Primary care groups will have to be good at this, and that and the other.

Functions of primary care groups (PCG) should be considered ahead of structures and those forming PCGs need to see the links between the key health and social policy initiatives. Early influence by PCGs will shape the design and local implementation of health action zones, health improvement programmes and performance frameworks. The Green Paper "Our Healthier Nation" and its successor are central to the emerging role of PCGs. Partnership work between GPs, practice staff, trusts, local authorities and health authorities needs emphasis. Recognition of what people and existing organisations can contribute needs to be given. Leadership themes of good primary care operations, health development and clinical leadership or their equivalents need time and space to emerge.     

Primary care. Otherwise engaged

Professional executive committees were devised to be the clinicians' voice in primary care trusts, but staff have complained of corporate sell-out. Policies like practice-based commissioning are seen as a catalyst to reform the committees. New-style PECs are abandoning some more general work to focus on modernisation.     

Association of population and practice factors with potentially avoidable admission rates for chronic diseases in London: cross sectional analysis

OBJECTIVES: To examine the association between underlying ill health, material deprivation and primary care supply factors and hospital admission rates for potentially avoidable admissions in primary care trusts in London. DESIGN: Cross sectional analysis at primary care trusts level using routine data from multiple sources. SETTING: All 31 primary care trusts in London with a total resident population of 7 million patients. MAIN OUTCOME MEASURES: Age-standardized hospital admission rates for asthma, diabetes, heart failure, hypertension and chronic obstructive pulmonary disease. RESULTS: Admission rates varied widely for the conditions examined across the 31 primary care trusts. In 2001, age adjusted admission rates for asthma varied from 76 to 189 per 100,000 and for diabetes from 38 to 183 per 100,000. There was a significant association between higher admission rates and measures of underlying ill health and material deprivation but not quantitative measures of primary care service provision. Provision of specialist chronic disease services in primary care for diabetes but not for asthma were significantly associated with reduced admission rates. There was no association of prescribing levels in primary care trusts with admission rates for any of the conditions examined. CONCLUSIONS: Although hospital admission for some chronic diseases is potentially avoidable and rates of hospital admission for these conditions are possible indicators of the quality of care, they should be interpreted in conjunction with measures of population composition and deprivation. Failure to do this may result in primary care trusts and general practitioners being criticized for aspects of health care utilization that are not under their direct control.     

Community care. In the know

People living in residential homes are becoming increasingly dependent and this trend is likely to continue, with more demands on district nursing services. An audit by one trust found that many staff in residential homes cared for highly dependent patients despite having little or no training. Primary care trusts are responsible for care in residential homes and should arrange staff training in preventing pressure injuries, managing incontinence, nutrition, rehabilitation, post-surgical care, and other topics.     

Support workers in intermediate care

Despite the proliferation of support worker roles in the UK, little is known about their actual numbers, employment conditions or levels of training. Intermediate care services appear to be an important employer of support workers, but the diversity of intermediate care services makes the task of understanding support worker roles even more complex. This paper presents data from 33 services which were involved in an NHS Modernisation Agency's Changing Workforce Programme project, the Accelerated Development Programme for Support Workers in Intermediate Care in England. Within this project, the main employers of support workers were primary care trusts and/or social services. Participating intermediate care teams were involved in admission avoidance, assisted discharge and reablement, or combinations of these services, and the majority of care was provided in the patient's own home. The 33 services employed 794 support workers and 368 professionally qualified staff. The mean ratio of professionally qualified staff to support workers was 0.95 (range = 0-4.9, SD = 1.05). Support worker 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 support worker training were National Vocational Qualifications 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: the allocation of a mentor; team supervision; and formal and informal line management. These findings illustrate the diversity of employment of support workers in intermediate care. The variations in training, supervision and skill mix have implications for clinical governance and support worker regulation. The employment of support worker staff jointly across health and social care raises cross-boundary issues around employment contracts and pay.     

Implementation of the hepatitis C guidelines in UK health care workers

BACKGROUND: The UK Health Department circular HSC 2002/010 requires health care employers to test certain groups of health care workers (HCWs) for hepatitis C, without additional funding. Little is known about the consistency of implementation of such guidelines. AIM: This study audited the process, completeness and problems of implementation of circular HSC 2002/010 in acute and ambulance trusts in London and the Southeast of England. METHOD: Telephone questionnaire survey of 51 National Health Service trusts between July and October 2005. RESULTS: The response rate was 92% (47/51). Eighty-five per cent (40/47) of the trusts reported partial or full implementation of the guidance. All compliant trusts reported testing HCWs entering exposure prone procedure specialities, although 40% (16/40) were testing more staff than specified in the guidance. CONCLUSION: Most trusts (85%) in this audit reported having implemented the guidance 3 years after publication and 90% claimed not to have needed additional funding. Implementation may be improved by greater clarity about which staff should be tested, frequency of testing and by raising HCWs awareness about hepatitis C infection and treatment. Newly published health clearance guidance addresses some of these points.     

