A realist evaluation of social prescribing: an exploration into the context and mechanisms underpinning a pathway linking primary care with the voluntary sector.

This article adopts a realist approach to evaluate a social prescribing pilot in the areas of Hackney and City in London (United Kingdom). It unpacks the contextual factors and mechanisms that influenced the development of this pilot for the benefits of GPs, commissioners and practitioners, and reflects on the realist approach to evaluation as a tool for the evaluation of health interventions. Primary care faces considerable challenges including the increase in long-term conditions, GP consultation rates, and widening health inequalities. With its emphasis on linking primary care to non-clinical community services via a social prescribing coordinator (SPC), some models of social prescribing could contribute to reduce the burden on primary care, tackle health inequalities and encourage people to make greater use of non-clinical forms of support. This realist analysis was based on qualitative interviews with users, commissioners, a GP survey, focus groups and learning events to explore stakeholders' experience. To enable a detailed analysis, we adapted the realist approach by subdividing the social prescribing pathway into stages, each with contextual factors, mechanisms and outcomes. SPCs were pivotal to the effective functioning of the social prescribing service and responsible for the activation and initial beneficial impact on users. Although social prescribing shows significant potential for the benefit of patients and primary care, several challenges need to be considered and overcome, including 'buy in' from some GPs, branding, and funding for the third sector in a context where social care cuts are severely affecting the delivery of health care. With its emphasis on context and mechanisms, the realist evaluation approach is useful in understanding how to identify and improve health interventions, and analyse in greater detail the contribution of different stakeholders. As the SPC is central to social prescribing, more needs to be done to understand their role conceptually and practically.

The impact of a social prescribing service on patients in primary care: a mixed methods evaluation.

BACKGROUND: Social prescribing is targeted at isolated and lonely patients. Practitioners and patients jointly develop bespoke well-being plans to promote social integration and or social reactivation. Our aim was to investigate: whether a social prescribing service could be implemented in a general practice (GP) setting and to evaluate its effect on well-being and primary care resource use. METHODS: We used a mixed method evaluation approach using patient surveys with matched control groups and a qualitative interview study. The study was conducted in a mixed socio-economic, multi-ethnic, inner city London borough with socially isolated patients who frequently visited their GP. The intervention was implemented by 'social prescribing coordinators'. Outcomes of interest were psychological and social well-being and health care resource use. RESULTS: At 8 months follow-up there were no differences between patients referred to social prescribing and the controls for general health, depression, anxiety and 'positive and active engagement in life'. Social prescribing patients had high GP consultation rates, which fell in the year following referral. The qualitative study indicated that most patients had a positive experience with social prescribing but the service was not utilised to its full extent. CONCLUSION: Changes in general health and well-being following referral were very limited and comprehensive implementation was difficult to optimise. Although GP consultation rates fell, these may have reflected regression to the mean rather than changes related to the intervention. Whether social prescribing can contribute to the health of a nation for social and psychological wellbeing is still to be determined.

General Practice in the United Kingdom ­ A training evolution / A evolução do treinamento em Medicina de Família no Reino Unido / La evolución del entrenamiento en medicina familiar en el Reino Unido

This article will outline the current state of training for UK General Practice, specifying some of the steps that must be taken in order to qualify, the challenges that trainees often face, and the career opportunities that may await them once completed. A historical perspective will be used to demonstrate the extent to which General Practice has evolved during the last sixty years. A few of the examples and explanations used in this article are by necessity simplistic, designed to highlight key areas of UK general practice in a bid to encourage readers to explore further if they wish to do so

Este artigo descreve o contexto atual da formação do Médico de Família no Reino Unido, especificando os desafios que muitas vezes os residentes enfrentam, as oportunidades de carreira que os esperam, uma vez concluído seu treinamento, bem como, alguns dos passos que devem ser seguidos para que possam se qualificar como Médicos de Família. Será utilizada uma perspectiva histórica para demonstrar em que medida a prática da Medicina de Família evoluiu ao longo dos últimos 60 anos. Alguns dos exemplos e explicações usados neste artigo são necessariamente simplistas, a fim de destacar as principais áreas de medicina de família no Reino Unido em uma tentativa de incentivar os leitores a explorarem ainda mais o tema, caso desejem fazê-lo.

Este artículo describe el contexto actual en la formación del médico de familia en el Reino Unido, detallando los retos que a menudo enfrentan los residentes, las oportunidades de carrera que ellos esperan una vez completado su entrenamiento, así como algunos de los pasos que ellos deben seguir para lograren habilitación como médicos de familia. Una perspectiva histórica será utilizada para demostrar de qué modo la práctica de la medicina familiar ha evolucionado en los últimos 60 años. Algunas de las explicaciones y ejemplos utilizados en este artículo son necesariamente simplistas con el fin de destacar las principales áreas de la medicina familiar en el Reino Unido en un intento de animar a los lectores a explorar el tema más a fondo, si desean hacerlo.

Impact of an intercalated BSc on medical student performance and careers: a BEME systematic review: BEME Guide No. 28.

INTRODUCTION: Intercalated BScs (iBScs) are an optional part of undergraduate (UG) medicine courses in UK, Eire, Australia, New Zealand, the West Indies, Hong Kong, South Africa and Canada, consisting of advanced study into a particular field of medicine, often combined with research. They potentially improve students' skills and allow exploration of specific areas of interest. They are, however, expensive for institutions and students and delay workforce entry. There is conflicting evidence about their impact. METHODS: A mixed-method systematic review (meta-analysis and critical interpretive synthesis) of the biomedical and educational literature, focusing on the impact of iBScs on UG performance, skills, and career choice, and to explore students' and other stakeholders' opinions about iBScs. RESULTS: In the meta-analytic part of this review, we identified five studies which met our predetermined quality criteria. For UG performance, two studies using different methodologies report an improvement in UG performance; one study reported an Odds Ratio [OR] of 3.58 [95% CI 1.47-8.83] and the second reported a significant improvement in finals scores (1.27 points advantage 95% CI 0.52-2.02). One study reported a mixed result, while two studies showed no improvement. Regarding skills and attitudes, one paper suggested iBScs lead to the development of deeper learning styles. With regard to subsequent careers, two studies suggested that for those students undertaking an iBSc there is an increased chance following an academic career [ORs of 3.6 (2.3-5.8) to 5.94 (3.6-11.5)]. Seven of eight studies (with broader selection criteria) reported that iBSc students were less likely to pursue GP careers (ORs no effect to 0.17 [0.07-0.36]). Meta-analysis of the data was not possible. In the critical interpretative synthesis analysis, we identified 46 articles, from which three themes emerged; firstly, the decision to undertake an iBSc, with students receiving conflicting advice; secondly, the educational experience, with intellectual growth balanced against financial costs; finally, the ramifications of the iBSc, including some suggestion of improved employment prospects and the potential to nurture qualities that make "better" doctors. CONCLUSION: Intercalated BScs may improve UG performance and increase the likelihood of pursuing academic careers, and are associated with a reduced likelihood of following a GP career. They help students to develop reflexivity and key skills, such as a better understanding of critical appraisal and research. The decision to undertake an iBSc is contentious; students feel ill-informed about the benefits. These findings could have implications for a variety of international enrichment programmes.