Effective communication between specialists and primary care providers is important for optimal care. This cross-sectional study explored primary care providers’ preferences for concise versus detailed clinical letters in otolaryngology–head and neck surgery.

A survey was sent to primary care providers in Manitoba, Canada, to reflect on their past experiences and review sample concise and detailed letters. Quantitative data were analysed using Wilcoxon matched-pairs signed-rank tests and chi-squared tests. Qualitative responses were thematically analysed.

Seventy-five percent of respondents (57 incomplete responses, 39 complete) preferred concise letters, citing the readability, inclusion of key information and clear treatment plans. Some participants requested the inclusion of interim recommendations and more comprehensive details. Preferences did not differ by profession (p < 0.05).

Most primary care providers prefer concise clinical letters. Detailed rationale and interim plans can be integrated into concise formats to enhance usability without sacrificing essential information. Optimising clinical letters for conciseness may enhance interprofessional communication and care coordination.

General practice (GP) training is central to the development of the primary care workforce but is often described as a bounded educational programme rather than a process shaped by clinical work, workplace culture, and wider service conditions.

To examine how GP training is represented in the literature and to develop a complexity-informed conceptual model of GP training.

Systematic review and complexity-informed synthesis of studies relating to GP training in primary care contexts.

Empirical and conceptual studies were identified through systematic searching and analyzed using thematic synthesis, informed by complex adaptive systems and Cohered Emergent Theory.

Three thematic areas were identified: GP–patient interactions, GP–professional interactions, and training intricacies. Four cross-cutting insights emerged: complexity in everyday training, the influence of power and hierarchy, the importance of diversity and adaptability, and the shaping role of wider system pressures. These informed the Cohered GP Training Model, which conceptualizes GP training as a dynamic system in which outcomes emerge from the degree of coherence between trainee formation, educational relationships, patient care encounters, workplace and team ecology, and the wider primary care system.

GP training is best understood as a relational and system-embedded process rather than a discrete educational intervention. The model may help explain variation in training quality across settings and offers a conceptual basis for improving training environments and workforce development.

Advance care planning (ACP), including end-of-life (EOL) conversations, helps frail older persons articulate goals and preferences for future treatments and care, ultimately enhancing quality of life. Nevertheless, a substantial gap exists between the many who wish to engage in such conversations and the minority who currently do so. To support earlier and broader engagement, we explored frail community-dwelling older persons’ perspectives and attitudes regarding ACP and EOL discussions.

We conducted a qualitative, purposively sampled, interview study of frail community-dwelling older persons (N = 16), identified from Dutch general practices. We analyzed the transcripts using reflexive thematic analysis.

We developed 5 themes regarding ACP and EOL conversations: (1) Personal identity as the foundation for ACP and EOL decision-making: personal values strongly shaped EOL preferences and decision-making; (2) external factors – including lived experiences, the social environment, and information channels – influenced EOL perspectives; (3) attitudes and motivations shaped engagement with ACP and EOL conversations, ranging from active engagement to reluctance; (4) organization and conditions of ACP and EOL conversations: the content of conversations varied across conversation partners; and (5) expectations regarding involvement of others in ACP, including EOL conversations: participants expressed a need for proximity to family, close friends, and healthcare professionals and for these others to be involved and take responsibility in supporting decision-making.

When asked about ACP, participants focused predominantly on preferences and expectations regarding EOL care and the period surrounding death. These reflections, grounded in personal values and identity, were most often shared with family and close friends and less frequently with healthcare professionals. These findings highlight the central role of informal networks in ACP communication, suggesting that healthcare professionals should actively involve these networks in ACP discussions and decision-making. Furthermore, ACP conversations may benefit from starting from persons’ underlying values and their priorities in life.

To explore general practitioners’ and radiologists’ expectations of ankle radiography for chronic complaints.

Ankle complaints are a frequent reason for general practitioner (GP) consultations and ±20% of ankle radiography requests are for chronic complaints. It is unknown what GPs and radiologists expect from ankle radiography for chronic complaints.

