Joining the digital dots across primary care and integrated care

My partner and I both received a letter today from our respective GPs. An invitation for a 'FREE LUNG HEALTH CHECK'.

Overleaf is an information sheet in landscape about the health check, plus three more sides of A4, similarly formatted - inviting trifold presentation.

After the 'Re. ......' an opening sentence asks: 'Have you ever been a smoker?'

Suddenly, I was dragged backwards through his-tory (some things don't change); not one history, but several:

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My personal and life experience  and not just since my teens . . .

The letter states: **If you have never smoked, you are not eligible for this service**

My mother and father  smoked when I was a child and my siblings.    They got the message early 1980s.    'Society' smoked back then!     Once old enough, I refused to go to the corner shop.   Into the 1990s, patients, smoking (some chain-smoking) on admission, long-stay and other clinical areas. As a community mental health nurse, I learned diplomatic and health promoting skills when in the car, giving a patient a lift to hospital. And, when visiting their home where I was, of course, usually, a guest.

I wondered what has happened to the GP's records? To the primary care clinical record ? The custodians of my health record, that they should need to ask that question?    Or, does confidentiality tie some bureaucratic knots?   Where is 'integrated care' and its driver 'clinical informatics'?  The letter included the NHS Number.    Don't get me wrong, I/we appreciate the obvious effort here, even if the chronology is confusing, or,  speaks of afterthought? The letters are dated 19/06/2025. I must admit I haven't accessed my GP record, checking it for accuracy.   If anything, this is a prompt to do so. And seek a general medical.

Previously: 'smoking' : 'winwick'

'Drama classes help GPs handle difficult patients' c/o BBC

'Hull Truck Theatre has just won the Innovation prize at the Stage Awards for their new training scheme for GPs. Associate Director Tom Saunders and GP Dr Eman Shamsaee discuss why drama classes are helping doctors treat patients.' 

BBC Radio 4 'Front Row' https://www.bbc.co.uk/sounds/play/m002q2jz (15 mins ...)

◇

Holly Phillips, East Yorkshire and Lincolnshire and Ian Youngs, Culture Reporter

Published - 21 January 2026

'A theatre company is using drama training to help doctors deal with challenging patients.

Hull Truck Theatre's classes feature actors performing difficult GP consultations, with GPs giving feedback before taking over the consultation themselves.

The theatre recently won the Innovation Award at the Stage Awards for the programme.

Dr Eman Shamsaee, who has taken part in the training scheme, described it as a "really creative way of doing GP training".'

BBC News:  Drama classes help GPs handle difficult patients

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The training programme has completed its pilot stage and is now in the delivery phase

A reminder of co-working to deliver STORM training with a Clinical Psychologist colleague. 

See also: 'communication' : 'primary care' : 'GP' : 'drama'

Primary & Secondary Health Care - How long...?

THE DAWSON REPORT

MINISTRY OF HEALTH.

CONSULTATIVE COUNCIL ON MEDICAL AND ALLIED SERVICES.

Presented to Parliament by Command of His Majesty. [... selected extracts]

3. The general availability of medical services can only be effected by new and extended organisation, distributed according to the needs of the community. This organisation is needed on grounds of efficiency and cost, and is necessary alike in the interest of the public and of the medical profession. Measures for dealing with health and disease become, with increasing knowledge, more complex, and, therefore, less within the power of the individual to provide, but rather require combined efforts. Such combined efforts to yield the best results must be located in the same institution. As complexity and cost of treatment increase, the number of people who can afford to pay for a full range of service diminishes. Moreover, enlightened public opinion is appreciating the fact that the home does not always offer the best hygienic conditions for dealing with serious illness, which requires special provision in order to give the patient a full chance of recovery.

4. In days gone by such conditions as appendicitis were treated with poultices and drugs in the patient’s home. Now they are treated by operation, which is more effective, but requires more equipment, a team of workers, and a larger expenditure. Such conditions as diseases of the lungs formerly received clinical examination and treatment by drugs. They now may require, in addition, the attention of the pathologist and the radiologist. This means greater efficiency, but more organisation and higher cost.

