Stephen Gillam

University of Cambridge | Cam · Cambridge Institute of Public Health

Background: Patient and public involvement in the development of health services is central to current government policy. In 2011 new financial incentives were introduced to promote the establishment of Patient participation groups (PPGs) which led to an increase in the number of PPG groups in England. PPGs are now well established in many practice...

Poorly planned policies could hasten its decline Governments are generally loath to alienate general practitioners. They fear that their discontented mutterings might inflame over 6 million patients a week. Now that the NHS is once more central to pre-election manifestos and voters’ concerns UK politicians of all parties are treading carefully.1...

These are embarrassing times for baby boomers. As beneficiaries of the Attlee settlement, we have enjoyed affordable health care, decent housing, free higher education and a generous welfare state. Notoriously, these are blessings that could be denied the next generation.1 The NHS is facing yet another funding crisis and social care is under incre...

‘ More than 26 million people in England had to wait for a week or more to see or speak to their GP last year. ’1 Those leading the College’s campaign for more investment cite this as evidence of a funding crisis in general practice. Others may see it differently but no one disputes our escalating workloads; the number of consultations has risen b...

Background: One in four adults are estimated to be at medium to high risk of malnutrition when screened using the 'Malnutrition Universal Screening Tool' upon admission to hospital in the United Kingdom. The Need for Nutrition Education/Education Programme (NNEdPro) Group was developed to address this issue and the Nutrition Education and Leadersh...

Landmark reports have confirmed that it is within the core responsibilities of doctors to address nutrition in patient care. There are ongoing concerns that doctors receive insufficient nutrition education during medical training. This paper provides an overview of a medical nutrition education initiative at the University of Cambridge, School of C...

The UK’s pay for performance system for primary care has produced some benefits, including reducing inequalities between practices, but Stephen Gillam and Nicholas Steel argue that it is time to reduce the proportion of general practitioners’ income that it governs Introduced in 2004, the UK Quality and Outcomes Framework (QOF) is the most compreh...

Interest in global health (GH) among medical students worldwide is measurably increasing. There is a concomitant emphasis on emphasizing globally-relevant health professions education. Through a structured literature review, expert consensus recommendations, and contact with relevant professional organizations, we review the existing state of GH ed...

‘Integrated care’ has long been identified as one way of addressing the challenges associated with the increasing fragmentation and specialisation of care.1 Following Ara Darzi’s NHS Next Stage Review , the Department of Health launched its Integrated Care Pilots (ICPs) programme in April 2009 amid much hullaballoo.2 From a national invitation acro...

Purpose: Primary care practices in the United Kingdom have received substantial financial rewards for achieving standards set out in the Quality and Outcomes Framework since April 2004. This article reviews the growing evidence for the impact of the framework on the quality of primary medical care. Methods: Five hundred seventy-five articles wer...

Neglected tropical diseases (NTDs) are those largely ignored by medical science, partly because they do not represent a viable commercial market for private pharmaceutical companies. These diseases are endemic in developing countries and have a significant impact at both personal and national levels. Globally, NTDs affect an estimated 2.7 billion p...

Problems such as hospital malnutrition (∼40% prevalence in the UK) may be managed better by improving the nutrition education of 'tomorrow's doctors'. The Need for Nutrition Education Programme aimed to measure the effectiveness and acceptability of an educational intervention on nutrition for medical students in the clinical phase of their trainin...

The question of how to fund long-term care of older and disabled people has long confounded politicians across the developed world. While health care in England has been ‘free at the point of delivery’ since 1948, social care has been subject to means-tested charges. Last autumn the coalition government asked Andrew Dilnot, an Oxford economist, to...

New frameworks help but old obstacles hamper progress Various trends demand ever greater involvement of doctors in management roles. Several factors have changed the ways in which health professionals are monitored, paid, and regulated. These include the expansion and systemisation of medical knowledge, constrained health service budgets, informed...

