Hate to say this, but you’ve lost me Ed.

Ed Milliband says “I just want to make the system work better.”  I don’t doubt the good intentions, but Labour’s pledge of a 48 hour maximum wait to see a GP is hollow. Let me spell out how to make it look like no patient waits more than 48 hours: 1.  Set the clinical system to release […]

Telephone consulting tips for GPs

Some of our GPs have shared their hints for safe, effective and efficient telephone consultations: A responsive service is a safe service.  Initial telephone assessment by an experienced clinician is well proven over decades through OOH services and in pioneer practices in core hours since 2000. Patients who need or who want to be seen […]

Michael Porter, you tell them

Professor Michael Porter of Harvard Business School is coming to Britain to talk to political and NHS leaders. The label “American business guru” tends to provoke a tissue rejection from the NHS, but let’s listen for a minute to what he’s saying, (Dave West in HSJ)  He is not advocating “the wrong kind of competition” […]

Why change doesn’t start

Much has been written on why change fails, and I’m not going to add to the literature. But why doesn’t change start? Click fullscreen and play to see what happens next.  

Variation, the dead giveaway of poor performance

One of the difficulties in trying to compare different bodies doing the same thing is that we don’t know what good is.  What is a good standard of timekeeping for trains?  The answer is rather different in Switzerland from Britain.  Theirs aren’t faster, just much closer to the stated time, which happens to be what […]

Machiavelli on innovation. He gets it.

“And it ought to be remembered that there is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things, because the innovator has for enemies all those who have done well under the old […]

£240m for online access to GPs. That’ll fix it.

The DH has announced £240m for online access to GP appointments, repeat prescriptions and patient records.  This will be match funded by other providers, so the figure could be doubled, but let’s stick to £240m for the sake of argument. Why?  Do we see marchers in the streets demanding online access to their GP?  Is […]

Why we don’t need rules on ward staffing levels

Point one:  you may not like this blog.  If this is you, read on. Point two:  I’m no expert on nurse staffing levels in hospitals. Cries of “Shame!” go up all over the media on the failure of Professor Don Berwick to state minimum nurse staffing levels on wards.  Here’s why I think he’s right. […]

NHS England reviews incentives, rewards and sanctions, but misses the point

  NHS England has released a discussion document on incentives, rewards and sanctions.  Here’s my open response: Dear NHS England review, Two contradictory messages shine through your document.  The first is that the system of incentives, rewards and sanctions is problematic, complicated, causing perverse outcomes and not fit for purpose.  The second is that the system […]

Hunt: good diagnosis, wrong treatment

There was something highly refreshing in Jeremy Hunt’s speech last week on primary care.  His diagnosis is well informed, and we know from a tweet that he spent time on the phones at Hurley practice in Kennington.  He talks about family doctors in terms of  strengthening relationships with patients.  This is a version of medicine […]