5. Preventive and curative medicine cannot be separated on any sound principle, and in any scheme of medical services must be brought together in close co-ordination. They must likewise be both brought within the sphere of the general practitioner, whose duties should embrace the work of communal as well as individual medicine. It appears that the present trend of the public health service towards the inclusion of certain special branches of curative work is tending to deprive both the medical student and the practitioner of the experience they need in these directions.

6. Any scheme of services must be available for all classes of the community, under conditions to be hereafter determined. In using the word “available,” we do not mean that the services are to be free; we exclude for the moment the question how they are to be paid for. Any scheme must further be such that it can grow and expand, and be adapted to varying local conditions. It must be capable of comprising all those medical services necessary to the health of the people.

7. The foregoing are some of the considerations which have guided us in drawing up the scheme outlined below.

The services maybe classified into-

Those which are Domiciliary as distinct from those which are Institutional.

Those which are Individual as distinct from those which are Communal.

1. We begin with the home, and the services, preventive and curative, which revolve round it, viz., those of the doctor, dentist, pharmacist, nurse, midwife, and health visitor. These we style domiciliary services, and they constitute the periphery of the scheme, the remainder of which is mainly institutional in character. A Health Centre is an institution wherein are brought together various medical services, preventive and curative, so as to form one organisation. Health Centres may be either Primary or Secondary, the former denoting a more simple, and the latter a more specialised service.

2. The domiciliary services of a given district would be based on a Primary Health Centre -an institution equipped for services of curative and preventive medicine to be conducted by the general practitioners of that district, in conjunction with an efficient nursing service and with the aid of visiting consultants and specialists. Primary Health Centres would vary in their size and complexity according to local needs, and as to their situation in town or country, but they would for the most part be staffed by the general practitioners of their district, the patients retaining the services of their own doctors.

3. A group of Primary Health Centres should in turn be based on a. Secondary Health Centre. Here cases of difficulty, or cases requiring special treatment, would be referred from Primary Centres, whether the latter were situated in the town itself or in the country round. The equipment of the Secondary Centres would be more extensive, and the medical personnel more specialised. Patients entering a Secondary Health Centre would pass from the hands of their own doctors under the care of the medical staff of that centre. Whereas a Primary Health Centre would be mainly staffed by general practitioners, a Secondary Health Centre would be mainly staffed by consultants and specialists. It would be a consultant service in function and would be carried out by specialists or by general practitioners acting in a consulting capacity.

4. Secondary Health Centres must of necessity be situated in towns, where alone an efficient consultant service and adequate equipment could be expected, and the necessary means of communication exist. The selection of these towns will need careful consideration, and full information will be required as to the extent of existing provision of hospital and allied facilities, and of its distribution in relation to population and means of public conveyance. In rural areas the natural currents of traffic and business and existing medical facilities will usually indicate the town or towns in which a Secondary Health Centre may best be placed. In this connection we would like to point out the importance of carrying out a “Hospital Survey” at an early date. The results of this survey would afford data for recognising the areas in which the existing provision is inadequate, and the degree of the inadequacy. The Secondary Health Centres would vary in size and elaboration according to circumstances.

5. Secondary Health Centres should in turn be brought into relation with a Teaching Hospital having a Medical School. This is desirable, first in the interest of the individual patient, that in difficult cases he may have the advantages of the highest skill available, and secondly in the interest of the medical men attached to the Primary and Secondary Centres, that they may have the opportunity to follow the later stages of an illness in which they have been concerned at the beginning, to make themselves acquainted with the treatment adopted, and to appreciate the needs of a patient after his return to his home. In those towns where Teaching Hospitals exist, Secondary Health Centres would sometimes be merged in them. 

