A paper examined the role of primary care trusts in reversing the trend towards disengagement from the public sector.
Source: Iestyn Williams, Joan Durose, Edward Peck, Helen Dickinson and Elizabeth Wade, How Can PCTs Shape, Reflect and Increase Public Value?, Health Services Management Centre/University of Birmingham (0121 414 7050)
Links: Paper
Date: 2007-Dec
An audit report said that practice-based commissioning (introduced in 2005-06 to give family doctors greater financial control and responsibility over the services they commissioned for patients) was making 'limited progress'. Where there had been some success, it was largely the result of a small number of enthusiastic practices working closely with supportive primary care trusts which recognized the commitment involved.
Source: Putting Commissioning into Practice: Implementing practice based commissioning through good financial management, Audit Commission (0800 502030)
Links: Report | Audit Commission press release | Kings Fund press release | NHS Confederation press release | BMA press release | NHS Alliance press release
Date: 2007-Nov
Two linked articles examined social problems presented to family doctors in inner cities, and family doctors' responses; described patients' help-seeking pathways; and considered how these pathways could be improved. There was a need for more integrated pathways to help and advice for social problems.
Source: Jennie Popay, Ute Kowarzik, Sara Mallinson, Sara Mackian and Jacqui Barker, 'Social problems, primary care and pathways to help and support: addressing health inequalities at the individual level. Part I: the GP perspective', Journal of Epidemiology and Community Health, Volume 61 Number 11 | Jennie Popay, Ute Kowarzik, Sara Mallinson, Sara Mackian and Jacqui Barker, 'Social problems, primary care and pathways to help and support: addressing health inequalities at the individual level. Part II: lay perspectives', Journal of Epidemiology and Community Health, Volume 61 Number 11
Links: Abstract (1) | Abstract (2)
Date: 2007-Nov
A study found that many dental patients in England were being forced to pay for private care, go without treatment, or even pull out their own teeth, because they could not get National Health Service treatment locally.
Source: Dentistry Watch: National survey of the NHS dentistry system with views from both patients and dentists, Commission for Patient and Public Involvement in Health (0845 120 7111)
Links: Liberal Democrats press release | BBC report | Telegraph report
Date: 2007-Oct
A report said that the National Health Service was failing to offer sufficient out-of-hours family doctor care for severely ill patients. Existing services were 'inadequate and inflexible', and there was a need for better diagnostic facilities.
Source: Acute Medical Care: The right person, in the right setting, first time, Royal College of Physicians (020 7935 1174)
Links: RCP press release | BBC report | Guardian report
Date: 2007-Oct
A report by an all-party group of MPs highlighted weaknesses in the management of sexual health services in family doctor practices by primary care trusts in England.
Source: A Report into the Delivery of Sexual Health Services in General Practice, All-Party Parliamentary Pro-Choice and Sexual Health Group (020 7219 3138)
Links: Report | FPA press release
Date: 2007-Oct
A briefing paper said that family doctors should do more to help people with depression keep their job, and should avoid keeping them off sick for too long. A linked paper looked at the barriers to employment for people with common and severe mental health problems.
Source: Work and Wellbeing: Developing primary mental health care services, Sainsbury Centre for Mental Health (020 7827 8300) | Mental Health and Employment, Sainsbury Centre for Mental Health
Links: Briefing paper (1) | Briefing paper (2) | SCMH press release
Date: 2007-Sep
A report by a committee of MPs said that too many primary care trusts were 'paying lip service' to a government programme intended to boost quality and safety. It criticized defective communication between primary care trusts, family doctors, and other healthcare contractors.
Source: Improving Quality and Safety: Progress in implementing clinical governance in primary care – Lessons for the new primary care trusts, Forty-seventh Report (Session 2006-07), HC 302, House of Commons Public Accounts Select Committee, TSO (0870 600 5522)
Links: Report | NHS Confederation press release | Telegraph report
Date: 2007-Sep
The Secretary of State for Health said that the government wanted family doctor practices to provide extended opening hours at weekends and in the evenings, and described existing arrangements as an 'anomaly'.
