Introduction: Work-related ill-health and resulting sickness absence is detrimental to the employees themselves, the employer and the national economy as a whole. To reduce the risk of work on health, information about causal factors and sectors at risk must first be gathered. General practice had been referred to as the ‘blind spot’ in occupational health as so little was known about work-related ill-health seen by GPs. The principal aim of this thesis was to estimate the incidence of work-related ill-health in the UK/GB as determined in general practice, to critically compare general practice reporting with other data sources and to evaluate the incidence and sickness absence burden of work-related ill-health. Methods: Data on incident cases of work-related ill-health and sickness absence were collected from GPs reporting to a UK-wide surveillance scheme (The Health and Occupation Reporting network in General Practice (THOR-GP)), and compared to information from other sources. To enable the calculation of incidence rates, THOR-GP population denominator information was gathered and characterised using Census information based on patient and practice postcode. Results were presented as a series of four peer-reviewed published papers and an additional chapter exploring the calculation of incidence rates.Results: The work-related ill-health diagnoses reported by GPs were mainly musculoskeletal (53%) and mental ill-health (30%). Overall, half the cases were issued with sickness certification. The proportion of cases issued with sickness certification differed by diagnosis; 79% of psychological cases had certified time away from work and these conditions were responsible for the majority of sickness absence days certified (56%) however these cases were rarely referred to secondary care (1%). Industries operating within the public and financial sectors had the highest incidence rates of work-related mental ill-health and correspondingly the highest rates of sickness absence. Industries with the highest proportions of self-employment had the lowest rates of sickness absence. When compared to reports from occupational physicians (OPs), GP information was more representative of the employed population of the UK, whereas OP data concentrated on industries covered by occupational health services. Incidence rates based on clinical specialists’ reports were much smaller than GP rates and biased by severity and referral patterns. Rates based on self-reported (SWI) data were higher than GP rates due to greater inclusivity; however diagnoses were unsubstantiated by medical opinion. The THOR-GP population denominator was characterised using approximately a million patient postcodes (and linking these to Census data) from over a hundred GPs. These population estimates compared well with those based on the practice postcode and enabled the calculation of incidence rates of work-related ill-health for this and (with weighting methods) the GB population. Rates of work-related ill-health were highest for those employed within construction and agriculture.Conclusion: This thesis has shown how the systematic collection of work-related ill-health data from GPs adds to the knowledge base about the distribution and determinants of work-related ill-health (and sickness absence) within the UK/GB workforce. This work also contributes to knowledge relating to the ‘primary care denominator problem’ in calculating rates of incidence from general practice.

Yes / Background: Reducing emergency admissions to hospital has been a cornerstone of health care policy. There is little evidence of systematic interventions which achieved this aim across a population. We report the impact on unplanned admissions to hospital through a complex intervention over a 44 month period in Frome, Somerset. Aim: A population health complex intervention of an enhanced model of primary care and compassionate communities to improve population health and reduce emergency admissions to hospital Design: A cohort retrospective study of a complex intervention on all emergency admissions in Frome compared to Somerset from April 2013 to December 2017. Setting: Frome Medical Practice, Somerset Methods: Patients were identified using broad criteria including anyone with cause for concern. Patient centred goal setting and care planning combined with a compassionate community social approach was implemented broadly across the population of Frome. Results: There was a progressive reduction, by 7.9 cases per quarter (95% CI: 2.8, 13.1; p=0.006) in unplanned hospital admissions across the whole population of Frome, over the study period from April 2014 to December 2017. At the same time, there was sharp increase in the number of admissions per quarter, within the Somerset, with an increase in the number of unplanned admissions of 236 per quarter (95% CI: 152, 320; p<0.001). Conclusion: The complex intervention in Frome was associated with highly significant reductions in unplanned admissions to hospital with reduction of healthcare costs across the whole population of Frome

No / This paper reports an evaluation of a counselling service that was introduced into 20 general practices within Bradford City Primary Care Trust. Clinical Outcomes in Routine Evaluation (CORE) Assessment and End of Therapy forms were used to record referral and attendance information along with problems identified and demographic information about clients. There was a large disparity in the number of referrals across practices illustrating a range of influences on take-up of the service. Levels of attrition from referral for counselling to commencing were relatively high (188 invitations: 89 took up counselling). A longitudinal evaluation of outcomes was conducted using the CORE outcome measure and the SF-36 Health Survey Questionnaire. Data was collected at the beginning of counselling, at six months and at 12 months follow-up. We found some indication of positive change relating to severity of problems and ability to engage in social activities. However, evaluators should be aware that high attrition rates can create problems in achieving statistical reliability in contexts where overall population numbers are relatively small and/or the time for data collection is relatively short. In light of the recent growth of counselling within primary care, and the need to evaluate these services, the issues encountered in setting up this counselling service, and in seeking to evaluate it, may be instructive to others. Focus groups with counsellors and practice staff explored the benefits and problems in providing the service within practices.

