The Health Foundation | Published online: August 2016
59% of GPs in the UK describe their job as extremely or very stressful, higher than anywhere else in the Commonwealth Fund Survey. Just 5% of GPs find general practice not too or not at all stressful.
By way of comparison, in Australia, only one in five (21%) of GPs find their job extremely or very stressful, and less than the one in four (24%) who find it not at all or not very stressful.
Of the UK respondents planning to leave medicine for a different career, 77% said their role as a GP was extremely or very stressful, compared to 49% of those who plan to stay. Improving stress levels will be critical to retention of GPs.
In our report Under Pressure, we looked at the satisfaction of GPs, as well as care coordination and use of electronic medical records in general practice. The report is UK-focused analysis by the Health Foundation of the Commonwealth Fund’s 2015 survey of primary care physicians across 11 countries, which included several UK-specific questions funded by the Health Foundation.
Objectives: To investigate the cost-effectiveness of a telehealth intervention for primary care patients with raised cardiovascular disease (CVD) risk.
Design: A prospective within-trial patient-level economic evaluation conducted alongside a randomised controlled trial.
Setting: Patients recruited through primary care, and intervention delivered via telehealth service.
Participants: Adults with a 10-year CVD risk ≥20%, as measured by the QRISK2 algorithm, with at least 1 modifiable risk factor.
Intervention: A series of up to 13 scripted, theory-led telehealth encounters with healthcare advisors, who supported participants to make behaviour change, use online resources, optimise medication and improve adherence. Participants in the control arm received usual care.
Primary and secondary outcome measures: Cost-effectiveness measured by net monetary benefit at the end of 12 months of follow-up, calculated from incremental cost and incremental quality-adjusted life years (QALYs). Productivity impacts, participant out-of-pocket expenditure and the clinical outcome were presented in a cost-consequences framework.
Results: 641 participants were randomised—325 to receive the telehealth intervention in addition to usual care and 316 to receive only usual care. 18% of participants had missing data on either costs, utilities or both. Multiple imputation was used for the base case results. The intervention was associated with incremental mean per-patient National Health Service (NHS) costs of £138 (95% CI 66 to 211) and an incremental QALY gain of 0.012 (95% CI −0.001 to 0.026). The incremental cost-effectiveness ratio was £10 859. Net monetary benefit at a cost-effectiveness threshold of £20 000 per QALY was £116 (95% CI −58 to 291), and the probability that the intervention was cost-effective at this threshold value was 0.77. Similar results were obtained from a complete case analysis.
Conclusions: There is evidence to suggest that the Healthlines telehealth intervention was likely to be cost-effective at a threshold of £20 000 per QALY.
The Health Foundation | Published online 25 August 2016
Significant event analysis (SEA) is a collective learning technique used to investigate patient safety incidents (circumstances where a patient was or could have been harmed) and other quality of care issues.
The project developed a framework and then a series of practical tools, which aim to help people working in primary care to apply the approach.
1. E-learning module
This short ‘read and click’ e-learning module is available as a PDF from the Quality Improvement Hub. It explains and illustrates the principles which underpin the enhanced SEA approach, including sections on: Basic error theory; Human factors principles; Taking a systems-centred approach; and the Enhanced SEA method.
2. Enhanced SEA booklet
The enhanced SEA booklet (PDF), developed by the project team, gives a clear, readable overview of the approach, including the basics of human factors theory and an example story. It aims to help individuals reflect on the potential emotional impacts of a significant event by using these principles to gain a clearer understanding of all of the contributory factors involved.
In addition to individual reflection, it’s important that teams reflect together on events and analysis. Each sheet of this enhanced SEA deskpad (PDF) contains instructions and prompts to help guide a team in taking this approach to event analysis, and to take notes on what was agreed.
4. Reporting template
The project team also designed and developed a new report format (PDF) for writing up SEAs, which accommodates this approach. This format is recommended for GP specialty training and medical appraisal, as well as for practice manager and nurse vocational training and appraisal. It is also being used in community pharmacy and dental practice in Scotland.
Responding to NHS Improvement’s report on the performance of NHS providers in the first quarter of the year, Richard Murray, Director of Policy at The King’s Fund, said:
‘Today’s report shows that new investment and actions taken to tackle overspending have reduced deficits among NHS providers in the first quarter of the year. This is welcome, but it would be a mistake to suggest that the financial pressures which have engulfed the NHS have eased.
‘While overall NHS trusts met their financial targets in the first quarter, our new survey of NHS finance directors shows only a third are confident this will be the case by the end of the year. It also shows a worrying decline in confidence among commissioners, with twice as many CCGs forecasting end-of-year deficits than at this time last year.
‘Demand for services is rising rapidly, waiting times are continuing to worsen and NHS leaders have been charged with delivering significant changes to services. Extra investment and the hard work of staff mean that NHS organisations are still just about coping for the time being, but the service is reaching a critical point.
‘The government must be honest with the public about what the NHS can achieve with the resources it has been given. It is not credible to argue that it can continue to meet rising demand for services, maintain standards of care and balance its books within its current budget.’
This document contains 13 examples showing community pharmacy services can integrate with the wider primary care and community health system. The examples cover working with GP practice, patients with long term conditions and mental health issues, enhanced out of hours provision, domiciliary care, pharmacists in GP Out of Hours services and support for health and social care integration.
This guide has been written to support commissioners and providers to effectively manage demand for NHS services. The guide covers peer review of referrals; shared decision making; choice; advice and guidance; alternatives to outpatient appointments; consultant-to-consultant referral protocols; direct access to diagnostics; and management and monitoring of outpatient follow-up appointments. It contains case studies and links to further information.