Perceived and reported access to the general practitioner: an international comparison of universal access and mixed private/public systems.

Timely and convenient access to primary healthcare is essential for the health of the population as delays can incur additional health and financial costs. Access to health care is under increasing scrutiny as part of the drive to contain escalating costs, while attempting to maintain equity in service provision. The objective was to compare primary care services in Republic of Ireland and Northern Ireland, and to report on perceived and reported access to GP services in universal access and mixed private/public systems. A questionnaire study was performed in Northern Ireland (NI) and the Republic of Ireland (ROI). Patients of 20 practices in the ROI and NI were contacted (n = 22,796). Main outcome measures were overall satisfaction and the access to GP services. Individual responses and scale scores were derived using the General Practice Assessment Questionnaire (G-PAQ). The response rate was 52% (n = 11,870). Overall satisfaction with GP practices was higher in ROI than in NI (84.2% and 80.9% respectively). Access scores were higher in ROI than in NI (69.2% and 57.0% respectively) Less than 1 in 10 patients in ROI waited two or more working days to see a doctor of choice (8.1%) compared to almost half (45.0%) in NI. In NI overall satisfaction decreased as practice size increased; 82.8%, 80.4%, and 75.8%. In both systems, in large practices, accessibility is reduced when compared to smaller practices. The faster access to GP services in ROI may be due to the deterrent effect of the consultation charge freeing up services although, as it is the poorest and sickest who are deterred by the charge this improved accessibility may come at a significant cost in terms of equity. The underlying concern for policy makers centres around provision of equitable services.

Relationships matter: The problems and prospects for social workers' relationships with young children in care

One of the key lessons learnt in the UK from the Laming Inquiry into the death of Victoria Climbié was the importance of social workers developing consistent and long-term relationships with young children in whose lives they are involved. This issue is now informing policy developments, including the proposed Social Work Practices which, based on a similar model to General Practitioner practices, aim to provide a lead professional to act as a parental figure and an advocate for every child in care. This paper begins by confirming the importance of developing relationships between social workers and young children, but questions the ability of the new policy developments to facilitate these. Drawing upon data from research involving interviews with social workers, the paper outlines the factors which hinder social workers' relationships with young children and argues that while the new proposals address some of the more surface structural and organizational factors, they do not address the deeper factors regarding attitudes, values and emotional competence which are crucial if social workers are to successfully build relationships with young children in care.

Mandated prevention in child welfare: Considerations from a framework shaping ethical inquiry

Summary: This article outlines a framework for approaching ethical dilemmas arising from the development, evaluation and implementation of child welfare policies. As such, it is relevant to policy-makers, social researchers and social workers. The central tenets of the framework are developed by drawing on ideas from moral philosophy and critical social theory. These ideas are presented as axioms, theorems and corollaries, a format which has been employed in the social sciences to offer a rational justification for a set of claims. • Findings: This process of reasoning leads to four principle axioms that are seen to shape the ethical scrutiny of social policy: 1) problematizing knowledge; 2) utilizing structured forms of inquiry to enhance understanding; 3) engendering enabling communication with those affected by the ethical concern; and 4) enhancing self-awareness. • Applications: The four axioms are then applied, by way of example, to the current and contentious, 'third way' policy of mandated prevention in child welfare, where the aim is to obviate deleterious outcomes in later life. It is argued that the framework can be applied beyond this specific concern to other pressing, ethical challenges in child welfare.