Editors' Blog

July 2008 - Posts

• Holidays are good for your health

  With the school holidays upon us, and August just around the corner, thoughts turn to summer holidays. Taking a break from work and going on holiday are both crucial in ensuring mental wellbeing and equipping people to deal with stress. Indeed NICE's document on workplace interventions for promoting mental wellbeing cites research showing that taking a ‘vacation' has an impact on burn out. When it comes to holidays, the talk this year has all been about whether you're going home or away. Apparently in these cash-strapped, credit crunch times, increasing numbers of Brits are choosing to holiday in the UK. The most famous person currently enjoying a ‘bucket and spade' British beach holiday is prime minister Gordon Brown. I suppose one has to admire the fact that he is setting an example for us all as to how to keep the British economy going in these troubled times, but I'm not convinced he's having the break he really hoped for. Yesterday, Mr Brown opened the papers to discover David Milliband was staking his claim as the next Labour leader and if he had taken a walk down Southwold's promenade earlier this week he would have been confronted by hoards of angry people protesting over a lack of investment in sea defences. I reckon Tony Blair had the right idea when it came to holidays. He used to head off to exotic locations around the world, staying in the homes of famous friends (Sir Cliff Richard, one of the Bee Gees and Silvio Berlusconi are three that I recall), where the weather and some privacy could be guaranteed. I'm sure he still had to read tales of fellow MPs plotting against him, and the occasional long-lens photo popped up in the Daily Mail, but he certainly never came across any pesky protesters. He also took a complete break, leaving John Prescott in charge of running the country for a whole month. And, while the press always used to poke fun at the set-up, it was probably much better for the PM's mental wellbeing than Mr Brown's arrangements. Apparently, Harriet Harman, Jack Straw and Alistair Darling are each take a turn ‘minding the shop', but Mr Brown is still in charge. But maybe we should not be unduly concerned about the PM not having a proper break. By all accounts he may not be in the job much longer, which will give him plenty of time to holiday without the worry of securing the long-term future of the NHS, the economy or the state of the nation's sea defences to interrupt his relaxation.   Posted Jul 31 2008, 02:40 AM by Emma Bower with no comments

• Do I have the obesity gene?

  Please excuse my ignorance, but I am now utterly confused about how to keep within a healthy weight range and unsure whether or not my love handles are entirely my own fault. (I am actually eating a doughnut as I write this, so perhaps I am being a little disingenuous...however, there is a serious point to be made.) Despite working for a nursing magazine, I am left baffled by the constant stream of weight-related stories reported in the trade, national and online press, many of which contradict ‘received knowledge'. I certainly do not envy health professionals their job of sorting out the wheat from the chaff, or reassessing the advice they give patients in light of new studies and revelations. This week, for example, we learnt that the FTO ‘obesity' gene (widely reported in April)  impacts on appetite, making those who carry the gene susceptible to overeating. The study of 3000 children found that those with the higher risk version of the gene tended to overeat and to struggle to recognise when they were full. The effect of the gene on appetite was the same regardless of age, sex, socio-economic background and body mass index. According to lead researcher Professor Jane Wardle, the gene makes carriers 'significantly more vulnerable to the modern environment which confronts all of us with large portion sizes and limitless opportunities to eat.' It clearly undermines the theory that, when it comes to weight loss, we were all pretty much in the same boat. I was under the impression that the obese simply ate more and exercised less than their slimmer counterparts and should probably pull themselves together. While sweating on the treadmill or bypassing  a Cornish pasty in favour of a dull low-fat sandwich I felt little sympathy for those who moaned about big bones or unfortunate genes/jeans. However, as Professor Andrew Hattersley of the Peninsula Medical School has said, the gene ‘could explain why two people can seem to eat the same things and do the same amount of exercise yet one may struggle to lose weight more than the other.' To add insult to injury, in May, Scientists at the Karolinska Institute in Sweden revealed their belief that the number of fat-hoarding cells in our bodies are set in adolescence, remaining the same for ever more. Apparently, this could explain why it is so tricky to lose weight and keep it off and means that fat children might be ‘tied to a lifetime of obesity'. These findings are contested by other scientists, but the very suggestion that our childhood eating habits impact on the rest of our lives is demotivating for adults hoping to shed a few stone. Just to consolidate the misery, on Tuesday it was reported that women who want to lose weight and keep it off need to exercise for almost an hour five days-a-week. The University of Pittsburgh study found that a 55-minute regime is the minimum needed to maintain a 10 per cent drop in weight and that, contrary to popular belief, 30 minutes of moderate exercise five days a week is not sufficient to maintain weight loss. The net result of all this information is that I am now less blithely certain that I will be able to control my weight; am unsure how much exercise I need to be doing; and dare not be too critical of those who are losing the battle against obesity: they may be facing a bigger struggle than their friends and peers. I wonder whether health professionals feel the same way when faced with a surgery full over overweight patients clutching print outs of weight-related stories from the Internet or copies of the Daily Mail? Perhaps some definitive guidance is needed...with updates on a weekly (or even daily) basis! Posted Jul 30 2008, 03:56 AM by Sarah Wild with no comments

