• Communication between South Asian patients and GPs: comparative study using the Roter Interactional Analysis System

      Neal, Richard D.; Ali, Nasreen; Atkin, Karl; Allgar, Victoria L.; Ali, Shahid; Coleman, Tim; Cardiff University; University of Leeds; University of Nottingham (Royal College of General Practitioners, 2018-06-22)
      Background The UK South Asian population has poorer health outcomes. Little is known about their process of care in general practice, or in particular the process of communication with GPs. Go to: Aim To compare the ways in which white and South Asian patients communicate with white GPs. Go to: Design of study Observational study of video-recorded consultations using the Roter Interactional Analysis System (RIAS). Go to: Setting West Yorkshire, UK. Go to: Method One hundred and eighty–three consultations with 11 GPs in West Yorkshire, UK were video-recorded and analysed. Go to: Results Main outcome measures were consultation length, verbal domination, 16 individual abridged RIAS categories, and three composite RIAS categories; with comparisons between white patients, South Asian patients fluent in English and South Asian patients non-fluent in English. South Asians fluent in English had the shortest consultations and South Asians non-fluent in English the longest consultations (one-way ANOVA F = 7.173, P = 0.001). There were no significant differences in verbal domination scores between the three groups. White patients had more affective (emotional) consultations than South Asian patients, and played a more active role in their consultations, as did their GPs. GPs spent less time giving information to South Asian patients who were not fluent in English and more time asking questions. GPs spent less time giving information to South Asian patients fluent in English compared with white patients. Go to: Conclusions These findings were expected between patients fluent and non-fluent in English but do demonstrate their nature. The differences between white patients and South Asian patients fluent in English warrant further explanation. How much of this was due to systematic differences in behaviour by the GPs, or was in response to patients' differing needs and expectations is unknown. These differences may contribute to differences in health outcomes.
    • Fluency in the consulting room

      Ali, Nasreen (Royal College of General Practitioners, 2003-01-01)
    • Going beyond blame: reporting NHS medication errors in nursing home residents with diabetes

      Milligan, Frank; Gadsby, Roger; Ghaleb, Maisoon; Ivory, Philip; McKeaveney, Colette; Newton, Kathryn; Smith, Jackie; Randhawa, Gurch; University of Bedfordshire; Warwick Medical School; et al. (Royal College of General Practitioners, 2015-07-01)
      It is widely accepted in literature on patient safety that an open culture — one that seeks to understand the multiple reasons for error — is required to promote incident reporting and maximise learning for system improvement.1 In the attempt to deliver the research described here we encountered a culture of blame. Such a culture leads to low levels of medication error reporting with regard to NHS systems supplying the nursing home setting. This article explores the problem of this low level of reporting being detrimental to future learning on NHS medication errors.2 The study we undertook, ‘Root causes of medication errors in nursing home residents with diabetes: enhancing safety in NHS medicines management’, was funded by the Research for Patient Benefit (RfPB) programme. It focused on residents with diabetes in nursing homes, as defined by the Care Quality Commission (CQC),3 and involved consenting homes in Bedfordshire and Hertfordshire. Nursing homes were selected because medication delivery processes are slightly different from residential care home provision, although the incident reporting systems are similar. The aim of the study was to gather data on NHS errors, and report on and analyse them for learning purposes and solution development. The comments made here relate to the data collection process. The final research findings will be summarised in future publications.
    • Improving access to organ donor registration in general practice: a feasibility study

      Penn-Jones, Catrin Pedder; Papadopoulos, Chris; Randhawa, Gurch; Asghar, Zeeshan; (Royal College of General Practitioners, 2020-06-25)
      Background Organ donor registration helps guide decision making for families. UK general practice provides the facility to register on the NHS Organ Donor Register, but only to new patients. An intervention was developed to present a registration opportunity to existing patients in this setting. Aim To assess the feasibility and acceptability of an organ donation intervention implemented in UK general practice. Design and setting The intervention ran in a large practice in Luton in the UK, for 3 months in 2018. A single practice feasibility study was conducted using an embedded experimental mixed methods design. Method Staff were trained to ask patients in consultations if they wished to join the register, and leaflets and posters were displayed in the waiting room. Data on feasibility and acceptability were captured using SystmONE questionnaires, surveys, and focus groups. Results Over 3 months, in 12.4% of face-to-face consultations, patients were asked if they would like to join the register (812 of 6569), and 244 (30.0%) of these patients joined the register. Common reasons staff did not ask patients were due to telephone consultations, lack of time, and it not being appropriate. Nurses and healthcare assistants performed prompted choice more than doctors (23.4%, 17.1%, and 1.6% respectively). Certain clinic types, such as phlebotomy or routine clinics, facilitated asking compared to those where patients presented with unknown or more serious issues. Conclusion The intervention was found to be feasible and acceptable by some staff and patients. Feasibility criteria were met; therefore, the intervention can progress to further testing.
    • Parents' expectations and experiences of the 6-week baby check: a qualitative study in primary care

