawing on Hodgson and Spours's four-level lifelong learning ecology and Nardi and O'Day's keystone species concept, our analysis characterises the role of the undergraduate programme leader as distinctive and critical within the further education context. Extremely multifaceted and busy, this role is also poorly defined, often involving individuals relying on craft wisdom accrued within specific contexts. Three overall strands of responsibility emerged in participants' view of their role: the administrative and organisational demands of colleges and the validation/franchising of higher education partners; the provision to learners of appropriate support in their studies; and the recognition of and response to pastoral needs of students. Tensions were identified between these, with one strand tending to preoccupy programme leaders at any time, obscuring their view of other important role objectives. As such, we introduce the concept of sightlines to capture the importance of enabling programme leaders to see through and beyond their institutional context and engage outwards, rather than turn inwards. Practical recommendations include the provision of time and licence to study for advanced qualifications, to undertake research and to help nurture distinctive cultures of higher education learning. [ABSTRACT FROM AUTHOR]

Understanding people's perceptions of teaching as an occupation, and their motivation or otherwise to teach, can help identify which initiatives/policies are most promising in improving teacher recruitment. Previous studies have often sought only the views of teachers/teacher trainees to understand why people choose teaching as a career. Recruitment strategies based on evidence from such research are therefore only appealing to those who are already interested in teaching. It is the views of those who might otherwise have gone into teaching that can provide better clues to what we can do to get more people into teaching. This paper compares the views of 4469 undergraduate students and 788 trainee teachers in England. Our analysis goes beyond the usual approach by comparing young people completely uninterested in teaching, those who considered teaching but rejected it, those intending to be teachers, and those already in training. Our study found little or no difference between prospective teachers and others in terms of generic career drivers and the attraction of financial incentives, although prospective teachers tended to have lower levels of qualifications and to come from less prestigious occupational backgrounds. However, those not planning to be teachers are much less concerned about teachers' workload, suggesting that this is probably not a great deterrent for those considering teaching. Compared to those who intend to be teachers, those who have considered but rejected teaching are less likely to view teaching as intellectually stimulating. They are least likely to see teaching as a high-status profession, offering good promotion prospects and job security. Policies to improve recruitment need to make teaching more attractive to the second group by addressing these issues. Additionally, these policies should be distinct from policies to retain existing teachers. [ABSTRACT FROM AUTHOR]

Background: Health services are increasingly using digital tools to deliver care, and online consultations are being widely adopted in primary care settings. The intended consequences of online consultations are to increase patient access to care and increase the efficiency of care.Aim: To identify and understand the unintended consequences of online consultations in primary care.Design and Setting: Qualitative interview study in eight general practices using online consultation tools in South West and North West England between February 2019 and January 2020.Method: Thematic analysis of semi-structured interviews with 19 patients and 18 general practice staff.Results: Consequences of online consultations were identified that restricted patient access to care by making it difficult for some patients to communicate effectively with a GP and disadvantaging digitally-excluded patients. This stemmed from patient uncertainty about how their queries were dealt with, and whether practices used online consultations as their preferred method for patients to contact the practice. Consequences were identified that limited increases in practice efficiency by creating additional work, isolation, and dissatisfaction for some staff.Conclusion: Unintended consequences often present operational challenges that are foreseeable and partly preventable. However, these challenges must be recognised and solutions resourced sufficiently. Not everyone may benefit and local decisions will need to be made about trade-offs. Process changes tailored to local circumstances are critical to making effective use of online consultation tools. Unintended consequences also present clinical challenges that result from asynchronous communication. Online consultation tools favour simple, well-formulated information exchange that leads to diffuse relationships and a more transactional style of medicine. [ABSTRACT FROM AUTHOR]

This paper describes an independently evaluated randomised controlled trial of a self-affirmation intervention, replicating earlier studies, mostly conducted in the US with ethnic minority students. Self-affirmation theory suggests that some stigmatised groups, such as those from ethnic minority or poor families, face stereotype threats which undermine their academic performance. Engaging in value affirmation writing activities when such threats are most salient can give individuals a positive sense of value, negating harmful feelings, and fostering academic learning. The present study, involving 10,807 pupils aged 14 to 16 in England showed that the intervention can be successfully replicated with children from low socioeconomic backgrounds in England. The analysis showed positive effects for the intervention group. Pupils who completed more exercises also performed better. The findings are worth consideration given that it costs virtually nothing and does no harm. [ABSTRACT FROM AUTHOR]

The article discusses the issue of teacher shortage in England and the possible solutions to address it. Also cited are the government programs to bolster teacher recruitment and retention like the Early Career Framework (ECF), the study to asses the career interests of undergraduates in the country, and the most influential factors they consider in their career choices like job security, job satisfaction, and pay.

