National survey of job satisfaction and retirement intentions among general practitioners in England

Objectives To measure general practitioners' intentions to quit direct patient care, to assess changes between 1998 and 2000, and to investigate associated factors, notably job satisfaction. Design Analysis of national postal surveys conducted in 1998 and 2001. Setting England. Participants 1949 general practitioner principals, of whom 790 were surveyed in 1998 and 1159 in 2001. Main outcome measures Overall job satisfaction and likelihood of leaving direct patient care in the next five years. Results The proportion of doctors intending to quit direct patient care in the next five years rose from 14% in 1998 to 22% in 2001. In both years, the main factors associated with an increased likelihood of quitting were older age and ethnic minority status. Higher job satisfaction and having children younger than 18 years were associated with a reduced likelihood of quitting. There were no significant differences in regression coefficients between 1998 and 2001, suggesting that the effect of factors influencing intentions to quit remained stable over time. The rise in intentions to quit was due mainly to a reduction in job satisfaction (1998 mean 4.64, 2001 mean 3.96) together with a slight increase in the proportion of doctors from ethnic minorities and in the mean age of doctors. Doctors' personal and practice characteristics explained little of the variation in job satisfaction within or between years. Conclusions Job satisfaction is an important factor underlying intention to quit, and attention to this aspect of doctors' working lives may help to increase the supply of general practitioners

Bridging the gap between methods research and the needs of policy makers: A review of the research priorities of the National Institute for Health and Clinical Excellence

Objectives: The aim of this study was to establish a list of priority topics for methods research to support decision making at the National Institute for Health and Clinical Excellence (NICE). Methods: Potential priorities for methods research topics were identified through a focused literature review, interviews, an email survey, a workshop and a Web-based feedback exercise. Participants were members of the NICE secretariat and its advisory bodies, representatives from academia, industry, and other organizations working closely with NICE. The Web exercise was open to anyone to complete but publicized among the above groups. Results: A list of potential topics was collated. Priorities for further research differed according to the type of respondent and the extent to which they work directly with NICE. Priorities emerging from the group closest to NICE included: methodology for indirect and mixed treatment comparisons; synthesis of qualitative evidence; research relating to the use of quality-adjusted life-years (QALYs) in decision making; methods and empirical research for establishing the cost-effectiveness threshold; and determining how data on the uncertainty of effectiveness and cost-effectiveness data should be taken into account in the decision-making process. Priorities emerging from the broadest group of respondents (through the Web exercise) included: methods for extrapolating beyond evidence observed in trials, methods for capturing benefits not included in the QALY and methods to assess when technologies should be recommended in the context of further evidence gathering. Conclusions: Consideration needs to be given to the needs of those who use the outputs of research for decision making when determining priorities for future methods research.NIHR Medical Research Council

Foundation trusts : a retrospective review

There is limited research evidence on foundation trusts (FTs) and much of the available material is in the form of commentary or the regular reports from Monitor. Comparative research is made difficult through lack of a counter-factual and robust methods are required to overcome bias. Summary points from the literature and from some initial analysis of Monitor reports that we have undertaken for this review are given below. Future policy and research issues are highlighted in the main report

From muddied waters to causal clarity? The use and limitations of Instrumental Variables in health economics

Randomisation is rightly regarded as the gold standard is assessing the causal effect of an intervention or risk factor on an outcome. However in many cases, randomisation is not feasible, desirable or practical. In such cases observational data may be the only source of empirical evidence, but comes with a distinct health warning that bias may occur if potential confounding factors are not adequately addressed in the statistical analysis. Instrumental Variables are a ‘signature’ technique of economics, rarely used elsewhere, which effectively propose exploiting fortunate coincidences in the data generating process to resolve omitted variable bias. The key element is whether it’s possible to identify at least one variable which is correlated with the causal variable of interest, but not directly related to the outcome. From the origins of John Snow’s 1855 seminal work in identifying the mode of communication of cholera we chart the use of IVs in economics and health economics specifically, outlying the theory and the key requirements for successful application and the problems of weak or implausible instruments. We show that although a neat and promising concept, IVs should be used with caution and only applied where circumstances permit identification of plausible instruments

Cost-Effectiveness of PHMB & betaine wound bed preparation compared with standard care in venous leg ulcers: A cost-utility analysis in the United Kingdom

