Medical Centre

The global Covid-19 pandemic has led to over 50,000 deaths in the United Kingdom, disrupted health services for many other conditions, and has had enormous economic impacts that have led to massive increases in unemployment and government debt.[1,2,3] With the United Kingdom’s failure to implement an effective test, trace and isolate programme as we have seen in countries such as South Korea and New Zealand, a vaccination programme offers us the best way to finally bring this pandemic under control[4]. It is therefore essential that the Covid-19 vaccination programme is implemented well and that we do not repeat the many mistakes we have seen in the government’s response to Covid-19, such as in the Test and Trace programme.[5] Primary care should be at the heart of the delivery of the UK’s vaccine programme. With around 7,000 general practices in England, for example, they are easy for patients to access and their staff are generally well-trusted by the public.  Unfortunately, a de...

  1. Was the government right to announce an easing of Covid-19 restrictions during Christmas? When the current lockdown in England ends, it’s likely the government will introduce a new system of tiered restrictions. My view is that these restrictions should remain in place through the Christmas and New Year period, based on the local community infection rate. Easing the restrictions too quickly risks undoing all the gains we have made during the lockdown. Greater social mixing indoors over the Christmas and New Year holidays will inevitably lead to an increase in Covid-19 infections.   2. Could allowing mixing of households actually mean people will die as a result? Most person to person transmission of Covid-19 infection occurs within households. This is the rationale for the government’s policy of stopping different households from mixing with each other indoors. Allowing mixing of households indoors will inevitably lead to an increase in infections, which would be ...

Increasing pressures on emergency departments present a considerable challenge worldwide, particularly during winter. Before the COVID-19 pandemic, serious infectious disease incidence had fallen with the success of vaccination programmes. However, amidst the ongoing global pandemic pressure on hospital EDs are stretched to their limit. This can strain health resources and budgets and can result in poor clinical outcomes. Increasing demand for EDs may be driven by rising morbidity in an ageing population, poor access to primary care and increase in patient expectations. In England, in 2017/2018, there were 23.8 million  emergency department attendances, an increase of 22% since 2008/2009; rises were higher in the under-5 (28%–30%), and one-third of all British children visit an  emergency department each year. Such increases pose immense challenges to the National Health Service (NHS) amidst significant cuts in funding, given that that nearly half of the health budge...

Whether we will come of the 4-week lockdown on schedule will depend on how low the government’s Covid-19 strategy brings the R-value for the country. The R value is the average number of people that each new case of Covid-19 infects. If the R value for England is less than one, the daily number of cases will start to fall; and if the R value is greater than one, the daily number of cases will continue to increase. Once the R value is below one, and the daily number of cases start to fall, the number of people being admitted to hospital and the number of deaths will also start to fall. There is though a lag before the number of hospital admissions and deaths begin to fall. This is because it can take 1-2 weeks from becoming infected before a person is unwell enough to need hospital treatment. There is then as further period of time before death. Hence, case numbers start to fall first, followed by the number of people admitted to hospital and then finally, the number of people dying fro...

Policy interventions aimed at reducing person-to-person transmission of SARS-CoV-2 (such as hand hygiene, physical distancing and wearing face coverings) were implemented globally to minimise healthcare burden, and to allow more time for an effective treatment and successful vaccine. After months of ‘lockdown’, many countries started to ease these measures recently only to see a surge in COVID-19 cases and deaths. During the winter of 2020–2021, we face the prospect of a dual burden of a COVID-19 pandemic and a seasonal influenza epidemic. However, what’s not being currently discussed is that the burden on healthcare could be further compounded by a potential surge of measles and rubella cases. This is due to: (1) a declining trend in Measles-Mumps-Rubella vaccine coverage accompanied by an increasing trend in Measles-Mumps-Rubella cases since 2016; and (2) disruption and suspension of Measles-Mumps-Rubella vaccination campaigns in 23 countries to cope with the COVID-19 pandemic. Our a...

The COVID-19 pandemic is imposing a profound negative impact on the health and wellbeing of societies and individuals, worldwide. One concern is the effect of social isolation as a result of social distancing on the mental health of vulnerable populations, including older people. Our findings were published in the journal Frontiers in Psychiatry . Within six weeks of lockdown, we initiated the CHARIOT COVID-19 Rapid Response Study, a bespoke survey of cognitively healthy older people living in London, to investigate the impact of COVID-19 and associated social isolation on mental and physical wellbeing. The sample was drawn from CHARIOT, a register of people over 50 who have consented to be contacted for aging related research. A total of 7,127 men and women (mean age=70.7 [SD=7.4]) participated in the baseline survey, May–July 2020. Participants were asked about changes to the 14 components of the Hospital Anxiety Depression scale (HADS) after lockdown was introduced in the UK, on 23r...

Despite the best efforts of clinicians, traditional healthcare models often struggle to meet the increasingly complex needs of children and young people under the age of 18 years, as well as 21st century challenges such as obesity and mental health problems. Policy makers and clinical leaders have argued that greater integration of primary and secondary care has the potential to meet the ‘Quadruple aim’ of better population health outcomes, patient and family satisfaction, provider satisfaction and reduced costs. More integrated services and improved data sharing across organisations are key enablers of child health improvement. However, there is sparse literature on how more integrated care for children and young people might work in practice or contribute to achieving these goals. We present the experience of developing a new model for integrated care delivery for children and young people in North West London, based on a common system of clinical records or dashboards across all pro...

Tobacco smoking remains the leading cause of preventable death and disease worldwide. Digital interventions delivered through smartphones offer a promising alternative to traditional methods, but little is known about their effectiveness. Our objective was to test the preliminary effectiveness of Quit Genius, a novel digital therapeutic intervention for smoking cessation. Our research was published in the journal JMIR Mental Health . We used a 2-arm, single-blinded, parallel-group randomized controlled trial design. Participants were recruited via referrals from primary care practices and social media advertisements in the United Kingdom. A total of 556 adult smokers (aged 18 years or older) smoking at least 5 cigarettes a day for the past year were recruited. Of these, 530 were included for the final analysis. Participants were randomized to one of 2 interventions. Treatment consisted of a digital therapeutic intervention for smoking cessation consisting of a smartphone app delivering...

There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed. We aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. The research was published in the Journal of Medical Internet Research . In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, ...