Medical Centre

 A second medical opinion is a medical decision-making tool for patients, physicians, hospitals and insurers. For patients, it is a way to gain an additional opinion on a diagnosis, treatment or prognosis from another physician. Physicians seeking another colleague’s opinion may refer a patient to another consultant to gain further advice. Many health insurers mandate second opinion programmes to reduce medical costs and eliminate ineffective or suboptimal treatments. Hospitals may also require second reviews as part of routine pathology, radiology reviews or for legal purposes. consultant to consultant referrals. Patients in primary care may also request an opinion from a second specialist when unhappy with the opinion from the first specialist. We carried out a systematic review to summarise evidence on (1) the characteristics and motivating factors of patients who initiate second opinions; (2) the impact of patient-initiated second opinions on diagnosis, treatment, prognosis and...

That rhetorical questions like the recent one posed by  some in the media  are even asked shows how deeply ill-informed and distorted the discourse on healthcare has become in the UK. Any dispassionate observer would know that GPs are the bedrock of the NHS; and without GPs the NHS will collapse. Here are just a few home truths: GPs in England manage a wide array of acute and chronic health conditions through over 300 million patient consultations each year compared to 23 million A&E visits. [ 1]  GPs issue about one billion prescriptions annually  and have delivered  two thirds  of phase 1 covid-19 vaccinations. [2] The public already know how hard their family doctors are working to care for them. Despite the challenges of the pandemic, soaring demand, a shrinking GP workforce and a workload that has often become unmanageable, GPs have one of the highest public satisfaction ratings of any public service in the UK. In a survey in July 2021, an overwhel...

The UK’s MPs and journalists repeatedly say they want “GPs to get back to work”. But instead of asking this, they need to speak to staff in their local general practices to understand what the issues are that are causing problems for patients in gaining access primary care services, whether via a face to face appointment or by telephone. The number of GPs per person in England has declined in recent years. At the same time, the volume and complexity of care has increased steadily year-on-year. These problems have been compounded by the rebound in primary care activity following an initial fall at the start of the Covid-19 pandemic. Many GPs report that they and their teams are now dealing with a record level of work. In this context, asking GPs to “get back to work” is insulting for them and their teams. GPs made major changes in the way they work at the start of the Covid-19 pandemic to protect patients – with little additional support from NHS England – and are now struggling with lo...

Now that covid-19 vaccination of children in the UK is starting, it is essential that the legal basis of consent for a medical intervention in this group are well understood A  Court of Appeal ruling on 17 September 2021  overturned a previous High Court ruling, and decided that parental consent is not needed for children under 16 to take puberty blockers. This reaffirms, again, that the responsibility to consent to treatment depends on the ability of medical staff to decide on the capacity of under 16 year olds to consent to medical treatment. The timing is auspicious. Just a few days before, the four UK Chief Medical Officers recommended that all healthy children aged 12-15 should be “offered” a single covid-19 vaccine, with a booster likely in the Spring 2022. Until now, the only children in this age group offered a vaccine  have been those with certain medical condition s, or those living in a household with a clinically vulnerable adult. With a mass vaccine campaign ...

A recent article in the  Daily Telegraph  article asked “ If the GPs went on strike, would anybody notice? ”  The  article claimed that no one would notice if GPs went on strike and the author suggested that making all GPs salaried, forcing them to work longer hours, would help improve general practice for patients. The author quoted “a  now retired GP in his 90s from Bristol who continued doing locum work until five years ago,” who apparently said, “Many GPs are using covid-19 as an excuse for not providing good clinical services. Being able to opt out of night/weekend cover and only working two or three days a week have caused the demise of general practice to the detriment of patients.” As GPs we have worked throughout this pandemic often face-to-face in the most basic of personal protective equipment (PPE), and we were disheartened to read this piece. GPs and their teams have played an essential role throughout the pandemic.  GP teams in England alone d...

 Covid-19 case numbers remain high in the UK. In this article, I discuss why this is and why vaccines are working as expected, and protecting us from serious illness and death. What is a breakthrough infection? No vaccine is 100% effective against preventing infection. An infection in a fully vaccinated person is sometimes described as a breakthrough infection because the infective agent has “broken through” the protection from infection provided by the vaccine. How common is Covid-19 infection in fully vaccinated people? Data from Public Health England show that the Covid-19 vaccines used in the UK reduce the risk of   infection by about 70-90% in people who are fully vaccinated, so vaccines prevent the majority of people who are vaccinated from becoming infected. However, some people who are fully vaccinated will still become infected. Over time, as the number of people in the population who are vaccinated increases, a greater proportion of infections will occur in va...

