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

NHS pay modernization: new contracts for general practice in England

National Audit Office

London: TSO, 2008 (House of Commons papers, session 2007/08; HC 307)

This report claims that, under their current contract with the NHS introduced in 2004, GPs are doing less work than before for more money, providing a poor deal for the taxpayer. Instead of using increased government funding to improve services, many appear to be pocketing it. GPs are handing over more work to practice nurses, but in many cases have not increased their wages in line with inflation. The report also claims that:

• The 2004 GP contract has cost the government £1.76bn more than it budgeted
• GP productivity has fallen by 2.5%, due to their opting out of provision of out-of-hours care
• GPs are now carrying out only 66% of consultations, compared to 79% in 2003. More work is being delegated to practice nurses
• No progress has been made with increasing the number of GPs in deprived areas.

Bridging worlds and balancing interests

S. Clark and S. Hotho

British Journal of Healthcare Management, vol. 14, 2008, p. 66-73

NHS Scotland restructured services around health board areas in 2004. This latest reorganisation saw the development of Community Health Partnerships (CHPs). These geographically-based organisations are committed to assessing the needs of local populations; monitoring the effectiveness of services delivered; and working closely with social services and voluntary agencies in the area. CHPs replaced local health care co-operatives (LHCCs), which were voluntary groupings of independent general practitioners supported by community and managerial staff. Within the health board area studied, LHCCs had been led by general practitioners who had taken on an additional role as chair of the LHCC. However, national guidance stipulated that CHPs had to be led by a general management structure. Consequently, LHCC chairs had to develop new roles within their health board. This study explored how they reacted to the change.

CNN code of conduct

Community Practitioner, vol. 81, Feb. 2008, p. 34-35

Presents a voluntary code of conduct for community nursery nurses working in community and primary care settings.

Health visiting and community matrons: progress in partnership

S. Harrison and J. Lydon

Community Practitioner, vol. 81, Feb. 2008, p. 20-22

There is an increasing focus in the UK on the management of patients with chronic conditions in the community so as to avoid emergency hospital admission. Warrington Primary Care Trust has identified marginalised groups such as homeless people, travellers and asylum seekers as being in need of preventative health care and at risk of undiagnosed physical and mental health problems. It has introduced community matrons to undertake care coordination and case management of the most complex clients, while ensuring that public health initiatives are delivered to reduce illness in vulnerable groups. This article points out the importance of health visitors working with community matrons to share their experience and skills.

Ministers vs. GPs: how did it come to this?

I. Torjesen

Health Service Journal, Feb. 21st 2008, p. 12-13

The British Medical Association's GPs' committee is at loggerheads with the Department of Health over government demands that doctors should open their surgeries for an extra three hours per week in one and a half hour blocks. The union would prefer doctors to be allowed to operate more flexibly and offer to see patients at unusual hours on request.

'Twas ever thus: why Darzi is 90 years too late

I. Kendall and J. Carrier

Health Service Journal, Feb. 28th 2008, p. 16-17

Lord Darzi's 2007 report on healthcare for London advocated the creation of polyclinics, at which a range of primary care, diagnostic and preventative services would be available under one roof. The idea was originally put forward in 1920 by Lord Dawson, physician-in-ordinary to George V. Dawson's main idea was to provide curative and preventive services delivered by multi-disciplinary teams comprising GP s, dentists, midwives, pharmacists, nurses and health visitors based in primary healthcare centres accessible to the local population. Dawson's ideas were well-received at the time, but not taken forward because the political climate was not propitious.

Who cares for the carers?

S. Shepherd

Health Service Journal, Feb. 21st 2008, p. 22-24

People caring for a sick or disabled relative are a vital part of the health and social care system, but many feel isolated and ignored. The government has recently awarded a £5.00m contract for the development of an expert carers programme, but many carers would say that they are already experts in the condition of the person they look after. There is also little tailoring of services to ensure that they are accessible to carers. Little respite support is available, and social services will often only intervene if there is a crisis and arrangements break down. Referrals to support services often depend on how sympathetic GPs are to the issues. The article describes a project in Surrey which aims to make them more sensitive.