Male patients and older patients found online systems particularly helpful, according to the University of Manchester study published in the British Journal of General Practice.

However, some respondents still wanted a return to traditional ways of accessing their GP.

The study was funded by the Wellcome Trust and supported by the National Institute for Health and Care Research (NIHR) Greater 91ֱ�� Patient Safety Translational Research Centre, a partnership between The University of Manchester and Northern Care Alliance NHS Foundation Trust.

The research team collected 21,467 written comments from almost 12,000 patients at 240 GP practices across England who used Patchs (www.patchs.ai), a popular online consultation system. They also carried out hour long interviews with 25 patients.

They analysed both the interview transcripts and written comments qualitatively, in nonnumerical form, to identify common themes.

Patchs system allows patients to request help from their healthcare team over the internet which are followed-up by written message, telephone call, video consultation, or arranging an in-person visit.

In the wake of the Covid-19 pandemic, almost all GP practices now use online consultations and patients are often forced to use them to contact their family doctor.

However, in-depth research into patients’ views on online consultations has not been carried out until now.

Lead author Dr Susan Moschogianis from The University of Manchester said: “Most of the patients in our sample said they preferred online consultations because they are more convenient, flexible, and efficient than in-person appointments for dealing with simple health problems such as rashes or colds.

“The primary benefit reported by most patients was the ability to receive a quick response to their query and male patients in particular reported they were more likely to contact their GP using them.

“Perhaps surprisingly, many older participants found the system easier to navigate than expected and often preferred using it to contact their GP practice than traditional methods.

“But not everyone were as positive. Some still wanted a return to traditional ways of accessing their GP practice using more traditional methods such as telephone and in-person visits.

“And poor communication about the online consultation systems often left patients disappointed and frustrated.”

Patients' experiences of online consultations with their GP practice can, the researchers found, be influenced by characteristics of the patient, the condition they consult about, system design, and how it is used by GP staff.

This research has implications for both GP practices and system designers for how they could improve the patient experience of online consultations.

Senior author Dr Ben Brown from The University of Manchester said: “Our findings provide new insight into why some patients prefer in-person consultations and why others prefer to use online consultations.

“We found that patients’ experiences of using these systems could be influenced by a range of factors such as the different demographics of patients and different conditions they are seeking help with.

“But also how GP practices conduct online consultations and aspects of the technological design were found to be key drivers of positive patient experiences.

“Some patients who struggle to communicate in in-person appointments, such as patients with autism, hearing loss and anxiety, prefer using online consultations.

“And some patients, especially men, preferred discussing sensitive topics online.

“Drawing directly from the findings we make specific recommendations for GP practices and online consultation system designers for how they can optimise patients’ experience.”

Patient experiences of an online consultation system: qualitative study in primary care post-COVID-19 is  published in the .

The study, published in the British Journal of General Practice links the prescribing behaviour of GPs to signs of burnout such as emotional exhaustion, feeling detached from colleagues and patients, lower job dissatisfaction, working longer hours and intentions to leave your job.

The NIHR Greater 91ֱ�� Patient Safety Translational Research Centre (GM PSTRC) is a partnership between Northern Care Alliance NHS Foundation Trust and The University of Manchester.

Researchers found that:

• Increased emotional exhaustion was associated with 1.2 times greater risk of higher strong opioid and 1.2 times greater risk of higher antibiotic prescribing.
• Feeling detached was associated with 1.1 times greater risk of higher strong opioid prescribing and 1.2 times greater risk of higher antibiotic prescribing.
• Low job satisfaction was associated with 1.3 times greater risk of higher strong opioid prescribing and 1.1 times greater risk of higher antibiotic prescribing.
• Intention to leave the job was associated with 1.3 times greater risk of higher strong opioid prescribing and 1.4 times greater risk of higher antibiotic prescribing.

The risk of increased strong opioid and antibiotic prescribing was also found in GPs:

• Working longer hours (4 times and 5 times greater risk respectively)
• Based in the north of England compared to the south (2 and 1.6 times greater risk respectively).

The team analysed UK Oxford-Royal College of General Practitioners (RCGP) Research Surveillance Centre (RSC) data for 13,483 patients on strong opioids and 26,744 patients on antibiotics- a total of 40,227 patients - from December 2019 to April 2020.

The RSC is the oldest sentinel network in Europe and an internationally renowned source of information, analysis, and interpretation of primary care data in England.

The prescribing data from the RSC were linked to the burnout scores of 320 GPs across 57 practices surveyed over the same four-month period.

