BMA Cymru Wales Blog

“Twitter helps us to provide a better service to our patients”

By administrator at February 21st, 2013

Guest blog by Dr Geraint Preest

GP Partner, Pencoed Medical Centre

Primary care Editor, onExamination from BMJ Learning

Is it just that I’m getting old or is general practice busier than ever? With increasing demands from all quarters it would seem illogical to add to our workload by maintaining a Twitter account. However, Twitter has become an invaluable way of keeping our patients informed and educated and has helped us tremendously.

More than a decade ago, we were one of the first practices in the UK to develop an online presence. We developed our first website in-house and have maintained full control ever since. We won a prestigious award for our efforts and we received lots of favourable comments from our patients (as well as visitors from distant shores who found some of our health information pages very useful).

As confirmed “early adopters”, we were quite late into Twitter. Put off by the possibility of tweeting something silly to a global audience and the perceived effort of maintaining a Twitter feed (because, let’s be honest, if you don’t keep it going then it’s hardly any use), we decided to hold back and watch while others led the way. The other disincentive (or “excuse”, depending on how you look at it) was that the majority of Tweeters seemed to be young and trendy and we thought that we’d miss most of our – ahem – more “mature” patients.

Then it dawned on us. Why didn’t we incorporate a live Twitter feed into our website? Twitter actually makes it very easy for you to do this and anyone with a basic grasp of web design can incorporate a live Twitter feed into a web page in less than 15 minutes. So that’s what we did and now all of the visitors to our “Home” and “News” pages get a live feed of our tweets, without having to be signed up to Twitter themselves.

So what do we tweet and how does it help? Who does the tweeting?

All of the GP partners and the practice manager have access to the account and can tweet from a PC or from anywhere on their mobile phone – Apple, Blackberry or Android. We tweet about changes to services and helpful information – these could be information written by us or information provided by reputable sources (such as NHS organisations or the Health Protection Agency, but it could be any information that we’ve appraised and deemed appropriate) which is “retweeted” from our account.

The trouble with spreading ourselves thinly between two surgeries, one of which is built on a very steep road which provides a perennial headache for us when the snow arrives, is logistics. We’ve found that when we’ve had heavy snowfall and access is very difficult, it’s much better – and safer for our patients – to operate out of our main surgery. During the recent heavy snowfall we were able to broadcast any service changes within seconds. We also had information from patients about weather conditions in the locality, with one patient offering to take a picture of the deep snow outside our branch surgery, showing that access was impossible. If clinics are cancelled for whatever reason, we can broadcast this within seconds – from the car if necessary and it’s a straightforward as sending a text. This shows up instantly on our website and is visible even if our patients don’t have a Twitter account. Hardly an arduous task. We could even “retweet” information from the local hospital about their cancelled outpatient appointments to help any of our patients who would otherwise have had a wasted journey.

Patients often complain (justifiably on many occasions) that they can’t get to see us. I wonder, sometimes, whether they need to be experts on “the system” to know whether to pre-book, how to see us quickly, when to try to see us – is it better to wait until the busy morning rush is over or to try to phone first thing? Are they helping us by rolling up at A&E instead? How are they to know? So, we’ve started tweeting the options available to patients – prebook with a named Dr in advance or arrive at open access in the morning and wait their turn. Mondays are always busier – common sense to us, but how are they to know? We’ve even resorted to sending “live updates” of open access waiting time. This was an interesting experiment and we’ve considered whether broadcasting the long wait on busy mornings would “put off” those who really should be seeing us, as well as agitating those who are keen to criticise us. Far better to help patients by letting them know when the waiting times are shorter.

There is a drive by the local health board and the local hospitals to cut waste from over-ordering repeat medication or by inappropriately attending A&E with “GP problems” – again, I worry sometimes that patients need to be experts on “the system” to know what to do and where to go. Again, we address this by tweeting relevant information about what to do and where to go. A recent study by Cancer Research UK demonstrated that a high percentage of patients defer seeing their doctor due to difficulties getting appointments, so we tweeted this link along with advice to say that patients could be seen the same day if they contacted our open access clinic before 10:30am and that it doesn’t have to be deemed “an emergency” either – if they’re simply worried and don’t mind waiting their turn, that’s fine.

