ObjectiveTo synthesise international evidence for demand, use and outcomes of primary care out-of-hours health services (OOHS).DesignSystematic scoping review.Data sourcesCINAHL; Medline; ...PsyARTICLES; PsycINFO; SocINDEX; and Embase from 1995 to 2019.Study selectionEnglish language studies in UK or similar international settings, focused on services in or directly impacting primary care.Results105 studies included: 54% from mainland Europe/Republic of Ireland; 37% from UK. Most focused on general practitioner-led out-of-hours cooperatives. Evidence for increasing patient demand over time was weak due to data heterogeneity, infrequent reporting of population denominators and little adjustment for population sociodemographics. There was consistent evidence of higher OOHS use in the evening compared with overnight, at weekends and by certain groups (children aged <5, adults aged >65, women, those from socioeconomically deprived areas, with chronic diseases or mental health problems). Contact with OOHS was driven by problems perceived as urgent by patients. Respiratory, musculoskeletal, skin and abdominal symptoms were the most common reasons for contact in adults; fever and gastrointestinal symptoms were the most common in the under-5s. Frequent users of daytime services were also frequent OOHS users; difficulty accessing daytime services was also associated with OOHS use. There is some evidence to suggest that OOHS colocated in emergency departments (ED) can reduce demand in EDs.ConclusionsPolicy changes have impacted on OOHS over the past two decades. While there are generalisable lessons, a lack of comparable data makes it difficult to judge how demand has changed over time. Agreement on collection of OOHS data would allow robust comparisons within and across countries and across new models of care. Future developments in OOHS should also pay more attention to the relationship with daytime primary care and other services.PROSPERO registration numberCRD42015029741.
Whilst post-GFC austerity state retrenchment is widely studied, there is little research which focuses on the experiences of those who work at the front-line of austere public services. Drawing on ...qualitative evidence with front-line workers in four UK local authorities significantly impacted by austerity, this paper explores 'coping mechanisms' developed by workers to manage resource restriction. It argues that existing conceptualisations of coping mechanisms, such as either resistance or adaptation, are insufficient to understand how workers manage contemporary austerity. This paper proposes an additional mechanism - absorption - and explores analytically how workers cope with austerity in terms of resistance, adaptation and absorption. The paper concludes that front-line local government workers are coping with austerity cuts, in large part, by acting as 'shock absorbers' of state retrenchment.
That contemporary austerity is being realised to a large extent in and through cities is a growing theme in urban scholarship. Similarly, the concern that the economically marginalised are ...disproportionately impacted as ‘austerity urbanism’ takes hold drives a significant body of research. While it is clear that substantial austerity cuts are being downloaded onto cities and their governments, the evidence on whether it is the most disadvantaged fractions of the urban population which suffer as a consequence remains thin. Moreover, the mechanisms by which the downloading to the poor occurs are unclear. This paper identifies how austerity cuts are transmitted to the poor and marginalised in the context of severe cuts to the spending power of English local government. It identifies three transmission mechanisms and shows how these operate and with what outcomes, drawing on empirical evidence at the English national and local city levels. The paper provides robust evidence from national data sources and from in-depth, mixed-method case studies to show that the effects of austerity urbanism are borne most heavily by those who are already disadvantaged. It also demonstrates the importance of identifying the specific mechanisms by which downloading on to the poor occurs in particular national contexts, and how this contributes to understanding, and potentially resisting, the regressive logic of austerity urbanism.
A reticence on the part of women to disclose domestic abuse (DA) to family doctors, allied to front‐line responses that do not always reflect an understanding of the structure and dynamics of DA, ...hampers the provision of professional support. Using data from 20 qualitative interviews with women who have experienced DA, this paper explores their discourse about interacting with family doctors. It is the first study to explore firsthand accounts of these interactions through Dixon Woods’ lens of candidacy. It finds disclosure to be inherently dynamic as a process and expands the candidacy lens by considering the: (i) conflicting candidacies of victims and perpetrators; (ii) diversionary disclosure tactics deployed by perpetrators and, (iii) the potential role of General Practitioner (GPs) in imagining candidacies from a structural perspective. By exploring the dynamics of disclosure through the concept of ‘structural competency’ it finds that in encounters with women who have experienced abuse GPs ineluctably communicate their views on the legitimacy of women's claims for support; these in turn shape future candidacy and help‐seeking. Greater GP awareness of the factors creating and sustaining abuse offers the potential for better care and reduced stigmatisation of abused women.
