General Practice

Health Literacy: report from an RCGP-led health literacy workshop – June 2014

Posted on August 4, 2014. Filed under: General Practice, Patient Participation | Tags: |

Health Literacy: report from an RCGP-led health literacy workshop – June 2014

“Health Literacy is needed for patients and the public to understand and act upon health information, to become active and equal partners in co-producing health, and to take control of their health to help shape health environments and health services for themselves, their families and their communities.

In view of the importance of health literacy to patients and the NHS, NHS England sponsored a meeting, hosted by CIRC in collaboration with Dr Gill Rowlands, the Chair of the SAPC Health Literacy specialist group.

The aim of the meeting was to facilitate discussion about the important principles around health literacy relevant to primary care. Central to the discussion was a shared understanding of what is meant by the term ‘health literacy’ and to formulate a number of recommendations.

Low health literacy is a problem for everyone, even in the least deprived areas there is still a significant proportion of the population that cannot understand health materials. Through the Health Literacy Report the College is urging the medical profession to avoid using medical jargon when speaking to patients about their health.

In addition to learning about health literacy and its impact on patients, the public and the NHS, those present brought their perspectives and expertise to the discussions. Several themes emerged and can be found the report.”

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GP Taskforce Report – NHS Health Education England – 22 July 2014

Posted on July 24, 2014. Filed under: Educ for Hlth Professions, General Practice |

GP Taskforce Report – NHS Health Education England – 22 July 2014

“The GP Taskforce Report was commissioned prior to the establishment of Health Education England. However, although it takes a very specific GP view, it contains some useful research and will be helpful information to consider as part of our Workforce Plan for England alongside other evidence and suggestions while many of the recommendations have been acted upon through commitments in our Mandate.

The full report can be found here”
Securing the Future GP Workforce: Delivering the Mandate on GP Expansion

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Meeting need or fuelling unnecessary demand? Understanding the impact of improved access to primary care – Nuffield Trust – 30 June 2014

Posted on July 1, 2014. Filed under: General Practice | Tags: |

Meeting need or fuelling unnecessary demand? Understanding the impact of improved access to primary care – Nuffield Trust – 30 June 2014

“Meeting Need or Fuelling Demand? Improved access to primary care and supply-induced demand examines how far increased access to general practice and other primary care services will deal with unmet need, or whether these efforts may only serve to stimulate additional use of services that would not have otherwise occurred.”

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Transforming Primary Care: Safe, proactive, personalised care for those who need it most – England, Department of Health – 14 April 2014

Posted on April 15, 2014. Filed under: General Practice, Primary Hlth Care |

Transforming Primary Care: Safe, proactive, personalised care for those who need it most – England, Department of Health – 14 April 2014

“Department of Health and NHS England’s joint plan to provide personalised, proactive care for people who need it most.

‘Transforming Primary Care’ sets out plans for more proactive, personalised and joined up care, including the Proactive Care Programme, providing the 800,000 patients with the most complex health and care needs with:

a personal care and support plan
a named accountable GP
a professional to coordinate their care
same-day telephone consultations

The plan builds on the role of primary care in keeping patients well and independent. It explains how professionals across the healthcare system can work together to transform care to become more proactive and tailored to patients’ individual need.”

 

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GP locum chambers – NHS – March 2014

Posted on March 26, 2014. Filed under: General Practice |

GP locum chambers – NHS – March 2014

“1.0 Executive Summary

In 2012 Dr Penny Newman undertook a review of the sustainability of GP leadership for commissioning1 on behalf of NHS Midlands and East SHA. This identified that GPs are under significant pressure due to increasing complexity of patient demand, changes in the GP workforce to more part-time and sessional roles, new commissioning responsibilities, poor access to GP locums and difficulties in recruitment with many GPs nearing retirement. New models of primary care were recommended to ensure sufficient GP capacity and capability as providers and commissioners in future.

This paper1 outlines how the innovative model of GP locum chambers can help address these challenges, options for development and how to get started. It is a resource for GPs, Clinical Commissioning Groups (CCGs), Commissioning Support Units (CSU) and others and aims:
• To encourage locum GPs to start a chambers themselves or join one already established
• To enable other local organisations to seed and grow interest
• To provide information on options for development, costs and benefits as a basis for local discussion.

This resource is published in two parts: The Executive Summary and a fuller description and start up guide available from penny.newman1@nhs.net. It accompanies work commissioned simultaneously by Penny Newman and Jill Matthews on behalf of the SHA from the Nuffield Trust and Kings Fund on new models of care Securing the Future of General Practice available from http://www.nuffieldtrust.org.uk/publications/securing-future-general-practice

1.2 What is a GP locum chambers?

Locum GP chambers are self-funding professional groups of locum GPs working as a ‘virtual practice’, supported by a team of managers and clinical directors. All business, professional and governance issues relating to the day-to-day engagement of all GPs in the chambers takes place within the chambers’ managed environment.

1.3 Why is chambers a good idea?”

… continues

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Practical Playbook – Public Health . Primary Care. Together. – CDC – Duke University School of Medicine , de Beaumont Foundation

Posted on March 10, 2014. Filed under: General Practice, Primary Hlth Care, Public Hlth & Hlth Promotion | Tags: |

Practical Playbook – Public Health . Primary Care. Together. – CDC – Duke University School of Medicine , de Beaumont Foundation

“What is the Practical Playbook?

The Practical Playbook is a stepping stone in the next transformation of health, in which primary care and public health groups collaborate to achieve population health improvement and reduced health care costs. It supports increased collaborations between primary care and public health groups by guiding users through the stages of integrated population health improvement. Throughout each stage, the Practical Playbook provides helpful resources such as success stories from across the country, lessons-learned from existing partnerships, and further guidance from industry experts.

We use the playbook metaphor because improving collaboration between public health and primary care takes a thoughtful game plan. Like a sports playbook, the Practical Playbook defines the role of each team member as well as actions for different situations. As a playbook, it’s neither a rulebook nor a set of peer-reviewed guidelines. It’s something more practical – because we need real-life, flexible guidance to help us apply the theoretical principles of integration to our work.”

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Which doctors take up promising ideas? New insights from open data – Nesta – 28 January 2014

Posted on March 4, 2014. Filed under: Evidence Based Practice, General Practice, Knowledge Translation, Primary Hlth Care | Tags: , |

Which doctors take up promising ideas? New insights from open data – Nesta – 28 January 2014

“The report looks at early adoption of promising new ideas across primary care in England and argues that analysing open data can help public services gain a greater understanding of their take up of innovations.

Key findings
No single group of GP practices were serial early adopters of all the innovations reviewed, but groups of early adopters were identified around specific types of innovations.
Larger GP practices are in a better position to explore and introduce new innovations, while neighbouring practices tended to have similar rates and patterns of adopting new innovations.
GPs rely on a range of resources to identify and learn about innovations – including informal local networks, personal relationships, and information systems. Fellow GPs and national guidance were particularly influential sources of information.
Local intermediaries – such as Academic Health Science Networks and Clinical Commissioning Groups – have an important role to play in the adoption process.

This report demonstrates a rising opportunity to inform practitioners and patients by making use of open data. Analysis of primary care open data shows the potential to chart GP surgeries’ uptake of promising innovations in technologies, drugs and practices.”

… continues

 

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Commissioning and funding general practice: Making the case for family care networks – King’s Fund – 19 February 2014

Posted on February 21, 2014. Filed under: General Practice, Primary Hlth Care | Tags: , , |

Commissioning and funding general practice: Making the case for family care networks – King’s Fund – 19 February 2014

“As England’s population both expands and ages, so the demands on primary care will grow. Within the current commissioning and funding system innovative models of primary care provision are already being used. This report describes examples of these through four case studies in different areas of England. It also highlights how the existing system is imperfectly understood, particularly regarding contracts.

Building on ideas articulated in previous work, the report argues for a new approach that brings together funding for general practice with funding for many other services. It would entail new forms of commissioning, with GPs innovating in how care is delivered. Over time, the report foresees ‘family care networks’ emerging that provide forms of care well beyond what is currently available in general practices.”

 

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Access all areas: new solutions for GP shortages in rural Australia – Grattan Institute – 29 September 2013

Posted on October 1, 2013. Filed under: General Practice, Pharmacy, Rural Remote Health, Workforce | Tags: |

Access all areas: new solutions for GP shortages in rural Australia – Grattan Institute – 29 September 2013

by Stephen Duckett and Peter Breadon

“This report outlines a plan for the parts of rural Australia with the lowest access to GP services. We don’t aim to bring these areas up to the national average, just to end the most extreme shortages. To achieve this, we have to make the most of scarce resources, while keeping GPs at the centre of the system.

The first step is to make much better use of pharmacists’ skills. Pharmacists are highly trained, have deep expertise in medicines, and are located in communities throughout Australia. But their role is far more limited in Australia than in many other countries.

With the agreement of GPs and patients, pharmacists should be able to provide repeat prescriptions to people with simple, stable conditions. They should also be able to provide vaccinations and to work with GPs to help patients manage chronic conditions.