      Gilworth, Gill; Milton, Sarah; Chater, Angel M.; Nazareth, Irwin; Roposch, Andreas; Green, Judith; King's College London; University of Bedfordshire; University College London (Royal College of General Practitioners, 2020-11-18)
      Background: The Newborn and Infant Physical Examination (NIPE) programme requires all babies to have a comprehensive health check at 6-8 weeks of age. These are typically completed by GPs. Although person-centred care has achieved prominence in maternity care policy in recent years, there is limited empirical evidence on what parents and/or carers expect from the check, and how far experiences meet their needs. Aim: To explore the expectations and experiences of parents attending their GP for a baby check. Design & setting: A qualitative study was undertaken in primary care in London. Method: Content analysis was undertaken of transcripts of semi-structured interviews. Interviews were conducted with a total of 16 participants (14 mothers and two fathers) who had recently attended for a 6-week check for their baby. Results: Despite the availability of plentiful sources of general advice on infants' health and development, a thorough check by a trusted GP was an important milestone for most parents. They had few specific expectations of the check in terms of what examinations were undertaken, but even experienced parents anticipated reassurance about their baby's normal development. Many also hoped for reassurance about their own parenting. Parents appreciated GPs who explained what they were doing during the examination; space to raise any concerns; and combined mother and baby checks. Referrals to secondary care were generally experienced as reassuring rather than a source of anxiety. Conclusion: The baby check meets needs beyond those of the NIPE screening programme. Protecting the time for a thorough consultation is important for parents at what can be a vulnerable time.
    • Patient uptake and adherence to social prescribing: a qualitative study

      Pescheny, Julia Vera; Randhawa, Gurch; Pappas, Yannis; University of Bedfordshire (Royal College of General Practitioners, 2018-08-08)
      Social prescription is an initiative that aims to link patients in primary care with sources of support within the community and voluntary sector to improve their health, wellbeing, and care experience. Such programmes usually include navigators, who work with referred patients and issue onward referrals to sources of non-medical support. Most research on social prescribing (SP) has focused on outcome evaluations, resulting in a knowledge gap of factors affecting uptake and adherence. Understanding such factors enables the refinement of programmes, which has the potential to enhance uptake and adherence, reduce health inequalities, and optimise investment. Aim To explore the experiences and views of service users, involved GPs, and navigators on factors influencing uptake and adherence to SP. Design & setting Qualitative interviews were conducted with stakeholders involved in an SP programme in the east of England (Luton). Method Data were collected from semi-structured face-to-face interviews with service users, navigators, and GPs. Thematic analysis was used to analyse the data. Results Factors affecting uptake and adherence to SP were related to patients’ trust in GPs, navigators' initial phone call, supportive navigators and service providers, free services, and perceived need and benefits. Reported barriers to uptake and adherence were fear of stigma of psychosocial problems, patient expectations, and the short-term nature of the programme. Conclusion This study provides an insight into factors affecting patient uptake and adherence to SP programmes. More research in this field, including patients who refused to participate in SP, is needed. Go to: Social prescription is an initiative that aims to link patients in primary care with sources of support within the community and voluntary sector to improve their health, wellbeing, and care experience. Such programmes usually include navigators, who work with referred patients and issue onward referrals to sources of non-medical support. Most research on social prescribing (SP) has focused on outcome evaluations, resulting in a knowledge gap of factors affecting uptake and adherence. Understanding such factors enables the refinement of programmes, which has the potential to enhance uptake and adherence, reduce health inequalities, and optimise investment. Aim To explore the experiences and views of service users, involved GPs, and navigators on factors influencing uptake and adherence to SP. Design & setting Qualitative interviews were conducted with stakeholders involved in an SP programme in the east of England (Luton). Method Data were collected from semi-structured face-to-face interviews with service users, navigators, and GPs. Thematic analysis was used to analyse the data. Results Factors affecting uptake and adherence to SP were related to patients’ trust in GPs, navigators' initial phone call, supportive navigators and service providers, free services, and perceived need and benefits. Reported barriers to uptake and adherence were fear of stigma of psychosocial problems, patient expectations, and the short-term nature of the programme. Conclusion This study provides an insight into factors affecting patient uptake and adherence to SP programmes. More research in this field, including patients who refused to participate in SP, is needed.
    • The Shoreham Airshow crash: personal reflections of the immediate medical responders

