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Annabelle L Mark

Publications and source records attributed to Annabelle L Mark.

3 recordsLinked to original sources
PubMed2003

How has NHS Direct changed primary care provision?

We studied a general practice cooperative in west London that served 900,000 patients. The telephone triage service subsequently became a pilot for the national service, NHS Direct. Both quantitative and qualitative data were used for the study. The quantitative data consisted of the (anonymized) patient computer records available on the telephone triage service for the first two weeks in December 1998, December 1999 and December 2000. Two significant events were identified. The first, which emerged principally from analysis of the quantitative call data, were changes in patient outcomes during the period that spanned the arrival of NHS Direct. The second, revealed mainly through analysis of the qualitative data, were changes in the behaviour, perceptions and work experience of the triage nurses. Significant behavioural and attitudinal transitions occur when primary care organizations are modified.

After-Hours Care↗
PubMedDate not supplied

NHS direct: managing demand for primary care?

This paper considers how NHS Direct is affecting demand for primary care in particular out-of-hours services from GPs. This is reviewed through a 3-year study of NHS Direct and HARMONI, the integrated telephone health helpline based in West London. It describes the policy background and development of the services on the site, and some of the outcomes of the HARMONI commissioned research to answer the question 'Has NHS Direct increased the workload for HARMONI doctors?'. The research adopted both a qualitative and quantitative approach using cross-sectional and longitudinal analysis of the data collected. The analysis of the data reveals the issues as both complex and dynamic in nature. The research shows that while there has been no significant change to the total volume of activity, changes within patient groups notably the elderly and children, and in individual GP practices may be significant. In addition, the changes in organizational arrangements may influence significant changes in referral patterns such as GP out-of-hours visits. This was confirmed in the interview data indicating a link between the change in nurses' role from gatekeeper to patient advocate, which happened when they ceased to be employees of the part-time co-op and began to work instead for the 24 hours, 7 days a week NHS Direct service. The conclusions drawn are that behavioural and organizational changes are at least as significant as the evidence-based computerized decision support software in changing the demand for primary care. Further evidence cited is that a different demand pattern of calls was experienced by those local GPs not integrated into out-of-hours provision at NHS Direct West London at the time of the study.

After-Hours Care↗