spotlight

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...

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...

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 gover...

The impact of incentivisation on general medical practice In late 2003 I was a junior partner in a primary care medical practice serving roughly 8000 patients on the south coast of England. General practice had been going through the doldrums, pay was low, morale was low and there was dissatisfaction with the contract with the NHS. (Looking back, the problems pale into insignificance compared with the current situation in UK general practice).The Labour government of the day sought to change that through radical changes to the GP contract with far reaching implications including the removal of 24 hour responsibility for one’s own patients and the introduction of a performance-related element to the remuneration of practices. This latter element was the QoF – the Quality and Outcomes Framework for general practice- which rewarded practices for carrying out a series of process indicators with the aim of reducing unwarranted variation in chronic disease management, business and ...

Whilst messing about on social media this weekend I stumbled across some conversations that gave me a bit of a jolt. Shared decision making, that pillar of the consultation in healthcare, something I thought was an unassailable pursuit, was under attack. Some even commented that it should be ditched altogether. In favour of what I thought? A return to paternalism? Perish the thought! I was incensed! I couldn’t stop thinking about this and wondering why some of my medical colleagues around the world had turned against this approach and were now describing it in a number of disparaging ways. Views ranged from it being a rather pompous term where the rhetoric far outstrips the reality to being something which is an assault on patient autonomy or in some cases, an assault on physician autonomy. In some cases, surely, doctor knows best? Shared decision making has been described as ‘a process in which both the patient and the physician contribute to the decision-making process.’ Other...