Search results

Torbay Care Trust has been widely promoted as an effective model of integrated health and social care, and yet the impact of reforms introduced by the previous and current governments has been to destabilise its partnership coherence and its organisational form. This paper seeks to explain why this is the case, highlighting the potentially damaging consequences for the local, currently productive, system of care; and to indicate the local adaptations necessary to maintain progress, which are seen as under continuing threat in the current financial environment.

This is a personal reflection by the chief executive of Torbay Care Trust, reviewing the documented progress made since 2005.

The model of partnership, collaboration and risk sharing carefully nurtured over 15 years in Torbay has been proven to be beneficial not only for local people, but for NHS financial and clinical performance generally, and for social care performance. This is now paradoxically being undermined by the more commercially‐minded policy approaches of Labour's Transforming Community Services programme and by the current NHS reforms. New tensions have arisen across the “health and social care divide”.

The current government is unequivocally committed to integrated care, and specifically to integrated health and social care. The Torbay experience gives insight firstly into the care and attention which may be needed by government to secure this over forthcoming years; and secondly to the way in which integrated commissioning will have to be conceived and organised in the new system, and how integrated services will have, in turn, to be commissioned, and operated.

This article presents the views of board members from two primary care groups in South West England on benefits and concerns relating to the imminent development of primary care trusts, and perceived implications for service delivery and management arrangements.

Primary care cancer lead clinicians (PCCLs) act strategically in primary care trusts (PCTs) in England to improve communication and understanding of cancer across primary and secondary care and provide a link between Cancer Networks and primary care. The aim is to evaluate the first three years of the initiative.

A postal questionnaire was sent to all PCT chief executives in all PCTs in England and some were passed on to other PCT managers for completion. The response rate was 61 per cent. PCT directors of public health were the largest group of respondents (29 per cent). Most (74 per cent) PCCLs were GPs and 22 per cent were nurses.

PCCLs were most likely to focus on palliative care and preventive services. Key achievements were identified as raising awareness of cancer, developing relationships and promoting primary care. The personal skills of the PCCLs were important as was support of colleagues at all levels. Lack of time was a major barrier to achievement, as was a lack of understanding of the role from others. Links with the Cancer Networks were being developed. About 85 per cent of managers wanted the role to continue.

The paper illustrates that PCCLs are at the forefront of improving cancer services in primary care. They are particularly important in view of the priority of reducing premature deaths and promotion of healthy lifestyles.

Clinical governance is a new policy introduced by the UK government to improve quality of care in the National Health Service; it imposes a “duty of quality” on all NHS organisations, and aims to bring together managerial, organisational and clinical approaches to improving quality of care. Infrastructures have been established to support quality improvement in NHS organisations and priorities for quality improvement have been established. Initial approaches are largely educational. However, information on quality of care is starting to be shared, and experiments are being conducted with a range of financial and contractual incentives for quality improvement. For widespread cultural change to occur, a “no blame” approach to quality improvement will be necessary; this may be incompatible with the need to identify and eliminate bad practice. Other tensions include the rapid pace of change being centrally driven and uneven development of the infrastructure to support clinical governance. What has not yet been shown is that quality of care has improved. It is too early to say this yet. Given the magnitude both of the vision and the work required, it is unlikely that change will be rapid, or seen on a widespread scale.

Despite evidence that early identification of dementia is of growing policy and practice significance in the UK, limited work has been done on evaluating screening measures for use in primary care. The aim of this paper is to offer a clinically informed synthesis of research and practice‐based evidence on the utility, efficacy and quality of dementia screening measures. The study has three elements: a review of research literature; a small‐scale survey of measures employed in three primary care trusts; and a systematic clinical evaluation of the most commonly used screening instruments. The authors integrated data from research and clinical sources. The General Practitioner Assessment of Cognition (GPCOG), Memory Impairment Screen (MIS) and Mini‐Cognitive Assessment Instrument (Mini‐Cog) were found to be: brief; easy to administer; clinically acceptable; effective; minimally affected by education, gender, and ethnicity; and to have psychometric properties similar to the Mini Mental State Examination (MMSE). Although the MMSE is widely used in the UK, this project identifies the GPCOG, MIS and Mini‐Cog as more appropriate for routine use in primary care. A coherent review of evidence coupled with an in‐depth evaluation of screening instruments has the potential to enhance ability and commitment to early intervention in primary care and, as part of a wider educational strategy, improve the quality and consistency of dementia screening.

THIS ARTICLE APPRAISES the Government's White Paper, The New NHS: Modern, Dependable, from the perspective of a health authority chief executive, outlining the context for developing health care, the joint challenges of the White Paper and the Green Paper, Our Healthier Nation, the role and potential of primary care groups (in detail), the developing role of the health authority, and the agenda for shaping and improving the delivery of health and health services. It ends with an appraisal of particular implications for community care.

Within the space of three years, the Department of Health oscillated between a commitment to partnership working and the imposition of structural change in the pursuit of integrated care. The idea of care trusts which integrate health and social care functions acquired political currency, despite the absence of any evidence base to inform the model. This article urges caution and suggests that the partnership model deserves a chance to deliver results.

Clinical audit may undergo organisational change as the new primary care trusts assume responsibility for community health services. Very little has been published, however, about community‐based audit. A survey of audit activities involving clinical audit staff was carried out in seven acute hospital trusts and seven community trusts in south east England in 1997. Audit staff completed survey forms for 65 acute projects and 75 community projects on defined topics. Managers in community trusts were much more likely to initiate audit projects or act as lead investigators than managers in the acute trusts, and they more frequently received copies of project reports. Clinical audit staff in community trusts participated more fully in the various phases of the audit process than staff in the acute trusts. If the best of the conventions for community audit practice are transferred to primary care trusts, the foundations of their clinical governance programmes should be strengthened.

STEPS is a primary care mental health team that has attempted to develop a very high volume multi‐level, multi‐purpose service for those with mild to moderate problems. The service attempts to overcome many of the limitations of more traditional services. This paper describes the services contained within the six level model.

The background is that clinical governance is a new mechanism for improving patient care within primary care organisations. The aim is to investigate the ability of practices in a single Primary Care Trust to improve influenza and pneumococcal vaccination uptake in high risk groups as a component of a clinical governance programme. A descriptive before and after study was undertaken at West Lincolnshire Primary Care Trust. Concludes that clinically, important improvements in influenza vaccination uptake occurred in patients over 65 years, and for influenza and pneumococcal vaccination in coronary heart disease and diabetic patients between the two audit cycles demonstrating the ability of participating practices to achieve and exceed national targets for influenza immunisation of these high‐risk groups.