Choice and the composition of general practice patient registers

Choice of general practice (GP) in the National Health Service (NHS), the UKs universal healthcare service, is a core element in the current trajectory of NHS policy. This paper uses an accessibility-based approach to investigate the pattern of patient choice that exists for GPs in the London Borough of Southwark. Using a spatial model of GP accessibility it is shown that particular population groups make non-accessibility based decisions when choosing a GP. These patterns are assessed by considering differences in the composition of GP patient registers between the current patient register, and a modelled patient register configured for optimal access to GPs. The patient population is classified in two ways for the purpose of this analysis: by geodemographic group, and by ethnicity. The paper considers choice in healthcare for intra-urban areas, focusing on the role of accessibility and equity

Mental health

PHN Discussion Paper #2 – Mental Health notes a key role for Primary Health Networks in realising effective and lasting improvement in mental health outcomes, through adopting a person-centred approach in service design and enabling integration across service providers in local health systems. The 2014 National Mental Health Commission report noted that “They (PHNs) can work in partnership and apply targeted, value-for-money interventions across the whole continuum of mental wellbeing and ill-health to meet the needs of their communities.” Notwithstanding this, there are challenges and barriers to be resolved in order to effect meaningful and sustainable improvement in mental health outcomes and health system performance.  Further exploration of the challenges and barriers is warranted in order to enable PHNs to deliver on their objectives.&nbsp

Modelling the impact of local reactive school closures on critical care provision during an influenza pandemic

Despite the fact that the 2009 H1N1 pandemic influenza strain was less severe than had been feared, both seasonal epidemics of influenza-like-illness and future influenza pandemics have the potential to place a serious burden on health services. The closure of schools has been postulated as a means of reducing transmission between children and hence reducing the number of cases at the peak of an epidemic; this is supported by the marked reduction in cases during school holidays observed across the world during the 2009 pandemic. However, a national policy of long-duration school closures could have severe economic costs. Reactive short-duration closure of schools in regions where health services are close to capacity offers a potential compromise, but it is unclear over what spatial scale and time frame closures would need to be made to be effective. Here, using detailed geographical information for England, we assess how localized school closures could alleviate the burden on hospital intensive care units (ICUs) that are reaching capacity. We show that, for a range of epidemiologically plausible assumptions, considerable local coordination of school closures is needed to achieve a substantial reduction in the number of hospitals where capacity is exceeded at the peak of the epidemic. The heterogeneity in demand per hospital ICU bed means that even widespread school closures are unlikely to have an impact on whether demand will exceed capacity for many hospitals. These results support the UK decision not to use localized school closures as a control mechanism, but have far wider international public-health implications. The spatial heterogeneities in both population density and hospital capacity that give rise to our results exist in many developed countries, while our model assumptions are sufficiently general to cover a wide range of pathogens. This leads us to believe that when a pandemic has severe implications for ICU capacity, only widespread school closures (with their associated costs and organizational challenges) are sufficient to mitigate the burden on the worst-affected hospitals

Towards the development of a resource allocation model for primary, continuing and community care in the health services - Volume 1

This report proposes a resource allocation model for the Irish health services based on the principle that each Irish resident should be provided with access to health services funded from general taxation and in proportion to their need for those services. At the moment, such a system cannot be deployed as some necessary financial information is not available. The information could be made available, and should be done as quickly as possible. If this information were made available, the model proposed here, while very crude, would serve as a good starting point for resource allocation and should be initiated as soon as possible. Any reasonable system of resource allocation would be an improvement on the system that is currently in place

Delivering effective NHS services to our multiethnic population: collection and application of ethnic monitoring within primary care

Government health policy has emphasised the importance of understanding and tackling ethnic disparities in health and healthcare for at least four decades. Yorkshire & the Humber includes areas with large, well-established minority ethnic populations. In addition, most cities in the region, including those that have in the past been dominated by the White British majority, are now experiencing rapid migration. Persistent patterns of health disadvantage among established minority ethnic communities are now compounded by the differing health needs of new migrant populations. NHS organisations in Yorkshire & the Humber have begun to respond more systematically to the needs of minority ethnic groups. However, there is still progress to be made on establishing basic requirements for effective commissioning, including effective ethnic monitoring systems that provide high quality intelligence to commissioners, service managers and health professionals. While there are examples of innovation and good practice, there is significant variation across the region and a lack of sharing and learning between organisations. Here we report on a workshop that was convened by the Strategic Health Authority in June 2009 as a first step towards addressing this recognised area of need. The Workshop Chair was John Chuter, Chair of NHS Bradford & Airedale. The aims of the workshop were to: • Highlight the policy context and imperatives for ethnic monitoring. • Raise awareness of the current position with regard to ethnic monitoring and use of data in Yorkshire & the Humber. • Share emerging good practice. • Identify ways to move forward to improved ethnic monitoring across the region

Payment for Environmental Services: First Global Inventory of Schemes Provisioning Water for Cities

In the perspective of the World Water Day 2011 - "Water for Cities" (March 22, 2011), the Natural Resources Land and Water Division (NRL) of FAO has launched an inventory of environmental schemes provisioning water to cities. Up to date there have been several studies addressing the payment for watershed services around the world, conducted by various UN agencies, NGOs, etc. None of these studies so far has focused on the PES schemes providing the water supply for cities and industries, i.e. urban areas. In that sense this inventory is unique. The report offers a very useful inventory of identified PES - "water for cities" schemes around the world. The report can be used as basis for further pursuit of information and analysis of the most relevant cases at least, and possible replication of these cases, primarily in East Africa that has become an area of interest lately for the potential development of this market based scheme in order to address the water issues of the region

Evaluation of children's centres in England (ECCE) : strand 1: first survey of children's centre leaders in the most deprived areas

This report is the first output from the Evaluation of Children's Centres in England (ECCE), a six year study commissioned by the Department for Education and undertaken by NatCen Social Research, the University of Oxford and Frontier Economics. The aim of ECCE is to provide an in-depth understanding of children's centre services, including their effectiveness in relation to different management and delivery approaches and the cost of delivering different types of services. The aim of Strand 1 is to profile children’s centres in the most disadvantaged areas, providing estimates on different aspects of provision with which to select centres for subsequent stages of the evaluation and to explore different models of provision. The findings below relate to 500 children's centres that are representative of all phase 1 and 2 centres (i.e. those in the 30percent most deprived areas).</p

Regional integrated infrastructure scoping study

The purpose of the study is to consider how the Region should take infrastructure forward in an integrated way at a strategic level and to help scope further work to inform the RSS 2009 Update. It is envisaged that this scoping study is the first part of a major work stream for the Assembly to enable infrastructure to influence future locational decisions and develop a better understanding of the impact of higher levels of growth on the Region’s infrastructure