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There has been a strong policy emphasis over the past decade on optimising patient‐centred care and reducing general practitioners' (GPs') workload by extending community pharmacy services and collaboration between pharmacists and GPs. Our aim was to review current evidence of pharmacists' and GPs' views of extended community pharmacy services and pharmacists' roles in the United Kingdom (UK). A systematic review was undertaken looking at UK studies investigating pharmacists' and/or GPs' views of community pharmacy services or roles from 2005 to 2017. A range of databases were searched including EMBASE, PubMed, Scopus, Web of Science, International Pharmaceutical Abstracts (IPA), PsycINFO, Science Direct and The Cumulative Index to Nursing and Allied Health Literature (CINAHL). In addition, reference lists of included studies were screened and grey literature was searched. Following the application of inclusion/exclusion criteria, the quality of papers was critically analysed, findings were extracted into a grid and subjected to narrative synthesis following thematic analysis. The search strategy yielded a total of 4,066 unique papers from which 60 were included. Forty‐seven papers covered pharmacists' views, nine combined both pharmacists' and GPs' views and four covered GPs' views. Study designs included interviews (n = 31, 52%), questionnaire surveys (n = 17, 28%) and focus groups (n = 7, 12%). Three main themes emerged from the data: "attitudes towards services/roles", "community pharmacy organisations" and "external influences". Pharmacists and GPs perceived a number of barriers to successful implementation and integration of pharmacy services. Moreover, collaboration between pharmacists and GPs remains poor despite the introduction of extended services. Overall, extending community pharmacy services require quality‐driven incentives and joint working between community pharmacists and GPs to achieve better integration within the patient's primary care pathway. [ABSTRACT FROM AUTHOR]

Aim(s) A discussion paper on the United Kingdom ( UK) National Health Service ( NHS) market reforms. Background NHS market reforms reliance on management science methods introduced a fundamental shift in measuring care for commissioning. Evaluation A number of key reports are discussed in relation to NHS market reforms and management science. Key issues NHS market reforms were influenced through a close alliance between policy makers, the department of health, free market think tanks and management consultancies. The timing of reforms coincided with reports on NHS failings and the evolution of measurement methods to focus on finance. Conclusions The balance in favour of measurement practises is of concern. Management science methods are criticised in the Francis Report yet promoted as the solution to some of the key findings; why may be explained by the close alliance. Implications for Nursing Management A return to principles of management involving consensus, trust and involvement to promote quality care and use management science methods to this end. [ABSTRACT FROM AUTHOR]

The article discusses the importance of collaboration on nursing management in Great Britain. The article focuses on the significance of government-professional cooperation on the success of the field of nursing and how the discipline has been affected by the move of nursing education away from the National Health Service.

Aim This paper examines the development of theory in the occupation of management, in order to determine how this process is similar to that which has occurred in nursing. Background The need for the Health Service to be effectively managed was a prominent feature of UK health policy in the 1980s and early 1990s and accounts of the introduction of ‘management methods’ into health care tend to focus on the conflict between management and nursing. More recently, however, the policy emphasis has shifted towards collaborative and co-operative approaches to the provision of health care. Method An examination of the development of nursing was conducted in a previous paper and serves as a point of reference in identifying areas of contrast and convergence in the development of nursing and management ideologies. This paper focuses on the development of theory in the occupation of management. Conclusion A consideration of the nature of nursing and management is beneficial because it provides insights which can help practitioners in their transition from nurse to manager. In the past the relationship between nursing and management has been presented somewhat simplistically and this paper demonstrates that the situation is much more complex. If this complexity is recognized it can be taken into account and serve as a basis for removing barriers between these two key groups of personnel. Ultimately, this may lead to the collaboration and co-operation necessary to deliver the responsive services identified as targets in recent policy pronouncements. [ABSTRACT FROM AUTHOR]

rutherford j., leigh j., monk j.&murray c.(2005)Journal of Nursing Management13, 97–105Creating an organizational infrastructure to develop and support new nursing roles– a framework for debateThis paper offers for debate a framework that will promote an effective organizational infrastructure when developing and supporting new nursing roles. The framework identifies key systems that need to work effectively in isolation but also clearly integrate to ensure a joined up approach to organizational thinking and working. A working example of how the infrastructure could be initiated in practice utilizing the concept of developing an Advanced Practitioner role is offered.The National Health Service has set out a modernization agenda to deliver consistent and high quality care to patients. However, often underpinning government vision and philosophy is the need for trust strategies to make real and operationalize recommendations made. It is against this background of government targets and change in the National Health Service that new nursing roles are created, which require an effective organizational infrastructure if they are to survive, let alone succeed. The government seems to be recognizing that lessons could be learned when developing new roles in the National Health Service by acknowledging the key themes identified from the earlier literature on the development and impact of new roles in nursing.In reality, each of the key systems identified as part of the framework is very complex, particularly in large organizations. However, the framework proposed offers a simplified and user-friendly approach to this complex subject. There is no suggestion that organizations do not have the systems in place but what is often missing is the underpinning communications to link the systems together. Although, this paper relates to nursing roles the framework is transferable to all health care practitioners and organizations.Whilst supporting new roles, the framework presented offers a wider dimension for enhancing organizational thinking and working practices. It is open to debate, which would be welcomed by the authors, yet provides a challenge to health care organizations in assessing how integrated their systems are in meeting its business, aspirations and new targets. [ABSTRACT FROM AUTHOR]