The study comes as non-medical use, prolonged use, and the misuse of opioids have risen significantly in recent years, leading to dependence, other serious health problems and death.

Similarly, antibiotic resistance is threatening modern medicine, which depends on the effective control of communicable diseases, of which many are bacterial in their origin.

Dr Alexander Hodkinson, NIHR Senior Fellow who works with the GM PSTRC at The University of Manchester said: “This is the first study to assess the association of prescribing of strong opioids and antibiotics with GP burnout as a practice-level problem.

“Over a four-month period we found higher prescribing of strong opioids and antibiotics among GPs experiencing more feelings of burnout.

“These included job dissatisfaction and intentions to leave their job, working longer hours and working in practices in the north of England that serve more deprived populations.

“That is why policies are urgently needed to help mitigate burnout in general practice.”

Dr Maria Panagioti, the principal investigator of the study, and Theme Lead at the GM PSTRC, said: “More and more research studies in other countries find that GPs who feel burnt out often decide to overprescribe drugs, which in the long term could harm instead of cure patients.

“However, thanks to our study, we now have such evidence in the UK on antibiotics and strong opioid prescribing.”

Dr Hodkinson added: “Strong opioids and antibiotic overuse can harm patients in the long-term which is why it is important to prevent their overprescribing.

“Our findings suggest that one possible way to prevent overprescribing maybe to encourage practices to take care of the well-being of their GPs.

“Perhaps more regular monitoring of the well-being of GPs through health-related surveys, wellness programmes and other measures to improve the working climate might be a helpful way to promote safe and appropriate prescribing strategies.”

Professor Tony Avery theme lead for ‘Improving Medication Safety at the GM PSRC  said: “As a practising GP, the priority here must be to do everything we can to minimise the risk of burnout in GPs. However, the association between workload, burnout and the use of medicines that may be overprescribed suggests that preventing burnout may help to improve prescribing quality.”

The study involved a collaboration of researchers at The University of Manchester, Keele University, Exeter Medical School, University of Southampton, University of Oxford, and was supported by Oxford’s Royal College of General Practitioners Research Surveillance Centre.

The analysis of 6,296 English general practices between 2015 and 2019 is the most detailed to date exploring the impact on delivery and patients’ experience of healthcare of the introduction of new roles including social prescribers, clinical pharmacists, paramedics and physician associates.

Published in the September 2022 issue of the journal and funded by the National Institute for Health and Care Research, the study is a response to the growing trend for professionals other than GPs to be involved in treating patients in general practice settings.

As is happening in many other countries, the move has been proposed by the NHS as a solution to critically low numbers of GPs and nurses. Until now, evidence of its impact on practice outcomes has been limited.

Using national data, the study explores the statistical relationship between the workforce composition and ten indicators of accessibility, clinical effectiveness, user experiences and health system costs.

The researchers grouped roles into four categories: GPs, Nurses, Healthcare Professionals (HP) and Healthcare Associate Professionals (HAP).

Healthcare Professionals included clinical pharmacists, physiotherapists, physician associates, paramedics, podiatrists, counsellors, and occupational therapists.

The Health Associate Professional group included dispensers, health care assistants, nurse associates, pharmacy technicians, psychological well-being practitioners and social prescribing link workers.

The study showed that employment increased over time for all the staff groups, with largest increases for Healthcare Professionals - from an average of 0.04 full time equivalent (FTE) per practice in 2015 to 0.28 in 2019.

The smallest increase was observed for Nurses, who experienced a 3.5 percent growth.

The employment of more staff in traditional primary care roles, such as GPs and Nurses, was positively associated with changes in practice activity and outcomes.

Patient satisfaction with primary care services showed a negative trend over the study period. The study found this drop in satisfaction to be larger in practices that had employed more HPs.

On average, a one FTE increase in HP staff employed at GP practices was associated with a 2.4 percent drop in overall patient satisfaction which is roughly equivalent in magnitude to the overall decrease observed between 2015 and 2019.

Similarly, a one FTE increase in HP was associated with a 1.3 percent drop in patient satisfaction with making an appointment, about a quarter of the overall decrease of 7.2 percent.

On the plus side, however, pharmacists contributed positively towards some tasks, improving the quality of medicine prescription and reducing the burden of these activities for existing staff.

The changes in workforce composition did not show significant relationships with other primary care outcomes measured in the study.

In addition, there was surprisingly little evidence of any complementarity or substitution between different staff groups, suggesting that any contribution made by HP and HAP staff to GP practice outcomes happened independently.

