Better systems

Today’s health systems rely on robust policies and guidelines to deliver the best care for patients

Our specialist skills and services help organisations improve their processes and achieve results.

Providing expert methodological advice to the UK’s National Health Service

The BMJ Technology Assessment Group (BMJ-TAG) conducts health research to help decide whether new drugs should be made available in the NHS.

This year’s work has included several “me too” drugs, that is, drugs that might be considered to have the same efficacy and safety as other available options in the NHS but at a lower cost. The importance of these drugs lies in the savings achieved for the taxpayer and importantly, much needed cost savings for the NHS.

Our team independently assessed two new treatments for diabetic macular oedema (dexamethasone and brolucizumab), a condition that can result in blindness, with both treatments.

BMJ-TAG is also called on to conduct its own research, when several new treatments need to be compared with current practice. This year, BMJ-TAG looked at three treatments for severe atopic dermatitis for use in adolescents and adults. As a result of our work, all three treatments were approved.

Patient groups commenting on the appraisal highlighted the debilitating nature of severe atopic dermatitis, which goes beyond uncontrollable and persistent itching, to detrimental effects on a person’s mental health and self-confidence.

BMJ-TAG contributed to 12 policy docs in 2022, which touched an estimated 235K lives of patients 29.

The Eczema Outreach Support group highlighted that these new treatment options offer hope to patients who have exhausted all available treatments and have the potential to improve a patient’s quality of life.

Helping to influence health policy in Peru

The pandemic has profoundly disrupted the provision of health services across the globe, particularly in remote and rural regions.

Mamás del Río (Mothers of the River) is a multidisciplinary initiative that improves the health of mothers and newborns in remote and rural indigenous communities along 1,000 kilometres of the Amazon river in Peru and Colombia. The initiative uses social innovations to empower community health workers by addressing the healthcare delivery gap using mobile devices with relevant information to ensure the best patient outcomes.

A special collection on social innovations in health30 published by BMJ Group in 2022 helps to showcase the Mamás del Río programme’s success in helping community workers adapt in response to communication challenges posed by a strict, national lockdown. In their paper, Dr Magaly Blas and her colleagues evaluate how technological interventions help communities adapt to a new clinical setting within a post-pandemic context.

Since the BMJ Innovations publication of the collection: Social Innovations in Health, Mamás del Río has expanded into remote regions of the border between Peru and Colombia. The Peruvian Health Minister is also considering the evidence provided in the paper to inform a policy change that will formalise the Mamás del Río programme throughout the region as part of the national health system.

Helping to influence health policy in Peru

This policy change will help build capacity and efficiency amongst community health workers and supervise the community workers in the field in a programme they need to improve maternal and neonatal health.

Blas believes that having an evaluation of her work published in a reputable and robustly peer-reviewed journal from BMJ Group provides credibility that can help influence the Peruvian government to consider implementing critical policy change. This change will promote better health systems by preventing diseases in Amazonian communities.

We found in BMJ Group a voice to report on what was happening to us during the pandemic to the international world.”

Dr Magaly Blas
Medical epidemiologist, professor and researcher at Cayetano Heredia Peruvian University in Lima, Peru

Connecting communities to inspire change

At the BMJ Research Forum 2022, attendees had the privilege of hearing Dr. Katherine Freeman from the Engineering and Physical Sciences Research Council (EPSRC) deliver a thought-provoking presentation on the “Sandpit Methodology” for awarding research grants. This innovative approach aimed to unleash free thinking and inspire interdisciplinary collaboration to tackle significant challenges.

Among the attendees was a representative from UCLPartners, a healthcare organisation, who was deeply inspired by the Sandpit Methodology’s potential to encourage collaboration and co-production. Determined to bring about change, she took the concept back to UCLP and applied it to their Climate Collaborative project37—an initiative aimed at implementing the NHS Green Plan in their hospitals.

The implementation of the Sandpit Methodology involved bringing together doctors, nurses, estates staff, and IT teams from across the entire UCL Trust to work collectively towards achieving Net Zero emissions. The success of this collaboration was so remarkable that Dominique Allwood, Chief Medical Officer at UCLPartners, volunteered to chair the sustainability session at the BMJ Forum on Quality and Safety in Healthcare – Copenhagen 2023, sharing insights and experiences from their work.