A qualitative study was conducted with GPs and radiologists. Semi-structured focus group discussions were held online or live until data saturation was reached. The topic guide included: reasons for radiography, content of requests and reports, and the impact of results on patient management. The recorded interviews were transcribed and subsequently coded inductively in Max-QDA.

Five focus groups with 24 GPs and 3 focus groups with 11 radiologists were held. Radiologists focussed more on urgent diagnoses that were less considered by GPs for their rareness. GPs indicated to request ankle radiography more often for patient-, physician-related and organizational reasons than for medical indications. Radiologists expect requests to include a specific question accompanied by applicable clinical information including a specific pain location. GPs in their turn expect a short conclusion of the report answering their question.

GPs and radiologists have different expectations of radiography for chronic ankle complaints. Important in GPs’ rationale behind requesting ankle radiography for chronic complaints are non-medical factors and prevalence of ankle disorders, while radiologists also focus on more rare diagnoses than GPs. More research on the added value and accuracy of ankle radiography for chronic complaints in primary care settings is necessary.

The COVID-19 pandemic significantly impacted primary care, including childhood infection management. Public health measures reduced respiratory infections, raising concerns about an ‘immunity debt’ in children. General practitioners (GPs) faced fewer in-person consultations, evolving diagnostic routines, and changing parental expectations. While hospital data are available, effects in general practice are less studied.

A cross-sectional online survey was conducted among Dutch GPs with experience before and after the pandemic. The 35-item questionnaire addressed infection patterns, management, parental behaviour, and communication.

Of 166 GPs, 32% noted changes in infection management and 44% observed altered seasonal trends. While consultation rates remained stable, diagnostic testing and antibiotic use increased. GPs reported longer consultations and rising parental demands, especially among those with lower health literacy or migrant backgrounds.

GPs reported key shifts in managing childhood infections. Strengthening communication and further qualitative research may enhance care and equity.

Continuity of care refers to the consistent and coordinated delivery of healthcare services over time. Continuity has been associated with improvements in morbidity and mortality, yet its decline has been identified as a significant concern amid increasing pressures in primary care.

This review aimed to inform current policy initiatives by synthesizing evidence on how continuity of care is measured, the current challenges faced and proposed future interventions in UK general practice.

We conducted a literature search for articles published before 15 February 2024, to explore continuity in UK primary care. Screening and data extraction followed PRISMA Scoping Review guidelines, with all studies undergoing double screening to determine eligibility.

A total of 180 papers were included (95 quantitative, 76 qualitative and 9 mixed-methods). Across the literature, continuity of care was most commonly conceptualized and measured as relational continuity, the Usual Provider of Care (UPC) Index was the most commonly used metric. Informational and managerial continuity were rarely assessed. Certain patient groups, including those with long-term conditions, mental health needs, and multimorbidity, were reported to place greater value on continuity of care. Higher relational continuity was associated with improved patient satisfaction, care coordination and reduced hospital admissions. However, sustaining continuity was frequently challenged by workforce pressures and fragmented information transfer. Although formal and informal interventions to enhance continuity were described, tensions between continuity and access persisted, and continuity was reported to vary across patient groups.

The decline in continuity of care has implications for patient experience and system outcomes. This review highlights the need for system-level approaches and national policy reforms to support continuity, while addressing workforce constraints, access pressures and unequal experiences of care. Further research is needed to evaluate the effectiveness and sustainability of continuity-enhancing interventions and to identify any potential unintended consequences.

Efficient triage in general practice is critical to optimize appointment allocation and minimize patient delays. Delays in receiving clinical information, such as photographs or symptom questionnaires, lead to unnecessary consultations and inefficiencies. This study evaluated the feasibility and impact of a structured pre-triage protocol requesting photos and questionnaires for common conditions (skin, eye, tonsillitis, and urinary tract infections).

A pre-post intervention quality improvement project was conducted in a UK general practice. Triage administrators were instructed to proactively request photographs for skin and eye complaints and symptom questionnaires for tonsillitis and UTIs at initial patient contact. Outcomes included process metrics (number of pre-triage requests, proportion of cases managed directly by the triage GP) and subjective measures of ease, speed, satisfaction, and confidence.

