Medical Centre

Workforce and resource pressures in the UK National Health Service (NHS) mean that it is currently unable to meet patients’ expectations of access to primary care. In an era of near-instant electronic communication, with mobile online access available for most shopping and banking services, many people expect similar convenience in healthcare. Consequently, increasing numbers of web-based and smartphone apps now offer same-day ‘virtual consulting’ in the form of Internet video conferencing with private general practitioners. While affordable and accessible private primary care may be attractive to many patients, the existence of these services raises several questions. A particular concern, given continued development of antimicrobial resistance, is that some companies appear to use ease of access to treatment with antibiotics as an advertising strategy. We examine online video consulting with private general practitioners in the UK, considering its potential impact on patients and ...

In a paper published in the Journal of the Royal Society of Medicine , we discuss the role that clinical pharmacists could play in primary care. Primary care in the United Kingdom’s NHS is in crisis. Systematic underfunding, with specific neglect of primary care compared to other clinical specialties, has combined with ever-rising demand and administrative workload to place a now dwindling workforce under unsustainable pressure. A major factor in the growing workload in primary care is prescribing. An aging population and higher prevalence of chronic diseases is leading to increased case complexity and polypharmacy, and consequently greater potential for prescribing errors. Nearly 5% of all prescriptions in general practices in England have prescribing or monitoring errors, while in some areas up to half of the prescriptions are prone to error. Although most errors are of mild or moderate severity, they can be life-changing for patients and costly for healthcare systems, accountin...

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 th...

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 tho...

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 coul...

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 p...

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 c...

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 ...

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 ...

General practices in England are independent businesses that are contracted to provide primary care for specified populations. Most are owned by general practitioners, but many types of organisation are now eligible to deliver these services. In a study published in the Journal of the Royal Society of Medicine , we examined the association between patient experience and the contract type of general practices in England, distinguishing limited companies from other practices. We analysed data from the English General Practice Patient Survey 2013–2014 (July to September 2013 and January to March 2014). Patients were eligible for inclusion in the survey if they had a valid National Health Service number, had been registered with a general practice for six months or more, and were aged 18 years or over. All general practices in England with eligible patients were included in the survey (n = 8017). Patients registered to general practices owned by limited companies reported worse experi...

Members of the School of Public Health held a very productive and informative meeting today with senior members of Imperial College including Sarah Waterbury, Vice President (Advancement); Maggie Dallman, Associate Provost (Academic Partnerships); Angela Bowen, Director of Development (Faculty of Medicine); and Tom Pearson, Head of Special Projects (Academic Partnerships). The Department of Primary Care & Public Health in the School of Public Health works with local community stakeholders – such as voluntary groups, local authorities, and general practitioners – on a range of community-based outreach projects. These projects aim to improve the health and wellbeing of local residents; improve access to professional careers for children from deprived backgrounds; and give medical students experience of working with deprived and marginalised groups to develop skills in health coaching and behavioural change. This work is in addition to the very high-quality teaching and research ...

Data collected in electronic medical records for a patient in primary care 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 (UK) to facilitate the use of research data generated from consultations between primary care professionals and their patients. In a study published in the  Journal of Innovation in Health Informatics , we carried out a bibliometric review to analyse the research outputs and the longitudinal growth in the number of publications that harness the three main UK primary care databases: CPRD, QResearch and THIN. These databases collectively produced 1,296 publications over a ten-year period, with CPRD producing 63.6% (n=825 papers), THIN 30.4% (n=394) and QResearch 5.9% (n=77). Pharmacoepidemiology and General Medicine were the most common specialities featured. The growth in publications from these databases shows that they are making an im...

Due to the increasing pressures on general practices within the National Health Service in England, the interface between primary and secondary care, and the division of labour between these, has become an important issue. This has long been an area prone to difficulties and conflict, the consequences of which can directly impact the quality and safety of patient care, particularly for patients with chronic conditions who regularly transition between these two sectors. In an article published in the Journal of the Royal Society of Medicine , Amy Price and I explore the measures recently implemented in the NHS Standard Contract which aim to target common issues at the primary–secondary care interface, with an aim to reducing inappropriate general practitioner workload in England. We discuss the context behind the implementation of the NHS Standard Contract as well as current concerns and areas for further consideration. The current crisis in primary care means the NHS Standard Contra...

