Views & Reviews If I Ruled the NHS

Don’t mention the P word

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2345 (Published 06 May 2015) Cite this as: BMJ 2015;350:h2345
  1. Stephen Gillam, general practitioner, Luton
  1. sjg67{at}medschl.cam.ac.uk

If I ran the NHS I would begin by abandoning all “pathways.” Many of medicine’s woes are self inflicted. Technological advances have driven a degree of subspecialisation that is insupportable. Patients often attest to the bewildering fragmentation of their care. The sticking plaster, often designed to remedy this after the event, is the care pathway.

One patient recently explained to me how her elderly mother’s discharge was delayed not for lack of facilities at home but because four different people needed to be involved in signing off her “discharge pathway.” Of course, some necessarily complex care requires intricate detailing, but the proliferation …

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