The nursing associate role was first deployed in England in 2019 to fill a perceived skills gap in the nursing workforce between healthcare assistants and registered nurses and to offer an alternative route into registered nursing. Initially, trainee nursing associates were predominantly based in hospital settings; however, more recently, there has been an increase in trainees based in primary care settings. Early research has focussed on experiences of the role across a range of settings, particularly secondary care; therefore, little is known about the experiences and unique support needs of trainees based in primary care.

To explore the experiences and career development opportunities for trainee nursing associates based in primary care.

This study used a qualitative exploratory design. Semi-structured interviews were undertaken with 11 trainee nursing associates based in primary care from across England. Data were collected between October and November 2021, transcribed and analysed thematically.

Four key themes relating to primary care trainee experiences of training and development were identified. Firstly, nursing associate training provided a ‘valuable opportunity for career progression’. Trainees were frustrated by the ‘emphasis on secondary care’ in both academic content and placement portfolio requirements. They also experienced ‘inconsistency in support’ from their managers and assessors and noted a number of ‘constraints to their learning opportunities’, including the opportunity to progress to become registered nurses.

This study raises important issues for trainee nursing associates, which may influence the recruitment and retention of the nursing associate workforce in primary care. Educators should consider adjustments to how the curriculum is delivered, including primary care skills and relevant assessments. Employers need to recognise the resource requirements for the programme, in relation to time and support, to avoid undue stress for trainees. Protected learning time should enable trainees to meet the required proficiencies.

The deployment of (Trainee) Associate Psychological Practitioners (T/APPs) to deliver brief psychological interventions focusing on preventing mental health deterioration and promoting emotional wellbeing in General Practice settings is a novel development in the North West of England. As the need and demand for psychological practitioners increases, new workforce supply routes are required to meet this growth.

To evaluate the clinical impact and efficacy of the mental health prevention and promotion service, provided by the T/APPs and the acceptability of the role from the perspective of the workforce and the role to T/APPs, patients and services.

A mixed-methods design was used. To evaluate clinical outcomes, patients completed measures of wellbeing (WEMWBS), depression (PHQ-9), anxiety (GAD-7) and resilience (BRS) at the first session, final session and at a 4–6 week follow-up. Paired-samples t-tests were conducted comparing scores from session 1 and session 4, and session 1 and follow-up for each of the four outcome measures. To evaluate acceptability, questionnaires were sent to General Practice staff, T/APPs and patients to gather qualitative and quantitative feedback on their views of the T/APP role. Quantitative responses were collated and summarised. Qualitative responses were analysed using inductive summative content analysis to identify themes.

T-test analysis revealed clinically and statistically significant reductions in depression and anxiety and elevations in wellbeing and resiliency between session 1 and session 4, and at follow-up. Moderate–large effect sizes were recorded. Acceptability of the T/APP role was established across General Practice staff, T/APPs and patients. Content analysis revealed two main themes: positive feedback and constructive feedback. Positive sub-themes included accessibility of support, type of support, patient benefit and primary care network benefit. Constructive sub-themes included integration of the role and limitations to the support.

The introduction of T/APPs into General Practice settings to deliver brief mental health prevention and promotion interventions is both clinically effective and acceptable to patients, General Practice staff and psychology graduates.

No previous studies have been found focusing on the long-term development of beliefs about health, illness and healthcare in migrant women with gestational diabetes mellitus (GDM). The aim of this study was to explore this and the influence on health-related behaviour (i.e. self-care and care seeking) in migrant women from the Middle East living in Sweden seven years after delivery.

GDM is increasing, particularly in migrant women. The risk of adverse outcomes of GDM for health can be improved by interventions reducing blood glucose and lifestyle modifications which medicalise the woman’s pregnancy due to intensive follow-up and demanding self-care. The reactions might have an enduring impact on the women’s long-term psychological and physical health and adoption of preventive health behaviours.

Qualitative exploratory study. Semi-structured follow-up interviews 7 years after delivery with women previously interviewed in gestational weeks 34–38 and 3 and 14 months after delivery. Data analysed with qualitative content analysis.