Source: BBC interview with Alan Johnson MP (Secretary of State for Health), 10 September 2007
Links: BBC report | BMA press release | Telegraph report | Personnel Today report
Date: 2007-Sep
A report said that 'outdated' family doctor services should be overhauled, to extend opening hours and make them more flexible. Businesses lost 38 million working hours each year because employees had to visit their family doctor during working hours.
Source: Just What the Patient Ordered, Confederation of British Industry (020 7395 8247)
Links: Report | CBI press release | NHS Confederation press release | BBC report | Personnel Today report | Telegraph report
Date: 2007-Sep
A report said that reforms to National Health Service dentistry introduced in 2006 had not had a negative impact on services for patients. But official statistics showed that 28.1 million people went to a National Health Service dentist in England in 2006-07 – 50,000 fewer than in the previous 12 months; and the number of NHS dentists fell from 21,111 to 21,038.
Source: NHS Dental Reforms: One Year On, Department of Health (08701 555455) | Statistical press release 7 August 2007, Department of Health (020 7210 4850)
Links: Report | DH press release (1) | DH press release (2) | Consumer Association press release | Liberal Democrats press release | Guardian report (1) | Guardian report (2) | BBC report
Date: 2007-Aug
A think-tank report said that local councils should be given a greater role in managing health services where primary care trusts were failing.
Source: Victoria Barbary, Primary Care Trusts: Tailoring Commissioning, New Local Government Network (020 7357 0051)
Links: Report | NLGN press release | Community Care report
Date: 2007-Aug
A survey found that family doctors were working roughly the same surgery hours in 2006-07 as they had in 1992-93: but the number of home visits had dropped.
Source: 2006/07 UK General Practice Workload Survey, NHS Information Centre (0845 300 6016)
Links: Report | NHS press release | BMA press release | Liberal Democrat press release | CBI press release | BBC report | Telegraph report | Guardian report
Date: 2007-Jul
A results were published of a survey of over 2 million people in England on issues relating to family doctor services. 84 per cent did not feel the need for extended early morning or evening surgeries: but 25 per cent of those who wanted to book more than two days ahead for an appointment were unable to did so.
Source: Ipsos MORI, The GP Patient Survey 2006/2007: National Report, Department of Health (08701 555455)
Links: Report | Summary | Hansard | DH press release | BMA press release | NHS Confederation press release | Kings Fund press release | Help the Aged press release | BBC report
Date: 2007-Jul
An article examined the characteristics of primary care in deprived communities. Overall differences between primary care quality indicators in deprived and prosperous communities were small. However, shortfalls in specific indicators, both clinical and non-clinical, suggested that focused interventions could be applied to improve the quality of primary care in deprived areas.
Source: Mark Ashworth, Paul Seed, David Armstrong, Stevo Durbaba and Roger Jones, 'The relationship between social deprivation and the quality of primary care: a national survey using indicators from the UK Quality and Outcomes Framework', British Journal of General Practice, Volume 57 Number 539
Links: Abstract
Date: 2007-Jun
An article examined the impact of financial incentives for quality of care on practice organization, clinical autonomy, and internal motivation of doctors and nurses working in primary care in England. Financial incentives did not seem to have damaged the motivation of family doctors: but more concern was expressed by nurses.
Source: Ruth McDonald, Stephen Harrison, Kath Checkland, Stephen Campbell and Martin Roland, 'Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study', British Medical Journal, 30 June 2007
Date: 2007-Jun
An article examined a project (in a Glasgow housing estate) which used participatory action research to involve a deprived community in improving the quality of local primary care services. Although successful in creating a partnership between academic researchers and lay researchers, and increasing participation by local people in evaluating services, the impact of the study in terms of immediate action taken over specific issues was 'modest'.
