Transforming Primary Care in Scotland and China to meet the needs of an ageing population - are health inequalities being tackled?

世界各国都面临着重大变化，许多人都活得更老了。全科医疗和初级保健提供了这类老龄人口的大部分保健需求。中国和联合王国(英国)在卫生和社会保健方面面临许多相似的挑战，包括老龄化和贫富之间广泛的健康不平等。在苏格兰，初级保健最近发生了重大变化，包括一项新的仅限苏格兰的全科医生合同，其中包括全科医生在“集群”中合作(5-8个诊所)，以提高向当地人口提供的护理质量，以及初级保健团队的其他成员(如护理、药房和理疗方面的高级从业者)的显著扩大。在中国，近年来建立了社区卫生中心。这些与苏格兰的全科医生实践相似，尽管规模稍大，由初级保健团队中的全科医生领导。一个关键的重点--在苏格兰初级保健中不那么突出--是系统的预防性保健，以支持人们过上更健康的生活并更好地管理自己的状况。随着初级保健领域的这些变化进一步发展，每个国家都有一个相互学习的重要机会。这项研究的目的是探索和比较苏格兰和中国最近在初级保健方面的这些变化的影响，并找出这些变化是否满足了患有长期疾病的老年患者的需求，以及减少了健康不平等。为了回答这一问题，我们将分两个阶段进行研究。第一阶段将探讨两国变化的预期影响。第二阶段将审查实际影响和关键学习。为了回答这些问题，我们将使用免费获得的关于患者意见的国家信息(在两个国家可用)，以及全科医生对工作满意度、工作量和最近组织变化的看法，我们将在两个国家收集这些信息。我们还将向两国的工作人员和患者进行深入的交谈。我们将在一系列不同的地理环境中开展这项工作，以便更详细地了解他们的意见，并根据共同主题以及发现的有助于或阻碍进展的因素对这些意见进行分析。我们会在这两个国家的电脑化医疗记录中记录常规数据，以补充这些调查结果。然后，我们将考虑这些发现对两国的影响，并与公众、政府、医疗保健人员和其他研究人员分享这些发现。这些发现可能也会引起正在开展类似努力的其他国家的兴趣，这些国家正在努力改善初级保健，以满足老龄化人口的需求，并帮助解决健康不平等问题。这项研究的一个独特特点将是具有不同专业领域的研究人员在社会和医学研究方面的合作。

Countries around the world are facing major changes, with many people living to an older age. General Practice and primary care provides much of the healthcare care needs of such ageing populations. China and the United Kingdom (UK) share many similar challenges in health and social care including ageing and wide health inequalities between rich and poor. In Scotland, significant recent changes have been made in primary care including a new Scotland-only GP contract which includes GP Practices working together in 'clusters' (of 5-8 Practices) to improve the quality of care delivered to their local population, and significant expansion of other members of the primary care team (such as advanced practitioners in nursing, pharmacy, and physiotherapy). In China, Community Health Centres (CHCs) have been established over recent years. These are similar to GP Practices in Scotland, though somewhat larger, led by GPs working within primary care teams. A key focus - which is much less prominent in Scottish primary care - is systematic preventive care to support people to live healthier lives and manage their own conditions better. There is an important opportunity for each country to learn from each other, as these changes in primary care develop further. The aim of the study is to explore and compare the effects of these recent changes in primary care in Scotland and China, and to find out if these changes are meeting the needs of ageing patients with long-term conditions, as well as reducing health inequalities. To answer this we will carry out the research in two phases. The first phase will explore what the expected impacts are of the changes in both countries. The second phase will examine the actual impacts and key learning. To answer these questions, we will use freely available national information on patients views (available in both countries), together with GPs views on job satisfaction, workload, and the recent organisational changes, which we will collect in both countries. We will also speak in-depth to staff and patients in both countries. We will do this in a range of different geographical settings to get more detailed information on their views, and analyse these in terms of common themes, and what has been found to help or hinder progress. We will supplement these findings with routine data recorded in the computerised medical records in both countries. We will then consider the implications of the findings for both countries, and share the findings with the public, government, healthcare staff, and other researchers. The findings may also be of interest to other countries that are embarking on similar attempts to improve primary care to meet the needs of ageing populations, and help tackle health inequalities. A unique feature of the research will be collaboration between researchers with different areas of expertise, in social and medical research.