The protocol increased photo requests for skin (mean increase 4.0/session, Cohen’s d = 7.77) and eye (2.2/session, d = 4.09) conditions, while questionnaire requests remained unchanged. The proportion of skin cases managed directly by the triage GP increased significantly (from 0.2 to 2.2 cases/session, d = 1.65), and eye case management also improved. Questionnaire-based pathways showed minimal change in efficiency or direct management. Subjective feedback indicated a slight reduction in triage speed, but ease and satisfaction were maintained, while diagnostic confidence increased, particularly for photo-supported conditions.

A structured pre-triage protocol is feasible, acceptable, and potentially effective in enhancing triage efficiency, particularly for visually assessable conditions like skin and eye presentations. By enabling earlier access to essential information, such protocols may reduce unnecessary consultations, improve workflow, and support clinician confidence.

To describe the development, delivery, and outcome of an action-oriented intervention comprising an awareness-raising educational video and workshop designed to support general practice teams to identify and plan decarbonization actions, delivered from May-September 2024.

Healthcare services internationally are committing to net zero targets. General practice is recognized as having a pivotal role in achieving these ambitions. However, limited awareness of decarbonization initiatives and insufficient support for implementation highlight the need for an educational resource to facilitate action planning.

Principles of organizational change, video-design, and barriers to decarbonization informed the intervention’s development. The video included modules featuring resource materials and ideas to support the development and implementation of decarbonization actions in general practice. Prompts for a facilitated workshop discussion were developed to support action planning. The intervention was delivered to 64 multidisciplinary staff across 12 general practices in England. A conceptual content analysis was conducted on completed practice green action plans (GAPs) and data from an online participant feedback form were analysed using descriptive statistics to assess perceptions of the intervention. Free-text comments were thematically analysed.

Across the 12 GAPs, each practice planned between three and eight decarbonization actions. ‘Managing waste’ was the most frequently addressed area, appearing in 10 practice GAPs, and most planned actions mapped onto those presented within the video. Thirty (46.9%) participants completed the evaluation survey. The intervention was well received, with 28 (93.3%) survey respondents rating the overall usefulness of the video as 4 or 5 (1 ‘not at all useful’ to 5 ‘very useful’). Free-text comments for suggested improvements related to time for consolidating learning, and concerns about the video’s audio quality and duration.

The educational workshop successfully facilitated the development of structured GAPs with explicit timescales and intended outcomes. This study did not assess the implementation of planned actions.

In the Netherlands, around 750 children (0–21 year) die annually from potentially palliative conditions. The majority of these children reside at home, receiving care from hospital services and primary care. This study aims to examine general practice utilization for pediatric palliative care patients in the last 2 years of life.

A retrospective cohort study was performed using the routine healthcare database of the Julius General Practitioners’ Network. The main outcome for general practitioner (GP) utilization was the number of GP consultations for children in the last 3 months of life. Participants were included who were children (0–21 years), and deceased in the period 01-01-2013 to 31-12-2022 from an underlying chronic condition. Data were analyzed using descriptive statistics and tested for differences in provided care between children who died in hospital and who died at home.

Forty-eight children from 32 GP practices met inclusion criteria. Median age was 10.0 years (interquartile range [IQR] 1.5–17.1). Common diagnoses were oncological (29%), congenital (29%), and metabolic conditions (23%). Ninety-six percent of children had contact with their GP in the last 3 months (median 7 consultations, IQR 3.0–10.0), i.e. 26 children who died in hospital had median 3.5 GP consultations compared to 20 children who died at home median 9.5 GP consultations (p < 0.001). Thirty-five percent of children were documented as being palliative, with 54% having some form of advance care planning discussions documented.

These results demonstrate that GPs are highly involved in providing pediatric palliative care. The palliative nature of these children and advance care planning discussions are not routinely documented and/or performed by GPs. Further insights into guidance that supports GPs, in collaboration with other healthcare professionals, in providing palliative care for children at home and their families are needed.

