Working together: a qualitative study of effective group formation amongst GPs during a cost-driven prescribing initiative

BACKGROUND: The need to control escalating NHS prescribing costs has become another, for many, contentious factor for GPs to consider when prescribing. Furthermore, despite not having a history of collaboration, GPs now need to work together within Primary Care Trusts. There is little in the medical literature about the development of GP groups. We present data from an evaluation of a cost-driven GP group prescribing initiative which fitted within Tuckman's framework of how groups become established, function and bring about changes to produce outcomes. OBJECTIVE: Our aim was to gain insight into GPs' experiences of working together in a group prescribing initiative. METHODS: Qualitative semi-structured interviews were conducted face-to-face with 32 GPs from a commissioning group pilot (nine GP practices) in Southern Derbyshire in 1999. The interviews were transcribed and analysed using thematic analysis. RESULTS: Initial reactions to the initiative included feeling anxious and imposed upon. However, reservations about divisive effects on practices and individuals behaving defensively proved largely unfounded. Meeting together enabled participants to discover that their similarities outweighed their differences. Prescribing changes did occur, often facilitated by the support of having group policies. However, for many participants, the most valued outcomes were process orientated: increased interaction between practices and a greater sense of group cohesion. These were regarded by some as providing the basis for further change. CONCLUSION: The experiences of the GPs reflected Tuckman's sequential model of group development to a large extent. The 'storming' phase was less problematical than anticipated. This model provides a useful framework against which to judge how near a group is to achieving goals.     

Community nurses and social workers learning together: a report of an interprofessional education initiative in South Wales

Collaboration between different professional groups and agencies is an essential element in the provision of high quality community care for people with complex health and social needs. There are, however, a number of barriers to effective interprofessional working. These include: the differing structures and operational philosophies of organizations; the differing languages and values of professional groups; professional and agency rivalries; and the fact that professional groups are, still, largely educated and trained in isolation. Interprofessional learning has been advocated as a possible solution to some of these problems. In this paper the rationale, planning, delivery and evaluation of one interprofessional education initiative are presented. Twelve months of planning between a team of three university teachers working in South Wales, United Kingdom, led to a combined group of community nursing and social work students following post-qualifying courses at undergraduate diploma and first degree level participating in two shared learning sessions. Using an interactive approach the student group explored, first, professional roles and responsibilities and secondly, engaged in group work focused on the discussion of case studies. Student evaluation of the sessions indicated an overwhelming appreciation of the importance of interprofessional education in unidisciplinary education programmes.     

Benchmarking cardiac surgery: a regional initiative to improve outcomes. Interview by Reggi Veatch

Many of the clinical benchmarking projects featured in the Lead Story are designed to produce quick results. The Northern New England Cardiovascular Disease Study Group (NNE), by contrast, is a long-term effort to improve patients' functional health status. Formed in 1987, NNE is a voluntary consortium comprising all providers of open heart surgery in Maine, New Hampshire, and Vermont--five facilities and 28 surgeons. Although NNE is just beginning to focus on best practices within the region, its early benchmarking efforts have produced a collaborative environment in which clinical information is now readily shared. Because of this, its accomplishments have been striking: the creation of a database that includes information on more than 18,000 patients; the development of a highly accurate mortality prediction tool for patients facing coronary bypass surgery; and a 24 percent decrease in regional operative mortality following coronary artery bypass graft (CABG) surgery.     

Fund raising for libraries: a case study

The present economic climate is forcing medical librarians to look at supplementary sources of income and actively to seek funds on behalf of their libraries outside their institutions. This paper looks at fund raising for medical libraries and describes the fund-raising activities of the Friends of the Library at the Royal College of Surgeons in Ireland.     

Downloading from MEDLINE: a comparison of personal database software

The compatibility of downloaded MEDLINE references with software packages designed for maintenance of personal bibliographic databases is considered. The nine packages reviewed enable one to import batches of records downloaded from one or more presentations of the MEDLINE database, online or CD-ROM; and enable the user to re-format records into the various styles required by journal editors. Some basic features of the packages are tabulated, and details of record-importing facilities are described. Details of suppliers and prices are given.     

Workshops advocating ASEAN Vaccine Security and Self-Reliance (AVSSR): A regional initiative

The concept of ASEAN Vaccine Security and Self-Reliance (AVSSR) has recently been advocated for by the National Vaccine Institute (NVI), a public organization of Thailand, through two workshops in 2014 and 2015 organized in cooperation with the World Health Organization (WHO) for the ASEAN Collaboration Initiatives for Regional Vaccine Security and Self-Reliance (VSSR). In both workshops relevant policy makers, Expanded Programme on Immunization (EPI) managers, and experts from government and partner agencies involved in the vaccine life cycle actively participated. A paradigm shift in leveraging the initiatives of VSSR from national to regional levels was noted and reiterated.The first workshop’s objective was to understand the perspectives and identify the needs of ASEAN countries regarding vaccine security, and to list potential areas for further collaboration. The existing vaccine-related capacities, collaborations, and networks in ASEAN were discussed based on findings from a pre-workshop, self-administered questionnaire survey. The workshop ended with four key areas unanimously recommended for regional collaboration strengthening: (1) system development for vaccine security; (2) human resource development; (3) ASEAN price policy for vaccine (APPV) and pooled procurement; and (4) communication and coordination. A call for immediate action was made, prompting the second workshop to focus only on “communication and coordination” to identify concrete, actionable collaborative models for effective communication and coordination. At the second workshop, a five-year Communication and Coordination Action Plan (CCAP) was developed to foster long-term AVSSR.The AVSSR’s ultimate goal is to avoid incidental vaccine shortage and ensure sufficient supply of affordable, quality vaccines for normal and urgent situations both at the national and ASEAN-wide levels. To date, collaboration for AVSSR is being strengthened according to the ASEAN post-2015 Health Development Agenda and its collaborative framework among concerned countries and development partners. Nevertheless, to achieve the goal, integration of multiple strategies based upon strong policy commitment and uninterrupted engagement among relevant partners are required.     

Portraying Islam and Muslims in MEDLINE: a content analysis

The growing number and diversity of Muslims in the United States and Western Europe challenge clinicians and researchers to understand this population's perspectives and experiences regarding health and biomedicine. For information about Muslim patient populations, clinicians and researchers routinely consult medical literature. To examine how this literature portrays Muslims, we conducted an ethnographic content analysis of 2342 OVID MEDLINE-indexed abstracts from 1966 through August 2005, derived from a Boolean search for "islam or muslim or muslims." Manifest (explicitly stated) themes included Muslim religious practices, Islamic law and ethics, history of Islamic medicine, public health, social medicine, and cultural competence. Latent (underlying) themes implied that being an observant Muslim poses health risks; Muslims are negatively affected by tradition, and should adopt modernity; and that "Islam" is a problem for biomedical healthcare delivery. A countervailing latent theme implies that being Muslim may promote good health. We discuss ambiguities in uses of the term "Muslim;" implications of Muslim practices for health management and healthcare delivery; and ways in which MEDLINE-indexed literature intersects with orientalist and colonialist discourse about religious Others. Such intersections highlight connections with potential structural inequalities in healthcare delivery to Muslim patients.     

Getting a job: the interview

The interview is a vital part of the process of selecting the best candidate for a hospital post from many suitable ones. Most doctors should be able to develop an interview technique that does justice to all their qualities.