Attitudes on cost-effectiveness and equity: viewpoints of medical professionals

The aim of this study is to determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making | BMJ Open

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Cost-effectiveness analysis does not accurately reflect the importance that medical professionals place on equity. Among medical professionals, practising physicians appear to be more egalitarian than residents-in-training, while medical students appear to be most utilitarian and cost-effective. Meanwhile, female respondents in all three cohorts favoured the more equitable option to a greater degree than their male counterparts. Healthcare policies that trade off equity in favour of cost-effectiveness may be unacceptable to many medical professionals, especially practising physicians and women.

Full reference: Li, D.G. et al. (2017) Attitudes on cost-effectiveness and equity: a cross-sectional study examining the viewpoints of medical professionals. BMJ Open 7:e017251.

The Recruitment, Retention And Return Of Nurses To General Practice Nursing In England

This report, authored by Ipsos MORI, outlines the findings of qualitative research into the drivers and barriers to entry into general practice nursing (GPN) | NHS England

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It finds that the general perception is that general practice is more suitable for older or more experienced nurses. As student placements in general practice are rare, there is a lack of opportunity for students to develop an understanding of the GPN role. The research also highlights the need for greater support for GPNs and the lack of standardisation in pay for GPN roles.

GP Forward View falling short on workforce but it is still the lifeline general practice needs

NHS England’s General Practice Forward View is falling short in its pledge to build the GP workforce by 5,000 more full-time equivalent family doctors by 2020, the Royal College of GPs has concluded today | RCGP

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Image source: RCGP

The College’s Annual Assessment of the plan, that was launched in April 2016, recognises that NHS England is making progress in delivering many of its approximately 100 pledges – and that the commitment to spend an additional £2.4 billion each year on general practice by 2020/21 is on track.

But the College’s analysis, based on the most up to date statistical and member feedback, raises concerns that the GP Forward View is not having the positive impact on frontline general practice and patient care to the extent and with the speed that is needed.

Today’s report follows an interim assessment by the College, published in January, that found whilst progress is being made, national ambition was not being matched by local delivery and many GPs had yet to see significant change.

Enhancing Patient Safety Through Physician Health and Well-being Research.

Keeping medical practitioners healthy is an important consideration for workforce satisfaction and retention, as well as public safety | Journal of Patient Safety

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However, there is limited evidence demonstrating how to best care for this group. The absence of data is related to the lack of available funding in this area of research. Supporting investigations that examine physician health often “fall through the cracks” of traditional funding opportunities, landing somewhere between patient safety and workforce development priorities. To address this, funders must extend the scope of current grant opportunities by broadening the scope of patient safety and its relationship to physician health. Other considerations are allocating a portion of doctors’ licensing fees to support physician health research and encourage researchers to collaborate with interested stakeholders who can underwrite the costs of studies. Ultimately, funding studies of physician health benefits not only the community of doctors but also the millions of patients receiving care each year.

Full reference: Brooks, E. et al. (2017) Investing in Physicians Is Investing in Patients: Enhancing Patient Safety Through Physician Health and Well-being Research. Journal of Patient Safety: Published online: July 20, 20.7

New framework to promote person-centred approaches in healthcare

Skills for Health, Health Education England and Skills for Care have announced a new Framework to support person-centred approaches for the health and social care workforce | Skills for Health

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Image source: Skills for Health

This approach, outlined in the Five Year Forward View, puts people, families and communities at the heart of health, care and wellbeing. It encourages people to speak with staff about what is important to them, helping to develop a shared understanding of what matters to them.

The new framework, commissioned by Health Education England, helps workers communicate meaningfully both verbally and non-verbally, tailoring the care and advice they give to suit peoples’ needs. It supports individuals to better manage their own health and wellbeing through bespoke care, planning and support. Where appropriate, the framework encourages shared decision making, outlining all reasonable options and ensuring that all information is personalised, accessible and useful.

General Practice Nursing – Developing confidence, capability and capacity

This Ten Point Action Plan for General Practice Nursing, describes the nursing element of the General Practice Forward View (GPFV) | NHS England

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Image source: NHS England

The GPN ten point action plan sets out the measures required to bring about the changes that are needed, which will be taken forward by NHS England, Health Education England, NHS Improvement, Public Health England, The Royal College of Nursing, The Royal College of General Practitioners, The Queens Nursing Institute and The British Medical Association. These organisations will support commissioners and providers to implement the actions at local level. Delivery of this Ten Point Action Plan at a local level will be supported by one of four Regional GPN Delivery Boards.

General practice at scale and new care models provide fresh opportunities for supporting general practice nurses to develop skills and advance their careers. This will assist recruitment and retention which will in turn ease GPs’ workload as well as improving the experience of care for individuals, the outcomes of care and treatment, the use of NHS resources and staff experience.

Practical value in the NHS

The King’s Fund has previously highlighted the fact that addressing waste and variability in clinical work can create better value in the NHS. But what does value mean to people working in the NHS – and how it is being applied in practice? | The King’s Fund Blog

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‘Value’ sounds like a familiar concept but it can mean different things to different people. One definition of value in the health and care sector is ‘health outcomes per dollar spent’, so attempts to increase value can look at either improving quality or reducing cost.

In early July we held a roundtable discussion with health service providers to better understand their approach to value improvement – initial research for a new project intended to understand the practical barriers and challenges that frontline clinical, operational and managerial leaders have encountered in pursuing better value health care. Experts who attended – including a chairman, chief executive, chief nurse, deputy chief operating officer, change leader, and representatives of national bodies – agreed that the emphasis should be on patient care. Clinicians are more likely to engage in a programme that revolves around the quality of services, and better care is typically less wasteful, so as one participant put it, ‘if you focus on quality, money will fall out’ [spending will reduce]. Consultants will often drive through successful programmes with change management teams, but we also discussed the role of junior doctors, nurses and therapists, who frequently witness low-value care and understand how to fix it. We know that substantial changes in practice can be delivered as we have seen, for example, in generic prescribing, reduced length of stay and the move towards day case surgery.

Read the full blog post here