The ability to link information and web pages or PDFs to our tweets is a real asset. A popular feature is our “What illnesses are we seeing at the moment?”. During a chickenpox outbreak we could tweet links to reputable advice about treatment and what to do in the case of pregnant women. We’re often asked for advice about returning to school after an infectious disease. No problem – the HPA have a very informative chart which gives “return to school times” for a number of common infectious diseases, so we tweet that as well. By following relevant Twitterers, we are provided with lots of useful information that we can filter and pass on to our patients, without having to spend time hunting down resources.

Ah, but I know what you’re saying “It takes a lot of time to do this”. Well, no actually. I can send a tweet from a smartphone in less than a minute. With the flick of a thumb I can scan tweets from those we follow, to weed out useful information, in less than a minute. It doesn’t take a lot of time, it just takes the motivation to do it.

Ultimately, it helps us to provide a better service, is valued by our patients and just may save us time by more efficient use of resources. There’s a lot of satisfaction to be had doing that.

Give it a go. You’ll be surprised by the results. If you want a few more ideas, take a look at the feed on our website, www.pencoedmedical.co.uk or check us out on Twitter @PencoedMedical

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Keep the ban

By Richard Lewis at February 19th, 2013

Dr Tony Calland, Chairman of the BMA’s Medical Ethics Committee gave evidence this morning to the Sub-Committee on smoke free premises. If you didn’t see the evidence session, take a moment to read this blog post written by Dr Calland about why we must keep the ban and not amend Wales’s smoke-free premises legislation for the creative industries.

In 2007 the Welsh government followed a long history of good public health measures by passing the smoking ban legislation for public places. This legislation has been widely popular across the country with a substantial majority of citizens showing it strong support.

However, despite this success, the Assembly is about to debate an amendment to the legislation to exempt film and programme makers from this law. If passed there would be serious consequences.

Firstly, the actors, directors and film crew would once again be subjected to the harm of second hand smoke.

Secondly, the change would be seen as the first crack in the dam of anti smoking legislation and other even more powerful lobby groups would follow.

Thirdly, even if shown in a negative storyline, the visual effects of smoking on screen can be influential to susceptible young people – which is why tobacco advertising was banned many years ago.

The medical benefits of the ban have been shown through a reduction in cases of acute coronary syndrome and acute asthma. If the government were to allow the poisoning of the public once again, however restricted that may be, it would demean the credibility of the government and especially the Health Minister and the Chief Medical Officer.

The Welsh heritage of good public health policy must not be undermined by this ill conceived proposal.

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Have you ever wondered what working in public health medicine is like? Dr Mark Temple, Consultant in Communicable Disease Control gives an insight into his branch of practice….

By Richard Lewis at February 11th, 2013

Public Health Medicine is an eclectic branch of practice, periods of apparent idleness followed by frenetic activity. In other words very similar to all other branches of medical practice, except the where, when and what aspects of a job plan are unpredictable! Being fleet of mind and foot is an advantage….

To demonstrate this, let me describe a week’s activity which I undertook earlier this year. I started the week by heading north to Blaenau Festiniog to participate in a multinational workshop on how the environment and biodiversity affects human health. The evidence seems to point towards the greater the biodiversity, the better for individuals and society. What was I doing there? I was giving a presentation to try to assist these researchers translate their ideas and data into a form that would help us medics understand the messages they were giving. For example, it is well known that having good view from your sick bed reduces post operative complications, pain and length of stay. So why do we insist on building hospital wards that look out on another building or wall, if they have windows at all?

We also know that walking down wooded paths especially if the route includes watercourses reduces depression scores, blood pressure, and numerous other predictors of illness. Interestingly reducing biodiversity in the form of trees and shrubs appears to increase violent crime, so why do we remove trees and flower-beds from the approach to A&E units and hospital car parks?

In the middle of that week I was helping to steer a medical student towards success in her intercalated degree project. I hope it will shortly result in a published paper. She was attempting to evaluate the effectiveness of reorganisations of the NHS. She has developed a clear analysis that shows the vast amount of money spent on reorganisation of the NHS since 1948 achieved no population benefit; they were vast wastes of money.

Finally on the Friday, I attended a meeting of a working group convened by the Welsh Risk Pool to try to stop the waste of resources that repetitive training the Welsh NHS represents. There are two aspects of this; the format of the training appears ineffective as no noticeable benefit of either staff safety or patient care has been recorded; and many staff who would benefit from good training, can’t get the time off to attend. This has clear implications for the finances of the NHS in Wales. If we could be a bit more clever with this, not only would only those who need the training would get it, (reducing pressure on those left to do the work) and enable the quality of the training to improve, the class room approach – that does not work with adults, could be replaced by a seminar based one, for example.

