Imelda McDermott | The University of Manchester (original) (raw)

Papers by Imelda McDermott

Research paper thumbnail of Implementation of behaviour change training in practice amongst pharmacy professionals in primary care settings: Analysis using the COM-B model

Research in Social and Administrative Pharmacy

Research paper thumbnail of To be or not to be: The identity work of pharmacists as clinicians

Sociology of Health & Illness

This study explores how pharmacists legitimise the expansion of their clinical work and considers... more This study explores how pharmacists legitimise the expansion of their clinical work and considers its impact on pharmacists’ professional identity work. In the context of pharmacy in the English NHS, there has been an ongoing policy shift towards pharmacists moving away from ‘medicines supply’ to patient‐facing, clinical work since the 1950s. Pharmacists are continuously engaging in ‘identity work’ and ‘boundary work’ to reflect the expansion of their work, which has led to the argument that pharmacists lack a clear professional identity. Drawing insights from linguistics and specifically Van Leeuwen's ‘grammar of legitimation’, this study explains how the Pharmacy Integration Fund, a nationally funded learning programme, provides the discursive strategies for pharmacists to legitimise their identity work as clinicians.

Research paper thumbnail of General practice managers’ motivations for skill mix change in primary care: Results from a cross-sectional survey in England

Journal of Health Services Research & Policy

Objectives The objectives are to determine the factors that motivated GP practice managers in Eng... more Objectives The objectives are to determine the factors that motivated GP practice managers in England to employ non-medical roles, and to identify an ideal hypothetical GP practice workforce. Methods Cross-sectional survey of GP practice managers in England ( n = 1205). The survey focused on six non-medical roles: advanced nurse practitioner, specialist nurse, health care assistant, physician associate, paramedic and pharmacist. Results The three most commonly selected motivating factors were: (i) to achieve a better match between what patients need and what the practitioner team can deliver; (ii) to increase overall appointment availability and (iii) to release GP time. Employment of pharmacists and physician associates was most commonly supported by additional funding. Practice managers preferred accessing new non-medical roles through a primary care network or similar, while there was a clear preference for direct employment of additional GPs, advanced nurse practitioners or prac...

Research paper thumbnail of Commissioning primary care services

Research paper thumbnail of Understanding primary care co-commissioning: Uptake, scope of activity and process of change

This is an interim report for the third phase (April 15 to December 17) of our ongoing project fo... more This is an interim report for the third phase (April 15 to December 17) of our ongoing project following the development of Clinical Commissioning Groups (CCGs) in England since their initial establishment as ‘Pathfinders’. The overarching aim is to explore the significant changes to the work of CCGs as they took over varying levels of new responsibility for commissioning primary care services from April 2015.

Research paper thumbnail of Exploring the GP ‘added value’ in commissioning: What works, in what circumstances, and how? Final Report

Research paper thumbnail of Processes supporting effective skill-mix implementation in general practice: A qualitative study

Journal of Health Services Research & Policy

Objectives Health policy and funding initiatives have addressed increasing workloads in general p... more Objectives Health policy and funding initiatives have addressed increasing workloads in general practice through the deployment of clinicians from different disciplinary backgrounds. This study examines how general practices in England operate with increasingly diverse groups of practitioners. Methods Five general practices were selected for maximum variation of the duration and diversity of skill-mix in their workforce. Individual interviews were recorded with management and administrative staff and different types of practitioner. Patient surveys and focus groups gathered patients’ perspectives of consulting with different practitioners. Researchers collaborated during coding and thematic analysis of transcripts of audio recordings. Results The introduction of a wide range of practitioners required significant changes in how practices dealt with patients requesting treatment, and these changes were not necessarily straightforward. The matching of patients with practitioners requir...

Research paper thumbnail of Scale, scope and impact of skill mix change in primary care in England: a mixed-methods study

Health and Social Care Delivery Research

Background General practices have had difficulty recruiting and retaining enough general practiti... more Background General practices have had difficulty recruiting and retaining enough general practitioners to keep up with increasing demand for primary health care in recent years. Proposals to increase workforce capacity include a policy-driven strategy to employ additional numbers and a wider range of health professionals. Objectives Our objective was to conduct a comprehensive study of the scale, scope and impact of changing patterns of practitioner employment in general practice in England. This included an analysis of employment trends, motivations behind employment decisions, staff and patient experiences, and how skill mix changes are associated with outcome measures and costs. Design NHS Digital workforce data (2015–19) were used to analyse employment changes and to look at their association with outcomes data, such as the General Practitioner Patient Survey, General Practitioner Worklife Survey, prescribing data, Hospital Episode Statistics, Quality and Outcomes Framework and ...

