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Welfare reform on the Web ( February 2007): National Health Service - primary and community care

Creating “NHS local”: a new relationship between PCTs and local government

J. Glasby, J. Smith and H. Dickinson

Health Services Management Centre, University of Birmingham, 2006

This paper proposes three possible new approaches to strengthening the relationship between local government and the NHS in England:

  • Transfer of responsibility for health care commissioning from primary care trusts to local councils
  • Bringing local legitimacy to service commissioning by primary care trusts through the introduction of measures such as direct elections to PCT boards
  • Creating some sort of new entity in between health and local government (for example drawing on the police authority model where a combination of local councillors, magistrates and independent people have powers to raise local tax, set the budget and appoint the Chief Constable).

The preferred approach is a system of local government-led commissioning of health care, with current PCTs remaining as provider trusts.


Integrating care in community hospitals

H. Tucker

Journal of Integrated Care, vol.14, Dec. 2006, p.3-10

The health and social care white paper launched in 2006 heralded a new future for community hospitals as centres for patient-led integrated care. The evidence emerging from national and international studies is demonstrating the benefits of the community hospital model of care. There is, however, a tension between national policy and the current financial pressures to close or reduce services in one in three community hospitals in England. Innovative ways of owning and managing these services are being put forward by communities actively seeking to maintain and develop their local hospitals.

Operating a pooled budget and lead commissioning using Health Act flexibilities: the Oxfordshire experience

D. Roberts

Journal of Integrated Care, vol.14, Dec. 2006, p.36-44

The clear direction of national policy over the past five years has been to increase joint working between local authorities and the NHS. This led Oxfordshire Primary Care Trusts and the County Council to enter into an agreement for a pooled budget and lead commissioning arrangements under Section 31 of the Health Act to purchase a range of bed-based services for older people. This article describes the processes involved, the benefits and outcomes to date and the initial lessons learnt.

PCT futures

J. Stephenson (editor)

Health Service Journal, vol.117, Jan. 25th 2007, p.29-33

This special report brings together the main themes emerging from a conference on the future of Primary Care Trusts held in December 2006. It covers strengthening of commissioning, the development of community services, the role of the private sector in service provision, and the public engagement agenda.

The process of health visiting and its contribution to parental support in the Starting Well demonstration project

J. McIntosh

Health and Social Care in the Community, vol.15, 2007, p.77-85

Significant resources have been targeted at interventions designed to reduce the adverse effects of deprivation and poverty on children’s health and development. One such intervention was the Starting Well demonstration project established in a Scottish city in 2000. The project aimed to improve child health through a programme of activities to support families. The home visiting component of the project consisted of an intensive visiting schedule during the child’s first three years of life, the requirement to complete a family health plan, the aim to engage parents in goal setting directed at improving their own and their infants’ health, a staged programme of topics, and use of the Triple P parenting programme. This paper draws on findings from one of the qualitative evaluations of the project which investigated how interventions provided by health visitors were operationalised and how they were perceived by parents.

Shifting discourses of professionalism: a case study of general practitioners in the United Kingdom

L. Jones and J. Green

Sociology of Health and Illness, vol.28, 2006, p.927-950

This article reports data drawn from interviews with 20 young general practitioners about their attitudes to their work. The interviewees were looking for interesting and stimulating work in a relaxed and friendly environment which allowed them time to form relationships with patients. Unlike old-fashioned GPs, they regarded the practice of medicine as a job and not a vocation, and expected to achieve a favourable work-life balance.

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