Medical Centre

Life expectancy at birth has been used as a measure of the health status of the population of England and Wales since the mid-nineteenth century. Recently published statistics from the  UK Office for National Statistics  show that the long-standing North-South divide in distribution of life expectancy across England continues, with people in the North of England generally living shorter lives than those living in the south. Life Expectancy at Birth Male life expectancy at birth was highest in East Dorset (82.9 years) and lowest in Blackpool (74.0 years). For females, life expectancy at birth was highest in Purbeck at 86.6 years and lowest in Manchester at 79.5 years. Life expectancy at birth increased across England and Wales by 1.3 years for males and 1.0 year for females between 2006–08 and 2010–12. This is part of a long-standing trend of improving life-expectancy, which is leading to a gradual increase in the average age of the population of England and Wales, and the ...

A recent analysis of causes of potentially avoidable deaths in England and Wales by the Mortality Team at the  Office for National Statistics  (ONS) showed that cardiovascular diseases were the largest cause of avoidable deaths between 2001 and 2006. In 2007, cancers became the leading cause of avoidable deaths and have remained so since then. This change in ranking has occurred because deaths from cardiovascular diseases have been falling for many years. Deaths from cancer in contrast have been falling much more slowly than deaths from cardiovascular disease and cancer has therefore now become the commonest cause of avoidable deaths. The rapid decline in age-standardised death rates from cardiovascular diseases have been driven by a range of factors. These include medical (e.g. statins) and surgical treatments (e.g. angioplasty); and changes in lifestyle (such as a reduction in the prevalence of smoking). The findings of this very useful analysis by the ONS illustrate th...

In a paper published in the Journal of Global Health , Michelle van Velthoven and colleagues describe a a collaboration between researchers in China and the UK that aimed to explore the use of mHealth in China. This is the first paper in a series of papers on a large mHealth project part of this collaboration. This paper includes the aims and objectives of the mHealth project, our field site, and the detailed methods of two studies. This large mHealth project is part of a collaboration between researchers in China and the UK. The mixed methods study evaluating factors that influence sample size calculations could help future studies with estimating reliable sample sizes. The cross–over study comparing face–to–face and text message survey data collection could help future studies with developing their mHealth tools. 

Simon Stevens has been appointed as the new Chief Executive of the NHS in England and will start in his post in April 2014. Stevens is the Executive Vice President of UnitedHealth Group and President for Global Health. He has been based in the USA in recent years. He has formerly worked as a NHS manager in England and as an adviser to Tony Blair when he as Prime Minister. Professor Malcolm Grant, Chairman of NHS England, said that Mr Stevens was the best man for the job because he could bring experience from many different models of healthcare delivery. His appointment has brought a mixed reaction in England. Many people view his appointment as NHS Chief Executive as a positive step, viewing him as someone who will bring innovative ideas and ways of working. Others are more wary and are concerned he may push further marketization and models of healthcare delivery derived from the USA.

Following the publication of her paper, " Evaluation of clinical threshold policies for cataract surgery among English commissioners ", in the Journal of Health Services Research and Policy, Sophie Coronini-Cronberg (Honorary Clinical Research Fellow in the Department of Primary Care & Public Health at Imperial College London) has been invited by the Royal College of Ophthalmologists to join its working group responsible for developing cataract surgery commissioning guidance. The work is due to be completed by the end of this year. 

In a letter published in the British Medical Journal (BMJ) , Michale Soljak, Chris Millett and I discuss the call by Krogsbøll to abandon the NHS Health Check Programme.As members of one of the research teams evaluating the national programme, we challenge their view that a randomised controlled trial (RCT) of the current programme should be the sole arbiter on which to base national health policy decisions. As noted in comments on the Cochrane review, the dearth of RCTs of screening for cardiovascular (CVD) risk since 1999 is unfortunate, but there were many RCTs of individual screening components over this period that have been used in subsequent NICE guidance. There are other reasons why Krogsbøll et al’s views should be challenged. Firstly, RCTs are expensive and time-consuming, and as a result, a lack of evidence from RCTs may deprive millions of people of potential benefits from interventions.  RCTs should therefore be complemented where possible by well-validated modelli...

The independent contractor model has been at the core of general practice in the UK since the NHS was first established and this model has many strengths. For example it has allowed the development of a s strong primary care sector that has allowed the NHS to operate efficiently - NHS general practices have typically used between 8-10% of the total NHS budget and dealt with up to 90% of all patient contacts with the NHS. However, in recent years, general practices have come under increasing pressure through a combination of rising workload, increased complexity of care, and a reduction in the resources allocated to primary care. Many general practitioners now find themselves struggling to cope with their day to day workloads. This makes it difficult for patients to gain timely access to their general practices and in turn increases pressure on other parts of the NHS, such as Emergency Departments. We are also now seeing a divide developing in the profession between salaried GPs and ...

