Spurgeon Peter, Hicks Carolyn, Field Stephen, Barwell Fred
University of Birmingham, Birmingham B15 2RT, UK.
Health Serv Manage Res. 2005 May;18(2):75-85. doi: 10.1258/0951484053723108.
In February 2003, a new General Practitioner (GP) contract was agreed between the profession's leaders and the government, which was later accepted following a national ballot of GPs. However, the ballot simply required respondents to vote for or against the proposal; it did not provide any opportunity to identify which aspects of the new contract were more or less acceptable. Since the proposed changes were far reaching, the implications of implementing and managing these were considerable. Consequently, some information about how GPs viewed various components of the new contract would enable a more targeted and effective management strategy to be developed that would facilitate the introduction of all aspects of the contract.
To survey GPs working within the West Midlands region regarding their opinions on each of the key features of the new contract.
A postal survey of 360 GPs was undertaken, using a specially devised questionnaire.
Four factors emerged as the most acceptable aspects of the contract: option to opt out of out-of-hours work, flexibility in the services provided, prediction of future income levels and linking practice to performance targets. Least acceptable were: performance monitoring systems, the new financial formula for calculating income, greater patient involvement in service development and 24/48 hour access. With regard to potential outcomes of the contract, the most positive were considered to be increased proportion of salaried GPs, increased salaries, appropriate quality standards for care, earlier retirement; the factors least likely to be of potential benefit were: reduction in occupational stress, simplification of the regulatory framework, improved equity of workload and improved staff retention. Further analysis of the results using inferential statistics revealed a range of subgroup differences in reaction to the contract.
Overall, those aspects of the new contract that are perceived to reduce workload and enhance salary were supported, while those that increase targets and bureaucracy were not. Generally, there was only moderate support for the changes, which could be explained by a general scepticism about any top-down modifications, the practicality and power of the changes to impact upon practice and/or a genuine belief that the modifications are unacceptable. Taken together, these results provide an indicative focus for managing the implementation of the new contract, especially with regard to its least acceptable components and the emerging differences between subgroups of GPs.
2003年2月，该行业的领导者与政府达成了一项新的全科医生合同，随后在全科医生的全国投票中获得通过。然而，这次投票只是要求受访者对该提案投赞成票或反对票；它没有提供任何机会来确定新合同的哪些方面或多或少是可以接受的。由于提议的变革影响深远，实施和管理这些变革的影响相当大。因此，一些关于全科医生如何看待新合同各个组成部分的信息，将有助于制定更有针对性和有效的管理策略，以促进合同各方面的引入。
调查西米德兰兹地区的全科医生对新合同各关键特征的看法。
使用专门设计的问卷对360名全科医生进行邮寄调查。
四个因素被认为是合同中最可接受的方面：选择不参与非工作时间的工作、所提供服务的灵活性、未来收入水平的预测以及将执业表现与绩效目标挂钩。最不可接受的是：绩效监测系统、计算收入的新财务公式、患者更多地参与服务开发以及24/48小时就诊服务。关于合同的潜在结果，最积极的方面被认为是受薪全科医生比例增加、薪资提高、适当的护理质量标准、提前退休；最不太可能带来潜在益处的因素是：职业压力减轻、监管框架简化、工作量公平性改善以及员工留用率提高。使用推断统计对结果进行的进一步分析揭示了在对合同的反应方面存在一系列亚组差异。
总体而言，新合同中那些被认为能够减轻工作量和提高薪资的方面得到了支持，而那些增加目标和官僚作风的方面则未得到支持。一般来说，对这些变革的支持程度适中，这可以通过对任何自上而下的修改普遍持怀疑态度、这些变革对实践产生影响的实用性和力度，以及/或者认为这些修改不可接受的真实信念来解释。综合来看，这些结果为管理新合同的实施提供了一个指示性重点，特别是在其最不可接受的组成部分以及全科医生亚组之间出现的差异方面。
