Category: English

Source: The Conversation – UK – By Helen Atherton, Professor of Primary Care Research, University of Southampton

Booking a GP appointment is a routine task, yet for many people it’s a source of frustration. Long waits, confusing systems and impersonal processes have become all too familiar. While much attention has been paid to how difficult it is to get an appointment, less research has asked a more fundamental question: what do patients actually want from their general practice?

To answer this, my colleagues and I reviewed 33 studies that were a mixture of study designs, and focused on patients’ expectations and preferences regarding access to their GP in England and Scotland.

What people wanted was not complicated or cutting edge. People were looking for connection; a friendly receptionist and good communication from the practice about how they could expect to make an appointment. And they wanted a general practice in their own neighbourhood with clean, calm waiting rooms. So far, so simple.

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People wanted booking systems that were simple and user-friendly, without long automated phone menus (“press one for reception”). Preferences varied. Some patients valued the option to book appointments in person at the reception desk, while others preferred the convenience of online booking.

Regardless of how they booked, patients wanted shorter waiting times or, at least, clear information about when they could expect an appointment or a callback.

Ideally, general practice would be open on Saturdays and Sundays for those who cannot attend during the week.

Remote consultations – by phone, video or email – have become more common since the pandemic, and many patients found them helpful. For those with caring responsibilities or mobility issues, they offered a convenient way to access care without needing to leave home.

However, remote appointments weren’t suitable for everyone. Some patients lacked privacy at work, while others – particularly those with hearing impairments – found telephone consultations difficult or impossible to use.

What patients consistently wanted was choice, particularly when it came to remote consultations. While in-person appointments were seen as the gold standard, many recognised that telephone or video consultations could be useful in certain situations. Preferences varied widely, which made the ability to choose the type of consultation especially important.

Patients also wanted choice over who they saw, especially for non-urgent issues or when managing ongoing health conditions.

In today’s general practice, care is often delivered by a range of professionals, including nurses, pharmacists and physiotherapists. While many patients were open to seeing different healthcare professionals, older adults and people from minority ethnic backgrounds were more likely to prefer seeing a GP.

Overall, patients wanted the option to choose a GP over another healthcare professional – or at least be involved in that decision.

Satisfaction at all-time low

Unsurprisingly, what patients want from general practice varies, reflecting different lifestyles, needs and circumstances. But what was equally clear is that many people are not able to get what they want from the appointment system.

According to a recent British Social Attitudes survey, patient satisfaction with general practice is at an all-time low, with just below one in three people reporting that they are very or quite satisfied with GP services.

Some elements of the UK government’s recently announced ten-year plan for the NHS in England may address some of these concerns, but it remains far from certain. The emphasis on the NHS app as a “doctor in your pocket” does not align with what many patients are asking for: genuine choice over whether they access care online or in person.

Read more:
NHS ten-year plan for England: what’s in it and what’s needed to make it work

The proposal to open neighbourhood health centres on weekends could benefit those who need more flexible access. However, simply increasing the number of appointments misses the point: patients want more than just availability. They want care that is accessible, personalised and responsive to their individual needs.

The evidence is clear and the solutions simple, yet patient satisfaction remains at an all-time low. The government must stop assuming technology is the answer and start listening to what patients are actually telling them. The cost of ignoring their voices is a healthcare system that serves no one well.

Helen Atherton receives funding from the National Institute for Health Research and the Research Council of Norway.

– ref. What people really want from their GP – it’s simpler than you might think – https://theconversation.com/what-people-really-want-from-their-gp-its-simpler-than-you-might-think-260520

Source: The Conversation – UK – By Natasha Lindstaedt, Professor in the Department of Government, University of Essex

Georgia was once considered a post-Soviet success story. After years of authoritarian rule, followed by independence which brought near state collapse, corruption and chaos, Georgia appeared to have transitioned to democracy.

In a period after independence in 1991 and before 2020, elections were regularly held and were deemed mostly free and fair, the media and civil society were vibrant and corruption levels had diminished significantly.

The “Rose revolution” in 2003 ushered in an era of unprecedented reform and suggested a move towards democracy and a closer relationship with the west. Georgians were full of hope for the country’s future, and prospects of joining the European Union – or at least moving closer to Europe.

