AimsUK medical students report high levels of stress, in particular within the coronavirus pandemic: 46% have a probable psychiatric disorder; almost 15% consider suicide; 80% describe support as poor or moderately adequate. Our aim was to propose a novel conceptual framework for the implementation of effective interventions to reduce their stress and support wellbeing.MethodA systematic review of MEDLINE, PsycINFO and CINAHL databases was undertaken with appropriate search terms, supplemented by reference searching. Published quantitative and qualitative primary research was included. Findings were reported in line with Preferred Reporting Items for Systematic Reviews and MetaAnalyses.ResultRecords identified through database searching 2,347; additional records 139; records following removal of duplicates 1,324. Full text studies included 41: ‘Curriculum and Grading’ (n = 4); ‘Mindfulness and Yoga’ (n = 11); ‘Stress Management/Relaxation’ (n = 13); ‘Behavioural Interventions’ (n = 3); ‘Cognitive & Self-awareness Interventions’ (n = 2); Mentorship (n = 3); ‘Education, Screening and Access to care’ (n = 3); ‘Multifaceted Interventions’ (n = 2).Effective interventions include those that reduce academic stress through grading changes and supporting transition to clinical training; resilience enhancing interventions such as mindfulness, yoga, CBT, group based exercise and relaxation; peer mentorship; faculty mentorship when actively engaged by the mentor; reducing stigma; improving detection; and improving access to treatment.Outcomes for clinical year students were less promising, suggesting interventions may be insufficient to combat clinical stressors.ConclusionWe propose a framework for implementing these effective interventions through ‘Ecological and Preventative’ paradigms. The former highlights an individual's interaction with their sociocultural environment, recognising multiple levels of influence on health: individual, interpersonal, institutional, community, and national. At each level the framework of primary, secondary and tertiary prevention can be applied.Primary Prevention (intervening before health is impacted): reducing academic stress; resilience interventions; mentorship; peer support; brief interventions to avoid progress to established disorders.Secondary Prevention (reducing prevalence of disorder): early detection through staff training and screening; treatment referral pathways; reciprocal arrangements if peers are placed within local settings.Tertiary Prevention (reducing impairment): reasonable adjustments, communicated between placementsThis recognises that medical students require a range of interventions at multiple levels to reduce stress, promote wellbeing and manage the spectrum of mental health difficulties they may encounter. The ecological framework also acknowledges the reciprocity of individuals being influenced by and influencing their environment, which aligns with the concept of co-production.

Older people's health and care needs are changing. Increasing numbers live with the combined effects of age-related chronic illness or disability, social isolation and/or poor mental health. Social prescribing has potential to benefit older people by helping those with social, emotional or practical needs to access relevant services and resources within the local community. However, researchers have highlighted limitations with the existing evidence-base, while clinicians express concerns about the quality of onward referral services, liability and upfront investment required. The current article provides a critical review of evidence on social prescribing, drawing on the RE-AIM Framework (Glasgow et al., 1999) to identify questions that will need to be addressed in order to inform both the design and delivery of services and the evolving research agenda around social prescribing. We emphasise the need for researchers and planners to work together to develop a more robust evidence-base, advancing understanding of the impacts of social prescribing (on individuals, services and communities), factors associated with variation in outcomes and strategies needed to implement effective and sustainable programmes. We also call on policymakers to recognise the need for investment in allied initiatives to address barriers to engagement in social prescribing programmes, provide targeted support for carers and improve access to older adult mental health services. We conclude that social prescribing has potential to support older people's health and wellbeing, but this potential will only be realised through strategic alignment of research, local level implementation and national policy and investment.

