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The challenge of clinical complexity

An ageing population, multimorbidity, frailty and polypharmacy are all contributing to an increase in the complexity of patients managed by the NHS in the UK and by health systems in other countries. Moreover, the interaction of these factors can lead to a “complexity cycle” which further increases the risks to patients and the pressures on the NHS. The convergence of these factors has shifted the NHS landscape from managing isolated illnesses to navigating patients with multiple complex health needs. This complexity arises because frail patients with multiple long-term conditions often require numerous medications, which significantly increases the risk of adverse drug interactions and hospitalisations.  Consequently, the NHS is aiming to move away from traditional, single-disease specialist models toward integrated, person-centred care that prioritises holistic assessment and strategic deprescribing to maintain patient independence and safety. To support this transition, we also ...
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Transforming Clinical Uncertainty into a Strategy for Safe Care

Managing uncertainty is a core skill in primary care and other frontline clinical specialties such as emergency medicine where patients frequently present with early, evolving or non-specific symptoms that do not fit clear diagnostic categories. Rather than eliminating uncertainty, safe practice depends on recognising it, communicating transparently with patients and colleagues, and managing risk over time.  This is especially important for serious illnesses that may initially present with vague or common symptoms where premature or inappropriate reassurance can delay diagnosis.An example is ovarian cancer which can present with symptoms such as abdominal pain and bloating; and where there is overlap with other, less serious illnesses such as irritable bowel syndrome/ Safe management in patients with such presentations begins with a structured clinical assessment that considers red flags, comorbidities and the patient’s clinical and social contexts; alongside an explicit acknowledg...
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Combining Clinical Practice with Research: What do I Need to Know?

 I was recently asked by the BMJ to offer comments for an article advising doctors how they could improve their research skills and get involved in research. Integrating research into a clinical career offers a pathway to professional fulfilment, intellectual growth, and the opportunity to influence patient care on a broader scale.  While the prospect of balancing clinical duties with academic pursuits can be daunting due to time constraints and the need for specialised skills, there are numerous entry points available for clinicians at every stage of their career. From early-career networking and trainee-led collaborations to structured fellowships and leadership roles in national trials, the research landscape is designed to accommodate various levels of involvement. By developing core competencies, seeking out mentorship, and identifying practical questions within their own daily practice, clinicians can successfully navigate the challenges of a dual career and contribute ...
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A New Vaccination Plan for England Must Start with Reinvesting in General Practice

 The Parliamentary Health and Social Care Committee states that the Government’s vaccination strategy is ‘a failure’ and should be replaced with a new plan. Vaccination rates in the UK have been falling since around 2012 when pressures on GP services began to increase. A key part of the solution to improving childhood vaccination rates in not to create new services like “family hubs” but to invest in core general practice services to increase primary care capacity. This needs to be combined with greater incentives for childhood vaccination. A successful vaccination strategy must strengthen and not sideline general practice. Without substantial reinvestment in general practice and improved incentives, any new structures will struggle to reverse the long-term decline in childhood vaccination coverage in the UK. GPs provide continuity, trusted relationships, accurate records, recalls, and opportunistic vaccination; all of which are  essential for high uptake. When GP capacity is ...
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Managing Complications of Overseas Medical Procedures: An Emerging Challenge for UK General Practices and Emergency Departments

General practitioners and emergency medicine doctors in the UK are increasingly encountering patients who return from overseas with complications following medical procedures. These cases can often be  challenging to manage. Frequently, there is limited or no access to operative notes, discharge summaries, or detailed information about the techniques and materials used, making clinical assessment and safe follow-up difficult. The complications themselves are often complex, including serious infections, wound breakdown, thromboembolic events, and implant-related problems. Many require urgent specialist input. GPs are typically the first point of contact and must manage patient distress, clinical uncertainty, and risk, while navigating referral decisions in the absence of clear guidance or established care pathways. For patients, the lower cost of surgical procedures overseas can be an appealing alternative to private care in the UK. However, this often comes at the expense of struct...
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Embedding AI Error Detection Into Primary Care Safety Culture

 As artificial intelligence (AI) become increasingly embedded in routine healthcare - supporting tasks such as triage, documentation, interpretation of investigation, diagnosis and patient communication - it introduces new patient safety risks through incorrect outputs (“hallucinations”) that should be treated as safety errors rather than technical glitches. In our article in the Journal of Patient Safety , we argue that primary care must extend its established safety culture to AI by systematically detecting, classifying, reporting, and learning from AI-related errors using principles already applied to human error, such as audit, governance, and incident reporting.  We highlight evidence that AI-generated clinical text can contain omissions, fabrications, or unsafe recommendations that may not be apparent to clinicians and patients and that risk becoming “silent errors” in electronic health records. These errors can then contribute to cognitive offloading if clinicians over-...
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The role of vaccination, infection control measures and early treatment in curbing the impact of flu

Influenza remains a major cause of preventable illness each winter and continues to place significant pressure on NHS general practices, urgent care services, and hospitals. This has been particularly evident this winter, with flu rates much higher than we would normally expect for this time of year.  As of mid-December 2025, UKHSA surveillance shows influenza positivity in primary-care sentinel samples running well above most pre-COVID seasons, and hospital and ICU admissions for confirmed influenza are rising sharply — especially among adults aged 65 and over and those with long-term medical conditions. In general practice, we see first-hand how flu can lead to severe complications, particularly in older adults, people with underlying conditions, and those who are immunocompromised. Vaccination remains the single most effective way to reduce the risk of severe illness, hospitalisation, and death from flu. Interim data for the 2025–26 season suggest that vaccination is already red...
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