In terms of more substantive responses to your questions on how best to “Rage Against The Machine”, below are some of my best tips.
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Do not waste your time on hammering through a local IT change - it’s going to exhaust you fighting with ‘parish council’-level local IT dickheads and even if you succeed you’ve fixed the issue LOCALLY, when medicine is global.
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So, think BIG and go global with ideas and projects. By publishing the code on something like GitHub you can get global reach, even though of course everything happens very slowly initially.
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Do everything in open source and refuse to be part of a project that wants to hide its source code. This is partly for ethical reasons, and partly because it s a ‘saved game’ strategy - when your code for any project is open source then even if the org you work for disappears (eg NHSX, NHSE&I, NHSD, the FCI, soon the PRSB too) then you never lose access to that work.
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Be outspoken (it works) Being Outspoken Works! - blog - Baw Medical Ltd
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I’ve had success with working with RCPCH and RCGP (to a lesser extent) so these can be ways to ‘go around’ the local IT blockers - I can tell you for sure that no NHS Trust or ICB would implement my dGC code if I was dealing with them directly. But they implement my code via the RCPCH because I’m hiding under that organisation’s gravitas and reputation. This article I wrote about the RCPCH Incubator has just been published today (sadly they would only let me make it Open Access for the first month, but I have preprint PDF if anyone wants) http://adc.bmj.com/cgi/rapidpdf/archdischild-2025-329017?ijkey=6KwuyucXMMMoosz&keytype=ref