Medicopolitical Digest

Physicians' role will change to meet patients' needsBMA wants national standards for community care(pounds sterling)300 000 allocated for research on medical educationBMA backs EU commissioner's antismoking initiativeDoctors can make computers workGovernment appoints commission on human genetic

BMJ 1996; 313 doi: (Published 14 December 1996) Cite this as: BMJ 1996;313:1558
  1. Linda Beecham

    Physicians' role will change to meet patients' needs

    District general hospitals will continue to play a major role in caring for patients who are acutely ill and need complex investigation and management. In its report Future Patterns of Care by General and Specialist Physicians the Royal College of Physicians recommends the retention of the acute general hospital serving between 200 000 and 300 000 people. The district general hospital of the future will provide care for the emergency admission and subsequent care of acutely ill patients round the clock.

    The college says that in the medical disciplines at least 70–80% of beds are occupied by patients admitted urgently or as emergencies. In some district general hospitals the figure is nearer 95%—a figure which the college says must not be ignored in proposals for bed reductions.

    The report says that while there has been a drift towards highly specialised physicians over the past two decades the balance is now returning towards the generalist. The college says that in the future both the general and specialist physician will need to play a key role in secondary care and suggests that there may also be a need for a new kind of physician with specific responsibilities for medical emergencies.

    Physicians of the future are likely to work in teams with other healthcare workers, collaborating with general practitioners in following jointly developed guidelines, and in outreach clinics where appropriate.

    As the hours worked by junior doctors fall more direct care will be delivered by consultants who will spend more time on non-clinical work, especially teaching and management. The report says that there will have to be “a substantial increase” in the number of consultant physicians to cope with the expanding work.

    Future Patterns of Care by General and Specialist Physicians is available from the Publications Department, Royal College of Physicians, 11 St Andrews Place, Regent's Park, London NW1 4LE

    BMA wants national standards for community care

    The BMA has called for national standards for community care, which would give vulnerable people a right to high quality care and take into account the needs of carers and the right to respite care.

    Giving oral evidence to the House of Commons Scottish affairs committee the vice chairman of the BMA Scottish council, Dr John Garner, said that local authorities took too narrow a view when granting planning permission for nursing homes. They were obliged to look at hygiene and not at whether there were enough family doctors to look after new nursing home residents. “It should be part of statute,” he said, “to ensure that there are adequate general medical services available.”

    In its written evidence the BMA Scottish office points out that community care is a much more expensive method of providing the service than institutional care. It supports the principle of a primary care led NHS but says that a partnership has to be developed between community trusts and general practice.

    The BMA asked the committee to note the burdens on primary care by the transfer into the community of patients whose medical care was previously the responsibility of the hospital service.

    The BMA thinks that the private sector could be used more effectively and that opportunities for more partnerships with the private sector should be explored. It was concerned, however, that some private homes were deliberately selecting more mobile and less dependent clients.

    (pounds sterling)300 000 allocated for research on medical education

    The Department of Health has allocated £300 000 for research on medical and dental education. It has decided to commission research into patterns for working and learning; developing the role of the clinical educator; developing the attributes of professional judgment and competence; and the evaluation of assessment during postgraduate medical education. Advertisements will be put in the national and specialist press inviting researchers to put in bids. The funding will be made available for suitable projects over three years.

    BMA backs EU commissioner's antismoking initiative

    The BMA has appealed to the president of the European Union, Jacques Santer, to support Commissioner Padraig Flynn's antismoking initiative.

    In a letter to Mr Santer, the chairman of the BMA council, Dr Sandy Macara, argues that tobacco subsidies are a misuse of public funds. The European Union spends more than 1bn ecu (£800m) each year supporting tobacco farmers whose crops have little commerical value and are dumped on developing countries. Only 1.55m ecu are spent on smoking prevention.

    Dr Macara says that it would now be cheaper to give farmers direct income support rather than continue to support tobacco production. “Stopping subsidies would release funds which could be used instead on smoking prevention and to invest in alternative crops and industries.”

    Doctors can make computers work

    Doctors are crucial to the success of hospital computer systems and should be fully involved in their development, NHS chiefs were told last week in a report by the Commons public accounts committee. It investigated shortcomings in hospital computer systems in England, where 16 projects were funded under a £56m ($84m) initiative to back up the NHS reforms.

    The committee criticises delays of up to three years caused by management failures and an increase of £14m in net costs which had to be met from other budgets, with an adverse impact on patient care.

    But one project, at Greenwich district hospital, had been relatively successful. The report says that a key factor was the involvement of a senior clinician as project director, and adds: “We believe that the commitment of clinicians is crucial to the success of such projects.”

    The committee wants the NHS Executive and managers to ensure that all users, including senior clinicians, are fully involved in developing hospital computer systems in future.

    Though disappointed by the gap between the executive's plans and their achievements, the committee says that integrated computer systems can enable hospitals to operate more efficiently and yield cash savings. The report blames the executive and hospital trusts for not managing the projects more effectively, and expects the executive to provide hospitals with convincing evidence of the value of such systems and clear guidance on how to proceed.

    Commenting on the report, the NHS's chief executive said: “We also agree that the commitment of clinicians is critical to the success of clinical information projects. The Clinical Systems Group led by the chief medical officer and the chief nursing officer has been established to encourage this commitment.”

    Government appoints commission on human genetic

    Sir Colin Campbell is to chair the new Human Genetics Advisory Commission, which will be concerned with the broad social, ethical, and commercial consequences of work in human genetics—for example, on public health, insurance, patents, and employment.

    There are eight other committees on aspects of human genetics and the commission is intended to provide an overview. It has been set up as the result of pressure on the government from the Commons select committee on science and technology (4 May, p 1119). It will review scientific progress “at the frontiers of human genetics and related fields” and will advise on ways to build public confidence in genetic science. It has been asked to consider how to make itself open to wider public views and will publish periodic reports.

    Sir Colin, vice chancellor of the University of Nottingham, is a former professor of jurisprudence. He chaired the Human Fertilisation and Embryology Authority from 1990–4 and chairs the medial workforce standing advisory committee. The other members include the Reverend Dr John Polkinghorne, chairman of the Genetic Testing Advisory Committee, and Professor Martin Bobrow, chair of medical genetics at the University of Cambridge.

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