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Fundación Salud, Innovación y Sociedad "Contribuimos a la formación de opinión independiente" |
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| Entrevista David Colin-Thome (inglés) Director de Asuntos Sanitarios en el GJW Government Relations. Profesor de Política Farmacéutica y Sanidad en la Escuela de Farmacia de la Universidad de Londres. Anteriormente: Director Asociado de Estudios Sanitarios de la Audit Commission (1992-1996) Fellow de Política Sanitaria en King's Fund (1989-1992) Presidente de los Servicios de Medicina de Familia de la Health Autohority de Lambeth, Southwark y LewisHam (Londres) (1985-1992) Subdirector de la Office of Health Economics (1976-1984). |
How and why did you involve yourself in the organisation of the National Health System?
I was a general practitioner, with no formal management experience. I made my name through fund holding at the beginning of the 90´s. As a result, I was offered a job of working in the management side of the Health service, part-time as a GP and part time in the region. The last five years, I worked in two different regions, in Scotland and now I am in London. I also do some advisory work for three of the national health organisations, occasionally.
The reform of 1990 introduced a voluntary fundholding system for general practitioners. It showed advantages such as practitioner's involvement, better cost-effectiveness but has been soon abandoned on the claim of greater inequality between patients' offers. First, how were budgets assigned to fundholders?
In those days, the regional office used to assign budget to fundholders. A group of GPs, generally three or four, had to demonstrate that their general practice management had given them the competency to hold the budget. The Health Authority would get most of the money. Fundholders did not have it concretely.
Why has it been accused of leading to less equity between services supplies?
Two things: one, genuinely, the better practises were in better areas, so poor areas tended to have practices who could not manage a budget as well. Then, once we got the budget, we became much more imaginative about how to use it. The inequity was on the range of services we became able to provide and access to hospital, reorganising hospital services. For instance, we used to ask places quickly, because we could use our budget saying that we would do the follow-up if they just operate quicker. We needed the money in the first place to make the hospital take notice of us.
What are now the actors of innovation in the UK, GPs, nurses, hospitals or consumers?
I think that most innovations from the Health service come as more from us, the doctors upon the nurses and certainly upon the managers that tend, with a few exceptions, to keep the system steady. We had more freedom. Now, the best solution would be to give the money to consumers but that does not fit in with the European concept of solidarity, often constraining to the state system.
What did you learn from the Spanish system that might be useful for Great Britain?
Some of the Spanish equity of distribution and structure is what we are trying to achieve. But, I do not want to make a rough judgement on a short visit, it seems that Spanish doctors do not have as much freedom to innovate. They are much more controlled and do what they are told and work seven hours. Since I became a fund holder I had more influence on the issues of the community than I could ever have had as an MP.
What could be incentives, new sources of motivation for GPs now?
Note that the fund holding system never gave personal incentives to GPs. We never made more money out of it. Some people might have done indirectly but it was so indirect. We did it because we thought we could manage the services better and thus, keep the trust of our patients. Fund holding just made work for GPs more interesting and challenging.
