英国基本医疗卫生体制及其改良对中国全科医学发展的启示
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摘要
英国全科医疗是国家卫生服务体系(National Health Service,NHS)的基石,不过近年出现了全科医生短缺的情况。对此,NHS进行了全面改良,提出了《五年发展规划》和《全科医学发展规划》。本文拟立足于此,结合英国前沿学术成果,介绍英国基本医疗卫生体制及其近五年改良的新举措,并与我国全科医学的发展现状相比较,以期为我国全科医学的进一步发展带来启示。
Primary care is the foundation of National Health Service(NHS)in the UK.Because recently there is an insufficient number of general practitioners to meet public healthcare needs,NHS launched a comprehensive reform,formulating two policies,Five Year Forward View and General Practice Forward View.On the basis of reviewing the latest related research in the UK,this paper gives a comparative analysis of the UK essential healthcare system and its reforms in recent five years,and the general practice development in China,with a view to bringing enlightenment to domestic general practice development.
Primary care is the foundation of National Health Service(NHS)in the UK.Because recently there is an insufficient number of general practitioners to meet public healthcare needs,NHS launched a comprehensive reform,formulating two policies,Five Year Forward View and General Practice Forward View.On the basis of reviewing the latest related research in the UK,this paper gives a comparative analysis of the UK essential healthcare system and its reforms in recent five years,and the general practice development in China,with a view to bringing enlightenment to domestic general practice development.
引文
[1]MARTIN M M D.A precious jewel:the role of general practice in the English NHS[J].The New England Journal of Medicine,2015,372(10):893-897.DOI:10.1056/NEJMp1411429.
[2]NHS England.Five year forward view[R].London:NHSEngland,2014.
[3]NHS England.General practice forward view[R].London:NHSEngland,2014.
[4]ERIC C S,DANA O S,DAVID S,et al.Mirror,mirror 2017:international comparison reflects flaws and opportunities for better U.S.health care[J/OL].The Commonwealth Fund,2017.[2019-05-04].http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror.
[5]MIKE H.General Practice and the NHS:past,present and future[R].沈阳:第五届中国全科医学大会,2018.
[6]MADAN A,MANEK N,GREGORY S.General practice:the heart of the NHS[J].British Journal of General Practice,2017,67(657):150-151.DOI:10.3399/bjgp17X689965.
[7]Health Education England.Securing the future GP workforce:delivering the mandate on GP expansion:GP taskforce final report[R].London:Health Education England,2014.
[8]FLETCHER E,ABEL G A,ANDERSON R,et al.Quitting patient care and career break intentions among general practitioners in South Wes England:findings of a census survey of general practitioners[J].BMJ Open,2017,7(4):e015853.DOI:10.1136/bmjopen-2017-015853.
[9]ALBERTI H,BANNER K,COLLINGWOOD H,et al.'Just a GP':a mixed method study of undermining of general practice as a career choice in the UK[J].BMJ Open,2017,7(11):e018520.DOI:10.1136/bmjopen-2017-018520.
[10]MARCHAND C,PECKHAM S.Addressing the crisis of GPrecruitment and retention:a systematic review[J].British Journal of General Practice,2017,67(657):e227-237.DOI:10.3399/bjgp17X689929.
[11]HARDING A,ROSENTHAL J,ALSEAIDY M,et al.Provision of medical student teaching in UK general practices:a crosssectional questionnaire study[J].Br J Gen Pract,2015,65(635):e409.DOI:10.3399/bjgp15X685321.
[12]ROLAND M,EVERINGTON S.Tackling the crisis in general practice[J].BMJ,2016,352:i942.DOI:10.1136/bmj.i942.
[13]RCGP.Spotlight on the 10 high impact actions[J/OL].London:RCGP,2018.
[14]WILSON M,MAZOWITA G,IGNASZEWSKI A,et al.Family physician access to specialist advice by telephone:reduction in unnecessary specialist consultations and emergency department visits[J].Canadian Family Physician,2016,62(11):e668-676.
