Energising Primary Care Posters 636 – 642
636 Perceptions of third sector workers supporting older people with depression: a qualitative analysis
Maatla Tshimologo, Tom Kingstone and Carolyn A. Chew-Graham
Aims and objectives To investigate the experiences of third sector workers in their work supporting older people with depression.
Content of presentation Depression and anxiety are common in older people; they may be un-diagnosed in primary care and inadequately managed. Third sector services provide support to older people, but there is limited evidence on their work with older people with depression. This study is a secondary qualitative analysis of interview transcripts with third sector workers exploring their work with older people.
Outcomes Third sector workers report providing a wide range of services to older people including social groups, counselling and signposting other organisations. They also report supporting older people with loneliness and depression. Some workers reported the value of being co-located in GP practices, which can improve awareness and increase the trust of patients in their services. Major challenges described were lack of funding, limited training, and high level of mental health needs.
Relevant impacts Third sector organisations provide support in the provision of healthcare services to older people with depression. GPs should be more aware of these services and Clinical commissioning groups (CCGs) need to consider longer term funding to improve sustainability.
Discussion Third sector workers need formal training in their work with older patients. More service integration is needed so that older people with depression can access these organisations.
637 Tackling suicide risk and self-harm in young people: what are the challenges faced by general practitioners?
Sabah Farooq Chaudry
Aims: Suicide is still the leading cause of death in adolescents. Approximately 145 young people below the age of twenty committed suicide in 2015, with the highest number reported in the 15-19 age group. Though a rare occurrence it is still a major public health concern. A large majority of young people who commit suicide or carry out self-harm do not seek contact with healthcare services prior to the act.
The role of primary care in identifying young people at risk is vital, along with their crucial collaboration with mental health services and social services. This poster will highlight the current challenges faced by GPs in primary care regarding the assessment and management of adolescent suicide risk.
Content: A literature review was conducted using Medline and Embase to identify the suicide risk assessment tools currently available for primary care use and whether the risk factors assessed in such tools are appropriate for adolescent patients.
Discussion: With very few age appropriate tools available for the assessment of risk, GPs need novel ways to target this age group. There may be an important role of mobile resources and applications in this scenario for self-assessment of suicide risk and self-harm by young patients prior to GP consultations. This could potential prompt young people to attend primary care when experiencing a crisis. Such technology may allow for assessment of young patients who are less inclined to attend appointments and also give an opening for further discussion of suicidal ideation and self-harm in GP consultations.
638 Energising local teams by increasing clinical capacity remotely
Aim This remote telephone consulting service was set up to address the increasing demands on GP practices and local GP recruitment crises. By providing calls in core hours with read/write access to NHS medical records this would ease pressure and energise local practice teams to care for patients most in need.
Content Flow diagram showing how the service works with practices by accessing their systems with NHS Smartcards. Exclusions included to enable continuity of care for patients most vulnerable. By keeping the receptionists in charge this allowed local control of the appointment booking process. Outcomes on resolved and unresolved calls with categories and results on a local OOHRS service in a 5 month pilot period for one practice
Relevance/Impact This model could be scaled up nationally to support practices in geographies with poor GP recruitment. Homeworking with secure laptops developed to release additional GP resource.
Outcomes Working with 8 practices nationally, across 3 IT systems (System One, Emis Web and Vision) we increased access to 50,000 patients. We have >70% complete resolution rates and at 6 week follow up there is a 25% return rate, compared with 31% for patients seen initially in face to face appointments. Patient satisfaction scores are at 93%. To date, we have received 70,000 calls, with no Serious Incidents. Reduction in attendances at local WIC, A+E and OOHRs by 33% compared with year before.
Discussion By increasing remote clinical capacity for GP practices it is possible to deliver safe, high quality care that relieves burden on local practice teams, improves patient access and satisfaction and reduces pressure on external local services – A+E, WICs and OOHRS.
639 What can be done in primary care to help women decide where to give birth?
Aims: Encourage GPs to be more involved in helping women choose where to deliver. The Birth Choices review 2015-16 recommended women need more guidance into where to give birth, so they can make fully informed decisions.
Content: The poster includes information collected from visiting birthing centres and discussions with midwives and pregnant women in Greater Manchester. It outlines the recommendations from the Birth Choices review and how these may be implemented. There is an overview of the different options and who may benefit from utilising these.
