The burden of chronic diseases such as chronic obstructive pulmonary disease (COPD) is increasing rapidly in low and middle-income countries. Despite this, their management in such countries has often not been well studied. In a paper published in JRSM Short Reports, Ailsa McKay and colleagues reviewed the nature and efficacy of current management strategies for COPD in India. They found information regarding current management – particularly on the implementation of national guidelines and primary prevention – to be very sparse. This led to difficulty in interpreting studies of management strategies, which were varied and generally of positive effect. Data regarding current management outcomes were very limited. They concluded that the current understanding of management strategies for COPD in India is limited due to a lack of published data. Determination of the extent of current use of management guidelines, availability and use of treatment, and current primary prevention strategies would be useful. This would also provide evidence that could be used to interpret existing and future studies of management outcomes and novel interventions.
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...

Comments