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The introduction of a market mechanism into the National Health service in the UK was underpinned by the belief that decentralised purchasing would both improve the quality of health care provision and restrain spiralling costs, through purchasers exercising their ability to choose between alternative providers. Focusing on budget holding General Practitioners, that is those practices responsible for purchasing hospital services for their practice populations, this paper explores the evolving purchasing behaviour of these professional intermediaries. Drawing on empirical evidence gathered as part of a broader study of the purchasing behaviour of GP Fundholders in Scotland, specifically it examines the key information sources and decisional criteria utilised by these professional intermediaries in selecting health care providers for their practice population. Utilising relational models of market behaviour, it addresses both the contextually specific issue of whether the market mechanism within the NHS is achieving the twin objectives of improving health care provision and restraining cost pressures, and the broader conceptual issue of the purchasing behaviour of professional intermediaries within a service sector environment. [ABSTRACT FROM AUTHOR]

The author argues that the National Health Service (NHS) in Great Britain needs general practitioners (GP) who are focused on patient-centered values. He emphasizes the role of GP in providing high quality care. He claims that the GP leaders needed by the NHS are those who are motivated to improve patient care and those who are committed to care for individual patients. The author also suggests ways in which GP can perform their commissioning responsibility under the British government's practice-based commissioning scheme.

AbstractA number of policy initiatives over the last few years have encouraged general practitioners (GPs) to participate in commissioning, as opposed to simply purchasing, health care. This role was reinforced in the white paper, The New NHS. A qualitative study of GPs in two health authorities uncovered not only concerns about the reforms which have since emerged in the medical and general press, but other issues which have been less frequently articulated. There was also evidence of goodwill towards professional colleagues, including those in social services departments. The preference for professional, as opposed to market relationships may help to secure the collaborative ethos desired by government. However, if the concerns the study uncovered are indicative of a more widespread response to the white paper, they suggest the need for careful support of developing Primary Care Groups (PCGs). [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to discuss the impact of contracts on general practise in the UK National Health Service. In particular, it is concerned with the response of practitioners to the apparent flexibilities offered in the new contract with its focus on outcomes rather than processes. Design/methodology/approach - Ethnographic studies of two general practices, using non-participant observation, documents and interviews with staff over a five-month period. Findings - Conclusions suggest that the new contracts, far from encouraging flexibility and responsiveness from general practitioners, have tended to strengthen bureaucratic forms in the way the contract is implemented. Originality/value - The new contract has introduced greater clarity regarding roles and responsibilities within practises. At the same time, when operating in financially tight conditions, the contract can make rationing more explicit. Decisions are made not in accordance with the targets but in light of local pressures and constraints, causing tensions between primary and tertiary care. [ABSTRACT FROM AUTHOR]

The article focuses on the need of proper health policy in Great Britain for the management of patients with psychiatric disorders in the community. To meet the need of patients with mental illness the role of the general practitioner has still to be agreed. Since the inception of the National Health Service of Great Britain, the matter has received sporadic attention.

The article focuses on the White Paper "Healthy Lives, Healthy People," which was produced as a response to the work of M. Marmot and to address wider social determinants of health. Several factors contributing to the challenges facing the public health system of Great Britain include policy failures, concerns over communicable disease control, the imminent reorganization of the National Health Service (NHS) and demoralized public health workforce. An extended public health role for general practitioners (GPs) is being offered by the White Paper.

The article presents the author's views on the future of primary care in Great Britain. The author reviews how a proposed new white paper on health and community services in England is expected to affect public, patients, and health professionals. The concept of patients' values and the role of general practitioners in reducing health inequalities are analyzed. It is the author's view that Great Britain's health system should aim to be patient centred, safe, accountable and of consistently high quality.

The author discusses the promotion of general practice (GP) commissioning in the White Paper on National Heath Service (NHS) reform in Great Britain. According to the article, the White Paper seeks to give GPs a mediating role between hospitals as corporate entrepreneurs and patients as consumers. He claims that the enhanced public health role of GPs is a reflection of the erosion of boundaries between the public and personal areas.

High-quality primary care services are an essential part of a successful health service. However, the planning and management of such services is complex. Using evidence from a study of recent extensive changes in the English NHS, the authors highlight the need for local service oversight by managers who understand local conditions and needs. The recent English experience supports an incremental policy adjustment approach, rather than wholesale organizational change. [ABSTRACT FROM AUTHOR]

Asthma guidelines focus on day-to-day control of symptoms. However, asthma attacks remain common. They continue to cause mortality and considerable morbidity, and are a major financial burden to the UK National Health Service (NHS) and the wider community. Asthma attacks have chronic consequences, being associated with loss of lung function and significant psychological morbidity. In this article we argue that addressing daily symptom control is only one aspect of asthma treatment, and that there should be a more explicit focus on reducing the risk of asthma attacks. Management of future risk by general practitioners is already central to other conditions such as ischaemic heart disease and chronic renal impairment. We therefore propose a revised approach that separately considers the related domains of daily control and future risk of asthma attack. We believe this approach will have advantages over the current 'stepwise' approach to asthma management. It should encourage individualised treatment, including non-pharmacological measures, and thus may lead to more efficacious and less harmful management strategies. We speculate that this type of approach has the potential to reduce morbidity and healthcare costs related to asthma attacks. [ABSTRACT FROM AUTHOR]

The article focuses on the reorganization plans of the British coalition government for the National Health Service (NHS) in 2010. Under the plans, general practitioners will commission most services and primary care trusts and strategic health authorities will be abolished. Other details of the government's white paper are explained by health secretary Andrew Lansley. The establishment of an independent and accountable NHS Commissioning Board is also cited.

