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Carrying out minor surgery procedures in the primary care setting is popular with patients, cost effective and delivers at least as good outcomes as those performed in the hospital setting. This paper aims to describe the central role of clinical leadership in developing an accreditation system for general practitioners (GPs) undertaking community-based surgery in the Irish national setting where no mandatory accreditation process currently exists.

In all, 24 GPs were recruited to the GP network. Ten pilot standards were developed addressing GPs’ experience and training, clinical activity and practice supporting infrastructure and tested, using information and document review, prospective collection of clinical data and a practice inspection visit. Two additional components were incorporated into the project (patient satisfaction survey and self-audit). A multi-modal evaluation was undertaken. A majority of GPs was included at all stages of the project, in line with the principles of action learning. The steering group had a majority of GPs with relevant expertise and representation of all other actors in the minor surgery arena. The GP research network contributed to each stage of the project. The project lead was a GP with minor surgery experience. Quantitative data collected were analysed using Predictive Analytic SoftWare. Krueger’s framework analysis approach was used to analyse the qualitative data.

A total of 9 GPs achieved all standards at initial review, 14 successfully completed corrective actions and 1 GP did not achieve the required standard. Standards were then amended to reflect findings and a supporting framework was developed.

The flexibility of the action-learning approach and the clinical leadership design allowed for the development of robust quality standards in a short timeframe.

Improvements were delivered in the care of patients on anti‐coagulants through a collaborative improvement methodology within one primary care organisation. Although a key clinical governance priority, the project was conducted in a low‐key manner with minimal support. Practice teams were encouraged to apply evidence through small‐scale testing of changes, using measurements to monitor improvement and to share what they learned amongst themselves. No specific model of care was pursued and instead the emphasis was on demonstrating an improvement at the practice level, by whatever means worked best. The methodology used was similar to that applied in major national and regional collaborative programmes. This project demonstrates how it can be simplified and implemented within one primary care organisation to deliver improvements in care as well as to support the building of teams and learning about measurement and quality improvement.

Social prescribing (SP) is an emerging area of public health that has the potential to alleviate pressure on primary care by offering non-clinical solutions to health problems. Whilst there is an increasing body of literature exploring service design and impact, there is little research that focuses specifically on the SP workforce. The purpose of this paper is to explore routes into SP, worker’s experiences of the sector and potential career progression.

For this qualitative study, semi-structured interviews were conducted with eight members of the SP workforce with varying levels of responsibility from within six different organisations in an urban/suburban area of South West England. Interviews were analysed using thematic analysis.

Pathways into the sector were varied, and those without direct experience often brought transferable skills from other professions. Careers in SP were clearly rewarding, and some providers had established good support structures for staff. However, some participants were in need of additional training in areas such as collaborative working and staff management. Staff working at a more senior level – particularly in community-based organisations – seemed less well supported overall, with limited career progression. Staff in such organisations also reported working beyond contractual hours.

This study has revealed inconsistencies between the experiences of staff in some community organisations vs those associated with larger, more established services. It has also highlighted a need for further training and capacity building in some areas. These findings may be of interest to those commissioning or funding SP services in the future.

This paper aims to show the results from a pioneering primary care‐based extended scope physiotherapist (ESP) led service, which placed patients directly onto the surgical waiting list of secondary care orthopaedic consultants over a two‐year period.

A retrospective data review was performed on all referrals from community‐based ESPs for direct listing at the secondary care hospital between 2 January 2008 and 31 December 2009.

A total of 130 referrals for direct listing were made by the ESP team during the two‐year period. Of these, 127 (98 per cent) went on to undergo a THR. Three patients (2 per cent) did not ultimately have a THR.

This process has continued over the two years of the direct listing service, with ongoing evaluation and refinement of the pathway, so referral criteria and clinical/administrative pathways have been changed in the light of experience.

Patients who were directly listed did not require a hospital orthopaedic outpatient appointment until attendance at preoperative assessment clinic shortly before their surgery. In addition to the reduction in inconvenience and travelling costs incurred by patients, there was an approximate saving of £145 to the primary care trust per directly listed patient.

The authors believe that this service evaluation is the first publication to show that direct listing by primary care based ESPs is a safe and effective process for some patients requiring primary THR.

This study aims to identify senior citizens’ requirements related to “embedded retirement facilities (ERFs)”, which are small-scale, multi-functional and community-based care facilities for senior citizens in mainland China, and to discuss whether senior citizens’ perceptions are influenced by their backgrounds.

A questionnaire type of research was administrated to gain senior citizens’ rankings of services that should be provided by ERFs. Non-parametric statistical models were applied to analyse the collected data.

Results reveal that health care services for senior citizens are considered the most important. Requirements regarding rehabilitation and entertainment and daily life assistance are ranked second and third, respectively. Culture-related activities are the least important. Differences in the senior citizens’ background also influence their choices.

This research is based on a questionnaire survey completed in northeast China. Opinions from other areas of mainland China will be collected in the future study. Furthermore, the key items identified in this research, which was completed by participants from the built environment discipline, can be further elaborated by combining interdisciplinary feedback.

This study explores services that are supposedly provided by ERFs. Findings will provide useful perceptions from senior citizens and will enable decision makers to prioritise services for senior citizens.

Although senior citizens are the end users of ERFs, their needs are easily overlooked. This study calls attention to their needs from ERFs, and the results are likely to serve as references for stakeholders in building improved facilities.

ERFs have been provided in mainland China to cater to senior citizens’ needs since 2014. However, few studies have identified senior citizens’ requirements for provided services. The survey-based results of this work will serve as references for various stakeholders in making enhanced decisions.