We also need to increase access to other services, including diagnosis, which currently only GPs can provide. Australia should introduce physician assistants, health workers who practise medicine under the supervision of a doctor. There is good evidence that physician assistants could expand the care available in under-served areas, without compromising quality or safety, and at an affordable cost.

The proposals in this report only apply to the seven rural areas with the worst shortages of GP services. They can be in place within five years. In 2011-12, they would have resolved the worst shortages for just $30 million. The costs would mostly have been offset by fewer, or less costly, hospitalisations as a result of better population health.”

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Securing the Future of General Practice in London – Londonwide LMCs – 19 September 2013

Posted on September 19, 2013. Filed under: General Practice |

Securing the Future of General Practice in London – Londonwide LMCs – 19 September 2013

News release

 

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Clinical commissioning groups: Supporting improvement in general practice? – The King’s Fund and the Nuffield Trust – 22 July 2013

Posted on July 24, 2013. Filed under: General Practice | Tags: , |

Clinical commissioning groups: Supporting improvement in general practice? – The King’s Fund and the Nuffield Trust – 22 July 2013

“Introduction

Clinical commissioning groups (CCGs) are one of the main components of the government’s reforms to the health and social care system. In April 2013, these newly established, clinically led organisations replaced primary care trusts as the commissioners of most services funded by the National Health Service (NHS) in England, and now control around two-thirds of the NHS budget. All general practices in England are now legally obliged to be a member of a CCG. The intention is to encourage clinicians to play a greater role in deciding how funds are spent in order to shape services to meet local needs.

CCGs have two important, but distinct, roles: they are responsible for commissioning secondary and community care services for their local populations; and they have a legal duty to support quality improvement in general practice. This second role has received less attention to date, but is vitally important if CCGs are to achieve their wider objectives and deliver more integrated forms of care. It will, however, be a challenging role for them to fulfil, particularly as general practitioner (GP) services are commissioned by NHS England.

About this research

The King’s Fund and the Nuffield Trust are working together over a three-year period to assess the implementation and impact of CCGs. We are examining clinical commissioning in six case study sites between 2012 and 2015, focusing on:
. the nature of relationships being built inside CCGs, particularly the interface with member practices and the extent of GP involvement in CCG activities
. the role of CCGs in supporting quality improvement in general practice
. the structures and processes through which these relationships and improvement activities are conducted.”

… continues

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Securing the future of general practice: new models of primary care – The King’s Fund and the Nuffield Trust – 18 July 2013

Posted on July 24, 2013. Filed under: General Practice, Primary Hlth Care | Tags: , , |

Securing the future of general practice: new models of primary care – The King’s Fund and the Nuffield Trust – 18 July 2013

“This report from the Nuffield Trust and The King’s Fund examines the new GP organisations forming to allow care provision at greater scale.”

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Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study – PLoS One 12 June 2013

Posted on June 18, 2013. Filed under: Emergency Medicine, General Practice, Primary Hlth Care |

Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study – PLoS One 12 June 2013

“Background

The number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England.”

Citation: Cowling TE, Cecil EV, Soljak MA, Lee JT, Millett C, et al. (2013) Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study. PLoS ONE 8(6): e66699. doi:10.1371/journal.pone.0066699

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Reclaiming a population health perspective – Nuffield Trust – April 2013

Posted on April 26, 2013. Filed under: General Practice, Public Hlth & Hlth Promotion | Tags: |

Reclaiming a population health perspective – Nuffield Trust – April 2013

“The report, which was written by the Nuffield Trust, commissioned by the National Association of Primary Care (NAPC), examines the arguments for encouraging and enabling general practices to take a much more proactive role in improving the health and wellbeing of their local populations, as well as their individual patients.

It also draws on analysis of routine data from a notional general practice of 10,000 patients and a series of interviews conducted with GPs and practice managers who are participating in the NAPC’s newly-established Practice Innovation Network, which brings together staff from GP practices to develop and test out new approaches to population health management.”

… continues on the site

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Primary care and general practice in Australia 1990-2012. A Chronology of Federal Government strategies, policies, programs and funding – ANU – March 2013

Posted on April 18, 2013. Filed under: General Practice, Primary Hlth Care | Tags: , , |

 

Primary care and general practice in Australia 1990-2012. A Chronology of Federal Government strategies, policies, programs and funding – ANU – March 2013

by Dr Lesley Russell

 

Opinion piece on this

Recommended reading on the history of primary care reform (and what can be learnt from it) – Croakey – 17 April 2013

 

 

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Working with Communities, Developing Communities – Royal College of General Practitioners – 2 April 2013

Posted on April 3, 2013. Filed under: General Practice, Patient Participation | Tags: , |

Working with Communities, Developing Communities – Royal College of General Practitioners – 2 April 2013

“Working with Communities, Developing Communities is the latest resource produced by the RCGP Centre for Commissioning, set up in 2010 to support GPs with the commissioning and delivery of healthcare and services. The publication coincides with the introduction of Clinical Commissioning Groups (CCGs) across England on 1 April.

The guide puts forward both a financial case and health case as to why investing resources in Community Development is beneficial for local populations, primary care practitioners and CCGs.

It emphasises that local populations must be seen as assets, not burdens, in order to make CCGs strong and successful. It also focuses on the need for CCGs to work together and build partnerships within their communities between health, education, housing and other services including policing.

Community Development comes in many forms but all focus on maximising the potential of local individuals and community groups in shaping how public services develop, creating opportunities and solving problems. It uses two main case studies to illustrate these along with numerous other examples, including Time Banks which use participants’ time and skills as currency instead of money.
Community Development professionals will work with residents to identify key, local issues and set agendas important to local people. Local authorities and public service organisations, such as NHS groups, will be involved in making decisions but fundamentally this should be an inclusive process.”

… continues

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GP in-depth review: Preliminary findings – Centre for Workforce Intelligence [UK] – March 2013

Posted on March 19, 2013. Filed under: General Practice, Workforce | Tags: , |

GP in-depth review: Preliminary findings – Centre for Workforce Intelligence [UK] – March 2013

The Centre for Workforce Intelligence (CfWI) has published preliminary findings from its in-depth review of the GP workforce in England.

The review’s remit is to provide the evidence base for planning the future GP workforce, looking ahead to 2030.

The report

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Healthy Communities: Australians’ experiences with primary health care in 2010-11 – National Health Performance Authority – 7 March 2013

Posted on March 7, 2013. Filed under: General Practice, Primary Hlth Care | Tags: |

Healthy Communities: Australians’ experiences with primary health care in 2010-11 – National Health Performance Authority – 7 March 2013

“This is the National Health Performance Authority’s first report on community-based health care services in the 61 Medicare Local areas across Australia. It looks at how Australians view their health and examines use and patient experiences with a range of GP-type services at the local level.”

Read Healthy Communities: Australians’ experiences with primary health care in 2010-11 HTML | PDF 7621 

Read Healthy Communities: Australians’ experiences with primary health care in 2010-11 Technical Supplement HMTL | PDF 247

Read our Media Release: Healthy Communities report finds five-fold variations in accessibility of GP care | PDF 142

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Six principles for delivering integrated out-of-hospital care – NHS Confederation – 19 December 2012

Posted on January 4, 2013. Filed under: Community Services, General Practice | Tags: , |

Six principles for delivering integrated out-of-hospital care – NHS Confederation – 19 December 2012

“Adopting six key principles will help the delivery of effective integrated out-of-hospital care, says a new report by the NHS Confederation and Royal College of General Practitioners.”

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General practice activity in Australia 2011–12 – University of Sydney Family Medicine Research Centre – November 2012

Posted on December 12, 2012. Filed under: General Practice, Health Informatics |

General practice activity in Australia 2011–12 – University of Sydney Family Medicine Research Centre – November 2012

Britt H, Miller GC, Henderson J, Charles J, Valenti L, Harrison C, Bayram C, Zhang C, Pollack AJ, O’Halloran J, Pan Y. General practice activity in Australia 2011–12. General practice series no.31. Sydney. Sydney University Press, 2012.

ISSN 1442-3022
ISBN 978-1-74332-018-1 pbk
ISBN 978-1-74332-019-8 online

Commentary on this:
Lack of EHR standards a massive fail: report – eHealth Space – 5 December 2012

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General practice in London: supporting improvements in quality – King’s Fund – 5 December 2012

Posted on December 10, 2012. Filed under: General Practice, Primary Hlth Care | Tags: , |

General practice in London: supporting improvements in quality – King’s Fund – 5 December 2012

Veena Raleigh, Yang Tian, Nick Goodwin, Anna Dixon, James Thompson, Christopher Millet, Michael Soljak

“General practice in London face a number of demographic and socio-economic challenges in addition to the unprecedented financial pressures facing the NHS as a whole.

NHS London commissioned an independent report to provide a fresh analysis of those challenges and the improvements that will be needed to address them. The report has been prepared by a team of researchers at The King’s Fund and Imperial College London.

