Community pharmacy in a commissioning-led NHS:can pharmacy compete effectively?

Introduction – The commissioning of services has been a core responsibility of English Primary Care Trusts (PCTs) since 2002. Primary care organisations (PCOs) in Scotland, Wales and Northern Ireland have also increased their commissioning activities but with, arguably, less fervour than their English counterparts. The commissioning function of English PCTs has been reinforced by the introduction of new contractual frameworks across primary care – for medical services, dentistry and pharmacy. The new pharmaceutical services contract for England and Wales introduced an “enhanced” category of services, the provision of which is dependent on the commissioning decisions of local PCTs. As the NHS, most pertinently in England, continues its transformation from a provider to a commissioner of healthcare, the ability of pharmacy to compete effectively for funding is likely to become increasingly important. Method - After piloting, in August 2006 a self-completion postal questionnaire was sent to a random sample of practising community pharmacists, stratified for country and sex, within Great Britain (n=1998), with a follow-up to non-responders 4 weeks later. Data were analysed using SPSS (v12.0). A final response rate of 51% (n=1023/1998) was achieved. Within the section of the questionnaire relating to service provision, respondents were asked “do you believe that pharmacy will be able to compete effectively with other healthcare providers for access to additional funding to develop services that address a public health need identified by your local Primary Care Organisation (PCO), e.g. PCT/LHB etc.?”. Answers were recorded on a three-point scale; pharmacy “will”, “may”, or “will not” be able to compete effectively for funding. Results - The attitudes of pharmacists showed variation depending on the type of pharmacy they worked in (supermarket, multiple (outlets (n)=200), large chain (200>n>20), small chain (20=n>5), or independent (n=5)) (?2 test with p=0.001). Over a third of survey pharmacists working in small chains and independents (37% (n=21/57) and 33% (n=113/341) respectively) believed that pharmacy would not be able to compete effectively for funding compared to 23% (n=15/65) for supermarket pharmacists, 22% (n=21/97) for pharmacists employed by large chains and just 18% (n=62/353) for pharmacists employed most regularly in multiples. Furthermore, attitudes also varied between the countries of residence of respondents (?2 test with p<0.05). 27% (n=242/893) of pharmacists resident in England and Wales believed that pharmacy would not be able to compete compared to 16% (n=18/116) of pharmacists resident in Scotland. Conclusions – It would appear that community pharmacists believe that the larger pharmacy chains and supermarkets will occupy an advantageous position in terms of attracting finance to develop services. This could have notable implications for service provision across the sector. If corporate pharmacy chains were to monopolise commissioning monies then the proportion of funding available to independents will be diminished; arguably further hastening their demise, as well as stifling the professional development of pharmacists employed within the independent sector. These findings, when combined with the variation observed between UK pharmacists operating under different contractual frameworks, may be a reflection of the divergent policy in the different administrations with developments in England, including the new pharmacy contract, reflecting a market-based approach with Scotland taking a near opposite stance with service integration and a commitment to new public health. However, it should be acknowledged that the questionnaire did not allow for detection of ambiguities in, or misunderstandings of, the survey question and this should be considered as a limitation of the research.

ImageLearn - Decoding Britain's Landscape

Abstract Ordnance Survey, our national mapping organisation, collects vast amounts of high-resolution aerial imagery covering the entirety of the country. Currently, photogrammetrists and surveyors use this to manually capture real-world objects and characteristics for a relatively small number of features. Arguably, the vast archive of imagery that we have obtained portraying the whole of Great Britain is highly underutilised and could be ‘mined’ for much more information. Over the last year the ImageLearn project has investigated the potential of "representation learning" to automatically extract relevant features from aerial imagery. Representation learning is a form of data-mining in which the feature-extractors are learned using machine-learning techniques, rather than being manually defined. At the beginning of the project we conjectured that representations learned could help with processes such as object detection and identification, change detection and social landscape regionalisation of Britain. This seminar will give an overview of the project and highlight some of our research results.

