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Alice Gerth: Taking sides in the junior doctors’ strike

25 Apr, 16 | by BMJ

junior_doc_strike_April2016As a full walk out is planned for this week, juniors need to ensure that they have carefully considered which side of the picket line they will stand on. Full disclosure, I have not been participating in strike action and my reasons can be found in a previous blog post: Strike action is not the answer.

I continue to engage with my colleagues on their plans for this week and I have noticed the mood shifting. They are disheartened and deeply concerned for two reasons. Firstly, the strikes have been going on for a long time with little evidence of progress; secondly, the prospect of withdrawing all junior doctor care is daunting.


Junior doctors’ strike 26 – 27 April 2016: Live blog

25 Apr, 16 | by BMJ Group

Demotix 28/09/2015This week, junior doctors in England will be undertaking a full withdrawal of labour between the hours of 8am and 5pm on Tuesday 26 and Wednesday 27 April, as the ongoing industrial dispute between the BMA and the government shows no sign of ending peacefully. This latest action marks an escalation from previous strikes this year as junior doctors will not be providing emergency cover. It is also a historic moment; the first time an all out strike has been called by junior doctors in the history of the NHS.  If you have any news, pictures, thoughts, or tweets to offer us for the blog, please send them to Gareth Iacobucci at


Chris Ham: Statesmanship among medical leaders could help resolve the junior doctors’ dispute

18 Apr, 16 | by BMJ

Whatever the rights and wrongs of the standoff between the government and junior doctors, failure to reach agreement on a new contract is bad for patients and for staff. The all out strike planned for the end of the month will cause disruption and delay for patients, and add to the pressures on staff who cover for absent colleagues. It will also create dilemmas for junior doctors torn between loyalty to their peers and their primary—and strongly felt—duty to patients.

The dispute may also affect recruitment into medicine and the willingness of newly qualified doctors to practise in England. It will have an impact too on the discretionary effort of junior doctors who form the backbone of patient care throughout the NHS. more…

Jennifer Stein: To Rio or not to Rio—that is the question

13 Apr, 16 | by BMJ

jennifer_steinShakespeare’s question about being springs to mind when as doctors we are faced with change. Do we “take Arms against a Sea of troubles, And by opposing end them?” That is, of course, if we are able to do this.

Rio is now a relatively common, though not ubiquitous, NHS IT replacement to medical notes, which is presented as a technological advance in relation to patient records. It involves all information taken during contact with patients, and in subsequent letters to GPs etc., being uploaded directly to the internet, therefore allowing widespread and immediate access by professionals with the appropriate clearance. more…

Are safety measures really the answer to spiralling clinical negligence costs?

7 Apr, 16 | by BMJ

mike_devlinAviation, rail, and oil and gas industries pride themselves, for good reason, on their safety records and associated culture. And a logical extension of the success of those industries is to apply similar approaches to medicine, with the aim of reducing risk. Instinctively, that makes sense—make medicine safer and there will be fewer errors, saving money by getting it right first time, and reducing litigation.

Jeremy Hunt, the secretary of state for health, speaking on a visit to the Virginia Mason Hospital in Seattle, sought to make the link explicit. He said that controlling safety was an essential part of controlling budgets. But is the evidence that clinical safety and litigation are linked particularly persuasive—or is there more to it? more…

Claudia Pagliari et al: Smartening-up NHS workforce management with IT

7 Apr, 16 | by BMJ

Media revelations of dramatic unexpected shortages in NHS nursing capacity, excessive dependence on overseas recruitment and costly agency staff (often NHS workers doing private shifts) are contributing to the public perception of a health service that doesn’t know how to effectively plan and manage its workforce. more…

David Oliver: An ideal minister?

6 Apr, 16 | by BMJ

david_oliver_2015I’ve been thinking a lot recently about MPs doubling as ministers of state politically responsible for key public services. What are the characteristics of a good or bad one?

I’ll start by saying upfront that while I understand the need for democratic accountability and oversight for large amounts of public money, even the system we have troubles me. It is rare indeed for ministers to have any background or expertise in the department they are leading. Nor have they been chosen by the electorate for the brief they are handed. They are often shuffled from post to post for party political expediency before they have had a chance to master their brief. more…

What are the consequences of recent caps on NHS agency staff spending?

4 Apr, 16 | by BMJ

phoebe-dunn-portraitFour months since the first caps on agency spending were introduced by NHS Improvement—and after new framework agreements came into force last week—what do we know about the impact of these measures so far?

Unfortunately, not a huge amount. Although NHS providers are submitting weekly data returns to NHS Improvement, no official figures have yet been published. Without this we are, to some extent, in the dark about the effects of the measures, instead relying on piecing together other sources of information—such as Freedom of Information requests and individual trust and agency experiences—to try and gauge early indications of impact. more…

Richard Smith: Is the NHS finally going to start taking patient safety seriously?

29 Mar, 16 | by BMJ

richard_smith_2014Jeremy Hunt, secretary of state for health, is embroiled in battles with junior doctors, GPs, and consultants over contracts and patient safety. He thinks that he will improve safety by reducing excess weekend deaths. The doctors think that he’s endangering patient safety through obliging them to work unsafely. Ironically, he’s the first secretary of state since the founding of the NHS to put patient safety at the top of his agenda. Earlier this month he launched a global movement on patient safety and announced developments intended to improve patient safety.

Neglect of patient safety
The sad truth is that patient safety was not an issue at all in the first 50 years of the NHS. This was true of all other health systems as well, and it’s still not an issue for many. more…

Mags Portman: The PrEP debate gains momentum

29 Mar, 16 | by BMJ

Mags Portman_imageThis blog was originally written for BMJ Clinical Evidence and posted on

Last week saw a landmark shift in the pre-exposure prophylaxis (PrEP) for HIV debate in England. After 18 months of work with key stakeholders—including clinicians, commissioners, and community advocates—NHS England announced that it was no longer able to fund a significant PrEP rollout; the outcome the Clinical Reference Group (CRG) thought that they had been working towards. The rationale given for this late stage decision is that NHS England does not commission HIV prevention. NHS England will be making up to £2m available over the next two years to run a number of early implementer test sites, which local authorities will have to bid to become. more…

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