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Welfare Reform on the Web (February 2006): National Health Service - Primary and Community Care

Community service

D. Carlisle

Health Service Journal, vol.116, Jan. 19th 2006, p.24-26

In the light of the imminent publication of the White Paper on healthcare outside hospitals, the article looks at how social care, primary care and community pharmacy services are evolving. Social care is focused on partnership working between local authorities and primary care trusts, and on the development of individualised and personalised care packages. Primary care is faced with the introduction of practice-based commissioning and the opening of the market to competition. It is responding by developing enhanced services and taking on a range of work currently done in hospitals. Community pharmacies under their new contract are in turn looking to enhance their role in the provision of medical advice and in health promotion activities, taking over work treating minor ailments and chronic conditions normally done by general practitioners.

Do incentive payments in the new NHS contract for primary care reflect likely population health gains?

R. Fleetcroft and R. Cookson

Journal of Health Services Research and Policy, vol.11, 2006, p.27-31

The new contract for general practitioners in the UK offers fee-for-service payments for a wide range of activities in a quality outcomes framework, with payments designed to reflect likely workload. This study explored the links between these financial incentives and likely population health gains. Results show that payments under the new contract do not reflect likely population health gain. There is a danger that clinical activity may be skewed towards labour-intensive services that are only marginally effective, to the detriment of more cost-effective interventions. Authors conclude that incentives should be designed to reflect likely health gain rather than likely workload.

Doctors losing enthusiasm for health service’s £6bn IT programme

N. Timmins

Financial Times, January 10th 2006, p.2

Scepticism among GPs about the National Health Service’s information technology programme appears to be growing. Enthusiasm for the programme is down, worries about confidentiality are growing, and two-thirds rate its progress as poor or unacceptable, according to a survey conducted by Medix.

[See also Guardian, January 10th 2006 p.7]

Euthanasia: doctors aid 3000 deaths

S. Boseley

Guardian, January 18th 2006, p.1

Safety concerns and the legality of doctors’ actions are discussed as findings from the first authoritative study of GPs’ decisions regarding the terminally ill are revealed. Nearly a third of all deaths are attributed to withdrawal of treatment.

GP commissioning “bribe” will “sink” policy before it begins

M.-L. Harding

Health Service Journal, vol.116, Jan. 5th 2006, p.5

Government is planning to offer general practitioners financial incentives to take up practice based commissioning of services. This approach has been severely criticised by the National Association for Primary Care on the grounds that centrally imposed standards will stifle innovation.

Influences on GPs' early retirement, and how to keep them

A. Hutchins and others

British Journal of Health Care Management, vol.11, 2005, p.367-374

Article used data from semi-structured interviews with 20 general practitioners to explore why they wished to take early retirement, and what measures might tempt them to stay on. Doctors nearing retirement age felt that their job satisfaction had declined considerably as a result of reduced autonomy, government targets, pressure of work, volume of paperwork, increased patient demand and incessant change. They might be tempted to stay on if offered the option of part time working and more administrative assistance.

A new primary care electronic record: what's in it for you?

M. Chambers

Community Practitioner,vol.78, 2005, p.426-428

Article explains the benefits for health visitors of using a shared electronic health record with standardised terminology, prewsenting a new system currently under development in Calderdale and Huddersfield Central Primary Care Trusts as a case study.

Number 10 health adviser calls for greater choice over GP services

N. Timmins

Financial Times, January 5th 2006, p.2

A report entitled Registering choice: how primary care should change to meet patient needs, started before its author Corrigan’s Downing Street appointment, calls for actual patient choice where local primary care services are inadequate. Where GP lists are closed choice is theoretical only. Additional service providers are needed to support a shift of focus from secondary to primary care in the NHS

Our health, our care, our say: a new direction for community services

Department of Health

London: TSO, 2006 (Cm 6737)

The White Paper signals a shift of NHS activity away from acute hospitals. Primary care trusts must move 5% of acute hospital activity into primary care over the next 10 years. There will be a new emphasis on community hospitals, possibly modelled on German polyclinics. Government is considering laying a statutory duty on the NHS and local authorities to work together to improve the health and well-being of older people. In the meantime the Department of Health will use inspection as a lever to achieve better joint working and commissioning. The budget cycle for the NHS and local authorities will be aligned from 2007-08, making pooling easier. Primary care trusts will also be required to increase spending on public health promotion and illness prevention in their populations.; Two pilot projects will be established to determine the extent to which psychological therapies can help people with mild to moderate mental health problems and enable them to return to work. There will be a wave of nationally supported procurements to improve access to primary care in the most deprived areas in Summer 2006. Social enterprises and the voluntary and independent sectors will be encouraged to bid. In future populations will shape their own procurements via as yet unidentified “local triggers” which will allow the public to voice concerns about the quality of services. PCTs will be expected to respond if there is evidence that needs are not being met. The Department of Health will introduce incentives in general practice in an attempt to improve access for patients. In future an element of GPs’ pay will be linked to patient satisfaction with opening hours and the bookings system.

(For comment see Health Service Journal, vol.116, Feb. 9th 2006, p.14-15)

Plans for overhaul of NHS attacked by MPs

B. Hall

Financial Times, January 11th 2006, p.3

The Health Select Committee finds little evidence to support the merger of primary care trusts and consequent staff transfers, and attacks the major restructuring.proposed by the government. Article provides background and reports the views of MPs, ministers and unions.

[See also Guardian, January 11th, p.10]

Traversing the network: a user-led Care Pathway approach to the management of Parkinson’s disease in the community

M. Holloway

Health and Social Care in the Community, vol.14, 2006, p.63-73

This article reports on a pilot study to develop and implement a Care Pathway framework for people with Parkinson’s Disease (PD) and their carers to facilitate more integrated and comprehensive health and social care, with a streamlining of the transfer of core information around the system. The pathway is user-led, conceptualising the user/carer as the “communications centre”, resourced and supported in the management of their situation by the professionals to achieve their own integrated package of care. The Care Pathway tools, comprising a local information pack, a Problems/Needs form, a Clinic Summary and a service record sheet, were designed by a working party consisting of service providers, a service user and carer and the researchers. The people with PD, their carers, the neurologist and specialist nurse involved in the pilot were all enthusiastic about the care pathway.

US company to take over GP practices

N. Timmins

Financial Times, January 12th 2006, p.2

United Health, whose president is a former Blair adviser, will take over two failing practices where services and health outcomes, according to the North Eastern Derbyshire trust, are poor. This is reportedly the first case of a major corporation taking on a GP practice; the move provides a foretaste of expected white paper proposals on the commissioning role of primary care trusts. Article touches on other corporate interest in primary care.

[See also Guardian, January 13th 2006, p.11]

What is the impact on individual health of services in general practice settings which offer welfare benefits advice?

S. Abbott, L. Hobby and S. Cotter

Health and Social Care in the Community, vol.14, 2006, p.1-8

Welfare benefits advice is increasingly being provided on primary care premises. It is assumed that the relief of poverty will also relieve ill health, although there is little evidence to support this. This paper reports findings of a study designed to measure changes in individual health associated with income increases as a result of such advice. The study uncovered relatively small but statistically significant improvements associated with income increase in bodily pain at six months and in mental health and emotional role at 12 months. While improvements in health associated with income increase are modest, they make a significant contribution to patients’ quality of life.

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