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BMC Health Services Research

, 8:248

First Online: 04 December 2008Received: 24 May 2008Accepted: 04 December 2008DOI: 10.1186-1472-6963-8-248

Cite this article as: Hamilton, S., Huby, G., Tierney, A. et al. BMC Health Serv Res 2008 8: 248. doi:10.1186-1472-6963-8-248


BackgroundHealthcare systems globally are reconfiguring to address the needs of people with long-term conditions such as respiratory disease. Primary Care Organisations PCOs in England and Wales are charged with the task of developing cost-effective patient-centred local models of care. We aimed to investigate how PCOs in England and Wales are reconfiguring their workforce to develop respiratory services, and the background factors influencing service redesign.

MethodsSemi-structured qualitative telephone interviews with the persons responsible for driving respiratory service reconfiguration in a purposive sample of 30 PCOs. Interviews were recorded, transcribed, coded and thematically analysed.

ResultsWe interviewed representatives of 30 PCOs with diverse demographic profiles planning a range of models of care. Although the primary driver was consistently identified as the need to respond to a central policy to shift the delivery of care for people with long-term conditions into the community whilst achieving financial balance, the design and implementation of services were subject to a broad range of local, and at times serendipitous, influences. The focus was almost exclusively on the complex needs of patients at the top of the long-term conditions LTC pyramid, with the aim of reducing admissions. Whilst some PCOs seemed able to develop innovative care despite uncertainty and financial restrictions, most highlighted many barriers to progress, describing initiatives suddenly shelved for lack of money, progress impeded by reluctant clinicians, plans thwarted by conflicting policies and a PCO workforce demoralised by job insecurity.

ConclusionFor many of our interviewees there was a large gap between central policy rhetoric driving workforce change, and the practical reality of implementing change within PCOs when faced with the challenges of limited resources, diverse professional attitudes and an uncertain organisational context. Research should concentrate on understanding these complex dynamics in order to inform the policymakers, commissioners, health service managers and professionals.

AbbreviationsMany of these explanations are based onor reproduced with permission, from the NHS Jargon Buster: Version 2 February 2008 Updated online at http:-www.impressresp.com

Acute TrustA legal entity formed to provide health services in a secondary care setting.

Community MatronWhen a patient has a number of long term conditions and complex needs, their care becomes more difficult for them to manage. Case Management is where a named coordinator, e.g. a Community Matron, actively manages care by offering continuity of care, coordination and a personalised care plan for vulnerable people most at risk.

COPDChronic Obstructive Pulmonary Disease

GPGeneral Practitioner Family doctor. Patients in the UK access healthcare through the GP practice with whom they are registered.

GPwSIGeneral Practitioners with a Special Interest. Practising GPs with a special expertise in respiratory medicine whose role often includes in service development as well as clinical care.

LDPLocal Delivery Plan. A 3 yr plan that every PCO prepares and agrees with its Strategic Health Authority SHA on how to invest its funds to meet its local and national targets, and improve services. It is a public document which provides an overview of PCO priorities, and how it intends to manage its resources.

LTCLong-term conditions. Illnesses which lasts longer than a year, usually degenerative, causing limitations to one-s physical, mental and-or social well-being. Symptoms may come and go, and usually there is no cure, but there are things that can be done to maintain or improve the person-s quality of life and wellbeing. Long Term Conditions include Diabetes, COPD, Asthma, Arthritis, Epilepsy and Mental Health.

LTC pyramidA pyramid with three levels of professional and self-care widely adopted as a model of service provision for people with long-term conditions. It is based on categorising care according to risk stratification.

NHSNational Health Service. The publicly funded healthcare system in England, Scotland, and Wales.

NSFNational Service Framework. These NHS documents set national standards for the provision of care for a range of disease areas.

PbRPayment by Results. How secondary care providers in England are now paid. There is a national fixed tariff for emergency care, elective in-patients, day cases and outpatients bought by NHS commissioners. The important principle is that only work done and recorded using appropriate coding is paid for.

PCOPrimary Care Organisation. Freestanding statutory NHS bodies Primary Care Trust in England; Local Health Boards in Wales with responsibility for delivering healthcare and health improvements to their local areas. They commission or directly provide a range of community health services such as district nursing as part of their functions.

UKUnited Kingdom

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-8-248 contains supplementary material, which is available to authorized users.

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Author: Sonya Hamilton - Guro Huby - Alison Tierney - Alison Powell - Tara Kielmann - Aziz Sheikh - Hilary Pinnock

Source: https://link.springer.com/

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