Aim: Research identifies a need for expanded therapeutic options for people with mild-to-moderate depression and anxiety disorders treated within the UK National Health Service (NHS). We aimed to examine potential benefits of a Sudarshan Kriya Yoga (SKY) based breath intervention delivered in this context. Background: SKY is a structured programme derived from yoga in which participants are taught relaxation and stress-management techniques including body postures, breathing exercises and cognitive-behavioural procedures. Previous research has demonstrated benefits for patients with clinical and non-clinical depression and anxiety. However, SKY has not yet been evaluated as a therapeutic option for patients accessing NHS primary care mental health services. Methods: We evaluated an existing programme available to NHS patients in South East England. The intervention is community-based and delivered via four weekly 'stress buster sessions' (1-h duration), one weekend intensive workshop (2.5 days) and four weekly (90 min) follow-up sessions. Analyses were conducted on existing data [measures of depression (Patient Health Questionnaire-9) and anxiety (generalised anxiety disorder-7)] collected as part of routine care, at the start of the programme and three follow-up assessments. Findings: Baseline data were available for 991 participants, of which 557 (56.2%) attended at least three weekly workshops, 216 (21.8%) attended the weekend workshop and 169 (17.1%) completed the programme. Statistically significant (P<0.05) improvements in depression and anxiety were observed in all three outcome assessments. Clinically meaningful change was observed for 74.6% of participants completing the programme. Findings indicate that SKY has the potential to benefit patient outcomes and could be offered more widely as a therapeutic option. We recommend further research to explore patients' experiences of the programme, determine the number of sessions necessary for improvement/recovery, define the population most likely to respond and examine potential cost savings (e.g., reductions in antidepressant prescribing/referrals to secondary care).

We report on two evaluability assessments (EAs) of social prescribing (SP) services in South East England conducted in 2016/7. We aimed to demonstrate how EAs can be used to assess whether a programme is ready to be evaluated for outcomes, what changes would be needed to do so and whether the evaluation would contribute to improved programme performance. We also aimed to draw out the lessons learned through the EA process and consider how these can inform the design and evaluation of SP schemes. EAs followed the steps described by Wholey, New Dir Eval 33:77, (1987) and Leviton et al., Annu Rev Public Health 31:213, (2010), including collaboration with stakeholders, elaboration, testing and refinement of an agreed programme theory, understanding the programme reality, identification and review of existing data sources and assessment against key criteria. As a result, evaluation of the services was not recommended. Necessary changes to allow for future evaluation include gaining access to electronic patient records, establishing procedures for collection of baseline and outcome data and linking to data on use of other healthcare services. Lessons learned include ensuring that: (a) SP schemes are developed with involvement (and buy in) of relevant stakeholders; (b) information governance and data sharing agreements are in place from the start; (c) staffing levels are sufficient to cover the range of activities involved in service delivery, data monitoring, reporting, evaluation and communication with stakeholders; (d) SP schemes are co-located with primary care services; and (e) referral pathways and linkages to health service data systems are established as part of the programme design. We conclude that EA provides a valuable tool for informing the design and evaluation of SP schemes. EA can help commissioners to make best use of limited evaluation resources and prioritise which programmes need to be evaluated, as well as how, why and when.

Salisbury’s article raises important points about the widespread rollout of social prescribing.1 Linking people with services that could help tackle problems that contribute to reduced wellbeing seems sensible, but the approach rests on several problematic assumptions. A recent systematic review2 concluded that current evidence on social prescribing is insufficient to judge either success or value for money. Of the 15 …

Aim: We aimed to develop, deliver and evaluate a brief training programme for primary care mental health staff in NW London focussing on long-term physical health conditions (LTCs). The objective was to improve participants' knowledge, understanding and confidence (self-efficacy) in providing effective support to people with LTCs. The second objective was to develop an online version to be made available more widely. Background: The project was commissioned by NW London Collaboration of Clinical Commissioning Groups as part of a strategy to develop more joined up care and support for people with mental health needs. Training was developed by a team of experts, with input from commissioners, service users, clinicians and service managers. Methods: Training was delivered via two-day interactive workshops providing: (i) key facts (informed by a review of published research and publically available health information); (ii) opportunity to engage with the 'lived experience' of people with LTCs (via videos, role plays, case studies and group discussion); (iii) skills-based training (in specific assessment and intervention methods). Knowledge, understanding and confidence (with respect to supporting people with LTCs) were assessed at the start and end of the training. An online training programme (with embedded evaluation questionnaire) was also developed, covering the same themes as the workshop. Findings: Mental health staff (n=60) reported limited knowledge, understanding and confidence before the workshop, underlining the need for training. Knowledge of LTCs improved significantly following training (P < 0.0001), along with awareness of the impact of poor psychological wellbeing on physical health (P< 0.05) and the role of psychological therapies in supporting people with LTCs (P <0.0001). Self-efficacy also improved (P <0.001). Online training was accessed by 894 participants in the first six months and 187 provided feedback via the evaluation questionnaire. Responses indicated that participants found the training useful (88%), interesting (91%) and easy to understand (97%).

