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Clare Marx: Give sustainability and transformation plans a chance

24 Oct, 16 | by BMJ

clare_marxThe NHS is treating record numbers of patients with better outcomes, but it is now facing some of the biggest challenges in its history.

Against this backdrop, Sustainability and Transformation Plans (STPs) will be unveiled over the next few weeks.  These are being designed by local NHS and social care leaders, working together across 44 patches of England, to find ways of transforming care and making their local NHS more sustainable within the current budget. more…

Andrew Furber: Should local government run the NHS?

21 Oct, 16 | by BMJ

andrew_furberA white paper published by the Conservative government in 1944 proposed that a new National Health Service should be managed by local authorities. [1] The Labour Party was split on the matter, but after their general election victory in 1945 Bevan proposed a plan favouring nationalisation of all hospitals. And so the NHS was born.

Nearly 70 years later the role of local government in the NHS is once again being debated. The integration of services delivered through local authorities and the NHS is underway in every part of the UK. In England there are now several NHS Clinical Commissioning Groups being led by local government officers. So should the NHS be run by local authorities, and would it be better? more…

Rammya Mathew and James McGowan: The role of shared decision making in a value based NHS

13 Oct, 16 | by BMJ

rammya_mathewjames-mcgowanLast month a controversial proposal was made by Vale of York clinical commissioning group (CCG) to deny obese patients access to elective surgery for up to a year. The headlines were alarming and the approach felt wrong. The CCG defended its position by saying that it was “the best way of achieving maximum value from the limited resource available.” The suggestion is now under review in the wake of the outcry it caused, but is this a sign of the kind of care rationing we will increasingly start to see?

As the Carter review of productivity in hospitals explained at length, the NHS must make better use of scarce resources. There is a strong ethical rationale for doing so; money spent on the care of one patient is money unavailable for the care of another. more…

Anna Miller: Asking all pregnant women for a passport before giving birth is simply wrong

13 Oct, 16 | by BMJ

anna_millerSt George’s University Hospitals Foundation trust is reportedly devising a pilot scheme to ask all pregnant women to show a passport to prove their right to NHS care before giving birth.

Although in some ways this does not mark a policy change—undocumented migrants are already charged for maternity care—it marks a departure from NHS guidelines to protect the most vulnerable women in our society.

The medical charity I work for, Doctors of the World UK, runs a clinic in London where we see pregnant women in the late stages of their pregnancy who often have not had any antenatal care. Some don’t think they are entitled, or don’t know how to access the NHS, or are too afraid to. Almost all the women we see do not have passports and are not able to prove their eligibility to NHS care. This is not because they are “visitors” in the UK. On average our patients have been living in the UK for over six years and usually they are unable to return to their country of origin. They include the most vulnerable women in our society—trafficked people, those trying to claim asylum, and people living and working in exploitative situations. It is these women who will be impacted by routine passport checks to access antenatal care. Only this week our clinicians spent close to an hour with a pregnant woman trying to persuade her to attend antenatal care and not just go to A+E during labour. more…

Laurence Gerlis: Is private medical practice that bad?

12 Oct, 16 | by BMJ

laurence_gerlisDuring my 30 years as a private GP I have become used to being insulted by other doctors. Some see us as mercenary quacks, with little genuine interest in patients’ needs, who overprescribe and bombard NHS GPs with useless health screening reports.

NHS doctors are not volunteers, they are paid. All patients pay for NHS treatment, even the poorest who pay via taxes including VAT. The money just takes a more circuitous route than it does in our clinic. So there is no moral discrepancy. My patients pay again, mainly because they cannot get an NHS appointment soon enough and they work in Central London where I am based. My average patient is not a rich oligarch, but a 30-something working person on a slightly above average salary. I don’t see this as vicious queue jumping, just being practical. I have never had any income apart from what I can earn in fees from individual patients, whereas NHS doctors have a guaranteed patient flow and income plus pension. One NHS GP confided to me, “I wish I had the nerve to take a chance as you did, but I need to know that I have regular income.” more…

Richard Thorley: Exception reporting—let’s show Jeremy how hard we really work  

11 Oct, 16 | by BMJ

richard_thorleyThe day we have all been dreading in obstetrics and gynaecology has arrived. Some trusts started to roll out the new contract for junior doctors last week. The cancellation of strike action recently left a select few determined strike activists fuming, but while it seems most of us welcomed the decision, it has left us bereft of any plan to stop Jeremy Hunt’s new contract for junior doctors in England. We await further announcements from the JDC, who remain firmly opposed in principle to the imposition. They talk of further action not based around strikes, but there is no indication of what this might be or how it could possibly halt the juggernaut that is the 2016 deal. The regrettable failure of Justice for Health to win a favourable outcome in the High Court recently means that with just days to go before the first tranche of us sign on the dotted line, any remaining fight to prevent the new conditions being introduced is futile.  more…

Partha Kar: Diversity in the NHS matters

10 Oct, 16 | by BMJ

The world we live in is in a fascinating space at the moment. Tolerance seems to be at a low ebb—whether that is due to the rhetoric fuelled by the Donald Trumps of this world or not—it has created a climate of interesting proportions. Against the backdrop of this febrile atmosphere, came a speech by Jeremy Hunt, England’s health secretary, at the recently concluded Conservative Party conference.

He announced a plan to create more medical school places, which on its own cannot be anything but lauded. There is no doubt that the UK needs more doctors—so surely that announcement would be welcome, wouldn’t it? Unfortunately, our pasts do define us, and for a health secretary who has just come through a bruising battle (perhaps yet to be finished) with some of the most hardworking staff in the NHS, this was only going to be wishful thinking. Rather than leave that positive announcement there, and have a debate over how to attract new medical students given the fact that medicine is not necessarily the most attractive career option at the moment, the talk veered into an area open to interpretation and perhaps most importantly, one that gave fodder to the media who needed a story. more…

Bhakti Visani: Experiences of providing psychiatric care in a mother and baby unit

7 Oct, 16 | by BMJ

During my F2 year I undertook a four month psychiatry placement, based in a mother and baby unit. Before starting, psychiatry was definitely not in my top 5 list of coveted jobs. I initially saw it as just having to “get through” the four months. Little did I know that this specialised combination of psychiatry, obstetrics, and paediatrics would afford me the opportunity to learn about topics that will be invaluable to me as a GP. To me, the most important of these was risk assessment of inpatient and outpatient perinatal mental health patients, and being aware of which services to call upon in different scenarios. more…

Humans of the NHS: Telling the stories of frontline NHS staff

6 Oct, 16 | by BMJ

humansofthenhsteam“To save a life or to make it better for someone else is why I chose to do this job. The thanklessness of it, however, has never dissuaded me from doing what I do everyday.” – Emergency Medicine Consultant 

“The patient that sticks in my mind is a young guy who had crashed his car. He had been thrown out of the car. As soon as we released the car from him, he would pass away. There was nothing we could do. He was 17. I was with him until the end. Myself and the police officers. To me it was important that he wasn’t on his own. Regardless of how he was driving before.” – Paramedic more…

Chris Packham: The trouble with public health

5 Oct, 16 | by BMJ

chris_packhamPeople think public health is all (lecturing the masses on) sex, drugs, and alcohol. Even fellow clinicians tend to forget about defined roles such as the public health specialist. These individuals focus on using public health approaches to ensure cost-effective and appropriate planning, commissioning, and provision of NHS services.

They can and do help the NHS and local government on the design, use, and evaluation of effective and efficient health interventions and care pathways. more…

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