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David Oliver: Do bring me problems

20 May, 15 | by BMJ

david_oliver_2015In her book Smile or Die: How Positive Thinking Fooled America and the World, Barbara Ehrenreich brilliantly deconstructed this cult. Her starting point was her own diagnosis of breast cancer and the bullying attitude that if you don’t “fight” the cancer and stay “positive” in the face of distress and worry, then your demise is your own doing. She showed how these exhortations to think positively had permeated thinking in many aspects of policy, business, careers, and “self-actualisation.” Jenni Murray referred to this as seeing “the glass as half full even when it lies shattered on the floor.” On a recent day on call, I bonded with another physician over her irritation at this US business phenomenon entering UK healthcare, while also agreeing that some NHS staff have embraced the equally unhelpful cult of “negative thinking.” more…

Daniel Barrett: Will a seven day NHS push primary care recruitment from crisis to catastrophe?

20 May, 15 | by BMJ

I listened with personal interest as the new conservative government re-launched its grand plan to deliver a “seven day health service.” In a little over a year I will be beginning life as a junior doctor along with thousands of others, all starting to question where our careers are heading. The answer for many of us could well be tied up inextricably with the fate of the “seven day NHS.” more…

Samir Dawlatly: A sideways look at the seven day working idea for GPs

19 May, 15 | by BMJ

Letter to the education secretary:

Dear Nicky Morgan
Congratulations on being appointed education secretary. Following on from your predecessor will either turn out to be really easy, as you can’t be as bad as all my teacher friends tell me he was, or will be very difficult if he has left everything in a bit of a mess for you. Good luck with that, but that isn’t why I am writing to you.

I would normally find myself writing to, cursing, or ridiculing your cabinet colleague, Jeremy. The reason being is that I am a GP. Not a very fashionable profession these days, especially as up to a third of training places are unfilled and many GPs plan to retire early, or emigrate, or retrain as plumbers. I’m joking about the last one, although there is this scheme to assess patients’ boilers. But I digress . . .  more…

David Zigmond: “Curing” dementia—medical possibility or political rhetoric?

14 May, 15 | by BMJ

david_zigmond2Talk of “curing” dementia can seriously distract us from the very difficult—yet humbly rewarding—tasks of pastoral care that are bound to increase.

David Cameron has said he wants dementia cured by 2025.” Of course, politicians must continually and publicly ply not just concern, but visions of positive assertion. A campaign trail intensifies the appetite and supply.

We can all share their aspirations, but next come tricky questions: what is really possible? And how? more…

Sally Carter and Emma Parish review Who Cares?

8 May, 15 | by BMJ

sally_carterA whirlwind of real voices from the NHS

by Sally Carter, technical editor, The BMJ.

“It’s a parade performance,” said the woman at the box office, “but some of it is outside so I’d keep your coat on if you think you might get chilly.” I had never been to a parade performance before and became nervous—any hint of audience participation and I’m ready to bolt from a theatre—but I needn’t have worried. It just meant I had to walk to different parts of the Royal Court Theatre in London that had been turned into hospital corridors, operating theatres, waiting rooms, and cubicles for the performance of Who Cares by Michael Wynne. It was an impressive transformation. more…

Richard Smith: Keeping the NHS alive

6 May, 15 | by BMJ

richard_smith_2014The NHS has to change radically if it is to survive. All those who study the NHS closely know that, but I’m not sure that all those who work in the NHS know it. And the necessity for radical change—as opposed to more money—features hardly at all in our depressingly shallow election. But how do you change radically such a monolith, something so loved that every criticism can feel hurtful, and a service soaked in ideology? The current answer is “from the bottom not the top.” more…

Robert Sale: Stand up and speak out for the NHS

6 May, 15 | by BMJ

rob_saleOne night about a year into the current “reorganisation” (aka upheaval) of the health service, my GP rang at 9.50 pm to give me the results of a blood test. “What on earth are you doing still at work?” I said, grateful though I was for his dedication.

At our next Patients Participation Group (PPG) meeting we had a refreshing and forthright discussion with staff about the real pressure the surgery was under—GPs, nurses, and reception staff alike—to carry on giving us the service we needed and they, as professionals are committed, against the odds, to providing. I think initially there was some wariness that a “PPG” with its “action plan” might just be one more thing in the long line of QOF’s, QIPP’s, DES’s etc sent to keep them firmly wedged between “the rock and the hard place.” But it was at that meeting that we committed ourselves to doing what we, as a local patients group, could do to help tackle that no 1 issue for the whole of our NHS—lack of adequate resources. more…

Alex Langford: Doctors should try to be politicians

5 May, 15 | by BMJ

alex_langfordIn psychiatry we’re taught to consider our patients in “biopsychosocial” terms. This is useful, but the term has become a bit of cliché. If I mention it when teaching medical students I can see the lights go out in their eyes.

I wonder if this is because when we analyse the roots of our patient’s distress, we only think in local, individualistic terms. For biological, we think of their aunt with schizophrenia and their coke habit; for psychological, we think of their limited coping mechanisms at times of stress; for social, we think of their crappy council flat. This is neither inspiring nor completely “holistic”—another stale stock phrase. more…

Alex Scott-Samuel: Simon Stevens—cheerleader-in-chief for NHS privatisation

1 May, 15 | by BMJ

alex_ssSimon Stevens’ Wikipedia entry describes him as “a health manager and politician.” This is appropriate not only because he was once a Labour councillor in Brixton but also because his output (since April 2014 he has been Chief Executive of NHS England) continues to demonstrate his deep ideological commitment to a commercial insurance-based market in healthcare.

After serving as policy adviser to New Labour’s first two Secretaries of State for Health, Frank Dobson and Alan Milburn, Stevens became Prime Minister Tony Blair’s No. 10 health policy adviser in 2001. In 2004 he moved to the largest US health insurance corporation, UnitedHealth, rising to the rank of Executive Vice President prior to his move back to England in 2014. more…

What are the political parties offering our children in 2015?

1 May, 15 | by BMJ

With the 7 May general election rapidly approaching, we have reviewed the manifestos of the five main political parties, standing in all UK regions, to determine what they are offering our children in 2015. All children exist in a context that shapes their health and wellbeing, and from which they cannot be separated. As advocates for children, it is our duty to engage with the political system and to be aware of how policies impact on our patients.

All of the political parties made some reference to children in their manifestos, but predictably with emphasis on different areas and with varying degrees of assurance. The Royal College of Paediatrics and Child Health has also published its own manifesto, “A vision for 2015,” which outlines key priorities for the incoming Parliament. more…

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