The Informal Rationing of Primary Medical Care

1979 ◽  
Vol 8 (4) ◽  
pp. 489-508 ◽  
Author(s):  
Peggy Foster
Keyword(s):  
Primary Care ◽  
General Practice ◽  
National Health Service ◽  
Health Service ◽  
Medical Care ◽  
Social Services ◽  
Primary Medical Care ◽  
Wide Range ◽  
Primary Care Sector ◽  
Welfare Agencies

ABSTRACTAll social services are rationed, yet the effects of such rationing on the client are rarely fully explored. This article reviews the evidence on the existence of informal rationing devices in general practice. It examines the effects on patients of a wide range of informal rationing devices now used by individual general practitioners. Various suggestions for reforming the present rationing of primary medical care are evaluated and the likelihood of any reform being carried out is assessed. Although this article concentrates solely on rationing in the primary care sector of the National Health Service, the issues discussed are relevant to most welfare agencies as they are presently organized.

scholarly journals ANALYSIS OF PROVISION OF MEDICAL SERVICES TO THE POPULATION BY PRIMARY MEDICAL CARE DOCTORS IN THE CONDITIONS OF HEALTH SYSTEM REFORM: REGIONAL LEVEL

2020 ◽  
Author(s):  
Vasyl Matviyiv ◽  
Keyword(s):  
Primary Care ◽  
National Health Service ◽  
Health Service ◽  
Medical Care ◽  
National Health ◽  
Primary Care Physicians ◽  
Free Choice ◽  
Medical Services ◽  
Primary Medical Care ◽  
Family Doctors

An important component of the development of the domestic medical system has been the reform of the primary level of health care facilities. The impetus for this was the adoption of the main draft laws, which significantly changed the distribution of funds for the financing of the medical sector in Ukraine. The article describes the percentage of the population that chose their primary care physician, analyzes the distribution of declarations by the number and structure of primary medical care providers who have concluded an agreement with the National Health Service of Ukraine in Ukraine and the Carpathian region. It was cleared up that both in Ukraine and in its regions the population had the right to choose primary care physicians among such specialties as family doctors, therapists and pediatricians, where as a result of compiling declarations the largest population in Ukraine chose family doctors in Transcarpathian, Lviv and Chernivtsi regionss, and the share of family doctors in these regions significantly exceeds the Ukrainian average in the country. It has been determined that an important factor is public awareness about the importance and necessity of electronic declarations. The study concludes that this, in its turn, has provided the population with a free choice of a therapist in urban areas or a family general practitioner in rural areas. It has been investigated that the population has a free choice to sign declarations with primary care doctors, and this allows each citizen to choose a doctor at his discretion, who, in turn, having the opportunity to provide services and receive a slightly higher fee according to the coefficients approved by the National Health Service of Ukraine. It has been concluded that patients have the opportunity to receive medical services from primary care physicians, as a result of which they can receive qualified medical care. Under conditions when in patients’ opinions medical care or services are not provided at the appropriate level, they can change doctors and automatically sign a declaration with another doctor.

Diagnosis and Treatment of Depression in General Practice

1993 ◽  
Vol 163 (S20) ◽  
pp. 14-19 ◽  
Author(s):  
Paul Freeling
Keyword(s):  
General Practice ◽  
National Health Service ◽  
Health Service ◽  
Subjective Experience ◽  
Normal Development ◽  
The Other ◽  
Treatment Of Depression ◽  
Wide Range ◽  
Tier System ◽  
First Contact

General practitioners (GPs) work in an environment different from that of most of their specialist colleagues. Some of these differences stem from being a doctor of first contact, some from working in one part of a multi-tier system for providing medical care, and some from the referral system which deals with the movement of patients between these tiers. Other differences stem from the GP's National Health Service contract to provide continuity of care 24 hours a day, and to make early diagnoses as well as monitoring normal development on one hand and chronic impairment, handicap, and disability on the other. The British GP works with a defined list of registered patients who can present symptoms representing disorders of a wide range of severity, originating in any bodily system. These symptoms can result from any type of pathogenic stimulus, including disordered perception: even temporary variation from the patient's usual subjective experience may arouse natural concern.

