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Welfare Reform on the Web (April 2012): National Health Service - primary and community care

The adoption of telecare in the community

J. Hendy and J. Barlow

Community Practitioner, vol. 85, Mar. 2012, p.41-43

The increased implementation of telecare and telehealth has been seen by successive UK governments since the late 1990s as an important way of coping with an ageing population and shifting care to lower cost settings in the community. Following encouraging results from large scale trials of telehealth and telecare services, the Coalition government is committed to rolling them out nationwide. This article discusses the implications for community practitioners.

'Animateurs' and animation: what makes a good commissioning manager?

K. Checkland and others

Journal of Health Services Research and Policy, vol.17, 2012, p. 11-17

The NHS reforms planned by the coalition government will transfer commissioning responsibilities to groups of GPs. These GP commissioners will need good managers to help them commission services, although it is not clear what being a good manager in this context means. This research begins the process of elucidating what commissioning managers in English primary care trusts actually do, and identifies some of the modes of working they adopt. Some of these are generic and involve managing information flows and networking inside and outside of the organisation. In addition, some managers with responsibility for facilitating practice-based commissioning adopt a mode of working which the researchers call being an 'animateur'. This approach involves actively managing disparate groups of people over whom the manager has no authority, and appears to be a factor in determining success. It is facilitated by managerial autonomy and is more prevalent where managers are seen to have legitimacy.

Capturing complex realities: understanding efforts to achieve evidence-based policy and practice in public health

K.E. Smith and K.E. Joyce

Evidence and Policy, vol. 8, 2012, p. 57-78

Most analyses conclude that research evidence plays a very limited role in health policy formulation. It has been argued that this can be explained by either lack of interaction between researchers and policymakers or by the fact that in many cases researchers are promoting ideas that challenge the perspectives of a dominant policy network. This paper argues that while political differences should be explored in knowledge transfer studies, it is important to ensure that employing policy network style theories does not merely replace a concern with professional divisions with a focus on political differences. Rather, it illustrates the importance of acknowledging the multiple boundaries and relationships that shape knowledge transfer. This is achieved through a discussion of two UK public health case studies, one of which considers the use of evidence in national policy aimed at tackling health inequalities and the other of which examines local public health decision makers' perceptions of the value of Geographical Information Systems (GIS) technologies.

Commissioning board to appoint all CSS leaders soon

D. Williams

Health Service Journal, Mar. 29th 2012, p. 8-9

The NHS Commissioning Board announced to the HSJ that it would appoint all commissioning support service (CSS) leaders in the Spring of 2012. It also explained that if a CSS plan was found to be unviable it could parachute in a new leadership team or force a takeover by a viable CSS.

Foreign GPs not tested in English

R. Smith

Daily Telegraph, Mar. 28th 2012, p. 12

Research by Pulse magazine found that 83% of EU doctors allowed to work as GPs in the NHS had never had their command of English tested in contravention of government policy. Trusts covering around one third of England provided figures to the survey. The British Medical Association GP Committee said the figures were extremely worrying.

General practitioners, primary care and support for carers in England: can training make a difference

R. Jones and others

Health and Social Care in the Community, vol. 20, 2012, p. 128-136

Recognising the major contribution made by carers, the Labour government developed a national strategy to assist them. One part of the national strategy was to improve the response carers got from GPs and other primary healthcare workers by developing and piloting a training programme on carers' needs and how to meet them. Six workshops were held across England. The workshops were each led by one or two GPs and a carer. This paper reports on one aspect of the evaluation of the pilot programme, i.e. how the attitudes of GPs and other primary healthcare workers towards carers changed after workshop attendance. Results showed that the training programme generated greater awareness and knowledge of the experience of carers and promoted action to meet their needs.

GPs private health firms shares revealed

D. Campbell

The Guardian, Mar. 28th 2012, p. 1

GPs preparing to take charge of £60bn of NHS funds were found to have shareholdings in private healthcare firms, prompting alarm about family doctors profiting from direct conflicts of interest. Fresh research showed that in 22 of the new clinical commissioning groups (CCGs), at least half and sometimes all of the GPs that dominated their boards had a personal financial interest in a private or other non-NHS provider. In 10 CCGs, a majority of GP board members belonged to a local "provider company" they helped run as a partnership with Virgin Care, which mades profits by being paid by the NHS to offer dermatology, physiotherapy and rheumatology services. In seven other CCGs, many of the board-level GPs received a second income from providing out-of-hours care in the area as members of not-for-profit family doctor collectives. Doctors' leaders warned that such conflicts of interest could anger patients, diminish trust in GPs and lead to more NHS services being taken over by private operators.

Level best

A. Moore (editor) Health Service Journal, Mar. 22nd 2012, supplement, 25p. This special supplement on commissioning presents a range of innovative solutions with accompanying case studies, including:

  • Tools to support best practice prescribing by GPs, potentially eliminating variation and saving the NHS billions
  • Expert guidance on how to run effective service reconfiguration consultations
  • Opportunities presented by the introduction of clinical commissioning groups for the establishment of creative partnerships between emerging NHS commissioning support services and the private sector
  • The NHS leadership framework, launched in June 2011, which is intended to provide a consistent approach to leadership development for staff irrespective of discipline, role or function
  • SHAPE (Strategic Health Asset Planning and Evaluation), a web-based tool which supports the strategic planning of services and estates across whole health economies.
  • New management information systems

Look after number one

D. Colin-Thomé and G. Craig

Health Service Journal, Mar. 15th 2012, p. 26-27

Commissioning in the NHS is in its infancy as a discipline and has so far failed to deliver transformational change. In the reformed NHS commissioners will need 'soft skills' which have previously been undervalued. They will need to use these to: 1) build relationships of trust with the local community; 2) develop partnerships with providers to co-design services; and 3)provide that kind of leadership that gives staff autonomy and space to work creatively.

