BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7427.1356 (Published 04 December 2003) Cite this as: BMJ 2003;327:1356

According to government rhetoric, we now have a “primary care led” NHS with “doctors and nurses in the driving seat.” Sadly, as the chairman of the NHS Alliance said at the fourth annual healthcare conference, “Primary care is virtually invisible even in Whitehall. Representation is tokenistic. The Department of Health is entirely insulated from primary care trusts by a so-called ‘top table’ of senior officials and strategic health authorities… We have created a managerialised NHS that effectively excludes the voices of frontline clinicians and lay people.”

A year on from coronary artery bypass surgery, women report a significantly more impaired quality of life than men. In particular, women have more cognitive difficulties and anxiety and are less active. These differences cannot be attributed to pre-operative differences, say the authors of a study in Psychosomatic Medicine (2003;65:944 -51). In many areas, they say, women start worse than men, finish worse than men, and have worse recovery profiles than men.

It took the second world war to establish that having blood banks was a good idea. A newspaper advertisement for the first donor sessions held in Bristol in 1944 was endorsed by none other than Winston Churchill, with the words “the hazards of …

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