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

Birth of the e-clinic: continuity or transformation in the UK governance of pharmaceutical consumption?

N. Fox, K. Ward and A. O'Rourke

Social Science and Medicine, vol.61, 2005, p.1474-1484

Paper considers three moments in the emergence of the "e-clinic" as an alternative route to prescription drugs in the UK: the electronic transfer of prescriptions, the development of the e-pharmacy and the "virtual" pharmacist on the Internet, and the establishment of online virtual medical consultations.

Could public health trusts win war on inequalities?

H. Mooney and M. L. Harding

Health Service Journal, vol.115, Aug.11th 2005, p.12-13

Presents an overview of current ideas about how public health can be improved in England. These include:

• Formation of dedicated public health trusts to commission services from a range of providers
• Punishing citizens who fail to adopt a healthy lifestyle, through, for example higher council tax bills
• Integration of primary care trusts and social services.

However, most primary care trusts are waiting for clearer government guidance before embarking on radical service redesign.

Crisp gives NHS a year to halve PCTs in £250m savings drive

M. L. Harding and A. McLellan

Health Service Journal, vol.115, July 28th 2005, p.5

By October 2006, the NHS is required to have halved the number of primary care trusts (PCTs) to match more closely the number of social services departments. PCTs will also be told to abandon direct provision of services unless no alternative can be found.

Does NHS Direct empower patients?

A. O'Cathain and others

Social Science and Medicine, vol.61, 2005, p.1261-1771

NHS Direct is a 24 hour helpline established in England and Wales to offer advice and information about health , illness and the NHS so that people are better able to care for themselves. Based on in-depth home interviews with 60 NHS Direct users completed in 2001/02, paper considers the extent to which the service facilitates patient empowerment. Research suggests that NHS Direct facilitates patient empowerment by enabling people to self-care and to access health advice and services. It is also seen to offer prerequisites for empowerment perceived to be lacking in the wider NHS, such as time, respect, listening, support and information. The service also offers an alternative contact point for people seeking to avoid being labelled "time wasters" by other busy healthcare providers.

From patients to providers: prospects for self-care skills trainers in the National Health Service

A. Kennedy, A. Rogers and C. Gately

Health and Social Care in the Community, vol.13, 2005, p.431-440

The Expert Patients Programme (EPP) has the potential to create a new community health workforce of self-management and self-care skills trainers and tutors. The paper considers the establishment of this system of trainers and its prospects for becoming an independent and autonomous workforce aimed at meeting need outside of the usual health-care settings inhabited by NHS staff. This is done through policy analysis and a process evaluation recording the development and implementation of the EPP. Telephone interviews were conducted with individual trainers to identify the way in which they are being introduced into the NHS. Prospects for the future development of self-management trainers remain uncertain. Two likely outcomes are examined. The first is that trainers will become integrated as a semi-professionalised group within the primary care workforce. The other option is for trainers to become free-lance consultants commissioned by PCTs to run local self-management, self-care support or EPP programmes.

PCT reform strategy slammed as 'intellectually incoherent'

M. L. Harding

Health Service Journal, vol.115, Aug.4th 2005, p.5

The government's directive that primary care trusts should stop directly providing services and act solely as commissioners to ensure that non-hospital care is contestable has provoked a storm of criticism.

Sea change or quick fix? Policy on long term conditions in England

B. Hudson

Health and Social Care in the Community, vol.13, 2005, p.378-385

Management of long-term conditions in the community is a policy area that has recently come to prominence in England, culminating in the development of the National Health Service and Social Care model in 2005. The model draws heavily on US ideas of case management and proposes the appointment of 3000 community matrons to undertake this role with the most vulnerable patients. Although welcomed in principle, some specific proposals in the model have attracted criticism. Problematic areas include patient identification, the transplanting of US models to England, the role of case management, workforce and funding issues, and the mix of medical and social models.

Sir Nigel’s streamlining could see PCT numbers cut to 144

D. Martin

Health Service Journal, vol.115, Aug.25th 2005, p.5-7

Each strategic health authority has been told by the NHS Chief Executive to reduce the number of primary care trusts (PCTs) in its area in order to cut management costs by around 15% and to improve co-terminosity with local authority social services departments. A survey by the HSJ shows that the total number of PCTs is likely to fall from 303 at present to 144 by October 2006, when the new organisations are supposed to be operational.

Support workers in intermediate care

S.A. Nancarrow and others

Health and Social Care in the Community, vol.13, 2005, p.338-344

The paper presents data from 33 services which were involved in the NHS Modernisation Agency's Changing Workforce Programme project, the Accelerated Development Programme for Support Workers in Intermediate Care. Within the project, the main employers of support workers were primary care trusts and/or social services. Their roles included multidisciplinary working, meeting rehabilitation needs, providing personal care and enablement. Team leaders included nurses, social workers, physiotherapists, professional managers, home carers, and support workers. The most commonly reported sources of training for support workers were NVQs and in-house training. In 80% of the services, at least half of the support workers had a qualification. Three models of supervision emerged across the services: allocation of a mentor, team supervision, and formal and informal line management.

Walk-in centres delayed until December

H. Mooney

Health Service Journal, vol.115, Aug.25th 2005, p.9

The government's much-hyped independently run primary care walk-in centres near main railway stations will not open until December 2005 at the earliest. The planned group of seven centres should have been open by Spring 2005, but the programme has been delayed by difficulties in finding suitable sites.

You choose: new forces to be reckoned with in primary care

M. L. Harding

Health Service Journal, vol.115, Aug.4th 2005, p.14-15

The government believes that some primary care trusts have failed to address gaps in provision in their areas. In advance of a White Paper due late in 2005, the HSJ has invited experts to present their visions of the future of community healthcare. In this article, professionals discuss how services could be reconfigured to give patients greater choice of provider.