The Resource Needs of Primary Care Teams in Supporting Youth Friendly Services Final research debrie

1
The Resource Needs of Primary Care Teams in
Supporting Youth Friendly ServicesFinal research
debrief

• Prepared for
• NHS Health Scotland and Fast Forward
• Woodburn House
• Canaan Lane, EDINBURGH
• Sept 2007

2
Presentation format

• Background
• The Service Provision Context
• Existing Service Provision
• Perceptions and Attitudes towards Youth Relevant
  Provision
• Perceived Information and Resource Requirements
• Considerations for Resource Development
• Conclusions and Recommendations

3
Background
4
Background to research

• Walk the Talk aims to reduce health inequalities
  in young peoples health and service provision
  supporting the development of relevant health
  services for young people aged 14 25.
• Various studies have indicated a variety of
  barriers faced by young people in accessing
  mainstream services.
• Research was commissioned by HS and Fast Forward
  to understand how to effectively meet the needs
  of mainstream service providers in order to
  achieve more youth friendly services.

5
Objectives

• To identify the guidance and information support
  needs of primary care practitioners in enabling
  them to provide more youth friendly services.
• Exploring the range and type of resources needed
  to most effectively support their work.
• Gaining insight into their experiences and
  perspectives on the issues faced by young people
  accessing services, and any areas of best
  practice, in order to inform the development of
  such resources.

6
Methodology

• A dual qualitative-quantitative methodology set
  out to explore and understand the issue, and
  measure prevalence of opinion.
• Qualitative phase
• face to face depths, paired discussions, triads
  and mini groups with the format varied
  according to the availability of the target
  audience.
• each session was 1 - 1 ½ hours in duration.
• Quantitative phase
• online survey disseminated via professional
  associations
• Royal College of General Practitioners (RCGP)
• Royal College of Nursing (RCN)
• Royal Pharmaceutical Society (RPS)
• Practice Managers Association (PMA)
• Scottish Practice Nurses Association (SPNA)
• Assoc. of Medical Secretaries, Practice
  Administrators Receptionists (AMSPAR)

7
Sample

• The audience included a range of primary care
  health professionals
• Practice staff
• GPs
• Practice nurses
• Practice managers
• Practice receptionists
• Community Pharmacists.

8
Qualitative phase

• The sample was drawn from a range of locations
  focusing on urban, rural and semi-rural areas of
  affluent and mid to high deprivation
• Glasgow, Dundee and Tayside, Forth Valley and
  Dumfriesshire.
• Respondents were screened on a battery of
  questions to ensure a mix of youth friendly
  service provision across the sample.
• Fieldwork was conducted in June 2007.

9
Qualitative sample composition

• The qualitative sample structure achieved was as
  follows

10
Quantitative phase

• The online survey was publicised via various
  means
• e-bulletins
• emailed to individuals or cascaded via
  professional networks
• website
• trade magazine (RCGPs Hoolet)
• A staged approach to disseminating the survey was
  adopted to accommodate publishing deadlines.
• The survey was live from the 2nd July to 17th
  August 2007, with 395 responses achieved overall.

11
Quantitative sample composition
12
Quantitative sample by NHS region
Western Isles (1)
Orkney (1)
Shetland (2)
Grampian (3)
Highland Argyll (11)
Tayside (6)
Forth Valley (9)
Fife (6)
Lothian (15)
Glasgow Clyde (22)
Borders (1)
Ayrshire Arran (10)
Lanarkshire (8)
Dumfries Galloway (6)
Source Q1 Base all respondents (n395)
13
Quantitative sample composition
Source Q4
Source Q5
14
The service provision context
15
Young peoples access to primary healthcare
services

• Claims that young people more aware of general
  health issues/ concerns
• education in schools and public campaigns
• influence from the media.
• in addition to positive reports that public
  health initiatives have increased traffic from
  young people on sexual health issues
• particularly with chlamydia testing.

