1. America’s primary care revolutionaries

    (Guest blogger)
    16 Dec 2014
    Comments

    A new breed of healthcare provider is subverting the model of American healthcare for its most needy patients, whilst improving care and reducing costs.

    Need a lift to the doctor? If you’re a patient of CareMore in the American southwest, they may well chauffeur you there. Worried about falling over in your sitting room? They’ll fit you a new carpet. Not sure when to pop your next pill? Don’t worry – your medicine box will sing you a tune when the time comes.

    Casual observers might...

    Continue reading
  2. Three key factors for making NHS England’s Forward View a success on the frontline

    31 Oct 2014
    Comments

    In my clinic last Friday I was shocked: four out of sixteen appointments were taken by patients who were unable to gain access to the hospital services they had been told they needed. Having each tried to contact the hospital several times, they came to me to ask for help in navigating hospital booking systems, for interim pain relief, and reassurance. GP appointments that should have been available for clinical problems were used for administrative support, alongside clinical advice on the symptoms that arose from delays in care.

    ... Continue reading
  3. Local leaders and MPs must embrace NHS England vision

    23 Oct 2014
    Comments

    It’s the report the NHS has been waiting for. 

    Simon Stevens’ vision for the future of how care will be organised and delivered in England is set out in the Five Year Forward View – the first time the arm’s length bodies in the NHS have come together to produce such a report. 

    Continue reading
  4. The ‘wicked’ problem of access: is the telephone a solution?

    6 Aug 2014
    Comments

    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
  5. Improving cancer diagnosis: is there a better way than naming and shaming?

    30 Jul 2014
    Comments

    In a drive to improve England’s record on cancer survival, Jeremy Hunt recently announced that he will 'name and shame' low-referring GPs. It’s clear that improving early diagnosis of cancer could improve survival. But it’s not clear how shaming GPs into referring more patients will solve the problem of delayed diagnosis.

    Continue reading
  6. The future of the hospital: some useful lessons

    13 Jun 2014
    Comments

    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
  7. Local leaders unleashed? What to expect from Simon Stevens’ reign

    4 Jun 2014
    Comments

    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
  8. General practice needs more than money

    3 Jun 2014
    Comments

    It seems that hardly a week goes by without another report of workload pressure, lack of funding and general imminent doom in general practice. As a response to this, the Royal College of General Practitioners (RCGP) has its Put Patients First: Back General Practice campaign, and the British Medical Association have Your GP Cares. Both focus on the need for more money to ease the pressures faced by GPs and their teams.

    Continue reading
  9. Primary care: will Stevens drop the 'cookie cutter'?

    30 Apr 2014
    Comments

    Simon Stevens’ first appearance in front of the Health Select Committee has produced some interesting changes in tone.

    He is less inclined to see competition as a barrier to change than his predecessor, hinting at a more pragmatic approach to how it is used.

    Continue reading
  10. Influencing GPs and the expanding role of Clinical Commissioning Groups

    1 Apr 2014
    Comments

    Since clinical commissioning groups (CCGs) moved into the driving seat of the commissioning system 12 months ago, the breadth of the job they are expected to do has become apparent.

    Responsibility for each of the big changes we are increasingly told that the NHS needs – better joint working with social care, further efficiency savings in hospitals, and radical change in the scale and scope of general practice – rests largely on the shoulders of CCG leaders as the key drivers of change.

    Continue reading
  11. Come again? What the data tells us about repeat A&E visits

    9 Jan 2014
    Comments

    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
  12. Common challenges, common solutions: lessons from primary care in Europe

    12 Dec 2013
    Comments

    The Nuffield Trust’s 2013 European Summit on primary health care brought together primary care leaders from 16 countries to discuss the common challenges facing primary care organisations across Europe.

    The key findings, published today, should make GPs in England feel encouraged. They are not alone in the pressure they experience and the need to develop new ways of working, and Europe is full of ideas and examples about how to develop and change to meet the challenges of an uncertain future.

    A cluster...

    Continue reading
  13. Hard truths or home truths?

    28 Nov 2013
    Comments

    It has been a very busy November for the NHS. Hospitals, general practice, community and other services have been battling to deal with the apparently incessant demand for emergency advice and care – a warning sign of how difficult it will be for the service to make it through the winter unscathed.

    How far this pressure is due to constrained funding, the effects of the recession on people’s health and access to social care, growing numbers of frail elderly...

    Continue reading
  14. What does the new drugs deal mean for the NHS?

    18 Nov 2013
    Comments

    The new Pharmaceutical Price Regulation Scheme (PPRS) agreement looks like a good deal for the NHS.

    Getting the budget fixed for the next five years for a sizeable chunk of spend is good news. It also matches the expected trend of spending and immediate pressures on the NHS with zero increases in the branded drugs budget in 2014 and 2015 and thereafter only a two per cent increase (i.e. more or less in line with expected inflation) in each of the remaining...

    Continue reading
  15. New century, new hospital

    30 Sep 2013
    Comments

    Since the money stopped flowing freely into the NHS, there has been a relentless focus on the hospital. Recent concerns about quality are matched by continuing concern about money.

    They come together in the increasing professional and managerial clamour for reconfiguration as the solution to quality and financial issues, targeting smaller hospitals in the way stranded explorers might look hungrily at their weakest comrade.

    The recent Royal College of...

    Continue reading
  16. CCGs: the current view from local GPs

    22 Jul 2013
    Comments

    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.

    ...

    Continue reading
  17. Back to first principles: primary care for the future

    18 Jul 2013
    Comments

    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...

    Continue reading
  18. Competition is not the way to improve general practice

    (Guest blogger)
    10 Jul 2013
    Comments

    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...

    Continue reading
  19. NHS @ 65: the need for investment in general practice

    (Guest blogger)
    8 Jul 2013
    Comments

    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...

    Continue reading
  20. Getting general practice organised for future challenges

    (Guest blogger)
    28 Jun 2013
    Comments

    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...

    Continue reading