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

Diagnostic decision making: the last refuge for general practitioners

M.C. Weiss

Social Science and Medicine, vol.73, 2011, p. 375-382

Nurses and pharmacists gained the right to prescribe as independent prescribers in the UK in 2007. Anxieties raised by medical doctors about these new roles have centred on concerns about patient safety and that nurses and pharmacists lack training in diagnosis. Public policy documents and the views expressed by healthcare professionals generally have conceptualised diagnostic decision making as being at a higher level than prescribing decision making. This paper addresses several issued related to the alleged difficulty of diagnostic decision making: 1) provision of some background on what is meant by diagnostic decision making; 2) consideration of whether diagnostic decision making is truly distinct from prescribing; 3) suggesting that it may be more appropriate to focus on 'difficult' clinical decisions, which include diagnostic and other patient management decisions, rather than diagnostic decisions per se; 4) consideration of the threat posed to medical doctors by nurses and pharmacists who may wish to diagnose; and 5) development of diagnostic expertise among pharmacist and nurse prescribers.

Feel good factors

N. Plumridge

Public Finance, Sept. 2011, p. 28-31

Under the coalition government's reforms, responsibility for public health in England is being transferred to local authorities, who will commission services using a ring-fenced budget carved out of NHS funding. Although these reforms are less controversial than GP-led commissioning, issues are emerging about what public health actually means, what should be expected of local authorities in their new role, how much money is actually spent on public health by primary care trusts, and how much should be transferred.

General practice after the introduction of the QOF

M. Al Yahya and M. Beck

British Journal of Healthcare Management, vol. 17, 2011, p. 345-352

The Quality and Outcomes Framework (QOF), a payment for performance system, uses financial incentives to motivate GPs to meet specified quality targets. This qualitative study of two GP practices in the North of England aims to explore the impact of the QOF on their organisational culture. Results suggest that, while the QOF did not alter the practices' core values, their organisational culture had become more market-oriented after the introduction of the scheme.

Gerada: GPs need legal advice

D. West

Health Service Journal, Sept. 15th 2011, p. 9

Clare Gerada, chair of the Royal College of General Practitioners, warned of a conflict between doctors' involvement in commissioning and their duties to patients under their professional code Good Medical Practice. The guidance makes the patient the first priority whereas involvement in commissioning groups may require GPs to make decisions about treatment rationing in order to cut costs. In place of local rationing decisions, Dr Gerada called for a major national health profession-led review to decide how much should be spent on health and what could be provided, following the model of the 2002 Wanless report.

NHS told to improve its multiple birth care

D. Campbell

The Guardian, Sept. 28th 2011, p. 12

The NHS has been told to improve its care for pregnant women carrying twins or triplets in order to reduce the significant medical risk for mothers-to-be and their babies. The National Institute for Health and Clinical Excellence which sets standards for the NHS, has issued its first guidance on how health professionals should manage multiple births after discovering wide variations in the quality of care provided by different parts of the NHS.

Patients hit by NHS rationing, say GPs

M. Beckford

Daily Telegraph, Sept. 15th 2011, p. 8

A survey of 300 GPs by Pulse magazine found that 22% said that patients were facing restrictions on access to hernia operations. A further 17% said that hip and knee replacement operations were being rationed. One in 10 GPs said direct access to MRI and CT scans was being rationed, while 29% reported barriers to getting IVF treatment for childless couples. GPs reported that NHS managers were rationing treatment as they tried to cut costs, with patients facing a postcode lottery as to whether or not they were seen.

Roughly stitched together

A. Maryon-Davis

Health Service Journal, Sept 8th 2011, p. 17

This article presents a critique of the proposed new public health system for England. This will consist of a national body, Public Health England, which will be established as an executive agency of the Department of Health. Public Health England will offer a national, sub-national and local service intended to strengthen emergency preparedness, gather health intelligence, support local public health teams, and provide leadership and a powerful voice. At the local level, council Directors of Public Health will lead on health improvement and will develop health protection plans jointly with the national body.

A viable plan for virtual reporting

L. Hollins, D. Elliott-Rotgans and M. Eaton

Health Service Journal, Sept. 15th 2011, p. 22-24

Technological developments are opening up new possibilities for locating diagnostic services in the community outside of hospitals. This study examined whether it would be financially and clinically viable to operate a new model of diagnosis and patient care, using a community-based diagnostic testing centre. Centres would provide simple imaging services, such as ultrasound and X-ray, as well as non-imaging modalities such as ambulatory ECG monitoring. They would use virtual reporting, linking information to the appropriate clinical setting for patient care, and would be staffed on a rota basis by the chosen tertiary provider.

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