Location of Repository

Bringing genetics into primary care: findings from a national evaluation of pilots in England

By Graham P. Martin, Graeme Currie and Rachael Finn

Abstract

This is the final draft, after peer-review, of a manuscript published in Journal of Health Services Research & Policy, 2009, 14 (4), pp. 204-211. The definitive version, detailed above, is available online at www.rsmjournals.com. \ud DOI:10.1258/jhsrp.2009.008158Objectives: Developments in genetic knowledge and clinical applications are seen as rendering traditional modes of organizing genetics provision increasingly inappropriate. In common with a number of developed world countries the UK has sought to increase the role of primary care in delivering such services. However, efforts to reconfigure service delivery face multiple challenges associated with divergent policy objectives, organizational boundaries and professional cultures. This paper presents findings from an evaluation of an English initiative to integrate genetics into ‘mainstream’ clinical provision in the National Health Service. \ud \ud Methods: Qualitative research in 11 case-study sites focusing on attempts by pilots funded by the initiative to embed knowledge and provision within primary care illustrating barriers faced and the ways in which these were surmounted. \ud \ud Results: Lack of intrinsic interest in clinical genetics among primary care staff was compounded by national targets that focused their attention elsewhere and by service structures that rendered genetics a peripheral concern demanding minimal engagement. Established divisions between the commissioning of mainstream and specialist services, along with the pressures of shorter-term targets, impeded ongoing funding. \ud \ud Conclusions: More wide-ranging policy and organizational support is required if the aim of entrenching genetics knowledge and practice across the Health Service is to be realized

Publisher: Royal Society of Medicine
Year: 2009
DOI identifier: 10.1258/jhsrp.2009.008158
OAI identifier: oai:lra.le.ac.uk:2381/7551
Journal:

Suggested articles

Preview

Citations

  1. Accounting for the 'dark side' of new organizational forms: the case of healthcare professionals. doi
  2. (2009). benefits and weaknesses of intermediate care: results from five UK case study sites. Health Soc Care Community 2008;16:629-37. This is the final draft, after peer-review, of a manuscript published in doi
  3. (2003). Breaking down barriers: integrating health and care services for older people in England. Health Policy doi
  4. (1989). Building theory from case study research. Acad Manage Rev
  5. Changing the culture of a hospital: from hierarchy to networked community. doi
  6. Delivering cancer genetics services – new ways of working. doi
  7. Foundation hospitals: a new direction for NHS reform? doi
  8. Incentives and control in primary health care: findings from English pay-for-performance case studies. doi
  9. Integrating genetics as practices of primary care. Soc Sci Med 2004;59:223- doi
  10. (1996). Managing through networks: some issues and implications for the NHS. doi
  11. (2006). New Labour’s State of Health: Political Economy, Public Policy and the NHS. doi
  12. Older people and the relationship between hospital services and intermediate care: results from a national evaluation. doi
  13. Primary health and social care services in the UK: progress towards partnership? Soc Sci Med doi
  14. Professional competition and modernising the clinical workforce in the NHS: possibilities and limits to the development of the specialist generalist in primary care.
  15. Raising the profile of genetics in primary care. doi
  16. Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the ‗modernization‘ of the medical workforce. Soc Sci Med 2009;68:1191-8. Ham C. World class commissioning: a health policy chimera? doi
  17. Representativeness, legitimacy and power in public involvement in health-care management. doi
  18. (2005). Sea change or quick fix? Policy on long-term conditions in England. Health Soc Care Community doi
  19. (2003). Secretary of State for Health. Our Inheritance, Our Future: Realising the Potential of Genetics in the NHS. London: The Stationery Office,
  20. service reform, and public-service networks: the case of cancer-genetics pilots in the English NHS. doi
  21. Significant factors in implementing cascade testing for familial hypercholesterolaemia. doi
  22. Tensions between policy makers and general practitioners in implementing new genetics: grounded theory interview study. doi
  23. The challenge of integrating genetic medicine into primary care. doi
  24. The impact of institutional forces upon knowledge sharing in the UK NHS: the triumph of professional power and the inconsistency of policy. doi
  25. Understanding general practice: a conceptual framework developed from case studies in the UK NHS.

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.