It is a companion piece to a framework that NHS London will be co-creating with practices across the capital as a resource for clinical commissioning groups in taking on their new responsibilities for continuously improving primary care services.

The King’s Fund and Imperial College London are also providing clinical commissioning groups with more detailed data on the indicators used in this report, along with guidance on how to interpret and use the data, as a starting point from which to understand priorities at local level.”

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Improving GP services in England – The King’s Fund – 7 November 2012

Posted on November 8, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, General Practice, Patient Participation | Tags: |

Improving GP services in England – The King’s Fund – 7 November 2012

“Exploring the association between quality of care and the experience of patients

Two key elements of the quality of health care provided by GPs are the Quality and Outcomes Framework (QOF), which rewards GP practices for achievement against a range of indicators of clinical quality, and the GP Patient Survey, which asks patients about their experience of using GP services.

Using data for more than 8,000 general practices in England, this paper examines the association between patients’ perceptions about the non-clinical aspects of care and practice performance on measures of clinical quality.”

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What does the community want from after hours care? – Croakey – 23 October 2012

Posted on October 24, 2012. Filed under: General Practice, Primary Hlth Care | Tags: |

What does the community want from after hours care? – Croakey – 23 October 2012

“What are the community’s priorities and concerns when it comes to after hours care? Some useful insights were gleaned from a citizen’s jury held in Tasmania earlier this year, including the need for much better information for the public about what services are available.”

… continues on the Croakey site

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A new Mental Health Discharge Summary – Royal College of Psychiatrists – 5 October 2012

Posted on October 16, 2012. Filed under: General Practice, Mental Health Psychi Psychol | Tags: , |

A new Mental Health Discharge Summary – Royal College of Psychiatrists – 5 October 2012

“A new Mental Health Discharge Summary has been developed to help standardise the information that GPs receive when a patient is discharged from in-patient mental health care.

Over the years GPs, patients and carers have expressed concerns that information received has been inconsistent or too detailed. This can lead to poor patient care. To meet this need, standards and summaries have been designed to provide useful, succinct information to help doctors improve the continuity of care.

The Summary has been developed in collaboration between the Royal Colleges of Psychiatrists, General Practitioners and Physicians and facilitated through the Department of Health Informatics Directorate’s Clinical Data Standards Assurance team.

This work builds on the headings that were developed by the Royal College of Physicians and approved by the Academy of Royal Medical Colleges in 2008. The Summary incorporates feedback from clinicians, patients, suppliers and health and social care representatives to ensure it meets the needs of GPs and their patients who have received in-patient mental health care.

The Summary will now be implemented at a number of Mental Health Trusts, including the Nottinghamshire Healthcare NHS Trust and Northumberland, Tyne and Wear NHS Foundation Trust. You can view the Summary

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Evaluation of the GP Super Clinics Program 2007-2008 – CONSAN Consulting – August 2012

Posted on October 16, 2012. Filed under: General Practice, Health Systems Improvement, Primary Hlth Care |

Evaluation of the GP Super Clinics Program 2007-2008 – CONSAN Consulting – August 2012

Extract from the executive summary

“The GP Super Clinics Program was one part of the health reforms, including primary care reforms, implemented by a newly-elected Labor government in 2007. The localities of the GP Super Clinics were based on criteria relating to need. The program provided grant funds to the value of $181.7 million for the construction or refurbishment of existing infrastructure for the first 36 GP Super Clinics, across 37 localities.

This evaluation addressed three aspects of the GP Super Clinics Program 2007-2008:
 Implementation: administration of the Program by the Department of Health and Ageing
 Establishment: the planning and construction of the 36 GP Super Clinics over 37 sites established in the 2007-2008 tranche
 Operations: service delivery in the seven clinics which were operational for a minimum of six months prior to the commencement of the evaluation.

In the context of these three aspects, the evaluation aimed to describe the historical context and processes for the implementation and the processes and influences which impacted on the construction of the GP Super Clinics. In the operational aspect it aimed to identify the short term impacts, and the activities being implemented to achieve the GP Super Clinics Program objectives. Learnings were also identified with regard to the three aspects of the program and the potential for informing further investment in primary health care  infrastructure and services.

Methods for the evaluation were tailored to each of the aspects of the GP Super Clinics Program. Common methods across each aspect included desk reviews, surveys and interviews with representatives of key stakeholder groups. A value-for-money assessment tool was also developed for the establishment aspect.”

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RACGP launches GP Psych website – eHealthSpace – 16 August 2012

Posted on August 21, 2012. Filed under: General Practice, Mental Health Psychi Psychol | Tags: |

RACGP launches GP Psych website – 16 August 2012

“The Royal Australian College of General Practitioners has launched a revamped website for GPs needing specialist psychiatric advice on behalf of patients.

Advice is delivered to GPs within 24 hours of their request.

The initiative is funded by the Department of Health and Ageing as part of its Better Outcomes in Mental Health program.”

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Australian Medicare Local Alliance launched 16 August 2012

Posted on August 17, 2012. Filed under: General Practice, Primary Hlth Care |

Australian Medicare Local Alliance launched 16 August 2012

“Australians can look forward to more effective and cohesive primary health care with the launch of a new national body to lead the network of Medicare Locals.

Minister for Health Tanya Plibersek and Minister for Mental Health and Ageing Mark Butler today attended the launch of the Australian Medicare Local Alliance in Parliament House, Canberra.

Ms Plibersek said the Australian Medicare Local Alliance will play a key role in ensuring Medicare Locals function effectively and efficiently and work as a cohesive group, responsive to changing Government priorities.”

… continues

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Medical Generalism. Why expertise in the whole person medicine matters – Royal College of General Practitioners – 26 June 2012

Posted on July 3, 2012. Filed under: General Practice | Tags: |

Medical Generalism. Why expertise in the whole person medicine matters – Royal College of General Practitioners – 26 June 2012

“The vital role of the “medical generalist” must be more widely recognised and enhanced if the NHS is to meet the challenges facing it, according to a landmark report launched by the RCGP today.

The College sets out a compelling case for why medical generalists – “experts in whole person medicine” – matter to all healthcare systems. It opens the debate on why the importance and influence of the role needs to be given fresh consideration within a much wider context than general practice and primary care.

The report describes how medical generalists provide care that is both focused on individual wellbeing and delivers wider benefits, helping to ensure that the NHS remains one of the most cost-effective health systems in the world. The RCGP calls for general practitioners to be given more support to protect and enhance their vital role, including longer training; more time with patients; better access to diagnostics and better communication with specialists.

The report is the RCGP’s formal response to the findings of the independent Commission on Generalism. It outlines the College’s overall position on the future of medical generalism, explores the challenges raised in the Commission’s report and proposes a programme of work to address issues such as continuity and access.

The RCGP has identified ten priority areas which aim to review the disciplines of General Practitioners and other medical generalists from different perspectives and ensure they are equipped to meet the changing needs of their patients:

• Effective use of patient feedback
• Policy on out of hours care
• Development of generalist models of care for complex and chronic conditions in the community
• Improved communication between GPs and specialists
• Extended training for GPs
• Enhanced training in paediatric care, learning disabilities, mental health, palliative and end of life care
• GP-led commissioning
• Further research into multiple morbidities and early, accurate diagnosis in primary care
• Use of IT, data sharing and inter-agency e-communications
• Nursing home care.”

… continues on the site

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The Tougher the Better: The Effect of an Increased Performance Threshold on the Performance of General Practitioners – Ofice of Health Economics [UK] – April 2012

Posted on May 17, 2012. Filed under: General Practice, Health Economics | Tags: |

The Tougher the Better: The Effect of an Increased Performance Threshold on the Performance of General Practitioners – Ofice of Health Economics [UK] – April 2012

Yan Feng, Ada Ma, Shelley Farrar and Matt Sutton

Research Paper

“In April 2006, payment thresholds were raised for GPs who participate in Scotland’s Ouality and Outcomes Framework.  GPs were required to meet new, higher thresholds on some indicators to receive maximum levels of payment.  In this paper, OHE’s Yan Feng and her colleagues examine whether this change in fact improved GP performance and whether the impact differed across GPs. Specifically, they examine whether low-, mid- and high-performing GPs changed behaviour and, if so, to what extent.”

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Primary care: Today and tomorrow. Improving general practice by working differently – Deloitte – May 2012

Posted on May 14, 2012. Filed under: General Practice, Primary Hlth Care | Tags: |

Primary care: Today and tomorrow. Improving general practice by working differently – Deloitte – May 2012

“Primary care, and in particular care delivered by general practice, has been a cornerstone of the United Kingdom’s healthcare system since the inception of the National Health Service (NHS) in 1948. Indeed, good quality primary care is considered an essential
feature of all cost-effective healthcare systems. Patient satisfaction with primary care delivered through general practice has traditionally been high, albeit with local variations in both patient experience and quality of care.

The general practice delivery model has evolved slowly with most general practitioners (GPs) working in single or dual practices until the 1990s. The promotion of a ‘primary care led NHS’ during the 1990s and the implementation of new contract models from 2003 onwards, have resulted in the majority of GPs now working in larger group practices and health centres. Nevertheless, the delivery model still  relies largely on face-to-face consultations between the patient and GP or, for a limited but growing number of interventions, between the patient and practice nurse.

