The perceptions of general practice among Central and Eastern Europeans in the United Kingdom: A systematic scoping review

BACKGROUND: Around 2 million people have migrated from Central and Eastern Europe to the UK since 2004. The UK Central and Eastern European Community (UK-CEE) are disproportionately exposed to the social determinants of poor physical and mental health. Their health and healthcare beliefs remain under-researched, particularly regarding primary care. OBJECTIVE: This review explores UK-CEE community members' use and perceptions of UK general practice. METHODS: A systematic search of nine bibliographic databases identified 2094 publications that fulfilled the search criteria. Grey literature searches identified 16 additional relevant publications. Screening by title and abstract identified 201 publications of relevance, decreasing to 65 after full-text screening. Publications were critically appraised, with data extracted and coded. Thematic analysis using constant comparison allowed generation of higher-order thematic constructs. RESULTS: Full UK-CEE national representation was achieved. Comparatively low levels of GP registration were described, with ability, desire and need to engage with GP services shaped by the interconnected nature of individual community members' cultural and sociodemographic factors. Difficulties overcoming access and in-consultation barriers are common, with health expectations frequently unmet. Distrust and dissatisfaction with general practice often persist, promoting alternative health-seeking approaches including transnational healthcare. Marginalized UK-CEE community subgroups including Roma, trafficked and homeless individuals have particularly poor GP engagement and outcomes. Limited data on the impact of Brexit and COVID-19 could be identified. CONCLUSIONS: Review findings demonstrate the need for codesigned approaches to remove barriers to engagement, culturally adapt and develop trust in GP care for UK-CEE individuals. COMMUNITY INVOLVEMENT: Community members and stakeholders shaped the conceptualisation of the review question and validation of emergent themes

What competencies do European general practice trainees value the most? A prioritisation exercise using a Delphi-informed approach

General Practice has changed over the past decade. Expansion of clinicians’ roles may create uncertainty, stress, and overload – particular for those at the start of their career. The WONCA Europe network for medical education, EURACT, has published competency-based aims and requirements for speciality training in general practice. Greater understanding of the trainee perspective would support planning and delivery of postgraduate training curricula. This two-step study aims to provide a competency priority list, created by European early career general practitioners, to highlight skills that this generation considers highly essential in future speciality training. A competency list was drafted with trainee- and early career general practitioners from across Europe at the Vasco da Gama Movement Forum (Edinburgh, January 2022). Participants identified competencies that they regarded as most relevant for future speciality training in their respective national contexts. Competencies were coded into categories and ranked in two consecutive rounds, the first taking place online and the second at WONCA Europe (London, June 2022). After two rounds, a consensual list of three main competencies for each category was drafted. The top three competencies for each category remained the same throughout both rounds and may be considered competencies that early career general practitioners in Europe consider important for training. Prioritisation of these competencies by institutions and educators within general practice training programmes may support trainees’ satisfaction and perceived preparedness for practice

Global primary care research challenges

Healthcare needs are changing globally as people live longer, but not necessarily in better health. Increased population migration is leading to culturally diverse patient populations with more diverse health needs and expectations. The provision of accessible and equitable primary care poses workforce, infrastructure and management challenges for high- and lower-middle income countries that transcend national borders. In this special issue, we describe ‘global primary care’ as primary care training, research and service delivery that places a priority on the needs and overall health of individuals and their communities, to advance health equity worldwide. Given this nascent definition, what should ‘global primary care research’ look like? The following case demonstrates the breadth of physical, mental, and social issues a primary care practitioner must consider when faced with a patient from a marginalised group in an inner-city practice and why training and research must have a focus on equity

What competencies do European general practice trainees value the most? A prioritisation exercise using a Delphi-informed approach

General Practice has changed over the past decade. Expansion of clinicians' roles may create uncertainty, stress, and overload - particular for those at the start of their career. The WONCA Europe network for medical education, EURACT, has published competency-based aims and requirements for speciality training in general practice. Greater understanding of the trainee perspective would support planning and delivery of postgraduate training curricula. This two-step study aims to provide a competency priority list, created by European early career general practitioners, to highlight skills that this generation considers highly essential in future speciality training. A competency list was drafted with trainee- and early career general practitioners from across Europe at the Vasco da Gama Movement Forum (Edinburgh, January 2022). Participants identified competencies that they regarded as most relevant for future speciality training in their respective national contexts. Competencies were coded into categories and ranked in two consecutive rounds, the first taking place online and the second at WONCA Europe (London, June 2022). After two rounds, a consensual list of three main competencies for each category was drafted. The top three competencies for each category remained the same throughout both rounds and may be considered competencies that early career general practitioners in Europe consider important for training. Prioritisation of these competencies by institutions and educators within general practice training GB AJ, Crebolder H, et al. may support trainees' satisfaction and perceived preparedness for practice

