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The experiences of physiotherapy independent prescribing in primary care: implications for practice
- Jacqueline Mullan, Janet Smithson, Nicola Walsh
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- Journal:
- Primary Health Care Research & Development / Volume 24 / 2023
- Published online by Cambridge University Press:
- 20 April 2023, e28
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Aim:
To explore the experiences of musculoskeletal (MSk) physiotherapy independent prescribing in primary care from the perspectives of physiotherapists and General Practitioners (GPs) and identify the implications these have for contemporary physiotherapy practice in primary care.
Background:Legislative change in the United Kingdom (UK) in 2013 enabled physiotherapists holding a postgraduate non-medicalprescribing qualification to independently prescribe certain drugs that assist in patient management. Independent prescribing by physiotherapists is a relatively contemporary development in role change and purpose, occurring alongside the development of physiotherapy first contact practitioner (FCP) roles in primary care.
Methods:A critical realist approach was used, with qualitative data collected via 15 semi-structured interviews with physiotherapists and GPs in primary care. Thematic analysis was applied.
Participants:Fifteen participants were interviewed (13 physiotherapists, 2 GPs). Of the 13 physiotherapists, 8 were physiotherapy independent prescribers, 3 were MSk service leads, and 3 were physiotherapy consultants. Participants worked across 15 sites and 12 organisations.
Findings:Whilst physiotherapists were empowered by their independent prescribing qualification, they were frustrated by current UK Controlled Drugs legislation. Physiotherapists reported vulnerability, isolation, and risk as potential challenges to independent prescribing, but noted clinical experience and ‘patient mileage’ as vital to mitigate these. Participants identified the need to establish prescribing impact, particularly around difficult to measure aspects such as more holistic conversations and enhanced practice directly attributed to prescribing knowledge. GPs were supportive of physiotherapists prescribing.
Conclusions:Establishment of physiotherapy independent prescribing value and impact is required to evaluate the role of, and requirement for, physiotherapy independent prescribers within primary care physiotherapy FCP roles. Additionally, there is a need for a review of physiotherapy prescribing permitted formulary, and development of support mechanisms for physiotherapists at individual and system levels to build prescribing self-efficacy and autonomy, and to advance and sustain physiotherapy independent prescribing in primary care.
Diverse and durophagous: Early Carboniferous chondrichthyans from the Scottish Borders
- Kelly R. Richards, Janet E. Sherwin, Timothy R. Smithson, Rebecca F. Bennion, Sarah J. Davies, John E. A. Marshall, Jennifer A. Clack
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- Journal:
- Earth and Environmental Science Transactions of The Royal Society of Edinburgh / Volume 108 / Issue 1 / March 2017
- Published online by Cambridge University Press:
- 13 July 2018, pp. 67-87
- Print publication:
- March 2017
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Chondrichthyan teeth from a new locality in the Scottish Borders supply additional evidence of Early Carboniferous chondrichthyans in the UK. The interbedded dolostones and siltstones of the Ballagan Formation exposed along Whitrope Burn are interpreted as representing a restricted lagoonal environment that received significant amounts of land-derived sediment. This site is palynologically dated to the latest Tournaisian–early Viséan. The diverse dental fauna documented here is dominated by large crushing holocephalan toothplates, with very few, small non-crushing chondrichthyan teeth. Two new taxa are named and described. Our samples are consistent with worldwide evidence that chondrichthyan crushing faunas are common following the Hangenberg extinction event. The lagoonal habitat represented by Whitrope Burn may represent a temporary refugium that was host to a near-relict fauna dominated by large holocephalan chondrichthyans with crushing dentitions. Many of these had already become scarce in other localities by the Viséan and become extinct later in the Carboniferous. This fauna provides evidence of early endemism or niche separation within European chondrichthyan faunas at this time. This evidence points to a complex picture in which the diversity of durophagous chondrichthyans is controlled by narrow spatial shifts in niche availability over time.
