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Background: Relational continuity of care (patients seeing the same GP) is associated with better outcomes for patients, but it has been declining in general practice in the UK. Aim: To understand what interventions have been tried to improve relational continuity of care in general practice in the UK. Design & setting: Scoping review of articles on UK General Practice and written in English. Method: An electronic search of MEDLINE, Embase, and Scopus from 2002 to the present day was undertaken. Sources of grey literature were also searched. Studies that detailed service-level methods of achieving relational continuity of care with a GP in the UK were eligible for inclusion. Interventions were described narratively in relation to the elements listed in the Template for Intervention Description and Replication (TIDieR). A logic model describing the rationale behind interventions was constructed. Results: Seventeen unique interventions were identified. The interventions used a wide variety of strategies to try to improve relational continuity. This included personal lists, amended booking processes, regular reviews, digital technology, facilitated follow-ups, altered appointment times, and use of acute hubs. Twelve of the interventions targeted specific patient groups for increased continuity while others focused on increasing continuity for all patients. Changes in continuity levels were measured inconsistently using several different methods. Conclusion: Several different strategies have been used in UK general practices in an attempt to improve relational continuity of care. While there is a similar underlying logic to these interventions, their scope, aims, and methods vary considerably. Furthermore, owing to a weak evidence base, comparing their efficacy remains challenging. [ABSTRACT FROM AUTHOR]

Objective: Frequent attendance at the ED is a worldwide problem. We hypothesised that frequent attendance could be understood as a feature of a complex system comprising patients, healthcare and society. Complex systems have characteristic statistical properties, with stable patterns at the level of the system emerging from unstable patterns at the level of individuals who make up the system.Methods: Analysis of a linked dataset of routinely collected health records from all 13 hospital trusts providing ED care in the Yorkshire and Humber region of the UK (population 5.5 million). We analysed the distribution of attendances per person in each of 3 years and measured the transition of individual patients between frequent, infrequent and non-attendance. We fitted data to power law distributions typically seen in complex systems using maximum likelihood estimation.Results: The data included 3.6 million attendances at EDs in 13 hospital trusts. 29/39 (74.3%) analyses showed a statistical fit to a power law; 2 (5.1%) fitted an alternative distribution. All trusts' data fitted a power law in at least 1 year. Differences over time and between hospital trusts were small and partly explained by demographics. In contrast, individual patients' frequent attendance was unstable between years.Conclusions: ED attendance patterns are stable at the level of the system, but unstable at the level of individual frequent attenders. Attendances follow a power law distribution typical of complex systems. Interventions to address ED frequent attendance need to consider the whole system and not just the individual frequent attenders. [ABSTRACT FROM AUTHOR]

PRIMARY CARE IS THE RIGHT PLACE TO UNDERTAKE RESEARCH DELIVERY Primary care is the largest medical specialty, most of the UK population is registered with a GP and 90% of NHS consultations occur in primary care. With national policy commitments to increase funding, local inititives to give primary care parity of esteem with secondary care, and with dedicated at-scale infrastructure, primary care could be a giant of the research delivery landscape. A sustainable NHS requires a shift from reactive acute care to proactive ambulatory care, from secondary care to primary care, with a focus on health creation by empowering people and communities. [Extracted from the article]

A 52-year-old lady was admitted with back pain, fever and reduced sensation in her left leg. Soon after admission she developed acute urinary retention. She underwent urgent MRI of the spine which showed an epidural abscess compressing the thecal sac which was treated with neurosurgical decompression and intravenous/oral antibiotics. Cultures from theatre grew Staphylococcus aureus sensitive to flucloxacillin. After 12 weeks of intravenous/oral antibiotics, she was discharged without any neurological disability. [ABSTRACT FROM AUTHOR]

Background: GPs are often required to make decisions about the management of acute illness in people living with dementia. These decisions are often complex and involve multiple informants., Aim: We aimed to explore how GPs made decisions about acute illness in people with dementia using a micropolitics approach., Design & Setting: Qualitative, semi-structured interviews with 13 GPs with a range of years of experience working in South Yorkshire, UK., Method: Interviews were conducted by phone. Interviews focused on GPs' accounts to reflect their own perceptions and choices as portrayed to the interviewer. The analysis used the lens of micro-politics in the analysis and interpretation of the themes, with a focus on decisions between GP, patient, family and carers, other health and social care providers about the management of acute illness in a person with dementia., Results: The results showed that GPs act as street-level bureaucrats while carrying out their role, using discretion during decision-making in an environment characterised by uncertainties and work pressures. In addition, GPs use the "soft power" skills of diplomacy such as negotiation, persuasion and engagement in navigating through difficult decision-making situations, while building relationships and partnerships with various actors in the health system., Conclusion: GPs possess and express power and influence decision-making in people living with dementia when navigating biomedical, social, economic and psychological factors. This power comes in the form of soft power (street level diplomacy) and the more formal power of street level bureaucracy., (Copyright © 2024, The Authors.)

Background: In the UK, epilepsy care involves both specialists (eg, neurologists) and generalists (eg, general practitioners). Policymakers typically consider that epilepsy care should be integrated and involve both specialists and generalists. However, few understand exactly how patients view and compare specialist and generalist care., Aim: This systematic review aimed to explore patient perspectives of specialist care and generalist care for epilepsy in a qualitative evidence synthesis., Design & Setting: Systematic Review, qualitative evidence synthesis using an identified framework., Method: Systematic searches in 5 databases retrieved 17 eligible studies. Data was extracted and synthesised using framework analysis informed by the 'United Model of Generalism'., Results: Three themes were developed: 'Epilepsy care can be burdensome' (eg, through care fragmentation); 'Patient's experience is that care is not always accessible' (eg, lack of a continuum between standardised and interpretive care); 'How care could change for people with epilepsy' (eg, clinicians currently have insufficient time to deviate from protocol-driven care to address psychosocial needs). People with epilepsy frequently observe that generalists lack expertise in epilepsy management., Conclusions: This synthesis of patient experiences indicates recommendations should focus on improving communication and integration between specialists and generalists for epilepsy care. Patient experiences indicate specialist care risks being burdensome and generalist knowledge insufficient, requiring enhanced primary care clinician skills and improved awareness of patient psychosocial needs. The findings argue in favour of healthcare policies, materials and tools to continually support patient perspectives in developing epilepsy services., (Copyright © 2024, The Authors.)

Objective: Frequent attendance at the ED is a worldwide problem. We hypothesised that frequent attendance could be understood as a feature of a complex system comprising patients, healthcare and society. Complex systems have characteristic statistical properties, with stable patterns at the level of the system emerging from unstable patterns at the level of individuals who make up the system., Methods: Analysis of a linked dataset of routinely collected health records from all 13 hospital trusts providing ED care in the Yorkshire and Humber region of the UK (population 5.5 million). We analysed the distribution of attendances per person in each of 3 years and measured the transition of individual patients between frequent, infrequent and non-attendance. We fitted data to power law distributions typically seen in complex systems using maximum likelihood estimation., Results: The data included 3.6 million attendances at EDs in 13 hospital trusts. 29/39 (74.3%) analyses showed a statistical fit to a power law; 2 (5.1%) fitted an alternative distribution. All trusts' data fitted a power law in at least 1 year. Differences over time and between hospital trusts were small and partly explained by demographics. In contrast, individual patients' frequent attendance was unstable between years., Conclusions: ED attendance patterns are stable at the level of the system, but unstable at the level of individual frequent attenders. Attendances follow a power law distribution typical of complex systems. Interventions to address ED frequent attendance need to consider the whole system and not just the individual frequent attenders., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)