GPs should have greater role in commissioning hospital services
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《英国医生杂志》
The British government should encourage GPs to take responsibility for commissioning hospital services on behalf of their patients, says the King抯 Fund charity.
The report, published this week, examined the implications of implementing a strategy whereby GPs and other primary care staff are given greater scope to shape services in their locality梐 policy known as practice led commissioning.
This policy would harness the talents of clinicians in managing and planning health services, something that has not happened in primary care trusts, where there are only small groups of doctors and nurses on official boards, says the report.
Primary care trusts have not made much impact on wider NHS decision making and have not yet proved to be adept at this crucial commissioning role, it continues. Instead, the commissioning power should be devolved from primary care trusts to primary care practices run by GPs and other health professionals, the report argues.
The report抯 author, Richard Lewis, said: "This could also help reduce the burden on already over-stretched hospitals. It should help reorganise healthcare delivery around local services and act as a powerful incentive to pull patients back into the community. It抯 a great idea; the problem is that so far it has failed to receive the attention of other government health reforms."
Practice led commissioning shares many similarities with the old GP fundholding scheme, to which the report made a direct comparison. GP fundholding was a prominent feature of the Conservative government抯 internal market in the NHS in the 1990s and was scrapped by Labour in 1997. Under this scheme, practices were allocated a cash limited budget to purchase services directly from healthcare providers on behalf of their local communities.
GP fundholding, at the time, aroused "enormous tensions within the NHS" and "divided the GP community," comments the report. However, it argues, although fundholding in its original form is no longer an appropriate model, a variation would have benefits in the context of today抯 health system, where patients are to be given a choice about where they are treated. The National Association of Primary Care and the NHS Alliance, which helped develop the report, agree with the report抯 findings.
The chief executive of the King抯 Fund, Niall Dickson, said: "The new market will operate in a different way —:with fixed prices for all operations, which should remove the potential for individual practices to lever favourable prices from hospitals desperate for extra income.
"All that should go some way to reducing anxiety over potential inequities that in theory could re-emerge if some GP practices are given greater freedoms to commission over others."(London Debashis Singh)
The report, published this week, examined the implications of implementing a strategy whereby GPs and other primary care staff are given greater scope to shape services in their locality梐 policy known as practice led commissioning.
This policy would harness the talents of clinicians in managing and planning health services, something that has not happened in primary care trusts, where there are only small groups of doctors and nurses on official boards, says the report.
Primary care trusts have not made much impact on wider NHS decision making and have not yet proved to be adept at this crucial commissioning role, it continues. Instead, the commissioning power should be devolved from primary care trusts to primary care practices run by GPs and other health professionals, the report argues.
The report抯 author, Richard Lewis, said: "This could also help reduce the burden on already over-stretched hospitals. It should help reorganise healthcare delivery around local services and act as a powerful incentive to pull patients back into the community. It抯 a great idea; the problem is that so far it has failed to receive the attention of other government health reforms."
Practice led commissioning shares many similarities with the old GP fundholding scheme, to which the report made a direct comparison. GP fundholding was a prominent feature of the Conservative government抯 internal market in the NHS in the 1990s and was scrapped by Labour in 1997. Under this scheme, practices were allocated a cash limited budget to purchase services directly from healthcare providers on behalf of their local communities.
GP fundholding, at the time, aroused "enormous tensions within the NHS" and "divided the GP community," comments the report. However, it argues, although fundholding in its original form is no longer an appropriate model, a variation would have benefits in the context of today抯 health system, where patients are to be given a choice about where they are treated. The National Association of Primary Care and the NHS Alliance, which helped develop the report, agree with the report抯 findings.
The chief executive of the King抯 Fund, Niall Dickson, said: "The new market will operate in a different way —:with fixed prices for all operations, which should remove the potential for individual practices to lever favourable prices from hospitals desperate for extra income.
"All that should go some way to reducing anxiety over potential inequities that in theory could re-emerge if some GP practices are given greater freedoms to commission over others."(London Debashis Singh)