In amongst all this I also undertook some analysis of the routine data on communicable disease cases in Wales, using less widely used statistical approaches, and supported colleagues with queries about a number of issues including Bovine TB.

Public Health Medicine is a branch of practice that happily works on immediate, short term, long term and very long term issues. I am lucky to have job that is so rewarding, I hope to help lay the foundations on which my great grandchildren will enjoy a healthier world to bring up their own children, which is the glory of PHM!

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Can we achieve high reliability in NHS Wales?

By Richard Lewis at February 5th, 2013

The Chairman of the BMA’s Welsh Council Dr Philip Banfield, asks if we can achieve high reliablity in NHS Wales.

Every doctor can tell you stories about how an unreliable system has let them down – whether it’s a patient not receiving the right medication on a ward, or a patient arriving in theatre inadequately prepped, or poor communication and missing details in patient notes.

These are all examples of poor reliability in the processes of healthcare – and when things go wrong it is much more likely to be down to these system errors than personal incompetence or wilful negligence.

So, how can we improve the processes to make sure that we are reliably delivering the right care at the right time in the right place to the right people?

This difficult question is at the heart of the 1000 Lives Plus white paper, Achieving High Reliability in NHS Wales. I confess to a vested interest in this, as I was the author, but I really believe there are important messages for all of us involved in caring for patients in Wales within those few pages.

There is a large body of work drawn from industries subject to catastrophic consequences when things go wrong. The white paper tries to transfer these concepts of high reliability to a healthcare setting in order to make NHS Wales a better and safer place to both work and be a patient in. Importantly, we tried to convert the managerial industry jargon into something clinical teams would relate to as well.

There are five core elements to achieving high reliability:

Effective engagement of clinical teams
Looking beyond the simple and obvious when something goes wrong – at the background system that led to the mistake or error
Learning from failure in a positive and constructive manner that values the workforce tasked with front-line care
Valuing expertise and promoting situational leadership – making the most effective use of the (expensive) clinical experts NHS Wales has at its disposal
Organisational reflection – how those tasked with supporting clinical teams help them to achieve safe and reliable high quality care

If we can get these five areas right, then we will have taken massive positive strides towards high reliability in our services. It doesn’t feel like that for you? Well, it is yours to change and the 1000 Lives Plus teams are there to help.

There are opportunities to lead this cultural change at all levels. At senior levels reviewing how well we engage is helpful. Being interested and seen to be concerned throughout the organisation helps staff to feel that someone cares. A team that feels appreciated and cared for is better able to care themselves, I would suggest.

Wherever we are in our career we will face challenges. It is easy to blame the person displaying ignorance of a policy or a lack of understanding or knowledge, but is this true, or did we place them in a position of unnecessary stress where they were set up for an increased chance of making mistakes? How often do we look beyond the simple and obvious? It may be harder to get to the root underlying cause of problems because we may have to face uncomfortable truths about ourselves or our own abilities, so how do we resist the easy way out of finding someone to blame? A high reliability organisation is accepting that all levels are prone to compounding error, but it embraces and learns from this.

Are we willing to learn from failure? The first step is to admit that sometimes we get things wrong. Are we courageous enough to do that? Not always, if we expect criticism and discipline when perhaps understanding and support may make us wiser and safer. A change in attitude and culture cost nothing, but are central to making the NHS in Wales safer.

Do we value expertise? Do we see it out? Are we willing to take a step back and let people with more knowledge of a given condition or a particular treatment take the lead? This is hard for more senior staff to do, but it is equally difficult sometimes to ‘step up’ and take the lead when you need to. High reliability teams value the whole team – difficult in these days of reduced junior doctors’ hours and shift working, I know, but also more possible with formal handovers and working much more as inter-professional teams in the clinical environment. Some of my best work happens because I listen to what I am told I have forgotten by students and our Healthcare Support Workers when I am rushing from one place to another. Learning to listen, as opposed to just hearing, is something I have taken a long time to get right (and I still get it wrong sometimes).

And finally, how do we create time to reflect on what we do and see if there are ways we could improve it? We are all under pressure. There is always more work to do. We need to consider building reflection periods into our work schedules, recognising that self-examination is work as well, and that if we neglect this, then our other work isn’t going to be of the highest quality. It is quite illuminating to do this with someone else – not even someone you know that well – as each of you learns something you would have otherwise missed on your own. It feels like the sort of reflection you did with your on-call firm and the night nurses at 4am ‘in the old days’, without the 120 hour week.

