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The future of pathology services in the NHS is currently under consideration. Recent developments in diagnostic technologies and their possible impact on pathology testing in the future are discussed. Trends and patterns of demand for all three main pathology specialties are analysed over the 12‐year period, 1974‐86. The inflation‐adjusted, revenue cost of pathology testing per hospital admission (excluding capital costs) is shown to have fallen in real terms over this period, although it is uncertain whether this would still be the case were capital costs to be included. In the hospital sector, reported increases in demand can be quite simply related to increasing hospital activity by using a linear regression model. However, the very large increases in demand observed in the primary care sector cannot be related reasonably to any routinely reported practice activity indicators. The implications of this highly volatile pattern of demand in general practice are discussed, especially in relation to recent technological advances designed to produce rapid, near‐patient, surgery‐based tests. Although analysis indicates no evidence for historical technology‐induced increases in demand for laboratory services following the introduction of laboratory automation in the 1970s, the possibility of technology‐induced demand in the primary health care sector following the widespread introduction of surgery‐based tests is discussed.

Workplace well-being is key to improving health and therefore productivity. Although the Chinese population and their influence on business in the UK are growing rapidly, little is known about the attitudes of Chinese employers and employees towards workplace well-being. The paper aims to discuss this issue.

The authors conducted a qualitative study to explore the views of Chinese employees and employers in London and interviewed occupational health and workplace well-being experts.

Employers’ understanding of workplace well-being was limited, their approach was reactive rather than proactive. Contextual factors hampered most efforts towards workplace well-being. Employees reported that working conditions were generally poor with likely implications for employees’ physical and mental health. Generational and migratory changes further complicate the scenario but potentially usher in positive change.

This study was conducted in a London area with a high density of Chinese businesses. The study nevertheless covered only a limited selection of business sectors. Caution may therefore be necessary in assuming the transferability of these findings to other parts of the UK.

Chinese businesses are agreeable to being informed about and considering the business case for workplace well-being. Chinese workers need better working conditions, easier access to health services preferably delivered through Chinese-based networks of community and business associations which are trusted by both employers and employees.

This study offers novel evidence on the attitude of Chinese employers and employees towards workplace well-being by comparing views from both groups. Chinese people face considerable health and mental health problems through their work environment, in contrast with conclusions from the Health Survey for England and Labour Force Survey.

A three‐year in‐depth study has examined three models to improvecare in residential homes for older people in England. The study showed that each aimed to provide a ‘home for life’ for residents. Using multi‐source data gained from a range of qualitative and quantitative methods involving residential home managers, care staff and extensive review of documentation related to key care functions, inhibitors and enhancers to the achievement of this aim were identified. Inhibitors were lack of available top‐up funding to meet increased care needs, care staff's inadequate knowledge of behaviour‐disordered residents, workload, cross‐sector barriers and environmental problems. Among the enhancers were flexible regulation, up‐skilling of care staff, care staff's achievement in palliative care, perceived avoidance of hospital admission, and sound practice‐led relationships with nurses. The implications for practice are of relevance to policy makers, educators, community health and social care professionals, and older residents, their relatives and representative organisations.

Describes the exploratory use of a statistical technique called data envelopment analysis (DEA), which has been widely used in other parts of the service sector, to measure the efficiency of 52 general practices in three health districts, serving 378,500 patients (78 per cent of the resident population). DEA identified over half (60 per cent) of the 52 practices as less than 100 per cent efficient, with 25 per cent potentially capable of large increases in activity without higher resource levels. There was no significant relationship between efficiency and whether partnerships were training practices, computerized, holding regular meetings, or the total list size, or age structure of practice populations except that multi‐site practices were found to be significantly more efficient as list size increased. DEA efficiency ratings were compared with a proxy for effectiveness (the ability of practices to reach target levels set in the new GP contract). Practices which were below target levels before the new contract was introduced were far less likely to be able to reach these targets once the contract was in place if they had been classified by DEA as 100 per cent efficient (i.e. judged to be unable to achieve greater outputs without increased resources). More research effort now needs to be devoted to exploring the use of DEA in measuring efficiency in general practice, and to examining the relationship between measures of efficiency and effectiveness in primary care.