Background Wounds cost £8.3 billion per year in the United Kingdom (UK) annually. Venous leg ulcers (VLUs) account for 15% of wounds and can be complicated to heal, increasing nurse visits and resource costs. Recent wound bed preparation consensus recommends wound cleansing and biofilm disrupting agents. However, inert cleansers such as tap water or saline are inexpensive, an evaluation of evidence is required to justify the higher upfront costs of treatment with active cleansers. We undertook a cost-effectiveness analysis of the use of a biofilm disrupting and cleansing solution and gel, Prontosan® Solution and Gel X, (PSGX) (B Braun Medical), as compared to the standard practice of using saline solution, for treating VLUs. Methods A Markov model was parameterised to one-year costs and health-related quality of life consequences of treating chronic VLUs with PSGX versus saline solution. Costs are viewed from a UK healthcare payer perspective, include routine care and management of complications. A systematic literature search was performed to inform the clinical parameters of the economic model. Deterministic univariate sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were undertaken. Results For PSGX an Incremental Net Monetary Benefit (INMB) of £1,129.65 to £1,042.39 per patient (with a Maximum Willingness to Pay of £30k and £20k per QALY respectively), of which cost savings are £867.87 and 0.0087 quality-adjusted life years (QALYs) gain per patient. PSA indicates a 99.3% probability of PSGX being cost-effective over saline. Conclusions PSGX for the treatment of VLUs is dominant compared with saline solution in the UK with expected cost-savings within a year and improved patient outcomes

Clinical and economic evaluation of laparoscopic surgery compared with medical management for gastro-oesophageal reflux disease : 5-year follow-up of multicentre randomised trial (the REFLUX trial)

Peer reviewedPublisher PD

Is bigger better for primary care groups and trusts?

SIGLEAvailable from British Library Document Supply Centre-DSC:m01/16032 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Regional variation in the productivity of the English National Health Service

At a time when there are severe pressures on reducing public spending there is increasing emphasis on determining which parts of the country secure best value for money in the NHS. By linking together large scale and routinely collected datasets we produce and compare productivity estimates across the ten Strategic Health Authorities in England in 2007/08

Cost-effectiveness of strategies preventing late-onset infection in preterm infants

OBJECTIVE: Developing a model to analyse the cost-effectiveness of interventions preventing late-onset infection (LOI) in preterm infants and applying it to the evaluation of anti-microbial impregnated peripherally inserted central catheters (AM-PICCs) compared with standard PICCs (S-PICCs). DESIGN: Model-based cost-effectiveness analysis, using data from the Preventing infection using Antimicrobial Impregnated Long Lines (PREVAIL) randomised controlled trial linked to routine healthcare data, supplemented with published literature. The model assumes that LOI increases the risk of neurodevelopmental impairment (NDI). SETTING: Neonatal intensive care units in the UK National Health Service (NHS). PATIENTS: Infants born ≤32 weeks gestational age, requiring a 1 French gauge PICC. INTERVENTIONS: AM-PICC and S-PICC. MAIN OUTCOME MEASURES: Life expectancy, quality-adjusted life years (QALYs) and healthcare costs over the infants' expected lifetime. RESULTS: Severe NDI reduces life expectancy by 14.79 (95% CI 4.43 to 26.68; undiscounted) years, 10.63 (95% CI 7.74 to 14.02; discounted) QALYs and costs £19 057 (95% CI £14 197; £24697; discounted) to the NHS. If LOI causes NDI, the maximum acquisition price of an intervention reducing LOI risk by 5% is £120. AM-PICCs increase costs (£54.85 (95% CI £25.95 to £89.12)) but have negligible impact on health outcomes (-0.01 (95% CI -0.09 to 0.04) QALYs), compared with S-PICCs. The NHS can invest up to £2.4 million in research to confirm that AM-PICCs are not cost-effective. CONCLUSIONS: The model quantifies health losses and additional healthcare costs caused by NDI and LOI during neonatal care. Given these consequences, interventions preventing LOI, even by a small extent, can be cost-effective. AM-PICCs, being less effective and more costly than S-PICC, are not likely to be cost-effective. TRIAL REGISTRATION NUMBER: NCT03260517

Productivity of the English National Health Service 2003/4-2009/10 - Report for the Department of Health

Objectives: We estimate output, input and productivity growth for the English NHS for the period 2003/4 to 2009/10 using the most detailed and comprehensive information at our disposal. Methods: Productivity growth is calculated by comparing growth in the total amount of health care ‘output’ provided to NHS patients to growth in the total amount of ‘input’ used to produce this output. Output consists of the volume of all health care services provided to NHS patients and also accounts for quality improvements. Inputs include the staff, general and clinical supplies, energy costs, equipment and capital resources that contribute to the production of health care