Timely diagnosis and management of heart failure (HF) is critical, but identification of patients with suspected HF can be challenging, especially in primary care where patients can present with a range of symptoms of varying severity. In a paper published in the journal Heart , we describe the journey of people with HF in primary care from presentation through to diagnosis and initial management. We used the Clinical Practice Research Datalink (primary care consultations linked to hospital admissions data and national death registrations for patients registered with participating primary care practices in England) to describe investigation and referral pathways followed by patients from first presentation with relevant symptoms to HF diagnosis, particularly alignment with recommendations of the National Institute for Health and Care Excellence guideline for HF diagnosis. 36 748 patients had a diagnosis of HF recorded that met the inclusion criteria between 1 January 2010 and 31...

Children and adults with gender identity concerns are increasingly presenting for treatment, with referrals to specialist clinics rapidly rising. The percentage of children with gender identity disorder that self-harm or attempt suicide is estimated at 50%, so it is essential that it is recognised early and managed appropriately. Gender identity disorder of childhood usually manifests before puberty. The child typically experiences distress resulting from an incongruence between their current gender identity (sense of themselves as ‘male’, ‘female’, or otherwise), and their gender assigned at birth. Behaviour and activities of the child may stereotypically be associated with that of the opposite gender and the child may be preoccupied with wanting to change their name and gender pronoun (‘she’, ‘he’). Depending on the age, they may also have a strong desire to acquire secondary sexual characteristics of the opposite gender. This may cause significant distress and can impact their pe...

I was in Vienna on Monday 9 October 2017 for the Annual Meeting of the European Epidemiological Forum, which this year is on the topic of “Real World Data and Pharmacoepidemiology in Europe". It’s been a good opportunity to catch up on biomedical research using ‘Big Data’. There is a lot of work going on in this field that will have a big impact on health. There was also some sadness among European colleagues about Brexit and uncertainty about the future role academics and companies from the UK will play in European research collaborations. At the meeting, I was asked to give one of the keynote presentations on the topic of Brexit and how it might affect the UK contribution to research on areas such as pharmacoepidemiology. In my talk, I outlined some of the current uncertainties for UK researchers and the what the future might look like for the UK’s universities, NHS and life sciences sector, depending on the type of Brexit we negotiate with the other countries of the European...

We were very pleased to host the Dean of the Faculty of Medicine, Professor Jonathan Weber, in the Department of Primary Care and Public Health on Wednesday 4 October 2017. Professor Weber met with some of the academic staff in the department to learn more about our research and teaching programmes. We had a good discussion about the more ‘social’ and community-based aspects of our work; such as our collaborations with the NHS, local government and voluntary organisations in the White City area of West London; and our work with medical students on areas such as health coaching and behavioural change. We also discussed how our academic work could support Imperial College’s plans for its Imperial West Campus, and creating opportunities for medical students to get involved in community-based research.

Cardiovascular disease (CVD) is a major cause of disability and premature mortality worldwide. In England, it accounts for a third of deaths and costs the National Health Service (NHS) and the UK economy £30 billion annually. The National Health Service (NHS) Health Check is a CVD risk assessment and management programme in England aiming to increase CVD risk awareness among people at increased risk of CVD. There was previously no tool to assess the effectiveness of the programme in communicating CVD risk to patients. In research published in the journal BMJ Open , we describe how we developed a questionnaire examining patients’ CVD risk awareness for use in health service research evaluations of the NHS Health Check programme. We developed an 85-item questionnaire to determine patients’ views of their risk of CVD. The questionnaire was based on a review of the relevant literature. After review by an expert panel and focus group discussion, 22 items were dropped and 2 new items we...

On 28 September 2017, I attended the Annual Institute of Global Health Innovation Lecture: Artificial General Intelligence and Healthcare, delivered by Dr Demis Hassabis, co-founder and CEO of Google DeepMind. Artificial intelligence is the science of making machines smart argued Dr Hassabis, so how can we make it improve the healthcare sector? Dr Hassabis then went on to describe the work that DeepMind was carrying out in healthcare in areas such as organising information, deep learning to support the reporting of medical images (such as scans and pathology slides), and biomedical science. Dr Hassabis also discussed the challenges of applying techniques such as reinforcement learning in healthcare. He concluded that artificial intelligence has great scope for improving healthcare; for example, by prioritising the tasks that clinicians had to carry out and by providing decision support aids for both patients and doctors. Dr Hassabis also discussed some of the ethical issues in using...

I was very honoured to have won the 2017 Lambeth CCG Award for Outstanding Contribution to Primary Care. Lambeth CCG noted that "Dr Majeed has made a huge contribution to primary care research knowledge as well as provide high quality, kind care to his patients. Dr Majeed was also recognised recently in Pulse magazine as one of the 50 most influential GPs in the UK."