GP working time and supply, and patient demand in England in 2015-2022: a retrospective study.

Background: English primary care faces a reduction in GP supply and increased demand.

Aim: To explore trends in GP working time and supply, accounting for factors influencing demand for services.

Design And Setting: Retrospective observational study in English primary care between 2015 and 2022.

What remains after the money ends? Evidence on whether admission reductions continued following the largest health and social care integration programme in England.

We study the long-term effects on hospital activity of a three-year national integration programme. We use administrative data spanning from 24 months before to 22 months after the programme, to estimate the effect of programme discontinuation using difference-in-differences method. Our results show that after programme discontinuation, emergency admissions were slower to increase in Vanguard compared to non-Vanguard sites.

Factors affecting the experience of joined-up, continuous primary care in the absence of relational continuity: an observational study.

Background: 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.

Aim: To explore the factors that affect the potential for providing joined-up, continuous care in a system where care is delivered away from a patient's regular practice, by a different organisation and set of staff.

Has the NHS national extended access scheme delivered its policy aims? A case study of two large scale extended access providers.

Objectives: In 2018, NHS England mandated that all patients in England should be able to access general practice services outside of ordinary hours. While some patients would access additional hours at their own practice, others would need supra-practice level provision - that is, they would be seen in a different location and by a different care team. The policy aim was to enhance patient access to care, with a particular focus on those who work during the day.

Evaluating primary care networks in low-income and lower middle-income countries: a scoping review.

Introduction: Primary care networks (PCNs) are claimed to be an effective model to organise and deliver primary healthcare through collaborative relationships and effective coordination of primary care activities. Though increasingly implemented in different contexts, there is limited evidence on the effectiveness of PCNs in low-income and lower middle-income countries (LLMICs).

Objective: Our scoping review aims to understand how PCNs in LLMICs have been conceptualised, implemented and analysed in the literature and further explores the evidence of the effectiveness of these networks.

Is bureaucracy being busted in research ethics and governance for health services research in the UK? Experiences and perspectives reported by stakeholders through an online survey.

Background: It has long been noted that the chain from identification of need (research gap) to impact in the real world is both long and tortuous. This study aimed to contribute evidence about research ethics and governance arrangements and processes in the UK with a focus on: what works well; problems; impacts on delivery; and potential improvements.

Methods: Online questionnaire widely distributed 20th May 2021, with request to forward to other interested parties.

Predictors and population health outcomes of persistent high GP turnover in English general practices: a retrospective observational study.

Objective: English primary care faces significant challenges, including 'persistent high turnover' of general practitioners (GPs) in some partnerships. It is unknown whether there are specific predictors of persistent high turnover and whether it is associated with poorer population health outcomes.

Design: A retrospective observational study.

General practice managers' motivations for skill mix change in primary care: Results from a cross-sectional survey in England.

Objectives: The objectives are to determine the factors that motivated GP practice managers in England to employ non-medical roles, and to identify an ideal hypothetical GP practice workforce.

Methods: Cross-sectional survey of GP practice managers in England ( = 1205). The survey focused on six non-medical roles: advanced nurse practitioner, specialist nurse, health care assistant, physician associate, paramedic and pharmacist.

Skill-mix change and outcomes in primary care: Longitudinal analysis of general practices in England 2015-2019.

Background: Increasing the employment of staff with new clinical roles in primary care has been proposed as a solution to the shortages of GPs and nurses. However, evidence of the impacts this has on practice outcomes is limited. We examine how outcomes changed following changes in skill-mix in general practices in England.

Processes supporting effective skill-mix implementation in general practice: A qualitative study.

Objectives: Health policy and funding initiatives have addressed increasing workloads in general practice through the deployment of clinicians from different disciplinary backgrounds. This study examines how general practices in England operate with increasingly diverse groups of practitioners.

Methods: Five general practices were selected for maximum variation of the duration and diversity of skill-mix in their workforce.

Unseen patterns of preventable emergency care: Emergency department visits for ambulatory care sensitive conditions.

