Cancer diagnostic tools to aid decision-making in primary care:

Cancer diagnostic tools to aid decision-making in primary care: mixed-methods systematic reviews and cost-effectiveness analysis
Health Technol Assess 2020;24(66) November 2020

• Systematic reviews to examine the clinical effectiveness and the development, validation and accuracy of diagnostic prediction models for aiding general practitioners in cancer diagnosis identified little good-quality evidence. Many diagnostic prediction models are limited by a lack of external validation. 
• A survey of general practitioners/ practice level staff found that cancer decision support tools were available in 83 out of 227 practices, and were likely to be used in 38 out of 227 practices.

Emergency admission risk stratification tools in UK primary care: a cross-sectional survey of availability and use.

Emergency admission risk stratification tools in UK primary care: a cross-sectional survey of availability and use.
Br J Gen Pract. 2020 Oct 1;70(699):e740-e748. doi: 10.3399/bjgp20X712793. PMID: 32958534; PMCID: PMC7510844.

• To describe availability and use of Emergency admission risk stratification (EARS) tools across the UK, and identify factors perceived to influence implementation. An online survey identified 39 different EARS tools in use. Nearly 40% of areas using EARS tools reported introducing or realigning services as a result, but relatively few reported use for service evaluation.

Quality and Outcomes Framework, 2019-20

Quality and Outcomes Framework, 2019-20
NHS Digital 20 August 2020

• The recorded prevalence of 21 conditions, including asthma, hypertension, dementia, diabetes, and depression as recorded by GPs in QOF for the reporting year 1 April 2019 to 31 March 2020.

How to enhance the integration of primary care and public health? Approaches, facilitating factors and policy options

How to enhance the integration of primary care and public health? Approaches, facilitating factors and policy options
European Observatory on Health Systems and Policies 2020

• This policy brief explores how primary care and public health can be brought together to improve the health of patients and populations. It describes the types of initiatives that have been undertaken; provides examples of such initiatives in Europe and beyond; and summarises the factors that can help to enhance or hinder the integration of primary care and public health.

Collecting rapid COVID-19 intelligence to improve primary care response

Collecting rapid COVID-19 intelligence to improve primary care response
NIHR ARC West

• The aim of this project is to identify the changing demands on GP practices across Bristol, North Somerset and South Gloucestershire during the COVID-19 pandemic and investigate common challenges and innovative solutions that practices have devised to cope with this.
• Researchers are publishing a series of regular reports summarising findings. Early reports:
• Project Summary Report 1-5 June 2020 (PDF) This first summary report presents qualitative findings from 22 interviews held with GPs and managers from 14 GP practices between 13 and 17 May 2020. There is a sub-section on new consultation models implemented in this report
• Project Summary Report 2-19 June 2020 (PDF) This second summary report presents qualitative findings from 23 interviews held with GPs and managers from 20 GP practices between 28 May and 13 June 2020. There is a sub-section on perceived impact on health inequalities in this report.

Reorganisation of primary care for older adults during COVID-1

Reorganisation of primary care for older adults during COVID-19: a cross-sectional database study in the UK
British Journal of General Practice 13 July 2020; bjgp20X710933. https://doi.org/10.3399/bjgp20X710933

• Data on consultations [n=3 851 304] between 17 February and 10 May 2020 for patients aged ≥65 years drawn from primary care practices within the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network, UK.
• Overall, the rate of consultations dropped by 27.1%. Face-to-face consultations fell by 64.6% and home visits by 62.6%. Telephone and electronic/video consultations made up 18.4% (17.9% teleconsultations, 0.5% electronic/video consults) of appointments in week 8, compared with 56.6% (55.1% teleconsultations, 1.5% electronic/video consultations) of appointments by week 14.
• "There was a high degree of inter-practice variation in terms of adoption of remote consultation means, and considerable unexplained variation within the current model. Categorisation of consultation type relies on how this has been recorded within the original dataset. This may lead to inaccuracies, for example, where a clinician changes between type but does not record the switch."

Abstract

A COVID-19 Risk Assessment Decision Support System for GPs

A COVID-19 Risk Assessment Decision Support System for General Practitioners: Design and Development Study

J Med Internet Res 2020 Jun 29;22(6):e19786. doi: 10.2196/19786.

• The aim of this study is to design, develop, and deploy a mobile-based decision support system for COVID-19 (DDC19) to assist GPs in collecting data, assessing risk, triaging, managing, and following up with patients during the COVID-19 outbreak.

Abstract

How to enhance the integration of primary care and public health?

How to enhance the integration of primary care and public health? Approaches, facilitating factors and policy options
European Observatory on Health Systems and Policies 2020

• This policy brief explores how primary care and public health can be brought together to improve the health of patients and populations. It describes the types of initiatives that have been undertaken; provides examples of such initiatives in Europe and beyond; and summarises the factors that can help to enhance or hinder the integration of primary care and public health.

Health workers’ perceptions and experiences of using mHealth technologies to deliver primary healthcare services

Health workers’ perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis.
Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD011942. DOI: 10.1002/14651858.CD011942.pub2.

• This review explores how health workers view and experience the use of mobile phones and tablets when delivering primary healthcare services. Researchers analysed 43 studies (published to January 2018) about health workers' views and experiences of mobile health (mHealth) programmes.
• Researchers have moderate or high confidence in the following findings.
• mHealth changed how health workers worked with each other
• mHealth changed how health workers delivered care
• mHealth led to new forms of engagement and relationships with clients and communities
• Health workers' use and perceptions of mHealth could be influenced by factors tied to costs, the health worker, the technology, the health system and society, poor network access, and poor access to electricity
• Listen to the podcast discussing the findings. 

