Primary health care team effectiveness:developing a constituency approach

The difficulties of developing theoretically sound and practically useful models of primary health care team effectiveness are described. Three models of team effectiveness: the goal model; the internal process model; and the systems resource model are discussed in relation to the work of primary health care team (PHCTs). The value of the constituency approach is also examined and it is suggested that this is the most appropriate model for the situations of PHCTs. This paper describes an application of the constituency approach in developing measures of effectiveness for PHCTs. Results yielded effectiveness criteria in four major areas: consumer outcomes; quality of care; team viability; and organizational issues. The disadvantages of the constituency model are explored and the next steps in research towards developing a model of PHCT effectiveness is indicated

Atrophy and anarchy: Third national survey of nursing skill-mix and advanced nursing practice in ophthalmology

Aims and objectives.  The aims of the study were to investigate the advanced nursing practice and the skill-mix of nurses working in ophthalmology. Background.  The expansion of new nursing roles in the United Kingdom in the past decade is set against the background of a nursing shortage. The plan to modernize the National Health Service and improve the efficiency and delivery of healthcare services as well as to reduce junior doctors’ hours contributes towards a profusion of new and more specialized and advanced nursing roles in various areas of nursing including ophthalmology. Design.  A self-reporting quantitative questionnaire was employed. The study used comparative and descriptive statistical tests. Method.  The questionnaires were distributed to all ophthalmic hospitals and units in the United Kingdom. Hospital and unit managers were responsible for completing the questionnaires. Results.  Out of a total 181 questionnaires 117 were returned. There is a downward trend in the total number of nurses working in ophthalmology. The results demonstrate more nurses working at an advanced level. However, there is a general confusion regarding role interpretation at the advanced level of practice, evident through the wide range of job titles being used. There was inconsistency in the qualifications expected of these nurses. Conclusion.  Whilst there are more nurses working at an advanced level this is set against an ageing workforce and an overall decline in the number of nurses in ophthalmology. There is inconsistency in job titles, grades, roles and qualifications for nurses who work at an advanced or higher level of practice. The Agenda for Change with its new structure for grading jobs in the United Kingdom may offer protection and consistency in job titles, pay and qualifications for National Health Service nurse specialists. The Nursing and Midwifery Council needs to provide clear guidelines to the practitioners on educational and professional requirements, to protect patients and nurses. Relevance to clinical practice.  The findings indicate that there is a need for better regulations for nurses working at advanced nursing practice

Health Care Reform in Britain and Germany: Recasting the Political Bargain with the Medical Profession

Health care systems in the postwar period have been governed by political bargains between the state and the medical profession that have delinzated their respective powers and jurisdictions. Recent health care cost containment reforms in Britain and Germany are altering these bargains, and thereby challenge the prerogatives and autonomy of the medical profession in health policy formulation and in administration of the health care systems. But these challenges to doctors\u27 power and autonomy vary between the two countries. Britain\u27s 1989 “internal market” reforms attack the corporatist bargain with physicians by introducing market mechanisms into the National Health Service and, at the same time, strengthening central state control of the health care system. In Germany, on the other hand, the government\u27s 1992 reforms only partially breached the corporatist bargain with doctors in order to strengthen rather than destroy this governance arrangement. The government has tried to curb what it views as excessive power of doctors while still allowing them a significant degree of corporatist self-governance. The reform efforts in both countries highlight some of the problems with different governance arrangements in health care systems and, more specifically, the difficulties associated with a market in health care