The NHS Healthy New Towns programme.

Health on the agenda in Scottish independence referendum

My Father and Mother Died at Home — Will Yours?

Sharing patients' records to boost medical research

UK doctors' anger over NHS cash crisis

Tackling the UK's alcohol problems

How high should it be?

Building the Genetic Counsellor Profession in the United Kingdom: Two Decades of Growth and Development

Medical EducationVolume 28, Issue s2 p. 3-4 Free Access Hospital Specialist Training: Implementing Calman * First published: Dec 1994 https://doi.org/10.1111/j.1365-2923.1994.tb04578.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat The three phases of medical education: basic, postgraduate and continuing, are under intense scrutiny throughout the world (World Federation for Medical Education 1994). The reasons are not difficult to discern. Technological advances have made therapeutic interventions effective and expensive, leading to increasing proportions of gross domestic products being devoted to health care. This in turn has created frustrations because of perceived gaps between the potential and achieved health gains for populations, in spite of the increasing investment in health care. In medical education, there are tensions between the desire to develop technical expertise through specialist experience and the wish to provide whole person medicine, which requires breadth in training. As the rate of change in medical knowledge and therapeutic interventions increase, there is a recognition that reliance on the apprenticeship model for postgraduate education assessed through the traditional forms of examination is an inefficient and unreliable model for producing competent doctors capable of continuing their professional development throughout their careers. This is the background and context in which the Working Group chaired by the Chief Medical Officer, Dr Kenneth Calman, seized the opportunity provided by the European Commission Directive on Harmonization of Specialist Qualifications to propose radical changes in postgraduate training in the United Kingdom for hospital specialists. The Recommendations of the Working Group cover the duration of training and the need for assessment as part of the educational process. The United Kingdom Government, in accepting the Recommendations of the Working Group, set a tight schedule for implementation and set major challenges for the institutions with interests and responsibilities in this field: the General Medical Council, the Royal Colleges and Faculties, Postgraduate Medical Deans and universities as well as the health authorities and National Health Service Trusts. This Supplement contains the papers presented at a conference organized by the Association for the Study of Medical Education on the ‘Implementation of the Calman Working Group Recommendations' held on 13 April 1994 and reports the discussion which took place. Over 140 doctors and educationalists from all over the United Kingdom attended. The conference was intended as a working meeting in which the ideas and proposals from some of the Royal Colleges, the General Medical Council and the NHS Management Executive could be presented and discussed. The Association for the Study of Medical Education (ASME) as organizers of the conference appreciate the open and frank way in which the College Presidents and others responded to the invitation to participate. Their willingness to share ideas and expose proposals on curricula to critical scrutiny at an early stage in their formulation is a very positive sign of the continuing constructive debate about the structure, content and assessment of postgraduate education. We hope the publication of this Supplement will itself stimulate further discussion about the fundamental changes in the practice of medicine in the United Kingdom which flow from the recommendations of the Working Group. These changes have relevance beyond the National Health Service and beyond the United Kingdom. The National Health Service is unusual in world terms on several counts. In this context it has been remarkable in matching the number of doctors in higher specialist training with subsequent career opportunities. One of the major questions to emerge in the conference is whether the reforms in postgraduate medical education can be achieved at the same time as restructuring of the National Health Service which gives a greater autonomy in manpower planning to individual hospitals and units. Countries in Eastern Europe and elsewhere will be watching to see whether relaxation of central planning controls can still accommodate systems which produce well-trained doctors in appropriate numbers. Footnotes * Hospital Doctors: Training for the Future. Report of the Working Group on Specialist Medical Training (Calman Report). 1993. Department of Health, London. References World Federation for Medical Education (1994) Report of the World Summit on Medical Education. Medical Education 28 (Supplement 1). Volume28, Issues2Dec 1994Pages 3-4 ReferencesRelatedInformation

Emergency Care Crisis in the United Kingdom and Ireland: Emergency Physician Exodus Looms in Wake of Pay Cuts, Staffing Shortages

This toolkit brings together those with first-hand experience of designing, delivering, evaluating and participating in a Longitudinal Integrated Clerkship (LIC) within a UK Higher Education Institution and those working closely on programmes focussing on Health Education England (HEE)'s and NHS England's national priorities. In August 2022, a collaborative workshop was held for students and tutors participating in a London-based LIC in 2021–2022, faculty with prior experience in running LICs, and HEE representatives. The aim of the workshop was to co-produce a toolkit to guide undergraduate institutions, who may wish to introduce an LIC within their medical school curriculum that aligns to these national priorities. Although this toolkit primarily focuses on a UK audience, we anticipate that other health systems facing a need for similar educational reform may also find use for this toolkit. The NHS Long Term Plan,1 the HEE Future Doctor Report2 and The Enhance Programme3 have outlined key national priorities for the future of health and social care (Figure 1), including how we can train our workforce to deliver these aims. These priorities include embedding generalist skills in early career doctors, so they can better provide person-centred care in the context of complex multi-morbidity, while considering the impact of deep-rooted health inequity and social determinants of health. They can better provide person-centred care in the context of complex multi-morbidity, while considering the impact of deep-rooted health inequity and social determinants of health. This toolkit has been written for medical schools but may also be beneficial for other undergraduate and postgraduate health educators, who are considering setting up longitudinal educational programmes to meet their local and national health and workforce priorities. This document may also enable health and social care providers and third sector organisations, who are partnering up to support educational programmes, to better understand how longitudinal courses may benefit their health priorities. Currently, undergraduate and postgraduate training is fragmented in its provision of educational supervision and patient care. The lack of continuity of relationships with patients, supervisors and peers, can make it harder to effectively address the increasing complexity of multi-morbidity at an individual and population level. Because this fragmentation continues in the educational experience of postgraduates, it has a domino effect on undergraduates placed within those fragmented clinical settings—it becomes easy to see how this cyclical lack of continuity could perpetuate workforce burnout and poor retention.4, 5 This cyclical lack of continuity could perpetuate workforce burnout and poor retention. There is also a need for the future workforce to better understand the effects of health inequity, both at an individual and community level. It is well-recognised that certain groups of patients have poorer health outcomes than others.6 However, a deeper understanding of local population health priorities is difficult to achieve within our current, fragmented teaching and training programmes and instead requires being embedded into a community over a period of time. A deeper understanding of local population health priorities is difficult to achieve within our current, fragmented teaching and training programmes and instead requires being embedded into a community over a period of time. LICs (Figure 2) are an ideal educational model to address the issues of fragmentation of the student experience, and the need for students to have a better grasp of local population health. LICs place a greater emphasis on continuity for students and patients,7 greater responsibility for patient care, with more rewarding outcomes for students/trainees, and their patients and communities.8 Furthermore, many of the LICs in the United Kingdom are based in primary care,9 which provides a fertile ground for students to develop meaningful longitudinal patient relationships, and allows students to be embedded within a local community. The discussions within our workshop were informed by the existing literature on LICs which provides an international lens on how to develop LICs, what benefit they can provide, and their pitfalls.10-12 This toolkit builds on this literature with our lived experience within a UK health care and higher education environment, and aims to re-frame the importance of LICs as an educational model that better aligns to new integrated care priorities in the United Kingdom. For consistency in this toolkit, we use the term 'Longitudinal Integrated Clerkship' as it is most commonly known within the literature. However, there is debate about whether this term is relevant to the UK context and whether a more general term such as 'longitudinal placement' would better capture what currently exists and is achievable within the UK landscape.13 Design & Development of an LIC Evaluation and Research of an LIC To ensure an LIC that is sustainable, it is important to identify and consult with key stakeholders from the outset. Consideration of your institution's culture will also be important to ensure the success of an LIC, particularly with regard to the assessment process and how the LIC will be perceived within the hidden curriculum.14 A co-created mission statement for your LIC can help to ensure that all stakeholders are on the same trajectory. The overarching aim of your LIC is likely to depend on your local context. For example, in your local area, a main driver may be the need to address workforce recruitment and retention. Alternatively, addressing health inequity within underserved communities in the local area may be your main driver. When considering learning outcomes for your LIC, these can be considered under the headings of educational and health outcomes to ensure mutual benefit for those served by health systems and educational institutions. Similarly to a programme's mission statement, LIC outcomes are best defined with input from educational, health and community stakeholders. Investment at this stage from all stakeholders will be important as there may be conflicting priorities that will need to be worked through. Educational outcomes should align with the broader priorities and values of your institution, as well as national priorities, such as the Medical Licencing Assessment and those from HEE. Creation of a curriculum blueprint will be useful at this stage. Health outcomes would consider NHS policy documents (such as the Five Year Forward view), as well as local policies relevant to health context. The success of an LIC will depend on how the principles of the longitudinal model are adapted to fit with existing educational and service delivery models in your institution and local area. While there are existing frameworks of what an LIC might look like, these are based on the international literature, and local context should be considered for the successful delivery of an LIC. For example, from current literature, an LIC should be long enough for students to establish meaningful relationships, and Worley et al. suggest that an appropriate length of time should be from 6 to 12 months.15 We would suggest the length of time should be conducive to students having repeated encounters with the same patients, educators and peers to maximise relationships. There is no formal consensus on how 'repeated encounters' should be defined but the aim is for students to experience patient care over time in different settings with different health care practitioners. Facilitating sustained patient–student partnerships across the course of an LIC lies at the heart of this educational model. It is through these partnerships that mutual benefit can be garnered. The aim is for students to experience patient care over time in different settings with different health care practitioners. Table 1 outlines some important factors to consider during the design of your LIC. Consider the overarching outcomes of your LIC. Use this to decide what stage of medical school it is best delivered in. Early years E.g., Key LIC outcome = deeper understanding of the health inequity and preventative care for your population. You may wish to introduce these foundational concepts via an LIC at an early stage of clinical training, when there may be more curriculum space to dedicate to these concepts, and students are establishing their values around health equity. Later years E.g., Key LIC outcome = enhancing preparation for practice in line with national priorities In this case, the LIC may be better suited for those who are about to graduate New medical schools or those undergoing curriculum review may wish to implement an LIC for an entire cohort Medical schools with an established curriculum could pilot an LIC with a small group of students, with a phased roll-out in future years, allowing for improvements in your model if you fully roll out. Or there are many LICs that are small cohort student-selected programmes. If do you choose to run a pilot LIC, consider how you will advertise and recruit prospective students. The format of an LIC can vary internationally. Within the United Kingdom, LIC structure can range from a full time LIC to 1 day a week. Also consider the balance between Consider if your original LIC outcomes can be achieved in your chosen format and whether you can evaluate and assess these outcomes (see below for evaluation and assessment) within the constraints of your given structure. LICs can take place in a variety of settings with one setting usually acting as the main base for student learning Adequate supervision ensures clinical and educational safety for students and the patients they care for. This is an important consideration across all clinical settings. Also consider how undergraduates and postgraduates, and students from different health professions within the same learning environment can be brought together to enhance learning for both groups, e.g., through group supervision, tutorials or patient care. Assessment should be considered from the outset of LIC planning to ensure there is alignment with learning outcomes, as well as medical school and national assessments. Consider How and when these assessments will be reviewed should also be factored into the timetable for students and supervisors. LICs are likely to require a shift in mindset and logistics from the existing culture of learning at your institution, not only from the perspective of students, but also placement supervisors and central faculty. Adequate support for all relevant groups will help to identify early teething problems and ensure smoother transitions during implementation (see Table 2). With any educational intervention, particularly one that is new to an institution, there will be multiple reasons to collect data. For future iterations of the course, it is important to establish what worked well and what could be improved. Broadly, this type of data would be regarded as evaluation. Additionally, different stakeholder groups will have particular outcomes they are interested in, and these data might fall under the category of research. When deciding what data to collect, it is worth looking back at the primary LIC objectives, and planning from the outset how evaluation will be conducted and data collected, alongside the design and development of the overall LIC. This will help make early decisions regarding why the data are being collected, when and from whom, and ensures timely ethics and funding applications. Reviewing the existing literature at this stage will help shape both the LIC and your evaluation and research questions. Kirkpatrick's hierarchy can be a useful heuristic when considering what type of data to collect—for example, collecting qualitative data from different stakeholders on their perceptions and experience of the LIC. You may also choose to collect specific quantitative student or patient outcome data. When deciding who to collect data from, consider the whole range of stakeholders. For example, if a key aim of your LIC is to improve patient access to health care in your local area, it would be important to hear from patients themselves on their experiences. When deciding who to collect data from, consider the whole range of stakeholders. While data are often collected to look at what additional value an intervention provided, it is equally important to ensure no harm has inadvertently been inflicted on stakeholder groups in the process. This is also something to consider when deciding what parameters should be evaluated. The timeframe of data collection is also an important consideration. In keeping with a longitudinal process, some research questions may be better answered by looking at different points across the course, to capture how data change over time. When writing up and presenting data, consider involving all stakeholders in this process. It would be worth looking at presenting and publishing avenues that reach a broad audience—for example, health care arenas, patient and community facing publications, and medical educators. The future health workforce will require new complex skills to manage increasingly complex population needs. Current undergraduate training needs to consider how it is preparing future graduates to develop the skills needed to adapt to the rapidly changing health care landscape. An LIC places continuity and integration at its core and is an ideal educational model to embed these key skills within the curriculum. This, in turn, could help prepare our future workforce in providing person-centred integrated care that meets population need. This toolkit can be used to guide those considering educational reform in line with population need. Finally, it is the collaborative partnerships with students, policy makers, educators, and health and social care providers that will help ensure alignment between population priorities, workforce needs and medical education. Current undergraduate training needs to consider how it is preparing future graduates to develop the skills needed to adapt to the rapidly changing health care landscape. We would like to thank Mohammed-Hareef Asunramu, one of our LIC students, and Monika Gupta from Health Education England's London Enhancing Generalist Skills Team for their contribution to this work. The authors have no conflict of interest to disclose. No data have been used in this submission that would require formal ethical approval. All participants of our workshop have been listed as authors and have contributed and consented to the work.