16
Young peoples access to primary healthcare
services

• Despite this, professionals reported a low
  penetration of young people using mainstream
  primary care services, particularly noticeable
  with teenagers aged 14 18 and young men.
• It was felt that practices and pharmacies were
  not the preferred first port of call for young
  people
• due to limited perception of the range of
  services practices offered
• a perception of a formal and less accessible
  environment compared to more relaxed youth
  service settings
• and a lack of trust surrounding confidentiality
• some recognised that young people required added
  reassurance
• an additional barrier for those in small or rural
  communities, where practitioner and other staff
  members are integrated into the community.
• It might be someone elses mum handing the
  prescription to them
• Practice receptionist

17
Young peoples access to primary healthcare
services

• Experiences of young people accessing services
  were often tinged with frustration in terms of
• delayed access often in an emergency
• poor negotiation of appointment systems
• difficulties with establishing rapport
• poor communication of their needs
• repeated risky behaviour.

18
Young peoples access to primary healthcare
services

• Thus there was minimal exposure to young people
  in the primary care setting
• with the effect of lower consideration of their
  needs, particularly where they represented a
  minority proportion of the practice population.
• Because you dont see young people as much, they
  arent on the radar as much as they could be.
• Practice Nurse
• The overall evidence suggests this may contribute
  to a lack of awareness among professionals of
  their knowledge gaps in meeting young peoples
  needs.

19
Experience of young people- Practice setting -

• Reports from colleagues are that GPs tend to be
  regarded as distant authority figures by young
  people, compared to nurses
• contributing to a heightened awareness of
  consulting room time constraints
• patients wary of wasting doctors time.
• Even with the best intentions, consulting room
  time pressures can result in a reluctance from
  the GP to probe further beyond reason for initial
  visit.
• Most GPs claim good rapport with young people -
• however, criticisms from colleagues of some GPs
  being out of touch with young people and with a
  inappropriate bedside manner suggests that GPs
  can be over-confident and unaware they are not
  fully meeting young peoples needs.

20
Experience of young people- Practice setting -

• Nurses deemed more approachable
• less formal consulting room setting facilitates
  easier rapport
• e.g. first name terms, informal dress
• slightly longer consultations perception of
  more relaxed time constraints by patient
• opportunities afforded for discussing or
  eliciting a wider variety of issues not related
  to the specific visit
• e.g. new patient registrations, Wellwoman
  clinics.
• Indications are that nurses are particularly
  confident and at ease with breaking down
  practitioner-patient barriers and initiating
  discussion on sensitive issues
• but good intentions to draw out patients on more
  complex issues often thwarted by time constraints
• with real reasons for visit often not revealed
  until end of consultation!

21
Experience of young people- Practice setting -
Quite often the doctors their attitude is what
they come in with and dont ask any questionsbut
not all of them Practice Manager
Its a big problem trying to care when you are
always watching the clock GP
We dont make ever make them feel were rushing
them out the door Doctors dont tend to look
at patients in a holistic way like we donurses
are more likely to say, is there something you
need to tell me about? Practice Nurses
22
Experience of young people- Community setting -

• Pharmacists seemed keen to embrace their wider
  health promotions remit and advisory role.
• Often welcome young people requesting advice on
  contraception and STIs
• more accessible than GPs
• no appointments required
• fewer time constraints
• a discrete option.
• However, acknowledged that existing set-up not
  conducive to dealing with young people
• lack of privacy/ consultation rooms
• dont yet feel fully equipped for consultation
  role
• information requirements desired for more
  proactive patient advice
• welcome guidance on patient handling.

23
Experience of young people- Community setting -

• Furthermore, the general publics expectations of
  their role still lagging behind the reality
• pharmacists hope minor ailments contract will
  continue to broaden out perceptions of their
  role.
• In comparison to the adult population, it was
  felt that young people were less aware of the
  pharmacists broader advisory role
• the new health promotions contract was felt by
  some to be a good opportunity to target young
  people and make them more aware of the service
  available.

• Sometimes they come in because they dont want
  to go to the GP
• Theyre not really aware of what a pharmacist is
  there fortheyre afraid of asking something
  silly
• Practice Pharmacists

24
Experience of young peoples health topic areas

• Existing research in this field has highlighted a
  broad range of unmet needs faced by young people
  ranging from acne, appearance related and family
  concerns, mental health, alcohol, smoking to
  family planning and sexual health.
• Other than general medical issues, the culture of
  young peoples health appears to be dominated by
  family planning and sexual health, as this is
  where practitioners have greatest exposure
• the only area where health promotion,
  identification, and treatment fully converge in
  terms of perceived relevance to the primary care
  practitioners role
• the most common and unstated benchmark for
  assessing ones youth friendliness.

