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Article
Publication date: 18 January 2013

David Colin‐Thomé

The aim of this paper is to set out the role of clinical governance within the new commissioning framework. It starts by considering the historical development of clinical…

2527

Abstract

Purpose

The aim of this paper is to set out the role of clinical governance within the new commissioning framework. It starts by considering the historical development of clinical governance and lays out ideas for the new arrangements around the concept of the primary care home and concludes with challenging questions for the future.

Design/methodology/approach

The paper draws on the author's role and experience as a senior policy maker in the UK Department of Health.

Findings

If we are to fulfil the defined attributes of clinical governance the NHS needs to adopt a more reflective self‐auditing leadership culture. Whether that supposition is accepted or not, a set of questions arises. Why, given for instance the gross failures of care for the frail elderly, have the principles of clinical governance not been systematically embedded? Why, given the NHS can no longer be described as poorly resourced, are clinical outcomes for many conditions lagging behind equivalent international healthcare systems? Why have the improved access and clinical outcomes of recent years been dependent on political rather than NHS leadership? And why in our publicly funded NHS is there frequently a culture of regarding patients as grateful supplicants rather than true partners to whom we should account? Clinical governance for personal, population and system care. Does this represent a coming of age?

Originality/value

This article provides a contribution to the emerging policy debate around clinical governance in the new commissioned NHS, rooted in experience from both the clinical front line and the heart of national health policy making.

Details

Clinical Governance: An International Journal, vol. 18 no. 1
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 18 January 2013

Fiona MacVane

The purpose of this paper is to enable busy clinicians to review the contents of the journal quickly. They can then choose which articles have the most relevance for them and…

173

Abstract

Purpose

The purpose of this paper is to enable busy clinicians to review the contents of the journal quickly. They can then choose which articles have the most relevance for them and focus on these.

Design/methodology/approach

The paper provides a brief synopsis of the main content of the journal prepared by the review editor.

Findings

Changes to healthcare commissioning and delivery will have long‐term consequences for the way in which the NHS functions.

Practical implications

It is important that all NHS staff have a clear understanding of recent and proposed changes so that they can participate in dialogue about the implications for their roles.

Originality/value

The review editor has no affiliation with any of the authors and no financial or other interest in commissioning and therefore is able to provide an independent overview of the journal contents.

Details

Clinical Governance: An International Journal, vol. 18 no. 1
Type: Research Article
ISSN: 1477-7274

Keywords

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Article
Publication date: 18 January 2013

Katie Barnes, Philip Longfield, Katie Jones, Gill Littlemore, Claire McDonough, Archie McIntyre, Jo Robertson, Neil Turton, Kevin Urdhin and Melanie McLaughlin

The purpose of this paper is to show how the new arrangements for commissioning services in the English NHS can facilitate innovations in service delivery leading to improvements…

544

Abstract

Purpose

The purpose of this paper is to show how the new arrangements for commissioning services in the English NHS can facilitate innovations in service delivery leading to improvements in outcomes and cost effectiveness.

Design/methodology/approach

The study uses cost modelling based upon the Hospital Episodes Statistics compiled by the NHS Information Centre to calculate recent expenditure upon treatment of routine childhood illnesses managed as short stay hospital admissions, and then uses a case study of a children's walk‐in centre to show how an alternative service can be provided, and a new service embedded in general practice to show a further alternative type of provision.

Findings

The study finds that large sums are currently being spent on inappropriate treatment of routine childhood conditions, especially in large urban conurbations. It demonstrates that in the case studies, the alternative provision can provide a viable and effective alternative.

Research limitations/implications

The research is based upon historical data by necessity. The new commissioning groups are not co‐located with the historical PCTs on which this study is based. The data are collected by providers and co‐ordinated by the NHS Information Centre. Therefore the investigators do not have control over the data quality. The second case study is a new service and therefore is used as an illustration of other service types.

Practical implications

This study suggests that paediatric ambulatory services can be provided at lower cost with better outcomes.

Social implications

This study provides the basis for a pilot study in Salford, where additional social benefits are targeted including better school attendance and increased self‐awareness over child health amongst local families.

Originality/value

The study provides quantitative evidence for commissioning alternative paediatric ambulatory services.

Details

Clinical Governance: An International Journal, vol. 18 no. 1
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 18 January 2013

Satish Bhagwanjee and Konrad Reinhart

The purpose of this paper is to outline the problem of sepsis and a global initiative to reduce the burden of this disease.

632

Abstract

Purpose

The purpose of this paper is to outline the problem of sepsis and a global initiative to reduce the burden of this disease.

Design/methodology/approach

This is a summary description of the strategy being applied by the Global Sepsis Alliance (GSA) and its partners to deal with sepsis.

Findings

The paper outlines the problem of sepsis, primary goals of the GSA, early indicators of the outcome from initiatives and proposes strategies for the future. The key initiative was WSD (World Sepsis Day), which succeeded in creating public and stakeholder awareness via the use of focused and informal meetings, use of the media and the internet.

Practical implications

Tackling the problem of sepsis requires a two pronged approach that creates public and stakeholder awareness that prompts action as well as focused research efforts that address the key clinical challenges in sepsis.

Social implications

The importance of community education and support for initiatives that change attitudes and behavior are highlighted.

Originality/value

The proposed initiatives for sepsis that have been implemented as outlined in this paper are novel for the field and have proven to be successful. On‐going supports for such initiatives are warranted.

