Primary Colours Issue 47

The latest monthly round up of primary care news, Issue 47 is available to download now

No incentive

The practice of offering financial inducements to encourage health behaviour change is put under the spotlight by a team from the University of Newcastle in Australia. In this review of reviews, the authors identify key principles for deciding on use of financial incentives to achieve public health aims. Another study looks at how the Locally Enhanced Service system has worked in relation to preventive services in primary care.

Customer turned commissioner

A study from the Joseph Rowntree Foundation looks at recent evidence of involving older people in commissioning health and social care. There's particular focus on the experience of programmes in Salford and Dorset. The Royal Pharmaceutical Society has published a discussion paper on involvement, shared decision making and medicines, highlighting the gap between the rhetoric and the present reality. Meanwhile, the Health Foundation has launched a self management resource support centre, offering an introduction to the theory behind and evidence for self care. A study in Journal of Public Health assesses the merits of using discrete choice experiements to incorporate public views into healthcare priority setting.

Patients, consumers or guinea pigs?

The need for effective public engagement is never more pressing than in this chilly economic climate, argues thinktank Involve. The NHS Confederation offers some advice to CCGs on how to make this work in the new commissioning landscape. Pressure Group the Patients Association has also done some research on the matter and amongst its concerns is how to reward and support patient representatives in CCGs. Elsewhere, the announcement that the government wants to foster innovation by releasing NHS patient data to researchers has not played brilliantly. Some have pointed out that the proposal to make every NHS patient "a research patient" does not sit particularly well with the patient empowerment agenda.

Joined up thinking

The need to integrate adult social care and health care is made from an economic viewpoint by the Audit Commission in a briefing and accompanying benchmarking tool. A systematic review of integrated working between health services and care homes finds a rather limited field of evidence, with integration happening mostly at patient level and very much health service led. Trafford PCT's faltering efforts to develop integrated care are analysed in a report from the Nuffield Trust. A batch of articles from the journal of integrated care examine inclusion of people with sight loss, a pilot in Norfolk addressing teenage pregnancy rates and the various models of integration used in Devon. RCGP offers guidance on commissioning integrated urgent and emergency care.

Supply your own punchline

What's the difference between a target and an outcome? The list of 60 outcomes in the new outcomes framework announced today looks a lot like a set of targets by another name, some have suggested. Others have focused on the attention these indicators pay to GPs' performance. Best of all is the hierarchical formula at the end, though, that begins in Tolkein mode but then gets a bit carried away:

One framework defining how the NHS will be accountable for outcomes
Five domains articulating the responsibilities of the NHS
Twelve overarching indicators covering the broad aims of each domain
Twenty-seven improvement areas looking in more detail at key areas within each domain
Sixty indicators in total measuring overarching and improvement area outcomes

Cancer survival rates

Improvements in cancer survival rates over the past 40 years in the UK are charted by Macmillan Cancer Support in a study undertaken by the London School of Hygiene and Tropical Medicine. Huge improvements for some cancers are contrasted with an absence of change for others, particularly lung, brain and pancreatic cancers. NHS Information Centre has published data on bowel cancer care that highlights the continuing problem with late diagnosis. A policy briefing from Breast Cancer Care takes a look at inequalities in care, especially amongst older women.

Quod erat demonstrandum

The waiting is up for the Whole System Demonstrator programme to report its findings and the headline is a careful yes to telecare: "if delivered properly, telehealth can substantially reduce mortality, reduce the need for admissions to hospital, lower the number of bed days spent in hospital and reduce the time spent in A&E." Started in 2008, this was the largest telecare RCT, covering 6191 patients and 238 GP practices in three areas (Kent, Newham and Cornwall) and covering three major long-term conditions, diabetes, heart failure and COPD . The figures look encouraging: in addition to reductions of 15% in A&E visits, 20% in emergency admissions and 14% in elective admissions, there's a 45% drop in mortality rates. However, this is only the top level data - the small print is yet to be released. The caveat of "if used properly" may constitute something of a warning: last month the King's Fund suggested that there's danger in the technology leading where the organisations cannot effectively follow without substantial change. DH has indicated that the yes is enough: its new campaign, "3 million lives," is aimed at "providing national leadership, strategic direction, and advice to NHS and social care organisations" in implementing telecare more widely. Again, the detail is to follow "in due course."

Commissioning round-up

A resource pack from Liverpool PCT points the way to effective commissioning for outcomes in health and social care, surveying appropriate use of a variety of models in programme planning and delivery. Thinktank Reform has published papers from their recent conference An NHS for patients: making commissioning work. The NHS Alliance's Nurses in Commissioning network considers the case for involving nurses in commissioning. Also from the NHS Alliance, a paper looking at commissioning urgent care and the scope for integration.