Heller Richard F, Edwards Richard, Patterson Lesley, Elhassan Moneim
Evidence for Population Health Unit, School of Epidemiology and Health Sciences, Medical School, University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK.
Public Health. 2003 May;117(3):157-64. doi: 10.1016/S0033-3506(03)00081-7.
This study was commissioned by the UK Health Development Agency to provide a snapshot of how, at the outset of the 2002 NHS reorganisation, Primary Care Trust (PCT) staff and Professional Executive Committee (PEC) members perceived their public health roles and functions, the opportunities and barriers to delivering those roles and functions and the development needs in order to fulfill them.
Taped group interviews were conducted with PECs of eight PCTs (covering a range of settings, size and stage of organisational development), followed up by structured telephone interviews with 35 frontline staff from four of the PCTs. Analysis was through content analysis and counting of themes including a quantitative assessment of the occurrence of themes and comparison between different categories of participants.
PEC members and frontline staff (particularly community based staff) were keen to address a broad public health agenda within the new PCTs, however a number of barriers to the ability of the PCT to fulfill its Public Health role were identified. The most important were lack of resources (staff and staff time) in the context of a host of competing agendas and excessive clinical workloads. There was a clear difference among frontline staff between those who were practice or community based-many practice-based frontline staff did not acknowledge any major public health dimensions to their daily work. A number of detailed suggestions for improvement were made.
At the start of the 2002 NHS reorganisation, PCTs need to improve their organisational capacity to address the public health if they are to deliver health improvement as envisaged. We make recommendations which should allow PCTs to perform their public health functions more effectively.
本研究由英国卫生发展局委托开展，旨在呈现2002年国民健康服务体系（NHS）重组初期，初级保健信托基金（PCT）工作人员和专业执行委员会（PEC）成员如何看待其公共卫生角色与职能、履行这些角色与职能的机遇和障碍以及为实现这些职能的发展需求。
对8个PCT的PEC进行了小组访谈录音（涵盖一系列组织发展的环境、规模和阶段），随后对其中4个PCT的35名一线工作人员进行了结构化电话访谈。分析采用内容分析法并对主题进行计数，包括对主题出现情况的定量评估以及不同类别参与者之间的比较。
PEC成员和一线工作人员（尤其是社区工作人员）热衷于在新的PCT内处理广泛的公共卫生议程，但也发现了一些阻碍PCT履行其公共卫生角色的因素。最重要的是在众多相互竞争的议程背景下缺乏资源（人员和人员时间）以及临床工作量过大。一线工作人员中，基于诊所或社区的人员存在明显差异——许多基于诊所的一线工作人员不承认其日常工作中有任何重大的公共卫生层面。提出了一些详细的改进建议。
在2002年NHS重组开始时，PCT若要按设想实现健康改善，就需要提高其处理公共卫生问题的组织能力。我们提出了一些建议，应能使PCT更有效地履行其公共卫生职能。
