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Alf Collins

@alfcollins.bsky.social

1.6K followers 690 following 480 posts

Doctor, patient advocate, Trustee Patients Association and Picker Institute. Person centred, high value care, esp. shared decision making and support for self management. Ex Health Foundation, NHS England. Rugby, family, good food, trying to stay alive.

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Alf Collins @alfcollins.bsky.social · 1d

😂.

Reposted by Alf Collins

Glyn Elwyn BA MD MSc PhD @glynelwyn.bsky.social · 2d

Thanks to the many coauthors of this primer for clinicians about shared decision making ... link.springer.com/article/10.1...

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Alf Collins @alfcollins.bsky.social · 2d

Too right Steve. The public aren’t daft and it wouldn’t take much to explain the reasoning.

Alf Collins @alfcollins.bsky.social · 2d

It’s a *brilliant* explainer. I’ve not seen a similar explainer for the whole population from DHSC which is a shame.

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Reposted by Alf Collins

Steve Senior @stevensenior.bsky.social · 2d

Bit nerdy, but it's worth having a skim over the number needed to vaccinate figures here. E.g. to avoid one hospitalisation in otherwise healthy people JCVI estimated 60-100k would need to be vaccinated (based on Autumn 2024 data).

www.gov.uk/government/p...

Appendix A: estimating the number needed to vaccinate to prevent a COVID-19 hospitalisation in autumn 2024 in England

www.gov.uk

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Alf Collins @alfcollins.bsky.social · 2d

It’s late. Don’t get me started on value, allocative efficiency, opportunity cost. And while you are at it, don’t mention provider capture of the market and unwarranted variation.

Reposted by Alf Collins

steve the skeptic @policyskeptic.bsky.social · 2d

Indeed. I've quoted it recently to demonstrate the absurdity of raising the QALY threshold since NICE already approves too many low value (high cost/QALY) interventions.

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Alf Collins @alfcollins.bsky.social · 2d

Yes and…here’s well evidenced high value work with people living with MLTcs that reduces cost and treatment burden and improves QOL: patientprioritiescare.org

Home - Patient Priorities Care

Choosing what matters. Doing what works.

patientprioritiescare.org

Alf Collins @alfcollins.bsky.social · 2d

Yup. Meanwhile the good old reliable non amazing stuff gets marginalised.

We wonder how to make healthcare financially sustainable and the answer is right in front of us.

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Alf Collins @alfcollins.bsky.social · 3d

I’d add that this comprehensive review by Sally Gainsbury and Huceyin Nasi makes the same argument: www.nuffieldtrust.org.uk/news-item/th...
It is unconscionable that we accede to big pharma.

The tough choices at the heart of the government’s dispute with big pharma

The government has been locked in a dispute with pharmaceutical companies for a number of months over how much the NHS pays for new branded medicines. Sally Gainsbury and Huseyin Naci set out the issu...

www.nuffieldtrust.org.uk

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Alf Collins @alfcollins.bsky.social · 3d

A 2025 review in the Lancet (www.thelancet.com/journals/lan... shows that our current spending on new medicines skews overall health spend away from more effective interventions. But it looks like we are about to spend more on meds, thus depriving our population of more effective healthcare.

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Reposted by Alf Collins

Sarah M @sarah-owl.bsky.social · 3d

Don’t get me started on “brave” people who “fight” cancer or “lose their battle with” a disease 😡

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Alf Collins @alfcollins.bsky.social · 3d

You’ve probably seen this. Bottom line is that new meds tend to skew spend away from higher value interventions. www.thelancet.com/journals/lan...

Population-health impact of new drugs recommended by the National Institute for Health and Care Excellence in England during 2000–20: a retrospective analysis

During 2000–20, NHS coverage of new drugs displaced more population health than it generated. Our results highlight the inherent trade-offs between individuals who directly benefit from new drugs and ...

www.thelancet.com

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Alf Collins @alfcollins.bsky.social · 3d

Sadly, I can believe it.

Alf Collins @alfcollins.bsky.social · 3d

Oh my word yes…..☹️

Alf Collins @alfcollins.bsky.social · 3d

A handful of us used to speak about psychologically informed care a couple of decades ago. Sue Roberts, (ex diabetes czar/Year of Care programme)was preeminent. But like much work in person-centred care, other priorities/concepts supervened and it was lost. So bravo for you!

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Alf Collins @alfcollins.bsky.social · 3d

Lovely blog. And if anywhere can achieve the required shift it’s Scotland with Gregor’s exemplary leadership

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Alf Collins @alfcollins.bsky.social · 3d

Totally Charlie. I have a wordcloud slide of the psychosocial impact of living with LTCs (grief/loss/identity/isolation etc) and the question: ‘why would we not feel these things?’ And yet in the medical world, these feelings are either not acknowledged or are labelled as mental health probs
.

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Alf Collins @alfcollins.bsky.social · 3d

Having worked in policy for almost a decade I completely agree. But the mental models held by senior policy makers are of a service that is transactional and medical.

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Alf Collins @alfcollins.bsky.social · 3d

Can’t wait to read it. It’s amazing to me that given that the bulk of the workload of the NHS is working with people with LTCs, many of us are stuck in ‘fixer’ mode. The failure to appreciate this does all of us- patients and clinicians- a disservice.

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Alf Collins @alfcollins.bsky.social · 3d

Dunno the back story but JO……knows his own mind.

Alf Collins @alfcollins.bsky.social · 4d

I just walked for an hour through Belgravia and I didn’t see a single Black person. It’s a disgrace.

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Alf Collins @alfcollins.bsky.social · 4d

I’m 65 years old and only today realised that crabs don’t have 8 legs

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Reposted by Alf Collins

Tim Onion @bencollins.bsky.social · 4d

This guy sounds like a fucking lunatic.

Aaron Rupar @atrupar.com · 4d

CNN: Isn't that hyperbolic to call them terrorists?

STEPHEN MILLER: No. If anything I'm understating the severity of the situation

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Alf Collins @alfcollins.bsky.social · 4d

I honestly don’t believe he knows who he is. He seems to utter racist obscenities in an attempt to define himself as well as to test out a political position.