NHS Education for Scotland

While the National Health Service (NHS) in the United Kingdom (UK) is increasing provisions for psychological interventions in primary care for patients with long-term conditions (LTCs), there is limited knowledge of effective implementation. This study reports on outcomes of an open pilot trial implementing the Accessible Depression and Anxiety Psychological Therapies for Long Term Conditions (ADAPT-LTC) programme in Scottish primary care services. This study entails a pragmatic, real-world implementation evaluation of ADAPT-LTC in primary care using data collected from routine outcome monitoring. Analysis focused on implementation (feasibility, suitability), service (clinical outcomes) and client (care experiences and satisfaction) outcomes. Rates of recovery, reliable improvement, reliable recovery and reliable deterioration were used as indicators of clinical outcomes. Approximately half of referred patients progressed to treatment. Patient engagement in treatment was split into groups of patients who attended few treatment sessions (approximately <4 sessions) or patients who accessed 6-8 sessions or more. Among patients who participated in treatment, CBT was associated with large pre- to post-treatment effects in reducing depression, anxiety, and functional impairment, with 35%-40% of patients no longer meeting criteria for psychiatric diagnosis and 60% reporting clinically reliable improvements. Patients reported positive care experiences and satisfaction. Delivering brief psychological intervention in primary care was effective for most patients with LTCs. However, a subgroup of patients did not start treatment or struggled to attend treatment suggesting the programme may not be suitable for all patients. Methods for enhancing engagement and implementation of ADAPT-LTC are discussed.

Workforce shortages cause disparity in access to health care for patients. Exploring non-traditional (off campus) routes to healthcare professional degree may widen access to professional registration. The aim of this scoping review is to explore the published literature describing non-traditional routes to healthcare professional degree, with relevance to pharmacy degree education. A systematic search of the international literature was conducted using four electronic databases (Medline, Embase, Education Resources Information Center, and Cumulative Index to Nursing and Allied Health Literature). Articles were eligible for inclusion if they were published in English and comprehensively described non-traditional routes to healthcare professional degree. Articles were collated and tabulated to facilitate a narrative analysis of the non-traditional routes found. There were eight non-traditional routes to healthcare professional degree found in the literature (n= 35) across five countries. These were: online and digital; hub and spoke; community-based distance education; degree apprenticeship; academic medical centre; articulation; accelerated degree; and longitudinal. Most papers related to the apprenticeship route (n= 14) and medical profession (n= 19). The main barriers to implementation included: regulatory and infrastructure complexity, adequate resources (staff recruitment; financial; technology), lack of targeted student selection & support, and cultural resistance. Facilitators included collaborative partnerships, adequate resources (technical support; funding; staffing), community engagement and need, targeted student selection, and measuring and sharing outcomes. This review found that the following non-traditional routes offer the most in terms of flexible degree-level programmes to enhance current provision of pharmacy degree programmes: online and digital; community-based distance education; and longitudinal placements. All future non-traditional approaches to pharmacy degree should be evaluated and published.

BackgroundClinical debriefing (CD) positively impacts individuals, teams and systems and has been shown to improve patient outcomes and staff wellbeing. Although there is a growing evidence base supporting CD, it has not been routinely adopted by many healthcare organisations. Despite the work environment being an important component of transfer of learning, there has been minimal focus on how it influences implementation and maintenance of CD in practice. The overall aim of this study was to explore the work environment barriers and enablers influencing the transfer of clinical debriefing skills from simulation to clinical practice.MethodsFollowing ethical approval, medical registrars who had participated in a simulation course involving a within-scenario CD were invited to participate in semi-structured interviews. These utilised Burke and Hutchins’ evaluation model as the initial conceptual framework and took place at least two months post-course. Interviews explored participants’ experiences of transferring learning related to CD from simulation to the clinical workplace, and were transcribed verbatim and dual coded using template analysis.ResultsFifteen medical registrars participated in interviews between January and May 2025. The work environment influences from Burke and Hutchins’ evaluation model resonated as important factors affecting adoption of CD. With the addition of subthemes generated inductively from the data, the model provided a framework for identification and articulation of the barriers and enablers to CD in the workplace. The most striking finding was participants’ sense of personal responsibility to engage with CD. In addition, participants identified the requirement for cultural change to enable CD.ConclusionsWork environment influences represent both barriers and enablers of CD in relation to the transfer of learning from simulation to clinical practice. Personal responsibility and workplace culture are important drivers of CD, and attention should be paid to the influence of both constructs in this context. Recommendations for practice, based on our findings, are designed to enable educators and organisations to promote the adoption of CD in their own settings. This will help to bridge the gap and make CD the norm, not the exception.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41077-025-00405-8.

