British Journal of General Practice

ObjectiveTo describe the impact of the COVID-19 pandemic on safe prescribing, using the PINCER prescribing indicators; to implement complex prescribing indicators at national scale using GP data. DesignPopulation based cohort study, with the approval of NHS England using the OpenSAFELY platform. SettingElectronic health record data from 56.8 million NHS patients general practice records. ParticipantsAll NHS patients registered at a GP practice using TPP or EMIS computer systems and recorded a...

BackgroundThe COVID-19 pandemic has disrupted healthcare activity across a broad range of clinical services. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible. AimsUsing routinely collected data, our aim was to describe changes in the volume and variation of coded clinical activity in general practice in: (i) cardiovascular disease, (ii) diabetes, (iii) mental health, (iv) female and reproductive health, (v)...

BackgroundThe COVID-19 pandemic has had a significant impact on primary care service delivery. With general practice delivering record numbers of appointments and rising concerns around access, funding and staffing in the UK National Health Service, we assessed contemporary trends in consultation rate and mode (face-to-face versus remote). MethodsWe did a retrospective analysis of 9,429,919 consultations by GP, nurse or other health care professional between March 2018 and February 2022 for pat...

ObjectivesWe developed an efficient Research-Ready Data Asset (RRDA) for the Welsh Longitudinal General Practice (WLGP) data within the Secure Anonymised Information Linkage Databank to standardise curation, enhance reproducibility, and facilitate research on primary care trends. Using this, we investigated primary care activity trends during and after the COVID-19 pandemic. MethodsThe RRDA involves cleaning, curation using GP-registration history, and transforming data into a structured, norma...

BackgroundPharmacy First, a national community pharmacy service, launched in January 2024 to improve access to primary care for patients with minor conditions facing backlogs caused by the COVID-19 pandemic. Pharmacies are required to share details about their consultations with general practices. We aimed to describe how and what clinical activity was recorded in general practice during the first year of the service. MethodsWith the approval of NHS England, we conducted a retrospective cohort ...

The COVID-19 pandemic had a substantial impact on healthcare delivery, particularly in general practice. This study aimed to evaluate how dispensing of medications in primary care in Ireland changed following the COVID-19 pandemics onset compared to expected trends. This interrupted time series study used data on medications prescribed in general practice 2016-2022 to patient eligible for state health cover, approximately one third of the population. Dispensing volumes for all therapeutic subgro...

BackgroundThe Additional Roles Reimbursement Scheme (ARRS) was introduced by NHS England in 2020 alongside Primary Care Networks (PCNs) with aims of increasing the workforce and improving patient outcomes. AimDescribe the uptake of direct-patient care (DPC)-ARRS roles and its impact on patients experiences. Design and SettingEcological study using 2020-2023 PCN and Practice workforce data, registered patient characteristics, the General Practice Patient Survey, and the Quality and Outcomes Fra...

AimTo apply the DU90% indicator (the number of unique drugs which make up 90% of a doctors prescribing) to GP practices prescribing in England to examine time trends, practice-level variation, and relationships with practice characteristics MethodThis is an observational cohort study of all general practices in England. It utilises publicly available prescribing data from the National Health Service (NHS) Digital platform for 2013-2017. The DU90% was calculated on an annual basis for each pract...

BackgroundThe migration status of the 9.8 million migrants living in England is not systematically recorded in primary care electronic health records (EHRs). Codelist approaches enable us to create cohorts of individuals who have had a predefined, optional migration-related code (e.g. "refugee") added to their EHR. AimsWe aimed to explore the use of migration-related SNOMED CT codes to inform future research using primary care data. Design and SettingWe used our Open Code Counts tool and R pac...

BackgroundGeneral practitioners (GPs) adapted their work practices rapidly in response to the COVID-19 pandemic. Limited research has explored their perspectives over this time, and factors that may affect their wellbeing. MethodWe conducted a social media analysis of NHS GPs practising in the UK during the COVID-19 pandemic to identify issues which may affect their wellbeing. To identify trends, we assessed 91,034 tweets from 185 GPs on Twitter who posted before and during the pandemic, (Janua...

