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Objectives: Changes in the contractual responsibilities of primary care practitioners and health boards have resulted in a plethora of arrangements relating to out-of-hours healthcare services. Rather than being guaranteed access to a GP (usually either their own or another through a local GP co-operative), patients have a number of alternative routes to services. Our objective was to identify and assess the availability and adequacy of relevant standards, responsibilities and information systems in Scotland to monitor the impact of contractual changes to out-of-hours healthcare services on equity of access.Design: Cross-sectional study.Setting: All providers of primary care out-of-hours services in Scotland.Participants: Not applicable.Main Outcome Measures: First, identification and policy review of current standards and performance monitoring systems, data and information, primarily through directly contacting national and local organizations responsible for monitoring out-of-hours care, supplemented by literature searches to highlight specific issues arising from the review; and second, mapping of data items by out-of-hours provider type to identify overlap and significant gaps.Results: In Scotland, data monitoring systems have not kept pace with changes in the organization of out-of-hours care, so the impact on access to services for different population groups is unknown. There are significant gaps in information collected with respect to workforce, distribution of services, service utilisation and clinical outcomes.Conclusions: Since 2004 there have been major changes to the way patients access out-of-hours healthcare in the UK. In Scotland, none of the current systems provide information on whether the new services satisfy the key NHS principle of equity of access. There is an urgent need for a comprehensive review of data standards and systems relating to out-of-hours care in order to monitor and evaluate inputs, processes and outcomes of care not least in respect of access and fairness of distribution of resources. [ABSTRACT FROM AUTHOR]

Situation Reports (SitReps) is an internal Department of Health performance data collecting system. Although intended primarily for internal use, the data are also used to answer parliamentary questions, brief ministers and to inform national performance indicators. This paper reviews the data collection system and data-set, and shows how it can be used to evaluate delays in hospital discharge under the Community Care (Delayed Discharges etc.) Act 2003. However, limitations in the data include the fact that the data have only recently been extended to National Health Service (NHS) non-acute settings and do not include NHS patients in the private acute sector. Further, as the data-set derives from a weekly aggregate return rather than from individualized person-based records, it cannot be used to evaluate length of delay, or to link to other relevant data such as emergency readmissions. The provision of individualized data to facilitate linkage and extending coverage would increase its potential future use. Categories of delay should be further refined to facilitate monitoring of delays due to disputes about eligibility. [ABSTRACT FROM AUTHOR]

The authors reflect on the effectiveness of independent treatment centers which have been developed by Great Britain's National Health Service. They suggest that there is no definitive evidence which supports the continued funding of the centers. They argue that concerns from patients, lawyers and healthcare professionals about the quality and safety of the centers are being ignored by the government.

Summary [ABSTRACT FROM PUBLISHER]

Background The aim of this study was to investigate how primary care groups (PCGs) were implementing clinical governance in their first year. [ABSTRACT FROM PUBLISHER]

Abstract The objective of this study was to compare hospitalisation rates by cause of admission, hospital death rates and length of stay for residents from nursing and residential care homes with those in the community. This is a retrospective study of acute hospital emergency admissions in one health district, Merton, Sutton and Wandsworth between April 1996 and March 1997. Data linkage and manual look up were used to derive emergency hospital admissions for residents of care homes aged 65 and over. Admission rates were calculated for cause, length of stay and hospital death for residents of care homes and in the community with relative risks. The relative risk of emergency admission from a care home compared with the community was 1.39 for all diagnoses, 2.68 for all injuries, and 3.96 for fracture of neck of femur. The relative risk of dying in hospital for care home residents was 2.58 overall, and 3.64 in the first 48 hours of a hospital stay (all P -values <0.0001). Admission rates were higher from residential than from nursing homes. There was some increase in admissions from homes during holiday periods and over Christmas. In conclusion, there are major difficulties in monitoring admissions from nursing and residential care homes due to poor quality recording and inaccuracies in NHS coding. This was compounded by an absence of data on the age and sex profile and healthcare needs of the resident population in care homes. Prospective studies are required to ascertain when admission is avoidable and when it is appropriate. The information strategy needs to ensure that routine data sources are capable of monitoring the use of hospital services by residents of care homes. [ABSTRACT FROM AUTHOR]

