Monthly Archives: September 2014

Inquiry calls for action to tackle north-south health divide

BMJ News 2014;349:g5805 reports: Inquiry calls for action to tackle north-south health divide

An independent inquiry has called for action to tackle the widening health gap between the north and south of England. The report, commissioned by Public Health England, said that the prospect of greater devolution within England represented an opportunity to reduce health inequalities.

Due North: Report of the Inquiry on Health Equity for the North,1 published by the Centre for Local Economic Strategies, said that a baby boy born in Manchester could expect to have 17 fewer years of good health in his life than a baby boy born in Richmond, London. Similarly, a baby girl born in Manchester could expect 15 fewer years of good health than a baby girl born in Richmond.

Uneven economic development in the United Kingdom has meant higher unemployment, lower incomes, worse working conditions, poorer housing, and higher unsecured debts in the north, which have all adversely affected health.

Although the north has 30% of England’s population, it has 50% of the poorest neighbourhoods. And poor neighbourhoods in the north tend to have worse health than those with similar levels of poverty in the rest of England. The gap in health is also greater between disadvantaged and prosperous socioeconomic groups in the north than in the rest of the country.

The report said that the centralised political system in England, where political and economic power is concentrated in London and the surrounding area, had contributed to the large inequalities between regions. It said that shifting power from central government to regions, local authorities, and communities would give the potential for a new approach to tackle health inequalities.

Margaret Whitehead, chair of public health at the University of Liverpool, who led the inquiry, said, “The austerity measures introduced as a response to the 2008 recession have fallen more heavily on the north, and on disadvantaged areas more than affluent areas, making the situation even worse.

“There are, however, new opportunities. Local government has recently been granted new responsibilities to tackle the causes of poor health and health inequalities, and increasingly local governments in the north are demanding greater control of resources previously controlled by Whitehall.”

The report said that agencies in the north should act to prevent poverty by providing high quality, universal early years education and childcare; promoting a living wage; and improving the quality and affordability of housing.

It also called on central government to prevent austerity measures from widening inequalities and to protect and prioritise spending on children in the early years.


The Risk Business – in the information age patients will need good explanations

The BMJ has an article by Christopher Martin on 20th September 2014: Risky business: doctors’ understanding of statistics

As medicine becomes increasingly preventive, doctors need a good grasp of risk

Nearly 40 years ago the New England Journal of Medicine published a short survey of doctors’ understanding of the results of diagnostic tests.1 The participants, all doctors or medical students at Harvard teaching hospitals, were asked, “If a test to detect a disease whose prevalence is 1/1000 has a false positive rate of 5%, what is the chance that a person found to have a positive result actually has the disease, assuming that you know nothing else about the person’s symptoms or signs?” This wasn’t a very difficult question, which made the results all the more shocking. Fewer than a fifth of participants gave the correct answer, and most thought that the hypothetical patient had a 95% chance of having the disease.

Of course, this was a long time ago, and medical curriculums now contain much more in the way of statistics and probabilistic reasoning. You might expect that if the exercise were repeated today almost everyone would give the right answer. But you’d …

For doctors with an interest in explaining risk to patients in meaningful ways and terms/language try David Spiegelhalter’s Personal Home Page. David is Winton Professor for the Public Understanding of Risk at the University of Cambridge and has been in post since 2007.  In The Information Age patients will need better and better explanations..

Understanding Uncertainty and Risk I work with a small team comprising Mike Pearson (web and animation), and Owen Smith (web). Our work focuses on the appropriate use of quantitative methods in dealing with risk and uncertainty in the lives of individuals and society. We fall into the broad category of ‘public understanding of science’, while our work with schools can be considered as ‘maths outreach’. However we try to take a view of the subject that extends beyond the application of probability and statistics, acknowledging that there are deeper uncertainties that cannot be easily put into a formal framework, and that social and psychological issues necessarily play a vital role. We are involved in a number of different areas: Website: Understanding Uncertainty

  • This is an educational resource featuring the use of probability and statistics in everyday life, and makes extensive use of animations to help ‘tell the story’ of the data. Googling ‘Uncertainty’ should find it. The Cambridge Coincidence Collection started as part of filming for theBBC4 programme, but since then over 3300 coincidences have been contributed to our website.Don’t get confused with The Institute of Risk Management (IRM) which is something completely different in the finance industry.

Perhaps the strategists should have thought about financial risk when they mooted devolution, and ignored the “frontier issues” which Aneurin Bevan warned about in “In place of fear”.

How doctors work out your risk of heart disease – BMJ 2012

BBC – Health: BMI calculator (imperial)

University of Edinburgh cardiovascular risk calculatorwhich leads to different graphical expositions.



Family doctors warn of ‘workforce crisis’ within general practice in the North East

Helen Rae in The Newcastle Journal 24th September reports: Family doctors warn of ‘workforce crisis’ within general practice in the North East 

Prominent family doctors have warned that there is a “workforce crisis” within general practice in the North East.

