Sunday, March 18, 2018

One Tribe...

This year I walked into the London EXCEL on a Tuesday morning with interest…the annual diabetes conference….was it to be more of the same or something different? Diabetes has had a reasonably good year- especially when you compare it to other areas- be it in the extra money to improve care, spread the type 2 diabetes prevention programme, a move into the sphere of digital technology…as well as on the background of studies such as DIRECT- its been interesting times. So how would that translate into on the ground- how would the general health care community feedback on that?

Tuesday started with the trainees day- and I have rarely been surprised at the ideas our trainees can bring to the table- if "Allowed". Tuesday was no different- a particular session where we asked trainees to come up with a few ideas to improve safety was fun along with being informative- and the plan is to take a few of those forward-with the folks who formed the ideas- involved in it. Who knows where it takes us- but the issues around blood sugar alerts to flag potential safety issues or indeed increasing better access to preconception advise…well, we have talked about them long enough- maybe with trainees involved, we can do better or at the least, improve the variation on this.

The next few days- to be honest- were a blur- and at the end -mentally, I felt fatigued, tired..yet perhaps quite happy.
A few things stood out- Simon Stevens, the NHS CEO announcing 40 million £ to continue the work done so far in 2017/18 was a big plus- but more poignant was him calling me and Jonathan Valabhji on stage to sit next to him as we took questions from the audience. A very clear signal of intent- as well as support if there ever was one- as well as showing the relation the diabetes team shared with the top tiers of the NHS.

Other things were moving things forward as regards the relevance of education- and a big shift towards the community backing initiatives being done so far- and further appetite for more. Talking to many companies as well as individuals, it was clear that many were keen on also looking at variation of professionals education- for example in the field of technology- and it was much pleasing to see all concerned happy to work as one pack-rather than as separate entities

Kind words from luminaries such as Andrew Hattersley, Gerry Rayman, Roy Taylor, George Alberti, Stephanie Amiel, Kamlesh Khunti, Melanie Davies et al stood out- and perhaps the biggest vote of confidence the national diabetes team needed from a professional perspective. It was also personally pleasing to hear the words- sometimes, it helps to heal the wounds this job creates too. A hug from Pratik & Emma meant a lot too- sometimes friends don't need to say much more.

It was a privilege to be able to introduce Mayank and May for their respective lectures- inspirational leaders whose never-give-up attitude sums up their successes- and more strengths to their arms too! Hope they inspired another generation too- at the end, its not just the money, the algorithm or the policy- its the drive of individuals -open to working with those living with diabetes- which opens the door to success too. A workshop- standing in for Jane Speight- along with Bob Swindells was fun too- as well as giving the #LanguageMatters group information we can use for the national document in the pipelines.

And then of course, there was the #DUKPCInsider event. I won't say much about it- simply because to me, this is fundamental to me learning- as well as improving care. Whether it be the TAD events or Rise of the Machines, working with those who live with diabetes has been a key thing for me- and part of my professional development. It was an honour to be invited, to talk with Chris Aldred aka Grumpy Pumper- as well as take questions from the audience. To me, the strength I get from encouraging words from those living with diabetes- negates in a flash any negativity from professionals or industry.

Finally? A big personal thanks to Chris Askew and in his team in Diabetes UK- who have landed this conference with the added insider day. There indeed was a good buzz- and the right challenges seem to be being laid to all. There was  a lot of positivity- and hopefully people will take that back home- and renew their battle to improve care. And we, in NHS England Diabetes team- are here to help. Just ask.

Will leave you with a few links of interest:

1. Technology & Diabetes: Link to best practice as regards Insulin Pumps etc:
Under Emma Wilmots guidance, I expect the DTN (Diabetes Technology Network) to be a game changer as regards technology access

2. Nurse specialists in Diabetes: A facebook group set up by Amanda Epps from Medway for Diabetes Nurse specialists- feel free to join and exchange ideas:

Thank you to all who made time to chat- and apologies to those who I couldn't give much time to. We take back home much to cherish…we must carry the momentum forward too.
We must be able to work together, channel all the passion we have- whether you are a doctor, nurse, carer, pharmacist, living with diabetes or in any way connected to diabetes.