• Go, Holly, Go!

  As I was reading the headline "Branson's daughter quits NHS to work with dad" in thelondonpaper on my way home last night, I couldn't help but think, oh another rich (daddy's) girl who thought she could have a "normal" job but soon realised her father's fortune was slightly more trouble-free than, say, working extended hours...    But in my tube heat-induced semi-coma I quickly gathered that Virgin tycoon Richard Branson has enlisted his daughter Holly, a trainee GP, to help advise on his bid to launch a network of super-surgeries replacing GP practices. Holly — who is 26 and expected to inherit a large chunk of her father's £2.7bn fortune — qualified as a junior doctor after five years of training and was about to enter her second year of hospital training. But instead she will postpone her training for a year to take up an internship working for Virgin Health. She said he father "just offered me such an exciting opportunity I couldn't turn him down". No kidding! The BMA's GP Trainees Subcommittee yesterday said GP trainees should not work during extended hours, but this will not be confirmed until the extended hours DES is published in October. Branson's polyclinics proved controversial at first so it's not surprising that he's trying to surround himself with the most trustworthy people in his new adventure. And who better than a GP to give him the advice and guidance he will need? Although GPs seem to have welcomed the plans and around 300 practices have already made contact with Virgin Healthcare to discuss setting up Virgin-branded health centres. The firm plans to open 19 new health centres by 2013 starting with the first in Swindon, reported to open in January of next year. It has also been reported that GPs would receive 10 per cent of the polyclinic's profits on top of their salaries, so it could be an substantial incentive for young GPs like Holly Branson. Go, Holly, Go!  Posted Jul 29 2008, 11:03 AM by Emilie Reymond with no comments

• Keep the serious stuff for Monday to Friday

  I sometimes think that reading the weekend papers - the bits not about lifestyle and travel- are bad for our health. Of course for a journalist to say this is sacrilege. But the jolt to my system of a distressing news story can ruin my attempts at de-stressing after a busy week. Perhaps you react the same way too. Yesterday morning found me calmly immersed in the post-East Glasgow travails of Gordon Brown as he departed for his hols. Mildly interested in the photo of Gordon and Sarah ‘politicking with sunbathers' (as the Sunday Times puts it) in a Norfolk park on his way to Suffolk resort Southwold, I speculated on what friends of mine, also holidaying at the resort, might say if he tried politicking with them on the beach. Next I tutted over the tax credits fiasco: overpayments and other blunders by HM Custom & Excise mean that taxpayers will end up paying for a £2.8 billion write-off. But the item that really caused my BP to spike was not an act of terrorism or something else vile. It concerned co-payments, expensive cancer drugs and other countries' healthcare systems. The shock - and yes, I mean an ‘omigod-it-can't-be-true shock' - was so big that I forgot to turn on the radio to listen to The Archers omnibus edition. And I really did want to know whether Oliver's Guernsey cows had tested positive or negative for TB. Did YOU know that in the US cancer patients can apparently get all or most of the cost (80 per cent) of the £3,000 per month bowel cancer drug cetuximab (Erbitux) funded by the Medicare system? Medicare for the elderly and Medicaid for the poor are the equivalent of our NHS, but for heaven's sake, this is the US I'm talking about!  And we all know how good or, allegedly, bad US healthcare can be depending on patients' ability to pay or fund via HMO or employer's insurer.  Back in the UK, terminally ill patients have been told that if they pay for costly cancer drugs not approved by NICE for NHS prescription they will lose the right to all further NHS cancer treatment. The furore has been such that DoH announced last month that cancer tsar Professor Mike Richards is to lead a review to finish in October on the co-payments question -an issue on which the medical profession is divided. It took a trip to Kew Gardens together with a resolve not to watch, listen to or read any news until this morning to bring down my BP again. Posted Jul 28 2008, 12:13 PM by Carole Slingsby with no comments

• Are you just a GP?

