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

23m have not seen dentist for two years

S. Borland

Daily Telegraph, Apr. 17th 2008, p. 6

Statistics obtained by the Conservatives have shown that 23.1 million people received no NHS dental care in the two years to September 2007. This represents an increase of 4% since the government introduced its new dental contract in 2006. The figures also showed that, as numbers of people routinely seeing a dentist decreased, hospital admissions for dental treatment rose.

A chance to peep under the primary care carpet

C. Santry

Health Service Journal, Apr. 3rd 2008, p. 12-13

Under proposals set out in a Department of Health consultation in March 2008, GP and dental practices will be included in the mainstream regulatory regime for the first time. Practices will have to register with the Care Quality Commission and be subject to spot checks. To register, they will need to demonstrate compliance with a new set of standards. Substandard practices could be fined or closed.

Good chemistry


Health Service Journal, Apr. 10th 2008, p. 27

The pharmacy profession is preparing itself to take a central role in public health improvement. They are moving towards providing enhanced services such as screening, personalised information for patients, medicines compliance reviews, and advice about minor ailments.

GPs in the dock: the case for the defence

D. Haslam

Health Service Journal, Apr. 3rd 2008, p. 16-17

The role of the GP as gatekeeper to NHS secondary services has been criticised, and it has been argued that it would be much simpler and cheaper for patients to self-refer to specialists. The author argues that GPs have a valid role in keeping people out of hospital except when admission is essential. Research has also shown that strong primary care improves health outcomes and reduces inequalities.

Home birth mothers 'need more support'

S. Boseley

The Guardian, April 2nd 2008, p. 14

The findings of an investigation into home births have revealed that they are generally safe but more support is needed if things go wrong and women need to be taken to hospital. Death rates during birth have improved in recent years, however, this trend has not been reflected so much in women choosing to have home births and is even less the case for those who are transferred to hospital after planning a home delivery.

Out-of-hours doctors told to reduce home visits to save cash

G. Cleland

Daily Telegraph, Apr. 16th 2008, p. 2

A leaked email suggests that private contractors offering out-of-hours care to NHS patients are telling their doctors to save money by speaking less to patients, cutting down on home visits, and making fewer referrals. The companies are having to make cuts to render the service cost effective.

Patient choice in general practice: the implications of patient satisfaction surveys

R. Robertson, A. Dixon and J. Le Grand

Journal of Health Services Research and Policy, vol. 13, 2008, p. 67-72

Current government policy aims to empower patients by giving them greater choice over the general practice with which they register. This study aimed to identify the factors that would be important to patients when choosing a practice using logistic regression analysis of English National Health Service national patient survey data. The findings suggest that patients value the quality of their relationship with their doctor more than the appearance of the surgery, accessibility of appointments and their experience in the waiting room. Therefore, if current restrictions on choice of GP were to be removed, we would in theory expect a patient's choice to be driven by the quality of the doctor-patient relationship. If the quality of the relationship deteriorated, patients might to expected to change to another practice.

PCTs face tough questions on QOF reporting

S. Gainsbury

Health Service Journal, Apr. 3rd 2008, p. 4-5

The Quality and Outcomes framework that offers GP practices financial rewards for meeting targets has long been suspected of being open to manipulation. For example, practices can discount or except certain patients when measuring their achievements. The Health Service Journal has examined the 2006/07 exception reporting rate of 8,331 GP practices across 31 indicators in the framework. The average exception rate across all the indicators was 7.4%. However, 168 practices had rates that were twice as high or more and nine practices had rates three times as high. The figures have given rise to a suspicion that some patients are being written off.

Pharmacy in England: Building on strengths, delivering the future

Department of Health

London: TSO, 2008 (Cm7341)

The government is proposing to set up a network of 'super chemists ' to deal with half of all minor illnesses within three years. The centres will have consulting rooms, with pharmacists expected to treat ailments such as coughs, colds, headaches and eye infections. Patients suffering from long-term conditions such as diabetes will be encouraged to visit their local centre for prescriptions instead of going to their GP. The pharmacies will also provide more vaccinations and will include a private area where procedures such as tests for sexually transmitted diseases can be performed. The centres will be open from 8.00am to 10.30pm, seven days a week.

(See also Society Guardian, Apr. 9th 2008, p. 7)

Polyclinics will cause upheaval, says Cameron

N. Watt

The Guardian, Apr. 22 2008, p. 13

David Cameron has criticised the government's plans to abolish many smaller GP practices in order to make way for a network of larger polyclinics. The leader of the opposition has warned that the scheme, which involves potentially closing around 1,700 existing surgeries, fails to take the concerns of the public into account.

(See also Daily Telegraph. Apr. 22nd 2008, p. 12 and The Guardian, May. 6th 2008)

Primary healthcare for people with mental health problems or learning disabilities

A. Nocon and L. Sayce

Health Policy, vol. 86, 2008, p. 325-334

Concerns about the poorer health and reduced life expectancy of people with mental health problems or learning disabilities led the Disability Rights Commission (DRC) to undertake a formal investigation into health inequalities and primary care between 2004 and 2006. The DRC was responsible for preventing discrimination against disabled people and advising how inequalities could be addressed. The investigation gathered data on the nature and extent of health inequalities, which would also provide a baseline against which to measure future trends. It also investigated reasons for inequalities, why previous initiatives had not worked, and what needed to be done to improve the situation.

Trust me I'm a modern healthcare professional

N. de Reybekill

Health Service Journal, Apr. 17th 2008, p. 16-17

The author reflects on the decline of public trust in the medical profession. This decline is attributed to poor communication skills among doctors, and the move towards large impersonal health centres for primary care delivery, in which there is no continuity of care. General practitioners also tend to see themselves as small businessmen, rather than as professionals with a vocation. There is no sense of selfless service.

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