Research paper thumbnail of Clinically led commissioning

Research paper thumbnail of Exploring the early workings of emerging CCGs: Final report

This report presents the findings from a study of developing Clinical Commissioning Groups(CCGs) ... more This report presents the findings from a study of developing Clinical Commissioning Groups(CCGs) in England. The aim of the study was to explore the early experiences of emergingClinical Commissioning Groups as they set themselves up as ?Pathfinders? and movedtowards authorisation, investigating the factors that had affected their development anddrawing out lessons for the future. The specific research questions addressed in this reportare:? What have been the experiences of Pathfinder CCGs over the past year?? What factors have affected their progress and development?? What approaches have they taken to:? Being a membership organisation?? Developing external relationships? ? Commissioning and contracting?? What lessons can be learned for their future development and support needs?

Research paper thumbnail of Understanding Primary Care Co-Commissioning: Uptake, Development, and Impacts (Final Report)

Research paper thumbnail of Involving GPs in commissioning: what 'added value' do they think they bring to Clinical Commissioning Groups?

British Journal of General Practice, 2014

Neil Perkins, BA(Hons), MPhil, Research associateCentre for Primary Care, University of Mancheste... more Neil Perkins, BA(Hons), MPhil, Research associateCentre for Primary Care, University of Manchester, Manchester, UK.Anna Coleman, BA(Soc Sci), MA, PhD, Research fellowCentre for Primary Care, University of Manchester, Manchester, UK.Michael Wright, MSc, FRACGP, GPCentre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW, Australia.Erica Gadsby, BSocSc, PGDipPH, DPhil, Research fellowCentre for Health Services Studies, University of Kent, Canterbury, Kent, UK.Imelda McDermott, BSc(Hons), Grad Dip, PhD, Research associateCentre for Primary Care, University of Manchester, Manchester, UK.Christina Petsoulas, BA, MPhil, DPhil, Research fellowDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.Kath Checkland, BMedSci, MA(Econ), PhD, MRCGP, Reader in Health Policy and Primary Care, GPCentre for Primary Care, University of Manchester, Manchester, UK.Address for correspondence Neil Perkins, Centre for P...

Research paper thumbnail of A comparative analysis of regional variation in practitioner employment in general practice

British Journal of General Practice, 2019

Research paper thumbnail of Challenges of maintaining accountability in networks of health and care organisations: A study of developing Sustainability and Transformation Partnerships in the English National Health Service

Social Science & Medicine

Research paper thumbnail of Contribution of supervision to the development of advanced practitioners: a qualitative study of pharmacy learners’ and supervisors’ views

BMJ Open

ObjectiveTo apply educational theory to explore how supervision can contribute to the development... more ObjectiveTo apply educational theory to explore how supervision can contribute to the development of advanced practitioners using the example of several postregistration primary care training pathways for pharmacy professionals (pharmacists and pharmacy technicians).DesignQualitative semistructured telephone interviews applying Billet’s theory of workplace pedagogy for interpretation.SettingEngland.ParticipantsFifty-one learners and ten supervisors.Primary outcomeContribution of clinical and educational supervision to the development of advanced practitioners in primary care.ResultsFindings were mapped against the components of Billet’s theory to provide insights into the role of supervision in developing advanced practitioners. Key elements for effective supervision included supporting learners to identify their learning needs (educational supervision), guiding learners in everyday work activities (clinical supervision), and combination of regular prearranged face-to-face meetings ...

Research paper thumbnail of The development and early operation of Clinical Commissioning Groups (CCGs)

Commissioning Healthcare in England, 2020

Chapter 3 deals with the development and early operation of Clinical Commissioning Groups (CCGs) ... more Chapter 3 deals with the development and early operation of Clinical Commissioning Groups (CCGs) of GPs. Building upon the context set out in chapter 2, we examine the factors affecting early CCG development, highlighting the complexity of their governance structures, approaches taken to engaging with their members and the development of external relationships with a wide range of new bodies. We found an explicitly ‘bottom up’ approach to policy implementation, with CCGs given considerable lee-way in developing their structures and processes. As a result, the history of previous commissioning structures and arrangements played an important role in the development of each CCG, as did the approach taken by local leaders and by the PCT/ developing NHS England local team. Engagement with local bodies such as Health and Wellbeing Boards and Local Authorities were also significantly affected by local history and geography. We found that the approach taken by NHS England to CCG development, with early freedom to develop as they chose increasingly curtailed by more prescriptive guidance and a complex assurance regime, led to some frustrations for those involved.