God and War: the Church of England and Armed Conflict in the Twentieth Century

Despite narratives of secularization, it appears that the British public persistently pay attention to clerical opinion and continually resort to popular expressions of religious faith, not least in time of war. From the throngs of men who gathered to hear the Bishop of London preach recruiting sermons during the First World War, to the attention paid to Archbishop Williams' words of conscience on Iraq, clerical rhetoric remains resonant. For the countless numbers who attended National Days of Prayer during the Second World War, and for the many who continue to find the Remembrance Day service a meaningful ritual, civil religious events provide a source of meaningful ceremony and a focus of national unity. War and religion have been linked throughout the twentieth century and this book explores these links: taking the perspective of the 'home front' rather than the battlefield. Exploring the views and accounts of Anglican clerics on the issue of warfare and international conflict across the century, the authors explore the church's stance on the causes, morality and conduct of warfare; issues of pacifism, obliteration bombing, nuclear possession and deterrence, retribution, forgiveness and reconciliation, and the spiritual opportunities presented by conflict. This book offers invaluable insights into how far the Church influenced public appraisal of war whilst illuminating the changing role of the Church across the twentieth century.

Financial stocks and political bonds: stock market participation and political behavior in the United States and Britain

This dissertation investigates the effect of stock market participation on political behavior. Some observers claim that financial assets—stocks and mutual funds—have a causal effect on political behavior. The “investor class theory” asserts that as people invest in the stock market their partisan attachments shift rightward. The “asset effect theory” claims that financial investments increase political interest and participation. I examine these claims with longitudinal data from the United States and Great Britain covering a twenty-year period from the early 1980s through the mid-2000’s. I also examine the effect of financial asset ownership on political attitudes in the United States during the 2008 stock market crash. I find no evidence to support the argument that stock market participation has any causal effect on partisanship, participation, or political attitudes.

Women, workplace militancy and political subjectivity in Britain, 1968-1985

This thesis examines the experiences and political subjectivity of women who engaged in workplace protest in Britain between 1968 and 1985. The study covers a period that has been identified with the ‘zenith’ of trade-union militancy in British labour history. The women’s liberation movement also emerged in this period, which produced a shift in public debates about gender roles and relations in the home and the workplace. Women’s trade union membership increased dramatically and trade unions increasingly committed themselves to supporting ‘women’s issues’. Industrial disputes involving working-class women have frequently been cited as evidence of women’s growing participation in the labour movement. However, the voices and experiences of female workers who engaged in workplace protest remain largely unexplored. This thesis addresses this space through an original analysis of the 1968 sewing-machinists’ strike at Ford, Dagenham; the 1976 equal pay strike at Trico, Brentford; the 1972 Sexton shoe factory occupation in Fakenham, Norfolk; the 1981 Lee Jeans factory occupation in Greenock, Inverclyde and the 1984-1985 sewing-machinists’ strike at Ford Dagenham. Drawing upon a combination of oral history and written sources, this study contributes a fresh understanding of the relationship between feminism, workplace activism and trade unionism during the years 1968-1985. In every dispute considered in this thesis, women’s behaviour was perceived by observers as novel, ‘historic’ or extraordinary. But the women did not think of themselves as extraordinary, and rather understood their behaviour as a legitimate and justified response to their everyday experiences of gender and class antagonism. The industrial disputes analysed in this thesis show that women’s workplace militancy was not simply a direct response to women’s heightened presence in trade unions. The women involved in these disputes were more likely to understand their experiences of workplace activism as an expression of the economic, social and subjective value of their work. Whilst they did not adopt a feminist identity or associate their action with the WLM, they spoke about themselves and their motivations in a manner that emphasised feminist values of equality, autonomy and self-worth.

