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NHS

Samir Dawlatly: How general do we want general practice to be?

26 Mar, 15 | by BMJ

As a medical student I got a parking ticket and three points on my driving license. The mistake I had made was parking in the wrong place on an unmarked road in the Peak District. When I sent in my fine I wrote a short note along the lines of, “I realise that being ignorant of this law is not a valid defence.”

For what it is worth, there has been a stir in social media this week over the publication of a survey carried out by ResilientGP, a fledgling organisation that purports to “stand up for general practitioners.” The organisation argues that one of the stressors in primary care, and there are many, is the unnecessary use of the NHS by patients with problems that seem unconnected to any health problem. more…

Chris Naylor: Integrated care—the end of the hospital as we know it?

25 Mar, 15 | by BMJ

Hospitals are often seen as an impediment to integrated care. The concern frequently voiced is that their dominant role in the health system makes it harder for commissioners to shift resources into the community, and to develop more coordinated services that cross organisational boundaries.

It is certainly true that an over-reliance on hospital based care—and the political reluctance to challenge this—has long been a barrier to necessary change in health systems across the world. Jean Rebert, one of the principal architects of the PRISMA integrated care system in Quebec, Canada, has made this case forcefully. Speaking at the World Congress on Integrated Care in Sydney last year, he said that in his experience, the greatest obstacle to integrated care is the political attractiveness of prioritising investment in hospitals over other forms of care. more…

Tony Kelly: Is being confident to speak up enough?

24 Mar, 15 | by BMJ

Tony KellyLast month we saw two key messages come through regarding patient safety. The first was the publication of Sir Robert Francis’s “Freedom to Speak Up report.” The second was a report by the Parliamentary and Health Service Ombudsman (PHSO), which found significant variation in the quality of NHS investigations into complaints of avoidable death and avoidable harm. Both reports have generated significant coverage and debate. more…

Samir Dawlatly: Do I obsess too much about the NHS?

17 Mar, 15 | by BMJ

When I was a teenager, I was obsessed with playing guitar. I taught myself to play on my sister’s guitar, taking it off her when she came back from lessons. For my GCSE music performance I sang and played an Eric Clapton song. While I was at medical school, I became obsessed with climbing after working in a children’s multi-activity centre one summer, where I also used to play the guitar every night in the bar with the staff after the children had gone to bed. more…

David Wrigley: Manchester—the birth and death of the NHS

12 Mar, 15 | by BMJ

david_wrigleyOn 5 July 1948, in Manchester, Labour Secretary of State for Health, Aneurin Bevan announced the birth of the NHS.

On 27 February 2015, in Manchester, Conservative Chancellor of the Exchequer, George Osborne signed a piece of paper that would bring about the end of a National Health Service.

There is no longer an NHS in Manchester—it is now the MHS—the Manchester Health Service.

These two events are 67 years apart but signal huge differences in how healthcare will be provided to the population. more…

Playing the percentage game: the arts of playing football and practising medicine

11 Mar, 15 | by BMJ

martin_marshallI’m proud to be working among a group of GPs in east London who, against all the odds, are delivering a remarkable level of clinical performance.

Ninety two per cent of our patients with cardiovascular disease have their blood pressure controlled, despite our practice serving one of the most socio-economically and ethnically diverse communities in the country. Ninety per cent of children are immunised at 2 years of age, despite more than a third of the whole population in Newham changing every year. And most of the patients at high risk of hospital admission have completed care plans, despite inadequate premises, and massive problems with recruiting and retaining GPs and practice nurses.

Yes, I’m proud, but sometimes it feels like a hollow kind of pride. more…

Samir Dawlatly: Sabre-toothed tigers and the lottery

10 Mar, 15 | by BMJ

The other day an older gentleman* was brought to the GP surgery where I used to work. He was feeling nauseous, and his concerned family had initially taken him to the local pharmacy to see if there was anything they could buy over the counter to ease his symptoms. As he was on a number of medications, the pharmacist was reluctant to sell them anything and advised them to see a doctor, so he was squeezed into my morning surgery as an emergency appointment. more…

Saffron Cordery: Enhanced tariff offer—what’s left for mental health?

27 Feb, 15 | by BMJ

Saffron CorderyThe big national health “system” story of the past week has been the surprise announcement of a voluntary tariff. This is one part of a solution put forward by NHS England and Monitor to resolve the current impasse, which arose from an objection mechanism to the proposals being triggered by those it affects—providers of NHS care.

As we all know, the annual setting of the tariff, and the process of balancing what can be afforded with what providers of NHS care need to be paid to stay afloat, is always a big deal. But this year it has been bigger than ever. Although this detail in the NHS’s arcane internal processes will pass most patients by, the quality and availability of their care could be profoundly affected by it. more…

Samir Dawlatly: Burnt out or boiled alive

25 Feb, 15 | by BMJ

The cleaner popped his head round the door, “You nearly finished, doc? Or are you happy to lock up?” The GP glanced at the bottom right corner of the glowing monitor that he had been looking at for the last two hours since the last patient left.

“No, I’m fine thanks,” he answered, “I’m happy to lock up, I’ve done it enough times,” which was true enough. Two hours previously he had had to weigh up finishing off reading the patient letters and reviewing patients that weren’t hitting blood pressure targets in the surgery, or getting home in time to kiss the children goodnight and peering at a laptop with remote, yet slower, access to the surgery computer system. more…

David Zigmond: The extinction of care by treatment—our healthcare’s heart failure

24 Feb, 15 | by BMJ

david_zigmond2At the end of last year, the media had a brief frisson over another dark story from our NHS: seven recent suicides and one homicide involving people who were acutely mentally ill. The transient newsworthiness came from the probability that the deaths were preventable: psychiatric beds were sought for these patients, but none were available. Typically, the media story has rapidly passed from view and memory, but the vast problems it signifies are still very much with us. What are these problems? How have they arisen and what can we do about them? more…

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