To work with service users and providers to optimise the design and implementation of handover forms to support the transfer of information between daytime and out-of-hours primary care services for patients with palliative care needs.

There is a need for improved informational continuity between daytime and out-of-hours primary care services for patients with palliative care needs. Research suggests that while handover forms are vital to ensure continuity of care, they remain underused for such patients. Audit work in an out-of-hours primary care service in South West England identified that their current system of handover forms was underused.

An action research study consisting of two phases was undertaken. In phase one, the views of general practitioners and nurses working in the out-of-hours and daytime primary care services (29 health professionals) in Devon (population c.1.4 million) and patients with palliative care needs and their carers (8 participants) were investigated using qualitative interviews and focus group methods. Participants’ views on the content and use of handover forms, and of the systems supporting their generation were sought. In phase two, additional feedback from the health professional stakeholder groups was collected and collaborative work undertaken with the out-of-hours service to implement recommendations emerging from the qualitative research.

Respondents identified variable use of handover forms and inconsistent practice in terms of: who was responsible for generating and updating forms; when and where they were discussed in primary care; the criteria used to define which patient needed a form; and the information forms should contain. There was uncertainty about how handover forms were used by the out-of-hours service and concerns about incomplete access to forms for certain groups of staff. An action plan to improve the existing system was developed. This included distribution of educational materials (desktop guide, newsletter) to key stakeholders, and the modification of information systems to facilitate the updating of messages and the accessibility of electronic records for previously under-served staff.

To explore the experiences of people with advanced cancer and/or their caregivers accessing out-of-hours care.

The organisation and delivery of out-of-hours in the United Kingdom has undergone major reforms over the past three decades culminating in the new General Medical Service contract in 2004. There are concerns around continuity of care for patients with complex needs under the new arrangements.

A qualitative interview study was undertaken recruiting patients from two primary care trusts in Southwest England. Semi-structured interviews were conducted with 28 people with advanced cancer and/or their caregivers who had recently requested out-of-hours care. Interviews were recorded, transcribed and analysed thematically.

Two main themes were identified including the legitimacy of seeking help and continuities of care. Most participants were reluctant to seek help, finding it difficult to decide whether their needs were sufficient to contact services. The degree to which services legitimised participants’ requests mediated their experiences. Distress arose when services were dismissive of their needs, whereas respondents were appreciative of clinicians who provided them with reassurance. Participants reported a lack of relational and informational continuity of care. Consulting with an unfamiliar clinician out-of-hours raised doubts in some participants’ minds about the quality of care. Some participants recounted episodes in which there were problems with pain management. While the themes suggest that the delivery of out-of-hours care as a whole was not always perfect, around-the-clock access to professional sources of support and reassurance was highly valued. However, the transfer of information to out-of-hours providers remains a key challenge; participants did not understand why out-of-hours providers could not access more information on their medical histories given the level of computerisation within the National Health Service. The findings highlight the need to improve continuity between in-hours and out-of-hours services for patients with complex needs.

To explore the acceptability amongst general practitioners (GPs) of an early intervention to prevent long-term sickness absence from work and to identify the appropriate broad characteristics of such a service.

The effect of long-term sickness absence from work on individuals and society has been the subject of recent policy debate. In the United Kingdom, a number of return-to-work interventions have been piloted and plans to reform the incapacity benefit system are underway. Since GPs play a key role in the sickness certification process, their views on the appropriateness of an early return-to-work intervention were sought to help inform the development of a primary care-based model.

A panel of nine GPs from eight practices in a mixed rural/urban area of the South West of England participated in a modified RAND/UCLA appropriateness method (RAM) study. Panellists completed two rounds of an online survey in which they were asked to read a summary of relevant research evidence and then rate the level of appropriateness of providing a return-to-work intervention in a series of clinical scenarios.

There was general support for a return-to-work intervention. Panellists considered the intervention would be more appropriate for patients with mild-moderate rather than severe symptoms and for those with longer symptom duration. There was support for early intervention after approximately seven weeks of absence from work, but not before four weeks of absence. The return-to-work intervention was considered most appropriate for patients with repeat or recurrent patterns of sickness absence, rather than those on their first sickness absence period, and for those not already receiving specialist health input for their condition. Panellists considered that a multidisciplinary team providing a combination of biopsychosocial and vocational support would be the most appropriate model, with the service possibly being located outside of a general practice setting.