Thirty-Five Years of General Practice Payment and Administration in England

IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES
Richard A. Young
{"title":"Thirty-Five Years of General Practice Payment and Administration in England","authors":"Richard A. Young","doi":"10.1111/jep.70064","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Rationale</h3>\n \n <p>Fee-for-service payment is commonly blamed for problems in the US healthcare system, including the current and projected shortage of primary care physicians. Britain's National Health Service (NHS) general practitioner (GP) workforce has been paid mostly by capitation since the creation of the NHS, which leads many US observers to conclude that capitation will solve many primary care problems.</p>\n </section>\n \n <section>\n \n <h3> Aims and Objectives</h3>\n \n <p>To compile and synthesize information about GP payment and administration from publicly-avalailable sources.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This was a compilation of 30+ years of articles I accumulated about GPs and the NHS supplemented by Google Scholar, NHS websites, and similar searches to close information gaps; as well as two trips to directly observe UK GPs care for their patients.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Thirty five years of cycles of scarce resources have impacted the GP workforce and scope of practice. There has never been a golden age of support for GPs. GPs have worked under a series of unfunded or under-funded mandates and have been tasked with responsibilities that more appropriately should have been handled by policy makers. The net result is that the scope of practice of GPs has gradually eroded. The years 2002–2009 were probably the most GP-friendly with the best population outcomes, when GPs were given additional resources and were empowered to positively affect other aspects of their local healthcare system.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The British GP experience shows that it is too easy for politicians to add more work responsibilities to physicians paid by capitation without seriously examining and supporting the GP workforce to achieve the desired goals, which has led some UK GPs to recently propose fee-for-service payment. Administering and paying for GP services through the lens of complex adaptive systems management, with adequate resources, will likely result in a more effective and sustainable GP workforce.</p>\n </section>\n </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of evaluation in clinical practice","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jep.70064","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0

Abstract

Rationale

Fee-for-service payment is commonly blamed for problems in the US healthcare system, including the current and projected shortage of primary care physicians. Britain's National Health Service (NHS) general practitioner (GP) workforce has been paid mostly by capitation since the creation of the NHS, which leads many US observers to conclude that capitation will solve many primary care problems.

Aims and Objectives

To compile and synthesize information about GP payment and administration from publicly-avalailable sources.

Methods

This was a compilation of 30+ years of articles I accumulated about GPs and the NHS supplemented by Google Scholar, NHS websites, and similar searches to close information gaps; as well as two trips to directly observe UK GPs care for their patients.

Results

Thirty five years of cycles of scarce resources have impacted the GP workforce and scope of practice. There has never been a golden age of support for GPs. GPs have worked under a series of unfunded or under-funded mandates and have been tasked with responsibilities that more appropriately should have been handled by policy makers. The net result is that the scope of practice of GPs has gradually eroded. The years 2002–2009 were probably the most GP-friendly with the best population outcomes, when GPs were given additional resources and were empowered to positively affect other aspects of their local healthcare system.

Conclusions

The British GP experience shows that it is too easy for politicians to add more work responsibilities to physicians paid by capitation without seriously examining and supporting the GP workforce to achieve the desired goals, which has led some UK GPs to recently propose fee-for-service payment. Administering and paying for GP services through the lens of complex adaptive systems management, with adequate resources, will likely result in a more effective and sustainable GP workforce.

求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
4.80
自引率
4.20%
发文量
143
审稿时长
3-8 weeks
期刊介绍: The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信