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Welfare Reform on the Web (February 2008): National Health Service - primary and community care

Prescribing costs in primary care

Public Accounts Committee

London: TSO, 2008 (House of Commons papers, session 2007/08; HC173)

The report claims that primary care trusts (PCTs) could save 200m a year if they encouraged GPs to prescribe cheaper generic drugs. Levels of generic prescribing vary widely between PCTs. For example, in some PCTs only 28% of statins prescribed are generic, whereas in others the rate is as high as 86%. Strategic health authorities should work with the National Prescribing Centre to spread best practice. The report also calls on the Department of Health to strengthen the medicines management indicators in the quality and outcomes framework for GP surgeries.

Community development in primary care: opportunities and challenges

R. Hogg and J. Hanley

Community Practitioner, vol. 81, Jan. 2008, p. 22-25

This qualitative study aimed to explore primary care professionals' views on community development, and to identify the opportunities and barriers associated with using this approach in practice. Participants in community development training - mainly health visitors - took part in small group discussions before, after and six months following the course. Opportunities for using a community development approach were identified, but were limited by lack of interest from some communities, lack of leadership and support within health visiting, and by the increasing medicalisation of health promotion. There is also a potential conflict between the ethos of community development and national public health priorities. Community concerns may not reflect government health promotion priorities.

Community hospitals grab local care lifeline

A. Moore

Health Service Journal, Jan. 31st 2008, p. 12-13

The White Paper Our Health, Our Care, Our Say proposed a new role for community hospitals as resources were shifted away from the acute sector. However, progress in defining this new role has been slow. Some primary care trusts have taken the bold step of turning their community hospitals into polyclinics, offering an array of services and but no inpatient beds. Care then has to be provided in patients' homes by multi-professional teams.

Efficacy of pre-school surveillance services in identifying children with special needs

A. Foo and J. Chaplais

Community Practitioner, vol. 81, Jan. 2008, p. 18-21

In Sheffield, a selective health visitor three-year review programme was set up in 1995 in advance of the 2003 Health for All Children Four national recommendations. This study aimed to determine how effective this targeted programme was, alongside other preschool surveillance services, in the early identification of children who developed special educational needs by their sixth birthday. The available records of 74 children with special educational needs born between April 1994 and March 1995 were studied to determine when and how their problems were identified. Results showed that the three-year review programme was reasonably well targeted on children who later developed SEN, but a significant proportion were identified both before and after the three-year review stage by other means. This points to early identification of SEN children being a multi-professional responsibility, requiring both improved information systems and the exchange of information between professionals.

From street-level bureaucrats to street-level policy entrepreneurs? Central policy and local action in lottery-funded community cancer care

R. Petchey, J. Williams and Y.H. Carter

Social Policy and Administration, vol. 42, 2008, p. 56-76

'Policy entrepreneurs' at the national and local level are individuals or organisations who help to open policy windows by investing time and resources in registering a specific issue on the policy agenda or promoting a particular solution to it. The fact that something is a national policy priority does not guarantee action locally; rather, it needs to appear on the policy agenda at both levels at the same time for successful implementation to occur. This article explores the relationship between central policy and local implementation in the context of a lottery-funded initiative to develop community cancer care in the UK. It examines the relationships between the Lottery Fund and central government; between it and the projects it funded; and between the projects and the local economy of cancer care. Evidence of success in both the vertical cascading of policy and local policy innovation was found. Due to two features of lottery funding, projects were buffered from both national policy change and from competing local priorities. In this protected space, street level policy entrepreneurs played a key role in developing cancer care innovations for adoption by mainstream funding agencies.

Integrated healthcare services: the future of commissioning and provision of out-of-hospital healthcare in the NHS

M. Irani

NHS Alliance, 2008

The report warns that adversarial competition, resulting from practice-based commissioning and payment-by-results, has led to primary care trusts, acute and foundation trusts competing for organisational preservation, while clinicians have retreated into professional self-preservation mode. The report proposes integrated provider organisations based around one or more practice-based commissioning groups, depending on population size. It also suggests the creation of community specialists and consultants, whose status would be equal to their hospital-based counterparts.

A tale of two cities and beyond: why getting even is proving tricky

S. Gainsbury

Health Service Journal, Jan. 24th 2008, p. 12-13

There are wide variations and inequities among primary care trusts in spending on coronary heart disease and prevention of premature deaths from the condition. The rate at which GPs detect heart disease patients and put them on their disease registers also varies across the country and between PCTs with similar premature death rates. Government has set an ambitious target of reducing the life expectancy gap between the 62 most deprived PCT areas and the England average by 10% from the 1996 baseline by 2010. In order for this to be achieved there are calls for better incentives for GPs to relocate to deprived areas and actively seek out cases.

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