Energising Primary Care Posters 622 – 628
622 Student GP Societies: Inspiring Medical Students to Consider Primary Care
Inspiring medical students to consider a career in general practice forms a crucial aspect of improving GP recuitment. The surge in the number of medical school GP Societies and their potential impact was highlighted on Saturday 12th March – a day on which 5 different student GP Societies held conferences attended by medical students from across the UK.The University of Bristol GP Society (Bristol GPSoc), now in its 4th year, holds events involving GPs with a range of backgrounds in order to showcase the opportunities offered by general practice and to explore important topics within primary care. The society also offers CV-building opportunities including the chance to present work at events and through providing access to elective and conference bursaries.
This year Bristol GPSoc extended its annual conference to a full-day event to include student poster presentations. The society also collaborated with the university student psychiatry society and Bristol Medico-Chirurgical Society to deliver two separate events focusing on mental health and domestic violence respectively.The Society has helped medical students at other universities develop their own GP Societies and has been involved in the University’s curriculum review – particularly that of primary care teaching.
Through this work, the society hopes to benefit medical students beyond those who are Bristol GPSoc members and consequently energise those who may not have initially expressed an interest in general practice. Furthermore, Bristol GPSoc has formed strong links with the Severn Faculty RCGP and encouraged the development of the new role of Faculty student representative.
623 Engaging community and primary care services in tackling low uptake of bowel cancer screening in inner city ethnic minority groups
Aim:Evidence shows that there is a lower uptake of the national bowel cancer screening programme in black and minority ethnic groups (BAME) compared to the general population. This means missed opportunities for early diagnose of colorectal cancer. Our aim was to use a multi-agency team (MAT) including members of the BAME community to explore ways to fund further research into improving BAME screening uptake.
Presentation: MAT was formed when data collected by Public Health was presented to local teams who noted inequalities in the uptake of the national screening programme. The complexity of joining national to local screening programmes revealed multiple barriers which MAT aims to tackle to make clear and effective changes. MAT was supported initially through the Evidence for Change (EfC) initiative which provided academic advice and leadership workshops.
Impact: On inequalities of bowel cancer screening uptake in the BAME and local community. On late bowel cancer diagnosis.Outcomes:Further research funding has been approved to develop a bowel cancer screening model tailored to the specific ethnic communities in our area. An eighteen month pilot study has been approved, commencing in Summer 2016, focusing on patients in GP practices.
Discussion: The EfC initiative improved MAT members’ motivation and leadership skills and their confidence to communicate with financial stakeholders. MAT believe EfC was pivotal in helping them to secure research funding.
624 Do we need a DEFCON status for primary care?
Aims: The Authors present a simple calculation used in one practice to understand and expose the level of pressure felt by the clinicians.
Content: The authors will use real data gathered from a large practice over a two year period to illustrate the relationship between patient demand and experience and clinician supply and experience. The resulting proxy measures for “pressure” will be explained and discussed to encourage other practices to develop awareness of demand induced pressures and its use as tool for strategic planning.
Relevance: We have increasing demand in primary care, a reducing supply of GPs and no system to indicate how clinicians are feeling and when they may be placed at an increased risk of poor performance.
Outcomes: The authors suggest that it is possible to avoid the McNamara fallacy (making only measurable things important) by making such an important thing as clinicians pressure measurable even as a proxy.
Discussion: Much is made of understanding demand in primary care. New systems abound designed to encourage access and improve response times to patient need. Early warning systems exist for cold weather, hot weather, and infections, figures are available for number of consultations per patient per year, but the understanding of impact on clinicians is often forgotten. Using modelling techniques it will be possible to recognise and predict times of potential stress for clinicians, with the subsequent option to respond in advance to avoid unforeseen consequences.
625 Quantitative analysis of case histories of patient referrals to Glasgow deep end practice links workers between April and July 2014
Aims and Objectives To describe the characteristics and engagement rates of the patients referred into the links worker service between 1 April 2014 and 31 July 2014. To apply these demographics to the bio-psychosocial model of wellbeing to assess the main areas of need in this population.
Content Thematic content analysis of the Links Workers case records for each referred patient identified variables and created a SPSS quantitative database which was analysed using descriptive statistics.253 patients were referred to the Links Workers over the 4 month period, with 74% of referrals from GPs. 59% were female, mean age was 49 years. 67% of those referred had at least one consultation with the Links Worker. On average 3 problems were identified by the Links Workers with each patient.