The focus of this report is on the general practice as a provider of primary care services, and while it is based on the English NHS, many of the solutions could apply equally to general practice in the rest of the United Kingdom.

In this report we acknowledge general practice and its registered patient list system as a strong foundation upon which different models of care can be built. We propose a range of solutions involving new business models and incentives, and accelerated use of technologies, which shift the focus of primary care from providers to consumers. While some of the proposed solutions are already being trialled by a number of GPs, and the challenge is to increase the scale of adoption, others have yet to be adopted in any meaningful way. What they all have in common is the need for primary care staff to work differently.”

… continues

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Involving primary care clinicians in quality improvement – The Health Foundation [UK] – April 2012

Posted on May 8, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, General Practice, Primary Hlth Care | Tags: |

Involving primary care clinicians in quality improvement – The Health Foundation [UK] – April 2012

An independent evaluation of the Health Foundation’s Engaging with Quality in Primary Care programme

ISBN 978-1-906461-37-9

“This is the report of an independent evaluation of our Engaging with Quality in Primary Care (EwQPC) improvement programme.

In 2007 we launched the EwQPC improvement programme. The programme funded nine projects that would increase the capacity for clinical quality improvement in primary care and engage primary care clinicians in clinical quality improvement. Building upon a previous initiative in secondary care (the Engaging with Quality Initiative), it aimed to engage primary care clinicians in clinical quality measurement and enable them to contribute to the knowledge base on improvement.

The independent evaluation, undertaken by a team from RAND Europe, identified a wide set of benefits. The projects secured and maintained the involvement of clinicians and were associated with changes in clinicians’ attitudes, behaviours and understanding. Patient involvement was an important and successful element of the programme. The projects also learned a lot about the challenges and opportunities of implementing improvement efforts. Measureable benefits for patients were found, but overall they were modest and patchy.

This thoughtful report highlights the lessons to be drawn from the programme and also offers a candid critique of quality improvement approaches and evaluation methods.”

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Benchmark of out of hours. An overview across the services. Report from the Primary Care Foundation – 19 April 2012

Posted on April 24, 2012. Filed under: Emergency Medicine, General Practice, Primary Hlth Care | Tags: , |

Benchmark of out of hours. An overview across the services. Report from the Primary Care Foundation – 19 April 2012

Prepared by Henry Clay

[Urgent care in general practice – benchmark report from April 2012]

Using data to Improve Care: A new national benchmark for Out of Hours services

“The Department of Health were keen to drive reliable comparisons of performance across out of hours services in England, building on the established national quality requirements, but breaking new ground in measuring outcomes as well as process.  Following a competitive tender, the Primary Care Foundation were appointed in November 2007 to develop a benchmark of out of hours services that would be seen as credible by commissioners and providers alike and would serve as a basis for service improvement.  The overall aim was to make accurate comparisons across different services so that providers and commissioners were in a position to recognise and take action to improve care for their patients.”

… continues

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Primary Care Partnerships Integrated Health Promotion 2011 Report – Victoria. Department of Health – 4 November 2011

Posted on December 13, 2011. Filed under: General Practice, Primary Hlth Care, Public Hlth & Hlth Promotion |

Primary Care Partnerships Integrated Health Promotion 2011 Report – Victoria. Department of Health – 4 November 2011

“This document sets out the achievements of Primary Care Partnerships (PCP) strategy to deliver Integrated Health Promotion (IHP) in Victoria. This document draws on findings from an evaluation conducted in 2008 on the impact of the PCP IHP strategy. Case studies have been included to demonstrate the range of health promotion programs and activities being led by PCPs, and the breadth of work that can be undertaken when organisations work in partnership.”

 

 

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My Health London

Posted on December 13, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, General Practice |

My Health London 

This newly launched website provides information on GP practices in London, as well as publishing the London outcome standards. The standards outline the minimum patients can expect to receive from general practice and form part of a suite of products designed to support and improve primary care in London, covering areas such as screening, diagnosis and patient experience.

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Funding Alternatives for Family Physicians – Office of the Auditor General of Ontario – 5 December 2011

Posted on December 12, 2011. Filed under: General Practice, Health Economics |

Funding Alternatives for Family Physicians – Office of the Auditor General of Ontario – 5 December 2011

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Person-based Resource Allocation (PBRA) – Nuffield Trust – 9 December 2011

Posted on December 12, 2011. Filed under: General Practice, Health Economics | Tags: |

Person-based Resource Allocation (PBRA) – Nuffield Trust – 9 December 2011

New approaches to estimating commissioning budgets for GP practices

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Guiding patients through complexity: modern medical generalism – Commission on Generalism Report – Royal College of General Practitioners – 7 October 2011

Posted on October 18, 2011. Filed under: General Practice |

Guiding patients through complexity: modern medical generalism –  Commission on Generalism Report – Royal College of General Practitioners – 7 October 2011

“This independent report raises questions about the concept of generalism and the role of the GP in today’s health service, as well as making some important recommendations for developing, strengthening and promoting medical generalism to deliver effective patient care in the NHS of the future.”

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Does Better Disease Management in Primary Care Reduce Hospital Costs? – Centre for Health Economics, University of York – August 2011

Posted on September 16, 2011. Filed under: Chronic Disease Mgmt, General Practice, Primary Hlth Care |

Does Better Disease Management in Primary Care Reduce Hospital Costs? – Centre for Health Economics, University of York – August 2011

Mark Dusheiko et al

“Abstract
We apply cross-sectional and panel data methods to a database of 5 million patients in 8,000 English general practices to examine whether better primary care management of 10 chronic diseases is associated with reduced hospital costs. We find that only primary care performance in stroke care is associated with lower hospital costs. Our results suggest that the 10% improvement in the general practice quality of stroke care between 2004/5 and 2007/8 reduced 2007/8 hospital expenditure by about £130 million in England. The cost savings are due mainly to reductions in emergency admissions and outpatient visits, rather than to lower costs for patients treated in hospital or to reductions in elective admissions.”

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The Quality and Outcomes: Framework (QOF): does it reduce health inequalities? – NHS National Institute for Health Research – April 2011

Posted on April 29, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, General Practice, Health Status, Primary Hlth Care, Public Hlth & Hlth Promotion |

The Quality and Outcomes: Framework (QOF): does it reduce health inequalities? – NHS National Institute for Health Research – April 2011

Dixon A, Khachatryan A, Wallace A, Peckham S, Boyce T, Gillam S The Quality and Outcomes Framework: does it reduce health inequalities? Final report. NIHR Service Delivery and Organisation programme; 2010.

Extract from the document:

“This research study set out to evaluate the impact of the Quality and Outcomes Framework (QOF) on the public health activities of general practices in deprived areas, and whether the QOF has contributed to reducing the gap in life  expectancy as defined in national targets.”

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Impact of Quality and Outcomes Framework on health inequalities – King’s Fund – 21 April 2011

Posted on April 21, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, General Practice, Preventive Healthcare, Public Hlth & Hlth Promotion | Tags: |

Impact of Quality and Outcomes Framework on health inequalities – King’s Fund – 21 April 2011

by Anna Dixon, Artak Khachatryan, Andrew Wallace, Stephen Peckham, Tammy Boyce, Stephen Gillam

Press release on the research:
No evidence that financial incentives for GPs have improved health or reduced inequalities

“The pay-for-performance scheme for GPs introduced in April 2004, known as the Quality and Outcomes Framework (QOF), has not resulted in improved ill-health prevention or health promotion by general practitioners, reveals new research published today.

Researchers looked at the impact of the QOF on public health and inequalities and revealed that where local practices were undertaking preventive activities, they usually pre-dated the QOF and were not a result of the incentives.

The research, based on analysis of routine data and interviews with practice and primary care trust staff, assessed the extent to which QOF has contributed to improving health in deprived areas of England.

The analysis found that:”

…continues

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Urgent and Emergency Care Clinical Audit Toolkit – UK – 30 March 2011

Posted on April 14, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, Emergency Medicine, General Practice |

Urgent and Emergency Care Clinical Audit Toolkit – UK – 30 March 2011

With Forewords from:
Royal College of General Practitioners
The College of Emergency Medicine
London Ambulance Service
Department of Health
Royal College of Paediatrics and Child Health

Extract from the introduction:

“This report comprises the evaluation of a six month project undertaken by the Royal College of General Practitioners (RCGP) and The College of Emergency Medicine (CEM). RCGP and CEM have worked closely with a wide range of Urgent Care providers and representatives throughout the course of the project.

The overarching aim of the project has been to work towards the creation of a universal clinical audit toolkit, applicable across a wide range of urgent and emergency care situations, and one which supports the implementation of a system of routine clinical audit along all urgent care pathways. Current urgent care provision pathways are often fragmented and complex, resulting in confusing care journeys for the many patients experiencing them. This situation is further complicated by the increasing plethora of organisations offering urgent care, and the wide range of professionals involved in the provision of that care.”

