Literature Collection

BACKGROUND: Since the Declaration of Alma-Ata in 1978 (1) global health policy has prioritised primary and integrated care reform to better manage chronic illness, improve health access, and prevent disease.(2) Yet internationally primary care, like the health systems it struggles to support, is currently far from strengthened; and is increasingly challenged by chronic underfunding, lack of recognition, and a diminishing and demoralised workforce.(3,4) AIM: To better understand the policy barriers responsible for the current status from the perspective of general practice in England DESIGN & SETTING: Key Informant Interviews with 12 general practice policy or practice leaders identified from publicly-available position statements, publications or innovative programs in UK primary care reform over the past decade METHOD: A qualitative deductive approach using thematic analysis to analyse informant data to understand historical barriers and explore enablers for future reform. RESULTS: The analysis resulted in eight main themes. 1. Dynamics of power and autonomy 2. Under-investment in primary care 3. Aligning policy and implementation 4. Navigating complexity and change 5. Building trust through relationships and leadership 6. The revolving door of policy and leadership 7. Valuing the workforce: A key to morale and retention 8. Strategic communication and media engagement CONCLUSION: Better-targeted funding reform, more effective systems integration building on general practice and community service strengths, and better valuing the complex role of the primary care sector as central to a high-functioning health system, were seen as key to the future. Participants also called for more effective policy input from those skilled in the delivery of care, and the capacity for earned autonomy and flexibility to deliver care relevant to individual community need. Action to address these opportunities is pressing, as finalisation of the 10 Year Health Plan and more-immediate NHS restructure rapidly gathers momentum.

BACKGROUND: Sleepio, a digital therapeutic offering digital cognitive behavioral therapy for insomnia, has been recommended by the National Institute for Health and Care Excellence in the United Kingdom as an alternative to offering sleep hygiene or sleeping pills. However, understanding of the referral behavior of general practitioners (GPs) regarding Sleepio is lacking. OBJECTIVE: The aim of this study was to investigate the feasibility of using an intervention targeting GPs in Scotland to increase referrals of patients with insomnia to Sleepio. METHODS: GPs working in primary care in Scotland were invited to join the study. GPs were recruited through the Primary Care Research Network in Scotland from June 10, 2024, to October 13, 2024. The behavior change wheel (BCW) was used to inform the design of the intervention. During the intervention, GPs reviewed an orientation on using Sleepio and received a visual reminder midway through the intervention. The primary outcome was the number of Sleepio referrals every 2 weeks over 2 months. The secondary outcome was the change in the GPs' reported confidence level that Sleepio will be successful in reducing patients' insomnia symptoms, and confidence in recommending Sleepio to patients. RESULTS: Of the 23 GPs who joined the study, 16 completed all stages. Overall, 68.8% (11/16) of participants were females, and the mean age was 42 (SD 8) years. The total number of Sleepio referrals in 2 months was 96 for all 16 GPs. In the first 2 weeks of the intervention, the mean referral rate to Sleepio was 22.4% for all 16 GPs, but this rate increased to 45% by the end of week 8. A repeated measures analysis indicated there was no statistically significant difference in GPs' referral rates across 4 data points. GPs' reported confidence level in recommending Sleepio increased significantly (z=-3.436; P<.001), from a mean of 5.44 (SD 1.7; somewhat confident) to 8.13 (SD 2; very confident). CONCLUSIONS: This study explored the feasibility and impact of an intervention aimed at supporting GPs to refer patients with insomnia to the digital therapeutic, Sleepio. Improvements were seen in GP-reported confidence levels at recommending Sleepio. A large-scale intervention and a longer study duration could provide useful information concerning how long the intervention effect on GPs' behavior toward Sleepio referrals might be maintained.