An article examined the extent of integrated working between care homes and primary and community health and social services in England. More integrated working had the potential to improve quality of care in a cost-effective manner: but strategic decisions to create more formal arrangements were required to bring this about. Commissioners of services for older people needed to capitalize on good working relationships and address idiosyncratic patterns of provision to care homes.
Source: Heather Gage, Angela Dickinson, Christina Victor, Peter Williams, Jerome Cheynel, Sue L Davies, Steve Iliffe, Katherine Froggatt, Wendy Martin, and Claire Goodman, 'Integrated working between residential care homes and primary care: a survey of care homes in England', BMC Geriatrics, Volume 12
Date: 2012-Dec
A study examined the early development of new clinical commissioning groups (CCGs) in the National Health Service in England. There had been 'a great deal of activity and enthusiasm' from leading family doctors on the ground as they engaged with the new structures. Developing structures were 'complicated and multi-layered', as CCGs worked out how relationships between governance structures, operational responsibilities, and 'grass-roots members' would work in the longer term.
Source: Kath Checkland, Anna Coleman, Julia Segar, Imelda McDermott, Rosalind Miller, Andrew Wallace, Christina Petsoulas, Stephen Peckham, and Stephen Harrison, Exploring the Early Workings of Emerging Clinical Commissioning Groups: Final report, Policy Research Unit in Commissioning and the Healthcare System
Links: Report | Summary | PRU press release | Manchester University press release
Date: 2012-Nov
A report examined family doctors' views of a possible new support service to help employed people who were off sick from work to return to work quickly and prevent them from falling out of paid employment. Doctors supported the idea of such a service and would be happy to engage with it, recognizing the benefits of work to patient well-being.
Source: Fiona Fylan, Beth Fylan Gwynn, and Lauren Caveney, GPs Perceptions of Potential Services to Help Employees on Sick Leave Return to Work, Research Report 820, Department for Work and Pensions
Date: 2012-Nov
A think-tank report examined the association between patients' perceptions of the non-clinical aspects of care by family doctors in England and measures of clinical quality. Generally speaking, practices that delivered a good experience for their patients had higher outcomes scores. With some exceptions, practices that performed poorly on both clinical outcome measures and patient experience were more likely to be located in London and in more deprived areas.
Source: Veena Raleigh and Francesca Frosini, Improving GP Services in England: Exploring the association between quality of care and the experience of patients , King s Fund
Links: Report | Kings Fund blog post | Guardian report
Date: 2012-Nov
An article examined local priority-setting activity across five English primary care trusts. There had been a shift towards more explicit priority-setting, and there was concern in relation to the instrumental effects and the wider legitimacy of priority-setting activities.
Source: Suzanne Robinson, Iestyn Williams, Helen Dickinson, Tim Freeman, and Benedict Rumbold, 'Priority-setting and rationing in healthcare: evidence from the English experience', Social Science & Medicine, Volume 75 Issue 12
Links: Abstract
Date: 2012-Nov
A report said that patients wanted to be more involved in their care, but felt that family doctors were not delivering good communication or shared decision-making. Patients too often felt disempowered and disengaged, and reported feeling patronized. When patients raised concerns, nearly 1 in 4 felt that the response was poor – and 4.4 per cent said that they had been removed from their family doctor's list after making a complaint.
Source: Patients and GPs – Partners in Care, Patients Association
Links: Report | Patients Association press release | Telegraph report
Date: 2012-Sep
A think-tank report examined ways to improve patient access to family doctor services in Scotland. It called for catchment areas to be enlarged; steps to make it easier for new family doctor practices to open up; ending the ban on private companies opening up family doctor practices; and the provision of more, and clearer, information to patients about family doctor services. It also said that there should be a separate general medical services contract for Scotland.
Source: Ben Thomson, Geoff Mawdsley, and Alison Payne, Patients First: Improving access to GP practices, Reform Scotland
Links: Report | Reform Scotland press release | BMA press release | BBC report
Date: 2012-Sep
An article examined the impact of case-mix adjustment on family doctor performance scores in a national survey of patient experience. Although its effect was modest for most practices, case-mix adjustment corrected significant underestimation of scores for a small proportion of practices serving vulnerable patients. It might reduce the risk that providers would 'cream-skim' by not enrolling patients from vulnerable socio-demographic groups.