Source: Peter Cawston, Stewart Mercer and Rosaline Barbour, 'Involving deprived communities in improving the quality of primary care services: does participatory action research work?', BMC Health Services Research, Volume 7
Date: 2007-Jun
A report said that primary care trusts were not ready for the new challenges of engaging the public and patients in local commissioning decisions.
Source: Alison Chisholm, Don Redding, Peter Cross and Angela Coulter, Patient and Public Involvement in PCT Commissioning: A survey of primary care trusts, Picker Institute Europe (01865 208100)
Links: Report
Date: 2007-Jun
A think-tank report said that the ability of primary care trusts to understand the health needs of ethnically diverse communities, and improve access to services, was being undermined by a lack of data about who used which National Health Service services.
Source: Ruth Thorlby and Natasha Curry, PCTs and Race Equality Schemes, King?s Fund (020 7307 2591)
Links: Report | King's Fund press release
Date: 2007-Jun
Researchers found that the behaviour of family doctors under performance-related pay was partially altruistic: 90.8 per cent of practices reported levels of achievement above the upper thresholds, which meant they could have reduced the number of patients treated by 12.4 per cent without reducing income. But delivered quality was lower in practices with more income-deprived patients and with a higher proportion of ethnic minority patients, though the effects of these variables were quite small.
Source: Hugh Gravelle, Matt Sutton and Ada Ma, Doctor Behaviour Under a Pay for Performance Contract: Evidence from the Quality and Outcomes Framework, Research Paper 28, Centre for Health Economics/University of York (01904 433648)
Links: Report
Date: 2007-May
An article reported a study which found no evidence that walk-in centres shortened waiting times for access to primary care. It said that the results did not support the use of walk-in centres for this purpose.
Source: Ravi Maheswaran et al., 'Impact of NHS walk-in centres on primary care access times: ecological study', British Medical Journal, 21 April 2007
Date: 2007-Apr
Two linked articles examined the new role of primary care mental health workers in practice. The first said that for patients with common mental health problems, primary care mental health workers might be effective at increasing satisfaction with an episode of care. The second said that primary care mental health workers appeared to provide a range of skills valued by patients and the primary care teams, and could increase patient access and choice.
Source: Helen Lester et al., 'Cluster randomised controlled trial of the effectiveness of primary care mental health workers', British Journal of General Practice, Volume 57 Number 536 | Elizabeth England and Helen Lester, 'Implementing the role of the primary care mental health worker: a qualitative study', British Journal of General Practice, Volume 57 Number 536
Links: Abstract (1) | Abstract (2)
Date: 2007-Mar
A report said that there was little evidence of any real growth in dental services since changes to the delivery of National Health Service dentistry were introduced in April 2006. 2 million people were still unable to find an NHS dentist.
Source: Gaps to Fill: CAB evidence on the first year of the NHS dentistry reforms, Citizens Advice (020 7833 2181)
Links: Report | Citizens Advice press release | CIPD press release | BBC report | Guardian report
Date: 2007-Mar
Researchers found evidence that general practices which had been given budgets were more active purchasers, that they reduced the types of admissions that they had to pay for, and that providers competed for their business by reducing waiting times for their patients.
Source: Hugh Gravelle and Mark Dusheiko, Budgets and Incentives in Primary Care, National Primary Care Research and Development Centre (0161 275 0611)
Links: Summary
Date: 2007-Mar
Researchers found a strong positive link between healthcare expenditure in England and health outcomes across primary care trusts.
Source: Stephen Martin, Nigel Rice and Peter Smith, The Link Between Health Care Spending and Health Outcomes: Evidence from English programme budgeting data, Research Paper 24, Centre for Health Economics/University of York (01904 433648)
Links: Paper
Date: 2007-Mar
A report by a committee of MPs said that the government had 'thoroughly mishandled' the introduction of a new system for out-of-hours healthcare by family doctors in England. Preparations had been 'shambolic', and only family doctors themselves had benefited from the new arrangements.