Health meant freedom from illness, feeling well and living long to be able to care for the children. The present situation was described either positively, changing to a healthier lifestyle, or negatively, with worries about being affected by type 2 diabetes. Beliefs changed among the majority of women, leading to a healthier lifestyle, and they looked positively back at the time when diagnosed and their reactions to it. With few exceptions, they were confident of being aware of future health risks and felt responsible for their own and their children’s health/lifestyle. None except those diagnosed with type 2 diabetes had been in contact with healthcare since the last follow-up a year after delivery. Yet, they still would like and need a healthcare model delivering more information, particularly on developing a healthy lifestyle for children, and with regular check-ups also after the first year after delivery.

Family practice aims to recognize the health problems and needs expressed by the person rather than only focusing on the disease. Documenting person-related information will facilitate both the understanding and delivery of person-focused care.

To explore if the patients’ ideas, concerns and expectations (ICE) behind the reason for encounter (RFE) can be coded with the International Classification of Primary Care, version 2 (ICPC-2) and what kinds of codes are missing to be able to do so.

In total, 613 consultations were observed, and patients’ expressions of ICE were narratively recorded. These descriptions were consequently translated to ICPC codes by two researchers. Descriptions that could not be translated were qualitatively analysed in order to identify gaps in ICPC-2.

In all, 613 consultations yielded 672 ICE expressions. Within the 123 that could not be coded with ICPC-2, eight categories could be defined: concern about the duration/time frame; concern about the evolution/severity; concern of being contagious or a danger to others; patient has no concern, but others do; expects a confirmation of something; expects a solution for the symptoms without specification of what it should be; expects a specific procedure; and expects that something is not done.

Although many ICE can be registered with ICPC-2, adding eight new categories would capture almost all ICE.

The one-year prevalence of diagnosed nonspecific back pain in Sweden is not known. Thus, this observational register-based study aimed to evaluate this prevalence by using data from the Region Västra Götaland, inhabiting 1.7 million people.

Data from 2014 to 2018 were extracted from the VEGA database register. This register holds all health data from the publicly funded health care establishments in Region Västra Götaland. Aggregated data are presented as the one-year prevalence of unique individuals diagnosed with nonspecific back pain (i.e., the ICD-10 code M54). Stratification by health care level, gender, age, and M54 sub-diagnoses were made.

Between 2014 and 2018, the annual prevalence of diagnosed nonspecific back pain in public primary health care increased from 4.8% to 6.0% (26% increase, P < 0.001, CI 25–27%). In 2018, the one-year prevalence was 7.2% among women and 4.8% among men (50% difference, P = 0.001, CI 49–52%). The one-year prevalence increased by age, and the highest figure (11%) was seen in the age group of 80–84. Low back pain, M54.5, was the most common sub-diagnosis. The one-year prevalence was significantly higher (P < 0.001) among women in all the M54 sub-diagnoses.

The one-year prevalence of diagnosed nonspecific back pain was 6% in public primary health care in 2018 and has increased since 2014. Women were diagnosed considerably more frequently than men. Publicly funded rehabilitation efforts, as well as actions focusing on the prevention of back pain, is probably money well spent.

Spirometry is known to be a gold standard for the diagnosis of chronic obstructive pulmonary disease (COPD). COPD Assessment Test (CAT) is an eight-item questionnaire currently in use to evaluate patients with COPD. In the present study, we aimed to evaluate if CAT is an adequate tool for screening COPD.

In total, 600 persons aging ⩾40 years old were randomly selected from three different family practice units located in the city center. CAT was asked to the participants and a spirometry was used to assess pulmonary obstruction. Pulmonary obstruction was defined as forced expiratory volume in first second/forced vital capacity (FEV1/FVC)<70% and then COPD diagnosis was confirmed with the reversibility test. The relationship between CAT results and pulmonary function test values was evaluated.

In this sampling, the prevalence of COPD was 4.2%. Reliability of the CAT in the study group was acceptable (Cronbach’s α: 0.84). The CAT scores was significantly higher in patients with COPD (P<0.001). There was a significant negative correlation between CAT score and FEV1, FVC and FEV1/FVC ratio (r=−0.31, P<0.001; r=−0.26, P<0.001; r=0.18, P=0.001). Among smokers, phlegm was the predominating symptom (P=0.01). Sensitivity of CAT was 66.67% and its specificity was 75.15% to determine COPD.

