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1 – 10 of over 27000Barbara Ann Allen, Elizabeth Wade and Helen Dickinson
Current English health policy is focused on strengthening the ‘demand-side’ of the health care system. Recent reforms are designed to significantly enhance the capability and…
Abstract
Current English health policy is focused on strengthening the ‘demand-side’ of the health care system. Recent reforms are designed to significantly enhance the capability and status of the organisations responsible for commissioning health care services and, in so doing, to address some of the perceived problems of a historically provider/supplierled health system. In this context, commissioning organisations are being encouraged to draw on concepts and processes derived from commercial procurement and supply chain management (SCM) as they develop their expertise. While the application of such principles in the health sector is not new, existing work in the UK has not often considered the role of health care purchasers in the management of health service supply-chains. This paper describes the status of commissioning in the NHS, briefly reviews the procurement and SCM literature and begins to explore the links between them. It lays the foundations for further work which will test the extent to which lessons can be extracted in principle from the procurement literature and applied in practice by health care commissioners.
Iestyn Williams, Helen Dickinson and Suzanne Robinson
Joint commissioning is an important part of the current health and social care context and will continue to be crucial in the future. An essential component of any commissioning…
Abstract
Joint commissioning is an important part of the current health and social care context and will continue to be crucial in the future. An essential component of any commissioning process is priority setting, and this paper begins to explore the idea of integrated priority setting as a key element of health and social care commissioning. After setting out the key terminology in this area and the main priority‐setting processes for health and social care, the paper describes a number of barriers that might be encountered in integrated priority setting. We argue that there are significant barriers in financing, accessibility, evidence and politics, and it is important that such barriers are acknowledged if priority setting is to become a component of joint commissioning. While these barriers are not insurmountable, the solution lies in engagement with a range of stakeholders, rather than simply a technical process.
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Emmanouil Gkeredakis, Jacky Swan, John Powell, Davide Nicolini, Harry Scarbrough, Claudia Roginski, Sian Taylor‐Phillips and Aileen Clarke
The paper aims to take a reflective stance on the relationship between policy/evidence and practice, which, the authors argue, is conceptually under‐developed. The paper aims to…
Abstract
Purpose
The paper aims to take a reflective stance on the relationship between policy/evidence and practice, which, the authors argue, is conceptually under‐developed. The paper aims to show that current research perspectives fail to frame evidence and policy in relation to practice.
Design/methodology/approach
A qualitative study was conducted in the English NHS in four Primary Care Trusts (PCTs). Seventy‐five observations of meetings and 52 semi‐structured interviews were completed. The approach to data analysis was to explore and reconstruct narratives of PCT managers' real practices.
Findings
The exploratory findings are presented through two kinds of narratives. The first narrative vividly illustrates the significance of the active involvement, skills and creativity of health care practitioners for policy implementation. The second narrative elucidates how problems of collaboration among different experts in PCTs might emerge and affect evidence utilisation in practice.
Practical implications
The findings exemplify that policies are made workable in practice and, hence, policy makers may also need to be mindful of practical intricacies and conceive policy implementation as an iterative process.
Originality/value
The contribution of this paper lies in offering an alternative and important perspective to the debate of utilisation of policy/evidence in health care management and in advancing existing understanding of health care management practice. The paper's rich empirical examples demonstrate some important dimensions of the complexity of practice.
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Anna Coleman, Stephen Harrison and Kath Checkland
The Local Government Act (2000) introduced new Overview and Scrutiny Committees, composed of elected non‐executive councillors, that can respond to proposals from the NHS for…
Abstract
The Local Government Act (2000) introduced new Overview and Scrutiny Committees, composed of elected non‐executive councillors, that can respond to proposals from the NHS for changes in services and also set their own agendas for more detailed scrutiny, including of the NHS. Limited capacity has meant that the focus of scrutiny has often been on statutory consultations from the NHS, service provision, NHS organisations and only occasionally on wider issues. However, it is commissioning that is officially seen as the main vehicle for shaping NHS services, so health scrutiny ought logically to address itself more to commissioning than to investigating providers. Practice‐based Commissioning (PBC) was introduced in 2004 with the aim of engaging front‐line clinicians in commissioning health care, though most such commissioning is being undertaken by groups of practices joining together to form consortia, rather than by individual GPs. In principle, this makes it more practicable for health scrutiny to include PBC, but consortia are not statutory bodies and cannot be compelled to participate. We suggest ways in which this omission might be addressed.