Lead author Dr Igor Francetic said: “The introduction of new roles to support GPs does not have straightforward effects on service quality or patient satisfaction.

“In fact we provide substantial evidence of detrimental effects on patient satisfaction when some Health Professionals and Healthcare Associate Professionals are employed. Patient satisfaction is a crucial dimension of quality of care, as it contributes to individuals’ willingness to seek care through GPs.

“There was limited evidence of interaction - in terms of either substitution or complementarity - between the GPs and other roles, suggesting they contribute independently to outcomes and quality in primary care. This goes against the common wisdom that some of these new roles will reduce the workload of existing GPs.

He added: “The results of our statistical analyses together with qualitative evidence gathered by colleagues at The University of Manchester suggest that these problems arise from the complex adaptation required to adjust practice organisation and from patients being unaccustomed with these new professionals and their competencies.

“The introduction of several of these new roles requires substantial supervision from GPs and complex changes to how work is organised that may ultimately reduce efficiency.

“These findings have profound implications for the implementation of policies emphasising the benefits of introducing staff with non-traditional roles in primary care.

“That is why we urge caution over the implementation of policies encouraging more employment of different professionals in primary care.”

At a national level, the use of locums was low and stable between 2017 and 2020 though some practices and areas used significantly more locums than others.

The proportion of locum GPs, compared to other GPs in rural practices was 25% greater than in urban locations.

Practices that were single handed- where a lone GP works- used locums at a rate 4.6 times higher that of practices employing more permanent GPs.

Practices rated as inadequate by the Care Quality Commission used locums at a rate 2.1 times higher than practices rated as outstanding.

The findings, say the team, are likely to reflect the difficulties many practices have in recruiting doctors and sheds light on the challenges facing primary care.

Locum GPs also tend to be male and younger, with an average age of 42, and more likely to have qualified outside of the UK when compared to other GPs.

The analysis, funded by the National Institute for Health Research (NIHR), used data from NHS Digital on almost 34,000 doctors and found:

• Locums made up on average 3.15% of the GP workforce in December 2017 and 3.31% September 2020, figures adjusted for full time equivalent
• Around 65% of the locums were UK qualified and around 54% were male
• Around 74% of the locums were used to cover long term absences or vacancies
• Locums were concentrated in parts of the North West, Greater London, West Midlands, Essex and the Isle of Wight.

Locum GPs are defined as doctors who provide cover for permanent staff including maternity/paternity leave, sick leave, annual leave, suspended doctors or vacancies.

Lead author Dr Christos Grigoroglou from The University of Manchester said: “Locum GPs have an important role in the delivery of primary care services, particularly in the delivery of out-of-hours care and in helping to address short-term workforce shortages.

“Despite expectations that locum GP numbers are rising we found that locum use in primary care has remained stable over time though their use seems to vary substantially across different practice types and areas of the country.”

 He added: “In recent years, the NHS has suffered from insufficient long term workforce planning, prolonged shortfalls in funding, and a high number of doctors leaving the profession early which have contributed to the current workforce crisis.

 “Before we conducted this study, research on the extent of GP locum use in general practice and the composition of the GP locum workforce was sparse.

“So identifying the drivers behind variation in locum use in English primary care provides useful context for those involved in workforce planning, especially in areas with high GP turnover.”

 Dr Thomas Allen from The University of Manchester said: “Accurate monitoring of the GP workforce may help policy-makers and commissioners to understand current challenges in primary care, including capacity and composition of the GP workforce and inform future workforce planning.”

&�Բ�����;“We suggest that relatively high and sustained levels of locum use may be an indicator of wider problems which are affecting recruitment and retention.”

“Practices in rural areas and those with inadequate CQC inspection ratings may face substantial challenges in recruiting and retaining permanent GPs, and this study highlights this.”

 Professor Kieran Walshe from The University of Manchester said: “Accurate monitoring of the GP workforce may help policy-makers and commissioners to understand current challenges in primary care, including capacity and composition of the GP workforce and inform workforce planning.

“This can be particularly useful to meet local health care needs with sufficient resources for training and deployment of GPs which will help ensure that the targets set out in the NHS long-term plan are met.”

A survey has estimated that around three million Britons - or 7.6 % of the country - believe they have experienced a harmful or potentially harmful but preventable problem in primary healthcare.

The research by University of Manchester epidemiologists and patient collaborators, also estimates that 1.5 million people believe their health has been made worse by a problem which could have been prevented.

