Health inequalities in practice - I'm a GP, what can I do?

Kamila Hawthorne, chair of the Royal College of General Practioners Council, and Bola Owolabi, director of the National Healthcare Inequalities Improvement Programme, offer a personal perspective on how their professional experiences have led them to see health inequality as urgent priority, and introduce initiatives that can help general practitioners make a difference individually and collectively.

Are insect bites responsible for the rise in summer flucloxacillin prescribing in United Kingdom general practices?

Background: Insect bite inflammation may mimic cellulitis and promote unnecessary antibiotic usage, contributing to antimicrobial resistance in primary care. We wondered how general practice clinicians assess and manage insect bites, diagnose cellulitis, and prescribe antibiotics.

Method: This is a Quality Improvement study in which 10 general practices in England and Wales investigated patients attending for the first time with insect bites between April and September 2021 to their practices.

Comparing international postgraduate training and healthcare context with the UK to streamline overseas GP recruitment: four case studies.

Background: There are ambitious overseas recruitment targets to alleviate current GP shortages in the UK. GP training in European Economic Area (EEA) countries is recognised by the General Medical Council (GMC) as equivalent UK training; non-EEA GPs must obtain a Certificate of Eligibility for General Practice Registration (CEGPR), demonstrating equivalence to UK-trained GPs. The CEGPR may be a barrier to recruiting GPs from non-EEA countries.

Overseas GP recruitment: comparing international GP training with the UK and ensuring that registration standards and patient safety are maintained.

Background: Ambitious overseas recruitment targets have been set by the UK government to help alleviate the current GP shortage. European Economic Area (EEA) doctors can join the UK's GP register under European law. Non-EEA doctors must obtain a Certificate of Eligibility for General Practice Registration (CEGPR), demonstrating equivalence to UK-trained doctors.

Sociolinguistic factors affecting performance in the Clinical Skills Assessment of the MRCGP: a mixed-methods approach.

Background: Differential performance in clinical skills assessments is a widespread phenomenon, for which there remain few explanations.

Aim: To better understand the conversational contexts of simulated consultations and how candidates actually behave in these consultations and to determine sociolinguistic factors for high- and low-performing candidates.

Design & Setting: Taking the Membership of the Royal College of General Practitioners' (MRCGP) clinical skills assessment (CSA) examination as a model, this research applied sociolinguistic analyses to case videos of 198 consecutive candidates presenting for the CSA examination.

Simulated consultations: a sociolinguistic perspective.

Background: Assessment of consulting skills using simulated patients is widespread in medical education. Most research into such assessment is sited in a statistical paradigm that focuses on psychometric properties or replicability of such tests. Equally important, but less researched, is the question of how far consultations with simulated patients reflect real clinical encounters--for which sociolinguistics, defined as the study of language in its socio-cultural context, provides a helpful analytic lens.

Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus.

Background: Ethnic minority groups in upper-middle-income and high-income countries tend to be socioeconomically disadvantaged and to have a higher prevalence of type 2 diabetes than is seen in the majority population.

Objectives: To assess the effectiveness of culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus.

Search Methods: A systematic literature search was performed of the following databases: The Cochrane Library, MEDLINE, EMBASE, PsycINFO, the Education Resources Information Center (ERIC) and Google Scholar, as well as reference lists of identified articles.

Option Grids to facilitate shared decision making for patients with Osteoarthritis of the knee: protocol for a single site, efficacy trial.

Background: Despite policy interest, an ethical imperative, and evidence of the benefits of patient decision support tools, the adoption of shared decision making (SDM) in day-to-day clinical practice remains slow and is inhibited by barriers that include culture and attitudes; resources and time pressures. Patient decision support tools often require high levels of health and computer literacy. Option Grids are one-page evidence-based summaries of the available condition-specific treatment options, listing patients' frequently asked questions.

How can simulated patients' experiences suggest ways to improve candidate performance in the MRCGP clinical assessments?

Background: Candidates sitting UK postgraduate clinical assessments in general practice see 'patients' in a 'simulated surgery'. These simulated patients (SP) are actors specifically trained for this role.

Aim: To describe SP experiences of postgraduate clinical exams in UK general practice.

The effect of the Talking Diabetes consulting skills intervention on glycaemic control and quality of life in children with type 1 diabetes: cluster randomised controlled trial (DEPICTED study).

Objective: To evaluate the effectiveness on glycaemic control of a training programme in consultation skills for paediatric diabetes teams.

Design: Pragmatic cluster randomised controlled trial.

Setting: 26 UK secondary and tertiary care paediatric diabetes services.

Involving lay and professional stakeholders in the development of a research intervention for the DEPICTED study.

AIM This paper focuses on stakeholders' active involvement at key stages of the research as members of a Stakeholder Action Group (SAG), particularly in the context of lay stakeholder involvement. Some challenges that can arise and wider issues (e.g.

Some effects of teaching undergraduate medical students on general practitioner thinking and learning.

Background: This study examined the processes of thinking and learning undertaken by general practitioners (GPs, family physicians) brought about by the presence of undergraduate medical students.

Method: A qualitative study was undertaken using critical incident templates (a novel approach in this context) and focus groups. Data were analysed thematically, with iterative discussion between members of the study team after independent analysis.

Development and Evaluation of a Psychosocial Intervention for Children and Teenagers Experiencing Diabetes (DEPICTED): a protocol for a cluster randomised controlled trial of the effectiveness of a communication skills training programme for healthcare professionals working with young people with type 1 diabetes.

Background: Diabetes is the third most common chronic condition in childhood and poor glycaemic control leads to serious short-term and life-limiting long-term complications. In addition to optimal medical management, it is widely recognised that psychosocial and educational factors play a key role in improving outcomes for young people with diabetes. Recent systematic reviews of psycho-educational interventions recognise the need for new methods to be developed in consultation with key stakeholders including patients, their families and the multidisciplinary diabetes healthcare team.

Evaluation of different delivery modes of an interactive e-learning programme for teaching cultural diversity.

Objective: UK medical schools find it challenging to provide standardised teaching to expanding year intakes. In addition, developing and implementing diversity training can cause difficulties. This paper describes the evaluation of an interactive e-learning programme to raise awareness and understanding of communication difficulties in diversity consultations.

Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups.

Background: Ethnic minority groups in upper-middle and high income countries tend to be socio-economically disadvantaged and to have higher prevalence of type 2 diabetes than the majority population.

Objectives: To assess the effectiveness of culturally appropriate diabetes health education on important outcome measures in type 2 diabetes.

Search Strategy: We searched the The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, SIGLE and reference lists of articles.