Fast forward two decades and Georgia has fully returned to authoritarianism. Six opposition leaders are in prison or facing charges and now thinktank leaders are being targeted with investigations that could land them in prison. Typically these charges centre around accepting foreign funding or criticising the government.

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In moves in line with other authoritarian regimes around the world, opposition organisations such as thinktanks are being told to produce financial documents in short timeframes, and accused of financial mismanagement and threatened with prosecution if they don’t.

In May 2024, Georgia passed a Russian-inspired foreign agent law — which would require non-governmental organisations (NGOs) receiving foreign funding to register themselves and face restrictions. Protests erupted each time Georgia’s parliament debated this measure, but eventually the pro-RussianGeorgia Dream party prevailed. More than 90% of NGOs receive funding from abroad, so the new law cripples the efforts of some 26,000 of them.

Many Georgians were outraged that the passage of the bill may end dreams of one day becoming a European Union candidate country. Regular surveys have found that about 80% of Georgians have aspirations for their country to join the EU.

Though Georgia faces a host of economic problems, the Georgia Dream party has campaigned on delivering a return to traditional values. Like Russia they have also passed a series of laws in 2024 that target the LGBTQ+ community, such as banning content that features same-sex relationships and stripping same-sex couples of rights, such as adoption.

Parallels with Russia?

Georgia Dream also passed legislation making treason a criminal offence, a clear attempt to eliminate political opponents. Any insults of politicians online are also considered a criminal offence.

Also, in June of this year civil society organisations in Georgia received court orders requiring them to disclose highly sensitive data. Meanwhile, members of the Georgia Dream party were accused of assaulting opposition party leader Giorgi Gakharia suffering a broken nose and a concussion, which they denied.

In another effort to exercise greater control over the state, since the beginning of this year more than 800 civil servants have been dismissed. Similar to the purges that took place in Turkey — this is not being done in the name of efficiency, but to ensure that the bureaucracy is loyal to wishes of the Georgia Dream government.

This hasn’t happened overnight, as the laws had already changed several times to weaken legal protections for civil servants.

During its time in government, the Georgia Dream party has moved the country much closer to Russia, often by portraying the nation as locked in a cultural struggle against the west. Despite this, 69% of Georgians still see Russia as Georgia’s main enemy, up from 35% in 2012.

Though the Georgia Dream party faces increasing public opposition to its rule, it gained nearly the same amount of votes in the 2024 elections as it did in 2012 – when it was at its peak of popularity. The election result in October 2024 may be partly explained by accusations of fraud and other irregularities.

How did this happen?

One of the first big threats to Georgia’s democracy came in August 2008 when Russia invaded the country to offer support for two breakaway regions in South Ossetia and Abkhazia which declared themselves independent from Georgia. The international community did little to censure Russia, giving Russian president Vladimir Putin the confidence to engage in further acts of aggression.

Russia has maintained troops in South Ossetia, only about 30 miles from Georgia’s capital Tbilisi, and continues to play an important role in Georgian politics, undermining democracy.

The next threat came from within. Billionaire Bidzina Ivanishvili was elected prime minister of Georgia in 2012 as the leader of Georgia Dream. despite the fact that he officially stepped down from this position in 2013, he has wielded power behind the scenes and is still widely considered to be the de facto leader of Georgia.

Though Georgia did not immediately slide towards autocracy under the Georgia Dream party, today there are few remnants of democracy left. The major opposition parties are banned, opposition politicians and journalists are spied on, and protests are repressed by the police.

Cameras are now installed on the streets of Tbilisi as part of a crackdown on protest and fines for protesting have increased. Elections are no longer considered to be free and fair by the European Union and others as the Georgia Dream party uses its access to the state resources to dole out patronage to its supporters and intimidate voters.

In just over two decades, Georgia has managed to plunge back to authoritarianism. Once hailed as a beacon of democratic reform, the country is now gripped by a Russian-influenced ruling party that has consolidated power through repression, surveillance and manipulation.

