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Welfare Reform on the Web (June 2010): National Health Service - primary and community care


Health Committee

London: TSO, 2010 (House of Commons papers, session 2009/10; HC 268)

Nearly twenty years ago the then Government introduced the purchaser/provider split whereby services were purchased or commissioned from provider bodies. Despite the stated aim of a more efficient health service, the purchaser/provider split has led to an increase in transaction costs, notably management and administration costs. Commissioners continue to be passive, when to do their work efficiently they must insist on quality and challenge the inefficiencies of providers, particularly unevidenced variations in clinical practice. Weaknesses are due in large part to Primary Care Trusts' (PCTs') lack of skills, notably poor analysis of data, lack of clinical knowledge and the poor quality of much PCT management. The report recommends The Department of Health (DH) should commission a quantitative study of what levers should be introduced to enable PCTs to better motivate providers of services and a review of contracts to ensure that rigid, enforceable quality and efficiency measures are written into all contracts with providers of health care. Insufficient progress has been made in specialised commissioning for rare diseases and conditions. Specialised commissioning is weakened by the fact that, as a pooled responsibility between PCTs, it sits in a 'limbo', where it is not properly regulated, performance managed, scrutinised or held to account. More recently the DH has appeared to place less emphasis on the market-based approach; however the NHS remains characterised by tensions between purchasers and providers. The report concludes that if reliable figures for the costs of commissioning prove that it is uneconomic and if it does not begin to improve soon, after 20 years of costly failure, the purchaser/provider split may need to be abolished.

Epilepsy care in the over 60s: a comparative audit

B. Chappell, J. Bagshaw and P. Crawford

British Journal of Healthcare Management, vol. 16, 2010, p. 231-237

This research aimed to ascertain current UK management processes for epilepsy in older patients through a comparison of two general practice audits. Seizure frequency in older patients with epilepsy is low and management for this patient group differs greatly from that provided for children and young adults. The results suggest that it is possible for practices to meet all the standards set in the General Medical Services contract.

From the ground up

C. Burke, V. Waring and F. Cook

Community Practitioner, vol. 83, May 2010, p. 36-37

The Healthy Child Programme and Child Health Strategy highlight the need for multi-agency universal services and seamless integrated working. This article describes the development of a local Healthy Child Programme and integrated pathway for maternal and child health promotion in NHS Bassetlaw.

Home care will be 'better and cheaper'

N. Timmins

Financial Times, May 24th 2010, p. 3

As the coalition government wants to get more for less out of public spending, this article looks at how the NHS might provide care at home for more people. Includes a case study of the approach being used in Dudley, in the West Midlands.

Involving men in targeted primary health care: men's health MOTs

S. Linnell and S. James

Community Practitioner, vol.83, May 2010, p. 31-34

Official statistics show that not only is men's health significantly worse than women's but also that it varies from ward to ward in local authority areas. Since the 1990s the government has sought to address the issue by targeting men's health in primary care. This paper describes the development of a project in North Staffordshire to target primary health services at men in a deprived area through health MOTs offering a 'one-stop-shop' tailored to their needs.

Minimum standards for equipment services

B. Donnelly

British Journal of Healthcare Management, vol. 16, 2010, p. 180-185

There are serious quality issues in the delivery of community equipment services which result in avoidable hospital admissions, acquired infections, untoward incidents and even unnecessary deaths. There are regular breaches of legal and welfare related obligations which expose health and social care organisations and employees to prosecution. This article argues that the introduction of National Minimum Standards would reduce risk, and improve quality and safety, while saving public funds through a reduction in secondary episodes of care.

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