What will happen in general practice…now that we have so many part time portfolio doctors, practices where the focus is on performance related income, increasing delegation to practice nurses and nurse practitioners, and patients often seen by someone who has little knowledge of their past medical history? Out of hours care, for at least 8 of 24 hours each weekday, weekends, and bank holidays is provided by contract doctors. Midwives provide maternity care, health visitors define their own role in routine paediatric care, palliative care is offered by specialist units, and a number of hospital clinics provide community outreach. You may see someone different each time you go to the surgery. The traditional GP providing personal, primary, and continuing care will soon be extinct. more…

Who should resign this week? The blame game continues with more Mid Staffs finger pointing. As newspapers identify further unpleasant aspects of the wider tragedy, there is a risk that we stop reading about it and just move on to the next news story. Sad, isn’t it, that the main messages from one of the low points in the history of the NHS could be lost in the fall out. more…

Harley Street. Even the name creates a picture. Executive medicine for the elite, cosmetic surgery for the glitterati, healthcare excellence and no expense spared. It’s more than just a street—it’s a brand with international recognition that would be the envy of any marketing campaign. A worldwide reputation that attracts patients from across the globe. As it’s not far from the BMJ offices I sometimes pass by and the street sign always startles with its familiarity. I see luxury cars parked outside—they could be doctors or patients. And, peering in at the plush waiting rooms, I imagine backgrounds for the patients—princes of royalty or industry—and what might have brought them here.   more…

When a politician speaks with passion and commitment about social inequality, I listen. When it is the chairperson of the Committee for Health, Social Services, and Public Safety, I listen carefully. Our practice is in an area internationally recognised as socially deprived, and, if politicians took a genuine interest and were prepared to invest resources, it could transform healthcare and improve the lives of so many people. Recently, the chair and deputy chair visited Cuba and, like many before them, were greatly impressed by the Cuban health system where they achieve impressive outcomes with services based very much on the family doctor. more…

Overwhelmed by the relentless tide of bad news stories about UK primary care? Well, this is a good news story. A webinar organised by The Commonwealth Fund (a US philanthropic organisation originally created by the Harkness Family to identify policies and practice that could improve the US health system) discussed findings from the latest International Health Policy Survey of Primary Care Physicians conducted in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, Sweden, the United Kingdom, and the United States. What did they find? The UK performed very well. While the UK spends 9.6% of its GDP on healthcare, less than its European neighbours, and less compared to 17.6% in the US, the findings were consistently positive in all areas. more…

“The surgeons who are not doctors.”

Reading this headline, I expected a story on training healthcare workers as surgical technicians in some under doctored developing country. But no, it was in the UK. I was intrigued.

Medicine is introspective, protective, and doctor centric; self regulating and self directing. Places at medical school are highly prized, access is increasingly competitive and based on academic achievement. We have created a professional fiefdom. But, could others do the job better? more…

As he hung up his coat at the end of the morning, he stunned his nursing and junior colleagues: “I will be glad when I don’t have to do that clinic anymore.” It was a cancer clinic in a non cancer speciality. Everyone in outpatients thought he was wonderful; a caring clinician, a good listener with time for everyone, and great with patients in many difficult circumstances.  He seemed to take it in his stride, everyone enjoyed working with him, a superb role model, and no one ever noticed that he found it difficult. He never said anything. more…

“GPs warned to steer clear of tranquiliser trap,” Reading the headline—I expected the usual GP bashing. But, the headline misled and the story was based on a joint statement by the Royal College of General Practitioners and the Royal College of Psychiatrists, supported by medical, nursing, social work, and lay bodies on the risks of addiction to painkillers and tranquilisers. It caught my partner’s attention too; someone put the Times on staff room coffee table—a rare sight. Today’s headline states “Victims of tranquiliser trap are being neglected.” But not by all. We put a huge effort into trying to minimise the use and abuse of tranquilisers in our practice. Let me tell you what its like. more…

“The thing that makes someone get up at 5am and run—we want it.” Besides the text was a picture of a running shoe. It was a recruitment advertisement for managers of Aldi, the low price supermarket store. The message was clear—they knew the type of person they wanted, and the reader knew immediately if it was for them. What type of advertisement would they create if recruiting a doctor? more…

Christmas Eve. Its a Monday.

It will be dark leaving home but, with no morning traffic, the drive to the surgery should take just a few minutes. Few people around—a few early shoppers collecting their turkeys or in a last minute panic to pick up a late gift. With businesses closed and no schoolchildren, it will feel like a Sunday. But, like every practice, the waiting room is seldom empty. more…