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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.

Previous studies of general practitioner views of paediatric home care have presented a rather negative view of such services. This study examines GPs’, nurses’ and managers’ views of a new, acute paediatric hospital‐at‐home nursing service in Rugby. Methods used are qualitative and quantitative questionnaires and interviews, including Likert‐type scales and open questions. Contrary to the mixed and somewhat negative findings of previous studies, this study reports positive views on the impact of hospital‐at‐home in Rugby, in terms of acceptability and impact on the roles and responsibilities of GPs.

Parental satisfaction with paediatric home care has previously been found to be high and the results presented here confirm this finding. This study is unique in that a well defined population from one geographical area was studied before and after the introduction of the new home care service. Referrers included general practitioners, doctors in emergency care and out‐patient clinics, referring children for a wide range of acute conditions. Compared with hospital admission only half the number of adverse effects on children and families were reported by parents. Interest has been increasing in alternative service provision to prevent or reduce paediatric hospital admissions to avoid adverse effects on children and families. This study examined the views of parents experiencing hospital at home compared with hospital referral between 1999 and 2001 across the whole spectrum of acute clinical conditions. Hospital at home was the preferred service for a wide range of illnesses. Parents and carers identified extension of hospital at home to 24‐hour cover as a future preference. Parental preference for paediatric hospital at home for acute illness was confirmed.

The clinical governance mechanism, introduced since 1998 in the UK National Health Service (NHS), aims to deliver high quality care with efficient, effective and cost‐effective patient services. Scally and Donaldson recognised that new approaches are needed, and operations management techniques comprise potentially powerful methodologies in understanding the process of care, which can be applied both within and across professional boundaries. This paper summarises four studies in hospital Trusts which took approaches to improving process that were different from and less structured than business process re‐engineering (BPR). The problems were then amenable to change at a relatively low cost and short timescale, producing significant improvement to patient care. This less structured approach to operations management avoided incurring overhead costs of large scale and costly change such as new information technology (IT) systems. The most successful changes were brought about by formal tools to control quantity, content and timing of changes.

Since 1990, the changes introduced in UK general practice, such as fund holding and national incentives, have altered the process of care. Audit, defined as “the systematic critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for patients”, is one method of monitoring change and raising standards. Presents a successful co‐ordinated audit in Warwickshire, 1991‐1993, involving 53 general practices. Highlights the influence of attitudes and communications within practices on the success of audit strategies. Associates aspects of practice culture, such as team working and decision‐making processes, with successful audit. Postulates six descriptive practice types, largely related to cultural factors. Suggests that if cultural factors within practices are identified, external assistance with audit may be more focused and effective.

The purpose of this paper is to investigate how organisational frames of reference, which are neither not appropriately communicated nor supported, affect the wellbeing of workers.

A review of the literature is used to develop a new model linking ambiguous frames of reference with reduced levels of workers' wellbeing. This is then tested using data collected in a study involving primary health care workers in Papua New Guinea (PNG).

This paper finds that, for these particular workers, the model linking ambiguous frames of reference and reduced worker wellbeing is valid.

The paper shows that there is a need for further research into a variety of areas including the importance of frames of reference to worker wellbeing, the significance of reference groups to organisational frames of reference and the consequences of reduced worker wellbeing in developing countries.

In this paper, recommendations for changes to current PNG primary health care management practices, including ensuring the support for as well as communicating the organisational frame of reference, are discussed.

The paper shows that the experiences of these particular primary health care workers not only demonstrates the validity of the new model but also brings a unique perspective to the field of worker wellbeing, which up until now has been dominated by research conducted in western countries.

Clinicians have the important quality assurance task of implementing changes to treatments offered, on the basis of clinical effectiveness. Problems seem to arise when evidence emerges, casting doubt on the effectiveness of existing treatments, that require services to be substituted or reduced. In such cases, change is often slow and inconsistent across wide geographic areas. This study identifies factors that influence the success or failure of attempts to replace or reduce ineffective treatments. Success factors include the need for external support for a change, the development of training and education for staff, transitional resourcing and multi‐agency planning. Conflicting evidence, poor implementation planning, a lack of experience and internal organization issues were generally associated with failure.

Based on a performance of a conversation between my white mother and myself – her mixed race black daughter – the purpose of this paper is to deconstruct the complexity of the intersection of migration, racism, sexism, disability, and class within the space and place of the dynamics of our relationship. “Migration” and “borders” metaphors explore the “in between space that is neither here nor there” addressing key issues such as “migratory subjectivity” or, in other words, the translation of the process of inclusion and exclusion across the borders of oppressive social constructions to the lived emotional experience of being a mother and a daughter.

I explore my lived experience as black woman raised by a white Mum. My decision to use intersectionality as a tool with which to explore my personal experiences was based on me finding it enabled me to fully engage with the freedom of exploration, without feeling the need to “fit” with what was expected, in other words to be free to be able to express the “[…] lived experience of a presumed ‘Other’ and to experience it viscerally” (Orbe and Boylorn, 2014, p. 15).

A truthful account to aid the understanding of the complexities faced in the lived experience of a white mother and her black daughter.

This piece has no limitations, and contains far reaching implications for social work practice and research methods.

This piece is embedded in social education and can be used as a research tool for best practice in anti-racist, black feminist practice.

Social implications include a potential impact on diverse communities, with relevance to community engagement, social work practice placements, and critical reflection, and also education of the young to help them understand their own journeys.

This is an original report of an evidence-based lived experience, integrating theory to practice.