NHS reforms offer new and wide ranging opportunities Involvement of patients and the public is meant to be at the heart of the coalition government’s health policy. Liberating the NHS claims to “strengthen the collective voice of patients and public.”1 Patient participation groups are one way in which the views of patients might be heard more clea...

The links between health and sustainability have become increasingly accepted in health policy. For many practitioners, however, sustainability and climate change remain marginal to day-today practice. The lack of modelled best practice, combined with GP trainers' uncertainty about content expertise, has resulted in a skills gap for new registrars....

This report presents the findings of research examining the impact of the QOF on preventable admissions, for example, appears modest. The QOF acts as a barrier to PCTs commissioning primary care that is focused on the health needs of the local population, and does not provide appropriate incentives for practices serving populations with complex nee...

Can the tide be stemmed?

Public health competencies, especially as they relate to the management of chronic disease, will be of increasing importance to the global health-care workforce. The General Medical Council's recommendations on basic medical education have helped to entrench the position of public health and related disciplines. Tomorrow's Doctors has recently been...

The medical assault on the menopause has, rightly, left women angry, finds Stephen GillamThe idea that women are biologically inferior to men has a depressingly long trajectory in Western civilisation. Prejudices concerning the modern menopause can be traced back to Aristotle and Galen. The belief that menstrual blood was a foul excretion was regul...

The successful delivery of primary care in the UK increasingly requires skills in strategic planning, needs assessment and service evaluation. With the evolution of the general practitioner's purchasing role, new educational models are needed. Community-Oriented Primary Care (COX) is one approach to the integration in practice of public health and...

Reinvigoration will require more than just extra funding

Most preventable deaths occur in poor countries. Poor people carry the greatest burden from communicable diseases including AIDS, TB and malaria, particularly in Africa. However, non-communicable chronic conditions, once regarded as diseases of affluence, are increasing in poor countries (World Health Organisation, 2005b). The changing burden of di...

Peter was the sixth generation in a line of doctors from north Norfolk and the Fens, stretching back to the mid-1700s. Peter did not exactly choose medicine at Cambridge but he accepted the sentence with relish. It was a calling to which his many gifts amply suited him. After higher training at University College Hospital and the Hammersmith, Pete...

To understand the effects of a large scale 'payment for performance' scheme (the Quality and Outcomes Framework [QOF]) on professional roles and the delivery of primary care in the English National Health Service. Qualitative semi-structured interview study. Twenty-four clinicians were interviewed during 2006: one general practitioner and one pract...

Thirty years after WHO highlighted the importance of primary health carein tackling health inequality in every country, Stephen Gillam reflects on the reasons for slow progress and the implications for today’s health systems

This paper discusses the policy background and development of primary care commissioning and discusses potential measures for maintaining and improving practice-based commissioning as well as the quality of the commissioning process itself.

In April this year, Fiona Godlee wrote in her editor's choice that the UK health service needs to be protected from party politics to halt the rapid turnaround in policies that seem to be destabilising the system. She argued that an independent NHS authority could be run by a board of governors responsible for managing health care within a set budg...

Recent policy initiatives in the United Kingdom (UK) have underlined the importance of public health education for health care professionals. We aimed to describe teaching inputs to medical undergraduate curricula, to identify perceived challenges in the delivery of public health teaching and strategies that may overcome them. We undertook a cross-...

This study explores how the term patient-centred care is understood, particularly by those who are involved in translating the concept from a theoretical idea into a practical application. It examines the ways in which intermediate level stakeholders such as health service managers, educationalists, professional leaders and officers of patient bodi...

A number of inquiries over the last 20 years have found London's primary care to be deficient when compared with the rest of the country, notwithstanding several development programmes aimed at addressing this inequity. Personal medical services (PMS) pilots were introduced in 1998 to replace the national contract for general practitioners and were...