If we start to apply these principles to our own areas of practice then together we can move towards the safer, transparent health service we aspire to in Wales. We can then hold up our heads and join the ranks of other high reliability organisations and be proud to say, ‘we care’.

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Medical Appraisal Revalidation System Demos

By Richard Lewis at January 31st, 2013

The Wales Deanery is working in conjunction with the BMA to deliver a series of MARS Demonstrations across Wales. The aim of these events is to provide an opportunity for Doctors to see the appraisal system, to run through a live appraisal cycle and to see how MARS supports the appraisal and revalidation process.

Friday 8^th March - 2.30pm – 4.30pm – Lecture Theatre, PGC, Royal Glamorgan Hospital, Llantrisant

Monday 11^th March – 9.30am- 11.30am – Lecture Theatre, PGC Morriston Hospital, Swansea

Thursday 14^th March – 10.30am – 12.30pm – Lecture Theatre, Hafan Derwen, St David’s Park, Carmarthen

Friday 15^th March – 2:30pm-4.30pm – PGC Lecture Theatre, Ysbyty Gwynedd, Bangor

Monday 18^th March – 10:00am-12.30pm – Wrexham Medical Institute, Technology Park Centre, Wrexham, LL13 7YP

There is no charge for attending. These events will be relevant to all doctors (other than doctors in training posts) and all are welcome to attend. Places will be allocated on a first come first served basis.

Programme (2 Hours)

BMA welcome and introduction
MARS demonstration showing Doctor and Appraiser view
Questions and the opportunity for individual queries

For further information and to register contact Sarah Ellmes mars@bma.org.uk

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Professional bodies in Wales unite to oppose plans to move neonatal services from North Wales

By Richard Lewis at January 31st, 2013

Here is our joint RCN, RCM & BMA Cymru Wales press release on plans to move neonatal services from north Wales, and below that some links to our coverage in the press. Check our blog for further updates.

Following the announcement of the Betsi Cadwaladr University Health Board’s final decision on its reconfiguration plans, the Royal College of Midwives Wales, the British Medical Association Wales and the Royal College of Nursing Wales held a press conference today to share their concerns about plans to move neonatal services from North Wales to England.

Neonatal care across Wales has been an area of specific concern to all three organisations. Rather than addressing the development needs of the service in North Wales Betsi Cadwaladr Health Board has chosen to ignore the clear clinical preference and put forward a proposal to simply outsource all longer term neonatal intensive care to Arrowe Park Hospital on the Wirral.

Removing this level of neonatal care from North Wales to England is a financial risk to NHS Wales. Once the service is removed it will be extremely difficult if not impossible to resurrect it. This means that the provider of the service based in the health market economy of England is in a very powerful position indeed in setting prices.

It is important that the provision of neonatal services is viewed from an all Wales perspective and not just within the Betsi Cadwaladr University Health Board.

The comprehensive neonatal services based in North Wales remain a viable and sustainable option.

Tina Donnelly TD DL, Director of the Royal College of Nursing in Wales, said: “The health minister and the Community Health Council need to listen to the people who are providing this service. From information from our members we are seeing insufficient accurate clinical data to move services out of Betsi Cadwaladr Health Board. As yet no case has been made to move services to Arrowe Park. We are asking for the health board to reverse their decision. We would expect the Health Minister to step in and take the sensible approach.”

Dr. Richard Lewis, Secretary of the British Medical Association in Wales, said: “We are asking the Health Board to reverse its decision. There is no reason why these services cannot be sustainable and viable in North Wales. We don’t feel the funding issues stack up. Services in North Wales are not inferior; they are of the very highest standard.”

Helen Rogers, Director of the Royal College of Midwives Wales, said: “Our members feel their concerns are not being listened to. There are more questions than answers at the moment. When transferring services from one country to another there is a big impact on women and their families. We are willing to take this to the health minister.”

Daily Post article here

Western Mail article here

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What the GP contract changes will mean for you

By Richard Lewis at January 29th, 2013

The GPC negotiators are visiting various locations in the Wales to inform GPs of the contract agreement and what it will mean in practice.

Come along to a roadshow where you are, this will give you the opportunity to ask the GPC negotiators any questions you have relating to the new contract and have your say.

