However, there was voiced confusion among leaders regarding how experiential knowledge from service users should be used and incorporated into the wider, population-level commissioning agenda of CCGs. A GP leader (site C) highlighted it was a challenge to engage patient groups into providing inputs at the locality and or CCG level: ‘ Patients are not usually interested in it ’ , ‘ they are busy and do not want to do things like this ’ (site B), ‘ patients will only be involved if there is money to be made ’ (site A). In addition, many GPs commen- ted that when inviting patients to provide feedback ‘ you get half a dozen [ … ] with particular reason or agenda ’ , suggesting this form of engagement did not lead to constructive dialogue on improving patient care. A GP from site B pointed out: ‘ I think they [ patients] are just there representing their own views as they see it ’ . Even though the wider perception from policy documents on public and patient involvement in commissioning was that patient views were valuable, there was no mechan- ism in place to operationalise lay representation and overall it was often carried out in a piecemeal fashion. For example, in some of the locality meetings we observed, individuals who had the ﬂ exibility to attend were listening attentively to discussions without engaging in overt dialogue. In other meetings, there was a set time given to patient representatives to present their perspectives. As such, several GP leaders felt that in the current ﬁ scal climate and organisational upheaval, investing scarce resources in organising Table 4 Site A and site B network ties
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We first contacted a GP professor in diabetes at Rutterford CCG. Through him, we met stakeholders who had been involved in the diabetes redesign. We spoke with a diabetes nurse consultant and a CCG transformation manager. We later followed up with the diabetes nurse consultant and interviewed the chief accountable officer at the CCG. At the time of our visit, the CCG had spent the previous year developing recommendations on ‘ delivering the best possible care ’ . Increased numbers of patients with diabetes, increased complications and increased spend were primary concerns in the CCG. The CCG had secured some funding that could be used to buffer any upfront losses from changes to the diabetes pathway. They also had a diabetes education programme in place for upskilling community staff. With these resources in place, a transformation team was put in place. They faced some challenges, which were mostly overcome by the creation of subgroups. These groups collected, evaluated and reported on evidences related to their specific disciplines. Each group made recommendations about the pathway that were then collated into one overall report. The team decided to improve care ‘ downstream ’ , that is, at the beginning of the pathway, in order to prevent complications, improve care and, ultimately, save money. At our last point of contact, which was approximately 2 years after the first interviews, around one-third of practices had attended the education programme, a specification for new services had been written, and they were in the process of evaluating referral data to understand the impact of their redesign work.
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The PAM was introduced into UK in 2005. Ellins and Coulter  validated the 22-item PAM in a National Telephone Survey study in the UK. They anglicised some key terms and phrases to better suit the UK popu- lation. Subsequently, the validated PAM (mostly 13-item version) has been used as an outcome measure to evalu- ate intervention programmes in the UK [13–16]. Use of the PAM is becoming much more frequent in the UK, and NHS England has agreed a five-year licence to use the PAM-13 with up to 1.8 million people across the NHS from 2016 as part of its ‘Self-Care programme’  which seeks to support people living with long-term health conditions to better manage their own health. Five Clinical Commissioning Groups (CCGS) and one disease registry are currently using PAM across a range of projects . However, some concerns have been raised about the appropriateness of the UK-version of PAM in these contexts .
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With the LETBs being dominated by health service pro- viders there is the danger of conflict of interest with a potential poacher-turned-gamekeeper role of employers, who now have responsibility for junior doctors’ training . Trusts often provide their own training courses so there is a real potential they could now commission from themselves and also be involved in quality assurance of the training they provide. Similarly, there are also exam- ples of individual LETB board members having additional roles in private health education providers, although the conflicts of interest associated with the LETBs do not ap- pear to be as “rife” as on the new clinical commissioning groups (CCGs), where a third of GPs on the CCG boards have financial links to private providers from whom the CCG board may commission patient services .
