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Promoting clinical effective practice. Attitudes of fundholding general practitioners to the role of commissioning.

Douglas, HR; Humphrey, C; Lloyd, M; Prescott, K; Haines, A; Rosenthal, J; Watt, I; (1997) Promoting clinical effective practice. Attitudes of fundholding general practitioners to the role of commissioning. J Manag Med , 11 (1) pp. 26-34.

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Abstract

Aims to evaluate the acceptability of commissioning to improve clinical effectiveness in secondary care and explore the conditions under which fundholders would be willing to use commissioning in this way. Describes how fundholders in two contrasting districts in North Thames Region were interviewed in 1995-1996. Respondents were selected from a list of all fundholders in the district with few fundholding practices and from lists of fundholders holding contracts with specified hospitals in the district with many fundholders. Interviews were analysed using the constant comparison method of content analysis. All fundholders in the districts were eligible. The sample represented a broad range of fundholders, containing all fundholding waves and large and small practices. Managers and general practitioners from multifunds outside the districts were also interviewed to assess whether they faced different issues from single practice fundholders. Many respondents felt unable to use commissioning to improve clinically effectiveness despite their awareness of the policy. Reasons identified included the problem of agreeing complex commissioning arrangements to reflect clinical issues, and an unwillingness to use fundholding to challenge hospital practice. Respondents from early wave fundholding practices and those with training in critically appraising research literature expressed more readiness to review research evidence, but only a few early wave fundholders said they would consider evidence-based commissioning. Concludes that steps should be taken to educate fundholders in clinical effectiveness and provide appropriate information to them. Also, they must be persuaded that clinical effectiveness is not a politically-driven policy or they will resist it.

Type: Article
Title: Promoting clinical effective practice. Attitudes of fundholding general practitioners to the role of commissioning.
Location: England
Keywords: Attitude of Health Personnel, Budgets, Clinical Competence, Contract Services, Evidence-Based Medicine, Family Practice, Feasibility Studies, Practice Guidelines as Topic, Quality of Health Care, State Medicine, Treatment Outcome, United Kingdom
UCL classification: UCL > School of Life and Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > UCL Medical School
UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > UCL Medical School > Vertical Module Tutors
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care > Primary Care and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/180766
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