Abbott S, Petchey R, Kessel A, Killoran A
Public Health and Primary Care Unit, St Bartholomew School of Nursing and Midwifery, City University Institute of Health Sciences, 20 Bartholomew Close, London EC1A 7QN, UK.
Public Health. 2006 Jun;120(6):551-6. doi: 10.1016/j.puhe.2005.12.001. Epub 2006 May 8.
Re-organization of the English National Health Service (NHS) has fragmented the public health workforce, relocating teams from about 100 health authorities into over 300 primary care trusts (PCTs). The UK Government announced the setting up of public health networks (PHNs) as a solution to the problems created by fragmentation.
Fifty-seven semi-structured telephone interviews were held with key players in PHNs in all strategic health authority areas in England in early 2003.
PHNs appeared to be primarily networks of public health professionals rather than of organizations. Informants were unsure about PCTs' commitment to public health. Predominantly, members were those NHS personnel with a clear and explicit public health role. Most PHNs intended to include others later (e.g. health visitors, environmental health officers), although a few thought that inclusivity was essential from the start. Continuing professional development for public health personnel dominated the work being undertaken, with some collaborative work across PCTs. PHNs were seen as a compulsory reconfiguration of existing networks, and informants doubted that they were appropriate for the many levels of networking that public health work requires.
The formation of PHNs does not appear to have been either necessary or sufficient. However, the public health community has a well-established tradition of networking, and therefore has the skills to use PHNs advantageously.
英国国家医疗服务体系(NHS)的重组使公共卫生工作队伍碎片化,各团队从约100个卫生当局重新安置到300多个初级保健信托基金(PCT)中。英国政府宣布建立公共卫生网络(PHN),以解决碎片化带来的问题。
2003年初,对英格兰所有战略卫生当局地区的公共卫生网络关键参与者进行了57次半结构化电话访谈。
公共卫生网络似乎主要是公共卫生专业人员的网络,而非组织网络。受访者不确定初级保健信托基金对公共卫生的承诺。主要成员是那些在公共卫生方面有明确角色的国民医疗服务体系人员。大多数公共卫生网络打算稍后纳入其他人员(如健康访视员、环境卫生官员),不过少数人认为从一开始就应包容各方。公共卫生人员的持续专业发展主导着正在开展的工作,同时也有一些跨初级保健信托基金的合作工作。公共卫生网络被视为对现有网络的强制性重新配置,受访者怀疑它们是否适合公共卫生工作所需的多层次网络建设。
公共卫生网络的形成似乎既非必要,也不充分。然而,公共卫生界有着悠久的网络建设传统,因此有能力有效地利用公共卫生网络。