1. Predictive risk: an idea whose time has come?

    (Guest blogger)
    29 Jul 2013
    Comments: 1

    The Nuffield Trust recently held its fourth annual conference on predictive risk - or applying statistical models to populations in order to identify patients who might benefit from health interventions of various kinds.

    The mere fact that this was the fourth conference on the subject shows that this is an idea with legs. And, indeed, it has just been given a boost by the Department of Health, which has included a directed enhanced service for ‘risk profiling and care management...

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  2. NHS @ 65: transparency is the future of the people’s NHS

    (Guest blogger)
    26 Jul 2013

    You attend a hospital with your disabled daughter. You do this pretty much every day because your daughter has regular seizures and emergencies. Every time, you have to start all over again because the hospital doesn’t know who your daughter is. More paperwork.

    Then you wait and wait because the staff have to find a hoist to lift your child out of her wheelchair onto a bed. Why couldn’t you have called in advance to tell them she was coming? Hours and hours of waiting.

    This is the NHS in the experience of one mother I met recently: everyday indignities and inhumanities and, in...

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  3. CCGs: the current view from local GPs

    22 Jul 2013
    Comments: 3

    Much has been written about the current pressures facing primary care. Perhaps it seems fairly predictable therefore, to hear that many GPs are finding it difficult to engage with the clinical commissioning opportunity.

    But unfortunately for CCG leaders working hard to increase involvement, it is the support and involvement from members that provides one of their greatest potential assets.

    So how big do GPs think the challenge is ahead? New research, along with a growing body of evidence, may provide a few tips.


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  4. Back to first principles: primary care for the future

    18 Jul 2013

    Looking back over recent blogs about primary care written by Jonathan Tomlinson, Clare Gerada, John Macaskill-Smith and Helen Parker, three things stand out.

    First, there is consensus that general practice is under significant pressure, struggling to meet demand from patients, blamed for contributing to the alleged crisis in accident and emergency care, and exhorted to reassume responsibility for out-of-hours patient care.

    Second, the ‘special sauce’ of general practice – the relationship between a patient and their family...

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  5. NHS @ 65: the NHS cannot do it alone

    (Guest blogger)
    12 Jul 2013
    Comments: 1

    We are in danger of losing our collective nerve over the future of the NHS. In 1948, in the midst of austerity and post-war national exhaustion, Britain created a comprehensive health service which offered care to those who needed it regardless of their means.

    It was a courageous idea whose time had come and it made compelling economic, political and social sense. It still does.

    In 2013 our far richer country can and should continue to embrace Aneurin Bevan’s vision. Of course we face very different...

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  6. Competition is not the way to improve general practice

    (Guest blogger)
    10 Jul 2013

    I have lived and worked as a GP in densely populated urban areas for the last 12 years and so I read with interest and dismay, Neil Bacon’s enthusiasm for the findings of the Competition and Cooperation Panel’s so-called: Empirical analysis of the effects of GP competition.

    This showed that GPs with neighbouring practices less than 500 metres away made fewer referrals for certain conditions and had patients who were 0.1 per cent more satisfied than patients from...

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  7. NHS @ 65: the need for investment in general practice

    (Guest blogger)
    8 Jul 2013

    The NHS is struggling and general practice is one area bearing the brunt of the pressure to meet increasing, and changing, patient needs.

    We have a growing and ageing population in the UK. From a GP’s point of view, we are seeing more patients than ever before, making up to 70 patient contacts a day, which previously would have only been seen in exceptional circumstances, such as a flu pandemic.

    And these patients are often presenting with complex, chronic and multiple conditions, both physical and mental.

    Additionally, another round of...

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  8. NHS @ 65: tender, fragile, fragmented, strained, vulnerable

    (Guest blogger)
    4 Jul 2013

    Tender, fragile, fragmented, strained, vulnerable. In disarray. At a cross-roads. These are just some of the words used by key contributors to the Nuffield Trust’s latest publication: The wisdom of the crowd: 65 views of the NHS at 65.

    The service has never been particularly good at celebrating its big anniversaries. The tenth, in 1958, was pretty much all sweetness and light. But most of the others – from the 20th through to the 50th – were overshadowed by one crisis or another, by a sense of foreboding, or by both.

    By contrast, the 60th, back...

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  9. NHS @ 65: views of patients must be heard

    3 Jul 2013

    It appears that the founding principles and aspirations of the NHS remain largely intact, but they are under great and increasing strain. This relates in part – but only in part – to increasing demands and costs brought about by demographic change, high expectations and new therapeutic opportunities offered by technological advance.

    But these factors are not the sole cause, nor in the views of patients, public and staff are they the most important.

    As the Francis Inquiry – the latest of several into shameful events – has so painfully shown, unless...

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  10. Getting general practice organised for future challenges

    (Guest blogger)
    28 Jun 2013
    Comments: 2

    Having had the opportunity to observe English general practice and the broader NHS for the last few months the question I am left with is this – is English general practice and primary care currently equipped to deal with the challenge of moving forward?