  Before beginning my illustrious career with GP, everything I knew about medicine I'd learnt from House M.D., the US drama in which Hugh Laurie plays an irritable but ingenious diagnostician. The show taught me that apparently trivial collections of symptoms could rapidly turn out to be life-threatening; that blood gushing from inappropriate orifices could turn out to be nothing more than a tummy bug; and that almost any collection of symptoms you care to name can be diagnosed as either Wilson's Syndrome or sarcoidosis, but actually never is. House came to mind as I listened to RCGP president Professor David Haslam explaining general practice to an audience of tomorrow's GPs at a conference in London yesterday. Every day, he noted, GPs are faced with patients complaining of apparently trivial symptoms, such as stomach pain or headaches that just won't go away. By distinguishing those in need of a rest from those in need of an MRI, he argues, GPs do the riskiest job in the NHS. Getting this right takes a lot of training. Professor Haslam notes that he once took a copy of the GP training syllabus to a meeting so as to make this point to other specialists. ‘We only printed one copy,' he says, ‘because we like forests'. Trainee GPs must learn more in a shorter time period than doctors in any other specialty. Yet when people discover he's a doctor, they invariably ask him the same question: ‘Are you a specialist, or just a GP?' ‘I hate that ‘just',' he says. ‘What is it about our society that says the smaller your area of expertise, the cleverer you must be?' The answer, one suspects, lies in the numbers. Economics states that value is determined by two things: demand, and scarcity. GPs may face plenty of demands, but there are also rather a lot of them: 40,000 or so, at the last count. That's around 50 times the number of cardiologists there are in the UK, and almost 100 times the number of neurologists. The result is that those who know everything about one part of the body seem somehow more ‘special' than those who know a lot about all of it. This isn't fair. GPs have to recognise a wider range of conditions, in a wider range of body parts, than other doctors. They must be able to connect apparently disparate symptoms with lifestyle factors, family history and a patient's emotional state. And they have to do all this in consultations that last for 10 minutes, and without the useful clues contained in a referral letter. In short, they have to do the same job as Greg House, only with less money, fewer staff, and lower prevalence of excitingly novel diseases like leprosy. Yet society still views them as the junior half of the medical profession. Professor Haslam, though, has a plan. The next time you bump into a fellow doctor over cocktails, he suggests, there's one question you should ask to turn the tables. ‘Are you a generalist?' he suggests. ‘Or just a partialist?' jonn.elledge@haymarket.com Posted Jul 25 2008, 09:40 AM by jonn elledge with no comments

• Do you 'hug a fatty' or make them walk?

  Last night I attended a meeting of the Fabian Society, where guest turn was health secretary Alan Johnson tackling a question that seems to have so many suggestions but no real solution: how do we tackle the obesity epidemic? We all know the stats: two-thirds of adults and a third of children in the UK are overweight or obese. Johnson's call to not blame the obese, but to help them has resulted in headlines of ‘hug a fatty' among other things. But perhaps the more important angle of Johnson's argument to stop vilifying people for their weight is that the majority of people in the UK, fat or thin, are pretty unhealthy. He called for a change in culture: have children walk to school instead of driven a mile from home by time-poor parents, make fast food chains and even upmarket restaurants display the fat and calories in each dish, get employers to lay on a fruit bowl to usurp the office's staple supply of chocolate bourbons. The move could even be drawn into the whole climate challenge, suggested Professor Ian Gilmore, president of the Royal College of Physicians. Mr Johnson seemed to welcome this strategy of effectively killing two birds with one stone, reiterating the need for everyone to club together and show the world how it's done. It's hard to disagree with any attempt to reduce the number of people who are overweight or obese and, in turn, the comorbodities that blight their lives and the NHS. So I was somewhat disappointed when I came out of Central Hall in Westminister to see Alan Johnson skip down the steps and into a waiting ministerial car. I just hope this isn't a case of do as I say, rather than do as I do. rachel.liddle@haymarket.com     Posted Jul 24 2008, 11:14 AM by Rachel Liddle with 2 comment(s)