IntroductionEvidence shows that non-medical prescribing is as effective as medical prescribing in a range of acute and chronic conditions and is well accepted by a diverse range of key stakeholders. Pharmacists in the UK are set to acquire prescribing skills at an earlier stage in their training, with prescribing integrated into the first five years of training and the ability to prescribe from the point of registration from August 2026. Therefore, reliable and reproducible methods of assessing their ability to prescribe safely need to be in place. The UK Prescribing Safety Assessment (PSA) could be a standard method to assess prescribing skills across professions.AimTo examine the performance of post-registration Foundation pharmacists in the PSA and to explore their views on its suitability as a development tool before enrolling on an independent prescribing (IP) course.MethodPharmacists in Scotland 12 months into the post-registration Foundation programme were invited to sit a 30-question, blueprint-aligned online PSA in September 2024. Mean scores and facility scores were determined. (Facility is a measurement of how easy a question is: higher facility index = question is considered easier; lower facility index = question is considered more difficult). An online evaluation questionnaire gathered feedback on content and appropriateness, analysed using thematic analysis.ResultsSeventy-one of 128 (55.5%) eligible pharmacists sat the PSA; mean total score was 72.5% (SD 10.2). Domain-level mean scores (facility) were: Prescription Review 13.51/16 (0.84); Providing Information 4.96/6 (0.83); Dose Calculations 6.85/8 (0.86); Adverse Drug Reactions 6.51/8 (0.81); Drug Monitoring 5.61/8 (0.70); Planning Management 5.01/8 (0.63); Data Interpretation 3.41/6 (0.57); Prescription Writing 26.62/40 (0.67). The questionnaire was completed by 16/71 (22.5%) PSA sitters: most agreed the assessment was appropriate for their stage and helpful preparation for an IP course; some community pharmacists considered hospital-based content less relevant.ConclusionFormative participation in the UK PSA by post-registration Foundation pharmacists provided domain-level performance data and was regarded by respondents as useful preparation for an IP course. Findings suggest potential value in situating the PSA during the Foundation Training Year, with consideration of sector relevance and targeted support for domains such as prescription writing and data interpretation.

In 2019, revision knee replacement (RevKR) services in England were reorganised into regional networks following the publication of clinical standards. These networks aim to improve outcomes through multidisciplinary decision-making and minimum surgical activity thresholds. This study examines changes in referral patterns, surgical volumes, and clinical outcomes before and after network implementation. RevKR procedures from 1 April 2012 to 31 December 2024 were identified using the Hospital Episode Statistics. Descriptive analysis of patient level national data assessed trends in referral patterns (based on mismatches between patient residence and surgical location), volumes, and outcomes. Low-volume surgeons (<10 cases/year) and units (<30 cases/year) were identified. The primary outcome was one-year re-revision. Secondary outcomes included 90-day mortality, readmissions, and length of stay. Across 67,363 procedures, out-of-area referrals remained stable, with slight increases in London. Since 2021, low-volume practise has declined nationally, particularly in the Northwest, London, and Northeast & Yorkshire. One-year re-revision rates improved from 11.4% in 2012 to 7.7% in 2023. However, 90-day mortality rose, possibly due to increasing patient complexity. Some regions showed reduced hospital stays between 2022 and 2024 compared to the pre-COVID era. The data suggest early signals of regions aligning with the implementation of revision networks, especially in the Northwest, Northeast & Yorkshire, and London regions. There are encouraging improvements in re-revision rates and hospital stays which may indicate potential benefits of the new model. As revision networks mature, strategies to increase surgical volume may be key to sustaining further improvements in patient outcomes.

Abstract Aim In 2024 bariatric surgery services in our trust were expanded to a surgical hub, a hospital with short-stay surgical beds, 24/7 anaesthetic and medical cover, but no critical care. Criteria for the surgical hub are BMI &amp;lt;45, gastric sleeves, no revisional surgeries, no significant pain issues and no post-operative critical care requirement. The aim of this study was to compare post-operative complications of patients operated on at the hub with those with BMI &amp;gt;45 operated on at the tertiary centre, with the aim of guiding future patient selection. Method Post-operative complications following laparoscopic sleeve gastrectomy were reviewed for 11 patients with BMI &amp;lt;45 at the surgical hub and compared with 16 patients with BMI &amp;gt;45 at the tertiary centre. Results There were no post-operative complications in the surgical hub patients. Three patients at the tertiary centre had planned HDU stays due to pre-existing medical co-morbidities. There was 1 unplanned HDU admission due to difficulty weaning from high flow nasal oxygen in recovery. One patient returned to theatre due to hypotension secondary to haemorrhage. This patient (BMI 39) had a planned HDU bed due to obstructive sleep apnoea but was subsequently admitted to ICU. Conclusions There is a low rate of post-operative complications in patients with BMI &amp;gt;45, without significant comorbidities, undergoing laparoscopic sleeve gastrectomy. With careful patient preselection, consideration could be given to increasing the BMI limit at the surgical hub, reducing waiting list times and freeing up surgical space at the tertiary centre.