Continued at: 

https://sochealth.co.uk/national-health-service/healthcare-generally/history-of-healthcare/interim-report-on-the-future-provision-of-medical-and-allied-services-1920-lord-dawson-of-penn/

LONDON PUBLISHED BY HIS MAJESTY'S STATIONERY OFFlCE

1920. Price 2s. Net. Cmd. 693

See also:
https://www.adph.org.uk/resources/175th-anniversary-timeline/ 

My emphasis.

Diagnostic Overshadowing

Diagnostic overshadowing

People with mental health problems experience diagnostic overshadowing. This is reports of physical ill health being viewed as part of the mental health problem or learning disability and therefore not investigated or treated.  Undertaking a full physical health check for patients with SMI helps identify opportunities for evidence-based interventions which can reduce people’s risk of death, avoidable ill health and reduce health inequalities.

Source: https://primarycare.lancashireandsouthcumbria.nhs.uk/wp-content/uploads/2025/05/20250527-A-practical-guide-to-delivering-physical-health-checks-for-people-with-SMI.pdf?x23654

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MIND	Surely, it's the mind -
	not the body?

Africa's Nutrition Movement: Seizing the Window with Primary Health Care

Africa's mission to eliminate malnutrition is more critical than ever. Bubbling down the high level commitments to strategic programmable goals will be critical at primary health care and community levels.

The continent has made significant progress in recent years, but the COVID-19 pandemic has highlighted the need for sustained efforts to address the complex issues surrounding malnutrition, particularly for women and children as we build traction to meet the sustainable development goals by 2030.

"The year 2025 will also be significant as it marks the end of the UN Decade of Action on Nutrition. N4G Paris will serve as a multi-stakeholder summit, advocating for ambitious financial and political commitments and fostering dialogue among diverse actors from around the world, including governments, international organizations, research institutions, civil society organizations, philanthropies, private sector entities, and more." - #N4G

Connecting dots is a a key imperative as we build Africa's nutrition movement. One of them is viewing nutrition from a programmable health systems lens. Have we given this enough traction ?

"The N4G conference presents a crucial opportunity for Africa to gain traction on its mission to eliminate malnutrition. The conference aims to mobilize ambitious financial and political commitments, foster dialogue among diverse stakeholders, and put nutrition at the center of the sustainable development agenda." - United Nations SDGs Professional Support Group for Africa

One of the key lessons from COVID-19 is the importance of strengthening health systems, particularly at the primary healthcare level. The pandemic has exposed weaknesses in many health systems, highlighting the need for increased investment in health care infrastructure, workforce, and services which will ultimately impact on nutrition delivery at the base of the health system.

The upcoming Africa Primary Health Care Forum , scheduled for Abuja on July 14-15, 2025, will provide a platform for stakeholders to discuss the importance of primary health care(PHC) in achieving universal health coverage (UHC) and health security, as well addressing malnutrition in PHC systems. The forum will also explore the role of digital health, digitised workforce, partnerships and financing in strengthening primary healthcare systems and improving general health outcomes.

More details continued at: https://www.phc.africa/

Dear Doctor, I have a list . . .

It seems reasonable to suggest that my trips to see the GP as a child:

"What's the problem Mrs Jones?"

"It's Peter, he's not eating!"

"Well, does he seem ill? ... Is he lying down all the time?"

"No, he's running around all day"

"Well he sounds OK but let's check" ... ... ...

"Say arr!"

 (That's to me - not you reader!)

"Argh!"

"Mmm.. ok, ok. ... What does he eat?"

"Tomato soup, chips, chicken, beans on toast, raw carrot, boiled egg."

"Oh! And jam butties!"

"Well he's of slim build, no doubt underweight, but he's fine. Keep the jam butties rolling, and I suspect he'll keep running around."

- were in the days pre-one-problem-per-visit to the surgery. Even now I wonder is this an urban (rural) myth. But then it rears itself with a comment by family, or overheard. The 1960s and 1970s were a different time, a different age. We always saw the same doctor. Continuity mattered then. Thankfully, I was not a regular 'visitor', or the more derogatory term frequent flyer.

