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The article presents the summaries of papers on dermatology presented at the main plenary sessions. The National Health Service (NHS) Plan 2000 proposed the development of specialist general practitioners (GPs) to take referrals from other GPs in specialties including dermatology. The NHS Modernization Agency Action on Dermatology program funded pilot site studies of dermatology GPwSI, services and preliminary results were encouraging. By the end of 2005, all referrals from primary care will be performed electronically using a referral template. Currently only a proportion of referrals are electronic, allowing comparison with established paper referrals.

Examines the reaction of general practitioners towards the proposals contained in the white paper 'Working for Patients' in Great Britain. Rejection of the proposals by general practitioners; Criticisms on the implementation of fixed budgets for specified surgical operations; Concerns on the cost effectiveness of the National Health Service.

Focuses on the publication of the working papers of the National Health Service (NHS) in Great Britain. Renegotatiation of the contracts of general practitioners; Implementation of the NHS review; Role of the Department of Health in the distribution of the working papers to general practitioners.

Focuses on the rejection of the general practitioners of the government's National Health Service (NHS) in Great Britain. Rejection of the government's proposal for general practitioners; Views regarding the white paper of the NHS; Compatibility of the concepts of the white paper with the principles of the NHS.

The author comments on the White Paper from the National Health Services (NHS) of Great Britain, titled "Equity and Excellence: Liberating the NHS," which proposes changes in the way decisions about health services are made. The author points out the lack of clarity on how the NHS Commissioning Board will promote involvement in research and the use of research evidence. The author discusses how research is funded and facilitated, topics for research, and the involvement of general practitioners (GPs).

This paper argues that the terms on which GPs entered the NHS, as self-employed contractors, have proved remarkably resistant to the managerial pressures which have come to dominate other sections of the National Health Service. However, this traditional mode of financing and organizing the delivery of a key element of the National Health Service has become increasingly incompatible with wider health policy objectives — the development of an integrated network of good-quality, equitable and well-coordinated primary and community health services which are responsive to local needs. Furthermore, primary health services have themselves come to play a crucially important role in securing other strategic changes in the wider health policy arena, such as securing and sustaining a shift in the traditional balance between hospital and community-based health services and controlling expenditure in a needs-led service. The paper argues that, notwithstanding the change of government, the 1997. NHS (Primary Care) Act and the White Paper "The New NHS" are both integral to the achievement of wider strategic health policy objectives, such as improving the quality and coherence of services, and increasing professional accountability for the financial consequences of clinical decisions. However, the greatest significance of these and other related measures is that they shift the emphasis of health policy from commissioning and purchasing by primary care to commissioning and contracting for primary care. They thereby extend the exposure of GP-based services to managerialist scrutiny and control. [ABSTRACT FROM AUTHOR]

The author reflects on the dilemmas of general practitioners (GPs) in taking decisions for patient care in view of a new health care policy of the British National Health Service. The policy emphasizes both effectiveness and cost of patient care. However, it becomes difficult for GPs to decide what is best for patients and what is cost effective for the government. Physician Lord Horder's view on the training of general practitioners has also been considered as a solution to the problem.

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.

Political influence on service delivery in the NHS has been significant in recent years with a drive for modernisation and service improvement. One consequence of this influence is the emergence of new roles and new ways of working. Supported by examples of three advanced practices roles (first contact care practitioner, medical care practitioner, advanced nurse practitioner), this paper will illustrate the policy drivers behind the developments and address the practice implications both for the practitioner and for the service. Healthcare practitioners undertaking these new roles will have specific learning and development needs and meeting these will be a challenge for education and health care alike. The paper will consider how work based learning models can be integral to the support infrastructure for role re-design and service improvement in the new NHS. It will also recognise the organisational development that is prerequisite to service innovation. [ABSTRACT FROM AUTHOR]

