This programme supports the local implementation of national policy initiatives to improve health and social care delivery. Below are details of the past and current projects that fall under this programme.
Risk and Protection - Complementary Medicine in the NHS
Funded by: British Academy
Project leader: Professor Annmarie Ruston
Project team: Sarah Cant & Peter Watts
Background: Complementary and alternative medicine (CAM) is a substantial and growing part of health care behaviour and provision in the UK. There has been a demand for the integration of CAM and conventional medicine and medically qualified, professionally regulated practitioners are increasingly incorporating CAM knowledge into their repertoire of practice. However, there is limited information concerning the interface between CAM and conventional medicine. Given the differing philosophies, polices and practices underpinning the two types of medicine, scientific-bureaucratic in the NHS and diverse, often contested, principles and techniques of craft knowledge within CAM, this represents an important gap.
Aim: To ascertain ways in which nurses and midwives practice CAM within their conventional biomedical practice and their decision making in relation to risks posed by combining the two different forms of knowledge/medicine.
Methods: In-depth interviews were conducted with 27 nurses and midwives working in NHS hospitals to examine how they implemented and practiced CAM within their everyday practice.
Outcomes: The study revealed that following initial success in developing and running CAM services the increasing application of scientific-bureaucratic approaches to managing risk within their organisations resulted in their CAM practice becoming dominated by bio-medical protocols. This approach generated a unified and predictable use of CAM knowledge and skills which increasingly became just another tool in the nurses or midwives repertoire of care rather than a means of providing individualised, holistic patient care based on a multi-dimensional, physical, mental and spiritual system.
Perceptions of the use of telehealth in diabetes care
Funded by: Primary Care Bursary
Partner: Dr Fernando, Thames Avenue Practice (Rainham)
Project leader: Professor Annmarie Ruston
Project team: Dr Alison Smith
Background: Diabetes is a long term condition which is ideally managed by a safe, efficient and effective partnership between the patient and a team of healthcare professionals and provides a useful disease on which to examine patients views about whether telehealth can offer solutions to providing more responsive healthcare.
Aim: To examine the ways in which people with diabetes currently use technology to manage their disease, their views on how it could be used to communicate with health professionals and to manage their disease more effectively in the future.
Methods: In depth telephone interviews were conducted with 30 people with type 1 diabetes who use either a pump or multiple injections to control their diabetes and face to face interviews with 15 patients with type 2 diabetes. The interviews were tape recorded and transcribed verbatim. The data was analysed using the Constant Comparative Method.
Preliminary outcomes: The preliminary findings suggest that people with type 1 diabetes rely on technology to manage their diabetes and feel it is important to be able to control their disease themselves. They did not feel that the use of telehealth to communicate with their health professionals would enhance their care unless it was used in real time. They considered that face to face communication in which they could 'interrogate' the specialist was more valuable. Type two diabetics were less concerned about maintaining personal control of their diabetes and held mixed views about the value of telehealth.
Evaluation of the GP Registrar placement in a Primary Care Trust (PCT)
Funded by: KSS Deanery
Project leader: Professor Annmarie Ruston
Background: A pilot Innovative Training Placement was set up by KSS Deanery to enable GPStRs (GP Trainees) to spend two days a week in a PCT in order to gain an understanding of the wider healthcare context in which they will deliver patient care and to develop their medical leadership competencies. The programme included a range of learning opportunities including observation, participation in meetings, learning sets, chairing meetings, doing a presentation and working on a project. The programme and the assessments were linked to the GP curriculum core competencies and the NHS Leadership Qualities Framework.
Aim: The overall aim of the evaluation was to determine the effectiveness, acceptability and appropriateness of the KSS Deanery GPStR specialist placement in PCT pilot scheme.
Methods: : A case study methodology was used to determine the effectiveness, acceptability and appropriateness of the KSS Deanery GPStR Placement in PCT Pilot Innovative Training Post (ITP). Interviews were conducted with GPStRs, Clinical Supervisors, Deanery and PCT staff and documentation was examined.
Outcomes: The placement was considered by all respondents to have been very successful and highly valued experience which provided personal benefits for GPStRs and their supervisors and added value for their organisations. The GPStRs reported and demonstrated a marked increase in their knowledge in relation to the workings of the PCT, World Class Commissioning, Practice Based Commissioning, the Commissioning Cycle, wider health policy and the implications for patient care etc. and that the placement had enabled them to see ways in which they could change practice, improve patient care and influence the PCT in future.
Evaluation of paramedic practitioner placements in general practice
Funded by: KSS Deanery
Project leader: Professor Annmarie Ruston
Background: The role of the 'Paramedic Practitioner' has developed against a background of changes in primary care provision, an annual rise in 999 call volumes and a call for ambulance services to move beyond their traditional 'transport to hospital' services. In future 'Paramedic Practitioners' will be expected to have the skills to provide patients with the right care, at the first point of contact, in a numbers of settings including general practice. In order to ensure that the training for 'Paramedic Practitioners' meets these expectations students undertake a two month innovative placement based in a general practice.
Aim: To determine the value, acceptability and appropriateness of the KSS GP Training Practice placements for 'Paramedic Practitioner' students.
Methods: In depth telephone interviews were conducted with 8 'Paramedic Practitioners' and their corresponding GP Trainer to determine how it was working. Wider members of the PCHT completed a questionnaire about the value and acceptability of the Scheme.
Preliminary outcomes: The data suggested that 'Paramedic Practitioners' valued the placement and felt that it improved their communication and consulting skills, their diagnostic and interpretive skills, enabled them to practice in a community orientated and holistic way and increased their knowledge and understanding of chronic disease. The GP Trainers also valued the scheme and considered that it had widen the skill base of 'Paramedic Practitioners'.