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Showing posts from September, 2016

Rethinking primary care’s gatekeeper role

Gatekeeping is the term used to describe the role of primary care physicians or general practitioners (GPs) in authorising access to specialist services and and diagnostic tests. Gatekeeping has important influences on service utilisation, health outcomes, healthcare costs, and patient satisfaction. In an article published in the British Medical Journal, we discuss the role of gatekeeping in modern health systems.

In the UK access to NHS and private specialists is generally possible only after a referral from a GP. Gatekeeping was developed as a response to a shortage of specialists and a desire to control healthcare spending and has been an accepted practice in the UK for many years. The NHS is under considerable pressure to use its resources efficiently, and GPs have helped the NHS to achieve this goal through managing a large proportion of NHS workload in primary care. However, GPs in the UK now find themselves under considerable workload pressures. In an 11-country survey of prim…

What impact will Brexit have on the NHS and universities?

I spoke recently at a Public Policy Exchange Symposium on the topic of ‘Brexit: What impact will it have on the NHS and universities?” The event was chaired by Dr Philippa Whitford MP. In my presentation, I outlined how Brexit will lead to major challenges for the UK’s NHS and universities, as well as for public health and the life sciences industry in the UK.

For the NHS, key issues include the retention of NHS employees from other EU countries; and the future recruitment of health professionals after the UK leaves the EU. The NHS will need to implement policies to train considerably more health professionals (including doctors) and retain them in the workforce. Another key issue is the right to publicly-funded healthcare of the EU nationals living in the UK and the UK nationals living in other EU countries. The future of the EHIC card also needs to be determined.

For public health, a key issue will be how the UK participates in future EU-wide public health initiatives. These cover …

Clinician-identified problems and solutions for delayed diagnosis in primary care

Delayed diagnosis in primary care is a common, harmful and costly to patients and health systems. Its measurement and monitoring are underdeveloped and underutilised. A recent study from Imperial College London published in BMC Family Practice created and implemented a novel approach to identify problems leading to and solutions for delayed diagnosis in primary care. We developed a novel priority-setting method for patient safety problems and solutions called PRIORITIZE. We invited more than 500 NW London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to delayed diagnosis in primary care. 113 clinicians submitted their suggestions which were grouped into a composite list of 33 distinct problems and 27 solutions. A random group of 75 clinicians from the initial cohort scored these and an overall ranking was derived.

The top ranked problems were poor communication between secondary and primary care and the inverse care law, i.e. a misma…