And this year? I got the feeling, we just might x

Sunday, March 11, 2018

Balance of power

The jostling for power is probably one of the most fascinating things being played out in the world of health. Science, technology, anecdotes have collided in a most interesting manner- and if you throw in the usual hierarchy of healthcare, the cocktail is complete/

There are the academics- for whom their science is rigid, the randomised controlled trials being the one and only barometer of success; there are the super centre specialists for whom the bubble only extends to their own centres, their own selected patients, there are the decision makers who hop between being "totally supportive" to "not really" for evidence based material- based on the cost involved; there are the healthcare professionals who would like to have their bit funded the most- above all- as obviously their own speciality or profession is THE most important above all....and finally, there are those who live with X, Y and Z.

Lets face it...very rarely do the policy makers or indeed academics who create the studies stand up and face the patients face to face. Rarely are decisions to fund- or not- made with a patient in the room- ensconced securely begins a layer of bureaucracy, decisions are not that tough to make. Public engagement events to explain why X, Y or Z can't be funded? Rare as hens teeth. Mostly due to lack f cojones to be honest.

In the midst of that all, the landscape is slowly changing- and its fascinating to see it develop. Maybe its a generational thing but folks are starting to question "Why" a bit more. Reasons such as "I am a Professor and I said so" doesn't wash much- and quite rightly too. People are starting to make their own innovations, their own adjustments to their lives and asking the profession and system to fall in line. Its a bit like any disruption...started with a few rabble-rousers- ignored conveniently by the system...but as their numbers and voice have grown, the system is being forced to listen. Whether it be a policymaker, healthcare professional or industry, there certainly is a subtle change in the air.

The trillion dollar question is as a healthcare professional where does our role it to resist, deny those who live with a condition what they feel they need using the shields of evidence or do we encourage disruption? Or do we help them to change the paradigm of the system? My experience in 2 years of doing this is that evidence is an interesting term- used differently by different people- to justify the reasoning for inclusion or exclusion- based on their personal prejudice or politics.

Personally. I am all for change...mostly because the rigid way if "we know best" ain't seem to be working that well per se. We deny folks a technology, they find a way around it; we restrict them to diet X or diet Y, they find out what works for them and use it- more to the point, they then cascade that info to others- whether we like it or not. My fundamental role is to pass on information, ensure safety is maintained and at the end of it all, id the individual uses something that works, surely that's exactly why we do this job? So I am all in favour of guiding such individuals, encourage their own innovation...why indeed not? If it works, why indeed not.

I suspect at the end - it does boil down to power- how much one is prepared to "give up"- or whether you see this as a power thing at all. The power thing has always bemused me- and in spite of what impression social media may give you, Consultants have, still, a lot of power in the system. The question is whether we use it to facilitate what patients need - or to maintain the status quo of hierarchy. My personal experience and tip after 10 years? Use it the right way...the rewards are far more. Using it to obstruct patients or what they need because of what a trial- not applicable in real life- showed is silly. Or simply just delaying the inevitable.

In any business, consumers drive is just about starting to wake up to it...times are changing...the power base is indeed...shifting.

And may it continue to gather force and pace. Amen.

Tuesday, February 27, 2018

Letting go...

I will be honest…the last few months have been tough. And at times it has felt very lonely. The barbs, the comments, the critiques, the arm chair opinions, sometimes simply the blunt brutal comments- mostly to do with an effort to bring a new technology to the NHS has hurt. I have smiled- in the most but its felt lonely. And there have been evenings when I have sat down and wondered whether this is all worth it. I tend to have a casual approach to most things…but even all that can wear thin after the umpteenth shot across the bows from yet another fellow professional or expert. If the intention was to hurt, it certainly left its effect.