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Ever since starting in the NHS as a nursing assistant, you became aware of the anxiety provoked by many patients when it is their turn to see the doctor. Being asked to bring the patient and any relative(s) through. It often entailed a walk.

I remember one instance their being 12 professionals. Learners can soon increase numbers and restrictions were imposed. Voices were raised. Patients did see the doctor separately. Back in 1980s, I became a CMHN (CPN) in 1985, I used to encourage patient's to prepare, to make notes of points - questions they wanted to ask. I framed it as their time, their opportunity. A learning opportunity too. Of course, humour always needs to be used carefully, but on occasion we would joke about walking into the meeting with a list.*

In case of long-term mental illness families are also greatly involved. Sometimes a case review would take place in the patient's home. If it's care in the community, delivered by the community team then surely the administration can be organised in support?

At times, I would offer to assist and the team were always responsive. This role of advocacy has changed, transformed over the decades, but it is still there. As a nurse you listen for the voice: but have to be ready to 'pick this up' on another's behalf. Ready

*Lists: Long a tool for safety and situational awareness.

Social Prescribing Student Champion Scheme - APPLICATION FORM

We are looking for champions!!! Student Nurses, Midwives, AHPs and Medics! Come join us!!! Share on all platforms as there is only one week remaining before the deadline! @LJMU_MHN_Soc @LJMU @LJMU_Health #socialprecribing #supportinthecommunity #futureofhealthcare https://t.co/p0BoW7CY7H

— student_ nurse _2021 (He/Him/His) (@STN_JW2021) October 6, 2022

 
APPLICATION FORM

There is a QR code to apply too.

Harvard Medical School Primary Care Review

"I'm writing to invite you to contribute your
narrative stories of health, community, and equity!"

 

Dear Spirit of 1848:

I hope this email finds you well. I'm a Family Medicine Physician, Instructor at Harvard Medical School, and Editor-in-Chief of the Harvard Medical School Primary Care Review. I'm writing to invite you to contribute your narrative stories of health, community, and equity!

The Harvard Medical School Primary Care Review is an international community-facing publication, and our mission is to “Share stories to amplify the voices of health everywhere.” Publications are approximately 750-1200 words in length, and all references should have hyperlinks (rather than end- or footnotes). The following is a brief set of guidelines for the Review: https://info.primarycare.hms.harvard.edu/review/submission-guidelines. The following Review pieces are nice examples of the type of narrative and community health content we strive for:

• https://info.primarycare.hms.harvard.edu/review/trauma-informed-holistic-health-care
  
• https://info.primarycare.hms.harvard.edu/review/food-access-navajo-nation

Please also share this call with your community partners! We look forward to hearing from you!

Warmly,

Rebekah

-- 

Rebekah Rollston, MD, MPH  (she/her)

Family Medicine Physician, Cambridge Health Alliance

Instructor in Medicine, Harvard Medical School

Editor-in-Chief, Harvard Medical School Primary Care Review

--
Posted from the Spiritof1848 Listserv WWW.SPIRITOF1848.ORG #Spiritof1848

c/o GPonline: "Social prescribing patients curate art exhibition at leading Cornish gallery"

"The ‘What Lies Behind’ exhibition, a recent display in Newlyn Art Gallery, saw 10 patients from Morrab Surgery in Penzance select works of art from Arts Council national collection of more than 8,000 pieces.

The group were asked to choose pieces that reflected their personal response to the pandemic. The works on display included textiles, sculpture, prints and paintings by artists including Pablo Picasso, Henry Moore and Chila Burman.

The project came about during lockdown after Morrab Surgery’s social prescribing link worker Ellie Moseley realised that many of the patients in the practice that she was working with had an interest in the arts." [ On GPonline ].

