Koperski M, Rodnick J E
Department of Family and Community Medicine, University of California, San Francisco 94143, USA.
J Fam Pract. 1999 Feb;48(2):140-5.
In 1990, changes to the National Health Service (NHS) in the United Kingdom introduced a form of US-style competition that broadened the role of general practitioners (GPs). However, the changes (called GP fundholding) produced greater inequality between practices and reduced the capacity of the NHS to plan strategically. Alternative models have been developed that retain the increased influence of primary care, promote community-oriented primary care (COPC), and facilitate strategic planning. A recent proposal from the government turns away from the competition model of 1990 to encourage GP commissioning. It offers the opportunity to create an NHS that is led by a primary care agenda, including better links with the community, and a focus on public health and social services with the goal of improving the health of populations.
1990年，英国国民医疗服务体系（NHS）的改革引入了一种美式竞争形式，扩大了全科医生（GPs）的职责。然而，这些变革（称为全科医生基金持有制）加剧了各医疗机构之间的不平等，并削弱了国民医疗服务体系进行战略规划的能力。人们已经开发出了替代模式，这些模式保留了初级医疗增加的影响力，促进了以社区为导向的初级医疗（COPC），并推动了战略规划。政府最近提出的一项提议摒弃了1990年的竞争模式，转而鼓励全科医生进行医疗服务委托。它提供了一个机会，来创建一个由初级医疗议程主导的国民医疗服务体系，包括与社区建立更好的联系，并关注公共卫生和社会服务，目标是改善民众的健康状况。
