Medical Centre

I don’t support the BMA's view that NHS GPs in England should consider taking industrial action. I think this will alienate the public and lose GPs support at a critical time. NHS England is not going to invest adequately in the current independent contractor model of general practice. Why does the BMA not ballot GPs about the NHS salaried option instead whereby GPs and their staff would become NHS employees?  The BMA’s GP Committee has always opposed the option of GPs becoming salaried employees of the NHS. For many years, NHS England has been unwilling to fully support the independent contractor model of NHS general practice. Instead, we are going to find the independent model gradually fading and GPs increasingly being employed by commercial companies contracted to deliver NHS services. This will be a much worse outcome for GPs and patients than other alternatives. And in anticipation of all the responses from GPs about why the current independent model is better than salar...

We all want to avoid another lockdown. We need sustainable public health interventions that will keep Covid-19 cases, hospitalisations and deaths at an acceptable level, and get us through the winter. What could this mean in practice? 1. The most important public health intervention to control Covid-19 is our vaccination programme. This has slowed down in recent months. Also, in effect, it has split into four distinct programmes: - a programme aimed at people 16 and over. This has almost stopped, with around 10% of adults in the UK still unvaccinated (higher in London). - a third primary dose programme aimed at people with weak immune systems . This has been poorly planned and implemented by NHS England and has caused a lot of confusion. - a booster dose programme. This is going OK but could be speeded up to provide more protection for key groups of people before the full onset of winter. - a programme for 12-15 year olds. This has got off to a very slow start in England.  Speedin...

On 1 st September 2021 the JCVI  recommended that certain patients aged 12 and over, who were thought to be immuno-suppressed (through disease or medication) around the time of their first two doses of Covid-19 vaccine, should be offered a third primary dose 8 weeks after their second dose. There has been considerable confusion about these third primary doses as they are different from the booster doses that many people who are now over 6 months after their second dose are being offered. Many patients have reported they have been unable to obtain their third primary dose ; or have only obtained after a lengthy dialogue with NHS clinicians and managers. Here are the steps that could be followed to safely implement the third primary vaccine dose programme for immunocompromised patients in England’s NHS. Identify your target population. This is an essential first step in any vaccination programme (or in any public health programme). Identifying the target population requires sea...

How a society treats its most vulnerable is always the measure of its humanity  is a well-known quote often attributed to Mahatma Gandhi. With the “levelling up” agenda being quoted widely by the UK government, and the effects of pre-existing health inequalities never more exposed than by the covid-19 pandemic, we all need to focus on the health of the most vulnerable in society. Our highest risk patients, and their household members, were rightly prioritised for covid-19 vaccination at the start of the rollout programme in December 2020. Early in the pandemic, the UK government recognised that certain patients with complex medical conditions, or who were immuno-suppressed through disease or medication, would be most at risk from the complications of covid-19. These patients were advised to take careful infection control precautions, and were classed as clinically extremely vulnerable” (CEV). Among the advice given to them was to “shield” and to facilitate this, they were added to ...

The numbers of pregnant and postpartum women in the UK admitted to hospital or intensive care because of Covid-19 peaked over the summer of 2021 Maternal mortality has reached concerning levels in 2021, with case fatality rates rising in the US, doubling in Brazil, and almost tripling in India since the beginning of the pandemic. In Brazil, health officials even suggested avoiding pregnancy to reduce risk during the pandemic. Inconsistent messaging from authorities, driven by lack of trial data, has increased Covid-19 vaccine hesitancy among pregnant women. This, coupled with the increased transmissibility of new variants and relaxing of social distancing restrictions, contributed to the surge in hospital admissions seen in successive waves. Concerns around the longer term effect of Covid-19 post partum, including long Covid, cardiovascular complications of covid-19, and widening socioeconomic disparities are also mounting. Despite a desperate need for treatments, pregnant women contin...

After a rapid start, the pace of the United Kingdom’s (UK) covid-19 vaccination programme has slowed down while the UK still faces high infection, hospitalisation, and death rates, and a more transmissible Delta SARS-CoV-2 variant. Now that vaccination of children aged 12-15 has started, it is essential to achieve a high uptake of vaccination in this group, and also in young adults, to both protect them and to move the UK closer towards population level immunity. [ 1,2]  Despite two doses of Pfizer-BioNTech, Moderna, and AstraZeneca vaccines offering good protection against the Delta variant— with Pfizer-BioNTech and AstraZeneca vaccines between 92-96% effective in preventing hospitalisations— many young people remain unvaccinated by choice,  raising their risk of infection, hospitalisation, and long-term complications from covid-19. [3-5] The UK population is among the most willing to receive a covid-19 vaccine;  as of 11 October 2021, over 49 million individuals (85.6% ...

During the previous winter (2020-21), rates of colds, flu and other respiratory infections were very low across the UK because of social distancing and other infection control measures. Now that these measures have largely stopped, we are seeing an increase in respiratory infections.  The symptoms of a cold can typically include a blocked or runny nose, sore throat, headache, cough , loss of smell, sneezing and muscle aches. Many of these symptoms can also occur in people with a Covid-19 infection. Now that most adults in the UK have been fully vaccinated with two doses of a Covid-19 vaccine, when people do contract Covid-19, it is often with milder symptoms that can overlap those from a cold. This means that for many people with these kinds of symptoms, a Covid-19 test will be needed to separate the two conditions.  There will be a lot of scope to confuse the symptoms of colds and Covid-19 during the winter. The message for the public should be to always be cautious if you ha...