The scale of the cuts to local government finance, coupled with increasing demand for services, has led to unprecedented 'budget gaps' in council budgets. Arguably, two competing narratives of the ...trajectory of local government have emerged in which contrasting futures are imagined for the sector - a positive story of adaptation and survival and more negative one of residualisation and marginalisation. Drawing on case study evidence from three English local authorities, the paper distinguishes and provides examples of three strategic approaches to managing austerity - efficiency, retrenchment and investment. It demonstrates how and why the balance of these strategies has shifted between the early and later phases of austerity and considers the extent to which the evidence of the case studies provide support for either the survival or marginalisation narrative. The paper concludes by arguing that a third narrative - responsibilisation - captures more fully the trajectory of local government in England.
En el presente trabajo se desarrolla un análisis historiográfico sobre las nuevas miradas de América Latina y sus aportes surgidos durante el siglo XX. La investigación toma como principales ...referentes a las contribuciones generadas por Ricardo Carpani y por Tomás Maldonado. Se hace foco en los aportes teóricos, donde ambos exponen sus nuevos modos de comprender el arte de la época y donde plasman cómo este campo se ve atravesado por diversos factores de su contexto histórico. El trabajo tiene como objetivo analizar sus respectivas propuestas y llevar a cabo una confrontación entre ellas, para estudiar sus similitudes y diferencias.
Normalisation Process Theory (NPT), used nationally and internationally to explore implementation within health services research, is used for the first time within policing to understand profound ...policy implementation failure and to generate broader discussion of policy implementation theory. The policy in question (Police to Primary Care P2PC) was an intervention designed to notify GPs when women are assessed by police as at high risk of future domestic abuse. Designed to improve interagency communication, it took place amidst radical organisational change.
Using qualitative interviews with domestic abuse specialist and frontline officers, this paper addresses how NPT helps to explain the (non)implementation of P2PC, how such an analysis differs from other policy implementation approaches, and what this means for our understandings of policy implementation more broadly.
NPT proved useful in understanding mechanisms leading to (non)implementation of the intervention: fuzzy alignment with existing practice, faulty communication of purpose, and inattention to discretionary implementation spaces. It helped us understand why the intervention came to be invisible. Dwarfed by its organisational context, made institutionally hard to read by a lack of formal protocols, and given restricted view to police officers, it was compromised by a failure to instigate systems of organisational learning.
More broadly, NPT helped reveal practices intersecting top‐down and bottom‐up implementation theory. The paper concludes by asking how NPT and theories of street‐level bureaucracy might be better used in tandem and, particularly, how this might help explorations of policy implementation where human actors are joined by technological actors in interpreting and making policy in vivo.
Rising levels of income inequality have been directly linked to rising levels of spatial segregation. In this paper we explore whether rising segregation may in turn erode support for the ...redistributive policies of the welfare state, further increasing levels of inequality—a form of positive feedback. The role of the neighbourhood has been neglected in attitudes research but, building on both political geography and ‘neighbourhood effects’ literatures, we theorise that neighbourhood context may shape attitudes through the transmission of attitudes directly and through the accumulation of relevant knowledge. We test this through multilevel modelling of data from England on individual attitudes to redistribution in general and to welfare benefit recipients in particular. We show that the individual factors shaping these attitudes are quite different and that the influence of neighbourhood context also varies as a result. The findings support the idea that neighbourhood context shapes attitudes, with the knowledge accumulation mechanism likely to be the more important. Rising spatial segregation would appear to erode support for redistribution but to increase support for welfare recipients—at least in a context where the dominant media discourse presents such a stigmatising image of those on welfare benefits.
PDF
