Medical Centre

Our new article in the Journal of the Royal Society of Medicine examines the impact of vaccination on hospital admissions for Covid-19 in England during 2021. Covid-19 vaccination substantially reduced the risk of hospital admission, particularly in people who received three doses.  We used data over a whole calendar year covering multiple variants of SARS-CoV-2, variable case rates and changing vaccine uptake.  This provides a population-level overview of the impact of vaccination that is not possible from studies over a shorter period. Using primary diagnosis of Covid-19 as the inclusion criteria increases the specificity of our study by excluding those co-incidentally Covid-19 positive but admitted for another reason. We excluded “ghost patients” that can bias the estimates of vaccine effectiveness.  We report a dose-dependent effect of vaccination, as well as waning of the effectiveness of each vaccination dose, highlighting the value of booster vaccinations. Our ana...

Our new article in the British Journal of General Practice discusses the importance England’s NHS having an effective workforce strategy. Staffing shortages in health and social care are limiting the delivery of services. Interventions to improve the recruitment and retention of staff, along with also improving staff wellbeing, are essential.  Health and social care organisations must invest in understanding what works to recruit and retain staff, and, in the case of general practice, in patient- facing roles. NHS Employers suggests target areas for focus for employing organisations, such as encouraging flexibility and supporting new starters; however, there is a lack of evidence on what is proven to keep people in post, recently highlighted by the Royal College of Anaesthetists concerned about staffing levels within their own specialty. Financial incentives including pay, taxation, and pensions must be optimised but do not exonerate the need to optimise working conditions. Outcom...

Dear Dr, I am writing to refer a 28-year-old male patient of mine, Mr [Patient's Name], for assessment for the diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD). After a thorough clinical assessment, I believe that Mr. [Patient's Name] meets the criteria for adult ADHD as outlined in NHS guidance for primary care teams in SE London. Mr [Patient's Name] has been under my care for XX years and, during this time, he reports several symptoms (greater than five symptoms in total) consistent with ADHD in adults that have been present for more than six months. These symptoms include difficulties in focusing, following through on tasks, hyperactivity, forgetfulness, impulsiveness, restlessness, and irritability. Mr [Patient's Name] also reports being easily distracted, struggling with time management, organisation, and completing tasks efficiently. Many of Mr [Patient's Name]'s symptoms have been present since he was under 12 years old; and have...

There has been considerable recent debate about charging for GP appointments after comments from two former UK health secretaries, Kenneth Clarke and Sajid Javid, elicited strong responses both for and against user fees. Let’s try to put aside ideology and emotion and look objectively at the evidence and arguments around user fees in NHS primary care. Debates over NHS user fees are not new. In 1951, Hugh Gaitskell introduced charges for prescriptions, spectacles, and dentures. Aneurin Bevan, minister for labour and architect of the NHS, resigned in protest at this abandonment of the principle of NHS care being free at the point of need. Many developed countries already charge users to access primary care services, often through a flat-rate co-payment. However, there is a lack of evidence about the impact of such fees on access to healthcare, health inequalities, and clinical outcomes. A key study on the impact of user fees in a high income country (the RAND Health Insurance Experiment)...

  1. Routine Covid-19 vaccination for people under 50 is ending Adults under 50 in England have until 12 February 2023 to take up the NHS offer of a Covid-19 vaccination. After this date, only people in higher-risk groups under 50 are likely to be eligible for a Covid-19 vaccination. See https://www.bbc.co.uk/news/health-64496025 2. Medical examiner system Implementation of the statutory medical examiner system will start from April 2023. Medical examiners are doctors who provide independent scrutiny of the causes of death.  The purpose of the medical examiner system is to: ·          provide greater safeguards for the public by ensuring independent scrutiny of all non-coronial deaths ·          ensure the appropriate direction of deaths to the coroner ·          provide a better service for the bereaved and an opportunity for them to raise any co...

On 23 July 2022, the World Health Organisation (WHO) declared monkeypox a public health emergency of international concern. By 15 December, over 82 500 confirmed cases of human monkeypox across 110 countries had been identified, with 98% of cases emerging in 103 non-endemic countries. Notably, most patients present without clear epidemiological links and non-specific clinical characteristics. We offer an overview of human monkeypox and of the assessment, diagnosis, and management of confirmed cases and at-risk patients based primarily on guidance from the WHO and the UK Health Security Agency (UKHSA). What is monkeypox? The monkeypox virus is a zoonotic orthopoxvirus related to the variola virus that causes smallpox. Its main reservoirs are rodents, apes, and monkeys. It was first described in humans in 1970 in the Democratic Republic of Congo (DRC). The following 11 countries have historically reported cases of monkeypox (that is, considered endemic for monkeypox virus): Benin, Camero...

Today’s clinical update looks at flu vaccine uptake. The NHS offers free vaccination to eligible patients in the UK but there is planning needed to ensure the flu vaccine programme is implemented effectively and achieves a high uptake. There is still scope to improve uptake this year and for the next flu vaccine campaign in the Autumn of 2023. Key steps in implementing the annual flu vaccination programme Give one member of the practice team responsibility for leading the vaccination programme, supported by the wider practice team. Ensure staff are informed about the programme; including start dates, who is eligible and the benefits of vaccination for the individual patient, their family and society. Prepare FAQs to common questions from patients. These are usually available on government websites such as those published by NHS England and the UKHSA. Ensure staff know where to look for these FAQs, which are essential in countering misinformation about vaccination. Ensure medical record...