Journal of management in medicine
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Patient process recognition and re-engineering (PPR) has become a major concern of recent health care development and management. This paper discusses the position of the National Health Service (NHS) in the UK; where it is at present and where it aims to be. ⋯ This paper aims to examine whether and how PPR can improve patient processes in the NHS. It does this through a case study of PPR in Peterborough Hospital.
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The objective of this paper is to indicate the importance of the pharmaceutical industry to the UK economy. Data on various aspects of the industry are presented and examined. ⋯ The evidence shows what the UK economy stands to lose if it loses its pharmaceutical industrial base. Concludes that policy and pressure affecting drug products also affect drug companies; some of this is not realised when drug product policies are considered; the people of the UK will still need drugs whether or not the UK has a pharmaceutical base; the UK economy stands to lose a significant amount of benefits if it loses its pharmaceutical industrial base.
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The role of doctors in hospitals continues to change due to both external (policy) and internal (organisational change) pressures. Comparisons between The Netherlands and the UK highlight that several models of medical management are formulated and exist alongside each other, leading to more flexibility in the roles of both doctors and managers. In particular, the agendas concerning the quality of clinical care and cost-effectiveness are converging, emphasising the increasingly important role of medical managers.
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The focus of the paper is on the relationship between General Practitioners (GPs) and central government. This relationship dates from the introduction of national health insurance in the UK. From the outset it had an impact on GPs' medical role, their professional status and income. ⋯ These tensions are related to current disputes over out-of-hours working and attempts by GPs to redefine a "core of service" approach to their job. The ambiguities of reliance on professionals combined with the desire to exert greater controls is traced in the recent policy statement by the Secretary of State, Primary Care: The Future (1996). The paper thus aims to contribute to the critical discussion of the impact of central government managerialist initiative on key professional groups in the welfare state.
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Total purchasing is an experimental extension of GP fundholding through which GP practices can purchase community, secondary and tertiary services not included in standard fundholding budgets, for their registered patient populations. The paper presents selected findings from a study of contracting by TPPs during the first year of purchasing, concentrating on the perceived relationship between aspects of the contracting process and the achievement of TPP's strategic objectives. These findings are of relevance to the development of commissioning by primary care groups in light of the Government's proposal that contracts be replaced by long-term service agreements as competition within the NHS internal market is replaced by more collaborative arrangements between commissioners and providers. The paper identifies features of the contracting process which have been instrumental to the achievement of TPPs' service development objectives and may need to be preserved to ensure effective commissioning within the context of the new service agreements.