Medicine and Science from The BMJ

Telephone consultations - no cost savings, but increased GP workload

If you're a patient in the UK, increasingly, your first interaction with the healthcare system won't be the traditional face to fact chat with your doctor - instead you'll have a telephone consultation.
The prevalence of these telephone consultations is increasing, and being promoted by CCGs and private companies who administer them - usually as a cost saving measure.
Now new research published on bmj.com looks at these phone consultation - how often they happen, how patients feel about them, and how much money they actually save.
In this podcast we're joined by Martin Roland, emeritus professor of health services research at Cambridge University, to find out more.
Read the full research:
http://www.bmj.com/content/358/bmj.j4197

Selling off NHS silver?

Should we welcome plans to sell off NHS land?
The government seems likely to back the recommendations of Robert Naylor (national adviser on NHS property and estates) to raise capital by selling off inefficiently used assets, but Kailash Chand (GP) worries that services could be threatened and that public consultation is lacking.
Read the Head To Head article: https://www.bmj.com/content/358/bmj.j4290

What Choosing Wisely looks like in the UK

Choosing Wisely was launched in the US, to much fanfare. Since then the movement has spread around the world, with successful chapters set up in Canada, Australia Brazil, Italy, Japan, new Zealand - and most recently the UK.
The campaigns have not been without criticism – from how individual recommendations were chosen, to the way in which patients have been involved.
In this podcast, we're joined by joined by 3 of Choosing Wisely UK’s steering group, professor Sue Bailey, head of the steering committee, Ramai Santhirapala, honorary consultant in anaesthesia and perioperative medicine, and, Richard Lehman, GP.
http://www.choosingwisely.co.uk/

Diabetes remission - ”treating blood glucose, when the disease process is to do with body fat”

In the UK - type 2 diabetes now affects between 5-10% of the population - and accounts for around 10% of our total NHS budget. For the individuals affected, treatments are effective at helping control glucose levels - however, the sequela associated with the disease - vascular problems, and a life expectancy that’s 6 years shorter - are still an issue.
However, for some, remission seems to be a possibility.
To discuss we're joined by Mike Lean, professor of human nutrition at the university if Glasgow, and co-author of an analysis, published on bmj.com, which impels doctors to make sure that type to diabetes remission is coded properly.
Read the full analysis:
http://www.bmj.com/content/358/bmj.j4030

The problems with peer review

One of the hurdles that anyone who submits research or analysis to The BMJ has to deal with is peer review.
The problems of the process, and some of the potential solutions, was a big part of the Peer Review Congress which took place last week.
In this interview, Sophie Cook, The BMJ's UK research editor, talks to Lisa Bero, who’s a professor of evidence based medicine at Sydney University, and spends a lot of time investigating the integrity of health research.

HIV in pregnancy - ”without the big picture, people aren’t going to be able to take the medication”

A new Rapid Recommendation from The BMJ suggests that for pregnant women, they may wish to avoid certain antiviral treatments for HIV.
This recommendation differs from the WHO's, and to discuss why that is, and what makes that difference important, we're joined by Reed Siemieniuk, a physician and methodologist from McMaster University, and Alice Welbourn, campaigner for gender and sexual and reproductive health rights, in the context of HIV and violence against women.
Read the full rapid recommendation:
http://www.bmj.com/content/358/bmj.j3961
And Alice Welborn's opinion article:
http://blogs.bmj.com/bmj/2017/09/11/alice-welbourn-who-and-the-rights-of-women-living-with-hiv/

Googling depression

In the USA, when googling "depression" patients will be presented with a link to the PHQ-9 screening test.
Google has developed this in collaboration with the National Alliance on Mental Illness - and Ken Duckworth, the alliance's medical director, debates the merits of this approach with Simon Gilbody, from the Department of Health Sciences at the University of York.
Also joining this podcast is David Gilbert, mental health services user and director of InHealth Associates, who argues that it's only through patient involvement that real improvements to mental health can be obtained.
Read the debate and commentary:
http://www.bmj.com/content/358/bmj.j4144
http://www.bmj.com/content/358/bmj.j4207

Nigel Crisp - The NHS isn’t just a cost to society, it’s a benefit

If you google "The NHS" you'll see screaming headlines from the Daily Mail about cost and waste - debate in parliament is about how much of our GDP we should be spending - and each year, hospital trusts go cap in hand to ask for more funding.
Against this backdrop, a new analysis, and a first in a series, published on bmj.com, looks at what it takes to have sustainable healthcare - and cruically, talks about this from the point of view of benefit, not cost.
I'm Duncan Jarvies, and I'm Navjoyt Ladher, and today we've come to the House of Lords to speak to Baron Nigel Crisp - cross-bench peer, former NHS trust executive, and health system guru.

The World Bank - creating a market in pandemic risk

The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds.
A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover;
Why the World Bank matters to global health
The World Bank’s turn to Universal health coverage
How the Bank’s trust funds are being used to fund specific projects - and why it’s hard to know what those are
The Global Financing Facility - grants and loans supplied together,
and finally, creating a market out of pandemic risk
In this final interview, Felix Stein a postdoctoral research fellow at the University of Edinburgh describes the bank's move to create a market for pandemic insurance.
Read the full analysis:
http://www.bmj.com/content/358/bmj.j3397

The World Bank - the Global Financing Facility

The world bank was set up in 1944. In the aftermath of the second world war, the institution was there to give loans to countries rebuilding after the conflict. Their first loan went to France - but with stipulations about repayment that set a tone for future funds.
A new series, authored by Devi Sridhar, and her team from the University of Edinburgh, and published on bmj.com, looks at where the World Bank has come. The series is , and the articles will cover;
Why the World Bank matters to global health
The World Bank’s turn to Universal health coverage
How the Bank’s trust funds are being used to fund specific projects - and why it’s hard to know what those are
The Global Financing Facility - grants and loans supplied together,
and finally, creating a market out of pandemic risk
In this fourth interview, Genevie Fernandes a PhD student at the University of Edinburgh discusses a new model of combing grants and loans in the Global Financing Facility.
Read the full analysis:
http://www.bmj.com/content/358/bmj.j3395