eight - Connecting with older people as project stakeholders: lessons for public participation and engagement in rural research
- Edited by Catherine Hagan Hennessy, Robin Means, University of the West of England, Vanessa Burholt, Swansea University
- Foreword by Alan Walker
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- Book:
- Countryside Connections
- Published by:
- Bristol University Press
- Published online:
- 04 March 2022
- Print publication:
- 29 April 2014, pp 221-244
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Summary
Background: public participation and engagement
Aspirations to increase ‘user involvement’ in the planning, provision and evaluation of public services have been a consistent feature on the political agenda in the UK. The Labour government that left office in 2010 aimed to increase public participation and engagement in a broad range of services, and in the health and social care sector in particular. For example, The NHS plan (Department of Health, 2002) asserted the rights of service users and the public to be involved in the planning and delivery of health care. This overall drive towards greater public engagement included the aim to involve older people in the planning of services (Le Mesurier, 2003). This theme was developed further through the National Health Service operating framework (Department of Health, 2011), placing a legal duty of involvement on strategic health authorities in relation to their plans setting out strategies for health improvement and health service provision. This broad agenda for public participation and engagement (PPE) included a specific focus on involving older people in service planning. For example, the National service framework for older people (Department of Health, 2001) contained a commitment to increase representation of older people within consultative groups across health and social care provision. The governments of both England and Wales have recognised the need to promote this agenda by supporting organisations that enable public input, such as Healthwatch and Involving People. The current Coalition government in England has given less emphasis to specific public engagement measures, possibly due to a commitment to reduce the overall amount of legislation in relation to the public sector. However, high-profile initiatives, such as localism and the Big Society, have public engagement at their core, through their aim to fundamentally shift power and responsibility for the delivery of public services to local communities.
In Wales, the role of older people in policy and decision-making is recognised in the Strategy for older people in Wales 2008–2013, under the heading of ‘Valuing older people: maintaining and developing engagement’ (Welsh Assembly Government, 2003, p 15). This includes a broad aim to embed the participation of older people in society and at all levels of government, including in the planning and development of local services. A wide range of forums have been developed in different areas in Wales to represent the concerns of the over 50s, including forums or networks within all 22 local authorities.
four - Comparing transitions to motherhood across contexts
- Edited by Ann Nilsen, Universitetet i Bergen, Norway, Julia Brannen, University College London, Suzan Lewis, Middlesex University
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- Book:
- Transitions to Parenthood in Europe
- Published by:
- Bristol University Press
- Published online:
- 01 September 2022
- Print publication:
- 18 April 2012, pp 41-66
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Summary
Introduction
As the average age of the birth of the first child has increased significantly for women in most European countries, and the transition period between youth and adulthood for many has been prolonged, the transition to motherhood must be seen in relation to other life course trajectories and discussed with reference to social class and educational level, as well as institutional arrangements such as welfare provision, workplace regulations and systems of education in national contexts. This chapter therefore examines and compares different types of trajectories and transitions to motherhood. It takes a biographical case approach and analyses selected cases of mothers from four of the seven countries in the study. In order to give ‘thick descriptions’ (Geertz 2000 [1973]) of individual cases many layers of empirical context are brought to bear on the analysis.
Transition to motherhood in context
Women's average age at birth of the first child varied between the seven countries. Figures from 1999 show that Bulgaria has the lowest age, at approximately 25 years, whereas the Netherlands and Sweden have an average age at nearly 30 (Fagnani et al, 2004, pp 113-14). The tendency for European women to become mothers relatively late in the life course compared to a few decades ago must be seen in relation to the extended period of education that has become common in most countries. There are still persistent class divisions with respect to length and level of higher education: middle-class young people have more education than young people of working-class background. Women with little or no higher education tend to become mothers earlier in the life course. This is a trend across all countries (Fagnani et al, 2004, pp 113-14).
The transition to motherhood typically follows a period of cohabitation and/or marriage and finding a house or a flat in which to ‘settle down’ and establish a family. In some countries, particularly in Southern and Eastern Europe, marriage and parenthood often happen while living in the parental home before the young couple is able to move to independent housing (Kovacheva, 2000; Roberts, 2009).
