The shift to collaborative working and integration in the English NHS: Developing shared leadership in Primary Care Networks

The purpose of this paper is to explore the leadership challenge of developing collaborative working with specific reference to Primary Care Networks in the English NHS, using the theoretical lens of shared leadership. This approach to leadership may be appropriate in the context of the policy shift towards collaboration and integrated care currently being pursued in the UK and in other countries. A conceptual framework is developed from extant literature, identifying the antecedents of shared leadership that help to explain how shared leadership may be developed. The framework is then used to offer insight into how shared leadership may be developed in the networks. The order of the paper is as follows: firstly, we discuss the policy background and changes in primary care in the NHS; next, we discuss shared leadership and its antecedents, and propose a conceptual framework; we then use the framework to offer a non-empirical understanding of the case of Primary Care Networks; and finally, we discuss the practical implications relating to developing shared leadership in this context

Do people with intellectual disabilities understand their prescription medication? A scoping review

© 2019 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd.Background: People with intellectual disabilities are more likely to experience poor health than the general population and are frequently prescribed multiple medications. Therefore, it is important that people with intellectual disabilities understand their medication and potential adverse effects. Method: A scoping review explored people with intellectual disabilities' knowledge of prescription medications, their risks and how medication understanding can be improved. Results: Ten journal articles were included. People with intellectual disabilities often lacked understanding of their medication, including its name, purpose and when and how to take it. Participants were often confused or unaware of adverse effects associated with their medication. Information was sometimes explained to carers rather than people with intellectual disabilities. Some interventions and accessible information helped to improve knowledge in people with intellectual disabilities. Conclusion: There is a need for accessible and tailored information about medication to be discussed with people with intellectual disabilities in order to meet legal and best practice standards.Peer reviewe

Managing a sustainable, low carbon supply chain in the English National Health Service: The views of senior managers.

Objectives:In an effort to reduce costs and respond to climate change, health care providers (Trusts) in England have started to change how they purchase goods and services. Many factors, both internal and external, affect the supply chain. Our aim was to identify those factors, so as to maintain future supply and business continuity in health and social care.Methods:Qualitative interviews with 20 senior managers from private and public sector health service providers and social care providers in south west England. Interviews were recorded, transcribed and thematically analysed.Results:There were four areas of concern: contradictions with government legislation which caused confusion about how best to deliver sustainable solutions; procurement was unclear and created multiple approaches to purchasing bulk items at low cost; internal organizational systems needed to be reconsidered to embed sustainability; and embedding sustainability requires a review of organizational systems. There are examples of sustainability solutions throughout the National Health Service (NHS) but the response continues to be patchy. More research is needed into why some Trusts and some staff do not recognize the benefits of a core approach or find the systems unable to respond.Conclusions:The NHS is one of the major purchasers of goods and services in England and is therefore in an excellent position to encourage sustainable resource management, manufacturing, use and disposal

Evaluating the implementation and delivery of a social prescribing intervention: a research protocol

Background: In response to the increasing numbers of people with (multiple) chronic conditions, the need for integrated care is increasing too. Social prescribing is a new approach that aims to integrate the social and healthcare sector to improve the quality of care and user experience. Understanding main stakeholders’ perceptions and experiences is key to the implementation of social prescription and for informing future initiatives.  Objectives: This paper presents the protocol of a qualitative research study to explore factors that (i) facilitate and hinder the implementation of a social prescribing pilot in the East of England, and (ii) affect the uptake, adherence, and completion rates by service users.  Methods: A qualitative study including semi-structured interviews with managers, health professionals, service providers, navigators, and service users. Iterative thematic analysis will be used to analyse the data.  Conclusion: This study will produce evidence on factors that hinder and facilitate the implementation of a social prescribing programme, as well as factors affecting the engagement, and non-engagement, of service users. Findings can contribute to the development of an evidence base for social prescription programmes in the UK, and inform practice, policy, and future research in the field

Clinical leadership in service redesign using Clinical Commissioning Groups: a mixed-methods study

Background: A core component of the Health and Social Care Act 2012 (Great Britain. Health and Social Care Act 2012. London: HMSO; 2012) was the idea of devolving to general practitioners (GPs) a health service leadership role for service redesign. For this purpose, new Clinical Commissioning Groups (CCGs) were formed in the English NHS.Objectives: This research examined the extent to which, and the methods by which, clinicians stepped forward to take up a leadership role in service redesign using CCGs as a platform.Design: The project proceeded in five phases: (1) a scoping study across 15 CCGs, (2) the design and administration of a national survey of all members of CCG governing bodies in 2014, (3) six main in-depth case studies, (4) a second national survey of governing body members in 2016, which allowed longitudinal comparisons, and (5) international comparisons.Participants: In addition to GPs serving in clinical lead roles for CCGs, the research included insights from accountable officers and other managers and perspectives from secondary care and other provider organisations (local authority councillors and staff, patients and the public, and other relevant bodies).Results: Instances of the exercise of clinical leadership utilising the mechanism of the CCGs were strikingly varied. Some CCG teams had made little of the opportunity. However, we found other examples of clinicians stepping forward to bring about meaningful improvements in services. The most notable cases involved the design of integrated care for frail elderly patients and others with long-term conditions. The leadership of these service redesigns required cross-boundary working with primary care, secondary care, community care and social work. The processes enabling such breakthroughs required interlocking processes of leadership across three arenas: (1) strategy-level work at CCG board level, (2) mid-range operational planning and negotiation at programme board level and (3) the arena of practical implementation leadership at the point of delivery. The arena of the CCG board provided the legitimacy for strategic change; the programme boards worked through the competing logics of markets, hierarchy and networks; and the practice arena allowed the exercise of clinical leadership in practical problemsolving, detailed learning and routinisation of new ways of working at a common-sense everyday level.Limitations: Although the research was conducted over a 3-year period, it could be argued that a much longer period is required for CCGs to mature and realise their potential.Conclusions: Despite the variation in practice, we found significant examples of clinical leaders forging new modes of service design and delivery. A great deal of the service redesign effort was directed at compensating for the fragmented nature of the NHS – part of which had been created by the 2012 reforms. This is the first study to reveal details of such work in a systematic way

