Medical Centre

Appointment lengths in primary healthcare should be flexible to accommodate the needs of each individual patient. This allows for personalized care and ensures that patients receive the appropriate amount of time and attention from their clinician.  It also allows for more efficient use of clinic time as appointments can be scheduled based on the specific needs of each patient rather than a one-size-fits-all approach. Offering flexible appointment lengths can improve patient satisfaction and build trust in the healthcare system. It can be challenging for doctors and other clinical staff to give more time to patients and increase appointment lengths when they are also required to see more patients given the demand for appointments and the shortages of key healthcare workers. Implementing digital technologies such as electronic medical records and online appointment booking, can help to streamline the appointment process and allow clinical staff to see more patients without sacrificing t

 In the fields of clinical medicine and public health, it is important to recognize and acknowledge the inherent uncertainties that exist. This is because these fields deal with complex systems that have a high degree of uncertainty and imprecision. This uncertainly can be in the diagnosis and treatment of individual patients, or in the implementation of public health policies. It is crucial for medical professionals and public health officials to communicate these uncertainties accurately and transparently.  This can help prevent the spread of misinformation and can also help individuals make informed decisions about their health and the use of interventions such as screening or vaccination. Furthermore, it is important to recognize that not all sources of information are equal. It is important to critically evaluate the evidence behind any claims being made. This is especially important in the era of social media, where anyone can share their opinions and ideas, regardless of their e

 A real change is on the horizon. In October 2021, Facebook announced that it would rebrand itself as ‘Meta’, and this generated high levels of public interest in the metaverse for the first time. Definitions for the metaverse vary and there is still much uncertainty in its eventual future manifestation. It is perhaps best defined as a fully immersive parallel digital reality where users will be able to interact at a scale previously unimagined. The advent of the metaverse could have transformational impact on every aspect of human life, from our social interactions to what we ascribe real value to. Just as the Internet has completely transformed health, the metaverse will redefine virtual and physical possibilities in health.2 This will have major implications for our health and for healthcare delivery. The coming of age of the metaverse is in due largely to the maturation of technological advances in artificial intelligence and devices that enable the delivery of mixed, augmented and

  Primary Care Clinical Update 8 December 2022   1. Group A Streptococcal infections There has been an increase Group A Streptococcal (GAS) infections in recent months, which has led to at least 15 deaths in children since September. Although GAS rates are higher than expected for this time of year, they have been higher at periods over the last decade as shown in the graph below from the UKHSA.  GAS causes a range of infections including Scarlet Fever and also more severe invasive disease. For more information on management, see: Scarlet fever: a guide for general practitioners. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649319/ The Centor score can be used to assess the probability of an illness being GAS pharyngitis: Tonsillar exudates, tender anterior cervical adenopathy, absence of cough, history of fever (>38 °C). Penicillin V (or Amoxicillin) is the preferred treatment unless contra-indicated in which case an alternative such as a cephalosporin or clarithromycin can

There is currently considerable media coverage and some public anxiety in the UK about Group A streptococcal (GAS) infections. Journalists who write about cases of infectious diseases need to understand the principles of the Poisson distribution. Events such as infections can sometimes cluster in time or space due to chance, and not because there is an underlying cause behind the cluster of cases. Some journalists and doctors are stating that the cases of Group A streptococcal infections we are currently seeing in the UK are from lower levels of immunity because of Covid-19 control measures over the last 2.5 years. This is not necessarily the case and needs further investigation. The UK has experienced large outbreaks of Group A streptococcal infections in the past. For example, the UK had a large outbreak of Group A streptococcal infections between September 2015 and April 2016 (the largest since 1969), resulting in PHE issuing an alert.  The current cluster of Group A streptococcal i