To investigate the decision-making processes of nurse prescribers in general practice when managing acute episodes of illness in patients with multimorbidity.

Nurse independent prescribers in UK general practice are facing increasing complex clinical decision-making when assessing patients presenting acutely with undifferentiated and undiagnosed conditions as multimorbidity and polypharmacy becomes increasingly common. This qualitative study investigated the decision-making processes of nurse prescribers in general practice when managing acute episodes of illness in patients with multimorbidity.

Fourteen general practice nurse prescribers were recruited through purposive sampling. Think aloud in response to staged vignettes was used followed by semi-structured interviews. Thematic analysis was used to analyse think aloud and interview data.

Participants were experienced nurses with a range of clinical exposure and training who mostly made appropriate diagnostic and prescribing decisions. Pockets of expertise were revealed which reflected participants’ clinical experience, but there was a high rate of referral to the GP for some vignettes. Participants’ decision-making was underpinned by both analytical and intuitive processes, the quality of which was dependent on their individual knowledge and experience. A reliance on pattern recognition, aligned to intuitive decision-making, to determine the content of the consultations was identified as an area of risk and showed all participants to be inconsistent in their identification of complex factors. Omission of these factors could have important implications for prescribing decision-making. Organizational issues such as time-limited clinics also shaped the content of participants’ consultations, encouraged a limited, problem-focused approach, and reduced the opportunity for mentorship. Comprehensive knowledge, clinical experience, and mentorship are critical to ensure nurse prescribers make optimal decisions in the context of patients with multimorbidity. A team approach to the management of acute presentations in these patients is recommended to improve patient experience and maximize nurse prescribers’ contribution to the general practice workforce.

Cardiovascular disease (CVD) is the leading cause of death worldwide. Research suggests people with Mental Health Disorders (MHDs) have increased CVD risk. However, knowledge gaps exist regarding CVD risk management for general practice patients with MHD, and interventions that might improve CVD prevention. This study examined the perspectives of general practice professionals in Ireland on cardiovascular risk assessment for patients already diagnosed with MHD and to describe current approaches to identifying this population using the Mental Health Finder (MHF) tool.

An embedded mixed-methods design was adopted, guided by constructivist grounded theory and the Social Ecological Model. Aggregated anonymised data, including availability and use of the MHF tool, were collected from five practices and analysed in SPSS. In-depth semi-structured interviews were conducted with 12 general practitioners and three practice nurses. Qualitative data were analysed using Braun and Clarke’s Reflexive Thematic Analysis.

Of the five practices, two had access to the MHF tool. These reported combined prevalence of 18.7% for MHD compared with 0.5–11.5% in practices without the tool, highlighting the importance of systematic identification. Qualitative analysis generated four themes: (1) prevalence of MHD in general practice, (2) association between MHD and CVD risk, (3) CVD risk management in patients with MHD, and (4) holistic care.

CVD risk assessment for patients with MHD in general practice is largely opportunistic and unstructured. Participants highlighted the need for structured frameworks, protocols, and enhanced supports to enable systematic cardiovascular assessment and management in this population.

To investigate how to recruit patients rigosrously in general practice for trials based on symptoms as predefined inclusion criteria rather than a well-defined diagnosis. We used persistent physical symptoms (PPS) as a target condition.

Conducting randomized controlled trials (RCTs) in general practice is crucial for evidence-based decision-making and treatment in frontline healthcare. However, recruitment is often challenged in general practice because many patients have vaguely defined conditions, such as PPS.

We used qualitative semi-structured interviews to explore the perspectives of general practitioners (GPs) on different recruitment scenarios, while paying particular attention to the logistics and feasibility in routine care. A total of 11 GPs from seven clinics were strategically recruited. The GPs were presented with one recruitment scenario (pre-consultation screening) and encouraged to suggest other scenarios. We conducted a thematic framework analysis of the interview material.

