Intended for healthcare professionals

Letters NHS hierarchy disruptors

Clinicians need time, not videoconferencing

BMJ 2019; 366 doi: (Published 21 August 2019) Cite this as: BMJ 2019;366:l5156
  1. Nick Mann, general practitioner
  1. London E9 7TA, UK
  1. drnickmann{at}

ECHO (extension for community healthcare outcomes) has a catchy name but seems to be less disruptive innovation and more a product patented in the United States being sold back to the NHS as “something new.”1 Notwithstanding the many differences between primary and secondary care, and their relations, in the US and the United Kingdom, we used to have fantastic liaison with outreach education from hospitals by specialists. We still have hospital based education sessions that aim to upskill general practitioners, but fewer of us are able to attend, largely due to relentless escalation of non-clinical meetings for management, commissioning, audit, referrals, pathways, prescribing, and more.

Patented videoconferencing? Clinicians simply need the time back to do what we have always sought to do for ourselves. Perhaps hailing Project ECHO is more an acknowledgment that we have lost something vital to medicine: the cohesion of clinical networks where clinicians support and educate each other to keep pace with evolving evidence, to inspire debate, and to achieve the best possible outcomes for patients.

ECHO might have better functional videoconferencing technology than does the NHS (not difficult), but that only serves to highlight the lack of will to develop the best technology for, and by, the NHS.


  • Competing interests: None declared.


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