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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 ...

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 ...

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 acknowled...

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 ...

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 ...