The saving grace in all this has been the diabetes community. In tough times, reading back some of the DMs or emails from someone I have never met has made me shake off the feeling of "why bother", put that flak jacket on one more time, battle yet another opinionated professional or manager within a CCG or even NHS England. And to all those who have asked why I embarked on the road to host an event which basically was encouraging the "rebels"- that pretty much was the reason. On Saturday just gone by, amongst many of those living with Type 1 diabetes, I felt at home, I felt happy, comfortable- and not having to do most things with my shields up, having to be wary of what would be interpreted in what way…I felt amongst friends. It perhaps is a telling tale of the NHS that in my last 18-20 months of doing the national role, the obstructions, the resistance has come from fellow NHS colleagues, not from those living with diabetes. Make of that what you want.

So Saturday was all about folks who were doing things…differently. I won't go through the details but if you fancy having a look at their presentations- have a peek here  Its -simply put- a different world- and something which could fundamentally change the game as regards Type 1 diabetes care goes. This is disruptive innovation at its finest- flipping on its head all conventional research, science and lobbing a stun-grenade into the world of diabetes technology. And the world is waking up to the concept of "OpenAPS"…no idea what that means? Have a look- here and take your time to absorb the level of disruption this can and is causing in the present world of Type 1 diabetes.

Is it for all? Nope. Could it be a game changer for some? Yup. The trillion dollar question is what we-as a system- do about it. Wait to see what happens? Wonder about the regulatory consequences for us rather than the patient? Or step into the breach and try and give some folks what works for them? Its clearly shaking up the industry- with companies looking at it; JDRF committing to it….could this be a big movement in science- or do we stay confined to what an RCT told us- and deny those who live with diabetes what THEY have come up with? Can we - or should we do that as people not living with diabetes? Do we become self appointed vanguards and make rules up to obstruct? Or do we do so more to protect ourselves rather than help the ones we undertook this job for?

It was fabulous to see all the relevant companies at this meeting- as well as the leading charities- and I am eternally grateful that they came on request. Its not an easy space for them to work in either- but they were there- and that is a big step forward for us all. It would be a travesty not to pay a huge amount of acknowledgement to Ben Moody and his super team at TechUK- without whom this wouldn't have happened.
And of course Tim Street- his energy is infectious- and frankly- I cant understand much of what he says- but what I do know? He knows how to look after himself- and he is dead keen to help others- and in my book? That deserves utmost respect.

Of course- who can forget Dana Lewis- all the way from Seattle- now there's a maverick and a half. I sat in silence- listening to her talk 2 days on the trot- and I had goosebumps listening to her drive and passion. I am honoured to know her- and be an acquaintance and who knows what the future holds? For now? A big thank you from me- you touched many hearts and inspired many- do come back again.

Finally? To many healthcare professionals out there…fear less- and perhaps worry less about "patients taking control". Trust me- its a good thing- it makes our job easier. Our job is to keep folks safe- not be vanguards of what they can or cannot have. If we genuinely want to improve diabetes care, self management is where it sits- however it is achieved…whether it is via an App, simple peer support or folks making their own algorithms. Be ready and feel comfortable about letting go; guide them as much as you can….the long term benefits are far more rewarding than anything else.

"Word cloud from "Type 1 Diabetes: Rise of the Machines"

Saturday, February 17, 2018

A Viennese whirl

Vienna. A short hop from the UK- and an effort to get some continuous professional development attending the Advanced Technology and Treatment for Diabetes.  I attended this event- just to get some education update- as well as take an overview from a policy point of view. Whats feasible for the NHS? Beyond the shiny tech, beyond the dazzle and dazzle, where in sits the technology which may benefit the many, not the few?

