70 years of NHS funding: how do we know how much is enough?

Charlesworth, Anita; Bloor, Karen

doi:10.1136/bmj.k2373

Cited by 14 publications

(9 citation statements)

References 8 publications

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“…The percentage increase fell after 2008, with the increases smaller than the growth in gross domestic product (GDP) during this period 67. A similar pattern is seen in the UK 20. This trend corresponds to budget cuts in the system before 2004, when the health reform law was presented to parliament.…”

Section: Healthcare Costs and Population Healthsupporting

confidence: 61%

Managing costs and access to healthcare in the Netherlands: impact on primary care

Weel

Knottnerus

Schayck

2020

BMJ

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Section: Healthcare Costs and Population Healthsupporting

confidence: 61%

Managing costs and access to healthcare in the Netherlands: impact on primary care

Weel

Knottnerus

Schayck

2020

BMJ

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“…Reorganising previously fragmented community health and social care services in England, whilst maintaining economic equilibrium, remains a challenge [1]. In common with health services across the world, the National Health Service (NHS) in England has, in recent years, seen an increasing focus on policies designed to integrate care between health sectors and between health and social care [2] with a greater emphasis on prevention and reducing health inequalities [3].…”

Section: Introductionmentioning

confidence: 99%

More that unites us than divides us? A qualitative study of integration of community health and social care services

et al. 2020

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Background: The integration of community health and social care services has been widely promoted nationally as a vital step to improve patient centred care, reduce costs, reduce admissions to hospital and facilitate timely and effective discharge from hospital. The complexities of integration raise questions about the practical challenges of integrating health and care given embedded professional and organisational boundaries in both sectors. We describe how an English city created a single, integrated care partnership, to integrate community health and social care services. This led to the development of 12 integrated neighbourhood teams, combining and co-locating professionals across three separate localities. The aim of this research is to identify the context and the factors enabling and hindering integration from a qualitative process evaluation. Methods: Twenty-four semi-structured interviews were conducted with equal numbers of health and social care staff at strategic and operational level. The data was subjected to thematic analysis. Results: We describe three key themes: 1) shared vision and leadership; 2) organisational factors; 3) professional workforce factors. We found a clarity of vision and purpose of integration throughout the partnership, but there were challenges related to the introduction of devolved leadership. There were widespread concerns that the specified outcome measures did not capture the complexities of integration. Organisational challenges included a lack of detail around clinical and service delivery planning, tensions around variable human resource practices and barriers to data sharing. A lack of understanding and trust meant professional workforce integration remained a key challenge, although integration was also seen as a potential solution to engender relationship building. Conclusions: Given the long-term national policy focus on integration this ambitious approach to integrate community health and social care has highlighted implications for leadership, organisational design and interprofessional working. Given the ethos of valuing the local assets of individuals and networks within the new partnership we found the integrated neighbourhood teams could all learn from each other. Many of the challenges of integration could benefit from embracing the inherent capabilities across the integrated neighbourhood teams and localities of this city.

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“…There is a perceived crisis in primary care in the English NHS: General Practitioners (GPs) are leaving the profession at an earlier age than previously, or choosing to work part-time, and there is a lack of newly trained doctors entering general practice (1,2). Alongside this, demands on the system are growing due to an increasingly elderly, multi-morbid population, and funding is failing to keep pace (3). The NHS Long Term Plan(4) set out a number of proposals to address these problems, including the introduction of Primary Care Networks (PCNs) to support GP practices and increase integration.…”

Section: Word Count: 3998mentioning

confidence: 99%

Exploring commissioners’ understandings of early primary care network development: qualitative interview study

et al. 2021

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Background: Primary Care Networks (PCNs) are financially incentivised groupings of General Practices (GP) in the English NHS. Their purpose is to deliver a number of policy goals set out in the NHS Long Term Plan. Clinical Commissioning Groups (CCGs) have a role in their establishment, support, and oversight. Aim: Explore commissioner’s perspectives on the early development of PCNs. Design and Setting: Qualitative study of CCGs using telephone interviews. Semi-structured interviews (n=37) with CCG employees involved in PCN establishment. Method: Interviewees were asked about local PCNs’ characteristics, factors shaping development and form, activities to date, challenges and benefits, and their CCGs’ relationship with PCNs. Interviewee responses were summarised within a matrix and analysed thematically. Results: Three meta-themes were identified: the multifaceted role of the commissioner; uneven advantages; engaging the broader system. Interviewees reported that the policy potentially favours PCNs working from a ‘blank slate’ and does not sufficiently account for the fact some GP practices and wider system organisations have been doing similar work already. The prescriptive, contractual nature of the policy has led to local challenges, trying to ensure local good practices are not lost during implementation. Interviewees also considered an important part of their work to be protecting PCNs from the weight of expectations placed upon them. Conclusion: CCGs are well placed to understand the complexities of local systems and facilitate PCNs and working practices between wider system partners. It is important that this local role is not lost as CCGs continue to merge and cover larger geographical populations.

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70 years of NHS funding: how do we know how much is enough?

Abstract: Although taxation is arguably the most efficient funding mechanism, NHS expenditure is a political choice, say Anita Charlesworth and Karen Bloor

Cited by 14 publications

References 8 publications

Managing costs and access to healthcare in the Netherlands: impact on primary care

Managing costs and access to healthcare in the Netherlands: impact on primary care

More that unites us than divides us? A qualitative study of integration of community health and social care services

Exploring commissioners’ understandings of early primary care network development: qualitative interview study

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