The state of medical education and practice in the UK report: 2016

General Medical Council | Published online: October 2016

Image source: GMC

This is our sixth annual report about the state of medical education and practice. As ever we consider some of the current challenges facing the profession and the systems in which it works. We also look at how the make-up of the profession continues to change.

For the second year running we have published an extensive online resource of the GMC’s registration, education and fitness to practise data. This contains more than 400 tables, set out in a structure designed to make it easy to find key figures.

By publishing this information, we aim to promote discussion and debate about some of the practical steps we and others could take in better supporting doctors and improving patient care.

Read the full overview here

Read the full report here


Quality and Outcomes Framework (QOF) – 2015-16


This Quality and Outcomes Framework (QOF) publication provides data for the reporting year 1 April 2015 to 31 March 2016. The QOF was introduced as part of the new General Medical Services (GMS) contract on 1 April 2004. The objective of the QOF is to improve the quality of care patients are given by rewarding practices for the quality of care they provide to their patients. The Calculating Quality Reporting Service (CQRS), together with the General Practice Extraction Service (GPES) were used for the extraction of QOF data. There have been changes to QOF coding and indicators. These are referred to throughout this publication. Consideration must be given to changes to indicators and their definitions each year when interpreting differences and comparing data from one year to the next.

Key facts

  • QOF recorded prevalence – Recorded prevalence for 2015-16 is presented for 7,619 general practices in England.
  1.  The highest prevalence rates are for Hypertension (13.8 per cent), Obesity (9.5 per cent) and Depression (8.3 per cent).
  2. Hypertension (7.9 million), Obesity (4.3 million) and Depression (3.8 million) are the conditions reporting the highest register numbers.
  3. The largest year on year differences in register numbers are in Depression (increase of 470,168) and Obesity (increase of 132,222).
Image source: NHS Digital
  •  QOF achievement  – Achievement data for 2015-16 shows that:
  1.  The average achievement score for practices was 532.9 points out of 559
  2. The highest levels of achievement were for Obesity and Chronic Kidney Disease where 99.9 per cent was achieved. The lowest level of achievement was in Osteoporosis at 87.5 per cent.
  3. 640 practices achieved the maximum of 559 points. In 2014-15 there were 448 practices which achieved the maximum of 559 points.
  •  QOF exceptions – Exceptions data for 2015-16 show that:
  1.  The condition with the highest percentage of exceptions is Cardiovascular Disease at 31.3 per cent overall
  2. The measure with the lowest percentage of exceptions is Blood Pressure at 0.5 per cent overall.

Read the full overview here

Read the full report here

Mirror, mirror, on the wall, whose local care is fairest of all

Cookson, R. Quality Watch. Published online: 31 October 2016

The problem with national data on health equity is that nobody owns it. It isn’t any one person’s problem, and it is easy to explain away bad news. Social inequalities in health and health care are influenced by all sorts of complex social, economic and technological factors, and there is no ‘national control group’ telling us what would have happened if national policy had been different. So it is hard to tell whether particular NHS policies are responsible for particular national equity trends. Policy makers are thus able to take credit for good news, and shift blame for bad news, without anyone learning any useful lessons.

Inequality gradients

Local equity is assessed by comparing the level of local inequality with the national picture and with ten similar CCG areas based on deprivation, age profile, ethnic mix and rurality. The diagrams below illustrate this for two CCGs in 2015. In the diagrams, each dot is a neighbourhood, with bigger dots for bigger neighbourhoods. The lines are linear regression lines through the dots, showing social inequality ‘gradients’ – the steeper the gradient, the greater the health inequality. The solid green line shows local inequality, as compared with the dashed red line showing national inequality and the dotted blue line showing inequality within ten similar CCG areas.


Liverpool health equity gradient 600px


Brent health equity gradient 600px

From the diagrams we can see that Liverpool has statistically significantly ‘worse-than-expected’ equity compared with these benchmarks, whereas Brent has significantly ‘better-than-expected’ equity.

Read the full blog post here

Things to consider when designing a refer a friend scheme

NHS Employers | Published online October 2016

Image source: NHS Employers

Incentivising employees to refer candidates through your reward offer encourages them to think about who they might know that has the right skills, knowledge and values for your organisation.

Refer a friend schemes can be a useful tool to help you meet some of your workforce challenges, such as recruiting to hard to fill posts, increasing staff retention and reducing recruitment times and costs.

Our guide looks at the things you could consider when designing and implementing a refer a friend scheme including:

  • the business case and defining what you want to achieve
  • the terms and conditions of the scheme and qualifying criteria
  • gaining buy in from key stakeholders
  • communicating the scheme to your staff
  • evaluating whether the scheme has been successful.

Find out more about reward in the NHS and view our range of reward resources.

View the final document here

Policy changes to implement the NHS five year forward view

Two years on from the publication of the NHS five year forward view, we assess how much progress has been made and what still needs to be done to align policies with the plan | The King’s Fund

Image source: The King’s Fund

In October 2014, NHS England and other arms-length bodies published the NHS five year forward view (Forward View). The Forward View set out a vision of how NHS services need to change to meet the needs of the population. It argued that the NHS should place far greater emphasis on prevention, integration of services, and putting patients and communities in control of their health.

The Forward View differed from previous policy documents; instead of setting out a blueprint for the future, it outlined a number of care models that can be adapted to put in place services appropriate to the needs of local populations. The emphasis was on ‘diverse solutions and local leadership, in place of further structural distraction’ supported by ‘meaningful local flexibility in the way payment rules, regulatory requirements and other mechanisms are applied’ (p 4).

In February 2015, The King’s Fund set out the main policy changes we thought were required to make a reality of the Forward View. These included changes in how NHS services are commissioned and paid for, how NHS organisations are supported to make improvements in care, and how a transformation fund could contribute. We argued that national bodies needed to provide clear and consistent leadership on these and other issues in order to support implementation.

Read the full report here

The role of clinical leadership in the evolving NHS

Lewis, M. The King’s Fund Blog. Published online: 28 October 2016


As a doctor who was recently Group Director responsible for medicine and emergency care across three sites in an inner city trust, I was keen to take up the opportunity of joining The King’s Fund.

One reason for this was to learn about best practice outside my own organisation. For a national health service, it seems strange that the benefits of having a single health care system do not always seem to be evident; examples include variations in clinical practice, procurement of devices and the engagement of staff across different parts of the NHS.

Possibly the culture of competition between neighbouring trusts is difficult to shake off, or perhaps individuals within organisations are reluctant to accept that other people have better ways of doing things. Certainly, there is a need to develop better co-ordination of services between local primary, community and secondary care providers – as recently illustrated in the Fund’s report on place-based systems of care.

Read the full blog post here

Doctors’ low morale ‘puts patients at risk’

Poor morale among doctors could put patients at risk, the General Medical Council has warned. | Story via BBC

stethoscope-1584223_960_720The GMC’s latest annual report into the state of medical education and practice in the UK has  said there was “a state of unease within the medical profession across the UK that risks affecting patients as well as doctors”.

The GMC noted that following the anger and frustration of the dispute between junior doctors in England and the Department of Health, levels of alienation “should cause everyone to pause and reflect”.

The GMC criticised healthcare funding, saying that years of constraint coupled with social care pressures were leaving services struggling to cope with rising demand.

NHS Employers, which represents management in the health service, said the report highlighted the need for skilled foreign workers in the NHS, adding: “We welcome the insight the report gives into the huge financial and service pressures the NHS is under.”

The Department of Health said listening to the concerns of staff was central to plans to improve services.

The state of medical education and practice in the UK report: 2016:

Full report

Executive summary