International recruitment now forms an important part of the government's policy to increase capacity in the NHS.1 By 2003, 89 general practitioners (GPs) had been recruited from countries of the European Union (EU), and in particular, Spain and France.2 The ability of the NHS to retain these GPs will, in part, depend on the support that they receive during the transition to work. In order that this can be achieved, the Department of Health recommend that all overseas doctors should participate in a thorough and comprehensive induction programme and receive support until they are fully integrated into the NHS.3 This paper describes the stages that we went through to develop an induction programme for EU GPs and reports on the programme evaluation. Evaluation of the programme has largely been positive, with most GPs suggesting that they would never have come to work in London general practice without the support of a formal programme that facilitated their transition to work in the NHS. Some components of the programme, for example facilitated peer support, provided unexpected outcomes, offering participants the opportunity to develop a supportive, cohesive team. Other aspects of the programme, for example the clinical placements, sometimes provoked an initial loss of confidence as participants found it difficult to move into a learning role, having previously been practicing ‘unwatched’ for many years. Programme evaluation also indicated that French GPs are generally not accustomed to self-directed continuing education or professional development. In order to maximize learning from the induction programme, therefore, participants tend to require clear direction regarding private study. At the time of writing this paper, 33 GPs have attended the programme, 26 (79%) of whom have taken up employment in London general practice. [ABSTRACT FROM AUTHOR]

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]

The article reports that the government of Great Britain has launched the White Paper, Equity and Excellence: Liberating the National Health Services (NHS) of Great Britain, to focus on healthcare management and quality of care. It states that the government wants to reduce the management costs of NHS by 45 percent. It mentions that the funding of services, that general practitioners (GPs) refer to patients will now be undertaken by GP commissioning consortia along with local authorities.

This paper outlines the processes of quality assurance of GP appraisal in Wales. These processes demonstrate the application of national guidance for quality assurance of medical appraisal as recommended by the National Clinical Governance Support Team (NCGST). The paper describes how defined standards of practice in the context of GP appraisal have, on a relatively large scale, been developed and demonstrated through robust internal and external quality assurance mechanisms. These quality assurance mechanisms reveal positive feedback from the vast majority of participants in the process. Both GPs and appraisers report that they benefited from their involvement in appraisal. The study demonstrates that the outputs of appraisal (summary and personal development plan) accurately reflect the content of the appraisal and help doctors to plan their learning, although further work is required with respect to specifying action plans. [ABSTRACT FROM AUTHOR]

The article focuses on the purchasing power and polarized professionalism in British medicine. The inception of fund holding, the opportunity to hold a budget at practice level, for general practitioners (GPs) has constituted a critical, formative moment for intra-professional relations in British medicine. Fund holding conferred purchasing power on GPs. This paper argues that they are using this financial leverage to enhance their influence within the British National Health Service (NHS). The mechanisms of fund holding have enabled GPs to accommodate their latent desire to shift the balance of power between themselves and the hospital consultants. This desire had remained latent as any overt intraprofessional challenge would have threatened public perceptions of all medical experts as exemplars of rationality, impartiality and civility. Societies rationalize socially significant but unclear domains, such as medicine, by professionalizing them and handing over decisions to licensed practitioners.

Background: During the COVID-19 pandemic, clinical services were severely disrupted, restricted, or withdrawn across the country. People living with Inflammatory Bowel Disease (IBD) – an auto-immune disorder for which medical treatment often results in immunosuppression, thus requiring regular monitoring—may have struggled to access clinical support. As part of a larger qualitative study, we investigated experiences of access to clinical services during the pandemic, and patient concerns about and preferences for services in the future. Methods: This exploratory qualitative study used semi-structured interviews to explore participants' experiences of clinical services across the UK during the pandemic. All data were collected remotely (March – May 2021) using online video-calling platforms or by telephone. Audio files were transcribed professionally and anonymised for analysis. Data were analysed using thematic analysis. Results: Of the eight themes found across all data, four related specifically to accessing GP, local (district) hospital, and specialist (tertiary) referral services for IBD: 1) The Risk of Attending Hospital; 2) Missing Routine Monitoring or Treatment; 3) Accessing Care as Needed, and 4) Remote Access and The Future. Conclusions: Our findings support other studies reporting changes in use of health services, and concerns about future remote access methods. Maintenance of IBD services in some form is essential throughout crisis periods; newly diagnosed patients need additional support; future dependence on IBD services could be reduced through use of treatment / self-management plans. As the NHS digitalises it's future services, the mode of appointment—remote (telephone, video call), or in-person – needs to be flexible and suit the patient. [ABSTRACT FROM AUTHOR]

Clinical commissioning groups (CCGs), part of the UK's National Health Service (NHS) since April 2013, are complex organizations requiring buy-in by GPs for strategic success. CCG budgetary deficits and lack of sustained engagement by GPs are a problem. This paper utilizes evidence of GP experience in commissioning models to determine the factors that may influence engagement in the governance of CCGs by GPs, which is crucial if clinically-led commissioning is to be part of a financially sustainable NHS. [ABSTRACT FROM AUTHOR]