 

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Personal expectations (care, medicine...) Emotional wellbeing Person-centred care Social prescribing as a care intervention	'What lies behind' exhibition, Newlyn Art Gallery
	Social prescribing as a care policy needs community resources (to match). Amid health policy calls for innovation and  sustainable healthcare systems and services; the community remains the sustainable resource (if not neglected). Funding - ... ££ $$ €€ ¥¥ ฿฿ ₫₫ ₴₴ ₪₪ ₽₽ ₹₹ ₩₩ ... local :: global health.

 

My source: @ActivateEurope

https://twitter.com/ActivateEurope/status/1491751271539351562?s=20&t=ZQHyHs2a9--xJpmJDzrdHQ

@GPonlinenews

RCGP Secure Environments Group 8th Health & Justice Summit: Communities of Practice in Secure Care

 

October 12-13, 2021 

Crowne Plaza Newcastle, Stephenson Quarter, Hawthorn Square, Forth Street, Newcastle upon Tyne, NE1 3SA

To address the complex health and social care needs of people resident in custodial settings, effective partnership work is required not only between health partners and the prison service but also with health and justice policymakers. PHE 2018-2019 Annual Health & Justice Review

Prisons and other secure settings can provide a unique opportunity to address a wide variety of health needs. These can range from infectious diseases such as HIV, hepatitis and tuberculosis as well as mental health issues, substance misuse disorders and long-term conditions.

‘Prison Health’ should be considered ‘Public Health’ as the vast majority of prisoners return to the community, and the investment in healthcare in these settings provides a wider overall benefit. The mission of this Summit is to share models of good practice, innovations in healthcare delivery and advances in treatment in order to best utilise the opportunity we have for our patients and for our society.

Following on from the highly successful 7th RCGP Secure environments summit in November 2019, and the 1st Virtual RCGP Health and Justice Summit in November 2020 the RCGP Secure Environments Group & Convenzis are very excited to share details of the 8th Annual RCGP Secure Environments Summit taking place on Tuesday the 12th and Wednesday 13th of October 2021 in central Newcastle.

This as always is ran with various key partners, this includes: Ethypharm, Mountain Healthcare, Spectrum Healthcare, Nottinghamshire Healthcare, Ashworth Hospital, Mersey Care, Merck Sharp & Dohme, Inclusion (Part of Midlands Partnership NHS Foundation Trust), Oxford Immunotec, SLD Training, Essex Partnerships, Public Health Wales and West London NHS Trust.

In recognition of the significant progress and collective contribution of our attendees, partners and sponsors, we are titling the 8th Summit:

Compassion, collaboration and continuity through the gate

We are now considering the next the next decade, and we look forward to receiving content on the following themes including:

• Clinical practice and teamwork
• Guidance, Research and analysis
• Innovation and technology
• Leadership and culture

As in previous years, the event will be held in partnership with a range of sector-leading strategic partners, more updates on this year’s partners will be disclosed soon.

Registration for the day is now open, and we look forward to seeing some familiar faces and new delegates across both days.

===

Having attended previously (in person) the knowledge and insights gained have proved invaluable working in Adult Community Mental Health Team, Early Intervention and START - Specialist Triage Assessment Referral and Treatment Team. So if you work in prison health, secure, forensic and related health, social and community services the potential gains should be even greater. The time invested also contributed to my revalidation. I plan to attend and possibly present Hodges' model.

