Medical Centre

Newly published statistics show that nearly 7,000 children and adults aged under 25 in the UK have been diagnosed with type 2 diabetes. The onset of Type 2 Diabetes is strongly associated with lifestyle factors such as obesity, lack of exercise and high calorie (high sugar) diets. In recent decades, countries such as USA and UK have seen large increases in the number of people with type 2 diabetes. Most of these cases have been among older people but we are now also seeing an increasing number of cases of Type 2 Diabetes among younger people. Reversing the increase in Type 2 Diabetes is not easy. It requires action by individuals, and also by governments and societies. For individuals, it is important that people eat a healthy, balanced diet that is not too high in calories, and not high in refined carbohydrates and sugars. Dietary changes need to be combined with regular exercise to keep weight down to healthy levels, thereby reducing the risk of developing type 2 diabetes. A num...

In an article published in the journal JRSM Open , we discuss patient safety in developing countries. Through a review of the literature, lessons and interventions from developed countries have been taken into consideration to identify the themes needed for patient safety improvement. We provide an integrated approach based on best practice which can be used to guide the development of a national strategy for improving patient safety. Policy makers need to focus on developing a holistic and comprehensive approach to patient safety improvement that takes into account the themes discussed in this article. DOI:  https://doi.org/10.1177/2054270418786112

Drugs used to treat diabetes are now responsible for 11.4% of total primary care prescribing costs in England, £1,012 million annually. The very high costs to the NHS of treating diabetes are an inevitable consequence of the increase in the prevalence of type 2 diabetes in recent decades. This increase in the prevalence of type 2 diabetes is in turn a consequence of lifestyle factors such as high-calorie diets (particularly diets high in sugars and refined carbohydrates), physical inactivity and obesity. We need effective strategies at both population and individual level, and changes in the obesogenic environment we live in, to reverse these adverse lifestyle- associated factors and bring down the prevalence of type 2 diabetes. Source: NHS Digital

Increasing workload, a reduced percentage of the budget and workforce retention and recruitment problems challenge the capacity of available general practitioners in the UK NHS. Consequently, patients’ ability to obtain general practitioner appointments has declined. Political pressure to improve access has been accompanied by promises of increased general practitioner numbers, but with a reported fall in 2016–2017,5 it remains unclear how this will be achieved. Meanwhile, financial constraints have also led to the loss of some community-based health services, such as district nursing and fragmentation of others. In a study published in the Journal of the Royal Society of Medicine , we examined whether the systematic deployment of community health workers in the NHS could help address current problems of fragmentation and inefficiency, while improving clinical outcomes through improved uptake of appropriate services. Conservative modelling suggested that 110,585 community heal...

In an article published in the British Medical Journal , I discuss the health outcomes achieved by the NHS in the UK and how these compare with other European countries. Health outcomes in the UK have improved substantially since the NHS was established in 1948. The NHS also performs well in many international comparisons on measures such as efficiency, equity, and access. Despite these achievements, however, problems with health outcomes remain. Moreover, other European countries have also improved their health outcomes in recent decades, often at a faster rate than the UK. Consequently, the UK now lags behind many other European countries in key health outcomes in areas such as child health and cancer survival. I conclude that new health policies in the UK should help the NHS to focus on improving health outcomes and that politically expedient schemes that are not evidence-based – such as extended opening hours in primary care – should be abandoned. Continued progress is also ne...

In a paper published in the Journal of Antimicrobial Chemotherapy , we discuss key issues in applying an evidence-based approach to the prescribing of antibiotics to children. Antimicrobial resistance is a growing threat to global health, yet antibiotics are frequently prescribed in primary care for acute childhood illness, where there is evidence of very limited clinical effectiveness. Moral philosophy supports the need for doctors to consider wider society, including future patients, when treating present individuals, and it is clearly wrong to waste antibiotics in situations where they are largely clinically ineffective at the expense of future generations. Doctors should feel confident in applying principles of antibiotic stewardship when treating children in primary care, but they must explain these to parents. Provision of accurate, accessible information about the benefits and harms of antibiotics is key to an ethical approach to antimicrobial stewardship and to supporting ...