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Improving the quality of care in general practice: Report of an independent inquiry commissioned by The King’s Fund – 24 March 2011

Posted on March 24, 2011. Filed under: Clin Governance / Risk Mgmt / Quality, General Practice | Tags: |

Improving the quality of care in general practice: Report of an independent inquiry commissioned by The King’s Fund – 24 March 2011

Summary
“General practice is often regarded as the bedrock of the English health care system. Surveys consistently report high levels of trust in GPs and good levels of patient satisfaction with the services they receive in general practice. However, other than data available through the Quality Outcomes Framework and the GP Patient Survey, very little information is published on the quality of care in general practice.

It was for this reason that The King’s Fund set up, in April 2009, an independent inquiry into the quality of general practice in England. The aim of the inquiry, which was conducted by an independent panel of experts and chaired by Sir Ian Kennedy, was to help to support the work of general practice and to provide a guide to ensure that quality is at the heart of the service that it offers to patients.

Improving the quality of care in general practice is the report of the inquiry; it represents the most extensive review of quality across general practice carried out in recent years. Its work was informed by specially commissioned research and analysis of routinely available data across a range of aspects of general practice including: core elements of day-to-day practice – for example, diagnosis, referral and prescribing; non-clinical aspects of quality – for example, access to care and patient engagement; and areas where the role is shared with others – for example, maternity and end-of-life care.”

…continues on the site

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A shared agenda in the new world: The role of GP consortia and public health in improving health and wellbeing and delivering effective health care – NHS Alliance – February 2011

Posted on March 4, 2011. Filed under: General Practice, Health Mgmt Policy Planning, Primary Hlth Care, Public Hlth & Hlth Promotion | Tags: |

A shared agenda in the new world: The role of GP consortia and public health in improving health and wellbeing and delivering effective health care – NHS Alliance – February 2011

Final report of a national colloquium

“A Colloquium took place in January 2011, sponsored by the NHS Alliance and QIPP Right Care Team and organised by Solutions for Public Health (NHS). The scale of national changes, and current uncertainties in precise processes and delivery mechanisms, provided significant potential to influence thinking and shape the future direction for relationships and interactions between public health and primary care to deliver health improvement and better health care within the new systems.”

…continues

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NICE launches online resource for general practice – 21 February 2011

Posted on February 22, 2011. Filed under: General Practice, Health Informatics | Tags: |

NICE launches online resource for general practice – 21 February 2011

“NICE has launched a new section of its website, designed to help staff in general practice get the most out of evidence and guidance provided by NICE.

Specifically created to support the use of evidence-based medicine and public health practice, this online resource offers solutions to enable the uptake of NICE and other national guidance in primary care, and contains a section on how NICE can help GP consortia.

Written with help from GPs, practice managers and practice nurses, it will prove a valuable tool to help to deliver high quality primary care and to improve patient outcomes.

Users can quickly access relevant guidance and information, advice to ensure the practice team is up-to-date, and to further their continuing professional development.

It also includes a range of useful information for general practitioners, such as a quick at-a-glance list of the top 10 NICE guidelines for general practice and summaries of the key points for general practice as NICE publishes new guidance each month.

These pages bring together all the resources that are available from NICE to support the emerging GP commissioning consortia, including links to the NICE quality standards, access to the best evidence to support commissioning, through NHS Evidence, and a range of practical tools and support.

The website has four key sections: NICE for my patients, Using NICE guidance in my practice, My NICE resources, and NICE for GP consortia. Each section is easy to access and read, providing high quality targeted information.”

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Medicare Locals – applications invited to form them – 22 February 2011

Posted on February 22, 2011. Filed under: General Practice, Health Mgmt Policy Planning | Tags: |

Are you interested in becoming a Medicare Local? – 22 Feb 2011

The call for applications

From the YourHealth site:

“A key component of the Australian Government’s National Health Reforms is the establishment of a new nation-wide network of Medicare Locals to be locally responsive, to address local needs, to improve access to services and to drive integration across the health care system.

The Australian Government Department of Health and Ageing now invites applications to establish Medicare Locals across Australia.

Approximately 15 Medicare Locals will commence in July 2011. A further 15 will commence in January 2012, with the remainder starting in July 2012.

The first group of Medicare Locals will be drawn from high performing Divisions of General Practice, preferably working in consortia with other high performing organisations with the advanced capacity needed to lead primary health care reforms in their catchment, and who have the capacity to take on the roles and functions expected under the new arrangements.

The subsequent groups of Medicare Locals will build on the expertise and capacity of existing primary care organisations, particularly Divisions of General Practice as well as other primary health care organisations and service providers.

Applications for Medicare Locals to commence in July 2011 close on 5 April 2011.

Applications for Medicare Locals to commence in 2012 close on 19 July 2011.

View the Invitation to Apply documentation

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Identification and Referral to Improve Safety of women experiencing domestic violence (IRIS) project – The Health Foundation (UK) – 11 February 2011

Posted on February 16, 2011. Filed under: General Practice | Tags: , |

Identification and Referral to Improve Safety of women experiencing domestic violence (IRIS) project – The Health Foundation (UK) – 11 February 2011

Case study: Identification and Referral to Improve Safety (IRIS)

“Domestic violence is a severe breach of human rights, with profound health consquences, particularly for women, who experience a greater proportion of domestic violence than men.

It is a major public health issue, and a risk factor for chronic ill health and premature death in women. Nevertheless, in primary care it is under-recognised and under-treated.

A training and support programme called Identification and Referral to Improve Safety (IRIS) is working to change this. The results from the first stage of the programme show a marked increase in referral to specialist domestic violence services, and significant improvement in the identification of women experiencing domestic violence.

The programme is now in its implementation phase, with a target of 12 primary care trusts (PCTs) for initial roll-out of the service.”

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Paying GPs to improve quality: Auditing payments under the Quality and Outcomes Framework – Audit Commission [UK] – 3 February 2011

Posted on February 3, 2011. Filed under: General Practice, Health Economics | Tags: |

Paying GPs to improve quality: Auditing payments under the Quality and Outcomes Framework – Audit Commission [UK] – 3 February 2011

“Summary

This briefing examines how well primary care trusts oversee the Quality and Outcomes Framework, which incentivises GPs to improve their services to patients. It looks at whether PCTs can be confident that payments to GPs are correct and justified and that they provide value for money. It highlights the great variation between practices when it comes to exception reporting, where GPs can exclude patients from their returns for payment.

The briefing outlines features of a good approach where PCTs arrange regular visits to GP practices, carried out by suitably trained GP and lay assessors, and oversee and check scores and exception rates.”

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Perceptions of economic hardship and implications for illness management: a survey of general practitioners in western Sydney – Menzies Centre for Health Policy

Posted on January 25, 2011. Filed under: General Practice, Health Economics, Health Mgmt Policy Planning | Tags: , |

Perceptions of economic hardship and implications for illness management: a survey of general practitioners in western Sydney – Menzies Centre for Health Policy

By Angela Beaton, Tim Usherwood, Stephen R. Leeder and Lesley M. Russell

“Abstract

Objective: To understand the options available to general practitioners (GPs) to help patients experiencing economic hardship to manage their illnesses and the implications of these findings for policy.

Method: Cross-sectional survey of 134 GPs practising within the WentWest Division of General Practice and Blue Mountains GP Network in NSW.

Results: Most general practitioners in our survey encountered patients whom they perceived to be experiencing economic hardship. Of the 134 responses received (21% response rate), 123 (92%) GPs reported treating patients who found it difficult to afford health care; and 86 (64%) GPs estimated that some of these patients had: (1) deterioration in their health; (2) been admitted to hospital as a consequence of failure to take prescribed medicines; or, rarely, (3) died, as a result of failure to take prescribed medicines. The GPs usually learnt about their patients’ financial difficulties because patients: told them; asked for their consultations to be bulk-billed; or were reluctant to take medications or to see specialists because of cost.  The GPs most often offered these patients bulk billed services, drug sample packs or a change to a more affordable treatment regimen.

Conclusion and Implication: GPs have limited options available to them to assist patients experiencing economic hardship. A policy response should ensure that copayments for medications and medical care do not block access to necessary prescription medicines or services.”

Commentary by the authors on their paper in Australian Policy Online, 25 January 2011:
Hospitalisation and death: no co-payment required

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GP commissioning: insights from medical groups in the United States – Nuffield Trust – 19 January 2011

Posted on January 24, 2011. Filed under: General Practice, Health Economics, Health Mgmt Policy Planning | Tags: |

GP commissioning: insights from medical groups in the United States – Nuffield Trust – 19 January 2011

Author: Ruth Thorlby, Dr Rebecca Rosen & Dr Judith Smith

Publisher: Nuffield Trust

“Handing control of commissioning budgets over to groups of GPs forms one of the most radical proposals set out by the Government in the NHS White Paper, Equity and Excellence: Liberating the NHS (Department of Health, 2010a).