Practical tips for virtual facilitation: Lessons from the Lancashire Next Generation GP team

The problem Working in health and care against the backdrop of COVID-19 has led to significant changes in practice, priorities and people. There will no doubt be many lessons to emerge from this time over the coming months and years. Not least how the workforce, together with the community, came together (despite being physically distant) to respond with courage, creativity and a determination to adapt where possible. Here we share how the Next Generation GP Lancashire team adapted their approach, looked for the opportunities and embraced the learning to emerge from working virtually. The approach In March 2020, the Lancashire Next Generation GP team were in the process of organising physical events for a local leadership programme based on the existing national programme model. Following cancellation of the programme due to COVID-19, regular virtual meetings were held to explore how to work differently. An associate from the NHS North West Leadership Academy contributed to discussions exploring virtual facilitation, leadership approaches and community building. The learning to emerge has shaped the design and delivery of the first virtual Lancashire and Manchester Next Generation GP programme. Findings Several recommendations emerged from the discussions around the transition towards working virtually. Firstly, there was early recognition of transition points indicating when to work differently, which were openly communicated with participants. Secondly, the new context presented the opportunity to reflect on how to shape the new approach to design, including building on feedback on both local leadership and community needs. Following this, community principles were examined to reduce potential barriers to virtual engagement and detailed consideration was given to the transition from creating a virtual community space into relationship building. 90 participants were subsequently recruited to the virtual programme, which is currently ongoing. Feedback from participants will be available to share at the meeting. Implications The complex adaptive system environments in which we work require different approaches to leadership and facilitation at different points in time. These recommendations can be applied to establish a social learning architecture which optimises engagement and relationship building among virtual communities. Ten top tips will be presented in the meeting, which can be flexibly applied to develop shared leadership approaches and design of other educational programmes which are transitioning into virtual delivery

The potential of point-of-care ultrasound in UK general practice

Ultrasound has been described as the stethoscope for the 21st century. It can rapidly answer a specific clinical question or support a procedure. Use of point-of-care ultrasound (PoCUS) by doctors has increased in the UK and internationally over the past decade. Training in PoCUS is now a core part of some undergraduate and postgraduate learning curricula. The World Organization of Family Doctors (WONCA Europe) has endorsed use of PoCUS in general practice. The rapid uptake of PoCUS in primary care in other countries suggests that the UK may soon follow suit. This article aims to provide an overview of PoCUS in primary care, including what PoCUS is, its current and potential use within primary care, limitations, legal considerations, and resources to develop an interest and skill in PoCUS as a GP in the UK

Measurement of the production of a W boson in association with a charm quark in pp collisions at √s = 7 TeV with the ATLAS detector

The production of a W boson in association with a single charm quark is studied using 4.6 fb−1 of pp collision data at s√ = 7 TeV collected with the ATLAS detector at the Large Hadron Collider. In events in which a W boson decays to an electron or muon, the charm quark is tagged either by its semileptonic decay to a muon or by the presence of a charmed meson. The integrated and differential cross sections as a function of the pseudorapidity of the lepton from the W-boson decay are measured. Results are compared to the predictions of next-to-leading-order QCD calculations obtained from various parton distribution function parameterisations. The ratio of the strange-to-down sea-quark distributions is determined to be 0.96+0.26−0.30 at Q 2 = 1.9 GeV2, which supports the hypothesis of an SU(3)-symmetric composition of the light-quark sea. Additionally, the cross-section ratio σ(W + +c¯¯)/σ(W − + c) is compared to the predictions obtained using parton distribution function parameterisations with different assumptions about the s−s¯¯¯ quark asymmetry

Youth Culturally adapted Manual Assisted Problem Solving Training (YCMAP) in Pakistani adolescent with a history of self-harm: protocol for multicentre clinical and cost-effectiveness randomised controlled trial