Aim This paper explores two theoretical perspectives that may help nurse managers understand why staff tolerate suboptimal standards of care. Background Standards of care have been questioned in relation to adverse events and errors for some years in health care across the western world. More recently, the focus has shifted to inadequate nursing standards with regard to care and compassion, and a culture of tolerance by staff to these inadequate standards. Evaluation The theories of conformity and cognitive dissonance are analysed to investigate their potential for helping nurse managers to understand why staff tolerate suboptimal standards of care. Key issues The literature suggests that nurses appear to adopt behaviours consistent with the theory of conformity and that they may accept suboptimal care to reduce their cognitive dissonance. Conclusion Nurses may conform to be accepted by the team. This may be confounded by nurses rationalising their care to reduce the cognitive dissonance they feel. Implications for nursing management The investigation into the Mid Staffordshire National Health Service called for a change in culture towards transparency, candidness and openness. Providing insights as to why some nursing staff tolerate suboptimal care may provide a springboard to allow nurse managers to consider the complexities surrounding this required transformation. [ABSTRACT FROM AUTHOR]

Prevention and management of delayed transfer of older people from hospital to community settings is an enduring issue in industrialised societies and is the subject of many recent policies in the United Kingdom. A deeper, evidence-based understanding of the complex organizational and interprofessional issues which contribute to delays in transfer has emerged in recent years. Despite this, and the relative success of recent policies, two recent reviews of the area highlight the lack of studies on patients’ perspectives. We sought to address this deficit by using conversational interviews and a phenomenological approach to explore and interpret participants’ perceptions of delayed transfer from hospital into the community. A purposive sampling strategy was employed to incorporate participants from different categories of delay identified on weekly Situation Reports. Participants aged 65 years and over (mean age 82 ± 5.4 years) and with a mean delay of 32 days (± 26) were recruited from three hospitals based in two NHS Trusts in the South of England. This paper focuses on their perceptions of the effects of delayed transfer into the community, their involvement in discharge planning and future community care needs. Our findings show that participants actively or passively relinquished their involvement in the processes of discharge planning because of the perceived expertise of others and also feelings of disempowerment secondary to poor health, low mood, dependency, lack of information and the intricacies of discharge planning processes for complex community care needs. Participants expressed a longing for continuity, emphasised the importance of social contact and sometimes appeared unrealistic about their future care needs. While current policies may have helped reduce overall numbers of delayed patients in the UK, our study suggests that there is scope for improvement in the involvement of delayed patients in planning their discharge into the community. [ABSTRACT FROM AUTHOR]

Medicines management services provided by community pharmacists have been proposed as one means to ensure that patients receive all the medicines they may benefit from in the English National Health Service. These services may also offer ways of addressing the historic under-utilization of community pharmacists’ clinical skills and expertise. Medicines management services differ significantly from the dispensing and medicines sales roles traditionally associated with community pharmacy, particularly in relation to the provision for pharmacists to make recommendations to both patients and doctors about pharmacological treatment and lifestyle management. This paper describes patients’ experiences of a medicines management service provided by community pharmacists for people with coronary heart disease, delivered in England. It draws on findings from semistructured, face-to-face interviews with 49 patients recruited from pilot sites delivering the service. Findings suggest that although patients cautiously welcomed the opportunity to consult with a pharmacist about their medicines, they had reservations about them making recommendations about treatment, and many still regarded the doctor as the health professional ‘in charge’ of their medicines. The implications of these findings are discussed in light of the developing sociological literature on pharmacy and medicines usage. [ABSTRACT FROM AUTHOR]

