Clin Med
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There have been considerable changes in the NHS, medical science and practice in the last 25 years. This article describes the developments in general practice over this period. The increase in the primary healthcare team members and the improved premises from which they now practise has revolutionised primary care. Issues of considerable influence have been the movement of care once provided in hospitals into primary care, the use of computers, new technologies, enhanced training, changes in the demographics of the workforce, the hours general practitioners work and commissioning.
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Workforce planning in medicine is at best an inexact science and at worst a dark art. Over the past year it has become clear that several forces influencing the consultant physician workforce are coming into play at the same time. Many of these forces cannot be easily controlled, but their effects are predictable and thus can be prepared for. Recommendations are made as to how the issues raised should be addressed.
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It is now clear that women doctors will soon make up the majority of the medical workforce. Research shows that women often prefer part time and flexible working, and are inclined to favour some specialist fields over others. Although these facts are widely known, as yet it appears that little account has been taken of their economic and organisational consequences. ⋯ Women's preference for flexible working at certain stages of their careers could be a major advantage in health service planning; models need to be developed that recognise women's willingness to work in new ways. Although women are under-represented in positions of national leadership, there is no evidence to suggest that they are disadvantaged in their endeavours, or unwilling to deliver the commitment necessary. However, they may need timely advice and encouragement to reach their full potential.
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Cardiovascular disease is predicted to be a leading cause of death and disability worldwide for the foreseeable future. Observational studies link a variety of prevalent early life experiences (for example, smoking in pregnancy, child poverty) to increased risk of adult cardiovascular disease. Experimental animal studies suggest plausible causal relationships. ⋯ This has led to a general policy emphasis on prevention and early intervention. To date, there are few examples of the evidence base being useful in shaping specific policies, despite potential to do so, and some examples of policy misunderstanding of science. Minor changes to the perspectives of epidemiological research in this area might greatly increase the potential for evidence-based policy.