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Fixing Britain’s health service means fixing its family doctors
解决英国的医疗服务问题意味着解决家庭医生的问题
Waiting-longer rooms
等待时间较长的房间
Don’t change the partnership model. Do change the targets
不要改变合作模式。一定要改变目标
Jan 12th 2023
Britons used to see the National Health Service (nhs) as a source of pride. It is now a source of danger. Leaked data suggest that, in one week in December, over 50,000 sick people in England waited more than 12 hours to be admitted to hospital from accident-and-emergency (a&e) departments. The Economist’s mortality model echoes the warnings from emergency doctors: around one in four excess deaths in recent months is attributable to delays in emergency care.
英国人过去将国民医疗服务体系(NHS)视为一种骄傲。现在它是一个危险的来源。泄露的数据显示，在去年12月的一周内，英国有超过5万名病人在急诊室等待了超过12个小时才被医院收治。《经济学人》的死亡率模型与急诊医生的警告相呼应: 近几个月来，大约四分之一的额外死亡是由于急诊护理的延误造成的。
The scenes in a&e are just the most alarming symptoms of a health-care system that is failing. Downstream, one in seven patients is ready to leave the wards, which would free up beds for those clamouring to get in, but they would have no one to look after them if they were released from hospital. The government’s proposed solution—an extra £200m ($243m) to block-book places in private care homes—seems sensible. But it will take more than that to deal with the deeper problem: a chronic shortage of staff.
【1】block-booking: the making of bookings for a number of people, or e. g. purchasing a number of seats in a theatre, concert hall, etc at the same time急诊室的场景只是一个正在失效的医疗保健系统最令人担忧的症状。其下游，七分之一的病人准备离开病房，这将为那些吵着要进来的人腾出床位，但如果他们出院了，就没有人照顾他们了。政府提出的解决方案似乎是明智的，即额外支付2亿英镑(2.43亿美元)批量预定私人养老院的名额。但要解决更深层次的问题:，即长期的人员短缺问题，这一解决方案还不够。
Upstream, the same issue bedevils general practice, the network of family doctors where many of the pressures on the nhs first build. General practitioners (gps) are conventionally a patient’s first and most frequent point of contact with Britain’s health-care professionals. But the system is buckling. Demand is rising—owing partly to a backlog in cases from the pandemic and partly to an increase in patients with complex, chronic diseases. And the number of doctors is dwindling, as gps retire early, emigrate or reduce their hours. There are 15% more junior doctors in hospitals than there were in 2019, but 2% fewer full-time family doctors (albeit more practice staff). As a result, millions are not getting the care they need. Many turn directly to the hospitals. Polling shows that one in five people who cannot see their family doctor goes to a&e instead. Many simply get sicker.
在上游，同样的问题困扰着全科诊疗（家庭医生系统是国民医疗服务体系最先承受压力的地方）。一般来说，全科医生通常是患者与英国医疗保健专业人员的第一个也是最频繁的接触点。但是这个系统正在垮掉。需求正在增加，部分原因是大流行病例积压，部分原因是患有复杂慢性病的患者增加。由于全科医生提前退休、移民或缩短工作时间，医生的数量正在减少。与2019年相比，医院的初级医生增加了15%，但全职家庭医生减少了2%(尽管执业人员增加了)。结果，数以百万计的人得不到他们所需的医疗服务。许多人直接求助于医院。民意调查显示，五分之一不能看家庭医生的人会去急诊室。许多人则是病情加重。
To slow the stampede of older gps retiring early, the government should exempt doctors from pension-tax rules that penalise high-earners. More advanced technology, including automated telephone services and online consultations, would calm the 8am panic to book an appointment.
为了减缓老年全科医生提前退休的蜂拥现象，政府应该免除医生的养老金税规定，因为这些规定对高收入者不利。更先进的技术，包括自动电话服务和在线咨询，将缓解早上8点预约的恐慌。
More profound changes are needed to make this foundation of the nhs sturdy again. General practices are businesses, most commonly owned by gp partners. The building will collapse if partners continue to quit. One option is to make all gps salaried nhs employees, as consultants are in hospitals. The Labour Party is considering this approach, along with other reforms such as allowing self-referrals to certain specialists.
需要进行更深刻的改革，才能使NHS的根基再次稳固起来。全科医生是企业，通常由全科医生合伙人拥有。如果合伙人持续退出，公司就会倒闭。一种选择是让所有全科医生都成为领薪的NHS雇员，就像医院的咨询师一样。工党正在考虑这种方法，以及其他改革，如允许自行转诊到某些专家。
Buying out gp partners and their premises would be costly. It would also be risky to jettison a model that, for all its faults, remains the envy of other countries. Primary care provides most of the nhs’s patient contacts for just 9% of its budget. Specialists, meanwhile, have seen their hospital waiting lists spiral to over 7m: self-referrals would make the problem worse.
收购全科医生合伙人及其经营场所的成本很高。抛弃一个尽管存在种种缺陷，但仍令其他国家羡慕不已的模式也是有风险的。初级保健能够为NHS大部分的病人提供服务，且仅占其9%的预算。与此同时，专家们发现他们的医院候诊名单已经上升到700多万人: 自行转诊将使问题变得更糟。
It would be better to make changes from within. The nhs should abolish the Quality and Outcomes Framework, a pointless pay-for-performance scheme which means that gps spend hours filling out forms instead of seeing patients. Pharmacies and other parts of the primary-care system should be encouraged to do more. Practices specialising in chronic illnesses should receive higher fixed fees per patient, enabling continuity of care for those who most need it. Reweighting funding to benefit clinics in the poorest areas would reduce health disparities: they care for 10% more patients than practices in the richest areas, but receive 7% less cash.
从内部做出改变会更好。NHS应该废除“质量与产出框架”，这是一项毫无意义的绩效薪酬计划，这意味着全科医生要花几个小时在填写表格上，而不是去看病人。应该鼓励药房和初级保健系统的其他部分做更多的工作。专门治疗慢性疾病的诊所应该从每个病人身上收取更高的固定费用，从而为那些最需要的人提供持续的治疗。对资金进行重新调整，从而使最贫困地区的诊所受益，将减少健康差距: 他们比最富裕地区的诊所多照顾10%的病人，但他们获得的现金却比他们少7%。
The nhs’s most urgent problem lies in its hospitals. But the health service will not be fixed unless general practice is, too. ■
NHS最紧迫的问题在于它的医院。但是，除非全科医生问题解决了，否则医疗服务问题不会解决。■ |
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发表于 2023-4-19 16:15:00
