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Since the outbreak of covid-19, overseas electives have been placed indefinitely on hold for UK medical students. With ever changing guidelines on social contact, health systems under intense pressure, and shifting rules on travel, universities are no longer able to sanction students travelling outside of the UK to complete their elective placements. This pause should provide us with an opportunity to consider whether the seemingly obvious advantages of overseas electives for future doctors can be justified, when in truth they hold both potential for harm and an underlying sentiment that is somewhat troubling. Many UK medical students, as well as medical educators, will undoubtedly be disappointed by what is, to all intents and purposes, another sad casualty of this pandemic. But it’s not just about students looking for that next high yield, “in real life” learning experience. In the General Medical Council’s own Outcomes for Graduates , they state that as part of their education, future doctors should “describe and illustrate from their own professional experience the range of settings in which patients receive care, including in the community, in patients’ homes, and in primary and secondary care provider settings.”1 Although it …

Oliver is right that primary and secondary care should work together better.1 The joy of palliative medicine is that I work across both sectors; my experience means I have greater sympathy with my primary care colleagues than do many of those in secondary care. With apologies to …

England’s health secretary must “confront the reality” facing NHS primary care, including the unsustainable workload, poor practice premises, the huge care backlog, and the transfer of work from secondary care, the BMA has said. The call came after Sajid Javid met the BMA General Practitioners Committee chair, Richard Vautrey, on 23 September to discuss the growing incidence of abuse of GPs and the increased support that primary …

Primary and secondary care are using more telemedicine and virtual professional collaboration to clear backlogs, reports Jacqui Wise. Using networks to deliver care, and better use of surgical beds, will be needed to restore routine services after the pandemic

If the province were scaled to England’s population, nearly eight million people would have been waiting over a year for hospital treatment, writes Lisa Smyth—and many for much longer

General practitioners should consider seeing all children under five with respiratory symptoms in person and referring them to secondary care if necessary, NHS England has advised. The guidance, given in NHS England’s latest bulletin to primary care staff, comes amid concerns that respiratory viruses which have been suppressed by measures such as social distancing and mask wearing during the past year will rise as covid-19 restrictions are …

What you need to know Dupuytren’s disease is a common condition of the hand affecting the palmar fascia. Initially, it manifests as pitting or thickening of skin over the palm. Later on, it can develop into nodules or cords that act as the powerhouse of the disease. These can then progress to contractures manifesting as flexion deformities of fingers (fig 1). The contracture can span across metacarpophalangeal and interphalangeal joints, most commonly affecting the ring and little fingers.1 Rates of prevalence vary greatly depending on the population group and study design.2 It is estimated that the condition affects between 3% and 5% of the UK population,3 but the exact numbers vary significantly between age groups and geographical locations. Fig 1 Dupuytren's contracture affecting the metacarpophalangeal joint (right hand) and interphalangeal joint (left hand) Science Photo Library In the UK and in other settings, eligibility criteria for the management of Dupuytren’s disease may vary,4 both in the community and in secondary care. This clinical update provides a summary of the latest evidence on operative and non-operative treatments including an overview of current guidelines. The exact cause of Dupuytren’s disease is unknown, although microvascular angiopathy has been suggested as a possible underlying mechanism.5 There is a strong genetic association, with one study finding 80% heritability.6 It is more common in northern Europeans, with highest rates of prevalence in Icelandic and Scandinavian populations.7 The age of first presentation is usually between 50 and 70 years old, …

With covid-19 causing growing waiting lists and ongoing staff shortages, greater use of robotics in secondary care and beyond might offer a way of dealing with the pressures facing the NHS in a post-pandemic world. Jo Best reports

Salisbury makes a good point about the differing views of what an opinion from a secondary care expert entails.1 Often it means different things to the patient, consultant, and referring GP. As a hospital consultant, I am aware that while I am an expert on a portfolio of medical conditions I am definitely not an expert on the …

When I sat down to consider the topic for this issue, it was January 2020 and the number of people affected by the strange pneumonia-like illness being reported in Wuhan could still be written with two figures, rather than the current eight. I wanted to choose a topic that would be relevant to those with an interest in primary or secondary care, something with thought provoking ethical and legal issues, something that would be important across different life stages. I also wanted the topic to be enticing enough for people to want to pick up the issue and read—and so the sex issue of BMJ Student was launched. Our themed articles cover sexual and reproductive health from several points of view, …