[15]KIRSI K,MARJA A,HELENA L.Barriers and facilitators to medication adherence:a qualitative study with general practitioners[J].BMJ Open,2018,8:e015332.DOI:10.1136/bmjopen-2016-015332.
[16]AFFLITTI J,LEE K,JACOBS M,et al.Improving provider experience and increasing patient access through nurse practitionerphysician primary care teams[J].The Journal of Ambulatory Care Management,2018,41(4):308-313.DOI:10.1097/JAC.0000000000000252.
[17]THOMAS R.GP training target exceeded for first time[J/OL].Health Serv J,2018.[2019-05-04].https://www.hsj.co.uk/workforce/gp-training-target-exceeded-for-first-time-/7023619.article?adredir=1.
[18]NHS.Next steps on thenhs five year forward view[J/OL].BMJ,2017,357:j1678.DOI:https://doi.org/10.1136/bmj.j1678.[2019-05-04].https://www.england.nhs.uk/publication/next-steps-on-the-nhs-five-year-forward-view.
[19]邱超奕.“身边的医生”多起来[N/OL].人民日报,2019-04-30[2019-05-04].http://news.hnr.cn/201904/30/34013.html.
[20]刘红,史卫红,乔学斌.江苏省乡镇卫生院卫生人才队伍建设现状及对策分析[J].中华医学教育探索杂志,2015,14(12):1195-1200.DOI:10.3760/cma.j.issn.2095-1485.2015.12.003.LIU H,SHI W H,QIAO X B.Status quo and countermeasures analysis of the construction of health personnel in township health centers in Jiangsu Province[J].Chinese Journal of Medical Education Research,2015,14(12):1195-1200.DOI:10.3760/cma.j.issn.2095-1485.2015.12.003.
[21]刘红,史卫红,乔学斌.江苏省基层全科医生岗位胜任力研究[J].中国全科医学,2017,20(25):3088-3093.DOI:10.3969/j.issn.1007-9572.2017.25.006.LIU H,SHI W H,QIAO X B.Competencies of grassroots general practitioners in Jiangsu Province[J].Chinese General Practice,2017,20(25):3088-3093.DOI:10.3969/j.issn.1007-9572.2017.25.006.
[22]高和荣.签而不约:家庭医生签约服务政策为何阻滞[J].西北大学学报(哲学社会科学版),2018,48(3):48-55.DOI:10.16152/j.cnki.xdxbsk.2018-03-006.GAO H R.Signed without agreement:why family doctor service policy hindered[J].Journal of Northwest University(Philosophy and Social Sciences Edition),2018,48(3):48-55.DOI:10.16152/j.cnki.xdxbsk.2018-03-006.
[23]李美萱,李秀霞,邢新,等.中国家庭医生签约服务现状[J].中国公共卫生,2019,22(19):22!!-22!!..DOI:10.11847/zgggws1122093.LI M X,LI X X,XING X,et al.Current situation of family doctor contract service in China[J].Chinese Journal of Public Health,2019.DOI:10.11847/zgggws1122093.
[24]肖蕾,张太慧,张雅莉,等.分级诊疗视角下家庭医生签约服务“签而不约”的原因及对策研究[J].中国全科医学,2018,21(25):3063-3068.DOI:10.12114/j.issn.1007-9572.2018.25.007.XIAO L,ZHANG T H,ZHANG Y L,et al.Reasons and countermeasures of residents signing the contract with the family doctor but not making appointments during the implementation of hierarchical medical system[J].Chinese General Practice,2018,21(25):3063-3068.DOI:10.12114/j.issn.1007-9572.2018.25.007.
[25]沈冰洁,胡琳琳,尤莉莉,等.我国中部地区乡村医生的离职意向及影响因素研究[J].中国全科医学,2018,21(34):4183-4187.DOI:10.12114/j.issn.1007-9572.2018.34.005.SHEN B J,HU L L,YOU L L,et al.Turnover intention and its influencing factors among village doctors in central China[J].Chinese General Practice,2018,21(34):4183-4187.DOI:10.12114/j.issn.1007-9572.2018.34.005.
