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Welfare Reform on the Web (March 1999): National Health Service - Community and Primary Care Services

NHS REFORM CONCESSIONS WIN OVER THE DOCTORS

D. Brindle
Guardian, 26th June 1998, p. 10

The Annual Conference of Local Medical Committeees voted to co-operate with the formation of Primary Care Groups (PCGs) which will eventually take over the commissioning of health care. GPs were won round by concessions guaranteeing index-linked funding for surgery premises, computers and staff costs and giving GPs the option of a majority on boards of primary care groups. The conference warned that the new PCGs must not inherit the debts of existing Health Authorities and fundholders.

THE CONTINUING CARE GUIDELINES AND PRIMARY AND COMMUNITY HEALTH SERVICES

C. Glendinning and B. Lloyd
Health and Social Care in the Community, vol. 6, no. 3, May 1998, p. 151-157

The confirmation of NHS responsibiities for continuing health care has important implications for primary and community health services. Interviews conducted in 1996 indicated that few GPs had responded to local consultation on draft local policies on continuing care. Local policies had apparently not addressed two issues which GPs and community nursing staff found particularly problematic: their responsibilities in relation to patients in private sector nursing and residential care homes, and the intensive care needed by some newly discharged hospital patients.

ETHICAL ISSUES IN COMMUNITY HEALTH CARE

R. Chadwick and M. Levitt (editors)
London: Arnold, 1998

Contributors explore the issues of theory and practice that arise in community health care from a multi-disciplinary perspective, and encourage reflection on the differences between hospital-based and community care. Issues of practice covered include discrimination, mental health, standard setting, rationing in health care, public health, health promotion and discharge decision-making.

THE MEDICAL PROFESSION ND THE STATE : GPs AND THE GP CONTRACT IN THE 1960s AND THE 1990s

J. Lewis
Social Policy and Administration, vol. 32, no. 2, June 1998, p. 132-150

Paper explores two major conflicts between general practitioners and the state in the mid-1960s and again in the late 1980s. In the 1960s, GPs were able to interpret the contract mechanism that attached them to the NHS in a way that bolstered their own professional ethos and autonomy. In the 1980s the government reinterpreted the contact to impose greater accountability and secure modifications in clinical practice through incentives.

NHS REFORM

R. Rowden and T. Le Vann
The Guardian. Society, 24th June 1998, p. 10

Two health practitioners put the case for and against Primary Care Groups. In favour of PCGs, it is argued that they will give GPs greater clout and will promote integration of health, social and voluntary services in the proposed health action zones. It is argued against PCGs that they will force GPs to be responsible for rationing patient care.

PICTURE IN PROFILE

R. Cook
Health Service Journal, vol. 108, no. 5612, 9 July 1998, p. 26-27

Clinical governance will be one of the main functions of Primary Care Groups, which are at risk of being ill-equipped for the task. Audit, risk management and research and development activities in primary care have been fragmented, and dissemination of results patchy: PCGs need urgently to assess their resources for undertaking clinical governance.

POTENTIAL ROLE OF COMMUNITY PHARMACISTS IN CARE MANAGEMENT

W. E. Harris, P.H. Rivers, and R. Goldstein
Health and Social Care in the Community, vol. 6, no. 3, May 1998, p. 151-157

The traditional dispensing role of the community pharmacist is increasingly being questioned and greater emphasis is being placed on the provision of advice. Article suggests that the NHS and Community Care Act 1990 and the Carers (Recognition of Services) Act 1995 have provided an opportunity to expand pharmaceutical services to include a care management role and assessment of individual needs. The introduction of community care training for community pharmacists in Derbyshire is described, and results of a study to evaluate assessments and referrals they carried out are reported.

PUZZLING IT OUT

L. Whitfield
Health Service journal, vol. 8, no. 5612, 9 July 1998, p. 14-15

Reports on problems encountered in establishing the boundaries of the new Primary Care Groups. Natural communities of about 100,000 people are proving hard to find. Managers' and doctors' leaders are also becoming anxious for guidance on the details of how to run and finance the new groups.

STAFF'S COUNSEL

B. Abberley
Health Service Journal, vol. 108, no. 5612, 9 July 1998, p. 28-29

Staff are concerned that the establishment of Primary Care Groups may lead to more direct employment of community staff by GPs. Primary Care Trusts (PCTs) will need to control staff resources if they are to plan services to the maximum benefit of patients. As PCTs develop, practice staff should be given the option of transferring their employment to the trusts. Regional clearing house arrangements should be established to assist the redeployment of NHS and fundholding staff displaced by the establishment of PCGs.

THUNDER AND ENLIGHTENING

M. Gould
Health Service Journal, vol. 108, no. 5611, 2 July 1998, p. 11-12

GPs at the British Medical Association's local medical committee's conference agreed to co-operate in the formation of Primary Care Groups, while expressing reservations over the tightness of the implementation timetable, imposition of artificial geographical boundaries, and likely conflict with managers.

TOTAL PURCHASING : A STEP TOWARDS PRIMARY CARE GROUPS

London: King's Fund, 1998

Evaluation of the first-wave total purchasing pilots that started in October 1995. The pilots cover about 30,000 people, about a third of the size of the proposed primary care groups. Yet the smaller schemes were able to achieve their objectives move often than the larger ones. Higher management costs were associated with greater achievements in the first year. Predicts that the introduction of Primary Care Groups is unlikely to reduce NHS management costs initially. Costs will rise at first as PCGs are established since health authorities will have to continue to operate as commissioners until all local PCGs are at level 2 and possibly at level 3.

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