Primary Medical Care in the United Kingdom
Department of Health Services Research, University of Cambridge, Institute of Public Health, Cambridge, England, United Kingdom.The Journal of the American Board of Family Medicine (Impact Factor: 1.98). 03/2012; 25 Suppl 1(Suppl 1):S6-11. DOI: 10.3122/jabfm.2012.02.110200
Since 1948 health care in the United Kingdom (UK) has been centrally funded through the National Health Service (NHS). The NHS provides both primary and specialist health care which is largely free at the point of delivery. Family practitioners are responsible for registered populations of patients and typically work in groups of 4-6 self-employed physicians. They hire nurses and a range of other ancillary staff, and act as gatekeepers to specialist care. Recent reforms include a wide range of national quality improvement initiatives and a pay for performance scheme that accounts for around 25% of family practitioners' income. These reforms have been associated with some major improvements in quality, including improved chronic disease management and reduced waiting times for specialist care. The four countries of the UK differ in some important aspects of health care organization: proposed reforms in England would move towards a more market-driven system, with family practitioners acting as payers for specialist care and controlling 70% of the NHS budget. The other countries (Scotland, Wales and Northern Ireland) focus more on trying to create area-based integrated systems of care.
- The Journal of the American Board of Family Medicine 03/2012; 25 Suppl 1(Suppl 1):S2-5. DOI:10.3122/jabfm.2012.02.120005 · 1.98 Impact Factor
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ABSTRACT: Quality is a hallmark of health care, although it is difficult to come to a consensus on who gets to define what "quality health care" is. Most health-care workers enter this field with the goal of improving the health of their patients (and the community), and while everyone tries to do the best job possible, we must continuously seek better methods and techniques for achieving better outcomes. The passion for continuous improvement is fundamental, but passion is not sufficient by itself. There is substantial opportunity to improve quality and reduce cost in health care. Multidisciplinary teams that include physicians, nurses, and other ancillary care providers have led to decreased waiting times to see specialists and have also led to better management of chronic disease. By including ancillary care, providers can increase cancer-screening rates and have the potential to decrease readmissions. Moreover, the addition of hospitalists and physician assistants can produce quality and efficiency outcomes that are commensurate with those enjoyed by traditional house staff. However, truly improving performance is difficult due to questions about how we define "quality," design care processes, measure inputs and outputs, develop multi-stakeholder collaborations, and develop incentive programs for delivering "good" care. There is a definite need for more thorough and robust studies of the impact of pay-for-performance programs, with the inclusion of ancillary care providers. Current research has not shown that there is not enough evidence to be able to determine what incentive structure might "work" in a particular health-care system. Payment systems will continue to evolve to incentivize greater collaboration among providers to yield higher-quality, lower-cost care. Future efforts will necessitate the need for strong physician leadership in helping to develop an optimal care team that is as patient-centered as possible. Technology adds dimensions of capability to making improvement real and systematic, as well as providing safer care with fewer errors and better adherence to proven best practices. The drive for quality with technology produces better clinical outcomes and maximizes efficiencies and financial metrics of organizational performance. Technology also adds capabilities for capturing key metrics and reporting them back to clinicians and others. Improved data transparency informs those who can actually do things differently to produce better results and outcomes. While health-care entities strive to focus on quality of care, measuring and reporting such care in a meaningful way are difficult. The best chance of improving overall care for patients is through the adoption of systems that improve coordination and continuity, not by health-care staff working harder. Only through collaboration and integration can health care incorporate a culture for improving quality and patient safety.The Journal of Bone and Joint Surgery 01/2013; 95(1):e31-9. DOI:10.2106/JBJS.L.00093 · 5.28 Impact Factor
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ABSTRACT: Confidence in healthcare may influence the patients' utilisation of healthcare resources and perceptions of healthcare quality. We sought to determine whether self-reported confidence in healthcare differed between the UK and the USA, as well as by rurality or urbanicity. A secondary analysis of a subset of survey questions regarding self-reported confidence in healthcare from the 2010 Commonwealth Fund International Health Policy Survey. Telephone survey of participants from the UK and the USA. Our final analysis included 1511 UK residents (688 rural, 446 suburban, 372 urban, 5 uncategorised) and 2501 US residents (536 rural, 1294 suburban, 671 urban). Questions assessed respondents' confidence in the effectiveness and affordability of the treatment. We compared survey outcomes from these questions between, and within, the two regions and among, and within, residence types (rural, suburban and urban). Significant differences were found in self-reported confidence in healthcare between the UK and US, among residence types, and between the two regions within residence types. Reported levels were higher in the UK. Within regions, significant differences by residence type were found for the US, but not the UK. Within the US, suburban respondents had the highest self-reported confidence in healthcare. Significant differences exist between the UK and US in confidence in healthcare. In the US, but not in the UK, self-reported confidence is related to residence type. Within countries, significant differences by residence type were found for the US, but not the UK. Our findings warrant the examination of causes for relative confidence levels in healthcare between regions and among US residence types.BMJ Open 05/2013; 3(5). DOI:10.1136/bmjopen-2013-002640 · 2.27 Impact Factor
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