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Under the UK Conservative government, GP fundholding represented a major increase in the involvement of primary care doctors in the management of local service provision. The Labour government's proposals for Primary Care Groups extends and develops this role. This article examines the experiences of fundholding of a group of general practices which participated in an external evaluation of their work. Opinions about the merits of fundholding were varied. Doctors and managers expressed concern about the administrative burden and questionable clinical value of the scheme. Uncertainties about the overall impact upon professional autonomy were also raised. These reservations are consistent with discussions elsewhere questioning the role of doctors as managers within health care systems.

Discusses involvement of primary care doctors in the management of local service provision; based on experiences of doctors and managers in one total purchasing project; Great Britain. Summaries in French and Spanish.

Informal carers (i.e. people who provide unpaid care to family and/or friends) are crucial in supporting people with long‐term conditions. Caring negatively impacts on carers' health and experiences of health services. Internationally and nationally, policies, legislation, professional guidance and research advocate for health and care services to do more to support carers. This study explored the views of health and social care providers, commissioners and policy makers about the role and scope for strengthening health service support for carers. Twenty‐four semi‐structured interviews, with 25 participants were conducted, audio‐recorded, transcribed verbatim and analysed by thematic analysis. Three main themes emerged: (a) identifying carers, (b) carer support, and (c) assessing and addressing carer needs. Primary care, and other services, were seen as not doing enough for carers but having an important role in identifying and supporting carers. Two issues with carer identification were described, first people not self‐identifying as carers and second most services not being proactive in identifying carers. Participants thought that carer needs should be supported by primary care in collaboration with other health services, social care and the voluntary sector. Concerns were raised about primary care, which is under enormous strain, being asked to take on yet another task. There was a clear message that it was only useful to involve primary care in identifying carers and their needs, if benefit could be achieved through direct benefits such as better provision of support to the carer or indirect benefit such as better recognition of the carer role. This study highlights that more could be done to address carers' needs through primary care in close collaboration with other health and care services. The findings indicate the need for pilots and experiments to develop the evidence base. Given the crucial importance of carers, such studies should be a high priority.

Informal carers (i.e. people who provide unpaid care to family and/or friends) are crucial in supporting people with long‐term conditions. Caring negatively impacts on carers' health and experiences of health services. Internationally and nationally, policies, legislation, professional guidance and research advocate for health and care services to do more to support carers. This study explored the views of health and social care providers, commissioners and policy makers about the role and scope for strengthening health service support for carers. Twenty‐four semi‐structured interviews, with 25 participants were conducted, audio‐recorded, transcribed verbatim and analysed by thematic analysis. Three main themes emerged: (a) identifying carers, (b) carer support, and (c) assessing and addressing carer needs. Primary care, and other services, were seen as not doing enough for carers but having an important role in identifying and supporting carers. Two issues with carer identification were described, first people not self‐identifying as carers and second most services not being proactive in identifying carers. Participants thought that carer needs should be supported by primary care in collaboration with other health services, social care and the voluntary sector. Concerns were raised about primary care, which is under enormous strain, being asked to take on yet another task. There was a clear message that it was only useful to involve primary care in identifying carers and their needs, if benefit could be achieved through direct benefits such as better provision of support to the carer or indirect benefit such as better recognition of the carer role. This study highlights that more could be done to address carers' needs through primary care in close collaboration with other health and care services. The findings indicate the need for pilots and experiments to develop the evidence base. Given the crucial importance of carers, such studies should be a high priority.

