GPs' implicit prioritization through clinical choices – evidence from three national health services

Acknowledgments The authors are grateful for valuable comments and inputs from participants at a series of seminars and conferences as well as to our three anonymous referees.Peer reviewedPostprin

Public Sector Resource Allocation Since the Financial Crisis

Acknowledgements: The authors thank Tim Butcher from the Low Pay Commission for helpful discussions regarding changes in occupation classifications. We also thank the Office for National Statistics (ONS) and the UK Data Service for permitting and providing secure access to the Annual Survey of Hours and Earnings. All results within this paper have been checked by the UK Data Service to ensure they are non-disclosive and cannot be used to identify a person or organisation. The Health Economics Research Unit is supported by the Chief Scientist Office (CSO) of the Scottish Government Health and Social Care Directorates (SGHSC). The views expressed here are those of the Unit and not necessarily those of the CSO.Peer reviewedPostprin

Hospital staff shortage : the role of the competitiveness of pay of different groups of nursing staff on staff shortage

This work was supported by the Medical Research Council under grant number G0800113-2.Peer reviewedPostprin

Rurality, healthcare and crises : investigating experiences, differences, and changes to medical care for people living in rural areas

Acknowledgements This research was funded through grant 20/027 from NHS Grampian's Endowments and CSO project HIPS 19/37. This research would not have been possible without the time given by members of the public in Grampian, and doctors across Scotland to talk about their own experiences. The authors would like to thank their PPI partners and advisory panel for their help and input throughout the research to date, as well as Dr Rosemary Hollick, Professor Jennifer Cleland, Professor Peter Murchie, Professor Alan Denison & Professor Verity Watson. This paper benefitted from having parts presented at various conferences including the NHS Grampian R&D Conference where Andrew was awarded the Delegates' Prize. The authors would like to thank the comments of two anonymous reviewers and the editor in improving this manuscript prior to publication. Andrew Maclaren would like to thank Lily Maclaren for her support and keen eye in proofreading various versions of this work before submission. For the purpose of open access, the authors have applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission.Peer reviewe

The development of a measure of social care outcome for older people. Funded/commissioned by: Department of Health

An essential element of identifying Best Value and monitoring cost-effective care is to be able to identify the outcomes of care. In the field of health services, use of utility-based health related quality of life measures has become widespread, indeed even required. If, in the new era of partnerships, social care outcomes are to be valued and included we need to develop measures that reflect utility or welfare gain from social care interventions. This paper reports on a study, commissioned as part of the Department of Health’s Outcomes of Social Care for Adults Initiative, that developed an instrument and associated utility indexes that provide a tool for evaluating social care interventions in both a research and service setting. Discrete choice conjoint analysis used to derive utility weights provided us with new insights into the relative importance of the core domains of social care to older people. Whilst discrete choice conjoint analysis is being increasingly used in health economics, this is the first study that has attempted to use it to derive a measure of outcome

Determinants of General Practitioners' Wages in England

We analyse the determinants of annual net income and wages (annual net income/hours) of general practitioners (GPs) using a unique, anonymised, non-disclosive dataset derived from tax returns for 21,657 GPs in England for the financial year 2002/3. The average GP had a gross income of £189,300, incurred expenses of £115,600, and earned an annual net income of £73,700. The mean wage was £35 per hour. Net income and wages depended on gender, experience, list size, partnership size, whether or not the GP worked in a dispensing practice, whether or not they worked in a Primary Medical Service (PMS) practice, and the characteristics of the local population (limiting long term illness rate, proportion from ethnic minorities, population density, Index of Multiple Deprivation 2000). The findings have implications for discrimination by GP gender and country of qualification, economies of scale by practice size, incentives for competition for patients, compensating differentials for local population characteristics, and the attractiveness of PMS versus General Medical Services contracts.Physician, family. General practitioner. Income. Wages. Contract.

