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An Exploration of How Clinical Commissioning Groups Are Tackling Health Inequalities

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An Exploration of How Clinical Commissioning Groups Are Tackling Health Inequalities The University of Manchester Research ‘An exploration of how Clinical Commissioning Groups (CCGs) are tackling health inequalities in England’ Link to publication record in Manchester Research Explorer Citation for published version (APA): Warwick-Giles, L. (2014). ‘An exploration of how Clinical Commissioning Groups (CCGs) are tackling health inequalities in England’. University of Manchester. Citing this paper Please note that where the full-text provided on Manchester Research Explorer is the Author Accepted Manuscript or Proof version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version. General rights Copyright and moral rights for the publications made accessible in the Research Explorer are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. Takedown policy If you believe that this document breaches copyright please refer to the University of Manchester’s Takedown Procedures [http://man.ac.uk/04Y6Bo] or contact [email protected] providing relevant details, so we can investigate your claim. Download date:06. Oct. 2021 An exploration of how Clinical Commissioning Groups are tackling health inequalities ‘A thesis submitted to the University of Manchester for the degree of Doctor of Philosophy (Ph.D.) in the Faculty of Medical and Human Sciences’ 2014 Lynsey Warwick-Giles School of Medicine Health Policy Politics and Organisation Group (HiPPO) Centre for Primary Care Table of Contents Abbreviations ............................................................................................................................................ 8 Table of Figures ........................................................................................................................................ 9 Abstract ................................................................................................................................................... 10 Declaration and Copyright Statement ..................................................................................................... 11 Acknowledgements ................................................................................................................................. 12 Chapter 1: Thesis Overview .............................................................................................................. 13 1.1 Introduction .............................................................................................................................. 13 1.2 Novelty of the Research .......................................................................................................... 13 1.3 Thesis outline .......................................................................................................................... 14 Chapter 2: Literature Review ............................................................................................................ 16 2.1 Introduction .............................................................................................................................. 16 2.2 Equity and Equality ................................................................................................................. 17 2.3 Models and Causes of Health Inequalities .............................................................................. 18 2.3.1 The Inverse Care Law ..................................................................................................... 18 2.3.2 Behavioural & Cultural Model .......................................................................................... 19 2.3.3 Psycho-Social Model ....................................................................................................... 19 2.3.4 The Material Model.......................................................................................................... 20 2.3.5 Life Course Approach ..................................................................................................... 21 2.3.6 Social Determinants of Health ......................................................................................... 22 2.3.7 Summary ......................................................................................................................... 23 2.4 General Practitioners Role in Tackling Health Inequalities ..................................................... 23 2.4.1 Avoidable Mortality/Amenable Deaths ............................................................................ 24 2.4.2 Access to Services .......................................................................................................... 25 2.4.3 Partnerships .................................................................................................................... 27 2.4.4 Summary ......................................................................................................................... 30 Chapter 3: Policy Context ................................................................................................................. 32 3.1 Introduction .............................................................................................................................. 32 3.2 History of policy relating to health inequalities ........................................................................ 32 3.3 Equity and Policy ..................................................................................................................... 39 2 3.4 The current NHS reform .......................................................................................................... 40 3.4.1 Initial Proposals ............................................................................................................... 40 3.4.2 The Pause ....................................................................................................................... 40 3.4.3 Policy Amendments after the Pause ............................................................................... 41 3.4.4 Previous GP involvement with Commissioning ............................................................... 43 3.4.5 Current Situation ............................................................................................................. 44 3.5 Summary of the Health Inequalities Literature and Policy Context ......................................... 46 3.5.1 Health Inequalities and the Literature ............................................................................. 46 3.5.2 The Role of Healthcare ................................................................................................... 46 3.5.3 Policy Context ................................................................................................................. 46 Chapter 4: Theoretical Framework ................................................................................................... 49 4.1 Introduction .............................................................................................................................. 49 4.2 What is Sensemaking? ........................................................................................................... 52 4.3 Sensemaking in the literature .................................................................................................. 53 4.3.1 Studies of Disasters ........................................................................................................ 54 4.3.2 Studies of Organisational Change .................................................................................. 55 4.3.3 Studies of Power and Institutions .................................................................................... 56 4.4 Summary ................................................................................................................................. 57 Chapter 5: Methods ........................................................................................................................... 58 5.1 Introduction .............................................................................................................................. 58 5.2 Research Questions ................................................................................................................ 58 5.3 Research Design ..................................................................................................................... 60 5.4 Sampling ................................................................................................................................. 63 5.5 Access ..................................................................................................................................... 64 5.6 Data Collection Methods ......................................................................................................... 65 5.7 Data Analysis .......................................................................................................................... 68 5.8 Ethical issues and limitations .................................................................................................. 70 Chapter 6: Site Descriptions ............................................................................................................. 73 6.1 Introduction .............................................................................................................................
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