In July 2010, the Secretary of State for Health, Andrew Lansley, announced major changes in the NHS commissioning structures – the most important one for this research being the devolution of PCT commissioning functions to the so-called Clinical Commissioning Groups, which will be led by GPs. At the time of writing it was still unclear how the various changes proposed by the 2010 White Paper would be implemented and what organisations and organisational arrangements would end up fulfilling the commissioning function in the NHS. Paradoxically, these changes, and the creation of new and less experienced commissioning organisations, makes this research particularly relevant insofar as: (a) evidence-based commissioning will continue to be a priority; (b) service redesign is considered the key vehicle for improving productivity, prevention, innovation and quality (QIPP) of healthcare; (c) conflict between individual vs. population commissioning decisions may become increasingly important in the emerging context of GP-led commissioning and; (d) new organisations risk repeating the mistakes of the past instead of capitalising on previous experience.
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Issues of prevalence and epidemiology in relation to self-harm and suicide in children and young people are complex. While there have been many studies published over the last twenty years seeking to establish accurate rates of occurrence, problems with differing definitions, criteria for inclusion, recruitment process and ways in which sample groups are selected, make aggregating data, difficult. This means that statistical estimates of prevalence rates should be held lightly. In addition, persistent pursuit of definitive rates of occurrence are likely to be unrealistic, offer only limited new insights and potentially deflect from the more important task of understanding the individual experience of those who self harm in order to respond in a way that is respectful and helpful.
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In! this! model! the! SP! intervention! is! doing! little! more! than! signposting! patients! onto! appropriate! networks! and! groups! who! may! assist! an! individual! patient! to! address! their! wellbeing! needs.! All! SP! models! have! an! element! of! signposting! in! their! package.! GPs! can! directly!refer!to!the!SP!intervention!and!leave!the!patient!to!their!own!devices!to!access!and! follow!through!on!the!local!wellbeing!offerings!available.!Or!the!SP!project!may!seek!to!address! patient! needs! independent! of! the! GP! and! will! simply! share! the! space! of! the! practice! but! not! necessarily!have!any!regular!or!formal!link!with!GPs.!The!activities!that!they!may!be!referred! too! could! include:! a! gym,! a! cooking! project,! peer! support! or! a! variety! of! counselling! opportunities!etc.!!The!practice!may!not!have!a!strong!direct!relationship!with!the!SP!project! and!there!will!be!little!or!no!follow<up!and/or!feedback.!!These!projects!will!have!only!minimal! evaluation!of!their!outcomes.!In!the!local!CCG!area!this!included!a!project!called!The!Mirror.! This!was!actually!a!tablet!(IT)!application!that!had!been!developed!to!help!patients!measure,! visualise,! and! see! the! potential! for! change! by! allowing! them! to! access! online! and! offline! networks!of!wellbeing!support.!Funding!had!come!from!different!sources!including!a!charity.!It! was!being!piloted!in!two!GP!practices!with!little!evidence!of!its!effectiveness.!In!essence!it!was! a!brokerage!approach!with!the!SP!intervention!highlighting!gateways!to!other!services.!
For this research, 18 interviews are conducted. (Guest, Bunce, & Johnson, 2006) suggest that for a data collection procedure, at least 12 participants are needed as minimum sample size recommendations. For this research, different perspectives on light rail projects were required. Since the aim is to improve the organisation of a T&C phase, not only clients are interviewed. For this investigative research, it is interesting and most exhaustive if interviewees from different companies and sectors are interviewed. These people contribute with different perspectives for this research. Therefore, five groups are made; Client, Project organisation, Supplier, Operator, Knowledge centres. These groups represent the parties involved in the project. An overview of the interviewees per party has been given in Table 8. The minimal number of 12 participants has been reached, but since this research used groups of participants this number must be adjusted. For subgroup sampling at least 3 participants are needed per subgroup (Onwuegbuzie & Leech, 2007). For this research six cases have been used. The number of interviews performed in the Netherlands is higher than for the international cases. Therefore, the national cases weigh more heavily in this research.
