Medical Centre

NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...

Diversity, equity, and inclusion (DEI) are essential in clinical and public health research, ensuring discoveries and interventions benefit all sections of society; and enhancing the quality, relevance, and impact of research. Ensuring that diverse populations are represented appropriately within research is a scientific necessity. By embedding DEI principles into research design and execution, researchers can generate findings that are broadly applicable across the population while also addressing long-standing health disparities. DEI is needed in clinical and public health research because it improves the generalisability and relevance of research findings. Research outcomes must apply to the diverse populations they are intended to serve. By including participants from different racial, ethnic, gender, socioeconomic, and geographic backgrounds, studies can avoid biases that result from the narrower recruitment into research studies we often saw in the past. Without such diversity, r...

In recent days, there has been discussion about the "overheads" or "indirect" costs that universities add on to the cost of research projects. This has been driven by a decision by the US government to reduce the indirect costs of research on grants awarded by the US National Institutes of Health (NIH) from the current 60% to 15%. Comments from people such as Elon Musk has suggested these costs are wasteful and can therefore be easily cut from research grants. In this blog, I make the case for retaining a fair amount of indirect costs on research grants. Without the indirect costs that universities receive on government research grants, universities would struggle to provide the essential support and infrastructure required for high-quality research to take place. While direct research costs (such as staff salaries, laboratory equipment, travel and consumables) are essential, they are only part of the funding needed. Research relies heavily on a wide array of indire...

Effective management of hospital resources was a critical component of the response to the COVID-19 pandemic. With fluctuating waves of infection and emerging virus variants, accurately predicting the demand for hospital beds has proven to be a complex but essential task. Our recent study, led by Derryn Lovett and published in BMJ Health Care Informatics , evaluates a pragmatic approach to forecasting COVID-19-positive hospital bed occupancy using simple, accessible methods.  Why Predicting Bed Occupancy Matters During the COVID-19 pandemic, healthcare systems around the world faced unprecedented challenges, with surges in demand for acute care beds due to severe cases of the virus. The ability to predict future bed occupancy is vital for several reasons: Resource allocation: Effective forecasting helps healthcare leaders plan staffing, equipment needs, and additional capacity. Crisis management: Accurate predictions enable health systems to anticipate surges and manage ove...

Primordial prevention and primary prevention are both crucial strategies for promoting health, but they operate at different levels. Primordial prevention aims to address the root causes of health problems and improve the wider determinants of health. It focuses on preventing the emergence of risk factors in the first place by tackling the underlying social, economic, and environmental determinants of health. This involves broad, population-wide interventions such as: Policies that promote healthy food choices: Think about initiatives like taxing sugary drinks to discourage unhealthy consumption, or providing subsidies for fruits and vegetables to make them more accessible. Urban planning that prioritises well-being: This could include creating walkable neighborhoods with safe cycling routes, ensuring access to green spaces for recreation and relaxation, and designing communities that foster social connections. Social programs that address inequality: Initiatives aimed at reducing pov...

There are many positive elements in the "Make America Healthy Again" (MAHA) movement that would be beneficial for public health. This would include improved physical health through promoting exercise, better nutrition, reducing rates of obesity and managing chronic diseases. Exploring ways to make healthcare more affordable and accessible by the US population is also important as is recognising the importance of mental well-being, reducing stigma, and increasing access to mental healthcare services.  Another key area is environmental health. This could include cleaner air and water, reducing pollution, and addressing climate change. The USA also suffers from high rates of drug addiction and this needs addressing through prevention, treatment, and harm reduction strategies. These would all be positive steps for public health in the USA (and countries that replicated these approaches). But it is also that the MAHA movement does not undermine effective public health intervention...

The Challenge of Diagnosing Alzheimer’s Alzheimer’s disease (AD) is a leading cause of death in the UK as well as affecting nearly a million people. Currently, the diagnostic pathway for AD is based on clinical symptoms that emerge late in the disease, often after 20 years of progressive accumulation of intracerebral pathological AD features.  When memory, mood, or personality changes are noticed, individuals or their family usually seek advice from a general practitioner, who may perform some cognitive tests along with some general blood tests.  If cognitive decline is suspected, the patient is often referred to a memory clinic or to Old Age Psychiatry Clinics within Mental Health Trusts for further evaluation, aimed at confirming cognitive decline and ruling out reversible causes.     The Promise of Blood Biomarkers Recent advances in blood-based biomarkers hold promise for transforming AD identification and care.  These biomarkers have shown similar sens...

In a recent post on the platform X, Elon Musk claimed that antidepressants were over-prescribed . In many countries, the prescribing of antidepressants has increased significantly over the past 30 years. During the 1990s, public health campaigns aimed at reducing the stigma surrounding depression encouraged more people to seek treatment. This contributed to a rise in antidepressant prescriptions in countries such as the UK.  Additionally, antidepressants - particularly selective serotonin reuptake inhibitors (SSRIs) - are now widely used not only for depression but also for other conditions such as anxiety disorders, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and chronic pain. This expanded range of indications has been a significant factor in their increased use in recent decades. One concern regarding antidepressant use is their potential toxicity and their role in suicide. SSRIs are generally considered safer than older antidepressants, such as t...

Diabetes mellitus is a chronic disease that affects hundreds of millions of people worldwide. Self-management is crucial for people with diabetes to maintain their health and prevent complications.  Mobile applications have emerged as promising tools to help people with diabetes self-manage their condition. Our recent article in the journal BMJ Open -  What are the perceptions and experiences of adults using mobile applications for self-management in diabetes? A systematic review - reviewed some of the the research literature in this area to obtain patient perspectives on these apps. What are the benefits of using mobile apps for diabetes self-management? Our systematic review explored the perceptions and experiences of adults with types 1, 2, and gestational diabetes using mobile applications for self-management.  The review included 24 qualitative studies that interviewed or surveyed people with diabetes who used mobile apps for self-management.    We found t...

The NHS in the UK is grappling with a worsening crisis, drug shortages, as we discuss in our recent article in the British Medical Journal . These shortages have doubled since 2022, with supply disruptions affecting vital medications like antibiotics, diabetes treatments, and hormone replacement therapy. The implications for patient safety and healthcare services are profound, making it imperative for the UK government and the NHS to address this challenge . Why Are Drug Shortages Happening? The root causes of these shortages lie in both global and local factors. Disruptions in international supply chains — driven by the COVID-19 pandemic, geopolitical conflicts like the Ukraine war, and rising energy costs — have hampered the production and transport of essential pharmaceutical ingredients. Domestically, the NHS faces challenges such as manufacturing inefficiencies, logistical delays, and regulatory hurdles. Brexit has also compounded the problem, introducing new trade barriers, custo...

 As we enter the new year, here are some tips on how to stay healthy and well and to make better use of the NHS in 2025: 1. Exercise regularly, aiming to include outdoor activities for sunlight exposure, which can help with physical fitness and improve mood, especially for those affected by Seasonal Affective Disorder (SAD). 2. Don’t smoke. Smoking is a major risk factor for diseases such as lung cancer and heart disease. Quitting smoking significantly reduces these risks. 3. Take-up the offer of any NHS vaccinations that you are eligible for. If you have young children, make sure they are also up to date with their NHS vaccinations. 4. Sunlight exposure may be limited in Winter, so consider vitamin D supplementation if you are in a group that this is recommended for. 5. Attend for NHS health screening appointments when invited. 6. Eat five portions of fruit & vegetables every day and eat plenty of high-fibre foods. Eating a nutritious diet is important for maintaining a health...