Social Policy Research Unit, University of York, Heslington, York, UK.
J Health Serv Res Policy. 2012 Apr;17(2):87-93. doi: 10.1258/jhsrp.2011.010176. Epub 2012 Feb 7.
To explore some of the key assumptions underpinning the continued development of general practitioner-led commissioning in health services.
Qualitative data from two studies of service improvement in the English NHS were considered against England's plans for GP-led commissioning. These data were collected through in-depth interviews with a total of 187 professionals and 99 people affected by services in 10 different primary care trust areas across England between 2008 and 2009.
Internationally, GPs are seen to have a central position in health systems. In keeping with this, the English policy places emphasis on the 'pivotal role' of general practitioners, considered to be ideally placed to commission in the best interests of their patients. However, our evidence suggests that general practitioners do not always have a pivotal role for all patients. Moreover, it is planned that the new commissioning groups in England will not be subject to top-down performance management and this raises the question of how agreed quality standards will be met under the proposed new system.
This paper questions the assumption that GPs are best placed to commission health services in a way that meets quality standards and leads to equitable outcomes. There is little evidence to suggest that GPs will succeed where others have failed and a risk that, without top-down performance management, service improvement will be patchy, leading to greater, not reduced, inequity.
探讨支持继续发展以全科医生为主导的医疗服务委托的一些关键假设。
对英格兰国民保健署（NHS）两项服务改进研究的定性数据进行了审议，并与英格兰关于以全科医生为主导的委托的计划进行了对比。这些数据是通过对英格兰 10 个不同初级保健信托地区的 187 名专业人员和 99 名受服务影响的人员进行深入访谈收集的，时间跨度为 2008 年至 2009 年。
在国际上，全科医生被认为在卫生系统中处于核心地位。为了保持这一地位，英国的政策强调全科医生的“关键作用”，认为他们最适合从患者的最佳利益出发进行委托。然而，我们的证据表明，全科医生并不总是对所有患者都具有关键作用。此外，计划中的英格兰新委托团体将不受自上而下的绩效管理的约束，这就提出了一个问题，即在拟议的新系统下，如何满足商定的质量标准。
本文对以下假设提出了质疑，即全科医生最适合以符合质量标准并导致公平结果的方式委托医疗服务。几乎没有证据表明全科医生会在其他人失败的地方取得成功，而且，如果没有自上而下的绩效管理，服务改进将参差不齐，导致更大而不是更小的不公平。