The majority of problems were issues with social or mental wellbeing. 89 different resources for patients were identified, with average of 2 identified for each patient. The majority of resources identified were targeted towards social issues and mental wellbeing. Age and gender did not significantly affect the problem identified, resource offered or engagement rates. There was a significant variation in patient age and the number of problems identified across practices.
Relevance and Impact Improvement of links between primary care and local community resources is imperative to reduce health inequalities in areas of high deprivation. This initial analysis of the links worker programme aims to illustrate the demographics of use and main areas of need to inform further resource allocation.Outcomes and Discussion The Links Workers saw 67% of patients referred, identifying a wide range of overlapping bio-psychosocial issues, and linked these patients to numerous community resources.
626 What are the knowledge and views of General Practitioners of the role of Physician Associates?
Aims: Physician Associates (PAs) are a relatively new allied healthcare profession with the capability to consult with patients and support doctors in practice. The overall aim of this project was to gain an initial understanding of General Practitioners’ (GPs’) views and knowledge about the role of a PA.
Findings:Three main themes were derived from the thematic analysis; 1) Perceived benefits, 2) Perceived challenges and 3) Ways to support integration.Discussion of Findings: The main finding from this project was the lack of GP knowledge of the PA role. With the PA workforce set to rapidly increase over the coming years, this is something that needs addressing to ensure a smooth introduction into general practice. The lack of knowledge by participants resulted in fears over how PAs would fit into practice.
Many potential logistical barriers were indicated, such as education of practice staff, space to consult and supervision, which would require consideration before integration of the role. Participants also highlighted benefits with regard to addressing workforce shortage in General Practice. Participants outlined a need for more clarity on their role as a supervisor and the specifics of what the role of a PA would entail.
Implications:Future implications would be to increase GP knowledge through education about the impact and specificities of the PA role in practice. It is hoped that some of the scepticism expressed will be addressed through education and hence aid in a successful integration of the PA role to enable its implementation to address current workforce shortages.
627 Medical student’s opinions on their first GP placements and how this affected their current career specialty interests
The demand for General Practitioners (GPs) has inevitably increased along with the aging population. Budget cuts, quota pressures and never ending paperwork are understandably causing a strain within practices in the NHS. A recent Department of Health commissioned survey found that approximately 40% of GPs plan to leave their practice within 5 years. Along with this, 600 GP placements were not filled in 2015.
To address the shortage of GPs in the NHS it is important to get medical students interested at an early point in their training. If GP practices can optimise the conditions that students are learning in and improve their experience, the shortage of GPs may potentially lower. A questionnaire study was performed on third year medical students to explore their opinions of a one month GP placement during the third year of the Keele MBChB programme. The aim of this was to identify common factors affecting a student’s decision to consider a career in general practice.
By exploring medical students’ opinions on their first experience in a GP practice, it is possible to get an understanding of what can be used to improve their experiences in the future and potentially motivate them to consider a career in general practice. The poster presentation will address these issues and possible solutions in efforts to make medical students seriously consider a profession in this speciality.
628 Practice nurse perspectives of role extension and diagnosis in long term conditions; a meta-synthesis
Aims and Objectives To understand practice nurse (PN) perspectives of role extension, including diagnostic work in long term conditions (LTCs) in primary care.
Content of Presentation Meta-synthesis of qualitative literature informed by meta-ethnography. Emergent themes and concepts are discussed. Relevance/ImpactInternationally, the rising prevalence of LTCs has demanded reforms aimed at optimising healthcare system efficiency, including role extension (substitution of doctors’ traditional role), with healthcare personnel extending their professional boundaries to include roles previously considered outside of their remit. PNs are considered fundamental to the management of patients with LTCs, but little is known of their role in diagnostic work.
Outcomes The synthesis suggests that PNs perceive their role in LTC care as ambiguous with few papers considering diagnostic work. Descriptions include a lack of clear professional boundaries which foster poor recognition and acceptance of the PN role amongst professionals and patients. Emergent themes perceived key to implementation of role extension include competence and professional responsibility. If diagnosis is to fall within PN remit, responsibilities and role boundaries must be explicit. The need to retain the caring role fundamental to nursing is also apparent: “While I am diagnosing… who is holding the hand of the recently bereaved widow”.
Discussion Role extension is fundamental to the future care of LTCs in primary care, yet little evidence regarding substitution of the doctor’s traditional diagnostic role exists. Final results of the meta-synthesis will be presented, informing the topic guide for an interview-based study through which this gap in the literature will be addressed.