Cardiff:

29 January 2013

Cardiff City Stadium,
Leckwith Road,
Cardiff,
CF11 8AZ

7.00 PM – 9.00 PM

Wrexham:

31 January 2013

The Kinmel Manor Hotel, St Georges Road, Abergele, LL22 9AS
7.00 PM – 9.00 PM

Swansea: 5 February 2013
Liberty Stadium, Landore, Swansea, SA1 2FA
7.00 PM – 9.00PM

If you wish to attend please email Donna Martin

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Could you be a future leader of the medical profession?

By Richard Lewis at January 25th, 2013

The medical profession is facing a period of change and challenge. Come and talk about issues that are important to you and meet colleagues from all over the UK and from all specialities. The Junior Members Forum is your opportunity to find out about the BMA, what it can do for you, and what you can for it, in a very sociable, relaxed atmosphere. This year, it is being held in Cardiff on Saturday 23 March & Sunday 24 March 2013.

The Junior Members Forum is a free weekend residential conference for BMA members that will:

• Help you find out more about what the BMA does and how it works

• Offer the chance to contribute to BMA policy on issues that matter to you

• Help you to develop your debating skills on key issues for junior doctors, including

a themed sessions on ‘Patient safety and healthcare reform’

• Enable you to network with like-minded doctors and students

• Meet the leaders of the BMA including Dr Mark Porter, Chair of BMA Council.

Doctors who are within 12 years of provisional registration or 11 years of full registration, plus medical students, can attend. Overnight accommodation, travel expenses and meals will be provided from Friday evening. Childcare will be available during the conference.

Places are limited, so register early to confirm your place – bma.org.uk/jmf

The conference is CPD accredited and accommodation and travel expenses will be provided.

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Meet the Chairman

By Richard Lewis at January 14th, 2013

Watch our new video clip with the Chair of Welsh Council, Dr Phil Banfield. Find out about what Welsh Council does, and the challenges facing the Welsh NHS.

Click here to view the video

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Researchers appeal for people in Wales to sign up to online flu project

By Richard Lewis at December 5th, 2012

Guest blog by the London School of Hygiene and Tropical Medicine

Does “man flu” exist? How effective is the flu vaccine? Do pets keep you healthy? And are people in Wales more or less likely to report flu-like illness than residents of the rest of the UK? These are just some of the questions scientists from the London School of Hygiene & Tropical Medicine want to explore in a nationwide flu survey.

The annual UK Flusurvey for 2012-13 has gone live. It aims to collect data from men and women of all ages around the country, in order to map trends as seasonal flu takes hold, enabling researchers to analyse how the virus spreads and who it affects. Anyone can take part in Flusurvey and it only takes a couple of minutes each week.

The online questionnaire at www.flusurvey.org.uk allows people to report their symptoms directly and the data is supplied to the Health Protection Agency’s national surveillance programmes.

Results from previous years of the Flusurvey suggest men are less likely than women to report flu-like illness. In fact, women had about a 16% higher risk of reporting flu-like symptoms.

But in a bid to work out if “man flu” is real, researchers hope to find out more about gender differences to determine if men are more likely to have severe symptoms or if there is any evidence that they make more of a fuss than women. They are also interested in exploring if owning a cat or dog reduces the risk of reporting flu-like symptoms, and comparing flu levels in different age groups and regions.

Last year was one of the mildest flu years reported but despite that about 30% of people in the United Kingdom and Europe reported having some flu-like illness. Last year nearly 28,000 people took part throughout Europe, and more than 2,000 people took part in the UK Flusurvey.

It is not possible to predict if and when seasonal flu will affect people this year but the Flusurvey team is keen to encourage people to sign up now to help find out. The more people who participate the more information they will be able to collect to increase understanding and help medics and health services prepare. Traditional monitoring methods rely on data from GPs or hospitals. The Flusurvey provides a unique insight because many people with flu-like illness do not visit a doctor.

This year the team would like to increase the number of participants from Wales. By spending a few minutes every week participants provide crucial data for increasing our knowledge of flu, monitoring its spread and developing methods to improve the handling of outbreaks of the virus. Seasonal flu can be a serious illness, potentially fatal in some cases, and we want to help the quest to keep people healthy.

To take part in the UK Flusurvey go to www.flusurvey.org.uk now!