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Chantal Edge, Nikki Luffingham, Georgia Black and Julie George
This paper seeks to understand relationships between prison healthcare and integrated care systems (ICS), including how these affect the delivery of new healthcare interventions…
Abstract
Purpose
This paper seeks to understand relationships between prison healthcare and integrated care systems (ICS), including how these affect the delivery of new healthcare interventions. It also aims to understand how closer integration between prison and ICS could improve cross system working between community and prison healthcare teams, and highlights challenges that exist to integration between prison healthcare and ICS.
Design/methodology/approach
The study uses evidence from research on the implementation of a pilot study to establish telemedicine secondary care appointments between prisons and an acute trust in one English region (a cross-system intervention). Qualitative interview data were collected from prison (n = 12) and community (n = 8) healthcare staff related to the experience of implementing a cross-system telemedicine initiative. Thematic analysis was undertaken on interview data, guided by an implementation theory and framework.
Findings
The research found four main themes related to the closer integration between prison healthcare and ICS: (1) Recognition of prison health as a priority; (2) Finding a way to reconcile networks and finances between community and prison commissioning; (3) Awareness of prison service influence on NHS healthcare planning and delivery; and (4) Shared investment in prison health can lead to benefits.
Originality/value
This is the first article to provide research evidence to support or challenge the integration of specialist health and justice (H&J) commissioning into local population health.
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David Rushforth, Jit Patel, Alison James and Siobhan Chadwick
The scale of current demand on primary care services from people seeking help with common mental health problems places enormous pressure on the existing front line workers in…
Abstract
The scale of current demand on primary care services from people seeking help with common mental health problems places enormous pressure on the existing front line workers in general practice. The paucity of training opportunities and competing pressures to deliver improved services across a range of general practice targets remains a major challenge for primary care professionals. The impact of government policy, to improve both access to and choice of treatments, has raised public expectations.The commissioning of the graduate workforce, the graduate worker in primary care mental health (GWPCMH), commenced in 2002, in response to the publication of target numbers detailed in the Priorities and Planning Framework, (DoH, 2002). It signalled a determination to expand the workforce provision and improve the quality of care for service users with common mental health problems.This paper examines the scale of common mental health problems, the policy response and the commissioning process. Particular attention is given to examining the barriers that have been shown to affect implementation, identifying the key influencers and the resources required to train these workers.
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Coral Sirdifield, Rebecca Marples, David Denney and Charlie Brooker
This study aims to investigate the views of commissioners, providers and criminal justice staff on how effective current health-care provision is at meeting the health needs of…
Abstract
Purpose
This study aims to investigate the views of commissioners, providers and criminal justice staff on how effective current health-care provision is at meeting the health needs of people on probation. Understanding perceptions of what constitutes effective provision, where barriers are encountered and where improvements could be made is an important step towards improving access to care for this hard-to-reach group.
Design/methodology/approach
The research was part of a wider study. This paper focusses on findings from case studies conducted via semi-structured telephone interviews with 24 stakeholders in a purposive sample from six geographical areas of England. Interviews were conducted by researchers from a variety of backgrounds and an individual with lived experience of the criminal justice system. Data were analysed using thematic analysis.
Findings
Participants provided examples of effective health-care provision, which largely involved multi-agency partnership working. It was apparent that there are many barriers to providing appropriate health-care provision to people on probation, which are underpinned by the complexity of this population’s health-care needs, the complexity of the health-care landscape and problematic commissioning processes.
Practical implications
Improvements are needed to provide appropriate and accessible health care that meets the needs of people on probation, thereby reducing health inequalities. These include shared targets, improved funding, clearer pathways into care and giving probation a voice in commissioning.