Introduction: Suicide is a global health concern. Sociocultural factors have an impact on self-harm and suicide rates. In Pakistan, both self-harm and suicide are considered as criminal offence’s and are condemned on both religious and social grounds. The proposed intervention ‘Youth Culturally Adapted Manual Assisted Problem Solving Training (YCMAP)’ is based on principles of problem-solving and cognitive–behavioural therapy. YCMAP is a brief, culturally relevant, scalable intervention that can be implemented in routine clinical practice if found to be effective. Method and analysis: A multicentre rater blind randomised controlled trial to evaluate the clinical and cost-effectiveness of YCMAP including a sample of 652 participants, aged 12–18 years, presenting to general physicians/clinicians, emergency room after self harm or self referrals. We will test the effectiveness of 8–10 individual sessions of YCMAP delivered over 3 months compared with treatment as usual. Primary outcome measure is repetition of self-harm at 12 months. The seconday outcomes include reduction in suicidal ideation, hopelessness and distress and improvement in health related quality of life. Assessments will be completed at baseline, 3, 6, 9 and 12 months postrandomisation. The nested qualitative component will explore perceptions about management of self-harm and suicide prevention among adolescents and investigate participants’ experiences with YCMAP. The study will be guided by the theory of change approach to ensure that the whole trial is centred around needs of the end beneficiaries as key stakeholders in the process. Ethics and dissemination: Ethics approval has been obtained from the Ethics Committee of University of Manchester, the National Bioethics Committee in Pakistan. The findings of this study will be disseminated through community workshops, social media, conference presentations and peer-reviewed journals. Trial registration number: NCT04131179

Joint Research Day, UClan, Burnley 2018

The Joint Research Day between Uclan and ELHT took place on the 27th of November, at Victoria Mills, Burnley. The event brought together researchers and clinicians to showcase recent research, share new ideas about clinical problems that need tackling and seek collaborative interest between ELHT and UCLan staff. Uclan researchers from various academic/ research disciplines such as engineering, computer science, psychology, and health participated. The event was an opportunity to: • Hear about current local research projects, • Get involved in planned research, • Develop research ideas, • Develop collaborative partnerships. The program included • Keynote lectures by Professor St John Crean, Pro Vice Chancellor, Uclan (the second keynote speaker to be announced), • Presentations and posters of local studies. • Workshops

Measurement of W± and Z-boson production cross sections in pp collisions at √s=13 TeV with the ATLAS detector

See paper for full list of authors - 17 pages plus author list + cover pages (34 pages total), 5 figures, 3 tables, submitted to Phys. Lett. B, All figures including auxiliary figures are available at https://atlas.web.cern.ch/Atlas/GROUPS/PHYSICS/PAPERS/STDM-2015-03/International audienceMeasurements of the $W^{\pm} \rightarrow \ell^{\pm} \nu$ and $Z \rightarrow \ell^+ \ell^-$ production cross sections (where $\ell^{\pm}=e^{\pm},\mu^{\pm}$) in proton-proton collisions at $\sqrt{s}=13$ TeV are presented using data recorded by the ATLAS experiment at the Large Hadron Collider, corresponding to a total integrated luminosity of 81 pb$^{-1}$. The total inclusive $W^{\pm}$-boson production cross sections times the single-lepton-flavour branching ratios are $\sigma_{W^+}^{tot}= 11.78 \pm 0.02 (stat) \pm 0.32 (sys) \pm 0.59 (lumi)$ nb and $\sigma_{W^-}^{tot} = 8.75 \pm 0.02 (stat) \pm 0.24 (sys) \pm 0.44 (lumi)$ nb for $W^+$ and $W^-$, respectively. The total inclusive $Z$-boson production cross section times leptonic branching ratio, within the invariant mass window $66 < m_{\ell\ell} < 116$ GeV, is $\sigma_{Z}^{tot} = 1.97 \pm 0.01 (stat) \pm 0.04 (sys) \pm 0.10 (lumi)$ nb. The $W^+$, $W^-$, and $Z$-boson production cross sections and cross-section ratios within a fiducial region defined by the detector acceptance are also measured. The cross-section ratios benefit from significant cancellation of experimental uncertainties, resulting in $\sigma_{W^+}^{fid}/\sigma_{W^-}^{fid} = 1.295 \pm 0.003 (stat) \pm 0.010 (sys)$ and $\sigma_{W^{\pm}}^{fid}/\sigma_{Z}^{fid} = 10.31 \pm 0.04 (stat) \pm 0.20 (sys)$. Theoretical predictions, based on calculations accurate to next-to-next-to-leading order for quantum chromodynamics and next-to-leading order for electroweak processes and which employ different parton distribution function sets, are compared to these measurements