UK National Health Service (uk + national_health_service)

Distribution by Scientific Domains

Selected Abstracts

A collaborative approach to embedding graduate primary care mental health workers in the UK National Health Service

Janine Fletcher MSc
Abstract The UK National Health Service (NHS) workforce has recently seen the arrival of the Graduate Mental Health Worker (GMHW) in primary care. We established a Quality Improvement Collaborative to assist in embedding this new workforce in one Strategic Health Authority Area of England. The intervention utilised ,collaborative' technology which involves bringing together groups of practitioners from different organizations to work in a structured way to improve the quality of their service. The process was evaluated by an action research project in which all stakeholders participated. Data collection was primarily qualitative. During the project, there was an increase in throughput of new patients seen by the GMHWs and increased workforce satisfaction with a sense that the collaborative aided the change process within the organizations. Involvement of managers and commissioners from the Primary Care Trusts where the GMHWs were employed appeared to be important in achieving change. This was not, however, sufficient to combat significant attrition of the first cohort of workers. The project identified several barriers to the successful implementation of a new workforce for mental health problems in primary care, including widespread variation in the level and quality of supervision and in payment and terms of service of workers. A collaborative approach can be used to support the development of new roles in health care; however, full engagement from management is particularly necessary for success in implementation. The problems faced by GMHWs reflect those faced by other new workers in healthcare settings, yet in some ways are even more disturbing given the lack of governance arrangements put in place to oversee these developments and the apparent use of relatively unsupported and inexperienced novices as agents of change in the NHS. [source]

The effects of expanding patient choice of provider on waiting times: evidence from a policy experiment

Diane Dawson
Abstract Long waiting times for inpatient treatment in the UK National Health Service have been a source of popular and political concern, and therefore a target for policy initiatives. In the London Patient Choice Project, patients at risk of breaching inpatient waiting time targets were offered the choice of an alternative hospital with a guaranteed shorter wait. This paper develops a simple theoretical model of the effect of greater patient choice on waiting times. It then uses a difference in difference econometric methodology to estimate the impact of the London choice project on ophthalmology waiting times. In line with the model predictions, the project led to shorter average waiting times in the London region and a convergence in waiting times amongst London hospitals. Copyright 2006 John Wiley & Sons, Ltd. [source]

A study into dentists' knowledge of the treatment of traumatic injuries to young permanent incisors

Summary. Objective., The aims of this study were to evaluate dentists' knowledge of the emergency treatment of traumatic injuries to young permanent incisors, and to investigate barriers to treatment. Design., A closed-ended questionnaire was sent to 1023 general dental practitioners (GDPs) and community dental officers (CDOs) in West/North Yorkshire and Humberside, UK. Methods., The questionnaire comprised 17 questions. Six questions asked for general information about the participants (i.e. profession, age, gender, year of graduation, training or education on dental trauma, and willingness to provide emergency care), 10 were relevant to the emergency treatment of crown fractures, root fractures, luxation and avulsion injuries, and the last question queried any perceived barriers to treatment. Results., Seven hundred and twenty-four questionnaires were returned, a response rate of 71%, and these indicated that dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. The CDOs were significantly more knowledgeable than the GDPs, as were younger and more recently graduated dentists compared with older ones. The GDPs regarded the difficulty of treating children and the inadequate fees of the UK National Health Service as important barriers to treatment. Dentists who attended continuing dental education courses on dental traumatology had a more thorough knowledge than those who did not. Conclusion., Overall, the dentists' knowledge of the emergency treatment of dentoalveolar trauma in children was inadequate. Greater emphasis on undergraduate and postgraduate education in this area is indicated. [source]

Calman,Hine reassessed: a survey of cancer network development in England, 1999,2000