25
Experience of young peoples health topic areas

• With the exception of pharmacists, GPs and nurses
  claimed confidence and skill in putting young
  patients at ease and dealing with their concerns
  through direct intervention or referral.
• Practitioner's ability and awareness depended on
  a number of factors
• length of professional experience and
  skill/confidence in patient handling
• regularity of professional exposure to young
  people and variety/ type of issues
• degree of empathy and understanding of young
  people
• e.g. through experience of working with young
  people
• and/or being a parent of children in the target
  age group
• training or experience in a specialist health
  topic area
• the potential seriousness and sensitivity of the
  issue (e.g. sexual abuse).
• You get an impression that someone comes in with
  a problem they dont want to discussbut you
  dont want to pry. GP

26
Experience of young peoples health topic areas

• Health topic areas can be broadly divided into
  three levels based on practitioners regularity
  of exposure and familiarity

27
Experience of young peoples health topic areas

• The findings suggest that confidence in dealing
  had some correlation with exposure
• for example, those with a higher proportion of
  young people on their roster reported greater
  confidence in dealing with mental health and
  teenage pregnancy.
• Claimed confidence across the sample was highest
  on areas that practitioners were used to dealing
  with on a regular basis
• Smoking cessation (90 very/ quite confident)
• Sexual health and activity (78 very/ quite
  confident)
• Teenage pregnancy (67 very/ quite confident)
• Alcohol misuse (60 very/ quite confident).
• N.B. Given the relatively low numbers by
  occupation, breakdown figures have not been
  provided.

Source Q8 Base (n315)
28
Experience of young peoples health topic areas

• Lower confidence levels were evident for issues
  where there was less exposure
• 43 very/ quite confident on drug misuse nurses
  were significantly less confident than GPS and
  pharmacists
• 44 very/ quite confident on mental health with
  pharmacists appearing to be least confident on
  this subject matter.
• Whilst there was general recognition that
  underlying concerns or emotional issues can
  present as physical ailments, emotional/ mental
  issues were perceived as requiring a highly
  specialised intervention that fell outwith the
  general practitioner remit
• practitioners have less exposure to issues such
  as self-harm, eating disorders, depression,
  gender identity - and therefore confidence can be
  lower
• early identification and handling is less
  ingrained in their repertoire of skills and as
  such likely to emerge over a period of
  consultations, or be flagged up by a family
  member or colleague.

29
Existing service provision
30
Existing service provision

• There was a mixed appreciation of the barriers
  young people face in accessing primary care
  services
• the online sample reinforced this with 48 who
  felt young people faced few barriers with seeking
  help from accessing primary care services.
• Indeed patient audits and surveys provided little
  evidence to indicate they were not meeting young
  peoples needs
• with the online survey revealing that only a
  minority (16) who were directly consulting with
  young people to determine whether access was an
  issue and how best to meet their needs.

Source Q9 Base (n391)
Source Q6 Base (n366)
31
Existing service provision

• The findings indicated that the level of youth
  friendly services being provided vary
  significantly with those who provide a greater
  number of services more likely to have a higher
  proportion of young people on their patient
  roster (i.e. 25)
• The chart overleaf indicates level of service
  provision ranged from
• limited or no consideration of young peoples
  needs, e.g.
• seeing young person without a parent
• providing contraception services to under 16s
• an ad hoc approach taking into account
  accessibility issues and more specific
  information needs, e.g.
• special appointment systems
• targeted information provision (e.g. youth
  corners and Summer holiday bags with sun cream
  and safe sex/ drinking advice)
• health promotion visits to schools
• to a more structured, holistic approach, among
  the minority, where service has been tailored or
  reorganised around young peoples needs
• consulting with young people on their service
  needs
• longer consultations
• opening a drop-in clinic.