Text messages that encourage the recipient to eat healthily and exercise can help prevent type 2 diabetes in people at high risk , a study has found. Researchers from Imperial College London and the India Diabetes Research Foundation recruited 537 men in South-East India with impaired glucose tolerance, a condition that commonly precedes type 2 diabetes. Half received frequent text messages reminding them to eat healthily and be physically active, while the other half had standard care from their doctor. After an average of 20 months’ follow-up, 18 per cent of the text message group developed type 2 diabetes, compared with 27 per cent of the control group. The findings were published in the journal Lancet Diabetes and Endocrinology . The messages included practical tips for healthy eating and reminders about the importance of exercise. They were also tailored to the individual’s behaviour. Those with the most unhealthy lifestyles were given information about the benefits of good...

I have written an article on why GPs should consider giving up their independent contractor status and become NHS employees , which was published in Pulse. In this blog post, I will make the opposing argument and will list reasons why we should retain the current independent contractor model of general practice . This will be helpful for those GPs who are against the proposal that we should become NHS employees but who are unable to put together a coherent or logical counter-argument. If anyone has further arguments in favour of the independent contractor model, please let me know and I will add them to the list. 1- The independent contractor model is very efficient. For between 8-10% of NHS spending, general practices deal with up to 90% of patient contacts in the NHS. 2- Because GPs are not NHS employees, they have more freedom to act as patient advocates and to speak up about deficiencies in the NHS. 3- The independent contractor model gives GPs a stake in their practices a...

A study by Dr Carmen Tsang and colleagues at Imperial College London has found a low incidence of patient safety incidents recorded in general practice. The research, which was published by the British Journal of General Practice , measured the extent of patient safety incidents recorded in 74 763 patients at 457 English general practices between 1999 and 2008, and the patient characteristics associated with these adverse events. Older patients, those with more comorbid diseases or who had more previous emergency admissions to hospital were at greater risk of complications of care. Dr Carmen Tsang, lead author of the paper, says “ Our finding of a low incidence of patient harm in general practice supports previously published studies. To better understand these adverse events, we must also examine the healthcare interactions from which they originate, and consider how to reduce the incidents that are potentially preventable ”. Outcomes following adverse events, including emerge...

Antidepressant prescribing rates in England have been increasing since the 1970s. The impact of the Improving Access to Psychological Therapies (IAPT) initiative on antidepressant prescribing rates is unknown. In a paper published in the British Journal of General Practice , Vaishnavee Sreeharan and colleagues from Imperial College London investigated the impact of the establishment of IAPT services on antidepressant prescribing rates in primary care trusts (PCTs) in England.  They used a longitudinal time-series analysis, using PCT-level data from 2008 to 2011. They reported that antidepressant prescribing rates in England increased by 10% per year during the study period. The implementation of IAPT services had no significant effect on antidepressant prescribing. They concluded that the introduction of a large-scale initiative to increase provision of psychological therapies has not curbed the long-term increased prescribing of antidepressants in England. You can read commentari...

In an article published in the Journal of the Royal Society of Medicine , I discuss some of the current challenges facing general practitioners in the UK, such as rising workload, increasingly complex patients, and reductions in budgets. In the article, I also discuss options for tackling these challenges. These include a fairer funding model for general practice that links patients needs and practices' workloads more closely to funding. Other options discussed in the article include the creation of practice federations or 'super partnerships' and the transfer of GPs from their current independent contractor status to becoming NHS employees on similar terms to other senior doctors working for the NHS. Many GPs (including my own colleagues in South London) are struggling to manage their workload with their current practice budgets; and this could have serious implications for patients, the public and the NHS. We do therefore need a serious debate about the future of primary...

The development and implementation of electronic health records (EHRs) remains an international challenge. Better understanding of patient and public attitudes and the factors that influence overall levels of support toward EHRs is needed to inform policy. In a paper published in the Journal of Medical of Medical Internet Research , Serena Luchenski and colleagues reported the findings of a study that explored patient and public attitudes toward integrated EHRs used simultaneously for health care provision, planning and policy, and health research. They carried out a cross-sectional questionnaire survey administered to patients and members of the public who were recruited from a stratified cluster random sample of 8 outpatient clinics of a major teaching hospital and 8 general practices in London . 5331 patients and members of the public responded to the survey, with 2857 providing complete data for the analysis presented here. There were moderately high levels of support for ...

