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Various psychological concepts have been proposed over time as potential solutions to improving patient safety and quality of care. Psychological safety has been identified as a crucial mechanism of learning and development, and one that can facilitate optimal patient safety in healthcare. We investigated the quantitative evidence on the relationship between psychological safety and objective patient safety outcomes. We searched 8 databases and conducted manual scoping to identify peer reviewed quantitative studies published up to February 2024. Objective patient safety outcomes of any type were eligible. The findings were analysed descriptively and discussed in a narrative synthesis. Nine papers were selected for inclusion which reported on heterogeneous patient safety outcomes. Five studies showed a significant relationship between psychological safety and patient safety outcomes (e.g., ventilator associated events, reported medical errors). The majority of studies reported on the experiences of nurses working in healthcare from the USA. Patient safety is consistently characterised as the absence of harm rather than a culture that creates a safe environment. No clear conclusions can be extracted regarding the relationship between psychological safety and patient safety. For example, reporting patient safety problems in a team can be an indication of both high and low psychological safety. Patient safety may be contradictory to elements of psychological safety, as the absence of harm is not congruent with a safety environment approach. Systematic review registration: This systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD4202347829).

Background Much policy attention focuses on increasing the supply of workers in the English NHS but there has been less attention paid to the rise in leavers. This paper seeks to explore how existing data sets can illuminate the decision-making of leavers and inform actions that could mitigate this. Method Secondary analysis of routinely collected data from 79 workforce projects in the UK ( n  = 46 339 participants) over a 4-year (2019–2023) period was undertaken. Free text data we extracted and analysed using content analysis, sentiment analysis and text mining. Inclusion criteria were those who stated they had resigned, had confirmed retirement date, and had secured employment elsewhere either within or without the sector but had not yet resigned. Exclusion criteria were those who had not indicated they were leaving or indicated intention to leave. These findings were then compared with themes from Herzberg’s work hygiene theory and Hoffat and Woods’s professional practice environment theory. Results Multiple reasons were given for leaving. Findings were congruent with Herzberg’s two factor work hygiene theory and demonstrate that leavers are driven by the inability to meet their intrinsic motivation to practice according to their professional standards as much as by terms and conditions. Leavers describe suboptimal professional practice environments which produce obstacles to achieving their work objectives and leaving their intrinsic motivation frustrated. Conclusion Whilst reasons for leaving differ between people, there is a relationship between intrinsic motivation (why they want to do the job) and the conditions in which they try to do the job. This study suggests that looking beyond the primary reason for leaving given in the national dataset could identify how the practice environment influences the decision.

Background This study aims to understand how the implementation of the advanced clinical practice framework in England (2017) was experienced by the workforce to check assumptions for a national workforce modelling project. The advanced clinical practice framework was introduced in England in 2017 by Health Education England to clarify the role of advanced practice in the National Health Service. Methods As part of a large-scale workforce modelling project, a self-completed questionnaire was distributed via the Association of Advanced Practice Educators UK aimed at those studying to be an Advanced Clinical Practitioner or who are practicing at this level in order to check assumptions. Semi-structured phone interviews were carried out with this same group. Questionnaires were summarised using descriptive statistics in Excel for categorical responses and interviews and survey free-text were analysed using thematic analysis in NVivo 10. Results The questionnaire received over 500 respondents (ten times that expected) and 15 interviews were carried out. Advanced clinical practice was considered by many respondents the only viable clinical career progression. Respondents felt that employers were not clear about what practicing at this level involved or its future direction. 54% (287) thought that ‘ACP’ was the right job title for them. 19% (98) of respondents wanted their origin registered profession to be included in their title. Balancing advanced clinical practice education concurrently with a full-time role was challenging, participants underestimated the workload and expectations of employer’s training. There is an apparent dichotomy that has developed from the implementation of the 2017 framework: that of advanced clinical practice as an advanced level of practice within a profession, and that of Advanced Clinical Practitioner as a new generic role in the medical model. Conclusions Efforts to establish further clarity and structure around advanced clinical practice are needed for both the individuals practising at this level and their employers. A robust evaluation of the introduction of this role should take place.

