Service Delivery Posters 3000 – 3006
3000 GPs don’t grow on trees – but can they be selected, educated or otherwise cultivated?
Aims/Objectives A range of initiatives have been devised to attract young doctors into general practice but little research evidence is available to inform understanding of the underlying reasons for their career choices. Evaluation of the relative importance of these background influences seems an important component in the development of effective strategies to support GP recruitment.
Content of Presentation In a large-scale online survey, over 800 second year Foundation School doctors (>12% total England cohort) provided a wide range of demographic, educational and experiential data. They completed a series of choice experiments exercises (Best Worst Scaling) in which recognised job attributes were selected according to the extent to which they (dis)associated them with GP work. This presentation will explore emerging links and correlations across different categories within the data.
Relevance/Impact As the sustainability of general practice and provision of a universal NHS service is threatened by a stretched GP workforce, recruitment of doctors whose orientation favours general practice is essential to support a multi-skilled primary care workforce.
Outcomes Ongoing analysis indicates variation in the proportions of GPs emerging from different Medical and Foundation Schools. Our analysis of background personal and demographic factors will confirm or challenge assumed links between these factors and career preferences and consider how they contribute to low recruitment to general practice training in the UK.
Discussion Recognition of influential personal, educational or experiential factors is a first step towards design and implementation of changes necessary to supply future general practice workforce requirements.
3001 What do new GPs want from their first job?
Recruitment of new GPs remains a challenge for many practices across the country. Demand for new GPs currently outstrips supply and so those looking for new roles can be increasingly discerning about how and where they chose to work. Coupled with this, the newer generation frequently see their future careers in general practice as evolving and developing in different directions to the traditional roles that have been on offer. We conducted a structured information gathering exercise with GPSTs and newly qualified GPs in Dorset using the nominal group technique, a recognised qualitative research method used to gain consensus within a group.
Newly qualified GPs or GP registrars were asked to suggest and then prioritise what they would realistically want from their ‘ideal GP job’. This generated 43 suggestions, which were ranked in order of importance by asking participants to vote on the five most important items for them. The most popular suggestions will be presented and discussed. They include a supportive team, pay, flexible working hours, workload, contracts & maternity, happy working relationships, opportunity for special interests, in-house education, indemnity cover, location, practice demographics, leave and sabbaticals, practice manager and administrative team, on-site MDT, a pleasant working environment (including access to a regular room), low staff turnover, a good website and even filter coffee!
3002 Counselling provision in primary care – a low cost sustainable model
Psychological problems are frequent in primary care consultations. National provision for counselling, such as “I talk”, has not fully met demand and has moved away from face to face provision. This presentation describes how a 15,000 patient GP practice provides a low cost, six session, face to face, CBT model of counselling. This is in conjunction with Higher Education providers, who require 100hr, BACP accredited, Diploma in Counselling placements for five trainees a year. GP referrals are prioritised by a counselling co-ordinator who is funded by free access to a surgery room for their private work.
A clinical supervisor meets each trainee for 2 hours every month and links with the HE tutor. Only the clinical supervisor is funded by the doctors. The service has been operating on a budget of £18 per week (£900/annum), with no reimbursement. This service has been in place for ten years at the practice and has provided on average 300 hours counselling per year (approximately £3 per hour).
All trainees have successfully completed their Diploma course and there has been high satisfaction from patients and doctors. This counselling model is transferable to other general practices. Healthcare organisations nationally should consider funding this model of education based counselling as it is a low cost model with benefit to all involved, when compared to approximately forty pounds per hour for direct funding of counsellors.
3003 Evaluation of an anticipatory care planning tool for care home residents and their families
Andrew Mackay, Gill Highet
Background Care home residents are among the frailest in society. When effective care planning and coordination for this population is inadequate, residents may be transferred to hospital and receive interventions that are burdensome and inappropriate.
Aims Creating robust ACPs can be a time consuming process. The Anticipatory Care Questionnaire (ACQ) is a simple and quick tool that can be delivered by care home staff to facilitate this process. This project evaluated the efficacy and acceptability of the ACQ in two contrasting care homes, and identified barriers and facilitators to its use.
Methods A prospective audit of acute clinical events was combined with a qualitative interview study involving a purposive sample of 27 relatives, care home staff, and local GPs. Interviews were digitally recorded, transcribed and analysed thematically. A focus group of 30 Lothian Unscheduled Care Service GPs discussed linked case vignettes.
