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Welfare Reform on the Web (October 2000): National Health Service - Community and Primary Care Services

ABSENT PATIENTS COSTING NHS 18M

J. Carvel

Guardian, Aug. 22nd 2000, p. 8

Reports that a survey of more than 1,100 GP's surgeries has shown that more than 10 million appointments are wasted annually through patients failing to turn up for appointments with either their doctor or the practice nurse. The loss to the NHS is estimated at 18.7 million per year, since the average eight minute consultation costs 18. Another survey shows a growing number of GPs wanting to charge patients 10 for consultations to stop them missing appointments and pestering doctors with problems unrelated to health.

(See also Independent, Aug. 21st 2000, p. 6; Times, Aug. 22nd 2000, p. 12; Daily Telegraph, Aug. 22nd 2000, p. 9; Times, Aug. 21st 2000, p. 6)

BED SPREAD

S. Last

Health Service Journal, vol. 110, Aug. 10th 2000, p. 22-23

Describes how the use of independent nursing homes for both terminal and intermediate care has successfully relieved the pressure on hospital beds in Liverpool.

BLAIR HAS IT WRONG ON NHS, SAY GPs

Anon.

Times, July 31st 2000, p. 8

A survey of 324 doctors has indicated that 56% have no faith in the government's NHS reform plans. More than 66% said that the proposed changes would lead to more bureaucracy. Forty per cent said that the plan would drive more doctors overseas.

COLLECTIVISING THE KULAKS? GENERAL PRACTITIONERS AND PRIMARY CARE GROUPS IN ENGLAND

K. Clegg

Journal of Health Service Research and Policy, vol. 5, 2000, p. 192-194

It has previously been predicted that a process of collectivisation would follow the limited introduction of market forces within a state controlled system of primary care in the UK. The advent of primary care groups would seem to fulfil this prophecy. It remains to be seen whether collectivisation will lead to greater central control and a damaging loss of local initiative and consumer responsiveness.

COUNTER ARGUMENT

N. Bosanquet

Health Service Journal, vol. 110, Aug. 17th 2000, p. 29

Supports proposals for a wider role for community pharmacies appearing in the NHS plan.

DESIGNING SERVICES FOR OLDER PEOPLE: LESSONS FOR PRACTITIONERS

P. Lenihan et al

Community Practitioner, vol. 73, 2000, p. 716-718

Article looks at community oriented primary care (COPC) methodology and introduces phase 1 of the primary care for older people programme which applied the COPC model to innovative primary care for the elderly.

FRIENDS AND RELATIONS

N. Walsh et al

Health Service Journal, vol. 110, Aug. 10th 2000, p. 28-29

Reports that personal medical services pilot schemes remain internally focused. In many areas hospital doctors' willingness to work with general practice has been hampered by chief executives' fear of loss of income. Health authorities has generally failed to take responsibility for the pilot schemes. There are some fears of the schemes creating equity at local level.

GPs ATTACK BLAIR'S PLANS FOR THE NHS

C. Hall

Daily Telegraph, Aug. 3rd 2000, p. 1

In a concerted attack on the government's NHS reform plans, family doctors have warned that the pledge to recruit an extra 2000 GPs over four years could not meet current or future patient demand. They have also indicated they will resist any moves to change their traditional contract.

GPs PLAN TALKS ON DRUG ADVERTS

N. Timmins

Financial Times, July 20th 2000, p. 2

Family doctors' leaders are planning talks with the pharmaceutical industry on a code of conduct that would allow direct-to-consumer advertising of prescription only drugs.

IMPLEMENTING PGCs; THE IMPLICATIONS FOR THE NHS

N. Goodwin

British Journal of Health Care Management, vol. 6, no. 7, 2000, p. 316-319

The article summarises qualitative research undertaken between 1998 and 1999 which focused on how four health authorities in England approached leading the implementation of the Primary Care Groups (PCGs) policy. In particular the article looks at possible explanations for the varying quality of leadership and thus of service delivery in the context of the NHS in England. The inability of the drive to improve leadership in order to improve the health services is considered.

