Solving the Recruitment Crisis in UK General Practice: Time to Consider Physician Assistants?

With large numbers of GPs due to retire by 2007, the recruitment and retention crisis in UK general practice is likely to get worse before it gets better. Urgent measures are now required. Policies such as offering doctors financial incentives to enter general practice or delay retirement, while increasing the number of medical school places, may, for a variety of reasons, be likely to enjoy only limited success. In this article, a more radical solution is proposed: the creation of an intermediate medical practitioner role, along the lines of the physician assistant in the USA. The establishment of such a role may go some way to resolving the workforce crisis that currently besets general practice and ensure that medical needs, especially in deprived areas, are adequately met. A number of specific occupational groups who may find the PA role attractive are identified. It is suggested that refugee doctors, unable to practise in the UK, may find PA training particularly attractive, especially if it could serve as a stepping-stone to GMC registration.     

The effects of prevailing wage laws: A comparison of individual workers’ wages earned on and off prevailing wage construction projects

I evaluate the effects of prevailing wage laws using a unique data set that shows the wages paid to workers on prevailing wage projects and the wages paid to the same workers during the same time period for work on projects not covered by prevailing wage regulations. The wage comparison shows that workers are generally paid more for work on prevailing wage projects than they are for work on nonprevailing wage projects. Thus, prevailing wage laws likely do increase the cost of public construction. In addition, to the extent that the quality of construction is improved, prevailing wage laws appear to be an inefficient mechanism by which to achieve additional quality, as the regulations often result in workers being paid more than they earn in the private market. This research was done originally for the Program Review and Investigations Committee of the Kentucky State Legislature. I thank the staff of the Program Review and Investigations Committee and the Legisla-tive Research Commission for assistance with data collection and Mark Berger for helpful comments. Due to confidentiality requirements, the data cannot be made available.     

Politics and Power within Multinational Corporations: Mainstream Studies,Emerging Critical Approaches and Suggestions for Future Research

Given the increased public interest in the use and misuse of power in multinationals in the aftermath of the financial crisis, it is notable that power relations in multinational corporations (MNCs) have not gained enhanced attention in the academic community. What is missing so far in the study of MNCs is a systematic examination of how power and politics within MNCs have been addressed in mainstream international business (IB) and sociological research studying the MNC. This paper starts by critically reviewing these two mainstream approaches in the study of MNCs as organizations and seeking to understand the shortcomings of former research. Next, it reviews new emergent critical perspectives, which the authors call socio‐political studies of MNCs, where power and politics are addressed not just more prominently, but also differently, from a more bottom‐up and actor‐centred perspective. After reviewing this emergent stream of research, the authors propose that future studies should take a more micro‐political perspective and focus in more detail on the micro‐foundations of power relations. In the concluding section, the authors show how future studies of MNCs can learn from both critical interactionist and discursive theories when analysing organizational politics and power relations. A framework is proposed for the study of micro‐level political game‐playing in MNCs, based on a three‐dimensional framework for organizational power (episodic, rules of the game and domination), and some key research questions for future studies are suggested.     

Revisiting the Rural-Urban Contrast: Personal Networks in Nonmetropolitan and Metropolitan Settings1

Abstract To revisit the rural-urban contrast, we use data from non-metropolitan and metropolitan subsamples of the 1985 General Social Survey to test whether, compared to personal networks in urban settings, personal networks in rural settings contain ties of greater intensity and role multiplexity, are based more on kinship and neighborhood solidarities rather than on friendship, are smaller, are denser, and have greater educational, race-ethnic, and religious homogeneity, but less age and gender homogeneity. Our results are generally consistent with these predictions. We then present evidence for rural diversity by comparing data from residents of a two-parish nonmetropolitan area in southwestern Louisiana to the nonmetropolitan subsample of the GSS. After discussing possible mechanisms for this covariation of spatial and aspatial communities, we conclude by commenting on the potential of network analysis to contribute to the resolution of these and other substantively important problems in rural sociology.     

Missing years of abuse in children's homes

This paper reflects upon the historic abuse of young people living in children's homes. Beginning with a recognition of ‘individual abuse’, it explores, first of all, the reasons why young people were abused, including: (1) the status of childhood and being in care; (2) the application of ‘approved’ treatment methods; (3) the failure of managerial, organizational and inspection systems; and (4) the institutional critique and the popularity of preventative policies. Second, by identifying common themes arising from this account, it is suggested we need to rethink the way abuse has been conceptualized. Individual direct abuse, sanctioned abuse, organized systematic abuse and system outcome abuse are discussed. Finally, the paper reviews recent changes in law, policy and practice, including the Children Act 2004, designed to prevent abuses happening again. It is argued that challenges still remain in addressing structural inequalities, improving protection, balancing needs and rights, extending protection to different groups of young people and in having a preventative vision for children's homes.     

Professionalism, educated labour and the state: hospital medicine and the new managerialism

This article examines the degree to which doctors, as members of an autonomous profession, function as organic intellectuals within capitalist society (Abercrombie and Urry, 1983) and, more generally, the complex and ambivalent relations that sustain their role within a ‘service class'. It is in this context that the organization of medical care and its delivery in Britain will be addressed. In particular, the current and intended changes in the organization and control of hospital medicine within the NHS, notably the issues of medical audit, clinical budgeting and the role of the ‘internal market’.     

On the block structure of proper block designs

In this paper we consider proper block designs and derive an upper bound for the number of blocks which can have a fixed number of symbols common with a given block of the design. To arrive at the desired bound, a generalization of an integer programming theorem due to Bush (1976) is first obtained. The integer programming theorem is then used to derive the main result of this paper. The bound given here is then compared with a similar bound obtained by Kageyama and Tsuji (1977).