Consumer advertising and doctors' prescribing

Editor—Braithwaite issues an interesting challenge in his personal view on axioms governing health sytems.¹ Collins shows how companies moving from good to great do so by developing a “hedgehog” principle.² The hedgehog principle is that great companies do repeatedly what they are good at and that they stop doing anything they are not good at, no matter how worth while or interesting these activities could be. Great companies take a complex world and simplify it so that it becomes clear for them, their staff, and their customers what they should be doing.

When these companies have discovered their hedgehog principle they implement it both by a “to do” list and a “to stop doing” list. The NHS at present does not have a hedgehog principle and suffers badly for this lack.^3-5

I want to propose a hedgehog principle for the NHS—namely, that it should aim to get the right patient to the right treatment at the right time. We can, and will, be debating forever about who the right patient is, what their right treatment is, and what the right time is. However, the basic aim remains sound, whatever changes in medical knowledge come through.

Doctors and others working on remedial treatment of patients should specifically work for a national medical service. Illness definition and treatment is what doctors are (or should be) good at doing. A clear focus for the service will be empowering for doctors and managers with shared goals allowing them to organise well so patients get a good service.

Those who want to work on the equally important aim of improving the health of the public should move outside of the national medical service towards a separate public health generation service with a wider remit to society, and not to its casualties.