INVOLVING THE PUBLIC IN GENERAL PRACTICE IN AN URBAN DISTRICT: LEVELS AND TYPE OF ACTIVITY AND PERCEPTIONS OF OBSTACLES

I. Brown

Health and Social Care in the Community, vol. 8, 2000, p. 251-259

Data were collected using a postal questionnaire completed by a practice manager and by interviews with health service managers responsible for primary care development. Results showed that levels of activity in promoting public involvement were low across the district. Pressures of existing workload, lack of resources and public apathy were given as among the main obstacles by survey respondents. The socio-economic environment did not appear to be a factor, but small practices were much less likely to develop activities. Concludes that Primary Care Groups need a clear strategic framework, models of best practice and adequate resources to manage, change and develop initiatives.

A NEW WAY THROUGH

D. Light and M. Dixon

Health Service Journal, vol. 110, Aug. 10th 2000, p. 24-25

The development of intermediate care, which will keep patients out of hospital, depends on co-operation between specialists and primary care organisations. Community hospitals and some nursing homes will have to take on new roles as community treatment centres. Action is needed to unlock budgets currently tied up in hospital services, and the potential for GPs and consultants to work together to commission services needs to be unleashed. Clinical criteria should be established for referral to these services.

PAINTED OUT OF THE PICTURE

D. Carlisle

Health Service Journal, vol. 110, July 13th 2000, p. 14-15

Community Health Care Trusts could be phased out as primary care trusts (PCTS) take over many of their functions. If they survive it may be as providers of mental health and learning disabilities services or as suppliers of corporate services such as estates management or IT support to a group of PCTs.

PRINCIPAL - AGENT RELATIONSHIPS IN GENERAL PRACTICE: THE FIRST WAVE OF ENGLISH PERSONAL MEDICAL SERVICES PILOT CONTRACTS

R. Sheaff and A. Lloyd-Kendall

Journal of Health Service Research and Policy, vol. 5, 2000, p. 156-163

Investigated how far English NHS Personal Medical Service (PMS) contracts embody a principal-agent relationship between Health Authorities and primary care providers and considered the implications for relational and classical theories of contract. Content analysis of 71 first-wave PMS contracts showed that most reflected current English NHS policy priorities, but few instituted mechanisms to ensure that providers realised those objectives. Although PMS contracts had some classical characteristics, relational characteristics were more evident. Some characteristics matched neither the classical nor the relational model. Future contracts will need to focus more on evidence-based processes of primary care, health outputs and patient satisfaction and less upon service inputs.

RELATIONSHIP-BASED SERVICES MARKETING: THE CASE OF THE NEW PRIMARY CARE GROUPS IN THE NATIONAL HEALTH SERVICE (UK)

J. Conway and S. Willcocks

International Journal of Public Sector Management, vol. 13, 2000, p. 68-84

Paper outlines the intended role of primary care groups (PCGs) in the NHS and explores GP commissioning of health care. Discusses the extent to which a relationship-based marketing perspective may help PCGs to make a strategic and collaborative contribution to commissioning.

THIS IS YOUR PILOT SPEAKING

J. Huntington et al

Health Service Journal, vol. 110, Aug. 3rd 2000, p. 30-31

The national plan for the NHS envisages that a third of all GPs will be on personal medical services contracts by 2002. However a study of 14 pilot schemes found that not all were using the freedoms and flexibilities offered by the legislation. The flexibility in funding offered by the schemes has allowed GPs greater leeway in managing their workload, and some of the financial risks of running a practice have been removed. Some schemes also reported a lack of support from their health authority.

TIME TO SHAPE UP

J. Beenstock and S. Jones

Health Service Journals, vol. 110, Aug. 24th 2000, p. 28-29

Primary care groups and primary care trusts have exciting freedom to decide on their preferred organisational model. They should aim to decentralise radically, encourage high user expectations, promote interdependency, distribute leadership to strong subgroups, set transparent performance standards, and break traditional boundaries.

WHAT A NASTY COMPLAINT

A. McGauran

Health Service Journal, vol. 110, Aug. 17th 2000, p. 13-14

GPs argue that the access to primary care targets in the NHS plan cannot be delivered without a 30% increase in the number of doctors. There is also concern about plans to move the "majority" of GPs to new personal medical services contracts by 2004, threatening their status as independent contractors.

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