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The distinction between a treatment being cost-effective and it being affordable for the NHS

There is an important distinction between a treatment being cost-effective and it being affordable for the NHS as illustrated by the example of tirzepatide. NICE has concluded that tirzepatide is cost-effective in appropriately selected patients because of the health gains it delivers through reductions in obesity-related disease and its complications. However, the overall budget impact is a separate question. When millions of people could potentially be eligible for treatment, even a cost-effective intervention can create major financial pressures for the NHS. We are still at a relatively early stage of implementation, yet tirzepatide has already become one of the NHS's highest-cost medicines. If access expands in line with NICE guidance over the coming years, expenditure will increase substantially unless drug prices fall significantly, prescribing criteria change or treatment strategies evolve. Another important issue is that we still have key unanswered questions about long-ter...

Protecting Young People from Meningococcal B Disease: The NHS Targeted Vaccination Programme

Meningococcal group B (MenB) infections are rare but can have devastating consequences. The decision to offer a targeted two-dose vaccination programme to Year 13 students and young people entering university or residential further education reflects concerns about recent outbreaks of meningococcal disease and the higher risk of transmission when large numbers of young adults mix closely for the first time in shared accommodation. The MenB vaccine has a well-established safety record, and evidence from the UK infant immunisation programme has shown substantial reductions in disease among vaccinated children. A targeted programme for those entering higher-risk settings is therefore a reasonable precautionary measure while further evidence is gathered on whether the recent increase in clusters represents a temporary fluctuation in disease patterns or a more sustained change in the epidemiology of MenB infection. The success of the programme will depend on achieving high uptake and ensuri...

The Vital Contribution of General Practice to Undergraduate Medical Education

It was a great pleasure to welcome GPs from across the UK to Imperial College’s Annual GP Teachers Conference today. General practice has a key role in the medical curriculum. It is where students see patients as individuals living with health conditions. Primary care provides opportunities to learn about areas such as prevention and health promotion, the early diagnosis of illness, continuity of care, and the management of frailty and multimorbidity. These are increasingly important aspects of healthcare as populations globally age and the burden of long-term conditions increases. Students also gain insight into the wider determinants of health and the importance of working with patients, families and multidisciplinary teams to deliver person-centred care. These experiences are essential in preparing future doctors for the realities of modern clinical practice, whatever specialty they ultimately choose. This teaching takes place against the backdrop of a very challenging en...

Appointments aren’t Access: The Hidden Work of Getting Care

Primary care access is often judged by appointment supply, waiting times, and utilisation, yet patients experience access as a series of small obstacles that accumulate into delay, drop-off, and avoidable deterioration. Building on existing literature on administrative burden, treatment burden, digital exclusion, and telemedicine inequity, this commentary proposes the Access Friction Index (AFI) as a practical framework for measuring the real-world effort required to convert a health need into timely assessment, follow-up, and treatment. Drawing on recent evidence from the UK, US and other settings, it links access friction to inequities for vulnerable groups, missed screening, medication non-adherence, unplanned return visits, and avoidable hospital use. It also outlines how routine service data and electronic records could be used to identify friction hotspots—including repeated contact, mode switching, handoffs, results handling failures, and delayed pathway closure—and how primary ...

The NHS App should focus on inequalities to improve population health

The 10-Year Health Plan for England aspires to create ‘the most digitally accessible health system in the world by 2028’ with the NHS App positioned as the primary gateway to the NHS. This is an ambitious and it is encouraging to see health inequalities given prominence in the plan’s executive summary. However, extensive evidence, including evaluations of the NHS App specifically, shows significant disparities in who is able and likely to use digital health technologies. Without addressing these broader social and structural determinants of digital access and use, an overreliance on the NHS App risks deepening existing health inequalities and failing to improve population health for all. Although the NHS App has been been broadly adopted, it risks widening health disparities unless the health service or community groups can support patients to access and use the App appropriately. There must be clear value from using the NHS App and its features for patients, alongside equitable opport...

UK Covid-19 Inquiry - The Importance of a Strong Primary Healthcare System

In my witness statement for Module 10 of the UK Covid-19 Inquiry, I discuss the pandemic's impact through from the perspectives of primary care and public health, drawing on my extensive experience as a senior academic at Imperial College London and as a practising GP and NHS Public Health Specialist. I emphasise that the pandemic disproportionately affected people who were clinically vulnerable, the disabled, ethnic minority communities and those living in deprived areas. The pandemic highlighted how structural inequalities, multigenerational housing, and employment in high-risk frontline roles exacerbated health disparities. My statement also critiques the weakening of public health infrastructure - particularly for the control of infectious diseases - and the lack of integrated health data systems to identify at-risk groups such as the clinically vulnerable. I also advocated for a more robust preventive healthcare model that prioritises community-based primary care ...