The Health service journal
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The health authority and trust proposals for Birmingham's health services, currently the subject of consultation, are radical, untested and uncosted. They assume that once emergency assessment and ambulatory care centres are operational, under half the current caseload will need inpatient stays. University Hospital Birmingham trust's proposal for a new hospital built and operated by the private sector assumes no growth in activity and a 17 per cent reduction in the present bed complement, at a time when emergency admissions in Birmingham are increasing by 5 per cent a year. Analysis of the proposals suggests they will destabilise an already precarious acute service in Birmingham.
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There is no evidence that the UK's pharmaceutical price regulation scheme is working. Arguments for abolishing it are that it is seriously flawed and inappropriate to today's health service, and that there are better alternatives. A regional drugs committee which makes evidence-based recommendations to GPs, could be a suitable alternative. The government should look to the experience of other countries and consult with healthcare professionals and the public before making any changes.
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Recruiting and retaining operating theatre staff is a constant problem for many trusts. One trust has introduced a pay supplement of 1,500 Pounds for all operating theatre staff, and is now planning to implement a single pay spine for all categories of operating theatre staff. The long-standing staffing difficulties suggest it is time to reconsider skill mix in operating theatres.
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Most initiatives to cope with increased winter workloads come from hospitals. The potential for co-operative efforts between hospitals and general practice is largely unexplored. One general practice, a total purchasing pilot site, plans to minimise the demand for emergency admissions by identifying patients at risk and having a nurse visit them in autumn to check their health. The practice estimates the project will be self-financing if it saves 12 admissions.