Writing in the Journal of the Royal Society of Medicine , myself, Austen El-Osta and Chris Rowe set out a vision for building sustainable, self-driven healthcare spanning primary care, secondary care and the wider health and social care system has been set out by medical innovators. Self-driven healthcare (SDH) is an umbrella term introduced by Innovate UK, the UK’s national innovation agency, to conceptualise aspects of healthcare delivery that can support people in becoming more engaged in managing their own health and wellbeing, rather than being passive receivers of healthcare. In our paper, we describe an SDH ecosystem that supports individuals to take more ownership of their health and wellbeing and in recording their own data (e.g. weight, blood pressure) using a phone app, tablet, computer or Bluetooth device. This self-generated data would then be uploaded onto a secure online SDH portal which holds all their health records, including those generated in the wider healthcare sy

Topics I presented in my practice’s clinical meeting today: 1. ADHD referral update a. ADHD referrals are rejected by a clinician in the specialist team if thought to be unsuitable for the service but sometimes this is a team decision, so they prefer not to give a specific name on the rejection letter. b. They don’t have the ability to “pause” referrals. Hence, if key information is missing, a referral is rejected as they can’t put it on hold. c.   When making a referral, ensure that the key diagnostic criteria are all included. These should be in the referral form but are also available online. https://selondonccg.nhs.uk/wp-content/uploads/2022/09/SEL-ICS-Adult-ADHD-referral-criteria-v1-2022.pdf d. Private patients and overseas patients. Consultant Connect can be used to get advice quickly and this can allow medication to be continued if indicated for patients with a confirmed diagnosis. Consultant Connect for the ADHD service is currently under-used by local GPs. e. Refe

A recent article in the British Medical Journal discusses work-related stress and burnout in healthcare workers. These are important problems in the NHS workforce in the UK a well as amongst healthcare workers in other countries. Addressing the underlying cause, which may relate to factors such as workplace demand, relationships, and support is necessary for sustained recovery and full engagement with work. Healthcare workers may experience guilt or shame due to stigma, preventing them from seeking help if they experience work related mental illness. Time off work and workplace changes to control the triggers may be necessary to allow recovery and sustainable return to work. Healthcare workers experiencing work related stress can seek support from colleagues, their own GP, occupational health, and specialised services for healthcare workers such as local mental health and wellbeing hubs and NHS Practitioner Health.

Our recent article in the Journal of the Royal Society of Medicine   discuses the diagnosis and management of Monkeypox in UK primary care settings but is also relevant to primary care clinicians working in other countries outside West and Central Africa that have  seen Monkeypox cases in 2022. Since its discovery in 1958 in monkeys, the Monkeypox virus has been rarely found outside west and central Africa until the current global outbreak. The first human case of the virus was in an infant from the Democratic Republic of Congo (DRC) in 1970; the infection has since spread to other regions, primarily in Africa. The first case of the current outbreak was confirmed on 6 May 2022, in the UK and was linked to travel to Nigeria. Two subsequent UK cases were detected a week later; however, neither affected individuals reported contact with the primary case in the UK nor travel to Africa.  On 23 July 2022, the World Health Organization (WHO) declared the current Monkeypox outbreak a public he

Much of the discussion about vaccination is on Covid-19 and flu vaccines or vaccines for children. But there are also other important vaccines for adults – such as for shingles - where there is scope to increase uptake and improve health outcomes for older people and the immunocompromised.  Shingles is caused by the reactivation of latent varicella zoster virus (VZV); sometimes decades after the primary chickenpox infection. For some people – particularly the elderly and the immunocompromised – shingles can be a very unpleasant illness with significant complications. In the UK, two vaccines are licensed for shingles: Zostavax which contains live, attenuated virus and which is given as a single dose. Shingrix which is a recombinant vaccine and which his given in two doses.  The main target group for shingles vaccination in the UK is people aged 70-79 years. Most people in this group will receive the Zostavax vaccine. People in this age group who are immunocompromised should receive the

Our new paper in the International Journal of Integrated Care reviews the role of multidisciplinary team (MDT) meetings in the management of multimorbidity in primary care. MDTs bring together professionals to work together to improve health outcomes for patients. MDT meetings are often recommended as a critical aspect of integrated care in guidance and opinion pieces, but it is not clear how and to what extent their use improves outcomes for patients with multimorbidity. Our review aimed to fill this knowledge gap. We found limited evidence that supports the implementation of MDT meetings in primary care settings for individuals with multimorbidity. There were also substantial problems with the methodological rigour of previous studies on MDT meetings in primary care. Although MDT meeting are a key strategy for delivering comprehensive integrated care, there is a lack of evidence concerning the efficacy of MDT meetings in primary care. The complexity of interventions meant that causa