BackgroundPopulation ageing has led to an increase in multimorbidity and polypharmacy. Some medications may need to be stopped, but patient attitudes towards deprescribing are poorly understood. This study explores attitudes towards (de)prescribing in patients with multimorbidity in the UK primary care. MethodsPatients with multimorbidity were invited to complete the Revised Patients Attitudes Towards Deprescribing (rPATD) Questionnaire using an Evergreen Lifes Personal Health Record App (Manch...

BackgroundStructured Medication Reviews (SMRs) were introduced into primary care in England for patients living with multiple long-term conditions (MLTCs), polypharmacy, increased frailty, in care homes or at risk of medicines-related harm. SMRs aim to optimise the therapeutic potential of medication and reduce medicine-related harms through holistic reviews. AimTo explore the day-to-day work being undertaken with, and by, clinical pharmacists to implement, embed and integrate SMRs into practic...

BackgroundGP practices in Scotland are changing with the emergence of megapractices. We aimed to update analyses of GP practice sizes in Scotland, and to begin the development of a typology of GP practices. MethodsFour methods were employed: 1. Analyses of routinely published data on GP practice sizes and listed GPs to identify and quantify megapractices; 2. Qualitative interviews; 3. Creation of commercial profiles; 4. Derivation of a GP practice typology. ResultsMost Scottish practices have ...

BackgroundReal-world evidence to support the adoption of SARS-CoV-2 point-of-care (POC) tests in primary care is limited. As the first point of contact of the health system for most patients, POC testing can potentially support general practitioners (GPs) quickly identify infectious and non-infectious individuals to rapidly inform patient triaging, clinical management, and safely restore more in-person services. ObjectivesTo explore the potential role of SARS-CoV-2 point-of-care testing in prim...

BackgroundCOVID-19 mandated a rapid and dramatic transformation of general practice. Total Triage (TT), where all consultations should be triaged first, and Remote-by-Default (RbD) consulting, where a clinician should consult remotely unless there is a "clinical exception", were advised. It is unclear how these new ways of working were implemented in practice, and how they impacted vulnerable patients. AimTo assess the impact of TT and RbD on vulnerable patients and identify mitigation strate...

IntroductionContinuous general practitioner (GP) and patient relations associate with positive health outcomes. Termination of GP-practice is unavoidable, while consequences of final breaks in relations are less explored. We will study how an ended GP-relation affects patients health care utilization and mortality, compared to patients with a continuous GP-relation. Methods and analysisLinking personal-level national registries data on GP-affiliation, sociodemographic characteristics, health ca...

ObjectivesThe present study aimed to evaluate the impact of structured medication reviews (SMRs), by examining the proportion of eligible patients who received a review in the first two years of the programme, and whether SMRs were associated with changes in prescribing. DesignRetrospective observational cohort study. SettingPatients registered to primary care practices in England contributing data to the Oxford Clinical Informatics Digital Hub (ORCHID) were included between 1st April 2020 and...

ObjectiveLimited evidence suggests integration of pharmacists into the general practice team could improve medicines management for patients, particularly those with multimorbidity and polypharmacy. This study aimed to develop and assess the feasibility of an intervention involving pharmacists, working within general practices, to optimise prescribing in Ireland. DesignNon-randomised pilot study SettingPrimary care in Ireland ParticipantsFour general practices, purposively sampled and recruit...

BackgroundThe management of the long-term sequelae of COVID-19 infection, known as post-COVID-19 syndrome (PCS), continues to challenge the medical community, largely due to a significant gap in the understanding of its aetiology, diagnosis and effective treatment. AimTo examine general practitioners (GPs) experiences of caring for patients with PCS and to identify unmet care needs and opportunities for improvement. Design and settingThis study follows a qualitative design, using in-depth semi...

Real time access to guidance for physicians has been offered through Rapid Access to Consultative Expertise (RACE) in British Columbia (BC) for the past 12 years. 1 In the context of the novel coronavirus (COVID-19), the service for RACE was expanded to include a Long-COVID RACE line. 1 We report here the types and frequencies of questions asked to General Internal Medicine (GIM) experts in Long-COVID, by general practitioners in BC. 149 calls over an 11-month period were tracked by GIM experts,...