Digital Primary Care workspace

Digital Primary Care

• A workspace on the FutureNHS collaborative platform [Registration required]

Covid-19: a remote assessment in primary care

Covid-19: a remote assessment in primary care
BMJ 2020; 368:m1182 25 March 2020 doi: https://doi.org/10.1136/bmj.m1182

• This article by Trish Greenhalgh et al presents some guiding principles on how to choose between telephone and video appointments, how to conduct a “query covid” consultation remotely, and considerations when arranging follow-up and next steps. Includes an infographic for use in primary care.

Video consultations for covid-19
BMJ 2020;368:m998, 12 March 2020doi: https://doi.org/10.1136/bmj.m998

• This editorial by Trish Greenhalgh et al discusses the opportunities for video consultation in the light of the covid-19 pandemic.

Realising digital-first primary care: Shaping the future of UK healthcare

Realising digital-first primary care: Shaping the future of UK healthcare
Deloitte February 2020

• This report focuses on digitalisation of primary care and discusses the current state, challenges and potential of digital transformation in general practice. It highlights the key steps needed to improve the adoption of technology by patients, practitioners and the wider healthcare system. The over-riding message is clear: if primary care is to survive and thrive, it has to make the most of technology.

The Effect of Assessing Genetic Risk of Prostate Cancer on the Use of PSA Tests in Primary Care: A Cluster Randomized Controlled Trial
PLoS Med, 17 (2), e1003033 7 February 2020 DOI: 10.1371/journal.pmed.1003033

• A small RCT (73 in each arm) carried out in USA concludes that providing GPs with access to a genetic test to assess lifetime risk of prostate cancer did not reduce the overall number of future PSA tests. However, among men who had a genetic test, knowledge of genetic risk significantly influenced future PSA testing.

Abstract

Informing NHS policy in 'digital-first primary care': a rapid evidence synthesis.

Informing NHS policy in 'digital-first primary care': a rapid evidence synthesis.
Health Serv Deliv Res 2019;7(41) December 2019

• Evidence suggests that uptake of existing digital modes of engagement is currently low. Patients who use digital alternatives to face-to-face consultations are likely to be younger, female and have higher income and education levels. There is some evidence that online triage tools can divert demand away from primary care, but results vary between interventions and outcome measures. A number of potential barriers exist to using digital alternatives to face-to-face consultations, including inadequate NHS technology and staff concerns about workload and confidentiality. There are currently insufficient empirical data to either substantiate or allay such concerns. Very little evidence exists on outcomes related to quality of care, service delivery, benefits or harms for patients, or on financial costs/cost-effectiveness. No studies examining how to contract and commission alternatives to face-to-face consultations were identified.

New social media techniques used to boost cancer screening rates

New social media techniques used to boost cancer screening rates
NHS Digital 29 October 2019

• Around 350 General Practice nurses and other practice staff have so far been trained in adopting technology to become Digital Health Champions as part of NHS Digital’s Widening Digital Participation projects, including learning how social media can help promote practice services.
• Watch the video case study here

How GPs designed new frailty models during population health pilot

How GPs designed new frailty models during population health pilot [blog]
NHS England 12 September 2019

• Dr Yasara Naheed, Clinical Director for Burnley East Primary Care Network discusses designing new frailty models as part of the NHS England Population Health Management (PHM) programme.
• The aim was to develop  with data analysts, public health, communication, council and finance colleagues, a data driven approach to map out detailed patient stories, lived experience and the possible impacts of interventions which can be used by the practice team.
• The work resulted in the introduction of three simple interventions to support patients with long terms conditions and with moderate frailty. 

Five tips for successfully leading a primary care network

Five tips for successfully leading a primary care network
Kings Fund 12 September 2019

• Based on their work supporting PCN development the Kings Fund offer five suggestions to support these new organisations and leaders:
• Develop a shared vision and direction
• Develop the skills to improve conversations
• Find the allies in your system
• Set up small shared projects
• Find personal support

Negotiating commissioning pathways for the successful implementation of innovative health technology in primary care

Negotiating commissioning pathways for the successful implementation of innovative health technology in primary care
BMC Health Services Research (2019) 19:648

• A case study exploring the commissioning considerations for a new photoplethysmography-based diagnostic technology for peripheral arterial disease in primary care in the UK. The evidence illustrates how reconfigurations of inter-organisational relations, and of clinical and related work practices required for the successful implementation of a new technology could become the major challenge in commissioning negotiations.

Abstract

Digital-First Primary Care Policy

Digital-First Primary Care Policy: consultation on patient registration, funding and contracting rules
NHS England 27 June 2019

• This document describes the proposals to reform patient registration, funding and contracting rules to ensure patients have both choice as well as access to integrated care; and to harness the potential of digital providers to help with our workforce shortages in a way that helps our most under-doctored and deprived communities. It sets out options and proposals for reform and invite views.
• Consultation closes 23 August 2019

GP at Hand evaluation

GP at Hand evaluation
Ipsos Mori and York Health Economics Consortium for Hammersmith & Fulham CCG 23 May 2019

• GP at Hand is a primary care practice that incorporated a ‘digital-first’ service model into an existing practice in 2017. The practice operates in North West London, commissioned through a GMS contract through NHS Hammersmith and Fulham CCG. The practice now offers a ‘digital-first’ model of primary care, primarily through use of a mobile app and video consultations provided by their subcontractor, Babylon.
• This evaluation discusses the impact of GP at Hand on registered patients, on the wider health system and on the workforce.
• Press: Digital Health 29 May 2019: Funding model for GP at Hand ‘not appropriate’, Ipsos Mori review finds