Donna Bramwell - Academia.edu (original) (raw)
Papers by Donna Bramwell
Springer eBooks, 2023
The new millennium saw the publication of The NHS Plan in 2000, which bought a welcome focus to c... more The new millennium saw the publication of The NHS Plan in 2000, which bought a welcome focus to community health services (CHS) and the role of community nursing. We outline the proposals contained in the plan which furthered the quasi-marketisation of the NHS and increased commissioning of health care at the local level of Primary Care Trusts (PCTs)-replacing Health Authorities (HAs) and Primary Care Groups (PCGs). A further review by Lord Darzi and subsequent policy, Transforming Community Services: Enabling new patterns of provision (DoH, 2009) instigated the separation of commissioning/provision and laid out timetables for how PCTs were to do this. The long held roles of the district nursing service continues in this era, although not always clearly defined, understood or acknowledged and policy attempts to expand their remit feature heavily. This included more clinical tasks as well as focusing on such things as public health/health protection and promotion programmes that improve health and reduce inequalities. This chapter also describes the uncertainty for frontline nurses that the Transforming Community Services (TCS) brought in terms of who their employer would be or what management arrangements they would work under given the establishment of some standalone Trusts, some third sector and some combined acute/community Trusts. The aims of the TCS programme were bold but in reality achieved little by the end of the era.
Community Nursing Services in England
This was another period of churn for the NHS. First, the service endured another restructuring ex... more This was another period of churn for the NHS. First, the service endured another restructuring exercise, reducing hierarchical layers to a less rigid bureaucratic structure. Area Health Authorities (AHAs) were abolished in 1982 and replaced by 192 District Health Authorities (DHAs). Second, there was a move away from ‘consensus’ style management towards ‘general management’ following the publication of the influential Griffiths Report in 1983. This marked an important phase in the NHS in which a clearly defined management function was implemented to improve efficiency, planning and accountability but bought shifting sands to the way community nursing services were managed. A review of community nursing services in a similar vein, The Cumberlege Report (1986), also proved significant. We focus on the recommendations of this report for improving the role and function of district nursing services and their geographical deployment to strengthen the concept of a localised, neighbourhood ...
BMJ Open Quality
BackgroundA 2018 review of the English primary care pay-for-performance scheme, the Quality and O... more BackgroundA 2018 review of the English primary care pay-for-performance scheme, the Quality and Outcomes Framework, suggested that it should evolve to better support holistic, patient-centred care and leadership for quality improvement (QI). From 2019, as part of the vision of change, financially incentivised QI cycles (initially in prescribing safety and end-of-life care), were introduced into the scheme.ObjectivesTo conduct a rapid evaluation of general practice staff attitudes, experiences and plans in relation to the implementation of the first two QI modules. This study was commissioned by NHS England and will inform development of the QI programme.MethodsSemistructured telephone interviews were conducted with 25 practice managers from a range of practices across England. Interviews were audio recorded with consent and transcribed verbatim. Anonymised data were reflexively thematically analysed using the framework method of analysis to identify common themes across the intervie...
International Journal of Workplace Health Management, 2016
Purpose – Given that current policy in the UK is focused on encouraging individuals with long-ter... more Purpose – Given that current policy in the UK is focused on encouraging individuals with long-term health conditions (LTCs) to work wherever possible, the purpose of this paper is to explore employer’s and manager’s perspectives of supporting those with LTCs as any successful workplace engagement will largely be influenced by their readiness to be supportive. Design/methodology/approach – In total, 40 semi-structured in-depth interviews were conducted with employers’ and managers’ from a range of organisations in the north-west of England during the period March 2011 to January 2012. Comparative analysis of the data was guided and informed by grounded theory principles. Findings – All bar one participant typified their role as one of a difficult “balancing” act of additional and often incompatible demands, pressures and feelings. It was evident that coping with this ambivalent situation incurred an emotional consequence for participants. Practical implications – Employers’ and manag...
British Journal of General Practice, Dec 12, 2023
Background: The Additional Roles Reimbursement Scheme (ARRS) provides funding to Primary Care Net... more Background: The Additional Roles Reimbursement Scheme (ARRS) provides funding to Primary Care Networks (PCNs) in England to recruit additional staff into specified roles. The intention is to support general practice by recruiting an extra 26,000 staff by 2024, increasing access and easing workload pressures. Aim: To explore the establishment of the ARRS as part of PCNs development to understand their role in supporting general practice. Design and Setting: Longitudinal, qualitative case study involving seven geographically dispersed PCNs across England. Method: Data were collected from July 2020 to March 2022, including 91 semi-structured interviews and 87 hours of meeting observations. Transcripts were analysed using the framework approach. Results: The implementation of the ARRS was variable across the study sites, but most shared similar experiences and concerns. The Covid-19 pandemic had a significant impact on the introduction of the new roles, and we found significant variability in modes of employment. Crosscutting issues included: the need for additional space to accommodate new staff; the inflexibility of aspects of the scheme, including reinvestment of unspent funds; and the need for support and oversight of employed staff. Perceived benefits of the ARRS include improved patient care and the potential to save GP time. Conclusion: Our findings suggests the ARRS has potential to fulfil its objective of supporting and improving access to general practice. However, attention to operational requirements including appropriate funding, estates and management of staff is important if this is to be realised, as is clarity for the scheme post contract end in 2024.
