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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…

Richard Smith: Why doesn’t the obvious happen?

1 May, 14 | by BMJ

Richard SmithIt’s obvious to me that all scientific research should be available free to everybody everywhere, the polypill to prevent heart attacks and strokes should be offered to all those over 55, and patients not health institutions should control their records. Why don’t these obvious things happen?

The core arguments for making all research free are that most of it is funded with public money and that ideas unlike physical objects can be shared infinitely, increasing their value and the chance they can be exploited. Something like 20% of scientific studies are now available free to everybody, but most are not. Vested interest is the main barrier: the profits of many organisations, many of them scientific societies ironically, and the jobs of many individuals depend on the present limited access model. As Maynard Keynes observed, it’s impossible to convince somebody of the value of an innovation if his or her job depends on not being convinced. more…

Kailash Chand: The survival of general practice is the survival of the NHS

16 Apr, 14 | by BMJ

Kailash ChandGeneral practice in England is under intense pressure at the moment from a variety of sources, including the plan to keep surgeries open from 8am to 8pm, seven days a week. These are combining to overstretch practices in an unsustainable manner.

A key factor is that patient demand is constantly increasing because of an ageing population. By 2011 the number of people aged over 65 had surpassed 10 million, and by 2031 it is predicted to hit a new peak of over 15 million. As many of these patients enter their 70s and 80s, they will develop increasingly complex health needs that require longer consultations and more intense, complicated care from their general practice. By the beginning of the next decade, there will be one million people living with dementia alone, while many more will have other conditions such as heart disease, diabetes, and additional degenerative conditions. In the majority of cases an older patient will have a number of these conditions at the same time. more…

Vidhya Alakeson: What will personal health budgets offer the NHS?

4 Apr, 14 | by BMJ

vidhya_alakeson2From this month, adults and children eligible for continuing healthcare will have the right to ask for a personal health budget. Five years on from the start of the national personal health budget pilot, awareness among doctors of this new approach remains low, and scepticism at times, high. But rather than being seen as something to confine to the margins of the NHS, personal health budgets could make a significant contribution to important priorities. There are three areas where personal health budgets could help deliver: increasing the self management of long term conditions, reducing demands on acute care, and integrating care across the NHS and social care. more…

David Wrigley: Standing up against the fragmentation of the English NHS

28 Mar, 14 | by BMJ

david_wrigleyOn a little known website an advert popped up recently that didn’t catch the eye of many people. Those that did see it realised the implications of it when they read the details.

The website is called Supply2Health and is the location for all outsourced tenders for services in the English NHS. It is a veritable goldmine for the private sector wishing to take over profitable services and get their hands on a piece of the juicy NHS £120bn pie. more…

Chris Hopson: Planning to meet the District General Hospital challenge

18 Mar, 14 | by BMJ

chris_hopsonA recent visit to a district general hospital (DGH) over the Christmas period gave a perfect illustration of the scale of immediate challenge that many acute trusts face over the next few years; challenges that were raised by both Chris Ham and Dr John Oldham in their November 2013 BMJ analyses on money and reform respectively.

The trust is a typical small rural DGH Foundation Trust: its nearest neighbours are a 35 minute drive away in one direction and nearly an hour in the other. It provides the usual range of DGH services, is well run, has low risk according to the CQC Intelligent Monitoring survey (a Band 5 rating), and is a good example of the sector. more…

Vijaya Nath: Medical revalidation: trauma, trivia, triumph

17 Mar, 14 | by BMJ

The United Kingdom is the first country in the world to introduce the mandatory revalidation of its medical workforce. How does this process feel for those engaged in it?

The King’s Fund have been exploring this question with doctors on development programmes, in masterclass events, and in a recent qualitative study and have found some variation in the answer. more…

Phil Koczan: Time to regain trust in

14 Mar, 14 | by BMJ

phil_koczanOver the past few weeks we have seen a lot of media interest around NHS England’s plan to bring health information together under the banner of, which will allow the linkage of de-identified patient data from different care settings in a secure environment. will have various uses which include measuring and improving the quality of services delivered by the NHS, and facilitating access to the data by approved research projects. more…

Kiran Varadharajan: A junior surgical trainee’s perspective on surgical simulation

13 Mar, 14 | by BMJ

kiran_varadharajanThe European Working Time Directive (EWTD) has reduced the number of hours that trainee doctors have to hone their skills. As a junior surgical trainee, I find that time in theatre is of the essence when it comes to improving my operative skills. “The Time for Training Report” highlighted these challenges with suggestions on how trainees can overcome the training barriers produced by EWTD. One of the key developments is simulation training. Simulation training forms an excellent way of developing skills in a controlled environment without causing potential harm to patients. These skills can then be transferred into real life operations. The upshot is that when operating on patients surgeons are honing their skills rather than learning from scratch. more…

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