Research paper thumbnail of Context

Commissioning Healthcare in England, 2020

Research paper thumbnail of Context: commissioning in the English NHS

Commissioning Healthcare in England, 2020

Chapter 2 provides the context, setting out the organisation and governance of commissioning in t... more Chapter 2 provides the context, setting out the organisation and governance of commissioning in the NHS. It includes a short summary of the architecture of commissioning pre-Health and Social Care Act (HSCA12), and highlights the important changes which were brought about by the Act, including the abolition of Primary Care Trusts and Strategic Health Authorities, the establishment of Clinical Commissioning Groups (CCGs), the creation of NHS England, transfer of commissioning responsibilities to different bodies (e.g. public health) and the setting up of local Health and Wellbeing Boards. The chapter also highlights the programme theories underlying the HSCA12, in particular the commitment to competition as a means of improving services and the expected benefits of greater clinical involvement in commissioning.

Research paper thumbnail of Motivating factors behind skill mix change: results from a practice managers’ survey in England

British Journal of General Practice, 2020

BackgroundThe expansion of the primary care workforce by employing a varied range of practitioner... more BackgroundThe expansion of the primary care workforce by employing a varied range of practitioners (‘skill mix’) is a key component of the General Practice Forward View (GPFV). The extent of skill mix change and where that has occurred has been examined using publicly available practice level workforce data. However, such data does not provide information regarding specific motivating factors behind employment decisions for individual practices nor future workforce plans.AimTo identify key motivating factors behind practice workforce decisions and their future workforce plans.MethodAn online questionnaire was sent to practice managers in England. Data collection is ongoing; however, 1000 practices have responded to the survey so far. The questionnaire was composed of questions related to current workforce, motivating factors behind employment decisions, planned future workforce changes, financial assistance with employing staff (for example, HEE or CCG funding) and ideal workforce.R...

Research paper thumbnail of Clinical engagement in commissioning

Commissioning Healthcare in England, 2020

Research paper thumbnail of Implementation of behaviour change training in practice amongst pharmacy professionals in primary care settings: Analysis using the COM-B model

Research in Social and Administrative Pharmacy

Research paper thumbnail of To be or not to be: The identity work of pharmacists as clinicians

Sociology of Health & Illness

This study explores how pharmacists legitimise the expansion of their clinical work and considers... more This study explores how pharmacists legitimise the expansion of their clinical work and considers its impact on pharmacists’ professional identity work. In the context of pharmacy in the English NHS, there has been an ongoing policy shift towards pharmacists moving away from ‘medicines supply’ to patient‐facing, clinical work since the 1950s. Pharmacists are continuously engaging in ‘identity work’ and ‘boundary work’ to reflect the expansion of their work, which has led to the argument that pharmacists lack a clear professional identity. Drawing insights from linguistics and specifically Van Leeuwen's ‘grammar of legitimation’, this study explains how the Pharmacy Integration Fund, a nationally funded learning programme, provides the discursive strategies for pharmacists to legitimise their identity work as clinicians.

Research paper thumbnail of General practice managers’ motivations for skill mix change in primary care: Results from a cross-sectional survey in England

Journal of Health Services Research & Policy

Objectives The objectives are to determine the factors that motivated GP practice managers in Eng... more Objectives The objectives are to determine the factors that motivated GP practice managers in England to employ non-medical roles, and to identify an ideal hypothetical GP practice workforce. Methods Cross-sectional survey of GP practice managers in England ( n = 1205). The survey focused on six non-medical roles: advanced nurse practitioner, specialist nurse, health care assistant, physician associate, paramedic and pharmacist. Results The three most commonly selected motivating factors were: (i) to achieve a better match between what patients need and what the practitioner team can deliver; (ii) to increase overall appointment availability and (iii) to release GP time. Employment of pharmacists and physician associates was most commonly supported by additional funding. Practice managers preferred accessing new non-medical roles through a primary care network or similar, while there was a clear preference for direct employment of additional GPs, advanced nurse practitioners or prac...