32
Level of Youth friendly service provision
HOLISTIC
Texting/email service (6)
Longer consultations (5)
Consult with young people on tailored service
(15)
Young persons drop-in service (11)
Train staff to deal with young people/ relevant
issues (18)
AD HOC
Promote emergency contraception in public areas
(42)
Special appointment system (23)
Links with schools/ colleges etc. (22)
LIMITED
Display confidentiality policy (59)
Provide contraception to young people under 16
(65)
See under 16s without adult (78)
Source Q6 Base all respondents (n395)
33
Meeting the needs of young people

• However, some disparity between perception and
  reality was evident
• despite the low level of tailored service
  provision, the majority (70) felt their service
  catered well for the needs of young people as
  much as other patient groups.
• Ownership of the issue also varied
• some appreciated the complementary role primary
  care services can play in meeting young peoples
  needs, via provision of discrete/more
  convenient alternative to specialist service
  provision
• in other cases, an efficient and well established
  culture of referral had an effect of diminishing
  responsibility beyond sign posting to services.
• furthermore, the pressure of contract work meant
  there was little incentive among some to explore
  the issue where young people were not perceived
  as a priority audience.
• The combination of these factors with known
  barriers among young people (e.g. poor
  recognition of service offering) serve to
  compound the lack of provision for this target
  audience.

(Source Q7)
34
Meeting the needs of young people- The service
provision gap -

• SERVICE PROVISION BARRIERS
• (PRIMARY CARE)
• practices are contract focused
• (YP not priority group)
• limited exposure/experience
• little or no evidence to suggest
• their service is not meeting
• needs of YP
• - time restraints in
• consultation may reduce
• probing on sensitive issues
• - positive culture of referral
• specialist services regarded
• as more appropriate/ desirable
• for YPs needs

• ACCESS BARRIERS
• (YOUNG PEOPLE)
• reluctance to come forward
• poor recognition of service
• offering
• - not forthcoming about
• concerns due to
• embarrassment and
• fears over confidentiality
• - may have issues in
• accessing specialist
• youth services
• (trust and stigma)

Access for young people is not embedded or fully
integrated into primary care culture
35
Perceptions and attitudes towards youth relevant
provision
36
The provision of youth friendly services-
Attitudinal variations -

• Attitudinal variations were evident throughout
  the research demonstrating a spectrum of
  awareness and outlook to the barriers young
  people faced in accessing primary care.
• The online survey suggests part of the reason for
  this may be low awareness of the national
  picture, with low awareness of the Walk the Talk
  initiative (74 of the online sample)1
• The qualitative research revealed three clear
  attitudinal segments
• Enlightened
• Uninitiated
• Conscientious Objectors.
• Applying our qualitative understanding of the
  attitudinal segments and the level of service
  provision associated with them, we have been able
  to identify the size of these segments within our
  online sample population (c.f. chart overleaf).

1 Source Q13 Base all respondents (n395)
37
The provision of youth friendly services-
Attitudinal segmentation -
THE UNINITIATED
You think youre doing ok and its only when you
speak to someone you maybe think - well were not
doing ok

• has both exposure and strong interest to the
  target age group
• personal experience or prompting on issues can
  lead to further consideration
• held back by barriers and lack of practical
  experience/ resources
• responsive to ideas for enhancing service
  offering
• welcome more to enhance their knowledge/understand
  ing

38
The provision of youth friendly services-
Segmentation by service provision -
ENLIGHTENED
Young persons drop-in service
Texting/email service
Train staff on young people/ relevant issues
Longer consultations
Consult with young people on tailored service
provision
UNINITIATED
Promote emergency contraception in public areas
Special appointment system
Links with schools/ colleges etc.
CONSCIENTIOUS OBJECTORS
See under 16s without an adult
Display confidentiality policy
Provide contraception to young people under 16
Those counted as Enlightened from the online
sample have attained 1-3 services within this
category
39
The provision of youth friendly services- The
Enlightened -

• HIGHLY TAILORED SERVICE PROVISION
• establishing trust and credibility with local
  youth population
• proactive targeting and legitimisation of a
  broad range of youth relevant concerns (e.g.
  bullying, bereavement)
• open door access (e.g. drop-in service)

• MOTIVATING FORCES
• gaps in local specialist youth provision
• a high youth population with prevalence of
  specific health concerns e.g. chlamydia, teen
  pregnancy, drug/ alcohol misuse
• driven by a champion with a strong background in
  youth provision
• support from management in terms of time and
  resources
• access to influencers with expertise and
  experience.