Objective: Admissions for ambulatory care sensitive conditions (ACSCs) are often used to measure potentially preventable emergency care. Visits to emergency departments with ACSCs may also be preventable care but are excluded from such measures if patients are not admitted. We established the extent and composition of this preventable emergency care.

Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions.

Background: Policy-makers expect that integration of health and social care will improve user and carer experience and reduce avoidable hospital use. [We] evaluate the impact on emergency hospital admissions of two large nationally-initiated service integration programmes in England: the Pioneer (November 2013 to March 2018) and Vanguard (January 2015 to March 2018) programmes. The latter had far greater financial and expert support from central agencies.

Variability in size and characteristics of primary care networks in England: observational study.

Background: General practices in England have been encouraged by national policy to work together on a larger scale by creating primary care networks (PCNs). Policy guidance recommended that they should serve populations of 30 000-50 000 people to perform effectively.

Aim: To describe variation in the size and characteristics of PCNs and their populations.

Changes in patient experience associated with growth and collaboration in general practice: observational study using data from the UK GP Patient Survey.

Background: For the last few years, English general practices - which are, traditionally, small - have been encouraged to serve larger populations of registered patients by merging or collaborating with each other. Meanwhile, patient surveys have suggested that continuity of care and access to care are worsening.

Aim: To explore whether increasing the size of the practice population and working collaboratively are linked to changes in continuity of care or access to care.

New integrated care models in England associated with small reduction in hospital admissions in longer-term: A difference-in-differences analysis.

Closer integration of health and social care services has become a cornerstone policy in many developed countries, but there is still debate over what population and service level is best to target. In England, the 2019 Long Term Plan for the National Health Service included a commitment to spread the integration prototypes piloted under the Vanguard `New Care Models' programme. The programme, running from 2015 to 2018, was one of the largest pilots in English history, covering around 9 % of the population.

Clarifying the concept of avoidable emergency department attendance.

Emergency department attendances are rising in several countries. Many of the policies aimed at reducing emergency department attendances are based on the assumption that a proportion of current utilization is 'avoidable' and therefore could be reduced. In considering how to achieve this aim, it is important to first understand the problem.

Trends in GP incomes in England, 2008-2017: a retrospective analysis of repeated postal surveys.

Background: There is widespread concern over the recruitment and retention of GPs in England. Income is a fundamental consideration affecting the attractiveness of working in general practice.

Aim: To report on trends in average incomes earned by GPs in England, adjusted for inflation and contracted time commitment.

How widespread is working at scale in English general practice? An observational study.

Background: Over the last 5 years, national policy has encouraged general practices to serve populations of >30 000 people (called 'working at scale') by collaborating with other practices.

Aim: To describe the number of English general practices working at scale, and their patient populations.

Design And Setting: Observational study of general practices in England.

The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice.

Background: The handling of laboratory, imaging and other test results in UK general practice is a high-volume organisational routine that is both complex and high risk. Previous research in this area has focused on errors and harm, but a complementary approach is to better understand how safety is achieved in everyday practice. This paper ethnographically examines the role of informal dimensions of test results handling routines in the achievement of safety in UK general practice and how these findings can best be developed for wider application by policymakers and practitioners.

Associations between Extending Access to Primary Care and Emergency Department Visits: A Difference-In-Differences Analysis.

Background: Health services across the world increasingly face pressures on the use of expensive hospital services. Better organisation and delivery of primary care has the potential to manage demand and reduce costs for hospital services, but routine primary care services are not open during evenings and weekends. Extended access (evening and weekend opening) is hypothesized to reduce pressure on hospital services from emergency department visits.

Complexity in the new NHS: longitudinal case studies of CCGs in England.

Objective: The reform in the English National Health Services (NHS) under the Health and Social Care Act 2012 is unlike previous NHS reorganisations. The establishment of clinical commissioning groups (CCGs) was intended to be 'bottom up' with no central blueprint. This paper sets out to offer evidence about how this process has played out in practice and examines the implications of the complexity and variation which emerged.