Phil Heywood

Evidence based general practice: a retrospective study of interventions in one training practice

Abstract Objectives: To estimate the proportion of interventions in general practice that are based on evidence from clinical trials and to assess the appropriateness of such an evaluation. Design: Retrospective review of case notes. Setting: One suburban training general practice. Subjects: 122 consecutive doctor-patient consultations over two days. Main outcome measures: Proportions of interventions based on randomised controlled trials (from literature search with Medline, pharmaceutical databases, and standard textbooks), on convincing non-experimental evidence, and without substantial evidence. Results: 21 of the 122 consultations recorded were excluded due to insufficient data; 31 of the interventions were based on randomised controlled trial evidence and 51 based on convincing non-experimental evidence. Hence 82/101 (81%) of interventions were based on evidence meeting our criteria. Conclusions: Most interventions within general practice are based on evidence from clinical trials, but the methods used in such trials may not be the most appropriate to apply to this setting. Key messages Key messages 81% of general practice can be described as evidence based using this method of assessment Evidence derived from different methodologies may be important for the assessment of the evidence base of general practice

How do receptionists view continuity of care and access in general practice

Background: Continuity of care is widely regarded as an important feature of general practice, but the role of receptionists in influencing continuity has been the subject of little research. Objective: To explore how receptionists might influence access and continuity of care in general practice. Methods: A questionnaire survey of receptionists in practices in Leeds, UK, was conducted. All 119 practices in Leeds were contacted to recruit receptionists via practice managers. A total of 148 receptionists responded from 50 practices. Results: The majority of receptionists (140, 94%) perceived continuity as team continuity. Most (139, 93%) felt it was important for the patient to be seen on the same day by any doctor, rather than the usual doctor. They were less willing to ask patients for more details of a routine problem than an urgent one. The majority (113, 76%) thought that non-attendance was more related to patient issues than to their own behaviour. Organizational factors affected how receptionists offered appointments. Advanced access could impede longitudinal continuity and, indirectly, relational continuity. Having a policy to deal with urgent appointments or routine appointments could facilitate such continuity. Conclusion: The majority of receptionists perceived continuity as a team response rather than longitudinal. However, if relational continuity is to survive in UK and European general practice, educational and training measures would need to be taken to promote these values to receptionists.

Developing cancer services strategy in primary care in England: primary care trust managers' views of the primary care cancer leads initiative.

PURPOSE Primary care cancer lead clinicians (PCCLs) act strategically in primary care trusts (PCTs) in England to improve communication and understanding of cancer across primary and secondary care and provide a link between Cancer Networks and primary care. The aim is to evaluate the first three years of the initiative. DESIGN/METHODOLOGY/APPROACH A postal questionnaire was sent to all PCT chief executives in all PCTs in England and some were passed on to other PCT managers for completion. The response rate was 61 per cent. PCT directors of public health were the largest group of respondents (29 per cent). Most (74 per cent) PCCLs were GPs and 22 per cent were nurses. FINDINGS PCCLs were most likely to focus on palliative care and preventive services. Key achievements were identified as raising awareness of cancer, developing relationships and promoting primary care. The personal skills of the PCCLs were important as was support of colleagues at all levels. Lack of time was a major barrier to achievement, as was a lack of understanding of the role from others. Links with the Cancer Networks were being developed. About 85 per cent of managers wanted the role to continue. ORIGINALITY/VALUE The paper illustrates that PCCLs are at the forefront of improving cancer services in primary care. They are particularly important in view of the priority of reducing premature deaths and promotion of healthy lifestyles.

First wave PMS pilots: a critical analysis of documentation.

Contracts and interim local evaluation reports for the 14 first wave PMS pilots in Northern and Yorkshire region were analysed by documentary analysis. Both contracts and reports were found to vary considerably in size and scope. Most contracts contained aims and objectives that were too broad or vague to guide project management and they lacked useful milestones. This made it difficult to identify criteria for measuring success. The local evaluation reports were also of variable quality. It is recommended that contracts should be accompanied by a development plan containing specific objectives, timescale and process for implementation as well as an evaluation strategy. The relative importance of different targets should be agreed and specified at the outset, to allow weighting of partial success, where some objectives, but not others, are achieved. Project milestones would be made explicit and measurable in the development plan. More clarity in contracts and evaluation for future pilots is essential.