In this chapter we have chosen to focus on cases from four countries only. These are selected with reference to the discussion of historical context in Chapter Two. The layers of context in which individual lives unfold need to be understood within a comparative macro-level framework. The four countries cover the main dividing lines outlined in Chapter Two: the former Eastern bloc is represented by Bulgaria, a Scandinavian social democratic system represented by Norway, a neoliberal government by the UK and a new Southern European democracy by Portugal. Discussion of and comparisons in the transition to motherhood follow the framework provided by a life course perspective, thus the timing and scheduling of motherhood in relation to other life course phases and transitions is described first. Workplace differences in terms of private or public sector employment have been discussed elsewhere (Lewis et al, 2009) and will not be the focus of the following discussion.
six - Supports and constraints for parents: a gendered cross-national perspective
- Edited by Ann Nilsen, Universitetet i Bergen, Norway, Julia Brannen, University College London, Suzan Lewis, Middlesex University
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- Book:
- Transitions to Parenthood in Europe
- Published by:
- Bristol University Press
- Published online:
- 01 September 2022
- Print publication:
- 18 April 2012, pp 89-106
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Summary
Introduction
This chapter considers the range of resources available for working parents in different national contexts. We draw on material from countries with different levels of public and private support, working hours and childcare, to provide a systematic overview and some cross-national comparisons of types and sources of constraint and support for working parents. Unlike Chapters Four and Five and the following chapter, the analysis is not based on the case studies of individual parents. Rather we conceptualise differences across countries with reference to the structural characteristics that provide support or constraints – the resources that can be drawn on to make working parenthood possible. Thus we analyse what the national contexts are ‘cases of ‘, where support for working parents is concerned. We have categorised sources and levels of support (see Table 6.1). We have also distinguished between three main types of support within these levels – regulatory, practical and relational (support from relationships within a workplace). Countries are first examined and categorised according to some of the key categories and comparators which were relevant to our research questions (see Tables 6.2 and 6.3) and which is in line with our multilayered case study approach (see Chapter Three), notably, formal state supports, organisational supports (policies, culture, managers and colleagues), childcare support, support from partners and wider family support. All of these are considered below, and we explore the links to gendered and cultural assumptions.
A cross-national comparative perspective delineates the social structural context of people's lives – in this study, public policy provision, workplace support and community and family support available. Whether this is identified by respondents as being of value to them in their everyday lives is, however, another matter. We therefore also take into account the kinds of support and constraints respondents take as given or fail to mention – what goes unsaid or is not viewed as important or relevant, and what is seen as an entitlement in each country.
Formal support from the state in the form of regulations and laws
Formal state support is greater in the Scandinavian and Eastern European countries than elsewhere. Employers in these countries are bound by regulations laid down by the state to implement lengthy paid parental leave, and in Sweden and Norway in this study, to provide flexible working hours during the period of breastfeeding.
Online discussion forums for young people who self-harm: user views
- Ray Jones, Siobhan Sharkey, Tamsin Ford, Tobit Emmens, Elaine Hewis, Janet Smithson, Bryony Sheaves, Christabel Owens
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- Journal:
- The Psychiatrist / Volume 35 / Issue 10 / October 2011
- Published online by Cambridge University Press:
- 02 January 2018, pp. 364-368
- Print publication:
- October 2011
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Aims and method
To explore what young people who self-harm think about online self-harm discussion forums. SharpTalk was set up to facilitate shared learning between health professionals and young people who self-harm. We extracted themes and illustrative statements from the online discussion and asked participants to rate statements.
ResultsOf 77 young people who participated in the forum, 47 completed the questionnaire. They said they learned more about mental health issues from online discussion forums than from information sites, found it easier to talk about self-harm to strangers than to family or friends, and preferred to talk online than face-to-face or on the telephone. They valued the anonymity the forums provided and reported feeling more able to disclose and less likely to be judged online than in ‘real life’.
