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Welfare Reform on the Web (August 2006): National Health Service - primary and community care

Exit, voice, governance and user-responsiveness: the case of English primary care trusts

S. Pickard, R. Sheaff and B. Dowling

Social Science and Medicine, vol.63, 2006, p.373-383

Hirschman defined two mechanisms, exit and voice, whereby users can exert influence on service providers. Voice involves users influencing management decision-makers, while exit means deserting an unresponsive provider in favour of an alternative service. Three governance structures are involved in regulating English primary care trusts: market competition; co-ordination of networks of service providers in the public, private and voluntary sectors, including GPs, most of whom are private contractors; and hierarchical state control. This article looks at how the mechanisms of exit and voice work in modern English primary care trusts. Two new exit mechanisms now exist in quasi-markets. Commissioner exit occurs when a third-party payer stops using a given provider. Professional proxy exit occurs when a GP fund holder behaves similarly. Neither exit mechanism requires users to switch from NHS to private provision, provided that strong voice mechanisms exist to make commissioners responsive to user demands.

Good intentions could be disguising a big, bad threat

H. Mooney

Health Service Journal, vol.116, July 13th 2006, p.14-15

Government is promoting the development of social enterprises to deliver primary care in the 21st century. Social enterprises are businesses with primarily social objectives whose profits are reinvested in the business or the community instead of being handed out to shareholders. However, a network of social enterprises is not in place to bid for primary care service delivery contracts, and there is a danger that in the interim the most lucrative will be let to the private sector. By the time that social enterprises have entered the market, there may be little left for them.

NHS loses track of children’s jabs

G. Wilson

The Daily Telegraph, July 7th, 2006, p.1

A report by the Health Protection Agency claims that a glitch in the computer software used by 31 London primary care trusts has put thousands of children at risk as records of their vaccinations could not be kept. The failure of the computer system means that children are at risk of developing measles, rubella and diphtheria as health services cannot follow up on those who have not been vaccinated.

Signs of the times: will people power deliver accountability?

D. Carlisle

Health Service Journal, vol.116, July 27th 2006, p.14-15

The new Commissioning Framework for the English NHS envisages mechanisms that would force primary care trusts to respond to petitions from the public and/or service users. Petitions could express demands for a new service or dissatisfaction with an existing service. There are concerns that petitions could be used by special interest groups to exert undue influence on the development of local services.

“We are not looking for blame but improvement”

A. Nolan

Health Service Journal, vol.116, July 13th 2006, p.24-26

In 2005 Mersey Regional Ambulance Service trust was the worst performing in England. A strategic review recommended a robust approach to performance measurement and management to improve the situation. A dramatic improvement in the service was achieved by simplifying management systems, rethinking responses to emergency patients, and introducing a new performance framework.

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