Details

Clinical Governance: An International Journal, vol. 18 no. 1
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 18 January 2013

H. Ayyash, S. Sankar, H. Merriman, C. Vogt, T. Earl, K. Shah and S. Banerjee

Attention deficit hyperactivity disorder (ADHD) is the most commonly studied and diagnosed psychiatric disorder in children. There is a need to engage service development…

702

Abstract

Purpose

Attention deficit hyperactivity disorder (ADHD) is the most commonly studied and diagnosed psychiatric disorder in children. There is a need to engage service development, commissioning and service managers to address primary care involvement and define service models that will enable effective management of people with ADHD. The purpose of this project is to define recommendations through consensus that can be implemented to improve ADHD management in the UK.

Design/methodology/approach

A set of 40 consensus statements has been developed by a multidisciplinary group of ADHD professionals in the UK. These statements cover ten topics, ranging from commissioning of ADHD services to optimisation of the care pathway. The aim of the project was to define a set of standards that could be tested across a wider clinical population.

Findings

A total of 122 respondents scored each statement on a questionnaire and levels of agreement were summated and analysed. Of 40 statements, only four scored less than 90 per cent agreement, with all statements achieving greater than 74.9 per cent agreement.

Originality/value

Recommendations support the wider integration of ADHD services and the closer involvement of commissioners within the new GP consortia to ensure that the potentially negative societal and personal impacts of ADHD are managed effectively and with appropriate use of resources.

Details

Clinical Governance: An International Journal, vol. 18 no. 1
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 18 January 2013

Robert Geyer

The purpose of the article is to explore the implications of GP commissioning through the lens of complexity theory. The key point that the article attempts to rise is that GP…

479

Abstract

Purpose

The purpose of the article is to explore the implications of GP commissioning through the lens of complexity theory. The key point that the article attempts to rise is that GP commissioning does imply greater freedom, responsibility and ability to move the English NHS in a more public oriented, locally responsive and public health oriented direction. At the same time, as demonstrated by the Stacey diagram, it forces GPs into difficult, complex situations that lie outside of their traditional skill range and experiences and implores them to deal with a much wider range of actors and institutions that they are unfamiliar with and are well beyond their control.

Design/methodology/approach

This is a discussion paper that explores the recent proposals for GP commissioning from a complexity framework, and in particular the “Stacey diagram”.

Findings

The commissioning reforms may represent a healthy organisational transformation of the NHS and over time generate a number of positive outcomes. Nevertheless, with a complexity perspective, one can begin to understand why this reform is so challenging for GPs, and that it will take a whole new range of GP skills and decision‐making strategies (and maybe even a shift in the overall GP culture) in order to make it work.

Originality/value

To the author's knowledge this is the first attempt to use complexity theory to explore the strengths and weaknesses of GP commissioning.

Details

Clinical Governance: An International Journal, vol. 18 no. 1
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 18 January 2013

Adrian Quayle, David Ashworth and Alan Gillies

The purpose of this paper is to consider how BS 11000 may be usefully deployed within a commissioning situation in the light of the Department of Health's suggestion that it…

585

Abstract

Purpose

The purpose of this paper is to consider how BS 11000 may be usefully deployed within a commissioning situation in the light of the Department of Health's suggestion that it represents “best practice”.

Design/methodology/approach

The study uses case studies from other sectors (criminal justice) and IT outsourcing to consider the nature of the commissioning relationship at the heart of the English NHS post‐2013. It looks at how BS 11000 is intended to support business relationships and how this can address potential problems identified in the case studies.

Findings

The study finds that business relationships are often regarded in a reductionist manner based on a simple contractual relationship. The case studies suggest that a richer more collaborative business relationship is required for effective provision of services. The authors suggest that BS 11000 can help organisations put in place the foundations of such relationships.

Research limitations/implications

The Clinical Commissioning Groups are still being formed, and the marketplace for service providers in the NHS is expanding dramatically. This means that there are limited opportunities for studying this issue in situ, and therefore it is necessary to use case studies from other domains.

Practical implications

This study suggests that the commissioning relationship is more complex than a simple contractual relationship, and a genuine partnership is needed between the new Clinical Commissioning Groups and their providers.

Social implications

From 2013, the NHS is intended to be a commissioner of services rather than a provider. Effective health and social care will depend upon an effective commissioning relationship.

Originality/value

The study provides insights from related fields into an area that cannot yet be studied itself, as it is still being formed. It has access to unpublished data from an ESRC funded study to provide new insights from a related public‐sector context.

Details

Clinical Governance: An International Journal, vol. 18 no. 1
Type: Research Article
ISSN: 1477-7274

Keywords

Available. Content available
Article
Publication date: 1 January 2014

Nick Harrop and Alan Gillies

579

Abstract

Details

Clinical Governance: An International Journal, vol. 19 no. 1
Type: Research Article
ISSN: 1477-7274

Available. Content available
Article
Publication date: 13 February 2007

129

Abstract

Details

International Journal of Health Care Quality Assurance, vol. 20 no. 1
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 4 February 2010

Bob Hudson

Ideas about joint commissioning between the NHS and social care have been around for a long time ‐ since at least the publication of Practical Guidance on Joint Commissioning for…

173

Abstract

Ideas about joint commissioning between the NHS and social care have been around for a long time ‐ since at least the publication of Practical Guidance on Joint Commissioning for Project Leaders by the Department of Health in 1995, and stemming from the roots of joint planning and joint finance way back in the mid‐1970s. Achievements have generally not been spectacular, but the issue is now squarely back on the policy stage with a rebranding: ‘integrated commissioning’. This implies a shift from ad hoc and opportunistic partnering to something more systemic and long‐term. However, the policy context is now very different, and the scale of ambition hugely heightened. This article examines whether integrated commissioning is an idea whose time has come.

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