Network of general practices aims to improve standards

Greater consistency and providing a choice of services are essential traits of future NHS general practice, says Simon Bradley. Photograph: Rex Features

Most people will have noticed that there is something up with the NHS and that Jeremy Hunt is no white knight, no matter how much he tells us he is. To expect GPs, facing a funding freeze despite burgeoning demand driven by demographic change and heightened consumer expectation, to come riding over the horizon may seem unlikely. However, that is what our new network of high-quality general practices, Quality Practice, is setting out to do.

Quality Practice is a national network of general practices that is designed to enhance standards of patient care and lift medical morale, as well as to strengthen practices by extending their core activities, share back-office services and increase efficiency, so that general practice will be able to deliver more for less, for everyone.

So, why form the Quality Practice network? Simply, because there seems to be no prospect of external investment in general practice. Quality Practice intends to bring new NHS and private income streams into practices. This may sound more like business than the caring profession but investment in primary care has been identified as a prerequisite for an effective healthcare system, and the NHS is not going to achieve the necessary shift of provision of more complex care into the community without it.

Sixty-five years on, Nye Bevan would readily recognise the general practice of today, and in that lies both its success and its weakness: personal, local and responsive on one side, but disparate and poor at working more corporately as a health community on the other. This builds in inefficiency and slows the adoption of new ways of working between practices, and, at least in part, explains the considerable variation in performance.

How can we achieve more consistently high standards? Albert, our social network platform, developed by Interact Intranet is our solution. Albert allows our member practices to work as one large virtual practice, pooling their talent, enhancing their practice and that of every member practice, with every good idea they share.

We also have a growing number of small federations, drawn together by geography, and in inner cities, the formation of "super practices" such as the Vitality partnership, which employs dozens of GPs. These might be seen as competition for the Quality Practice model but also clearly demonstrate that the need for change is not just being felt on the ground, but acted upon.

So how will Quality Practice differ? The Quality Practice model differentiates itself by scale: our ambition is to get to a total of around 500 member practices over the next four years, to both maximise economies in shared services and to provide local outlets for regional and national contracts. Ownership will also differ, with our member practices owning shares in the organisation.

They will have to have an outstanding commitment to continuous quality improvement that is essential for sustaining our relationship with NHS and other commissioners.

Setting up this sort of organisation at this time in the NHS's evolutionary stage means we have to contend with practices barely coping with everyday demands. But, working with our foundation practices in London, Manchester, Bristol and beyond, we are convinced that we have the model right. Funding is tight in practices, and so our financial model has to be solid. This was successfully tested in a public fundraising session through Crowd Cube recently, bringing in two more early investor practices and more than 40 private investors.

Greater consistency between general practices while simultaneously providing an extended choice of services for patients, as varied as chemotherapy and eyelid surgery, are essential traits of future NHS general practice. Achieving this is how Quality Practice will re-set general practice as the cornerstone of the NHS.

Dr Simon Bradley is founder and medical director of Quality Practice

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Revealing the gene network for producing the toxin in green potatoes may help improve crops

Main Category: Water - Air Quality / Agriculture
Article Date: 04 Aug 2013 - 0:00 PDT Current ratings for:
Revealing the gene network for producing the toxin in green potatoes may help improve crops

In 1924, Science magazine reported on a fatal case of potato poisoning: James B. Matheney of Vandalia, Illinois, had gathered about one and a half bushels of tubers, which had turned green due to sunlight exposure. Two days after eating the potatoes, most of his family - wife, two daughters and four sons - showed symptoms of poisoning; the only exceptions were James himself, who didn't eat the potatoes, and a breast-fed baby boy. His wife, aged 45, died a week later, followed by their 16-year-old daughter. The other five members of the family recovered.

Although such fatalities are rare among human beings, farm animals often get sick or die after eating green potatoes. Symptoms include damage to the digestive system as well as loss of sensation, hallucinations and other neurological disturbances. Death can be caused by a disruption of the heart beat. The culprits are the toxic substances solanine and chaconine; their concentration rises sharply with exposure to light or during sprouting, and they protect the tubers from insects and disease.

Solanine and chaconine belong to the large family of glycoalkaloids, which includes thousands of toxins found in small amounts in other edible plants, including tomatoes and eggplant. These substances have been known for over 200 years, but only recently has Prof. Asaph Aharoni of the Plant Sciences Department begun to unravel how they are produced in plants. He and his team have mapped out the biochemical pathway responsible for manufacturing glycoalkaloids from cholesterol. Their findings will facilitate the breeding of toxin-free crops and the development of new crop varieties from wild strains that contain such large amounts of glycoalkaloids, they are currently considered inedible. On the other hand, causing plants to produce glycoalkaloids if they don't do so naturally or increasing their glycoalkaloid content can help protect them against disease.

Two years ago, in research reported in The Plant Cell, the scientists identified the first gene in the chain of reactions that leads to the production of glycoalkaloids. In a new study published recently in Science, they have now managed to identify nine other genes in the chain by using the original gene as a marker and comparing gene expression patterns in different parts of tomatoes and potatoes. Disrupting the activity of one of these genes, they found, prevented the accumulation of glycoalkaloids in potato tubers and tomatoes. The team then revealed the function of each of the genes and outlined the entire pathway, consisting of ten stages, in which cholesterol molecules turn into glycoalkaloids.

An analysis of the findings produced an intriguing insight: Most of the genes involved are grouped on chromosome 7 of the potato and tomato genome. Such grouping apparently prevents the plants from passing on to their offspring an incomplete glycoalkaloid pathway, which can result in the manufacture of chemicals harmful to the plants.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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The research was conducted by postdoctoral fellow Dr. Maxim Itkin, who worked with Dr. Uwe Heinig, Dr. Oren Tzfadia, Pablo D. Cardenas, Dr. Samuel Bocobza, Dr. Sergey Malitsky and Dr. Ilana Rogachev of Prof. Aharoni’s lab; as well as Dr. Tamar Unger of the Israel Structural Proteomics Center at the Weizmann Institute, and scientists from the National Chemical Laboratory in Pune, India, the Hebrew University of Jerusalem and the Wageningen University, the Netherlands.

Prof. Asaph Aharoni's research is supported by the Clore Center for Biological Physics; the Kahn Family Research Center for Systems Biology of the Human Cell; the Tom and Sondra Rykoff Family Foundation; Roberto and Renata Ruhman, Brazil; the Adelis Foundation; the Leona M. and Harry B. Helmsley Charitable Trust; the Minna James Heineman Stiftung; and the Raymond Burton Plant Genome Research Fund. Prof. Aharoni is the incumbent of the Peter J. Cohn Professorial Chair.

Weizmann Institute of Science

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