Source: The Provision of Out-of- Hours Care in England, Sixteenth Report (Session 2006-07), HC 360, House of Commons Public Accounts Select Committee, TSO (0870 600 5522)
Links: Report | BMA press release | NHS Confederation press release | BBC report | Guardian report
Date: 2007-Mar
A survey found that primary care trusts were struggling to support all patients in making choices about their hospital care. Two-thirds of trusts responding to the survey had not yet carried out any assessment to identify patients who might need support in making choices about which hospital to go to. A similar proportion had not commissioned any new services to support the introduction of patient choice.
Source: Ruth Thorlby and Paul Turner, Choice and Equity: PCT Survey, King's Fund (020 7307 2591)
Links: Report | King's Fund press release | Community Care report
Date: 2007-Mar
A study found huge regional variations in the availability of National Health Service dental care, as well as a continuing lack of practitioners taking on new patients. Just over a third of dental practices (36 per cent) were taking on any new NHS patients - no significant improvement since 2005 when the figure was 31 per cent. In some parts of the country, the figure was even lower.
Source: Press release 26 March 2007, Consumers' Association (020 7770 7000)
Links: Consumers' Association press release | BBC report
Date: 2007-Mar
Researchers examined the evidence for four different approaches to reducing demand for specialist outpatient treatment. They identified proven and promising interventions, but also evidence of ineffective or potentially harmful strategies where continued funding should be reviewed. There were common but unfounded assumptions about the effectiveness of some interventions.
Source: Martin Roland et al., Outpatient Services and Primary Care: A scoping review of research into strategies for improving outpatient effectiveness and efficiency, National Primary Care Research and Development Centre (0161 275 0611) and Centre for Public Policy and Management/University of Manchester
Date: 2007-Mar
Date: 2007-Feb
An article examined whether, and how, individual family doctors were influenced by a patient's age. Age was found to directly influence decision-making about angina investigation and treatment by half of the doctors in primary and secondary care samples.
Source: Clare Harries, Damien Forrest, Nigel Harvey, Alastair McClelland and Ann Bowling, 'Which doctors are influenced by a patient's age? A multi-method study of angina treatment in general practice, cardiology and gerontology', Quality and Safety in Health Care, Volume 16 Number 1
Links: Abstract | Age Concern press release | Telegraph report
Date: 2007-Feb
A report examined how to deliver improved primary care services for people with mental health problems. Practice-based commissioning needed to be extended to mental health in order to provide a range of services and treatments to patients. This would require commissioning training for family doctors and other primary care staff, and the introduction of a national tariff for mental health.
Source: Primary Concerns: A better deal for mental health in primary care, Mental Health Foundation (020 7803 1100) and Pharmaceutical Schizophrenia Initiative
Links: Report | MHF press release | Community Care report
Date: 2007-Jan
A report presented the findings of a small qualitative study of how family doctors felt about patient choice. There was broad support for extending patient choice: but family doctors identified several constraints that could affect patients? ability to choose between different providers.
Source: Rebecca Rosen, Dominique Florin and Ruth Hutt, An Anatomy of GP Referral Decisions: A qualitative study of GPs' views on their role in supporting patient choice, King?s Fund (020 7307 2591)
Links: Report
Date: 2007-Jan
An audit report said that almost all primary care trusts had clinical governance structures and processes in place that should assure the quality and safety of patient care. But progress in the implementation of these structures and processes varied within and between trusts. More needed to be done to provide assurance about family doctor performance and protect patient safety.
Source: Improving Quality and Safety: Progress in implementing clinical governance in primary care - lessons for the new primary care trusts, HC 100 (Session 2006-07), National Audit Office, TSO (0870 600 5522)
Links: Report | NAO press release | NHS Alliance press release | BBC report
Date: 2007-Jan
The Secretary of State for Health reportedly said that, with hindsight, the government should have capped the money family doctors could take out of their practices under the terms of their new contract agreed in 2004.
Source: BBC report, 19 January 2007
Links: BBC report | BMA press release | Guardian report | Personnel Today report
Date: 2007-Jan