Paper: Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review

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"Implementing NCD care in humanitarian crises requires the development of a context-adapted approach or ‘model of care’. A model of care may be characterized as a conceptual and pragmatic framework that describes how services are delivered within a health system (Davidson et al., 2006; Agency for Clinical Innovation, 2013)." Models of care "We found that there was no single unifying model of care for HTN/DM care in humanitarian crises, and the variance in care models included in this review was highly dependent on context. In order to descriptively synthesize the diverse models presented in the included studies, we created a typology based on the type of crisis, region and integration with the health system, since these factors likely influenced model design"   patient’s expectations

hypertension and diabetes (HTN/DM) Crisis type and Region Natural: Hurricane, Flood, Earthquake Palestine, Lebanon, Jordan,  China, Pakistan,  India, Philippines, Syria, Iraq, Turkey, Nepal Camp, Non-Camp; Rural, Urban Location of services - Location of people in need, transport, travel time, distance Refugee population - Local population forced displacement, disruption of treatment and support, interrupted health services, movement and attrition of health care workers (HCWs), insecurity, destruction of infrastructure,  breakdown in supply chains and data processes "The domains of access — availability, affordability, accessibility, accommodation, and acceptability — were derived from previously described measures of coverage (Penchansky and Thomas, 1981; Hernández-Quevedo and Papnicolas, 2013; Levesque et al., 2013)."

Refugees and Host Communities Humanitarian crises "Responsiveness has been defined as the ability of health services meet a patient’s holistic needs; in this framework, it also encompassed a model of care’s ability to respond to changing patient needs in a volatile context (.Hernández-Quevedo and Papnicolas, 2013; Kruk et al., 2018). Integration described the linkage between different levels and sites of care, such as facility-based care and community-based support as well as coordination between providers and institutions, while continuity of care referred to uninterrupted care throughout the patient’s disease and life course."

Formal health system and community-based formal or informal systems Non-governmental organisations Crisis type and Region Political: Conflict, Disaster Affordability, income, worth of service Accommodation Person :: Service centrednesss

 

"Availability was defined as the volume and type of existing services and whether this was adequate for the volume and needs of service users. Affordability constituted the patient’s capacity to use financial resources to obtain care balanced against their income and the perceived worth of the service. Accessibility addressed the match between the location of services vs the location of people in need, including transport, travel time, distance, and cost. The accommodation was defined as the organization of service delivery, such as opening times and ability of service users to accommodate to this. Acceptability was considered as the relationship between the services and the patient’s expectations of appropriate care."

(My emphasis)

NCD  - Non-communicable disease

My source: HIFA list

CITATION: Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review, Michael S Jaung, Ruth Willis, Piyu Sharma, Sigiriya Aebischer Perone, Signe Frederiksen, Claudia Truppa, Bayard Roberts, Pablo Perel, Karl Blanchet, Éimhín Ansbro

Health Policy and Planning, https://doi.org/10.1093/heapol/czab007

Southern Sudan Medical Journal: May 2019 issue on Primary Health Care

Dear SSMJ Reader,

 

The special May 2019 issue on Primary Health Care is now online here and includes items on support for PHC in refugee camps, approaches and strategies for PHC, charging for health care, literacy and health, community screening for diabetic retinopathy, vaccination coverage and CHWs treating malnutrition.  See details below.

Send us your feedback, your manuscripts (which we can help you prepare), encourage colleagues to join the mailing list here, follow us on twitter: @SSMedJournal and our Facebook Group, and find previous SSMJ articles at African Journals Online (AJOL) and the Directory of Open Access Journals (DOAJ).

 

The SSMJ Editorial team

admin AT southernsudanmedicaljournal.com.

In the May 2019 issue:

EDITORIAL

• Forty years of primary health care programming and its future in South Sudan Dr Ayat Jervase 

ORIGINAL RESEARCH

• Using livelihoods to support primary health care for South Sudanese refugees in Kiryandongo, Uganda Dominic Odwa Atari and Kevin McKague 

MAIN ARTICLES

• Integrated Primary Health Care (iPHC) for developing countries: a practical approach in South Sudan Victor Vuni Joseph and Eluzai Hakim 
• Addressing high vaccination coverage in primary health care setting: challenges and best practices Bobby Paul and Indranil Saha 
• Preventing blindness from diabetic retinopathy through community screening Wani G Mena 
• UK-South Sudan Alliance: a strategy for increasing capacity and access to primary care and public health Rich Bregazzi 
• What is the best way for healthcare systems to charge sick patients? Alfred Lumala, Lucien Wasingya-Kasereka, Martin Opio, Jenard Ntacyo, Samuel Mugisha, John Kellett 
• How can we bridge the gap between literacy and health in South Sudan? China Mayol Kuot 

