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what is the nature of health services?
- Gray Southon (11 February 2006)
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Possible solutions for the NHS (but do not take the steam out on poor WHO).
- Dr. Rajesh Chauhan (21 February 2006)
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Gray Southon, Honorary Research Fellow University of Auckland, NZ
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The important question is not what is the purpose of health services, but what is their nature. We have forgotten that it is essentially a professional service by which clinicians address the needs of people funded by the government, and have tried to treat it as a production system controlled by a management hierarchy. We have fogotten that whatever happens to patients is dependent first and formost on the skills, values and commitment of every clinician, and pretended that with proper structures, regulations and accountability systems we can guarantee outcomes, or at least outputs. Health services will continue to stuggle from crisis to crisis until we focus on the nature of clinical service, and the support that clinicians need to be effective. It is only in this context can we address issues of the needs of the community as a whole as well as financial control. Competing interests: None declared |
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Dr. Rajesh Chauhan, Consultant Fam Med, Hospital & Health Administration 309/9 A.V. Colony, Sikandra, AGRA -282007. INDIA.
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Dear Editor, Must the WHO be included [1], while considering the problems pertaining to the NHS of the UK? It reminds of a boss who by habit passed down his frustation to his juniors as soon he reached his office, and the juniors promptly kept passing it down the channel. Ultimately, it would be the turn of junior most of the lot to receive it, but experience had made him clever. He had a dog kept tethered to a leash outside the premises for such occasions, and he instantaneously let it out on this pet. NHS is under a bit of crisis and pressures are building up to iron out the associated issues. It definitely calls for courage in restructuring NHS and outlining its future, aimed at better patient outcomes, improved clientele satisfaction, in association with certain obligatory and desired levels of satisfaction amongst the health providers. Let it not drift further into insolvency by becoming an unhappy profession [2]. Although the health set-up of the UK is one of the best, the article by Mavromaras K and Scott A [3] should provoke the decision makers to rethink. It shall again call for courage when dealing with undue political interference in the NHS [1]. The health system cannot remain oblivious to the rapidly changing technological landscape and mindset. New millennium has already brought in a revolution in medical sciences along with changes in patient’s perceptions, attitudes and desires. However, excessive and ever increasing fragmentation of care needs to be restricted [4,5]. With or without legislation, prescribing by nurses and pharmacists is happening [6] which has been accorded acceptance and foretells the unmet health needs of the masses. Strengthening of primary care [7], appropriately backed up by tertiary care, is probably the way forward for the NHS. By restoring & improving competency of family medicine, much can be accomplished. Medical curriculum may be duly amended for enhancing the competency. Strides in e-health and information technology can aid in difficult cases and would facilitate prompt second opinion and advice on further management. Many diseases can be dealt deftly by primary care physicians if provided proper encouragement and, more importantly, respite from the morbid fear of being prosecuted [8,9]. Possibly owing to the latter, the costs of medical care are rising. It seems like a global phenomenon. Over-care, over-investigations, and over-prescribing ought to be avoided to cut down unnecessary costs. Use of newer drugs under specific indications and more reliance on time tested and cheaper drugs will help contain costs [10]. Additionally self-help, wherever tenable, should be encouraged. The BMJ can assist by highlighting the fact that majority of the diseases can still be effectively managed at the primary care level. With regards. References: 1. Fiona Godlee. A time for courage. BMJ 2006;332 (11 February), doi:10.1136/bmj.332.7537.0-f 2. David Spurgeon. Medicine, the unhappy profession? CMAJ • March 18, 2003; 168 (6). 3. Mavromaras K, Scott A. Promotion to hospital consultant: regression analysis using NHS administrative data. BMJ, doi:10.1136/bmj.38628.738935.3A (published 31 October 2005) 4. Barraclough K. Specialisation creep. BMJ 2005;331:1031 5. Antony R Charles. Inexorable march of specialization. BMJ 3 November 2005. 6. Chauhan R. Restituting Primary Care and the discipline of Family Medicine. Ann Fam Med 10 December 2005. http://www.annfammed.org/cgi/eletters/3/6/485#3667 7. Chauhan R et al. The sulking GP. Where are we going? Ann Fam Med 9 May 2005. http://www.annfammed.org/cgi/eletters/3/2/115#1731 8. Michael Day. UK doctors protest at extension to nurses' prescribing powers. BMJ 2005;331:1159 (19 November), doi:10.1136/bmj.331.7526.1159 9. Angela Coulter. What do patients and the public want from primary care? BMJ 2005 331: 1199-1201. 10. Prescription drug expenditures rising — too fast? Editorial. CMAJ.• May 10, 2005; 172 (10). doi:10.1503/cmaj.050460. Competing interests: None declared |
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