In an open letter sent exclusively to The Journal, leaders of the region’s Local Medical Committees (LMCs) say they are very worried about problems with GP recruitment and retention and the message must be “invest now or lose general practice”.

Recent surveys undertaken across Tyne and Wear by LMCs show that 34% of practices in the area are having difficulty recruiting GPs while a staggering 71% of doctors are thinking about early retirement, with 36% of those in their 50s planning to leave their role in the next three to five years.

The letter comes just a day after Labour leader Ed Miliband used his keynote party conference speech in Manchester to pledge that under his leadership £2.5bn-a-year would be poured into a Time To Care fund which could support 20,000 more nurses, 8,000 more GPs, 5,000 more care workers and 3,000 more midwives by 2020.

Yet medics in the North East insist that people are not wanting to join the profession as there are many vacancies within the local GP training scheme as only 20% of medical students are pursuing a career in general practice within the region but around 50% is needed to maintain the present workforce.

The letter says: “Patients complain bitterly that they cannot get an appointment to see their GP. This is getting worse and will continue to worsen in the near future, as there is a workforce crisis within general practice now. This crisis, which has been predicted for a while, is already upon us.”

Signatories of the letter include Dr George Rae, Dr Ken Megson and Dr Roger Ford, chairmen of local medical committees in Newcastle and North Tyneside, Gateshead and South Tyneside and Sunderland.

Persistent political  denial has led to undercapacity….

Update 26th September – BMJ News 2014;349:g5828  reports: GP leader warns of exodus from the profession

The chair of the Royal College of General Practitioners will next week urge the government to act to avert a potential exodus from the profession, as ongoing pressure prompts more UK trained doctors to consider early retirement or working overseas.

Speaking ahead of the college’s annual conference in Liverpool on 2-4 October, Maureen Baker warned that the United Kingdom was letting good doctors “slip through our fingers” and said that urgent action was required to try to prevent more doctors leaving the UK workforce.

Figures released on 19 September by the Health and Social Care Information Centre showed that UK GPs have seen their income fall for the seventh successive year in …


NHS pay – too complex. But also unfair and a strike is pending..

Richard Baum, a newly employed NHS strategic planner, opines in the Guardian: NHS pay is complicated, unfair and frankly absurd

We must put all the facts on the table and remove perverse incentives if we are serious about making NHS pay fairer

Threatened strikes are becoming reality. Just as the Regional Health Services are unsustainable and broke, the staffing levels and pay are inadequate for the future….. Demographic changes mean we have to ration health care seriously and quickly if we are to save them, and reduce Perverse Incentives… And that’s without re-inventing the larger mutual destroyed by devolution.

Dennis Cambell reports in the Guardian 23rd September 2014: NHS faces week of industrial action by up to 500,000 staff

Unions set to announce four-hour strike and other actions amid anger over Jeremy Hunt’s denial of 1% pay rise

The Independent 24th September reports: NHS workers across England to strike for four hours over pay 

I faced burnout working as a GP in the NHS – I had to stop
Weekend staff shortages are the fatal flaw at the heart of the NHS

David Cameron faces ‘day of reckoning for trashing NHS’, says Labour

Rowena Mason in The Guardian 24th September reports: David Cameron faces ‘day of reckoning for trashing NHS’, says Labour

NHSreality feels that the start of the trashing began when Mr Blair broke up the largest and most effective health mutual in the world – with devolution.

Shadow health secretary Andy Burnham reminds party of PM’s ‘barefaced lie’ over health service shakeup and privatisation

David Cameron will face a day of reckoning with the electorate for “trashing” the NHS without the public’s permission, Andy Burnham, the shadow health secretary, has said.

Burnham, a former health secretary under Gordon Brown, got several standing ovations at the Labour conference on Wednesday as he promised that the party would give people the right to be treated in their own home and make the NHS responsible for social care as well as medical problems.

Invoking the spirit of Nye Bevan, the architect of the NHS, Burnham said he would write to everyone in the country explaining what they could expect to get from the health service under Labour.

He was able to promise more cash for vital services after the Labour leader, Ed Miliband, said he would raise money from mansion owners, tobacco companies and tax avoiders to protect NHS funding.

Burnham also followed an emotionally charged address from 91-year-old activist Harry Leslie Smith, who spoke of growing up in a “barbarous, bleak and uncivilised” time before public healthcare. His sister was tortured by tuberculosis while his parents could not afford the doctor’s bill and she had to be buried in a pauper’s grave, he said…..

Roy Lilley on the same day says: Ed Miliband’s NHS pledge may force the Tories’ hand on its funding

The Labour leader’s £2.5bn for the NHS will not be enough to save it. But it shows how Tory neglect has brought the system to its knees


Pledge to spend NHS cash on sending obese people in Norwich to Slimming World

Adam Gretton for The Eastern Daily Press (EDP) reports 24th September 2014: Pledge to spend NHS cash on sending obese people in Norwich to Slimming World

The GP-led group in charge of health budgets in the city yesterday agreed to continue spending part of their budget on paying overweight residents to attend Slimming World groups.

More than 2,000 people from Norwich with a body mass index (BMI) of over 30 have taken part in the pilot project over the last two years, which has seen the NHS funding vouchers for participants to join the weight loss organisation for a 12 week period….

NHSreality has asked before “what is the opposite of deserts based rationing?” The goods and services supplied by the Regional Health Services should be about fear, particularly in a time of financial distress… Greed and inactivity are the main causes of obesity, which is virtually unknown in the third world… However, once local taxation is allowed, would a local tax on sugar products be feasible – I doubt it – and such taxation would have to be National.

The GP as Independant Contractor

Sofia Lind reports on 23rd September in Pulse Magazine reports: GPs to be brought under hospital trusts’ control under plans announced by Labour

Labour has announced plans for every hospital to become an ‘integrated care organisation’ with ‘GPs at the centre’, but GP leaders have warned this could lead to the ‘destruction of practices’.

GP Magazine 14th May asks: Does the DoH want independent contractors? and in the letters on 28th May: Government won’t value independent contractors and on 26th September by Should GPs give up independent contractor status?

Recent comments on the possible demise of GPs’ independent contractor status by outgoing RCGP chairwoman Professor Clare Gerada went down, by her own admission, ‘like a bowl of sick’.

Opinions are sharply divided over the benefits or otherwise of the self-employed partner model that has helped to define the British GP over 65 years of the NHS.

Professor Gerada called the model a ‘millstone’ around the neck of general practice, set up out of ‘political and professional expediency’.


The contractual arrangement was a compromise at the foundation of the NHS between the government and GPs who opposed losing their independence and becoming employees of the state health service.

Professor Gerada, who takes up a position overseeing primary care transformation in London with NHS England in November, made her comments while outlining her vision for GP-led, integrated provider organisations, a model she calls ‘integrated care co-operatives’.

Speaking to GP, she says doctors in this system would be a mix of salaried and ‘not-for-profit shareholders’. Independent contractor status is not incompatible with a move to federations and could even remain in place, she adds, if local areas want to keep it.

However, Professor Gerada believes the case for changing GPs’ contractor status is overwhelming. ‘We are expected to do more for less, we are expected to fund our own defence, our own training, we are expected to fund our own representation on committees, our own exam, our own examiners, we are expected to participate in inand out-of-hours care for no additional resources.

‘I think the only way forward is for GPs to give up their GMS, PMS, to pool it and then to work with our secondary care colleagues to develop proper referral systems, proper care pathways.’

Long-time advocate of a salaried profession Dr Peter Fellows was a GP in Gloucestershire and a GPC member for more than 20 years before he retired earlier this year. He agrees that the cost of partnerships has become prohibitive for young GPs, many of whom would rather take salaried work. It has become ‘increasingly threatening’ for GPs looking at partnership with the amount they have to stump up.

After years of tight contracts, independent practice is becoming increasingly difficult to sustain, says Dr Fellows, and a salaried service is now ‘on the cards’.

‘More and more people are coming round to the idea that the only way we will improve the lot of GPs is if we are salaried,’ he says.

In the Journal of the Royal Society of Medicine, GP and head of primary care at Imperial College London, Professor Azeem Majeed, also argues that it is time for GPs to become NHS employees.

‘Under the current capitation-based funding method, GPs face unrestricted demands for their services and their time, while having to operate on a fixed budget,’ he says.

Moving to a salaried service could overcome the divide between principals and salaried GPs, he adds.

That need for a more ‘egalitarian’ approach is recognised by the chairman of the National Association of Primary Care, Dr Charles Alessi, who says independent contractor status was created at a time when the doctor was ‘the beginning and end of everything’.

The need today for relationships with a wider, multidisciplinary and integrated team puts the independent contractor at a disadvantage. Another problem with the self- employed model for Dr Alessi is that it favours smaller practices, when there is a growing ‘necessity to have scale’.

Financial pressure

On top of financial pressures, there are cultural drivers against independent contractors.

Ross Clark, a partner at law firm Hempsons who specialises in establishing GP provider organisations, argues that there are patientand doctor-led cultural factors.

Patients’ access demands and the changing outlook on work-life balance by GPs could both eventually spell the end for the independent, self-employed GP, he says.

Some who regard independent contractor status as having brought great benefits to the profession admit there are problems.

Chairman of the Family Doctor Association Dr Peter Swinyard says while it is not dead yet, it ‘may be struggling’. ‘It’s very hard to think you have a great deal when your income is going down year on year,’ he says.

‘There will be some who will say, “It’s just not worth it anymore, let’s just be salaried and be done with it.” I think the number of people who feel like that is increasing.’

For Dr Swinyard, the independent contractor provides the ‘engine room of innovation’ in general practice. Independence means GPs are not tied down by the bureaucracy…..

If the public wishes to hear the truth about the NHS they are more likely to hear it from their GP who cannot be punished by his employer since he is self employed, than from a consultant who fears for his livelihood. The whistleblowing and the gagging scandals alone should make the media cry “foul” at this suggestion. A soviet union type healthcare system will result..