With England’s NHS under immense pressure even before the full onset of winter, here are some tips on how you can make the most of the NHS, use health services more appropriately, and obtain the care you and your family need to protect your health and wellbeing. 1. Attend for appointments for medication reviews and for the management of long-term conditions when invited. 2. Take-up the offer of Covid-19 and flu vaccinations if you are eligible. Make sure you are up to date with any other vaccinations you are eligible for. Attend for health screening appointments when invited. 3. Use the NHS app to book appointments, view your GP medical record and order repeat prescriptions. 4. Be aware of the range of options for NHS care – including opticians, pharmacists, self-referral services (e.g. podiatry, IAPT, smoking cessation), and NHS 111. 5. Use the NHS electronic prescription service so that your prescription is sent directly to a pharmacy. 6. For queries about hospital care, contact the

Our new study in JRSM Open led by Dr Raj Chandok and Dr Poonam Madar examines factors influencing Covid-19 vaccine hesitancy among South Asians in London. Vaccines have a key role in suppressing serious illnesses, hospitalisations and deaths from Covid-19. London has amongst the lowest Covid-19 vaccination rates in the UK and it’s important to understand the factors behind this so we can work better with local communities to address this key public health challenge. This includes looking at factors such as confidence in Covid-19 vaccines, complacency about the severity of illness arising from Covid-19, communication about vaccines in both the mainstream media and social media, and the context in which people live and work.

If you consult your doctor about bowel symptoms, they may speak about getting FIT. What is FIT? In this context, it is nothing to do with exercise or how far you can run. FIT stands for faecal immunochemical test, which aims to detect blood in your faeces. The test is highly sensitive.  People with lower bowel symptoms such as a change in their bowel habits will understandably be concerned about the possibility of bowel cancer. The risk of colorectal cancer in people with a negative FIT, a normal examination and normal full blood count is <0.1%. This is lower than the general population risk of colorectal cancer. So this combination of clinical findings allows your doctor to conclude that you are very unlikely to have bowel cancer. However, many people with lower GI symptoms still do not undergo FIT before referral to a specialist. Patients with a FIT of fHb <10μg Hb/g, a normal full blood count, and no ongoing clinical concerns do not need to be referred on a lower GI urgent can

Our new paper in the British Medical Journal reviews the implementation of the UK’s Covid-19 vaccination programme. The programme is essential in keeping down the number of serious cases, hospitalisations and deaths from Covid-19 and allowing society to function more normally.  Overall the programme performed well. But it’s important to address some common misconceptions about the programme. Firstly, the rapid implementation of the Covid-19 in vaccination in the UK was not due to Brexit. When the programme started, the UK had not finalised Brexit. Secondly, the vaccination programme was good and all those who supported the programme are to be congratulated for their efforts but it was not “world-leading” as some politicians have claimed. Many other countries have outperformed the UK in areas such as vaccine uptake.  One limitation of current vaccines is that although they are very successful in reducing the number of serious cases of covid-19, they are less effective in preventing inf

 The NHS is now starting to rollout flu vaccinations for eligible people. Although the public health focus since early 2020 has been very much on Covid-19, flu remains a major threat to vulnerable individuals and the NHS in the UK.  We have been fortunate that in the last few years, flu rates have been very low in the UK. However, there are signs from Australia that we may see much higher rates of flu in the UK this winter. Australia has seen its highest flu rates since the start of the Covid-19 pandemic and this may be a predictor of what the UK may face during our own winter. Because flu rates have been low in recent years, this means that people will have less immunity from a previous infection. The end of Covid-19 control measures – such as face masks and social distancing  - combined with the return of normal social activities also increase the likelihood of a large flu outbreak this winter. This makes flu vaccination essential – particularly for the elderly, the clinically vulner