Objective: To understand current U.K. management pathways for patients with resected stage III melanoma and changes expected with the routine availability of systemic adjuvant melanoma treatments. Methods: In April–May 2018 (pre‐National Institute for Health and Care Excellence approval of adjuvant therapy), 49 structured interviews were conducted with U.K. health professionals involved in melanoma management (28 oncology, 12 dermatology and 9 surgery) from 34 geographically dispersed National Health Service Trusts (1–6 respondents/Trust). Results: Respondents expect to see a median of 5 (range 1–35) patients/month eligible for adjuvant therapy. Currently, 31 (63%) respondents include standardised BRAFV600 mutation testing for primary melanoma in their local guidelines; 30 (61%) respondents are from centres offering sentinel lymph node biopsy (SLNB) on‐site after excision of melanoma from the trunk/limbs; 21 (43%) after excision of head/neck melanoma. Referral for SLNB (if not performed on site) is not always offered. With systemic adjuvant treatments becoming routinely available, respondents expect oncology involvement in patient care to increase considerably. Significant impacts are predicted on staffing, training, commissioning, service structure, local guidelines and patient psychological support requirements. Conclusion: The routine availability of systemic adjuvant melanoma treatments is expected to have wide‐ranging implications for the commissioning, organisation and delivery of melanoma services. [ABSTRACT FROM AUTHOR]

Very little is known of the activities of the most senior managers in organisations providing social care in the community to people with intellectual disabilities. Yet the importance of the focus and activities of senior managers in directing and supporting staff practice and staff experiences is likely to be central to an organisation's functioning and support provided for staff and service users. This study employed Delphi methodology with a panel of 11 senior managers, mostly chief executives, managing small to very large organisations providing support for people with intellectual disabilities, in the UK. Answering three rounds of questions, senior managers described their face‐to‐face and non‐face‐to‐face contacts with staff and decision‐making. Narrative data were subject to quantitative and thematic analysis. In the last round, themes were subject to quantitative analysis. Most contacts between senior managers and staff were in formal structured contexts and all managers used social media to promote the organisations' ambitions regarding good practice. The panel focused upon accessing and understanding the informal aspects of their organisations and staff factors. Decisions were both short‐term reactive and long‐term strategic and an effort to link these was felt to improve organisational functioning. A framework for understanding senior managers' activities emerged showing two sources of demands and opportunity, extra‐organisational focused upon meeting legal and regulatory demands and intra‐organisational focused upon understanding and influencing informal staff practices/experiences and cultures within their organisations. [ABSTRACT FROM AUTHOR]

This paper considers integration of health and social care as an exercise in learning and knowledge management (KM). Integration assembles diverse actors and organisations in a collective effort to design and deliver new service models underpinned by multidisciplinary working and generic practice. Learning and KM are integral to this process. A critical review of the literature is undertaken to identify theoretical insights and models in this field, albeit grounded mainly in a private sector context. The findings from a research study involving two integrated services are then used to explore the role of, and approach to, learning and KM. This case study research was qualitative in nature and involved an interrogation of relevant documentary material, together with 25 in-depth interviews with a cross-section of strategic managers and professionals undertaken between March and May 2011. The evidence emerging indicated no planned strategies for learning and KM, but rather, interventions and mechanisms at different levels to support integration processes. These included formal activities, particularly around training and appraisal, but also informal ones within communities of practice and networking. Although structural enablers such as a co-location of facilities and joint appointments were important, the value of trust and inter-personal relationships was highlighted especially for tacit knowledge exchange. The infrastructure for learning and KM was constructed around a collaborative culture characterised by a coherent strategic framework; clarity of purpose based on new models of service; a collaborative leadership approach that was facilitative and distributed; and, a focus on team working to exploit the potential of multidisciplinary practice, generic working and integrated management. The discussion and conclusion use Nonaka's knowledge conversation model to reflect on the research findings, to comment on the absence of an explicit approach to learning and KM, and to develop a template to assist policy-makers with the design of planned strategies. [ABSTRACT FROM AUTHOR]

The UK's departure from the European Union (Brexit) is likely to result in greater immigration and employment restrictions on European Union/European Economic Area (EU/EEA) nationals within the United Kingdom. EU/EEA citizens constitute a significant proportion of the current social care workforce. Research evaluating the impact of Brexit on social care has highlighted potentially severe future workforce shortfalls, but has not engaged in detail with the experiences of social care personnel involved in day‐to‐day recruitment and retention activities. This article explores how social care managers evaluate Brexit's prospects for future workforce sustainability, through the prism of their organisation's workforce requirements. This qualitative study incorporated in‐depth semi‐structured interviews and questionnaire surveys with domiciliary and residential care managers. Data collection focused on an urban conurbation in south‐west England, with demographic characteristics likely to make post‐Brexit recruitment and retention in social care particularly challenging. A key finding is that, irrespective of whether they employ EU/EEA workers or not, research participants have deep concerns about Brexit's potential impact on the social care labour market. These include apprehensions about future restrictions on hiring EU/EEA nurses, as well as fears about increased competition for care staff and their organisation's future financial viability. This article amplifies the voices of managers as an under‐researched group, bringing their perspectives on Brexit to bear on wider debates on social care workforce sustainability. [ABSTRACT FROM AUTHOR]

