According to the BMA central consultants and specialists committee:
24/7 care, professional clans, costs vs demand, centralization vs politics/public, waiting times vs primary care, junior working hours.
BMA calls for consultant based care, ie leading teams, being involved in all major decisions related to patient care, and delivering care appropriate to their levels of skills and training. Te term "consultant led care "is too ambiguous. Academy of Medical Royal Colleges and the National Confidential Enquiry into Patient Outcome and death have both published reports illustrating the benefits of a consultant based system. .
Glasgow Acute now includes north, south and yorkhill - fewer chief execs, fewer boards, less conflict in strategy. Stobhill & Western inpatients to close. But communication better when people in same building...
National Patient Safety Association - special authority created in 2001 to co-ordinate national efforts to report, and learn from mistakes and problems that affect patient safety. Encourages open, blameless reporting of incidents, collect reports and initiate preventative measures. But also encompasses:
A Clinical Director needs to be hands on but fair. Rotation?
Benefits cannot be balanced against risks, since one is concrete and the other abstract. Should be benefit:harm ratio.
MMC (Modernizing Medical Careers) has come on the back of an expansion in graduate numbers (including several new medical schools). These numbers were planned on a fairly conservative estimate of an expansion in consultant numbers. Overseas graduates were ignored, perhaps on the basis that they would tend to be at a disadvantage cf local graduates. MMC harmonizes with European idea of specialists (in terms of service and training duties). No thought was given to the additional demands for training new "specialists" ie middle grades with a special interest.
Alan Craft said new CCT will signify less experience, so new consultants will need to work in teams to ensure patient safety. Will CCT holders all progress to true consultant status? Probably not. Better value for money for NHS but will put off future students from profession. See Subconsultant grade below.
Highly skilled migrant programme is not unique to medicine. Allows for residence without a definited job offer. Unclear what function it serves. Overseas graduates already in the system are due protection, but some 2 tier system must exist to protect new local graduates. There is plan to introduce a resident labour market Centest
Tooke report - after MTAS debacle. MTAS was botched by a rushed and centralised implementation, a rigid and unfit application system (that was not piloted or even tested), shortfall in number of training posts. FY1 to be uncoupled from FY2, to stop European graduates taking foundation programme places from UK graduates. Finals to be used to inform entry to FY2. FY2 to be coupled with both ST1 and ST2 to become core specialty training 1 to 3; competition would then be for entry to ST3. CCT should prove ability to work independently at level of consultant, but note the need for enhanced roles eg education, research. Should be workable under consultant contract.
Subconsultant grade: the main appeal is mopping up surplus trainees, the result of increased student numbers and specialty trainees. The BMA has always pushed for "consultant led care", which this wouldn't be exactly, but is there really funding (and structures) available to give everyone a consultant job? And anyway, if you believe in CPD then the difference between a trainee and a trainer is pretty arbitrary. Establishing a new tier would reduce the appeal of specialist training, since there would always be the potential for getting stuck at the junior level. Plans for post-CCT training put forward by MMC would take training time and resources away without guaranteeing senior jobs. But the extra tier would create capacitance, with the flexibility to allow overseas experience, and at the same time allow overseas trainees some work experience.
National Curriculum for Foundation Years – from GMC, being reviewed by PMETB but should become the only piece of paper required to achieve full registration. Experience but also demonstration of specified skills required.
The European Working Time Directive gives a 48hr target in 2009. But means more full shift rotas, arguably more disruptive to home life. Split weekends in some jobs. Increased time spent handing over, more doctors shared between specialties. Probably only Sweden and Denmark will achieve target; other countries will just give up. UK currently uses an opt out, which is due to be phased out over next 3 years.
Should the opt out be continued? Ian Wilson report to MMC regarding improving training in the light of reduced working hours, Jan 2009.
The 24 hours a day Scottish telephone and website service that offers advice on non-emergency health issues. Covers GP practices when closed. Gives selfcare advice (with clinical supervision) else refers to Ambulance/Hospital services. But also does public health information including outbreaks, Breathing Space service for low mood, etc.
