Summary
The British National Health Service is a closed managed care system. This single health
care system for the United Kingdom is funded by the government and paid for by general
taxation. All UK citizens are registered with primary care physicians who control
access to secondary care services. As a managed care system it should be able to offer
integrated care across the whole patient pathway. In reality there are professional,
organizational, and institutional barriers to coordination and delivery of care in
the NHS. Historically, the United Kingdom has been among the lowest health care spenders
of organizations for economic cooperation in developed countries, in absolute terms
as well as proportion of the gross domestic product. However, since a Government pledge
to place quality at the heart of the NHS and a commitment in 2000 to increase spending
on the NHS, the NHS budget has more than doubled—an unprecedented rate of growth,
roughly by 7.5% annually in real terms. A quality and outcomes framework has been
introduced into primary care to systematically incentivize process measures such as
computerization and chronic disease management by establishing practice-based disease
registers. The strategic planning for kidney services in England has been developed
in this national environment complemented by local research findings and the wider
international consensus that has emerged since the publication of the classification
of chronic kidney disease in 2002. This program of work has resulted in a paradigm
shift from kidney disease being viewed as a secondary care condition to being a primary
care priority as part of vascular disease control and management. In the first 2 years
of the initiative more than 40% of the expected chronic kidney disease stage 3 to
5 population have been registered in primary care. Kidney disease now is recognized
as a public health problem in the United Kingdom, preventative strategies are being
integrated into comprehensive vascular risk assessment and management programs, and
kidney disease has become an NHS priority area.
Keywords
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© 2009 Published by Elsevier Inc.