Introduced in England in 2011, the pupil premium policy was an ambitious reform aimed at tackling the persistent attainment gap between disadvantaged pupils and their more affluent peers. The policy provides school leaders with the professional autonomy to determine how pupil premium funding should be used. This article examines the decision-making processes and influences involved in the use of these additional resources. We conducted interviews with 21 school leaders from different contexts across the Midlands in order to investigate the approaches, perceptions and experiences that influenced their engagement with the pupil premium policy. The findings highlight the range of strategies employed to determine how the funding should be used and the factors that influence the decisions made. Our data also indicate the tensions and challenges that are experienced by school leaders in relation to effective use of the funding. We conclude with recommendations for policymakers and practitioners in relation to the requirement for high-quality, accessible information to support pupil premium use, the role of accountability mechanisms and the need for wider societal reform in order to tackle social disadvantage. [ABSTRACT FROM AUTHOR]

The Free Schools policy in England has led to the opening of a number of new autonomous state-funded schools. This article uses data from the Annual Schools Census to present the proportions of socioeconomically disadvantaged children attending the first three waves of these schools. It updates and builds on previous work that focused on the student composition of the first wave of Free Schools that opened in 2011. The analysis compares the Free School intakes with other local schools and Local Authority ( LA) data and seeks to establish whether the schools are taking an equal share of disadvantaged children in relation to their nearby competitors. Differences emerge between the different waves of schools with those that opened in 2011 generally underrepresenting disadvantaged children. In the second and third waves the picture is more mixed. It is also the case that Free Schools with a faith designation or an alternative or specialist curriculum appear particularly likely to have proportionally fewer disadvantaged children than might be expected based on their location. The potential impacts of having an increasing number of new schools with unbalanced intakes are discussed. [ABSTRACT FROM AUTHOR]

This paper presents the results of an analysis of the admissions criteria used by the first two waves of secondary Free Schools in England. The type of criteria and their ranked order is explored and their potential impact on the school composition is considered. The findings demonstrate the diversity of criteria being used by this new type of school and give some insight in to how Free Schools appear to be prioritising access. As Free Schools operate outside Local Authority control with regards to admissions procedures they are able to choose their own feeder schools, set their own catchment areas, prioritise particular postcode districts, guarantee places for children of the school’s founders or opt to use banding systems. Whilst the admissions policies of the majority of secondary Free Schools appear to be adhering to the 2012 Admissions Code legislation, this study highlights the influence that such criteria may have in creating intakes which are less balanced in terms of socioeconomic status, ethnicity or religious affiliation. [ABSTRACT FROM PUBLISHER]

Objective To combine insights from service users with long-term conditions ( LTCs) to assist the development of a community referral intervention designed to promote engagement and improve access to health-relevant resources. Background Social deprivation and reduced access to resources have been causally linked with social isolation and the ability to manage LTCs. Participation in meaningful activity has been associated with positive health benefits, and strategies to promote access to community activities have shown some potential to improve outcomes for people with LTCs. This suggests the need to develop an engagement and referral intervention in partnership with service users and community groups as part of mainstream self-care support. Method A series of focus groups and interviews with members of community groups in Greater Manchester designed as an iterative and collaborative approach to elicit the role of personal and community networks that support long-term condition management ( LTCM) to develop a community referral tool. Results Participants reported a broad range of resources relevant to LTCM that often went beyond the usual concerns associated with self-care. This helped to inform a tool ( PLANS) to tailor access to types of community-based resources which can support LTCM. Conclusions Understanding the everyday challenges of living with a LTC highlighted the importance of connecting and engaging with localized support for people. In response to this, we developed an intervention ( PLANS) which tailors access to local resources based on personal preferences, needs and acceptability to encourage service users to engage with sustainable health choices. [ABSTRACT FROM AUTHOR]

The article focuses on the longitudinal qualitative study that investigates the influences self-management priorities for individuals with multiple long-term conditions. It mentions the effects of multiple conditions on many aspects of people's illness management. It also discusses the results of the study which finds the variable nature of multimorbidity experience and management for patients.

