This week's edition of the New England Journal of Medicine contains the first article in a series on medical education. Medical education in both the USA and UK is undergping major reform, driven by societal changes that have encouraged greater patient autonomy and patient choice, and by changes in medical practice and the provision of medical services that are changing the traditional 'hospital bedside' mode of teaching to more community-based models of teaching.
NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...
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