The authors describe the complexity of the financing arrangements of primary care premises. They explain how the early vision of integrating health and social services within local health centres failed to be realized, with GP-owned practice premises remaining as the dominant model. There was a switch to private finance when the government loan body (General Practice Finance Corporation) was privatized in 1989. Although capital can now be freely raised by the private sector for investment in the National Health Service (NHS), these debts have to be repaid through NHS funds or user charges. The complexity, combined with demographic factors, makes it likely that as GPs opt for the Personal Medical Services (PMS) scheme and a salaried service, the trend towards for-profit corporations owning and buying out GP premises will accelerate. [ABSTRACT FROM AUTHOR]

Discusses the reasons why private finance is moving primary care into corporate ownership. Reasons for the establishment of the National Health Service (NHS) of Great Britain, to integrate primary care and health and social services in health centers; How the aim was compromised by the absence of public capital and the reluctance of the Treasury to buy out practice premises owned by general practitioners; Question about the extent to which planning, population needs and accountability are incorporated into the procurement process.

Background This study describes a method for combining health and social services data on service provision to develop a framework for monitoring eligibility and service criteria as an aid to development and joint care planning in an inner city area. Methods The population studied was all residents of the London Borough of Wandsworth aged 18 and over in receipt of social services and/or community health services on one ‘snapshot’ day. Data matching and linkage was undertaken between social services data and community health services data for Wandsworth. Residents receiving social and community health services and joint packages of care were profiled by age, sex, description and intensity of service. Results Community health services input is high among women aged 25–34 and the over-65s. Social services input is provided mainly to the over-65s, who are three times more likely to receive a social service than a community health service. Eleven per cent of individuals receiving a social care package also received community health services. These joint care packages were mainly for home care and district nursing services. Conclusions This is the first time this technique has been applied to health and social services. The exercise highlighted problems of data quality, indicating the relevance of adopting a person-based system for health in the longer term to obtain a more accurate picture of activity. [ABSTRACT FROM PUBLISHER]

The article reports that the U.S. Health and Social Care Act 2012 will replace the administrative structure of the NHS in England and its implications on existing routine data systems and the production of routine statistics. As stated, under the Act, unlike primary care trusts (PCTs), commissioning groups will no longer have responsibility for geographical areas and their practices will be able to recruit patients living anywhere in England. It also states that some health services for which PCTs are responsible will be out of the health service entirely or may be provided under the new public health system.

The article reports on an initiative by the Department of Health of Great Britain to develop a strategy to collect comprehensive information that would make it possible to track, at local levels, trends in major risk factors and in patterns of disease. The government is seeking views on such a strategy. The consultation document outlines how such a vision should be realized to provide real-time, high quality public health data to public health and local authorities.

A letter is presented in response to the article "Dismantling the signposts to public health? NHS data under the Health and Social Care Act 2012" by Allyson M. Pollock, Alison Macfarlane and Sylvia Godden in the April 2012 issue; a response by Pollock and colleagues to this letter is also included.

Background This article describes the issues encountered when designing a study to evaluate recruitment of minority ethnic groups into clinical cancer research in order to monitor adherence to the principles for good practice set out in the Department of Health, Research Governance Framework, England. Methods (i) A review of routine data sources to determine whether their usefulness as a source of data on prevalence of cancer in the population by ethnic category. (ii) A local case study at one hospital trust to ascertain whether the ethnicity of cancer trial participants was representative of admitted cancer patients. Results (i) The lack of a comparator population makes it problematic to assess recruitment levels by ethnic group in clinical research. (ii) The odds of being in a trial were 30% lower for a member of a minority ethnic group compared to a white cancer patient after adjusting for disease, age and gender, OR 0.70 (0.53 to 0.94). These results differed for each ethnic group; Asian patients did not appear under-represented while Black and Chinese did so. However, there are important caveats to the findings based on the limited recording of ethnicity. Conclusions The lack of available data on the ethnicity of participants in clinical research and the prevalence of cancer in the population according to ethnicity makes it difficult to design a study to monitor representation of minority ethnic groups. This information is necessary to assess adherence to the Research Governance Framework principle that research evidence reflects the diversity of the population. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Equity, Waiting Times, and NHS Reforms: Retrospective Study," by Z. N. Cooper and colleagues in the September 3, 2009 issue.

Focuses on community health services in Great Britain. Policy and regulation governing community health services; Information on their computer system and data management; Purpose the government for its decision to abandon work on a standardized community dataset.