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Ceinwen Giles: Patient leaders at the NHS Confederation Conference

10 Jun, 14 | by BMJ

ceinwen_gilesAs readers of The BMJ will know, leadership is a widely discussed and hotly debated topic across the NHS at the moment. It’s also a theme that permeated the NHS Confederation Conference in Liverpool last week. Of particular interest to me was the issue of patient leadership, as I was asked to speak at a plenary session called “Patients in the Driving Seat” on the last day of the conference.

As I walked around the conference, I heard much talk of the need to involve patients and work with them—some of it tokenistic, but much of it well meaning. Various sessions highlighted the value of working with patients in different ways, and provided examples of patients who had managed to bring about new services, or shape old services in a new way. more…

Azeem Majeed: Are federations the way forward for general practices in England?

9 Jun, 14 | by BMJ

Azeem_majeedAs general practices in England come under increasing workload, funding, and contractual pressures, a new type of primary care organisation—the GP Federation—is becoming more common. The RCGP defines GP federations as practices “working together to share resources, expertise, and services.” In their simplest form, federations allow the general practices in one locality to share some administrative functions, and work together to bid collectively for NHS contracts.

However, as GP federations are not statutory organisations, they vary widely in both their structure and the activities they undertake. Some of the more advanced federations have established themselves as independent legal entities, and have already begun to compete for contracts against NHS hospital and community trusts. more…

David Zigmond: Is it time to renationalise the NHS?

30 May, 14 | by BMJ

david_zigmond2Recently the media has told us that the Labour Party is considering a long journeyed return: back to the nationalisation of rail services. Some claim that this will offer better long term value, efficiency, and safety.

Many would welcome this, but there is a puzzling anomaly: why do we not, instead, start with the NHS? For surely, the contentious market principles of competitive commissioning are better suited to human transport than human healthcare. This is an important distinction, and our failure to recognise the difference between the mechanical and the human has led to a new tranche of serious NHS problems. more…

Michael West: Collective leadership—fundamental to creating the cultures we need in the NHS

28 May, 14 | by BMJ

michael-westPositivity, compassion, respect, dignity, engagement, and high quality care are key to creating the cultures we need in the NHS. And, just as importantly, we must deal decisively, consistently, and quickly with behaviours that are inconsistent with these values—regardless of the seniority of people exhibiting them.

Yet in the King’s Fund’s most recent survey of NHS staff, two fifths of those surveyed felt that negative behaviours—typically incivility, aggression, discrimination, carelessness, brusqueness, and poor performance—were not being dealt with in a timely or effective fashion in their organisation. How then can we ensure that positive NHS cultures (with a focus on patient care) are encouraged, and inappropriate behaviours and performance are reduced? more…

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…

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