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Acceptance of a social prescribing service ranged between 80-92% in all of the districts. However in one district the acceptance rate was as low 60%. Men and women accept the social prescription at similar levels. But people who were younger (18-25 and 26-35 groups) had higher levels of declining or disengaging with the service and/or being uncontactable. Prescribers link to patients vary. Each case can be very different requiring different challenges. Most patients receive information, advice and guidance. But many other prescribers go beyond what is perhaps anticipated by GCCG. Thus the co-ordinators have been extraordinary innovative and undertaken a range of activities including: accompanying patients with low confidence to activity classes and self-help groups, become involved in advocacy, liaised with family members, co-ordinated quotations for building projects, identified communities of interest to patients and helped to direct patients into volunteering and employment opportunities.
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10. Broader competition, training of the officials, good salaries, dynamic purchasing system. In response to the question “What liability shall be imposed on members of procurement commissions for offenses (if they do not pertain to bribe taking) in the field of public procurement?” most of the experts suggested to impose administrative or disciplinary liability. Sometimes they proposed intensification of one or another punishment by imposing financial sanctions. One of the experts suggested imposing of criminal liability for such offenses if they concern the large- value procurements. It is worthy of note that two experts expressed the opinion that imposing of real punishments on members of the procurement commission would result in inability of the commissioning party to establish the procurement commission (employees of the commissioning party will refuse to work in procurement commissions).
on MTX or placebo, will be allowed to continue taking the treatments for knee OA that they are taking at their screen- ing visit for the duration of the trial. Investigators will be re- sponsible for the overall management of a participant’ s medication, and will ask participants to avoid changing their analgesic or anti-inflammatory medication for the duration of the trial. However, if a participant is experiencing in- creased pain and requires an increase in the dose of analge- sics then the use of paracetamol, topical or oral NSAIDs or opioids, or a combination of these will be permitted, but the reason for the dose increase and the dose used will be docu- mented. The choice of medications and doses to be used lie with the principal investigator and clinicians working at study sites in order to ensure that treatment for participants in both groups is optimized. Participants will be permitted to continue current use of chondroitin and glucosamine, provided the dose has been stable for three months at study entry; however their use must be clearly documented in the case report form (CRFChondroitin or glucosamine therapy will not be commenced during the duration of the trial. Chronic NSAID and opioid use days in the last three months) will be included as a covariate in the analysis.
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authority public health, social care and children’s services departments, were also created at the same time. HWBs work to inform those who commission services, so they can work in partnership and use their budgets to provide the best services for local people. They do this by undertaking a Joint Strategic Needs Assessment (JSNA) and develop a joint strategy for how needs can be addressed. Most local areas will have an agreement, which is sometimes called a Compact, that outlines local arrangements for commissioning services provided by the voluntary and community sector (VCS). The Compact covers issues such as tendering and how the VCS can contribute to needs assessments and use their knowledge of issues – such as mental health – to advocate for services and represent the
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The goal we strive to achieve is to integrate heterogeneous resources transparently, in a way that minimizes exposure of our end users to infrastructure issues. Sometimes there are issues that go undetected, contributing to frustration among many teams. With over a decade of experience with resources commissioning, we developed an idea of how to make the commissioning process smoother: a standard HammerCloud job is a full-chain job that interacts with the distributed data management and workload management systems of the experiments, the resources/infrastructure, and a variety of services necessary for the successful job run. We would like to be able to reproduce this kind of environment, however, in a controlled way, where we can fail early, spot infrastructure issues and address them before exposing the user community to these issues.
The HSE Manual for Pre-commissioning and Commissioning is done by referring and adopting the international standards such as OISD, OSHA, ANSI, NFPA and Regulations/ Acts such as Factories Act (1948), EPA (1986) and also the company guidelines for Health, Safety and Environment. A brief description of safety aspects and the standards and acts which they are adopted are discussed below.
process (guide to self-evaporating low-temperature BOG into the receiving station, using LNG spray temperature control tank progressive pre-cooling, until the completion of cooling small filling LNG). It is of great significance to reduce the BOG flow rate in the cooling process of storage tanks, satisfy the working condition requirements of receiving stations, realize the zero emission of BOG in the cooling of storage tanks and save the commissioning cost for the newly added storage tanks in the LNG receiving stations which have been put into operation in China.
