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  • 1
    Online Resource
    Online Resource
    Medicine and Management in English Primary Care: A Shifting Balance of Power?
    Cambridge University Press (CUP) ; 2009
    In:  Journal of Social Policy Vol. 38, No. 4 ( 2009-10), p. 627-647
    Details
    In: Journal of Social Policy, Cambridge University Press (CUP), Vol. 38, No. 4 ( 2009-10), p. 627-647
    Abstract: The English NHS has been repeatedly restructured since 1991. Drawing on multiple case studies in English primary health care from 1998 to 2005 and on (other) published studies, this article uses Therborn's theory of power to make a framework analysis of how these reforms redistributed power between medicine and management in NHS primary care. Legal changes ended the GP monopoly of primary medical care provision and, with greater managerial discretion in NHS spending, allowed more diverse organisational forms of primary care provision to appear, although general practice remained predominant. Changes in managerial and professional ideologies relaxed the restrictions on managerial decisions about general practice. Re-negotiations between the medical profession and the state mostly tended to increase managerial power. Evidence-based medicine has tended to weaken the impersonal sources of medical power. On balance, these events have tended to increase managerial power over medical practice. They also suggest adjustments to Therborn's conceptualisation of power.
    Type of Medium: Online Resource
    ISSN: 0047-2794 , 1469-7823
    URL: Article
    DOI: 10.1017/S0047279409990183
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2009
    detail.hit.zdb_id: 1478899-8
    SSG: 3,4
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  • 2
    Online Resource
    Online Resource
    Impacts of case management for frail elderly people: A qualitative study
    SAGE Publications ; 2009
    In:  Journal of Health Services Research & Policy Vol. 14, No. 2 ( 2009-04), p. 88-95
    Details
    In: Journal of Health Services Research & Policy, SAGE Publications, Vol. 14, No. 2 ( 2009-04), p. 88-95
    Abstract: To assess the impacts of different forms of case management for people aged over 65 years at risk of unplanned hospital admission, in particular the impacts upon patients, carers and health service organization in English primary care; and, in these respects, compare the Evercare model with alternatives. Methods: Multiple qualitative case studies comparing case management in nine English Primary Care Trusts which piloted the Evercare model of case management and four sites which implemented alternative forms of case management between 2003 and 2005. Data were obtained from 231 interviews with patients, carers and other key informants, and from content analysis of documents and observation of meetings. Results: All the projects established functioning case management services, but none led to major service reorganization or savings elsewhere in the health care system. Many informants reported examples of admissions which case management had prevented, but overall hospital admissions did not significantly change, possibly due to increased case-finding. Patients and carers valued case management for improving access to health care, increasing psychosocial support and improving communication with health professionals. Conclusion: Case management was highly valued by patients and their carers, but there were few major differences in outcomes between Evercare and other models.
    Type of Medium: Online Resource
    ISSN: 1355-8196 , 1758-1060
    URL: Article
    DOI: 10.1258/jhsrp.2008.007142
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2039416-0
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  • 3
    Online Resource
    Online Resource
    Principal—Agent Relationships in General Practice: The First Wave of English Personal Medical Services Pilot Contracts
    SAGE Publications ; 2000
    In:  Journal of Health Services Research & Policy Vol. 5, No. 3 ( 2000-07), p. 156-163
    Details
    In: Journal of Health Services Research & Policy, SAGE Publications, Vol. 5, No. 3 ( 2000-07), p. 156-163
    Abstract: To investigate how far English National Health Service (NHS) Personal Medical Services (PMS) contracts embody a principal—agent relationship between health authorities (HAs) and primary health care providers, especially, but not exclusively, general practices involved in the first wave (1998) of PMS pilot projects; and to consider the implications for relational and classical theories of contract. Methods: Content analysis of 71 first-wave PMS contracts. Results: Most PMS contracts reflect current English NHS policy priorities, but few institute mechanisms to ensure that providers realise these objectives. Although PMS contracts have some classical characteristics, relational characteristics are more evident. Some characteristics match neither the classical nor the relational model. Conclusions: First-wave PMS contracts do not appear to embody a strong principal—agent relationship between HAs and primary health care providers. This finding offers little support for the relevance of classical theories of contract, but also implies that relational theories of contract need to be revised for quasi-market settings. Future PMS contracts will need to focus more on evidence-based processes of primary care, health outputs and patient satisfaction and less upon service inputs. PMS contracts will also need to be longer-term contracts in order to promote the ‘institutional embedding’ of independent general practice in the wider management systems of the NHS.