Changes in medical education

1997 ◽  
Vol 86 (03) ◽  
pp. 152-155 ◽  
Author(s):  
Trevor Gibbs
Keyword(s):  
Primary Care ◽  
Medical Education ◽  
General Practice ◽  
National Health Service ◽  
Health Service ◽  
Medical School ◽  
Student Development ◽  
Early Stage ◽  
Educational Resource ◽  
Curriculum Changes

AbstractOver the last few years, apparent dissatisfaction with undergraduate medical education has stimulated some medical schools to change their curricula to varying degrees, both in content and philosophy. In line with Government thinking on a primary care led National Health Service, the change has stimulated use of general practice and the community as an educational resource. This paper describes the curriculum changes in one medical school and the opportunities that have arisen, allowing homoeopathy to be taught at an early stage of student development.

The National Health Service in England

2018 ◽  
pp. 118-135
Author(s):  
Richard M. Titmuss
Keyword(s):  
United States ◽  
General Practice ◽  
National Health Service ◽  
Health Service ◽  
Medical Care ◽  
Present State ◽  
Historical Context ◽  
The United States ◽  
Historical Evolution ◽  
Patient Relationship

This concluding chapter reviews how, during the past decade, there has been an increasing volume of studies and reports on general practice in Britain, the United States, and other countries. No doubt much of this interest has been provoked by the growing impact of scientific developments on medicine over the same period. These have raised many questions about the present state of general practice, its historical evolution, and its future place in medical care. The chapter discusses the association of these developments with the changing character of demand for medical care and its effects on the doctor–patient relationship. It also looks at the questions of science and specialism in a broader historical context.

scholarly journals Teamwork and leadership training for health workers - is it worth it?

2003 ◽  
Vol 4 (6) ◽  
pp. 192-196
Author(s):  
Peter Nightingale ◽  
Adrian Ibbetson ◽  
Rob Pugh
Keyword(s):  
Primary Care ◽  
General Practice ◽  
National Health Service ◽  
Health Service ◽  
Leadership Training ◽  
Health Workers ◽  
Learning Skills ◽  
District Nurses ◽  
Detailed Evaluation ◽  
The Impact

A group of general practice (GP) registrars, GP trainers and student district nurses from North Lancashire and Cumbria attended a one-day event to focus on learning skills related to teambuilding and leadership relevant to work in primary care. A detailed evaluation of the impact of this experience was undertaken. 'Team maintenance' type behaviours (aspects of selfawareness and awareness of others, communication, listening and encouragement and support) were significantly improved by the educational event. Delegates reported that the event would be helpful for their work within the National Health Service (NHS) as an organisation. They clearly enjoyed the day.

scholarly journals Levels of detection of hypertension in primary medical care and interventions to improve detection: a systematic review of the evidence since 2000

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019965 ◽  
Author(s):  
Richard Baker ◽  
Andrew Wilson ◽  
Keith Nockels ◽  
Shona Agarwal ◽  
Priya Modi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
General Practice ◽  
Medical Care ◽  
Low Cost ◽  
Meta Analysis ◽  
Premature Mortality ◽  
Eligibility Criteria ◽  
Detection Rates ◽  
Primary Medical Care

