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

Application of health equity audit to health visiting

C. Pritchard and B. de Verteuil

Community Practitioner, vol. 80, May 2007, p. 38-41

The inverse care law states that those most in need are least likely to access health services, thereby resulting in an increase in health inequalities. Health equity audit is a tool that enables the identification and redistribution of resources on the basis of need. Within the former Charnwood and North West Leicestershire Primary Care Trust, a health equity audit was undertaken to ensure that provision of health visiting resource was based on the needs of the population. Equity was assessed using neighbourhood-based indices of multiple deprivation and hours of health visiting activity.

Care UK chief urges swift ISTC take-up

H. Mooney

Health Service Journal, vol.117, May 17th 2007, p. 18-19

Report of an interview with Mike Parish, Chief Executive of Care UK. Care UK is a growing private company, which aims to expand its provision of health services to the NHS. It owns independent treatment centres, walk-in centres and GP practices.

Cash-strapped contraceptive services plead for a target

H. Mooney

Health Service Journal, vol. 117, May 3rd 2007, p. 14-15

A recent survey by the Faculty of Family Planning and Reproductive Health Care has revealed that 40% of the current 207 community sexual and reproductive health clinics are having to reduce services due to financial constraints.

Governing the ethical consumer: identity, choice and the primary care medical encounter

R. McDonald and others

Sociology of Health and Illness, vol. 29, 2007, p. 430-456

The UK government is actively promoting the idea that one of the marks of a good citizen is the making of healthcare consumption choices of which it approves. These include not making unnecessary demands, acting reasonably when ill and so on. Ethical consumption of health services appears to involve balancing individual needs and wants with a moral obligation to think of others and use services only when essential. In the context of consulting a GP, people can feel torn between a sense of personal entitlement to use NHS services and anxiety about taking up the doctor’s time when others might be in greater need. The ethical health service consumer balances their needs with those of others, is reluctant to complain, and is grateful for the health services which the state provides.

Health visitor cuts affecting vulnerable families

C. Adams and I. Craig

Community Practitioner, vol. 80, May 2007, p. 14-17

The most recent annual survey of health visitors shows that:

• 79% of respondents said their workloads and levels of responsibility had increased
• 55% of respondents said that the number of core visits made had reduced
• 77% of respondents indicated that staffing levels in their unit had fallen
• 53% of respondents said that morale in their unit was poor

These results show the impact of reconfiguration on the levels of service being provided to families.

Making trouble for the NHS? Entrepreneurs and innovators in primary care, and the obstacles they face

NHS Alliance, 2007

This report examines policy proposals to increase entrepreneurial provision in primary care. It highlights the need for serious and sustained commitment to developing and regulating this market and warns of the danger of resistance from within the NHS. There are concerns that local NHS commissioners may create virtual monopolies, while appearing to implement the policy. The report recommends the creation of a fast-moving and flexible unblocking system to support entrepreneurs who can demonstrate that they are being obstructed.

(For comment by a panel of stakeholders see British Journal of Healthcare Management, vol. 13, 2007, p. 156-159)

NHS tops health system survey

N. Timmins

Financial Times, May 21st 2007, p.2

US based health foundation The Commonwealth Fund has ranked the NHS as the best system among the largest English speaking nations and Germany. The health systems of nations including the UK, New Zealand, Australia, Canada, the US and Germany were tested on efficiency, quality of care and equity. The UK offers the best coordinated care at a low cost. However the UK NHS scores poorly for access to care in terms of long waiting times. The UK is also at the bottom of the table for healthy lifestyles. The article claims that the results could be used as evidence to vindicate the decisions taken by the NHS in recent years with regard to the setting of GP targets and its administrative reforms.

PCTs grapple with grey areas of GP-led commissioning

A. Moore

Health Service Journal, vol. 117, May 24th 2007, p. 14-15

There are concerns that conflicts of interest may emerge if GP consortia commissioning new services also have a hand in providing them. There is also a danger that easier cases may be creamed off for treatment by GP-led services in primary care, while only complex cases will end up in hospitals. This could lead to a significant loss of income for acute trusts, and could undermine services. Patients may also be influenced by their GP into choosing a service in which the doctor has a financial interest. Primary care trusts face a considerable challenge in regulating this new market for services.

Self-care and the English National Health Service

M. Bury

Journal of Health Services Research and Policy, vol. 12, 2007, p. 65-66

The English NHS has invested heavily in the Expert Patients Programme, with the aim of helping patients with long term conditions manage them more effectively. Participants, all well-motivated volunteers, report immediate improvements in health, which tend to wear off over time. The benefits of self-care should not be exaggerated and its promotion must not lead to barriers to accessing professional help.

Welsh framework will cut through boundaries

H. Howson

Health Service Journal, vol.117, May 31st 2007, p. 16-17

In Wales chronic conditions are placing increasing demands on health and social care services. The Welsh Assembly government aims to meet this challenge by:

• Enabling patients to manage their conditions and remain independent
• Shifting services from acute care to local communities
• Integrating primary, secondary and social care