The British journal of general practice : the journal of the Royal College of General Practitioners
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The Scottish Government's vision for older people is that 'Older people are valued as an asset; their voices are heard and they are supported to enjoy full and positive lives.' In the health and social care setting in Scotland it is increasingly recognised that there is a need for careful planning of care for older patients with complex comorbidities, and that this should involve the patient where possible via a process of shared decision making (SDM). ⋯ Plans for decision making around resuscitation were reasonably well developed. However, planning for other, more complex, future medical care needs was less well defined or explored with older patients.
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It is estimated that 28.9% (17.8 million) of the UK population live with a musculoskeletal (MSK) condition. They are a major cause of morbidity, and a significant reason for presentation to primary care. ⋯ This study demonstrates that MSK presentations account for a large proportion of GP workload. There are no current mandatory training requirements in orthopaedics as part of the GP curriculum. Structured MSK education for GPs is important and would reduce the burden of re-presentations, particularly that of the lumbosacral spine and knee. Competency in joint injection is also a valuable skill for GPs.
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Continuity of care is a fading type of care because GPs are working more flexibly and at reduced working hours. The GP Contract gave a financial incentive to provide prompt GP appointments, but to the detriment of continuity of care. Increased patient demand for appointments has seemingly led to patients favouring 'any' appointment with a GP rather than 'an appointment with the same GP'. Continuity of care in general practice is associated with greater patient satisfaction and is the preferred type of care for patients with chronic disease or psychological problems. In the Northeast of England there is a multi-partner GP practice that operates a true personalised list system. Other GP practices in the area do offer a degree of continuity of care, but this has not been measured. ⋯ Continuity of care is still observed in GP practices that do not have personalised lists.
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Anxiety and psychological trauma are common presentations in general practice and may lead to long-term prescribing and/or time-consuming talking therapies. ⋯ The acceptability and effectiveness of a new therapeutic approach were demonstrated by presenting them in a show at the Edinburgh Fringe.
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Involving patients and carers in decisions that influence the delivery of health services is a statutory requirement across the NHS. However, current evidence suggests a gap exists between the theory, legislation and policy intentions and their practical implementation. ⋯ The literature suggests that no existing framework addresses all three key themes. Therefore, a revised framework for involvement was developed, informed by the three key themes, that can be tested across a larger sample and different healthcare settings.