The ability to teach as a doctor in general practice (GP) is not only a requirement for the GP curriculum but is increasingly being recognized as a key skill for any doctor in the modern National Health Service (NHS). The recent guidance document from the General Medical Council, ‘Duties of a doctor’ clearly states: ‘Teaching, training, appraising and assessing doctors and students are important for the care of patients now and in the future. You should be willing to contribute to these activities’. Long gone are the days when doctors were expected to know all they needed to know simply because they were doctors. New models of working and the drive for all new alternative providers of medical services practices to offer training mean that the ability to teach is also an attractive skill for you to offer to future employers. The types of people involved in teaching and learning in primary care are now more diverse than ever before. Working in a multidisciplinary team with other colleagues brings unique challenges that could see you feeling out of your comfort zone. This article will help you to feel more prepared to teach others, using the example of teaching about asthma. [ABSTRACT FROM PUBLISHER]

General practitioner fundholding (GPFH) in the English National Health Service was abolished by the Blair administration in 1999 amid concerns that it was inequitable, helped to foster a "two-tier" health service, and incurred high transaction costs. In April 2005 in an apparent volte face, the Blair government reintroduced delegated budgets to individual GP practices under the banner of Practice Based Commissioning (PBC). As PBC bears many similarities to GPFH it is timely to take stock of evidence-based policy lessons from the earlier initiative in the NHS. Based on a review of the latest empirical evidence, the aim of this article is to help inform the development and implementation of PBC by identifying the policy lessons of GPFH. To do this the discussion focuses on three main areas: it (1) reviews key ideas and conceptual frameworks for understanding stability and change in health systems; (2) summarizes the origins and evolution of primary care commissioning in the NHS; and (3) examines the latest literature and empirical analysis on the impact of GPFH and assesses the success of GPFH in meeting a range of health policy objectives. The article concludes with an examination of the policy implications of the present review and a look forward at the emerging research agenda. [ABSTRACT FROM AUTHOR]

The multi-billion NHS Connecting for Health programme in England has completely reconfigured the relationships between the Department of Health, the National Health Service (NHS), primary care computing suppliers and healthcare professionals (including general practitioners). The implications of this reconfiguration are now becoming apparent and have potentially significant effects on the delivery of information and information systems in the health context. This article explores the changes in these relationships by drawing on comparisons with the previous system for procurement of primary care computing systems, which ran for much of the 1990s. The article also comments on characteristics of the CfH procurement/contracting process, the differing responses of suppliers, and the role of the existing installed base as an actor in building a new infrastructure for health records. [ABSTRACT FROM AUTHOR]

Objective: To define the role and responsibilities of the sports medicine specialist using a recognised research technique. Methods: A Delphi technique was employed using anonymous postal questionnaires sent to a random sample of 300 members of the British Association of Sport and Exercise Medicine. The questionnaire of 300 putative attributes was developed in a pilot study and the Delphi technique used allowed participants to modify their responses according to the responses of other participants. Results: There was a 53% response to both rounds of the study with 75.6% of the respondents being male, 39% having a higher qualification in sports medicine, and 45.6% being general practitioners. Some 86.3% strongly agreed that sport and exercise medicine should be a recognised speciality and 90% strongly agreed that it should be available on the National Health Service (NHS). The most important specialist attributes were orthopaedic and soft tissue medicine (83.6% strongly agreed) and emergency medical management (79.7% strongly agreed). More than 75% of respondents did not agree that either research or personal playing experience were relevant. Conclusion: Sports and exercise medicine is an evolving speciality in the United Kingdom. We believe this is the first systematic attempt to define the role and responsibilities of the sports medicine specialist and the findings are of relevance to the future development of a career pathway. [ABSTRACT FROM AUTHOR]

Background In the late 1990s, one NHS region created posts of ‘medical care epidemiologists’ (MCEs) to employ public health skills in NHS Trusts in pursuit of the ‘evidence‐based medicine’ agenda. [ABSTRACT FROM PUBLISHER]

Alcohol misuse is a major public health problem. In the UK, general practitioners are perceived as key players in prevention and management of alcohol problems, but may not be prepared sufficiently to undertake this work. A systematic review of the literature by computerized search of the Medline database, hand search of review article citations and a survey of relevant educational and training organizations and agencies were undertaken. Although there is no shortage of educational materials, there has been little evaluation of their effectiveness. A need for more training and support has been identified, but this requires better co-ordination and a more multidisciplinary approach. Forthcoming changes in the National Health Service and the organization of continuing professional development offer a unique opportunity to advance this agenda. [ABSTRACT FROM PUBLISHER]

This article focuses on a central feature of the former Conservative Government's approach to the National Health Service (NHS), the introduction of General Practitioner Fundholding. It examines the nature of business planning undertaken by fund holding practices in the North West Region by looking at the participation of various stakeholders in the business planning process, the business planning techniques adopted and the extent to which fundholding practices set and monitor their objectives. [ABSTRACT FROM AUTHOR]

The context in which medicine is practiced in Great Britain has changed beyond all recognition since the profession took its first strides into the comprehensive system of heath care enshrined in the postwar ideal of a national health service. For the first 40 years of the National Health Service (NHS) the accountability of doctors was to their patients and to a broad and non-specific professional code. The NHS at first provided a setting where doctors could exercise their skills with almost complete autonomy.

In this article the author discusses the plans of the coalition government to protect the National Health Service (NHS) funding and to avoid health service reorganisation in Great Britain. Health secretary Andrew Lansley states that health spending will not increase as a percentage of Gross Domestic Product (GDP). It notes that the proposed NHS Management Board will support the 60 billion pounds budget given to General Practitioners (GPs) to commission services for patient population.