Flusurvey is on Facebook https://www.facebook.com/pages/flusurveyorguk/220599440047 and Twitter @flusurvey

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Life in Lesotho

By Richard Lewis at November 27th, 2012

By Dr Mim Rees

After completing foundation training, I decided to take a year out to work in a developing country, and I came to hear about Lesotho from a GP in north Wales. Lesotho is called ‘the kingdom in the sky’ for good reason; it is the only independent state in the world that lies entirely above 1,000 metres in elevation. Although completely surrounded by South Africa it is very different with its traditional culture and rural lifestyle. Lesotho is a developing country with a high prevalence of HIV (about 23%) and TB. Half of the population live below the poverty line and the life expectancy is approximately 40 years.

To prepare us for working in a developing country, my colleague Catrin and I first spent three months in Liverpool studying tropical medicine. Through Dolen Cymru we were then placed to work for four months in Maluti Adventist Hospital, a 150-bed rural mission hospital. We were working alongside a permanent team of doctors from Argentina, DRC, Uganda, Madagascar, Zimbabwe, Holland and USA.

I spent my time working on the paediatric ward and in the out-patient department. My role in the hospital was similar to back home; attending ward rounds, doing the ward jobs and admitting patients into hospital. Except in Lesotho I was seeing and treating different medical diseases, dealing with a constant lack of resources and drug supplies, and having to think about the financial cost of every intervention as it was added onto the patient’s hospital bill. Despite the challenges it really was such a privilege to be able to work there as a junior doctor.

During my time at Maluti hospital I was able to conduct a 4-month mortality review on the paediatric ward. After presenting my audit findings to the medical staff, we identified several target areas for improvement. One key area we aimed to improve was the management of malnutrition in the paediatric department. Just by implementing some simple changes (such as putting a malnutrition protocol on the walls of the admission clinic) we saw a significant reduction in the mortality rate. One of the doctors who is there long-term is continuing the process of regular mortality reviews on the paediatric ward and is working to sustain changes.

Coming back to work in Wales now brings mixed emotions. There are many things I miss about Lesotho; including the simple lifestyle and the community I felt a part of at the hospital and its surrounding village. Working in a developing country really has made me appreciate our health service here much more, as well as the quality of training we receive as doctors in the UK. My time in Lesotho has given me a fresh perspective on life and work, and has changed me as an individual and a doctor. The only down-side is, now I’m thinking about when I can go back to Africa….

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Your IT

By Richard Lewis at October 5th, 2012

Dr Martin Murphy

Dr Murphy is the Clinical director and architect on the NHS Wales IT program in NWIS, the Caldicott Guardian for NHS Wales and a practicing GP.

Welcome to my new monthly guest blog for BMA Cymru Wales about the development of the information systems that support your clinical work in Wales. The blog is an opportunity for me to describe how we are tackling the issues of communicating and sharing information electronically and for you to have your say and contribute to this work.

The blog will cover a number of themes ranging from specific products that are being rolled out across Wales, to the impact of modern technology and wider issues about how these may affect our relationships with our patients.

I have recently published a new information systems strategy for comment here .

This reviews the progress we have made on developing and rolling out information services across Wales which you may have used including the IHR, WCCG, MHOL and Test ordering, medicines and discharges etc in the Welsh Clinical Portal.

The strategy highlights the next steps – focusing on records, community systems, supporting communication with social care and how the Welsh platform supports clinical networks and reconfigurations under discussion.

I am very interested on your views on the way forward. We are asking for comments by the end of October. Please send comments back via this blog. More in-depth commententry on these issues can be found at my blog sowhatfollows.wordpress.com and on Twitter @MartinMurphy001

As a final issue in this introductory blog I would like to draw your attention to, the BMA guidance on using social networking tools. This can be found here .

Great advice on staying out of hot water when using social media.

Contact Martin:

Dr Martin Murphy

Clinical Director NHS Wales IS

Martin.murphy@wales.nhs.uk

Twitter@martinmurphy001

Blog sowhatfollows.wordpress.com

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Keep the ban

Have you ever wondered what working in public health medicine is like? Dr Mark Temple, Consultant in Communicable Disease Control gives an insight into his branch of practice….

Can we achieve high reliability in NHS Wales?

Medical Appraisal Revalidation System Demos

Professional bodies in Wales unite to oppose plans to move neonatal services from North Wales

What the GP contract changes will mean for you

Could you be a future leader of the medical profession?

Meet the Chairman

Researchers appeal for people in Wales to sign up to online flu project

Life in Lesotho

Your IT