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We need a review of all sepsis deaths, not the conviction of health professionals, to improve the care of patients with sepsis

Dr Paul Morgan and I discuss deaths from sepsis in a letter published in the British Medical Journal. NHS England estimates that approximately 37 000 deaths a year are caused by sepsis.[1] This means that in the seven year period between 2011 and 2017, around 259 000 people died from sepsis in England. Only one of these deaths, that of Jack Adcock in Leicester in 2011, has resulted in the conviction of health professionals for manslaughter (Hadiza Bawa-Garba and Isabel Amaro).[2]

Sepsis can be difficult to diagnose, and delays and omissions in its diagnosis and treatment contribute to the high death rate. Even the former chair of the General Medical Council, Graham Catto, has admitted that he failed to diagnose sepsis in a timely manner, an error that contributed to a patient’s death.[3] Because of the problems diagnosing and treating sepsis, numerous initiatives have aimed to improve its management in both primary care and hospital settings. Details of one of the most recent of thes…
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Seven-day access to NHS primary care: how does England compare with other European countries?

It is often assumed that providing easier access to community-based general practice during evenings and weekends can reduce demand for emergency and other unscheduled care services, promoting more appropriate care and reducing the costs associated with expensive hospital-based treatment. For example, in England’s NHS there is political pressure to expand general practice surgeries’ opening hours to progress towards a ‘seven-day NHS’.

When considering extension of primary care opening hours in England, it is useful to compare primary care access across other countries in the European Union. Despite differences in healthcare commissioning and funding, European countries face comparable challenges such as ageing populations and increases in chronic conditions and mental health problems, all of particular relevance to primary care.  In a paper published in the Journal of the Royal Society of Medicine, we examined England’s current in-hours general practice services relative to those of …

Extending GP opening hours will not ease the rising burden on A&E departments

A study published in the journal BMJ Quality and Safety concluded that extending GP opening hours will not ease the rising burden on Accident and Emergency departments. The observational study was led by Imperial College London. Lead author Dr Thomas Cowling from Imperial College's Department of Primary Care and Public Health and colleagues compared patients' experiences of GP surgeries with the number of Accident and Emergency visits in their areas in England from 2011-2012 to 2013-2014. They examined reports from NHS England's annual GP Patient Survey, and included patients registered to 8,124 GP surgeries.

We measured levels of patient satisfaction using three factors: the ease of making an appointment, opening hours, and overall experience. They then matched these responses with A&E departments in their area to observe any correlation with the number of visits to A&E. Overall, areas where patients were happier with the ease of making appointments, which could …

Research Outputs of England’s Hospital Episode Statistics Database

Hospital administrative data, such as those provided by the Hospital Episode Statistics (HES) database in England, are increasingly being used for research and quality improvement. To date, no study has tried to quantify and examine trends in the use of HES for research purposes. We therefore examined trends in the use of HES data for research. Our study was published in the Journal of Innovation in Health Informatics.

Publications generated from the use of HES data were extracted from PubMed and analysed. Publications from 1996 to 2014 were then examined further in the Science Citation Index (SCI) of the Thompson Scientific Institute for Science Information (Web of Science) for details of research specialty area. 520 studies, categorised into 44 specialty areas, were extracted from PubMed. The review showed an increase in publications over the 18-year period with an average of 27 publications per year, however with the majority of outputs observed in the latter part of the study per…

Research outputs of primary care databases in the United Kingdom: bibliometric analysis

Data collected in electronic medical records for a patient in primary care in the United Kingdom can span from birth to death and can have enormous benefits in improving health care and public health, and for research. Several systems exist in the United Kingdom to facilitate the use of research data generated from consultations between primary care professionals and their patients. General Practitioners play a gatekeeper role in the UK’s National Health Service (NHS) because they are responsible for providing primary care services and for referring patients to see specialists.

In more recent years, these databases have been supplemented (through data linkage) with additional data from areas such as laboratory investigations, hospital admissions and mortality statistics. Data collected in primary care research databases are now increasingly used for research in many areas, and for providing information on patterns of disease. These databases have clinical and prescription data and ca…

Career opportunities for GPs in North and West London

On Wednesday 22 November 2017, I spoke at an event organised by the North and West London Faculty of the Royal College of General Practitioners. The event was aimed at ‘First Five’ general practitioners. I spoke on the topic of opportunities in research. The event was chaired by Dr Camille Gajria and Dr Nilesh Bharakhada. Other speakers at the conference included Dr Ian Goodman, Chair Hillingdon CCG, who spoke on the topic of emerging opportunities for GPs through new models of care; Dr Sohail Hussain who spoke on media opportunities; Dr Krishan Aggarwal who spoke on finance; Dr Shivani Tanna who spoke on teaching opportunities; Dr Sonia Tsukagoshi who spoke on international opportunities; and Dr Nilesh Bharakhada who spoke on the Care Information Exchange and opportunities in technology for GPs. The event was a good opportunity for First Five GPs to learn about career opportunities in London and also update themselves on areas such as personal finance and key developments in the NHS…

Reorganisation of stroke care and impact on mortality in patients admitted during weekends

In a study published in BMJ Safety and Quality, we evaluated mortality differences between weekend and weekday emergency stroke admissions in England over time. We aimed to determine whether a reconfiguration of stroke services in Greater London was associated with a change in this mortality difference.

We extracted patient-level data from national routinely collected administrative data (Hospital Episode Statistics or HES) from 1 January 2008 to 31 December 2014. Records include information of all admissions to English National Health Service (NHS) hospital trusts. Each patient record contains information on demographics (such as sex, age and ethnicity), the episode of care (such as trust name, date of admission) and diagnosis.

Our study covers a 30-month period before (January 2008 to June 2010) the reorganisation of stroke service in Greater London, and a 54-month period afterwards (July 2010 to December 2014). All admissions during the same period in the rest of England were used…