The purpose of this paper is to train primary health care workers to be trainers and implementers of community‐based AIDS prevention activities in Oyo State, Nigeria, by describing an evaluation of the project.

A total of 148 primary health care workers recruited from the 33 local government areas (LGA) of the state were trained as trainers. They were provided seed grants to replicate similar training for health workers, implement and evaluate community‐based AIDS prevention activities. Questionnaires were used before and after the training and the community based projects to evaluate its impact on knowledge of cause of AIDS, routes of HIV transmission, signs and symptoms of AIDS, and precautions to prevent.

At pre‐test, only 30.8 per cent of trainers could list at least four signs and symptoms of AIDS compared with 70.9 per cent who could do so after the training. The trainers trained 973 health workers; the number trained ranged from 20‐80 with a mean of 32.4. The trainers also implemented community‐based AIDS prevention interventions which reached 2,082 persons including adolescents (48.2 per cent), long‐distance drivers (16.6 per cent), market men and women (15.8 per cent), female sex workers (14.2 per cent), traditional birth attendants (4.6 per cent) and herdsmen and women (5.6 per cent). The evaluation conducted after four months of implementation of the community‐based projects showed improvement in knowledge of HIV among all the target groups. It suggests reduction in reported unprotected sex among drivers (from 44 per cent at pre‐test to 18.9 per cent at post‐test) and increase in reported consistent use of condoms (from 53.4 per cent at pre‐test to 71.4 per cent at post‐test) among female sex workers.

Primary health care workers can successfully implement community‐based HIV/AIDS prevention activities.

Primary health care workers can make important contributions to HIV/AIDS prevention and control efforts.

Health education interventions delivered by primary health care workers multiplied the effects of HIV/AIDS prevention and control activities.

This chapter draws from the authors’ experiences with service-learning pedagogy in allied health training programs, and illustrates ways in which community-engaged teaching and learning can prepare students to become ethical healthcare practitioners. The authors infuse examples from their own courses throughout the chapter, mostly from the clinical fields of speech-language pathology, audiology, and occupational therapy. However, the chapter is applicable and generalizable to faculty from a wide scope of allied health training programs. The chapter introduces considerations for establishing campus–community partnerships in an ethical manner, as well as ways to foster student self-reflection and critical thinking through an ethical lens. Principles from the codes of ethics of various allied health professions are incorporated throughout the chapter along with examples of how each can be applied in community-based clinical experiences. Through a review of relevant literature, analysis of professional codes of ethics, case-based examples, and a step-by-step guide to course development, this chapter provides readers with a mechanism to ground their courses in professional ethics in a way that is relatable and relevant to students.

A critical commentary on policy and practice over time in English health and social care. The paper aims to discuss these issues.

Personal reflections based on prior experience as a senior leader in the English health and care system, combined with insights and relevant evidence from other senior leaders and health and care “think-tanks”.

Shifting the balance of care from a hospital to a community setting can potentially be cost-effective as well as improving quality for service users. However, it will require a change in the approach to planning and implementation, by focussing on service users and communities, rather than on statutory organisations. It will also require a greater level of integration between primary care, community health services, social care and the voluntary sector, and greater levels of “co-production” with service users and the public.

Front-line health and care leaders are generally unaware of the evidence base in this field. Emergent findings in this field need to be rapidly evaluated and then communicated to front-line leaders and practitioners.

Incorporates direct experience of senior leaders in the field together with the existing and emerging evidence base.

In 2019, St Johns Winchester, a CQC-registered charity, launched the Hand in Hand (HiH) Service, a social prescribing (SP) initiative to alleviate social isolation/loneliness amongst older people via integration between primary care and the third sector. Arising from collaborative stakeholder reflection, this article explicates processes instigated to plan, implement and evaluate the HiH service which has been locally recognised as an exemplar of good practice. It aims to fill a gap in the literature which has hitherto lacked contextual description of the drivers, mechanisms and processes of SP schemes, leading to confusion over what constitutes SP and which models can work.

The article defines the context of, drivers for and collaborative process followed to implement and evaluate HiH and reflects on challenges, facilitators and key points for transferable learning. Early evaluation findings are presented.

Key features underpinning the success of the pilot phase were: having clear referral pathways, working collaboratively with health and voluntary sector partners, building relationships based on trust, adherence to high-quality standards and governance, a well-trained team of volunteers and access to up-to-date information source. There remains a disparity between the urgent need for rigorous evaluation data and the resources available to produce it.

The article offers a novel contribution for those planning SP at the level of practice and policy and for the developing field of SP evaluation.

The standard of health care in prisons should be equivalent to that provided in the community. Prison populations are multiply disadvantaged and primary health care practitioners in prisons routinely face organisational and ethical challenges which are rare in community‐based general practice. This raises the question of whether doctors working in prisons consider they would benefit from additional clinical skills or training, the range of prison‐specific competencies they consider important and what they would like to see included in induction programmes. Through a series of semi‐structured, faceto‐face interviews with doctors and health care managers working in prisons, this study sought to identify views on the training needs for doctors working in prisons. Practitioners demonstrated that induction processes were varied and fragmented and that delivering primary care in prisons raised additional clinical and organisational challenges. Relationships with prisoner patients were generally good. Few ethical issues were raised by this small sample, with the exception of confidentiality. However, aspirations towards equivalence were tempered by tensions between custodial needs and clinical requirements, and more research should be directed to the ways practitioners negotiate this interface. Induction programmes should ensure that all practitioners receive practical and ethical guidance to help them address these tensions.