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

GP governance: handle with care

A. Fresko and S. Rubenstein

Health Service Journal, Aug. 12th 2010, p. 14-15

This article considers how the good governance of the new GP consortia which the coalition government plans to make responsible for service commissioning can be assured. It explores what needs to be done to fulfil the three governance roles of formulating strategy, ensuring accountability, and shaping culture.

PCTs raise the bar in final assurance test

S. Gainsbury, A. Taylor and S. Lewis

Health Service Journal, Aug. 12th 2010, p.4-6

Primary care trusts (PCTs) have significantly improved their performance over 2009 against the standards and competencies assessed in the 2010 world class commissioning assurance test. PCTs improved on all 30 of the individual competency tests they were assessed on in 2009 and 2010, with an average 42% increase in scores. They also improved their governance processes in 11 out of the 14 standards assessed in 2009 and 2010.

(For comment see Health Service Journal, Aug.12th 2010, p. 12-13)

Professional status in a changing world: the case of medicines use reviews in English community pharmacy

R. McDonald and others

Social Science and Medicine, vol. 71, 2010, p. 451-458

Recent reforms in community pharmacy in England and Wales encourage pharmacists to reduce their dependence on dispensing as a source of income. They also offer pharmacists financial incentives to expand their role in a way that enhances their professional status. This article focuses on one of the new interventions offered by community pharmacists, namely the medicines use review and prescription intervention service, which has the potential to enhance pharmacists' professional status. The analysis suggests that pharmacists are unable to fully capitalise on the potential to enhance professional status that recent state sponsored reforms offer.

Referral management: lessons for success

C. Imison and C. Naylor

London: King's Fund, 2010

Half of primary care trusts (PCTs )using referral management believed that their schemes had cut demand for secondary care. However, they were no more likely to have cut referrals than PCTs using other methods. The report also finds that some schemes can undermine quality of care, by misdirecting referrals in the absence of clinical information or by delaying patient access to a specialist. It offers seven evidence-based principles for commissioners when considering referral management strategies. These include involving both primary and secondary care clinical leadership and not introducing financial incentives to drive blanket reduction.

Review puts merits of breast cancer screening under the microscope

J. Lawrance

The Independent, Aug. 4th 2010, p. 4

The success of the national breast screening programme which offers tests to almost two million women a year has been called into question by a review which says it is harming almost as many women as it helps and must be urgently re-evaluated. The benefits of breast screening - early detection of cancer followed by rapid treatment - are finely balanced against the harms of overdiagnosis followed by unnecessary treatment and suffering. These have never been properly weighed against each other, the review by a leading epidemiologist says.

(See also The Independent, August 4th 2010, p. 4-5; The Independent, August 5th 2010, p. 9)

The role of GPs in maternity care - what does the future hold?

A. Smith, J. Shakespeare and A. Dixon

The King's Fund, 2010

This paper asks whether there still is a role for GPs in maternity care, attempts to define a future role for GPs in pre-conception, antenatal and postnatal care and discusses the merits of shared care between GPs and midwives. The report begins by setting out the history of GPs' role in maternity care in the United Kingdom and how policy has changed over the past 20 years. It then summarises the current role GPs play in maternity services and what current guidance says about it. Finally, there is a discussion of the potential future role GPs could play in maternity care.


User involvement: children's participation in a parent-baby group

H. Maconochie and F. McNeill

Community Practitioner, vol. 83, Aug. 2010, p. 17-20

According to the National Service Framework, children have a right to participate in the development of healthcare services, but research suggests that very young children are at risk of exclusion from user involvement initiatives. This paper outlines the findings of a participatory action research project conducted with families attending a health visitors' parent-baby group. A combination of participatory research methods were used to ascertain the infants' perspectives on the service, and this led to a number of changes in terms of professional attitudes, service provision and working practices.

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