40
The provision of youth friendly services- The
Enlightened -

• I went on the best conference I had with Walk
  the Talk. I so loved it you were meeting all
  the different health professionals and you got
  into these groups and it was just so inspiring
  and humbling. It was fantastic to find out what
  works without trying X amount of things as that
  can be a disaster.
• Enlightened

I think youll find in general, GPs are
motivated by money. GP Enlightened
41
The provision of youth friendly services- The
Uninitiated -

• AD HOC SERVICE PROVISION
• accessible and targeted information
• outreach health promotion activity

• MOTIVATING FORCES
• a high youth population compounded by a
  prevalence of specific health concerns - e.g.
  chlamydia, teen pregnancy, drug/ alcohol misuse
• practice nurses with a strong interest or
  background in teenage health
• good access and support from specialist services

42
The provision of youth friendly services- The
Uninitiated -
It has become a tick box mentality having to
meet certain targets and having to gather
information of a nature we didnt have to before
checking peoples weight, blood pressurea lot
of time in surgery is now spent managing chronic
disease GP Uninitiated
Advertising would be quite good in raising
awareness of the profession as a whole so that
when the new public health initiative contract
comes in, people will be more aware of what they
can go to the pharmacy for. Community
Pharmacist Uninitiated
43
The provision of youth friendly services- The
Conscientious Objectors -

• LIMITED SERVICE PROVISION
• little or no allowances made for youth
  population
• reactive approach to provision

• BARRIERS
• likely to have limited exposure to range of
  youth health concerns
• low knowledge, awareness and understanding of
  youth mindset and barriers to access
• service pressures contribute to low
  prioritisation of youth audiences

Here we have so much access to other agencies
that its not an issue. GP Conscientious
objector
44
Youth friendly accreditation

• Receptiveness to steps that can be taken at the
  national level to overcome the issue also varied
  across the segments, with mixed reactions to the
  idea of accreditation on service provision
  emerging from the online survey
• whilst 38 were in favour overall1 interest was
  highest among those most aware of service
  provision gaps2
• 52 Enlightened, 40 Uninitiated vs 28
  Conscientious objectors.
• Where reservations were expressed, this was in
  response to a perceived overemphasis by the NHS
  on an assessment culture
• almost half the sample (48) unsure of the
  benefits proffered to their service with doubts
  expressed in the qualitative research as to its a
  profile among young people.
• 56 Conscientious objectors vs 46
  Uninitiated and 35 Enlightened.
• Should it be introduced, it was felt that
  accreditation criteria needed to be achievable to
  encourage uptake by services.

2 Base all those within each attitudinal segment
1 Source Q12 Base all respondents (n395)
45
Preferredresource requirements
46
Preferred resource requirements - Overview -

• In the qualitative phase, staff information and
  guidance needs in this area were rarely top of
  mind and considered at a spontaneous level.
  Initial responses were often
• a good idea for new entrants but not for
  experienced practitioners
• and, in eliciting response from young people on
  sensitive issues, practitioners emphasised need
  for quality of patient handling skills and time
  available in consultation.
• Rather than directing efforts at professionals,
  many felt a public campaign to encourage young
  people into mainstream services was better placed
  to address the issue.

47
Preferred resource requirements - Overview -

• Pharmacists were more likely to volunteer
  information and guidance needs due to their
  increasing advisory and health promotions role
  and limited consultation experience
• receptive to training on soft skills (e.g.
  establishing rapport, handling sensitive issues,
  identification of vulnerable individuals)
• service relevant information
• access/ point of referral/ what is involved to be
  able to offer advice and added value to patients
• child protection issues
• consultation tools to support patient handling on
  specific issues e.g. flow charts/ templates.
• Id like to know what to do with the information
  because the more we are promoting ourselves as
  health professionals, the more people will come
  in
• Something to help you spot the signs.
• Its knowing where to refer and when to
  refer...its good to be able to say, this is what
  will happen, then theyll get the same message
  from the GP.
• Community Pharmacists