What you need to know A 62 year old woman presents to her general practitioner with bilateral lower leg swelling and aching. She has extensive varicose veins on both legs which developed during her last pregnancy, 25 years ago. She has experienced increasing discomfort in both legs over the past five years and lower leg swelling which worsens during the day. She has started to develop some eczematous skin changes around the ankle of the right leg. Annually, 1-2% of people with skin changes related to varicose veins develop lower limb ulceration,1 which affects their quality of life and creates socioeconomic burdens on health services.1 Each year up to 7% of people with varicose veins develop lower leg skin changes (such as haemosiderin deposition and/or lipodermatosclerosis),1 which are a sign that they are at increased risk of slow wound healing and ulceration. Ulceration and skin changes are both signs of chronic venous insufficiency and require treatment. Timely specialist referral can reduce the impact on quality of life and reduce costs.2 This article offers guidance to general practitioners and non-specialists on the assessment of patients presenting with varicose veins, how to recognise chronic venous insufficiency, when to refer to secondary care, and appropriate management strategies that can be initiated in primary care. We also provide a summary of management options that might be considered in secondary care. The advice offered in this paper is based on our clinical experience as well as the limited evidence that is available on non-specialist assessment and management of varicose …

As a primary care dean with educational responsibility for transforming the primary care workforce, I was disappointed to read Rayner and colleagues’ article on writing outpatient letters to patients from solely a secondary care perspective.1 I endorse their proposal to promote patients’ understanding of their health and management; my patients frequently ask me …

At medical school we learn to recognise the patterns of symptoms and physical signs that add up to predefined diagnoses. They appear in the textbooks and again in exam scenarios, but many of the real patients we meet in the clinic don’t fit neatly into diagnostic boxes. Sometimes they’re just variants on a theme (the pneumonia without a cough, the painless heart attack), but a sizeable minority of patients in both primary and secondary care have symptoms we can’t explain. Estimates vary, but this is said to be a feature of …

Rimmer writes about supporting colleagues who are under investigation, but the article is focused on secondary care and the three expert authors all have job titles that suggest they do not …

What you need to know Awareness of the Ehlers-Danlos syndromes (EDS) in the UK has risen over the past decade, in part due to high profile of EDS patient organisations and the EDS National Diagnostic Service commissioned in 2009. Significant advances in genetic testing have culminated in the publication of a new international classification in 2017 with 13 types identified.1 Clinicians will see an increasing number of patients, some of whom will suspect a diagnosis of EDS themselves. This article is intended to support non-specialist clinicians to consider the diagnosis of this group of conditions in appropriate patients. It discusses the features of the different types of EDS and explains how clinicians can expect their patients to be managed in secondary care. ### How this article was created The authors are members of the International Consortium on Ehlers-Danlos Syndromes and Related Disorders and participated in literature searches used for the basis of the articles written on the new classification of EDS published in 2017. The authors have more than 10 years’ experience of EDS patient consultations and data collection in the highly specialised EDS service. Ehlers-Danlos syndromes (EDS) refer to a group of inherited connective tissue …

GPs will be asked to avoid referring some patients to secondary care as part of a strict programme of service rationing tabled by NHS bosses in west London. The North West London Collaboration of Clinical Commissioning Groups has also proposed cutting the number of outpatient appointments, restricting consultant to consultant referrals, and “repatriating” elective operations from specialist centres outside the area to local hospitals to help tackle a projected £112m (€125m; $140m) deficit for 2019-20—more than double the £51m the collaboration had forecast at the start of the financial year. The CCGs, which commission care for two million patients, said that “difficult choices” were needed, as local finances had worsened significantly …

Four fifths of secondary care doctors said their teams experienced staff shortages last winter, a survey conducted by the Royal College of Physicians has found. The college sent a survey to 19 358 fellows and members in the UK, including trainees, consultants, and specialty and associate specialist (SAS) doctors, between 3 and 10 April and received 1449 responses (7% response rate).1 It asked doctors what problems they had noticed in their …

GP are increasingly being put under pressure to prescribe beyond their clinical competency because of a lack of specialist service provision, local medical committees have warned. The annual conference of England’s LMCs, which represent GPs, heard on 23 November in London that there were particular problems accessing services for gender identity and eating disorders, putting pressure on GPs to prescribe outside their clinical competency. The conference unanimously backed calls for the BMA’s General Practitioners Committee to negotiate for “safe and effective secondary care high risk medical monitoring” for patients with eating disorders to be available everywhere in England. A separate section of the motion, calling …

