title: Primary medical care in the United kingdom.
abstract: Since 1948 health care in the United Kingdom (UK) has been centrally funded through the National Health Service (NHS). The NHS provides both primary and specialist health care which is largely free at the point of delivery. Family practitioners are responsible for registered populations of patients and typically work in groups of 4-6 self-employed physicians. They hire nurses and a range of other ancillary staff, and act as gatekeepers to specialist care. Recent reforms include a wide range of national quality improvement initiatives and a pay for performance scheme that accounts for around 25% of family practitioners' income. These reforms have been associated with some major improvements in quality, including improved chronic disease management and reduced waiting times for specialist care. The four countries of the UK differ in some important aspects of health care organization: proposed reforms in England would move towards a more market-driven system, with family practitioners acting as payers for specialist care and controlling 70% of the NHS budget. The other countries (Scotland, Wales and Northern Ireland) focus more on trying to create area-based integrated systems of care.
authors.affiliation: Department of Health Services Research, University of Cambridge, Institute of Public Health, Cambridge, England, United Kingdom. mr108@cam.ac.uk
authors.forename: Martin
authors.initials: M
authors.lastname: Roland
authors.forename: Bruce
authors.initials: B
authors.lastname: Guthrie
authors.forename: David Colin
authors.initials: DC
authors.lastname: Thomé
mesh_terms: D005194:Family Practice / Q000458:organization & administration; D058006:General Practice / Q000458:organization & administration; D018166:Health Care Reform / Q000458:organization & administration*; D006801:Humans; D061214:Patient Safety; D011320:Primary Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom; D019472:Universal Health Insurance