Medics and managers combine to lead CCGs

D. West

Health Service Journal, Mar. 15th 2012, p. 4-5

The accountable officer will be responsible for each clinical commissioning group's duties, functions, finance and governance. Most emerging groups are set to make a person from a management background, rather than a clinician, their accountable officer according to a HSJ survey. Of the 81 clinical commissioning groups that had identified their preferred accountable officer and responded to the survey, 50 chose someone with a managerial background.

Missing piece? How telehealth can help complete the care puzzle

R. Creamer (editor) Health Service Journal, Mar. 1st 2012, supplement, 13p Telehealth involves remote monitoring of a patient's condition using devices installed in their home. The Department of Health's Whole System Demonstrator programme showed that telehealth can deliver a 45% reduction in mortality; 15% fewer accident and emergency department visits; 20% fewer emergency hospital admissions; 14% fewer bed days; and an 8% reduction in tariff costs. Telehealth technologies need to be integrated into existing health economies so that they complement what the NHS does and create capacity by decreasing the workloads of doctors and nurses. The supplement concludes with a description of a telehealth application which gives GPs access to immediate expert interpretations of ECG tests run on equipment in the surgery.

Out of hours fears are falling on deaf ears

D. Carlisle

Health Service Journal, Mar. 22nd 2012, p. 22-23

This article presents an interview with Dr Mark Reynolds, a GP and leading figure in the development of out of hours services. In 1991 Dr Reynolds set up England's fourth GP co-op to provide out-of-hours services in Maidstone Kent. He discusses the future of out-of-hours services in the face of the introduction of clinical commissioning groups, the new NHS 111care helpline, and pressure to prove that they can reduce demand on hospital emergency departments.

Pack to the future

S. Hennell

Health Service Journal, Mar. 29th 2012, p. 26-27

The Department of Health has committed to working alongside the NHS to support the phased roll-out of extended patient choice of 'any qualified provider'. The roll-out is due to start with selected community and mental health services from April 2012. Eight primary care trusts were selected to manage individual projects in order to produce any qualified provider implementation packs for a particular service area. This article describes how Wirral produced an implementation pack for a community continence service.

Public involvement in end of life services

R. Gandy and S. Wilford

British Journal of Healthcare Management, vol. 18, 2012, p. 144-151

Patient and public involvement in end of life care is of critical importance to everyone in society as all will be touched by the death of a loved one at some point. This article describes a national project to establish how best to undertake public and patient involvement in end of life services. The project demonstrated key commonalities and differences in engaging patients with cancer, dementia and long-term conditions in decisions about end of life care. It found that in general it was better to engage with people about end of life care in the early stages of their illness, on a prospective basis. Improved engagement should enable improved end of life services and better patient experiences.

The role of community pharmacists in public health: a scoping review of the literature

C.O. Agomo

Journal of Pharmaceutical Health Services Research, vol. 3, 2012, p. 25-33

The UK government has recognised the potential of community pharmacists for promoting population health improvement. This scoping review of the research literature aims to identify the role of community pharmacists in public health, to identify key emergent themes, and to isolate gaps in the research evidence. The study identified the wide range of roles that community pharmacists were already playing in public health improvement, including provision of smoking cessation services, healthy eating and lifestyle advice, emergency contraception, substance misuse services, and blood pressure monitoring and control. Gaps were found where there were no UK studies, such as on the role of community pharmacists in falls prevention, response to bioterrorism and potential pandemics, provision of vaccination services and prevention of osteoporosis.

Wanted: clinical entrepreneurs

K. Manning

Health Service Journal, Mar. 29th 2012, p. 20-21

A new breed of leader is needed to transform primary and out-of-hospital care. These services demand diversity, experimentation and localism, and need entrepreneurial leadership. Unfortunately the NHS has traditionally been profoundly suspicious of the entrepreneur. Clinical Commissioning Groups are well placed to respond to the challenge. They need to: 1) invest in local clinicians acquiring basic business skills; 2) explicitly encourage the development of new service and business models; 3) create protected opportunities for new local businesses; and 4) learn to celebrate entrepreneurial success.

'We are doing our best': African and African-Caribbean fatherhood, health and preventive primary care services in England

R. Williams and others

Health and Social Care in the Community, vol. 20, 2012, p. 216-223

Health policy in England advocates engagement of fathers with preventive primary care services to improve child health. However, there is little research examining African and African-Caribbean fathers' beliefs about fatherhood, health and local preventive health services. This study attempts to fill the gap in the research literature through data gathered at nine focus groups involving 46 African and African-Caribbean fathers. Fatherhood was seen as a core aspect of the participants' identities. The fathers had concerns about their bodies, medical conditions and physical activity, but their primary focus was on the maintenance and protection of their children's health and wellbeing. However, they reported limited contact with preventive primary care services, and were not aware of their purpose, function or availability.

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