It’s the time of year when academics – including myself - are marking MSc and MPH dissertations. Once again, I see many errors in how students write their dissertations. What are these errors and how can students avoid them to make their dissertations more readable? Spend time planning the outline of your dissertation with chapter headings and subsection headings for each chapter. Decide what key tables, figures and graphs you need to include to reinforce what is in the main text of your dissertation. Many students assume that longer words are “more scientific” and therefore preferable than shorter words. For example, using terms like perspiration rather than sweat or haemorrhage rather than bleed. Imagine if Churchill had written his speeches in this “more scientific” way.  Use shorter sentences when possible. Longer sentences are more difficult to read and can lead to the examiner missing the key points you are trying to make. The same applies to paragraphs – don’t make them too long

Traditional face-to-face smoking cessation interventions may result in significant delays between the patient's decision to quit and access to effective pharmacological support or behavioural therapies. In a study published in the journal Public Health in Practice , we evaluated digital solution to streamline access to smoking cessation interventions This was the first attempt in the UK where a GP-led online portal with added functionality was used to streamline timely access to pharmacotherapy for smoking cessation using an asynchronous formal request for treatment. We evaluated the findings of a primary care pilot from two general practices in West London where 4337 patients who are registered as smokers were contacted with unique link to access the portal. Whereas smoking is the major avoidable cause of preventable morbidity and mortality in the UK and internationally, there are surprisingly few examples of a patient-facing primary care led IT system to streamline the delivery o

 One of my educational roles is update staff in my medical practice about topical public health issues in our weekly clinical meeting. In the most recent meeting, I gave an update on polio in London, including some key facts that health professionals need to understand. 1. Understand the difference between the two types of polio vaccines: inactivated and live. The inactivated polio vaccine has been used in the UK since 2004. Once polio has been eradicated from a country, it is safer to use the inactivated vaccine. 2. Check each patient’s polio vaccination status and encourage those patients who are not vaccinated or only partly vaccinated to receive a full course of vaccinations. Ensure that vaccine status is recorded on the patient’s electronic medical record. 3. Support the booster programme for children aged 1-9 years old that is currently being rolled out across London. Address vaccine hesitancy and any concerns about vaccination in parents sympathetically and aim to understand why

I was explaining to a student recently how we did literature searches in the 1980s and 1990s. We had to look up articles in a printed copy of Index Medicus, and then pushed a trolley around the library to collect the journals so we could photocopy the articles. There was an incredulous look in her eyes. We had to pay for the photocopies, which made us very selective about the articles we used in our literature reviews.  And when we got to the photocopier, we had to hope that it had not broken down or that the queue to use it was too long. Arriving well before library closing time was also important. Online articles did not exist then and sometimes we had to wait for weeks for articles to arrive using the Inter-Library Loan Service if they were not in the library’s own collection. Eventually, printed copies of Index Medicus were replaced by a CD-ROM version (which you have to book a slot in advance to use) and then eventually by online bibliographic databases. And now, we have immediate

Our recent study in the journal Thorax examined patient outcomes following emergency admission to hospital for COVID-19 compared with influenza. We used routinely collected primary and secondary care data. Outcomes, measured for 90 days follow-up after discharge were length of stay in hospital, mortality, emergency readmission and primary care activity. The study included 5132 patients admitted to hospital as an emergency, with COVID-19 and influenza cohorts comprising 3799 and 1333 patients respectively. Patients in the COVID-19 cohort were more likely to stay in hospital longer than 10 days (OR 3.91, 95% CI 3.14 to 4.65); and more likely to die in hospital (OR 11.85, 95% CI 8.58 to 16.86) and within 90 days of discharge (OR 7.92, 95% CI 6.20 to 10.25). For those who survived, rates of emergency readmission within 90 days were comparable between COVID-19 and influenza cohorts (OR 1.07, 95% CI 0.89 to 1.29), while primary care activity was greater among the COVID-19 cohort (incidence