T(2)ARDIS is a study of the full costs of care for a sample of people with type 2 diabetes in the UK. This paper reports on individual earnings lost by patients (n=653) and carers (n=253) aged <65 years, based on 1998 values. Mean annual lost earnings are calculated on three different bases. Across the total survey population aged <65 years, mean l...

Yet more reform of the National Health Service in England has been announced by the Department of Health. In opposition, the Labour Party criticized the creation of an "internal market" for health care by the Conservative government, but five years into the Blair administration, market incentives are to be reinvigorated and the private sector is to...

The UK National Health Service has long delivered public health programs through primary care. However, attempts to promote Sidney Kark’s model of community-oriented primary care (COPC), based on general practice populations, have made only limited headway. Recent policy developments give COPC new resonance. Currently, primary care trusts are assum...

Objective To explore how those working in and with primary care organisations understand the term 'health improvement'. Design Six qualitative case studies. Setting Primary Care Groups and Trusts and partner organisations. Method Semi-structured interviews with senior personnel from participating organisations. Results Informants offered a wide ran...

National service frameworks (NSFs) provide national standards for delivering health services in England. As central guidance they shape the core functions of PCG/Ts and reflect important health issues and needs for service improvement. The National Tracker Survey is a longitudinal study of the development of 72 randomly selected PCG/Ts and is chart...

A study of six primary care trusts showed that those most successful in tackling health improvement had certain common characteristics. Strong board-level support and leadership, combined with development funding, were the most effective. Successful PCTs also showed a corporate recognition of local health and socio-economic inequalities.

A study of six primary care trusts showed that those most successful in tackling health improvement had certain common characteristics. Strong board-level support and leadership, combined with development funding, were the most effective. Successful PCTs also showed a corporate recognition of local health and socio-economic inequalities.

Negotiations for a new contract for British general practitioners have begun. Following an announcement in July by Alan Milburn, the secretary of state for health, ministers and civil servants of the department of health no longer negotiate the terms of the national contract directly with general practitioners.1 NHS managers, represented by the NHS...

Objective This study sought to track the development of Health Improvement Programmes (HImPs) from 1999 to 2000. Design A documentary analysis of pairs of HImPs produced by 26 health authorities in 1999 and 2000. Method A structured analytic tool was devised, based on government guidance on the content of HImPs. Results HImPs have become longer, an...

An analysis of primary care groups' investment plans revealed their main concerns were premises, IT and workforce issues. About a quarter of plans did not address out-of-hours care or community nursing. The plans lacked detail of the process guiding resource allocation. The plans showed little indication of services being organised around the prior...

Less than three years after initiating a series of health service reforms, the Blair government has launched another plan for the U.K. National Health Service. This article considers the origins and contents of the plan. A major investment program is designed to bring health care spending up to European averages over the next five years. In return,...

This is the third in a series of five articlesUnderpinning contemporary theories of quality improvement is the axiom that poor individual performance usually reflects wider “system failure” or the absence of an organisation-wide system of quality assurance.1 In healthcare organisations, critical incidents can lead to death, disability, or permanent...

The long-standing method of paying GPs through a complex system of fees and allowances is under review. The proposed expansion of personal medical services pilots and an increase in the number of salaried GPs could destabilise the current system and lead to perverse outcomes. The introduction of a weighted capitation system allocating resources to...

An analysis of 36 health authorities' health improvement programmes found they reflected national priorities well. The average number of priorities was 13, with coronary heart disease/stroke, mental health and cancer being the most common. One plan set no priorities. Most programmes included some consultation with the public. Only seven HImPs inclu...

The implications of the 1997 NHS (Primary Care) Act have been largely overlooked in the rush to establish Primary Care Groups. Allowing health authorities to develop local contracts for primary care has far-reaching implications and is an important departure from the national system of negotiation that has characterized general practice to date. Th...

