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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…

Florence Wilcock: Improving maternity care is everybody’s business

29 Sep, 16 | by BMJ

florence_wilcockPersonalised care. Continuity of care. Safer care. Better postnatal and perinatal mental healthcare. Multiprofessional working. Working across boundaries. A fair payment system.

This vision of care could apply to pretty much any healthcare service: it is essentially individualised care with seamless coordination across whatever professional or geographic boundaries may exist. In fact, these are the seven aims outlined in Better Births: Improving outcomes of maternity services in Englandmore…

Ahmed Rashid: The UK junior doctor contract dispute in 10 hashtags

29 Sep, 16 | by BMJ

ahmed_rashidHashtag: #iminworkjeremy

Description: When Jeremy Hunt (Secretary of State for health) accused the NHS of having a “Monday to Friday culture,” healthcare workers from across the country posted selfies of themselves busy at work on their weekend shifts.

Example: @trentconsultant #ImInWorkJeremy been round with registrar. Every patient seen. All poorly ones or who need decision seen by consultant. New contract needed? (18/07/15). more…

Andrew Green: Patients, GPs, and private medical insurance

28 Sep, 16 | by BMJ

andrew-greenYou know, it’s hard not to feel sorry for clinical commissioning groups (CCGs). Set up to allow GPs to commission services for their patients—as the ones with the best knowledge of what local needs are—CCGs have seen the continued drive to deliver more and more with less and less remove what little freedoms they may have had, and reduced most of them to scrabbling for pennies to balance the books. This is, of course, becoming increasingly unlikely and, as happens when you put people in impossible positions, decisions born out of desperation and made without consideration of longer term harms are the likely result. more…

Matthew Honeyman: Saving paper, saving money, or transforming care?

27 Sep, 16 | by BMJ

Yesterday we published a briefing on the digital agenda that has been pursued by the NHS since 2013 – the year Secretary of State for health Jeremy Hunt challenged the NHS to “go paperless.” We chart progress made to date and look at some of the barriers and opportunities presented.

This comes two weeks after the Wachter review of health IT was published. Much of the commentary on Wachter’s review has been focused on its messages about unrealistic timetables and insufficient funding. But it also calls for a re-launch of the government’s digital agenda with a new name by the end of this year. Could the “paperless” branding finally end up in the bin? more…

David Shaw: Delaying surgery for obese and smoking patients is illogical and unethical

23 Sep, 16 | by BMJ

david_shawIt was recently reported that Vale of York clinical commissioning group (CCG) plans to delay all elective surgery for obese patients for a year until they lose 10% of their weight, and to smokers for six months unless they stop smoking for eight weeks. [1] Both the overall rationale for this policy and the clinical rationale for targeting these particular groups are unclear.

The most obvious objection to the proposed policy is that it is unfair to target specific patient groups in this way. Why should the obese and smokers be singled out? The rationale cannot be clinical risk: while surgery is riskier for morbidly obese patients, and smoking is bad for your health in the long term, mildly obese patients and smokers are just as likely to recover well from surgery as slim non-smokers. The CCG seems to think that it is logical to target both smokers and obese patients simply because patients who are very obese and smoke are at greater clinical risk. more…

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