Why doctors and dogs should not mix on house visits to patients. This might seem a strange topic to discuss but it is important to health professionals and is something they don’t teach you about in medical school. Bottom line: always ensure the dog is in a separate room when you do a house call. It’s very common when you arrive at a house to be do a home visit to be greeted by the sound of barking dogs. The owners will always try to reassure you that the dogs are "just being friendly" and are "harmless". Ignore them and insist the dogs are put in another room before you enter. This sometimes causes resentment with the patient who often views the dog as a much-loved, close family member that is perfectly entitled to be present in the room while the patient has their consultation with the doctor. Do not give in to this pressure. It is very difficult to carry out a clinical consultation while you have a dog (sometimes several dogs) jumping all over you, distracting yo...

Early in the Covid-19 pandemic, the elderly and people who were clinically extremely vulnerable were asked to shield to reduce their risks of Covid-19 infection and its complications. We evaluated the effectiveness of shielding in a study published recently in the journal BJGP Open .  We found that Covid-19 rates were much higher in the shielded group compared with non-shielded group (6.5% vs 1.8%). The increase in risk of infection in the shielded group persisted after adjustment for a wide range of factors in a Cox proportional hazards regression model. We also found that Covid-19 rates were seven times higher in people living in care homes; and were also higher among people from ethnic minorities, those living in poorer areas, and in people with long-term medical conditions such as respiratory disease. Our results suggest that shielding alone is not enough to protect clinically vulnerable people and that vaccination, along with suppressing community infection rates, remains the ...

Depression is common in people with multiple sclerosis (MS), and a new study from our research group shows that people with both conditions are more likely to die over the next decade than people with just one or neither condition. The study was published in the September 2021, online issue of   Neurology , the medical journal of the American Academy of Neurology. The study also found that people with MS and depression have an increased risk of developing vascular disease such as heart attack and stroke. "These findings underscore the importance of identifying depression in people with MS as well as monitoring for other risk factors for heart disease and stroke," said lead author Raffaele Palladino, MD, PhD, of Imperial College of London in the United Kingdom. "Future studies need to be conducted to look at whether treating depression in people with MS could reduce the risk of vascular disease as well as death over time." The study involved 12,251 people with MS and...

Physical inactivity adversely affects older adults, with more than 60% of those aged over 75 years not sufficiently physically active for good health as defined by meeting the WHO and UK guidelines. From March until June 2020 in the UK, a national ‘lockdown’ was implemented to reduce exposure to, and transmission of, COVID-19. Although applied to the whole population, adults aged over 70 years and those with underlying health conditions at higher risk of severe COVID-19 disease were asked to follow more stringent social distancing measures. These included remaining at home where possible; avoiding social mixing in the community; avoiding physically interacting with friends and family; and avoiding public transport. In a paper published in the journal BMJ Open , we examined self-reported physical activity before and after the introduction of lockdown, as measured by metabolic equivalent of task (MET) minutes. Associations of physical activity with demographic, lifestyle and social facto...

In an article published in the British Medical Journal , we discuss the topic of vaccinating healthcare workers against Covid-19. Our conclusion is that compulsion is unnecessary and inappropriate.  Parliament’s decision to make vaccination against covid-19 a condition of employment for care home workers has fuelled the debate around compulsory vaccination for healthcare workers, which may follow. Compulsory vaccination is not a panacea and may harm the safety of patients and healthcare workers, as well as affecting workload and wellbeing. It is a dilemma familiar to occupational health services in many NHS trusts. Is there a vaccine hesitancy problem in UK healthcare for which mandatory vaccination is an appropriate solution? Data suggesting pockets of poor uptake of covid-19 vaccination among care home staff led the government to make vaccination compulsory, abandoning a targeted but voluntary approach. The government’s Scientific Advisory Group for Emergencies (SAGE) has not pub...

In a letter published in the British Medical Journal , I discuss the topic of how we assess the long-term safety and efficacy of Covid-19 vaccination. Vaccines for COVID-19 were eagerly awaited; and their rapid development, testing, approval and implementation are a tremendous achievement by all: scientists, pharmaceutical companies, drugs regulators, politicians and healthcare professionals; and by the patients who have received them.[1] Early real-world data from vaccine recipients in England, Scotland and Israel show that vaccination provides a high level of protection from symptomatic COVID-19 infection and serious illness, along with a large reduction in the risk of hospital admissions and death. However, because these vaccines are new, we do not yet have information on how long the immunity generated by COVID-19 vaccines will last; or on how well they will protect against new variants of SARS-CoV-2. Longitudinal data on ‘vaccine failures’, or re-infections can help guide national...

Early on during the pandemic, the UK government took the decision to give second doses of the Pfizer Covid-19 vaccine after 12 weeks rather than the recommended 3-4 weeks. It has now reduced the gap to 8 weeks and is considering reducing the gap to 3-4 weeks. What are the arguments in favour of reducing the gap between doses to 3-4 weeks? 1. Giving the two doses of the Pfizer vaccine 3-4 weeks apart is in line with the manufacturer’s guidance. 2. This is what most other countries using the Pfizer vaccine are doing. 3. Evidence from randomised controlled trials and subsequent evidence from real-world data provides strong evidence that two doses of Pfizer vaccine given 3-4 weeks apart provide excellent protection against severe disease. 4. Data from PHE in England shows that two doses of vaccine provide much better protection against the delta variant than one dose. Hence, giving second doses after 3-4 weeks instead of after 8-12 weeks could help reduce the current ratee of infection in ...

