716 research outputs found

    Contracting with General Dental Services: a mixed-methods study on factors influencing responses to contracts in English general dental practice

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    Background: Independent contractor status of NHS general dental practitioners (GDPs) and general medical practitioners (GMPs) has meant that both groups have commercial as well as professional identities. Their relationship with the state is governed by a NHS contract, the terms of which have been the focus of much negotiation and struggle in recent years. Previous study of dental contracting has taken a classical economics perspective, viewing practitioners’ behaviour as a fully rational search for contract loopholes. We apply institutional theory to this context for the first time, where individuals’ behaviour is understood as being influenced by wider institutional forces such as growing consumer demands, commercial pressures and challenges to medical professionalism. Practitioners hold values and beliefs, and carry out routines and practices which are consistent with the field’s institutional logics. By identifying institutional logics in the dental practice organisational field, we expose where tensions exist, helping to explain why contracting appears as a continual cycle of reform and resistance. Aims: To identify the factors which facilitate and hinder the use of contractual processes to manage and strategically develop General Dental Services, using a comparison with medical practice to highlight factors which are particular to NHS dental practice. Methods: Following a systematic review of health-care contracting theory and interviews with stakeholders, we undertook case studies of 16 dental and six medical practices. Case study data collection involved interviews, observation and documentary evidence; 120 interviews were undertaken in all. We tested and refined our findings using a questionnaire to GDPs and further interviews with commissioners. Results: We found that, for all three sets of actors (GDPs, GMPs, commissioners), multiple logics exist. These were interacting and sometimes in competition. We found an emergent logic of population health managerialism in dental practice, which is less compatible than the other dental practice logics of ownership responsibility, professional clinical values and entrepreneurialism. This was in contrast to medical practice, where we found a more ready acceptance of external accountability and notions of the delivery of ‘cost-effective’ care. Our quantitative work enabled us to refine and test our conceptualisations of dental practice logics. We identified that population health managerialism comprised both a logic of managerialism and a public goods logic, and that practitioners might be resistant to one and not the other. We also linked individual practitioners’ behaviour to wider institutional forces by showing that logics were predictive of responses to NHS dental contracts at the dental chair-side (the micro level), as well as predictive of approaches to wider contractual relationships with commissioners (the macro level) . Conclusions: Responses to contracts can be shaped by environmental forces and not just determined at the level of the individual. In NHS medical practice, goals are more closely aligned with commissioning goals than in general dental practice. The optimal contractual agreement between GDPs and commissioners, therefore, will be one which aims at the ‘satisfactory’ rather than the ‘ideal’; and a ‘successful’ NHS dental contract is likely to be one where neither party promotes its self-interest above the other. Future work on opportunism in health care should widen its focus beyond the self-interest of providers and look at the contribution of contextual factors such as the relationship between the government and professional bodies, the role of the media, and providers’ social and professional networks. Funding: The National Institute for Health Research Health Services and Delivery Research programme

    The New Old Legal Realism

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    Do the decisions of appellate courts matter in the real world? The American judicial system, legal education, and academic scholarship are premised on the view that they do. The authors want to reexamine this question by taking the approach advocated by the original Legal Realists. The current project seeks to add to our knowledge of the relevance of case law by focusing on an area that has received little examination: how pronouncements about employment discrimination law by appellate courts translate into understandings and behavior at the ground level. As our lens, we use evidence of how people talk about the relevance of changes in the law. This new Old Legal Realist perspective suggests that social and economic factors play a more important role than case law in outcomes on the ground. Cases cannot have an impact, if the local social and economic variables are not aligned in a fashion that allows the impact to occur

    Bulletin of Information 1996-1997

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    Annual bulletin with academic calendar, school objectives & course of studies, faculty, administration, degrees conferred, course descriptions, fees & tuition, financial assistance, admission requirements, academic regulations, examinations & grades, student organizations, Alumni Association, nondiscrimination & affirmative action policieshttps://ir.lawnet.fordham.edu/bulletins/1090/thumbnail.jp

    Medicaid: Anatomy of a Dilemma

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    The Impact of the Internationalisation of Higher Education on Scientists’ Multimodal Communication: A case study from Catalonia