But while the Georgia Dream party has tried to dismantle the country’s democratic institutions, support for resistance is high. According to a poll in 2025, more than 60% of respondents supported protests against the government and 45% identified as active supporters. And 82% feel Georgia is in crisis, with 78% blaming Georgian Dream.

It appears that Russia may have succeeded in undermining democracy in Georgia, but not in shaping hearts and minds.

Natasha Lindstaedt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Georgia: how democracy is being eroded fast as government shifts towards Russia – https://theconversation.com/georgia-how-democracy-is-being-eroded-fast-as-government-shifts-towards-russia-260430

Source: The Conversation – UK – By Sander Hölsgens, Assistant Professor, Leiden Institute of Cultural Anthropology and Development Sociology, Leiden University

At a school in Malmö, Sweden, skateboarding is on the curriculum. John Dahlquist, vice principal of Bryggeriets High School, teaches skate classes and brings lessons from skateboarding into other subjects. By encouraging teenagers to have fun together through skating and beyond, he notices that they want to attend school. Writing in a recent book I co-edited on skateboarding and teaching, Dahlquist notes that he even sees students longing to be back in the classroom after the weekend.

Skateboarding is creative, requiring ingenuity in adapting to new environments. It’s collaborative and social: skaters cheer each other on when they try to learn something new, acknowledging that everyone operates at a different level and faces a distinct challenge.

When skateboarding is done well, individual growth takes place among a community of care and mutual support. And it requires a willingness to fail. There’s no way to master a trick without trying and failing, over and over again.

My colleagues and I have researched the value of a skateboarding philosophy in schools, and how teachers can bring it into their classrooms.

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Take Dahlquist’s teaching in Malmö. He notes that interweaving skate classes with other subjects has multiple noteworthy effects. The physical activity of skateboarding improves levels of concentration. Some students even say that they’d never been successful in any other learning environment. Elsewhere, they’d be unable to focus on the task at hand.

What’s more, a skateboarding mindset – being prepared to learn difficult tricks in unfamiliar settings – equipped students with the capacity to master other kinds of new skills.

Able to fail

The process of overcoming the anxiety to fail is crucial. Skaters cannot be afraid to fall if they want to learn new tricks. The motivation to learn through repeated efforts helps skaters in other areas of life, too. Skaters at Bryggeriet aren’t worried as much about failing grades, precisely because they see it as an opportunity to learn and move forward.

As Dahlquist says, “At the end of my classes, I usually have to throw my students out of the classroom. A lot of them beg for three more tries: ‘I’ve got this, just give me three more tries. I promise I will learn.‘”

This mindset decreases grades as education’s cornerstone and, by extension, enhances students’ mental health. My colleague Esther Sayers, who conducted fieldwork at Bryggeriets, found another effect. Teachers help students to develop the skills to get motivated, to reach a point of feeling inspired – or what skaters call “stoke”.

Bryggeriets High School isn’t the only place where skateboarding is helping teach people how to learn. Reaching beyond its historical status as a self-regulated street culture, skateboarding now plays an important role in building engaged learning communities across the globe. Berlin-based skate organisation Skateistan hosts skate classes, gives young people access to education and offers funds for young and upcoming community leaders.

Concrete Jungle Foundation co-builds skateparks with young people in Peru, Morocco and Jamaica, in order to exchange knowledge and drive local ownership and apprenticeship. Similarly, the New York-based Harold Hunter Foundation runs skate workshops that also provide mentoring and career guidance.

Colleagues Arianna Gil and Jessica Forsyth have studied working class black and Latin American skate crews, run by genderdiverse community organisers. They found that skate crews such as Brujas and Gang Corp mobilise skaters according to the “for us, by us” spirit.

Challenging institutional models of authority, these skate crews develop services based on the hopes and aspirations of their communities – ranging from teach-ins to recreational programmes. This includes a talk on the history and meaning of hoodies, and modules on the power of storytelling and the danger of propaganda. The crux, here, is to learn about stuff you encounter in your daily lives.

Skaters who experience poverty and oppression create their own ecosystem for learning from one another, from being out of an educational system that is organised in a top-down way. This means creating a grassroots school model where skate crews choose what and how they want to learn. Rather than grades and degrees, education here is structured around the process of learning from your peers – with the idea of passing on this knowledge in the near future.