BackgroundIn 2008 Department of Health commissioned nine the ‘Healthy Towns’ (HT) in England to implement and evaluate community-based environmental interventions to prevent obesity. Healthy Towns were encouraged to test whole-town...

The core reform of the British National Health Service (NHS) was the establishment of a quasi market with a split between purchasers and providers. Health authorities and general practitioner (GP) fundholders were to be discriminating purchasers seeking more efficient and responsive services. This market orientation was embedded in a larger context of managerial, allocational, public health, and primary care changes. This paper reviews the background and dynamics of these modifications and offers an early assessment. There is evidence that the reforms have unleashed much energy, activity, and thoughtfulness about future health care, but it remains unclear whether the gains justify the increased administrative and other transaction costs and potential threats to equal access.

In this report the Labour Party give its view of the current status of the British National Health Service (NHS), and outlines its plans for the NHS under a Labour government. The values underlying the NHS - comprehensive health care, free at the point of use, based on need rather than ability to pay - have been betrayed. The truly national health service, created by a Labour government in 1948, has been replaced by a market-based service led by accountants. Patients are suffering, health care professionals are dissatisfied, some of the nation's finest hospitals are closing, community care is in chaos, and NHS dentistry has all but been privatized. Under the Tories, the NHS faces a future of privatization, competition, and markets, money wasted on bureaucracy, and the unfairness of a two-tier system. Under Labour, the NHS faces modernization, planned progress, money spent on frontline services, and excellence for all. Labour will follow a model of health care that is patient centered and community led, a properly coordinated and efficient public service.

Sharpening the global focus on ethnicity and race in the time of COVID-19

BackgroundEnduring ethnic inequalities exist in mental healthcare. The Covid-19 pandemic has widened these.AimsTo explore stakeholder perspectives on how the Covid-19 pandemic has increased ethnic inequalities in mental healthcare.MethodA qualitative interview study of four areas in England with 34 service users, 15 carers and 39 mental health professionals from NHS and community organisations (July 2021-July 2022). Framework analysis was used to develop a logic model of inter-relationships between pre-pandemic barriers and Covid-19 impacts.ResultsImpacts were largely similar across sites with some small variations (e.g., positive service impacts of higher ethnic diversity in area 2). Pre-pandemic barriers at individual level included mistrust and thus avoidance of services and at a service level, the dominance of a monocultural model, leading to poor communication, disengagement, and alienation. During the Covid-19 pandemic remote service delivery, closure of community organisations, and media scapegoating exacerbated existing barriers by worsening alienation and communication barriers, fueling prejudice and division, and increasing mistrust in services. Some minority ethnic service users reported positive developments, experiencing empowerment through self-determination and creative activities.ConclusionsDuring the Covid-19 pandemic some service users showed resilience and developed adaptations which could be nurtured by services. However, there has been a reduction in the availability of group-specific NHS and third sector services in the community exacerbating pre-existing barriers. As these developments are likely to have long term consequences for minority ethnic groups’ engagement with mental health care, they need to be addressed as a priority by the NHS and its partners.