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 services 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.
Mots-clés Pascal : Royaume Uni, Médecin généraliste, Contrat, Système santé, Soin santé primaire
Mots-clés Pascal anglais : United Kingdom, General practitioner, Contract, Health system, Primary health care
Notice produite par :
ENSP - Ecole nationale de la santé publique (devenue EHESP)
Cote : 99/06 V
Code Inist : 002B30A07. Création : 16/11/1999.