Considers the changes which are being implemented in primary care, and the patterns which are now beginning to emerge. Examines the changing context within which practices now function (both political and managerial), and considers the power which GPs are beginning to exert, as well as the impact which they may have on the interface between primary and secondary care. Examines the systems being developed for assuring quality in general practice. Predicts an explosion in the need for appropriate information for management and for medical audit in UK primary care, because the context within which general practitioners (GPs) deliver primary care in the NHS is changing rapidly. It is only now becoming evident that this turbulence may well offer major new opportunities to GPs, as well as permanently altering the balance of power in the NHS between primary and secondary care.

The purpose of this paper is to gain an in-depth understanding of beliefs, attitudes, and reasons for decision making about colorectal cancer (CRC) screening among South Asian (SA) immigrants.

Six focus groups conducted in English, Punjabi, and Urdu were held with 42 SA immigrants, 50-74 years old and at average risk for CRC, from November 2012 to May 2013. All focus group discussions were audio-taped and transcribed verbatim. Data analysis used an inductive and systematic approach employing constant comparison techniques.

Three dominant themes emerged. Beliefs and attitudes towards cancer and screening represented SA immigrant’s perceptions that early detection was beneficial; screening was not necessary in the absence of symptoms; cancer was scary; and the loss of previously established bowel practices upon immigration as potential risks for CRC. Knowledge and awareness focused on unscreened participants’ cancer stories; screened participants’ knowledge of CRC, risk factors, and screening; experiential learning from focus groups; and screened participants’ strategies to promote screening. Support and accessibility concentrated on physician support and responsibility to provide information, explanation, and recommend screening to facilitate access.

Findings provide novel insights on socio-cultural context, beliefs, and barriers to CRC screening among SA immigrants. Culturally appropriate community-based strategies included story-telling, the use of social networks, and greater physician engagement. Enhancing collaborative partnerships with physicians and public health may minimize structural barriers and reduce health disparities. Future research could explore effectiveness of outreach strategies including these collaborations.

The purpose of this paper is to place the future development of technology within the existing reality of the diversity of care homes.

Using the findings from a learning exercise, the paper illustrates “diversity” in terms of the meaning staff, relatives, and residents attach to the words “care home”. This tri-partite approach provides a basis for exploring types of technology that could, if appropriately introduced, prove to be of benefit to the different users and staff.

Technology is more likely to be “fit for purpose” when it has been developed jointly with those who work, live in, and who visit care homes. Costs and benefits will be issues to be taken into account.

A lack of research evidence on the role of technology in care homes was a key limitation. In future, research should adopt a co-production approach to technology development.

The authors take a pragmatic stance that if due care is taken in preparations for and the introduction of technology, this would increase uptake of technology to meet different needs.

The paper makes the points that: older people can learn new technological skills; the concept of care homes as user-led is in accord with increased opportunity to engage residents in new technology. Technology in care homes while posing challenges also could prove to be a major lucrative market.

By triangulating the perspectives of residents, relatives, and staff the authors hope to have presented a realistic and evidence-based overview of the potential for technology advancement in care homes.

Objective and study design: to assess quality of a quick and early diagnosis route (QED) by determining effectiveness and cost‐ effectiveness of five clinics compared with three conventional outpatient clinics. Prospective economic evaluation. Six‐month cohort of all referrals (November 1996‐April 1997). Subjects: all referrals for suspected cancers of: upper gastro‐intestinal tract; urinary tract, prostate and testis; skin. Effectiveness: median days saved between GP referral and date of: diagnostic appointment; consultant decision; intervention. Results: GP referral to diagnostic appointment: QED was effective (median days) for all clinics. Diagnostic appointment to consultant decision: QED was effective for testicular and haematuria clinics. Consultant decision to intervention: QED was effective for haematuria, testicular and melanoma clinics. Cost‐effectiveness: extra (incremental) NHS cost per patient diagnosed. Results: Less than £5 per day saved between GP referral and diagnostic appointment for: endoscopy; haematuria; prostate; testicular; melanoma. Less than £3 per day saved between GP referral and consultant decision for: testicular; haematuria. Less than £3 per day saved between GP referral and intervention for: endoscopy; haematuria; testicular; melanoma. Conclusion: A “quick and early” diagnostic route provides a higher quality service through improved effectiveness and cost‐effectiveness compared to conventional outpatients.