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Samir Dawlatly: Can we have our (political) football back please?

20 Feb, 15 | by BMJ

With the budget of the NHS being over £100 billion, coming from taxpayers’ money, it is inevitable that health is overtly political. How such a large chunk of the nation’s budget is spent is the interest of those in government, as well as those who are governed. One of the consequences of this is that health becomes a political football for politicians to kick, discuss, debate, and accuse each other over. more…

Ciara Bottomley: Whistleblowing in the NHS—there is no room for complacency

19 Feb, 15 | by BMJ

Ciara BottomleyOut of the harrowing and often tragic cases that were highlighted by the Mid Staffordshire NHS Inquiry, Sir Robert Francis has started an extremely important conversation about whistleblowing with his follow-up review of the reporting culture in the NHS. The recommendations from his report, depending on how they are implemented, could have a far reaching impact in the NHS and beyond.

Our research echoes some of the trends identified by the Francis review. Evidence from the whistleblowing advice line we operate demonstrates that concerns raised in the health sector too often remain under protracted investigations that yield fewer resolutions, with more whistleblowers subjected to formal sanctions than in other sectors. more…

Jim Sherifi: I am an antibiotic resistance denier

19 Feb, 15 | by BMJ

Jim Very Good[2]I write as a humble jobbing GP incapable of sound clinical practice without instruction, guidance, and supervision from the National Institute for Health and Care Excellence (NICE), my clinical commissioning group, my colleagues, or by reading today’s newspapers. Despite practising medicine for 40 years, it is apparent to all that I am still incapable of differentiating a minor viral infection from a potentially more serious bacterial one.

I am profligate with my antibiotic prescribing, and am personally responsible for “antibiotics resistance being as grave a threat as terrorism” (Sally Davies, chief medical officer for England). I’m the go-to guy to blame for this threat to the “survival of the human race” (Mark Baker, director for clinical practice at NICE). more…

John Appleby: The cost of reform

13 Feb, 15 | by BMJ

john-applebyAsked in 1972 whether the French Revolution had been good or bad, the then Chinese Premier Zhou Enlai said that it was “too early to say.” As it turns out this was not an extreme example of the Chinese long view: Enlai was apparently opining about events that happened four years previously—in 1968—and not that other (somewhat more momentous) revolution that occurred more than 180 years earlier.

So, the coalition government’s reforms of the NHS: good or bad? As part of our review of the reforms of the NHS in England, the King’s Fund has argued that the changes introduced by the 2012 Health and Social Care Act led to a top-down reorganisation that has been damaging and distracting; structural change that is complex and confusing; and a new, fragmented system of leadership that is seen as a barrier to much needed change in services—such as integration across care and organisational boundaries. In short, the reforms were likely to turn out to be a costly diversion. more…

Mohammed Bahgat et al: Is the friends and family test a true feedback tool of NHS services?

12 Feb, 15 | by BMJ

The NHS friends and family test (FFT) was launched in April 2013 to support the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience. [1] The results are submitted to NHS England monthly. When combined with supplementary follow-up questions, the FFT provides a mechanism to highlight both good and poor patient experience. more…

James Buchanan: Genomics, the data revolution, and health economics—the 2015 Astellas Innovation Debate

2 Feb, 15 | by BMJ

James BuchananIt’s early days, but 2015 is already shaping up to be another exciting year for researchers in genomics. In his State of the Union address last month, Barack Obama launched a new $215m Precision Medicine Initiative, which aims to collect genomic sequencing data for one million individuals. In the UK, we’re slightly further down this road: the pilot phase of the 100 000 Genomes Project is coming to an end, and full scale recruitment of patient samples begins today (2 February). more…

Guddi Vijaya Rani Singh: What matters—medicine, culture, and the space in between

16 Jan, 15 | by BMJ

guddiMy grandfather passed away last year. Surrounded by travel weary loved ones (from an extended family that also extends across continents), this man from rural India was promised a peaceful death in dignity.

Except that he died in 2013 in one of Delhi’s largest private hospitals, with every medical test and procedure made available by his anxious progeny. In the last 42 days of his life, he sustained two chest drains, urinary catheterisation, daily blood tests, and repeated intubation and ventilation; he became a pin cushion for Delhi’s doctors. more…

Saurabh Jha: The overdiagnosed party/ the false positives rave

16 Jan, 15 | by BMJ Group

Saurabh_JhaConsider this equation.

Early Diagnosis = Early Diagnosis + Overdiagnosis (1.1)

This sort of unequal algebra will fail GCSE mathematics. A new NHS initiative is arithmetic defying as well. Patients who think they have symptoms of cancer will be allowed to book medical imaging directly, without seeing their GP. This is to catch cancer early. The logic is impenetrable: early diagnosis of cancer saves lives. more…

Ted Willis: Consequences of the “John Wayne” contract (“A GP has to do what a GP has to do”)

9 Jan, 15 | by BMJ

Ted WillisWhy is general practice unpopular, with low morale, falling applications for training, and—according to some experts—poor overall performance? I have worked as a GP for over 25 years and it is clear to me that this is an inevitable result of the way we are paid mainly according to capitation, rather than by item of service. This has allowed our managers to add massively to our workload, while workforce capacity has only increased slightly. more…

Ahmed Rashid: Leadership in primary care—the “odd one out”

8 Jan, 15 | by BMJ

ahmed_rashidPicture the scene. It was the first day of the NHS national medical director’s clinical fellow scheme induction. A group of junior doctors, who had successfully applied to take a year out of their training programmes to develop clinical leadership skills, were sat around meeting tables, making introductions in a grand committee room in the Royal College of Physicians’ building in London.

As we worked our way around the room, I realised it was actually quite fitting that we were sat in this college, as the group had a very physician-ly flavour to it. Every doctor knows how tribal we are about specialty groups, and I was keen, as I’m sure others were, to see the mix we had in the room. more…

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