Perkins Neil, Coleman Anna, Wright Michael, Gadsby Erica, McDermott Imelda, Petsoulas Christina, Checkland Kath
Centre for Primary Care, University of Manchester, Manchester, UK.
Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW, Australia.
Br J Gen Pract. 2014 Nov;64(628):e728-34. doi: 10.3399/bjgp14X682321.
The 2012 Health and Social Care Act in England replaced primary care trusts with clinical commissioning groups (CCGs) as the main purchasing organisations. These new organisations are GP-led, and it was claimed that this increased clinical input would significantly improve commissioning practice.
To explore some of the key assumptions underpinning CCGs, and to examine the claim that GPs bring 'added value' to commissioning.
In-depth interviews with clinicians and managers across seven CCGs in England between April and September 2013.
A total of 40 clinicians and managers were interviewed. Interviews focused on the perceived 'added value' that GPs bring to commissioning.
Claims to GP 'added value' centred on their intimate knowledge of their patients. It was argued that this detailed and concrete knowledge improves service design and that a close working relationship between GPs and managers strengthens the ability of managers to negotiate. However, responders also expressed concerns about the large workload that they face and about the difficulty in engaging with the wider body of GPs.
GPs have been involved in commissioning in many ways since fundholding in the 1990s, and claims such as these are not new. The key question is whether these new organisations better support and enable the effective use of this knowledge. Furthermore, emphasis on experiential knowledge brings with it concerns about representativeness and the extent to which other voices are heard. Finally, the implicit privileging of GPs' personal knowledge ahead of systematic public health intelligence also requires exploration.
2012年英国《健康与社会照护法案》用临床委托小组（CCGs）取代了初级医疗保健信托基金，使其成为主要采购机构。这些新机构由全科医生主导，据称这种增加的临床投入将显著改善委托实践。
探讨支撑临床委托小组的一些关键假设，并检验全科医生为委托工作带来“附加值”这一说法。
2013年4月至9月期间，对英格兰七个临床委托小组的临床医生和管理人员进行深入访谈。
共访谈了40名临床医生和管理人员。访谈聚焦于全科医生给委托工作带来的感知“附加值”。
关于全科医生“附加值”的说法集中在他们对患者的深入了解上。有人认为，这种详细而具体的了解能改进服务设计，且全科医生与管理人员之间密切的工作关系能增强管理人员的谈判能力。然而，受访者也表达了对他们面临的巨大工作量以及与更广泛的全科医生群体沟通困难的担忧。
自20世纪90年代实行基金持有制以来，全科医生就以多种方式参与委托工作，诸如此类的说法并不新鲜。关键问题是这些新机构是否能更好地支持并有效利用这些知识。此外，对经验知识的强调引发了对代表性以及其他声音被倾听程度的担忧。最后，在系统的公共卫生情报之前，对全科医生个人知识的隐性优待也需要探讨。
