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I saw an advert in BMJ Careers last week. It is searching for a cohort of newly CCT’d doctors to be Senior Fellows in Clinical Leadership. This is the first time I have seen a job advert that is seeking consultants primarily for their management and leadership potential (other than medical director type posts). Clinical leadership posts have traditionally been seen as mainly clinical, with leadership bolted on the side.

I am known at my hospital for having worked at the National Patient Safety Agency. People approach me frequently with queries about the surgical safety checklist. Nearly all questions I can answer easily, but last week I was posed a problem that I still haven’t really got a good answer for.

The NHS has been given the job of saving £20 billion in four years. This is variously known as the QIPP programme or the Nicholson Challenge. It has been described as so big it can be see from outer space. Last month the Audit Commission produced their summary of the NHS financial year to remarkably little fanfare. The summary is that £4.3 billion was saved.

The first ever web page was published twenty years ago this month. The Linux project is also celebrating its twentieth birthday this month. These are two examples that are emblematic of how free has changed the world. They are free as in speech, but also free as in beer.

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