The government published revised guidance designed to increase the number of family doctor practices directly commissioning health services. There would be reduced bureaucracy around business cases and tendering; practices would be able to take on a larger budget covering an increased scope of services; and there would be strengthened local incentive schemes.
Source: Practice Based Commissioning: Practical Implementation, Department of Health (08701 555455)
Links: Guidance | DH press release | NHS Alliance press release
Date: 2006-Nov
The government announced a survey (involving 5 million patients) designed to discover how easy it was for people to see their family doctor. The results of the survey would be used to reward those family doctor practices offering patients good access to services.
Source: Press release 27 November 2006, Department of Health (020 7210 4850)
Links: DH press release | Guidance note | BBC report | Guardian report
Date: 2006-Nov
An article examined whether the quality of primary care measured by the 2004 contract varied with socio-economic deprivation. It said that the system did not reward the additional work required in deprived areas.
Source: Gary McLean, Matt Sutton and Bruce Guthrie, 'Deprivation and quality of primary care services: evidence for persistence of the inverse care law from the UK quality and outcomes framework', Journal of Epidemiology and Community Health, Volume 60 Number 11
Links: Abstract
Date: 2006-Oct
A report examined the impact of family doctor supply on individual health in England. A 10 per cent increase in supply led to an increase of 6 per cent in the proportion of the population in the area concerned reporting very good health.
Source: Hugh Gravelle, Stephen Morris and Matt Sutton, Are General Practitioners Good for You? Endogenous supply and health, Centre for Health Economics/University of York (01904 433648)
Links: Report
Date: 2006-Oct
A survey of dentists indicated that reforms to National Health Service dentistry (from April 2006) had not improved access for patients. 55 per cent of those surveyed said that the new contractual arrangements did not allow them to see more patients than previously. A further 23 per cent said they were seeing about the same number.
Source: Press release 19 October 2006, British Dental Association (020 7935 0875)
Links: BDA press release | Summary | BBC report
Date: 2006-Oct
A revised version was published of the professional code of conduct for family doctors. Doctors' right to practise would be at risk if they formed sexual relationships with either existing or former patients, or viewed pornography.
Source: Good Medical Practice, General Medical Council (020 7915 3507)
Links: Code | Guardian report
Date: 2006-Oct
Dentists who worked to the general dental services contract earned more from private work than from the National Health Service during 2004-05.
Source: Dental Earnings and Expenses: GB, 2004/05, NHS Health and Social Care Information Centre (0845 300 6016)
Links: Report | HSCIC press release | BBC report
Date: 2006-Sep
A statistical report said that family doctors in England provided higher quality services, and a wider range of services, to patients in 2005-06. On average, practices achieved 96 per cent of available points compared with 91 per cent in 2004-05. 1 in 10 practices achieved top marks.
Source: National Quality and Outcomes Framework: Statistics for England 2005/06, NHS Health and Social Care Information Centre (0845 300 6016)
Links: Report | DH press release | BMA press release | NHS Employers press release | BBC report
Date: 2006-Sep
An article examined the factors that differentiated those primary care trusts in financial deficit from those in surplus. The two groups of PCTs were found to serve two distinct populations with marked differences between the two. Deficit PCTs tended to be in relatively affluent and rural areas. Poor management alone was unlikely to be the cause of deficits. Potential reasons for deficits, including rurality and increased demand for health services in more affluent communities, needed further study.
Source: Padmanabhan Badrinath, Rosemary Anne Currell and Peter Bradley, 'Characteristics of primary care trusts in financial deficit and surplus a comparative study in the English NHS', BMC Health Services Research, Volume 6
Links: Article | Guardian report
Date: 2006-Sep
An article examined values-based practice as an approach to supporting clinical decision-making. (Values-based practice is a framework, developed originally in the domain of mental health, which maintains that values are pervasive and powerful parameters influencing decisions about health.)
Source: Mila Petrova, Jeremy Dale and Bill Fulford, 'Values-based practice in primary care: easing the tensions between individual values, ethical principles and best evidence', British Journal of General Practice, Volume 56 Number 530
Links: Abstract
Date: 2006-Sep
The government announced plans to give patients more say over how their local health services were organized and run. Primary care trusts would for the first time be required to formally respond to public petitions if more than one per cent of the local community were unhappy with a particular health service. The plans were published alongside new guidance on commissioning by primary care trusts.
Source: A Stronger Local Voice: A framework for creating a stronger local voice in the development of health and social care services, Department of Health (08701 555455) | Health Reform in England: Update and Commissioning Framework, Department of Health
Links: Local voice plan | Commissioning framework | Annex | Hansard | DH press release | CPPIH press release | LGA press release | NHS Alliance press release | Kings Fund press release | DHN press release | CBI press release | BBC report
Date: 2006-Jul
A report highlighted the early benefits of the new system of practice-based commissioning in the National Health Service.