ObjectivesIn England, many hypertensives are not detected by primary medical care. Higher detection is associated with lower premature mortality. We aimed to summarise recent evidence on detection and interventions to improve detection in order to inform policies to improve care.DesignData sources: systematic review of articles published since 2000. Searches of Medline and Embase were undertaken. Eligibility criteria: published in English, any study design, the setting was general practice and studies included patients aged 18 or over. Exclusion criteria: screening schemes, studies in primary care settings other than general practice, discussion or comment pieces. Participants: adult patients of primary medical care services. Synthesis: study heterogeneity precluded a statistical synthesis, and papers were described in summary tables.ResultsSeventeen quantitative and one qualitative studies were included. Detection rates varied by gender and ethnic group, but longitudinal studies indicated an improvement in detection over time. Patient socioeconomic factors did not influence detection, but living alone was associated with lower detection. Few health system factors were associated with detection, but in two studies higher numbers of general practitioners per 1000 population were associated with higher detection. Three studies investigated interventions to improve detection, but none showed evidence of effectiveness.LimitationsThe search was limited to studies published from 2000, in English. There were few studies of interventions to improve detection, and a meta-analysis was not possible.Conclusions and implicationsLevels of detection of hypertension by general practices may be improving, but large numbers of people with hypertension remain undetected. Improvement in detection is therefore required, but guidance for primary medical care is not provided by the few studies of interventions included in this review. Primary care teams should continue to use low-cost, practical approaches to detecting hypertension until evidence from new studies of interventions to improve detection is available.

scholarly journals Is psychiatry losing touch with the rest of medicine?

2000 ◽  
Vol 6 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Peter Kennedy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
National Health Service ◽  
Health Service ◽  
Social Services ◽  
White Paper ◽  
Psychiatric Services ◽  
Best Interests ◽  
Professional Relationships ◽  
General Hospitals

What is happening in and around psychiatric services that raises fears of a harmful separation between psychiatrists and the rest of the medical fraternity? The last National Health Service (NHS) reforms at the beginning of the 1990s split some mental health services into separate organisations from their local acute services. Paragraph 5.14 in the Government's White Paper The New NHS (NHS Executive, 1997a) seems to favour specialist mental health trusts. Combined whole district trusts are under threat. Shotguns are loaded to ‘encourage’ the marriage with social services. All this may seem to conspire against psychiatrists maintaining close professional relationships with physicians and surgeons in general hospitals. Instead it puts the emphasis on aligning psychiatric work much more closely with social services and primary care. Much restructuring is already afoot. It is a time for sober reflection on what is in the best interests of patients now and in the future (see Box 1).

Clinical Psychology Interventions in Primary Care

2010 ◽  
pp. 601-618
Author(s):  
Leonard J. Haas
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Clinical Psychology ◽  
Psychological Services ◽  
Clinical Psychologist ◽  
Health Care Environment ◽  
Care Environment ◽  
Primary Medical Care ◽  
Case Examples ◽  
Effective Work

This chapter reviews the need for clinical psychology services that are integrated into the primary health-care environment and covers in depth the issues that an effective primary care clinical psychologist must understand to function effectively in primary care. These are understanding the primary medical care environment, recognizing the unique characteristics of primary medical care patients who seek psychological services, and the key treatment tactics and strategies necessary for effective work in a primary care environment. Recommendations are illustrated with numerous case examples adapted from the experiences of a veteran primary care clinical psychologist.

Viewpoint From the Division of Community Child Health

PEDIATRICS ◽  
1974 ◽  
Vol 54 (2) ◽  
pp. 251-251
Author(s):  
Joel Bass ◽  
Dorothea Johnson ◽  
Jacqueline Kirby ◽  
George A. Lamb ◽  
Janice C. Levy ◽  
...  
Keyword(s):  
Primary Care ◽  
Child Health ◽  
Medical Care ◽  
Medical Schools ◽  
House Staff ◽  
Teaching Hospitals ◽  
Primary Medical Care

We read with interest Dr. Nathan's comments on primary medical care (Pediatrics, 52:768, 1973), but feel compelled to add another viewpoint. One of the striking changes occurring today in teaching hospitals and medical schools is an increased awareness of and interest in primary care. Some institutions, including our own, have created residencies and fellowships in ambulatory pediatrics as a response to house staff interests and also in response to the needs of the surrounding community.

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