SHORT ITEMS

• The Evidence for Contraceptive Options and HIV Outcomes (ECHO)
• Performance of low-literate community health workers treating severe acute malnutrition in South Sudan Elburg Van Boetzelaer, Annie Zhou, Casie Tesfai, and Naoko Kozuki 
• Martha Primary Health Care Centre: how resilience and international collaboration is transforming a community Poppy Spens 
• Point Of Care Ultrasound (POCUS) is saving lives Achai Bulabek 
• Juba College of Nursing and Midwifery milestones in 2018 Anna Modong Alex 
• Obituary: Dr Joy Theophilus and Dr Emmanuel Kenyi

LETTER TO THE EDITOR

• What South Sudan must do to reduce high maternal and infant deaths? Janet Mugo and Munawwar Said 

BACK COVER

• The Ten Steps to Successful Breastfeeding WHO

We thank all the authors, reviewers and editors who helped to produce this special issue.

Patient Education: Stable - Unstable Plaques c/o twitter ...

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'The patient' Insight, Awareness, Understanding Attention, Engagement, Recall Health Literacy	Stable-Unstable Plaques Statins Post Myocardial Infarction Evidence-Based Care
Love this unstable plaque explanation - why this man should take a statin post MI @Channel4 #GPsBehindClosedDoors - please namecheck this nurse if you know her @theRCN @RCNconnects @NursingTimes @TheBHF @BritishCardioSo @DrPascalMeier @Heart_BMJ @JACCJournals #medshr pic.twitter.com/r1t0VCL0SL — Dr Asif Qasim (@DrAsifQasim) December 5, 2018	Policy Post MI Intervention or Pre MI? Clinics ('Real time'?) Public Health Funding

Social prescribing: c/o @TheKingsFund - Three questions

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Does it work?	What is it?
What is #socialprescribing? Does it work, and how does it fit in with wider health and care policy? A quick refresher ahead of our event tomorrow… https://t.co/46cJqjBKeR — The King's Fund (@TheKingsFund) November 5, 2018	And how does it fit in  with wider health and care policy?

Social prescribing is not a quick fix, a social distraction from a clinical problem. How this is approached - negotiated - will be a clear factor in the shared success of social prescribing as an effective, intervention for the person concerned, the NHS AND society.

"One-size-fits-all" Assurance of Insurance needed?

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mental health problems affect Self-employed, single No previous history of MH problems PURPOSE# Psychology - Counselling	12.5 million adults - 1 in 4 PROCESSES (automated?)* 'Life cover' Insurer access to GP record - deemed high-risk 500,000 people affected by
Untimely death of a parent Mother killed by drug-using driver Refused IVF treatment PRACTICE	insurance company POLICIES driver jailed Voided application for life cover (figures) suggest insurers reject up to 625,000 people a year By law ins. companies cannot discriminate

*Need to discuss an application with a person, fill in 'gaps' then less likely to become subjected to an algorithm and an automated rejection.

^# What were the reasons for referral to psychology and counselling?

My source:
Miller, L. (2018) My fight to get life cover after mental health trauma, The Daily Telegraph, Money, 22 September, pp.1-2.

See also: https://www.telegraph.co.uk/insurance/life/get-life-insurance-mental-health-problem/

Technology can, will and is helping to 'disrupt' the insurance market.

Primary Care and the GP crisis: Individual - Group [Consultations]

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Mental health (use of groups) One-to-One Interpersonal skills Psychological therapies PURPOSE Psychotherapy	Time, Place Efficiency Cost-effectiveness Evidence-based same conditions PROCESS
Group Consultations Group Therapy - an established therapeutic modality Group CBT for Older Adults PRACTICE	POLICY Treatment Therapy Education Doctor or Nurse led other disciplines too...

