Integrated Teams in Primary Care

Glyn Elwyn

• Publisher: CRC Press
• Year: 2018
• eBook ISBN: 9781315348575
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Rewritten with the new primary care environment in mind, this greatly expanded and updated edition of Child Mental Health in Primary Care extends the structured approach of the first edition to adoelscent mental health. As in the first edition, Primary Child and Adolescent Mental Health covers each problem in a uniform way, offering definitions, assessment outlines, detailed management options and indications for referral. Numerous case examples further illuminate aspects of many conditions. Comprehensive and practical, the forty-eight chapters of Primary Child and Adolescent Mental Health cover the full range of difficulties and disabilities affecting the mental health of children and young people. The book is divided into three volumes, and can either be read from cover to cover or used as a resource to be consulted for guidance on specific problems. This book is vital for all healthcare professionals including general practitioners, health visitors and other staff working in primary care to assess, manage and refer children and adolescents with mental health problems. School medical officers, social workers and educational psychologists, many of whom are in the front line of mental health provision for children and young people, will also find it extremely useful. Reviews of the first edition: 'This very comprehensive and detailed book provides the tools for primary care health professionals not only to assess a child's needs but in many cases also to implement an initial package of care.' JUST FOR NURSES 'I have no reservation in recommending the book to all people working with children and families in any capacity. An important training text for a variety of professions. A very effective text to be used in daily practice for quick reference.' CHILD AND ADOLESCENT MENTAL HEALTH 'This book is well produced and clearly written. A useful book for anyone interested or involved with children.' FAMILY PRACTICE 'I looked through the book again and again but could not find anything missing.' NURSING TIMES

1

The changing organisation of primary care

Geoff Meads

For the NHS, primary care is where the State and the individual meet. In its settings the dynamic of the constantly changing relationship between collective and personal responsibility for health and healthcare finds its principle expression. For the contemporary NHS, in 1998, this relationship is clearer cut than ever before – there are now simply no buffers between its central and local boundaries. Regional and Family Health Services Authorities have departed the scene and with them much of the capacity of the NHS to plan and develop itself internally. Arrangements for professional representation have undergone an apparently irrevocable process of fragmentation during the present decade, as the requirement in NHS politics for a majority consensus has been replaced by the need for simply a winning constituency to promote strategic developments, however small such constituencies might be. During the first half of the 1990s several individual general practitioner fundholders had direct access to and considerable personal influence with health ministers. Even after the change of central government in May 1997, applications by local practices to be pilots under the terms of the 1997 NHS (Primary Care) Act landed straight on the Secretary of State’s and his ministerial colleagues’ desks. From both a top-down and a bottom-up perspective the advent of alternative primary care organisations can properly be regarded as at the cutting edge of societal change. It is where the agendas of the public’s elected and professional representatives come together.

Conventional general practice, of course, has long enjoyed a position of special symbolic significance in UK society. General practitioners have been in contract separately with both the individual and the State – semidetached from both, yet still representing each to the other. The importance of this position goes back a long way. The 1911 National Insurance Act first associated the individual’s rights to register with a general practitioner with a fundamental responsibility of the State to fund this form of primary healthcare: a form which had many of its origins in the need of an industrial island society for a fit enough labour force. Fifty per cent of would-be military recruits in 1856 had failed their medical examinations at the onset of the Crimean War, and the figures for the Boer War, four decades later, were scarcely much better. At a time when poorly resourced parish and municipal authorities on the one hand, and largely still churchbased charities on the other, were both vying to establish their positions as public service organisations, and at the same time for financial reasons, restricting their responsibilities for universal care, the professional role of family doctors emerged across the country as the vehicle through which national governments could hope to guarantee the basic standards of population health. General practice supplied some sort of safety net for what then comprised the central policy of community care.¹

A century later it is the same story. Primary care is being redefined once more in the context of public health, and its organisational forms are being addressed in ways that respond to the changing social and economic circumstances of a UK in which health policy increasingly has to encapsulate a new combination of consumerist, regional and European imperatives. The uniprofessional partnership of independent contractors has served the country well, but as the exclusive form of organisation in primary care it has now had its day. Conventional general practice is increasingly being regarded as one service outlet among many – still the focal point for healthcare in most suburbs and many market towns, but elsewhere, and especially within inner cities, the changing organisation of primary care actually means specific, individual, alternative primary care organisations increasingly hold sway.

In 1996, as Box 1.1 illustrates, most of these could be regarded as local prototypes and as such perhaps as many of these organisational initiatives could properly be expected to have a short shelf life as aspire to enduring successes. By 1998, however, what is clear is that the stage of local inventions has given way to that of national innovation. To refer now simply to the 10 000 general practices in the UK simply misses the point. The King’s Fund has led the way in recognising that the new plurality is here to stay, and it can now be claimed, without being too disingenuous, that there are presently around 1000 primary care organisations in the UK.² As Box 1.2 illustrates, an extraordinarily large number of these are developing with national ‘pilot evaluation’ status. The dramatic shift from general practice to primary care is unequivocally the subject of central sponsorship. There are around 270 000 000 consultations each year in general practice. The scale and potential scope of these personal care encounters is simply too enormous for any government to ignore. It would do so at its peril. Contemporary primary care has to be organised in ways that, at worst, do not limit tomorrow’s political imperatives and, at best, actually promote the changing balance of responsibilities between the modern State and its individual citizens.

Box 1.1 Primary care organisational developments.

Role	Purpose	Management	Population
The consortium, e.g. Isle of Wight	Effective jo...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Forewords
• Preface
• List of Contributors
• Acknowledgements
• Introduction
• Chapter 1 The Changing Organisation of Primary Care
• Chapter 2 Integrated Nursing Teams and Healthcare ‘Substitution’
• Chapter 3 The Political and Policy Context
• Chapter 4 Integrated Nursing Teams and the PHCT: Integral or Alternative?
• Chapter 5 Professional Training Issues for Integrated Nursing Teams
• Chapter 6 Nursing Roles in Integrated Teams
• Chapter 7 Integrated Nursing Teams: Sprouting Up Everywhere?
• Chapter 8 Budgets and Management: The Oxfordshire Approach
• Chapter 9 The Legal Aspects
• Chapter 10 Future Directions for Primary Care
• Index