Welfare Reform on the Web (April 2008): National Health Service - primary and community care
Angry GPs reluctantly accept plan for evening and weekend surgeries
J. Carvel
The Guardian, March7th 2008, p. 7
A British Medical Association poll of GPs has found that although 92% reluctantly agreed to accept government proposals which will extend surgery opening hours to provide some appointments at evenings and weekends, 98% said that the government's negotiating tactics were unacceptable. GPs' leaders have claimed that patients' safety may be at risk if doctors are exhausted by extended hours. Extended opening hours are set to be introduced to surgeries, depending on local demand, from April 1.
(See also The Independent, March 7th 2008, p. 10; The Times, March 7th2008, p. 26; Daily Telegraph, March 7th 2008, p. 14)
Community public health in policy and practice: a sourcebook. 2nd ed.
S. Cowley (editor)
Edinburgh: Baillere Tindal Elsevier, 2008
Since the first edition of this book was published, there has been considerable change across public health, health visiting and community nursing. A positive emphasis on developing and describing all services in relation to their purpose and client/user group is reflected in this second edition, emphasizing multi-disciplinarity and service focus rather than individual professions, whilst retaining the essential emphasis on policy and practice. Familiar occupational titles, such as health visitor, community development worker, midwife or nurse are still used within the chapters, recognizing the continued division of labour and major contributions to public health made by specific grass roots occupations. This second edition has been completely reorganised, expanded and updated to keep up with the rapid progress across the field of community public health.
Dentists' new contract has left the provision of NHS care 'full of holes'
N. Hawkes
The Times, March 6th 2008, p.21
According to a report from the Patients' Association, the dental contract introduced in 2006 has failed to solve longstanding problems: funding is short, dentists are unhappy and patients are confused about access to dentists and dental charges.
Developing evidence-based recommendations in public health: incorporating the views of practitioners, service users and user representatives
M. J. Renfrew and others
Health Expectations, vol.11, 2008, p. 3-15
Guidance based on a systematic assessment of the evidence base has become a fundamental tool in the cycle of evidence-based practice and policy internationally. The process of moving from the formal evidence base derived from research studies to the formation and agreement of recommendations is acknowledged to be problematic, especially in public health, and the involvement of practitioners, service commissioners and users in that process is both important and methodologically challenging. As part of the development of national public health recommendations to promote breast feeding in England, the methodological challenges of involving stakeholders were examined and addressed. There were three main stages:
- an assessment of the formal evidence base
- electronic and field-work based consultation with practitioners, service commissioners and user representatives, and an in-depth analytical consultation in three 'diagonal slice' workshops
- synthesis of the previous two stages.
The process resulted in widely agreed recommendations together with suggestions for implementation.
Doctor shortage is threat to care, warns BMA
J. Carvel
The Guardian, March 31st 2008, p. 5
According to the British Medical Association a chronic shortage of junior doctors is threatening the quality of patient care. Newly introduced changes designed to accelerate the promotion of junior doctors to consultant level has led to gaps at a junior level which can only be filled by registrars and house officers working excessive hours.
GPs urge PCTs to remain flexible
I. Torjesen
Health Service Journal, Mar. 13th 2008, p. 7
Primary care trusts will have to negotiate with family doctors over how to implement extended hours locally after GPs voted to accept the government's proposals. Practices will provide 30 minutes of consultations outside of core hours for every 1000 patients. Consultations are meant to be pre-booked and delivered in 90 minute blocks by one GP, but PCTs will have some scope to vary these arrangements.
High costs and long waits force patients abroad
J. Laurance
The Independent, March 11th 2008, p.19
High costs and the difficulty of finding an NHS dentist have made dental tourism the fastest growing category of medical tourism, with Hungary the most popular destination for dental treatment.
Home-grown change will reshape the NHS
J. Deffenbaugh
Health Service Journal, Mar. 6th 2008, p. 16-17
Argues that primary care trusts are primarily commissioning organisations which need to divest themselves of provider services as quickly as possible. However, in order for them to achieve critical mass as commissioners, numbers need to be reduced from 152 and size increased. This can be achieved through joint ventures, partnerships and contractual relationships as well as outright mergers and acquisitions.
Hospital deaths 'are a postcode lottery'
R. Smith
Daily Telegraph, Mar. 25th 2008, p. 14
At least 20% more patients are dying at 10 hospital trusts across the country than expected. The Healthcare Commission has launched an enquiry into mortality rates at Mid Staffordshire NHS Foundation Trust, but has declined to investigate the other nine.
(See also Guardian, Mar. 18th 2008, p. 6)
Improving access to primary care: eight case studies of introducing Advanced Access in England
C. Pope and others
Journal of Health Services Research and Policy, vol. 13, 2008, p. 33-39
Advanced Access was developed in the USA to improve access to primary care in Kaiser Permanente. Also called 'same-day scheduling' or 'open access scheduling', it is informed by queuing theory and aims to ensure that there is sufficient capacity in the system to allow patients to be seen on the day of their choice. General practices in England were encouraged to adopt Advanced Access as part of a programme of quality improvement led by the National Primary Care Development Team. This paper examines what happened when Advanced Access was implemented in general practices in England, focusing on its impact on appointment systems. Considerable variation in the interpretation and implementation of Advanced Access was found, and practices claiming to operate the system often did not follow its key principles. Advanced Access was diluted because it became confused with same-day appointment systems and other incentives and targets.
Is it easier to clear the bar?
A. Taylor
Community Care, Feb. 28th 2008, p. 24-25
In October 2007, the government introduced a national system of eligibility criteria for NHS continuing care, replacing regionally-based criteria. However, there are concerns that primary care trusts across England are not applying the new system consistently.
Proposal for multi-doctor centres 'may result in worse care'
N. Hawkes
The Times, March 21st 2008, p. 27
Martin Roland, the director of the National Primary Care Research and Development Centre at the University of Manchester has indicated that proposals for polyclinics are misguided and will reduce levels of clinical quality rather than improve them. Rather, he has indicated that extending choice means more high-quality practices, not fewer larger ones as suggested by the poly-clinics model.
Women in labour turned away by maternity units
J. Carvel
The Guardian, March 20th 2008, p. 6
Women in labour are being refused entry to overstretched maternity wards and told to find somewhere else to give birth. Information released under the Freedom of Information Act stated that maternity wards in almost 10% of trusts were unable to accept new admissions on at least 10 days last year.
Young dentists desert the NHS in favour of lucrative private work
C. Brown
The Independent, March 6th 2008, p.4
Reports on the issue of young dentists who appear to be switching from the NHS to highly lucrative private cosmetic treatment jobs, possibly exacerbating the lack of availability of NHS dentists.