• Understanding adolescents’ experiences in secure care is important. • Effective care was linked to supportive, empathetic staff. • ’Peer solidarity,’ based on shared experiences, fostered trust and friendship. • Personalised care plans and a supportive, therapeutic environments was beneficial. • Our findings offer valuable insights for professionals involved in service design. There is a paucity of literature qualitatively exploring adolescents’ experiences in secure care, which is an essential consideration for future service design. We aimed to increase understanding of factors which contribute both positively and negatively to these young people’s experience. A systematic review was conducted following PRISMA guidelines. Studies were identified by searching five online databases in June 2024. The quality and risk of bias of each study meeting inclusion criteria was independently assessed by two authors using the Crowe Critical Appraisal Tool. 26 relevant studies were identified. Analysis revealed key themes: relationships/communication with others, rules and regulations, thoughts towards self and perspectives on treatment plans. Effective care appeared linked to supportive, empathetic staff and a balance between regulation and freedom. ’Peer solidarity,’ based on shared experiences, appeared important, fostering trust and friendship. Transition periods, especially to adult services, were identified as disruptive and anxiety-inducing. The importance of personalised care plans and supportive, therapeutic environments was emphasised, though findings varied across settings and age groups. Most papers were of moderate to high quality. Our findings offer valuable insights for professionals involved in design of supportive secure care environments tailored to the needs of involved young people. Future research should focus on directly exploring the lived experiences of less explored populations, such as the impact of neurodiversity or living in the developing world, on young people’s experience of secure care. This would ensure a more inclusive range of perspectives shape effective and compassionate care strategies.

Addressing the shortage of primary-care physicians, especially in remote and rural areas, is a crucial target in many countries. This article introduces the Scottish Graduate Entry Medicine (ScotGEM) programme: a compressed, tailor-made curriculum designed to equip and enthuse its graduates to practice generalist and rural medicine in Scotland, within the ethos of socially accountable medicine. This curriculum paper describes ScotGEM in sufficient detail for the reader to translate elements to their own context. It then collates findings from evaluations, research projects and many critical discussions about the programme. This work is used to describe and evaluate the curriculum design and delivery, with a focus on the distributed aspects. Three key innovations of the curriculum are explored in detail: the Generalist Clinical Mentor (GCM) role; the year-long primary care Longitudinal Integrated Clerkship (LIC); and the Agents of Change curriculum. There are early signs that ScotGEM is encouraging generalist, rural careers within Scotland. There is also growing evidence of the benefits ScotGEM faculty and students bring to the clinical workforce in the distributed settings. Distributed programmes require additional organization for students and faculty. Partnerships can be challenging but immensely rewarding. Healthcare partners in rural areas need to be involved early in planning and strong relationships fostered with local "champions."

Background/Aims This study aimed to gain a deeper understanding of the career aspirations and learning needs of NHS support staff and to explore the factors that encourage or prevent them from developing their careers. Methods A qualitative interview study was conducted with staff working in the NHS support workforce in Scotland, comprising business and administration, estates and facilities roles. Semi-structured interviews were conducted via telephone with 41 staff members from two health boards in 2023–24. Data were analysed using a theoretical thematic analysis approach, with open coding. Data coding and categorisation were undertaken using NVivo 12 software. Results Four main themes were identified: career aspirations; learning needs; enablers of learning and development; barriers to learning and development. Participants had undertaken a large amount of training, but several learning needs remained, especially relating to digital skills, project management, leadership, people skills and presentation skills. Enablers of learning and development included: clarity about the skills and qualifications required to progress; managerial support; positive role models; protected time and/or funding; and thorough job inductions. Barriers to development included: a lack of structured plans for learning and development; lack of availability of courses; lack of managerial support; and limited time and budgets for training. Conclusions The NHS support workforce face challenges in developing their skills and careers. Managerial support for development is crucial, highlighting the need for managers to undergo leadership and mentoring training to help them develop their teams. Every role needs clear objectives; staff should know what is required to progress and suitable training should be provided to facilitate this. Implications for practice Where possible, protected time and space for learning should be provided, as well as the promotion of flexible, hybrid and part-time working and recognition of previous learning, to help recruit and retain staff. Focusing on succession planning, as well as encouraging experienced staff to stay in their posts, should be a priority in NHS support services.