Medical Centre

Abolishing NHS England and reducing Integrated Care Board (ICB) staffing by 50% may appear substantial, but the projected savings - around £500 million annually if fully achieved - would represent only a modest increase (approximately 0.25%) in annual NHS funding in England, given the NHS England budget is approaching £200 billion per year. Evidence from past NHS reforms (like the 2012 Health and Social Care Act) shows mixed results; some efficiency gains but often offset by new layers of complexity elsewhere in NHS structures. Without parallel initiatives to streamline administrative processes, improve efficiency, and enhance clinical productivity, such structural changes to NHS England and ICBs alone will not significantly improve frontline clinical care or health outcomes. Administrative costs, while important to minimise, make up a relatively small proportion of the overall NHS budget. Genuine productivity gains will therefore require systematic reforms aimed at reducing unnecessar...

Emergency departments (EDs) are often the first point of contact for patients requiring urgent medical attention. With increasing patient volumes and limited resources, EDs face challenges in maintaining efficiency and ensuring timely care. A recent systematic review published in the Journal of Medical Internet Research by our research group explores the role of digital check-in and triage kiosks in addressing these challenges.   Key Findings from the Systematic Review The review analysed five studies conducted between 2019 and 2022 across Canada, the United States, and the United Kingdom, encompassing a total of 47,778 patients and 310,249 ED visits. These studies varied in design, including cross-sectional analyses, pilot studies, retrospective analyses, and randomised controlled trials, 1. Efficiency Improvements Digital kiosks have been associated with reduced patient wait times and improved patient flow within EDs. By streamlining the check-in and triage processes, th...

Dementia, including Alzheimer's disease, is a significant public health challenge in Europe, with nearly 14 million people currently affected. Despite available healthcare and social care services, utilisation of these services by people living with dementia remains suboptimal due to various barriers. Our recent systematic review published in BMC Geriatrics provides critical insights into these challenges, highlighting barriers across informational, organisational, cultural, stigma-related, financial, and logistical domains. Informational and Educational Barriers A lack of awareness and insufficient knowledge among caregivers and healthcare professionals stands out as a key barrier. Inadequate dissemination of dementia-related information contributes to difficulties in planning and accessing appropriate care. Enhancing educational resources and improving health literacy among caregivers and healthcare workers are essential for overcoming these challenges. Organisational Barriers F...

As we reach the fifth anniversary of the onset of the Covid-19 pandemic, this moment provides an opportunity for reflection on the many challenges faced by healthcare workers like me during the early days of the pandemic. At that time, the SARS-CoV-2 virus was a largely unknown entity. Clinical guidelines were still under development and personal protective equipment (PPE) was scarce. For those on the NHS frontline, the experience was marked by a mix of anxiety, urgency, and dedication to the patients we were trained to serve.  Unfamiliar Territory  In the initial stages, Covid-19 was a "novel" infection. There was a scarcity of data on the illness, and the disease was manifesting in ways that were not entirely well understood. As primary care physicians, we were suddenly thrust into the realm of the unknown, treating patients with undifferentiated respiratory illnesses that did not yet have well-defined and evidence-based treatment protocols.  The Personal Risk Factor...

The COVID-19 pandemic brought many terms into the spotlight, one of which was "non-pharmaceutical interventions" (NPIs). Used widely in academic papers, public health guidelines, and media reports, NPIs became a catch-all phrase for measures like contact tracing, quarantine, and hand hygiene; essentially anything that wasn’t a drug or vaccine. However, BMJ Editor Kamran Abbasi and I argue in our editorial  it is time to end the use of this term in favour of "public health and social measures." Here’s why this shift matters. The Problem with Defining by Negation The term "non-pharmaceutical interventions" defines these strategies by what they aren’t rather than what they are. This framing is inherently limiting. Imagine calling surgery a "non-drug intervention"—it sounds absurd because surgery stands on its own as a complex, evidence-based practice. Similarly, public health measures like sanitation or hand hygiene aren’t just stopgaps until a drug...

Our recent article in the Journal of Patient Safety discusses the topic of missed appointments in healthcare. Missed appointments are often seen as an administrative inconvenience in healthcare; wasting appointments that could have gone to other patients. However, missed appointments are also a critical patient safety concern that can delay necessary interventions, worsen health outcomes, and erode trust between patients and clinicians. Instead of viewing them as patient noncompliance, we must shift our perspective to understand the underlying barriers that prevent people from attending their scheduled appointments. Understanding the Root Causes of Missed Appointments Patients miss appointments for a variety of reasons, many of which are outside their control. Socioeconomic challenges, work obligations, caregiving responsibilities, mental health issues, transportation difficulties, and previous negative experiences with the healthcare system all contribute to non-attendance. Disadva...

Living with Type 2 Diabetes (T2D) can feel like a full-time job. Regular check-ups, monitoring blood sugar levels, adjusting medications, and managing lifestyle changes all demand time and effort. For the 460 million people worldwide dealing with diabetes (a number projected to climb to 700 million by 2045), finding convenient and effective healthcare solutions is more critical than ever. Enter virtual consultations (VC); a modern approach to healthcare delivery that is transforming how people with T2D manage their condition. Our recent systematic review and meta-analysis published in the Journal of Diabetes Science and Technology sheds light on just how powerful this tool can be. Let’s examine the benefits of virtual consultations for people with T2D and why they’re becoming more important in the care of people with long-term conditions like T2D.  Convenience Without Compromise: Effectiveness Matches In-Person Care One of the key findings from the review is that virtual consultat...

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...