I used to love Yes Minister. The civil service is full of very clever and erudite people who are hugely creative. Their brilliance shines through in the guidance just issued to PCTs and clinical commissioning groups on strategies to achieve cost-effective prescribing. As it says in the widely circulated Chief Executive’s Bulletin, “This guidance reflects […]
Category: Martin McShane
Martin McShane: My nose is out of joint
As is my wont, I was skimming the BMA news and hovered over the “See one, do one” column about working and surviving as a junior doctor. It was a well written and entertaining piece about getting behind the real reason for a patient’s presentation. A youngish, male patient presented with nasal symptoms but, in […]
Martin McShane: The fossilisation of general practice
“If you take it to its logical conclusion, the Secretary of State will have to define exactly what primary care does – forever,” said the GP on the other end of the line. We were, of course, talking about the white paper. This GP has been at the forefront of redesigning services, leading colleagues into […]
Martin McShane: The boa constrictor of bureacracy
Another request for “urgent” reporting pinged into my inbox today. It is the third or fourth in as many days. At least two were asking for identical information from different people, for different templates. The desire for central reporting is incessant and has not lessened one iota since May. If anything, it has increased. My […]
Martin McShane: Is there such a thing as evidence based management?
I grew up as a clinician during an era when evidence-based medicine, as a concept, penetrated the consciousness of the professions. Nowadays, one of my favourite meetings, which I chair, is PACEF (a pan health community Prescribing and Clinical Effectiveness Forum). It is regularly attended by clinicians, including GPs and consultants, to dissect, debate and […]
Martin McShane on boundaries
“How much does the PCT spend on healthcare for people over the age of 65?” the telephone caller enquired. An impossible question to answer accurately, but after a moment’s reflection I suggested applying the Pareto principle. Most of our money is now consumed by long-term conditions management or, is it fair to say, mis-management. A […]
Martin McShane on volcanology
I set off on holiday in early July. Part of the trip included a visit to a volcanic island. It is awe-inspiring to see how central eruptions from the volcanic crater would, intermittently, over the years send out huge streams of lava which completely reshaped the landscape. Trying to predict what will happen when an […]
Martin McShane: The money
I was at a conference, struggling with one of those sharp sticks on which a bit of chicken was impaled whilst holding a plate of food in the other hand, when I noticed a short, bald bloke checking out the conference buffet. It was Greg Dyke. He had come to talk to about 250 managers […]
Martin McShane: Trust
Decades after it was introduced, the impact of fundholding still resonates. Many GPs hanker after the influence it brought, the way it made the big providers in the system sit up and take notice of primary care. My own experience, as a GP at the time, was one of quality improvement. Suddenly, we could directly […]
Martin McShane: Paragraph 142, page 33
The non-executive asked a simple question; “Why can’t we just say no?” In the world of business they inhabit, this is a rational question. We were on one of our regular board development sessions. I had been endeavouring to explain why we were pursuing a particular course of action. Reasonably, but with a modicum of […]