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Azeem Majeed: Three obstacles to increasing the use of statins for the primary prevention of cardiovascular disease

20 May, 14 | by BMJ

Azeem_majeedStatistics from the OECD show that the per person use of statins in the UK is the highest in Europe and the second highest among all OECD countries. There are a number of reasons for the very high use of statins in the UK, which include the emphasis on evidence based medicine in the training of UK doctors; the 2004 GP contract, which introduced financial incentives for the management of long term conditions such as coronary heart disease and diabetes; and the NHS Health Check programme, which aims (among its objectives) to increase the use of statins for the primary prevention of cardiovascular disease (CVD) in England in people with a 20% or more 10 year risk of CVD. more…

Mary E Black: Look at me

19 May, 14 | by BMJ

maryeblack copyI was a bit of a star in my early 30s at Harvard’s School of Public Health. On a fully funded and prestigious Harkness Fellowship (so a treasured person in the Harvard lexicon), I was bubbly, thin, well dressed, elected to student government, volunteering for just about everything, and winner of the competition to represent graduate students at graduation. The clever, golden girl with boundless energy, no family commitments, and junior enough not to be a threat. They loved me. I loved myself.

Fast forward six years—I return to Harvard as a student’s spouse with a baby in tow. Same place, same person, five more years experience at a much more senior level including in the UN, WHO, a war zone, and heading next to a professorship in Australia. I was just about invisible, pushing an inexpensive buggy across Harvard front square. Everyone looked at the cute baby. No one sought my eye. My IQ dropped 30 points. My degrees were not assumed. I tried sucking my baggy tummy in—to no effect. A designer buggy might have helped, but our cash had gone on living expenses. Harvard looked a bit pompous when I was no longer a full member of the club. more…

David Maher and David Pencheon: Adding wider social value when commissioning

14 May, 14 | by BMJ

Increasingly, we are being asked to do more with less. The Public Services (Social Value) Act 2012, a private member’s bill, became law in January 2012. It requires all commissioners of public services to consider economic, social, and environmental value—not just price—when buying goods and services. Social value is about how well scarce resources are allocated and used; it reflects a more balanced approach in assessing outcomes, taking into account the wider benefits to the patient and their community.

For clinical commissioning groups (CCGs), who are faced with increasing pressure to deliver more and better services under tighter budget constraints, social value is not just about squeezing suppliers or applying cost reduction schemes. It is about thinking creatively on how things could be done differently to ensure that the local community, as a whole, gets additional benefit through commissioning activity. more…

Mary E Black: Essential reading for new NHS Executives

12 May, 14 | by BMJ

maryeblack copyI have just joined the NHS Executive fast track programme. There will be 51 of us in total—36 clinicians from within the NHS and 15 application from outside the NHS. We will need to get up to speed fast on understanding the NHS in England. Here is my starter list of ten key sources of information that might be especially useful to NHS newbies. All feedback and suggestions for additions are welcome. more…

Tim Rudin: Ethical Sourcing—how organisations can learn from other public sector bodies

12 May, 14 | by BMJ

tim_rudinTransport for London (TfL) has been implementing ethical sourcing into our procurement practices since the launch of the Greater London Authority (GLA) Responsible Procurement Policy in 2006. When we first started, very few other public sector bodies in the UK were looking at ethical sourcing. It had traditionally been the preserve of the private sector, where ethical sourcing practices can be a pressing business need because of the possibility of negative publicity and the threat of consumer boycotts. The drivers in the public sector are different—generally, if you live or work in London, it would be very difficult to avoid TfL’s services. However, TfL’s brand is exceedingly high profile, and protection of that brand through mitigation of potential reputational risks is of great importance. That is by no means the only driver though.


Tim Ballard: The wider consequences of healthcare delivery

9 May, 14 | by BMJ

Tim_BallardIn January we saw the launch of the NHS Sustainable Development Unit’s (SDU) strategy for the NHS. Since its inception, the SDU has tirelessly promoted the wider responsibilities that we have when providing healthcare and social care. At its heart, this strategy reminds us that we need to act if we wish to decrease the environmental impact of healthcare, and, consequently, minimise adverse health effects both now and in the future. This strategy launch was reinforced by the recent IPCC statement, which underlined the effect that anthropogenic climate change will have on health.

In a similar way, the Medical Fair & Ethical Trade campaign asks us to think about the wider consequences of healthcare delivery in our Western democracy. The collapse of the garment factory in Bangladesh in 2013 brought the activities of the fashion industry into the spotlight; the workers who sadly lost their lives worked in unsafe conditions that would simply not be tolerated in the UK. Now it is time to shine the spotlight on the activities of the NHS. more…

Chris Ham: Wanted—an even Better Care Fund

7 May, 14 | by BMJ

The King’s Fund’s new analysis of serious and growing financial pressures in the NHS should serve as a wake up call to politicians of all parties. As the analysis shows, with an increasing number of providers in deficit, and the prospect of a further seven years of no growth in funding, the NHS is rapidly approaching a major crisis.

The arrival of this crisis has been accelerated by the transfer of almost £2 billion into the Better Care Fund in 2015/16. The purpose of the Fund—to support moves to integrate health and social care—is well intentioned. If it is used to support the kind of interventions we summarised in our recent evidence based guide, it should deliver benefits to the NHS as well as to social care. However, it will put additional stress on an NHS already struggling to balance the books and maintain acceptable standards of patient care. Acute hospitals will be particularly affected by the requirement to find even higher levels of efficiency savings than they have achieved to date. more…

Arthy Santhakumar: Shining a torch on medical supply chains—the great paradox

7 May, 14 | by BMJ

arthy-santhakumarHave you ever found yourself wondering where the equipment used by the NHS comes from? Maybe, maybe not. If you are in the latter category, then you may find that the answer makes for an uncomfortable truth.

Healthcare is a big business, and navigating through the NHS, its organisations, and supply chains is no easy feat. This industry spends nearly £40 billion per year on the procurement of goods and services, serving more than 63 million people. The supply chains that provide these commodities are global—employing millions of people worldwide, and elevating the NHS to the fifth largest employer in the world. This brings us back to our opening question—as, with such vast sums of money spent and human resources involved, we should question the circumstances under which such goods are produced in. more…

Jonathon Tomlinson: “Four problems”—a typical day for a GP

2 May, 14 | by BMJ

jonathon_tomlinsonI had only three patients left to see at the end of my morning surgery. It was 12.30. I had started at 8am, taking urgent phone calls for an hour before starting face to face appointments. It had been a typically challenging morning. Many patients had complicated mixtures of physical, mental, and social problems which is typical of all general practice, especially in deprived areas like Hackney. As a result I was running about half an hour behind and feeling pretty harried.

My next patient was a young, healthy looking, smartly dressed woman, in contrast to my previous patient, an elderly Turkish man with depression and chronic back pain who didn’t speak a word of English and came without an interpreter. The young woman was cheerful and friendly. “This shouldn’t take too long,” I thought as I called her in. more…

Azeem Majeed: General practitioners should give up their independent contractor status and become NHS employees

2 May, 14 | by BMJ

Azeem_majeedGeneral practitioners (GPs) have worked as independent contractors since the NHS was first established in 1948. However, we now need to review whether this model of general practice is what the NHS needs in the 21st century, and consider an alternative model in which general practitioners become NHS employees.

In many ways, GPs are already de facto ‘employees’ of the NHS. Much of the independence that GPs once had has been taken away by the government over the last decade. GPs’ workload and funding is now largely determined by the contract that their practices have with the NHS. more…

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