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Mary McCarthy: Would fewer than 25 consultations a day be a safer model for GPs?

4 Nov, 15 | by BMJ

mary_mccarthyI conducted a survey* earlier this year that looked at the workloads of doctors in family practice from 25 EU states (this survey was presented at the 2015 summer meeting of UEMO (the European Union of General Practitioners) and is to be published fully in the British Journal of General Practice). It looked at doctors’ hours of work; how family doctors were organised (in groups or in single practice); if they worked with others—nurses, administrative staff, or healthcare assistants; if they did home visits; how long consultations were; and how many patients they saw in a working day.

Some countries described two concurrently running systems: a public health system—funded by the state, with doctors working from clinics—and a private system, funded by insurance, with doctors working from their own surgeries. more…

Rebecca Stout: Refugees and their right to access healthcare in the UK

30 Oct, 15 | by BMJ

rebecca_stoutOver the past few months it would be very difficult to have missed the news stories reporting on the Syrian refugee crisis. Civil war has now continued in the country for more than four years and the World Health Organization states that there are currently “12.2 million people in need of humanitarian assistance, with more than 7.6 million of them internally displaced.” Moreover, over 4 million Syrian people are registered outside the country as refugees.

The UK has agreed to take 20 000 of these refugees over the next five years. As doctors, it is important to educate ourselves about what to do should someone present whose legal status we are unsure about. more…

Global Health Curriculum group: A changing world and what it means for medical training

30 Oct, 15 | by BMJ

core_global_health_competenciesThis month the BMA released a report on the need for pre and post-graduate medical education and training to adapt in the face of a rapidly “changing world.”

We are pleased to see recognition of the need to update postgraduate competencies. However, as doctors in training who are dedicated to the integration of global health into current postgraduate training programmes, we fear that there are important gaps that have not been adequately addressed. The report recognises increased complexity in “characteristics of the population” and “public expectations of healthcare,” but we believe that equally important is the increasing complexity of social, political, and economic systems which profoundly influence health.  more…

Mary E Black: On public health—Roy Lilley gets it wrong

30 Oct, 15 | by BMJ

maryeblack copyRoy Lilley—blogger, NHS and social care agent provocateur, fettered by none, master of the timely hyperlink, and coiner of deliciously irreverent names for the great and the good. I do chuckle when he refers to Simon Stevens as Tarzan. I read all his blogs—his often acid shots are compelling . . . unless they are pillorying you, then they are infuriating. He writes with great kindness about patients, he cares about frontline health workers, and is passionate about the NHS.

But in his blog on 26 October he got it wrong. Launching Tony Blair into sole sainthood over the UK 2007 ban on smoking in the workplace and consigning public health professionals to the slag heap of oblivion? Unfair. more…

Samir Dawlatly: Do I need to be more mindful?

21 Oct, 15 | by BMJ

In my relatively short career as a GP there has been a surge of interest in talking therapies for mental health problems. It seems that the “one-size-fits-all” population-based research being shoe-horned and imposed onto every patient in the consultation approach is what is needed and required by our paymasters. The current trend of therapy that has been researched and shown to be just as effective as medications in trials that may or may not be representative of my patients is supposed to be offered. Never mind that the waiting list may be [insert random number that sounds big] weeks long. First, cognitive behavioural therapy seemed to be all the rage. Now it appears that mindfulness is popular in both the counsellor’s room and in the mass media. One can even become mindful by colouring in patterns in expensive books, apparently. more…

Amy Godden: Women in surgery

21 Oct, 15 | by BMJ

amy_goddenIn the 13 years since embarking on my medical training I have witnessed unbelievable progress in many different aspects of medicine as a whole, not least, within gender equality.

I am a female general surgical registrar in North West London. I am married to a recently retired professional rugby player. I have no children…yet.

I would like to lay my cards on the table; gender inequality in the operating theatre has been the least of my hurdles. I do not wish to sound flippant or deny that in some spheres it remains a problem. I will be eternally grateful and humbled by my female predecessors that have carved the way for me in a predominantly male profession, enabling me to speak so positively about my experience. more…

Henry Murphy: The impact of the junior doctor’s protest march

19 Oct, 15 | by BMJ

henry_murphy_nhs_protestI couldn’t sleep yesterday morning. Something was wrong. On Saturday I joined 20 000 people marching in protest at the government’s threats to impose a new contract on all doctors below consultant level. Police in riot vans were parked on Parliament Square, and were met with smiling parents, pushchairs, and a lot of stickers. A helicopter circled overhead, filming the crowd. The chants in union for our union, the BMA, could be heard across London. I was so tired from being on my feet chanting all day, I thought I would have slept like a log, but I woke up on Sunday too early, feeling uneasy and restless. I checked the Junior Doctor’s Contract Facebook campaign group (55 117 members); all was well. I started receiving donations into a crowdfund to thank the organisers of the protest. more…

Mary McCarthy: Are GPs doing “penance” for the 2004 contract?

16 Oct, 15 | by BMJ

mary_mccarthyRecently, Jeremy Hunt said that GPs are undergoing penance for the 2004 contract. To quote, he said: “Labour signed a disastrous contract in 2003 and since then, in penance really, the NHS has not really wanted to put extra money into general practice and it been has starved of resources progressively.”

Is he really saying that general practice has been deliberately starved of resources because GPs achieved more than they were expected to in the years following the new General Medical Services contract for general practice? And if he really believes that GPs and their patients are being punished for a decision a government made 10 years ago, why hasn’t Hunt, as secretary of state for health, done something about it? more…

Richard Smith: How global health can help the NHS

13 Oct, 15 | by BMJ

richard_smith_2014Africa has 25% of the global health burden and 2% of the health workforce. In contrast, North America has 2% of the health burden but 25% of the health workforce. This is the inverse care law (those who need healthcare the most get the least) on a gargantuan scale. And now the US is trying to recruit 500 000 more nurses to implement Obamacare. It may not feel like it to those in the NHS, but it too has both more staff than it “deserves” and a shortage of health workers. The Global Health Exchange, which was launched earlier this week in Manchester, is one response to this paradox.  more…

John Hughes: The UK will slip from world leaders in palliative care if complacency replaces progress

7 Oct, 15 | by BMJ

John HughesThe Quality of Death Index report from The Economist Intelligence Unit once again ranks the UK as providing the best “quality of death” and “quality of palliative care” as compared with 80 countries around the world. The report uses a number of indices to reach its conclusions in what is an extremely well researched document.

The exemplary features of the highest scoring health economies include a national policy framework for palliative care, relatively high levels of healthcare expenditure, good specialist and generalist palliative care training, financial subsidies (from the charitable sector in the case of the UK), availability of opioids, and public awareness of palliative care. more…

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