I must say I came back with mixed feelings- as well as reinforcement of some views I have held for a long time. To begin with, a slick, well organised event- and a pleasure to meet Tadej Battelino who along with individuals such as Moshe Phillips have been a driving force behind it. A great event to showcase the latest advancements in technology and the differing approach many other countries have towards it. The bias towards data we may or may not have, the little silos we work in, the strong beliefs we have….they were all on show- whatever be the country.

For me, it was a bit beyond that too- what- from a policy point of view- could work? Some of it felt like a technological world beyond the scope of many; some of it felt like the opinions of a few who lived in a bubble…a bubble of looking after certain groups of individuals, a bubble where other issues rarely pervade. The inherent strong views and "camps" of technology were stark- whether as a clinician one favoured Dexcom or Medtronic- whilst the aim perhaps should be to look at technology as a whole. We all benefit I suppose if we are not stuck in "camps" but hey ho, such is the world we live in. I also looked at, got told, was informed many times over about the importance of Continuous Glucose Monitoring or as as the parlance now should be "rtCGM".

Then there is the bigger picture of the world beyond Type 1 diabetes- or even diabetes itself. In the bigger context of things, and as someone who does work with patients of all types (yes, MODY too!) we perhaps forget context. Lets do some simple maths for you. I get pointed emails/tweets suggesting how rtCGM should be made available to all with Hypoglycaemia unawareness. Ok, thats about 15-20% of the Type 1 population- thats about 50-60 K folks- at a pop of £3K / year. Rough maths- but thats about 150 million£/ year. Take a pause. Yes, thats 150 million £.

And I haven't even added the staff cost to it. At the moment, we have about 5k folks on this tech in the country- so we are ready for an increase of that number? In a system where we are scared of patients actually taking charge? I mean I haven't even added up the numbers for those who are pregnant- as CGM would be fab for them too- plus to put that approx 150 million£ / year into context, we -after a serious degree of "making the case" got 42 million£ for the WHOLE of diabetes care in the UK. And Type 1 diabetes is about 10% of the whole diabetes population

Lets even say we make the argument- as the benefits all "bear itself out" in the future- but answer me this…if we did make the argument for 150 million£ with the department of Health and NHS England…did you want to invest that into better safety in hospitals? Or go wider- and look into better lifestyle choices? Or mental health? Or better community support? Or more practice / district nurses? Or better managers? Or better social care? Or improve inequality? Not easy, is it? When you start looking beyond your super-centre or your own super specialised silo of work…demanding that money doesn't look as easy, does it? Neither does it when you are a patient champion or an expert patient…do you champion your own "bit" or do you make tough choices as the elderly frail person at hoe needs better social care- and you give up on your championing of that "wonderful tech" for the greater good?

Tough call, isnt it? Hurts a bit too, no? And how fortunate are many that these choices are not ones you have to make. That role falls on the policy makers- and the burden of that we live with too. So shall I give you the good news? The good news is that the tech access is possible- some of it will depend on companies who also need to have a reality check about their prices and where it sits as regards the NHS. Simply saying we have a premium product and thus our price is premium isnt good enough- its a balance…if you do want to genuinely help patients, it cuts both ways. There also- is perhaps - just about enough money within overall diabetes budgets to do much more than what we do- and yes, I include access to 670G pumps, G6 sensors or whatever else is the latest tech in town

The not so good news? I am not convinced the UK is ready yet- to make that level of change. Whether it be clinicians, industry, charities or patient champions/experts, there needs to be much better unity than at present- lot less sneering, lot less siloed thinking, a whole lot less of "we know better than you"and a lot more of "lets see whats feasible"-rather than "how dare you don't do X,Y or Z". A long way to go yet- though a collective is slowly starting to build. It will be interesting to see where the next piece of work takes us. The whirlwind trip of Vienna was fun- but it was a mixed one too. As a clinician, the technology was exciting. As someone in a policy role, it was less so- with more of a worry about lack of coherence or perhaps unwillingness of super-specialists to look beyond their own views and thoughts.