Relevance: Patient centred care and shared decision making are vital aspects of all management plans, and having the best possible management plan for every pregnancy is essential. Many women feel they could personalise their care more and healthcare professionals in the community could facilitate this. This also adds to the existing debate on whether pregnancy and birth is over medicalised in this country.
Outcomes: The poster gives some recommendations on how GPs could structure conversations with women about delivery options. There are also suggestions for good resources to direct patients to for each birth choice.
Discussion: With birth being such an important and emotive time for a mother, her baby and the family, making the best delivery choice has a huge impact. There has been much literature on different birthing locations and techniques and it is felt that many women do not have this fully explained to them.
640 Inspiring sixth form students to become GPs
Aims To encourage sixth form students to consider a career in General Practice. To create a long-term strategy for improving GP recruitment to undersubscribed areas of the UK. To open up GP recruitment to students of all backgrounds.
Content An event was held for A level students from local state schools on ‘Applying to Medicine and becoming a GP’ as local students are more likely to return to the area where they grew up and work in currently under-served communities. The presenters were local GPs at various stages in their careers. The presentations covered reasons for becoming a GP, the diversity within General Practice and advice on getting into medical school. A question and answer session was held with current medical students and GPs with experience of medical school admissions.
Relevance There is currently a crisis in GP recruitment. In 2015, some areas only filled 62% of GP training places, even with a third recruitment round.A long-term strategy is needed to combat this issue and there is evidence that widening access to medical school helps ensure more doctors return to work in deprived, undersubscribed and rural areas.
Outcomes The number of students considering a career in General Practice had doubled after the event and the number considering a career in the local area also increased significantly. Students found the evening “very informative” and said they enjoyed listening to GPs’ personal experiences and appreciated information on applying to medical school.
Discussion To take the project forwards, the event could be repeated more widely and combined with work experience in a GP practice.
641 Bringing a positive view of general practice to junior doctors and medical students
Health Education England faces a challenge to the fill 3,250 GP trainee posts requested by the government for 2016-17 in order to deliver an additional 5,000 GPs by 2020. The key problems deterring doctors from applying to GP training were identified through a qualitative analysis of medical student’s and junior’s attitudes.
They included; negative experiences at medical school, lack of exposure to GPs and trainees post medical school, negative attitudes of consultants throughout training, negative media attitudes, concerns about working in isolation, fear of getting bored, concerns about the job being not hands on and the pace of work. We reflected on these findings to design a series of inspirational events, with talks and small group sessions, for medical students and junior doctors. We enlisted enthusiastic GPs throughout their training and career, who reflected the diversity of possibilities of work in GP. Attendees appreciated the chance to meet enthusiastic GPs and trainees whose career and life choices they could relate, and aspire to.
Additionally we developed a session for structured protected Foundation year teaching time. We got a high rate of attendance (78%), scoring 93% for ‘overall value to you’. We have subsequently secured a yearly teaching slot in the Foundation School teaching timetable at hospitals through the local and neighbouring deanery. In future, deaneries could share efforts and successes with the view to implementing a series of coordinated and effective programmes to attract trainees throughout England.
642 Working with Primary Care to improve cancer outcomes: The Cancer Research UK Facilitator Programme
Aims/ Objectives The Cancer Research UK Facilitator programme supports healthcare professionals and organisations to improve prevention and early diagnosis.
Content of Presentation Facilitators provide face-to-face support to help healthcare professionals adopt best practice in cancer prevention and early diagnosis, tailored to local needs.Two mixed-methods evaluations have investigated the impact and perceptions of the programme of within early adopter areas and in a devolved nation context.
Relevance/Impact After 1 year, CCGs covered by the Facilitator programme had almost double the uptake of cancer improvement activities compared to CCGs not covered by the programme.The programme in the devolved nation had visited and supported 103 practices within the health board covered within its first year (rising to 70% coverage by year two).The programme encouraged practices to discuss cancer and review their performance as well as having a wider influence (CCG, health board) on strategies and processes, e.g. referral forms.At a practice level, an example of impact was that the adoption of new engagement methods reduced bowel screening non responder rates by 15%.
Outcomes The evaluations have demonstrated the value of our approach and have led to development of what is offered across the UK.
Discussion This model appears to be an effective way of engaging primary care practices in improving cancer outcomes (such as bowel screening uptake, referral processes as well as the relationship between primary and secondary care).