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

AbstractAimTo explore, for the first time, whether a modified mindfulness-based cognitive therapy (MBCT) course has the potential to reduce stress and burnout among National Health Service (NHS) General Practitioners.BackgroundThere is a crisis of low morale among NHS GPs, with most describing their workload as ‘unmanageable’. MBCT has been demonstrated to improve stress and burnout in other populations, but has not yet been evaluated in a cohort of NHS GPs.MethodsNHS GPs in South East England (n=22) attended a modified version of the MBCT course approved by National Institute for Health and Care Excellence for prevention of depressive relapse. This comprised eight weekly 2-h sessions with homework (mindfulness practice) between sessions. Participants completed the Maslach Burnout Inventory (MBI) and Perceived Stress Scale (PSS) before (baseline) and then again one month (T2) and three months (T3) after attending the course. We also obtained qualitative data on participants’ experiences of the course.FindingsCompliance with the intervention was very high. All GPs attended at least six sessions and all completed baseline questionnaires. At T2, data were obtained from 21 participants (95%); PSS scores were significantly lower than at baseline (P<0.001), as were MBI emotional exhaustion (P<0.001) and depersonalization scores (P=0.0421). At T3 we obtained data for 13 participants (59%); PSS scores and MBI emotional exhaustion scores were significantly lower (P<0.001; P=0.0024, respectively) and personal accomplishment scores were significantly higher (P<0.001) than at baseline. Participants reported that the course helped them to manage work pressures, feel more relaxed, enjoy their work and experience greater empathy and compassion (for self, colleagues and patients). Findings of this preliminary evaluation are promising. Further research is needed to evaluate this approach within a larger randomized-controlled trial.

Aim We aimed to evaluate a pilot service to facilitate discharge of patients with stable long-term mental health needs from secondary to primary care. Background Patients with stable long-term mental health conditions are often not discharged from secondary mental health services when no longer needed due to insufficient systems and processes to enable safe, effective, recovery-focussed treatment and support. The Primary Care Mental Health Specialist (PCMHS) Service was developed to address this gap; new PCMHS posts were introduced to act as a conduit for patients being discharged from secondary care and a single point of referral back into secondary care, should it be required. The two-year pilot, across six Clinical Commissioning Groups in South East England, began in March 2013. Methods Interviews were conducted with all PCMHS employed in the pilot service (n=13) and a sample of service users (n=12). The views of professionals working alongside the service, including GPs, Psychiatrists and Mental Health Nurses, were captured using a brief online questionnaire (n=50). Time and Activity Recording Sheets were used to capture data required for economic analysis. Findings Our findings indicate that the service is working well from the perspective of patients; staff employed within the service and professionals working alongside the service. Patients described the service as a ‘safety net’ they could fall back on in case of difficulties, whereas staff used the analogy of a ‘bridge’ to describe the way the service improved communication and collaboration between the various professionals and organisations involved in the patient’s care. Improvements in well-being were seen to result from increased support for those transitioning from secondary to primary care, a more pro-active approach to relapse prevention and increased engagement in daily activities. Each PCMHS covered 36 patients in a one-month period, with a unit cost of £73.01 per patient.

BACKGROUND:Parents and school staff lack knowledge and confidence when providing postural care to physically disabled children. This can act as a barrier to the successful implementation of therapy. To address this problem, we developed a novel training programme to improve knowledge and confidence in providing postural care and evaluate the impact of the training programme in parents and school staff. METHODS:The postural care training programme included three elements: a 2-h interactive workshop facilitated by physiotherapists and occupational therapists, a follow-up home/school visit and a follow-up telephone call. The Understanding, Knowledge and Confidence in Providing Postural Care for Children with Disabilities questionnaire was utilized to evaluate the impact and includes subscales assessing knowledge and understanding, concerns and confidence in providing postural care. The Understanding, Knowledge and Confidence in Providing Postural Care for Children with Disabilities questionnaire was completed at baseline and 6 weeks later. The training programme was delivered to N = 75 parents and school staff. Of these, N = 65 completed both baseline and follow-up measures and were used in the data analysis. Participants and therapists were also invited to provide further feedback on the overall training programme via interviews and focus groups. RESULTS:Paired samples t-tests were used to determine statistically significant differences between baseline and follow-up scores for each of the three subscales. Mean levels of understanding and knowledge and confidence improved (P < 0.001), while concerns decreased (P < 0.001). Qualitative data were collected via interviews and group discussions providing an in-depth perspective on how participants experienced change. DISCUSSION:Results suggest improvement in knowledge, understanding and confidence in parents and school staff that care for children with significant physical postural care impairments.

