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Guddi Vijaya Rani Singh: What matters—medicine, culture, and the space in between

16 Jan, 15 | by BMJ

guddiMy grandfather passed away last year. Surrounded by travel weary loved ones (from an extended family that also extends across continents), this man from rural India was promised a peaceful death in dignity.

Except that he died in 2013 in one of Delhi’s largest private hospitals, with every medical test and procedure made available by his anxious progeny. In the last 42 days of his life, he sustained two chest drains, urinary catheterisation, daily blood tests, and repeated intubation and ventilation; he became a pin cushion for Delhi’s doctors. more…

Saurabh Jha: The overdiagnosed party/ the false positives rave

16 Jan, 15 | by BMJ Group

Saurabh_JhaConsider this equation.

Early Diagnosis = Early Diagnosis + Overdiagnosis (1.1)

This sort of unequal algebra will fail GCSE mathematics. A new NHS initiative is arithmetic defying as well. Patients who think they have symptoms of cancer will be allowed to book medical imaging directly, without seeing their GP. This is to catch cancer early. The logic is impenetrable: early diagnosis of cancer saves lives. more…

Ted Willis: Consequences of the “John Wayne” contract (“A GP has to do what a GP has to do”)

9 Jan, 15 | by BMJ

Ted WillisWhy is general practice unpopular, with low morale, falling applications for training, and—according to some experts—poor overall performance? I have worked as a GP for over 25 years and it is clear to me that this is an inevitable result of the way we are paid mainly according to capitation, rather than by item of service. This has allowed our managers to add massively to our workload, while workforce capacity has only increased slightly. more…

Ahmed Rashid: Leadership in primary care—the “odd one out”

8 Jan, 15 | by BMJ

ahmed_rashidPicture the scene. It was the first day of the NHS national medical director’s clinical fellow scheme induction. A group of junior doctors, who had successfully applied to take a year out of their training programmes to develop clinical leadership skills, were sat around meeting tables, making introductions in a grand committee room in the Royal College of Physicians’ building in London.

As we worked our way around the room, I realised it was actually quite fitting that we were sat in this college, as the group had a very physician-ly flavour to it. Every doctor knows how tribal we are about specialty groups, and I was keen, as I’m sure others were, to see the mix we had in the room. more…

David Oliver: Discharging patients from overcrowded hospitals—fewer “progress chasers” and more “doers” please

7 Jan, 15 | by BMJ

david_oliverThis year, urgent activity in English NHS hospitals has reportedly hit a record high. Officially reported “delayed transfers of care” (inpatients medically fit to leave, but awaiting community health and care services) have also peaked. These figures routinely underestimate the real number of people in beds whose needs no longer require the full facilities of the general hospital.

Hospitals are routinely declaring “Red” and “Black” status alerts and their executives are coming under increasing pressure from politicians, regulators, and NHS England over declining performance against the four hour standard for emergency department assessment and treatment (a target almost unique to the NHS). Emergency readmissions to hospital within 30 days are running at around 15% for patients aged 65 or over. more…

Billy Boland: Some New Year’s resolutions

2 Jan, 15 | by BMJ

billy_bolandEarlier this week, I saw someone put up their New Year’s resolutions from last year (NYE 2013) on social media to evaluate what they had achieved. It was, in fact, rather a lot, and got me wondering how successful I am at staying committed to change. Now I’m as blindly optimistic as the next person when it comes to estimating my capacity for reinvention, and can set resolutions with gusto. But right now, I can barely recall any that I’ve made.

If I’ve learnt anything about change management, it’s that in order to see outcomes you need to set goals and measure progress. So, in an effort to improve my paltry record, I’m sharing with you my leadership resolutions for 2015: more…

Ted Willis: Can the NHS meet the challenges of the next 20 years?

2 Jan, 15 | by BMJ

Ted WillisExpenditure on our health services in the UK has been rising consistently at around 4% per year in real terms for the last 30 years. It has doubled in real terms in just over 10 years. If this trend continues, this would mean us spending the real term equivalent of £230 billion in 2030, which would be 18% of current gross domestic product (GDP) and over double our present expenditure. Most developed countries follow a remarkably similar trend, with the United States well ahead, and Canada, France, and Germany also consistently above the UK. more…

Samir Dawlatly: How GP practices are funded—between a rock and a hard place

23 Dec, 14 | by BMJ

There are many uncertainties about the future of healthcare in the United Kingdom. This is largely because health is inherently political and, unfortunately, appears to be used by politicians to garner votes in forthcoming elections or gain points in opinion polls, without a great deal of thought being given to the consequences and feasibility of promises and plans. One of the major areas of concern is the funding of primary care. more…

Emma Spencelayh: To FT or not to FT—that is the question. Or is it?

16 Dec, 14 | by BMJ

Emma Spencelayh_2As part of the Health Foundation’s work on analysing the controversial decision to prohibit the proposed merger of Poole Hospital NHS Foundation Trust and the Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust, we’ve been grappling with what the role of foundation trusts really is in an ever changing system. more…

Samir Dawlatly: The ills of general practice

10 Dec, 14 | by BMJ

“Have a seat; sorry to keep you waiting. I’m Dr Dawlatly. What brings you here today Mrs, err, Practice?”

“General,” she replied grumpily.

“I’m sorry, what?”

“General. That’s my title. I’ve risen through the ranks to General, so I would be grateful if you would address me properly, doctor,” she answered curtly. more…

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