ScHARR, University of Sheffield, Sheffield, UK.
J Health Serv Res Policy. 2012 Jan;17 Suppl 1:31-9. doi: 10.1258/jhsrp.2011.010191.
To determine the extent to which primary care trusts (PCTs) in England employed processes associated with quality commissioning and to assess whether changes occurred in these processes during a policy drive to improve commissioning.
Telephone surveys of PCT managers leading commissioning for diabetes, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), and emergency and urgent care in all 152 PCTs in both 2009 and 2010.
The response rate was 51% (77/152) of PCTs in 2009 and 60% (91/152) in 2010. Two-thirds of commissioners had commissioned initiatives starting in the previous financial year. Over half of initiatives starting in 2008/09 had been instigated by the PCT alone. This reduced to a third in 2010, showing a shift towards partnership working. Commissioners reported that a large proportion of initiatives had been developed and shaped with the involvement of general practitioners (GPs) with direct links to the PCT and of specialist clinicians (70%), but that a lower proportion of initiatives had involvement from other GPs (40%). Patients or the public were less likely to be involved in initiatives than clinicians, but there was evidence of increasing involvement over the two years from 35% (52/149) to 51% (67/132) of initiatives. There was no evidence of changes in whether needs assessment was undertaken, how evidence was used or how initiatives were led and performance managed.
PCT commissioners reported clinical engagement in the majority of commissioning initiatives, a shift towards partnership commissioning, and increased involvement of patients and public in the development of initiatives. The new model of commissioning in England through clinical commissioning groups will need to improve on these processes if it is to demonstrate a higher quality approach to commissioning.
确定英格兰的初级保健信托（PCT）在多大程度上采用了与质量委托相关的流程，并评估在改善委托政策推动期间这些流程是否发生了变化。
对英格兰所有 152 个 PCT 中负责糖尿病、慢性阻塞性肺疾病（COPD）、冠心病（CHD）以及急诊和紧急护理的委托管理的 PCT 经理进行了电话调查，调查分别于 2009 年和 2010 年进行。
2009 年的响应率为 51%（77/152），2010 年为 60%（91/152）。三分之二的委托者已经启动了上一个财政年度开始的委托计划。2008/09 年开始的计划中有一半以上是由 PCT 单独发起的。这一比例在 2010 年降至三分之一，表明合作工作的转变。委托者报告说，很大一部分计划是在与 PCT 有直接联系的全科医生（GP）和专科临床医生（70%）的参与下制定和形成的，但只有 40%的计划涉及其他 GP。患者或公众参与计划的比例低于临床医生，但有证据表明，在这两年中，参与度从 35%（52/149）增加到 51%（67/132）。没有证据表明是否进行了需求评估、如何使用证据或如何领导和管理计划的方式发生了变化。
PCT 委托者报告说，在大多数委托计划中都有临床医生的参与，合作委托的模式发生了转变，患者和公众在计划的制定过程中也有了更多的参与。如果要展示对委托的更高质量方法，英格兰通过临床委托小组实施的新委托模式将需要改进这些流程。