Changing how we think about healthcare improvement, as Braithwaite suggests,1 does not tackle the key questions facing healthcare systems as “socially designed complex adaptive systems.”2 How many people require healthcare—from whom and where? Most of us are healthy enough to not require health professional services. Kerr White’s groundbreaking study in 1961 showed that health and …

Doctors who qualified in other European countries make up 9% of those on the UK medical register, data released by the GMC show. The GMC’s report, The State of Medical Education and Practice in the UK: 2017, shows that in some secondary care specialties over a quarter of registered doctors qualified outside the UK and more than one in eight qualified in other European countries.1 For instance, …

Placements in secondary care expose medical students to negativity about general practice, researchers have found. A report by the Royal College of General Practitioners and the Medical Schools Council said that better collaboration was needed across primary and secondary care to stop students being put off becoming GPs.1 The report was based on research conducted by Shift Learning, a market research agency, which sent an online survey to UK medical students through deans, heads of schools, and education leads. The survey received responses from 3680 students in 30 UK medical schools, representing 9.4% of the total medical student population. It found that 70% of medical students had come across negativity towards general practice in clinical settings. Nearly four fifths (79%) said …

NHS England wants all GP referrals to secondary care to be peer reviewed, and it believes that this can reduce referrals by “up to 30%.”1 The plans have met with shock and outrage in the tabloid press. Outrage is justified, but for rather different reasons. This is yet another example of non-evidence based policy making, capable of doing more harm than good. And it’s not a new idea. The NHS has been looking at similar proposals for years. The BMJ reported in January that a third of clinical commissioning groups have employed private companies to scrutinise referrals: three quarters were unable to show whether they’d saved …

Is the mandate for GPs to check colleagues’ referrals a good idea? Reactions have been mixed, reports Zosia Kmietowicz

GPs will be expected to discuss with other GP colleagues their decision to refer any new patients to hospital, as part of a push by NHS England to curb inappropriate referrals to secondary care. Guidance issued by NHS England to clinical commissioning groups (CCGs) in May stated that all areas of the country should have a system in place from September 2017 to ensure that all new GP referrals are subject to clinical peer review. A spokesman for NHS England told The BMJ that around half of CCGs already had a peer review process in place and that it was up to the other half to follow suit. NHS England emphasised that any system should not be “established …

Hospitals often fail to tell GPs when children miss appointments, and most practices have no protocol for dealing with such children when they become aware of them, a study has found.1 Poor communication between primary and secondary care has important implications for child protection, as doctors may miss the opportunity to identify children at risk, said researchers from the University of Bristol. To learn more about the characteristics of children who do not attend, the …

GPs should push back on inappropriate work given to them by hospitals, the BMA has said. The BMA has published guidance for GPs on how to transfer unnecessary work back to secondary care managers.1 The organisation said that the 2017/18 NHS standard contract for secondary care trusts, which came into force …

Minerva notes that the majority of patients with coronary heart disease in a recent Norwegian survey failed to achieve the targets for secondary prevention.1 The study indicates that the intervention was led and monitored in secondary care with no input from general practitioners. …

Schemes to recruit doctors from overseas are being launched in a bid to help the UK tackle some of the workforce problems it faces in both primary and secondary care. Abi Rimmer explores how some of these schemes are working out

What you need to know With more than 120 different “special tests” of the shoulder described,1 it is easy to see how its assessment can seem an enigma for non-specialists. Shoulder pain is common, and most cases will be managed in the community.2 Its prevalence in Dutch primary care is around 11 per 1000 patients seen each year,3 and as many as two in three people may experience it at some point in their life.4 Most diagnoses can be made from the patient’s history and examination considering relevant risk factors such as age, occupation, previous trauma, and relevant comorbidities. Here, we simplify the process of shoulder assessment to empower non-specialists evaluating a patient presenting with shoulder pain for the first time and provide an update on common shoulder pathologies. Take a targeted history —For some guide questions, see box 1. Watch out for features that may warrant secondary care specialist referral, orthopaedic or otherwise (fig 1⇓).5 #### Box 1: Questions for a targeted shoulder pain history Fig 1 Red flags for shoulder pain that warrant urgent referral. Images adapted from BMJ Best Practice (http://bestpractice.bmj.com/best-practice/monograph/709.html), Physiopedia (www.physio-pedia.com/Shoulder_Dislocation), LITFL (http://lifeinthefastlane.com/a-funny-fracture/ …

