在听过了中国的全科医生和患者的故事，你有没有好奇，国外的全科医生（General Practitioner, GP）是什么样的呢？ 今天，让我们走进正在北京为英国驻华大使馆担任健康政策高级官员的英国全科医生安瑞秋（Rachel Ainley），了解她在英国全国卫生系统内担任全科医生的经历：是哪些因素引领她走上了全科医生的职业道路？英国全科医生系统有哪些亮点可供中国借鉴？▼ “2014年，英联邦基金（Commonwealth Fund）将英国国家医疗服务体系 （NHS）评定为全球最优医疗系统，认为英国全国卫生系统，与其它医疗系统相比，提供了更加质优价廉的服务。英国全国卫生系统的宗旨就是：基于临床需要求而不是支付能力，为英国每个人提供医疗服务，做到医疗服务使用点免费。”同中国一样，英国也面临着老龄化人口医疗服务方面的挑战，非传染性疾病问题日趋严重，一线医疗服务承受的压力上升。但幸运的是，1948年以来，英国的医疗系统不断改善，英国的基层医疗系统已经相当成熟。”“在英国，病人获取医疗服务的流程与眼下的中国完全不同。在英国，病人95%的问题由全科医生负责处理；人们只会在紧急状况下才直接去医院。在英国，如果全科医生确认病人需要接受专科诊疗，会安排转诊；但看完专科之后，病人通常还会再次被转回到自己的全科医生那里。这就形成了一个‘守门员’系统——没有全科医生的转诊安排，病人无法去看专科医生。这种设计也控制了医疗系统的成本。同时也意味着医生个人就要独立负责为病人提供全面的、以病人为中心的医疗关怀。” “来中国之前，我在伦敦接受过全科医生实训。作为全科医生，我几乎每天都要和很多来访者面对面交流，还要承担电话咨询接待、家庭访视，还要处理一些文案工作。我服务的病人，有老有少，他们都在我们诊所这片儿居住，其中很多儿童快接近成年但都还没看过儿科医生。我工作中，很大一部分是进行健康促进，包括就膳食、运动和吸烟问题提供意见建议。有些病人既有躯体疾病，也有精神健康问题。通常，病人整个家庭的情况都会在同一个全科医生诊所登记在册；病人们会长年定期看全科医生。其实，在英国，全科医生只是整个社区卫生服务团队的一部分而已；团队中除了全科医生，还有接待人员、管理人员、护士、理疗师、营养师、药剂师和社会工作者。”“大家经常问我，为什么要成为全科医生。对我来说，我希望有机会了解我的病人，了解病人的家庭，跟踪观察他们长期的状况。我希望自己的职业具有灵活性，让我能够把非全日制临床工作和研究教学工作结合起来。英国全科医生的收入和大医院医生相当，而且同样很受尊敬。也就是说，全科医生是十分吸引人的职业。最近一项调查显示，十个人中几乎有九人都表示他们信任全科医生；所有职业（包括法官、学校教师、警察）比较来看，对全科医生的信任程度最高。这份信赖的一大关键原因在于全科医生接受的严格培养——英国全科医生培养课程体系与考核标准均由英国皇家全科医师学会制定。” “中国正在快速推进医疗改革。我们承认，中英两国都有自己特殊的国情。同时，我们也希望英国的经验能够为中国提供一些帮助。我现在在英国驻华使馆负责中英医疗卫生合作工作。今年，我们支持中国开展了一系列基层医疗服务项目。我去过中国各地的医院，亲眼看见过医院承受的压力。我也到过社区诊所，亲眼看到现在已经取得的进步。随着时间推移，我希望医改能够确保全科医生享受更好的薪酬，这样可以吸引最优秀的人才加入全科医生队伍；我还希望全科医生能够获得更好的培训，这样可以赢得病人的信任。到那时，中国也会和英国一样，病人的看病习惯会改变，他们会看到全科医生诊疗的好处——全科医生了解病人以及病人的家人，并且就在病人自己的社区里工作。” 在全科医生系统方面，你认为有哪些英国经验值得中国借鉴？你到海外看过全科医生吗？有没有积极经验与我们分享呢？ 给我们留言，或点击“阅读原文”，进入微博#你好全科医生#话题页面，加入我们的讨论吧！晒出你的视角和故事！ General practitioners Overseas: Lessons from the UK Today we hear from Dr Rachel Ainley, a General Practitioner (GP) from the UK, currently based in Beijing working in the British Embassy as a Senior Policy Officer on Health. She tells us about her experience as a GP in the UK’s National Health System: what led her to follow this career path and what strengths the UK GP–system has that China could learn from. “The UK’s National Health System, or NHS, was rated as the best healthcare system in the world by the Commonwealth Fund in 2014, providing superior care to other, much more expensive healthcare systems. Its purpose is to provide healthcare to every person in the population, free at the point of use and based on clinical need, not ability to pay. Like China, the UK is also facing the challenge of providing healthcare to an ageing population with rising levels of non-communicable disease, putting pressure on front-line services. But we are fortunate that our healthcare system has been developing since 1948 and that we already have a well-established primary care system.” “The pathway that patients use to access medical care is very different from today’s situation in China. In the UK, General Practitioners (GPs) deal with 95% of the problems patients’ experience, meaning they only go directly to a hospital in the event of an emergency. If a GP decides a patient needs to see a specialist, they will arrange this, but after the patient sees the specialist they are usually referred back to their GP. This creates a gatekeeper system, as a patient cannot be seen by a specialist without a referral from their GP, and contains costs for the healthcare system. It also means that one doctor is responsible for taking a holistic, patient-centred approach to care.” “Before moving to China, I trained as a GP in London. A typical working day at my GP surgery, or clinic, was a mixture of face-to-face appointments, telephone consultations, home visits and paperwork. I treated patients both young and old, all of whom lived locally, with most children reaching adulthood without seeing a paediatrician. A large part of my work was health promotion, including advice on diet, exercise and smoking. I saw patients with both physical and mental health problems. Often the whole family is registered at the same GP surgery and patients see their GP regularly over many years. But GPs are only one part of a large community team – supported by receptionists, managers, nurses, therapists, dieticians, pharmacists and social workers.” “People often ask why I became a GP. I wanted to have the opportunity to get to know my patients and their families and follow their progress long-term. I wanted a flexible career, giving me the option to combine part time clinical work with research and teaching. GPs in the UK are paid a similar salary to hospital consultants and are highly respected, meaning that it is a very attractive career. Almost nine out of ten people in a recent survey said they would put their trust in a GP, higher than for any other profession, including judges, school teachers and police officers. A key reason for this trust is rigorous training of GPs – with the training curriculum and examination standards set by our Royal College of General Practitioners (RCGP).” “China’s healthcare reforms are progressing fast. We recognise that our two countries are not the same, but hope that our experience can help. In my role at the British Embassy I work on UK-China healthcare collaboration and we are supporting a number of projects this year on primary care. I have visited hospitals across China and seen the pressure that they are under. I have also visited community clinics and seen how much progress has been achieved. Over time I hope that reforms ensure that GPs are better paid, to attract the best doctors; and better trained, to gain the trust of their patients. Only then will patient behaviour change and they will see the benefits of being treated by a GP who knows them and their families, and who work in their community - as in the UK.” What lessons do you think China can learn from the UK on their GP-system? Have you had a positive experience visiting a GP overseas? Tell us about it! Join our discussion using #HelloGP on Weibo through "Read more", share your views and story with us!