Thesis Manchester Uk the University of Manchester 2014, Feb 20, 2014
Background: Evidence from the employee perspective frequently suggests that unsupportive manageri... more Background: Evidence from the employee perspective frequently suggests that unsupportive managerial relations present a considerable barrier to those with long-term health conditions (LTCs) both on their ability to sustain employment and manage their condition at work. However, little is empirically known about employers' and managers' experiences of supporting those with LTCs, or indeed about their perception of their supportive role in the social context of the workplace on which employees suggest they depend for workplace success. This presents a disparity in understanding the contribution of the management role in influencing the (re)entry process to employment for those with LTCs. This is important to explore in light of ongoing objectives by the UK Government to move people with LTCs off incapacity benefits and back into the labour force, as any successful return to work will largely be influenced by employers' and managers' readiness to support them. Method: A qualitative approach informed by Grounded Theory principles to guide data collection and analysis was taken for this 3½ year study (September 2009 to March 2013). 40 semi-structured in-depth interviews were conducted with employers and managers from a range of organisations in the North West of England and analysed thematically. Findings were interpreted in relation to a framework of sociological theories of emotion and work. Results: Regardless of industry type, sector and size or condition, several themes emerged which contributed to a sense of burden and tension for participants in supporting those with LTCs. These included discerning legitimacy and tangibility of conditions, having difficult conversations with employees and the influence of the employees' personality on support. More significantly, all bar one participant typified their role as one of a difficult 'balancing' act of additional and often incompatible demands, pressures and feelings arising from managing a complex and emotive situation many considered non-normative to their everyday role. This was typified by feelings of conflict and emotional discomfort, interpreted as ambivalence, stemming from contradictions between and within the normative expectations of their social roles and appropriate feeling rules. For example between the obligations of the professional 'public' managerial role in providing value to the organisation, and philanthropic concerns for the welfare of the employee concomitant with their personal 'private' role as an individual. Interpreted from a combination of both spoken word and 'unsaid' gestures, is the emotion management conducted by managers to cope with negative feelings of ambivalence in a culture which favours rationality over emotionality. Conclusion: Overall, findings indicate that participants in this study concur with the employees' perspective as to the importance of socially supportive managerial relations. However, it is theorised that managing the emotions of ambivalence serves to undermine manager's capacity to translate intention to provide support into tangible action, and hence is reflected in the employee's perception of unsupportive relations. It is suggested that this research could be used to inform the development of a potential intervention to support managers in their pivotal role in the return-to-work process, being beneficial for all stakeholders-the Government, employees and employers alike.
Commissioning Healthcare in England, 2020
Chapter 6 reports a longitudinal study of commissioners’ (and providers’) use of competition and ... more Chapter 6 reports a longitudinal study of commissioners’ (and providers’) use of competition and cooperation. This chapter reports research which aimed to investigate how commissioners in local health systems managed the interplay of competition and cooperation in their local health economies, looking at acute, mental health and community health services. The understanding of the regulatory context of the NHS market by both commissioners and providers of care was unclear. There were differences between local areas in terms of the volume and mode of using competition as a commissioning mechanism, with some having more enthusiasm for and experience in running competitive procurements than others. Commissioners noted that the procurement process was very resource intensive. By 2018 there was a marked decline in the appetite to use competition, especially for large scale service reconfigurations. Collaborative planning involving key local providers was a preferred way for CCG commission...
Commissioning Healthcare in England, 2020
Chapter 8 reports research on the changing role of commissioning in the restructured public healt... more Chapter 8 reports research on the changing role of commissioning in the restructured public health system. The chapter will discuss how public health commissioning responsibilities have changed and become more fragmented, being split amongst a range of different organisations, most of which were newly created in 2013. It will focus on discussing how the re-organisation substantially changed the way public health commissioning is done, who is doing it, and what is commissioned, since the reforms. There have been significant changes in commissioning processes, with important consequences for what health improvement services are ultimately commissioned. Also new opportunities for creativity and joining public health with wider determinants of health (e.g. housing and leisure).
Public Money & Management, 2018
The version in the Kent Academic Repository may differ from the final published version. Users ar... more The version in the Kent Academic Repository may differ from the final published version. Users are advised to check http://kar.kent.ac.uk for the status of the paper. Users should always cite the published version of record.