In December 2022, our inaugural BMJ Research Forum saw 300 individuals gather in BMA House, London, where the concept of the Sandpit Methodology took root.

One attendee from UCL Trust embraced this idea and brought it back to an organisation that manages 17 hospitals who provide care for over 6 million patients. Such impressive statistics highlight how a single idea implemented within a large healthcare system can yield significant change.

The success of the Sandpit Methodology has led to its presentation at the International Forum, this time to an audience of over 3,000 attendees. The potential for these ideas to spread across organisations worldwide is immense; all it takes is one individual to carry them back to their respective institutions.

The impact of BMJ Group’s events extends far beyond the conference room. By connecting communities, inspiring change, and facilitating the exchange of knowledge and experiences, these platforms can transform entire sectors and healthcare systems. The success story of the Sandpit Methodology and its implementation at UCL Trust exemplify how a single idea, shared among passionate individuals, can create global ripples of change.

BMJ Group’s global reach and its ability to convene diverse audiences of leaders, innovators, and specialists are what make such knowledge-sharing and expertise exchange possible. The organisation has demonstrated its commitment to amplifying the voices that deserve to be heard, enabling experiences and insights to be shared, and inspiring individuals across functional and national boundaries.

Dominique Allwood
Chief Medical Officer, at UCLPartners; Senior Visiting Fellow at The Health Foundation; Director of Population Health at Imperial College Healthcare NHS Trust, England

Campaigning on the climate emergency and changing how we operate in pursuit of a healthier world

The healthcare sector contributes 4-5% of global greenhouse gas emissions. The physical health effects of climate breakdown are well established and occur through diverse pathways often disproportionately affecting vulnerable populations the most. There is increasing evidence that the climate emergency impacts mental health and wellbeing too, with “eco-anxiety” a growing problem for patients and doctors.31

The BMJ has been raising awareness about the climate crisis since the 1990s,32 emphasising its impact on health through changing patterns of disease, extreme weather events, loss of biodiversity and disruption to healthcare.33, 34 Our collective failure to respond to the climate crisis means we cannot reverse the damage already done. However, with urgent action we can mitigate against further damage to create a more sustainable future. Doctors and other health professionals have a key role to play in this change.

The BMJ collaborated with the UK Health Alliance on Climate Change (UKHACC) to simultaneously publish a joint editorial in more than 200 journals calling on world leaders to take emergency action.35, 36 The joint editorial emphasised the health impacts of the climate emergency and the need for governments to do more, and act faster to limit global temperature increases, restore biodiversity, and protect health.

In order to align BMJ’s editorial voice with its internal operational practices, the business has become a signatory of the UN SDGs Publisher Compact and has also signed the ten commitments established by UKHACC, promoting positive impact on people and planet in all aspects of its operational activities. A healthier world requires a healthier environment and therefore BMJ Group is committed to global sustainability and becoming carbon neutral as a business by 2040, at the latest.

Fostering positivity and activism through the climate issues themes

Ahead of COP26,37 The BMJ published its first themed issue on the climate crisis,38 which focused on tangible actions for health professionals to empower them to make change.

The second climate issue in October 2022 focused on hope39, arguing that hope is “a powerful driver to achieve change”40 in the face of government and corporate inaction to mitigate the climate crisis. Through ongoing coverage of the climate emergency The BMJ proactively empowers practising doctors to recognise the urgency and severity of the climate crisis, fostering a sense of collective responsibility including discussing the topic with patients.41

In the 2021 Climate issue, The BMJ published an opinion piece42 by Mala Rao and Richard Powell, highlighting the increasing levels of eco-anxiety, especially among children and young people, and its potential negative impact on individuals and society.

The publication raised awareness and prompted action on the issue of eco-anxiety. It gained national media attention and was featured in The Guardian.43 Following the publications of the opinion piece, Professor Mala Rao OBE, one of the authors of the piece and a member of The BMJ’s climate steering committee, was invited to lead a special issue on eco-anxiety for the Royal College of Psychiatrists.44

The [Climate Issue] is so fantastic, and everyone ignored the first hour of work to read through it cover to cover. There’s such a diversity of thoughts, all positive and pulling in the right direction.”

Nick Watts
Chief Sustainability Officer of the NHS