Researchers said that family doctor-led companies had been more successful than corporate healthcare providers in winning contracts to run family doctor practices in England.
Source: Jo Ellins, Chris Ham and Helen Parker, Choice and Competition in Primary Care: Much Ado About Nothing?, Health Services Management Centre/University of Birmingham (0121 414 7050)
Links: Report | Birmingham University press release
Date: 2008-Nov
A think-tank report said that the relationship between family doctors and patients was being undermined by the government's culture of targets. The 'quality and outcomes framework' offered inappropriate financial incentives that could distract family doctors from providing high-quality personalized care for patients.
Source: James Gubb and Grace Li, Checking-up on Doctors: A review of the quality and outcomes framework for general practitioners, Civitas (020 7401 5470)
Links: Report | Civitas press release
Date: 2008-Nov
A think-tank report said that practice-based commissioning had so far proved to be an expensive investment that had delivered little in terms of better services for patients or financial savings for the National Health Service since its introduction in 2005. The government needed to carry out a fundamental reassessment of the policy and tackle waning enthusiasm among family doctors if it wanted to build on the limited progress the scheme had made.
Source: Natasha Curry, Nick Goodwin, Chris Naylor and Ruth Robertson, Practice-based Commissioning: Reinvigorate, Replace or Abandon?, King's Fund (020 7307 2591)
Links: Report | King's Fund press release | NHS Alliance press release | Alzheimers Society press release | BBC report | Pulse report
Date: 2008-Nov
A paper examined the link between spending and outcomes for several programmes of primary healthcare. There was a strong positive link between expenditure and better health outcomes (lower mortality rate).
Source: Stephen Martin, Nigel Rice and Peter Smith, The Link Between Health Care Spending and Health Outcomes for the New English Primary Care Trusts, Research Paper 42, Centre for Health Economics/University of York (01904 433648)
Links: Paper
Date: 2008-Oct
A report by a committee of MSPs said that there needed to be a shift in family doctors from affluent areas to more deprived areas where they were most needed.
Source: Health Inequalities Inquiry: Response to the Scottish Government, Scottish Parliament Health and Sport Committee, available from Blackwell's Bookshop (0131 622 8283)
Links: Report | SP press release
Date: 2008-Oct
A report highlighted problems in the quality and accessibility of primary healthcare services for older people.
Source: Primary Concerns: Older people's access to primary care, Age Concern England (020 8765 7200)
Links: Report | Age Concern press release | Community Care report
Date: 2008-Oct
New statistics showed that more than one-half of family doctor surgeries in England offered extended opening in the evenings and at weekends, meeting a government target.
Source: Statistical press release 14 October 2008, Department of Health (020 7210 4850)
Links: Statistical press release | DH press release | BBC report | Personnel Today report | Guardian report
Date: 2008-Oct
The government responded to a report by a committee of MPs on dental services. It said that the new dental contractual arrangements provided a better basis for primary care trusts to commission services, as the new system equipped them with greater powers and flexibility to meet the needs of local people. But it accepted that progress on improving access had been 'disappointing' to date, and that it would work with professional and patient groups to review how to achieve the maximum benefits for patients from the reforms.
Source: Government Response to the Health Select Committee Report on Dental Services, Cm 7470, Department of Health, TSO (0870 600 5522)
Links: Response | Hansard | DH press release | MPs report
Date: 2008-Oct
An article said that proposals in the Darzi review of the National Health Service for improving the supply of family doctor services in deprived communities underestimated the degree to which, relative to their healthcare needs, older populations experienced low availability of primary care. Many deprived practices appeared to have a better match between need and supply than practices serving affluent but ageing populations: but practices serving the oldest and most deprived populations had the worst availability of all.
Source: Sheena Asthana and Alex Gibson, 'Deprivation, demography, and the distribution of general practice', British Journal of General Practice, Volume 58 Number 555
Links: Abstract
Date: 2008-Oct
A report by a committee of MPs said that family doctors in England were working less but being paid more after the introduction of a new contract 'failed to live up to expectations'. Over the first three years the contract had cost £1.8 billion more than expected. Pay for family doctor partners had risen by 58 per cent to £114,000 a year: but much smaller rises had been seen for salaried family doctors and nurses.
Source: NHS Pay Modernisation: New contracts for general practice services in England, Forty-first Report (Session 2007-08), HC 463, House of Commons Public Accounts Select Committee, TSO (0870 600 5522)
Links: Report | NHS Confederation press release | NHS Alliance press release | RCN press release | BBC report | Guardian report | Telegraph report
Date: 2008-Oct
A survey found that unsuitable and potentially dangerous advice was being given by poorly trained staff in some pharmacies. Independent pharmacies fared particularly poorly, giving unsatisfactory advice on around half of visits.