  Why are so many people coming down with Covid again? The current wave of Covid-19 infections is being caused by highly infectious subvariants (BA.4 and BA.5) of the Omicron variant that entered the UK in late 2021. These subvariants are more infectious than the previous variants of the coronavirus that the UK has faced. They are also more likely to cause reinfections. Other factors increasing the number of infections include greater mixing of people now that Covid-19 measures in the UK have ended and reduced protection from infection from vaccines because many people are more than six months since their last Covid-19 vaccination.   Are the new variants worse than the other variants? Although they are more infectious than other variants, the new subvariants of Omicron do not cause more severe disease and on average, they probably cause a milder illness. However, because of the very large number of infections caused by these subvariants, some people will have a serious illness

Despite the very low risk of seroconversion, occupational HIV exposure is a very stressful situation. Our new article in the Journal of the Royal Society of Medicine provides guidance on how such exposures should be managed to minimise risks and improve health outcomes for staff exposed to contaminated body fluids.  Careful risk communication can help in addressing anxiety. Pre-Exposure Prophylaxis (PEP) is seldom indicated for occupational exposures if the index case is of unknown HIV status, as the transmission risk is very low. PEP is indicated to reduce the transmission risk following high-risk incidents – exposures where the index case is known to be HIV-positive with a detectable viral load – and is most effective if started promptly.

One of the causes of increased workload in general practice are the many requests that doctors get for letters, reports and forms from patients or from external organisations. It’s now so common that doctors have coined a term for it: GANFYD – Get A Note From Your Doctor.  It’s seems that large sections of society can’t function without these “letters from doctors”. Instead of using common sense or employing their own clinical advisers, external organisations make repeated requests to NHS doctors for letters which are often not at all needed. Often the worst offenders come from the public sector – e.g. universities who seem to look upon NHS general practice as a source of free occupational health advice for their students. Universities never – of course - offer to pay for this advice they get from NHS GPs. Instead, university requests will come with a mealy-mouthed statement that any fee is the responsibility of the student. Like doctors are going to impose heavy fees on impoverished s

During the COVID-19 pandemic, health systems globally shifted towards treating COVID-19 infection in adults and minimising use of health services for other patients, including children and young people (CYP), who were less susceptible to severe COVID-19. In March 2020, the NHS recommended remote triaging before any face-to-face contact to reduce infection risk.  The UK Government announced a nationwide lockdown in England from 23 March 2020, and the public was advised to stay at home to limit transmission of COVID-19 and avoid strain on health resources. GPs were asked to prioritise consultations for urgent and serious conditions, and suspend routine appointments for planned or preventive care.  Children’s access to primary care is highly sensitive to health system changes. We examined the impact of COVID-19 on GP contacts with children and young people (CYP) in England. We used a longitudinal trends analysis was undertaken using electronic health records from the Clinical Practice Res

Recent draft guidance from NICE gives a much bigger role to exercise and weight loss in people with osteoarthritis, and painkillers such as paracetamol and strong opioids not advised. I agree that the aims of the new draft NICE guidance on the management of osteoarthritis in primary care are good but the problem will be in providing patients with access to suitable lifestyle and exercise programmes. In many parts of England, these services are either not currently in place or have very limited capacity. As well as putting in place services with sufficient capacity, we also need to ensure there is equitable access to them, based on clinical need. We know from prior experience that it is more affluent and better educated patients who are more likely to take up these kind of lifestyle and exercise interventions. We also need to simplify clinical pathways and allow patients to refer themselves directly to services without requiring a referral from a GP. This will improve the speed of acce

An article published in the BMJ by Allyah Abbas-Hanif, Neena Modi and myself discusses the long term implications of Covid-19 in pregnancy. Covid-19 in pregnancy increases the risk of severe complications for both mother and baby. The long term implications are unknown, but emerging signals warn of substantial public health threats. To counter high vaccine hesitancy in pregnancy we must end the default exclusion of pregnant women from the rigorous regulated drug development process and implement systematic, long term, population-wide surveillance of infected and non-infected people. The full article can be read in the British Medical Journal . 

