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

Collaborative effort

S. Ward

Public Finance, Sept. 19th-25th 2008, p. 20-21

Reports on the unique joint appointment of Tracie Evans as both Director of Finance at the Royal Borough of Kingston upon Thames and Director of Finance at Kingston NHS Primary Care Trust. This new departure follows the push towards integration given by Lord Darzi's next stage review of the NHS. Darzi proposes new integrated care organisations (ICOs) to act as local umbrella bodies for partnerships covering housing and employment as well as health and social care. Ms Evans' joint appointment make Kingston a frontrunner for creating a pilot ICO.

Concern as PCTs stick to same old providers

H. Crump

Health Service Journal, Oct. 9th 2008, p. 4-5

An HSJ survey has shown that 40 out of 60 primary care trusts (PCTs) that responded had failed to decommission any services in 2007. The total value of services decommissioned was 14m, a tiny fraction of the 70bn PCTs spend each year. World class commissioning requires PCTs to 'stimulate the market', 'manage the local health system' and 'make sound financial investments'. It is doubtful if any of this can be achieved without decommissioning.

Dentists face curbs on abuse of salary system

J. Laurance

The Independent, Oct. 13th 2008, p. 15

The Department of Health is planning a crackdown on dentists who have been exploiting the system to maximise their incomes, denying thousands of patients access to treatment. It is alleged that dentists recall healthy patients for checks too frequently and divide courses of treatment to trigger extra payments. Primary care trusts (PCTs) across the country are thought to be affected by the practice which, if eliminated, could release an estimated 800,000 appointments nationwide. No figure for the overall cost is available but each PCT is said to be losing 'tens of thousands of pounds'.

Distance learning: the future of continuing professional development

J. Southernwood

Community Practitioner, vol. 81, Oct. 2008, p. 21-23

Higher education institutions are looking toward distance learning to expand their activities, widen opportunities for students, and make effective use of new technologies. This paper considers opportunities that web-based and online education programmes can offer community practitioners to promote professional skills while maintaining a work/life balance, and the role of the lecturer in successfully supporting professionals on web-based learning programmes.

GPs paid 1 not to send people to hospital

D. Brown

The Times, Oct. 20th 2008, p. 13

GPs are receiving 1 per patient to review their decision to send someone to hospital and a further 1 for every name on their surgeries' list if they reduce their previous year's referral rate. This practice is taking place despite warnings from the NHS's National Institute for Health Research (NIHR) which suggests that incentive payments made to doctors can reduce quality of patient care.

(See also The Independent, Oct. 20th 2008, p. 14)

Health scrutiny and practiced-based commissioning: contradictory or complementary?

A. Coleman, S. Harrison and K. Checkland

Journal of Integrated Care, vol. 16, Oct. 2008, p. 18-21

The Local Government Act 2000 introduced new Overview and Scrutiny Committees, composed of elected councillors, that can respond to proposals from the NHS for changes in services and can also set their own agendas for more detailed scrutiny, public services including the NHS. Practice-based commissioning was introduced in 2004 with the aim of engaging frontline clinicians in commissioning healthcare. Most such commissioning is being undertaken by groups of practices joining together to form consortia, rather than by individual GPs. These consortia are not statutory bodies and cannot be compelled to participate in health scrutiny. The authors suggest ways in which this omission might be addressed.

An investigation of non-participation in health promotion interventions and its impact on population level outcome

G.M. Davies and others

International Journal of Health Promotion and Education, vol.46, 2008, p. 107-112

The success of interventions aimed at improving population level measures of health or education is seriously threatened by high levels of non-participation due to population transience and non-engagement with routine health checks in some areas. Prior to implementation of such interventions, measurement should be made of population churn to establish whether the intervention effect would be measurable and to inform planners of the appropriate geographical area over which it should be provided.

Not just a matter of time: a review of urgent and emergency care services in England

Healthcare Commission

2008

This report investigated the quality of emergency and urgent health services from the perspective of the patient. Faced with a myriad of services, including NHS Direct, minor injuries units, walk-in centres and accident and emergency departments of hospitals, patients are confused about where to go. Other findings include:

  • national targets on 999 life threatening calls attended by ambulance crews within eight minutes are being met, along with the four hour Accident and Emergency waiting time target
  • in a third of areas, GP out-of-hours services were too slow to assess patients' conditions after they first called for help
  • more than half of GP surgeries diverted calls automatically to an out-of-hours service when they were closed
  • four in ten primary care trusts scored poorly on management
  • only a third of areas had good networks in which different organisations providing aspects of urgent services worked closely.

Patients to be given right to self-refer

J. Laurance

The Independent, Oct. 21st 2008, p. 11

Patients are to be given the right to seek physiotherapy, speech therapy and dietary treatment from practitioners directly without needing referral from their GP in an attempt to avoid the unnecessary time delays and 'hoop jumping' involved in the present system.

(See also The Guardian, Oct. 21st 2008, p. 4)

Your life, your choice

R. Lewis

Public Finance, Sept. 12th-18th 2008, p. 22-24

Lord Darzi's review of the NHS indicates that the patient choice revolution is to be extended into primary care, with patients obtaining services from providers that suit them. By 2010 all patients with long term conditions will be provided with a care plan, which will set out what treatments they want and when, where and from whom they wish to receive them. Choice will be supported through improved information on services available, including a 'patient prospectus' of available resources. Primary care trusts will be responsible for 'market making' in community care, that is, creating more diversity of supply and greater competition between providers. This article considers the radical changes needed to make this vision a reality.

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