The effects of this approach are threefold. First, it centers mentorship and apprenticeship, resulting in intergenerational knowledge exchange. Second, skateboarding’s DIY spirit can help overcome access barriers. By embracing grassroots teaching practices and formats, education can be tailored to the specific needs and desires of a community, rather than following standardised learning objectives.

Third, rather than focusing on memorising facts or learning for grades, this new ecosystem is structured around problem-based learning. Presented with worldly problems such as human rights violations and hostile architecture, skaters learn not just how to analyse their surroundings, but also how to cope with and engage oppressive societal structures.

As formal education faces incremental budget cuts and deepened governmental influence, skateboarding shows us new ways to organise our learning spaces. Schools and teachers can engage their students by integrating aspects of a learning culture that decentres evaluations and assessments and celebrates attempts, rather than just successes.

Sander Hölsgens received a ‘starting grant’ from OCW, The Netherlands. He is affiliated with Pushing Boarders, a platform tracing the social impact of skateboarding worldwide.

– ref. What schools can learn from skate culture – https://theconversation.com/what-schools-can-learn-from-skate-culture-255239

Source: The Conversation – UK – By Nathalie Seddon, Professor of Biodiversity, Smith School of Enterprise and Environment and Department of Biology, University of Oxford

Nature in the UK appeared to receive a rare funding boost in the June spending review, with the government setting a spending target of up to £2 billion a year for England’s environmental land management (ELM) scheme by 2028-29.

By steering public funds toward farmers who restore hedgerows, soils and wetlands, England’s ELM programme is meant to renew landscapes that absorb carbon, support pollinators and keep water clean while helping rural businesses stay viable in a changing climate.

If delivered in full, the package would elevate the UK’s post-Brexit model of investing public money in shared ecological care (rather than payments based on acreage) to one of the most generously funded in the world.

Yet, scrutinise the details and a more complicated story emerges.

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The review has trimmed the day-to-day budget of the Department for Environment, Food and Rural Affairs (Defra) in real terms. Defra now faces the unenviable task of signing and monitoring thousands of new ELM agreements with fewer staff and shrinking data resources. Without the capacity to check whether fields really have become richer in skylarks or streams clearer of fertiliser, large sums could be delayed or misdirected.

Scale is another challenge. An independent analysis published in 2024 estimated that roughly £6 billion every year across the UK is needed to bring agriculture in line with the Environment Act targets for habitat restoration and net zero commitments.

Even the full £2 billion promised for England would meet only about half of that evidence-based need. And the “up to” £400 million for trees and peatlands is not new money: it is funding that was first promised in 2024 and the payment schedule has still not been confirmed.

While the review earmarked £4.2 billion for flood and coastal defence, it does not specify how much of that will support nature-based measures such as floodplain restoration, or the creation of saltmarshes or riparian woodlands. The Environment Agency is consulting on a funding model that could embed such solutions, but the Treasury papers are silent on who will pay for that shift.

Tech spending dwarfs habitat investment

Contrast this with the sums heading to the Department for Energy Security and Net Zero.

Roughly £30 billion is earmarked for nuclear fission, fusion research and carbon-capture hubs. These projects are heavy on concrete and steel (materials with a hefty carbon cost) but have no immediate ecological benefit.

While new low-carbon technologies are crucial, thriving and resilient soils, wetlands and woodlands nourish food systems, safeguard water and hold vast stores of carbon – benefits that deepen and become more cost-effective over time.

Nature-based solutions can also revitalise local economies. The Office for National Statistics estimates that replacing the benefits flowing from the UK’s forests, rivers and soils – flood buffering, crop pollination, cleaner air, recreation and more – would cost about £1.8 trillion, a figure that only hints at their deeper, immeasurable value.

Yet the review sets out no plan to safeguard these life-support systems, or to factor their decline into the Treasury’s green book (the rule book used to appraise public investments) or the Bank of England’s stress tests, which check how shocks could ripple through the financial system.

This is also a matter of fairness and public health. Growing evidence shows that regular contact with nature lowers the risks of heart disease and anxiety, while improving children’s cognitive development. These are benefits with a value that defies any price tag.