Thanks to Covid-19 vaccination, we have seen a substantial weakening of the link between Covid-19 infections and hospitalisations / deaths in the UK. But we don't yet know how well this protection from serious illness and death will persist in the longer-term. We are also seeing "vaccine fatigue" set in with many people not keen on booster vaccines. For the UK, the future challenges will include determining how frequently and in what groups Covid-19 booster vaccines are needed; ensuring a high take-up of vaccinations in all eligible groups; and having vaccines that are updated when necessary to protect against new variants. We have already had one additional booster vaccination programme in the UK this year; which targeted people 75 and over, residents of care homes, and people who are immunocompromised. A larger booster programme is planned for later this year that will target a wider range of people, including NHS staff. Although some people are very optimistic about th

Earlier this month, a case of Monkeypox was reported in London, followed by reports of further cases in the UK and in many other countries. Understandably, people are anxious whenever an outbreak of an unusual infectious disease occurs, likely more so because of their experiences during the Covid-19 pandemic. Although we need to take the disease seriously, Monkeypox is much less of a threat to global health than Covid-19 and won’t have the same impact on societies or lead to the type of control measures we have seen for Covid-19 over the past two years. The virus that causes Monkeypox is found primarily in small animals, like rodents, in parts of West and Central Africa – but was first identified in monkeys (hence the name). It can sometimes spread to humans and because of international travel, then spread to other parts of the world. But unlike Covid-19, which is easily transmissible and has caused huge waves of infection globally, Monkeypox spreads much more slowly, requiring close c

Whether it be a simple telephone call or more sophisticated video conferencing systems, virtual care tools have been in use in primary care settings worldwide in one form or another throughout the past two decades. Over time, these tools have grown in availability, matured in their capabilities, but played a largely supportive role as an alternative option to traditional face-to-face consultations. This all changed in early 2020 with the onset of the COVID_19 pandemic. The COVID-19 pandemic presented a unique opportunity globally which put virtual care tools at the forefront of primary care delivery. The need for social distancing to limit disease transmission resulted in virtual care tools becoming the primary means with which to continue providing primary care services. Hence, our study’s goal was to capture the spectrum of GP experiences using virtual care tools during the initial months of the pandemic so as to better understand the perceived benefits and challenges, and explore wh

In this concise guide, Dr Sophie Farooque – a Consultant in Allergy at St. Mary’s Hospital in London and one of the UK’s leading experts on the treatment of allergic disorders – gives an excellent overview of allergies that will be a very useful guide for the public and also for health professionals.  Allergic disorders have increased substantially in prevalence in recent decades. This is shown in our personal experience as well as by research on the epidemiology of allergic disorders. When I was in school, problems such as hay fever and food allergy were all uncommon in my classmates. This in contrast to now, when many families will have a member who suffers from an allergic disorder. In milder cases, these disorders can be irritating and reduce people’s quality of life. But in more severe cases, they can lead to hospitalisation and sometimes even to death.  Hence, some knowledge of allergies and how they can be managed is very helpful to families who have a member who suffers from an

Colorectal cancer is one of the most common cancers and most common cause of cancer deaths worldwide. Despite the availability of screening, disparities in survival from colorectal continue in certain ethnic minority groups. This may, in part, be secondary to low take-up of bowel cancer screening. Different ethnic groups may have different cultural and health beliefs, different levels of education, understanding and acculturation that negatively impacts upon their use of faecal testing and endoscopic procedures. In a systematic review published in the journal Perspectives in Public Health , we examined studies that had investigated ethnic differences in the uptake of colorectal cancer screening. We found that disparities in colorectal cancer screening are multifactorial and complex in their origin and that ethnicity plays an important role. Although seemingly intuitive, this is the first systematic review that summarises the association between uptake of screening in specific ethnic gr

In the USA, over one-third of adults self-diagnose their conditions using the internet, including queries about urgent (ie, chest pain) and non-urgent (ie, headache) symptoms. The main issue with self-diagnosing using websites such as Google and Yahoo is that user may get confusing or inaccurate information, and in the case of urgent symptoms, the user may not be aware of the need to seek emergency care. In recent years, various online symptom checkers (OSCs) based on algorithms or artificial intelligence (AI) have emerged to fill this gap Online symptom checkers are calculators that ask users to input details about their symptoms of sickness, along with personal information such as gender and age. Using algorithms or AI, the symptom checkers propose a range of conditions that fit the symptoms the user experiences. Developers promote these digital tools as a way of saving time for patients, reducing anxiety and giving patients the opportunity to take control of their own health. The di