[26]林恺,邱卫黎,郑晓华.广东省粤东地区岗位培训全科医生职业满意度状况研究[J].中国医学创新,2016,13(26):64-67.DOI:10.3969/j.issn.1674-4985.2016.26.018.LIN K,QIU W L,ZHENG X H.Research on the career satisfaction of job training general practitioners in eastern Guangdong[J].Medical Innovation of China,2016,13(26):64-67.DOI:10.3969/j.issn.1674-4985.2016.26.018.
[27]郑艳玲,余芳,陈艳黎,等.我国全科医生职业倦怠状况及影响因素研究[J].中国全科医学,2019,22(7):764-769.DOI:10.12114/j.issn.1007-9572.2019.07.005.ZHENG Y L,YU F,CHEN Y L,et al.Prevalence and influencing factors for job burnout among general practitioners in China[J].Chinese General Practice,2019,22(7):764-769.DOI:10.12114/j.issn.1007-9572.2019.07.005.
[28]国务院办公厅.国务院办公厅关于改革完善全科医生培养与使用激励机制的意见[Z].2018.
[29]国家卫生健康委员会.2018中国卫生健康统计年鉴[M].北京:中国协和医科大学出版社,2018.
[30]科技教育司.住院医师规范化培训基地(综合医院)全科医学科设置指导标准(试行)政策解读[EB/OL].(2018-09-03)[2019-05-04].https://mp.weixin.qq.com/s?__biz=MjM5Mzk1NTE2MA%3D%3D&idx=1&mid=2455764138&sn=c6cebdcc97e30dc75db779b899468e0a.
[31]刘娟娟,刘颖,任菁菁.数字信息化技术在全科医疗中的应用研究[J].中国全科医学,2015,18(13):1488-1492.DOI:10.3969/j.issn.1007-9572.2015.13.004.LIU J J,LIU Y,REN J J.Application of digital information technology in general practice[J].Chinese General Practice,2015,18(13):1488-1492.DOI:10.3969/j.issn.1007-9572.2015.13.004.
[32]高翔,张新宇,赵世鸿.江苏省医患关系现状分析[J].中国公共卫生,2016,32(8):1013-1016.DOI:10.11847/zgggws2016-32-08-02.GAO X,ZHANG X Y,ZHAO S H.Current situation of doctorpatient relationship in Jiangsu Province[J].Chinese Journal of Public Health,2016,32(8):1013-1016.DOI:10.11847/zgggws2016-32-08-02.
[33]王怀诗,祁静.家政服务业缘何处于“高需求量低满意度”怪圈[N].连云港日报,2018-11-07(04).
[34]张鸣旭.我国非营利组织志愿者现状研究[J].管理观察,2016,36(24):55-58.DOI:10.3969/j.issn.1674-2877.2016.24.014.ZHANG M X.A Study on the current situation of volunteers of nonprofit organizations in China[J].Management Observer,2016,36(24):55-58.DOI:10.3969/j.issn.1674-2877.2016.24.014.
[2]NHS England.Five year forward view[R].London:NHSEngland,2014.
[3]NHS England.General practice forward view[R].London:NHSEngland,2014.
[4]ERIC C S,DANA O S,DAVID S,et al.Mirror,mirror 2017:international comparison reflects flaws and opportunities for better U.S.health care[J/OL].The Commonwealth Fund,2017.[2019-05-04].http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror.
[5]MIKE H.General Practice and the NHS:past,present and future[R].沈阳:第五届中国全科医学大会,2018.
[6]MADAN A,MANEK N,GREGORY S.General practice:the heart of the NHS[J].British Journal of General Practice,2017,67(657):150-151.DOI:10.3399/bjgp17X689965.
[7]Health Education England.Securing the future GP workforce:delivering the mandate on GP expansion:GP taskforce final report[R].London:Health Education England,2014.
[8]FLETCHER E,ABEL G A,ANDERSON R,et al.Quitting patient care and career break intentions among general practitioners in South Wes England:findings of a census survey of general practitioners[J].BMJ Open,2017,7(4):e015853.DOI:10.1136/bmjopen-2017-015853.