Beth Kewell BA PhD
Abstract Rationale, aims and objectives,The paper assesses preliminary national data on the development of cancer care networks in England. Methods,In January 2000, a national postal survey was sent to lead clinicians at 36 cancer centres and associate centres. Respondents were asked to provide basic numerical data on the design of the network (i.e. its configuration), detailing how many units it encompassed, and whether the centre was a multiple or a single entity. Results,The survey highlighted national variations in the size and configuration of networks. The survey also highlighted tentative signs of shifts in clinical practice. The results showed that consultants at cancer centres and units were engaging in two forms of collaboration across centre,unit boundaries. Type 1 involved routine multidisciplinary team (MDT) outreach from centres to units, incorporating joint planning between clinicians at cancer centres and cancer units. Type 2 collaboration involved joint planning but also promoted joint centre and unit training and continuing professional development (CPD) programmes. Conclusions,In our estimation, both forms of collaboration represented early evidence of qualitative changes in medical working practices. Organizational changes within cancer services have moved swiftly since initial soundings were taken in 2000 and we update our initial commentary in the light of recent empirical data. The findings may be of wider significance to managers and health practitioners who are working towards the implementation of delivery network elsewhere in the UK National Health Service. [source]

Complaints and claims in the UK National Health Service

T.S. Usha Kiran MRCOG

The Antecedents of Middle Managers' Strategic Contribution: The Case of a Professional Bureaucracy

Graeme Currie
abstract Our study contributes towards a burgeoning literature that argues organizational performance is heavily influenced by what happens in the middle of the organization, rather than at the top. Examining the UK National Health Service, our study develops the work of Floyd and Wooldridge (1992, 1994, 1997, 2000). It utilizes role theory to conceptualize changing experiences of middle managers in organizations as a role transition. Associated with this are problems of role conflict and role ambiguity (Biddle, 1979, 1986; Biddle and Thomas, 1966; Kahn et al., 1964, 1966). Our study illustrates that there are limiting factors to a more strategic role for middle managers associated with the professional bureaucracy context. However, role conflict and ambiguity can be mediated by a socialization process, which values incoming identity and personal characteristics (Van Maanen and Schein, 1979). [source]

Evidence based guidelines and current practice for physiotherapy management of knee osteoarthritis

Nicola E. Walsh MSc MCSP
Abstract Objectives:,To document physiotherapy provision for patients with knee osteoarthritis (OA) in relation to the United Kingdom (UK) recently published National Institute of health and Clinical Excellence (NICE) guidelines for osteoarthritis. Design:,Questionnaire survey of chartered physiotherapists. Method:,300 postal questionnaires were distributed to Physiotherapy Departments requesting information regarding source of referrals, treatment aims, preferred methods of treatment and service delivery. Results:,Responses were received from 83 physiotherapists (28 %), predominantly working in the UK National Health Service. Approximately equal numbers of referrals came from primary and secondary care. Aims of physiotherapy management were to; encourage self-management; increase strength and range of movement; reduce pain; and improve function. To achieve these, exercise was utilised by 100% of practitioners, often supplemented with electrotherapeutic modalities (66%), manual therapy (64%) and acupuncture (60%). The majority of patients received individual treatment for a total contact time of 1,2 hours, whilst most group interventions lasted 5,6 hours. Approximately half (54%) of respondents reported using outcome measures to determine treatment efficacy. Conclusions:,Although knee OA is usually managed in primary care, the similar number of referrals from primary and secondary care may suggest a deviation from evidence-based management guidelines. The guidelines' recommendations of exercise, patient education and self-management are observed by physiotherapists, but other modalities are often used despite poor or no research evidence supporting their efficacy. Whether any of these interventions are clinically beneficial is speculative as treatment outcomes were frequently under-evaluated. Copyright 2008 John Wiley & Sons, Ltd. [source]

From ,part of,' to ,partnership': the changing relationship between nurse education and the National Health Service