Background: An implementation gap exists between policy aspirations for provision and the delivery of self-management support in primary care. An evidence based training and support package using a whole systems approach implemented as part of a randomised controlled trial was delivered to general practice staff. The trial found no effect of the intervention on patient outcomes. This paper explores why self-management support failed to become part of normal practice. We focussed on implementation of tools which capture two key aspects of self-management support - education (guidebooks for patients) and forming collaborative partnerships (a shared decision-making tool). Objectives: To evaluate the implementation and embedding of self-management support in a United Kingdom primary care setting. Design: Qualitative semi-structured interviews with primary care professionals. Settings: 12 General Practices in the Northwest of England located within a deprived inner city area. Participants: Practices were approached 3-6 months after undergoing training in a selfmanagement support approach. A pragmatic sample of 37 members of staff - General Practitioners, nurses, and practice support staff from 12 practices agreed to take part. The analysis is based on interviews with 11 practice nurses and one assistant practitioner; all were female with between 2 and 21 years' experience of working in general practice. Methods: A qualitative design involving face-to-face, semi-structured interviews audio- recorded and transcribed. Normalisation Process Theory framework allowed a systematic evaluation of the factors influencing the work required to implement the tools. Findings: The guidebooks were embedded in daily practice but the shared decision- making tools were not. Guidebooks were considered to enhance patient-centredness and were minimally disruptive. Practice nurses were reluctant to engage with behaviour change discussions. Self-management support was not formulated as a practice priority and there was minimal support for this activity within the practice: it was not auditable; [ABSTRACT FROM AUTHOR]

Background: Health systems are seeking to harness digital tools to promote patient autonomy and increase the efficiency of care worldwide. The NHS Long Term Plan created the right for patients to access 'digital first' primary care by 2023-2024, including online patient access to full medical records., Aim: To identify and understand the unintended consequences of online patient access to medical records., Design and Setting: Qualitative interview study in 10 general practices in South West and North West England., Method: Semi-structured individual interviews with 13 patients and 16 general practice staff with experience of patient online access to health records., Results: Online access generated unintended consequences that negatively impacted patients' understanding of their health care, with patients finding surprising or difficult to interpret information. Online access impacted GPs' documentation practices, such as when GPs pre-emptively attempted to minimise potential misunderstandings to aid patient understanding of their health care. In other cases, this negatively impacted the quality of the records and patient safety when GPs avoided documenting speculations or concerns. Contrary to assumptions that workload would be reduced, online access introduced extra work, such as managing and monitoring access, and taking measures to prevent possible harm to patients., Conclusion: The unintended consequences described by both staff and patients show that, to achieve the intended consequences set out in NHS policy, additional work is necessary to prepare records for sharing and to prepare patients about what to expect. It is crucial that practices are adequately supported and resourced to manage the unintended consequences of online access, now that it is the default position. A table of potential unintended consequences and mitigation measures is provided to aid practice managers and clinicians implementing online access., (© The Authors.)

Objectives: Primary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients' needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need., Design: Focus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach., Setting: Focus groups and interviews were conducted in community settings in the UK., Participants: Fifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else., Results: Participants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated., Conclusions: Discussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To examine general practitioner (GP) understanding of the never event (NE) concept in general practice, and to identify potential enablers and barriers to implementation in UK general practice., Design: Qualitative study using focus groups. The data were analysed thematically and were informed by the normalisation process theory., Setting: General practice in Northwest England and Southwest Scotland., Participants: 25 GPs took part in five focus groups. 13 GPs were female and 12 male with an age range of 28-60., Results: The NE approach of avoiding serious preventable adverse outcomes from healthcare fitted with participants expectations of the delivery of care but the implementation of strategies to prevent the specific NE was considered complex and variable. The main themes identified participants' understandings and perceived limitations of the NE concept; the embedded layers of responsibility to implement NE within practices and the work required for implementation within general practices. Participants' accounts highlighted the differential nature of work in general practice and that the implementation of initiatives to address specific NE should be situated within a learning and systems approach to implementation. Some NEs were considered more relevant and amenable to simple solutions than others which could influence implementation., Conclusions: The NE concept was considered overall an important approach to help address key primary care patient safety issues. The utility of individual NEs may vary depending on the complexity of the initiatives that would be needed to manage related risks to as low as reasonably practicable., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To examine the role of community groups to support people living with long-term conditions and the organisational factors that influence this role., Methods: Thirty-three semi-structured interviews were conducted with voluntary group organisers purposefully sampled in Greater Manchester from a local database of community groups. Interviews explored the organisations role in supporting people living with a long-term condition, their social networks and the origins of the groups., Results: Respondents' construed their role in supporting individual capacity for management either explicitly (e.g. providing exercise) or implicitly (e.g. emotional support). This role was influenced by a combination of group ideology, funding and social networks. Analysis highlights the role of the non-clinical setting, the social support provided within the group, as well as organisational processes that influenced their capacity to support people living with long-term conditions., Conclusion: By examining the organisation of voluntary groups, this study highlights the way in which they may support or constrain access to an extended range of support for people with long-term conditions. This paper has implications for commissioning of services by the health service from the third sector because of the differing ideological perspectives and limited operational capacity., (© The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)