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Heading for new professionalism? Experiences in the NHS. Ruth McDonald ruth.mcdonald@nottingham.ac.uk. Acknowledgements. SDO, Department of Health, Commonwealth Fund

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heading for new professionalism experiences in the nhs

Heading for new professionalism? Experiences in the NHS

Ruth McDonald

ruth.mcdonald@nottingham.ac.uk

acknowledgements
Acknowledgements
  • SDO, Department of Health, Commonwealth Fund
  • Sudeh Cheraghi-Sohi, Martin Tickle, Martin Roland, Tim Doran, Stephen Campbell, Steve Harrison, Darren Ashcroft, Caroline Sanders, Russell Mannion, Keith Milsom.
new professionalism
‘New’ professionalism?
  • Dynamic context
  • Changes to incentive structures
  • Aligning payment to policy goals
  • GP contract & Practice-based Commissioning (PBC)2004
  • Pharmacy contract 2005
  • Dental contract 2006
  • Policy goals multiple, complex and competing
gp contract
GP contract
  • Self-employed contractors (partnerships)
  • Quality and outcomes framework (QOF)
  • Contract with practice
  • End to OOH
  • Software to facilitate delivery
  • Negotiated, ballot, own data
  • New money, MPIG
impact
Impact?
  • Self surveillance
  • Surveillance by others (including non doctors)
  • Hierarchy
impact1
Impact?
  • Critical of other practices
  • Improvements in other practices
  • Acceptance of public accountability
slide9
PBC
  • GPs act as commissioners
  • Elites & rank & file
  • New strata
  • Surveillance of self & by others
pharmacy professional status
Pharmacy Professional status
  • Business vs. public interest
  • Control over the substance of work
  • ‘Incomplete professionals’ (Denzin & Mettlin 1968)
  • Subordinate to medicine
  • Increasingly ‘corporate’
  • Divisions/ fragmentation
professional status
Professional status
  • Conflict with business concerns overstated
  • Knowledge imbues drug with social significance
  • Pharmacists respond to disorder, ‘providing tools for the sick person to respond to the question “What is happening to me? What do the disordered senses of my body mean?”’ (Dingwall and Wilson 1995: 122).
pharmacy contract
Pharmacy contract
  • Contractors
  • 61% multiples (>5 pharmacies)
  • Essential (dispensing)
  • Enhanced (smoking cessation, minor ailments)
  • Advanced
slide13
MURs
  • Consultation room
  • £28 per MUR
  • Max 400 per annum
  • Copy to GP & patient
professional status1
Professional status
  • Targets for MURs
  • Tick box MURs
  • Home delivery of medicines
  • Delegation to other staff
  • Competitive market
dental contract
Dental contract
  • End to open ended funding
  • End to patient registration
  • UDAs
  • Band 1 - Diagnosis, treatment planning and maintenance 1 UDA
  • Band 2 – Treatment (e.g. fillings, root canal treatment, extractions) 3 UDAs
  • Band 3 - Complex treatment that includes a lab element (e.g. bridges, crowns) 12 UDAs
slide17

No of

extractions vs. year

Our findings are consistent with economic theory that suggests that

No of

root-fillings vs. year

summary
Summary
  • a contribution to high levels of attainment of quality targets and a reduction, over time, in the variation in care quality related to deprivation in general medical practice
  • increasing volumes of incentivised activities in community pharmacy
  • a shift towards dental treatments which pay more, relative to effort expended