      Eastman, Karen; Kemp, Anthony (Royal College of General Practitioners, 2016-03-31)
    • Stage at diagnosis, survival and diagnostic delays for lung, colorectal, prostate and ovarian cancer: comparison between patients referred urgently from primary care and patients diagnosed through other routes

      Neal, Richard D.; Ali, Nasreen; Allgar, Victoria L.; Heywood, Phil; Leese, Brenda; Proctor, Gill; Evans, Joyce; University of Leeds (Royal College of General Practitioners, 2007-03-01)
      Background Very few studies have reported cancer outcomes of patients referred through different routes, despite the prominence of current UK cancer urgent referral guidance. Aim This study aimed to compare outcomes of cancer patients referred through the urgent referral guidance with those who were not, with respect to stage at diagnosis, survival, and delays in diagnosis. Design of study Analysis of hospital records. Setting One hospital trust in England Method The records of 889 patients diagnosed in 2000–2001 with one of four types of cancer were analysed: 409 with lung cancer; 239 with colorectal cancer; 146 with prostate cancer; and 95 with ovarian cancer. Outcome measures were diagnostic stage, survival, referral and secondary care delays. Results For lung cancer, urgent referrals had more advanced TNM (tumor, node, metastasis) stage than patients diagnosed through other routes (P = 0.035) and poorer survival (P = 0.020). There was no difference in stage or survival for the other cancers. For each cancer, a higher proportion of urgent referrals was seen within 2 weeks. Secondary care delays for lung and colorectal cancer were shorter for inter-specialty referrals. Conclusion For patients with lung cancer, the guidance appears to be prioritising those in the more advanced stages of disease. This was not the case for the other three cancers. Referral delays were shorter for patients urgently referred, as is the intention of the guidance. The avoidance of delays in outpatient diagnostics probably accounts for shorter secondary care delays for inter-specialty referrals.
    • 'Would you like to join the NHS Organ Donor Register?' a general practice feasibility study

      Penn-Jones, Catrin Pedder; Papadopoulos, Chris; Randhawa, Gurch; Asghar, Zeeshan; ; University of Bedfordshire; NHS Blood and Transplant (Royal College of General Practitioners, 2020-06-18)
      BACKGROUND: A shortage of organ donors exists in the UK and targeting family consent is key for increasing donation consent rates. Registration on the NHS Organ Donor Register (NHS ODR) facilitates this, as it guides families on their loved ones donation preference. In general practice, an opportunity to register is provided, however only to new patients. To improve access to registration opportunities, an intervention was designed where general practice staff asked their patients if they wished to register as an organ donor. AIM: To assess an organ donation registration intervention for feasibility and acceptability in a UK general practice setting. METHOD: One general practice, in Luton, UK, conducted the intervention for 3 months (April to July 2018). Training was held in March 2018, and leaflets and posters were displayed for the 3-month period. An embedded experimental mixed-methods design was used, with data collected via SystmONE questionnaires, surveys and focus groups. RESULTS: The intervention was found to be feasible and acceptable to conduct with some patients by some staff members. During the 3 months, patients were asked in 12.4% of face-to-face consultations (n=812). Nurses and healthcare assistants were more able to conduct the intervention than doctors. Lack of time, telephone consultations, and it not being appropriate were the most common reasons for not asking. Finally, 244 patients joined the NHS ODR; 30.4% of those asked. CONCLUSION: This study demonstrates that general practice could be a feasible location in which an intervention designed to increase NHS ODR registration could be conducted.