A final thank you to the ATTD folks for their time and effort - lets see whether next year, we can share some stories of success from the UK regards uptake of technology. THAT is our challenge. Cos the best tech isnt the one which gives us papers in a journal or tick boxes in a CV but the ones which improves the life of someone living with the pathology.

We shall see.

Sunday, February 11, 2018

Being there

I have been asked this question a fair times now in the diabetes world- more so recently- and I suspect bar those close to me, most folks won't know the answer- and opinions are formed based on what they see in the public persona, social media, blogs etc.

The question has been simple (or in some cases, its been more of a statement..well ya know what the world is like nowadays…the smorgasbord of instant opinions and all that!) -"Are you a Libre-Man or a CGM-man?" Forgetting the basic fact that nowadays they are deemed to be the same thing-yet on a paradigm (not by me, I MUST stress!) its  silly question to start with- but I suspect warranted to an extent by my very public and open support for getting this technology to people with diabetes. Its also come with the usual conspiracy theories…"He must have been paid, No?" / "Does he have shares in Abbott?" / "He must be lining up a job with them"…I won't rehash all the reasons here- but it maybe worth all those characters taking off their tin foil hats for a moment. Nope- not paid, didn't have any of my research or MD/PhD work funded by them, nor do I have shares or taking up a job.

Do also please give me some credit and don't insult my intelligence to that extent- if I wanted to make money off this, I wouldn't really be so public about my support for it, would I? I have even had some clever clogs whispering "he is close to industry"- it makes me chuckle when you see that view from even within NHS circles- someone must have forgotten to pass them the memo about the  "NHS drive to work closer to industry" or even the role of AHSNs to work with industry to accelerate innovation". Ah well- a blog on that some time soon too.

So the answer to the question is….well..neither. I couldn't care less about whether its a Roche CGM or a Medtronic super-pump or a Dexcom whiz-product- or for that matter Libre. I don't think any of them are the panacea or something I must favour..if I believe in 1 thing- its about something that is more ethereal- its funnily enough, not a product.
Its something I was taught by some of my best tutors in life…and it ain't a super tech. Not some fancy insulin either…so let me share a personal view. I have been a Consultant now for nearly 10 years now- and I have had a few "success stories"- none, I repeat, NONE of them down to me or a whiz-tech. A fair few of my patients are active on social media- they can verify- but I have never done a clinic in my life offering someone a Libre or a CGM as a panacea. On the contrary I have only 1 simple rule of doing diabetes care..whatever be the type. It goes as follows:

"You don't have diabetes; You don't live their lives; You don't have the same socio-economic situation. Thus, you have no right to judge them"

Thats pretty much is it, to be honest. I talk a lot about Type 1 diabetes- but am equally passionate about Type 2 diabetes- about working for the population (Super Six Model-remember that?), about treating the individual, de-prescribing where needed, keeping the frail elderly safe, using the appropriate drug or diet what suits the individual- not my personal preference. Its stood me well- and I plan to continue to do so. Its not about the Libre or the CGM- its about being a guide in the persons life- providing them with the tools they need- whether that be education, peer support, just a kind word- or sometimes? Just keeping quiet.

The reason for championing Libre has been the principle of moving the paradigm from finger pricking to the next phase of innovation. I couldn't care less if it was called "Mickey Mouse"- or produced by a start-up company. For me, its the principle of shifting the care paradigm to the next phase- and that extends to every part of diabetes care. If we genuinely want to improve diabetes care. we need to be nimble, flexible, accept that what controlled setting such as trials tell us is not the gospel- but guides at best to help us. That we may need to rethink our strategies such as providing education only by face to face means -is the only way or that it an only be given after 6-12 months after diagnosis in type 1 diabetes. Lets face it, beyond a few chosen centres of excellence, diabetes care in the main is about "You have diabetes; sorry thats a bit shite; here are some leaflets; An education programme on a set day: see you in 6-12 months". The person is left with their diabetes…alone, looking for direction, friends, support- but we as a system resist change…because? Evidence says we must do it in only 1 set way- damn the fact that not many are coming to the protocolised versions of education sessions or clinics.

