Prospects for progress on health inequalities in England in the post-primary care trust era: professional views on challenges, risks and opportunities
Prospects for progress on health inequalities in England in the post-primary care trust era: professional views on challenges, risks and opportunities
复制标题
后初级保健信托时代英格兰健康不平等问题的进展前景：对挑战、风险和机遇的专业看法
作者：
D. Turner;S. Salway;G. Mir;G. Ellison;John Skinner;L. Carter;B. Bostan
背景解决健康不平等仍然是当前英国政府的一个突出的政策目标，但目前的NHS改革涉及角色和责任的重大转变。临床医生现在被置于医疗保健委托的核心，必须解决医疗保健服务的获取，吸收和影响方面的重大不平等问题。人们不禁要问，这些新的安排是否会有助于或阻碍在健康不平等方面取得进展。本文探讨了有经验的医疗保健专业人员的角度内的委托竞技场工作，其中许多人可能仍然是关键的演员在这个展开scenario.MethodsSemi-structured访谈进行了42个专业人员参与卫生和社会保健委托在国家和地方层面。这些包括卫生部，初级保健信托，战略卫生当局，地方当局和第三部门organisation.ResultsIn一般，受访者感叹缺乏对PCT调试时代，强有力的政策没有导致可衡量的改善健康不平等的进展。然而，有人担心，GP主导的调试情况不会好到哪里去，特别是在开支减少的时候。具体关注的问题集中在：减少了对健康不平等议程的承诺;技能不足和专业知识的损失;以及削弱了伙伴关系的工作和参与。对于全科医生专员是否比他们的前任更有能力挑战大型提供者的信任并将支出转向预防和早期干预，以及全科医生的临床经验是否会支持对不平等采取委托行动，人们的意见更为复杂。虽然在很大程度上是悲观的，受访者强调了一些机会，包括医疗保健专员更大的责任，以公众和更有影响力的需求评估，通过紧急Health & Wellbeing Boards.ConclusionsThere是怀疑的能力，GP专员采取更明确的行动，对健康的不平等比PCT历史上取得的。主要行为体预计，在新的安排中，委托处理保健不平等问题的贡献将变得更加零碎，因为这将取决于新委托团体中特定个人的利益和代理权，以吸引和影响更广泛的利益攸关方。
BackgroundAddressing health inequalities remains a prominent policy objective of the current UK government, but current NHS reforms involve a significant shift in roles and responsibilities. Clinicians are now placed at the heart of healthcare commissioning through which significant inequalities in access, uptake and impact of healthcare services must be addressed. Questions arise as to whether these new arrangements will help or hinder progress on health inequalities. This paper explores the perspectives of experienced healthcare professionals working within the commissioning arena; many of whom are likely to remain key actors in this unfolding scenario.MethodsSemi-structured interviews were conducted with 42 professionals involved with health and social care commissioning at national and local levels. These included representatives from the Department of Health, Primary Care Trusts, Strategic Health Authorities, Local Authorities, and third sector organisations.ResultsIn general, respondents lamented the lack of progress on health inequalities during the PCT commissioning era, where strong policy had not resulted in measurable improvements. However, there was concern that GP-led commissioning will fare little better, particularly in a time of reduced spending. Specific concerns centred on: reduced commitment to a health inequalities agenda; inadequate skills and loss of expertise; and weakened partnership working and engagement. There were more mixed opinions as to whether GP commissioners would be better able than their predecessors to challenge large provider trusts and shift spend towards prevention and early intervention, and whether GPs’ clinical experience would support commissioning action on inequalities. Though largely pessimistic, respondents highlighted some opportunities, including the potential for greater accountability of healthcare commissioners to the public and more influential needs assessments via emergent Health & Wellbeing Boards.ConclusionsThere is doubt about the ability of GP commissioners to take clearer action on health inequalities than PCTs have historically achieved. Key actors expect the contribution from commissioning to address health inequalities to become even more piecemeal in the new arrangements, as it will be dependent upon the interest and agency of particular individuals within the new commissioning groups to engage and influence a wider range of stakeholders.