In a study published in the journal Nicotine and Tobacco Research , we evaluated the secondary effectiveness outcomes for Quit Genius, a digital clinician-assisted cognitive behavioural therapy (CBT) intervention for smoking cessation. Adult smokers (N=556) were randomly assigned to Quit Genius (n=277), a digital, clinician-assisted CBT intervention or Very Brief Advice (VBA) to stop smoking, an evidence-based, 30-second intervention designed to facilitate quit attempts, coupled with referral to a cessation service (n=279). Participants were offered combination nicotine replacement therapy (patches and gum) tailored to individual nicotine dependence. Analyses (N=530), by intention-to-treat, compared Quit Genius and VBA at 4, 26, and 52 weeks post-quit date.  The primary outcome was self-reported seven-day point prevalence abstinence at 4 weeks post-quit date. Consecutive seven-day point-prevalence abstinence, defined as abstinent at two or more consecutive timepoints, was examined at w

The National Health Service (NHS) 111 helpline was set up to improve access to urgent care in England, efficiency and cost-effectiveness of first-contact health services. Following trusted, authoritative advice is crucial for improved clinical outcomes. In paper published in the journal PLOS ONE , we examined patient and call-related characteristics associated with compliance with advice given in NHS 111 calls.  The importance of health interactions that are not face-to-face has recently been highlighted by COVID-19 pandemic. In this retrospective cohort study, NHS 111 call records were linked to urgent and emergency care services data. We analysed data of 3,864,362 calls made between October 2013 and September 2017 relating to 1,964,726 callers across London. A multiple logistic regression was used to investigate associations between compliance with advice given and patient and call characteristics.  Caller’s action is ‘compliant with advice given if first subsequent service interacti

Our new article in Lancet Infectious Diseases discusses why some migrants in Europe are at risk of under-immunisation and show lower vaccination uptake for routine and COVID-19 vaccines. Addressing this issue is critical if we are to address vaccination inequities and meet the goals of WHO's new Immunisation Agenda 2030.  We carried out a systematic review exploring barriers and facilitators of vaccine uptake (categorised using the 5As taxonomy: access, awareness, affordability, acceptance, activation) and sociodemographic determinants of under-vaccination among migrants in the EU and European Economic Area, the UK, and Switzerland.  We identified multiple access barriers—including language, literacy, and communication barriers, practical and legal barriers to accessing and delivering vaccination services, and service barriers such as lack of specific guidelines and knowledge of health-care professionals—for key vaccines including measles-mumps-rubella, diphtheria-pertussis-tetanu

Multimorbidity, the co-occurrence of two or more chronic conditions, is increasing in prevalence and affecting approximately a third of all adults globally. In the UK, the prevalence of individuals with four or more long-term conditions is projected to increase to 17% by 2035, compared to 9.8% in 2015. Approximately two thirds of this population will have a mental illness such as depression , which is in turn strongly associated with the incidence of a multitude of long-term conditions.  As the number of physical conditions a person increases, the odds of having a mental health disorder increase by almost double for one condition, and six times for more than five conditions. The presence of a mental health comorbidity such as depression is associated with poorer clinical outcomes and quality of life, compared to individuals with physical conditions only. In an article published in the journal PLOS ONE , we summarised the current evidence on the association between depression and unplan

Throughout the pandemic, the UK’s covid-19 data systems have been guiding global as well as local policies. The well-established health information systems combined with the more recently established National Immunisation Management System in England provided timely information on infections, emergence of new variants, and the value of different interventions. But one of the most important contributions from the UK came from the ability to rapidly track vaccine effectiveness.  Vaccination is the best method for societies to reduce the severity of illness and number of deaths from covid-19; and to start to return to a more normal way of living, working , and studying.[1] But vaccination programmes need to be evidence-based, so that vaccines and healthcare resources are used appropriately, and there is equitable vaccine delivery. The covid-19 pandemic has shown the importance of data from medical records and the National Immunisation Management System in guiding national vaccination p