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Welfare Reform on the Web (May 2009): National Health Service - primary and community care

Action to revive the health visitor role

N. Puffett

Children and Young People Now, Mar. 26th/Apr. 1st 2009, p. 9

Figures show that there were a total of 9,056 health visitors in 2007, down by around 10% on 1997. The Health Secretary has responded by launching the Action on Health Visiting programme, which will examine the role of health visitors and look at what action is needed to increase numbers.

GP quality: the final frontier for scrutiny

H. Mooney

Health Service Journal, Apr. 16th 2009, p. 10-11

There is little information available nationally about the quality of primary care. The King's Fund has now entered the debate and is launching an ambitious 18-month inquiry into the quality in general practice. Its ultimate aim is to come up with a way of measuring general practice that is scientifically robust but also echoes the reality of patient experience. The intention is to develop a 'quality dashboard' for general practice that can be used by professionals, managers, commissioners and regulators to improve patient care.

Healthy Weight, Healthy Lives: one year on

Department of Health


This new strategy aims to make England the first nation to reverse the current rise in obesity. Adults aged between 40 and 74 will be ordered to attend their GP for a 'fat test' and prescribed weight management and exercise if they are overweight. GPs will be expected to test 2.25 million people a year, with each person called back every five years for a new check. Overweight NHS staff will also be targeted to 'boost the credibility of the healthy living messages that they give'.

A healthy start in life

J. Stephenson

Children and Young People Now, Mar. 26th/Apr. 1st 2009,

This article introduces the Mini-Mend education programme which is showing parents and toddlers how to live healthy lifestyles in order to reduce obesity.

Loud and clear

D. Carlisle

Health Service Journal, Apr. 16th 2009, p. 20-22

Discusses how primary care trusts (PCTs) can use commercial advertising techniques to convey health promotion messages to their local populations. Such social marketing is critical to reducing health inequalities by educating and changing the behaviour of the public, but is not a panacea. It is gaining momentum as preventive services and world class commissioning rise in PCT priorities.

NHS trusts fail to meet new hygiene tests


The Independent, Apr. 3rd 2009, p. 14

All NHS trusts have been told they must comply with government standards for cleanliness as part of their registration with the new Care Quality Commission. But 21 trusts - including hospitals, primary care trusts and ambulance trusts and four with foundation status - have failed to meet the standard. They could face prosecution if they do not improve.

Practice nurses and the effects of the new general practitioner contract in the English National Health Service: the extension of a professional project?

R. McDonald, S. Campbell and H. Lester

Social Science and Medicine, vol. 68, 2009, p. 1206-1212

The aim of this paper is to examine the effects on practice nurses of a new contract for UK primary care doctors introduced in 2004. Interviews with nurses from 20 practices showed them to be taking on tasks which had previously been the exclusive preserve of medical professionals. The ability to undertake work which was previously the exclusive preserve of doctors was seen by most as a positive development. Skilled nurses were in many cases supported by health care assistants, who performed a caring role. The new contract appears to encourage nurses to prioritise population and disease-based concerns over caring.

Professionalization of general practitioners with a special interest: rationalization, restratification and governmentality

S. Pickard

Sociology, vol.43, 2009, p. 250-267

This article critically examines the professionalization of general practitioners with special interests (GPSIs) in the UK. It examines the rationale for the establishment of this professional grouping, the construction of the field of expertise, the negotiation of boundaries with other professions, issues of professional control and autonomy and internal organisation. It concludes that the professionalization of GPSIs is leading to a restratification within the medical profession, which continues the shift in the balance of power from secondary to primary care. This restratification, which enhances GPSIs' work satisfaction, status and in some cases remuneration, is heavily intertwined with managerial and bureaucratic accountabilities.

Rethinking collegiality: restratification in English general medical practice 2004-2008

R. McDonald and others

Social Science and Medicine, vol. 68, 2009, p. 1199-1205

Under the new arrangements introduced in 2004, the practice rather than the individual GP is contracted to the NHS through the local primary care trust. These new arrangements also include a Quality and Outcomes Framework (QOF), a series of performance targets which significantly influence practice income. A further reform was introduced in 2005 in the shape of Practice Based Commissioning (PBC), which allows practices or groups of practices to volunteer to receive an 'indicative budget' with which to commission secondary and community care for their patients. These reforms have led to the formation of new professional elites within general practice. Groups of doctors have emerged who ensure compliance with quality standards in order to maximise practice income under the QOF. In practice based commissioning, the new elite comprises volunteer members of PBC boards. Findings from this study also suggest that most GPs accepted the changes and many welcomed them, in spite of the constraints on individual autonomy they entailed.

'There's no limit to how much you can consume': the New Public Health and the struggle to manage healthy bodies

T. Thanem

Culture and Organization, vol.15, 2009, p. 59-74

This paper investigates how the New Public Health seeks to construct and manage people as healthy bodies beyond the boundaries of the workplace. It does so through a discourse analysis of the UK '5 A Day' campaign to promote healthy eating. Drawing on Foucault's theory of governmentality, it explores how the campaign used neo-liberal managerialism to improve public health.

Shaping PCT provider services

C. Imison

London: King's Fund, 2009

Primary care trusts must hive off their provider functions by November 2009. This report urges them to undertake a comprehensive strategic overview of the community services required. They need to clearly define the role they envision for community services, their priority areas for expansion and any important partnerships they want, such as joint health and social care teams for older people. PCTs also need to prepare a workforce plan taking account of their strategic objectives, and to consider whether or not to retain ownership of community services premises.

Weighing and measuring primary school children: evaluation of the TRENDS model for implementation of Department of Health guidelines

R.S. Levine and others

Child: Care, Health and Development, vol. 35, 2009, p. 365-368

The Department of Health has issued guidance to all primary care trusts, which have responsibility for school nursing services, for the annual weighing and measuring of all children on entry to primary school and at age 11 under the National Child Measurement Programme. This paper describes the conduct and evaluation of the 2006 monitoring exercise in a 10% sample of Leeds primary schools.

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