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David Zigmond: NHS stewardship—the missing personal factor

28 Oct, 14 | by BMJ

david_zigmond2In healthcare our systems of governance are increasingly developed and vaunted. Yet these are very different from our capacities for stewardship.

Inevitably and predictably, the recent party political conferences each designated the NHS as a crucial battleground: each claimed the better vision, ethos, and competence. Yet there is something recurrently missed by politicians, planners, and orbiting think tanks. It is the crux of personal attitudes, relationships, and investments: the human conductors of our best personal continuity of care. more…

Julie Browne: Why do some clinical supervisors become bullies?

28 Oct, 14 | by BMJ

Julie BrowneThe literature on bullying in the medical workplace makes disturbing reading. In the General Medical Council’s 2013 national training survey, 13.2% of respondents said that they had been victims of bullying and harassment in their posts, nearly one in five had seen someone else being bullied or harassed, and over a quarter had experienced “undermining” (unfair or belittling treatment). more…

Samir Dawlatly: A GP on why I still go to work

24 Oct, 14 | by BMJ

Recently Lord Howe warned GPs to stop complaining about their work conditions, so that they did not cause a workforce crisis. Similar noises were heard from NHS England at the recent Royal College of General Practitioners Annual Conference, where politicians and leaders were questioned about the state of primary care and, in particular, general practice, by delegates who seemed close to breaking point.

As a GP, I have every sympathy with those raising issues about excessive, unreasonable patient demand; arbitrary health and safety checks (including the state of paintwork in the cleaner’s cupboard); and the morale sapping nature of being the current political football of choice. And yet I still go to work. As do most GPs. more…

Richard Smith: The joy of a hernia repair

14 Oct, 14 | by BMJ

richard_smith_2014I had a hernia repair recently, but the day turned out to be one of the pleasantest I’ve had in a long time. Can that really be true?

Oddly, I looked forward to the day. It was partly the thought of being “made whole,” partly it being a different day from the normal, and partly a chance to experience the NHS doing what it does well. more…

John Middleton: The “Hospital of the Future” comes to the West Midlands

1 Oct, 14 | by BMJ

john_middletonOn 14 July this year, the chancellor of the exchequer announced the go ahead for the new Midland Metropolitan Hospital (MMH) in Smethwick, serving the people of West Birmingham and Sandwell in the West Midlands of England. As the chancellor returns to Birmingham for his party conference, the Royal College of Physicians has launched its manifesto, promoting its Future Hospital programme, around the party conference circuit. If any hospital could claim to hold the essence of the RCP aspirations for the “Future Hospital,” it is surely MMH. more…

Richard Smith: Using data to improve care and reduce waste in health systems

30 Sep, 14 | by BMJ

richard_smith_2014Annual expenditure on healthcare in the United States is currently $2.8 trillion, and about a third of it is wasted, says the Institute of Medicine. The sum wasted is about five times the GDP of Bangladesh, a country of 160 million people. This is waste on a spectacular scale, and reducing it while improving the quality of care is the main aim of the information technology developed by Optum, the services part of the UnitedHealth Group, said Richard Migliori, a former transplant surgeon and chief medical officer of the UnitedHealth Group. I don’t come to tell you what to do, said Migliori speaking last week to the Cambridge Health Network, but I hope to at least elicit your sympathy. more…

David Lock: Avastin and Lucentis—It’s time for NHS commissioners to act rationally by limiting the choices for wet AMD patients

26 Sep, 14 | by BMJ

The news that a Cochrane Review has concluded that Avastin (bevacizumab) is as safe as Lucentis (ranibizumab) to treat patients with wet age related macular degeneration (“wet AMD”), along with other studies that have shown the two drugs have broadly the same level of clinical effectiveness, comes as no surprise to those of us who have been involved in this debate for a number of years.

Lucentis is a “licensed” drug for wet AMD, whereas Avastin is not licensed for this condition. But Avastin is not an unlicensed drug per se; it is just licensed for a different condition, namely treating patients with certain cancers. The beneficial use of the drug for wet AMD patients seems an unintended and highly cost effective benefit. There is nothing unlawful in clinicians using an unlicensed drug to treat NHS patients, as paediatricians know because they use unlicensed drugs all the time. So why should the NHS keep paying out for a drug that is 10 times more expensive than an equally safe and clinically effective alternative? more…

David Pencheon: Public health’s essential role in sustaining the NHS

25 Sep, 14 | by BMJ

david_pencheon_3Simon Stevens, chief executive of NHS England, illustrated the state of public health at last week’s Public Health England conference by showing the audience his assistant’s lunch deal bought on the way to Warwick. A cheese and pickle sandwich is not bad, but why include the sugary drink and packet of crisps? He then pulled out the “Juicy Bits” that were included in the deal. He had high hopes that they were pieces of fruit, but no, they were sugary sweets. Disgusted, he gave the lunch back to his assistant sat in the front row.

Public health, Stevens said, has a vital role in sustaining not only the health of the public but also the health of the NHS. Spending more on bariatric surgery than on preventing type 2 diabetes, as England apparently does at the moment, is not sustainable. more…

Hugh Alderwick: The ups and downs on the road to health service improvement

19 Sep, 14 | by BMJ

hugh_alderwickParallels between the successful transformation of the Veterans Health Administration (VA) in the United States and the changes needed in the NHS in England have been made for a number of years. But recent troubles at the VA offer some important lessons for the NHS in the future, as explored in a roundtable discussion held at the King’s Fund last week.

The story of the transformation of the VA is familiar to many. Once a fragmented and hospital centred public healthcare system, changes made in the late 1990s helped the VA to become an organisation renowned for providing high quality, affordable care. more…

Samir Dawlatly: A case of semantics

19 Sep, 14 | by BMJ

The problem lies in semantics. GP. General practitioner. Could one be more vague than that? There’s an argument that since, on the whole, we provide general medical services (in medical centres) we should be called general medical practitioners. After all, my undergraduate training was in medicine and surgery, not simply everything in general.

Around the time I completed my training to become a G(M)P, I became very downhearted by what I expected to be the likely outcomes of the Health and Social Care Act. I hadn’t been particularly politically aware in the lead-up to the passing of the bill, as I was too busy trying to cram consultations into 10 minutes and learn all the red flags that I was supposed to know. more…

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