48
Preferred resource requirements- Overview -

• Experienced GPs tended to be the most resistant
  to guidance and information on practice and
  procedure
• often feeling they are given obvious or
  commonsensical information easily gained from
  on-the-job experience
• wary of being bombarded by materials and
  information - a waste of resources
• little inclination to absorb detailed information
  unless of direct relevance
• Resources received often have very short shelf
  life or not used at all.
• GPs are overwhelmed by the information coming
  in
• Practice Manager

49
Preferred resource requirements- Overview -

• However, the online survey indicated that when
  prompted on the issue and offered suggestions for
  support in this area, the potential value of
  guidance in this area was more patently
  recognised
• with 81 agreeing that they could improve their
  knowledge and understanding of young people and
  related issues1
• 85 of nurses, 83 of practice managers, 65 of
  GPs
• 89 agreeing that information and guidance to
  improve the service they provide to young people
  would be valued1
• 89 of nurses, 91 of practice managers, 78 of
  GPs
• and 82 would appreciate training1
• 86 of nurses, 84 of practice managers, 55 of
  GPs.
• Findings suggest a hunger for filling knowledge
  gaps, with few (3) claiming no need for support2
  

1 Source Q7 Base all respondents (n395)
2 Source Q10 Base all respondents (n395)
50
Preferred resource requirements- Practical
considerations for service provision -

• The findings indicate that perceived information
  and resource needs do differ with variations also
  emerging across the segments
• 72 would value practical considerations for
  making their service more youth friendly1
• with demand highest among the Uninitiated (75
  Uninitiated vs 70 Conscientious objectors
  and 65 Enlightened2)
• 69 would value information on local youth
  relevant services or initiatives1
• with demand significantly higher among the
  Conscientious objectors who are less motivated
  to make changes to their own service to meet need
  (79 Conscientious objectors vs 67
  Uninitiated and 50 Enlightened2)

1 Source Q10 Base all respondents (n395)
2 Base all those within each attitudinal segment
51
Preferred resource requirements- Practical
considerations for service provision -

• Demand for support and guidance is also high for
  more specialist information on the youth
  population
• 69 for information on how to promote services to
  young people
• 57 on improving their understanding and ability
  to identify the needs of vulnerable groups1.
• A significant proportion (48) indicated the need
  for guidance on how to consult with young people
  to meet their service needs.
• Relative to other support requirements
• fewest felt they would benefit from guidance on
  soft skills (building rapport) with young people
  (34) given high practitioner confidence in
  patient handling
• and a similar sized proportion (37) saw the need
  for guidance on developing partnership approaches
  with schools and colleges.
• Whilst these low perceived needs are indicative
  of high confidence levels, underlying this may be
  an under-developed appreciation of the impact
  best practice can have on easing access.

Source Q10 Base all respondents (n395)
52
Preferred resource requirements- Topic areas -

• 29 of the online sample claimed they would
  appreciate detailed literature to refresh or
  enhance their knowledge - the qualitative
  research suggests this may be with regards to
  information on services, or more niche
  requirements such as information on different
  faiths and religions.
• Most support was valued (831), however, in terms
  of topic-specific information, with most popular
  requests where confidence and exposure was
  lowest
• 84 mental health (e.g. depression, self harm,
  eating disorders)
• 70 drug misuse
• 62 alcohol misuse
• 49 Teenage pregnancy
• 47 sexual health and sexual activity
• 28 smoking cessation2.
• There were little differences in resource needs
  across the three attitudinal segments, with equal
  value placed on the topic areas of greatest need
  such as mental health and drug misuse.

1 Source Q9 Base all respondents (n395)
2 Source Q9 Base those who coded one or more
topic (n326)
53
Information resource requirements by topic
84 mental health
70 drug misuse
62 alcohol misuse
increasing information needs
49 pregnancy
higher levels of exposure and confidence
47 sexual health
28 smoking
54
Preferred resource requirements- Patient
materials -

• In terms of addressing the type of resource
  requirements, the greatest emphasis was on the
  provision of patient materials with a practical
  focus
• show and tell literature (60)
• with perceived value in terms of enhancing
  communication and more efficient use of
  consultation time
• and waiting room literature (56)
• posters and leaflets promoting services or
  lifestyle booklets
• There was evidence of much lower demand for less
  accessible mediums such as DVDs for patients to
  take away (25)
• There was also less demand for prompting tools
  (e.g. picture cards and dictionaries) to
  facilitate communication with young patients
  (20)
• indicating perhaps the nature of our sample in
  terms of a low perceived need for guidance in
  interpersonal/ communication skills.