So- no- I aint in any camps- fact of the matter is- past the Libre- I am also starting to spearhead the CGM work (I bet the next query would be why I am supporting CGMs and not education!)- as much as working on individualised targets in the elderly- or championing different style of education programmes. They ALL matter to me- they all mean improving self management for those living with diabetes, keeping them safe….its not that tricky - we don't need to fit ourselves into boxes, we just need to see ourselves as support for those on their journey with diabetes.
I appreciate how tough that is as a professional, how tricky it is to let go of that control (thats not what our training teaches us)- but all I can say? That is what brings the best results- for what its worth- 10 years of being a Consultant has taught me that- as have my patients.

Go on- do give it a try. Just try and be there. It makes for much better diabetes care. And oh- easy on the conspiracy theories. Much better time spent on improving diabetes care. Honest.

Sunday, February 4, 2018


This blog- for the first time, I will take this opportunity-to even the few who read my blog- to consider something-just as a favour.
Its for something which has made me think. Made me think of perspective. Made me think in the context of the job I do, the specialty I work in, the efforts I try to bring regards improving care- and more so, in the context of the blessed life I live.
Working in the NHS, a system which for all its flaws, purports to give folks what is needed irrespective of their social status, ability to buy etc; a system which has also given me a comfortable life, a good working condition, some fabulous colleagues and he golden opportunity in a national role- to make some difference, somewhere.

If you find a moment, do spare some time to have a look at "Spare A Rose". Much kudos to "Grumpy Pumper" aka Chris Aldred for drawing my attention to it- and in my role, the least I can do -apart from contribute- is to draw some attention towards it. We live in a country where insulin is "free", care is "free"… we debate, discuss, jostle, make snide remarks about the ability to get FreeStyle Libre,split hairs about evidence, post code lottery... we rail against the NHS for not providing all the latest technology…yet …well, have a look at the website- if you can.
In many countries, many children are not even able to access any insulin. Simply put, a life saving drug in Type 1 diabetes that many can't get.

A sobering thought- and perhaps also a time for perspective. A time for taking a moment and thanking our blessings that we -still- live in a country- where this rarely, if ever, enters our consideration. So if you can, have a look, take a moment- and see if you can contribute something.Beyond the bubbles of our world, there exists a vast one where healthcare isn't "free" for all- and if we can, even in a small way, the contribution would be most appreciated.

So- if you read my blogs, find my rants entertaining, then for this Valentines day, try and spare a rose. A simple gesture- but could help in perhaps saving a life-somewhere. I have donated- would be grateful if you could consider the same.

Thank you x


Saturday, January 27, 2018


This week- no surprise- a blog to reflect upon the Bawa Garba case. This isn't one to discuss the intricacies of the case (its been already played out widely in the media -general or social) or the "closing of ranks" -as some have suggested- but a personal viewpoint from someone who has been in the NHS for 20 years now.

To begin with, my views as a parent. Whatever the rights & wrongs of this case, a father & mother lost their child- and nothing in the world can equate to that sorrow- unless one has faced that sort of tragic circumstances. My blood turns cold at the very thought of even the slightest harm to my children- and simply put, there is no words to comfort them enough for their grief. However much time maybe a healer, the scar will remain- as will the fact that errors contributed to a child passing away.
It also makes me wonder whether, we as a system, have contributed to the whole murky saga too. Past examples of patient harm- have never quite ended up anywhere much- beyond "We will learn- and move on". For the individual who has lost a loved one, its perhaps all vey good for someone else to say "we are looking to learn"- but the physicality of seeing an individual who you believe has caused the ending of life to your loved one, continue working…sucks. Its not unnatural to say "accountability needs to lie at the doorstep of someone- not the ethereal system" . I suspect those of us who- fortunately- haven't faced anything of that magnitude may not realise that sometimes in the cold light of day- the passion is likely to be ignited more when the harm is your "own".

