Recent developments in primary care in the United Kingdom: from competition to community-oriented primary care.
In 1990, changes to the National Health Service (NHS) in the United Kingdom introduced a form of US-style competition that broadened the role of general practitioners (GPs). However, the changes (called GP fundholding) produced greater inequality between practices and reduced the capacity of the NHS to plan strategically. Alternative models have been developed that retain the increased influence of primary care, promote community-oriented primary care (COPC), and facilitate strategic planning. A recent proposal from the government turns away from the competition model of 1990 to encourage GP commissioning. It offers the opportunity to create an NHS that is led by a primary care agenda, including better links with the community, and a focus on public health and social services with the goal of improving the health of populations.
Department of Family and Community Medicine, University of California, San Francisco 94143, USA.
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Koperski
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Rodnick
D003284:Contract Services / Q000191:economics*; D003431:Cross-Cultural Comparison; D004465:Economic Competition; D005194:Family Practice / Q000458:organization & administration* / Q000639:trends; D018166:Health Care Reform; D006291:Health Policy; D006801:Humans; D008329:Managed Care Programs; D017146:Models, Organizational; D009313:National Health Programs / Q000458:organization & administration* / Q000639:trends; D011320:Primary Health Care / Q000458:organization & administration* / Q000639:trends; D006113:United Kingdom; D014481:United States