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Integrating a nationally scaled workforce of community health workers in primary care

Increasing workload, a reduced percentage of the budget and workforce retention and recruitment problems challenge the capacity of available general practitioners in the UK NHS. Consequently, patients’ ability to obtain general practitioner appointments has declined. Political pressure to improve access has been accompanied by promises of increased general practitioner numbers, but with a reported fall in 2016–2017,5 it remains unclear how this will be achieved. Meanwhile, financial constraints have also led to the loss of some community-based health services, such as district nursing and fragmentation of others.

In a study published in the Journal of the Royal Society of Medicine, we examined whether the systematic deployment of community health workers in the NHS could help address current problems of fragmentation and inefficiency, while improving clinical outcomes through improved uptake of appropriate services.

Conservative modelling suggested that 110,585 community health worke…
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Health outcomes in the UK: how do we compare with Europe?

In an article published in the British Medical Journal, I discuss the health outcomes achieved by the NHS in the UK and how these compare with other European countries. Health outcomes in the UK have improved substantially since the NHS was established in 1948. The NHS also performs well in many international comparisons on measures such as efficiency, equity, and access.

Despite these achievements, however, problems with health outcomes remain. Moreover, other European countries have also improved their health outcomes in recent decades, often at a faster rate than the UK. Consequently, the UK now lags behind many other European countries in key health outcomes in areas such as child health and cancer survival.

I conclude that new health policies in the UK should help the NHS to focus on improving health outcomes and that politically expedient schemes that are not evidence-based – such as extended opening hours in primary care – should be abandoned. Continued progress is also needed…

Telling the truth about antibiotics: benefits, harms and moral duty in prescribing for children

In a paper published in the Journal of Antimicrobial Chemotherapy, we discuss key issues in applying an evidence-based approach to the prescribing of antibiotics to children.

Antimicrobial resistance is a growing threat to global health, yet antibiotics are frequently prescribed in primary care for acute childhood illness, where there is evidence of very limited clinical effectiveness. Moral philosophy supports the need for doctors to consider wider society, including future patients, when treating present individuals, and it is clearly wrong to waste antibiotics in situations where they are largely clinically ineffective at the expense of future generations.

Doctors should feel confident in applying principles of antibiotic stewardship when treating children in primary care, but they must explain these to parents. Provision of accurate, accessible information about the benefits and harms of antibiotics is key to an ethical approach to antimicrobial stewardship and to supporting shar…

Patients value the quality of care they receive from their GP over extended access

In recent years, the NHS has invested in 'extended hours' schemes, whereby general practice are encourage to open beyond their contracted hours of 8am to 6.30pm Monday to Friday. In a study published in the British Journal of General Practice, we examined associations between overall experience of general practice and patient experience of making appointments and satisfaction with opening hours using data from the General Practice Patient Survey.

We found that patient experience of making appointments and satisfaction with opening hours were only modestly associated with overall experience. Patient satisfaction was most strongly associated with GP interpersonal quality of care

We concluded that policymakers in England should not assume that recent policies to improve access will result in large improvements in patients’ overall experience of general practice.

The article was covered by the medical magazine Pulse.

The F3 year: Why increasing numbers of foundation doctors are deciding against specialty training programmes

In an article published in the Journal of the Royal Society of Medicine, Paul Jewell and I discuss the issue of foundation doctors and specialist training. Only around 43% of junior doctors entered straight into a UK specialty training programme after completion of their foundation programme in 2017, a substantial decrease from 71% in 2011. Given the National Health Service in the UK is under ever-increasing workforce pressures, this is a worrying trend. The decline in entry to specialty training can be partly explained by the rise in what is known as ‘the F3 year’. Concerns over this ‘junior doctor exodus’ are not new, having been previously raised in 2010, when the figures were far more favourable than they are now. Similar trends can also be seen at earlier stages, with fewer school students applying to medical school, and fewer medical students applying to the foundation programme,4 indicating wider issues. To reverse this trend and the shortage of doctors in many specialties, so…

Measles outbreak in England

England is currently experiencing an outbreak of measles, with around 440 laboratory confirmed cases between January to May 2018. The outbreak is linked to ongoing outbreaks in Europe. Most cases are unimmunised teenagers and young adults. Children and young adults who did not receive MMR vaccine when they were younger, and people from under-vaccinated communities, are particularly at high risk.
Measles is a highly infectious illness that can sometimes cause serious complications such as pneumonia and encephalitis, and which can occasionally be fatal. Anyone who missed out on their Measles, Mumps and Rubella (MMR) vaccine or is unsure if they had 2 doses should therefore ensure they are fully immunised.
The outbreak also reinforces the importance of parents to ensure their children receive two doses of the MMR vaccine, the first at around 12 months of age and the second around 3-4 years of age.

Who is responsible for the vaccination of migrants in Europe?

An article from Imperial College London published in the Lancet discusses vaccination from migrants in Europe. Ensuring high levels of coverage is a key priority of the European Vaccine Action Plan, whereby all WHO Europe Member States have committed to eliminating endemic measles and rubella (>95% coverage with the measles mumps rubella vaccine), sustaining polio-free status, and controlling hepatitis B infection.

Changing nationwide trends in endoscopic, medical and surgical admissions for inflammatory bowel disease: 2003–2013

Our recent paper in BMJ Open Gastroenterology examines trends in endoscopic, medical and surgical admissions for inflammatory bowel disease in England from 2003–2013. In the last decade, there have been major advances in inflammatory bowel disease management but their impact on hospital admissions requires evaluation. We aim to investigate nationwide trends in inflammatory bowel disease surgical/medical elective and emergency admissions, including endoscopy and cytokine inhibitor infusions, between 2003 and 2013.

We used Hospital Episode Statistics and population data from the UK Office for National Statistics. Age-sex standardised admission rates increased from 76.5 to 202.9/100 000. Rising inflammatory bowel disease hospital admission rates in the past decade have been driven by an increase in the incidence and prevalence of inflammatory bowel disease. Lower GI endoscopy and surgery rates have fallen, while cytokine inhibitor infusion rates have risen. There has been a concurrent s…