Karen Gillett
GILLETT K,. Nursing Inquiry 2010; 17: 197,207 From ,part of,' to ,partnership': the changing relationship between nurse education and the National Health Service Worldwide, many countries have moved towards incorporating nurse education into the higher education sector and this inevitably has implications for the relationship between nurse education providers and local health service providers. This study explores the changes to the relationship in the UK between nurse education providers and the UK National Health Service over the past 20 years and demonstrates how two political ideologies have been central to those changes. The two ideologies of interest are the introduction of internal markets to the National Health Service by the Conservative government at the end of the 1980s and the New Labour response to the fragmentation of public services caused by Conservative neoliberal policy, which was to introduce the notion of ,partnership working'. This study reviews the wider debate around partnership policy and applies that debate to evaluate the way that nurse education providers and the National Health Service are working in partnership to provide clinical practice placements for nursing students. [source]

Lost in Translation: A Multi-Level Case Study of the Metamorphosis of Meanings and Action in Public Sector Organizational Innovation

Catherine Pope
This paper explores the early implementation of an organizational innovation in the UK National Health Service (NHS) , Treatment Centres (TCs) , designed to dramatically reduce waiting lists for elective care. The paper draws on case studies of 8 TCs (each at varying stages of their development) and aims to explore how meanings about TCs are created and evolve, and how these meanings impact upon the development of the organizational innovation. Research on organizational meanings needs to take greater account of the fact that modern organizations like the NHS are complex multi-level phenomena, comprising layers of interlacing networks. To understand the pace, direction and impact of organizational innovation and change we need to study the interconnections between meanings across different organizational levels. The data presented in this paper show how the apparently simple, relatively unformed, concept of a TC framed by central government is translated and transmuted by subsequent layers in the health service administration, and by players in local health economies, and, ultimately, in the TCs themselves, picking up new rationales, meanings and significance as it goes along. The developmental histories of TCs reveal a range of significant re-workings of macro policy with the result that there is considerable diversity and variation between local TC schemes. The picture is of important disconnections between meanings, that in many ways mirror Weick's (1976) 'loosely coupled systems'. The emergent meanings and the direction of micro-level development of TCs appear more strongly determined by interactions within the local TC environment, notably between what we identify as groups of 'idealists', 'pragmatists', 'opportunists' and 'sceptics' than by the framing (Goffman 1974) provided by macro and meso organizational levels. While this illustrates the limitations of top down and policy-driven attempts at change, and highlights the crucial importance of the front-line local 'micro-systems' (Donaldson and Mohr 2000) in the overall scheme of implementing organizational innovations, the space or headroom provided by frames at the macro and meso levels can enable local change, albeit at variable speed and with uncertain outcomes. [source]

Exploring the suitability of the European Foundation for Quality Management (EFQM) Excellence Model as a framework for delivering clinical governance in the UK National Health Service

Sue Jackson
Abstract In December 1997 the United Kingdom (UK) government publicized its vision for the National Health Service (NHS) to become the best health care system in the world. In line with this vision a number of consultative and directive documents were circulated, one of which was Clinical Governance: in the new NHS. This particular document provided insight into the principles and proposed framework for delivering clinical governance. However, the document suggested that health care organizations create mechanisms for delivering clinical governance which implied that the government had failed to recognize that suitable mechanisms were already available. The author suggests that one such suitable mechanism/framework is the EFQM Excellence Model. The article therefore examines the similarities of the principles behind clinical governance and the EFQM Excellence Model and recommends the latter as a suitable tool for ensuring that the country's people have the best health care system in the world. Copyright 2001 John Wiley & Sons, Ltd. [source]

Economic analysis of VenUS I, a randomized trial of two bandages for treating venous leg ulcers

C. P. Iglesias
Background: The study investigated the cost-effectiveness of four-layer and short-stretch compression bandages for treating venous leg ulcers. Methods: Cost-effectiveness and cost-utility analyses were performed using patient-level data collected alongside the VenUS I leg ulcer study. The perspective for the economic analysis was that of the UK National Health Service (NHS) and Personal Social Service. The time horizon for the analysis was 1 year after recruitment. Health benefit was measured as differences in ulcer-free days and quality-adjusted life years (QALYs). Results: The mean healing time for ulcers treated with four-layer bandages was 109 (95 per cent confidence interval (c.i.) ,68 to 291) days less than that for ulcers treated with short-stretch bandages. Mean average difference in QALYs between compression systems was ,002 (95 per cent c.i. ,008 to 004). The four-layer bandage cost a mean of 22732 (95 per cent c.i. 1653 to 448 30) less per patient per year than the short-stretch bandage. Conclusion: On average, four-layer bandaging was associated with greater health benefits and lower costs than short-stretch bandaging. Copyright 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Inequalities in the dental treatment provided to children: an example from the UK