Yet the places with the fewest trees and parks tend to be the same post-industrial towns ministers want to “level up”. The review is silent on biodiversity net gain (the flagship policy meant to channel private finance into local habitats) and on a proposed national nature wealth fund that could blend public and private capital for large-scale restoration.

Housing money could repeat past mistakes

One line in the spending review could still shift the balance.

The chancellor has earmarked £39 billion for building social and affordable housing over the next decade. If every development delivers at least a 10% net gain for biodiversity onsite, and if schemes build in climate-smart design (living roofs, shade-giving street trees, permeable surfaces) with local residents, Britain could pioneer the world’s first large-scale, nature-positive, net-zero housing programme.

Without those safeguards, “levelling up” risks repeating old mistakes: sealing green space under concrete today and paying tomorrow to retrofit drainage, shade and parks.

That risk is heightened by the government’s planning and infrastructure bill, now before parliament. In an open letter to MPs, economists and ecologists warn that the bill would let developers “pay cash to trash” irreplaceable habitats by swapping onsite protection for a levy, a move they describe as a “licence to kill nature”.

At the next UN climate summit, Cop30 in Brazil in November 2025, the UK will have to show the world that its domestic spending matches its international rhetoric.

More than 150 UK researchers made that point in an open letter to the prime minister, urging him to put nature at the centre of the UK’s Cop30 stance. Converting the Treasury’s headline figures into habitat gains and locking robust rules into both the planning bill and the housing drive would give ministers credible proof of progress when they update the UK’s climate and nature pledges on the Cop30 stage.

The spending review may have nudged farm policy in the right direction and set a new higher water mark for nature-positive agriculture. Yet amid the squeeze on Defra, the recycling rather than expansion of tree and peat budgets and the continued dominance of technology over habitat, nature still comes a distant second to hard infrastructure in the UK growth model.

There is still time to change course. Guaranteeing Defra’s capacity, publishing a timetable for the tree-and-peat fund, reserving part of the flood budget for community-led nature-based solutions and hardwiring strong biodiversity net gain rules into housing and planning reforms would turn headline promises into projects that enrich daily life while stewarding public money wisely.

Don’t have time to read about climate change as much as you’d like?

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Nathalie Seddon receives funding from UKRI and the Leverhulme Trust and sits on the UK Climate Change Committee. She is also a trustee of the Circular Bioeconomy Alliance and is a non-executive director of the social venture, Nature-based Insights.

– ref. Nature-friendly farming budget swells in UK – but cuts elsewhere make recovery fraught – https://theconversation.com/nature-friendly-farming-budget-swells-in-uk-but-cuts-elsewhere-make-recovery-fraught-259091

Source: The Conversation – UK – By Stefan Wolff, Professor of International Security, University of Birmingham

Recent news from Ukraine has generally been bad. Since the end of May, ever larger Russian air strikes have been documented against Ukrainian cities with devastating consequences for civilians, including in the country’s capital, Kyiv.

Amid small and costly but steady gains along the almost 1,000km long frontline, Russia reportedly took full control of the Ukrainian region of Luhansk, part of which it had already occupied before the beginning of its full-scale invasion of Ukraine in February 2022.

And according to Dutch and German intelligence reports, some of Russia’s gains on the battlefield are enabled by the widespread use of chemical weapons.

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It was therefore something of a relief that Nato’s summit in The Hague produced a short joint declaration on June 25 in which Russia was clearly named as a “long-term threat … to Euro-Atlantic security”. Member states restated “their enduring sovereign commitments to provide support to Ukraine”. While the summit declaration made no mention of future Nato membership for Ukraine, the fact that US president Donald Trump agreed to these two statements was widely seen as a success.

Yet, within a week of the summit, Washington paused the delivery of critical weapons to Ukraine, including Patriot air defence missiles and long-range precision-strike rockets. The move was ostensibly in response to depleting US stockpiles.

This despite the Pentagon’s own analysis, which suggested that the shipment – authorised by the former US president Joe Biden last year – posed no risk to US ammunition supplies.

