Medicine is becoming increasingly specialised: there are now almost 30 sub-specialties within the Royal College of Physicians alone. This is partly in response to the exponential rate at which scientific knowledge is produced – it is simply not possible to stay on top of the latest developments beyond a limited scope of practice.

Greater standardisation and new knowledge management tools could change this in future, but for now there are benefits to specialising. Once you have a diagnosis you are probably better off seeing someone who has expert knowledge and up-to-date skills in treating your condition. But is ever increasing specialisation in the best interests of patients? more…

“What we are doing, through amendments to the legislation, is to make it absolutely clear that integration around the needs of the patient trumps other issues, including the application of competition rules.” more…

The government’s decision to consult with stakeholders during this pause in the passage of the Health and Social Care Bill through parliament creates an opportunity to revisit the problems the bill is intended to address. more…

Taking time out from the debate about NHS reform, I visited Intermountain Healthcare (IHC) in Salt Lake City, Utah, to find out what makes it one of the most admired health care systems in the US, and to discover what the NHS could learn from this organisation. more…

Historically, clinicians have had a strong tradition of connecting the health of the individual in their surgery to the population’s health. Doctors were, for example, active in early campaigns for clear air and clean water. More recently, many doctors have called for a ban on smoking in public places and a reduction of salt in food, and some choose to train specifically to become public health specialists. But what about the “jobbing” clinician? Do they have a responsibility for the population as well as the individual? more…

If familiarity breeds contempt, then distance lends perspective. This much I learned – or remembered – on a recent visit to Australia.

Invited to give the keynote address at the Australian General Practice Network National Forum 2010 in Perth, I was reminded of the strengths of general practice in the NHS. Registration with a practice, a blended payment system based on capitation and rewards for quality, team working, and the absence of co-payments mean that general practice in the NHS is rightly admired throughout the world. Contrast this with patients shopping around for doctors in Australia, fee for service reimbursement that rewards GPs for contacts with patients rather than continuity, and the lack of incentives for quality and teamwork, and the advantages of the UK model are plain to see. more…

The past few months have been busy for anyone like me whose job it is to make sense of the government’s policy on health care. The coalition government launched a series of detailed consultations to accompany the health white paper “Equity and Excellence: liberating the NHS” back in August, and the 12-week period for consultation has now closed. more…

Today, The King’s Fund launches a new commission on leadership and management in the NHS.

The NHS is a complex organisation employing more than 1 million people and spending more than £100 billion. It is a system that requires sound management – rather than traditional administration – and leadership at every level. more…

Earlier this month, the first set of data on post-operative patient reported outcome measures (PROMs) was published by the Department of Health. For the first time, this has provided a patient-based assessment of changes in patients’ health-related quality of life following hip replacement. The data also cover surgery on knees, varicose veins, and groin hernias. more…

The coalition government has moved quickly in its first 100 days to set out its plans for the NHS in England. Although ministers have stressed that these plans build on Labour’s health reforms, in reality they are much more radical. Tony Blair’s policies may have paved the way for choice and competition to play a bigger part in the NHS, and Ara Darzi laid the foundations for quality of care to be taken seriously, but neither sought to do so at the speed and the scale now proposed. more…