Objectives The aim of the hermeneutic review was to identify and clarify the mechanisms by which the Diabetes Specialist Nursing workforce affect the outcomes of diabetes patients, with a focus on those in the United Kingdom. A clarification of diabetes specialist nurses’ work is necessary in understanding and improving diabetes inpatient care. Design The design is a hermeneutic evidence review and was part of a wider evaluation of Diabetes Inpatient Specialist Nurses for which the evidence was sourced. The literature search was limited to specialist nursing workforce caring for adults with diabetes. In order to gain global understanding of the impact of specialist nursing in diabetes, worldwide literature was included. Methods A hermeneutic literature review of 45 publications was carried out, which included citation analysis. Relevant literature was identified from 1990 to 2018. Results Evidence suggests that Diabetes Specialist Nurses educate patients and other healthcare professionals as well as delivering direct care. The outcomes of these actions include a reduced patient length of stay in hospital, reduced inpatient harms and complications, and improved patient satisfaction. Additionally, they are cost-effective. Conclusions The Diabetes Specialist Nursing workforce is essential in diabetes care, particularly in hospital settings. They improve patient experience and outcomes.

Resolving NHS workforce issues requires the NHS to see workers as an asset, not simply a resource, writes Alison Leary

The NHS's single minded pursuit of admission avoidance risks ignoring other important outcomes, writes Alison Leary

Background General practice nurses’ (GPNs) in UK primary care have undergone significant role expansion over the past decade, encompassing chronic disease management, independent prescribing, preventive care and patient education. Despite this growth, evidence on patient experiences, satisfaction, and organisational factors supporting these roles remains fragmented. Aim This scoping review synthesises evidence on the roles and responsibilities of practice nurses in primary care, patients’ perspectives on their care and the organisational and leadership factors that support effective practice within multidisciplinary teams. Methods Following the Arksey and O’Malley framework with Levac et al. enhancements and PRISMA-ScR guidelines, we conducted a comprehensive search of major databases and grey literature sources. English-language studies published between 2010 and 2025, including qualitative, quantitative, and mixed-methods designs, were included if they focused on UK general practice nurses and patient experiences. Data were extracted and synthesised thematically to identify patterns related to nursing roles, patient perceptions, and organisational influences. Results General practice nurses deliver a wide range of clinical services and are highly valued by patients for their accessibility, approachability, and continuity. Patient satisfaction is highest when nurses demonstrate person-centred communication, clinical competence, professional autonomy, and strong therapeutic alliances. Effective integration within primary care teams is supported by formal leadership, structured professional development, role clarity, and organisational infrastructure. Persistent barriers include variability in employment conditions and the lack of standardised leadership pathways. Conclusions General practice nurses are central to delivering high-quality, patient-centred care in the UK. Strengthening formal leadership, enhancing professional development, clarifying roles through supportive policy frameworks and addressing employment variability are essential to maximise their contributions. Investment in these areas will improve patient outcomes, workforce satisfaction and the long-term sustainability of primary care services.

ObjectiveThe aim of this study was to generate a consensus definition for the work informally referred to as ‘liaison haematology’, by UK health professionals within haematology, including a list of tasks and routes by which requests are received. The objective was to help inform current workloads and future job plans.DesignA modified Delphi study using focus groups sought to reach consensus on a definition and scope of work for ‘liaison haematology’.Setting and participantsAn expert panel of 20 healthcare professionals from a range of backgrounds within UK practice. Participants attended one of two focus groups before responding to two rounds of anonymous questionnaires.ResultsParticipants reached consensus (>75%) on a range of users, routes and activities that should be considered liaison haematology. Advice and guidance to other healthcare professionals was broadly considered to be liaison haematology. Advice directly delivered to patients did not reach consensus for inclusion. A definition for ‘liaison haematology’ was agreed by 87% of respondents after two iterative questionnaire rounds.ConclusionThis study provides a first definition for ‘liaison haematology’ as well as new insights into the activities that make up this work. There is a paucity of previous literature on this topic, and it is hoped that establishing terms of reference in this way informs workforce planning associated with hidden labour and prompts further study. Further work is needed to explore liaison haematology in supporting healthcare teams as well as the increasing demands it places on haematology services. This study begins this process which will build a better understanding of how haematology and healthcare systems operate.