CAT is a reliable questionnaire and there is an apparent relationship between the total CAT scores and COPD. However, CAT’s ability to screen COPD is limited since it may miss the symptom-free cases.

To suggest how to improve primary epilepsy care by assessing the strengths and weaknesses of epilepsy care in general practice by reviewing practice records in relation to qualities and outcomes framework (QOF) indicators and epilepsy guidelines.

Concerns have been raised about epilepsy care in the UK. The general practice QOF indicators offered the first opportunity to take on structured epilepsy care in the UK. The QOF includes targets for this condition and national guidelines list key priorities to improve care. This study explores how general practice systems are delivering this care.

A case notes review in 27 practices in the north-east of England. Adults with epilepsy were identified from practice morbidity registers and a READ code search. Data from 1333 patients were collected on the frequency and location of epilepsy review, type of epilepsy and classification of seizures, epilepsy medication ordering, and individual and practice demographic data. The data were entered into SPSS for frequency analysis and grouped for further analysis: Primary Care Trust (PCT), age and medication ordering groups (satisfactory, moderate or poor).

Of the patients, 24% did not have a record of type of epilepsy and about a third of patients had no seizure classification recorded. One-fifth of patients were not reviewed in the previous year but of those who were, the majority were seen in general practice. Seizure frequency was not recorded in the last 12 months in one-quarter of patients. Adherence and recording of seizure information were related to age of patient. Epilepsy registers were inaccurate. The findings suggest that epilepsy care can be improved by using review and monitoring systems to ensure a complete and accurate epilepsy register and appropriate annual clinical and medication review.

Cardiovascular disease (CVD) is the leading cause of death for Chinese migrants around the world. Chinese CVD patients rely heavily on their native Chinese language, cultural values and beliefs, which adds challenges for the healthcare providers to offer primary healthcare services with standard protocol. The inappropriate treatment could lead to life loss, mistrust in doctor-patient relationship and heavy burden for healthcare funding.

28 participants were included for focus group study with the grounded theory methodology.

There is considerable misunderstanding among the Chinese community about the role of primary care doctors in the treatment of cardiovascular disease resulting in the variable use of primary care services.

Chinese CVD patients or identified risk factors for CVD arguably need closer management, culturally sensitive advice, support and robust follow-up compared to the general population. Doctors and nurses should enhance their practice and give them confidence in their interaction with Chinese patients on the basis of how they think and behave in relation to help seeking.

This study aimed to explore the ability of sexual health nurses working in the South West of England, to implement new learning within existing sexual health service delivery models. Drawing on Lipsky’s account of street-level bureaucracy to conceptualise policy implementation, the impact of workforce learning on the development of integrated services across this region of the United Kingdom was assessed.

In order to achieve the United Nations’ goal of universal access to sexual health, it is essential for reproductive and sexual health, including HIV provision, to integrate into a single service. This integration requires a commitment to collaboration by service commissioners and an alignment of principles and values across sexual health and contraceptive services. UK health policy has embraced this holistic agenda but moves towards integrating historically separate clinical services, has presented significant workforce development challenges and influenced policy success.

Employing a qualitative approach, the study included data from semi-structured telephone interviews and focus groups, and longitudinal data from pre- and post-intervention surveys, collected between September 2013 and September 2015. Data were collected from 88 nurses undertaking a workforce development programme and six of their service managers. Data were analysed using thematic analysis to identify consistent themes.

Nurses confirmed the role of new learning in enabling them to negotiate the political landscape but expressed frustration at their lack of agency in the integration agenda, exposing a clear dichotomy between the intentions of policy and the reality of practice. Nevertheless, using high levels of professional judgement and discretion practitioners managed the incongruence between policy and practice in order to deliver integrated services in the interests of patients. Workforce education, while essential for the transition to the delivery of integrated services, was insufficient to fulfil the sexual health agenda without a strengthening of public health.

To evaluate a medicines reablement initiative involving health and social care, to include consideration of the training package, proportion of patients reabled successfully, and patient and staff perspectives of the service.

