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Samir Dawlatly: The slippery slope of general practice

19 Aug, 14 | by BMJ

I live at the top of a hill. One winter it snowed after a hard frost, just a thin layer of snow on top of the existing ice. The morning after the snowfall, I jumped into my car, put the radio on, and was into second gear before I knew what I was doing.

Better check the brakes, I thought. They didn’t work. I tried dabbing them, pumping them, squeezing them, praying for them, but quickly realised that I had picked up too much momentum and was simply sliding down the hill. I managed to somehow avoid the haphazardly parked cars and slithered towards the T-junction at the bottom of our road. It all happened in slow motion, either because time was playing a trick on me, or because I was actually just gently sliding. more…

Mary McCarthy: UK GPs versus EU GPs

12 Aug, 14 | by BMJ

mary_mccarthyI sometimes wonder if the UK government realises how much general practices in this country accomplish in comparison to their counterparts in Europe and the United States.

There was a time, 20 or 30 years ago, when there was not much to choose between GPs in the UK and family doctors in other countries, apart from the fact that GP surgeries were usually open for considerably longer than the two to four hours a day that was normal in Europe, and that GPs here did house calls, which were becoming a rarity in Europe and the US.

However, general practice in the UK is now very different from the practices of many of our European colleagues. In a recent report, the American think tank the Commonwealth Fund placed the NHS at the top of the countries they studied, for the excellence and cost effectiveness of its health system. more…

Chris Hopson: NHS waiting times—the long and the short of it

7 Aug, 14 | by BMJ

chris_hopsonHealth secretary Jeremy Hunt’s speech earlier this week, which called on NHS hospitals to clear their backlog of patients waiting more than a year for treatment, rightly pointed to the personal consequences of each individual case on the waiting list. While recognising that some delays are the result of patient choice or good clinical reasons, waiting for treatment if you are immobile, in discomfort, or in pain can be distressing and debilitating—the more so the longer the wait.

That’s why the Foundation Trust Network (FTN) and its members strongly welcomed the government’s pledge in June of £250m (€314m; $421m) to reduce waiting lists, and the £400m (€504m; $674m) announced at the same time to support the urgent and emergency care pathway this winter. The FTN has consistently called for extra funding to improve patient care and for any announcements to be made as far in advance as possible. We also recognise how difficult it is for health ministers to find such funding at the moment, given the need to reduce the overall budget deficit. more…

Rachael Addicott and Kieran Walshe: How do CQC hospital inspections measure up?

5 Aug, 14 | by BMJ

rachael-addicottOver the past few years, we have seen several high profile failures of care in NHS acute hospitals in England, leading many in the system to question the ability of performance management and regulatory mechanisms to identify and act on poor performance.

Last year, in response to these events and concerns, the Care Quality Commission (CQC) developed a new model for inspecting and regulating NHS acute hospitals, and commissioned a team from Manchester Business School and the King’s Fund to evaluate this new and evolving approach as they rolled it out. more…

Mary Rance: Loneliness—it’s time to stop talking and start doing

30 Jul, 14 | by BMJ

Mary RanceExtreme loneliness in older people in the UK is a topic that always ignites debate. Partly because the problem is only getting worse as the population ages and, I suspect, partly because for many of us it resonates deeply as a fear we hold about the process of getting older.

The impact of chronic loneliness on health is well documented, with research suggesting that isolation is worse for an older person than obesity or smoking 15 cigarettes a day. Loneliness also means that our older people are less likely to recover successfully from an illness, increasing the chance of an earlier death. The knock on effect of this is, of course, greater demand on our health service. more…

David Zigmond: Depression needs more than formulaic treatment

29 Jul, 14 | by BMJ

david_zigmond2An eminent academic psychologist, Professor David Clark, recently broadcast on the BBC’s Today programme (1 July) authoritative hope to the many sufferers of depression. He informed us how current scientifically formulated, measured, and monitored cognitive behaviour therapy (CBT) is positively transforming the efficiency and economy of care.

To me, this picture is a misleading exaggeration. I know this from several decades of working in the NHS with the mentally anguished. Yes, CBT certainly has much to offer in terms of apparent clarity, comprehensibility, reproducibility, and thus mass production—little wonder then, that it has ready allure for service designers, economists, and politicians. more…

Neal Maskrey: Feeling the force of the QOF

28 Jul, 14 | by BMJ

neal_maskreyIt’s the season for graduation ceremonies. Proud parents and partners, relieved graduates, and a lump in everyone’s throat as that enormous rite of passage is eased by impressive ceremony, thoughtful words, cheap university wine in plastic glasses, and finally by long, late, cheerful family lunches.

My generation began their medical careers in a different world, where competence was implicit. After several decades of serial NHS disappointments, disasters, and scandals, new doctors—fresh and eager, but apprehensive—enter a brave new world. more…

Billy Boland: Life after the NHS Leadership Academy

23 Jul, 14 | by BMJ

billy_bolandIs it nearly over? Putting the final touches to my portfolio seems all wrong somehow. The outcome of my time at the NHS Leadership Academy depends on this submission, and while it’s now due, I feel I’ve only just started. Come to think of it, this experience has been one of the key features of my learning on the programme: the way I feel about something isn’t always the best guide to what is actually going on. And let me tell you, as someone who can tend to draw on emotions to help make decisions, that can be pretty confusing at times.

As I reflect on this latest stage in my leadership journey, it seems like a good time to share some of the highlights of my learning since my first blog in October last year: more…

Bijal Chheda-Varma: Bariatric surgery is unsustainable

22 Jul, 14 | by BMJ

Bijal Chheda-Varma2Obesity is widely recognised as one of the greatest health threats of the 21st century across the developed world, with about a third of the global population now obese or overweight.

While the evidence of the problem is undisputed, there is little agreement as to how to solve it. Many solutions are being brandished about in terms of both prevention and cure; in the UK, for example, a sugar tax has been suggested, and NICE has issued its headline grabbing draft recommendations that patients with a BMI of 30 or more should be given bariatric surgery. From my experience of treating overweight and obese patients, it seems clear that, as standalone solutions, these are not sustainable as they do not address the root causes of obesity. more…

The BMJ Today: Coca-Cola . . . for real?

10 Jul, 14 | by BMJ

Coca-Cola tackling obesity might sound surprising, not least if we consider the close relationship the soft drinks manufacturer enjoys with the rotund Father Christmas.

But the company recently announced that it was extending its scheme to tackle obesity (piloted last year in Birmingham) to 50 parks in three English cities, committing £20m to help local councils set up activities such as running, cycling, rounders, tai chi, and bushcraft.

In her column in The BMJ this week, Margaret McCartney casts a trademark critical eye over proceedings, arguing that while the move is allowing Coca-Cola to tick the box for corporate social responsibility, the company is unduly benefitting from the advertising space its products are being afforded. more…

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