The British journal of general practice : the journal of the Royal College of General Practitioners
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Background A growing literature examines the way two changes in primary care - the shift towards remote working, and the diversification of practice teams to incorporate, for instance, physician associates and paramedics - affect patient care within the practice. However, little is known about these changes' effects on community nurses. Aim To explore community nurses' experiences of delivering palliative care in the context of GPs' new ways of working. ⋯ Second, nurses increased their workload by taking the lead in person-centred care where they saw remote provision by GPs as unsatisfactory. Where workforce diversification led to delegating home visits to paramedics or nurse practitioners, community nurses described feeling a lack of the "GP back-up" that many identified as essential for community palliative care. Conclusion When considering and evaluating interventions that change the way GPs work, policy-makers and commissioners should look not only at consequences affecting primary care teams, but also at effects across the complex ecosystem within which these teams operate.
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Faecal Immunochemical Testing (FIT) is now core to the management of patients presenting in primary care with symptoms of possible colorectal cancer. Patients with a positive FIT (≥10μg Hb/g faeces) qualify for an urgent suspected cancer referral. FIT negative patients are typically managed in primary care or referred through routine pathways. ⋯ Symptomatic FIT is largely seen as beneficial; however, health professionals would welcome further evidence and guidance around optimal application.
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Post-inpatient discharge is a risky time for older patients, especially those with polypharmacy and multi-morbidity. General practice care at this time, including the processes for managing hospital discharge summaries, lacks standardisation and is of variable quality. Understanding these processes will support the design of interventions and guidance to improve general practice management of the post-discharge period. ⋯ General practice systems for inpatient discharge summary processing are complex and varied. New roles in general practices are being used extensively, often requiring significant input in supervision by GPs. Our findings highlight safety features of different systems and should help practices understand the advantages/limitations of models they work within.
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To develop and internally validate a model predicting life-threatening events for out-of-hours primary care callers with shortness of breath. ⋯ A prediction model consisting of age, gender, call characteristics, and symptoms holds promise for improving telephone triage of callers to out-of-hours primary care with shortness of breath.
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Identification of rheumatoid arthritis (RA) in primary care is challenging and often delayed. Anti-cyclic citrullinated peptide (anti-CCP) antibody testing of people presenting to primary care with new-onset musculoskeletal symptoms without synovitis could help address this; those testing positive are at increased risk of developing RA. ⋯ Implementing a prediction model to guide targeted anti-CCP testing in primary care could be feasible. Further research is required to explore the potential benefits, risks, and costs of a pathway for identifying/managing people at risk of RA.