Outcomes Anticipatory care planning should start before care home admission and be a coordinated, ongoing care process tailored to individual needs and embedded in the routine procedures of the care home. Clear plans, recorded electronically, ensured most acute clinical events were handled appropriately. The system was most vulnerable when protocol-driven decisions were made by NHS call handlers.
Discussion Information about outcomes and options for managing deteriorating health in care home residents helps prepare people for shared decision-making and anticipatory care planning. Clinician-led decisions are effective out-of-hours but protocol driven care and triage needs improved to avoid inappropriate interventions.
3004 Specialist support for trainee doctors
I am an independent consultant and service provider, offering a unique, flexible and supportive service for trainee doctors in all specialisms, and have helped hundreds of doctors in training go on to pass their CSA, AKT and other medical exams. I have, in particular, worked with doctors training for General Practice and have developed valuable insights into the difficulties experienced by International Medical Graduates.
Of the trainees I have supported, over 85% have gone on to pass their CSA, having had 2 or even 3 previous attempts. This is a great relief to them as their previous lack of success has left them stressed, demoralised and baffled. The stumbling block for IMGs often lies in their consultation and communication skills, their use of everyday language and the cultural differences around the doctor/patient relationship I therefore work with trainee doctors through role plays, case cards and review of video consultations, exploring and practising consultation and communication skills, focusing on expressive language and the CSA domains.
Also, for the AKT, I offer effective time management and revision tips and strategies, and valuable memory techniques. Of the doctors I have supported for AKT preparation, 98% have gone on to pass. I am also a qualified Dyslexia Specialist and can therefore provide support for specific difficulties which can impact in various ways, according to the individual. I have numerous examples of the positive feedback received.
3005 Stakeholder opinion on the incorporation of physician associates into the primary care workforce
Aims/Objectives To explore barriers and facilitators within stakeholders on incorporating physician associates into primary care and how these might be addressed.
Content Findings from research into stakeholder opinions on incorporating physician associates into the primary care workforce.RelevanceThis session is relevant to GPs who are considering how to provide primary care differently through incorporating new professional roles into the service they provide.
Impact General Practice is under enormous strain. Successful campaigning has led to the Department of Health recognising primary care remains the backbone of the NHS. It remains clear that workforce difficulties will continue in the foreseeable future and new ways of working will be necessary in some places for front line services to be maintained. Local commissioners have been challenged to come up with plans to make general practice ‘sustainable.’
A significant development is that of new health professionals such as the physician associate who might support GPs through a new injection of medically trained personnel into the service.The response to such developments from General Practice has been mixed. Despite emerging evidence from pockets around the UK on the acceptability, effectiveness and utility of physician associates adoption of the role has been limited.
Outcomes Delegates will be able to review current evidence related to physician associates working in primary care and hear new evidence on factors affecting the wider adoption of physician associates in regions unfamiliar with the role. DiscussionDiscussion will allow examination of these factors and how physician associate training might be delivered to address these and support a future role in primary care.
3006 Focussing on What Matters in Community Services: Using Quality Markers as the basis for a contract
The CCG has decided to re-commission its community services. The project aims to focus the actions of community services on useful interventions for patients using a quality scheme that rewards different kinds of marker. These include Person Centred Care, Integration and Workforce. This is used to control the contract specifications.
Some of the quality criteria produced so far are available to view but the effect of the change is not known as the contract is due to start of 1st October.
Functional areas like workforce or person centred care are used to create quality criteria within a framework that is applied to individual clinical services. For example in Person Centred Care the criteria chosen will measure continuity, holistic assessment, supporting information for patients, decision making and a changed workforce to be sufficiently senior to have the autonomy to implement those decisions.
For Integration the new provider is asked to reconfigure teams to work with other community staff including GPs. They will require service change that will affect the community and local health economy.It aims to move measurement to function rather than structure or appointment numbers. It will produce information across the health economy to describe the relative effectiveness of hospital and community services.
Over time, development, change and informed redesign of services focus hospital admission on appropriate cases. Once created the criteria and standards could be generalised nationally. The poster will describe the vision, creation and contracting phase of re-commissioning a community contract. The outcome is better services through integration and person centred care. The framework and specifications are scalable for use elsewhere and the markers could be adapted for GPs in an Accountable Care System.