The government’s chief medical officer says he will continue to wear a face mask when appropriate. We should follow his example. Covid-19 is an infection that is largely spread indoors – particularly in crowded, poorly ventilated areas – through inhaling droplets and aerosols produced by infected people when they cough, sneeze, sing, talk, or breathe. Face masks are a simple method of reducing the risk of infection – but only if they are worn by large numbers of people. The main function of a mask is to reduce the emission of droplets from infected people into the air. The droplets are captured by the mask and hence less virus enters the air. Much of the benefit of wearing face masks goes to other people but they can also benefit the wearer, particularly if a high-specification mask is worn that filters out more droplets when the wearer breathes in air.  Wearing face masks will reduce the spread of the coronavirus and help protect others. This is very important in settings where we...

  Why are all restrictions being lifted even though Covid cases are rising? The number of cases of Covid-19 has been increasing since May and there are now nearly 30,000 cases each day in the UK. In the past, such a high number of cases would have led to a large number of people admitted to hospital and also an increase in deaths. Fortunately, because of vaccination, the number of people with a severe Covid-19 illness is now much lower than previously. For example, in the last week, there have been around 20 deaths per day on average from Covid-19 across the UK. This compares to more than 1,000 deaths per day during some days in January. The number of hospital admission is also low, with around 300 hospital admission each day in the UK. The government believes that vaccination is breaking the link between the number of cases and the number of people with severe illness; and it therefore safe to end Covid-19 restrictions in England on 19 July. The government accepts that the numbe...

 More than 375,000 pupils in England are currently are out of school for Covid-related reasons, an increase of more than 130,000 in a week. Not being at school is very disruptive for children’s education and their social development, and also for their families. The government is therefore considering other options for managing children in whom there has been a Covid-19 case in their school bubble. This could include daily testing  rather than exclusion from school. If the policy for children does change, it is likely to start in the new school term in September.   Will there be regular testing in schools even without any positive cases? The current policy of testing secondary school children twice each week is likely to continue in the new school year in September. This will be the case even in schools where there are no cases.   What will happen someone in my child’s class tests positive? Currently, everyone in the class and the wider school bubble is e...

The rapid spread of the delta variant of SARS-CoV-2 (coronavirus) in the UK in recent weeks shows the importance of foreign travel rules, such as on testing, immunisation and quarantine, to limit the import of Covid-19. Countries need to look at their own situation and put in place the most appropriate rules for them. This will including rules on Covid-19 testing for inbound and outbound travellers, and when and for how long travellers should quarantine; as well as guidance on whether travellers who are fully immunised can be exempted from some of these rules.  Holidays in foreign destinations carry risks. Settings such as restaurants, bars, night clubs and indoor concert venues have all been linked to large outbreaks of Covid-19. We all need to do our part to reduce these risks when we travel by following the local rules on social distancing and on the use of other preventive measure such as wearing face masks; and ensuring we get tested if we have symptoms of Covid-19 or have bee...

Countries globally are considering the implementation of Covid-19 vaccination programmes for children. In this article for the Daily Mirror , Matt Roper and I answer some of the common questions from parents about Covid-19 vaccination for children.  I'm worried about vaccinating my child - how safe is it? Clinical trials of Covid-19 vaccines in children aged 12-15 years in the UK and USA confirm that the vaccines are very safe. The rate of side effects in children in these studies was similar to that seen in young adults. As in young adults, most side effects were mild to moderate, such as a sore arm or tiredness.   Will children need two jabs like adults? Children will need two doses of vaccine because this provides much better protection against serious illness than one dose of vaccine.   How likely is it they will suffer from side effects? The most common side effects in children aged 12 to 15 years of age are pain at the injection site (> 90%), tired...

There will be a lot of disappointment about the 4-week delay to the relaxation of Covid-19 control measures in England until 19 July that was announced today by the Prime Minister. But it is the right decision. A delay of a few weeks allows more people to be fully vaccinated with two doses of a Covid-19 vaccine. The vaccination programme in the UK is progressing well; with 79% of adults in the UK having received one dose of a vaccine and with 57% who have received two doses. But this still leaves many adults unvaccinated, including some people in the 50+ age groups who are at highest risk of serious illness, hospitalisation and death.  The delta variant in circulation in the UK appears to be more infectious and more likely to result in an illness severe enough to require hospitalisation than other strains of SARS-CoV-2; and now accounts for the vast majority of Covid-19 infections. One dose of a Covid-19 vaccine is less effective in preventing symptomatic infection from the delta ...