Rachel Johnson

The Telegraph’s agony aunt encourages a reader to face the reality of her relationship with a man 13 years her junior

It was only 9.15am on week 2 of the summer holidays and I'd already said "I've asked you three times" more often than I'd had a cup of tea. Listen to this article One child was refusing to get dressed, another had disappeared...

My youngest son, Oliver, has asked me to make a speech at his wedding. I am very flattered even to be invited as, given the Beckham family meltdown

A fear of organised groups, heights, horses and camping didn’t stop our writer saying ‘yes’ when invited to ride across the Celestial Mountains led by Alexandra Tolstoy

Background Healthcare services are mainly organised around single health conditions and need reconfiguration to meet the needs of people with multiple long-term conditions (multimorbidity). Typically, people are offered annual reviews for each of their long-term conditions separately. In a randomised controlled trial, a comprehensive computerised template based on a personalised care model increased the person-centredness of multimorbidity reviews in primary care, but there were implementation challenges. We sought to understand and address the challenges of implementing a template to support personalised primary care for people with multimorbidity (PP4M).Objectives To explore the extent of implementation and factors influencing uptake of the PP4M intervention. To understand factors influencing implementation and normalisation of the template.Design Convergent parallel mixed methods within a non-randomised hybrid implementation-effectiveness study. Normalisation Process Theory (NPT) informed design, data collection and analysis.Setting Primary care (general practices) in three English regions.Participants Quantitative: Patients aged 18 years or over and had at least three types of long-term conditions (routine data collection); staff involved in using the template in implementation practices (Normalisation MeAsure Development (NoMAD) questionnaire).Qualitative: Staff at implementation practices.Intervention A multimorbidity computerised template to support personalised annual reviews. NPT-informed implementation package delivered to implementation practices included: process mapping, software support and training.Data collection Routine medical record data; NoMAD questionnaires and qualitative interviews in implementation practices.Primary/secondary outcomes Measures of reach, fidelity, acceptability and sustainability.Analysis Quantitative data: descriptive statistics, logistic regression and difference-in-difference models. Qualitative data analysis conducted using NPT coding manual.Results In practices that received an NPT-informed implementation package, use of the template increased more, across patients with a range of demographics and health conditions, than in those that did not receive the implementation package (OR 2.86 (95% CI 2.34 to 3.49)). The implementation package successfully triggered NPT processes of coherence and cognitive participation, and, to a lesser extent, collective action and reflexive monitoring. Contextual factors, including a lack of staff generalist skills and disease-specific incentives, impeded engagement and sustained implementation.Conclusions Focusing on the processes of normalisation as mechanisms of implementation facilitated development of an implementation strategy with potential to trigger those mechanisms, but did not sufficiently address contextual factors. Implementation strategies to support personalised care must consider wider system and practice level contextual factors, such as incentives and staff training.Trail registration number (2022–08-03, retrospectively registered.)Data are available upon reasonable request. Availability of data and materials: The anonymised data collected are available as restricted data via the University of Bristol online data repository: .

A recording from Rachel Johnson and Sinem Günel's live video

It doesn’t take long for me to fall in love. A young Adonis with a six-pack bounced on a trampoline, his dark curls flapping like spaniels’ ears. Waiters flitted about with drinks. Ridiculously attractive couples, all with perfect bodies, lounged on...

Lake Como It doesn't take long for me to fall in love. A young Adonis with a six-pack bounced on a trampoline, his dark curls flapping like spaniels' ears.

Chicken Meatballs & Napa Chicken Salad

Gloucester Services, on the M5, proves the perfect gourmet gateway to a luxurious Cotswolds hotel with a somewhat hit-and-miss restaurant