Intended for healthcare professionals

Letters NHS hierarchy disruptors

Project ECHO director responds to concerns

BMJ 2019; 366 doi: (Published 22 August 2019) Cite this as: BMJ 2019;366:l5157
  1. Max Watson, director of Project ECHO and consultant in palliative medicine
  1. Hospice UK, London WC1X 9JG, UK
  1. m.watson{at}

Mann highlights concerns about liaison between primary and secondary care expressed by general practitioners across the United Kingdom in these days of ever increasing pressure.12

As a GP, I hugely valued the opportunity to learn from and be supported by my colleagues at the local district general hospital on Friday lunchtimes. Sadly those days have all but disappeared across the UK as the demands on practice have exploded. My hope is that, for some, ECHO could provide an opportunity to regain a little of that major loss by enabling regular contact and helping rebuild trust between primary and secondary care.

One of our recently started ECHO networks, called Mind the Gap, links a district general hospital with its primary care community with the specific goal of improving understanding of problems on either side of the referral-discharge interface. ECHO is committed to building trust and support through collaborative problem solving across such interfaces rather than any particular software package.

There is no financial cost of engaging with Project ECHO, which has been supported by philanthropic and government funding in the UK. The approach has been helpful in a wide range of countries and healthcare systems across the globe.

The ECHO patent, about which Mann expresses concern, is not linked to any particular videoconferencing software nor is it focused on preserving the commercial success of Project ECHO. The patent was taken out to prevent ECHO from being used by those who would seek to make commercial capital out of the methodology.

If in the future nobody remembers the name ECHO but the movement has encouraged a more collaborative, networked, and less siloed way of caring for patients in our hard pressed NHS, that will be a huge success for ECHO in the UK.


  • Competing interests: I am director of Project ECHO at Hospice UK.


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