Welfare Reform on the Web (August 1999): National Health Service - Community and Primary Care Services

CLINICAL GOVERNANCE: THE ROLE OF COMMUNITY PRACTITIONERS

R. Cook

Community Practitioner, vol. 72, 1999, p. 83-85.

Clinical governance is a new term covering a range of professional activities which together should ensure the quality and appropriateness of clinical care and services. The most important foundation for clinical governance is the acceptance by practitioners of three key principles:

• that clinical governance is intended to safeguard standards of care for the benefit of patients;
• that it is part of the professional practice of every nurse, midwife and health visitor;
• that PCGs effectively dissolve the organisational barriers between primary and community health care, so open, co-operative information sharing and action on clinical governance can become the norm.

FIRST ASSESSMENT: A REVIEW OF DISTRICT NURSING SERVICES IN ENGLAND AND WALES

Audit Commission

Abingdon: Audit Commission Publications, 1999.

Report recommends that:

• trusts and commissioners need to agree clear service objectives with district nurses;
• referral procedures must be reviewed and clear referral criteria produced;
• out of hours services should be reviewed;
• further integration of district nurses with other community nurses should be considered;
• poor clinical performance should be identified and tackled;
• trusts should help district nurses manage their workloads by matching the numbers and skills of nurses to the needs of their patients.

(For comment see Community Practitioner, vol. 72, 1999, p. 78).

LESSONS IN COLLABORATION AND JOINT PURCHASING OF THE LOCALITY LEVEL

S. Peckham

British Journal of Health Care Management, vol. 5, 1999, p. 101-103.

Article reports on a recent study examining joint purchasing by health and social services at the locality level and identifies lessons for emerging primary care groups.

PRIMARY CARE GROUPS

Health Committee

London: TSO, 1999. (House of Commons papers, Session 1998/99; HC 153)

Preliminary examination of the development and implementation of proposals for Primary Care Groups. Concludes by expressing overall support for the policy underlying PCGs, but points out that as they develop further questions about their performance and structure and the role of Health Authorities are likely to arise.

RESEARCH MATRIX REVEALS REAL TYPOLOGY OF PRIMARY CARE

G. Meads

British Journal of Health Care Management, vol. 5, 1999, p. 96-100.

Research identifies four distinct organisational types of PCG using an analysis of differences in organisational purpose and objectives, management arrangements, health strategies and public health functions, information sources, and internal and external relationships. The models which emerge are PCG as defence association, PCG as friendly society, PCG as executive agency and PCG as franchised company.

THERE MAY BE RUBBLE AHEAD

J. Davies

Health Service Journal, vol. 109, April 29th 1999, p. 10-11.

Reports that relations between clinicians and managers in some primary care groups are under strain as GPs fear that their status as independent contractors is under threat.

WALK-IN CLINICS "POSE A THREAT" TO GP PRACTICES

D Brindle

Guardian, April 14th 1999, p. 12

Reports major speech by Tony Blair on the future of the NHS in which he announced:

• the creation of 20 walk-in centres, open 8 am to 10 pm, to pilot basic primary care for people unable to get to their GP;
• the extension of NHS Direct in West London, Nottinghamshire and the North-East to refer people to out-of-hours health and social services;
• a telephone service in the West Midlands to call people who may need help;
• an on-line version of NHS Direct to offer health advice on the Internet;
• up to 200 NHS Direct on-line screens and telephones to be established in surgeries, libraries, post offices and pharmacies.

(See also Independent, April 14th 1999, p. 11 and Daily Telegraph, April 14th 1999, p. 15)

A WORD IN PRIVATE

K. McIntosh

Health Service Journal, vol. 109, 29th April 1999, p. 9-11.

New initiatives such as NHS Direct, nurse prescribing and "fast access walk-in centres" will undermine traditional general practice and threaten continuity of care. Primary care will become a shambles with patients being given conflicting advice and little control over access to secondary care.