Impact of NHS Direct on other services: the characteristics and origins of its nurses

OBJECTIVE:: To characterise the NHS Direct nurse workforce and estimate the impact of NHS Direct on the staffing of other NHS nursing specialties. METHOD: A postal survey of NHS Direct nurses in all 17 NHS Direct call centres operating in June 2000. RESULTS: The response rate was 74% (682 of 920). In the three months immediately before joining NHS Direct, 20% (134 of 682, 95% confidence intervals 17% to 23%) of respondents had not been working in the NHS. Of the 540 who came from NHS nursing posts, one fifth had come from an accident and emergency department or minor injury unit (110 of 540), and one in seven from practice nursing (75 of 540). One in ten (65 of 681) nurses said that previous illness, injury, or disability had been an important reason for deciding to join NHS Direct. Sixty two per cent (404 of 649) of nurses felt their job satisfaction and work environment had improved since joining NHS Direct. CONCLUSION: The NHS Direct nurse workforce currently constitutes a small proportion (about 0.5%) of all qualified nurses in the NHS, although it recruits relatively experienced and well qualified nurses more heavily from some specialties, such as accident and emergency nursing, than others. However, its overall impact on staffing in any one specialty is likely to be small. NHS Direct has succeeded in providing employment for some nurses who might otherwise be unable to continue in nursing because of disability

Integrating community pharmacy and NHS Direct - pharmacists' views

AIM:To establish the views of community pharmacists on NHS Direct and its forthcoming integration with community pharmacy. DESIGN: Postal questionnaire survey. SUBJECTS AND SETTING: Pharmacists working in community pharmacies within the area of the NHS Direct Pharmacy pilot scheme - Essex, Barking and Havering. RESULTS: The response rate to the postal survey was 72% (263/364). Most pharmacies were generally supportive of NHS Direct (80%) and the pharmacy scheme in principle (83%), although their experience of the scheme in practice was limited. Perhaps because of this, the majority of pharmacists were unsure as to whether NHS Direct was referring appropriately, or whether the pharmacy would be able to meet the needs of patients without further referral. Almost half believed that patients referred by NHS Direct should be seen in a quiet area, away from the counter. Over two-thirds of pharmacists were willing to accommodate an NHS Direct information point in their pharmacy, although space was an issue. CONCLUSION: Overall the results of this study suggested that community pharmacists welcome their increasing involvement in the developing immediate care system. As the Government commitment in the NHS plan to integrate community pharmacy with NHS Direct becomes a reality across England and Wales over coming months the implications for pharmacists, in terms of workload and the adequacy of premises, will become clearer. Careful audit of the operation of the scheme will be essential

Do people with intellectual disabilities understand their prescription medication? A scoping review

© 2019 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd.Background: People with intellectual disabilities are more likely to experience poor health than the general population and are frequently prescribed multiple medications. Therefore, it is important that people with intellectual disabilities understand their medication and potential adverse effects. Method: A scoping review explored people with intellectual disabilities' knowledge of prescription medications, their risks and how medication understanding can be improved. Results: Ten journal articles were included. People with intellectual disabilities often lacked understanding of their medication, including its name, purpose and when and how to take it. Participants were often confused or unaware of adverse effects associated with their medication. Information was sometimes explained to carers rather than people with intellectual disabilities. Some interventions and accessible information helped to improve knowledge in people with intellectual disabilities. Conclusion: There is a need for accessible and tailored information about medication to be discussed with people with intellectual disabilities in order to meet legal and best practice standards.Peer reviewe

Challenges for the National Institute for Clinical Excellence

Rationing health care is inevitable, and NICE should inform NHS decision making. Adoption of new technologies by NHS clinicians should be informed by costs as well as effectiveness. The NHS needs better information from NICE on the equity implications of new and existing technologies. NICE appraisal should focus not only on service enhancement but also on withdrawal of existing ineffective or inefficient therapies. Giving NICE a real budget to fund its recommendations would encourage it to examine the effect of its decisions on the whole NHS

New labour and reform of the English NHS: user views and attitudes.

