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NHS

Hoong-Wei Gan: Strike on, strike off: why junior doctors are fighting for their patients

9 Feb, 16 | by BMJ

Striking is not integral to any doctor’s identity. As others have pointed out over the last few months, a doctor pledges, before anything to else, to “first do no harm.”

However, as doctors we no longer have to decide between amputating a gangrenous limb or leaving a patient to die. Our decision-making is becoming an ever more subtle balancing act of benefit versus risk—my neurosurgical colleagues for instance regularly have to choose between resecting as much brain tumour as possible to prevent recurrences and cutting out so much as to leave the patient severely disabled. more…

Chris Ham: The proposed NHS and social care commission should report quickly and engage with staff and the public

8 Feb, 16 | by BMJ

After the government’s spending review, the NHS has just over two years at best to stabilise rapidly deteriorating finances and declining standards of patient care. At that point the harsh reality of planned real growth in funding of only 0.2 per cent in 2018/19 (and even less the following year) will have to be confronted.

It is inconceivable that the NHS will be able to balance its books and maintain current standards, let alone implement new commitments such as seven day working, with such a small increase in its budget. And even if councils take advantage of new powers to increase council tax, social care faces a funding shortfall of approaching £3 billion by the end of the parliament. Something will have to give. more…

Henry Murphy: Resignation to Jeremy

8 Feb, 16 | by BMJ

Another blog about the junior doctor’s contract, another march, and another strike. What is left to be said? The argument has been detailed in every way; with eloquence, with anger, with emotional outpourings, and cold hard evidence. Under our belt now are two big marches and one big strike, with the support of two choirs and one guitarist, actors, fashion designers, poet-laureates, and even Doctor Who. Sympathy has also been found in the most unlikely places, such as the Conservative front benches, Justin Bieber’s Twitter account, and The Daily Mail. We’ve had thousands of selfies, hundreds of interviews with perplexed news anchors across the country, radio phone-ins, and even a bit of finger-wagging on BBC Question Time. Public support has risen.  more…

Saffron Cordery: The old slogans are often the best

4 Feb, 16 | by BMJ

Saffron Cordery_2016Sometimes it’s good to revive an old slogan. The one that’s been running round my head recently is that 80s environmental campaign: think global; act local. There isn’t necessarily an instant connection between that and mental health until you consider the underlying intention: small scale changes, grass roots action, and commitments carried out by individuals can have a large scale impact.

I’ll take a bit of “blog licence” and tweak the slogan: think national; act local. So much has been happening at a national level in terms of mental health over the past few years. The previous government made progress in putting mental health on the policy and political map—it was a key item on the coalition’s health and social care agenda. Parity of esteem was the key phrase. more…

Patrice Baptiste: What is the future of the NHS?

1 Feb, 16 | by BMJ

patrice_baptisteDuring my foundation years I wasn’t completely sure about what specialty I wanted to pursue within medicine so I decided to take a year out of training. Although not my passion, I thought a lot about general practice as this encompasses a broad range of specialties, including the possibility of a “special interest,” as well as opportunities for teaching. I would actually get to see and know my patients over a longer period of time instead of one day in accident and emergency (A&E), or a week or two on the wards, not to mention being able to have a good work life balance in comparison to working in a hospital. more…

Paul Sooby: The last of an endangered species? The view of a LAT trainee

27 Jan, 16 | by BMJ

paul_soobyIn January 2016 NHS employers withdrew locum appointed for training (LAT) posts in England. The numbers of doctors undertaking LATs has fallen since 2014 and there were vacant posts last year. There are concerns that doctors staying in LATs year after year gain pay progression without career progression, and that direct observation and educational supervision can be harder to review.

So, the solution to these potential problems was simple—scrap the whole programme.

My confession, I did not get my specialty training number (NTN) at first attempt. This was not because I didn’t prepare enough for the interview, or didn’t have enough clinical exposure, or wasn’t engaged in enough academic activity to enhance my CV. It was because on the day, on what should be considered an exam rather than a job interview, I didn’t score as highly as my peers in one station. I ranked six places below the cut-off for a NTN. I can’t begin to tell you how demoralising that was, and how hard it was to realise that all the work, preparation, and courses had been in vain. more…

John Fabre: The absence of a national leadership structure within the NHS

26 Jan, 16 | by BMJ

2015_0922_1725_Neil&EllaBarclay&John&ClarissaFabre_JW_DSC_8336The strike by junior doctors illustrates a fundamental fact about the National Health Service: the de facto chief executive is the minister for health, and there are no advisory or decision making bodies between him and doctors and nurses at the coal face. While there was a broad consensus for the principles underlying the NHS, this was not a serious problem. Over the past 20 or 30 years it has been the root cause of the initially slow and now accelerating demise of the NHS. more…

Ahmed Rashid on “Goldilocks Medicine”: the quest for “just right”

20 Jan, 16 | by BMJ

ahmed_rashidWeek after week, NHS general practitioners receive messages about changes they should consider making to their clinical practice. These messages come from national and local guidelines, research papers, blogs, social media, and articles in the medical and lay press. It can often feel like these messages are pulling doctors in all sorts of different directions. In particular, two major narratives seem to conflict. One of them, emerging perhaps most typically from guideline producers, urges general practitioners to take a more proactive and aggressive approach to managing risk factors and diseases. The other, exemplified by The BMJ‘s Too Much Medicine campaign, urges a more cautious approach that acknowledges the harms of overdiagnosis and iatrogenic harm.  more…

Andrew Moscrop: Should we extend NHS charges for overseas visitors and migrants?

20 Jan, 16 | by BMJ

Jeremy Hunt has been talking “tough measures.” Not junior doctors’ contracts, but migrants. Overseas visitors and migrants who get sick in Britain should be charged for using A&E and primary care health services, the Health Secretary says. Until now, non-UK residents have only ever had to pay for non-urgent hospital care. Jeremy Hunt proposes that foreigners should start paying for their own ambulance call-outs, diagnostic blood tests, chest x-rays, plaster casts, and so on. This, he thinks, might recoup “up to £500 million per year” for the NHS. more…

BMA research into end of life care: Consulting patients is a step in the right direction

19 Jan, 16 | by BMJ

Paul TeedThe BMA’s consultation with doctors and members of the public on their views and perceptions of end of life care and the assisted dying debate is a welcome step forward. A postcode lottery of care is unacceptable and no campaign group involved in the assisted dying debate disagrees with making end of life care a priority.

It is critical for policymakers and policy influencers, such as the BMA, to engage with the public and listen to their wishes on issues such as assisted dying. For too often this most important group has been sidelined in the debate. more…

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