Source: Practice Based Commissioning: A primary care led NHS, NHS Alliance (01777 869080)
Links: NHS Alliance press release
Date: 2006-Jul
An article examined user-responsiveness among primary care trusts in England, in the context of the emergence of quasi-markets in healthcare.
Source: Susan Pickard, Rod Sheaff and Bernard Dowling, 'Exit, voice, governance and user-responsiveness: the case of English primary care trusts', Social Science & Medicine Volume 63 Issue 2
Links: Abstract
Date: 2006-Jul
A report by a committee of MPs said that it was not possible to determine if a 1 billion public-private scheme to upgrade family doctors' surgeries and other primary care trust buildings was good value for money. It was essential to find a mechanism for evaluating the 'Lift' project, and there was a need for greater transparency.
Source: NHS Local Improvement Finance Trusts, Forty seventh Report (Session 2005-06), HC 562, House of Commons Public Accounts Select Committee, TSO (0870 600 5522)
Links: Report | UNISON press release | BBC report
Date: 2006-Jul
An audit report identified the key areas that primary care trusts and family doctors should be focusing on in the early stages of implementing practice-based commissioning.
Source: Early Lessons in Implementing Practice Based Commissioning, Audit Commission (0800 502030)
Links: Report
Date: 2006-Jun
A report said that there was growing enthusiasm for practice-based commissioning among family doctors practices. But they faced real obstacles, including a lack of communication from the Department of Health, strategic health authorities, and primary care trusts.
Source: Linda Marks and David Hunter, Practice Based Commissioning: Policy into practice, NHS Alliance (01777 869080)
Links: Report | NHS Alliance press release
Date: 2006-Jun
The government announced a reorganization of primary care trusts in England. The number of PCTs would be reduced from 303 to 152; and they would be more closely aligned with local authority boundaries, to improve joint working between health and social services.
Source: Press release 16 May 2006, Department of Health (020 7210 4850)
Links: DH press release | Hansard | LGA press release | Kings Fund press release | BBC report
Date: 2006-May
An audit report said that there had been shortcomings in the process of setting up new arrangements to provide out-of-hours primary medical care in England in 2004, although there was no evidence that patient safety had been compromised. The primary care trusts which took over responsibility for organizing out-of-hours services from family doctors lacked knowledge and experience in this area: but most patients said that they were receiving a good service, with 6 out of 10 rating it as excellent or good.
Source: The Provision of Out-of-Hours Care in England, HC 1041 (Session 2005-06), National Audit Office, TSO (0870 600 5522)
Links: Report | NAO press release | DH press release | BMA press release | NHS Alliance press release | RCGP press release | BBC report | Guardian report
Date: 2006-May
The government said that new contracts signed by dentists by the April 2006 deadline accounted for around 96 per cent of existing National Health Service dental services: claims of a 'mass exodus' of dentists from the National Health Service had proved unfounded.
Source: Press release 7 April 2006, Department of Health (020 7210 4850)
Links: DH press release | BBC report | Guardian report
Date: 2006-Apr
A think-tank report said that community-based organizations risked being left behind in the race to enter the primary healthcare market unless the government did more to support them.
Source: Richard Lewis, Peter Hunt and David Carson, Social Enterprise and Community-based Care: Is there a future for mutually owned organisations in community and primary care?, King s Fund (020 7307 2591)
Links: Report | King's Fund press release
Date: 2006-Apr
A paper said that primary care organizations should make mental health a priority for primary care within the National Health Service.
Source: Mental Health and Primary Care, Royal College of General Practitioners (020 7581 3232)
Links: Paper | RCGP press release
Date: 2006-Mar
The government began consultation on proposals to reform the regulation of pharmacists in Great Britain and pharmacy technicians in England and Wales.
Source: Pharmacists and Pharmacy Technicians Order 2006: A paper for consultation, Department of Health (08701 555455)
Links: Consultation document | DH press release
Date: 2006-Mar
The government responded to a report by a committee of MPs on the reconfiguration of primary care trusts.
Source: Changes to Primary Care Trusts: Government response to the Health Committee s report on changes to primary care trusts, Cm 6760, Department of Health, TSO (0870 600 5522)
Links: Response | MPs report
Date: 2006-Mar
A new book examined the background and development of primary care groups and primary care trusts in the English National Health Service. It drew evidence-based lessons for developing and researching primary care organizations.
Source: Judith Smith and Nick Goodwin, Towards Managed Primary Care: The role and experience of primary care organizations, Ashgate Publications (01235 827730)
Links: Summary
Date: 2006-Feb
An article examined how family doctors decided whether or not to offer a sick note. Doctors were more likely to offer a sick note to patients with a psychological problem. Issuing sick notes was unrelated to the patient's family circumstances or patient demand.