It’s great to hear #RCGP lead acknowledging the value of group consultations. Many of these pilots have been formulated & run by #nurses in general practice. It’s a shame their work wasn’t acknowledged on .@BBCr4today @weGPNS @theRCN https://t.co/zh4H7swoUv

— RCN GPN Forum (@RCNGPNForum) October 6, 2018

My source:
The Telegraph, GPs to see patients in groups of 15

@weGPNS - text corrected from original.

The Socio-Politics of Migration...?

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Julian Simpson (2018) Migrant architects of the NHS - South Asian doctors and the reinvention of British general practice (1940s-1980s). University of Manchester Press.

Alex Matthews-King. The Independent, Jeremy Hunt backs special visa for foreign people coming to work for NHS. 9 May, 2018.

My source (book): Noted in Blackwells, Manchester, £25 from £75.

Finding space in Hay-on-Wye: Complexity & healthcare - book

This time last week I was in Hay-on-Wye the book town on the border of England and Wales. February is still pretty cold, a good excuse to really browse.

complexity and healthcare - book cover

Amongst some great finds were three books on complexity in primary care and medicine.

I am sure that the way complexity can be woven within Hodges' model are manifold. On page 4 of Sweeney & Griffiths: 

Using the idea of multidimensional phase space can help us understand categories of disease without clear boundaries. Instead of thinking of a person's illness as a walled off and separate pigeon hole, it can be useful to think of it as a point within a multidimensional illness space.

Kieran Sweeney, Frances Griffiths (eds). (2002) Complexity and healthcare: an introduction. Radcliffe Medical Press Ltd.

Clusters of empathy

There still is a Complexity in Primary Care group but it is now essentially silent. I've met several people through the group over the years.

It might be decades since James Gleick's book Chaos (1987) and yet there is plenty of mileage left in complexity. One of the people I met through the group and hoped to meet in Australia at the ICN Congress is Paul Bennett who informed me of the following paper:

Academic Psychiatry, 33:6, Nov-Dec 2009 p.489

Winseman, J., Malik, A., Morison, J., Balkoski, V. (2009) Students’ Views on Factors Affecting Empathy in Medical Education. Academic Psychiatry. 33:484–491.

In explaining Hodges' model to Paul he was struck by the conceptual clustering in this paper. It isn't that there is a direct match between the paper's figure 2 and the care (knowledge) domains of the model, but multidimensional scaling is a potential tool to explore Hodges' model too.

The influence of political factors in medical education might be another aspect to consider. This is a dimension Hodges' model can encompass.

An acute concern at present in the NHS is the prospect of a seven day service, necessitating changes to the contracts of doctors and other disciplines.

Thanks to:
Paul Bennett, Primary Health Care Education Officer
Broken Hill University Department of Rural Health - Broken Hill
PO Box 457, BROKEN HILL NSW 2880
http://sydney.edu.au/medicine/drh/

RCN nursing journals are now available through HINARI

Dear All,

I am pleased to share that, as of last month, the journals published by the Royal College of Nursing (UK) are now available through HINARI, which means that HINARI users can now access the following journals:-

- Cancer Nursing Practice
- Emergency Nurse
- Learning Disability Practice
- Mental Health Practice
- Nurse Researcher
- Nursing Children and Young People Nursing Management
- Nursing Older People
- Nursing Standard
- Primary Health Care

This brings the total number of nursing journals available via HINARI to 172, including journals from BMJ Publishing, Cambridge University Press, Elsevier, Informa Healthcare, John Wiley, Lippincott Williams & Wilkins, Mary Ann Liebert, Sage, SLACK, and Thieme.

Best wishes to all.

Richard Gedye
Publisher Co-ordinator
Research4Life

My source:
HIFA2015 Health Information For All by 2015