The British journal of general practice : the journal of the Royal College of General Practitioners
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Direct oral anticoagulants (DOACs) are commonly co-prescribed with statins. Although biologically plausible, whether there is a drug interaction between DOACs and atorvastatin/simvastatin is unclear. ⋯ This study shows no evidence of interaction between DOACs and atorvastatin/simvastatin. However, people starting a DOAC whilst taking atorvastatin/simvastatin, were at high risk of bleeding and mortality, likely due to temporal clinical vulnerability.
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Background Additional Roles Reimbursement Scheme (ARRS) was introduced in England in 2019 to alleviate workforce pressures in general practice by funding additional staff such as clinical pharmacists, paramedics, first contact physiotherapists and from 2024/25, the scheme will fund recently qualified GPs. However, the employment and deployment models of ARRS staff present ongoing complexities and challenges that require further exploration. Aim This study explores the decision-making processes behind Primary Care Networks (PCNs) and general practice staffing choices, and how these choices influence the operationalisation of ARRS. ⋯ The optimal deployment model involved rotations across a limited number of GP practices, ideally two, with one serving as a base, ensuring consistency in training and management. Conclusion This study provides novel insights into the complexities of different employment and deployment models of ARRS staff. These findings will be invaluable for creating a sustainable GP practice workforce and informing future workforce strategies as the scheme expands to include recently qualified GPs.
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England is short of General Practitioners (GPs). GP consultation rates, consultation duration, and workload are increasing. Electronic clinical decision support (eCDS) tools assist decision-making for screening, diagnosis, and risk-management. Cancer detection is one area where tools are designed to support GPs. Electronic risk assessment tools (eRATs) estimate risk of current cancer based on symptoms. We aimed to explore any association between eRATs impact and GP workload and workflow during consultations. ⋯ There was no evidence to suggest that eRATs should not be used to support GPs in early cancer diagnosis from a workload perspective. eRATs were not associated with increased workload across a session. Definitive findings regarding the clinical effectiveness of eRATs, not the related workload/workflow implications, will ultimately determine whether the use of eRATs should be rolled out more widely.
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Background In England online services in general practice encompass a range of provision from ordering repeat medication to having a consultation. Some groups of individuals may find accessing and/or using such services difficult and may require 'digital facilitation', that is the range of processes, procedures, and personnel which seeks to support NHS patients in their uptake and use of online services. Aim To gain insight, from the perspective of general practice staff and patients/carers, into how and why digital facilitation might lead to benefits, and the key processes involved in supporting patients to use online services. ⋯ It was understood by practice staff that patients with challenging personal circumstances may require specific support to access online services. Conclusion At present patient use of online services is supported by digital facilitation which is primarily delivered by reception staff. Supporting patients to use online services requires review of how many services are provided and what for, and consideration for the time and effort needed to support patients to use them.
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Background: Diagnosing cancer in general practice is complex, given the non-specific nature of many presenting symptoms and the overlap of potential diagnoses. This trial evaluated the effectiveness of a technology, Future Health Today (FHT), which provides clinical decision support, auditing, and quality improvement monitoring, on the appropriate follow-up of patients at risk of undiagnosed cancer. ⋯ The FHT cancer module intervention did not increase the proportion of patients receiving guideline-concordant care. The proportion of patients receiving recommended followed-up was high, suggesting a possible ceiling effect for the intervention.