Establishing the validity of English GP Patient Survey items evaluating out-of-hours care

Background A 2014 national audit used the English General Practice Patient Survey (GPPS) to compare service users’ experience of out-of-hours general practitioner (GP) services, yet there is no published evidence on the validity of these GPPS items. Objectives Establish the construct and concurrent validity of GPPS items evaluating service users’ experience of GP out-of-hours care. Methods Cross-sectional postal survey of service users (n=1396) of six English out-of-hours providers. Participants reported on four GPPS items evaluating out-of-hours care (three items modified following cognitive interviews with service users), and 14 evaluative items from the Out-of-hours Patient Questionnaire (OPQ). Construct validity was assessed through correlations between any reliable (Cochran's α>0.7) scales, as suggested by a principal component analysis of the modified GPPS items, with the ‘entry access’ (four items) and ‘consultation satisfaction’ (10 items) OPQ subscales. Concurrent validity was determined by investigating whether each modified GPPS item was associated with thematically related items from the OPQ using linear regressions. Results The modified GPPS item-set formed a single scale (α=0.77), which summarised the two-component structure of the OPQ moderately well; explaining 39.7% of variation in the ‘entry access’ scores (r=0.63) and 44.0% of variation in the ‘consultation satisfaction’ scores (r=0.66), demonstrating acceptable construct validity. Concurrent validity was verified as each modified GPPS item was highly associated with a distinct set of related items from the OPQ. Conclusions Minor modifications are required for the English GPPS items evaluating out-of-hours care to improve comprehension by service users. A modified question set was demonstrated to comprise a valid measure of service users’ overall satisfaction with out-of-hours care received. This demonstrates the potential for the use of as few as four items in benchmarking providers and assisting services in identifying, implementing and assessing quality improvement initiatives.

A Constitution of Social Governance for the European Union

his chapter considers the EU’s socio-economic constitution under the lens of humaneness. It argues that the EU’s unique socio-economic constitution demands equilibrium of socio-economic integration instead of widening the gap between economic integration at EU levels and social integration at national levels. While the EU lacks the legislative competences to achieve this equilibrium, the constitutional principle still prevails. Indeed, the EU competences reflect its own values as well as the socio-economic constitutions of its constituent Member States. These frequently do not allow for total state-governance of social spheres such as working life, education, care or other social services. Instead, societal actors are given scope to (co-)govern these spheres at national levels. Accordingly, the apparent tension between the EU’s socio-economic values and principles and its limited competences in the social policy field can be resolved through a dynamic interpretation of the EU Treaties towards a “constitution of social governance”. This interpretation reads the Treaties as authorising governance by societal actors. The chapter connects the idea of humanness to the ideals of social governance at EU level and proposes two options for practical application of the concept. These are rules for trans-national labour markets based on European collective labour agreements and a European higher education sector developed by agreements between universities.

'A Land Beyond the Wave': Transnational Perspectives on Easter 1916

Despite the appeal and significance of nationalism as a near universal political force, Irish historians – in common with the historians of most nationalist movements – have struggled to analyse nationalism from beyond the perspective of the nation state. The reasons for this are varied, arising both from practical aspects, such as the availability and accessibility of sources, to more conceptual issues such as the resilience of the national perspective in the framing of historiographical narratives. This paper considers the Easter Rising as a case study in assessing how a transnational framework complicates traditional historiographical perspectives. Accounts of the Easter Rising generally interpret the rebellion within local, national, or international (particularly Anglo-Irish or imperial) frameworks. Interpretations that adopt a broader framework have tended to focus on international rather than transnational dimensions: the First World War context, revolutionary links with Germany, and the role of the United States. This paper assesses the potential of a transnational approach by analysing four aspects of the Rising: the significance of the transnational movement of people prior to the event; the influence of the transnational circulation of political ideas; the impact of transnational cultural currents in shaping the framing of revolutionary ideals; and the impact of the Rising on Irish nationalist communities beyond Ireland.

Commemoration in the United Kingdom: A multitude of memories

In the United Kingdom (UK) the centenary commemoration of the First World War has been driven by a combination of central government direction (and funding) with a multitude of local and community initiatives, with a particular focus on 4 August 2014; 1 July 2016 (the beginning of the Battle of the Somme) and 11 November 2018. ‘National’ ceremonies on these dates have been and will be supplemented with projects commemorating micro-stories and government-funded opportunities for schoolchildren to visit Great War battlefields, the latter clearly aimed to reinforce a contemporary sense of civic and national obligation and service. This article explores the problematic nature of this approach, together with the issues raised by the multi-national nature of the UK state itself.

Examining Participatory Governance in a Devolving UK: insights from national parks policy development in Northern Ireland

This paper provides a contemporary examination of policy making and participatory practice in the context of devolving governance in the UK. The paper takes Northern Ireland as its focus and is particularly timely considering the context of devolved governance, the ongoing transition from conflict to relative peace and the potential for rejuvenating democracy through participatory
governance. The paper concentrates on one particular policy process, namely the attempted designation of a national park in the Mournes Area of Outstanding Natural Beauty. A thematic analysis of qualitative data is drawn upon to analyse the structural factors that framed the policymaking process, in particular the role of power in determining how consultation processes were 2 initiated, designed and undertaken. Using Lukes’ model) as an analytical framework, power is shown to manifest at multiple levels within the policy-making process to influence policy outcomes. The paper reveals how the persistence of a top-down approach to policy development combined with a highly parochial political outlook undermined attempts to designate a Mourne National Park. The paper concludes that, given the immaturity of recently devolved government in
Northern Ireland, in this instance, the democratising intentions of devolved governance have not been met. This has implications for Northern Ireland’s recent reform of public administration which devolves certain planning powers to local authority level and the management of the internationally significant Mournes landscape.