The paper discusses the issue of family involvement in the process of obtaining consent to treatment. Legally, doctors have a duty to inform the patient, and the patient has a right to be informed before making a decision. In this context, however, there is no requirement to involve relatives or to take into account their interests or requests. Yet, findings from in-depth interviews with NHS general practitioners presented in the paper indicate that in reality relatives have a substantial impact on the process of informed consent. Their presence may lead the doctor to provide more information to the patient and help the patient better understand the information conveyed by the doctor. Ultimately, the relatives' involvement enhances the patient's ability to make an informed decision, even though in some cases - when the relative is dominant - this may have a negative impact on the channel of communication between doctor and patient. These findings reflect a relational approach to patient autonomy. They lead the author to suggest that the current doctor-patient partnership model in English medical law would benefit by the addition of relatives as an integral component of the decision making team. Such a significant shift in the legal approach requires changes in the type of information conveyed by the doctor to the patient; in the means to increase the patient's understanding; and lastly at the point when decisions are actually made. [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]

Background: Leaders who have the capability to deliver service improvement in healthcare are much sought after at this time of structural change. This paper describes a leadership programme trialled in the UK in the medical specialty of general practice, which gave participants the opportunity to learn about the principles of leadership in healthcare, and approaches to service improvement. In their own practices, participants used the skills and knowledge that they had gained from the programme to identify, implement and evaluate a change in healthcare service provision. Method: A total of 13 general practitioners and one practice business manager participated in the one-year programme, supported by a faculty team of three. Participants and faculty met as a learning set for one day a week over three terms, first to focus on the knowledge and skills needed to lead change, secondly to support the projects as they developed, and thirdly to review and evaluate them. Results: The outcomes of the programme were evaluated using a number of data sources, including the Medical Leadership Competency Framework (a self-assessment rating scale). Participants completed the scale at the start and end of the programme. Statistical analysis (Wilcoxon signed-rank test) of the scores demonstrated statistical significance across 60 (75%) of the 80 items. Further data about the impact of the programme on their personal and professional development arose from their service improvement project reports and reflective accounts of the programme. Conclusions: The Practice Leaders Programme (PLP) was found to be effective in developing competent and capable improvement leaders in NHS general practice. It supported the participants in developing new skills and confidence to make changes to healthcare services, and also provided insight into their learning and interaction with other practice team members. [ABSTRACT FROM AUTHOR]

The UK National Health Service (NHS) Plan has focused attention on the need to improve patient access to general practice. In trying to achieve the targets set for access, general practitioners (GPs) encounter a number of managerial dilemmas. For example, consultation times need to be limited, but the needs of individual patients for immediate care are unpredictable; continuity of care is highly valued, but GPs must be released for administration, training and other duties; delegation of tasks to other healthworkers can improve access, but dictates the need for training and the definition of legal and ethical responsibility. The management of access in general practice involves a number of constituencies including doctors, nurses, reception staff and, not least, patients themselves. Access to general practice constitutes a hybrid system, having some components that can be objectively viewed and quantified and others that remain qualitative, either because they are subjective by nature (e.g., morale and professionalism) or because data on that facet of the operation is simply not available. Hybrid management problems are amenable to treatment by qualitative systems methods and this paper describes an ex ante, real-life intervention using a qualitative system dynamics approach known as QPID (Qualitative Politicised Influence Diagrams). The method ascribes agents and actors to the connections in an influence diagram of the system under consideration. This process structures thinking about the appropriate actions (aimed at these agents and actors) for managing the system behaviour. The method is applied to the process of developing patient access policies for a large NHS practice in the South of England. It demonstrates the use of QPID to derive practical action plans for the management of this challenging aspect of general practice. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

There is concern that the UK general practitioner (GP) workforce has declined relative to the expanding needs of a primary care-led NHS. Much of the debate about possible solutions within the profession and amongst medical workforce planners has focused on the need to raise medical school intakes and recruit more new GPs. However, other evidence shows that, as with medicine in general, a differential relation ship exists in the GP labour market based upon socially ascribed characteristics. It follows that many already qualified GPs (e.g. women, ethnic minority and older doctors) are under-used in the context of generally accepted career structures. Hence, we would argue, part of the solution to workforce shortages lies in better retention and management of existing human resources. This paper first suggests a simple re-conceptualisation, which will help to frame a more sophisticated analysis than so far used for workforce planning of the nature of GP demand and supply. The framework is then used to explore the findings of the first ever national survey (n = 621) and follow-up interviews (n = 32) with a cohort of GP principal leavers. These showed that a variety of more flexible employment arrangements are needed in order to improve both GP recruitment and retention. In taking this approach, the paper also explores the potential implications of changing social trends for the structure of the GP profession. [ABSTRACT FROM AUTHOR]

Background. This paper describes a study to develop and test an instrument to measure the level of appropriate admissions and days of care in the paediatric hospital population. [ABSTRACT FROM PUBLISHER]

The paper reports some of the findings of a study which investigated opioid users' views on and use of available treatment services in Britain. Samples were drawn from among addicts currently receiving a prescription from a National Health Service (NHS) clinic, a general practitioner and a private practitioner and addicts who were currently dependent solely on black-market supplies. Addicts were interviewed using a combined structured and semi-structured interview schedule. There was little evidence that users dependent on black-market sources only had actively rejected available treatment services in the past. The majority of the black-market users had approached at least one type of doctor in connection with their addiction. Most of the users currently receiving a prescription from a clinic or a general or private practitioner had at some time approached other types of doctor. The main reasons given for not approaching various types of doctor concerned a belief that such doctors were unavailable locally and an expectation that they were unwilling to prescribe opioids. Given a free choice, the majority of addicts said that they would prefer to attend a GP rather than a clinic or private practitioner. [ABSTRACT FROM AUTHOR]

Background: Following a large-scale, pandemic-driven shift to remote consulting in UK general practice in 2020, 2021 saw a partial return to in-person consultations. This occurred in the context of extreme workload pressures because of backlogs, staff shortages, and task shifting. Aim: To study media depictions of remote consultations in UK general practice at a time of system stress. Design and setting: Thematic analysis of national newspaper articles about remote GP consultations from two time periods: 13–26 May 2021, following an NHS England letter, and 14–27 October 2021, following a government-backed directive, both stipulating a return to in-person consulting. Method: Articles were identified through, and retrieved from, LexisNexis. A coding system of themes and narrative devices was developed iteratively to inform data analysis. Results: In total, 25 articles reported on the letter and 75 on the directive. Newspaper coverage of remote consulting was strikingly negative. The right-leaning press in particular praised the return to in-person consultations, depicting remote care as creating access barriers and compromising safety. Two newspapers led national campaigns pressuring the government to require GPs to offer in-person consultations. GPs were quoted as reluctant to return to an 'in-person by default' service (as it would further pressurise a system already close to breaking point). Conclusion: Remote consultations have become associated in the media with poor practice. Some newspapers were actively leading the 'war' on general practice rather than merely reporting on it. Proactive dialogue between practitioners and the media might help minimise polarisation and improve perceptions around general practice. [ABSTRACT FROM AUTHOR]

Purpose – In these cash-stricken times, healthcare commissioners are calling for all staff to deliver more for less. In the UK, there is a growing focus on involving junior doctors in this change. This paper seeks to address these issues. Design/methodology/approach – This article considers the barriers in involving doctors in training in change and mentoring future clinical leaders, based on the observations of a junior doctor. Findings – There are many barriers between management and junior doctors, including the invisibility of junior doctor work and the transient nature of their employment. However, the next step is to go beyond a simply audit requirement, to encourage service improvement training as part of the postgraduate curriculum. This will only happen if journals, conference organisers and other agencies incentivise complex service evaluation projects, by providing opportunities for presentation and publication. Research limitations/implications – It is important to look beyond a four-month rotation and consider the many years service doctors will give to the NHS. Junior doctors need to be mentored through projects that focus more on the process of change, rather than completion of the audit cycle. This will mentor future leaders, but also give juniors an understanding of their organisational role and the demands of service. Originality/value – This article provides an interesting perspective on the difficulties faced by a junior and view on steps to improving the links between service and training. [ABSTRACT FROM AUTHOR]

Objective To review the evidence on commissioning schemes involving clinicians in the United Kingdom National Health Service, between 1991 and 2010; report on the extent and impact of clinical engagement; and distil lessons for the development of such schemes both in the UK and elsewhere. Methods A review of published evidence. Five hundred and fourteen abstracts were obtained from structured searches and screened. Full-text papers were retrieved for UK empirical studies exploring the relationship between commissioners and providers with clinician involvement. Two hundred and eighteen published materials were reviewed. Results The extent of clinical engagement varied between the various schemes. Schemes allowing clinicians to act autonomously were more likely to generate significant engagement, with ‘virtuous cycles’ (experience of being able to make changes feeding back to encourage greater engagement) and ‘vicious cycles’ (failure to influence services generating disengagement) observed. Engagement of the wider general practitioner (GP) membership was an important determinant of success. Most impact was seen in GP prescribing and the establishment of services in general practices. There was little evidence of GPs engaging more widely with public health issues. Conclusion Evidence for a significant impact of clinical engagement on commissioning outcomes is limited. Initial changes are likely to be small scale and to focus on services in primary care. Engagement of GP members of primary care commissioning organizations is an important determinant of progress, but generates significant transaction costs. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this article is to delve into the precise leadership and governance roles required of general practitioners (GPs) in England as they are propelled into clinical commissioning groups (CCGs). Design/methodology/approach – A conceptual framework which captures the complementary essences of both leadership and governance is developed and then used to assess the extent to which GPs will be undertaking leadership and/or governance roles under the reformed National Health Service (NHS) plan. Findings – It is found that there are some key particular aspects of both leadership and governance which are likely to be required of GPs as they form clinical commissioning groups. These elements are identified and discussed. Practical implications – Using this analysis, general practitioners, health service managers and policy makers will be able to make a more informed assessment of the roles that they will have to adopt in the future and those roles which they may find it difficult to play. GPs in future will need to expand their roles in line with new responsibilities. The ways in which, and the success with which, they discharge their new roles will depend crucially on how they, and significant others (NHS managers), understand the nature of leadership and governance. Originality/value – Most analyses of the new GP commissioning consortia have focused on issues concerning size and structure of commissioning consortia, the risks involved, the population size required, and risk. This article is original in its clear focus on the teasing-out of the distinct leadership and governance elements required under the GP commissioning arrangements. [ABSTRACT FROM AUTHOR]

The article presents information on the first batch of GP (general practitioner)-run commissioning bodies, announced by Great Britain's Department of Health. As part of the Government's plans set out in the NHS (National Health Service) White Paper Equity and Excellence: Liberating the NHS, 52 groups of GP practices from across the country have been chosen to be the first to commission healthcare services for patients.

The author discusses the changes made to the National Health Service (NHS) in Great Britain. She mentions that a key alteration is to shift duty for commissioning services to general practitioners (GPs) responsible for determining how to spend approximately 80% of the budget of the NHS. She states that organizations owned by NHS that operate hospitals will be converted to the status of independent Foundation Trust.

It is generally believed that the most deprived populations have the worst access to primary care. Lord Darzi's review of the NHS responds to this conventional wisdom and makes a number of proposals for improving the supply of GP services in deprived communities. This paper argues that these proposals are based on an incomplete understanding of inverse care which underestimates the degree to which, relative to their healthcare needs, older populations experience low availability of primary care. Many deprived practices appear to have a better match between need and supply than practices serving affluent but ageing populations. However, practices serving the oldest and most deprived populations have the worst availability of all. [ABSTRACT FROM AUTHOR]

New Labour's concept of 'clinical governance' is an essentially bureaucratic strategy in that it places great emphasis on controlling the behaviour of NHS clinical professionals via a web of rules, including clinical guidelines and National Service Frameworks, supported by new external agencies such as NICE and CHI. In the context of primary medical care, however the classic organizational means for implementing such rules, the bureaucratic hierarchy, is largely absent. Despite the current development of new forms of primary care organization (PCGs, PCTs and PMS Pilots) which display some hierarchical characteristics, these remain highly attenuated and a priori unfitted to implement bureaucratic rules. This paper explores the validity of such doubts through three sources of evidence: research into 'total fundholding' (many of whose characteristics are shared by the new organizational forms), contemporary Internet user group discussions between GPs in PCGs, and some pilot interviews of GPs in a northern PCG. The latter two data sources are not presented as representative, but rather to highlight the apparent lack of fit between central components of New Labour health policy and the need for empirical research on the topic. [ABSTRACT FROM AUTHOR]

The implications of the 1997 (Primary Care) Act have been largely overlooked in the rush to establish Primary Care Groups. Allowing health authorities to develop local contracts for primary care has far-reaching implications and is an important departure from the national system of negotiation that has characterized general practice to date. This paper describes a content analysis of a sample of Personal Medical Services (PMS) pilot contracts. In the first year little attention has been given to achieving cost savings or greater efficiency and few contracts promote clinical guidelines. The difficulties of specifying services sensitive to local health needs are highlighted and the national Statement of Fees and Allowances (the 'Red Book') may not be swiftly supplanted. However, The pilots have introduced innovations such as salaried general practitioners, nurse-led services and NHS trust-managed care. The development of local contracts provides a valuable learning experience for general practitioners and health authorities in advance of the establishment of Primary Care Trusts. [ABSTRACT FROM PUBLISHER]

Background: Changing demographics across the UK has led to general practitioners (GPs) managing increasing numbers of older patients with multi-morbidity and resultant polypharmacy. Through government led initiatives within the National Health Service, an increasing number of GP practices employ pharmacist support. The purpose of this study is to evaluate the impact of a medicines optimisation intervention, delivered by GP practice-based pharmacists, to patients at risk of medication-related problems (MRPs), on patient outcomes and healthcare costs. Methods: A multi-centre, randomised (normal care or pharmacist supplemented care) study in four regions of the UK, involving patients (n = 356) from eight GP practices, with a 6-month follow-up period. Participants were adult patients who were at risk of MRPs. Results: Median number of MRPs per intervention patient were reduced at the third assessment, i.e. 3 to 0.5 (p < 0.001) in patients who received the full intervention schedule. Medication Appropriateness Index (MAI) scores were reduced (medications more appropriate) for the intervention group, but not for control group patients (8 [4–13] to 5 [0–11] vs 8 [3–13] to 7 [3–12], respectively; p = 0.001). Using the intention-to-treat (ITT) approach, the number of telephone consultations in intervention group patients was reduced and different from the control group (1 [0–3] to 1 [0–2] vs 1 [0–2] to 1 [0–3], p = 0.020). No significant differences between groups were, however, found in unplanned hospital admissions, length of hospital stay, number of A&E attendances or outpatient visits. The mean overall healthcare cost per intervention patient fell from £1041.7 ± 1446.7 to £859.1 ± 1235.2 (p = 0.032). Cost utility analysis showed an incremental cost per patient of − £229.0 (95% CI − 594.6, 128.2) and a mean QALY gained of 0.024 (95% CI − 0.021 to 0.065), i.e. indicative of a health status gain at a reduced cost (2016/2017). Conclusion: The pharmacist service was effective in reducing MRPs, inappropriateness of medications and telephone consultations in general practice in a cost-effective manner. Trial registration: ClinicalTrials.Gov, NCT03241498. Registered 7 August 2017—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03241498 [ABSTRACT FROM AUTHOR]

This paper first examines the usefulness of the internal markets being proposed in NHS reforms. The impact of those reforms on hospitals and general practitioners (GPs) is then assessed. Finally, the long-term implications of replacing medical culture with competition are discussed. [ABSTRACT FROM AUTHOR]

It is found that health maintenance organizations (HMOs) initially increase, but will eventually significantly decrease, a population's health care costs. Thus, HMOs appear to require a significant amount of time to control effectively physician and patient behaviour and achieve reductions in costs. Unlike health care costs, HMOs are found to have no significant impact on a population's aggregate health in either the short- or the long-run. Thus, HMOs are found to achieve savings in health care costs in the long-run and they apparently do so with no resultant decline in health. The paper also has important implications for the National Health Service (NHS) in Great Britain given the similarities that exist between HMO physician reimbursement and NHS funding of its general practitioners. [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.

This section presents new and views concerning family medicine in Great Britain as of June 2009. The British government plans to encourage patient to rate doctors on the National Health Service (NHS) Choices Web site. A discussion paper that questions the traditional structure of general practice was released by the Royal College of General Practitioner (RCGP).

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 article presents a speech by Doctor John Ferguson, president of the Section of General Practice of the Royal Society of Medicine (RSM), delivered at the National Health Service (NHS) at the RSM Reflections: Past, Present and Future on July 8, 1998. He talks about the general practice industry in Great Britain in 1948, the changes that took place in the quality and workload in the industry and the concept of evidence-based medicine.

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.