The modernisation of general practice in the UK: 1980 to 1995 and beyond. Part I

Abstract

The UK is unusual in providing universal free healthcare in which access to specialists is largely controlled by general practitioners with 24-hour responsibility, throughout the year, for a defined list of patients of all ages. It is generally considered that this gatekeeper function has contributed to the relatively low cost of the National Health Service, but major changes in the organisation and clinical role of general practitioners have occurred, culminating in a new contract that aims to re-orientate general practice towards health promotion, disease prevention and the management of chronic disease. The implications of these changes are discussed.

Use of Prescribed Drugs Among Older People in Japan: Association with Not Having a Regular Physician

“…Second, not having a regular physician is the only one of the four factors that can, at least in theory, be modified directly by changes in healthcare policy and in patterns of geriatric practice. For example, in the United Kingdom, 97% of the population is registered with a general practitioner, 17 and in the United States about 75% of people aged 75 or older have a regular physician 18 . In contrast, the present data indicate that fewer than half of all older people in Japan have a regular physician.…”

Primary Care-based Evaluation of Patient Education for Osteoarthritis of the Knee

“…Among them are: a) The low priority given by primary healthcare providers to research projects perceived as external and intrusive -an issue discussed above. b) The low priority given to primary care research in a context in which practices are coming under increasing pressure to provide patient care in settings in which their workload has increased dramatically [4]. The fee for service and the incentive system in general practice mitigates against innovation and change.…”

“…Surveys of patient attitudes and experiences and exhortations about recognizing patient involvement in health care, however, do not necessarily mean that active engagement in primary care (or indeed secondary) provision is being fostered. For example, attempts to establish patient participation groups have had a chequered history [4,5]. Furthermore, it is difficult to determine and measure the impact of patient involvement and participation on policy [6] and it is only where practices are already dedicated to improving patient involvement that any influence is discernable.…”