For the past two decades some doctors’ groups in the United States have held the equivalent of a commissioning budget. Up to 2,000 doctor-led networks and groups emerged across the country from the mid-1980s onwards to contract with insurance providers and take responsibility for fixed budgets with which to deliver their patients’ care. Only a small proportion of these groups have survived to the current day.

As part of our work on international comparisons, senior researchers from the Nuffield Trust visited a number of medical groups led by doctors in California. This briefing paper is based on the findings from their study visit and highlights important lessons for the NHS in England as the Government prepares to transfer control of £80 billion of the NHS budget to GP consortia.

The US experience shows that holding risk-bearing budgets can motivate doctors to deliver efficient, coordinated care that reduces avoidable and repeated admissions to hospital. However, to achieve this, the groups had to ensure that primary and specialist doctors cooperated closely and were able to invest in a range of high quality and innovative services that offer alternatives to hospital care, particularly for older patients with chronic conditions.

The US experience also shows that those groups which initially underestimated the importance of investing in management support – including data and IT systems, experienced analysts, and other management and financial expertise – struggled at first to manage their responsibilities effectively.

GP commissioning: insights from medical groups in the United States will be of interest to policy-makers and commissioners of GP services, as well as academics and researchers in this area.”

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Primary care economics – Institute of Health Economics, Alberta Canada – September 2010

Posted on October 14, 2010. Filed under: General Practice, Health Economics, Primary Hlth Care |

Primary care economics – Institute of Health Economics, Alberta Canada – September 2010

Extract from the summary

“Reforms of primary care hold promise in influencing health outcomes, especially among the chronically ill, but there is little supporting evidence about what these initiatives will cost. This paper addresses how our primary care resources are currently utilized and what they cost, what are the current funding systems established to support these resources, and what are the economic aspects of suggested reforms.”

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Productive General Practice – Releasing time to care – NHS Institute for Innovation and Improvement – October 2010

Posted on October 8, 2010. Filed under: General Practice | Tags: |

Productive General Practice – Releasing time to care – NHS Institute for Innovation and Improvement – October 2010
http://www.institute.nhs.uk/index.php?option=com_content&task=view&id=3868&Itemid=6005

The Productive General Practice is a new programme from the NHS Institute which aims to support general practices in realising internal efficiencies, while maintaining quality of care and releasing time to spend on more value added activities.

The Productive Approach

The Productive Series supports NHS teams to redesign and streamline the way they manage and work. This helps achieve significant and lasting improvements – predominately in the extra time that they give to patients, as well as improving the quality of care delivered whilst reducing costs.

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How does teamwork support GPs and Allied Health Professionals to work together? Primary Health Care Research and Information Service – September 2010

Posted on October 5, 2010. Filed under: Allied Health, General Practice | Tags: , |

How does teamwork support GPs and Allied Health Professionals to work together? Primary Health Care Research and Information Service – September 2010

“A well coordinated health system provides a comprehensive and continuous experience for the patient, promotes teamwork between practitioners, and the coordination of service delivery organisations. Improving teamwork between General Practitioners (GPs) and Allied Health Providers (AHPs) has been an ongoing challenge for Australia due to the split responsibility for primary health care between Commonwealth and State jurisdictions leading to incompatible systems of funding and accountability. Integration of services at the regional level has been identified as a priority in Australia’s Primary Health Care Strategy. This issue of RESEARCH ROUNDup highlights Australian research and systematic reviews that have addressed the role of teamwork in system integration in primary health care.”

…continues on the site

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GP commissioning consortia: building a better healthcare system for patients – September 2010

Posted on September 29, 2010. Filed under: General Practice, Health Mgmt Policy Planning |

GP commissioning consortia: building a better healthcare system for patients

“Tribal has launched the first in a series of white papers exploring how GP commissioning consortia can meet the new responsibilities they will face under the proposed government reforms for the NHS. It also suggests how the process of transferring the various tasks and functions from the Primary Care Trusts (PCTs) can be managed.”

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Decisions, Decisions: Family Doctors as Gatekeepers to Prescription Drugs and Diagnostic Imaging in Canada – September 2010

Posted on September 28, 2010. Filed under: General Practice, Health Economics, Health Policy | Tags: |

Decisions, Decisions: Family Doctors as Gatekeepers to Prescription Drugs and Diagnostic Imaging in Canada – September 2010

Health Council of Canada

Extract from the foreword:

“As Canada’s population ages and more and more Canadians live with chronic conditions, the use of Canada’s universal,  publicly-funded health care system increases. In our 2009 discussion paper, Value for Money: Making Canadian Health Care Stronger, we found that this increased use – among other factors – had caused health care spending to double over the last decade, reaching an all-time high of $183 billion in 2009.

As a result, we set out to better understand three major drivers of this use – physician services, prescription drugs, and diagnostic imaging – and the relationships among these drivers. We consulted researchers, experts, and government officials in the fields of physician services, pharmaceuticals, and diagnostic imaging. We also turned to other national organizations – noted in the acknowledgements section – for their data and expertise.

In this report, we discuss the role of family physicians as gatekeepers in the use of prescription drugs and diagnostic imaging, since they are often the first point of contact for Canadians, and their decisions directly impact which specific health care services are used. In particular, we set out to identify the main factors – including the available tools and resources – that influence these physician decisions and ensure that health services are safe and appropriate, an objective shared by all Canadians who are interested in better medicine and ensuring a sustainable health care system.”

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Practice Incentives Program, Department of Health and Ageing, Medicare Australia – Australian National Audit Office – 2010

Posted on September 20, 2010. Filed under: General Practice, Health Economics | Tags: |

Practice Incentives Program, Department of Health and Ageing, Medicare Australia – Australian National Audit Office – 2010

ISSN 1036–7632
ISBN 0 642 81149 0

The Practice Incentives Program (PIP) aims to provide a flexible, cost-effective mechanism for the Government to encourage both short and long-term changes to general practice, to support quality care, and to improve access and health outcomes with a minimum of red tape.

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The impact of incentives on the behaviour and performance of primary care professionals – NHS National Institute for Health Research – Service Delivery and Organisation programme – 4 August 2010

Posted on September 14, 2010. Filed under: General Practice, Health Economics, Primary Hlth Care | Tags: |

The impact of incentives on the behaviour and performance of primary care professionals – NHS National Institute for Health Research – Service Delivery and Organisation programme – 4 August 2010

“Aims: To explore and explain the impact of incentives in primary care on professional behaviours and performance. To examine these impacts on primary care professionals (PCPs) as providers of primary care and as commissioners of primary care and other services.” …continues

Commissioning brief Download (PDF 123Kb)
Executive summary Download (PDF 37Kb)
Final report Download (PDF 924Kb)

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Improving the Identification of Aboriginal and Torres Strait Islander People in Mainstream General Practice – The Lowitja Institute – August 2010

Posted on September 6, 2010. Filed under: Aboriginal TI Health, General Practice, Health Informatics | Tags: |

Kelaher, M., Parry, A., Day, S., Paradies, Y., Lawlor, J. & Solomon, L. 2010, Improving the Identification of Aboriginal and Torres Strait Islander People in Mainstream General Practice, The Lowitja Institute, Melbourne.

Download media release: GPs can help Close the Gap: Report (27 August 2010)

Publication: Improving Identification for GP Services

“The Lowitja Institute and the Australian National University have launched a new publication with recommendations on how GPs can help Close the Gap.

Better identification of Indigenous patients in general practices would improve their access to Medicare benefits such as health checks that could help ‘Close the Gap’, yet many GPs don’t consider ethnicity to be relevant to quality of care, according to a study from The Australian National University.
 
The study, commissioned by the Australian Primary Health Care Research Institute (APCHRI) at ANU and conducted under the auspices of The Lowitja Institute, reviewed the effectiveness of strategies that aim to improve the identification of Indigenous people.
 
National data and research evidence indicate that less than one third of general practices routinely collect information on the Indigenous status of patients. Improved identification of Aboriginal and Torres Strait Islander patients would support new ‘Closing the Gap’ initiatives to extend the delivery of routine health checks and chronic disease management services. “

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Referral management: lessons for success – The King’s Fund – 2010

Posted on August 20, 2010. Filed under: General Practice | Tags: , |

Referral management: lessons for success – The King’s Fund – 2010

76 pages ISBN: 978 1 85717 600 1

This report aims to provide practical advice to those seeking to influence the content and pattern of GP referrals. It draws on the current literature and new qualitative and quantitative research to evaluate the full range of referral management activities from full-scale referral management centres to the ‘passive’ provision of guidelines to GPs.

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Patient safety in primary health care – Australian Commission on Safety and Quality in Health Care – August 2010

Posted on August 18, 2010. Filed under: General Practice, Patient Safety, Primary Hlth Care | Tags: |

Patient safety in primary health care – Australian Commission on Safety and Quality in Health Care – August 2010

Discussion Paper – Draft for Public Consultation

“The field of patient safety emerged following Australian and international research showing that a large number of harmful, but potentially preventable, incidents occur in hospitals.1-3 This was emphasised by a number of high profile inquiries into incidents at specific hospitals.4-5 These origins mean that the focus of early patient safety work was mostly on issues that were particularly relevant for acute care settings, and there has been little examination of the patient safety risks that exist in primary health care.

