Emergency care access, hospital rotations in GP training, undergraduate GP placements, and communicating test results
Emergency care access
There is a strong association between socioeconomic deprivation and emergency department (ED) utilisation, and patients from deprived areas are more likely to present to EDs with lower acuity problems. This UK study aimed to assess how deprivation influences referral pathways to EDs and how these pathways affected subsequent outcomes.1 Compared to the least deprived, patients from the most deprived areas were more likely to arrive via ambulance and less likely to be referred by a GP or 111. Referral source and not deprivation was associated with subsequent ED outcomes including admissions, unplanned returns, and 4-hour breaches: those who presented via GP or 111 were admitted less, had fewer unplanned returns, shorter ED stays, and fewer breaches. The authors therefore suggest that ‘much of the observed inequality in hospital service performance is shaped before ED presentation, particularly through differential access to and engagement with primary or urgent care services.’
Hospital rotations in GP training
Readers will have wide-ranging views on the value of hospital rotations in GP training, likely driven by the quality of the jobs they endured or enjoyed. I personally had a mixed bag but feel hospital jobs can profoundly influence the way we view the healthcare system and our place within it as GPs. This scoping review aimed to map out the literature on strengths, issues, and concerns regarding hospital rotations in GP training.2 Of the 31 articles included, the majority focused on registrars’ experiences of hospital rotations. Structured education and relevance to primary care were crucial, as were the quality of supervision and a sense of belonging. Ongoing contact with primary care during hospital placements to contextualise and apply knowledge within primary care settings was felt to be particularly beneficial in the form of scheduled returns to practice during hospital posts or regular release from posts to attend GP teaching. The balance between service provision and educational attainment was, as in any training programme, a difficult balance.
Undergraduate GP placements
With medical school places continuing to increase, teaching capacity in primary care needs to keep up, particularly as primary care experience during medical school influences subsequent choices to go into general practice. This UK mixed-methods survey study of general practices in England including participants from 30 of 42 integrated care systems explored factors influencing practices’ decisions around whether to engage with undergraduate medical placements.3 Estates within general practice was the most frequently described issue, particularly for practices also accommodating ARRS staff and postgraduate registrars, whose numbers are also increasing. The impact on GP workload and lack of available time were barriers, though views on whether reimbursement was adequate were mixed. Responders questioned the design of GP placements and assessments that had to be completed were excessive and burdensome. This is an important study for medical schools to read.
Communicating test results
With patient portals including the NHS app allowing patients direct access to their test results, there needs to be careful thought about how these results are communicated by GPs. This qualitative study in Dutch general practice interviewed GPs to explore their experiences and challenges in communicating test results to patients.4 Clear pre-test communication of possible outcomes, and when and how results will be conveyed was key in simplifying subsequent communication and managing patient expectations. While digital platforms could make communication more efficient, they could also lead to patient questions and uncertainty, which may require further contacts to provide clarification and reassurance. This was particularly true for radiology reports using complex medical language, and clinically insignificant findings.
Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature
