Headlines and stories about the ‘crisis’ in general practice have become commonplace over the last year or so. A demoralised and squeezed workforce is struggling to meet the needs of increasing numbers of patients demanding immediate appointments. Or so the narrative goes.Continue reading
3 Mar 2015Comments
9 Jan 2015Comments
Earlier this week there was a sense of panic in the air as a number of hospitals declared ‘major incidents’ and missed their waiting time targets. It’s a response somewhat out of proportion to the scale of the problem – while performance is among the worst it has been in the last decade, it’s still high by international and longer-term historical standards.Continue reading
17 Dec 2014Comments
Listening to reaction to the chancellor’s Autumn Statement on 3 December, anyone would think that Simon Stevens’ NHS Five Year Forward View was no more than a clearly made case for more money for the NHS.
But the cornerstone of the forward view is the new models of care that will unlock change in the NHS: from GP networks becoming large scale community services providers, to district general hospitals as hubs of new accountable care organisations.Continue reading
(Guest blogger)9 Dec 2014Comments
I read Amit Bhargava’s recent blog with interest – among many other pieces on the financial pressures facing the NHS, and the recruitment pressures facing GPs. The one that affected me most was a blog by a female GP who faced burning-out under the stress of it all and ended up with a silent breakdown.Continue reading
23 Oct 2014Comments
1 Oct 2014Comments
My heart sank when we got a glimpse of Labour’s thinking about post-election health policy, with hints that hospitals would be expected to evolve into integrated care organisations providing...Continue reading
25 Sep 2014Comments
Our health services are not just about our health. They are also heavily involved in our deaths.
This year, for every 1,000 people in England, nine will die. Eight of those nine will have some hospital care during their final year of life. For four or five, a hospital bed will be their last.
Unsurprisingly, people who are near to the end of their lives are disproportionately high users of hospital services. We estimate, that approximately 15% of all emergency hospital admissions in England belong to the 1% of people in their final year of life.Continue reading
6 Aug 2014Comments
This week a study in the Lancet concluded that phone consultations with patients who request same-day appointments generate additional work for GPs when compared to face–to-face encounters. In some ways, the study provides further evidence for the existence of induced demand – the phenomenon that widening access for health care fuels use – that we highlighted in a recent Nuffield Trust report (June 2014).Continue reading
(Guest blogger)19 Jun 2014Comments
On June 9, I finished my ward round of 24 inpatients – median age 80-plus, legged it to the station and got into London just in time to set up my workshop on models of care for frail older people at the Nuffield Trust Future Hospitals conference.
At the event, I presented some challenging ‘home truths’ alongside an animation and some practical solutions.Continue reading
13 Jun 2014Comments
NHS England Chief Executive Simon Stevens issued his challenge to rethink the role of the hospital in more imaginative ways after this week’s Nuffield Trust’s conference on the future of the hospital was already in the diary.
There were some clear lessons from our audience of hospital leaders – many on the theme that simple answers of hot-cold splits (separating emergency from elective care), centralisation, mergers etc are not working. I took away a number of lessons.Continue reading
4 Jun 2014Comments
The response to NHS England Chief Executive Simon Stevens’ first interview says as much about the challenges facing the NHS as the content of the interviews themselves.
Mr Stevens’ message – to be pragmatic, to decide what’s right locally, to be bold, and to look beyond current bricks-and-mortar configurations – quickly transmuted under the media spotlight into one of harking back to a bygone age of cottage hospitals...Continue reading
(Guest blogger)2 Jun 2014Comments
A recently published Nuffield trust report offers a fascinating insight into the routes that cancer patients take through the care system. In an era that promotes integrated care we all accept that caring for a person extends beyond one organisation; and treatment for cancer may include primary, community and social care on top of acute hospital activities.Continue reading
30 May 2014Comments
As the noise generated by last week’s local and European elections fades, political energy will now be directed towards defining the policy battlegrounds on which next year’s General Election will be fought, which will have to be much wider than immigration and the European Union.Continue reading
8 May 2014Comments
Yesterday's Guardian reports that the Government’s plans for the Better Care Fund have been put on hold as the Cabinet Office demand that the Department of Health do more to explain how the savings needed to pay for it will be secured. Government sources have been quick to dampen speculation that this signals trouble for the plans.Continue reading
17 Apr 2014Comments
Recently, on one of my clinical general practice days, I made 21 phone calls to a London hospital trying to leave a message asking a consultant to call me urgently. A patient I had seen at 9am had decided not to have a disfiguring operation for a cancer that was planned for 10 days later.
I needed urgent advice about the options for reconstructive surgery so that I could have an informed discussion with her during the following week about the choice she had made.Continue reading
17 Jan 2014Comments
Most of the services we receive nowadays (be it internet shopping, high street banking or health care) have a trail of data associated with them. We’ve come to expect that these trails will be used to help future interactions be more efficient for us and/or those providing the service.
This applies as much to public as private sector services – though we’ve also come to expect that the public sector lags well behind the private sector when it comes to IT matters.
In many cases this perception of the public sector is probably true (any luck making a GP appointment online...Continue reading
9 Jan 2014Comments
The BBC’s research, published yesterday, on frequent users of A&E makes for interesting reading. They found that nearly 12,000 people made more than 10 visits to the same unit in 2012/13, and a small number of those attended more than 50 times. This is an eye catching finding and it is important to consider what those numbers might actually mean.
While the 200,000 attendances used by people attending A&E more than 10 times a year is a big number, it represents just a tiny fraction of the 14 million total attendances at...Continue reading
6 Nov 2013Comments
Implementing new models of care is not easy – and especially so when organising community-based services that aim to tackle the challenges of more chronic disease and greater levels of emergency care.
One of the more interesting approaches of the past few years has been the Virtual Ward and we recently published a report, funded by the National Institute for Health Research Service Delivery and Organisation Programme, looking at three early examples of Virtual...Continue reading
5 Nov 2013Comments
All too often in discussion of the NHS, pharmacy is seen as something of a niche concern. General practitioners, consultants, nurses and even managers loom large in parliamentary debates on the future of health care, in newspaper articles and the public mind.
Pharmacists, meanwhile, punch well below their weight in policy and management circles despite being the third largest health care profession.
The innovative, often inspiring services I saw as chair of the Royal Pharmaceutical Society’s...Continue reading
12 Aug 2013Comments
Today we publish our response to the Care Quality Commission’s (CQC) consultation on changes to the way it inspects, regulates and monitors care services: A New Start.
Our response builds on the findings from our review of provider ratings, commissioned by the Secretary of State for Health, as well as drawing on the expertise of various members of our team with a past in regulation.