Courtesy Corps at Cedar Point

To make Cedar Point more guest-oriented, a Courtesy Corps was created, much like that at Disneyland. College girls were recruited for their guest services skills. They answered questions and provided information and assistance to guests. This picture of a young lady who was part of the corps was taken in 1968.

[Topographic map of portion of Aberdeen Proving Ground, Maryland, and topographical and architectural examples and exercises] /

Relief shown by contours.

The difference of Being in the early modern world: a relational-material approach to life in Scotland in the period of the witch trials

This thesis investigates how ways of being in different ontologies emerge from material and embodied practice. This general concern is explored through the particular case study of Scotland in the period of the witch trials (the 16th and 17th centuries C.E.). The field of early modern Scottish witchcraft studies has been active and dynamic over the past 15 years but its prioritisation of what people said over what they did leaves a clear gap for a situated and relational approach focusing upon materiality. Such an approach requires a move away from the Cartesian dichotomies of modern ontology to recognise past beliefs as real to those who experienced them, coconstitutive of embodiment and of the material worlds people inhabited. In theory, method and practice, this demands a different way of exploring past worlds to avoid flattening strange data. To this end, the study incorporates narratives and ‘disruptions’ – unique engagements with Contemporary Art which facilitate understanding by enabling the temporary suspension of disbelief. The methodology is iterative, tacking between material and written sources in order to better understand the heterogeneous assemblages of early modern (counter-) witchcraft. Previously separate areas of discourse are (re-)constituted into alternative ontic categories of newly-parallel materials. New interpretations of things, places, bodies and personhoods emerge, raising questions about early modern experiences of the world. Three thematic chapters explore different sets of collaborative agencies as they entwine into new things, co-fabricating a very different world. Moving between witch trial accounts, healing wells, infant burial grounds, animals, discipline artefacts and charms, the boundaries of all prove highly permeable. People, cloth and place bleed into one another through contact; trees and water emerge as powerful agents of magical-place-making; and people and animals meet to become single, hybrid-persons spread over two bodies. Life and death consistently emerge as protracted processes with the capacity to overlap and occur simultaneously in problematic ways. The research presented in this thesis establishes a new way of looking at the nature of Being as experienced by early modern Scots. This provides a foundation for further studies, which can draw in other materials not explored here such as communion wares and metal charms. Comparison with other early modern Western societies may also prove fruitful. Furthermore, the methodology may be suitable for application to other interdisciplinary projects incorporating historical and material evidence.

Diseño y aplicación de un modelo de remuneración variable para una empresa del sector de las telecomunicaciones

Actualmente encontramos una fuerte presión en las organizaciones por adaptarse a un mundo competitivo con un descenso en las utilidades y una incertidumbre constante en su flujo de caja. Estas circunstancias obligan a las organizaciones al mejoramiento continuo buscando nuevas formas de gestionar sus procesos y sus recursos. Para las organizaciones de prestación de servicios en el sector de telecomunicaciones una de las ventajas competitivas más importantes de obtener es la productividad debido a que sus ganancias dependen directamente del número de actividades que puedan ejecutar cada empleado. El reto es hacer más con menos y con mejor calidad. Para lograrlo, la necesidad de gestionar efectivamente los recursos humanos aparece, y aquí es donde los sistemas de compensación toman un rol importante. El objetivo en este trabajo es diseñar y aplicar un modelo de remuneración variable para una empresa de prestación de servicios profesionales en el sector de las telecomunicaciones y con esto aportar al estudio de la gestión del desempeño y del talento humano en Colombia. Su realización permitió la documentación del diseño y aplicación del modelo de remuneración variable en un proyecto del sector de telecomunicaciones en Colombia. Su diseño utilizó las tendencias de programas remunerativos y teorías de gestión de desempeño para lograr un modelo integral que permita el crecimiento sostenido en el largo plazo y la motivación al recurso más importante de la organización que es el talento humano. Su aplicación permitió también la documentación de problemas y aciertos en la implementación de estos modelos.