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Welfare Reform on the Web (May 2002): National Health Service - Primary and Community Care

BETTER INTEGRATION IS ESSENTIAL IF THE NHS IS TO MOVE FORWARD

S. Crowe

Primary Care Report, vol. 4, issue 3, Feb. 20th 2002, p. 4-7

Article discusses the future of the NHS in comparison to the Kaiser System in California. It argues for the NHS having more freedom and highlights the need for mixed skills in the primary care sector.

CHANGING WORKFORCE PROGRAMME JUMPS THE HURDLES TO SHIFT ROLES

J. Hargadon

Primary Care Report, vol. 4, issue 2, Feb. 2002, p. 20-25

Describes how the changing workforce programme has been working across health care to redesign roles so that they improve both services and job satisfaction. The programme is also helping to clear a number of blocks that impede role redesign and innovation in primary care.

EXPERIENCES AND CAREER INTENTIONS OF GENERAL PRACTICE REGISTRARS IN THAMES DEANERIES: POSTAL SURVEY

I. Bowler and N. Jackson

British Medical Journal, Feb. 23rd 2002, p. 464-465

Results of a survey of 470 trainee GPs in South East England showed that only 30% of women respondents intended to work full-time a compared with 75% of men. Since the majority of young GPs are women, this will make a big difference to the total number needed to meet the NHS Plan targets. Authors conclude that the government's promise of 550 new training posts to deliver 2000 new GPs will not be enough. Qualified doctors currently in practice need to be retained.

HEALTH AND LIFE HISTORIES

C. Wright

Community Practitioner, vol. 75, 2002, p. 80-81

The role of health visitors and community nurses has been expanding over recent years to cover disease prevention. Article reports interviews with professionals involved with the Scottish Family Health Nurse pilot project. Family Health Nurses are trained to explore with families how all aspects of their life and medical history affect their health and how they can assume responsibility for their own health problems.

HOW MUCH WILL UNIFIED BUDGETS RESTRAIN PCTS?

S. Brown

Primary Care Report, vol. 4, issue 2, Feb. 2002, p. 10-11

Primary Care Trusts will receive unified budgets which will have to cover running and management costs, commissioning hospital, mental health and learning disability services, providing community services, and paying GPs. These budgets will be cash limited, and an overspend in one area will have to be covered by savings in another.

HOW PCTS APPOINT LAY EXECUTIVES AND INVOLVE PATIENTS AND THE PUBLIC

M. Pownall

Primary Care Report, vol. 4, no.4, Mar. 6th 2002, p. 35-37

Describes varying approaches by primary care trusts to the appointment of lay members to their non-executive boards, and other strategies that have used to achieve patient and carer involvement.

HOW TO BRING PHARMACY UNDER THE PCT GOVERNANCE UMBRELLA

M. Lakhani

Primary Care Report, vol. 4, no. 4, Mar. 6th 2002, p. 38-39

Clinical governance is now being extended to include community pharmacists. Article reviews the Department of Health guidance on this subject and considers the role of the primary care trust in its implementation.

IMABALANCES IN THE GP LABOUR MARKET IN THE UK: EVIDENCE FROM A POSTAL SURVEY AND INTERVIEWS WITH GP LEAVERS

R. Young, B. Leese and B. Sibbald

Work, Employment and Society, vol. 15, 2001, p. 699-719

Authors find that doctors whose real or assumed lifestyles or value systems make them unable to conform to the standard pattern of full-time equity partnership in general practice are either excluded or confined to relatively "low status" GP employment. This applies to women, older, and minority ethnic doctors , who are also over-represented in deprived urban areas. Authors concluded that GP shortages could be partly ameliorated by moves to address these inequalities in order to mobilise and deploy already qualified doctors more effectively.

INNOVATIVE PCOS ARE ADAPTING NATIONAL POLICY TO MEET RURAL NEEDS

M. Greener and N. Bostock

Primary Care Report, vol. 4, no. 3, Feb. 20th 2002, p. 36-37

This article looks at how rural Primary Care Organisations are reconfiguring services to suit the needs of their population.

INTERMEDIATE CARE AND SPECIALIST GPs

Royal College of General Practitioners et al

Retford: NHS Alliance, [2002?]

Concludes that intermediate care could offer significant potential advantages to patients and the NHS provided that it is accompanied by a substantial expansion in the numbers of GPs and suitable nurses. It is not a cheap option. Sees some risks in the introduction of GPs with special interests, especially in the diversion of effort from existing primary care responsibilities. Is not persuaded that the option of developing better secondary care services has been fully explored.

IT'S GOOD TO TALK - HOW WE BROUGHT GPS AND PATIENTS TOGETHER

M. McCarthy

Primary Care Report, vol. 4, no. 3, Feb. 20th 2002, p. 32-33

Article examines the use of patient panels by the Coventry East Primary Care Group to ensure the publics have a say in improving services. It outlines how the panels were set up and what they achieved.

