Response by Dr. David Grimes http://www.vitamin-d-deficiency.co.uk
In the UK, for interesting historical reasons that go back to King Henry VIII th, there is total separation between primary and secondary care.
Primary care (general or family practice) is based one doctor or now group of doctors (GPs) having responsibility for a group of patients, a ratio of about 1:2000. The government pays the GP a basic capitation fee per patient, with adjustments for age of patient. They would rather increase income by 20% without increasing number of patients treated, but your suggestion is basically correct. The government aim is to reduce the doctor:patient ratio towards 1:1500.
There are other payments made for other services, mainly those of screening and preventative medicine. This is an excellent way to deliver preventative care, within a close doctor-patient relationship ("cradle to grave"). GPs are becoming very keen on vitamin D screening and things are happening years ahead of government action. It looks good and I am in close contact. They feel that early pregnancy is the group on which to concentrate.
There is also a public health function based on population groups of about 250,000 working with GPs, more closely linked to central government. Again vitamin D awareness is developing quickly.
Secondary care doctors in hospitals, like me, are paid a salary, with no adjustment for number of patients treated etc. They can supplement the salary by merit awards and by private clinical practice outside the NHS, and based on fee for service.
I know that in the USA the UK NHS has a bad press. In practice it works well, with obvious frustrations of an organisation that is working under efficiency pressures, but there is a very high level of satisfaction from those treated. Delays in treatment are very brief these days.
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- Low vitamin D associated with low socio-economics in UK – Aug 2011 same Doctor
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