• Bradshaw forgets the charm in his BMA charm offensive

  Last night was the DoH summer reception. It is one of two parties the DoH throws each year for journalists at its Richmond House base in Whitehall. It's usually a slightly bizarre variation on the traditional ‘fireside chats' journalists have with ministers - with alcohol and a buffet thrown in. Alan Johnson is the fourth health secretary I've known to host the event and it's been fascinating to watch them all in action. Alan Milburn never seemed to have much time for the trade press but was surrounded by special advisors who did. During Milburn's reign it was not uncommon for journos to go salsa dancing post-party with advisers, health czars, press officers but sadly not Alan. John Reid was down-to-earth and keen to sing the praises of the NHS at every opportunity. Poor old Patsy Hewitt got nothing but a rotten press but would always earnestly explain the importance of turning around the NHS's finances despite the pain it was causing to anyone willing to bend an ear. Last night current health secretary Alan Johnson was on fine form and cemented his reputation as a bit of a charmer. He never attends these receptions for long but always makes his mark. He's not one for one-to-ones and always seems to prefer playing to an audience. An hour in he usually dashes in, claps his hands, calls for silence, gathers everyone around and performs. He doesn't quite have the charisma and charm you'd expect of a prime minister but you can't help but think he'd be more fun than poor old Gordon Brown. Highlights from last night's routine included failing to recognise soprano Lesley Garrett backstage at an awards do and instead asking her how long she'd worked for the NHS. Those with diary pieces to write would have plenty of material from last night's do, he insisted. Yesterday was of course the day when the DoH threatened to get tough with the drinks industry and, true to form, there it was serving up red and white wine for the assembled hacks. ‘And tomorrow, of course, I'll be talking about obesity,' lamented the health secretary, pointing at the tables of buffet food available for the schmoozing journos. One of the biggest laughs of the evening was the result of a little gentle ribbing of his colleagues. Paying tribute to each of his health team by turn, he described health minister Ben Bradshaw as being sent out on a ‘charm offensive' with the BMA. ‘Unfortunately Ben forgot the charm,' Mr Johnson added. neil.durham@haymarket.com Posted Jul 23 2008, 02:17 AM by Neil Durham with no comments

• PCTs seem subdued by patient survey's positive results

  "We are extremely pleased that the GP Patient Survey continues to show such positive results [...] However, there is still more to be done to achieve first rate services across the board". This was the lukewarm response of the PCT Network, which is part of the NHS Confederation, to the GP Patient Survey results published last week. In a press release published today, David Stout, director of the Primary Care Trust Network, stated that although the survey shows "some improvement" on most measures since last year, "We know some patients still find it hard to get an appointment that suits them in advance, and a significant minority want better access to services". You would expect that with such encouraging results (87 per cent of patients satisfied with telephone access to their local practice, 87 per cent of patients able to see a GP within 48 hours and 77 per cent of patients able to book ahead for an appointment with a GP), the PCT Network would be a tad more enthusiastic about the outcome of a survey that costs £10m of public money. It is true that while attention has recently focused largely on GP opening hours and contractual negotiations with the BMA there are broader challenges to improve GP access. The issue of GP access will not be magically fixed by extending GP opening hours and the GMS contract, although, as the PCT Network puts it, they do play an important part. Indeed, the survey showed that patient satisfaction with GP opening hours has fallen over the past year, despite the Government's year-long drive for extended opening hours. Patient surveys, and in particular their high cost, have been highly criticised by GPs who argue that they are just a waste of money. And to make things worse, the DoH has announced that the GP Patient Access Survey will be run quarterly from 2010. Let's just hope they can find a consultancy that can offer them a discounted deal... Posted Jul 22 2008, 12:33 PM by Emilie Reymond with 1 comment(s)

