Gray R W, Carter Y H, Hull S A, Sheldon M G, Ball C
Department of General Practice and Primary Care, St Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London.
Br J Gen Pract. 2001 May;51(466):371-4.
The movement of medical education into the community has accelerated the development of a new model of general practice in which core clinical services are complemented by educational and research activities involving the whole primary care team.
To compare quality indicators, workload characteristics, and health authority income of general practices involved in undergraduate medical education in east London with those of other practices in the area and national figures where available.
A comprehensive survey of undergraduate and postgraduate clinical placements and practice-based research activity within general practice.
One-hundred and sixty-one practices based in East London and the City Health Authority (ELCHA).
Cross-sectional survey comparing routinely-collected information on practice resources, workload, income, and performance between teaching and non-teaching practices.
In east London, teaching practices are larger partnerships with smaller list sizes, higher staff costs, and better quality premises than non-teaching practices. Teaching practices demonstrate significantly better performance on quality indicators, such as cervical cytology coverage and prescribing indicators. Patient-related health authority income per whole time equivalent (WTE) general practitioner (GP) is significantly lower among teaching practices. A multiple regression analysis was used to explore the association between teaching status and income. Eighty-eight per cent of the variation in patient-related income could be explained by the combination of list size, list turnover, removals at doctor's request, quality of premises, and immunisation and cytology rates.
This study demonstrates that practice involvement in undergraduate education in east London is associated with higher scores on a range of organisational and performance quality indicators. The lower patient-related income of teaching practices is associated with smaller list sizes and may only be partially replaced by teaching income. Lower vacancy rates suggest that teaching practices are more attractive to doctors seeking partnerships in east London.
医学教育向社区的拓展加速了一种新型全科医疗模式的发展，在这种模式中，核心临床服务由涉及整个基层医疗团队的教育和研究活动加以补充。
比较伦敦东部参与本科医学教育的全科医疗机构与该地区其他机构以及（如有）全国数据在质量指标、工作量特征和卫生当局收入方面的情况。
对本科和研究生临床实习以及全科医疗中基于实践的研究活动进行全面调查。
位于伦敦东部和城市卫生当局（ELCHA）的161家医疗机构。
横断面调查，比较教学机构和非教学机构在常规收集的关于机构资源、工作量、收入和绩效方面的信息。
在伦敦东部，教学机构是规模更大的合伙制机构，患者名单规模更小，员工成本更高，房舍质量更好。教学机构在质量指标方面表现显著更好，如宫颈细胞学检查覆盖率和处方指标。每名全职等效全科医生（GP）的患者相关卫生当局收入在教学机构中显著更低。采用多元回归分析来探究教学状态与收入之间的关联。患者相关收入88%的变化可以通过患者名单规模、名单周转率、应医生要求移除的患者、房舍质量以及免疫接种和细胞学检查率的综合情况来解释。
本研究表明，伦敦东部参与本科教育的机构在一系列组织和绩效质量指标上得分更高。教学机构中较低的患者相关收入与较小的患者名单规模有关，且可能仅部分由教学收入所弥补。较低的空缺率表明教学机构对在伦敦东部寻求合伙机会的医生更具吸引力。