Primary care trusts. No can do

Primary care trusts are already chronically short of staff and there is little evidence of workforce planning for the future. Some PCGs, managing sizeable budgets, have no finance staff at all. PCTs will face a shortage of GPs and difficulty retaining nurses. PCTs should make sure they are involved in their local workforce confederation in order to restructure the workforce.     

Primary care trusts. Leading lights

Involving clinicians, lay members and managers on the boards of primary care trusts has great potential for producing innovative services. The involvement of clinicians means decisions are more likely to be acceptable to staff on the frontline. It is important that strategic health authorities foster innovation and do not seek to become controlling of PCTs. It is vital that a culture of performance management does not hamper PCTs' development.     

A cost-effectiveness analysis of domestic radon remediation in four primary care trusts located in Northamptonshire, UK

The paper considers how primary care trusts (PCTs), which are relatively new organisations in the UK health service, might respond to the health hazards associated with radon in domestic properties. To this end, the cost-effectiveness of radon remediation programmes in four primary care trusts is calculated and compared with those of other interventions that can avert and treat lung cancer. The results suggest remediation programmes in the primary care trusts are cost-effective on various criteria. Policy recommendations that follow for the primary care trusts include encouraging remediation among their populations and identifying those most at risk from radon's effects.     

Part-time work and job sharing in health care: is the NHS a family-friendly employer?

This paper examines the nature and level of flexible employment in the National Health Service (NHS) by investigating the extent to which part-time work and job sharing arrangements are used in the provision and delivery of health care. It attempts to analyse the reasons for an increasing number of part-timers and a very limited number of job sharers in the NHS and to explain the advantages and disadvantages of each pattern of employment. Data collected through the use of questionnaires and interviews from 55 NHS trusts reveal that the use of part-time work is a tradition that seems to fit well with the cost-saving measures imposed on the management of the service but at the same time it has led to increasing employee dissatisfaction, and that job sharing arrangements are suitable for many NHS employees since the majority of them are women with a desire to combine family commitments with career prospects but a very limited number of employees have had the opportunity to job share. Therefore it is concluded that to attract and retain the quality of staff needed to ensure high performance standards in the provision and delivery of health care the NHS should accept the diversity that exists within its workforce and take a more proactive approach to promoting a variety of flexible working practices and family-friendly policies.     

Care trusts. A question of trust

The constitution, powers and accountability of care trusts have yet to be announced by the government. Their establishment offers opportunities for more integrated care. It is important that they are not perceived as takeovers of one organisation by another. The appointment of board members will be a key issue.     

Teaching primary care trusts. In a class of their own

The first three teaching primary care trusts, which came into operation in April 2001, have increased recruitment of GPs and practice staff. Sunderland PCT has reduced practice list sizes as a result of the initiative. Salford teaching PCT has tripled the number of training practices. Eighteen GPs have been recruited in Bradford.     

民营医院医疗风险致因分析与防范

目的 通过对2家大型民营医院风险信息进行收集和分析,探索出有效的防范措施,以减少医疗风险带来的损失,维护医患双方的共同利益.方法运用SPSS 17.0统计软件,对2家民营医院2005-2009年医疗纠纷、医疗意外和投诉资料信息进行统计学分析.结果因民营医院诊疗环境的复杂性,增加了医疗风险致因和防范的难度.其复杂性体现在卫生技术人员梯队构建不合理;依法执业意识薄弱,存在非法或跨范围执业;全民保健和维权法律意识的增强,提升了患者就医的期望值等种种供需矛盾的存在,体现出民营医院的不成熟的经营模式.有效的风险防范措施,要从实际出发,不断改进和完善医疗风险控制体系.结论民营医院在医疗风险防范措施上应从这几方面考虑：建立健全医疗风险监测、预警和追溯机制,制定医疗风险防范预案和奖惩制度;健全医院管理体制,引用高端卫生技术人员,合理组建人才梯队;重点科室、关键环节及时检测;贯彻落实医疗安全管理制度和防范措施;提高医务人员风险防范意识,实施三不放过,即：事实经过不放过、经验教训总结不放过、当事人认识不清不放过.     