• Bradshaw can't blame the Daily Mail

  Everyone blames the Daily Mail for everything, and we all believe them because it's so easy to believe that the Daily Mail is the source of all evil. So it was no surprise to see our esteemed health minister Ben Bradshaw confidently suggesting that the Daily Mail was to blame for the bad press received by GPs over the past year. But hang on a minute, not even the Daily Mail makes up everything that it prints. Surely there must be some element of truth in the attacks on GPs that we have read and heard across all of the media over the past year? Well, let's have a quick look in the Healthcare Republic archive...In just the past six weeks Mr Bradshaw has complained that GPs do not invest in services, that they operate gentlemen's agreements against patient choice, and that they make false claims in misleading and mendacious campaigns. Incidentally, all of these comments were made directly to MPs or the BBC. But poor old Ben does not have much of an example to follow, with health secretary Alan Johnson having spent most of his first year bashing GPs over working hours and pay. Indeed, they were both so busy slating GPs that they rarely had time to visit a real practice. Alan only managed one trip in nine months, and Ben prefers walk-in centres because he can't afford to be ‘sat in a surgery for several hours'. Yes the Daily Mail and Co have jumped on the bandwagon but it was health ministers themselves who gave the wagon an almighty first push and continue to keep it rolling. Through their words and deeds they have created a media environment in which it is standard practice to criticise GPs. That is the inescapable truth, whether or not their vitriol ends up being published in the Daily Mail.   Posted Jul 21 2008, 11:44 AM by Colin Cooper with no comments

• A gender for change

  Yesterday, Healthcare Republic reported that former GPC negotiator Dr Stewart Drage has become a woman and will now be known as Michelle. I'm sure that the decision to switch genders is not one that individuals make lightly. It is likely that many people will have reached this point after years of struggling with their identity. For those with a high profile within their profession or local community, such as Dr Drage, it must be additionally difficult, because of the extra scrutiny they will face. The Gender Trust, the charity that supports those affected by gender identity issues, says estimates of prevalence of transsexualism vary from between 1 in 4,000 and 1 in 10,000 people. This is a significant number of people but, despite this, there is still a lot of misunderstanding and misinformation about gender dysphoria, and many members of the transgender community (transsexuals, transvestites and cross-dressers) face discrimination and even ridicule on a regular basis. However, in spite of the challenges trans men and women face, particularly during the transition phase, for most people the relief of finally being ‘the right sex' must be profound. And, while there is a lot of prejudice out there, people can also be amazingly supportive. A couple of years ago 60-year-old Miss Celia Macleod returned to work as a consultant gynaecologist after having a sex change. Officials at the hospital where she worked had written to patients to tell them about her decision to become a woman and set up a telephone helpline in case they had any concerns. No one contacted the hospital. Instead, when she went public, Miss Macleod was inundated with letters of support, including a large number from her patients. I sincerely hope Dr Drage receives the same reception from her patients and colleagues. More information about gender identity issues, including an introductory guide for GPs and other health professionals about the medical aspects of gender dysphoria, can be found on The Gender Trust's website.   Posted Jul 18 2008, 02:04 AM by Emma Bower with no comments

• Are we all VSPs (Very Stupid Patients)?

  I once worked on a local newspaper where we were coached to write for VSRs (Very Stupid Readers). Not so much dumbing-down the news but mashing it up and liquidising it before spoonfeeding it straight down the throat, avoiding the bib. I was reminded of this as my dentist sat me down after a consultation last week and asked to show me two videos about how to clean my teeth properly. I resisted the temptation to ask for one to teach my grandmother how to suck eggs or to suggest that after 38 years of trying I might have just mastered the art, and prepared to be enlightened. They weren't quite of the put-the-paste-on-brush, then put-the-brush-in-mouth variety but they weren't much more advanced. My dentist's a reasonable man (his wife's a GP), he knows how I make my living and we've known each for a few years, so I was hoping for more respect. But, perhaps my sore gums and I-know-best attitude didn't deserve such sensitivity? If the point was to make me feel like a numpty, start flossing with wire brushes and vow not to suffer the same ignominy in six months, then I suppose it was box ticked. But is this really the best way to treat patients? The pain of this brush with oral embarrassment hit home again yesterday as I read a report by the Healthcare Commission and the Audit Commission which found that DoH public health programmes had failed to lower levels of obesity or cases of alcohol misuse. What next I wondered? Should practices be screening educational videos to chubby teens after each consultation about how too much pizza and too little exercise cause weight gain? Perhaps more entertaining but as fruitless would be a selection of YouTube clips charting Amy Winehouse's physical decline to convince skinny clubbers that the beehived diva's lifestyle might not be ‘best practice'? Perhaps your PCO is already preparing to send you the aforementioned DVDs through the post. But what difference would it make? Are we all VSPs (Very Stupid Patients)? Is there a point at which the nanny state should just loosen the apron strings and assume patients might just have the gumption to change ‘lifestyle choices' for themselves? Or not. I'd be keen to know your thoughts if my failure to wear my glasses as often as I should and my ‘iPod ears' didn't make it quite so difficult to see and listen. neil.durham@haymarket.com     Posted Jul 17 2008, 02:11 AM by Neil Durham with no comments

• Infamy, infamy...