Source: Advice Guide to Pharmacists, Consumers' Association (020 7770 7000)
Links: Report | Consumers' Association press release | RPSGB press release | Guardian report | BBC report
Date: 2008-Sep
An article examined the relation between socio-economic inequalities and quality of clinical care in the first 3 years of the quality and outcomes framework (a financial incentive scheme that remunerates general practices for their performance against a set of quality indicators). The results suggested that financial incentive schemes had the potential to make a substantial contribution to the reduction of inequalities in the delivery of clinical care related to area deprivation.
Source: Tim Doran, Catherine Fullwood, Evangelos Kontopantelis and David Reeves, 'Effect of financial incentives on inequalities in the delivery of primary clinical care in England: analysis of clinical activity indicators for the quality and outcomes framework', The Lancet, 5 September 2008
Links: Abstract
Date: 2008-Sep
A think-tank report said that there were widespread variations in how much National Health Service primary care trusts in England spent on different health problems – even after the different needs of local communities were taken into account. Spending between the highest and lowest spending PCTs varied 2.9-fold on mental health, 2.5-fold on cancer, and 2.2-fold on circulatory diseases.
Source: John Appleby and Sarah Gregory, NHS Spending: Local variations in priorities – An update, King's Fund (020 7307 2591)
Links: Report | King's Fund press release | NHS Confederation press release | St Mungos press release | Liberal Democrats press release | Telegraph report | BBC report | Guardian report
Date: 2008-Sep
An article examined the experience and impact of the new general medical services contract (introduced in 2004) on public health activities in general practice. Although the contract had only been operating for three full years, there was emerging evidence to suggest that it might have a negative impact. The use of financial incentives appeared to be skewing practice towards areas that were rewarded, which might not be those that maximized health outcomes; and there was some emerging evidence suggesting that there was a negative effect on health inequalities.
Source: Stephen Peckham and Alison Hann, 'General practice and public health: assessing the impact of the new GMS contract', Critical Public Health, Volume 18 Number 3
Links: Abstract
Date: 2008-Sep
In 2007-08, family doctor practices in England were awarded an average score of 96.8 per cent achievement against a set of evidence-based indicators developed to assess the quality of care provided to patients. This compared with an average achievement of 95.5 per cent in 2006-07.
Source: Press release 30 September 2008, NHS Information Centre (0845 300 6016)
Links: NHS press release | BMA press release
Date: 2008-Sep
A report by a committee of MPs said that changes designed to improve National Health Service dental services in England had not been successful. Access remained 'patchy', and there had been a sharp fall in the number of complex procedures carried out.
Source: Dental Services, Fifth Report (Session 2007-08), HC 289, House of Commons Health Select Committee, TSO (0870 600 5522)
Links: Report | Liberal Democrats press release | BBC report | Telegraph report | Guardian report
Date: 2008-Jul
An audit report in Scotland said that the new contract for family doctor practices should have been better planned, and would take time to improve care for patients. However, there was evidence of improvement in the care of some patients.
Source: Review of the New General Medical Services Contract, Audit Scotland for Accounts Commission and Auditor General (0131 477 1234)
Links: Report | Audit Scotland press release | BMA press release | RCN press release | BBC report
Date: 2008-Jul
An article examined the effects of a large scale 'payment for performance' scheme (the 'Quality and Outcomes Framework') on professional roles and the delivery of primary care. Payment for performance was driving major changes in the roles and organization of primary healthcare teams. Non-incentivized activities and patients' concerns might receive less clinical attention. Practitioners would benefit from improved dissemination of the evidence justifying the inclusion of new performance indicators in the QOF.
Source: Susan Maisey et al., 'Effects of payment for performance in primary care: qualitative interview study', Journal of Health Services Research and Policy, Volume 13 Number 3
Links: Abstract
Date: 2008-Jul
The government published a strategy setting out the future direction for primary and community care in England. It said that the new strategy would give patients and the public a stronger voice, enable them to make informed decisions, and have greater choice and control in managing their health and healthcare.
Source: Our Vision for Primary and Community Care, Department of Health (08701 555455)
Links: Strategy | DH press release | Kings Fund press release | NHS Confederation press release | NHS Alliance press release | RCN press release | Turning Point press release | UNISON press release | RPSGB press release
Date: 2008-Jul
The healthcare inspectorate said that more patients reported being 'completely satisfied' with care in family doctor practices and health centres, with high proportions saying that they were treated with dignity and listened to carefully. But patients wanted better access to family doctors and dentists.
Source: National NHS Patient Survey Programme: National Survey of Local Health Services, Commission for Healthcare Audit and Inspection (020 7448 9200)
Links: Report | CHAI press release | BBC report | Guardian report | Telegraph report
Date: 2008-Jul
The Scottish Government announced that it would legislate to prevent commercial companies being able to run family doctor services.
