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Welfare Reform on the Web (May 2011): National Health Service - primary and community care

Caries, change and the dental profession

W. Richards

British Journal of Healthcare Management, vol. 17, 2011, p.101-107

General dental practitioners face three fundamental changes: in disease trends, in diagnostic modalities, and in preventive practice. In the last four decades, caries have become far less prevalent and severe. However, social inequality in oral health in the UK is increasing. Research is challenging deeply held beliefs on caries diagnosis and management. A move to a more preventive model of care would result in less intervention. However, dentists could see such a move as devaluing their traditional restorative skills. Less interventions for middle-class people who visit their dentist regularly could free up resources for the care of people in deprived groups who are more likely to have oral disease. Pilot projects following the reviews of the 2006 dental contract could help develop services that reduce inequalities and improve oral health.

Cancer survivorship

I. Torjesen (editor)

Health Service Journal, Apr. 14th 2011, supplement, 13p

Some 1.8 million people in England have had a cancer diagnosis at some point in their lives. After therapy, some cancer survivors will be managing the effects of the disease and its treatment, coping with other chronic conditions, or living with active or advanced illness. Many feel abandoned by the NHS when their treatment is finished. The articles in this supplement describe new approaches to supporting the cancer survivor population. These include supported self-management, improved assessment and personalised care planning, health and wellbeing clinics to ease the transition from treatment into survivorship, tackling adverse effects of cancer treatment, vocational rehabilitation to help patients return to paid work, and encouraging survivors to take exercise. The final article summarises the benefits of joined up care for cancer survivors.

Consortium boards are 'closed shop'

S. Lewis

Health Service Journal, Apr. 28th 2011, p. 4-5

Details were obtained of the composition of 51 of the 335 emerging GP consortia boards across England. An analysis of their composition shows that they are dominated by GPs and practice managers, with no clinicians from local hospitals. Public health and social care were represented on less than one in ten boards. Only 12% had a representative of the local council and less than a third had a patient representative on their board.

Ethical issues in targeted HIV prevention work among 'Black African' migrants in London

M. Chinouya and P.J. Aspinall

International Journal of Migration, Health and Social Care, vol. 6, Dec. 2010, p. 20-33

'Black Africans' in England are disproportionately and highly affected by the heterosexually contracted HIV epidemic. Policy and practice frameworks have advocated ethnic matching in HIV prevention. This article examines how self-identifying 'Black African' workers construct a 'Black African' identity for targeting in HIV prevention outreach in London. It raises important questions about the ethics of ethnic matching and the identities of those commissioned to target minority ethnic populations in England. Workers can project their own sense of selves onto the ethnically targeted population, and the wider evidence base is equivocal with respect to the benefits of ethnic matching compared with non-matching.

Get your health and wellbeing boards in gear

P. Kenmore

Health Service Journal, Apr. 28th 2011, p. 28-29

There will be a statutory duty on local authorities to establish health and wellbeing boards to lead on improving the strategic coordination of commissioning across the NHS, social care, and related children's and public health services. In a time of fiscal austerity and radical structural reform, it will be challenging to make the boards work effectively rather than being mere talking shops. It is argued that board success will depend on culture and leadership, and this article offers a range of hints and tips on how to make them effective.

Identifying poorly performing general practices in England: a longitudinal study using data from the Quality and Outcomes Framework

M. Ashworth and others

Journal of Health Service Research and Policy, vol. 16, 2011, p. 21-27

This study used performance data contained within the Quality and Outcomes Framework (QOF) to identify the characteristics of sustained poor performance among general practices. The researchers obtained QOF data covering April 2004 to March 2008 for all general practices in England. The analysis showed that the strongest predictors of poor QOF performance were singlehanded and small practices, and practices staffed by elderly GPs.

