General practitioners in partnership with management: an organisational model for debate.

The role of general practitioners is changing and expanding. Doctors have more control over the treatment received by their patients but remain largely unaccountable to the public and management. This article proposes an organisational model for integrating primary and secondary care which retains the advantages of fund-holding while giving management control over overall strategy. It proposes that general practitioners control funds for all primary and secondary care. Secondary care will be contracted through a joint team of managers and an elected general practice executive committee. A new health care purchasing authority will contract for primary services with individual practices or primary care provider units. General practitioners will have local contracts reflecting their desire to provide an expanded range of services and the needs of the community.     

Psychological and social problems in HIV infection: interviews with general practitioners in London.

OBJECTIVE--To assess current practice and opinions of general practitioners in London about managing psychological and social problems relating to HIV infection. DESIGN--A stratified random sample of general practitioners, including those with a range of experience of people with HIV infection, were interviewed by medically trained interviewers. SETTING--Doctor''s surgeries. PARTICIPANTS--270 General practitioners working within the area covered by London postcodes. RESULTS--Two thirds of doctors had treated at least one patient with HIV infection and described their work with these patients. General practitioners were counselling and educating many of their patients about AIDS and associated risk behaviours and were aware of the need for careful attention to confidentiality. Doctors with no experience of patients with HIV infection were often older, in singlehanded practice, less inclined to deal with drug abusers or to counsel their patients on risk behaviours, and more in favour of insurance companies'' policies towards people with HIV infection. CONCLUSIONS--General practitioners in London are quickly becoming involved in the care of patients with HIV infection and their relatives and friends. Many are counselling patients and testing for antibodies themselves and regard this as an integral part of their work. A considerable workload in primary care comprised patients who obsessively fear contracting HIV infection.     

Free anonymous screening consultation and clinical management of HIV infection

In France, since 1988, anonymous and free consultations (called CDAG) have been settled in the country to facilitate an individual and volunteer approach for HIV screening. At the time, there are more than 380 CDAG with newly defined objectives. CDAG are supposed to encourage early screening, facilitate access to precarious persons and persons at risk for sexually transmitted diseases, and reinforce prevention, helping consultants to define a personal preventive strategy. CDAG are also supposed to play a role in prevention of both hepatitis B and C, and syphilis. They may help to link screening and healthcare. Their activity is increasing and the rate of positive test is twice that of private laboratories. Patients consulting those facilities are younger and more at risk than general population. Between 1000 and 2000 HIV positive tests are detected in CDAG each year (11 % of positive tests in the country). The real impact on prevention and screening at the national level is unknown, in part because of anonymity. To improve the characterization of consultants, data collection will be modified in 2004, and a network of selected and volunteer centres will collect continuously more accurate data.