Exploration of Ethical Issues in Primary Care in England, UK

Abstract

Background: Most healthcare interactions occur in primary care (PC), where primary care clinicians (PCCs) provide healthcare services to local populations. Notwithstanding its pivotal gateway function and laudable impacts, PC is arguably confronted by several multi-layered ethical issues which could affect clinicians, patients and services. Exploring these issues and how they should be addressed could help improve health outcomes. The study reviewed the literature to comprehensively identify ethical issues in PC. It also examined these issues, which support mechanisms clinicians draw on, and what structure(s) should be made available to address them going forward.
Method: Scoping literature review was conducted, using PRISMA-ScR framework. Web of Science, Scopus, Medline and PUBMED were searched for “primary care” and “ethical issues”. Data collected from PCCs in England, UK through semi-structured interviews was coded and thematically analysed with NVivo.v.1.7, using an inductive approach.
Findings: From 359 screened publications, 18 were eligible for the review. Most (12/18) publications were journal articles and 15/18 used qualitative approaches. The literature revealed key issues including patient privacy, confidentiality, informed consent, and decision-making which recurred across identified themes. A framework was conceptualised to analyse the multifaceted and commonly experienced ethical issues, which impact the practice, patients and clinicians. Empirical evidence also identified predominant issues, including patient autonomy, decision-making, (in)capacity, confidentiality, sex/contraceptive use (among under-aged children), requests for inappropriate treatment/sick notes, and interpersonal conflicts. The Covid-19 pandemic compounded existing issues and added extra layers to them. PCCs thought having approachable Ethics Leads and other support structures would help them to competently address ethical issues in future.
Implications: Ethical issues are complex with implications for stakeholders, including patients at the centre of healthcare. Regular ethics-specific training and learning resources should be provided to PCCs, while Ethics Leads should also support them to efficiently handle these issues as they discharge their responsibilities.

Date of Award	1 Oct 2024
Original language	English
Awarding Institution	University of Bristol
Sponsors	Wellcome Trust
Supervisor	Richard Huxtable (Supervisor), Gemma Lasseter (Supervisor) & Lucy C Potter (Supervisor)