NO CAN DO

T. Bosma and J. Higgins

Health Service Journal, vol. 112, Feb. 21st 2002, p. 26-27

Primary care groups and trusts (PCG/Ts) are already chronically short of staff and there is little evidence of workforce planning for the future. Some, although managing sizeable budgets, have no finance staff at all. They will face a shortage of GPs and difficulty in retaining nurses. They should make sure they are involved in their local workforce confederation in order to facilitate planning and restructuring.

NURTURE NOT NATURE

M. Bond

Health Service Journal, vol. 112, Feb. 21st 2002, p. 30-31

The creation of primary care groups and trusts (PCG/Ts) met with little political hostility, although they had few precedents in NHS institutional arrangements. However they appear to have achieved little. Their record on health improvement is poor, and progress in commissioning is minor, as budgets are held at a level that is PCG/T wide, without any devolution of control to practice level.

PCTs FEEL THE SQUEEZE AS NICE DEADLINE MEANS OTHER SERVICES SUFFER

N. Bostock

Primary Care Report, vol. 4, issue 2, Feb. 2002, p. 4-7

Faced with a three-month time limit to implement NICE guidance in introducing treatments, Primary Care Trusts are worried that cuts will have to be made elsewhere to cover spiralling prescribing costs.

PCTS MUST PREDICT WHAT WILL PUT STRAIN ON SAFFS

S. Brown

Primary Care Report, vol. 4, no. 4, Mar. 6th 2002, p. 11-16

Describes how primary care trusts allocate their budgets and commission services from hospitals. This process culminates in the production of a balanced budget laid out in a Service and Financial Framework document, which is submitted to the Department of Health.

QUALITY IN COUNSELLING IN PRIMARY CARE: A GUIDE FOR EFFECTIVE COMMISSIONING AND CLINICAL GOVERNANCE

P. Bower, J. Foster and J. Mellor-Clark

Manchester: NPCRDC, University of Manchester, 2001

This handbook aims to provide primary care trusts with the information they need to effectively commission counselling services. It covers evidence of the effectiveness of counselling in primary care, procedural issues such as accountability, confidentiality and referral processes, and alternative treatments such as group therapy, self-help and computer delivered approaches.

READY, STEADY, STOP

K. Baxter et al

Health Service Journal, vol. 112, Mar.14th 2002, p. 28-29

A survey of primary care groups and trusts in the SouthWest Region showed that most felt they had little autonomy. Most were level-2 PCGs, taking responsibility for managing a budget for commissioning services. About a third were still relying heavily on their health authority for commissioning. The results suggest that the proposal to allocate 75% of NHS funds to PCTs by 2004 will be unrealistic in some areas.

A SOLID ESTATES STRATEGY IS NOT JUST CONCERNED WITH BRICKS AND MORTAR

R. Moore

Primary Care Report, vol. 4, issue 2, Feb. 2002, p. 26-30

Primary Care Trusts should not plan their estates strategy in isolation from their service strategy. The facilities strategy should be embedded in an understanding of national priorities and local needs, should have the support of the PCT board, and should be compatible with regulations governing how GPs are paid.

SOLVING THE RECRUITMENT CRISIS IN UK GENERAL PRACTICE: TIME TO CONSIDER PHYSICIAN ASSISTANTS?

M. Gavin and A. Esmail

Social Policy and Administration, vol. 36, 2002, p. 76-89

Proposes the creation of an intermediate medical practitioner role, along the lines of the physician assistant in the USA. The establishment of such a role might go some way to resolving the current shortage of general practitioners in he UK. It is suggested that refugee doctors unable to practice in the UK might find physician assistant training particularly attractive, especially if it could serve as a stepping-stone to GMC registration.

USING A "WHOLE SYSTEMS" APPROACH TO CHANGE SERVICE DELIVERY

A. Rowe

Community Practitioner, vol. 73, 2002, p. 91-93

Government expects the role of health visitors and school nurses to be changed to further develop its public health aspect. Article reports on the results of pilot schemes which used a "whole systems" approach to changing the orientation of health visiting and school nursing services in line with current policy.

WHY WE NEED FAIRER INCENTIVE SCHEMES

R. Lewis

Primary Care Report, vol. 4, issue 2, Feb. 2002, p. 32-33

Discusses the characteristics of a good incentive scheme for GPs. Good schemes:

  • are devised and agreed locally;
  • focus on what is required rather than on how it is to be achieved;
  • target local priorities;
  • are integrated with clinical governance arrangements;
  • reward practitioners and their teams for higher quality and/or a greater volume of service;
  • have clear indicators to measure achievements.
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