spotlight

                          Value-based healthcare is sexy A few days ago I was reminded yet again of the importance of words and how the way we use language has the ability to enthuse people....or switch them off entirely. I had been asked to speak on the topic of value-based healthcare at a respiratory study day hosted by the British Lung Foundation. Why? Well a local value-based healthcare project had resulted in significant investment in pulmonary rehabilitation and the ability to join this up with further community interventions to support people living with Chronic Obstructive Pulmonary Disease earlier in the course of their illness. The participants in this project had therefore become evangelists for this way of working across programmes of healthcare and felt it should be discussed. It didn't look promising. I had the last slot of the day, the coffee had run out and the last Welsh cake had been eaten. The title of my talk was uninspiring and 20% of the audience left b

Mandatory peer review of GP referrals - why this gets my goat I see that referral management through peer review of referrals is doing the rounds again as the NHSE panacea for managing demand into secondary care. It is of course a well-intentioned attempt to ensure that we are using scant NHS resources wisely , but in the face of growing unmet needs in the community I am fairly certain that it will be an expensively futile endeavour. Here is my ham-fisted attempt to explain why I believe this is so. Referral for consultant opinion is one of the few tools a general practitioner has to help people get better from their symptoms and the reasons for referral can be divided up in a pretty straightforward way: 1. The patient has unexplained symptoms or there is diagnostic uncertainty. Medical diagnoses are often difficult to make and do not come neatly wrapped in boxes. Clinical diagnoses (i.e. those made without a diagnostic test) are often particularly difficult and people m