1 Source Q11 (Total mentions) Base all
respondents (n395)
55
Preferred resource requirements- Staff materials
-

• With regards staff focused resources
• aide memoirs on protocol or procedure was most
  popular, with 31 perceiving this to be of value
  for quick reference purposes1.
• 26 would appreciate web-based tools or CD Roms
  providing access to downloadable templates and
  toolkits
• demand for this was significantly higher among
  the Enlightened segment (at 40) suggesting a
  more sophisticated identification of support
  needs and a greater willingness to provide
  tailored services.

1 Source Q11 (Total mentions) Base all
respondents (n395)
56
Preferred resource requirements- Training and
other support -

• The research evidence indicated that Practice
  Managers were most receptive to training support
  suggesting the potentially valuable role they
  have to play in disseminating resources and
  training at the local level.
• The most popular form of training was
  face-to-face presentations (411)
• if delivered effectively, a potentially
  compelling way of engaging a range of staff.
• However, other resources to facilitate in-house
  training were valued given some of the known
  challenges associated with releasing staff for
  externally based training
• 26 responsive to e-learning packages (enabling
  staff to learn at their own pace)
• 20 amenable to interactive CD Roms for staff
  training purposes
• 17 requesting training DVDs, perceived to be
  useful by managers for training new entrants
  (e.g. patient rapport)1.

1 Source Q11 (Total mentions) Base all
respondents (n395)
57
Considerations for resource development
58
Resource development- Practical considerations -

• Those moving towards a paperless environment
  value option of electronic based formats
• But hard copies are also desirable
• Higher production values/ durability can enhance
  shelf-life of printed materials (e.g. laminated
  cover)
• Style of format can increase point of
  differentiation and less likely to be filed away
  (e.g. RCGP tip card).
• You need something that grabs your attention
  straight away
• Community Pharmacist

FORMAT
59
Resource development- Practical considerations -

• Advantages offered by both staff and patient
  resources that are flexible and adaptable for use
  (e.g. templates or flow charts for procedure and
  protocol, patient literature which can be printed
  on a per needs basis)
• With many having regular access to the internet
  at work, web-based resources were desirable
  providing
• reassurance of up-to-date information
• a potential one stop shop for all patient and
  practitioner information requirements
• CD Rom based formats can be useful for supporting
  management and administrative work.
• You have so many leaflets that end up in a
  drawer, but a graph I can put on the shelf and
  see it all the time.
• Practice Nurse

FUNCTION
60
Resource development- Content considerations -

• Offers practical tips and suggestions
• Information resources designed for dual patient/
  practitioner purpose
• Comprehensive with information readily to hand
  (e.g. contact names, opening hours and telephone
  details of services)
• Of local as well as national relevance.
• Straightforward, not too wordy and with
  practical things you can think aboutif youre
  starting from zero in your practice, then simple
  ideas that are proven to work.
• Practice Nurse

PRAGMATIC FOCUS
61
Resource development- Content considerations -

• Clearly demarcated sections for quick reference
• Key points highlighted easing navigation of
  detail (headings, bullet points, bolded text)
• if website - user friendly and easily navigable
• Offering detail where sought in addition to
  economised information for time-starved seeking
  quick message absorption
• Graphics and illustrations to break up text and
  facilitate digestion of information.
• Something you can look at quickly and reminds
  you keep it simple
• Practice Nurse
• I like colour coding so you dont have to spend
  ages looking at it.
• GP

SIMPLE AND STRAIGHTFORWARD
62
Resource development- Tonal considerations -
Tonal positioning
Content requirements
respectful supportive non-judgemental
professional credible trustworthy
persuasive encouraging facilitating
stimulating informative pragmatic
63
Learnings from existing resources- RCN Getting
it Right -