AbstractAlthough the use of strategic planning has become widespread in INGDOs they have often been accused of strategic drift—continuous change in their strategic directions with plans only loosely coupled to their activities. However, the way that they prioritize their activities, and the reasons why strategic drift occurs has generally escaped in‐depth research. This article draws on detailed, qualitative research of strategic planning meetings at the executive levels in a major INGDO, carried out between July 2006 and December 2007 to identify the reasons why strategic drift occurs and the role of strategic planning. It was found that by deliberately crafting multiple, ambiguous, and ambitious strategies, managers were able to effect organizational change, not by literal strategy implementation, but by using these strategies as metaphors to harness consensus and legitimacy in key stakeholder groups. Senior managers utilize the symbols, language and deliberative arenas of formal strategic planning to effect organizational change; however, strategy, in rational terms, needs to be located in the background for its role to be properly understood. The research unpacks complex decision‐making processes in an INGDO and, contrary to normative literature, recommends that, in order to avoid inflationary planning, managers should not take their strategy literally. Copyright © 2009 John Wiley & Sons, Ltd.

This is the first international and inter-disciplinary social science Handbook on health and medicine. Five years in the making, and building on the insights and advice of an international editorial board, the book brings together world-class figures to provide an indispensable, comprehensive resource book on social science, health and medicine. Pinpointing the focal issues of research and debate in one volume, the material is organized into three sections: social and cultural frameworks of analysis; the experience of health and illness; and health care systems and practices. Each section cons

Cover -- Half Title -- Title Page -- Copyright Page -- Original Title Page -- Original Copyright Page -- Table of Contents -- Acknowledgements -- 1 Introduction -- Part 1: Illness and Help Seeking -- 2 Lay Concepts of Illness -- 3 The Illness Iceberg and Aspects of Consulting Behaviour -- 4 Social Class, Ethnicity, and Illness -- Part 2: The Experience of Treatment -- 5 Communicating with Patients -- 6 Compliance -- 7 Anxiety, Hospitalization, and Surgery -- 8 Satisfaction with Health Care -- Part 3: Chronic and Terminal Illness -- 9 The Psychological Consequences of Cerebrovascular Accident and Head Injury -- 10 Perceiving and Coping with Stigmatizing Illness -- 11 Coping with Terminal Illness -- References -- Name Index -- Subject Index.

Coping with chronic illness encapsulates both practical and emotional aspects of living life in relation to one's long‐term health condition(s). Dominant health psychology approaches for understanding coping, which underpin a more recent policy discourse on 'self‐management', focus sharply on the person affected by illness and potentially mask the influence of overarching social structure. In this paper we draw on qualitative interviews with 48 people living with long‐term conditions (LTCs), in order to highlight the role that structural configurations such as healthcare systems may play in either helping or hindering people's efforts to cope with chronic illness. We argue that coping is a social process in which health and related services, situated within their wider political‐economic contexts, play an active role in shaping people's attempts to live well with LTCs. More specifically, health systems are sites of social and cultural capital exchange that can differentially mobilise coping resources through access, continuity of care, and coordination across services. Whilst it is essential to recognise the personal agency of people living with chronic illness, it is also vital to acknowledge the underlying inequalities that affect the ways in which services can support such resourcefulness.

SummaryIn summer 1987, 584 students at Oxford University were sent a questionnaire enquiring about their sexual behaviour and contraceptive practice, and about the effect that AIDS has had on these. Of the 374 students who replied, 65% of the women and 62% of the men had experienced sexual intercourse. Twenty-seven per cent of female undergraduates did not use adequate contraception on the first occasion of intercourse. During the 4-week period preceding the questionnaire, 15% of sexually active female undergraduates did not use adequate contraception. The use of contraception has changed over the last 5 years, with fewer students using oral contraceptives as their most frequent means of contraception and more using barrier methods. In general, knowledge about AIDS was high. Most students did not consider that they were at risk of becoming infected by the AIDS virus and, by their reported sexual behaviour, very few students appeared to be at any risk. However, 35% of women and 44% of men who were sexually active said that because of risk of AIDS they had been more likely to use the sheath, and 49% of women and 30% of men said that they had, or would have, fewer partners. These findings suggest that attitudes, and possibly behaviour, are changing towards a reduction in risks of sexually transmitted infection.