Salaries in community health agencies--1980. Report of the annual study conducted by NLN's division of Home Health Agencies and Community Health Services.
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In the absence of a single primary health care authority (except in Scotland) district health authorities and family practitioner committees must cooperate in planning health services for the community. Equally, in the field, the potential for teamwork between salaried district health authority nursing staff and the independent general practitioners remains largely unrealized. Yet the government has restated its commitment to the development of primary health care teams as the best means of delivering health care in the community. In Newcastle upon Tyne the local medical committee and the community health services management team have set out their shared aspirations for future development in a joint 'Statement of intent'. This statement, since endorsed by the district health authority and family practitioner committee, includes a number of key principles as a basis for future joint working. These principles emanate from an understanding of the complementary nature of general practice and district health authority community services, and firmly support the primary health care team approach. This statement of intent could serve as a useful model for collaboration and planning of services elsewhere in the country.
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OBJECTIVE: To examine whether the sociodemographic and morbidity characteristics of populations influence their use of the following community heath services: district nursing, health visiting, chiropody, community maternity, community mental illness, and the professions allied to medicine. DESIGN: Observational study. SETTING: Nationally representative sample of provider trusts in England. MAIN OUTCOME MEASURES: Activity levels for each service calculated for enumeration districts within the catchment areas of the sample of trusts and standardised to allow for differences in age structure. Regression analysis to determine whether the standardised activity rates for each service could be predicted by a range of socio-demographic and morbidity proxies. RESULTS: Morbidity or deprivation, or both, seemed to influence the use of services in each of the care programmes examined. CONCLUSIONS: The allocation of funds for community health services should allow for differences in the health and socio-demographic characteristics of health authorities.
Community mental health nurses have been criticized for failing to prioritize work with people with a severe or enduring mental illness, many of whom have no contact with specialist mental health services and rely entirely on their general practitioner and primary care team. It is important to ensure that those in contact with specialist services actually need this level of input but, conversely, that those in contact with only primary care receive a service that is equipped to meet their needs. This study examines the differences between these two groups of patients. A sample of 253 community-based patients with a severe or enduring mental illness was divided into those with mental health service contact and those without. Differences in the demographic characteristics of the two groups were assessed and further, more detailed, comparisons were made with a sub-sample of 49 individuals randomly drawn from this larger sample. Instruments adopted for these purposes comprised the Camberwell Assessment of Need and the Life Fulfilment Scale. It was found that patients with a psychotic disorder were more likely than those with neurosis to be in contact with mental health services and patients with schizophrenia were significantly more likely to be on the active caseload of a community mental health nurse than those from all other diagnostic groups. However, patients' levels of need, unmet need and quality of life did not differ in relation to their service contact. Whilst the study provides limited evidence that community mental health nurses are targeting people with the most serious disorders, questions remain about the large proportion not receiving specialist care. Because primary care plays a significant role in the care of severely mentally ill people living in the community, the further mental health training of general practitioners and practice nurses is becoming increasingly important.
In common with many other trusts, East Surrey Hospital and Community Health Services is faced with a budget deficit that means staff redundancies are among the measures proposed to deal with it. For Gary Needle, Director of Service Development and Deputy Chief Executive, its back to the drawing board with the business plan -- but personnel issues and purchaser relationships need some careful handling.
The length of service and reason for resignation of Aboriginal health workers recruited from 1976 to 1978 are discussed. Resignation rates in the first and second years of employment were 46% and 22.4%, respectively. Resignation was often the final outcome of intolerable personal conflicts with family, community and workmates, compounded by confusion and diversity of opinion over job roles.
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