Research paper thumbnail of Commissioning primary care services

Research paper thumbnail of Understanding primary care co-commissioning: Uptake, scope of activity and process of change

This is an interim report for the third phase (April 15 to December 17) of our ongoing project fo... more This is an interim report for the third phase (April 15 to December 17) of our ongoing project following the development of Clinical Commissioning Groups (CCGs) in England since their initial establishment as ‘Pathfinders’. The overarching aim is to explore the significant changes to the work of CCGs as they took over varying levels of new responsibility for commissioning primary care services from April 2015.

Research paper thumbnail of Exploring the GP ‘added value’ in commissioning: What works, in what circumstances, and how? Final Report

Research paper thumbnail of Processes supporting effective skill-mix implementation in general practice: A qualitative study

Journal of Health Services Research & Policy

Objectives Health policy and funding initiatives have addressed increasing workloads in general p... more Objectives Health policy and funding initiatives have addressed increasing workloads in general practice through the deployment of clinicians from different disciplinary backgrounds. This study examines how general practices in England operate with increasingly diverse groups of practitioners. Methods Five general practices were selected for maximum variation of the duration and diversity of skill-mix in their workforce. Individual interviews were recorded with management and administrative staff and different types of practitioner. Patient surveys and focus groups gathered patients’ perspectives of consulting with different practitioners. Researchers collaborated during coding and thematic analysis of transcripts of audio recordings. Results The introduction of a wide range of practitioners required significant changes in how practices dealt with patients requesting treatment, and these changes were not necessarily straightforward. The matching of patients with practitioners requir...

Research paper thumbnail of Scale, scope and impact of skill mix change in primary care in England: a mixed-methods study

Health and Social Care Delivery Research

Background General practices have had difficulty recruiting and retaining enough general practiti... more Background General practices have had difficulty recruiting and retaining enough general practitioners to keep up with increasing demand for primary health care in recent years. Proposals to increase workforce capacity include a policy-driven strategy to employ additional numbers and a wider range of health professionals. Objectives Our objective was to conduct a comprehensive study of the scale, scope and impact of changing patterns of practitioner employment in general practice in England. This included an analysis of employment trends, motivations behind employment decisions, staff and patient experiences, and how skill mix changes are associated with outcome measures and costs. Design NHS Digital workforce data (2015–19) were used to analyse employment changes and to look at their association with outcomes data, such as the General Practitioner Patient Survey, General Practitioner Worklife Survey, prescribing data, Hospital Episode Statistics, Quality and Outcomes Framework and ...

Research paper thumbnail of Clinically led commissioning

Research paper thumbnail of Exploring the early workings of emerging CCGs: Final report

This report presents the findings from a study of developing Clinical Commissioning Groups(CCGs) ... more This report presents the findings from a study of developing Clinical Commissioning Groups(CCGs) in England. The aim of the study was to explore the early experiences of emergingClinical Commissioning Groups as they set themselves up as ?Pathfinders? and movedtowards authorisation, investigating the factors that had affected their development anddrawing out lessons for the future. The specific research questions addressed in this reportare:? What have been the experiences of Pathfinder CCGs over the past year?? What factors have affected their progress and development?? What approaches have they taken to:? Being a membership organisation?? Developing external relationships? ? Commissioning and contracting?? What lessons can be learned for their future development and support needs?

Research paper thumbnail of Understanding Primary Care Co-Commissioning: Uptake, Development, and Impacts (Final Report)

Research paper thumbnail of Involving GPs in commissioning: what 'added value' do they think they bring to Clinical Commissioning Groups?

British Journal of General Practice, 2014

Neil Perkins, BA(Hons), MPhil, Research associateCentre for Primary Care, University of Mancheste... more Neil Perkins, BA(Hons), MPhil, Research associateCentre for Primary Care, University of Manchester, Manchester, UK.Anna Coleman, BA(Soc Sci), MA, PhD, Research fellowCentre for Primary Care, University of Manchester, Manchester, UK.Michael Wright, MSc, FRACGP, GPCentre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW, Australia.Erica Gadsby, BSocSc, PGDipPH, DPhil, Research fellowCentre for Health Services Studies, University of Kent, Canterbury, Kent, UK.Imelda McDermott, BSc(Hons), Grad Dip, PhD, Research associateCentre for Primary Care, University of Manchester, Manchester, UK.Christina Petsoulas, BA, MPhil, DPhil, Research fellowDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.Kath Checkland, BMedSci, MA(Econ), PhD, MRCGP, Reader in Health Policy and Primary Care, GPCentre for Primary Care, University of Manchester, Manchester, UK.Address for correspondence Neil Perkins, Centre for P...

