Pedersen L L, Leese B
National Primary Care Research and Development Centre, University of Manchester.
BMJ. 1997 May 3;314(7090):1337-41. doi: 10.1136/bmj.314.7090.1337.
Ongoing negotiations on the general practitioner contract raise the question of remunerating general practitioners for increased workload resulting from the shift from secondary to primary care. A review of the literature shows that there is little evidence on whether a shift of services from secondary to primary care is responsible for general practitioners' increased workload, and scope for making generalisations is limited. The implication is that general practitioners have little more than anecdotal evidence to support their claims of greatly increased workloads, and there is insufficient evidence to make informed decisions about remunerating general practitioners for the extra work resulting from the changes. Lack of evidence does not, however, mean that there is no problem with workload. It will be increasingly important to identify mechanisms for ensuring that resources follow workload.
目前关于全科医生合同的谈判引发了一个问题，即如何因应从二级医疗向初级医疗转变导致的工作量增加而对全科医生进行薪酬补偿。文献综述表明，几乎没有证据能证明从二级医疗向初级医疗的服务转移是否导致了全科医生工作量的增加，而且进行归纳总结的空间有限。这意味着全科医生支持其工作量大幅增加说法的依据仅仅是轶事证据，并且没有足够的证据来就因这些变化产生的额外工作对全科医生进行薪酬补偿做出明智的决策。然而，缺乏证据并不意味着工作量不存在问题。确定确保资源随工作量变动的机制将变得越来越重要。