  Any member of the health profession can now post and read reviews about named politicians at 'I-fancy-saying-something-rude-about-an-MP.com which launched this weekend. Sorry, only joking. But just see how tempted you were to add a knee-jerk response without much thought for the consequences? How cathartic might it be to voice criticisms ‘out loud' and to rate the efforts of those in a position of power? Having glimpsed some posts about politicians on doctors.net.uk, it is hard to imagine that many messages on such a platform would be particularly complimentary. This of course, is the danger of the new review site for doctors, iwantgreatcare.org which launched at the weekend. The resource gives any member of the public the opportunity to write and read reviews about named GPs. More than 2,500 reviews were posted on its first day, most of which appear (at a quick glance) to be positive. While it's nice to think that the majority of feedback will be measured and (hopefully) favourable, the BMA warns that it might be used by people with vendettas, or making unproved accusations. I tend to agree. Health professionals are vulnerable to unfair criticism due to the complexity of their relationships with patients: by its very nature, medicine (and nursing) may involve permeation of physical and emotional barriers, plus in-depth, often intimate, questioning. Frontline clinicians have to let patients know that they have responsibilities as well as rights; that they cannot necessarily get the drugs or treatments they want on the NHS; and may have to tackle thorny issues such as a patient's obesity; chain smoking; or other bad habits. The resentment this can provoke might, in future, inspire some people to 'name and shame' their doctor on iwantgreatcare.org, holding them up as a ‘named example' in order to purge their anger towards the NHS; their poor health; or their personal circumstances. What is more, even people who are usually judicious can ‘lose the plot' when contributing to online forums: one only needs to look at the posts on social networking sites; Wikipedia; and emails forwarded from person-to-person, to realise that people feel safe to say what they like on the Internet. They don't see it as ‘publishing'. But of course, it is. Libel lawyers have warned the website's founder, specialist Dr Neil Bacon, that posters might be sued should ‘inaccurate, irresponsible and defamatory allegations' be published on ‘iwantgreatcare.org', an outcome that would be unlikely to enhance the doctor/patient relationship. However, Dr Bacon (also founder of doctors.net.uk) remains unalarmed, pledging that ‘the systems to protect doctors are fantastic and secure' and ‘the vast majority of comments have been positive'. He adds that: ‘..interestingly, the small number of spoof and malicious comments we have received have been traced back to doctors.' His latter point is worrying because it doesn't matter by whom malicious comments are made, they still cause harm. It is not only patients who might have a vendetta against their GP, a doctor's colleagues; former colleagues; ex-partners; or aggrieved acquaintances might also fancy taking a pop. (In an increasingly competitive NHS, it might prove attractive to publicly criticise the local opposition! ) Even where praise is given, who is to say that it is actually unbiased? Positive posts may come from a doctor's family member or friend, rendering it inaccurate and unrepresentative. In light of this, I am not really sure how helpful this new site will be or whether it will weed out poor practice: at best it could be a channel for praise and an opportunity for patients to make genuine criticisms about ‘below par' doctoring; at worst it could ruin doctors' reputations; launch libel cases; and cause damage to the doctor/patient relationship.  Most doctors welcome constructive feedback, but surely not in this potentially dangerous-for-all format? After all, there is already an official DoH site, NHS Choices, that enables patients to rate their practices: perhaps it is a safer (if less enticing) option for people to make use of this should they wish to air their positive - or not-so-positive views - about their local GP. Posted Jul 16 2008, 03:35 AM by Sarah Wild with no comments

• Should the NHS be run more like a business?