Impact of Quality and Outcomes Framework on health inequalities

A. Dixon and others

King's Fund, 2011

Under the Quality and Outcomes Framework introduced by the Labour government in 2004, GP practices are rewarded financially for meeting a series of targets on managing long-term conditions, providing extra services such as maternity care, allowing patients to give their views, and improving their organisational skills. This research studied GP practices and primary care trusts in four areas of England to see if the system improved the health of the general population or helped deprived communities. It found little evidence that the scheme had reduced hospital admissions or resulted in more ill patients being brought in for treatment. Instead, the system was seen as a 'tick-box' exercise that failed to encourage doctors to look at the health of the wider community.

Managing long term conditions

A. Moore (editor)

Health Service Journal, Apr. 28th 2011, p. 15-20

Cost effectively managing patients with long term conditions is expected to be a high priority for the new GP commissioning consortia. These will need to focus on stratifying patients with long term conditions to identify those most at risk of deterioration so that resources can be concentrated on improving care for the most vulnerable. Engaging with the most vulnerable patients leading chaotic lifestyles will involve innovative approaches such as using text messaging, social media networks, and buddying schemes. In order to keep patients out of hospital, GPs will also need to work closely with social care service provision and introduce telehealth technologies to facilitate self-management of conditions by patients. The second article in this special report looks at barriers to the adoption and implementation of telehealth technologies, especially the difficulties involved in demonstrating cost savings, disruption of existing work patterns and lack of GP enthusiasm. The final article looks at the uncertain future of two programmes aimed at supporting people with long term conditions either to return to work or to stay in work: Fit for Work and Pathways to Work.

My health - whose responsibility? Healthy behaviours and prophylactic drugs

P. Elwood

Quality in Ageing and Older Adults, vol. 12, Mar. 2011, p. 50-55

At government and local health authority level, decisions have to be taken about the balance between short-term interventions in disease and long-term policies aimed at the preservation of health. There is a profound difference between these - the treatment of disease has in the main been delegated to healthcare professionals, while the protection of health is the responsibility of the individual. Healthcare practitioners are responsible for ensuring that the general public is adequately informed so that individuals can make informed choices about both the adoption of healthy lifestyles and the use of prophylactic medicines to ward off diseases.

No more than a shot in the dark

J. Dixon

Health Service Journal, Apr. 28th 2011, p. 12-13

It is hoped that more 'out of hospital' interventions will prevent avoidable downstream ill health and hospital costs, particularly for older people and those with chronic conditions. Although it is difficult to find strong research evidence that 'out of hospital' interventions are cost effective, a consensus is emerging as to the ingredients of successful programmes, in particular integrated care. These are: integrated information systems, good clinical leadership, aligned financial incentives, and high patient participation.

Some dentists seeing patients too often, say health officials

J. Meikle

The Guardian, Apr. 12th 2011, p. 2

Some dentists in England are seeing patients more than they need to, in breach of their contracts with government, according to a Department of Health briefing. Figures for April to September 2010 show that patients are being called in for checks less than three months apart and that 58% of patients are seen at three to nine months intervals. The National Institute for Clinical Excellence (NICE) recommends that patients are called for check-ups depending on risk factors including tobacco, alcohol and diet, every three months in the most at risk and every two year for those least at risk of dental problems.

There's too much at stake on quality

S. Thornton

Health Service Journal, Apr. 21st 2011, p. 16-17

This article calls for the new GP Commissioning Consortia to have good governance in place to enable them to build public trust and confidence. They will need independent non-executive directors or governors to guarantee transparent decision-making, guard against conflicts of interest, and oversee the stewardship of public money.

Transforming community services

D. Carlisle, A. Burnell and I. Torjesen

Health Service Journal, Apr. 14th 2011, p. 20-27

This special section presents articles on the new types of organisation that are emerging from government plans to reform the delivery of community health services by requiring primary care trusts (PCTs) to hive off their provider arms. It includes interviews with the chief executives of three aspiring community foundation trusts about what they hope to gain from the move, a description of how community health services in Hull came to be delivered by a social enterprise, City Health Care Partnership, and a discussion of the merger of some PCT provider services with mental health trusts.

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