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October 1999

Ophthalmology in the United Kingdom

Arch Ophthalmol. 1999;117(10):1407-1408. doi:10.1001/archopht.117.10.1407

IN EACH PART of the United Kingdom—England, Scotland, Wales, and Northern Ireland—the National Health Service (NHS) provides comprehensive health care for all, free at the point of service and financed by general taxation. There have always been minor differences in the administrative arrangements in these different countries, but the principles and the regulation have been uniform. This year, however, some functions of government, notably health and education, have been devolved to separate elected assemblies; therefore, the possibility exists that a different emphasis in health policy could emerge in each country. About 11% of the population has private health insurance, sometimes provided by employers. It is estimated that about 20% of elective surgery is carried out in the private sector, and of this, one tenth is commissioned by the NHS, often in short-term contracts to reduce waiting lists. Recently, there has been much public interest in the success rate of medical interventions, and the profession's regulatory body, the General Medical Council, is to introduce a system of periodic revalidation of fitness to practice for all registered medical practitioners. This will be based on performance and assessed by appraisal, audit, peer review, and continuing professional development. At the same time, government legislation has given medical management clear responsibility for the quality of clinical services (clinical governance) in addition to existing responsibilities for organizational quality and financial probity. The revalidation process for individual physicians will be part of the clinical governance system. In this and many other ways, the regulation of medical care in the United Kingdom is being revised to ensure the highest possible quality of care based on scientific evidence of effectiveness. The medical royal colleges are professional organizations with responsibility for postgraduate education and training, including professional examinations for specialist qualifications. They also have an important role in ensuring the highest standards of practice. They publish good practice guidelines and supervise the specialty-specific systems of continuing medical education and continuing professional development.

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