Employment and deployment of additional roles: What works for whom, how and why?

Background Additional Roles Reimbursement Scheme (ARRS) was introduced in England in 2019 to alleviate workforce pressures in general practice by funding additional staff such as clinical pharmacists, paramedics, first contact physiotherapists and from 2024/25, the scheme will fund recently qualified GPs. However, the employment and deployment models of ARRS staff present ongoing complexities and challenges that require further exploration. Aim This study explores the decision-making processes behind Primary Care Networks (PCNs) and general practice staffing choices, and how these choices influence the operationalisation of ARRS.

Special Requirements of Electronic Health Record Systems in Pediatrics: Clinical Report.

Pediatricians' use of electronic health record (EHR) systems has become nearly ubiquitous in the United States, yet many systems lack full functionality to deliver effective and efficient pediatric care. This clinical report seeks to provide a compendium of core pediatric functionality of importance to child health care providers that may serve as the focus for EHR developers and clinicians as they evaluate their EHR needs. Also reviewed are important but less critical functions, any of which might be of importance in a specific pediatric context.

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.

The hidden work of general practitioners: An ethnography.

High quality primary care is a foundational element of effective health services. Internationally, primary care physicians (general practitioners (GPs), family doctors) are experiencing significant workload pressures. How non-patient-facing work contributes to these pressures and what constitutes this work is poorly understood and often unrecognised and undervalued by patients, policy makers, and even clinicians engaged in it.

The patient experience of skill mix changes in primary care: an in-depth study of patient 'work' when accessing primary care.

Background: This paper presents insights into patient experiences of changes in workforce composition due to increasing deployment in general practice of practitioners from a number of different professional disciplines (skill mix). We explore these experiences via the concept of 'patient illness work'; how a patient's capacity for action is linked to the work arising from healthcare.

Methods: We conducted four focus group interviews with Patient Participation Group members across participating English general practitioner practices.

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.

Methods to expose subsurface objects of interest identified from 3D imaging: The intermediate sample preparation stage in the correlative microscopy workflow.

The correlative imaging workflow is a method of combining information and data across modes (e.g. SEM, X-ray CT, FIB-SEM), scales (cm to nm) and dimensions (2D-3D-4D), providing a more holistic interpretation of the research question.

Body Mass Index Increased at a Large Midwestern Children's Hospital During the COVID-19 Pandemic.

The COVID-19 pandemic has presented a great challenge to children and their families with stay-at-home orders, school closures, decreased exercise opportunities, stress, and potential overeating with home confinement. Our study describes the body mass index (BMI) changes over an entire decade, including a year of the COVID-19 pandemic at a large children's hospital. With our retrospective observational study, data were extracted from Cincinnati Children's Hospital's Epic electronic medical record, a free-standing children's hospital with 670 inpatient beds and >1.

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.

Investigating the links between diagnostic uncertainty, emotional exhaustion, and turnover intention in General Practitioners working in the United Kingdom.

Background: General Practitioners (GPs) report high levels of burnout, job dissatisfaction, and turnover intention. The complexity of presenting problems to general practice makes diagnostic uncertainty a common occurrence that has been linked to burnout. The interrelationship between diagnostic uncertainty with other factors such as burnout, job satisfaction and turnover intention have not been previously examined.

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.

User-Centered Evaluation of a Visual Annotation Tool for Rapid Assessment of Pediatric Weight Entry Errors.

Weight entry errors can cause significant patient harm in pediatrics due to pervasive weight-based dosing practices. While computerized algorithms can assist in error detection, they have not achieved high sensitivity and specificity to be further developed as a clinical decision support tool. To train an advanced algorithm, expert-annotated weight errors are essential but difficult to collect.

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.

Primary care workforce composition and population, professional, and system outcomes: a retrospective cross-sectional analysis.

Background: The diversification of types of staff delivering primary care may affect professional, population, and system outcomes.

Aim: To estimate associations between workforce composition and outcomes.

Design And Setting: Cross-sectional analysis of 6210 GP practices from a range of geographical settings across England in 2019.

Development and Evaluation of an Automated Approach to Detect Weight Abnormalities in Pediatric Weight Charts.

Inaccurate body weight measures can cause critical safety events in clinical settings as well as hindering utilization of clinical data for retrospective research. This study focused on developing a machine learning-based automated weight abnormality detector (AWAD) to analyze growth dynamics in pediatric weight charts and detect abnormal weight values. In two reference-standard based evaluation of real-world clinical data, the machine learning models showed good capacity for detecting weight abnormalities and they significantly outperformed the methods proposed in literature (p-value<0.

Consultation patterns and frequent attenders in UK primary care from 2000 to 2019: a retrospective cohort analysis of consultation events across 845 general practices.

Objective: To describe the distribution of consultations at the practice level and examine whether increases are uniform or driven by people who consult more frequently.

Design: Retrospective cohort study.

Setting: UK general practice data from the Clinical Practice Research Datalink (CPRD) GOLD database.

Rates of turnover among general practitioners: a retrospective study of all English general practices between 2007 and 2019.

Objective: To quantify general practitioners' (GPs') turnover in England between 2007 and 2019, describe trends over time, regional differences and associations with social deprivation or other practice characteristics.

Design: A retrospective study of annual cross-sectional data.

Setting: All general practices in England (8085 in 2007, 6598 in 2019).

Animal-human two-shot images: Their out-of-context interpretation and the implications for zoo and conservation settings.

Images containing both animals and humans (two-shot images) are popular across social media and zoo advertising. However, these images, even when taken in ethical and conservation settings, have the potential for misinterpretation and may inadvertently promote the illegal wildlife trade, exotic pet trade or photo-prop industries. We examined whether zoo visitors' (n = 531) attitudes and stated Willingness to Donate (WTD) altered depending on whether they viewed a two-shot image set in a photo-prop setting (typically associated with negative welfare) or in a zoo or wild setting.

Peri-operative Variables Associated With Prolonged Intensive Care Stay Following Cytoreductive Surgery for Ovarian Cancer.

Background: Peri-operative variables associated with prolonged Intensive Care Unit (ICU) admission following cytoreductive surgery for ovarian cancer were investigated.

Patients And Methods: A retrospective review was carried out of patients admitted to the ICU following cytoreductive surgery for ovarian cancer in a single tertiary referral centre from 2015-2019. Patients were categorized according to length of ICU stay (<48 h and ≥48 h), and peri-operative variables were compared across the two groups.

Motivating factors behind skill mix change: results from a practice managers' survey in England.

Background: The expansion of the primary care workforce by employing a varied range of practitioners ('skill mix') is a key component of the General Practice Forward View (GPFV). The extent of skill mix change and where that has occurred has been examined using publicly available practice level workforce data. However, such data does not provide information regarding specific motivating factors behind employment decisions for individual practices nor future workforce plans.

Determinants of primary care workforce variation in England.

Background: The General Practice Forward View (GPFV) outlined how the government plans to attain a strengthened model of general practice. A key component of this proposal is an expansion of the workforce by employing a varied range of practitioners, in other words 'skill mix'. A significant proportion of this investment focuses on increasing the number of 'new' roles such as clinical pharmacists, physiotherapists, physician associates, and paramedics.

Regional variation in practitioner employment in general practices in England: a comparative analysis.

Background: In recent years, UK health policy makers have responded to a GP shortage by introducing measures to support increased healthcare delivery by practitioners from a wider range of backgrounds.

Aim: To ascertain the composition of the primary care workforce in England at a time when policy changes affecting deployment of different practitioner types are being introduced.

Design And Setting: This study was a comparative analysis of workforce data reported to NHS Digital by GP practices in England.