Springer eBooks, 2023
The new millennium saw the publication of The NHS Plan in 2000, which bought a welcome focus to c... more The new millennium saw the publication of The NHS Plan in 2000, which bought a welcome focus to community health services (CHS) and the role of community nursing. We outline the proposals contained in the plan which furthered the quasi-marketisation of the NHS and increased commissioning of health care at the local level of Primary Care Trusts (PCTs)-replacing Health Authorities (HAs) and Primary Care Groups (PCGs). A further review by Lord Darzi and subsequent policy, Transforming Community Services: Enabling new patterns of provision (DoH, 2009) instigated the separation of commissioning/provision and laid out timetables for how PCTs were to do this. The long held roles of the district nursing service continues in this era, although not always clearly defined, understood or acknowledged and policy attempts to expand their remit feature heavily. This included more clinical tasks as well as focusing on such things as public health/health protection and promotion programmes that improve health and reduce inequalities. This chapter also describes the uncertainty for frontline nurses that the Transforming Community Services (TCS) brought in terms of who their employer would be or what management arrangements they would work under given the establishment of some standalone Trusts, some third sector and some combined acute/community Trusts. The aims of the TCS programme were bold but in reality achieved little by the end of the era.
Community Nursing Services in England
This was another period of churn for the NHS. First, the service endured another restructuring ex... more This was another period of churn for the NHS. First, the service endured another restructuring exercise, reducing hierarchical layers to a less rigid bureaucratic structure. Area Health Authorities (AHAs) were abolished in 1982 and replaced by 192 District Health Authorities (DHAs). Second, there was a move away from ‘consensus’ style management towards ‘general management’ following the publication of the influential Griffiths Report in 1983. This marked an important phase in the NHS in which a clearly defined management function was implemented to improve efficiency, planning and accountability but bought shifting sands to the way community nursing services were managed. A review of community nursing services in a similar vein, The Cumberlege Report (1986), also proved significant. We focus on the recommendations of this report for improving the role and function of district nursing services and their geographical deployment to strengthen the concept of a localised, neighbourhood ...
BMJ Open Quality
BackgroundA 2018 review of the English primary care pay-for-performance scheme, the Quality and O... more BackgroundA 2018 review of the English primary care pay-for-performance scheme, the Quality and Outcomes Framework, suggested that it should evolve to better support holistic, patient-centred care and leadership for quality improvement (QI). From 2019, as part of the vision of change, financially incentivised QI cycles (initially in prescribing safety and end-of-life care), were introduced into the scheme.ObjectivesTo conduct a rapid evaluation of general practice staff attitudes, experiences and plans in relation to the implementation of the first two QI modules. This study was commissioned by NHS England and will inform development of the QI programme.MethodsSemistructured telephone interviews were conducted with 25 practice managers from a range of practices across England. Interviews were audio recorded with consent and transcribed verbatim. Anonymised data were reflexively thematically analysed using the framework method of analysis to identify common themes across the intervie...
International Journal of Workplace Health Management, 2016
Purpose – Given that current policy in the UK is focused on encouraging individuals with long-ter... more Purpose – Given that current policy in the UK is focused on encouraging individuals with long-term health conditions (LTCs) to work wherever possible, the purpose of this paper is to explore employer’s and manager’s perspectives of supporting those with LTCs as any successful workplace engagement will largely be influenced by their readiness to be supportive. Design/methodology/approach – In total, 40 semi-structured in-depth interviews were conducted with employers’ and managers’ from a range of organisations in the north-west of England during the period March 2011 to January 2012. Comparative analysis of the data was guided and informed by grounded theory principles. Findings – All bar one participant typified their role as one of a difficult “balancing” act of additional and often incompatible demands, pressures and feelings. It was evident that coping with this ambivalent situation incurred an emotional consequence for participants. Practical implications – Employers’ and manag...
British Journal of General Practice, Dec 12, 2023
Background: The Additional Roles Reimbursement Scheme (ARRS) provides funding to Primary Care Net... more Background: The Additional Roles Reimbursement Scheme (ARRS) provides funding to Primary Care Networks (PCNs) in England to recruit additional staff into specified roles. The intention is to support general practice by recruiting an extra 26,000 staff by 2024, increasing access and easing workload pressures. Aim: To explore the establishment of the ARRS as part of PCNs development to understand their role in supporting general practice. Design and Setting: Longitudinal, qualitative case study involving seven geographically dispersed PCNs across England. Method: Data were collected from July 2020 to March 2022, including 91 semi-structured interviews and 87 hours of meeting observations. Transcripts were analysed using the framework approach. Results: The implementation of the ARRS was variable across the study sites, but most shared similar experiences and concerns. The Covid-19 pandemic had a significant impact on the introduction of the new roles, and we found significant variability in modes of employment. Crosscutting issues included: the need for additional space to accommodate new staff; the inflexibility of aspects of the scheme, including reinvestment of unspent funds; and the need for support and oversight of employed staff. Perceived benefits of the ARRS include improved patient care and the potential to save GP time. Conclusion: Our findings suggests the ARRS has potential to fulfil its objective of supporting and improving access to general practice. However, attention to operational requirements including appropriate funding, estates and management of staff is important if this is to be realised, as is clarity for the scheme post contract end in 2024.