The experiences of disease and treatment for patients diagnosed with head and neck cancer (H& NC) are known to be important indicators of the quality of care but are represented poorly in the literature. Survival is a major outcome measure to which health-related quality of life ( HRQoL) adds detail but outcomes are not fully representative of the patients' experiences because quality of care and reality of treatment are overlooked. This study explored the HRQoL, quality of care and reality of treatment themes using a mixed-methods approach, Q Methodology. In total, 18 participants who were at least 12 months post-diagnosis rank-ordered 45 prepared statements to reflect their own experiences of H& NC. After the statements had been sorted, the participants reviewed the order in an interview to clarify experiences. The statements become a way of facilitating the discussion because the participant can explain the position of specific statements that are notable for them. The ranking was factor-analysed case-wise and five factors provided the best conceptual fit: meaning and attachment to illness; overwhelmed by the cancer; surviving or not; change and recovery; and keep control for the greater good of others. The findings suggest there are distinct ways that H& NC patients experience the disease and its treatment. The concept of the experience being different and defined for individuals has practical implications at a clinical level and is a way of ensuring care is truly patient-centred. [ABSTRACT FROM AUTHOR]

haycock-stuart e. & kean s. (2012) Journal of Nursing Management 20, 372-381 Does nursing leadership affect the quality of care in the community setting? Aim To examine perceptions about how nursing leadership affects quality of care in the community setting. Background Quality care is considered an essential component of nursing work and recent policy has emphasized the role of leadership in meeting the quality agenda. As shifting the balance of nursing care from the hospital to the community occurs in the UK, there is an imperative to confirm more effectively the quality of care that patients and families receive from nurses working in the community. Methods A qualitative study involving community nurse leaders ( n = 12) and community nurses ( n = 27) in semi-structured individual interviews ( n = 31) and three focus groups ( n = 13). Results Tensions exist between 'leading' for quality care and 'delivering' for quality care. Organisational decision making is challenged by limited measures of quality of care in the diverse roles of community nursing. Conclusions Frontline community nurses and nurse leaders need to articulate how they intend quality of nursing care to be appreciated and actively indicate ways to show this. Implications for nursing management Mechanisms to monitor patient safety, a key aspect of the policy agenda for quality care and other technical aspects of care are important for nurse leaders to develop with frontline community nurses. [ABSTRACT FROM AUTHOR]

(2011) Journal of Nursing Management, 507-516 This study aimed to (1) identify how leadership is perceived and experienced by community nurses, and (2) examine the interaction between recent policy and leadership development in community nursing in the United Kingdom (UK). Leadership is a 'hot topic' yet little is known about leadership in community nursing. Traditionally, the study of leadership is viewed from a leader-centric perspective in which the discussion of followership and its impact on leadership in theory and research is noticeable absent. A qualitative study using individual interviews ( n = 31) and three focus groups ( n = 13) was conducted. 'Following' is a complex process with a socially co-constructed view of leaders undertaken in a variety of ways through 'doing following''standing by' or 'resisting following'. Followers do not necessarily fit into one category but may move between categories depending on the situation. Future research into leadership requires consideration of leadership and followership as interdependent concepts. Successful leadership is dependent on the actions of many within organizations. Followers play an active role in leadership. Failure to consider differences amongst followers denies the impact followers have on the success (or failure) of the leadership process and ultimately on an organization's ability to achieve goals. [ABSTRACT FROM AUTHOR]

The NHS in the 1990s places increasing emphasis on primary care and puts pressure on general practitioners (GPs) and community nurses to deliver a broad range of high quality care in the most cost-effective possible way. In attempting to achieve these objectives, the British National Health Service (NHS) and its individual health authorities have re-examined the available range of organizational choices and increasingly the tendency is to organize community nursing around the focal point of general practice. The authors' evaluation of six innovative ‘pilot projects’ showed the effects of different organizational choices with respect to basing, purchasing, provision and management of community nursing services. It was found that there are some advantages to focusing primary care on the GP; basing of nurses on the practice is particularly advantageous. There are, however, some very clear indications that the adoption by GPs of multiple, and sometimes conflicting, roles of manager, provider and purchaser of community nursing inhibits the development of fully integrated primary health care teams and can be detrimental to the nursing function. It is concluded that the NHS needs to explore other less GP-centred organizational configurations within primary care. [ABSTRACT FROM AUTHOR]