Palmer J D
Department of Neurosurgery, Plymouth Hospitals NHS Trust, Plymouth, UK.
Br J Neurosurg. 2007 Apr;21(2):180-6. doi: 10.1080/02688690701317219.
The change programme in the National Health Service has moved the Acute Trusts providing neurosurgical services to very different ways of delivering healthcare. The process of reform has been supported by investment but the next few years will see far less additional money, and success and failure of services will be dependent upon the approach to those reforms. The 'payment by results' system of funding through tariff, the 'plurality of providers' policy of forcing commissioners to purchase activity from independent providers, the 'patient choice' process of encouraging patients to select treatment from a number of providers, and the '18-week wait' target of bringing down referral to treatment times are all major shifts in the way services are delivered and developed. The reforms have not been made with neurosurgery in mind, how will they affect the way this small specialty is delivered?
国民医疗服务体系的变革计划已促使提供神经外科服务的急症信托机构采用截然不同的医疗服务提供方式。改革进程得到了投资支持，但在接下来的几年里，新增资金将大幅减少，服务的成败将取决于改革的实施方式。通过关税进行“按绩效付费”的资金制度、迫使采购机构从独立供应商处购买服务的“供应商多元化”政策、鼓励患者从多家供应商中选择治疗方案的“患者选择”流程，以及缩短转诊至治疗时间的“18周等待期”目标，都是服务提供和发展方式的重大转变。这些改革并非针对神经外科制定，它们将如何影响这个小众专科的服务提供方式呢？