Thesis Manchester Uk the University of Manchester 2014, Feb 20, 2014
Background: Evidence from the employee perspective frequently suggests that unsupportive manageri... more Background: Evidence from the employee perspective frequently suggests that unsupportive managerial relations present a considerable barrier to those with long-term health conditions (LTCs) both on their ability to sustain employment and manage their condition at work. However, little is empirically known about employers' and managers' experiences of supporting those with LTCs, or indeed about their perception of their supportive role in the social context of the workplace on which employees suggest they depend for workplace success. This presents a disparity in understanding the contribution of the management role in influencing the (re)entry process to employment for those with LTCs. This is important to explore in light of ongoing objectives by the UK Government to move people with LTCs off incapacity benefits and back into the labour force, as any successful return to work will largely be influenced by employers' and managers' readiness to support them. Method: A qualitative approach informed by Grounded Theory principles to guide data collection and analysis was taken for this 3½ year study (September 2009 to March 2013). 40 semi-structured in-depth interviews were conducted with employers and managers from a range of organisations in the North West of England and analysed thematically. Findings were interpreted in relation to a framework of sociological theories of emotion and work. Results: Regardless of industry type, sector and size or condition, several themes emerged which contributed to a sense of burden and tension for participants in supporting those with LTCs. These included discerning legitimacy and tangibility of conditions, having difficult conversations with employees and the influence of the employees' personality on support. More significantly, all bar one participant typified their role as one of a difficult 'balancing' act of additional and often incompatible demands, pressures and feelings arising from managing a complex and emotive situation many considered non-normative to their everyday role. This was typified by feelings of conflict and emotional discomfort, interpreted as ambivalence, stemming from contradictions between and within the normative expectations of their social roles and appropriate feeling rules. For example between the obligations of the professional 'public' managerial role in providing value to the organisation, and philanthropic concerns for the welfare of the employee concomitant with their personal 'private' role as an individual. Interpreted from a combination of both spoken word and 'unsaid' gestures, is the emotion management conducted by managers to cope with negative feelings of ambivalence in a culture which favours rationality over emotionality. Conclusion: Overall, findings indicate that participants in this study concur with the employees' perspective as to the importance of socially supportive managerial relations. However, it is theorised that managing the emotions of ambivalence serves to undermine manager's capacity to translate intention to provide support into tangible action, and hence is reflected in the employee's perception of unsupportive relations. It is suggested that this research could be used to inform the development of a potential intervention to support managers in their pivotal role in the return-to-work process, being beneficial for all stakeholders-the Government, employees and employers alike.
Commissioning Healthcare in England, 2020
Chapter 6 reports a longitudinal study of commissioners’ (and providers’) use of competition and ... more Chapter 6 reports a longitudinal study of commissioners’ (and providers’) use of competition and cooperation. This chapter reports research which aimed to investigate how commissioners in local health systems managed the interplay of competition and cooperation in their local health economies, looking at acute, mental health and community health services. The understanding of the regulatory context of the NHS market by both commissioners and providers of care was unclear. There were differences between local areas in terms of the volume and mode of using competition as a commissioning mechanism, with some having more enthusiasm for and experience in running competitive procurements than others. Commissioners noted that the procurement process was very resource intensive. By 2018 there was a marked decline in the appetite to use competition, especially for large scale service reconfigurations. Collaborative planning involving key local providers was a preferred way for CCG commission...
Commissioning Healthcare in England, 2020
Chapter 8 reports research on the changing role of commissioning in the restructured public healt... more Chapter 8 reports research on the changing role of commissioning in the restructured public health system. The chapter will discuss how public health commissioning responsibilities have changed and become more fragmented, being split amongst a range of different organisations, most of which were newly created in 2013. It will focus on discussing how the re-organisation substantially changed the way public health commissioning is done, who is doing it, and what is commissioned, since the reforms. There have been significant changes in commissioning processes, with important consequences for what health improvement services are ultimately commissioned. Also new opportunities for creativity and joining public health with wider determinants of health (e.g. housing and leisure).
Public Money & Management, 2018
The version in the Kent Academic Repository may differ from the final published version. Users ar... more The version in the Kent Academic Repository may differ from the final published version. Users are advised to check http://kar.kent.ac.uk for the status of the paper. Users should always cite the published version of record.