Research paper thumbnail of A comparative analysis of regional variation in practitioner employment in general practice

British Journal of General Practice, 2019

Research paper thumbnail of Challenges of maintaining accountability in networks of health and care organisations: A study of developing Sustainability and Transformation Partnerships in the English National Health Service

Social Science & Medicine

Research paper thumbnail of Contribution of supervision to the development of advanced practitioners: a qualitative study of pharmacy learners’ and supervisors’ views

BMJ Open

ObjectiveTo apply educational theory to explore how supervision can contribute to the development... more ObjectiveTo apply educational theory to explore how supervision can contribute to the development of advanced practitioners using the example of several postregistration primary care training pathways for pharmacy professionals (pharmacists and pharmacy technicians).DesignQualitative semistructured telephone interviews applying Billet’s theory of workplace pedagogy for interpretation.SettingEngland.ParticipantsFifty-one learners and ten supervisors.Primary outcomeContribution of clinical and educational supervision to the development of advanced practitioners in primary care.ResultsFindings were mapped against the components of Billet’s theory to provide insights into the role of supervision in developing advanced practitioners. Key elements for effective supervision included supporting learners to identify their learning needs (educational supervision), guiding learners in everyday work activities (clinical supervision), and combination of regular prearranged face-to-face meetings ...

Research paper thumbnail of The development and early operation of Clinical Commissioning Groups (CCGs)

Commissioning Healthcare in England, 2020

Chapter 3 deals with the development and early operation of Clinical Commissioning Groups (CCGs) ... more Chapter 3 deals with the development and early operation of Clinical Commissioning Groups (CCGs) of GPs. Building upon the context set out in chapter 2, we examine the factors affecting early CCG development, highlighting the complexity of their governance structures, approaches taken to engaging with their members and the development of external relationships with a wide range of new bodies. We found an explicitly ‘bottom up’ approach to policy implementation, with CCGs given considerable lee-way in developing their structures and processes. As a result, the history of previous commissioning structures and arrangements played an important role in the development of each CCG, as did the approach taken by local leaders and by the PCT/ developing NHS England local team. Engagement with local bodies such as Health and Wellbeing Boards and Local Authorities were also significantly affected by local history and geography. We found that the approach taken by NHS England to CCG development, with early freedom to develop as they chose increasingly curtailed by more prescriptive guidance and a complex assurance regime, led to some frustrations for those involved.

Research paper thumbnail of Context

Commissioning Healthcare in England, 2020

Research paper thumbnail of Context: commissioning in the English NHS

Commissioning Healthcare in England, 2020

Chapter 2 provides the context, setting out the organisation and governance of commissioning in t... more Chapter 2 provides the context, setting out the organisation and governance of commissioning in the NHS. It includes a short summary of the architecture of commissioning pre-Health and Social Care Act (HSCA12), and highlights the important changes which were brought about by the Act, including the abolition of Primary Care Trusts and Strategic Health Authorities, the establishment of Clinical Commissioning Groups (CCGs), the creation of NHS England, transfer of commissioning responsibilities to different bodies (e.g. public health) and the setting up of local Health and Wellbeing Boards. The chapter also highlights the programme theories underlying the HSCA12, in particular the commitment to competition as a means of improving services and the expected benefits of greater clinical involvement in commissioning.

Research paper thumbnail of Motivating factors behind skill mix change: results from a practice managers’ survey in England

British Journal of General Practice, 2020

BackgroundThe expansion of the primary care workforce by employing a varied range of practitioner... more BackgroundThe expansion of the primary care workforce by employing a varied range of practitioners (‘skill mix’) is a key component of the General Practice Forward View (GPFV). The extent of skill mix change and where that has occurred has been examined using publicly available practice level workforce data. However, such data does not provide information regarding specific motivating factors behind employment decisions for individual practices nor future workforce plans.AimTo identify key motivating factors behind practice workforce decisions and their future workforce plans.MethodAn online questionnaire was sent to practice managers in England. Data collection is ongoing; however, 1000 practices have responded to the survey so far. The questionnaire was composed of questions related to current workforce, motivating factors behind employment decisions, planned future workforce changes, financial assistance with employing staff (for example, HEE or CCG funding) and ideal workforce.R...

Research paper thumbnail of Clinical engagement in commissioning

Commissioning Healthcare in England, 2020