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Welfare Reform on the Web (April 2000): National Health Service - Community and Primary Care Services

CONTINUING HEALTH CARE: THE LOCAL DEVELOPMENT OF POLICIES AND ELIGIBILITY CRITERIA

H. Lewis et al

Health and Social Care in the Community, vol. 7, 1999, p.455-463

Article reports the results of a structured content analysis of all the policies and eligibility criteria for continuing health care in three regions, in the light of 1995 guidance issued by the Department of Health. Only a minority of authorities were found to have identified investments in services, despite the requirement to do so in the guidance. Most documents were not comprehensive in their coverage of client groups, with more information being provided about services for older people and those with mental health problems. Few policies contained action plans and eligibility criteria frequently took the form of descriptions of services and/or were so general as to be difficult to apply individual cases. Most documents contained no criteria for community health services. They contained far more detail about institutionally based services, and appeared likely to reinforce the imbalance towards the latter.

DISSENTING VOICES

B. Millar

Health Service Journal, vol. 110, Jan. 20th 2000, p.14-15

Reports concern about the costs of phoning NHS Direct, which bears most heavily on those who can least afford it, such as the homeless and travellers.

DIVERTED TRAFFIC

K. Hassell

Health Service Journal, vol. 110, Jan. 6th 2000

A trial scheme has shown that GP workloads can be cut if patients with self-limiting conditions are referred to pharmacists. The pharmacists prescribe from a formulary agreed in consultation with GPs and the health authority. Pharmacists receive a payment for the consultation whether or not a prescription is dispensed.

DOES GENERAL PRACTITIONER GATEKEEPING CURB HEALTH AND EXPENDITURE?

D. Delnoij, et. Al.

Journal of Health Service Research & Policy, vol. 5, no. 1, 2000, p.22-26

The study addresses the following questions: do health care systems with GPs acting as gatekeepers to specialized care home lower health care expenditure than those with directly accessible specialist care. Does health care expenditure increase more rapidly in countries without the gatekeeping system? Though multiple regression analyses on total and ambulatory health care expenditure in 18 OECD countries the authors were able to show that gatekeeping systems are better able to contain ambulatory care costs.

GOING WITH THE GRAIN? GENERAL PRACTIONERS IN THE NEW NHS

N. North, C. Lupton and P. Khan

Health and Social Care in the Community, vol. 7, 1999, p.408-416

A number of policy initiatives over the last few years have encouraged GPs to participate in commissioning, as opposed to simply purchasing, health care. Paper discusses the results of a qualitative investigation of the views of GPs about 'the new NHS', and contextualises these in a discussion of developments which have impacted on the organisation of general practice, GP responsibilities and ultimately the collective consciousness of the profession. GPs were concerned that their role within PCGs as managers of a finite local budget would attract public criticism when they had to make hard decisions about rationing. They were willing to value the contribution of nurses and social workers as professionals, but envisaged managers as functionaries who would provide the evidence for decisions and afterwards carry them out.

HEALTH SIDE-EFFECTS OF BYPASSING RULE BOOK

D. Brindle

Guardian, Jan. 6th 2000, p.8

Describes how the run-down Pennywell estate in Sunderland got its first medical centre through the employment of a salaried GP in a personal medical services (PMS) pilot scheme.

KITE-FLYING HERALDS DANGER

W. Barker and M. Piggott

Community Practitioner, vol. 73, 2000, p.442

Critique of government proposals to reform primary care nursing where there are at present eight different types of practitioner. Ministers are set to launch a review of the situation, with a view to removing some of the distinctions between the various professions.

NHS DIRECT: LEARNING FROM THE LONDON EXPERIENCE

London: King's Fund, 1999

Report of a study of London's first two NHS Direct schemes were found to be well-established, with rising call numbers. However, the impact of the telephone service on quality of health services remained unclear. Report calls for national standards to ensure uniform quality over all NHS Direct sites. The rapid implementation of NHS Direct before the pilot study evaluations were available has alienated many GPs and may hinder its future development.

OUT IN FRONT

K. McIntosh

Health Service Journal, vol. 110, Jan. 20th 2000, p.16-17

Predicts a power struggle between GPs and managers for control of the newly launched primary care trusts. An executive committee of clinicians will control day-to-day operations, overseen by a board with a lay chair and a professional chief executive. PCTs will therefore be led by a triumvirate consisting of a lay chair, a chief executive and a chair of the executive committee (a GP).

TOTAL PURCHASING COMMUNITY AND CONTINUING CARE: LESSONS FOR FUTURE POLICY DEVELOPMENTS IN THE NHS

S. Wyke et al

Health and Social Care in the Community, vol. 7, 1999, p.394-407

Five case studies of total purchasing pilots in the NHS showed that they indicated little awareness of national or local policy for community and continuing care (CCC). Four of the case study TPPs had begun to investigate the potential for integrated purchasing, and three of them had relatively sophisticated models of both horizontally and vertically integrated provision of care. However the TPPs developments were not based on systematic population based needs assessment. Paper concludes that while there is potential for PCGs to improve integration of care both horizontally and vertically, they may need policy guidance to:

  • encourage them to put CCC high on their agenda for action;
  • work with people with expertise in population based needs assessment;
  • find innovative ways to include users, carers, and voluntary agencies.
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