BACKGROUND: The British National Health Service has undergone significant restructuring in recent years. In England this has taken a distinctive direction where the New Labour Government has embraced and intensified the influence of market principles towards its vision of a 'modernized' NHS. This has entailed the introduction of competition and incentives for providers of NHS care and the expansion of choice for patients. OBJECTIVES: To explore how users of the NHS perceive and respond to the market reforms being implemented within the NHS. In addition, to examine the normative values held by NHS users in relation to welfare provision in the UK. DESIGN AND SETTING: Qualitative interviews using a quota sample of 48 recent NHS users in South East England recruited from three local health economies. RESULTS: Some NHS users are exhibiting an ambivalent or anxious response to aspects of market reform such as patient choice, the use of targets and markets and the increasing presence of the private sector within the state healthcare sector. This has resulted in a sense that current reforms, are distracting or preventing NHS staff from delivering quality of care and fail to embody the relationships of care that are felt to sustain the NHS as a progressive public institution. CONCLUSION: The best way of delivering such values for patients is perceived to involve empowering frontline staffs who are deemed to embody the same values as service users, thus problematizing the current assumptions of reform frameworks that market-style incentives will necessarily gain public consent and support

Implementation of Physician Orders for Life Sustaining Treatment in nursing homes in California: evaluation of a novel statewide dissemination mechanism.

BackgroundImplementing Physician Orders for Life Sustaining Treatment (POLST) forms aims to improve communication of life-sustaining treatment preferences across care venues. California enabled this clinical tool in 2009, and a novel intervention of community coalitions was undertaken to advance POLST in localities around the state. Coalitions engaged facilities, including nursing homes (NHs), to foster POLST adoption. Eighteen months after introduction of POLST, we studied POLST implementation in California NHs.MethodsNHs randomly selected in coalition and non-coalition areas were mailed surveys about POLST preparation and use in 2010. Coalitions identified which NHs they worked with.ResultsOf 546 NHs surveyed, 143 (52 %) in coalition areas and 141 (52 %) in non-coalition areas responded. In 82 % of responding NHs, staff received POLST education and 59 % of NHs reported having a formal policy on handling POLST. Two-thirds of NHs had admitted a resident with a POLST, and 15 % of newly admitted residents over the past month had a POLST (range 0-100 %). Eighty-one percent of NHs had completed a POLST with a resident. Fifty-four percent of residents were estimated to have a POLST (range 0-100 %) (coalition area NHs 60 % vs. non- coalition area NHs 48 %, p = 0.02). Within coalition areas, NHs that had worked with coalitions were more likely to have completed a POLST with a resident after admission than NHs that had not worked with coalitions. Few NHs (7 %) reported difficulty following POLST orders, but 38 % noted difficulty involving physicians in POLST completion.ConclusionLess than 2 years after introduction, many California nursing homes report using POLST, although some NHs reported no experience. A novel community coalition intervention facilitated POLST implementation

Reforming the contract of UK consultants

The NHS Plan expressed the intention of government to "fundamentally overhaul" the national contract for UK hospital specialists to "reward and incentivise those who do most for the NHS." How can this be achieved

With a likely cost of £4 billion, the Health and Social Care Bill has all the hallmarks of an avoidable policy fiasco

This week sees the release of a highly critical report from the cross-party Health Select Committee on the Health Minister, Andrew Lansley’s proposals to reorganise the NHS. The Committee’s Chairman, the former Health Secretary, Stephen Dorrell, said that the NHS should focus on achieving efficiencies rather than on management upheaval. Patrick Dunleavy argues that the proposed NHS reorganization will be a policy disaster for the government, which may end up costing up to £4billion – 1/5th of the amount needed to be saved by the NHS through efficiency gains

Towards a New Model of Leadership for the NHS

This paper was commissioned by the NHS Leadership Academy as a contribution to thinking about the future development of leadership in and around the NHS. It was prepared in collaboration with the Hay Group. The backdrop and one of the triggers was the launch of a new suite of professional development programmes sponsored and organised by the NHS Leadership Academy. From the research reported in this paper a new framework for leadership in the healthcare is built. This is being used to guide the construction of a new Leadership Model. To quote the NLA this 'will be a well-researched, evidence-based model that reflects the values of the NHS, what we know about effective leadership, what we have learned from the Leadership Framework and what our patients and communities are now asking from us as leaders'