Intermediate care services provide short-term intervention to support patients with chronic conditions transition from hospital to community-based services and involves maximising patients’ independence through reablement. The term ‘medicines reablement’ describes the process of rehabilitating patients to be independent with their medication.

Pharmacy technicians led the medicines reablement initiative. They delivered a competency-based training programme for frontline health and social care staff. They assessed and set goals with patients to facilitate independence in self-administration of their medication. The pharmacy technicians provided on-going support to staff helping patients to reable. They reassessed patients after six weeks to determine if medicines reablement had been successful or whether further input was needed. Data were collected by means of a questionnaire and semi-structured interviews with pharmacy technicians, frontline staff, managers, and patients.

Twenty per cent of patients discharged from hospital to intermediate care were assessed to be suitable for medicines reablement. Of these patients, 44% were successfully reabled and a further 25% benefited from the input of a pharmacy technician. Patients and staff were positive about medicines reablement, emphasising the importance of patients attaining independence for self-administration of medication. Although following training, health and social care staff felt confident in facilitating medicines reablement they valued on-going access to pharmacy technicians for timely support, help with problem solving, and advice throughout the reablement process.

Medicines reablement can lead to patients becoming independent with taking medication and contribute to staff satisfaction. Pharmacy technicians can play an important part in delivering medicines reablement training to frontline staff and overseeing the reablement process. Further research examining medicines reablement is needed to develop a stronger evidence base.

The Unified Health System (SUS) is the Brazilian set of public health services that offers global access to health care and disease treatments for all citizens. These services have been evaluated by means of a national survey assessing the users’ perceptions.

To explore and characterize the SUS users’ perceptions regarding primary dental team practices in the five Brazilian geographical regions.

Descriptive study. The sample consisted of 37 262 subjects. Data were collected by means of the Ministry of Health survey, conducted between 2012 and 2014. Variables used in the present study are associated with SUS users’ perspectives of satisfaction, access, and use of services. The study utilized bivariate data analysis, and dichotomous variables were derived for analysis following 95% reliability.

This study observed similarities and proportionality of perceptions in the Brazilian territory. In most macro-regions, dental teams did not develop an active search for dental treatment absentees. However, the SUS users reported very good and good perceptions, which were homogeneously distributed across five Brazilian regions, thereby showing an overall positive perception of primary dental treatment.

To determine whether a community-based, multidisciplinary team consisting of home-based caregivers and supervised students could improve the functional status and quality of life of patients living with chronic obstructive pulmonary disease (COPD) in a low-income, peri-urban setting in South Africa.

This was a quasi-experimental study conducted over three months. Attention was paid to health literacy, inhaler technique, respiratory conditioning and nutrition.

Health literacy was poor and most patients were not using their inhalers correctly. Five of 12 patients found exercising challenging and withdrew from the study early. In the remaining seven patients, statistically significant improvements in FEV1%, and quality of life scores were seen at three months. Improvements in exercise tolerance and BODE prognostic index did not reach statistical significance.

A home-based multidisciplinary student team can improve the functional status and the quality of life in patients living with COPD in a low-income setting. This approach offers a suitable model for community-based service learning.

The study sought to explore parents’ views of the injury risks to young children at home and their perceptions of supervision, targeting families living in economically deprived areas, including those living in black and minority ethnic communities.

Unintentional injury is a leading cause of death and disability in young children; most injury occurs in and around the home, and children from more deprived families are more vulnerable. Inadequate supervision is often cited as an important risk factor in childhood injury.

Qualitative semi-structured interviews were carried out with 34 families (23 white, 6 black, 5 South Asian) in economically deprived communities in Bristol, UK from September 2005 to July 2006.

The four main interview themes were perceptions of risk, coping with kitchen hazards, attitudes to supervision, and learning strategies. No major differences were seen between different ethnic groups in perceptions expressed or methods used by parents to keep children safe. The common practice of barring children from entering the kitchen when cooking by using stair gates is discussed. Reduced use of safety equipment and a perceived risk of burns from irons in the South Asian communities are highlighted. Constant supervision and learning by experience are common strategies employed by these parents to keep their children safe in often adverse living conditions. Parents need to be aware of the link between child development and injury risk, and also of differences in injury rate as a function of the child’s individual temperament and ability.