My thread on primary care in Spain generated a rich debate about continuity & scale. Continuity is a key part of effective primary care but there are different ideas about what it is, who needs it or when it is needed. Loads of great insight – here's a sample 🧵 RCGP have a good paper on this rcgp.org.uk/getmedia/11f26… but it takes 2 pages to define it & 2 more to discuss who it applies to best. H/T
@keithgrimes

Some findings from last weeks visit with a @WHO_Europe team to look at primary care in Spain 🇪🇸led by @melittajakab and @TomasZapata111 with @OBritoFernandes @SaraCalderonL @medgonfuen Dionne Kringos @AnaBelenEspino2 and @JosCerezo14 – quick thoughts 1/16 Primary care in Spain is seen as very good with well trained staff and (at the moment) public confidence. It has an extensive scope of practice with large multidisciplinary teams. Individual patient lists for doctors are a good feature for maintaining continuity. 2/16

Recent use of healthcare by people I know - much of their poor experience caused by a basic failure to organise things effectively. Healthcare is very complex but some of the things that don't work are amenable to basic management and admin. Why is this? Possible hypotheses: It's not (just) the application of well meaning amateurism that characterises the British approach - these problems exist elsewhere

From bonfire of the bureaucrats, to introducing a two-tier health system there is a lot of excitable nonsense doing the rounds about the NHS at the moment. Yet underneath this this is the reality that the health service is in deep trouble. Thread Rather than reaching for headline-grabbing solutions, here are five practical things the Government should do right now to help the health service and put it on a firmer footing

The columnists attacking the NHS don’t really have an explanation beyond clichés and lazy tropes about the NHS as a religion. Here are some hypotheses & more in the thread that follows 1/15

https://twitter.com/NuffieldTrust/status/1522553804369141760

Service deficits – long term underinvestment in staff, especially docs & nurses. Bed numbers are low doi.org/10.1787/ae3016… but rehabilitation, intermediate care and social care are not compensating for this as they do in e.g. Netherlands 2/15

Excellent thread here - I agree with the points Hugh makes so won't repeat them - a few additional thoughts 1/8

https://twitter.com/hughalderwick/status/1491454503291617281

2/8 The WP partially corrects the over-emphasis on health and social care integration vs within NHS integration in earlier policy, but as Hugh points out, is perhaps over optimistic about the scale of the task, and the time it takes nuffieldtrust.org.uk/research/putti…

Some thoughts on ideas on GP ‘nationalisation’ to reduce hospital admission floated by @sajidjavid and reported by @Smyth_Chris 1/10

TL;DR The evidence to support this proposal is poor Framing the goal of GP as being about reducing admissions represents a serious misunderstanding of the role of primary care. Better GP can reduce admission to hospital but defining its purpose as doing this misses its much wider role. 2/10

We are expecting a white paper on the NHS. Unlike in 2012, this time it has been greeted by consensus that reform is necessary. But it is striking that every reorganisation since 1974 contains the seeds of the next one 1/11 That’s largely because most reforms fail to acknowledge five key tensions in the way healthcare is run in this country. The urge is to do something radical in one direction, rather than learning to live with them. 2/11

I’ve been speaking to leaders in hospitals, community & primary care about the return to full NHS operations while living with the virus
nuffieldtrust.org.uk/resource/here-…
1/13 The logistical issues of returning the NHS to normal are daunting & the impact on its ability to operate at anything like pre-outbreak levels are profound & worrying 2/13

The furore over Primary Care Networks (PCNs) is a good example of the perils of national policymakers making detailed policy proposals on a complex issue. And the problems that have emerged were sadly rather predictable. 1/7
theguardian.com/society/2020/j… 2/7 Last year we ran a ‘premortem’ on PCNs with a group of experts to look at reasons why they might fail. We projected forward to 2025 (we didn’t anticipate that things might go so wrong quite so quickly).
nuffieldtrust.org.uk/resource/prima…

Let's put aside the usual question about their funders & use of data and take the argument on its own terms 1/9

I can agree the NHS has some significant dysfunctions and is burdened by its very centralised nature and the overly close involvement of politicians. .

https://twitter.com/iealondon/status/1159102111147266048

Having worked in really broken systems I can tell you that the sort of change that IEA advocate would require 1) a major expansion of staff especially doctors, nurses and other staff
You cannot have Swiss results with UK staffing levels

We hosted a confidential roundtable for experts & leaders working on the #NHS and #Brexit this week at @NuffieldTrust, thinking about how to monitor the impact of no deal and the hovering uncertainty around it. So many big issues - and some are still discussed alarmingly little! Medical devices face a bizarre no deal landscape. DHSC say they'll need to get their products signed off by EU based agencies gov.uk/guidance/regul…. But we heard these bodies are snowed under with implementing the new EU Regulation - can they really take on so much more work?

Ahead of the long term plan, what are the lessons from history from the 6 national strategic plans produced by the NHS over the last 20 years? Our collection of essays out today tries to answer this and here are some things I think are especially important. THREAD 1. Beware of optimism bias. The NHS has long been prone to unreasonable expectations about how quickly the system can deliver complex change at once. Does anyone remember the Better Care Fund promising to make emergency admissions fall 3.5% in just one year? (they rose)

THREAD: The PM is making a speech about money for the NHS and will be on #Marr tomorrow. It’s likely there will be a shopping list of reforms requested in exchange for the cash. But what have we learned about previous calls for reform in return for money? 1/9: When promising reform, don’t assume that all the new money can be used for new initiatives in the NHS. There is often a need to repair the foundations and plug financial and quality holes after years of underspending. More on this from @sallygainsbury on Monday

THREAD: We’re hearing about new NHS money to be announced soon. Watch out for some old tricks and ask what the announcement really means. Here’s a list from me and @sallygainsbury 1/9: Is extra money for the NHS for England or UK? If it’s UK deduct around 15% to get the figure for England