The purpose of this thesis is to examine the relationship between consultants and general practitioners, particularly as far as hospital in-patient care is concerned. How has the role of each of them evolved? What is the effect of the division between consultants and general practitioners on in-patient care? What is the role of the general practitioner as far as in-patient care is concerned, particularly in general practitioner units? In order to examine these questions the historical origin of the general practitioner and consultant is described, and the results of two surveys are presented. The first survey was carried out in 1970 in a teaching hospital, The Radcliffe Infirmary, Oxford, and is called the Radcliffe Survey. The second was carried out in 1970-71 and consisted of a survey of all medical admissions from one general practice in Wantage to Wantage Hospital and consultant wards in the United Oxford Hospitals; this is called the Wantage Survey. The results of these surveys are used to examine a number of hypotheses. These will be stated in detail, but broadly speaking the aim of the surveys was to try to discover how much hospital care can be provided in a general practitioner hospital as an alternative to consultant care, how the admissions to the two types of hospital are selected and how they differ. Obstetrics is not included in either survey because the role of G.P. obstetric units has been well covered in a number of publications. The Radcliffe Survey was concerned with medical and surgical patients, but it is medical admissions that form the largest part of in-patient care in general practitioner hospitals and, at the same time, the least investigated. Therefore, the Wantage Survey was concerned almost exclusively with medical admissions.

To train to be a general practitioner in the U.K. a doctor must spend two years in hospital training posts and one year in general practice as a general practice registrar (GPR). Concern has been expressed in the literature about both the duration and adequacy of general practice training. A literature review identified that there was limited knowledge of and understanding about the learning experiences of GPRs. The aim of the study was to describe and interpret the learning experiences of GPRs in the South East of Scotland during their year in general practice. The methodology was derived from Denzin's concept of Interpretivism and involved in depth interviews over time with GPRs and thick description to capture and interpret the GPRs learning experiences. Two cohorts of 24 GPRs were recruited, cohort one ran from September 2002 to July 2003 and cohort two from September 2003 to August 2004. The GPRs were interviewed on three occasions during their year. In addition to the interviews six GPR focus groups and six GP trainer focus groups were held over the period December 2002 to September 2003. 21 GPRs in cohort one completed all three interviews and 20 GPRs in cohort two. All the participating GPRs completed at least two interviews. The results were interpreted within the educational concept of the curriculum. Four main curricula were identified during the GPR year: these were the formal, assessment, individual and hidden. Each independently contributed to the GPRs learning and also interacted synergistically at various times during the year. In the last quarter of the year there was a tension between the requirements of the assessment and individual curricula. The individual curriculum which was composed of the GPRs clinical experiences and in particular epiphanies was the main driver of GPR learning. Epiphanies were identified by GPRs as having the most significant impact on their learning. Central to this learning was the contribution of their general practice trainer who supported their learning both through the development of the practice learning environment and the promotion of reflection and self directed learning. GPR learning during the year was an iterative process, which involved a reflective and supported interaction between the GPR, their clinical experiences, epiphanies and their trainer. Through this process the GPRs became self directed and reflective learners and developed individual learning networks which led to changes in the way they practiced medicine. This process also led to the socialisation of their learning and promoted their integration into the culture of working general practice, through which they were exposed to the working realities of life as a general practitioner and these experiences had a critical effect on their future career choice. A number of important policy implications were identified which have implications for the present and future direction of training for general practice. The process of thick description and the longitudinal nature of the study allowed for a new interpretation of the learning experiences of GPRs and added to the knowledge and understanding of how GPRs learn during their training.

As a result of the recent NHS reforms following the white paper, liberating the NHS (Department of Health, 2010a), which subsequently became the Health and Social Care Act 2012, it is clear that primary care, led by GPs, faces a considerable change to how healthcare to the population is delivered. Meeting these challenges proves to be difficult due to the nature of primary care contracting, in that GPs are responsible for their own organisations and are required to reconfigure their organisations accordingly. Due to the traditional structure of primary care, GPs appear to lack skills in business management and leadership. The study gains an understanding of the qualities GPs have, and need, from a business perspective, in relation to primary care management, and further develops a qualities framework for use by both current and future GPs. This has been achieved through a qualitative study making use of both structured and unstructured research methods, with the use of thematic analysis drawing meaning from the data. Findings indicate that doctors who have chosen to become a GP tend to not consider their role as business leaders, and opt to learn these skills while on-the-job, although since the implementation of the recent NHS reforms, newly qualified doctors are undertaking business skills training to support their applications for partnership posts. Findings also indicate that GPs see the need to hold business skills as partners within their own organisations as a necessary evil, but see the need to hold these same skills for their membership of the CCG as unnecessarily imposed. A qualities framework has been developed to support GPs with their need to obtain business management and leadership skills, from a general practice perspective. This maps six key qualities across nine domains, measured through a number of competencies for each mapping. It is recommended that the qualities framework developed as part of this research study is applied in general practice in relation to both organisational development and educational strategy. It is anticipated that this will contribute to both general practice performance and improvements in primary healthcare service delivery, from a general practice perspective.