Source: Press release 8 July 2008, Scottish Government (0131 556 8400)
Links: SG press release | FT report
Date: 2008-Jul
A think-tank report examined the opportunities and risks of developing polyclinics. It welcomed the government's ambition to develop more patient-focused and integrated models of care: but it warned that poor implementation of the polyclinic model could create 'significant risks' for patient care.
Source: Candace Imison, Chris Naylor and Jo Maybin, Under One Roof: Will polyclinics deliver integrated care?, King's Fund (020 7307 2591)
Links: Report | Kings Fund press release | NHS Confederation press release | BMA press release | Guardian report | BBC report | Telegraph report
Date: 2008-Jun
A report said that although there was a place for large health centres in primary care, they were not the only route towards high-quality, integrated health services in every community. In many places an alternative approach – one that built on the strengths of the GP-led primary care service – might offer an equally effective or better route towards improved patient care.
Source: Stephen Field, Clare Gerada, Maureen Baker, Mike Pringle and Ken Aswani, Primary Care Federations: Putting patients first, Royal College of General Practitioners (020 7581 3232)
Links: Report | RCGP press release | RPSGB press release
Date: 2008-Jun
A think-tank report said that further devolution within the health service could help to improve service delivery. It said that local authorities should be given a more significant role in, and share more of their expertise with, local primary care trusts.
Source: Matthew Clifton, Healthy Places: Bonds that bind local government and primary care trusts, New Local Government Network (020 7357 0051)
Links: Report | NLGN press release
Date: 2008-Jun
A think-tank report said that the conversation between family doctors and patients was under enormous pressure, and should be rethought for a less deferential age in which patients had access to vast amounts of medical information.
Source: Jack Stilgoe and Faizal Farook, The Talking Cure: Why conversation is the future of healthcare, Demos, available from Central Books (020 8986 5488)
Links: Report | Demos press release
Date: 2008-May
Two reports examined ways of improving the access to, and responsiveness of, family doctor services for black and minority ethnic groups. The first focused on the variation in patient satisfaction between practices; the second examined the reasons for lower satisfaction among patients from some BME communities.
Source: David Colin-Thome, Report of the National Improvement Team for Primary Care Access and Responsiveness, Department of Health (08701 555455) | Mayur Lakhani, No Patient Left Behind: How can we ensure world class primary care for black and ethnic minority people?, Department of Health
Links: Report (1) | Report (2) | DH press release
Date: 2008-May
A think-tank report examined whether polyclinics would improve the quality and accessibility of healthcare and deliver cost savings. Although there were opportunities to improve the quality of care and address some longstanding problems in the English healthcare system, there were also risks, particularly around the transition to this new model.
Source: Candace Imison, Chris Naylor and Jo Maybin, Under One Roof: Will polyclinics deliver integrated care?, King's Fund (020 7307 2591)
Links: Report
Date: 2008-May
An article examined the autonomy or 'room for manoeuvre' of local organizations within local health economies in England, with specific reference to primary care trusts.
Source: Mark Exworthy and Francesca Frosini, 'Room for manoeuvre? Explaining local autonomy in the English National Health Service', Health Policy, Volume 86 Issue 2-3
Links: Abstract
Date: 2008-May
A report said that most National Health Service patients were living with long-term and multiple conditions, and could not be treated by a one-off episode of hospital care: instead they dealt on a continuing basis with their family doctor, practice nurse, various community services, social care, and occasional – sometimes frequent – hospital admissions as well. It said that family doctors should therefore reclaim responsibility for round-the-clock care; that joint working between consultants, family doctors, and other clinicians should be improved; and that a new type of doctor was needed – the 'community specialist consultant', equivalent to a hospital consultant but with special training in the clinical and management skills needed to work across the boundaries between hospitals and primary care.
Source: In Sickness and in Health: Achieving an integrated NHS, NHS Alliance (01777 869080)
Links: NHS Alliance press release | BBC report | Telegraph report
Date: 2008-Apr
The government published a White Paper which proposed a bigger role for pharmacists in treating sickness and promoting good health. It was estimated the proposals could save 57 million family doctor consultations a year.
Source: Pharmacy in England: Building on strengths – delivering the future, Cm 7341, Department of Health, TSO (0870 600 5522)
Links: White Paper | Hansard | DH press release | RPSGB press release | NHS Confederation press release | BMA press release | CBI press release | BBC report | Guardian report
Date: 2008-Apr
A report examined the 'polyclinic' model – bringing family doctors together with diagnostic and other services. Many of the potential benefits of the new model had not been fully considered due to 'misconceptions' about it.