We present an evaluation of the role of a link-worker trained in health promotion and aspects of chronic disease management. A shift in workload occurred from the practice nurse to link-worker, and there were improvements in asthma and diabetes care. A link-worker can be successfully trained to do traditional nursing tasks, which permits a change o...

The implications of the 1997 (Primary Care) Act have been largely overlooked in the rush to establish Primary Care Groups. Allowing health authorities to develop local contracts for primary care has far-reaching implications and is an important departure from the national system of negotiation that has characterized general practice to date. This p...

At the time of its publication in late 1996 the Choice and Opportunity white paper was seen as heralding revolutionary changes in British general practice.1 The “listening exercise” by the then health minister, Stephen Dorrell, had identified once more the inflexibility of existing contractual arrangements as a major barrier to remedying poor quali...

A survey of lead GPs in total purchasing pilots revealed poor understanding of the responsibilities of clinical governance. Many saw it in a negative light and were concerned about its administrative costs. Explicit guidance is needed, spelling out the clinical governance responsibilities of GPs and others in primary care groups.

This is the third of five articles on ways of managing demand for health care. Increasing patient expectations are placing strains on general medical services. While empirical evidence for increasing demand is difficult to establish, the population's use of primary care services has changed and will continue to change in response to demographic an...

This is the third in a series of six articles describing approaches to and topics for health needs assessment, and how the results can be used effectively The purpose of needs assessment in health care is to gather the information required to bring about change beneficial to the health of the population. It is generally, but not universally, accep...

The Primary Care Act, passed in April, allowed for experimentation with new forms of service delivery and enabled health authorities to commission GP services directly, suspending the national contract. It encouraged HAs, general practices and trusts to submit proposals for pilot projects to improve primary care. More than 500 proposals have been d...

Colin Francome, David Marks Middlesex University Press, £14.95, pp 310 ISBN 1 898253 05 6Wiser heads than mine may place the revolutionary events of ‘89 in a cyclical context. The publication of the Working For Patients white paper still feels like the most influential event of my career. The fifth anniversary of the NHS and Community Care Act has...

Full textFull text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (496K), or click on a page image below to browse page by page. 1311 1312

In his continuing drive to appease disillusioned and overworked general practitioners, Britain's secretary of state for health has made major concessions over the data on health promotion that general practitioners are required to record.1 The more than 120 items of data that were previously required have now been reduced to eight. The move will pl...

With the advent of general practitioner fundholding, there has been growth in outreach clinics covering many specialties. The benefits and costs of this model of service provision are unclear. A pilot study aimed to evaluate an outreach model of ophthalmic care in terms of its impact on general practitioners, their use of secondary ophthalmology se...

Financial incentives for increasing health promotion activity in primary care, introduced with the 1990 contract for general practitioners, were amended in 1993 and are now focused on cardiovascular disease. Payments for health promotion clinics were abolished and target payments were introduced. The study aimed to evaluate the effect of the change...

The results of a 1-year follow up of children discharged from a nutritional rehabilitation centre (NRC) in eastern Nepal are presented. One hundred and one children were visited at home on discharge from the NRC, at 6 months and 1 year later. Data were collected concurrently on one sibling and two neighbouring children matched for age and sex. Anth...

The contribution of different general practitioner characteristics, views, and experiences to the likelihood of their providing child health surveillance (CHS) was determined and their perceived training needs discovered. Family health service authority administrative data on the study population was combined with a postal questionnaire survey. Sub...

To describe the views of general practitioners, health visitors, and clinical medical officers on child health surveillance, recent changes, perceptions of each other's roles, and attitudes to audit. Postal questionnaire survey. Three health districts in North West Thames health region. All 602 general practitioners, 272 health visitors, and 42 cli...

THE creation of internal markets and the develop ment of audit have intensified interest in parental perceptions of community child health services. This paper describes the views of 236 parents on develop mental checks administered in both general practice and community clinic settings in Barnet in Septem ber to November 1991. Generally high level...