No description available.

Mini-dissertation'submitted in partial compliance with the requirements for the Master's Degree in Technology: Homoeopathy, Durban Institute of Technology, 2005. / Homoeopathy in South Africa is a relatively new health profession, and there seems to be limited awareness of homoeopathy amongst the public and healthcare authorities. The national health care system in South Africa is currently undergoing major restructuring, with the focus on primary health care. The homoeopathic community needs to reflect on its role in public health care. However, in order to gain acceptance and understanding from other health care professions, meaningful research needs to be conducted. There is an urgent need to investigate the views of conventional health care professionals towards homoeopathy. A survey method was employed to investigate the perceptions of homoeopathy of two major groups in the medical community in the Greater Durban area: General Practitioners (GPs) and pharmacists. The study was carried out by using a questionnaire as a measuring tool. The sample of GPs was drawn from the medical pages of the Durban Telephone Directory (October 2003/2004) and the sample of pharmacists was drawn from the Durban Yellow Pages (October 2003/2004). A total of 484 questionnaires were distributed and a total of 155 responses were received. The percentage of return of questionnaires was 32,02%. The original sample size was 370 for GPs and 114 for pharmacists. A total of 97 GPs and 58 pharmacists responded. The response rate was 26,22% for GPs and 50,87% for pharmacists. / M

Introduction: La dépression est un motif fréquent de consultation en médecine générale. Sa variabilité rend son diagnostic difficile. Un outil diagnostique efficace, stable et ergonomique serait une aide en recherche en médecine générale. L’objectif de cette étude était de trouver un outil consensuel entre médecins généralistes (MG) et psychiatres sur plusieurs pays européens. Méthodes: Une revue systématique de littérature été entreprise pour trouver les outils validés en médecine générale contre le psychiatre. Un consensus selon une RAM en a sélectionné un. Il a été traduit selon une procédure garantissant la stabilité du transfert et l’écologie en médecine générale. Un protocole de validation a été produit pour s’assurer de la conservation des qualités psychométriques. L’étude de validation externe française a été réalisée.Résultats: Sept outils ont été extraits : CESD-R, GDS 5-15-30 questions, PSC-51, HADS, HSCL-25. Les données psychométriques d’efficacité (Se, Sp,VPP, VPN) ont été colligés. La HSCL-25 a été sélectionnée pour ses hautes qualités combinées d’efficacité, de stabilité et d’ergonomie. Elle a été traduite en 9 langues relatives à 3 groupes linguistiques : le grecque, les langues romanes et slaves. L’étude de validation française a prouvé que la forme française de la HSCL-25 (F-HSCL-25) a de hautes performances diagnostiques (Se 59,4%, Sp 91,4%, VPP 69,8%, VPN 86,9%) adaptées à la recherche en médecine générale.Implication: la HSCL-25 est un outil valide et efficace pour le diagnostic de la dépression en soins primaires. Ils pourraient augmenter les performances diagnostiques des MG et favoriser des recherches collaboratives. / Depression is a common reason for consultation in general practice. Its variability makes its diagnosis difficult. An effective, reliable and ergonomic diagnostic tool would be an aid to research in general practice. The aim of this study was to find a consensual tool between general practitioners (GPs) and psychiatrists in several European countries.Methods: A systematic literature review was undertaken to find validated tools in general practice against the psychiatrist. A consensus according to a RAM (RAND/UCLA Appropriateness Method) has selected one. It has been translated according to a procedure guaranteeing the stability and the ecology in general practice. A validation protocol has been produced to ensure the retention of psychometric qualities. The French external validation study was carried out.Results: Seven tools were extracted: CESD-R, GDS 5-15-30 items, PSC-51, HADS, HSCL-25.Psychometric effectiveness data (Se, Sp, VPP, VPN) were collected. The HSCL-25 has been selected for its high combined qualities of effectiveness, reliability and ergonomics. It has been translated into 9 languages relating to 3 linguistic groups: Greek, Romance and Slavic languages. The French Validation Study has proven that the French form of HSCL-25 (F-HSCL-25) has high diagnostic performance (Se 59.4%, Sp 91.4%, VPP 69.8%, and VPN 86.9%) adapted to research in general practice.Implication: HSCL-25 is a valid and effective tool for diagnosing depression in primary care. They could increase the diagnostic performance of GPs and foster collaborative research.

No description available.