Privacy in clinical information systems in secondary care {#article-title-2} Two years ago Sunday Times reporters were able to gain access to the private medical records of Dr Sandy Macara by paying a small fee to a commercial agency. As computerised clinical information systems that are capable of holding large amounts of high quality information become more widespread in NHS trusts, the privacy of patient information is becoming an increasingly important issue. Lack of privacy can be damaging to both the patient and the organisation concerned. For example, Barber cites the following problems1: In the BMA consultation document Security in Clinical Information Systems Anderson identifies nine principles governing the design of a clinical information system meeting the requirements for patient privacy.2 Doubts have been raised about the feasibility of adopting the code for governing access to patients' electronic records in secondary care. Our experience is that the principles are achievable. This article is based on our experience of a large scale clinical information system in use in three British hospitals—Conquest Hospital, Hastings; Aintree Hospital, Liverpool; and Royal Devon and Exeter Hospital, Exeter. We describe the approach taken to ensuring control over access to confidential patient information on the basis of expected relationships between staff and patients. ### Summary points

Referral management centres are intended to improve referrals between primary and secondary care. The aim is good but so far we have little evidence that they can deliver

Investigating and improving patient safety in health care is now an international phenomenon. The establishment of the National Patient Safety Agency in the United Kingdom1 and of the Center for Quality Improvement and Patient Safety in the United States2 are prime examples of the prominence given to safety within the wider concept of healthcare quality. No longer can there be any doubt that the most fundamental ethical principle in medicine—first, do no harm—is being taken seriously by a wide constituency. The next step is to embed safe practice into everyday clinical behaviour. Why is there so much interest in patient safety? Why now? Data have been available on error rates in medicine for at least a decade. Although there had been earlier work in the 1970s, the landmark Harvard Medical Practice study of hospital inpatients was published in 1991.3 Additional studies followed from Australia and other contexts.4 This research points to an adverse event rate in secondary care close to 10%. The error rate in primary care is less well studied.

Objective: To determine which characteristics were the best predictors of high rates of prescribing of glyceryl trinitrate buccal tablets. Design: Practice and patient characteristics from 197 practices were examined, and a multiple regression analysis was performed to examine which variables were important in predicting this prescribing. Setting: Former family health services authority (197 practices). Main outcome measure: Volume of prescribing of glyceryl trinitrate buccal tablets. Results: Four variables contributed significantly to a multiple regression model: the catchment area of the secondary care establishment; the number of partners in a practice; the level of practice deprivation; and whether the practice served an urban or a rural area. The model suggests that the most important variable was the catchment area of the secondary care establishment in which the practice was located. Conclusion: Although only the prescribing of short acting glyceryl trinitrate buccal tablets was studied, an impact of this size on primary care prescribing may have extensive implications for all drug expenditure in primary care. Key messages Using glyceryl trinitrate buccal tablets as an example, this study measured the “hospital effect” in different catchment areas in a family health services authority Catchment area was the single most important variable in predicting prescribing levels A statistical model comprising catchment area, urbanity, number of partners in a practice, and a deprivation score explained over 47% of the variation in the prescribing of glyceryl trinitrate buccal tablets

The guidelines are simple and evidence based About 600-700 people sustain acute traumatic injuries to the spinal cord in the United Kingdom each year. Previously published data indicate that the injury to the spinal cord remains unrecognised in 4-9% of individuals.1 2 Inadequate management of patients with injury to the spinal cord has the potential to lead to neurological deterioration, additional functional handicaps, and possibly medical litigation. Thousands of patients, however, routinely present to primary care centres every day with injuries to the neck and back. The immediate care and appropriate assessment of patients with spinal injury is a skill that is expected of all doctors. General practitioners and hospital doctors with little or no training and experience of caring for patients with trauma might have to help the victims of a recent accident. They will certainly have to advise patients who complain of spinal pain after injury. This article is written to guide clinicians in these situations. The evidence base for this subject has improved recently with some large scale studies from North America.3 4 Several consensus guidelines have been published by the National Institute for Clinical Excellence and the British Trauma Society.5 6 Most of the patients in these studies have been treated in secondary care, but …

Part of the burgeoning workload of GPs in the United Kingdom is being an NHS gatekeeper. Successful gatekeeping is a challenge, and poor decisions have consequences. Over-referral risks inappropriate use of resources, while under-referral risks potential harm and dissatisfaction among patients. Direct access to specialists may sound appealing: it could reduce GPs’ workload as well as widening patients’ access. But what would be the effect on secondary care? This week Geva Greenfield and colleagues ask whether it’s time to rethink primary care’s gatekeeper role (doi:10.1136/bmj.i4803). They argue that “a …

