Welfare Reform on the Web (February 2005): National Health Service - Primary and Community Care

CHILDBIRTH 'LONELY AND FRIGHTENING' FOR THOUSANDS OF WOMEN

M. Frith

The Independent, Jan. 13th 2005, p.15

Chronic shortages of midwives and the 'medicalisation' of childbirth are leaving women terrified, alone and in pain during labour, according to a survey published in January 2005. The survey of more than 3,000 new mothers found that many antenatal classes left them unprepared and that childbirth and its aftermath was dominated by a lack of good-quality care.

(See also The Guardian, Jan. 13th 2005, p.3; The Daily Telegraph, Jan. 13th 2005, p.8)

THE DOCTOR WON'T SEE YOU NOW

S. Lister and D. Charter

The Times, Jan. 19th 2005. p.3

A scheme costing millions of pounds that will allow patients to choose and book hospital appointments electronically from GPs surgeries by the end of the year is a serious risk of failure, according to auditors. More than a third of GPs will not be linked up to the system by December, despite government promises that the network would be up and running, a report by the National Audit Office has concluded. The report warns the Government that the £196 million Choose and Book project is likely to derail unless a series of technological problems and doctors' concerns are addressed as a matter of urgency.

GENERAL PRACTICE: A FORCE FOR GOOD IN A BRIGHTER FUTURE

N. Brocklehurst

Community Practitioner, vol.77, 2004, p.455-459

Explores ways in which the new GP contract and practice-based commissioning offer potential benefits for health visiting. The new GP contract allows practices to opt out of providing certain services which could be taken on by health visiting. Practice-based commissioning opens up the possibility of health visitors holding budgets and purchasing services.

GO WITH THE FLOW

A. Nolan

Health Service Journal, vol.115, Jan. 13th 2005, p.24-26

A lack of high-quality managers and a need for more commissioning muscle will encourage primary care trusts to merge, although they will not be forced to do so by the government. However, full-scale mergers are not the only option. Trusts may opt to share back office services, organising themselves into confederations or clusters. These arrangements allow trusts to keep a local focus while freeing up resources from improved management capacity.

INDIVIDUAL IDENTITY AND ORGANISATIONAL CONTROL: EMPOWERMENT AND MODERNISATION IN A PRIMARY CARE TRUST.

R. McDonald

Sociology of Health and Illness, vol.26, 2004, p.925-950

Article presents a case study of an initiative to "empower" staff in an English primary care trust. In fact the exercise can be seen as a means of increasing management control over employees by pressurising them into conforming with organisational "values" and "norms". The initiative aimed to encourage staff to engage in a process of self-transformation by participating in a self-development course.

INFORMED CHOICE IN MATERNITY CARE

M. Kirkham (editor)

Basingstoke, Hants: Palgrave Macmillan, 2004

This text brings together key research in maternity care and midwifery education and provides a forum for the concerns of all involved. Factors constraining women's choices are examined from a wide range of perspectives, including service users, midwives, obstetricians and social scientists, to highlight the social, cultural and clinical factors influencing decision making. Topical concerns discussed include:

• 'request' Casareans;
• birth experiences of ethnic minority women;
• the different ways in which the MIDIRS informed choice leaflets can be used;
• client choice within health care bureaucracies.

NATIONAL SERVICE FRAMEWORKS AND UK GENERAL PRACTICE: STREET LEVEL BUREAUCRATS AT WORK

K. Checkland

Sociology of Health and Illness, vol.26, 2004, p.951-955

National Service Frameworks (NSFs) introduced by the UK government in 1997 specify detailed models of service provision that health care providers are expected to follow. Study explores the responses of three general practices to the first four NSFs. The failure of NSFs to make any significant impact is compared to the practices' positive responses to purely clinical guidelines such as those developed by the British Hypertension Society. Lipsky's concept of public service workers as "street level bureaucrats" is used as a framework within which to view the findings.

PATIENT CHOICE AT THE POINT OF GP REFERRAL

National Audit Office

London: TSO, 2005 (House of Commons papers, session 2004/05; HC180)

A quarter of primary care trusts are forecasting that they will miss the target of offering all patients a choice of 4-5 providers of elective procedures by December 2005. The report identifies low clinical engagement with the choice agenda as the key risk to the delivery of the target. Sixty-one per cent of GPs feel either negative or "a little negative" about being able to deliver the choice agenda due to lack of capacity, increase in workload, greater consultation length and fears that existing health inequalities will be exacerbated. On present plans, only 60-70% of the NHS will have "choose and book" or e-booking facilities in place by December 2005. This means that choice will have to be delivered in a less efficient way.

PATIENTS WIN RIGHT TO SEE GPS' RECORDS

D. Charter

The Times, Jan. 27th 2005, p.11

Patients are to be given the right to see doctors' disciplinary and performance records on the internet under a sweeping review of medical accountability. The move is also likely to spell the end of the General Medical Council's historic right to judge doctors after a series of failures culminating in the Harold Shipman case.

SELF CARE: A REAL CHOICE

Department of Health

London: 2005

Document sets out how the NHS should be making self care a central part of supporting people with chronic illnesses such as asthma and diabetes through:

• more use of nurse-led education classes for newly diagnosed patients;
• the NHS Direct services;
• support of the most vulnerable patients by community matrons.

SERIAL SICK NOTE GPS 'FACE RETRAINING'

N. Timmins and B. Hall

Financial Times, Jan. 20th 2005, p.4

Family doctors who sign too many people off as sick or disabled could face retraining or even lose the right to practice under new proposals. The government is to set up a new Office for Disability Issues to improve the life chances of disabled people over the next 20 years. But as part of its proposals, a report from the Prime Minister's strategy office says that the performance of family doctors in signing people off should be monitored. Doctors who perform poorly could face "retraining and revalidation".

SUPPORTING PEOPLE WITH LONG TERM CONDITIONS: AN NHS AND SOCIAL CARE MODEL TO SUPPORT LOCAL INNOVATION AND INTEGRATION

Department of Health

London: 2005

The NHS and Social Care Model is a blueprint to support local NHS and social care organisations in improving services for people with long term conditions. The model involves:

• identifying all long term condition patients in the health community;
• identifying the most vulnerable patients and applying a case management approach to those with multiple illnesses;
• providing people with a complex single condition with responsive, specialist services, using disease-specific protocols such as National Service Frameworks;
• collaboratively helping individuals and their carers to develop the knowledge, skills and confidence to manage their condition effectively.

TEENAGE SEXUAL HEALTH PROMOTION: THE DUMFRIES AND GALLOWAY PERSPECTIVE

J. Currie and P. Lyttle

Community Practitioner, vol.77, 2004, p.450-452

Describes how school nurses in Newton Stuart, Scotland, worked to revamp sex education and sexual health advice services in their schools. Following a consultation with pupils, peer sex education was introduced. The youth clinic was relocated from a draughty old building to a purpose built youth facility.

USE OF POST NATAL COMMUNITY SERVICES: RCT EVIDENCE

H. Turner and others

Community Practitioner, vol.78, 2005, p.11-15

Paper draws on data from a randomised controlled trial evaluating the effectiveness of two support interventions in improving the health of mothers and their new born babies in a deprived area of inner London. The intervention discussed in this paper entailed women being assigned to one of eight community groups that offered support to mothers with young children in their area. Uptake of this service was low at 19% of participants. The reasons women gave for non-use included being too busy, having enough support already, not wanting to be associated with groups for women "with problems", and that groups did not proactively contact them. Uptake was highest when groups were proactive in offering support and included home visiting as part of their service.