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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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Reposted by Alf Collins

Greg Fell @felly500.bsky.social · 11h

aheblog.com/2025/10/14/c...

Cost-effectiveness thresholds under political pressure: where are the health economists

There have been occasions I've disagreed with Chris's take on some matters
Im 100% with him on this one

Cost-effectiveness thresholds under political pressure: where are the health economists? - The Academic Health Economists' Blog

The UK government is reportedly preparing to raise NICE’s cost-effectiveness threshold by 25%, as a bargaining chip to avoid US pharmaceutical tariffs. It’s time for health economists t…

aheblog.com

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Alf Collins @alfcollins.bsky.social · 9h

For the life of me I can’t understand why Prostate UK (supposedly there for patients) keeps promoting screening and early diagnosis.

Reposted by Alf Collins

Greg Fell @felly500.bsky.social · 12h

Theres soon to be a test on whether those who opine about screening actually understand the principles on which screening programmes are based
Get your revision done

In the meantime here is a masterclass from Prof Baum

(More advanced classes are available)

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Alf Collins @alfcollins.bsky.social · 20h

Posting this again because I am now using ChatGPT as my coach to help me reduce my cardiac risk. I’m health literate, I have my data, I know where to look for the evidence but *I am now not relying on the NHS to help me make decisions about managing my cardiac risk* @finnikin.bsky.social

Alf Collins @alfcollins.bsky.social · 26d

Me: 65 years, relatively fit for age, recently retired doctor . BP trending up (135/80)
I’ve just spent 30 mins discussing pros and cons of treatment with ChatGPT. A wonderful *dialogue*.
Question: Why choose the NHSApp when we have ChatGPT?

Alf Collins @alfcollins.bsky.social · 1d

Yes. Totally get that. I’ve been working with a few others on the rewrite of the AoMRC guidance and we have considered this…and not come to an easy answer. DM if a call would help though I guess you know more than me!

Alf Collins @alfcollins.bsky.social · 1d

He sounds like a 5 year old who has just shat his pants and desperately needs to change the subject.

Alf Collins @alfcollins.bsky.social · 1d

Are you promoting writing letters firstly to patients Luke, as per AoMRC recommendations?
Hope all well!

Alf Collins @alfcollins.bsky.social · 3d

Aaaaagggghhhhhhhh

Alf Collins @alfcollins.bsky.social · 4d

😂.

Reposted by Alf Collins

Glyn Elwyn BA MD MSc PhD @glynelwyn.bsky.social · 5d

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 · 5d

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

Alf Collins @alfcollins.bsky.social · 5d

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 · 6d

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 · 6d

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 · 6d

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 · 6d

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 · 6d

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 · 6d

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 · 6d

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 · 6d

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 · 6d

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 · 6d

Sadly, I can believe it.

Alf Collins @alfcollins.bsky.social · 6d

Oh my word yes…..☹️

Alf Collins @alfcollins.bsky.social · 6d

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 · 6d

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

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