    Type of Medium: Online Resource
    ISSN: 1355-8196 , 1758-1060
    URL: Article
    DOI: 10.1177/135581960000500306
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2000
    detail.hit.zdb_id: 2039416-0
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  • 4
    Online Resource
    Online Resource
    Governance Structures and Accountability in Primary Care
    Informa UK Limited ; 2008
    In:  Public Money & Management Vol. 28, No. 4 ( 2008-08), p. 215-222
    Details
    In: Public Money & Management, Informa UK Limited, Vol. 28, No. 4 ( 2008-08), p. 215-222
    Type of Medium: Online Resource
    ISSN: 0954-0962 , 1467-9302
    URL: Issue
    URL: Article
    DOI: 10.1111/pmam.2008.28.issue-4
    DOI: 10.1111/j.1467-9302.2008.00647.x
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2008
    detail.hit.zdb_id: 2008976-4
    SSG: 3,2
    SSG: 3,6
    SSG: 3,7
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  • 5
    Online Resource
    Online Resource
    Bridging the discursive gap between lay and medical discourse in care coordination
    Wiley ; 2017
    In:  Sociology of Health & Illness Vol. 39, No. 7 ( 2017-09), p. 1019-1034
    Details
    In: Sociology of Health & Illness, Wiley, Vol. 39, No. 7 ( 2017-09), p. 1019-1034
    Abstract: For older people with multiple chronic co‐morbidities, strategies to coordinate care depend heavily on information exchange. We analyse the information‐sharing difficulties arising from differences between patients’ oral narratives and medical sense‐making; and whether a modified form of ‘narrative medicine’ might mitigate them. We systematically compared 66 general practice patients’ own narratives of their health problems and care with the contents of their clinical records. Data were collected in England during 2012–13. Patients’ narratives differed from the accounts in their medical record, especially the summary, regarding mobility, falls, mental health, physical frailty and its consequences for accessing care. Parts of patients’ viewpoints were never formally encoded, parts were lost when clinicians de‐coded it, parts supplemented, and sometimes the whole narrative was re‐framed. These discrepancies appeared to restrict the patient record's utility even for GP s for the purposes of risk stratification, case management, knowing what other care‐givers were doing, and coordinating care. The findings suggest combining the encoding/decoding theory of communication with inter‐subjectivity and intentionality theories as sequential, complementary elements of an explanation of how patients communicate with clinicians. A revised form of narrative medicine might mitigate the discursive gap and its consequences for care coordination.
    Type of Medium: Online Resource
    ISSN: 0141-9889 , 1467-9566
    URL: Issue
    URL: Article
    DOI: 10.1111/shil.2017.39.issue-7
    DOI: 10.1111/1467-9566.12553
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2011845-4
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  • 6
    Online Resource
    Online Resource
    Marketing in the national health service: Prospects and variants
    Informa UK Limited ; 1991
    In:  Public Money & Management Vol. 11, No. 2 ( 1991-06), p. 25-32
    Details
    In: Public Money & Management, Informa UK Limited, Vol. 11, No. 2 ( 1991-06), p. 25-32
    Type of Medium: Online Resource
    ISSN: 0954-0962 , 1467-9302
    URL: Article
    DOI: 10.1080/09540969109387651
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 1991
    detail.hit.zdb_id: 2008976-4
    SSG: 3,2
    SSG: 3,6
    SSG: 3,7
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  • 7
    Online Resource
    Online Resource
    Strategic preparation for crisis management in hospitals: empirical evidence from Egypt
    Emerald ; 2004
    In:  Disaster Prevention and Management: An International Journal Vol. 13, No. 5 ( 2004-12-01), p. 399-408
    Details
    In: Disaster Prevention and Management: An International Journal, Emerald, Vol. 13, No. 5 ( 2004-12-01), p. 399-408
    Abstract: This study examines Egyptian managers' perceptions of their hospitals' preparation for crisis management. A total of 259 participants completed a 24‐item Strategic Preparation for Crisis Management (SPCM) instrument. The instrument was found to be valid and reliable in a non‐Western context. The study detected a positive relationship between long‐term strategy and crisis readiness. A significant statistical relationship was also found between external strategic orientation and crisis readiness. Finally, organizational complexity was found to be significantly and negatively associated with perceived crisis readiness.
