Pitstop plans

HSJ reports that the government will send in teams of surgical experts to 20 NHS trusts to improve theatre productivity. High-intensity theatre (HIT) lists have been used by Guys and St Thomas’ Foundation Trust to significantly increase the number of operations carried out each day.

According to an article in the journal Nature last year “This increase is achieved by meticulous planning and parallel processing of patient care on the day of surgery, aiming to minimise or eliminate turnaround time, minimise non-operative time and maximise operating time.”

The cost of living is very high in central London, and staff are more likely to volunteer for additional duties. This may be why HIT has worked at GSST and may well work at other central London trusts. We should not assume the same can be applied to rural DGHs in the North of England, say wise readers.

Source: Henry Anderson HIT teams to be sent into trusts to improve efficiency HSJ 25 September 2024 

UK’s next great social reform

On 15 November, Lord Falconer’s Assisted Dying for Terminally Ill Adults Bill will have its second reading in the House of Lords, in what he has argued is a step towards the “UK’s next great social reform”.

Given the prime minister’s past support for assisted dying, as well as his commitment – reiterated after the general election – to let MPs vote based on conscience, rather than party line, it is perhaps more likely to succeed than any similar bills that have come before it.

As this issue rises up the political agenda, there is a pressing need to explore the complexity of how assisted dying could work in reality. Too often people are pushed towards picking one side or the other of the debate, with the discussion reduced to broad arguments of individual autonomy versus the risk of harm to the vulnerable.

Less often explored is the uncertainty in implementing this kind of reform and the nuance in public opinion, as well as intricate issues around the nature of consent and how to best ensure patient safety.

Join the Policy Institute and the Complex Life and Death Decisions group as they reveal findings from new polling and tease apart principle from practice when it comes to the debate on assisted dying.

Assisted dying: principles, practice and politics:  Policy Institute Event 

 Wednesday 16 October, 19:00–20:30 BST, Bush House, 8th Floor (North Side)
30 Aldwych, London WC2B 4GB

https://www.eventbrite.co.uk/e/assisted-dying-principles-practice-and-politics-tickets

Hospital violence

An Italian nurses’ union called for the national public order and security committee to convene immediately and for soldiers to be deployed to halt a “dramatic” increase in attacks on doctors, nurses and other staff by patients and their relatives. 

In one televised episode in which staff barricaded themselves into an office of a hospital in Puglia, a group of 50 relatives and friends of a 23 year old woman turned on hospital staff when the patient died after an emergency operation.

Sources: BMJ 2024; 386 doi: https://doi.org/10.1136/bmj.q2008 (Published 13 September 2024) BMJ 2024;386:q2008

Home truths about General Practice

General practice is struggling in some places for lack of staff and increased demand for appointments. Practices vary from place to place, and services seem to run smoothly for one practice but painfully for its neighbour. 

To try and understand such variation News from Nowhere calls for explanations from its’ readers, starting with five home truths: 

1. Funding for general practice modernisation, available from the 1960s, did increase staff recruitment and limited improvement of buildings. GPs needed to contribute to improvements, which some saw as erosion of profits. The most advanced medical centres were developed in the LIFT programme, launched in 2001, but the coverage of the 11,000 practices of the NHS was limited.

2. New technologies (mainly imaging) have not been taken up by general practice, but the development of Electronic Medical Records (EMR) in general practice has outpaced the same development in hospital services.

3. “Demand Management” in various forms results in GP work being pushed away (limits to number of appointments) or diverted to other professionals (practice nurses, Associate Doctors, out-of-hours doctors). Productivity declines.

4. The growth of large group practices and the introduction of multi-disciplinary teams have occurred despite the evidence that practices with 6000 registered patients offer greater continuity of care, and have better clinical outcomes.

5. General practice lacks the professional heft to give it a leading role in the NHS, but claims are made for the discipline; “general practice is the beating heart of the community”. The Future of General Practice Parliament 2022

NfN moles are sceptical about general practice being the heart of a community, but no doubt there are positive as well as negative features of general practice. Send us your opinions and experiences!

Read more News from Nowhere and articles on the NHS in ERA 3 at