A paper published in the journal Informatics in Primary Care  describes the protocol for a systematic review of the provision and impact of online patient access to their electronic health records (EHR) and transactional services on the quality and safety of health care. The review aims to assess the factors that may affect the provision of online patient access to their EHR and transactional services, and the impact of such access on the quality and safety of health care. Developers have piloted improvements in communication, changed patterns of practice and patient empowerment from online access to electronic health records. International studies of online services, such as prescription ordering, online appointment booking and secure communications with primary care, show good uptake of email consultations, accessing test results and booking appointments; when technologies and business process are in place. Online access and transactional services are due to be rolled ...

Patients diagnosed with cancer by the emergency route often have more advanced diseases and poorer outcomes. Rates of cancer diagnosed through unplanned admissions vary within and between countries, suggesting potential inconsistencies in the quality of care. To reduce diagnoses by this route and improve patient outcomes, high risk patient groups must be identified. In a paper published in BMC Health Services Research , Carmen Tsang and colleagues report the results of a cross-sectional observational study that determined the incidence of first-ever diagnoses of cancer by emergency (unplanned) admission and identified patient-level risk factors for these diagnoses in England. Data for 74,763 randomly selected patients at 457 general practices between 1999 and 2008 were obtained from the General Practice Research Database (GPRD), including integrated Hospital Episode Statistics (HES) data and Office for National Statistics (ONS) mortality data. The proportion of first-ever diagnose...

Health research using routinely collected National Health Service (NHS) data derived from electronic health records (EHRs) and health service information systems has been growing in both importance and quantity. Wide population coverage and detailed patient-level information allow this data to be applied to a variety of research questions. The sensitivity, complexity and scale of such data also hamper researchers from fully exploiting this potential. In an article published in the journal Informatics in Primary Care , Vasa Curcin and colleagues examine the current challenges preventing researchers from making optimal use of the data sets at their disposal, on both the legislative and practical levels, and give recommendations as to how these challenges can be overcome. Several projects have recently been launched in the UK to address poor research data-management practices. Rapid Organisation of Healthcare Research Data (ROHRD) at Imperial College, London produced a useful prototy...

High and equitable coverage of systematic cardiovascular disease (CVD) prevention programmes, such as the NHS Health Check programme in England, is essential if they are to effectively reduce the population CVD burden. In a paper published in the Journal of Public Health, Macide Artac report the findings of a cross-sectional study using data from 151 English primary care trusts (PCTs) on NHS Health Check coverage during 2011–12. They examined the associations between programme coverage and primary care and population factors, including patient demographics, primary care workforce and cardiovascular health need. Artac and colleagues reported that the median coverage of NHS Health Checks was 8.2%, with wide PCT-level variation (range = 0–29.8%). Coverage was significantly higher in PCTs in the most deprived areas compared with the least deprived, after adjusting for covariates. Significant negative associations between coverage and a higher proportion of PCT population aged 40–74 year...

Heart failure is an important clinical problem. Expert consensus has defined heart failure as a primary care-sensitive condition for which the risk of unplanned admissions may be reduced by high quality primary care, but there is little supporting evidence. In a paper published in the European Journal of Heart Failur e, Rachel Brettell and colleagues analysed time trends in Heart failure admission rates in England and risk and protective factors for admission. They used Hospital Episodes Statistics to produce indirectly standardized HF admission counts by general practice for 2004–2011. Clustered negative binomial regression analysis produced admission risk ratios and assessed the significance of potential explanatory covariates. These included population factors (deprivation; HF, coronary heart disease, and smoking prevalence), primary care resourcing [access; general practitioner (GP) supply], and primary care quality (‘Quality and Outcomes Framework’ indicator.) There we...

The North-West London Integrated Care Pilot (ICP), originally launched for one year in July 2011 and later extended for a further year, is a large-scale change programme involving two hospitals, two mental health providers, three community health care service providers, five municipal providers of social care, two non-governmental organisations and (by April 2012) 103 general practitioners. Its aims are to improve health outcomes and reduce unnecessary admissions to hospital by pro-actively managing people living with diabetes and/or those aged 75+ through creating better access to more integrated care outside hospital and by enabling effective working of professionals across organisations.  In a paper published in the International Journal of Integrated Care , researchers from Imperial College London and the Nuffield Trust describe the results of the evaluation of the first year of the programme. The evaluation was funded by the Imperial College Healthcare NHS Trust Charity and...

The use of emergency departments is a prominent policy issue in both England and the USA. In a letter published in JAMA , Thomas Cowling and I compare the use of emergency departments in the two countries. The annual number of hospital ED visits in England increased from 15.4 million in 2007-2008 to 18.4 million in 2011-2012.1 The patient was given advice only or did not receive treatment in approximately 48% of these ED visits, and no investigations were performed in approximately 40% of ED visits.