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

Community engagement to improve health

National Institute for Health and Clinical Excellence

London: 2008

The guidance identifies who should take action on recommendations, which range from the small-scale and detailed, such as using community workshops, to general principles that are linked to major issues of social justice, power and politics. These recommendations are organised under four over-arching themes:

• Prerequisites for effective community engagement, under headings of policy development, long-term investment, organisational and cultural change, levels of engagement and power, and mutual trust and respect
• Infrastructure required to develop effective practice, including measures relating to training and resources, partnership working and area-based initiatives
• Approaches to encourage the involvement of local communities, set out under headings of community members as agents of change, community workshops and resident consultancy
• Evaluation aimed at improving the quality of evidence and developing better evaluation processes, in order to increase understanding of how community engagement works and its impact on health and social outcomes.

(For summary and comment see Community Practitioner, vol. 81, Aug. 2008, p. 12)

Dental patients face delays after shake-up

K. Devlin

Daily Telegraph, Aug. 7th 2008, p. 8

While more than 80 million treatments should be carried out in England in the coming year, primary care trusts have not yet commissioned 3.7 million. One of the causes of this commissioning delay appears to be that PCTs had only been given enough money to cover three-quarters of their dental budget. The remaining quarter is supposed to come from patient fees, but the British Dental Association claims that this as led to delays in money being provided to pay for treatments.

Effects of payment for performance in primary care: qualitative interview study

S. Maisey and others

Journal of Health Services Research and Policy, vol. 13, 2008, p. 133-139

Financial incentives can change behaviour, and policymakers in the UK have sought to improve the quality of primary care by making more payments to professionals dependent on performance against predetermined standards. Since April 2004 general practices in England have received up to 20% of their income according to their performance against targets set out in the Quality and Outcomes Framework. Semi-structured interviews with 24 clinicians in 2006 showed that payment for performance is driving change in the roles and organisation of primary health care teams. Non-incentiv ised activities and patients' concerns may receive less clinical attention. Some participants described data manipulation to maximise practice income.

Health in the age of migration: migration and health in the EU

C. Maffia

Community Practitioner, vol. 81, Aug. 2008, p. 32-35

International migration is a growing phenomenon throughout the European Union (EU). This paper is not intended to be a definitive account of migration in the EU, but to alert community practitioners to the factors that impact on the health of migrant communities. It emphasises that ill-health among migrants is less to do with where they come from than with the conditions under which they travel (eg as refugees or as trafficked people) and how they are obliged to live once they have arrived in the EU. Community practitioners are well placed to develop 'migrant-friendly' initiatives and overcome barriers to service access. Such initiatives could include provision of information about the organisation of health services in the UK, engagement of the migrant communities themselves in health promotion campaigns, and help with development of social support networks.

Local trusts to blame for postcode lottery, says NICE chief

R. Prince

Daily Telegraph, Aug. 18th 2008, p. 8

Andrew Dillon, the chief executive of the National Institute for Health and Clinical Excellence, has blamed primary care trusts for the postcode lottery that sees cancer patients denied new medicines. PCTs may fund drugs not approved by NICE in exceptional cases. This has led to a postcode lottery where access to treatments is based on location. Dillon argues that individual PCTs should not fund drugs which NICE has judged to expensive and which are not available to all patients. At the same time the chairman of NICE has attacked pharmaceutical companies for excessively high prices of new drugs.

Social networks and health inequalities: evidence from working with disadvantaged groups

C. Mackereth and J. Appleton

Community Practitioner, vol. 81, Aug. 2008, p. 23-26

This paper examines the growing body of research that identifies links between poverty and ill health, and evidence of the adverse impact of social isolation and exclusion on health. Epidemiological studies clearly demonstrate links between inequality, poor social networks and ill health. This paper critically examines these core public health concepts and provides a way for practitioners to demonstrate to managers and commissioners that community work which aims to build social networks should be properly funded.