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A value-based odyssey in Australia

  A value-based healthcare odyssey in Australia I am freshly back in Wales having returned from a full immersion in the Australian healthcare system over the past few weeks. I have had the immense privilege of working with all parts of the system across 3 states and the federal government, talking to patients and consumers, clinicians, provider organisations, the primary health networks, policy leads, academics and politicians. Why go, you may well ask? As Australia increasingly moves towards a value-based approach supported by the Australian Healthcare and Hospital Association I had been asked by that organisation to give the keynote address at the VBHC Congress in Brisbane at the end of October. I have been struck by the similarity in approach to Value in Health in Australia to that of ours in Wales and much of the rest of Europe. Value in health is about striving to achieve the outcomes that matter to people and to promoting sustainability in healthcare systems around the world (f
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Tackling the backlog...or...meeting people's needs

  As we emerge from the terrible throes of the pandemic, anxiety is growing about the large numbers of people waiting for services.The backlog of people waiting is enormous and compounded by the fact that we will face reduced capacity in the system for some time to come. I wrote about the challenges of delivering essential and life-preserving services during the pandemic in this previous article . Arguably the challenges of tackling the backlog, of meeting the needs of those waiting, are even greater and will require a collective and creative redesign of our systems.  None of this is new of course. We have known for some time that our system of healthcare does not always entirely meet the needs of the population. Lack of funding is often highlighted as the reason for this and it is true that investment is needed in some areas, but fundamentally we are still operating in a system which was designed in a different context, a different culture of healthcare, a population with different n
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Navigating the Covid seas - time to focus on what really matters

Recovering from Covid-19 – maintaining a focus on outcomes The Covid-19 pandemic has generated an extraordinary response from the healthcare system in transforming the way that we work in order that we operate in a way that minimises spread of infection and allows services to cope during a surge of cases of viral infection. However, this came at a price with the temporary cessation of virtually all outpatient and elective activity in hospitals. We have in our response moved to remote triage for all patients in primary care and have seen a rapid rise in the use of video consulting to support safe decision making. Face to face consultations have been minimised and QOF activity has been formally postponed. Change has happened at great speed and been made possible through a considerable cutting of red tape, using the goodwill and flexibility of the workforce and digitally supported remote management. Some of this system change in healthcare delivery is positive and should be captured
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General practice - things to preserve

This blog is a personal and an emotional reflection on my 20 year journey through General Practice. I know that there will be many of my colleagues who disagree with my stance and that's ok. It is just one girl's opinion after all. I entered general practice in 1998 having originally intended to become a hospital physician. I had quickly felt constrained by the medical hierarchy and the hospital environment and was attracted by the wild frontiers of community medicine, along with the idea of longitudinal care. I qualified in 2000 and immediately became a partner in my training practice, overseeing the introduction of QOF in 2003/4 before moving back to a South Wales valley practice in late 2005. I became a trainer, a senior partner and was a big advocate of GP independence. Since 2011 I have held other roles too, but that is not important here. Over the 20 years of my life as a GP there have been many changes, some good, some not so good. Of those that are not so good, the b
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The adoption of new medical technologies - a focus on outcomes and value

Medical devices – is value-based healthcare a help or a hindrance? Any innovative intervention in healthcare should demand us to ask of ourselves   the problem we are trying to solve, the desired outcome for this individual , and   the associated costs and ramifications for the wider healthcare system. Nowhere is this more true than in the development and adoption of diagnostic, monitoring and therapeutic medical devices. An evidence-based path to adoption of novel devices which may be of very high value to patients has been problematic, as highlighted by the recent excellent article by Campbell et al, ‘ Generating evidence for new high-risk medical devices’ . Additionally there are differences between the type of data collection required and evidence needed to support HTA decision making between diagnostic and therapeutic devices. What we are seeking to do is achieve value for patients (in terms of the outcomes that matter to them) and healthcare providers and governments wh
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