We begin 2019 and Brexit still haunts us. JRSM welcomes debate on the health implications, except Brexit is an unusual issue in the sense that most medical organisations are united in their opposition to it. Analyses by think tanks and foundations tend to raise concerns too. The supposed ‘will of the people’ is being prioritised over the health of the people. It makes more sense for a medical journal to prioritise health; hence, this month’s research paper focuses on the potential loss to the NHS if doctors and researchers from Europe were unable to immigrate.1 What will happen, of course, is unclear, but the authors conclude that the UK’s global leadership roles in medical science and local healthcare provision will both be affected.
What’s clear though is that the UK will be competing hard for trade. Competition is also a feature of many health systems that lean towards a market approach, but it provokes strong philosophical disagreement. Livio Garattini and Anna Padula discuss the success of competition in health systems financed by taxation, social insurance and private insurance and conclude that competition is undesirable and our efforts are best directed towards boosting public services.2
Another more fruitful avenue might be to better implement the strategies that we expect to succeed. For example, the NHS listed a number of drugs as low priority for prescribing. Goldacre et al. analysed the prescribing trends for these drugs in 2018.3 In a follow-up analysis, they find that the NHS advice has not had a noticeable effect on prescribing habits.4 It isn’t enough to simply publish advice, say the authors, but better ways are required to disseminate, implement and audit guidance.
Alternatively, artificial intelligence might mean that patients and the public receive an improved service with less involvement from health professionals. Yet, like NHS guidance, competition, and Brexit, artificial intelligence isn’t as straightforward as it might seem. Sandeep Reddy and others explain why enthusiasm, as with most new enterprises, needs to be matched by caution and careful planning.5 In the spirit of our times, JRSM wishes you a cautious and carefully planned new year.
References
- 1.Begum M, Lewison G, Lawler M, Sullivan R. The value of European immigration for high-level UK research and clinical care: cross-sectional study. J R Soc Med 2019; 112: 29–35. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Garattini L, Padula A. Competition in health markets: is something rotten? J R Soc Med 2019; 112: 6–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Walker AJ, Curtis HJ, Bacon S, Croker R, Goldacre B. Trends and variation in prescribing of low-priority treatments identified by NHS England: a cross-sectional study and interactive data tool in English primary care. J R Soc Med 2018; 111: 203–213. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Walker AJ, Bacon S, Curtis H, Croker R, MacKenna B, Goldacre B. Six months on: NHS England needs to focus on dissemination, implementation and audit of its low-priority initiative. J R Soc Med 2019; 112: 4–4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Reddy S. Fox J and Purohit MP. Artificial intelligence-enabled healthcare delivery. J R Soc Med 2019; 112: 22–28. [DOI] [PMC free article] [PubMed] [Google Scholar]