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

10 laps around the park, prescribed by your family GP

R. Prince

Daily Telegraph, Aug. 13th 2009, p. 8

As part of the government's Let's Get Moving campaign, GPs are being encouraged to prescribe exercise regimes for overweight patients. Follow-up appointments will be made so that doctors and nurses can ensure that patients stick to their prescriptions. GPs will be helped to develop links with local private gyms, council sports centres, and local exercise clubs so that they can refer patients to fitness instructors who will be able to design tailor-made programmes.

Dentists in NHS 'more likely to pull teeth'

R. Smith

Daily Telegraph, Aug. 20th 2009, p. 8

Figures show that NHS dentists are removing teeth rather than carry out complex treatments following the introduction of a new contract in 2006. There has been a sharp decrease in some treatments, such as fitting bridges and carrying out root canal work, in the past year compared with work performed under the old system.

First contact: effective health care for children, young people and families

B. Symmonds

Community Practitioner, vol.82, Aug. 2009, p. 18-21

First contact care can provide a way in which clients can access primary health care for children, young people and their families in addition to general practice. In establishing the new role of first contact practitioner, choice and available support may be increased for families. This paper describes the establishment of a first contact care service in Doncaster, making use of initial feedback elicited through two user consultation exercises.

GPs in the spotlight

G. Clews

Health Service Journal, Aug. 13th 2009, p. 22-24

Tight budgets mean that primary care trusts must scrutinise all contractors, including GPs, to ensure that they are providing value for money and high quality services. This article looks at the role of the balanced scorecard tool, which attempts to combine quality and efficiency indicators. GPs' concerns about the process include possible publication of the scorecard data without their agreement.

Market reforms in English primary medical care: medicine, habitus and the public sphere

R. McDonald

Sociology of Health and Illness, vol. 31, 2009, p. 659-672

Recent reforms in the English National Health Service seek to expand the market for primary and secondary care. These new arrangements ended the traditional general practice partnership's monopoly over provision of primary care to the NHS by providing opportunities for private companies to enter the market. This article uses data from interviews with 23 GPs to examine their reactions to the reforms in the light of Bourdieu's theory of habitus. GPs take for granted the superiority of public providers, ie GP partnerships, in the provision of care. GPs are actively involved in the defence of the public sphere, which is neither a neo-liberal minimalist market state, nor a wholly altruistic state, responding to consumers' wants. The public sphere they defend is one in which boundaries are drawn around entitlements, and GPs are actively engaged in policing these boundaries. The GP habitus can be seen as shaping responses in ways that serve GPs' interests. At the same time, the habitus constrains action in a way which limits resistance to reforms that threaten their interests. Rather than downing tools or engaging in active resistance to the reforms, GPs respond by coping. This response can be understood in terms of GPs doing what they have always done, coping with whatever is thrown at them.

Mixing grades, blurring lines

K. Ly

Community Practitioner, vol. 82, Aug. 2009, p.8-9

As the NHS faces severe financial constraints in the coming years, reorganising the local workforce to reduce costs may be particularly attractive to primary care trusts. Where savings need to be made, it is feared that PCTs will opt to have a mix of cheaper grades of staff instead of fully qualified health visitors and school nurses. This will lead to the delegation of tasks usually carried out by health visitors to staff with different qualifications.

Patients 'distressed' by drugs shortage

M. Butterworth

Daily Telegraph, Aug. 24th 2009, p. 2

A survey of over 150 community pharmacists has shown that difficulties in obtaining drugs have led to nearly a third of patients suffering. Nearly 90% of respondents said they were very concerned about difficulties in getting hold of some medicines.

Variation shows community services ripe for efficiencies

H. Crump

Health Service Journal, Aug. 13th 2009, p. 4-5

Primary care trust provider arms are responsible for a wide range of community-based services such as district nursing and health visiting. An HSJ snapshot survey based on information supplied by 77 provider arms shows huge variations in working practices and the potential for large efficiency savings if services and workflows are redesigned. Spending on community services per head of population varies from under 100.00 to over 200.00. Some district nurses are making three times more visits to patients per week than others.

What's in a name? PCT rebranding still has a long way to go

H. Crump

Health Service Journal, July 30th 2009, p. 10-11

In 2008 primary care trusts got permission from the Health Secretary to rename themselves as NHS organisations, following concerted lobbying. The majority of PCTs now use the NHS prefix (eg NHS Haringey) in conversations with local populations. However they still face challenges in communicating complex messages to the public.

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