Takes 1.5 million calls per year.
IT system has access to Emergency Care Summaries and local knowledge, includes decision support. Can access previous calls. Can pass calls on to pharmacists, dental nurses.
NICE tries to exclude contributions from those with an interest, on the basis of potential bias. But politically naïve to make an enemy of those most involved with an issue. It should publicise its methods, rather than having a black box economic model. It uses an arbitrary threshold of £30 000 per QALY for justification, a figure that has not changed since inception 9 years ago! Inflation, at least?
Single Technology Appraisal established for single products with single indications close to their introduction to market, are supposed to be fast track. But evidence comes from manufacturer, who is not required to include evidence that it does not consider "appropriate". Stakeholders incl Primary care trusts in England are not given the opportunity to comment during the appraisal, only a right of appeal before final guidance issued. Responses to draft guidance must be made within 15 days, hardly feasible for most organizations.
NICE also fails to provide guidance on affordability. Each new treatment is assessed purely on its own merits; a recommendation to fund it does not take into account the potential for money to be diverted away from more effective treatments for other conditions.
See website.
Organization addressing issues of:
Offers online educational resource to help you use clinical governance and risk management quality in your work.
Has a small collection of child health findings and advice (from NICE, HTA etc). Email newsletter.
Hall report (Health for all children) - all about surveillance and promotion. Universal but with targetting of uulnerable families, data collection. Early years (hearing, vision, language, motor), oral health, diet. Expanded school nurse role. Parent held child health record. Now on version 4.
Moving away from top down approach, Patient's eye view of care. QIS, Community Health Partnerships (not same as in England, where they're about private co-ventures), MCNs. Encourages local innovation by clinicians. Early years and children both emphasized.
80 kids become homeless daily. 40% born to unmarried mothers. Move towards single shared assessment, key worker.
An overall strategic process for the NHS in Scotland, addressing in particular:
Delivering for Health (2005) is the policy response to the Kerr Report, same sort of thing. Then there comes Building a health service fit for the future, and A Guide for the NHS in Scotland, which includes a specific Child Health Action Team Final Report:
Feb 2007. Various targets and milestones, incl:
Scottish Executive 5yr action plan, launched December 2007.
A more mutual NHS. eg more Managed Clinical Networks, new roles for staff, workforce planning, Community health partnerships, Supported self management and self management framework (support for carers, voluntary sector, patient information etc)
Some of the important targets:
Health inequalities are also targetted.
From December 2011, 18 weeks will become the maximum wait for treatment following referral by a GP for non-urgent patients - the Referral To Treatment (RTT) standard. Incorporates the whole patient care pathway, from GP referral, up to actual admission to hospital for treatment.
2008/09 HEAT targets [NHS Performance Targets, online system - agreedfor each NHS area Board. 28 key targets, 31 key performance measures] relating to paeds:
Challenge of increasing workload, but less doctors due to European Working Time Directive. Also increasing inequalities, long term disabling conditions. Solutions:
Ends with a warning about likely impact of MMC, and inadequate expansion of nurses & AHPs to cope with it.
Community Health Partnerships have taken over from Primary Care Operating Division and Local Health Care Co-operatives (LHCCs) - based on Kerr report. Are the next level down from the NHS board, remain separate from Acute Operating Division. NOT the same as English Community Health Partnerships, which promotes Public-Private modernizing of health/social facilities!
The new plan for medical training, where you get 2 yrs foundation training, which can include paeds, then you enter a basic training phase before graduating to a higher specialist training phase. Various grey boxes along the way for people who don't manage to graduate. No role for overseas graduates in this system...
Helen Taussig (as in Blalock-Taussig) was a female cardiologist, and deaf - had an amplified stethoscope.
What has chicken pox got to do with chickens? Good question! Because it looks like you've been pecked? There was an old coin called a zicchero, from where we get the word sequin, so that's one idea. Or else the word chicken is used to trivialize something eg chicken feed, so maybe distinguishes it from small/great pox.
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