    Recently released data shows that over 50 per cent of GPs in the UK are providing more than 40 consults a day – demand is continuing to grow as the population ages and...

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  11. Act now or repent at leisure

    27 Jun 2013
    Comments: 1

    The Chancellor announced the outcome of the 2013 Spending Review yesterday. He confirmed that the NHS has been spared the full force of Government cuts for another year. The health budget is rising in headline terms by just 0.1 per cent after inflation. As expected, part of the health budget is earmarked to be transferred to social care.

    This continues the precedent established in the 2010 Spending Review which set aside money each year for...

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  12. Community-based interventions: how do we know what works?

    26 Jun 2013
    Comments: 2

    Over the past four years the Nuffield Trust have been asked to look at a range of service innovations and assess whether they lead to a change in service use – most typically a reduction in inpatient hospital activity, which is something that seems to have become the holy grail of health service planning.

    Our new report summarises observations from our studies and efforts that might help those planning and evaluating new services in the future. In particular, the report should provide useful learning for the new...

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  13. Keeping our NHS fit for the future

    (Guest blogger)
    25 Jun 2013
    Comments: 4

    If we stand back now, the NHS may tip over the edge of its own ‘fiscal cliff’. Future health care services face serious challenges such as changing demographics (particularly ageing), increasing obesity levels and rising costs of new treatments and medicine.

    To do nothing about the increasing demands being placed upon the system would be a political mistake.

    I believe that the current infrastructure, and the widespread and relatively unchallenged acceptance of a service funded solely by the taxpayer, will lead to poorer patient outcomes than we should...

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  14. Reconfiguration versus re-election: public expectations and health reform

    (Guest blogger)
    24 Jun 2013

    Clinicians and health service administrators can often identify ways of reconfiguring services, particularly hospital services. These reconfigurations usually appear to deliver improved outcomes but prove hard to sell to a sceptical public. On these occasions, local politicians are urged to be brave and support such moves.

    All too often though, the politician is found fanning the flames of popular discontent and those inside the NHS look upon them with varying degrees of sympathy, bewilderment, despair or contempt. The situation is actually made worse if health insiders believe that...

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  15. Where next for hospital mergers?

    (Guest blogger)
    21 Jun 2013

    Next week sees the deadline for responses to Monitor on their consultation on the proposed approach to advising the Office of Fair Trading on the benefits for patients of mergers involving NHS foundation trusts.

    It acts as a further reminder that competition and choice will play an increasing role in the NHS, challenging those involved in proposed hospital mergers to demonstrate that there are...

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  16. The challenges facing our hospitals – doing what needs to be done

    (Guest blogger)
    20 Jun 2013

    The litany of challenges facing hospitals is by now familiar: rising demand, spending restraint, making the best use of new technologies, and finding ways to adjust the acute sector to a world of chronic illness.

    A service that has struggled to make progress on productivity for decades now faces a future in which there will be no alternative but to make steady efficiency improvements, year on year, while at the same time maintaining a level of quality upon which vulnerable people depend.

    The task is daunting, but I remain an...

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  17. Do home palliative care services have an impact on where people die?

    (Guest blogger)
    18 Jun 2013

    As in many other developed countries, the UK population is rapidly ageing. This has implications for the provision of health and social care, as older age and life-limiting, chronic conditions are closely linked. There is a growing need for palliative care.

    One of the key values of palliative care is to enable people to choose where to be cared for at the end of life. When asked for their...

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  18. Would we know it if we saw it?

    30 May 2013
    Comments: 6

    A week after the Government's integrated care pioneer programme kicked off, the evaluation of North West London's integrated care pilot was published. The ingredients of the pilot were sensible, for example: investment in IT, risk stratification and targeting of high risk patients, leadership, coordination of multidisciplinary groups, and project management.

    The results so far: high commitment by professionals; greater collaborative working across teams and with social...

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  19. The benefits to patients of 'healthy' competition

    (Guest blogger)
    28 May 2013
    Comments: 3

    I once worked with a consultant who had an uncanny ability to extract the truth from his junior staff. When he suspected dubious information (such as “I’m sure the patient had a high erythrocyte sedimentation rate (ESR)”) he’d say, “Is that a guess, rumour, fact or lie?”

    Of course, he did it in such an intimidating manner that the answer was clear by the blood draining from the face of the poor, unfortunate wretch who didn’t have all the information to hand.

    The current debate about the absolute need to reorganise and improve the NHS often reminds me of that consultant’s total...

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  20. Transforming general practice: GP providers thinking big

    23 May 2013

    General practice seems to be considered by politicians and the media as both the cause of and solution to the current crisis in demand for urgent and emergency care.

    At the same time, the primary care community is recognising that the current business model of general practice is under threat due to increased demand by patients, growing regulatory workload and, for some this year, significantly less income.

    From discussions with GPs and policy makers, there appears to be some consensus that the current ‘small scale’...

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