Challenges of private provision in the NHS
Bibliographic record
Abstract
Editor—Timmins questions whether the benefits of using independent providers for health care outweighs the risks.1 He notes the tendency for treatment centres to take on simpler cases, leaving the NHS to deal with complex surgery, but he brushes over the devastating effect that this is having on surgical training.1 Cataract surgery is the most common operation performed by treatment centres. It takes intensive training to become a good cataract surgeon. It is usually possible to predict which cataract operations are going to be difficult or high risk when the patient is seen before the procedure.2 In our department, these complex cases are listed as “consultant to do.” The remainder are listed as “any surgeon to do,” and it is these patients who may be suitable for training.training. Figure 1 Credit: PASCAL GOETGHELUCK/SPL Since Netcare, a mobile treatment unit, and the Shepton Mallet treatment centre started operating in Somerset, we have noticed a dramatic reduction in training opportunities for cataract surgery. The number of “any surgeon to do” patients on each consultant list has halved from three patients per operating list in 2003 to 1.5 patients per list in 2005. Trainees are often unable to operate because of a lack of suitable cases. This will affect all ophthalmic training grades, but particularly senior house officers. Fielder and Watson, noting that Action on Cataracts had failed to consider surgical training, made some excellent suggestions about how training could be improved.3 Their ideas of high volume service and low volume training surgical lists, with blocks of intensive surgical training seem eminently sensible. The demand for surgery was apparently overestimated when planning treatment centres.1 Could the NHS now use this excess capacity in the form of low volume surgical training lists? It seems very “short sighted” that, although the number of cataract operations performed in the UK is increasing, the future of cataract surgery training is under threat.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.060 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.011 | 0.015 |
| Scholarly communication | 0.019 | 0.021 |
| Open science | 0.004 | 0.009 |
| Research integrity | 0.036 | 0.039 |
| Insufficient payload (model declined to judge) | 0.028 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".