The British journal of general practice : the journal of the Royal College of General Practitioners
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The Additional Roles Reimbursement Scheme (ARRS) was set up to recruit 26 000 additional staff into general practice by 2024, with the aim of increasing patient access to appointments. Despite the potential benefits of integrating ARRS practitioners into primary care, their implementation has not always been straightforward. ⋯ Most ARRS staff felt valued, but the scheme broadened expertise available in primary care rather than reducing GP burden, which was originally anticipated. Some PCNs, especially those in areas of high deprivation, found it difficult to meet the population's needs as a result of the scheme's inflexibility, potentially leading to greater health inequalities in primary care. Recommendations are proposed to optimise the effective implementation of the primary care workforce model. Further research is required to explore administrative role solutions, further understand the impact of health inequalities, and investigate the wellbeing of ARRS staff.
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Despite many benefits of continuity of care with a named regular GP (RGP), continuity is deteriorating in many countries. ⋯ Higher disease-related and overall RGP UPC are both associated with lower mortality. However, changing RGP did not significantly affect mortality, indicating a compensatory benefit of informational and management continuity in a patient list system.
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System problems, known as operational failures, can greatly affect the work of GPs, with negative consequences for patient and professional experience, efficiency, and effectiveness. Many operational failures are tractable to improvement, but which ones should be prioritised is less clear. ⋯ This study identified the highest-priority operational failures in general practice according to GPs and patients, and indicates where improvement efforts relating to operational failures in general practice should be focused.
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Orlistat is recommended as an adjunct to diet and exercise for weight loss in type 2 diabetes mellitus (T2DM). The aims were to explore (i) associations between patient characteristics and orlistat prescribing and to determine (ii) associations of orlistat with weight loss in T2DM/prediabetes. ⋯ Orlistat was significantly associated with weight loss in T2DM/prediabetes when taken for at least 12 weeks. However, orlistat is infrequently prescribed and often taken for <12 weeks. Orlistat may be a useful adjunct to lifestyle modifications in T2DM/prediabetes however barriers to continuing orlistat means it may not be effective for everyone in managing weight loss.
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Substantial increases in UK consulting rates, mean consultation duration and clinical workload were observed between 2007 and 2014. No analysis of more recent trends in clinical workload has been published to date. This study updates and builds on previous research, identifying underlying changes in population morbidity levels affecting demand for primary health care. ⋯ Findings show sustained increases in consulting rates, consultation duration and clinical workload until 2014. From 2015, however, rising demand for healthcare and a larger administrative workload have led to capacity constraints as the system nears saturation.