Fears over potential risks to patients have been raised after a clinical commissioning group (CCG) in England proposed suspending all non-urgent referrals to secondary care, in a bid to save at least £2.5m (€3m; $3.3m) over the current financial year. In its two year financial recovery plan, published at the beginning of August, St Helens CCG, in Merseyside, proposed a temporary halt on all non-urgent referrals to secondary care for four months during the coming winter. Clinically urgent referrals, suspected cancer, and referrals of sick children would not be affected. The CCG has to make £12.5m worth of savings this financial year and £17.5m in 2017-18 to balance its budget. St Helens CCG told …

By now, if all had gone to plan, England would be reaping the early benefits of a national database of patients’ medical records spanning primary and secondary care. Patients would have the comfort of knowing that their records could soon be accessed wherever they were treated; the ability to monitor outcomes might already be suggesting better ways of doing things; and researchers might be starting to interrogate anonymised datasets to generate and test hypotheses. But all did not go …

Linking primary and secondary care data can successfully identify patients with severe mental illness whose cardiovascular disease (CVD) is undertreated, a UK study has shown,1 confirming that many of these patients are currently not receiving treatment for their heart disease. Researchers studied primary and secondary care records of patients aged 16 and over with severe mental illness in one London borough and looked at their prevalence of CVD and the measurement and treatment of CVD risk factors. The team extracted pseudonymised …

The basic needs of a vulnerable workforce are not being met Today I’ve been working as a sessional GP in a village practice near Cambridge, seeing the usual mixture of common colds, hot children, lumps needing urgent referral, heart attacks, depression, and the worried well. Around me, in leafy Cambridgeshire, GPs are worrying about the recruitment crisis in primary care, with as many as 40% of GPs due to retire in the next five years. Junior doctors are going back to work after a 48 hour strike over the imposition of their new contract. Administrators are trying to fill rota gaps without spending any money, and patients are trying to negotiate the complex bureaucratic barriers we’ve put in their paths to …

Nearly half of Dutch doctors have cried at work, and a quarter have cried in the presence of their patients, a study by researchers at Tilburg University in the Netherlands has shown. Doctors found this “undesirable” but not necessarily “unprofessional.” The confidential inquiry, published in the Dutch Medical Association’s journal Medisch Contact , gathered responses from 776 doctors in primary and secondary care, approached …

Migrants and overseas visitors from outside the European Union are to be charged for using emergency departments, ambulances, and some general practice services in England under new plans tabled by the UK government. A Department of Health (DH) consultation published on 7 December 20151 proposes to extend the range of services that non-EU patients must pay for beyond those set out in the current regulations, which apply only to secondary care treatment in hospitals. Under the new proposals non-EU patients would be required to pay for primary care services such as phlebotomy, physiotherapy, eye care, and dentistry, as well as for ambulance services and attendance at emergency departments. Standard GP consultations would remain free. The consultation also proposes tightening the eligibility …

As a GP, Jennings must deal with many distressed and worn out carers of older people.1 2 And as an acute hospital geriatrician I understand what he is saying. Many of my older patients don’t have close family or friends let alone relatives who are carers. For those who do, in many cases, hospital admission can …

Although need is often assumed to be the most important factor in determining the use of health services, there are many inequities in the provision and use of NHS services in both primary and secondary care. For example, existing data from district child health information services have been combined with census data for small areas to show wide variations in immunisation rates between affluent and deprived areas. Purchasers of health care are already responsible for assessing health needs and evaluating services, and the process of monitoring equity is a logical extension of these activities. Routine data sources used to collect activity data in both primary and secondary care can be used to assess needs for care and monitor how well these needs are met. Purchasers and providers should collaborate to improve the usefulness of these routine data and to develop a framework for monitoring and promoting equity more systematically.

