David E Cunningham

Scottish pharmacists' perceptions and experiences of a practice-based small group learning pilot: a qualitative study.

INTRODUCTION CPD is an important feature of healthcare professions and regulatory bodies consider it mandatory. Studies of CPD activity of pharmacists showed that 10% were undertaking no CPD. Practice-based small group learning (PBSGL) is a well-received and popular learning resource for GPs in Scotland. From 2011, a pharmacy pilot was undertaken: pharmacists were trained as peer-facilitators and existing PBSGL modules were adapted. Four NHS boards took part and this study aimed to explore the perceptions and experiences of pharmacists. METHODS A qualitative research approach was adopted using focus groups and in-depth interviews. Interviews were audio-recorded and transcriptions made. Transcripts were coded and themes developed using grounded theory methods. RESULTS Participants welcomed PBSGL: it was a feasible learning method, acceptable and had educational impact. They appreciated its interactive nature and discussions founded on their experiences in practice. Participants liked the self-reliance of PBSGL in that they were not dependent on specialist practitioners. There were logistical challenges that impacted on the success of group discussion; some pharmacists were less familiar with small group work. Pharmacists felt isolated during work and appreciated peer discussion. There was a tentative welcome to inter-professional learning but group composition and module topics might impact on the success of this. CONCLUSION Pharmacists were able to change their learning practice in uni-professional PBSGL groups and were able to learn from each other. There may be further learning opportunities if pharmacists participate in inter-professional groups.

Quality and safety issues highlighted by patients in the handling of laboratory test results by general practices–a qualitative study

BackgroundIn general practice internationally, many care teams handle large numbers of laboratory test results relating to patients in their care. Related research about safety issues is limited with most of the focus on this workload from secondary care and in North American settings. Little has been published in relation to primary health care in the UK and wider Europe. This study aimed to explore experiences and perceptions of patients with regards to the handling of test results by general practices.MethodsA qualitative research approach was used with patients. The setting was west of Scotland general practices from one National Health Service territorial board area. Patients were purposively sampled from practice held lists of patients who received a number of laboratory tests because of chronic medical problems or surveillance of high risk medicines. Focus groups were held and were audio-recorded. Tapes were transcribed and subjected to qualitative analysis. Transcripts were coded and codes merged into themes by two of the researchers.Results19 participants from four medical practices took part in four focus groups. The main themes identified were: 1. Patients lacked awareness of the results handling process in their practice. 2. Patients usually did not contact their practice for test results, unless they considered themselves to be ill. 3. Patients were concerned about the appropriateness of administrators being involved in results handling. 4. Patients were concerned about breaches of confidentiality when administrators were involved in results handling. 5. Patients valued the use of dedicated results handling staff. 6. Patients welcomed the use of technology to alert them to results being available, and valued the ability to choose how this happened.ConclusionsThe study confirms the quality and safety of care problems associated with results handling systems and adds to our knowledge of the issues that impact in these areas. Practices need to be aware that patients may not contact them about results, and they need to publicise their results handling processes to patients and take steps to reassure patients about confidentiality with regards to administrators.

Good practice statements on safe laboratory testing: A mixed methods study by the LINNEAUS collaboration on patient safety in primary care

ABSTRACT Background: The systems-based management of laboratory test ordering and results handling is a known source of error in primary care settings worldwide. The consequences are wide-ranging for patients (e.g. avoidable harm or poor care experience), general practitioners (e.g. delayed clinical decision making and potential medico-legal implications) and the primary care organization (e.g. increased allocation of resources to problem-solve and dealing with complaints). Guidance is required to assist care teams to minimize associated risks and improve patient safety. Objective: To identify, develop and build expert consensus on ‘good practice’ guidance statements to inform the implementation of safe systems for ordering laboratory tests and managing results in European primary care settings. Methods: Mixed methods studies were undertaken in the UK and Ireland, and the findings were triangulated to develop ‘good practice’ statements. Expert consensus was then sought on the findings at the wider European level via a Delphi group meeting during 2013. Results: We based consensus on 10 safety domains and developed 77 related ‘good practice’ statements (≥ 80% agreement levels) judged to be essential to creating safety and minimizing risks in laboratory test ordering and subsequent results handling systems in international primary care. Conclusion: Guidance was developed for improving patient safety in this important area of primary care practice. We need to consider how this guidance can be made accessible to frontline care teams, utilized by clinical educators and improvement advisers, implemented by decision makers and evaluated to determine acceptability, feasibility and impacts on patient safety.