Does general practitioner involvement in commissioning maternity care make a difference?

OBJECTIVES: To evaluate the impact of general practitioners' commissioning of maternity services on women's experiences of care and on resource use, and to consider the implications for primary care commissioning. METHOD: Comparison of women's experiences and resource use between 11 commissioning and 10 non-commissioning general practices. Face-to-face interviews with 212 staff in general practices, National Health Service trusts and health authorities between 1996 and 1998 to establish how maternity care was organised. Women's experience of information, choice, control and resource use obtained by questionnaire mailed 4 weeks post-partum. Data were analysed using multi-level modelling to adjust for case-mix differences. RESULTS: After two reminders, 1957 women (62%) responded to the questionnaire (inter-practice range 52-81%). There were no significant differences in women's experience of care or their resource use between commissioning and non-commissioning practices. Commissioning practices were more likely to be associated with more vertically integrated models of service organisation, but responses to only three of 21 questions about experience of information, choice and control over care, or about resource use, differed between the four models of service organisation identified. CONCLUSIONS: The expectation that giving primary care organisations responsibility for commissioning care will result in improved patients' experiences of care or better use of resources should be treated with caution. The presence of strong national policy may be equally important. Models of service organisation are not proxies for quality of care. The most powerful force shaping patients' experiences of care may be health care professionals' ability to translate national policy into local services.     

Predicting turnover rates among the staff of English and Welsh old people's homes

Staff turnover and wastage are particularly damaging in the personal social services where the establishment of staff-client relationships and a fund of experience are so important for ‘successful’ service or care. The vulnerability and dependence of the frail elderly in old people's homes make staff turnover and wastage especially problematic. The implications of staff turnover are briefly reviewed in this paper, and used as a basis for a study of the extent of staff turnover in the residential care sector. Using data on the personal characteristics of 8588 staff employed in old people's homes in England and Wales during 1976–1977, we estimated the individual propensities to change jobs and to leave social work-related employment altogether. These propensities were found to be significantly associated with age, sex, length of service, basic education and professional qualifications.     

Organization and financing of British primary care groups and trusts: observations through the prism of US managed care

There are many parallels between the UK's new primary care commissioning organizations and the managed care organizations and integrated delivery systems that have evolved in the USA over the last three decades. Those building primary care groups and trusts (PCG/Ts) can learn from the American experience with health maintenance organizations and other similar entities. These lessons should also be relevant to those in other countries interested in establishing innovative primary care led organizations within the broader structure of a socialized health care system. Following an overview of US managed care and an update of the progress of the UK's PCG/Ts, we go on to suggest how new consortia of PCG/Ts might be developed and how budgets and provider incentives could be structured. This international comparison suggests that the resources needed to support the development of effective PCG/Ts will be considerable, as will the need to maintain organizational flexibility. If primary care organizations are to thrive, it will be essential to develop truly integrated budgets for primary and secondary care.     

Staff attitude surveys. The morale majority

Since April 2000, it has been mandatory for all NHS organisations to conduct annual surveys of staff morale. Analysis of staff attitude surveys in 18 trusts and 20 health authorities in 2001 showed that most staff groups were not happy with their pay or the recognition they received. Managers were happy with all aspects of their jobs. Doctors and nurses were concerned about their safety. All employing organisations must act on these results to improve employment practice and help to develop motivation.     

Care pathways. Paving the way

Care pathways are most commonly used in acute trusts and private hospitals, according to a survey by the National Pathway Association. Orthopaedics is the specialty most likely to employ pathways, followed by surgery, medicine and care of elderly people. A third of respondents found the tool helped control costs, but a similar number found it did not. Setting and implementing standards of care and improving communication between staff are the most commonly reported benefits of using care pathways.     

Risk,governance and the experience of care

Drawing on perspectives from the governmentality literature and the sociology of risk, this article explores the strategies, tools and mechanisms for managing risk in acute hospital trusts in the United Kingdom. The article uses qualitative material from an ethnographic study of four acute hospital trusts undertaken between 2008 and 2010 focusing on the provision of dignified care for older people. Extracts from ethnographic material show how the organisational mechanisms that seek to manage risk shape the ways in which staff interact with and care for patients. The article bridges the gap between the sociological analysis of policy priorities, management strategy and the organisational cultures of the NHS, and the everyday interactions of care provision. In bringing together this ethnographic material with sociological debates on the regulation of healthcare, the article highlights the specific ways in which forms of governance shape how staff care for their patients challenging the possibility of providing dignified care for older people.