A close observer of the NHS over the past 10 years might be forgiven for thinking that the debate about the concentration of acute hospital services has been driven more by the needs of NHS managers and the medical professions than by the needs of the local populations that they are supposed to serve. Managers have faced pressures to reduce unit costs and, in particular, the “wasteful” costs of management itself. The medical professions, through their respective royal colleges, have encouraged the closure or rationalisation of smaller units through pressures for greater subspecialisation. The result has been pressure for further concentration in the provision of hospital services through rationalisation and trust mergers. The logic is inescapable: larger units reduce average costs through the operation of economies of scale and larger units improve patient outcomes by increasing average volumes of activity by clinicians. Unfortunately, this logic is not supported by the evidence. #### Summary points NHS managers have been subject in recent years to considerable pressure to increase concentration and trust mergers This pressure has been justified by a belief that larger hospitals lead to lower average costs and better clinical outcomes Evidence from research does not support any general presumption that larger hospitals benefit from economies of scale or that service concentration leads to improved outcomes for patients Service planners would do well to give more prominence to the importance of ensuring that hospital services are local and easily accessible Even the most committed believers accept that there is a limit to the operation of economies of scale. Otherwise, the most efficient solution would be to concentrate all acute hospital services for the United Kingdom at a new mega-hospital somewhere around Leeds. The empirical literature on economies of scale …

Peak expiratory flow varies throughout the day in normal subjects, and this diurnal variation is increased in people with asthma.1 Current asthma guidelines recommend that diurnal variability of the peak expiratory flow rate should be calculated when diagnosing asthma and assessing its severity,2–7 including during exacerbations.34 Diurnal variability of peak flow has been used as a marker of airway responsiveness,8 9 particularly in epidemiological studies,10 11 and as an outcome measure in clinical asthma trials.12 However, there are problems associated with its use. #### Summary points Variation in peak flow over days or weeks provides helpful information about asthma control Asthma guidelines recommend that diurnal peak flow variability is calculated to provide an index of airway lability These calculations are too time consuming for normal clinical practice Factors such as the time of recording or recent use of β2 agonist drugs result in minor changes in peak flow, but can cause large errors in diurnal variability Diurnal variability may fail to detect important changes in lung function An alternative, simpler index of peak flow variation such as the lowest morning peak flow expressed as percentage of the patient's personal best peak flow value should be evaluated for inclusion in asthma guidelines Although diurnal variability in peak flow has been included in asthma guidelines for many years, doctors in primary and secondary care settings rarely use it, because of the cumbersome calculations involved. Several alternative equations may be used. The most common are the amplitude percentage mean ((maximum—minimum)/mean) or the amplitude percentage maximum ((maximum—minimum)/maximum), calculated for each day, and then averaged over a period of 1 to 2 weeks.13 Determining the amplitude percentage mean from as few as 7 days of twice daily peak flow readings for one patient (see fig 1) is …

Dear Caroline I’m interested in looking at a career in sport and exercise medicine. What is the best way to find out more? Aaron Cassidy, second year medical student at University of Leicester, UK Caroline replies . . . Sports and exercise medicine (SEM) is a relatively new kid on the block because it only became a specialty in 2005. SEM offers a variety of career options, such as working in NHS funded musculoskeletal services and exercise medicine clinics across primary and secondary care, and also private sports medicine practices …

Mozaffarian and colleagues propose an interesting concept of “soft healing,” as opposed to “hard healing,” which is what goes on in primary care (GP practices) and secondary care (NHS hospitals).1 Although they refer to the limits of “hard power” they do not mention the shortcomings of “soft power.” We think it …

The government’s plan for a seven day GP service risks the destruction of general practice, Maureen Baker, chair of council at the Royal College of General Practitioners, has said. Baker said that GPs were already under “extraordinary strain” from rising numbers of consultations of increasing complexity, together with workforce shortages, falling resources, and “overburdensome” administration. “Trying to meet demand for the services we already run is phenomenally difficult,” she said. “At the very point we should be putting general practice at the core of the NHS, taking time to innovate and building its strength, we’re risking the destruction of this hugely valued and valuable public service.” Baker was speaking at a seminar on the future of seven day services in primary and secondary care settings, held by the Westminster Health Forum on 10 September. “We need 5000 more GPs promised in the new deal just to stop the …

A third (32%) of doctors said that they regularly or quite often encountered barriers when explaining risk to patients, a survey carried out by the Medical Protection Society has found. The survey received responses from 536 members of the society, including doctors working in primary and secondary care. Respondents cited the …

At the Conservative party spring conference David Cameron pledged that, if they formed a new government, the party “would substantially extend weekend working of NHS services.” Post-election, the question is how will it be possible to resource a fully functioning 24/7 NHS when we are struggling to afford the current system? Provision of care seven days a week will increase the demand on already stretched primary and secondary care services, and therefore we need to ask who exactly will be expected to provide it. In a research paper, Fiona Warren and colleagues analysed results of the GP …