Clinical implicationsMental health professionals should be aware of the value of anonymous online discussion forums for some young people who self-harm, so that they can talk about them and assess their use with their patients.
seven - Work–life initiatives and organisational change in a UK private sector company: a transformational approach?
- Edited by Suzan Lewis, Middlesex University, Julia Brannen, University College London, Ann Nilsen, Universitetet i Bergen
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- Book:
- Work, Families and Organisations in Transition
- Published by:
- Bristol University Press
- Published online:
- 16 July 2022
- Print publication:
- 22 July 2009, pp 97-112
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Summary
Introduction
There is now abundant evidence that work–family policies without systemic change in work structures, cultures and practices have limited impact on employees or organisations (Lewis, 1997, 2001; Rapoport et al, 2002). Contemporary organisations are undergoing dramatic changes in response to new forms of competition in the global context and technological developments (White et al, 2003). Yet despite the pervasiveness of change, employers often adopt a relatively minimal approach in response to changing demographics and the work–family needs of employees. A minimal approach might involve ignoring this issue altogether, or taking token actions, for example developing policies to support equality of opportunities but paying little attention to the implementation process and the deeper changes needed for policies to be effective (Lewis, 1997, 2001).
Some employers genuinely aim to transform workplaces to benefit both employees and the organisation and to keep ahead of contemporary economic and social trends – a transformational approach (Lee et al, 2000), although they may encounter many barriers along the way (Lewis and Cooper, 2005). While a minimal approach seeks quick fixes and has only short-term effects, a transformational approach has the potential to harness change in positive ways and to contribute to innovation and long-term benefits. We refer to a transformational approach rather than good practice, family friendliness or flexibility in order to emphasise a dynamic ongoing process in response to or anticipation of changing needs. The search for ‘good practices’ in relation to work–family arrangements assumes that there are once-and-for-all solutions to work–life issues – that once good practices are in place, employees’ work–family problems are taken care of. This obscures the need to keep work–life issues constantly in mind as things change, ‘mainstreaming’ them into organisational decision making.
In this chapter we consider aspects of a potentially transformational approach to work–life issues in the rapidly changing contemporary context. We consider how this may be conceptualised, what would be the criteria for a transformational approach and what the barriers to transformational change are, drawing on one case study of a finance sector organisation in the UK, from the Transitions study.
10 - Work–life balance, best practices and healthy organisations: A European perspective
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- By Christina Purcell, Faculty of Health, Special Care and Education, Manchester Metropolitan University, Manchester, UK, Suzan Lewis, Middlesex University Business School, London, UK, Janet Smithson, School of Law, University of Exeter, Exeter, UK, Sue Caton, Faculty of Health, Social Care and Education, Manchester Metropolitan University, Manchester, UK
- Edited by Ronald J. Burke, York University, Toronto, Cary L. Cooper, Lancaster University
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- Book:
- Building More Effective Organizations
- Published online:
- 05 June 2012
- Print publication:
- 13 December 2007, pp 228-251
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Summary
Introduction
Managing paid work and family life is a major challenge for many European workers. Growing numbers of women with children are remaining in paid employment albeit with a diverse range of working time regimes and different levels of state support across Europe for reconciling work and family (Fagnani, Houriet-Ségard and Bédouin, 2004). In addition, with changing family structures more men want to or need to be involved in family care. The European Commission, driven by the twin concerns of gender equality and the demographic challenges of the twenty-first century, has encouraged the participation of both women in the workforce and men in family life. Gender equality has historically been constructed by the EC in relation to the position of women in the labour market, leading first to an emphasis on equal pay and, more recently, to a commitment to combat the structural barriers to equality in the workplace through the promotion of a “level playing field” in which women can compete fairly alongside their male counterparts (Lewis, 2001). This has involved promoting policies which take account of the position of women as primary childcarers in the family and of the impact this has on the career progression and wages of women. This coincides with the recent preoccupation in Western Europe with “ageing societies” (OECD, 2006) and the need to encourage the labour market activity of sections of the working age population that are traditionally less active, such as women with children.