This was bad news for Ukraine. The halt in supplies weakens Kyiv’s ability to protect its large population centres and critical infrastructure against intensifying Russian airstrikes. It also puts limits on Ukraine’s ability to target Russian supply lines and logistics hubs behind the frontlines that have been enabling ground advances.

Despite protests from Ukraine and an offer from Germany to buy Patriot missiles from the US for Ukraine, Trump has been in no rush to reverse the decision by the Pentagon.

Another phone call with his Russian counterpart, Vladimir Putin, on July 3, failed to change Trump’s mind, even though he acknowledged his disappointment with the clear lack of willingness by the Kremlin to stop the fighting. What’s more, within hours of the call between the two presidents, Moscow launched the largest drone attack of the war against Kyiv.

A day later, Trump spoke with Zelensky. And while the call between them was apparently productive, neither side gave any indication that US weapons shipments to Ukraine would resume quickly.

Trump previously paused arms shipments and intelligence sharing with Ukraine in March, 2025 after his acrimonious encounter with Zelensky in the Oval Office. But the US president reversed course after certain concessions had been agreed – whether that was an agreement by Ukraine to an unconditional ceasefire or a deal on the country’s minerals.

It is not clear with the current disruption whether Trump is after yet more concessions from Ukraine. The timing is ominous, coming after what had appeared to be a productive Nato summit with a unified stance on Russia’s war of aggression. And it preceded Trump’s call with Putin.

This could be read as a signal that Trump was still keen to accommodate at least some of the Russian president’s demands in exchange for the necessary concessions from the Kremlin to agree, finally, the ceasefire that Trump had once envisaged he could achieve in 24 hours.

If this is indeed the case, the fact that Trump continues to misread the Russian position is deeply worrying. The Kremlin has clearly drawn its red lines on what it is after in any peace deal with Ukraine.

These demands – virtually unchanged since the beginning of the war – include a lifting of sanctions against Russia and no Nato membership for Ukraine, while also insisting that Kyiv must accept limits on its future military forces and recognise Russia’s annexation of Crimea and four regions on the Ukrainian mainland.

This will not change as a result of US concessions to Russia but only through pressure on Putin. And Trump has so far been unwilling to apply pressure in a concrete and meaningful way beyond the occasional hints to the press or on social media.

Coalition of the willing

It is equally clear that Russia’s maximalist demands are unacceptable to Ukraine and its European allies. With little doubt that the US can no longer be relied upon to back the European and Ukrainian position, Kyiv and Europe need to accelerate their own defence efforts.

A European coalition of the willing to do just that is slowly taking shape. It straddles the once more rigid boundaries of EU and Nato membership and non-membership, involving countries such as Moldova, Norway and the UK.
and including non-European allies including Canada, Japan and South Korea.

The European commission’s white paper on European defence is an obvious indication that the threat from Russia and the needs of Ukraine are being taken seriously and, crucially, acted upon. It mobilises some €800 billion (£690 billion) in defence spending and will enable deeper integration of the Ukrainian defence sector with that of the European Union.

At the national level, key European allies, in particular Germany, have also committed to increased defence spending and stepped up their forward deployment of forces closer to the borders with Russia.

US equivocation will not mean that Ukraine is now on the brink of losing the war against Russia. Nor will Europe discovering its spine on defence put Kyiv immediately in a position to defeat Moscow’s aggression.

After decades of relying on the US and neglecting their own defence capabilities, these recent European efforts are a first step in the right direction. They will not turn Europe into a military heavyweight overnight. But they will buy time to do so.

Stefan Wolff is a past recipient of grant funding from the Natural Environment Research Council of the UK, the United States Institute of Peace, the Economic and Social Research Council of the UK, the British Academy, the NATO Science for Peace Programme, the EU Framework Programmes 6 and 7 and Horizon 2020, as well as the EU’s Jean Monnet Programme. He is a Trustee and Honorary Treasurer of the Political Studies Association of the UK and a Senior Research Fellow at the Foreign Policy Centre in London.

– ref. US backs Nato’s latest pledge of support for Ukraine, but in reality seems to have abandoned its European partners – https://theconversation.com/us-backs-natos-latest-pledge-of-support-for-ukraine-but-in-reality-seems-to-have-abandoned-its-european-partners-260334