Generics
High dudgeon today as GPs are accused of overprescribing medication & generally being responsible for wasteful supply of medication to the tune of between £85 million to £300 million a year.
A few home truths then for those interested.
Not all generics are created equally. Some might not be suitable for a proportion of patients because of side-effects / efficacy / convenience, being usually atleast a generation older than the medication still on patent.
Using statins as an example, not all patients can be switched to generics from the newer versions due to the significant numbers who develop musculoskeletal problems.
Three cheap pills a day that a patient does not take are not better than the more expensive single pill regimen he or she does comply with.
Patients stockpiling drugs or simply not taking them account for a large proportion of the waste highlighted.
Of course No Free Lunch is pretty important in this effort.
“One in five GPs indicated they felt that pharmaceutical companies have more influence than [the primary care trust] prescribing advisers,”
Perhaps pharmacists might be better used to provide advice on medicines management rather than becoming diagnostic assistants treating patients independently.
A look at Diabetes related illness & the fact that it accounts for 10% of NHS spending.
The Guardian profiles a GP practice that provides an interesting model of midwifery care. But we are told it is too expensive. I wonder if we have our priorities wrong.
Many women see different health professionals throughout their pregnancy, labour and birth, and postnatally, but Oakwood’s women are given a named midwife who carries out nearly all of their antenatal and postnatal appointments and in many cases delivers their baby at home or in hospital.
“This type of service offered by Oakwood is considered too expensive and too demanding for midwives by many in the NHS,” said Newburn, “but if you look at the overall ratios of midwives to women it looks like it could be possible for far, far more women to have this kind of care.”
And I am surprised that there are not more stories like this one.
Despite asking instead if she could stay in the waiting room until someone could come and collect her as she couldn’t afford the £40 taxi fare, she was discharged at 2:30am. Miss Beale, who has no family, then spent six hours on a bench in the hospital grounds before walking into the city in her hospital slippers.
Once upon a time this would have been dealt with sensibly.
I used to work in Manchester around the turn of the millenium & was thankful for the introduction of unbreakable pint glasses there. I can’t believe that there is still a reluctance to introduce them nationally.
The MP John Grogan, chairman of the All-Party Parliamentary Beer Group, said: “We are calling for a sensible approach rather than a blanket ban. Banning glass is the wrong way to attract a wide and diverse set of customers.â€
Nathan Wall, operations director at JD Wetherspoon, who attended the BEDA meeting, said: “There’s a philosophical difference between us and the police. They are of the view that one glass injury is one too many, but ultimately we have to consider that we are punishing the vast majority.â€
Alcohol awareness campaigners claimed recently that a typical glassing incident costs the NHS £184,000 to deal with, before the cost of a police investigation is added to the equation.
Now I am not able to understand the reasoning behind these statements but I guess that I am not qualified to be a connoisseur. What exactly is the punishment? On second thoughts, don’t bother explaining. But aren’t metal tankards more traditional?
A clutch of letters in the papers today with some propounding the view that “Increased spending is not the answer” for the NHS. To me it is part of the answer as the correspondent quoted explains.
The answers are simple and well known within the service. First, the austerity years under the Tories led to a massive backlog in capital expenditure, notably for repairs and rebuilding. Redressing this has soaked up funds with little immediate effect on care outcomes. Secondly, and more importantly, the NHS for 50 years was predicated on the basis of the trust and sacrifice of its workers at a time when vocational commitment meant long hours for little reward. When politicians, in a desperate attempt to find cheap solutions to NHS ills, declined to believe the hidden value of this benevolence, and demanded contractual rigidity and centralised control, they dissipated that goodwill and found to their cost that they had underestimated its contribution severalfold. To their shame they are now engaged in a desperate scramble to reverse their largesse.
And “Choice” is debated as well with a few interesting participants.
So is this realism or undue pessimism?
“Today only 30%, we estimate, of our projects and programmes are successful. Why shouldn’t it be 90% successful?” he said in a speech to this week’s Government UK IT Summit, reported in Computer Weekly. “It’s about improving performance in projects and programmes and our day-to-day services as well as our procurement processes.” Predictable weaknesses such as inadequate requirements were often to blame.
I have to agree & these are not limited just to IT projects. I have raised the same concerns regarding a number of DoH programmes.
Stephen Timms, chief secretary to the Treasury, was more upbeat in a speech to the same conference, brushing aside criticisms of the NHS IT programme, describing the scale of the scheme as “heroic”.
Not sure that I wan’t heroic to be the word used.
A DWP spokesman said the figure Mr Harley quoted came from an independent report with “very narrow criteria”, which was also highly critical of private sector projects. “Only projects which were on time, on budget and exactly to specification were deemed a success. If they never saw the light of day they were deemed a failure. Anything in between - around 63% of the projects - was deemed neither a success nor failure.”
Seems fair to me & not particularly narrow, though details of the report would be welcome.
Not a get out of jail free card this time but better than James Johnson / Carol Black at the very least given that the BMA is haemorrhaging members after its recent shennanigans (700 resigning in just one day). This is unlikely to cut much ice.
As you are aware, the failure of MTAS, the application system into the new ‘MMC’ training programmes has been one of the most negative and destructive events in medical training in recent years and has damaged confidence in those bodies involved. Among those are the Royal Colleges, whose statutory responsibility for training doctors was taken away and transferred to PMETB but who are still perceived by many junior and senior doctors to have failed to intervene – indeed been complicit – in the failures of the last few months. We have been deeply damaged by insistence that “The Royal Colleges’ agreed to these changesâ€. As responsible professionals we have worked with the Department of Health in its wish to train a medical workforce in a way it perceives as appropriate for the NHS for which it has responsibility. We have however repeatedly expressed concerns and caveats that have gone largely unheeded. There has been consultation but little true listening.
Th Royal College of Physicians has been slightly ahead of its compatriots by virtue of having a more switched on PR department & has responded to the concerns of its members. This letter would have received a much stronger welcome a few months ago & the medical establishment needs to learn when to walk away from futile exercises. But they are trying & that is a sign of progress.
Especially curious is the revelation by the Department of Health during the hearings for the judicial review that MTAS was work in progres
The legal team for the Secretary of State for Health presented a second witness statement by Mr Nick Greenfield from the Department of Health.
In it he states that the matching algorithm (that underpins the MTAS computer system) was not, and is not, functional or reliable.
Mr Greenfield states “The decision not to proceed with MTAS for matching candidates to training posts was taken as a result of recent security difficulties and the fact that the Defendant could not be certain that the algorithm necessary to operate the ’single offer system’ would be effective.”
Further, this had been raised with the Review Group in early April. To add insult to injury he concludes “the required algorithm… was a ‘work in progress’”
The judgement is expected in a week or so.
And as for the Tooke inquiry, I will update this later.