The Dot-com Meltdown and the Web

Presents findings from a survey conducted between August and September 2001. Looks at how the collapse of the dot-com economy has had tangible effects on personal lives, and how online Americans have made quick adjustments to the changing Web environment

Reflections on contemporary medical professionalism; an exploration of medical practice as refracted in doctors’ narratives

Background During a period of continuing changes in society and increasing availability of medical information, publication of patients’ views on experiences of health and illness have gained greater prominence. By contrast, studies of medical perspectives have tended to concentrate on reported discontent and implications for workforce planning while leaving broader insights and concerns under-investigated. Since the applied skills of highly trained and publicly funded clinicians are vital for safe and effective delivery of the nation’s health care, it seemed important to explore new ways to consider components of medical professionalism and to set these in current NHS contexts. Rationale and fieldwork Focussing attention on the individual perspectives of NHS doctors in order to hear and understand their experiences of work was central to development of this thesis. An interpretive epistemological approach to biographical narratives as told by a group of 12 doctors drawing on 25 years of NHS experience included use of Situational Analysis Mapping to support detailed analysis of their richly informative, first-hand accounts. As knowledgeable and reflective informants with stories from diverse clinical specialties and differing personal viewpoints, their narratives produced a range of views and observations shaped by their lived experiences as clinicians. Poetic representation of sociologically-informative narrative extracts provided an effective vehicle for engaging mixed audiences and has evoked emotionally resonant reactions from doctors. Findings Strong connections between individuals’ core principles and enacted responses were evident; doctors identified preferred working practices which they believed supportive of delivery of high quality health care. Key aspects of professionalism, including professional autonomy, self-regulation and application of clinical knowledge, were challenged by progressive introduction of new working processes and regulatory mechanisms. Increased recording of clinical and administrative data for performance monitoring and achievement of targets produced reactive strategies in individuals and teams while challenging their sense of professional position or developed medical identity. Poorly performing colleagues and difficult team interactions caused much disruption while blurred ethical boundaries exposed contestable decision-making and demonstrated the limited effectiveness of external regulatory monitoring. Conclusions This research indicates that contemporary NHS doctors may experience conflict between what is expected in managed medical practice and their interpretation of best professional performance. Better understanding of these fundamental relationships could constructively contribute to reconsideration of contemporary medical professionalism and assist with progressive workforce preparation for an effective future NHS

General practitioners' views of clinically led commissioning: cross-sectional survey in England.

OBJECTIVES: Involving general practitioners (GPs) in the commissioning/purchasing of services has been an important element in English health policy for many years. The Health and Social Care Act 2012 handed responsibility for commissioning of the majority of care for local populations to GP-led Clinical Commissioning Groups (CCGs). In this paper, we explore GP attitudes to involvement in commissioning and future intentions for engagement. DESIGN AND SETTING: Survey of a random sample of GPs across England in 2015. METHOD: The Eighth National GP Worklife Survey was distributed to GPs in spring 2015. Responses were received from 2611 respondents (response rate = 46%). We compared responses across different GP characteristics and conducted two sample tests of proportions to identify statistically significant differences in responses across groups. We also used multivariate logistic regression to identify the characteristics associated with wanting a formal CCG role in the future. RESULTS: While GPs generally agree that they can add value to aspects of commissioning, only a minority feel that this is an important part of their role. Many current leaders intend to quit in the next 5 years, and there is limited appetite among those not currently in a formal role to take up such a role in the future. CCGs were set up as 'membership organisations' but only a minority of respondents reported feeling that they had 'ownership' of their local CCG and these were often GPs with formal CCG roles. However, respondents generally agree that the CCG has a legitimate role in influencing the work that they do. CONCLUSION: CCGs need to engage in active succession planning to find the next generation of GP leaders. GPs believe that CCGs have a legitimate role in influencing their work, suggesting that there may be scope for CCGs to involve GPs more fully in roles short of formal leadership

The GP Workforce Pipeline: increasing the flow and plugging the leaks

Letter to the Editor

Regional variation in practitioner employment in general practices in England: a comparative analysis

Background In recent years, UK health policy makers have responded to a GP shortage by introducing measures to support increased healthcare delivery by practitioners from a wider range of backgrounds. Aim To ascertain the composition of the primary care workforce in England at a time when policy changes affecting deployment of different practitioner types are being introduced. Design and setting This study was a comparative analysis of workforce data reported to NHS Digital by GP practices in England. Method Statistics are reported using practice-level data from the NHS Digital June 2019 data extract. Because of the role played by Health Education England (HEE) in training and increasing the skills of a healthcare workforce that meets the needs of each region, the analysis compares average workforce composition across the 13 HEE regions in England Results The workforce participation in terms of full-time equivalent of each staff group across HEE regions demonstrates regional variation. Differences persist when expressed as mean full-time equivalent per thousand patients. Despite policy changes, most workers are employed in long-established primary care roles, with only a small proportion of newer types of practitioner, such as pharmacists, paramedics, physiotherapists, and physician associates. Conclusion This study provides analysis of a more detailed and complete primary care workforce dataset than has previously been available in England. In describing the workforce composition at this time, the study provides a foundation for future comparative analyses of changing practitioner deployment before the introduction of primary care networks, and for evaluating outcomes and costs that may be associated with these changes

Gramene database in 2010: updates and extensions

Now in its 10th year, the Gramene database (http://www.gramene.org) has grown from its primary focus on rice, the first fully-sequenced grass genome, to become a resource for major model and crop plants including Arabidopsis, Brachypodium, maize, sorghum, poplar and grape in addition to several species of rice. Gramene began with the addition of an Ensembl genome browser and has expanded in the last decade to become a robust resource for plant genomics hosting a wide array of data sets including quantitative trait loci (QTL), metabolic pathways, genetic diversity, genes, proteins, germplasm, literature, ontologies and a fully-structured markers and sequences database integrated with genome browsers and maps from various published studies (genetic, physical, bin, etc.). In addition, Gramene now hosts a variety of web services including a Distributed Annotation Server (DAS), BLAST and a public MySQL database. Twice a year, Gramene releases a major build of the database and makes interim releases to correct errors or to make important updates to software and/or data

Student Satisfaction and Performance in an Online Teacher Certification Program

The article presents a study which demonstrates the effectiveness of an online post baccalaureate teacher certification program developed by a Wisconsin university. The case method approach employing multiple methods and multiple data sources were used to investigate the degree to which pre-service teachers were prepared to teach. It was concluded that the study supports online delivery as an effective means of teacher preparation, but it was limited in the number of students followed into their first year of teaching