The findings revealed a large divide between the opinions of patients and clinicians: of the preventable-problems reported by patients, clinicians said only a small percentage might be potentially harmful.

The figures are based on a representative survey of 4000 people which looked at the experience of respondents over the previous 12 months. The survey was carried out in England, Scotland and Wales, and was designed and analysed by the 91ֱ�� team, which includes patients.

It is published in BMJ Open and funded by the NIHR Greater 91ֱ�� Patient Safety Translational Research Centre..

Problems reported by patients which could have been avoided included:

• A patient prescribed medication without necessary blood tests resulting in hospital admission and cardiac arrest
• Dentists extracting the wrong teeth.
• A GP failing to spot the dangers of chronic nose bleeding over several months, which turned out to be cancer
• A GP failing to identify that a new mum had a retained placenta – a potentially life threatening condition.

Around 20% of the problems reported by patients involved prescribing of medicines and 12% involved late, and missed or wrong, diagnoses.

A further 15% were communications problems – such as apparent lack of interest, not listening to patients and not passing on important information.

Around 70% of the problems reported had occurred in general practice, and another 9% in dental surgeries.

Problems were also reported by the respondents in A&E, ambulance service, walk in clinics, pharmacy, community or district nursing, opticians and community mental health services.

from The University of Manchester, who led the study, said: “Our survey suggests there are probably a large number of patients in Great Britain who believe they have experienced a potentially-harmful preventable problem in primary care.

“Importantly, only around half of the patients discussed their concern with somebody working in primary care yet those that did retained a higher level of confidence and trust in their GP.”

Patient research partner and study team member Ailsa Donnelly said: “Our respondents told us they want more patient centred care, more resources and better communication.

However, we need to develop ways for patients to raise problems in care easily and discuss them with clinicians, not only to make primary care safe but, crucially, to ensure it is felt to be safe by patients. Trust is an essential part of safe care.

Professor of General Practice from The University of Manchester, was also part of the research team.

He said: “This study shows that the views of patients are important when something goes wrong, irrespective of whether significant harm is caused.

“We also show that working with patients when something has gone wrong can help re-build trust with the GPs and other clinicians.”

’ Stocks SJ, et al is published in BMJ Open 2018;0:e020952. doi:10.1136/bmjopen-2017-020952

The number of GPs who say they are likely to quit direct patient care within five years rose to 39% in 2017 from 35% in 2015, according to a carried out by University of Manchester researchers.

The figure rose from 61% in 2015 to 62% in GPs over 50. Among this group, the majority said it was highly likely (47%) or considerably likely (15%).

In contrast, 13% of GPs under 50 said there was a considerable or high likelihood of leaving direct patient care within five years and 45% reported that there was no likelihood.

More than nine out of 10 GPs reported experiencing considerable or high pressure from ‘increasing workloads’.

Although there has been relatively little change between 2015 and 2017, average reported pressures remain at a high level relative to previous surveys.

Particularly high average levels of pressure were reported in ‘having insufficient time to do the job justice’, ‘increasing workloads’, ‘paperwork’ and ‘increased demand from patients’.

The National GP Worklife Survey is a national survey of GPs in England, which has been carried out nine times since 1999.

It analyses two samples in 2017: 996 GPs responded to a random sample of 4000 people and 1,199 responded (out of 22280) after being followed up after responding to the 2015 survey.

Also in the survey, overall job satisfaction has increased slightly since the previous survey in 2015, though levels of satisfaction in 2015 were the lowest since 2001.

Satisfaction with aspects of the job, such as remuneration, hours of work and amount of responsibility given, although slightly higher than in 2015, remain lower than in the surveys undertaken before the introduction of the new GP contract in 2004.

The respondents reported working an average of 41.8 hours per week. Stated working hours per week have remained largely stable since 2008. 36% said they worked fewer than 40 hours per week, 28% between 40-49 hours, 16% reported working between 50-59 hours and 20% reported working 60+ hours per week.

The percentage of respondents earning £110,000 per year or more fallen from 34.6% in 2010 to 31% in 2015 and rose to 32.5% in 2017; their median hours worked per week increased between 2010 and 2017.

Professor Kath Checkland, who led the study said: “Our survey shows there has been little change in the satisfaction and stressor results between 2015 and 2017 survey, though 2015 were already at very high levels.

“Although the declines in satisfaction seen between previous years has stopped, low satisfaction and high pressures have been sustained.

“The all-time high figure of 39% of GPs who say they intend to quit within 5 years is particularly worrying in terms of the possible implications it might have on recruitment, retention and patient care.”