Black D G, Birchall A D, Trimble I M
Nottingham Non-fundholders, Sherwood Health Centre.
BMJ. 1994 Oct 8;309(6959):930-2. doi: 10.1136/bmj.309.6959.930.
The 1991 health service reforms introduced the internal market and grave individual fundholding practices budgets with which they could attempt to secure preferential access to secondary health care for their patients. In the view of many doctors this undermined the principle of equity on which the NHS was founded. In Nottingham 200 non-fundholding general practitioners have joined together to act in liaison with their purchasing health authority. A committed representative group of general practitioners can collectively offer more time and knowledge to the contracting process while minimising the impact on clinical workload. As a large purchaser with low management costs the group has secured access to quality secondary care which is equitably available to all patients, preventing the development of a local two tier service. Nottingham's non-fundholding model of commissioning is equitable and efficient.
1991年的医疗服务改革引入了内部市场和严重的个人基金持有做法预算，通过这些预算，他们可以试图为患者争取优先获得二级医疗服务的机会。在许多医生看来，这破坏了国民医疗服务体系建立所基于的公平原则。在诺丁汉，200名非基金持有全科医生联合起来，与他们的采购卫生当局联络。一群忠诚的全科医生代表可以集体为签约过程提供更多时间和知识，同时将对临床工作量的影响降至最低。作为一个管理成本低的大采购方，该组织已获得了所有患者均可公平享有的优质二级医疗服务，防止了当地两级服务的发展。诺丁汉的非基金持有委托模式是公平且高效的。