[9]ALBERTI H,BANNER K,COLLINGWOOD H,et al.'Just a GP':a mixed method study of undermining of general practice as a career choice in the UK[J].BMJ Open,2017,7(11):e018520.DOI:10.1136/bmjopen-2017-018520.
[10]MARCHAND C,PECKHAM S.Addressing the crisis of GPrecruitment and retention:a systematic review[J].British Journal of General Practice,2017,67(657):e227-237.DOI:10.3399/bjgp17X689929.
[11]HARDING A,ROSENTHAL J,ALSEAIDY M,et al.Provision of medical student teaching in UK general practices:a crosssectional questionnaire study[J].Br J Gen Pract,2015,65(635):e409.DOI:10.3399/bjgp15X685321.
[12]ROLAND M,EVERINGTON S.Tackling the crisis in general practice[J].BMJ,2016,352:i942.DOI:10.1136/bmj.i942.
[13]RCGP.Spotlight on the 10 high impact actions[J/OL].London:RCGP,2018.
[14]WILSON M,MAZOWITA G,IGNASZEWSKI A,et al.Family physician access to specialist advice by telephone:reduction in unnecessary specialist consultations and emergency department visits[J].Canadian Family Physician,2016,62(11):e668-676.
[15]KIRSI K,MARJA A,HELENA L.Barriers and facilitators to medication adherence:a qualitative study with general practitioners[J].BMJ Open,2018,8:e015332.DOI:10.1136/bmjopen-2016-015332.
[16]AFFLITTI J,LEE K,JACOBS M,et al.Improving provider experience and increasing patient access through nurse practitionerphysician primary care teams[J].The Journal of Ambulatory Care Management,2018,41(4):308-313.DOI:10.1097/JAC.0000000000000252.
[17]THOMAS R.GP training target exceeded for first time[J/OL].Health Serv J,2018.[2019-05-04].https://www.hsj.co.uk/workforce/gp-training-target-exceeded-for-first-time-/7023619.article?adredir=1.
[18]NHS.Next steps on thenhs five year forward view[J/OL].BMJ,2017,357:j1678.DOI:https://doi.org/10.1136/bmj.j1678.[2019-05-04].https://www.england.nhs.uk/publication/next-steps-on-the-nhs-five-year-forward-view.
[19]邱超奕.“身边的医生”多起来[N/OL].人民日报,2019-04-30[2019-05-04].http://news.hnr.cn/201904/30/34013.html.
[20]刘红,史卫红,乔学斌.江苏省乡镇卫生院卫生人才队伍建设现状及对策分析[J].中华医学教育探索杂志,2015,14(12):1195-1200.DOI:10.3760/cma.j.issn.2095-1485.2015.12.003.LIU H,SHI W H,QIAO X B.Status quo and countermeasures analysis of the construction of health personnel in township health centers in Jiangsu Province[J].Chinese Journal of Medical Education Research,2015,14(12):1195-1200.DOI:10.3760/cma.j.issn.2095-1485.2015.12.003.
[21]刘红,史卫红,乔学斌.江苏省基层全科医生岗位胜任力研究[J].中国全科医学,2017,20(25):3088-3093.DOI:10.3969/j.issn.1007-9572.2017.25.006.LIU H,SHI W H,QIAO X B.Competencies of grassroots general practitioners in Jiangsu Province[J].Chinese General Practice,2017,20(25):3088-3093.DOI:10.3969/j.issn.1007-9572.2017.25.006.
[22]高和荣.签而不约:家庭医生签约服务政策为何阻滞[J].西北大学学报(哲学社会科学版),2018,48(3):48-55.DOI:10.16152/j.cnki.xdxbsk.2018-03-006.GAO H R.Signed without agreement:why family doctor service policy hindered[J].Journal of Northwest University(Philosophy and Social Sciences Edition),2018,48(3):48-55.DOI:10.16152/j.cnki.xdxbsk.2018-03-006.
[23]李美萱,李秀霞,邢新,等.中国家庭医生签约服务现状[J].中国公共卫生,2019,22(19):22!!-22!!..DOI:10.11847/zgggws1122093.LI M X,LI X X,XING X,et al.Current situation of family doctor contract service in China[J].Chinese Journal of Public Health,2019.DOI:10.11847/zgggws1122093.