Then comes the reaction of some professionals towards those who raise issues. I will give you the example of James Titcombe- some of the vitriol he takes is pretty..well…special. Comments such as "using his child death to make a point" angers me, annoys me- and belittles us many folds over. Cue? Entrenched camps where strong patient voices- driven by personal hurt- clash incessantly with many- strengthening the confirmation bias that professionals are just out to cover their own backs- losing out attempts at rational discussion. For many, there has been-frankly- no closure.

But none of these irk me- my views above are reflections of what I see- and part of me understands the angst. What irks me about this whole thing are a few other bits- and thats more about us, as the NHS, than anything else.

First- the factor of responsibility. However you want to couch it, this junior doctor was left high and dry by her Consultant. Period. The Consultant was aware of the pH and Lactate of the patient, wrote it in his notebook but decided not to review the patient as he expected her to "stress" the results.
I don't even know where to begin with this- but frankly? That irks me. I have always maintained that the Junior doctor strike/ contract issue was a reflection of something much bigger, a lack of support, many instances of seniors not standing by their juniors- and here we have the tip of the spear. Its little things you know, annual leaves, unjustified demands from management, making sure they are safe….and then the culture gets further worse- and there we have it.
Then there is the issue of corporate responsibility- how does any of this not reflect on the Trust and Execs/Managers at that time who allowed such conditions to appear- well, another bit which makes me shake my head. Basically, when it came down to it- and the system needed a "head", it was the junior doctor- someone who could be sacrificed as collateral damage.

Second- the issue of race & colour- that uncomfortable fact. Many many papers etc have been written about GMC convictions and how things are judged- and the perceived bias. Would this case have been looked at differently if the said person was locally trained & white? Its an uncomfortable question which the system needs to be keep asking- but my belief is Yes- it would have been.
Lets give you a simplistic example- a liver surgeon has a bit of lark, plays God- and brands his initials on a liver- gets a 12 month community order and a fine of 10K. Different case- but I can bet you if that surgeon was non-white, he would be doing a bit more than that. I say that from personal experience- the system struggles with anyone who doesn't fit the mould, the judgement of "success" or " failure" is different- however many powerpoint presentations or committees you create to make yourself feel a bit better.

Third- the long term implications. I have always debated here the issue about whether being a medic is a vocation or a job. If its the former, how far does that take you? How far would you cover- how far is that rubber band of safety? How far do you keep trying as "otherwise who will help the patients?" This ruling will challenge that more- and frankly? We are poorer for that. I may smile at their vocational drive- but privately I admire them- and appreciate them for that extra they do.
The impact on personal reflection has been well rehearsed already- and that irks me. A bugbear of mine is improving insulin safety in hospitals…this drives a spear through that endeavour…with a big part of this taking away reflective practice in a safe environment. It drives defensive medicine further up- the system is already creaking with the unnecessary tests we do- "just because" or "what if". This now changes that fact…lets be honest, you would rather organise a CT scan- rather than face the possibility of missing something which could compromise your career, yup?

A murky place indeed- much of our own doing- and some of it the GMC bid to appear muscular- when in the past, they and the NHS have been accused of being far too lenient to medical staff in the face of patient errors- its a crying shame that the pendulum swing has taken us to this place. It irks me especially when there is a such a strong commitment to improve safety for #diabetes patients within hospitals from our end.

If there is any silver lining to this cloud, it perhaps also bares some uncomfortable truths to us as a system- the role of seniors, the issue of race- and the culture of safety we love talking in aviation terms.
Ask any aviation expert, someone would certainly be accountable- its unlikely it would be the first officer flying the plane. The NHS just got a bit more murky.