In recent years, the NHS has invested in 'extended hours' schemes, whereby general practice are encourage to open beyond their contracted hours of 8am to 6.30pm Monday to Friday. In a study published in the British Journal of General Practice , we examined associations between overall experience of general practice and patient experience of making appointments and satisfaction with opening hours using data from the General Practice Patient Survey. We found that patient experience of making appointments and satisfaction with opening hours were only modestly associated with overall experience. Patient satisfaction was most strongly associated with GP interpersonal quality of care We concluded that policymakers in England should not assume that recent policies to improve access will result in large improvements in patients’ overall experience of general practice. The article was covered by the medical magazine Pulse .

In an article published in the Journal of the Royal Society of Medicine , Paul Jewell and I discuss the issue of foundation doctors and specialist training. Only around 43% of junior doctors entered straight into a UK specialty training programme after completion of their foundation programme in 2017, a substantial decrease from 71% in 2011. Given the National Health Service in the UK is under ever-increasing workforce pressures, this is a worrying trend. The decline in entry to specialty training can be partly explained by the rise in what is known as ‘the F3 year’. Concerns over this ‘junior doctor exodus’ are not new, having been previously raised in 2010, when the figures were far more favourable than they are now. Similar trends can also be seen at earlier stages, with fewer school students applying to medical school, and fewer medical students applying to the foundation programme,4 indicating wider issues. To reverse this trend and the shortage of doctors in many specialties, so...

England is currently experiencing an outbreak of measles, with around 440 laboratory confirmed cases between January to May 2018. The outbreak is linked to ongoing outbreaks in Europe. Most cases are unimmunised teenagers and young adults. Children and young adults who did not receive MMR vaccine when they were younger, and people from under-vaccinated communities, are particularly at high risk. Measles is a highly infectious illness that can sometimes cause serious complications such as pneumonia and encephalitis, and which can occasionally be fatal. Anyone who missed out on their Measles, Mumps and Rubella (MMR) vaccine or is unsure if they had 2 doses should therefore ensure they are fully immunised. The outbreak also reinforces the importance of parents to ensure their children receive two doses of the MMR vaccine, the first at around 12 months of age and the second around 3-4 years of age.

An article from Imperial College London published in the Lancet discusses vaccination from migrants in Europe. Ensuring high levels of coverage is a key priority of the European Vaccine Action Plan, whereby all WHO Europe Member States have committed to eliminating endemic measles and rubella (>95% coverage with the measles mumps rubella vaccine), sustaining polio-free status, and controlling hepatitis B infection.

Our recent paper in BMJ Open Gastroenterology examines trends in endoscopic, medical and surgical admissions for inflammatory bowel disease in England from 2003–2013. In the last decade, there have been major advances in inflammatory bowel disease management but their impact on hospital admissions requires evaluation. We aim to investigate nationwide trends in inflammatory bowel disease surgical/medical elective and emergency admissions, including endoscopy and cytokine inhibitor infusions, between 2003 and 2013. We used Hospital Episode Statistics and population data from the UK Office for National Statistics. Age-sex standardised admission rates increased from 76.5 to 202.9/100 000. Rising inflammatory bowel disease hospital admission rates in the past decade have been driven by an increase in the incidence and prevalence of inflammatory bowel disease. Lower GI endoscopy and surgery rates have fallen, while cytokine inhibitor infusion rates have risen. There has been a concurrent...

Health inequalities start very early in life. By the time of school reception year (4-5 years of age), children from the most deprived areas of England are twice as likely to be obese as children from the most affluent areas. This illustrates the importance of the implementing policies to improve health at a very early stage, starting before conception, continuing through pregnancy, and then into infancy and childhood. See NHS Digital for further details.

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...