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    Les universitats de tot el món són instades a participar en el procés d' ‘internacionalització’ com a distintiu de qualitat i com a reclam per atraure estudiants. Aquest estudi aborda aquesta qüestió des del context de les institucions catalanes d’educació superior, que afronten el dilema de donar suport a la/les llengua/gües local/s i, alhora, abraçar el multilingüisme i, sobretot, l’anglès. L'objectiu principal d'aquest estudi és examinar l'impacte de la internacionalització de l'educació superior en la comunicació diària dels científics. Les dades etnogràfiques s’han recopilat al llarg d’un període d’11 mesos d’observació de dos grups de recerca (RGs) multinacionals amb seu en una universitat catalana, i s’han contrastat amb dades extretes d’un RG amb seu a Alemanya i amb idees inspirades en les pràctiques del RG de la pròpia investigadora. De l'objectiu empíric n’ha derivat un objectiu teòric, que consisteix a dissenyar i provar un marc teòric adequat per estudiar el fenomen proposat de manera integral. Aquest estudi té l’objectiu de contribuir a la limitada literatura que descriu aquelles pràctiques comunicatives "informals" i inèdites dels científics, així com a la literatura sobre la internacionalització de l’ensenyament superior. A nivell pràctic, aquest treball pretén contribuir a la millora de les polítiques d’internacionalització de les institucions d’ensenyament superior de Catalunya, d’Europa i potencialment d’altres contextos arreu del món.Las universidades de todo el mundo son instadas a participar en el proceso de ‘internacionalización’ como distintivo de calidad y como reclamo para atraer estudiantes. Este estudio aborda esta cuestión desde el contexto de las instituciones catalanas de educación superior, que afrontan el dilema de apoyar la/s lengua/s local/es y, a la vez, abrazar el multilingüismo y, sobre todo, el inglés. El objetivo principal de este estudio es examinar el impacto de la internacionalización de la educación superior en la comunicación diaria de los científicos. Los datos etnográficos se han recopilado a lo largo de un período de 11 meses de observación de dos grupos de investigación (RGs) multinacionales con sede en una universidad catalana, y se han contrastado con datos extraídos de un RG con sede en Alemania y con ideas inspiradas en las prácticas del RG de la propia investigadora. Del objetivo empírico ha derivado un objetivo teórico, que consiste en diseñar y probar un marco teórico adecuado para estudiar el fenómeno propuesto de manera integral. Este estudio tiene el objetivo de contribuir a la limitada literatura que describe aquellas prácticas comunicativas "informales" e inéditas de los científicos, así como a la literatura sobre la internacionalización de la enseñanza superior. A nivel práctico, este trabajo pretende contribuir a la mejora de las políticas de internacionalización de las instituciones de enseñanza superior de Cataluña, de Europa y potencialmente de otros contextos en todo el mundo.Universities worldwide are urged to engage in the process of ‘internationalisation’ as a hallmark of quality and as a lure to attract students. The current study approaches this issue from the context of Catalan higher education institutions, which deal with the dilemma of supporting the local language(s) and at the same time embracing multilingualism and especially English. The main aim of this study is to examine the impact of the internationalisation of higher education on the daily communication of scientists. Ethnographic data have been collected throughout a period of 11 months from two multinational research groups (RGs) based in a Catalan state university, and contrasted with data taken from a RG based in Germany and with insights from the researcher’s own RG. From the empirical objective has derived a theoretical objective, consisting in designing and proving a suitable theoretical framework to study the phenomenon holistically. This study aims to contribute to the limited body of research describing scientists’ "informal" and unpublished communicative practices, as well as to the literature on the internationalisation of higher education. On a practical level, this work is intended to aid in the improvement of internationalisation policies of higher education institutions in Catalonia, in Europe and potentially in other contexts worldwide

    Exploring the training and scope of practice of GPs in England, Germany and Spain

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    OBJECTIVE: To explore general practitioner (GP) training, continuing professional development, scope of practice, ethical issues and challenges in the working environment in three European countries. METHOD: Qualitative study of 35 GPs from England, Germany and Spain working in urban primary care practices. Participants were recruited using convenience and snowball sampling techniques. Semi-structured interviews were recorded, transcribed and analysed by four independent researchers adopting a thematic approach. RESULTS: Entrance to and length of GP training differ between the three countries, while continuing professional development is required in all three, although with different characteristics. Key variations in the scope of practice include whether there is a gatekeeping role, whether GPs work in multidisciplinary teams or singlehandedly, the existence of appraisal processes, and the balance between administrative and clinical tasks. However, similar challenges, including the need to adapt to an ageing population, end-of-life care, ethical dilemmas, the impact of austerity measures, limited time for patients and gaps in coordination between primary and secondary care are experienced by GPs in all three countries. CONCLUSION: Primary health care variations have strong historical roots, derived from the different national experiences and the range of clinical services delivered by GPs. There is a need for an accessible source of information for GPs themselves and those responsible for safety and quality standards of the healthcare workforce. This paper maps out the current situation before Brexit is being implemented in the UK which could see many of the current EU arrangements and legislation to assure professional mobility between the UK and the rest of Europe dismantled

    National Health Insurance: A Review of Policies and Proposals

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    Review of Scotland's colleges: equalities issues report

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