  There have been numerous examples in the past week of the NHS trying to become more business-like in its approach. These are usually cack-handed attempts by trusts to make a bit of extra cash and inevitably result in unfavourable headlines. So this week we had junior doctors being told they would no longer be entitled to free accommodation during their first year of hospital training. We then heard about a trust clamping ambulances that stayed in hospital drop-off bays for too long - with a £50 release fee. The market reforms of the health service also mean that nowadays all NHS institutions simply must have a marketing department. I noticed a job advert today in which a trust was trumpeting the way it had turned around its formerly dire financial situation to the point where it now felt able to spend up to £90,000 establishing a new PR team. Of course, the other big news in the past week has been the staggeringly bad management of some maternity services, as revealed in Sir Ian Kennedy's report. And when you put all those things together, it makes for a pretty strong case that the NHS should stop spending time on money-making scams and PR puff, and instead focus on its core business.   Posted Jul 15 2008, 09:00 AM by Colin Cooper with no comments

• Should doctors have a flawless past?

  After reading several articles in the national press about Majid Ahmed, a straight A-grade state school pupil who was recently refused a place to study medicine at Imperial College London on the ground he had been convicted of a minor criminal offence, I made a mental list of pros and cons (like I always do when I have to make a choice) for both arguments. But in this case, I couldn't decide who's right and who's wrong. Last week, Imperial College London was coming under pressure to review its decision as MPs said it was taking the chance away from Ahmed to become a GP just because he made a "one-off" mistake as a teenager. Ahmed was convicted of burglary in 2005 and ordered to serve a four-month referral order for community service. Burglary is a serious offence but Ahmed has already paid his dues. He has since done volunteer work for disability charities and achieved four A grades at A-level and the conviction is spent, according to media reports. Imperial College offered him a place but withdrew it after he wrote a letter to inform the university of the conviction. Has Ahmed been a victim of discrimination? On the other hand, with medical courses already over-subscribed, not enough jobs for the number of doctors trained this year, should Imperial College give a place to a someone with a conviction (minor or serious)? Critics say Ahmed should not have to pay the consequences of a one-off mistake for life and should be given the chance to fulfil his dream to become a doctor.  The GMC said that people can still become GPs if they have a criminal record and that "a candidate could be barred if thought to pose a risk, but evidence including references would be considered." In Ahmed's case, it doesn't look like the references he got from a PCT have been considered. What concerns me is the negative message the heavy media coverage around Ahmed's story is sending to young teenagers from underprivileged backgrounds, particularly in the current climate. Posted Jul 11 2008, 11:21 AM by Emilie Reymond with 1 comment(s)

• Carrot (cake) or stick: divided we fall

  While ('bad cop') health minister Ben Bradshaw has been laying into GPs about their so-called ‘gentlemen's agreements' (sinister compacts which apparently ‘block patient choice'),‘good cop' health secretary Alan Johnson has been putting on his pinny. Yes, rumours are true: the top man in health really has baked nurses a cake, presumably because he promised to do so at April's RCN Congress. And because it's a darn sight cheaper than giving the profession the pay rise it deserves. The cake (reportedly an ‘orange-flavoured, nutty' affair ) was presented after a ceremony in Westminster Abbey to mark the 60th anniversary of the NHS. It was given to nurse manager BJ Waltho who, at the Congress, requested to know what nurses would receive to mark their diamond anniversary. Mr Johnson replied: ‘I will personally bake you a cake, I promise you that.' The rest - like the cake - is history. In continuing to court nurses' good will, Mr Johnson is capitalising on his Congressional standing ovation, received while setting out a timetable for honouring a long-standing commitment to end mixed-sex accommodation in NHS hospitals. Few would deny that the cake was a nice little touch, showing that the charismatic - yet seemingly down-to-earth - Mr Johnson is keen to show public appreciation for the profession. However, cynics might say that nurses are being fobbed off with such low-cost, publicity-rich gimmicks. It is notable that the health secretary hasn't been trying out his home-baking on GPs, towards whom his demeanour is decidedly frosty. (Mr  Bradshaw is positively hostile, even accusing doctors of lying to patients with their ‘misleading and mendacious' BMA petition against polyclinics.)   Nurses may currently be basking in the warmth of ministerial favour but the latter's ‘divide and conquer' strategy should be treated with caution, hindering, as it does, a unified front from health professionals at a time of great change in the NHS. While there may be advantages for nurses in distancing themselves from the perceived negativity of their GP colleagues, they should keep in mind the meagre pay rise they have been awarded over the next three years; the potential burden of extended hours for general practice; plus the spectre of those controversial and, as yet, untested polyclinics. A celebratory cake is a charming gesture, but proper pay (and a genuine debate about the role of the private sector in our health service) would be the cherry to top it! Posted Jul 10 2008, 02:51 AM by Sarah Wild with no comments