However, most health care in Australia is provided in primary health care settings. Almost one in five people visit a general practitioner (GP), and one in ten visit an allied health professional in any given two week period.6 Given the size and importance of this sector, it is essential that the care provided in it is safe, and that risks of unnecessary harm associated with the delivery of health care are minimised.

There are a large number of organisations that have a role in quality and safety in primary health care in Australia, and many programs and initiatives are in place to improve care provided in this sector. One of these organisations is the Australian Commission on Safety and Quality in Health Care (the Commission), which was established in 2005 to lead and coordinate improvements in safety and quality nationally.

The purpose of this paper is to stimulate discussion about patient safety in primary health care in Australia. The Commission wants to raise awareness of these issues, and supports coordinated national action to address them. Improving patient safety in primary health care requires a new approach and new thinking that includes a greater emphasis on safety and prevention from harm.

The Commission would like to work with primary health care stakeholders to identify priority areas for improving safety, and to take action to address these priorities. The development of this paper and subsequent consultation process is the first step in this process and the outcomes of the consultation will be used to guide the Commission’s actions to support patient safety in primary health care.”

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The role of GPs in maternity care – what does the future hold? – The King’s Fund’s Inquiry into the Quality of General Practice in England – August 2010

Posted on August 5, 2010. Filed under: General Practice, Obstetrics | Tags: |

The role of GPs in maternity care – what does the future hold? – The King’s Fund’s Inquiry into the Quality of General Practice in England – August 2010  Report in pdf    (pdf 397 kb)

“To inform its work, the Inquiry panel commissioned a discussion paper to examine what good-quality maternity care looks like and the implications for general practice. The [report] assesses the current state of general practice involvement in maternity care, what GPs can do to stimulate and maintain care quality, and how care quality can be measured. The paper’s authors are Alex Smith, former Health Policy Researcher, The King’s Fund, and Judy Shakespeare, GP.”

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What Factors Influence the Earnings of GPs and Medical Specialists in Australia? Evidence from the MABEL Survey – July 2010

Posted on July 21, 2010. Filed under: General Practice, Medicine, Workforce |

What Factors Influence the Earnings of GPs and Medical Specialists in Australia? Evidence from the MABEL Survey – July 2010
Terence Chai Cheng et al 
Melbourne Institute Working Paper No. 12/10
ISSN 1328-4991 (Print)
ISSN 1447-5863 (Online)
ISBN 978-0-7340-4223-1

“Abstract
To date, there has been little data or empirical research on the determinants of doctors’ earnings despite earnings having an important role in influencing the cost of health care, decisions on workforce participation and labour supply. This paper examines the determinants of annual earnings of general practitioners and specialists using the first wave of the Medicine in Australia: Balancing Employment and Life (MABEL), a new longitudinal survey of doctors in Australia. For both GPs and specialists, earnings are higher for men, for those who are self-employed, who do after hours or on-call work, and who work in areas with a high cost of living. GPs have higher earnings if they work in larger practices, in outer regional or rural areas, and in areas with lower GP density, whilst specialists earn more if they are a fellow of their college, have more working experience, spend more time in clinical work, have less complex patients, or work in inner regional areas. Overall, GPs earn about 32% less than specialists. The returns from on-call work, experience, and self-employment are higher for specialists compared to GPs.”

Media release
Female GPs Earn 25% Less Than Male Counterparts – 21 July 2010

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RCGP revalidation pilots: England & Wales

Posted on July 12, 2010. Filed under: Clinical Education, Educ for Hlth Professions, General Practice | Tags: , |

RCGP revalidation pilots: England & Wales

“Revalidation for UK doctors is due to be introduced in April 2010. This report is the result of a feasibility study in relation to collecting supporting information required for strengthened medical appraisal and a GP revalidation ePortfolio. Recommendations are made towards further training and support to allow GPs, GP appraisers and responsible officers to engage effectively in the revalidation process.”
NHS Revalidation Support Team – publications 
Revalidation processes for sessional GPs: a feasibility study to pilot current proposals 

This study set out to explore the potential problems that locum, salaried and remote GPs might encounter with the proposed supporting information required for appraisal as part of the revalidation process. The study makes recommendations towards cultural changes in order to provide the necessary support for sessional GPs in completing their revalidation.
NHS Revalidation Support Team – publications

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National Demonstration Project and the Patient-Centered Medical Home – Supplement issue of Annals of Family Medicine – 2010

Posted on June 10, 2010. Filed under: General Practice, Primary Hlth Care |

National Demonstration Project and the Patient-Centered Medical Home – Supplement issue of Annals of Family Medicine – 2010

American Academy of Family Physicians (AAFP) – Patient-Centered Medical Home website

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Stocktake of Primary Health Care Research in Australia – ANU – May 2010

Posted on June 8, 2010. Filed under: General Practice, Primary Hlth Care |

Stocktake of Primary Health Care Research in Australia – ANU – May 2010

Primary Health Care Research and Information Service (PHC RIS)
Discipline of General Practice
Flinders University of South Australia

“In light of the development of Primary Health Care Research over the past 10 years, and the current agenda for reform, this work sets out to do three things: provide a stocktake of the current state of primary health care research in Australia; identify the current strengths and weakness of Australian primary health care research in light of current health priorities; identify ways in which current research gaps might be addressed.”

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At the tipping point: health leaders share ideas to speed primary health care reform [Canada] – 26 May 2010

Posted on May 28, 2010. Filed under: General Practice, Primary Hlth Care | Tags: |

At the tipping point: health leaders share ideas to speed primary health care reform [Canada] – 26 May 2010

Earlier this year, the Health Council of Canada sponsored a day-long discussion on primary health care reform through the McMaster Health Forum. Twenty health care leaders from across the country came together to talk about ways to strengthen primary health care in Canada.

Media release

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Lessons from Major Initiatives to Improve Primary Care in the United Kingdom – May 2010

Posted on May 24, 2010. Filed under: General Practice, Health Economics |

T. Doran and M. Roland, “Lessons from Major Initiatives to Improve Primary Care in the United Kingdom,” Health Affairs, May 2010 29(5):1023–29.

“The Issue
After a decade of low morale and perceived poor working conditions, a 2001 survey found that 90 percent of U.K. general practitioners (GPs) felt they were overworked, undervalued, and underresourced. To address a shortage of GPs, improve physician morale, and address public concerns about quality of care, the U.K. Department of Health in 2004 negotiated a new GP contract that increased payments to practices based on performance on more than 100 clinical and health improvement indicators. The authors of this Commonwealth Fund–supported study examined the intended and unintended effects of this pay-for-performance program on the supply of GPs, quality of care, practice behavior, and income.”

…continues

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Network organizations of general practitioners: antecedents of formation and consequences of participation – May 2010

Posted on May 18, 2010. Filed under: General Practice |

Network organizations of general practitioners: antecedents of formation and consequences of participation
Giovanni Fattore  and Domenico Salvatore
BMC Health Services Research 2010, 10:118doi:10.1186/1472-6963-10-118
Published: 11 May 2010    pdf version

“Abstract (provisional)

Background
Network forms of organization are increasingly popular in primary care. At the end of the 1990s General Practitioners (GPs) in Italy were given the opportunity to adopt network forms of organization with the aim of improving the quality of their services. However factors affecting GPs’ choices to join a network and the consequences of network membership have not been evaluated.

Methods
Administrative data of a Local Health Authority in Central Italy were analyzed using statistical methods at individual and dyadic levels of analysis.

Results
Homophily factors seem to influence a GP’s choice of network. The consequences of network membership on GP performances seem very limited.

Conclusions
When considering to foster the diffusion of network organizational forms in health care creating a network structure, like that of Italian GPs, is not sufficient. Other features of the implementation phase, work organization and human resource management should also be considered.”

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Primary Care and Emergency Departments: Report from the Primary Care Foundation – March 2010

Posted on March 16, 2010. Filed under: Emergency Medicine, General Practice | Tags: |

Primary Care and Emergency Departments: Report from the Primary Care Foundation – March 2010
Prepared by David Carson, Henry Clay and Rick Stern

From the Executive summary:

“The number of primary care clinicians based within or alongside emergency departments has expanded rapidly in recent years, promising better care for patients who do not need emergency department services and a reduction in admissions.

Primary care practitioners can enhance emergency departments by bringing vital skills and expertise to a multi-disciplinary team. To achieve this, managers and clinicians need to develop strong working relationships. Building mutual respect takes time, but it is vital if initiatives of this kind are to lead to a more integrated service. As one GP put it “if everyone is involved it becomes seen as a joint baby, not a primary care service in their midst”.

Successful schemes are the product of sustained attempts to test out new ideas, learn from each other and improve patient care, based on clear recognition of the skills of each group of clinicians and mutual respect. However, in practice there can be a clash of cultures, with staff divided by different training, approaches to managing risk, governance systems, language and their experience of different case mixes.”

