Engaging GPs in commissioning: realist evaluation of the early experiences of Clinical Commissioning Groups in the English NHS.

Objectives To explore the 'added value' that general practitioners (GPs) bring to commissioning in the English NHS. We describe the experience of Clinical Commissioning Groups (CCGs) in the context of previous clinically led commissioning policy initiatives. Methods Realist evaluation. We identified the programme theories underlying the claims made about GP 'added value' in commissioning from interviews with key informants. We tested these theories against observational data from four case study sites to explore whether and how these claims were borne out in practice. Results The complexity of CCG structures means CCGs are quite different from one another with different distributions of responsibilities between the various committees. This makes it difficult to compare CCGs with one another. Greater GP involvement was important but it was not clear where and how GPs could add most value. We identified some of the mechanisms and conditions which enable CCGs to maximize the 'added value' that GPs bring to commissioning. Conclusion To maximize the value of clinical input, CCGs need to invest time and effort in preparing those involved, ensuring that they systematically gather evidence about service gaps and problems from their members, and engaging members in debate about the future shape of services

Commissioning through competition and cooperation in the English NHS under the Health and Social Care Act 2012: evidence from a qualitative study of four clinical commissioning groups.

OBJECTIVE: The Health and Social Care Act 2012 ('HSCA 2012') introduced a new, statutory, form of regulation of competition into the National Health Service (NHS), while at the same time recognising that cooperation was necessary. NHS England's policy document, The Five Year Forward View ('5YFV') of 2014 placed less emphasis on competition without altering the legislation. We explored how commissioners and providers understand the complex regulatory framework, and how they behave in relation to competition and cooperation. DESIGN: We carried out detailed case studies in four clinical commissioning groups, using interviews and documentary analysis to explore the commissioners' and providers' understanding and experience of competition and cooperation. SETTING/PARTICIPANTS: We conducted 42 interviews with senior managers in commissioning organisations and senior managers in NHS and independent provider organisations (acute and community services). RESULTS: Neither commissioners nor providers fully understand the regulatory regime in respect of competition in the NHS, and have not found that the regulatory authorities have provided adequate guidance. Despite the HSCA 2012 promoting competition, commissioners chose mainly to use collaborative strategies to effect major service reconfigurations, which is endorsed as a suitable approach by providers. Nevertheless, commissioners are using competitive tendering in respect of more peripheral services in order to improve quality of care and value for money. CONCLUSIONS: Commissioners regard the use of competition and cooperation as appropriate in the NHS currently, although collaborative strategies appear more helpful in respect of large-scale changes. However, the current regulatory framework contained in the HSCA 2012, particularly since the publication of the 5YFV, is not clear. Better guidance should be issued by the regulatory authorities

The regulation of competition and procurement in the National Health Service 2015-2018: enduring hierarchical control and the limits of juridification.

Since 1990, market mechanisms have occurred in the predominantly hierarchical National Health Service (NHS). The Health and Social Care Act 2012 led to concerns that market principles had been irrevocably embedded in the NHS and that the regulators would acquire unwarranted power compared with politicians (known as 'juridification'). To assess this concern, we analysed regulatory activity in the period from 2015 to 2018. We explored how economic regulation of the NHS had changed in light of the policy turn back to hierarchy in 2014 and the changes in the legislative framework under Public Contracts Regulations 2015. We found the continuing dominance of hierarchical modes of control was reflected in the relative dominance and behaviour of the sector economic regulator. But there had also been a limited degree of juridification involving the courts. Generally, the regulatory decisions were consistent with the 2014 policy shift away from market principles and with the enduring role of hierarchy in the NHS, but the existing legislative regime did allow the incursion of pro market regulatory decision making, and instances of such decisions were identified

Medical tourism from the UK to Poland : how the market masks migration

Much medical travel happens, but it is misleading to label it as ‘medical tourism’. Rather, patterns of travel reflect a range of drivers: from longstanding cultural, economic and political ties to the country providing treatment, to word-of-mouth networks. Poland provides a particularly interesting case, as it has been touted as the leading medical tourism destination for UK medical travellers in Europe; marketing by Polish providers is advanced and there is strong government support for the industry. In this paper examining data from the UK's International Passenger Survey for the past 15 years, we demonstrate that, while travel to Poland has indeed increased dramatically, much of this actually reflects a wider pattern of Polish migrants living in the UK and returning to Poland for medical care rather than increased ‘medical tourism’ consumer activity by Britons in Poland

Making sense of sensors: older people’s and professional caregivers’ attitudes towards telecare

This book is about the ways digital technology can contribute to the welfare of older people. The Internet, mobile phones and other technologies have changed how we live and work. Such technologies also shape how services for older people are organised in ways that potentially place carers and older people at the centre of service provision. Telecare can make homes 'smart' so that they are more comfortable and less risky for people who can take advantage of devices that help make them independent members of their community. Digital Welfare is part of the broader project in Britain and elsewhere to adopt new information and communications technologies (ICTs) to organise and deliver health and social welfare services. This includes mundane technologies like an alarm to call for help to complex telecare 'smart homes' and electronic patient records. The intended and unintended consequences of such new technologies must be explored if we are to benefit from these innovations. Based on recent research this book seeks to highlight and examine the new opportunities and dilemmas that confront older people and all those concerned with their welfare in the network society. This edited collection provides original contributions from leading academics and researchers in the field to access the evidence for improved professional integration and user-centred health and social care services for older people arising from health informatics. Digital Welfare for the Third Age will be of interest to all those working with older people

Conceptualisations of Welfare Deservingness by Polish Migrants in the UK

AbstractThe issue of reconciling ethnic diversity with the welfare state is a subject of long-standing theoretical debate. In particular, it remains unclear to what extent a shared national identity is necessary for endorsing claims to welfare at the individual and societal levels. Surveys show that migrants are seen as the least deserving category of welfare recipients. Yet migrants’ own views are rarely considered. Based on a qualitative study, this paper explores how Polish migrants residing in London conceptualised their deservingness to British welfare benefits and social housing. It finds a strong preference for conditionality of welfare predicated on contributions through work, payment of taxes and law abidance. Such conditionality applied to both in-group and out-group members thus transcending identity-based claims. These contributions were seen as both necessary and sufficient for laying claims to the British welfare system. Solely needs-based claims were seen as problematic.</jats:p