Source: Charlotte Paddison, Marc Elliott, Richard Parker, Laura Staetsky, Georgios Lyratzopoulos, John Campbell, and Martin Roland, 'Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey', BMJ Quality & Safety, Volume 21 Issue 8
Links: Abstract
Date: 2012-Jul
A report examined progress by the new clinical commissioning groups in the National Health Service in England. It included 12 case studies. It said that there had been 'real progress' in improving services for patients.
Source: Clinical Commissioning in Action, NHS Clinical Commissioners
Links: Report
Notes: Clinical commissioning groups – representing local doctors, nurses, and patients – will formally replace primary care trusts from April 2013.
Date: 2012-Jul
An article examined associations between the size of financial incentives and expected health gain in the 2004 and 2006 versions of the performance framework for family doctors (the 'Quality and Outcomes Framework'). No statistically significant associations were found between the expected health gain and the incentive gained from a marginal 1 per cent increase in performance. In addition, no associations were found between the size of financial payment for achievement of an indicator and the expected health gain at the performance threshold for maximum payment, measured in lives saved or quality-adjusted life years.
Source: Robert Fleetcroft, Nicholas Steel, Richard Cookson, Simon Walker, and Amanda Howe, 'Incentive payments are not related to expected health gain in the pay for performance scheme for UK primary care: cross-sectional analysis', BMC Health Services Research, Volume 12
Links: Abstract
Date: 2012-Jul
A professional organization for family doctors said that personal health budgets 'might have the potential, under the right circumstances' to provide benefits for 'some' patients: but their implementation in England posed a number of challenges that the government had not adequately addressed. There should be a delay while evidence from pilot studies was evaluated.
Source: Nigel Mathers, Mark Thomas, and Vanita Patel, Personal Health Budgets, Royal College of General Practitioners
Links: Statement
Date: 2012-Jul
Date: 2012-Jun
A report examined the capacity and capability of general practice, with a focus on family doctors and general practice nurses. Rising life expectancy, accompanied by increasingly complex long-term health conditions, a stretched primary care workforce, and unprecedented financial and healthcare reform were among the greatest challenges facing primary care. The report highlighted the need for general practice to work differently to cope effectively with the increasing demands it faced: this would be especially pertinent as family doctors took on the role of commissioners of local healthcare services.
Source: Primary Care: Today and Tomorrow – Improving general practice by working differently, Deloitte Centre for Health Solutions
Links: Report | Deloitte press release
Date: 2012-May
The fair trading watchdog said that half a million patients each year might have unnecessarily paid to receive private dental care after receiving inaccurate advice from their dentist.
Source: Dentistry: An OFT market study, Office of Fair Trading
Links: Report | OFT press release | BBC report | Guardian report | Public Finance report
Date: 2012-May
An article examined some of the key assumptions underpinning the continued development of family doctor-led commissioning in health services. It questioned the assumption that family doctors were best placed to commission health services in a way that met quality standards and led to equitable outcomes. There was little evidence to suggest that family doctors would succeed where others had failed; and there was a risk that, without top-down performance management, service improvement would be patchy – leading to greater, not reduced, inequity.
Source: Kate Gridley, Gemma Spiers, Fiona Aspinal, Sylvia Bernard, Karl Atkin, and Gillian Parker, 'Can general practitioner commissioning deliver equity and excellence? Evidence from two studies of service improvement in the English NHS', Journal of Health Services Research and Policy, Volume 17 Number 2
Links: Abstract
Date: 2012-Apr
An article examined the diversity of approaches to organizing and financing primary healthcare in the Netherlands, England, and United States of America. Approaches differed widely in the three countries: in England the emphasis was on improving the management of patients with multimorbidity, preventing hospital admissions in order to contain costs, and satisfying the increased demand of patients for access to primary care. In all three countries the need to improve co-ordination and integration of chronic disease care remained a core challenge.
Source: Antje Erler, Thomas Bodenheimer, Richard Baker, Nick Goodwin, Cor Spreeuwenberg, Hubertus Vrijhoef, Ellen Nolte, and Ferdinand Gerlach, 'Preparing primary care for the future – perspectives from the Netherlands, England, and USA', German Journal for Evidence and Quality in Health Care, Volume 105 Issue 8
Links: Abstract
Date: 2012-Mar