Martin Tickle
Abstract Objectives: To identify the relationship between the socioeconomic status of frequently attending children and the dental care of their primary dentition provided by dentists working in the General Dental Service (GDS) of the UK National Health Service (NHS). Methods: The study design involved a retrospective investigation of the case notes of 658 children who were regularly attending patients of 50 General Dental Practitioners (GDPs) working in the North West of England. The socioeconomic status of each subject was measured using the Townsend score of their electoral ward of residence. Logistic regression models, taking into account the clustering of the subjects within dental practices, were fitted to identify whether or not socioeconomic status was significantly associated with the proportion of carious teeth that were restored, all dental extractions, dental extractions for pain or sepsis alone and courses of antibiotics prescribed after controlling other variables. Results: A significant association between socioeconomic status and caries experience could not be found. There was also no association between socioeconomic status and the proportion of carious teeth filled or courses of antibiotics prescribed. Disadvantaged children were significantly more likely to have teeth extracted than their more affluent peers, but there was no association between deprivation and extractions for pain or sepsis alone. Conclusions: Children from deprived backgrounds who regularly attended this group of UK dentists were more likely to have extractions than their more affluent peers, irrespective of their caries experience. [source]

Communication skills for behaviour change in dietetic consultations

K. Whitehead
Abstract Background:, Both the UK's National Health Service (NHS) and the National Institute of health and Clinical Excellence (NICE) have recommended increased training for health professionals in communication skills. There is evidence to suggest that communication skills are important in helping people to change health-related behaviour, which is a key role for dietitians. This study investigated the views of UK dietitians about their training needs and experience in relation to communication skills in dietetic practice. Methods:, In October 2007, a cross-sectional survey was mailed to all British Dietetic Association members (n = 6013). The survey gathered quantitative data and free-text comments to ascertain the level, type and effect of communication skills training received by dietitians at both the pre- and post-registration level. Results:, There were 1158 respondents; a response rate of 19.3%. Ninety-eight percent (n = 1117) rated communication skills as either very or extremely important in client consultations. Post-registration training had been undertaken by 73% (n = 904). Of these, over 90% of respondents perceived that post-registration training had led to improvements in their relationships with patients, their confidence in client interviews and their ability to cope with challenging clients. However, 248 (21.4%) felt time keeping in interviews had worsened. Lack of time for client interviews was also the most commonly identified barrier (19%, n = 216) to implementing the skills. Conclusions:, This study has explored an important and under-researched area. Respondents strongly endorsed the importance of good communication skills and the benefits of post-registration training in this area. Some felt that good communication was time consuming but others felt that time management had improved. Further research and training is required to support the implementation of these skills into dietetic practice. [source]

New Contractual Relationships in the Agency Worker Market: The Case of the UK's National Health Service

Kim Hoque
In recent years, there has been a trend towards the negotiation of closer contractual relationships between employers and employment agencies. However, little is known about this change or its likely consequences. In theory, such relationships can benefit employers by lowering fees and also reducing many of the hidden costs associated with the use of agency staff by improving the effectiveness of placement matching. Against this is the suggestion that formal partnerships are unlikely to have a positive impact given the uncertainty of demand for temporary labour and broader tendencies for risk displacement in buyer,supplier networks. In this article, our aim is to explore this matter focusing on recent developments in the UK's National Health Service. We find that new contractual relationships such as framework agreements and master vendor contracts are having mixed effects. While they serve to reduce direct costs for employers in the short term, this has been at the expense of relationship building and improvements in placement matching. These developments are also found to have some potentially negative consequences for the agency workforce itself. [source]