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背景英国《2012年健康和社会保健法案》取缔了初级保健信托,建立临床医生委托团体(clinical commissioning groups,CCGs)为主要购买机构。CCGs由全科医生(GPs)领导,主张加大投入以完善委托实践。目的检验CCGs的一些关键假设,评估GPs给委托带来的“附加值”。方法 2013年4—9月,对英格兰7个CCGs团体的临床医生及管理者进行了深度访谈。共有40名临床医生和管理者参加了访谈。访谈聚焦GPs对委托带来的附加值。结果受访者认为GPs的附加值主要在于他们对病人的了解。然而,关于对病人的详细了解能否改善服务设计,以及GPs与管理者之间的紧密合作能否增强管理者的交涉能力,被访者的意见并不一致。此外,受访者还对繁重的工作和参与更大GPs队伍工作的困难表示担忧。结论自20世纪90年代费用负责制(注:英国政府发给GPs支付某些医院服务费用的制度)实施以来,GPs就以各种方式参与委托实践,因而对于此类主张似乎并不陌生。关键问题是这些新机构能否提供更好的帮助,能否有效地运用此类知识。此外,对经验性知识的过度关注引发了担忧,因为这可能会影响代表性和其他意见的采纳。总之,GPs的个人知识是否优于系统的公共卫生情报还需进一步探究。
Background The Health and Social Care Act of 2012 in the United Kingdom has banned primary health care trusts and established clinical commissioning groups (CCGs) as its main buying agency. CCGs, led by GPs, advocate increased investment to improve commissioning practices. Objective To examine some of the key assumptions of CCGs and assess the “added value” that GPs bring to the delegate. Methods From April to September 2013, in-depth interviews were conducted with clinicians and regulators in seven CCGs groups in England. A total of 40 clinicians and managers participated in the interview. The interview focused on the added value of GPs to the commission. Results The respondents considered the added value of GPs mainly due to their understanding of the patients. However, respondents ’opinions were not consistent with whether better understanding of patients can improve service design and whether close cooperation between GPs and managers can enhance managers’ ability to negotiate. In addition, respondents also expressed concern about the difficulty of working and participating in the work of the larger GPs. Conclusion Since the introduction of cost-accountability in the 1990s (Note: GPs pay GPs to pay for certain hospital services), GPs appear to be familiar with such claims in a variety of ways in the commissioning practice. The key question is whether these new agencies can provide better assistance and can effectively use such knowledge. In addition, over-attention to empirical knowledge raised concerns as it may affect the adoption of representation and other opinions. In short, GPs personal knowledge is better than the system of public health information needs further exploration.