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

ACTION ON SEXUAL HEALTH CAN'T WAIT UNTIL THE MORNING AFTER

S. Prestwood

Primary Care Report, vol.5, June 25th 2003, p. 4, 7

A recent report by the Commons Health Select Committee has declared that there is a crisis in sexual health services in Britain. Demand is far outpacing supply. The Committee laid much of the blame for this state of affairs on primary care trusts, which have failed to understand their commissioning role.

CHANGE OF PACE

P. Everden and others

Health Service Journal, vol.113, July 24th 2003, p.28-30

In order to reduce pressure on Accident and Emergency departments, a general practice in North Walsham, Norfolk pioneered a project for assessing people who claimed to be in urgent need of medical assistance in the community. The assessment may take place at the GP surgery or elsewhere as appropriate. Assessments are carried out by a multidisciplinary team consisting of a GP, a practice nurse, a new health care assistant and a paramedic on loan from the local ambulance service. The first eight months of operation dramatically cut accident and emergency admissions and sped up ambulance response times.

"HEALTH CONTRACTS" FOR THE NHS?

A. Cowper

British Journal of Health Care Management, vol.9, 2003, p.237-241

Compilation of comments by health professionals and academics on government proposals to bring in "health contracts" between GPs and patients. These are intended to promote healthy lifestyle choices and could lead to sanctions against patients for non-compliance.

HOW LHSCGs CAN RATIONALISE PRESCRIBING IN NORTHERN IRELAND

H. Mcleod

Primary Care Report, vol.5, June 25th 2003, p.18-23

A study of five commissioning projects in Northern Ireland has shown how Local Health and Social Care Groups can manage prescribing by GPs through implementation of repeat prescribing protocols, development of specific formularies and disease management guidelines, targets for generic prescribing rates, financial incentives linked to savings targets, and budget caps.

ONLY CONNECT

G. Clews

Health Service Journal, vol.113, July 3rd 2003, p.14-15

A document written by Simon Stevens, an adviser to the Prime Minister on health policy, suggests that primary care trusts should form loose federations or networks, sharing management and back office functions.

RESPIRATORY DISEASE: WHY GPSIs ARE A BREATH OF FRESH AIR

D. Ryan

Primary Care Report, vol.5, June 25th 2003, p.16-17

GPs with a special interest who treat respiratory conditions in primary care will cut hospital referral rates, save primary care trusts money, and improve patient and staff satisfaction.

SHORTAGE OF GPs CREATES LONGER WAITING TIMES

O. Wright

The Times, July 21st 2003, p. 8

Patients are having to wait substantially longer to see their family doctor than they were five years ago, according to official figures. A survey of more than 140,000 NHS patients found that 72 per cent had to wait more than two days for an appointment in 2001/02 compared with 63 per cent in 1998.

STRAIGHT TO VIDEO

A. McGauran

Health Service Journal, vol.113, July 31st 2003, p.26-27

Videoconferencing sessions involving patients, GPs and consultants have speeded up assessment and reduced the need for hospital referrals. The pilot scheme currently covers cardiology and peripheral vascular disease in one GP practice, but there are plans to extend it across the primary care trust.

TELEPHONE TRIAGE BY NURSES IN PRIMARY CARE: WHAT IS IT FOR AND WHAT ARE THE CONSEQUENCES LIKELY TO BE?

H. Charles-Jones and others

Journal of Health Services Research and Policy, vol.8, 2003, p.154-159

It is likely that telephone triage by practice nurses of patients' requests for same day appointments with their GPs will grow, driven by the need to reduce the doctors' workloads. Semi-structured interviews with GPs, practice nurses and practice managers elicited four viewpoints about use of the triage system:

  • respondents justified telephone triage by emphasising the managerial benefits of controlling access;
  • accounts suggested that triage operates by allocating patients to the clinician who can most appropriately "manage" them, removing any notion of patient-centredness from the system;
  • the system was found to confirm and extend existing professional hierarchies within practices, with GPs at the top tackling complex problems and minor problems delegated to nurses;
  • a tension became evident between the managerial benefits of triaging patients by diagnosis and aspirations to personal and patient care.
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