Primary care-led commissioning: applying lessons from the past to the early development of clinical commissioning groups in England
Primary care-led commissioning: applying lessons from the past to the early development of clinical commissioning groups in England
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DOI：
10.3399/bjgp13x671597
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发表时间：
2013-09-01
影响因子：
5.9
通讯作者：
Peckham, Stephen
中科院分区：
文献类型：
--
作者：
Checkland, Kath;Coleman, Anna;Peckham, Stephen
背景英国国民保健服务目前的重组是有史以来最全面的重组之一。本研究报告的早期证据，从发展的临床调试组（CCGs），一个关键因素，在新的structure.AimTo探讨的发展CCGs的背景下，什么是已知的从以往的研究GP参与commission.Design和settingCase研究分析，从网站选择，以提供最大的多样性，在许多方面，方法采用8个详细的定性案例研究，辅以两个时间点网络调查的描述性信息进行案例分析。数据收集涉及观察各种会议，并与主要participator.ResultsPrevious研究表明，临床参与委托是最有效的，当全科医生觉得能够自主行动。复杂的内部结构，加上不断发展的外部问责关系，意味着社区团体的行动自由可能受到相当大的限制。有效的全科医生参与在确定临床调试的结果方面也很重要，CCG有一些悬而未决的问题，包括：谁觉得CCG的“所有权”;内部沟通是如何概念化和实现的;以及地方团体的作用和职权范围。以前的GP主导的委托的化身往往侧重于当地和初级保健服务。CCG热衷于采取行动，以提高质量，在其组成的做法，使用的方法，许多开发的实践为基础的委托。约束的管理支持和需要保持GP的参与可能会产生影响。ConclusionCCGs是新的组织，面临着重大的新责任。这项研究提供了CCG和负责CCG发展的人可能希望解决的问题的早期证据。
BackgroundThe current reorganisation of the English NHS is one of the most comprehensive ever seen. This study reports early evidence from the development of clinical commissioning groups (CCGs), a key element in the new structures.AimTo explore the development of CCGs in the context of what is known from previous studies of GP involvement in commissioning.Design and settingCase study analysis from sites chosen to provide maximum variety across a number of dimensions, from September 2011 to June 2012.MethodA case study analysis was conducted using eight detailed qualitative case studies supplemented by descriptive information from web surveys at two points in time. Data collection involved observation of a variety of meetings, and interviews with key participants.ResultsPrevious research shows that clinical involvement in commissioning is most effective when GPs feel able to act autonomously. Complicated internal structures, alongside developing external accountability relationships mean that CCGs' freedom to act may be subject to considerable constraint. Effective GP engagement is also important in determining outcomes of clinical commissioning, and there are a number of outstanding issues for CCGs, including: who feels 'ownership' of the CCG; how internal communication is conceptualised and realised; and the role and remit of locality groups. Previous incarnations of GP-led commissioning have tended to focus on local and primary care services. CCGs are keen to act to improve quality in their constituent practices, using approaches that many developed under practice-based commissioning. Constrained managerial support and the need to maintain GP engagement may have an impact.ConclusionCCGs are new organisations, faced with significant new responsibilities. This study provides early evidence of issues that CCGs and those responsible for CCG development may wish to address.