Originality/value
To the best of authors’ knowledge, this is the first study of commissioner, provider and criminal justice staffs’ views on the effectiveness of current health-care provision at meeting the health needs of people on probation.
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David Stewart Briggs, Richard Nankervis, John Baillie, Catherine Turner, Kevin Rigby and Lorin Livingstone
The purpose of this paper is to review the establishment of Primary Health Network (PHN) in Australia and its utility in commissioning Primary Health Care (PHC) services.
Abstract
Purpose
The purpose of this paper is to review the establishment of Primary Health Network (PHN) in Australia and its utility in commissioning Primary Health Care (PHC) services.
Design/methodology/approach
This study is an analysis of management practice about the establishment and development of a PHN as a case study over the three-year period. The PHN is the Hunter New England and Central Coast PHN (HNECCPHN). The study is based on “insiders perspectives” drawing from documentation, reports and evaluations undertaken.
Findings
HNECCPHN demonstrates a unique inclusive organisation across a substantial diverse geographic area. It has taken an innovative and evidence-based approach to its creation, governance and operation. HNECCPHN addresses the health challenges of a substantial Aboriginal and/or Torres Strait Islander population. It contains significant and diverse urban, coastal and distinct rural, regional and remote populations. It can be described as a “virtual” organisation, using a distributed network of practice approach to engage clinicians, communities and providers. The authors describe progress and learning in the context of theories of complex organisations, innovation, networks of practice, knowledge translation and social innovation.
Research limitations/implications
The study provides initial publication into the establishment phase of a PHN in Australia.
Practical implications
The study describes the implementation and progress in terms of relevant international practice and theoretical concepts. This paper demonstrates significant innovative practice in the short term.
Social implications
The study describes significant engagement and the importance of that with and between communities, service providers and health professionals.
Originality/value
This is the first study of the results of the implementation of an important change in the funding and delivery of PHC in Australia.
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The report of the Royal Commission on Long Term Care, published in March 1999, is to be subject to further consultation, thus delaying any progress on its recommendations which…
Abstract
The report of the Royal Commission on Long Term Care, published in March 1999, is to be subject to further consultation, thus delaying any progress on its recommendations which include important links to other Government initiatives in health and social care. The paper argues that its proposal for a National Care Commission could be the missing link to equity of care provision and care standards for older people, and early implementation should not be lost.
Jenny Billings and Esther de Weger
Service transformation of health and social care is currently requiring commissioners to assess the suitability of their contracting mechanisms to ensure goodness of fit with the…
Abstract
Purpose
Service transformation of health and social care is currently requiring commissioners to assess the suitability of their contracting mechanisms to ensure goodness of fit with the integration agenda. The purpose of this paper is to provide a description and critical account of four models of contracting, namely Accountable Care Organisations, the Alliance Model, the Lead Provider/Prime Contractor Model, and Outcomes-based Commissioning and Contracting.
Design/methodology/approach
The approach taken to the literature review was narrative and the results were organised under an analytical framework consisting of six themes: definition and purpose; characteristics; application; benefits/success factors; use of incentives; and critique.
Findings
The review highlighted that while the models have relevance, there are a number of uncertainties regarding their direct applicability and utility for the health and social care agenda, and limited evidence of effectiveness.
Research limitations/implications
Due to the relative newness of the models and their emerging application, much of the commentary was limited to a narrow range of contributors and a broader discussion is needed. It is clear that further research is required to determine the most effective approach for integrated care contracting. It is suggested that instead of looking at individual models and assessing their transferable worth, there may be a place for examining principles that underpin the models to reshape current contracting processes.
Practical implications
What appears to be happening in practice is an organic development. With the growing number of examples emerging in health and social care, these may act as “trailblazers” and support further development.
Originality/value
There is emerging debate surrounding the best way to contract for health and social care services, but no literature review to date that takes these current models and examines their value in such critical detail. Given the pursuit for “answers” by commissioners, this review will raise awareness and provide knowledge for decision making.
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