Medical Centre

The UK transport minister, Grant Shapps,   announced on 28 April 2021  that the UK government plans to use the existing NHS App to provide proof of covid-19 vaccination status for international travel. For many years, proof of smallpox, polio, and yellow fever vaccinations have been an entry requirement for many countries. The  World Health Organization “yellow card”  scheme has been in place since 1969, and proof of  ACWJ meningococcal vaccine  is required for Hajj to Saudi Arabia. So while discussions on “vaccine passports” are old, the scale of the covid-19 pandemic will require a large number of global travellers to use a vaccine passport, which is an unprecedented development; and the technological options are far more advanced than for the previous paper-based certificates used for other vaccines. There are  arguments for and against  vaccine passports. We are facing a global pandemic, with huge variations in disease prevalence and vaccine m...

Lower limb amputations are an important and largely preventable complication of type 2 diabetes mellitus that impact considerably on the life expectancy and quality of life of those affected. In England, more than 9000 diabetes-related amputations are performed each year, with decreasing rates but higher absolute numbers of major amputations, and the annual direct healthcare costs of diabetic foot ulceration and amputation are approximately £1 billion.  In an article published in BMJ Open Diabetes Research & Care , we investigated the associations between attainment of primary care quality clinical indicators, completion of National Diabetes Audit care processes, and non-traumatic lower limb amputations among people with type 2 diabetes. We observed that minor or major, as well as major-only, amputation rates were 26%–51% and 3%–51%, respectively, lower among those who met the HbA1c indicator and 14%–47% lower among those who met the cholesterol indicator for our primary outcom...

In an article published in the Journal of the Royal Society of Medicine , we discuss the safe management of full-capacity live events in the era of Covid-19. The importance of the live events industry to the UK economy is significant, with the creative industries1 alone contributing £117bn to the UK economy in 2018. However, the public health response to COVID-19 led to an unprecedented fall in theatrical sales of 93%, with the entertainment industry estimated to lose £110 m per month of full closure.  Several high-profile live music events have been cancelled. There has been limited experience of the reopening of live events in other countries; however, this has only been possible due to effective public health interventions to reduce community transmission to near zero levels. The sustainability of stringent border control measures to virus transmission is much debated; however, it is clear that the ability for the UK to achieve and then sustain low community transmission le...

Nearly three million people in England have type 2 diabetes. Diabetic retinopathy is a common complication, affecting nearly a third of patients with type 2 diabetes with considerable impacts on visual acuity and quality of life. In a paper published in the journal BMC Medicine , we examined the associations between attainment of primary care indicators and incident diabetic retinopathy among people with type 2 diabetes in England. We found that that attainment of primary care HbA1c and BP indicators is associated with lower incidence of diabetic retinopathy in patients with type 2 diabetes. There is scope to enhance coverage of HbA1c and BP indicator attainment, and thus to potentially limit the incidence of diabetic retinopathy in England, through appropriate community-based measures. Further research is required to examine whether tighter glycaemic and/or BP control could achieve greater reductions in diabetic retinopathy.

The latest data from the Office for National Statistics confirms that ethnic minorities in England are considerably less likely to receive a covid-19 vaccine than their White counterparts. While 90.2% of those aged 70 years and over living in England had received at least one dose of vaccine by 11 March 2021, uptake rates were 58.8% and 68.7% in Black African and Black Caribbean groups, respectively. [2] This was followed by Bangladeshi (72.7%) and Pakistani (74.0%) populations, with the most pronounced differences seen in those living in the most deprived areas of England.  Vaccine take-up also varied by religious affiliation with Muslims (72.3%) and Buddhists (78.1%) having the lowest rates, despite Pfizer-BioNTech, AstraZeneca and Moderna confirming that their vaccines do not contain animal products, and despite endorsement of the vaccines by the British Islamic Medical Association, the Dalai Lama, the Hindu Council UK and the Board of Deputies of British Jews. Vaccination rates...

England has invested considerably in diabetes care over recent years through programmes such as the Quality and Outcomes Framework and National Diabetes Audit. However, associations between specific programme indicators and key clinical endpoints, such as emergency hospital admissions, remain unclear. In a study published in the Journal of the Royal Society of Medicine , we aimed to examine whether attainment of Quality and Outcomes Framework and National Diabetes Audit primary care diabetes indicators is associated with diabetes-related, cardiovascular, and all-cause emergency hospital admissions. Diabetes, cardiovascular and all-cause unplanned hospital admission rates were 7%–12% lower among those who met the Quality and Outcomes Framework HbA1c indicator, and 8%–14% lower among those who met the cholesterol indicator. By contrast, univariate analyses demonstrated that blood pressure indicator attainment was associated with higher rates of all types of unplanned admission. However, ...

In an editorial published in the British Medical Journal , Tasnime Osama, Mohammad Razai and I discuss the practical and ethical issues in the implementation and use of vaccine passports, and the need to ensure they do not exacerbate current societal or health inequalities. With millions of people receiving covid-19 vaccines globally, some countries have already started planning the implementation of “vaccine passports”—accessible certificates confirming covid-19 vaccination linked to the identity of the holder. The purpose of vaccine passports, governments argue, is to allow people to travel, attend large gatherings, access public venues, and return to work without compromising personal safety and public health. There remain, however, considerable practical and ethical challenges to their implementation. Vaccine passports are not only permissible under international health regulations, they already exist. The World Health Organization endorses certificates confirming vaccinat...

With the weather improving and people in England now allowed to meet with others outdoors, we will be heading to the beaches and parks. Being outdoors and getting exercise are essential for our physical and mental health but also comes with some risks because of the Covid-19 pandemic. Here are some steps you can take to protect yourself and others from the risk of infection. Travelling safely . If you are travelling by car, try to travel with people from your household or support bubble. If using public transport, make sure you wear a face mask. The best way to travel is by foot or bicycle but this won’t be practical for more distant locations. Follow Covid-19 rules on how many people can meet. In England, you can currently meet with a maximum of five other people if they are from more than two other households. Make sure your total group size does not exceed six people if this is the case. If there are people from just two households meeting, then your group can be bigger than si...