Source: Ideas from Darzi: Polyclinics, NHS Confederation (020 7959 7272)
Links: Report | NHS Confederation press release | BMA press release | Turning Point press release
Date: 2008-Apr
A think-tank report said that there was a need for greater clarity about what politicians meant when they talked about increasing local accountability in the National Health Service. It was not even clear to what extent people wanted more control over how their primary care trust spent its money.
Source: Ruth Thorlby, Richard Lewis and Jennifer Dixon, Should Primary Care Trusts Be Made More Locally Accountable?, King's Fund (020 7307 2591)
Links: Report | King's Fund press release
Date: 2008-Apr
A survey found widespread confusion among patients in England about access to dental services in their locality; and an unacceptably variable service depending on the primary care trust commissioning the services. Patients were at risk of inadequate care because units of dental activity were being funded, rather than patient need.
Source: The New Dental Contract: Full of holes and causing pain? A survey of primary care trusts in England, Patients Association (020 8423 9111)
Links: Report | Patients Association press release
Date: 2008-Mar
An article examined efforts made at an organizational level in England to improve the quality of primary care for people with mental health problems through the new institutional processes of clinical governance. Despite some achievements with regard to monitoring and standardization of prescribing practice, mental healthcare in primary care seemed to have so far largely 'eluded the gaze' of clinical governance.
Source: Linda Gask, Anne Rogers, Stephen Campbell and Rod Sheaff, 'Beyond the limits of clinical governance? The case of mental health in English primary care', BMC Health Services Research, Volume 8
Date: 2008-Mar
An article examined patients' views of sickness certification within general practice consultations, and how these could be improved. Patients did not feel that being questioned by their family doctor or discussing return to work threatened the doctor-patient relationship.
Source: Kathryn O'Brien, Naomi Cadbury, Stephen Rollnick and Fiona Wood, 'Sickness certification in the general practice consultation: the patients' perspective, a qualitative study', Family Practice, Volume 25 Number 1
Links: Abstract
Date: 2008-Mar
The union representing family doctors said that it would accept government proposals for extending surgery opening hours by three hours per week.
Source: Press release 8 February 2008, British Medical Association (020 7387 4499)
Links: BMA press release | Guardian report | BBC report
Date: 2008-Feb
Researchers examined the factors affecting the quality of family doctor services under a system of financial incentives. The results suggested that doctors were partially altruistic, in that the majority produced markedly higher quality than was required to maximize their financial rewards.
Source: Hugh Gravelle, Matt Sutton and Ada Ma, Doctor Behaviour under a Pay for Performance Contract: Further evidence from the Quality and Outcomes Framework, Research Paper 34, Centre for Health Economics/University of York (01904 433648)
Links: Paper
Date: 2008-Feb
An audit report said that the new contract for family doctors had contributed to improved recruitment and retention of family doctors, with numbers increasing from 26,833 to 30,931 since 2003. However, the contract had cost the government £1.76 billion more than it originally budgeted for; and in the first two years of the contract productivity had fallen by an average of 2.5 per cent per year. The pay of salaried family doctors had increased by only 3 per cent, while partners in family doctor practices had taken a profit that had increased their earnings by 58 per cent.
Source: NHS Pay Modernisation: New contracts for general practice services in England, HC 307 (Session 2007-08), National Audit Office, TSO (0870 600 5522)
Links: Report | NAO press release | NHS Employers press release | BMA press release | Liberal Democrats press release | Guardian report | BBC report | Telegraph report | Personnel Today report
Date: 2008-Feb
A report by a committee of the National Assembly for Wales said that a new family doctor contract, which included a 25 per cent pay rise, had not brought enough improvements for patients – with many still having problems in getting an appointment.
Source: Review of the New General Medical Services Contract in Wales, Audit Committee/National Assembly for Wales (029 2082 5111)
Links: Report | NAW press release | NHS Wales press release | BMA press release | BBC report
Date: 2008-Jan
A survey found that lack of access was the most common reason cited by people in England and Wales for not seeing a National Health Service dentist (along with not needing treatment). It was mentioned by 31 per cent of respondents who had not been to an NHS dentist since April 2006 – equivalent to approximately 7.4 million people.
Source: Press release 16 January 2008, Citizens Advice (020 7833 2181)
Links: Citizens Advice press release
Date: 2008-Jan
A report examined ways to improve the local accountability of primary care trusts. Greater accountability could be achieved by: strengthening existing structures – in particular, health overview and scrutiny committees in local government; more deliberative events to promote further public involvement in primary care trust decision-making; greater transparency and information for the public about how decisions were made; building better relationships and more information-sharing between local government and primary care trusts.
Source: Principles for Accountability: Putting the public at the heart of the NHS, NHS Confederation (020 7959 7272)
Links: Report | NHS Confederation press release
Date: 2008-Jan
