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Welfare Reform on the Web (May 2003): National Health Service - Community and Primary Care Services

AHEAD OF THE GAME

J. Spinks

Practice Management, Mar. 2003, p.34-35

Under the new GP contract, the practice will become a small firm subcontracted to supply some of the primary care services the primary care trust is required to provide. Services will fall into three groups:

  • essential
  • additional
  • enhanced

Of these, only essential services will definitely be provided by a practice. The primary care trust will be responsible for organising alternative provision for services in practice chooses not to offer. The PCT will also be responsible for monitoring the quality of the services offered, on which a third of practice income depends.

AWAY WITH THE FAIRIES

A. Moore

Health Service Journal, vol. 113, Mar. 13th 2003, p. 12-13

Primary Care Trusts are finding that resource constraints are compelling them to prioritise achieving national targets over meeting local needs when drawing up local delivery plans. Tight timescales for producing the plans also mean that it has not been possible in many cases to involve the public or the local authority.

DOCTORS THROW GP REFORM INTO DOUBT

D. Brown

The Guardian, March 17th 2003, p.14

Government plans to modernise GP services were in doubt after NHS family doctors signalled they might veto the proposals. A ballot of 35,000 GPs has been postponed after an emergency meeting of the British Medical Association. Under new contracts, part of GPs pay would be based on the quality of treatment.

(See also The Times, March 17th 2003, p.1)

DRUG PRESCRIBING BY GPs OUTSTRIPS NHS SPENDING RISE

N. Timmins

Financial Times, March 28th 2003, p.9

Reports that drug prescribing by family doctors was outstripping even the large increases in National Health Service spending, according to the Audit Commission. The budgets of primary care trusts were under pressure and more needed to be done to cut unnecessary prescribing.

GP APPRAISAL: IS THE END OF THE ROAD IN SIGHT?

N. Bostock

Primary Care Report, vol. 5, Mar. 19th 2003, p.36-39

Implementation of GP performance appraisal by primary care trusts has been patchy. Problems include GP scepticism, lack of ring-fenced funding and difficulties getting staff into appraisal training schemes.

GP ATTACHMENT VERSUS GEOGRAPHICAL WORKING: WHAT'S BEST?

N. Brocklehurst, J. Heaney and C. Pollard

Community Practitioner, vol. 76, 2003, p. 81-82

Article examines, through two case studies, one particular aspect of the modernisation of primary care: the appropriateness of GP attachment for health visitors. The alternative model presented is based on geographical team working with GP linkages.

THE GP CONTRACT AND ITS IMPLICATIONS FOR PCOs

N. Walsh

Primary Care Report, vol. 5, Mar. 5th 2003, p. 15-18

The proposed new GP contract will mean primary care organisations (PCOs) managing practices each of which will be providing a different range of services. The PCO will need to identify gaps and secure alternative provision for patients. It will also have to set up systems to monitor the quality of care provided by practices.

HAS LIFTING THE CAP ON MANAGEMENT COSTS PROVED A RED HERRING

M. Limb

Primary Care Report, vol. 5, Mar. 5th 2003, p. 32-33

There is concern that underinvestment in management is inhibiting the development of primary care trusts and making it more difficult for them to hit government targets. Since April 2002, primary care trusts have had the freedom to spend as much as they see fit on management. However PCTS still have to agree levels of expenditure on management with their professional executive committees and costs are monitored by the strategic health authorities. These constraints mean that spending on management has not increased appreciably.

IT'S NOT HOW BIG YOUR PCT IS - IT'S WHAT YOU DO WITH IT

S. Prestwood

Primary Care Report, vol. 5, Mar. 19th 2003, p.30-32

Mergers of primary care trusts do not give rise to economics of scale and can cause disruption to services. Larger trusts are also in danger of recreating bureaucratic hierarchies and losing touch with their local communities. An effective alternative to merger may be integration and pooling of senior management expertise.

NICE GUIDANCE CAUSES A NASTY HEADACHE FOR FINANCIAL PLANNERS

S. Brown

Primary Care Report, vol. 5, Mar. 5th 2003, p. 24-26

Implementation of National Institute for Clinical Excellence guidance will increase Primary Care Trusts' prescribing costs.

PERFORMANCE COMES FIRST IN GMS CONTRACT

M. Pownall

Primary Care Report, vol. 5, Mar. 5th 2003, p. 6-9

In a radical departure from current practice, the proposed new GP contract links increased earnings to service quality. About one third of GPs' income will eventually come from meeting 80 new quality targets in 10 clinical areas.

PHYSICIAN, HELP THYSELF

M. Baker

Practice Management, Mar. 2003, p. 19-21

Discusses the feasibility of introducing US-style physicians' assistants (Pas) to reduce GPs' workloads.

POINTS THE WAY

C. Brown

Practice Management, Mar. 2003, p. 7-8

Under the new GP contract, one third of practice income will be paid on the basis of quality of service. This will be measured using a points system which could be an administrative nightmare.

PRIMARY CARE PRESCRIBING

Audit Commission

London: 2003

Prescribing costs in Primary Care Trusts have risen by 29% between 1998/99 and 2001/02 and are expected to increase by a further 11-13% in 2002/03. This rise has left most PCTs facing a funding shortfall. Report estimates that cost savings of up to £130m could be made by adopting measures such as prescribing cheaper brands and reducing over-prescribing. However the report acknowledges that much of the increase costs is due to implementation of National Institute for Clinical Excellence guidance and of the National Service Frameworks.

THE ROLE OF PERFORMANCE INDICATORS IN CHANGING THE AUTONOMY OF THE GENERAL PRACTICE PROFESSION IN THE UK

M. Exworthy and others

Social Science and Medicine, vol. 56, 2003, p. 1493-1504

Paper reviews GPs' reactions to the application of performance indicators (PIs) to their clinical practice in order to offer insights into the link between performance assessment and professional autonomy. GPs associated the advent of clinical PIs with the need to demonstrate competent practice. Perceived loss of autonomy was central to GPs' objections to clinical PIs although such views were not universal. Most GPs linked PIs with a "carrot and stick" approach used by government to reward good and penalise bad performance. Finally, concerns regarding the competence of the agencies which would be compiling and interpreting the PI data were expressed.

SMALL PRACTICES DON'T HAVE TO GO IT ALONE

M. Taylor and M. Auchterlonie

Primary Care Report, vol. 5, Mar. 5th 2003, p. 28-29

Report results of a survey highlighting the level of support offered to small GP practices by Primary Care Trusts. This includes in-house training, backing for funding bids, holiday and sickness cover, retirement planning, and support for Personal Medical Services bids.

WILL BED BLOCKING FINES SOUR RELATIONS BETWEEN PCTs AND SOCIAL SERVICES?

S. Prestwood

Primary Care Report, vol. 5, Mar 5th 2003, p. 30-31

There is widespread opposition to government plans to fine social services departments for delayed hospital discharges due to a lack of alternative care. The situation could be improved by closer co-operation between the NHS and social services. Fines would simply undermine such partnership working.

WORLDS APART

P. Gordon and M. Fisher

Health Service Journal, vol. 113, Mar. 13th 2003, p. 28-29

A programme bringing together primary care trust non-executives and local councillors from the same area changed participants' perceptions of each other. Organisers found both parties to be convinced of the benefits of joint working but unsure how to go about it.Knowledge of each other's worlds was initially poor. Concludes that to break down barriers annual structured visits between PCTs and local authorities should be encouraged.

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