To ensure valid intervention research, one predefined scenario was discussed, and three additional scenarios were co-created during the interviews: (1) opportunistic screening, (2) pre-consultation screening, (3) audit (retrospective and prospective), and (4) random sample screening of the practice population. These scenarios differ with respect to logistical complexity, comparability to daily clinical practice, and entailed selection bias. Every scenario requires individual adaptation and implementation support to be feasible in routine care in general practice. The present study provides approaches for rigorous primary care research based on RCTs for frequent and vaguely defined conditions, but it also highlights a need to develop research methods better suited to frontline healthcare interventions.

The aim of this study is to describe the rollout of nursing activities during the pilot project’s first 12 months (2019–2021), especially relating to what was initially planned in the nurses’ job description.

To provide more comprehensive services and reinforce primary care, a pilot implementation study assessed the integration of nursing activities into eight general practitioners’ (GPs’) practices. The study evaluated how new types of activities were integrated and rolled out over the first year.

A mixed-methods observational study collected quantitative data on nursing activities and duration and qualitative data via five interviews with nurses and patients and one focus group with six GPs. Investigators combined quantitative and qualitative data in discussions about their results.

New nursing activities were rolled out progressively, especially follow-up activities with chronically ill patients, with a median time dedicated/month of 21h58 (range: 9h25 to 64h50) at six months and 48h43 (range: 11h01 to 59h51) at 12 months. One-off clinical activities are more easily integrated: the median time dedicated/month was 40h01 (range: 13h44 to 74h53) at six months and 40h30 (range: 9h38 to 76h51) at 12 months. Three elements were crucial in the implementation of nursing activities. The nurse’s previous professional experience influenced the scope of activities developed. GPs’ willingness to refer patients to the nurses enabled the latter to carry out follow-up activities with care plan. Lastly, the implementation of nursing activities was also made possible by patients’ acceptance of being cared for by nurse instead of a GP.

Implementation of nursing activities increased progressively, although more slowly for activities with chronically ill patients and within care plans, principally due to the overall change faced by GPs and nurses.

The European General Practitioners Research Network (EGPRN) designed and validated a comprehensive definition of multimorbidity using a systematic literature review and qualitative research throughout Europe. Identification of risk factors for decompensation would be an interesting challenge for family physicians (FPs) in the management of multimorbid patients. The aim was to assess which items from the EGPRN’s definition of multimorbidity could identify outpatients at risk of decompensation at 24 months.

A cohort study. About 120 multimorbid patients from Western Brittany, France, were included by general practitioners between 2014 and 2015. The status “decompensation” (hospitalization of at least 7 days or death) or “nothing to report (NTR)” was collected at 24 months of follow-up.

At 24 months, there were 44 patients (36.6%) in the decompensation group. Two variables were significant risk factors for decompensation: the number of visits to the FP per year (HR = 1.06 [95% CI 1.03–1.10], P < 0.001) and the total number of diseases (HR = 1.12 [95% CI 1.013–1.33], P = 0.039).

FPs should be warned that a high number of consultations and a high total number of diseases may predict death or hospitalization. These results need to be confirmed by large-scale cohorts in primary care.

We assessed patient experience of care, comparing current and past smokers, and whether frequency of advice to quit smoking impacts patient rating of care.

Experience of care may be a concern for people who smoke and affect their partnership with healthcare providers.

We surveyed adults aged over 35 years who had visited a general practitioner (GP) for health care in the past year (n = 611 current and n = 275 ex-smokers). Questions assessed smoking history, experience of care, anticipation of stigma, and perceptions of smoking cessation advice received in general practice.

Fewer than half (48.8%) of current smokers reported ‘always’ or ‘usually’ being advised to quit smoking, or being advised in a way that motivated them to quit by a GP or other care provider at their GP practice. Current smokers tended to delay or avoid help seeking when needed and experienced more anticipation of stigma in healthcare settings. Conversely, respondents who reported being advised to quit more frequently rated overall quality of care more highly. These data show that asking about smoking and providing advice to quit smoking was acceptable to most respondents and associated with higher ratings of quality of care. However, advice should be provided in a way that motivates patients, without exacerbating the stigma associated with smoking, which may impact help seeking.

