"Challenging but ultimately rewarding": A qualitative analysis of Deep End GPs' experiences.

Background Living in socioeconomically deprived areas is associated with shorter lives, in worse health. GPs working in these areas face additional challenges. Aim Establishing GPs' motivation for working in these areas, what the challenges are, and insights from GPs on potential improvements and changes. Design and Setting An Interpretative Phenomenological Analysis of GPs' lived experiences of working in the most socioeconomically deprived practices, in Northern Ireland (NI), the most deprived country within the UK. Method Interviews with GPs finding out the challenges facing them, why they work in a "Deep End" area and what suggestions, ideas and solutions they have to improve patient care and GP experience at NI's 'Deep End'. Results The challenges related to wider health service failures including the increased demand on GPs and feelings of powerlessness. Patient population challenges included 'missingness', late or crisis presentations, alongside the clinical difficulties of a highly 'medicalised' patient population, as well as the high prevalence of mental health problems. However, GPs choose to work in 'Deep End' areas because it's clinically stimulating and rewarding, as well as feelings of belonging and fulfilling a duty to 'their' area. Improvements focused on providing more flexible access, increased mental health provision and future training and recruitment, particularly around widening participation in medicine. Conclusion Improving the environmental conditions, empowering individuals and investing in communities are essential to achieving health. The current model of providing reactionary acute care is leading to GPs experiencing powerlessness and feelings of helplessness at the 'Deep End'.

A scoping review of the reasons for and approaches to non-uptake of pertussis and influenza vaccinations in pregnant women in the United Kingdom and Ireland.

BACKGROUND: Pertussis and influenza cause significant morbidity and mortality in pregnancy and the neonatal period. Maternal vaccination in pregnancy would reduce harm, but low vaccine uptake is a concern. This scoping review aimed to understand the reasons for, and approaches, to non-uptake of pertussis and influenza vaccinations in pregnant women in the UK and Ireland. METHODS: The inclusion criteria of this scoping review consist of pregnant women who avail of pertussis and influenza vaccines in the UK and Ireland. MEDLINE, EMBASE, Web of Science and CINAHL databases were searched in June 2021 and updated in October 2022. Searches were limited to English language reports published after 2011. We followed the Joanna Briggs Institute guidance on scoping reviews. Data were extracted and charted. RESULTS: Five themes emerged from the literature. Acceptability, as well as organisational and awareness issues, were overarching themes regarding reasons for and approaches to non-uptake of the vaccines respectively. Other themes included healthcare professional factors, information interpretation and pregnancy-related factors. CONCLUSIONS: Women need clear, comprehensible information, ideally provided by their healthcare professionals, in a way that is meaningful and addresses their circumstances and risk perceptions. This research will serve as a base for future work that aims behaviour science interventions at the wider pregnant population as well as the target groups that have been identified in this review.