    Type of Medium: Online Resource
    ISSN: 0965-3562
    URL: Article
    DOI: 10.1108/09653560410568525
    Language: English
    Publisher: Emerald
    Publication Date: 2004
    detail.hit.zdb_id: 2020866-2
    SSG: 3,2
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  • 8
    Online Resource
    Online Resource
    Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data
    BMJ ; 2007
    In:  BMJ Vol. 334, No. 7583 ( 2007-01-06), p. 31-
    Details
    In: BMJ, BMJ, Vol. 334, No. 7583 ( 2007-01-06), p. 31-
    Type of Medium: Online Resource
    ISSN: 0959-8138 , 1468-5833
    URL: Article
    DOI: 10.1136/bmj.39020.413310.55
    Language: English
    Publisher: BMJ
    Publication Date: 2007
    detail.hit.zdb_id: 1479799-9
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  • 9
    Online Resource
    Online Resource
    Clinical focus and public accountability in English NHS Trust Board meetings
    SAGE Publications ; 2013
    In:  Journal of Health Services Research & Policy Vol. 18, No. 1 ( 2013-01), p. 13-20
    Details
    In: Journal of Health Services Research & Policy, SAGE Publications, Vol. 18, No. 1 ( 2013-01), p. 13-20
    Abstract: Previous studies have suggested that greater focus on clinical matters in NHS commissioner and provider Trust Board meetings might improve the range, quality or cost of clinical care. This study reports the extent of clinical focus in Board meetings in three types of NHS Trust and considers the implications for public accountability. Methods: (1) Content analysis of published minutes of Board meetings from 105 randomly selected NHS Trusts in 2008/09. (2) Structured observation of 24 Board meetings in a qualitative sub-sample of eight of the above Trusts in 2008/09. Results: The percentage of clinical items among the items discussed by NHS Trust Boards ranged from 0% to 51%, but did not differ by Trust type. Primary Care Trusts (PCTs) recorded more items than NHS Trusts and NHS Foundation Trusts because of PCTs’ dual role as service providers and commissioners. There were significant differences between Trusts’ board meetings in the numbers of clinical items concerning service design, clinical outcomes and activity levels. The availability and accessibility of supposedly publicly-available minutes from NHS Foundation Trust Board meetings was sometimes problematic. Observation of meetings revealed a number of dynamics not evident in the minutes. Board meetings were generally chair-led (conducted according to the chair's discretion); collegial; had similar levels and extent of discussion from the non-executive directors, with a focus on current policy initiatives. Boards differed in the extent of public questioning, how they exercised internal governance over the provision and quality of patient care, and the extent of pre-planning before the Board meeting. Published minutes were not always an accurate record of meetings. Conclusions: Findings illuminate important transparency issues which should be given careful consideration in the English NHS.
    Type of Medium: Online Resource
    ISSN: 1355-8196 , 1758-1060
    URL: Article
    DOI: 10.1258/jhsrp.2012.011154
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2013
    detail.hit.zdb_id: 2039416-0
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  • 10
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    Online Resource
    Plural provision of primary medical care in England, 2002–2012
    SAGE Publications ; 2013
    In:  Journal of Health Services Research & Policy Vol. 18, No. 2_suppl ( 2013-10), p. 20-28
    Details
    In: Journal of Health Services Research & Policy, SAGE Publications, Vol. 18, No. 2_suppl ( 2013-10), p. 20-28
    Abstract: Health care reforms often include provider diversification, including privatization, to increase competition and thereby health care quality and efficiency. Donabedian's organizational theory implies that the consequences will vary according to the providers' ownership. The aim was to examine how far that theory applies to changes in English NHS primary medical care (general practice) since 1998, and the consequences for patterns of service provision. Methods: Framework analysis whose categories and structure reflected Donabedian's theory and its implications, populated with data from a systematic review, administrative sources and press rapportage. Results: Two patterns of provider diversification occurred: 'native' diversification among existing providers and plural provision as providers with different types of ownership were introduced. Native diversification occurred through: extensive recruitment of salaried GPs; extending the range of services provided by general practices; introducing limited liability partnerships; establishing GPs with special clinical interests; and introducing a wider range of services for GPs to refer to. All of these had little apparent effect on competition between general practices. Plural provision involved: increased primary care provision by corporations; introducing GP-owned firms; establishing social enterprises (initially mostly out-of-hours cooperatives); and Primary Care Trusts taking over general practices. Plural provision was on a smaller scale than native diversification and appeared to go into reverse in 2011. Conclusions: Although the available data confirm the implications of Donabedian's theory, there are exceptions. Native diversification and plural provision policies differ in their implications for service development.
    Type of Medium: Online Resource
    ISSN: 1355-8196 , 1758-1060
    URL: Article
    DOI: 10.1177/1355819613489544
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2013
    detail.hit.zdb_id: 2039416-0
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