254 research outputs found
Understanding quality from a user perspective
Patient articles in professional journals used to be seen
as an invasion of territory. Now patients are invited to
contribute. We need to share each othersā space if we are
to understand one another.So writes Mitzi Blennerhassett, one of the contributors.
This is the first in a series of special issues of Quality
in Primary Care that we plan to publish as a regular
feature. As well as this issue on the āPatient Perspectives
on Quality in Primary Careā we are also planning
an issue on āCommissioning for Quality Improvementā
later this year and next year the āDevelopment of
Nursing Practice and Scopeā, āProfessional Regulationā
and finally āOrganisational and Educational Interventions
for Quality Improvementā
Commissioning for quality
Practice-based commissioning (PBC) is no longer
the new kid on the block of NHS reform. A direct
descendant of the purchaserāprovider split conceived
by Margaret Thatcher and Alan Enthoven as part of
the market reforms of the 1990s, referred to in earlier
policy documents and developed in the White Paper on community care, Our health, our Care, our Say it is nevertheless a move towards greater partnership and
patient centredness in health care. Whereas general
practice (GP) fundholding encouraged individual entrepreneurialism which subsequent primary care groups
and trusts were never able to match, PBC, by working
directly at the coalface of primary care, does have the
potential to lead to rapid transformation more widely
Contemplating thinking about thinking
Despite the increasing move to community care, general practitioners sensing that the traditional gatekeeper role is being eroded by other pre-hospital and community health professionals, assailed by private organisations and now even under threat from the acute sector have staked their claim to the central ground of providing interpersonal care, dealing with uncertainty and managing diagnostic complexity.
As every general practitioner and āHouseāaficionado
knows,diagnosis has always been the most challenging,
interesting and difficult aspect of our work,presenting, as it does, many pitfalls and much potential for error
Raising the game: nurturing research and development in the newly reconfigured ambulance services in the United Kingdom ā opportunities for research for better health in prehospital settings
Ambulance services will need a new and robust structure to support the growing prehospital research agenda for the short and medium term. This structure will need to inform and be informed by effective knowledge management and dissemination and will need to ensure that research helps lead to high quality, safe (no needless harm), effective (evidence-based), patient centred (no feelings of helplessness and in accordance with patients reasonable expressed wishes), timely (no needless delay), efficient (no waste and with realistic outcomes) and equitable (fair to all patients) ambulance services which are integrated with and aligned to the wider health system.
This paper recommends a structure which supports local as well as national research activity and research capacity development. In order to foster a research culture and research activity within a robust research governance framework a National Research Steering Group with representation from each ambulance service is advocated
Releasing the potential of health services: translating clinical leadership into healthcare quality improvement
A great deal of talk and effort is devoted to developing
leadership and clinical leadership in the health service,
for example through the work of the NHS Leadership
Centre.The policy change, which has increased the
likelihood of private companies, with shareholders
as well as patients to consider, contracting for NHS
services means an ever-increasing variety of health
service providers producing models of leadership rather
than just the traditional models within the NHS
The rise and rise of non-medical prescribing
The reaction from some quarters of the medical profession to the extension of prescribing rights to extended formulary nurse prescribers and pharmacists encompassing the whole British National Formulary is likely to be seen by many as a visceral response to the inherent threat to powerful vested interests in what has been described as the professional monolith of medicine. Although individual nurses and pharmacists and their professional bodies may welcome this move as a just reward for long and hard-fought battles to be recognised as equal partners with the medical
profession, the implications of such a profound policy
change need to be examined in the cold light of the available evidence, expected positive benefits and potential
negative consequences
A voice for quality
I am delighted to take up my appointment as editor of
Quality in Primary Care, which I believe will continue
to develop as a key journal for our discipline. Although
quality may be difficult to define, it is a concept that we
are familiar with and aspire to. Mayur Lakhani, my
distinguished predecessor, as chair of the Royal College
of General Practitioners, leads an institution that stands
for quality as well as caring, and will continue to
support the work of the journal through the editorial
board. Quality is about the pursuit of excellence. It
also refers to a distinctive voice and it is therefore
appropriate that I begin by expressing my values and
vision as editor
Should the Quality and Outcomes Framework be abolished? No
Head to Head: Steve Gillam (doi:10.1136/bmj.c2710) argues that the general practice pay for performance scheme is not good value for money, but Niroshan Siriwardena (doi:10.1136/bmj.c2794) believes it needs to be improved not remove
- ā¦