The British journal of general practice : the journal of the Royal College of General Practitioners
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Observational Study
Factors affecting the experience of joined-up, continuous primary care in the absence of relational continuity: an observational study.
There is an international trend towards the at-scale provision of primary care services, with such services often provided in different settings by a clinician unfamiliar to the patient. It is often assumed that, in the absence of relational continuity, any competent clinician can deliver joined-up, continuous care if they have access to clinical notes. ⋯ Healthcare systems increasingly rely on the assumption that any competent clinician can deliver joined-up, continuous care if they have access to clinical notes. This appears not to be the case. This study presents a model of factors affecting the patient's experience of continuity. The model needs validating in in-hours general practice and other settings.
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Comment Letter Randomized Controlled Trial
Depression follow-up monitoring with the PHQ-9: open cluster-randomised controlled trial.
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Observational Study
Continuity and breaches in GP care and their associations with mortality for patients with chronic disease: an observational study using Norwegian registry data.
Despite many benefits of continuity of care with a named regular GP (RGP), continuity is deteriorating in many countries. ⋯ Higher disease-related and overall RGP UPC are both associated with lower mortality. However, changing RGP did not significantly affect mortality, indicating a compensatory benefit of informational and management continuity in a patient list system.
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Significant health inequalities exist in England. Primary care networks (PCNs), comprised of GP practices, were introduced in England in 2019 with funding linked to membership. PCNs have been tasked with tackling health inequalities. ⋯ Allocated PCN funding has become more pro-poor over time, suggesting that the need to account for deprivation within funding models is understood by policymakers. The following additional approaches have been highlighted that could support PCNs to tackle inequalities: better management support; encouragement and support to redistribute funding internally to support practices serving more deprived populations; and greater specificity in service requirements.
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The Additional Roles Reimbursement Scheme (ARRS) was set up to recruit 26 000 additional staff into general practice by 2024, with the aim of increasing patient access to appointments. Despite the potential benefits of integrating ARRS practitioners into primary care, their implementation has not always been straightforward. ⋯ Most ARRS staff felt valued, but the scheme broadened expertise available in primary care rather than reducing GP burden, which was originally anticipated. Some PCNs, especially those in areas of high deprivation, found it difficult to meet the population's needs as a result of the scheme's inflexibility, potentially leading to greater health inequalities in primary care. Recommendations are proposed to optimise the effective implementation of the primary care workforce model. Further research is required to explore administrative role solutions, further understand the impact of health inequalities, and investigate the wellbeing of ARRS staff.