…continues

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Widespread Adoption of Information Technology in Primary Care Physician Offices in Denmark: A Case Study – 11 March 2010

Posted on March 16, 2010. Filed under: General Practice, Health Informatics | Tags: |

Widespread Adoption of Information Technology in Primary Care Physician Offices in Denmark: A Case Study
March 11, 2010

D. Protti and I. Johansen, Widespread Adoption of Information Technology in Primary Care Physician Offices in Denmark: A Case Study, The Commonwealth Fund, March 2010.
 
Issue Brief (529K PDF) 
 
“Overview
 
Denmark is one of the world’s leading countries in the use of health care technology. Virtually all primary care physicians have electronic medical records with full clinical functionality. Their systems are also connected to a national network, which allows them to electronically send and receive clinical data to and from consultant specialists, hospitals, pharmacies, and other health care providers. Under the auspices of a nonprofit organization called MedCom, over 5 million clinical messages are transferred monthly. One of the most important innovations has been the “one-letter solution,” which allows one electronic form to be used for all types of letters to and from primary care physicians; it is used in over 5,000 health institutions with 50 different technology vendor systems.”

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Primary Healthcare: Improving Canada’s primary healthcare: benefits and opportunities – Canadian Health Services Research Foundation – January 2010

Posted on January 27, 2010. Filed under: General Practice, Primary Hlth Care | Tags: |

Primary Healthcare: Improving Canada’s primary healthcare: benefits and opportunities – Canadian Health Services Research Foundation

“About the reports

These three reports summarize the current state of primary healthcare in Canada, investigate best international practices and provide concrete recommendations on how Canada can redefine its priorities in order to strengthen the system.

Commissioned by CHSRF and the Canadian Working Group for Primary Healthcare Improvement, the three reports will be used to guide activities in developing a pan-Canadian strategy for using evidence to improve the design and delivery of primary healthcare.

The Canadian Working Group for Primary Healthcare Improvement was formed at an April 2008 meeting of leaders in primary healthcare (researchers, practitioners, funders and policy makers) that was convened by CHSRF – the group’s lead agency.

The reports

What are the Critical Attributes and Benefits of a High-quality Primary Healthcare System?
Dale McMurchy
January 2009 (released January 2010)

This paper summarizes the key attributes and benefits of high-quality primary healthcare systems. It covers factors such as orientation and design, organization and process, effective governance, physician supply and the critical features unique to primary care delivery.

The Health and Economic Consequences of Achieving a High-quality Primary Healthcare System in Canada – “Applying What Works in Canada: Closing the Gap”
Alan Katz, Richard H. Glazier, Janani Vijayaraghavan
February 2009 (released January 2010)

Currently, there is a large gap between the ideal primary healthcare system – one that relies on evidence-based practice – and the reality of Canada’s system. This report analyzes the effects, both health-related and economic, of moving the reality toward the ideal.

A Structure for Co-ordinating Canadian Primary Healthcare Research
G. Russell, S. Johnston, P. Thille, R. Geneau, J. Conklin, W. Hogg, Y. Ikezawa
February 2009 (released January 2010)

If Canada wants a high-quality primary healthcare system that integrates emerging evidence into practice and policy, then it needs a co-ordinating body to support all those working to improve primary healthcare through evidence. The authors investigate international and domestic models, examine various frameworks and processes, compare the pros and cons, and explore the feasibility of implementing a network model in the Canadian context.”

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How to increase the delivery of effective smoking cessation treatments in primary care settings: Guidance for doctors, nurses, other health professionals & healthcare organisations – New Zealand – December 2009

Posted on December 30, 2009. Filed under: General Practice, Public Hlth & Hlth Promotion | Tags: |

How to increase the delivery of effective smoking cessation treatments in primary care settings:  Guidance for doctors, nurses, other health professionals & healthcare organisations – New Zealand – December 2009

“Summary of publication

This report summarises the evidence on the delivery of effective smoking cessation. It focuses on the ABC approach to smoking cessation which brings with it a more “assertive” manner in which clinicians can work.

This guidance for health professionals provides different elements and key points of leverage that can be used to better implement and support smoking cessation in primary care.”

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General practice activity in Australia 2008-09 – Australian Institute of Health and Welfare – 2 December 2009

Posted on December 2, 2009. Filed under: General Practice | Tags: |

General practice activity in Australia 2008-09 – Australian Institute of Health and Welfare – 2 December 2009
Authored by Britt H.
General practice series no. 25

“This report presents results from the eleventh year of the BEACH program, a national study of general practice activity. From April 2008 to March 2009, 1,011 general practitioners recorded data about 101,100 GP-patient encounters involving the management of 149,462 problems. For an `average’ 100 encounters, GPs recorded 106 medications, 34 clinical treatments, 17 procedures, 9 referrals to specialists and 4 to allied health services, and ordered 46 pathology and 10 imaging tests.”
Published 2 December 2009; ISSN 1442-3022; ISBN-13 978 1 74024 972 0; AIHW cat. no. GEP 25; 198pp

General practice activity in Australia 1999-00 to 2008-09: 10 year data tables
Authored by Britt H.
General practice series no. 26

“This report presents results from the most recent 10 years (April 1999 to March 2008) of the BEACH program, a national cross-sectional study of general practice activity. During this time 9,901 GPs provided details of almost 1 million GP-patient encounters. Readers can review changes that have occurred over the decade in the characteristics of general practitioners and the patients they see; the problems managed and the treatments provided. Changes in patients’ body mass index, smoking status and alcohol use are described for a subsample of adult patients.”
Published 2 December 2009; ISSN 1442-3022; ISBN-13 978 1 74024 973 7; AIHW cat. no. GEP 26; 176pp

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Patient-Centred Primary Care in Canada: Bring it on Home – College of Family Physicians of Canada – Discussion Paper – October 2009

Posted on November 10, 2009. Filed under: Chronic Disease Mgmt, General Practice, Health Systems Improvement | Tags: , |

Patient-Centred Primary Care in Canada: Bring it on Home – College of Family Physicians of Canada – Discussion Paper – October 2009

“The College of Family Physicians of Canada (CFPC) recommends the introduction of the medical home concept for the people of Canada; incorporating the strengths of medical home models elsewhere in the world with the primary care renewal experiences currently unfolding across Canada.

A medical home is a patient-centred medical care setting where: 1) patients have a personal family physician who provides and directs their medical care; 2) care is for the patient as a whole; 3) care is coordinated, continuous and comprehensive with patients having access to an inter-professional team; 4) there is enhanced access for appointments; 5) the practice includes well-supported information technology, including an electronic medical record; 6) remuneration supports the model of care; and 7) quality improvement and patient safety are key objectives.”

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Shared Record Professional Guidance – NHS Connecting for Health and Royal College of General Practitioners – 18 August 2009

Posted on August 19, 2009. Filed under: General Practice, Health Informatics, Medical Records |

Shared Record Professional Guidance (SRPG)

“NHS Connecting for Health has been pleased to commission the Royal College of General Practitioners to produce the Shared Record Professional Guidance report, published today (18 August 2009).

We thank the Royal College of General Practitioners for co-ordinating the involvement of other professional and patient stakeholder groups in order to achieve a wide agreement on principles.

This report, ‘Informing Shared Clinical Care’, will provide key principles for professional bodies as the first step towards creating guidelines for Shared Electronic patient records.

The report was written by the Royal College of General Practitioners (RCGP) Informatics Group who consulted over 30 different professional and patient stakeholder groups in order to achieve agreement and endorsement of the 16 principles.”

…continues on the website

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General practice in Australia, health priorities and policies 1998 to 2008 – AIHW Report – 8 July 2009

Posted on July 8, 2009. Filed under: Aged Care / Geriatrics, Chronic Disease Mgmt, General Practice, Pathology, Public Hlth & Hlth Promotion, Workforce | Tags: , |

General practice in Australia, health priorities and policies 1998 to 2008
Authored by Britt H & Miller GC.  Published by the Australian Institute of Health and Welfare, 8 July 2009; ISSN 1442-3022; ISBN-13 978 1 74024 934 8; AIHW cat. no. GEP 24; 308pp.   General practice series no. 24

“This report looks extensively at changes in the activities of GPs from 1998 to 2008 in the light of numerous government initiatives and changes in the GP workforce and in the population. It shows that GP activity generally correlates well with health policy initiatives and clinical guidelines, notably with Type 2 diabetes and the control of asthma and high blood cholesterol levels. In some areas, however, there is less evidence of an effect so far. The report also raises some potential concerns about the costs from the continued rapid growth in orders for pathology testing and the overall challenge for the GP workforce in dealing with an ageing population with complex needs.”

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The remuneration of general practitioners and specialists in 14 OECD countries

Posted on April 8, 2009. Filed under: General Practice, Workforce | Tags: |

The remuneration of general practitioners and specialists in 14 OECD countries: what are the factors influencing variations across countries?

OECD Health Working Papers – no. 41  Directorate for Employment, Labour and Social Affairs, Health Committee 18 December 2008

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