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Saffron Cordery: Spending review—time to do the maths

5 Oct, 15 | by BMJ

Saffron CorderyI can’t think of a time when the machinery of government has had to work harder. Austerity is a tough call for everyone. Looking out of the windows of NHS Providers’ offices I can see the home of HM Treasury, where the number crunchers, the money men and women, and the purse string holders hang out. It seems pretty busy. They are doing the maths.

And it’s no surprise. All minds are focused on the spending review, when the government of the day works out not only how it will spend public money for the next three years, but the processes it will use. more…

David Zigmond: Competence or compliance? The corrosive cost of professional practitioner appraisals

25 Sep, 15 | by BMJ

david_zigmond2Current appraisal systems sacrifice more of value than they can assure. Clarifying why and how this happens gives us wider insights into our ill faring welfare systems.

“The more laws, the less justice”
German Proverb

Some healthcare management axioms seem incontestable: all our healthcarers should have a good standard of human and technical competence; these should then be held within a firm frame of moral probity. Therefore we need systems for professional appraisals, then validation. more…

Samir Dawlatly: Why bother with my cholesterol?

24 Sep, 15 | by BMJ

For reasons that I have previously written about, I have to have my blood pressure, cholesterol, and blood glucose checked every year. These measurements have always been normal. Of these, I don’t know a single one of my cholesterol measurements. Not one. In fact, one of my previous GPs asked me if I wanted to know what my cholesterol measurement was. I remember smiling at her and saying that I didn’t, because even if it was elevated my risk would still be low. She nodded and smiled back. I don’t know whether she thought I was eccentric but she didn’t pursue the matter. more…

#imajuniordoctor: Junior doctors respond to the new junior doctor contract on social media

24 Sep, 15 | by BMJ

An online petition has already collected over 50,000 signatures calling for the BMA to support doctors taking strike action against the planned introduction of new junior doctor contracts. Doctors are concerned that a recent government decision to impose new junior doctor contracts will result in lower pay and increased hours. This has been met with huge criticism and backlash.

In a three day period last week, over 1600 doctors expressed an interest in applying for roles outside the UK. The General Medical Council said it would normally receive about 20 requests a day for certificates needed to work abroad. This sharp spike in the number of requests began a day after the government’s announcement. Social media has been the platform for much of the outpouring of views and perspectives. more…

Hugh Alderwick: Is the NHS delivering enough things right?

17 Sep, 15 | by BMJ

hugh_alderwickRecently, I’ve written blogs about overuse and underuse in the NHS—the problems of doing too much of the wrong things and not enough of the right ones. The final chapter in this story is misuse: when health services are poorly delivered, resulting in preventable harm to patients.

In reality, the distinctions between these three concepts are blurred. Take underuse and misuse: while harm sometimes happens because things aren’t done right (for example, people are given the wrong drug or operated on in the wrong place), it also happens because the right things to prevent harm aren’t done in the first place. more…

Edward Ng: Quality assessments in general practice—have we gone too far?

10 Sep, 15 | by BMJ

ed_ngUK general practice receives an unprecedented level of scrutiny to verify that quality is maintained. We have the Quality and Outcomes Framework (QOF) to incentivise GPs to provide better quality care; we have NHS England Area Team visits for contract breaches; we have Care Quality Commission (CQC) inspections; we have appraisals and revalidation; and, depending on the clinical commissioning group (CCG), there may well be local assessments for quality.

At the same time, GP morale is widely reported to be plummeting, with a third of GPs considering retirement in the next five years, many considering leaving the UK, and around 30% of GP training positions unfilled after the first round of recruitment. While the reasons for plummeting morale are multifactorial and complex, the rise and rise of quality assessments is likely to be an important factor. There is certainly widespread discontent with our various inspections, and the Royal College of General Practitioners (RCGP) council has called for the suspension of CQC inspections. more…

Kwesi Nyan Amissah-Arthur: Improving patient care has to start at an individual level

10 Sep, 15 | by BMJ

kwesiSometimes it takes a visual cue, a short reference, or a good analogy for one to grasp the philosophy of a place. This was certainly so when I visited Aravind Eye Hospital in Madurai, South India. As a Ghanaian born, British trained ophthalmologist, I have always had a yearning for developing country eye care work, and one of the institutions that has made a name for itself in this field is Aravind. Their eye care system has been well described, however what is always difficult to conceptualise in these institutions is the ethos or spirit of the place. Why is it that per doctor more cataract surgery is done in Aravind than anywhere else in the world? How can they keep the cost so low, yet have fantastic quality indicators?


Samir Dawlatly: Why is it hard to do the right thing?

9 Sep, 15 | by BMJ

“You want a blood test to make sure that there isn’t a reason why you’re tired?” I ask the patient sat in front of me, checking that I have understood what they have been telling me about for the last five minutes. I now know that they work shifts, have three children under the age of five, and that their mother has recently been diagnosed with cancer. more…

Tim Ballard: Will a tax on sugary drinks work?

7 Sep, 15 | by BMJ

tim_ballard2Channel 4 recently aired a documentary by Jamie Oliver called Jamie’s Sugar Rush. Following on from his successful advocacy aimed at improving the nutritional quality of school meals he has now moved his attention to the obesity epidemic and in particular the part that sugary drinks play. In addition to obesity the documentary aims to raise awareness of the thousands of children undergoing dental extractions under a general anaesthetic each year on the NHS as a consequence of sugar filled soft drinks. more…

Abi Rimmer: Seven day services lack definition

4 Sep, 15 | by BMJ

abi_rimmer2What exactly are “seven day services?” This is something that I have been wondering ever since David Cameron announced in March that the NHS would run a seven day service by 2020. And, despite all the rhetoric from Cameron and health secretary Jeremy Hunt, the government doesn’t seem to have a clear definition of what seven day services are going to involve.

Without a clear definition, it will be impossible to measure whether we have “seven day services.” Lots of the doctors already work at evenings and weekends, so we need to understand how these new plans will be different from the services already offered by the NHS. more…

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