Pay or conditions? The role of workplace characteristics in nurses’ labor supply

Acknowledgments We are grateful for the thoughtful comments of two referees. We would also like to thank conference participants at the Scottish Economic Society Conference and seminar participants at Newcastle University. Receipt of financial support from the ESRC is gratefully acknowledged (RES-000-23-1240). The Health Economics Research Unit is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The views expressed in this article are solely those of the authors.Peer reviewedPostprin

Unforeseen emotional labour: a collaborative autoethnography exploring researcher experiences of studying long COVID in health workers during the COVID-19 pandemic.

The concept of "emotional labour" describes the regulation of feelings and expressions to fulfil a specific job role, discussed extensively in relation to commercial and caring professions, with more recent scholarship recognising the emotional role performed by qualitative researchers. During the COVID-19 pandemic, this role was likely further heightened due to changes in the socio-political context affecting both individual circumstances and research practice. Despite this, accounts of emotional labour performed by qualitative researchers during this time are lacking. This paper presents a collaborative, autoethnographic account reflecting on the emotional labour experiences of a small team of researchers working on a highly emotive and often distressing study. This longitudinal, mixed methods study: "Long COVID in Health Workers" (LoCH), investigated the lived experiences of healthcare workers from across Scotland, living with the long-term impacts of COVID-19 or Long COVID. Remote interviews were used to explore their experiences in relation to work, their personal and home lives, and coping mechanisms. Collectively, various factors served to construct and intensify our emotional labour experiences: the novelty of Long COVID; its devastating, unpredictable nature and impacts; and a web of factors pertaining to the socio-political context at the time. National lockdowns, enforced social-distancing, homeworking and inaccessibility of NHS services meant a lack of formal and informal support for participants. This heightened their willingness to share highly personal, emotional and often distressing experiences during interviews, with participants often suggesting researchers fulfilled an emotional support role - conseqentially, the usual defined research parameters became blurred. Reactively, researchers engaged in lengthy, ongoing processes in order to negotiate unintended and unforeseen levels of emotional labour, so that they could continue to collect data and remain "professional" during interviews. This was challenging to negotiate in an already difficult homeworking and lockdown climate, with researchers having their own workplace and personal challenges, concerns and responsibilities to balance, in addition to their new and unplanned emotional role. This context also dictated the use of remote methods for both data-gathering and interacting with colleagues, which impeded our ability to provide and receive support. Emotional labour needs to be recognised and acknowledged, and formal plans need to be put in place to support researchers across individual, research team and institutional levels, with critical consideration of socio-political influences at the time of study - an area which merits further consideration. This paper firstly outlines the context for the unforeseen emotional labour borne by the researchers while conducting the LoCH study during the COVID-19 pandemic, before drawing on the collected data to discuss researchers' experiences, and the strategies they employed to cope during and after interviews. Goffman's dramaturgical perspective is employed as a lens to make sense of researcher experience, and to highlight challenges with managing and maintaining professional and emotionally-neutral presentation of self during interviews. The emotional costs of such presentations are explored through emotional vignettes from the researchers. The paper also discusses implications for future research, with regards to managing difficult subject matter in challenging conditions, and mechanisms for coping, emotional management and successful project delivery. Outcomes are relevant to future studies in this subject area, and help to draw attention to and normalise discussions of researcher wellbeing and unanticipated role-pressures

Vocation, Mental Illness and the Absenteeism Decision

Peer reviewedPostprintPostprin

Evaluation of the introduction of a pay for performance contract for UK family doctors using participant perceptions

In 2004 the UK government introduced a new ‘pay for performance’ element into the contract for family doctors (FDs). Its universal introduction with no pre-intervention data is not atypical of system-wide health reform but poses a considerable evaluation challenge. We derive estimates of its impact based on qualitative perceptions of the treatment effect reported by a sample of participants. We exploit variation in the firstyear achievements of those participants who thought quality had remained the same to generate pre-intervention estimates for those that perceived a change in quality. The average partnership of 4 FDs was paid £74,000 for achieving 982 of the 1,050 quality points available in the first year. Of these, we estimate the mean net gains attributable to the new contract to be less than 4 quality points. These gains were predominantly made on the clinical criteria and were larger for partnerships facing more competition for patients and with markers of higher quality prior to the introduction of the new contract.Family doctors, pay for performance, perceptional evaluation