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Samir Dawlatly: Could general practice survive without the NHS?

25 Aug, 15 | by BMJ

General practice is often described as the cornerstone of the NHS. Though its funding doesn’t necessarily reflect this, having its proportion of funding decline in recent years, 90% of all interactions with patients happen in general practice. It is therefore easy to predict that if, for whatever reason, general practice were to collapse or cease to exist as we know it, that the NHS itself would be threatened. The only alternative place for patients to go would be hospitals, via accident and emergency. That is probably an apocalyptic view given that one would hope that if general practice, as we know it, was to cease to exist that this would not happen overnight. more…

Jim Sherifi: The tyranny of excellence

24 Aug, 15 | by BMJ

Jim Very Good[2]When one reads the history of any autocratic, despotic regime, one is always struck by how they managed to secure the submission of the educated and intelligent through remarkably simple methods. Doctors in the NHS are currently being subjected to the same tried and trusted processes of indoctrination used by totalitarian regimes.

These may be dressed up under laudable banner headlines, such as the General Medical Council’s (GMC) “Working with doctors: Working for patients,” but then Mao also used vague exhortations such as the “Great Leap Forward.” Anodyne words suggesting a greater good, a striving for excellence. Sadly, the consequences are often the reverse and require years to recover from. more…

Phillippa Hentsch: A new way of paying for urgent and emergency care services

21 Aug, 15 | by BMJ

Phillippa Hentsch-Different parts of the urgent and emergency care (UEC) pathway are paid for in different ways. Acute and specialist facilities are predominately funded through the national tariff, whereas UEC services offered by mental health and community trusts—such as rapid response, crisis teams, and psychiatry liaison services—are paid predominately through block contracts. For commissioners and providers attempting a system wide redesign of UEC services, this patchwork of payment approaches gives you a headache. more…

Samir Dawlatly: Can you measure what is good about general practice?

18 Aug, 15 | by BMJ

The Health Foundation, at the behest of the government, is gathering thoughts from professionals and the public on the use of data to inform the quality of primary care until 24 August 2015. Although they say that this will not be used to “rate” practices, data about so-called quality has been used to “band” or should that be “brand” practices in the past, with the media immediately interpreting them as ratings. Putting that aside I would like to make three broad points: more…

Dominic Patterson: Why general practice

13 Aug, 15 | by BMJ

Dominic PattersonGeneral practice is in crisis.

Those are the first words on my site—launched in July along with the hashtag #whyGP—which aims to be a space for positive messages about general practice.

Strange first words for such a site, but they are of deliberate choosing. I’m no crisis denier, and I recognise personally and from spending time with friends and colleagues that perhaps now, more than ever, we are a profession on the edge. We are stretched. We are bending. And some of us are breaking. more…

Samir Dawlatly: There is no dementia wonder cure

13 Aug, 15 | by BMJ

The daughter of one of my patients booked an appointment to see me*. She often came to see me about her father who had lived alone ever since his wife had died five years ago. He was in the early stages of dementia, probably Alzheimer’s, but was still just about managing to live at home with support from his family and social services.

She sat down and took out a tablet of some sort that her own daughter had encouraged her to buy. She held it in an unfamiliar way. more…

Samir Dawlatly: Will general practice survive?

28 Jul, 15 | by BMJ Group

Just before I completed my training as a GP the 2012 Health and Social Care Act was passed. I had a sinking feeling that general practice wasn’t quite going to be what I thought it was. Up until that time I had been concentrating on passing my exams and assessments and not really taken much of an interest in medico-politics. At times I felt like there was little hope of stability and security in primary care.


Ferelith Gaze: The NHS is a duty to uphold, not just a function to devolve

17 Jul, 15 | by BMJ

Ferelith_gazeThe government is heralding the Cities and Local Government Devolution Bill—currently making its way through parliament, with broad cross party support for its intentions—as reversing 150 years of centralisation.

The bill opens up a number of exciting opportunities. Local partners—from Manchester to Cornwall, from Dorset to Hertfordshire—are making headway in their plans, with strategically aligned and integrated services at the top of the “to do” list. more…

Michael Devlin: Duty of candour—make apologising easy

16 Jul, 15 | by BMJ

mike_devlinSeven months ago a statutory duty of candour was introduced for hospitals in England, and four months later it was extended to all healthcare bodies registered with CQC. Are we likely to have seen a remarkable improvement in patient safety as a result? I suspect not, although to be scrupulously fair it will probably take years to establish what difference, if any, the new duty has made.

It has never been entirely clear what the statutory duty of candour would achieve that the existing professional duty would not. The difference is that the threshold of harm requiring action by healthcare bodies in the statutory duty is higher than the professional duty, which is confusing. more…

Andrew Moscrop: Would it be a good idea to charge for missed appointments at the doctors surgery?

14 Jul, 15 | by BMJ

The studio audience of BBC Question Time applauded and health secretary Jeremy Hunt appeared to wriggle with delight when a member of the public asked whether patients should be charged if they miss their appointment in general practice. “I don’t actually have a problem in principle with the idea of charging people for missed appointments,” the health secretary said.

His remarks were reported by news sources the next day. But a Downing Street spokesperson swiftly announced that the government had “no intention” of charging for missed appointments. “Bigmouth strikes again” decried the Mirror in its report of how “the millionaire Health Secretary” had been “slapped down by David Cameron” for his suggestion that “sick and vulnerable people should pay for any doctors’ appointments they miss.” more…

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