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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…

Ian R Barker: Compassion fatigue—the neglected problem

20 Sep, 16 | by BMJ

ian_barkerCompassion fatigue—also known as vicarious traumatisation results in a gradual reduction in compassion over time. It is more common in those dealing with trauma or caring for close relatives (1). If often presents as hopelessness, decrease in experience of pleasure, constant stress and anxiety, and a pervasive negative attitude (2). Interestingly, it has been claimed that as a result of the media portraying constant tragedy the general public has been somewhat more cynical and resistant to suffering, a form of compassion fatigue. more…

Nick Hopkinson: Saving the NHS—a lesson from Carthage

20 Sep, 16 | by BMJ

nick_hopkinsonCato the Elder is said to have concluded every speech he made in the Roman Senate, regardless of the topic, with “Delenda est Carthago”—Carthage must be destroyed. In answering the Editor of The BMJ’s call for ideas on how the medical profession can protest against the destruction of the NHS, a similar clarity and consistency of message is essential.

The simple proposal is that in every discussion on every topic of medical interest, the management of long term conditions, novel therapies, the causes and the cures of cancer, avoidable deaths, whatever thing awareness is being raised about this week, good news or bad, doctors need to include a clear statement that it is government policy to underfund the NHS by £20 billion pounds by 2020. more…

Health apps and how to evaluate them: Review of the PHE 2016 conference, part two

20 Sep, 16 | by BMJ

suchita_shahEmbedded in the NHS Five Year Forward View is a sleek, bullet pointed ministerial promise: “an expanding set of NHS accredited health apps that patients will be able to use to organise and manage their own health and care.” Whatever your views might be on ministerial promises, it’s definitely true that digital technology is making its way into mainstream public health. In my previous blog, a roundup of several sessions at the Public Health England (PHE) annual conference, I wrote about how digital technology is partnering with behavioural science to influence the health choices we make. Here, I’ll share what I learned about health apps. more…

Using behavioural science and digital technology to “nudge”: Review of the PHE 2016 conference, part one

19 Sep, 16 | by BMJ

suchita_shahBeing a GP at a public health conference is, I imagine, like being a proctologist at a plumbers’ convention: familiar subject matter, different perspective. I spend a lot of my clinical time advising people about smoking, alcohol, healthy eating, weight loss, mental health, contraception—all sorts of things that have at their core the vagaries of human behaviour—but I’m not sure I do it very well. A tidal wave of long term conditions is flooding the NHS, and I’m always interested to know what new tricks the population health approach has to address these. more…

David Zigmond: How and why do we retire? Ill omens for younger doctors

14 Sep, 16 | by BMJ

david_zigmond2The nature of our departures from our work often tells us much about what kind of problems are being left behind. The individual may escape, but what about the wider community?

The continuing troubles and discontents of junior doctors have evident newsworthiness; not so the equivalent problems in later careers. This is easy to understand: younger doctors have (we hope) a long future career ahead—that future is also our future healthcare, so we want them to be there, and in fine fettle. Older doctors will have retired from that picture: we are less concerned. more…

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