GPs' perceptions of workload in England: a qualitative interview study.

Background General Practitioner (GP) morale is the lowest amongst doctors, job satisfaction is low, and the GP workforce is diminishing. Workload is frequently cited as negatively impacting on commitment to a career in general practice, and many GPs report their workload to be unmanageable. Aim To gather in-depth understanding of GPs’ perceptions and attitudes towards workload. Design and Setting All GPs working within NHS England were eligible. Of those who responded to advertisements, a maximum variation sample was selected until data saturation was reached. Method Semi-structured, qualitative interviews were conducted. Data were analysed thematically. Results 171 GPs responded, and 34 were included. GPs described an increase in workload over recent years, with current working days being long and intense, which raised concerns over wellbeing of GPs and patients. Full-time partnership was generally not considered to be possible, and many participants felt workload was unsustainable, particularly given the diminishing workforce. Four major themes emerged to explain increased workload: 1) increased patient needs and expectations, 2) changing relationship between primary and secondary care, 3) bureaucracy and resources, and 4) the balance of workload within a practice. Continuity of care was perceived to be being eroded by changes in contracts and working patterns to deal with workload. Conclusion This study highlights the urgent need to address perceived lack of investment and clinical capacity in general practice; and suggests that influencing patient expectations of what primary care can deliver and reducing bureaucracy have become key issues, at least until the capacity issues are resolved.</p

Chimeric Vastus Lateralis and Anterolateral Thigh Flap for Restoring Facial Defects and Dynamic Function following Radical Parotidectomy

BACKGROUND: Extirpation of malignant tumors of the parotid results in creation of a complex facial defect often in combination with facial nerve palsy. This study presents the authors\u27 experience using vastus lateralis muscle as a chimeric flap with anterolateral thigh flap to allow both soft-tissue reconstruction and dynamic reanimation in radical parotidectomy. METHODS: A retrospective review of the medical records of cancer patients who had undergone radical parotidectomy and reconstruction using a chimeric vastus lateralis and anterolateral thigh flap between March of 2013 and May of 2017 was performed using the Sydney Head and Neck Cancer Institute database. The return of dynamic midface movement was the primary outcome investigated. Electronic, clinician-graded facial function scale grades were used to formally assess postoperative outcomes. RESULTS: A total of 27 patients were included in the study with an average age of 72 years (range, 31 to 88 years). Thirteen patients (48 percent) had developed dynamic function by the end of the study period. Young age predicted a more rapid return to dynamic function (p = 0.018). Both being a woman and having an intact facial nerve before surgery improved dynamic midface movement (p = 0.005 and p = 0.036, respectively). On multivariable analysis, superior midface dynamic function was associated with neurotization using midface facial nerve branches as opposed to using nerve-to-masseter alone (p = 0.05). CONCLUSION: The chimeric vastus lateralis and anterolateral thigh flap is a suitable option for restoring defects and dynamic function following radical parotidectomy