Many consultations in primary care involve patients with mental health problems, and primary care is typically the place where many such patients initially seek help. While considerable research has examined the prevalence of mental health disorders in primary care, relatively few papers have examined this issue in recent years. This study aims to address this gap by reviewing contemporary literature from 2014 to 2024 on the prevalence of mental health disorders among general practice patients.

A comprehensive search across PubMed, PsycINFO, and Google Scholar was conducted, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for article selection and assessment, examining the prevalence of mental health disorders in general practice.

Studies varied in methodologies and healthcare settings, with reported prevalence rates of mental health disorders ranging from 2.4% to 56.3%. Demographic characteristics (female gender, older age) were associated with a higher prevalence of mental health disorders in the studies identified. Studies based on patient interviews reported broader prevalence (2.4–56.3%) compared to studies using electronic medical record reviews (12–38%). Prevalence also varied between countries. Notably, there has been a lack of post-COVID-19 studies, especially within Europe, examining the prevalence of mental health prevalence in primary care.

Mental health problems are still common among patients attending general practice; the approach to data collection (i.e., prospective interviews with patients), female gender and older age appear to be correlates of higher estimates. Further research involving a large-scale study with multiple sites is a priority.

The funding of primary care is subject to intense debate internationally. Three main funding models predominate: capitation, pay-for-performance, and fee-for-service. A number of systematic reviews regarding the effect of primary care funding structures have been published, but not synthesized through an equity lens. Given the urgent need for evaluating funding models and addressing inequalities, a reliable, synthesized evidence base concerning the effects of funding on inequalities is imperative.

This umbrella review aims to systematically evaluate all systematic reviews available on the effect of different primary care funding models in high-income countries on inequalities in funding, access, outcomes, or experience from inception until 2024.

Three databases (MEDLINE, EMBASE, Cochrane) and a machine learning living evidence map were searched. Abstracts and titles were double screened, before two authors independently screened full texts, extracted data, and performed quality assessments utilizing the AMSTAR2 tool.

The search identified 2480 unique articles, of which 14 were included in the final review. Only one review compared reimbursement systems; capitation systems were more equitable between ethnic groups compared to pay-for-performance in terms of primary care access, continuity, and quality. Twelve reviews reviewed the impact of the introduction of pay-for-performance models, predominantly focusing on the Quality and Outcomes Framework (QOF) in the UK. Synthesized findings suggest that QOF’s introduction coincided with reduced socioeconomic health inequalities in the UK overall, but not in Scotland. Overall, inequalities in age narrowed, but inequalities measured by sex widened. One review found evidence that targeting funding for minority groups, with poorer health, was effective. A further review found that introducing privately provided general practices in Sweden and allowing patients to choose these over public-owned options generally benefitted those with higher income and lower health needs. We identify a range of gaps in the literature, which should inform future research.

The use of technology including digital decision support tools has become more ubiquitous in general practice. Australian GPs’ use of digital decision support tools, the sentiments, and associations with practitioner and practice characteristics. Positive and negative sentiments were considered facilitators and barriers to the uptake of digital decision support tools.

Secondary analysis of a cross-sectional study was undertaken with data from the Medicine in Australia: Balancing Employment and Life (MABEL) survey was analysed. 3,126 GPs responded from a total of 27,829 participants representing all types of physicians, surveyed in September 2018. Descriptive statistics was used to examine facilitators and barriers to GP uptake of digital decision support tools, and multivariable logistic regression was used to examine its associations with practitioner and practice characteristics.

2240 GPs in this study (83.8%) reported using digital decision support tools with largely positive sentiments regarding technology use in consultations. Reservations include privacy concerns, system incompatibility, and lack of support. Those using digital decision support tools were more likely to be female, younger and bulk-billing.

Perceived facilitators of digital decision support tools in Australian general practice include improvements in patient outcomes, satisfaction, care processes, and saving time. Barriers include concerns about data privacy, lack of support, incompatibility, and being time-consuming. There was higher uptake amongst bulk-billing and female practitioners. Further research on the clinical usefulness of digital decision support tools and its impact on decision-making in general practice would be of value.