Forty-eight hour access to primary care: practice factors predicting patients' perceptions

Background: The government has proposed a 48-hour target for GP availability. Although many practices are moving towards delivering that goal, recent national patient surveys have reported a deterioration in patients' reports of doctor availability. What practice factors contribute to patients' perceptions of doctor availability? Method: A cross sectional patient survey (11 000 patients from 54 inner London practices, 7247 (66%) respondents) using the General Practice Assessment Survey. We asked patients how soon they could be seen in their practice following non-urgent consultation requests and related their aggregated responses to the characteristics of their practice. Results: Three factors relating to practice administration and appointments systems operation independently predicted patients' reports of doctor availability. These were the proportion of patients asked to attend the surgery and wait to be seen, the proportion of patients seen using an emergency surgery arrangement, and the extent of practice computerization. Conclusion: Some practices may have difficulty in meeting the target for GP availability. Meeting the target will involve careful review of practice administrative procedures.

Model inter-comparison between statistical and dynamic model assessments of the long-term stability of blanket peat in Great Britain (1940-2099)

We compared output from 3 dynamic process-based models (DMs: ECOSSE, MILLENNIA and the Durham Carbon Model) and 9 bioclimatic envelope models (BCEMs; including BBOG ensemble and PEATSTASH) ranging from simple threshold to semi-process-based models. Model simulations were run at 4 British peatland sites using historical climate data and climate projections under a medium (A1B) emissions scenario from the 11-RCM (regional climate model) ensemble underpinning UKCP09. The models showed that blanket peatlands are vulnerable to projected climate change; however, predictions varied between models as well as between sites. All BCEMs predicted a shift from presence to absence of a climate associated with blanket peat, where the sites with the lowest total annual precipitation were closest to the presence/absence threshold. DMs showed a more variable response. ECOSSE predicted a decline in net C sink and shift to net C source by the end of this century. The Durham Carbon Model predicted a smaller decline in the net C sink strength, but no shift to net C source. MILLENNIA predicted a slight overall increase in the net C sink. In contrast to the BCEM projections, the DMs predicted that the sites with coolest temperatures and greatest total annual precipitation showed the largest change in carbon sinks. In this model inter-comparison, the greatest variation in model output in response to climate change projections was not between the BCEMs and DMs but between the DMs themselves, because of different approaches to modelling soil organic matter pools and decomposition amongst other processes. The difference in the sign of the response has major implications for future climate feedbacks, climate policy and peatland management. Enhanced data collection, in particular monitoring peatland response to current change, would significantly improve model development and projections of future change.

Bioclimatic envelope model of climate change impacts on blanket peatland distribution in Great Britain

Blanket peatlands are rain-fed mires that cover the landscape almost regardless of topography. The geographical extent of this type of peatland is highly sensitive to climate. We applied a global process-based bioclimatic envelope model, PeatStash, to predict the distribution of British blanket peatlands. The model captures the present areal extent (Kappa = 0.77) and is highly sensitive to both temperature and precipitation changes. When the model is run using the UKCIP02 climate projections for the time periods 2011–2040, 2041–2070 and 2071–2100, the geographical distribution of blanket peatlands gradually retreats towards the north and the west. In the UKCIP02 high emissions scenario for 2071–2100, the blanket peatland bioclimatic space is ~84% smaller than contemporary conditions (1961–1990); only parts of the west of Scotland remain inside this space. Increasing summer temperature is the main driver of the projected changes in areal extent. Simulations using 7 climate model outputs resulted in generally similar patterns of declining aereal extent of the bioclimatic space, although differing in degree. The results presented in this study should be viewed as a first step towards understanding the trends likely to affect the blanket peatland distribution in Great Britain. The eventual fate of existing blanket peatlands left outside their bioclimatic space remains uncertain.