I became interested in commissioning through Fundholding. Like the majority of GP practices that got involved we did so because we wanted to improve the experience and the services our patients received. We used the influence which holding a budget gave us to address quality.  For example, we improved the safety of anticoagulation management, we accessed investigations without having to send people to hospital so we could deliver more effective care, and we reduced waiting times for planned care. Fundholding made me realise that getting involved, as a doctor, in how the system was managed could improve quality for patients. The advent of PCTs drew me into the more complex and difficult agenda of large-scale change and whole-system improvement. I realised that if I didn’t want to disadvantage my own practice, because of the obvious conflict of interest I had in being able to influence funding flows across the whole system, then I needed to leave general practice and commit to commissioning. more…

Systematic reviews have something of an image problem. To the uninitiated, they can be considered too effete because they run on for hundreds of pages, with lots of forest plots and risk of bias calculations. And what is a GRADE table? I know that I generally head straight for the conclusion section of the abstract—does it work? How much do I take? Of course, I have drunk the Kool Aid and come clean about my status as a Cochrane reviewer yet I am always aware of the reaction of one of my senior and greatly esteemed colleagues who upon hearing of me bringing in a grant to develop a centre for systematic review at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) cornered me and demanded, “Is this how you use your powers? For bad!” more…