Source: Amaryllis Campbell and Jane Ogden, 'Why do doctors issue sick notes? An experimental questionnaire study in primary care', Family Practice, Volume 23 Number 1
Links: Abstract
Date: 2006-Feb
A report examined the determinants of annual net income and wages of family doctors in England. The average family doctor in 2008 had an annual net income of £97, 500 and worked 43 hours per week. Net income depended on gender, experience, list size, partnership size, whether or not the family doctor worked in a dispensing practice, whether they were salaried or self-employed, whether they worked in a practice with a nationally or locally negotiated contract, and the characteristics of the local population.
Source: Stephen Morris et al., Determinants of General Practitioners' Wages in England, Research Paper 36, Centre for Housing Policy/University of York (01904 433691)
Links: Paper
Date: 2006-Jan
A think-tank report advocated the use of patient choice to drive up standards in primary healthcare, and ensure equitable provision. Patients should be allowed to bypass their primary care trust and invite new primary care providers into their area if there was a shortage.
Source: Paul Corrigan, Registering Choice: How primary care should change to meet patient needs, Social Market Foundation (020 7222 7060)
Links: Report | Guardian report (1) | Guardian report (2)
Date: 2006-Jan
An article used data from a detailed qualitative study of the introduction of practice-based commissioning to examine structural interests in the National Health Service. Changes since 2002 had systematically privileged 'corporate monopolizers', and this was under challenge from 'professional rationalizers'.
Source: Kath Checkland, Stephen Harrison and Anna Coleman, '"Structural Interests" in health care: evidence from the contemporary National Health Service', Journal of Social Policy, Volume 38 Issue 4
Links: Abstract
Date: 2006-Jan
The inspectorate for healthcare and social care said that the National Health Service might fail to spot concerns about patient safety unless it improved its monitoring of out-of-hours family doctor services.
Source: Update on Enquiry Into Take Care Now and Out-of-Hours Services, Care Quality Commission (03000 616161)
Links: Report | Letter | CQC press release | NHS Confederation press release | Patients Association press release | REC press release | Guardian report | BBC report | Pulse report | Telegraph report
Date: 2006-Jan
A report highlighted the importance of improving clinical leadership, as well as general management skills, in primary care.
Source: Peter Reader, The Future of Clinical Leadership in Primary Care, NHS Alliance (01777 869080)
Links: NHS Alliance press release
Date: 2006-Jan
An article examined how reforms in English primary healthcare from 1998 to 2005 redistributed power between medicine and management. Evidence-based medicine had tended to weaken the impersonal sources of medical power. On balance, these events had tended to increase managerial power over medical practice.
Source: Rod Sheaff, 'Medicine and management in English primary care: a shifting balance of power?', Journal of Social Policy, Volume 38 Issue 4
Links: Abstract
Date: 2006-Jan
An article said that short-stay unplanned hospital admission rates in young children in England had increased substantially in recent years and were not accounted for by reductions in length of in-hospital stay. The majority were isolated short-stay admissions for minor illness episodes that could be better managed by primary care in the community and might be evidence of a failure of primary care services.
Source: Sonia Saxena, Alex Bottle, Ruth Gilbert and Mike Sharland, 'Increasing short-stay unplanned hospital admissions among children in England; time trends analysis 1997-2006', 15 October 2009, PLoS ONE
Links: Abstract | Imperial College press release | Telegraph report
Date: 2006-Jan
An article examined the hospital and community health service component of the formula for funding of England's 304 primary care trusts. It concluded that it might be better to put future resources into developing direct, rather than proxy, measurements of health needs.
Source: Mervyn Stone and Jane Galbraith, 'How not to fund hospital and community health services in England', Journal of the Royal Statistical Society: Series A, Volume 169 Issue 1
Links: Abstract
Date: 2006-Jan
A report by a committee of MPs said that a proposed restructuring of primary care trusts raised important questions about why shortcomings identified by the government, including increased management costs and dilution of bargaining power, could not have been easily anticipated and addressed before the introduction of the trusts. To introduce a large-scale reconfiguration of NHS organizations only three years after the previous reform pointed to an "ill thought-out approach to policy-making".
Source: Changes to Primary Care Trusts, Second Report, (Session 2005-06), HC 646, House of Commons Health Select Committee, TSO (0870 600 5522)
Links: Report | King's Fund press release | NHS Confederation press release | Guardian report
Date: 2006-Jan
A report examined the latest primary care mental health research, and the social and policy context of primary mental healthcare.
Source: Primary Care Mental Health, National Primary Care Research and Development Centre (0161 275 0611)
Links: Report | NPCRDC press release
Date: 2006-Jan