Background: Research indicates a crisis of low morale among UK General Practitioners, with 73% describing their workload as unmanageable, 71% suffering or at risk of burnout, 42% considering early retirement and 25% leaving the profession entirely. We aimed to examine potential benefits of Mindfulness Based Cognitive Therapy (MBCT) for reducing stress and burnout in this population. Methods: NHS GPs (N=22) completed measures of stress (Perceived Stress Scale; PSS) and burnout (Maslach Burnout Inventory; MBI) before attending an 8-week MBCT course (baseline) and then again one-month (T2) and three months (T3) after the end of the course. Paired t-tests were used to analyze the change from baseline at follow-up. Qualitative data on participants’ experiences of the course were analysed using thematic analysis. Results: All GPs attended at least six of the eight sessions. Data were obtained from 22 participants (100%) at baseline, 21 (95%) at T2 and 13 at T3. PSS scores were significantly lower at T2, compared to baseline, as were MBI Emotional Exhaustion and Depersonalisation scores. All differences were significant at p<.001 and maintained at T3. Participants reported that the course helped them to manage work pressures, feel more relaxed, enjoy their work and experience greater empathy and compassion (for self, colleagues and patients). Discussion: NHS GPs experienced lower levels of stress and burnout after attending an 8-week mindfulness course. The intervention is acceptable to GPs and has potential to be offered more widely. Further research is needed to evaluate this approach within a larger randomized controlled trial.

This powerpoint presentation was designed to accompany a train the trainer workshop linked to a postural care training programme. POSTED is a training programme designed to improve understanding, knowledge and confidence in parents, teachers and teaching assistants responsible for the postural care needs of children with physical disabilities. This powerpoint explain the aims of the training and why this was developed, the structure of the training programme and the role of the therapist and introduces tools and resources. The powerpoint was originally designed for use in research commissioned by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (grant reference number PB‐PG‐ 0110‐21045). When using/referring to this powerpoint please acknowledge authorship as appropriate. Details of the study can be found in the following publication. Hotham, S., Hamilton-West, K., Hutton, E., King, A. and Abbott, N. (2017) A study in to the effectiveness of a postural care training programme aimed at improving knowledge, understanding, and confidence in parents and school staff. Child: Care, Health and Development. ISSN 0305-1862.

Objective: Explore the support needs of parents and carers of children with physical disabilities (< 18 years) within a therapy service in the South East of England. Method: Qualitative methods were used including focus groups and interviews with 9 parents/carers of children with a physical disability. Framework analysis approach was used to analyse the data. Results: Data was organised into the following themes. • Parent and carer experiences of using services including direct experience of therapy services • Education • Organisation of services and access to information • Impact of disability on family and carer life • Experiences and views of personalised care. Conclusions: Parents and carers had varied experiences of therapy services. Parents and carers valued close relationships established over time when therapists had knowledge and understanding of their child and family situation. Families experienced most difficulty over the provision of equipment and poor liaison between different parts of the care system added to stress and frustration. Few parents and carers had knowledge or awareness of personal health budgets and were unsure about whether a personal budget would improve their access to or experience of therapy.

In this article Kate Hamilton–West describes her role as a Practitioner Health Psychologist at KCA, a charity providing NHS mental health services. Kate is also a Senior Research Fellow at the University of Kent and Research Advisor (Health Psychology Lead) for the NIHR Research Design Service South East. She Chairs the DHP Practitioner Subcommittee and the Kent, Surrey and Sussex Health Psychology Network (KSSHPN). Kate reflects on the relationship between research and practice in health psychology and considers how Health Psychologists can contribute to the development of more integrated NHS services.

This manual describes POSTED - a training programme for parents, teachers and teaching assistants who are responsible for the daytime postural care needs of children with a physical disability. The training programme is intended to improve understanding and knowledge of postural care and the confidence carers. The training should be facilitated by occupational therapists and/or physiotherapists who have attended a train-the-trainer workshop. It contains background information relating to the development, structure and content of the training programme. The contents of the manual were originally designed for use in research commissioned by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (grant reference number PB‐PG‐ 0110‐21045).