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

The future of commissioning

A. Cowper (editor)

Health Service Journal, June 12th 2008, supplement, 9p

This special supplement on commissioning health services covers:

  • Public engagement in decision-making
  • A quality assurance system developed by the Department of Health to help primary care trusts achieve their targets
  • Practice-based commissioning
  • Joint working between local authorities and primary care trusts.

In sickness and in health: achieving an integrated NHS

NHS Alliance, 2008

The majority of NHS patients are now people living with long term conditions associated with population ageing. This report says that primary care has the expertise to manage the needs of these patients by creating a system of integrated healthcare designed around them and offering access when and where required. It recommends that:

  • GPs should reclaim responsibility for round-the-clock care
  • Consultants, GPs and other clinicians should work together in integrated care organisations based around large GP surgeries, polyclinics or community hospitals
  • The new role of Community Specialist Consultant should be created, with training in the skills needed to work across the boundary between primary and secondary care
  • The needs of all patient groups must be considered, including those with long term conditions and those suffering deprivation
  • Virtual health centres, based on collaboration between GP practices, specialist doctors and other services such as physiotherapy should be considered as an alternative to new build polyclinics
  • Practice-based commissioning should be boosted by setting up Innovation Funds to facilitate service redesign.

Inclusion in primary care for people with intellectual disabilities: getting the perspective of service user and supporting primary care staff

M.C. Jones and others

Journal of Intellectual Disabilities, vol. 12, 2008, p. 93-109

This study aimed to gain service user and social care staff perspectives on the barriers facing people with intellectual disabilities when accessing primary healthcare. Focus groups were used with social care staff (N=19) and individual interviews with people with intellectual disabilities (N=6). The results revealed a number of themes that were shared by people with intellectual disabilities and social care staff, and themes that were unique to each group. While physical access to surgeries was not problematic, reports from social care staff suggest that practitioners in primary care may not have sufficient knowledge about how to communicate with people with intellectual disabilities. The primary settings did seem flexible in offering appointment times, but despite this, waiting at the surgery was a challenge for many service users.

Radical ideas can keep service out of casualty

L. Kendall

Health Service Journal, June 26th 2008, p. 14-15

The ambulance service is one of the most important access routes to the health and social care system. However, the vast majority of calls it receives are from people with urgent but not life-threatening conditions. In order to promote effective and appropriate use of ambulance services, the author proposes:

  • A single access point for the assessment and prioritisation of calls, using a new national telephone number and supported by a local directory of services
  • Improved round-the-clock access to primary and community care services
  • Assessing ambulance services according to patient outcomes and experiences, as well as response times
  • More treatment delivered by ambulance service personnel in callers' homes

Shock of the new

L. Eaton

Health Service Journal, June 12th 2008, p. 24-26

Sherford is a new town which will be built near Plymouth in Devon. An open meeting was held in May 2008 to discuss healthcare provision. Devon Primary Care Trust's current plan is for a single health and well-being centre housing eight GP practices. Opinion is divided on the proposal, with smaller GPs in fear of being squeezed out by larger businesses.

Under one roof: will polyclinics deliver integrated care?

C. Imison, C. Naylor and J. Maybin

London: King's Fund, 2008

The report warns that patients will be forced to travel further to see their GP without any improvements in care under government plans for the development of 'co-located' polyclinics offering some outpatient and community services as well as access to GPs. The elderly and those living in rural areas will be worst affected. The new 'super surgeries' will also cost the NHS money because they will offer services such as diagnostic tests and minor surgery that are more expensive when provided outside hospitals. The report comes down in support of the 'hub and spoke' model, with the polyclinic as a central resource base in a co-ordinated network of GP practices. It emphasises that substantial savings are unlikely and significant workforce issues will need to be addressed.

(For summary see Public Finance, June 6th-12th 2008, p. 24-27

What the CHPP means

C. Adams and R. Newland

Community Practitioner, vol. 81, June 2008, p. 36-37

Universal public health services for children have been run down in recent years as funding has been redirected to early years education provision. However the new Child Health Promotion Programme sets the scene for the development of a public health-focused child health promotion service that is led by health visitors, is evidence-based and prioritises the development of early interventions and preventive services.

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