Intended for healthcare professionals

Editor's Choice

Innovative solutions can help repair the NHS

BMJ 2023; 380 doi: (Published 26 January 2023) Cite this as: BMJ 2023;380:p187
  1. Rebecca Coombes, head of journalism
  1. The BMJ
  1. rcoombes{at}
    Follow Rebecca on Twitter @rebeccacoombes

Amid the collapsing NHS, “we can’t carry on as we are” is the mantra repeated by patients, professionals, and the public. Some have jumped the gun with solutions. Wes Streeting, the shadow health secretary, proposes phasing out England’s GP partnership system (doi:10.1136/bmj.p134).1 Blunt and misguided? Yes. But, faced with the immense challenge of running health services in a post-pandemic world, Streeting is not alone in calling for new solutions rather than continuing with the traditional ways (doi:10.1136/bmj.o2455).2

With shrinking numbers of GP partners, general practice has had to adapt to survive, in some places with mergers to create “super-partnerships” (doi:10.1136/bmj.p134).1 Some practices have been brought under the control of NHS trusts or corporations.

In the acute care sector, surgeons, faced with the immense task of clearing record waiting lists, are turning to novel solutions to treat more patients than before the pandemic (doi:10.1136/bmj.p162).3 “If we need 130% activity, something’s got to give,” says Neil Mortensen, president of the Royal College of Surgeons (doi:10.1136/bmj.o2455).2 Surgical hubs, which ringfence beds and resources for elective surgery, are gaining support. Overlapping surgery, or “high intensity theatre,” is getting results, allowing one trust to do the equivalent of a month’s operating in a day. Smarter scheduling and a focus on getting the basics right are also delivering.

These solutions are never one size fits all. Low complexity operations are a good fit for drives to clear waiting lists, but what about the patients who are excluded (doi:10.1136/bmj.p162)?3 For example, 50% of people aged 65 already have multiple comorbidities. In the UK nearly half of patients having elective surgery that needs an anaesthetist are older than 65.

Future models of healthcare are emerging, but we can’t just leave it to innovative doctors, hospital leaders, or the market to generate ideas (doi:10.1136/bmj.p134).1 Instead of presiding over piecemeal change, governments need to take an active role in putting services on a sustainable path. Policymakers should listen and learn from staff and patients and articulate a positive vision, instead of starting with business models and contracts.

Some new ideas may not survive being held up to scrutiny: regular prostate specific antigen tests for all men over the age of 50 (doi:10.1136/bmj.p168),4 hydration stations for staff (doi:10.1136/bmj.p164),5 national alerts to patients without any assessment of their effect on the health service (doi:10.1136/bmj.p136),6 and assessing all people with more than a 5% risk of heart attack or stroke in the next 10 years for statins (doi:10.1136/bmj.p168).4

Other ideas promise to take us forward to a better future. Shared digital medical records—or a “single version of truth”—that are accessible to all health and care clinicians are edging closer to reality and have the potential to substantially reduce medication errors (doi:10.1136/bmj.o3068).7

BMJ Appeal 2022-23

Thank you for all your contributions to this year’s BMJ appeal. Your support for the International Federation of Red Cross and Red Crescent Societies means more help for the world’s poorest people this winter. In this last week of the appeal please keep donations coming (doi:10.1136/bmj.p141).8