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S Jenkins-Clarke

Publications and source records attributed to S Jenkins-Clarke.

6 recordsLinked to original sources
PubMed2000

Skill mix between nurses and doctors working in primary care-delegation or allocation: a review of the literature.

The fundamental role of primary health care teams (PHCT) is to deliver effective services to the local population. Demands on the PHCT have increased since the early 1990s and, with the advent of Primary Care Groups (PCGs), will continue to do so in a primary health care led National Health Service (NHS). Rapid changes, however, raise questions about the feasibility and delivery of new services with skill mix and the distribution of workload within the PHCT being key issues. This paper reviews the literature on workload in primary care, attitudes to delegation, inter-professional relationships and teamworking and concludes that in order to deliver the vision of a primary care led NHS, meet the health care needs of users, address the inevitable anxieties of general practitioners and bring forth the professional aspirations of nurses and other health care professionals, more equitable and less hierarchical models of multi-professional teamworking in primary care will be most successful.

Attitude of Health Personnel↗
PubMed1998

Do minutes count? Consultation lengths in general practice.

OBJECTIVE: To document the variability in consultation length and to examine the relative weight of different kinds of characteristics (of the patients, of the general practitioner (GP), or of the practice) in affecting consultation length, and, thus, to assess whether consultation length can legitimately be used as a quality marker. DESIGN: A multilevel statistical analysis of 836 consultations across 51 GPs in ten practices. SETTING AND SUBJECTS: Ten general practices across four regions in England with varying list sizes, number of partners and fundholding status. MAIN OUTCOME MEASURES: Length of time face-to-face with patients in consultation measured in minutes and fractions of minutes. RESULTS: There is substantial inter-practice variation in consultation length, from a mean of 5.7 minutes to one of 8.5 minutes. In some practices the longest average GP consultation time is about twice that of the shortest. Trainees and new partners spend, on average, about 1 minute less than their longer-serving colleagues. Consultation lengths for individual GPs range from a mean of 4.4 minutes to 11 minutes. Late middle-aged women (55-64 years) receive the longest consultations, followed by elderly people, with children receiving the shortest consultations. The number of topics raised affects the length of the consultation by about 1 minute per additional topic. When female patients consult female GPs, approximately 1 minute is added to the average consultation. A significant fraction of the variability in consultation lengths can be explained in terms of characteristics of patients, of GPs and of practices. CONCLUSIONS: The fact that there is little unexplained variation in GP consultation lengths that might be attributable to variations in quality (i.e. GP-related) throws doubt on the proposition that length of consultation can be used as a marker for quality of consultation in general practice.

Aged↗
PubMed1998

Teams and seams: skill mix in primary care.

The study described in this paper is set against a background of rapid changes in primary (community) care delivery in the United Kingdom (UK) and consequently the methodology of the study has been shaped by three broad issues - workforce changes, increase in workload and changing roles and boundaries. Ten 'ordinary' general practices (general practitioners (GPs) and the 'attached' community nurses) participated in the study and a large amount of data were collected over a 2-week observation period. Three study objectives are described, relating to workload, delegation and attitudes to delegation. The characteristics of the workload of the three main groups of community nurses (practice nurses, district nurses and health visitors) are described and compared. Thirty-nine per cent of all the GP consultations (836) had a delegatable element and 17% were deemed to be delegatable in their entirety. General practitioners most frequently referred to delegation to practice nurses in the current team and nurse practitioners in an enhanced team. The study identified the activities most amenable to delegation to these two groups of nurses. Attitudes to delegation were sought through focus group discussions, with reservations being expressed by both doctors and community nurses. This study provides evidence that GPs are prepared to delegate a considerable proportion of their workload; this clearly has implications for the nursing profession.

Community Health Nursing↗
PubMed1995

Measurement systems in principle and in practice: the example of nursing workload.

There has been a rapid development of measurement systems in the health services in the United Kingdom (UK) over recent years, not always matched by a thorough understanding of the phenomenon being measured and rarely based on any assessment of reliability or validity. A particularly flagrant example of this process is the development of nursing workload measurement systems (NWMS). The estimates from four NWMS were examined. They were substantially different from each other for no obvious reason, and the difference between any of the estimates and the actual nursing hours worked could not be explained in terms of any other aspect of the nursing process. There is no evidence that the NWMS deployed in the UK are anything more than an expensive numbers game; without this kind of investigation of how they actually work in practice, it would be prudent to be wary about any of the measurement systems which have been proposed. Yet many of the measurement systems used in other sectors of the health service are equally untested.

England↗
PubMed1992

Marking time.

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Nursing Staff, Hospital↗