• Well received
• Eye catching and visually relevant to subject
  matter
• Offers practical ideas and suggestions
• Succinct facilitating quick message absorption
• Mini-audit encourages thinking about level of
  service offered
• Offers a good starting point for discussion
  among influencers within the practice or
  community setting with potential to prompt action

64
Learnings from existing resources- RCGP tip card
-

• Mixed reactions to content
• A distinctive and handy format offering a point
  of differentiation more likely to be kept close
  to hand rather than filed away
• Higher production values (e.g. lamination)
  facilitating a longer shelf-life
• Practical focus with key points for
  consideration for simple message absorption
• However, experienced practitioners can feel
  nature of content adds little to existing
  knowledge and tone can be perceived to be
  patronising and dogmatic.

65
Conclusions and recommendations
66
Conclusions and recommendations

• This research echoes evidence which suggests
  young peoples access of mainstream healthcare is
  limited.
• An appreciation among staff of the barriers young
  people face in accessing mainstream healthcare
  is, as yet, under-developed
• good practice is evident but appears to be patchy
  and fragmented
• both service provision and attitudinal stances
  vary widely
• acknowledgement of information and guidance needs
  is rarely top of mind.
• experience of young peoples health issues is
  dominated by sexual health and family planning
  suggesting opportunities to promote understanding
  of the topic areas less top of mind.
• With prompting, the evidence suggests
  professionals are likely to be receptive to the
  barriers faced by young people and the value of
  resource provision - indicating that with the
  appropriate support, more will feel confident and
  motivated to be proactive in this area.

67
Conclusions and recommendations

• The research evidence points to a need for
  resources to fulfil three key functions
• prompting awareness of the barriers young people
  face in accessing primary care services and
  stimulating discussion on the issue
• meeting specific information needs (e.g. staff
  and patient literature
• particularly topic areas where practitioners have
  less exposure and confidence such as mental
  health, drug misuse and emotional wellbeing (e.g.
  gender identity and bullying)
• organisational/ management resource needs (e.g.
  tools and templates, promoting young peoples
  services)
• Addressing these areas will ensure that a full
  spectrum of needs are met in relation to
  attitudes, prior knowledge, experience and
  confidence (c.f. chart overleaf).

68
Conclusions and recommendations

• Resource/ materials to prompt thought, discussion
  
• and sharing of experiences e.g. face to face
  presentations,
• training support documents

• Resources to facilitate circulation among
  decision
• makers and influencers at practice/pharmacy level
  
• e.g. leaflets with practical suggestions/checkli
  sts/
• mini-audit tools

• E.g. patient/practitioner information and
  promotional
• literature (electronic/ web/ paper), info and
  guidance
• on specialist service provision, practical
  guidance on
• identification and handling of vulnerable
  groups, aide
• memoirs etc.

69
Conclusions and recommendations

• The provision of resources need to be combined
  with a communications strategy to generate and
  sustain momentum on the issue across the primary
  care community
• targeting of influencers such as GP trainers,
  Practice Managers and Pharmacist champions may
  assist with enhancing message penetration and
  optimising resource dissemination at the micro
  and macro level
• endorsement by professional bodies and
  associations (e.g. Family Planning Association,
  RCGP, RCN, SPNA) may assist with raising the
  profile of the issue with the respective
  professions.

70
Conclusions and recommendations
To address the needs of primary care teams, the
following summary considerations are required to
fulfil both strategic communication needs and
tactical needs (i.e. resource materials provided).
EMOTIONAL
FUNCTIONAL
FEATURES
MESSAGE/ TARGET
Young peoples needs are not met
CONSCIENTIOUS OBJECTORS
- arrests attention - raises profile of the issue

• - engages
• inspires
• motivates

Delivered from a credible youth perspective

• - provokes
• - stimulates
• - challenges perceptions

- encourages dialogue - triggers thought debate
Persuasive/ evidence based information on unmet
needs
Primary care is integral to the mix of
accessible healthcare UNINITIATED

• - keeps at the forefront of peoples minds
• increases confidence in taking action
• sustains momentum

Offers practical, realistic solutions to overcome
barriers
You can make a difference ENLIGHTENED

• - informs
• - demonstrates
• - involves