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Mary McCarthy: Are GPs doing “penance” for the 2004 contract?

16 Oct, 15 | by BMJ

mary_mccarthyRecently, Jeremy Hunt said that GPs are undergoing penance for the 2004 contract. To quote, he said: “Labour signed a disastrous contract in 2003 and since then, in penance really, the NHS has not really wanted to put extra money into general practice and it been has starved of resources progressively.”

Is he really saying that general practice has been deliberately starved of resources because GPs achieved more than they were expected to in the years following the new General Medical Services contract for general practice? And if he really believes that GPs and their patients are being punished for a decision a government made 10 years ago, why hasn’t Hunt, as secretary of state for health, done something about it? more…

Richard Smith: How global health can help the NHS

13 Oct, 15 | by BMJ

richard_smith_2014Africa has 25% of the global health burden and 2% of the health workforce. In contrast, North America has 2% of the health burden but 25% of the health workforce. This is the inverse care law (those who need healthcare the most get the least) on a gargantuan scale. And now the US is trying to recruit 500 000 more nurses to implement Obamacare. It may not feel like it to those in the NHS, but it too has both more staff than it “deserves” and a shortage of health workers. The Global Health Exchange, which was launched earlier this week in Manchester, is one response to this paradox.  more…

John Hughes: The UK will slip from world leaders in palliative care if complacency replaces progress

7 Oct, 15 | by BMJ

John HughesThe Quality of Death Index report from The Economist Intelligence Unit once again ranks the UK as providing the best “quality of death” and “quality of palliative care” as compared with 80 countries around the world. The report uses a number of indices to reach its conclusions in what is an extremely well researched document.

The exemplary features of the highest scoring health economies include a national policy framework for palliative care, relatively high levels of healthcare expenditure, good specialist and generalist palliative care training, financial subsidies (from the charitable sector in the case of the UK), availability of opioids, and public awareness of palliative care. more…

Emma Ladds: Remembering to care

7 Oct, 15 | by BMJ

photo (5)There is something both heartwarming and heartbreaking about the sight: an older man, so stooped he is bent almost double, pushing an empty wheelchair down the pavement. His wristband marks him out as a hospital inpatient. Step by faltering step, he totters back towards the large white building and the awaiting ward.

A woman—his wife I presume—walks beside him, now and again reaching a hand out to the chair—for support herself or perhaps to correct its wavering course. She too is frail, with silver hair pulled back tightly, and wearing a neat twinset and pearls. Despite her sensible shoes, it is impossible to imagine how she could possibly propel her husband in his chair—perhaps they have simply run out of walking frames on the ward again. more…

Saffron Cordery: Spending review—time to do the maths

5 Oct, 15 | by BMJ

Saffron CorderyI can’t think of a time when the machinery of government has had to work harder. Austerity is a tough call for everyone. Looking out of the windows of NHS Providers’ offices I can see the home of HM Treasury, where the number crunchers, the money men and women, and the purse string holders hang out. It seems pretty busy. They are doing the maths.

And it’s no surprise. All minds are focused on the spending review, when the government of the day works out not only how it will spend public money for the next three years, but the processes it will use. more…

David Zigmond: Competence or compliance? The corrosive cost of professional practitioner appraisals

25 Sep, 15 | by BMJ

david_zigmond2Current appraisal systems sacrifice more of value than they can assure. Clarifying why and how this happens gives us wider insights into our ill faring welfare systems.

“The more laws, the less justice”
German Proverb

Some healthcare management axioms seem incontestable: all our healthcarers should have a good standard of human and technical competence; these should then be held within a firm frame of moral probity. Therefore we need systems for professional appraisals, then validation. more…

Samir Dawlatly: Why bother with my cholesterol?

24 Sep, 15 | by BMJ

For reasons that I have previously written about, I have to have my blood pressure, cholesterol, and blood glucose checked every year. These measurements have always been normal. Of these, I don’t know a single one of my cholesterol measurements. Not one. In fact, one of my previous GPs asked me if I wanted to know what my cholesterol measurement was. I remember smiling at her and saying that I didn’t, because even if it was elevated my risk would still be low. She nodded and smiled back. I don’t know whether she thought I was eccentric but she didn’t pursue the matter. more…

#imajuniordoctor: Junior doctors respond to the new junior doctor contract on social media

24 Sep, 15 | by BMJ

An online petition has already collected over 50,000 signatures calling for the BMA to support doctors taking strike action against the planned introduction of new junior doctor contracts. Doctors are concerned that a recent government decision to impose new junior doctor contracts will result in lower pay and increased hours. This has been met with huge criticism and backlash.

In a three day period last week, over 1600 doctors expressed an interest in applying for roles outside the UK. The General Medical Council said it would normally receive about 20 requests a day for certificates needed to work abroad. This sharp spike in the number of requests began a day after the government’s announcement. Social media has been the platform for much of the outpouring of views and perspectives. more…

Hugh Alderwick: Is the NHS delivering enough things right?

17 Sep, 15 | by BMJ

hugh_alderwickRecently, I’ve written blogs about overuse and underuse in the NHS—the problems of doing too much of the wrong things and not enough of the right ones. The final chapter in this story is misuse: when health services are poorly delivered, resulting in preventable harm to patients.

In reality, the distinctions between these three concepts are blurred. Take underuse and misuse: while harm sometimes happens because things aren’t done right (for example, people are given the wrong drug or operated on in the wrong place), it also happens because the right things to prevent harm aren’t done in the first place. more…

Edward Ng: Quality assessments in general practice—have we gone too far?

10 Sep, 15 | by BMJ

ed_ngUK general practice receives an unprecedented level of scrutiny to verify that quality is maintained. We have the Quality and Outcomes Framework (QOF) to incentivise GPs to provide better quality care; we have NHS England Area Team visits for contract breaches; we have Care Quality Commission (CQC) inspections; we have appraisals and revalidation; and, depending on the clinical commissioning group (CCG), there may well be local assessments for quality.

At the same time, GP morale is widely reported to be plummeting, with a third of GPs considering retirement in the next five years, many considering leaving the UK, and around 30% of GP training positions unfilled after the first round of recruitment. While the reasons for plummeting morale are multifactorial and complex, the rise and rise of quality assessments is likely to be an important factor. There is certainly widespread discontent with our various inspections, and the Royal College of General Practitioners (RCGP) council has called for the suspension of CQC inspections. more…

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