[24]肖蕾,张太慧,张雅莉,等.分级诊疗视角下家庭医生签约服务“签而不约”的原因及对策研究[J].中国全科医学,2018,21(25):3063-3068.DOI:10.12114/j.issn.1007-9572.2018.25.007.XIAO L,ZHANG T H,ZHANG Y L,et al.Reasons and countermeasures of residents signing the contract with the family doctor but not making appointments during the implementation of hierarchical medical system[J].Chinese General Practice,2018,21(25):3063-3068.DOI:10.12114/j.issn.1007-9572.2018.25.007.
[25]沈冰洁,胡琳琳,尤莉莉,等.我国中部地区乡村医生的离职意向及影响因素研究[J].中国全科医学,2018,21(34):4183-4187.DOI:10.12114/j.issn.1007-9572.2018.34.005.SHEN B J,HU L L,YOU L L,et al.Turnover intention and its influencing factors among village doctors in central China[J].Chinese General Practice,2018,21(34):4183-4187.DOI:10.12114/j.issn.1007-9572.2018.34.005.
[26]林恺,邱卫黎,郑晓华.广东省粤东地区岗位培训全科医生职业满意度状况研究[J].中国医学创新,2016,13(26):64-67.DOI:10.3969/j.issn.1674-4985.2016.26.018.LIN K,QIU W L,ZHENG X H.Research on the career satisfaction of job training general practitioners in eastern Guangdong[J].Medical Innovation of China,2016,13(26):64-67.DOI:10.3969/j.issn.1674-4985.2016.26.018.
[27]郑艳玲,余芳,陈艳黎,等.我国全科医生职业倦怠状况及影响因素研究[J].中国全科医学,2019,22(7):764-769.DOI:10.12114/j.issn.1007-9572.2019.07.005.ZHENG Y L,YU F,CHEN Y L,et al.Prevalence and influencing factors for job burnout among general practitioners in China[J].Chinese General Practice,2019,22(7):764-769.DOI:10.12114/j.issn.1007-9572.2019.07.005.
[28]国务院办公厅.国务院办公厅关于改革完善全科医生培养与使用激励机制的意见[Z].2018.
[29]国家卫生健康委员会.2018中国卫生健康统计年鉴[M].北京:中国协和医科大学出版社,2018.
[30]科技教育司.住院医师规范化培训基地(综合医院)全科医学科设置指导标准(试行)政策解读[EB/OL].(2018-09-03)[2019-05-04].https://mp.weixin.qq.com/s?__biz=MjM5Mzk1NTE2MA%3D%3D&idx=1&mid=2455764138&sn=c6cebdcc97e30dc75db779b899468e0a.
[31]刘娟娟,刘颖,任菁菁.数字信息化技术在全科医疗中的应用研究[J].中国全科医学,2015,18(13):1488-1492.DOI:10.3969/j.issn.1007-9572.2015.13.004.LIU J J,LIU Y,REN J J.Application of digital information technology in general practice[J].Chinese General Practice,2015,18(13):1488-1492.DOI:10.3969/j.issn.1007-9572.2015.13.004.
[32]高翔,张新宇,赵世鸿.江苏省医患关系现状分析[J].中国公共卫生,2016,32(8):1013-1016.DOI:10.11847/zgggws2016-32-08-02.GAO X,ZHANG X Y,ZHAO S H.Current situation of doctorpatient relationship in Jiangsu Province[J].Chinese Journal of Public Health,2016,32(8):1013-1016.DOI:10.11847/zgggws2016-32-08-02.
[33]王怀诗,祁静.家政服务业缘何处于“高需求量低满意度”怪圈[N].连云港日报,2018-11-07(04).
[34]张鸣旭.我国非营利组织志愿者现状研究[J].管理观察,2016,36(24):55-58.DOI:10.3969/j.issn.1674-2877.2016.24.014.ZHANG M X.A Study on the current situation of volunteers of nonprofit organizations in China[J].Management Observer,2016,36(24):55-58.DOI:10.3969/j.issn.1674-2877.2016.24.014.