Ten years of practice-based small group learning (PBSGL) in Scotland – a survey of general practitioners

Abstract Introduction: Practice-based small group learning (PBSGL) has grown in Scotland since its pilot in 2004. There are now over 2,100 clinicians in 370 groups across the UK. The programme is used by all 14 territorial health boards in NHS Scotland. It seemed timely to undertake an evaluation of the programme. Method: A questionnaire was developed and piloted. It consisted of 16 questions with two free text questions asking respondents what had motivated them to join PBSGL, and what encouraged them to stay. The questionnaire was converted into an electronic format and emailed to all qualified general practitioners (GPs) in Scotland. Results: A wide range of GPs were involved in PBSGL and the mean number of modules studied per year was 6.8. The vast majority (589 (88.2%)) of respondents met in their own home or practice and were either very likely (549 (82.2%)) or likely (93 (13.9%)) to continue with the programme. The dominant reasons to join and stay with the programme related to learning issues: meeting learning needs, learning from peers and issues of peer support. Conclusion: PBSGL has become an established continuous professional development resource for many GPs in Scotland. It is well-received and likely to continue.

What are the CPD needs of GPs working in areas of high deprivation? Report of a focus group meeting of ‘GPs at the Deep End’

(2015). What are the CPD needs of GPs working in areas of high deprivation? Report of a focus group meeting of ‘GPs at the Deep End’. Education for Primary Care: Vol. 26, No. 3, pp. 139-145.

Healthcare professionalism: improving practice through reflections on workplace dilemmas

Healthcare professionals work under the scrutiny of various professional regulatory bodies and news articles relating to professional and unprofessional activities are constantly in the public aren...

Also human – the inner lives of doctors

Caroline Elton is an occupational psychologist, and in her new book, writes about her interactions with clients from the world of medicine. She gives an in-depth account of her career and presents ...

Handbook of primary care ethics

As in other green reviews, I (DC) have compiled this review aided by contributions from two UK colleagues: Dr Patrick Wills (PW) who is a GP and GP trainer in the Isle of Wight and Professor Kay Mo...

Practice-Based Small Group Learning (PBSGL) in Scotland – a survey of registered pharmacy staff and general practice nurses

Abstract Introduction: Practice-based small group learning (PBSGL) has grown in primary healthcare in Scotland, and is used regularly by 2244 GPs and GP specialist trainees. The programme has been available to general practice nurses (GPNs) and pharmacy staff since uni-professional and inter-professional pilot studies were considered successful. Growth has been slower compared to GPs uptake but has now reached significant levels. It seemed timely to evaluate the use of the programme by these professions. Method: A questionnaire previously used by GPs was adapted. It consisted of 16 questions and two free text questions asking respondents what had motivated them to join PBSGL, and what encouraged them to maintain membership. The questionnaire was converted into an electronic format and emailed to pharmacy and GPNs in Scotland who were PBSGL members. Results: A range of pharmacy staff and GPNs were involved in PBSGL and the mean number of modules studied by pharmacy staff was 3.93 and 4.48 by GPNs in the last year. A high percentage were likely or very likely to continue with membership (pharmacy staff – 95.6%, GPNs – 90.1%). The dominant reasons to join and stay in the programme related to learning issues: meeting learning needs, learning from peers and professional socialisation. Video abstract Read the transcript Watch the video on Vimeo

NHS Scotland’s community GP fellowship – a qualitative study of the first year

ABSTRACT NHS Scotland faces the challenges of an ageing population and a GP recruitment problem. Research has shown that hospital admissions can be reduced if community services can offer enhanced support, in keeping with the Scottish Government’s 2020 Vision for healthcare. This study presents the findings of an evaluation of the first year of a three-year community GP fellowship which included working in primary care and secondary care and an educational programme. A grounded theory approach was adopted with data collected from GP fellows and key stakeholders using focus groups and individual interviews. A total of 12 fellows were interviewed at various times in the first year and 22 key stakeholders were interviewed once. The main themes were: aspirations for the fellowship, career choices of recently-qualified GPs, perceptions of primary care and secondary care components, planning and preparation of educational events, the creation of community hubs and identity and status of fellows. The fellowship showed potential for a change in practice and was a good foundation for further collaboration between health care sectors. Physical hubs need to be constructed and resourced to allow fellows to demonstrate a reduction in hospital admissions. More research is needed throughout the lifetime of the fellowship.