AICAR: Aminoimidazole carboxamide ribonucleotide; ALT: Alanine aminotransferase; CCG: Clinical Commissioning Group; CCP: Cyclic citrullinated protein; CCRN: Comprehensive Clinical Research Network; CPPD: Calcium pyrophosphate crystal disease; CRF: Case report form; CRP: C-reactive protein; CVD: Cardiovascular disease; DMARD: Disease modifying anti-rheumatic drug; eGFR: Estimated glomerular filtration rate; FBC: Full blood count; GP: General practitioner; HADS: Hospital Anxiety and Depression Scale; IA: Intra-articular; ICER: Incremental cost-effectiveness ratio; ICOAP: Intermittent and Constant Osteoarthritis Pain; IL: Interleukin; LFT: Liver function test; LTF: Lateral tibiofemoral; MHRA: Medicines and Healthcare Products Regulatory Agency; MOAKS: MRI Osteoarthritis Knee Score; MRI: Magnetic resonance imaging; MTF: Medial tibiofemoral;
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Guidance for quality control of radiotherapy equipment is available most recently in the form of IPEM Report 81. Guidance on the commissioning of linear accelerators and ancillary equipment (multileaf collimators, EPIDs etc.) is over ten years old and is currently being re-written. However, neither of these documents cover to a great extent the commissioning and quality assurance aspects of the networking systems (and their processes) which interconnect the wide variety of equipment now used in and providing data for radiotherapy. The systems of work and their interconnection are still in their infancy and both commissioning and quality assurance aspects have yet to be considered in any great depth.
Interviews will explore the acceptability and perceived value of the intervention to PWD and their informal carers. Topic guides are given in Additional file 5. We will also explore the extent to which participants felt the intervention was tailored, their views on the intensity of the intervention and staff involved in delivering the intervention and any suggested changes to the interven- tion. PWD consenting to a qualitative interview will be interviewed separately from their informal carer where possible, but jointly if preferred by the participant. Inter- views will take no longer than 60 min and will be audio recorded with participants’ permission (as documented on the initial study consent form; consent to recording will be verbally confirmed at the time of the interview). The clinical researcher undertaking baseline and follow-up assessments will include some open-ended questions to explore participants’ views on the outcome measures. These qualitative data will be recorded in de- tail on the case report form (CRF) and passed to the qualitative team for analysis.
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It is resoundingly clear that NHS Sheffield is ahead of the game in terms of public engagement when looking at the National picture. When comparing feedback from this evaluation with the findings of The Picker Institute (2009) NHS Sheffield are achieving well. Like other PCTs there is as sense that World Class Commissioning (WCC), and the PPI expectations within WCC, have prompted organisational change and boosted the status of engagement. However, NHS Sheffield is not alone in seeking new ways to engage seldom heard groups. A common difficulty for PCTs is "overcoming the difficulties of engaging 'hard to reach' / 'seldom heard', minority and disadvantaged groups and communities" (The Picker Institute, 2009). Some of the issues and recommendations of the participants of this evaluation are mirrored by the participants of the national survey, with a call for more creative, participatory, collaborative and targeted approaches to engagement with SHGs.
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From study inception to submission the interest and quality of policy, guidance and reports into LMHC has increased and improved. However, national guidance such as the current Government Mental Health strategy (HM Government, 2011) attest LMHC has yet to become integrated within the acute hospital setting. There is a clear conflict between the tentative evidence base for only offering high impact work and education (Parsonage et al, 2012) and the good practice guidance for commissioning (Fernandes, 2011; JCPMH, 2012), policy implementation (Aitken, 2007) and patient experiences (NICE, 2011). Further research and evaluation is required to add to the evidence base for the effectiveness of LMHS provision. There remains a debate about the function and role of LMHC. Adoption of a more integrated approach to mental and physical health care is currently recommended which will place LMHC higher up the agenda in non-mental health settings. The current interest in ensuring all hospitals have a LMHS offers the opportunity to evaluate services as they develop.
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