Thank

you both very much. As we said earlier, that editorial by Wendy and Chris, should we worry about a growing threat from bird flu, is now available on bmj .com, links from the podcast page. As we said in our last episode, this is the year of elections, including in the UK. Our Commission on the Future of the NHS has set out the ways in which the NHS could make sure it is true to its founding principles and yet becomes more resilient in the future. Our commissioners have released their own manifesto as it happens. Helen Salisbury, GP and columnist for the BMJ, joins Juliet Dobson, our opinion editor to discuss. We

know from NHS satisfaction surveys that patient satisfaction in the NHS is falling, but we also know that it's a really kind of key issue for voters in the election and something that the majority of the population hold very dear to their hearts and something people really value as a key kind of election point. But equally, satisfaction in the NHS is currently at the lowest ever level. Only 24% of respondents were satisfied with the NHS in the most recent survey. So how would you seek to rebuild that trust and confidence in the NHS? Yes, I mean it's very difficult. I think most Brits

are really proud of the concept of the NHS. There's something so civilised out. We all look after each other. You don't have to get your checkbook out when you're ill. The concept of the NHS is very, very dear to people, but their daily experience of the NHS is getting worse and worse. And they've now have in lots of places lost confidence and they're not absolutely sure that when they need it, it will be there for them. But there's another element to that restoring trust in the NHS I think doctors are not convinced that the best interests of them and the patients are there in government agendas. in government in NHS England, in the Royal Colleges, in the GMC, and all these bodies that have authority over doctors, we kind of need to be convinced that they have our best interests at heart, our patients' best interests at heart. It's going to be quite a tough road to get back there to where we once were, but it definitely needs doing. And without trust, it's very difficult to improve anything. Yes,

and as you've said, staff are key to the NHS and to restoring that trust and improving patient care. And we've heard a lot about workforce and the particular challenges around and retention. So what do you think are the most important things that need to be tackled in terms of recruitment, retention and staff well -being? I

mean there's some very basic things like pay, but it's not just about pay, it's also about respect, it's about how people are treated. One of the ways we're not valuing people is not helping them have good careers. People are finishing at the end of being a medical student and finding they've no idea where they're going to be working in two months time because it's not been sorted out and they're getting through those next two the foundation years, and not managing to get on any training programs. So there has been a plan to increase the number of medical students and doctors, but we also need a plan to train them further and get them to where they want to be eventually as GPs or as specialists. There's a real lack of planning, the fact that we have a workforce plan. And there's also lots of issues about how we integrate other people who aren't doctors into the workforce, which we are a long way from getting that right.

and it's interesting, you've touched on so many different things there, but you've spoken before on this podcast and you've written in your weekly column about this strange contradiction between patients not being able to get appointments with their GPs, but also that we're now seeing some GPs that are unemployed or unable to find jobs. I suppose funding is relevant to all of this and it's also relevant to a subject that I imagine is close to your heart which is general practice. And the manifesto calls for investment into general practice and to reverse the replacement of doctors with less highly trained professionals. So is that such an important manifesto pledge? Well,

we definitely need more funding in the NHS. There's a calculation that there's about a £32 billion short fall. If we'd been kept on a trajectory we should have been on we would be a lot better than we are now. A lot of the time health spending has just flatlined or even not kept up with inflation and this is very much the case in general practice and in the whole of medicine money spent upstream is most effective. So most effective in public next most effective, probably in primary care in general practice. Actually, by the time you are in the hospitals, you know, things get very expensive. So if we want to keep people well, one of the places we should be spending is in general practice, we should be enabling every patient to have a named GP and continuity with that GP. There's loads of research that shows that actually, continuity of care is the thing that keeps people well, keeps them alive, keeps them out of hospital, stops them having emergency admissions. That's the thing that most works and we should we should be spending the money in an evidence -based way and that would be one thing to do is to rebuild general practice. Yes and as

you say we know that better access to GPs and continuity of care improves patient outcomes and is cost effective. And very important for prevention, which is another key point in the manifesto around prevention. And we know that the health of the UK population is deteriorating and inequality is widening. So how should some of those causes of ill such as, for example, tobacco or alcohol, junk food and gambling be tackled?