Prospects for progress on health inequalities in England in the post-primary care trust era: professional views on challenges, risks and opportunities

BMC Public Health

Bushara Bostan¹  Lynne Carter³  John Skinner²  George TH Ellison⁵  Ghazala Mir⁶  Sarah Salway⁴  Daniel Turner⁴ 

[1] NHS Leeds, Reginald Centre, 263 Chapeltown Road, Leeds, LS7 3EX, UK;NHS Sheffield, Town Hall, Pinstone Street, Sheffield, S1 2HH, UK;NHS Airedale, Bradford and Leeds, Douglas Mill, Bowling Old Lane, Bradford, BD5 7JR, UK;Centre for Health and Social Care Research, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, S10 2BP, UK;Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, 8.001 Worsley Building, Leeds, LS2 9JT, UK;Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building,101 Clarendon Road, Leeds, LS2 9LJ, UK

关键词: Restructuring;    CCG;    General practitioners;    NHS;    Health inequalities;    Commissioning;   

Others  :  1162406
DOI  :  10.1186/1471-2458-13-274

 received in 2012-11-22, accepted in 2013-03-22,  发布年份 2013

【 摘 要 】

Background

Addressing health inequalities remains a prominent policy objective of the current UK government, but current NHS reforms involve a significant shift in roles and responsibilities. Clinicians are now placed at the heart of healthcare commissioning through which significant inequalities in access, uptake and impact of healthcare services must be addressed. Questions arise as to whether these new arrangements will help or hinder progress on health inequalities. This paper explores the perspectives of experienced healthcare professionals working within the commissioning arena; many of whom are likely to remain key actors in this unfolding scenario.

Methods

Semi-structured interviews were conducted with 42 professionals involved with health and social care commissioning at national and local levels. These included representatives from the Department of Health, Primary Care Trusts, Strategic Health Authorities, Local Authorities, and third sector organisations.

Results

In general, respondents lamented the lack of progress on health inequalities during the PCT commissioning era, where strong policy had not resulted in measurable improvements. However, there was concern that GP-led commissioning will fare little better, particularly in a time of reduced spending. Specific concerns centred on: reduced commitment to a health inequalities agenda; inadequate skills and loss of expertise; and weakened partnership working and engagement. There were more mixed opinions as to whether GP commissioners would be better able than their predecessors to challenge large provider trusts and shift spend towards prevention and early intervention, and whether GPs’ clinical experience would support commissioning action on inequalities. Though largely pessimistic, respondents highlighted some opportunities, including the potential for greater accountability of healthcare commissioners to the public and more influential needs assessments via emergent Health & Wellbeing Boards.

Conclusions

There is doubt about the ability of GP commissioners to take clearer action on health inequalities than PCTs have historically achieved. Key actors expect the contribution from commissioning to address health inequalities to become even more piecemeal in the new arrangements, as it will be dependent upon the interest and agency of particular individuals within the new commissioning groups to engage and influence a wider range of stakeholders.

【 授权许可】

   
2013 Turner et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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