What's the problem with patient experience feedback? : A macro and micro understanding, based on findings from a three-site UK qualitative study

CONTEXT: Collecting feedback from patients about their experiences of health care is an important activity. However, improvement based on this feedback rarely materializes. In this study, we focus on answering the question-"what is impeding the use of patient experience feedback?" METHODS: We conducted a qualitative study in 2016 across three NHS hospital Trusts in the North of England. Focus groups were undertaken with ward-based staff, and hospital managers were interviewed in-depth (50 participants). We conducted a conceptual-level analysis. FINDINGS: On a macro level, we found that the intense focus on the collection of patient experience feedback has developed into its own self-perpetuating industry with a significant allocation of resource, effort and time being expended on this task. This is often at the expense of pan-organizational learning or improvements being made. On a micro level, ward staff struggled to interact with feedback due to its complexity with questions raised about the value, validity and timeliness of data sources. CONCLUSIONS: Macro and micro prohibiting factors come together in a perfect storm which provides a substantial impediment to improvements being made. Recommendations for policy change are put forward alongside recognition that high-level organizational culture/systems are currently too sluggish to allow fruitful learning and action to occur from the feedback that patients give

'Join us on our journey': Exploring the experiences of children and young people with type 1 diabetes and their parents

This paper focuses on children and young people with type 1 diabetes and on their parents, and their experiences of diabetes care provision. Nine acute hospitals in the Yorkshire and the Humber region, UK, were recruited to participate in a qualitative research study. Children and young people with type 1 diabetes, aged 6–25, and their parents (approximately 250 participants), took part in talking groups to find out about their experiences of diabetes care provision. Findings show that there are key areas for improvement in the future diabetes care provision for children and young people, including communication and support, schools, structured education and transition. These have important implications for practice and service redesign. This study is thought to be the first of its kind to consult with children, young people and parents to find out about their experiences of type 1 diabetes care provision. The research findings add to the current evidence base by highlighting the disparities in care, the urgent need for change in the way services are delivered and the involvement of service users in this process

UK policy on social networking sites and online health: from informed patient to informed consumer?

Background: Social networking sites offer new opportunities for communication between and amongst health care professionals, patients and members of the public. In doing so, they have the potential to facilitate public access to health care information, peer-support networks, health policy fora and online consultations. Government policies and guidance from professional organisations have begun to address the potential of these technologies in the domain of health care and the responsibilities they entail for their users. Objective: Adapting a discourse analytic framework for the analysis of policy documents, this review paper critically examines discussions of social networking sites in recent government and professional policy documents. It focuses particularly on who these organisations claim should use social media, for what purposes, and what the anticipated outcomes of use will be for patients and the organisations themselves. Conclusion: Recent policy documents have configured social media as a new means with which to harvest patient feedback on health care encounters and communicate health care service information with which patients and the general public can be ‘empowered’ to make responsible decisions. In orienting to social media as a vehicle for enabling consumer choice, these policies encourage the marketization of health information through a greater role for non-profit and commercial organisations in the eHealth domain. At the same time, current policy largely overlooks the role of social media in mediating ongoing support and self-management for patients with long-term conditions

Falls assessment and prevention in older people: an evaluation of the Crisis Response Service

The elderly population of the world is growing, with increasing trends of older people falling and accessing emergency services. The Crisis Response Falls Service in Northamptonshire (UK) was designed to identify health and social care needs, promote independence and limit the impact of falls. This paper presents the findings of an evaluation of the service. A mixed-method approach was applied, drawing on the views of service users (via a survey and telephone interviews) and reviewing existing East Midlands Ambulance Service NHS Trust (EMAS) data with routinely collected data from the service. A decrease in the numbers of patients conveyed to hospital following a fall was observed. Best estimates of financial calculations suggest savings. High levels of patient satisfaction were achieved; patients felt treated with dignity and staff were considered friendly, approachable and well-informed. First responder services can provide positive impacts for those who fall in the community. The development and impact of the CRS shows the importance of evidence-based client centred training to inform the approaches taken to supporting those who fall, and the impact of a strong values based approach on the experiences of patients