Medical Centre

Doctors and other NHS professionals in England are often asked to write in support of patients applying for benefits such as Personal Independence Payments (PIP) or Employment Support Allowance (ESA); which support people with disabilities and long-term health conditions. Here are some tips on how to write a good letter of support based on my long experience as an NHS doctor (over 30 years) of writing such letters. Introduce yourself and describe your relationship to the patient, including how long you have known them and in what capacity. This will help establish your credibility as a reliable source of information in support of their application for a personal independence payment or another state benefit. Provide a detailed description of the patient's medical conditions, including any diagnoses they have received, how their medical conditions affect their daily life, and any symptoms they experience. Also include any medication they are taking and any past medical or surgical i...

The primary purpose of general practice electronic health records (EHRs) is to help staff deliver patient care. In an article published in the British Medical Journal , Lara Shemtob, Thomas Beaney, John Norton and I discuss the need for the general practice staff entering data in electronic health records to be more connected to those using the information in areas such as healthcare planning, research and quality improvement. Documentation facilitates continuity of care and allows symptoms to be tracked over time. Most information is entered into the electronic record as unstructured free text, particularly during time pressed consultations. Although free text provides a mostly adequate record of what has taken place in clinical encounters, it is less useful than structured data for NHS management, quality improvement, and research. Furthermore, free text cannot be used to populate problem lists, calculate risk scores, or feed into clinical management prompts in electronic records, al...

Today's clinical meeting includes updates on the implications of the 2023 budget for NHS primary care, the SE London campaign to raise awareness of childhood immunisation, and new NICE guidance on treatments for Covid-19 in high-risk patients. 1. Budget 2023 The 2023 budget included several measures that will affect NHS staff: Pension tax reforms. The Lifetime Allowance (LA) charge will be removed from next month and abolished entirely from April 2024. The Annual Allowance will be raised to £60,000. Digitised NHS Health Check. Digitising mental health services. The Government will ‘modernise and digitise’ mental health services in England. Work Capability Assessment and Work Coaches Increased occupational health coverage See https://www.pulsetoday.co.uk/analysis/politics/spring-budget-at-a-glance-how-it-will-affect-gps/   2. Childhood vaccination Campaign to encourage parents and carers to get their children up to date with routine vaccinations steps up over th...

1. New GP Contract for 2023-24 NHS England has imposed a new contract on general practices for the 2023-24 year following the breakdown of negotiations with the BMA. We will need to look at this in more detail in a future meeting. Some of the changes are in areas such as access to GP services, access to medical records, QOF, additional roles (ARRS) and telephone systems.   2. ADHD Update Following previous discussions, I have prepared a template referral letter for adults with suspected ADHD based on NHS guidance. See https://medical-centre.blogspot.com/2023/02/example-adhd-referral-letter.html   3. Covid-19 vaccination The Autumn booster vaccination programme has now ended. A Spring booster programme will start soon. This will target adults aged 75 years and over, residents in care homes for older adults, and individuals aged 5 years + who are immunosuppressed. People who are not fully vaccinated will no longer be able to get a first or second dose of Covid-19...

In a study published in the  European Journal of Epidemiology , we assessed 20-year retrospective trajectories of cardio-metabolic factors preceding dementia diagnosis among people with type 2 diabetes (T2D).  We identified 227,145 people with T2D aged > 42 years between 1999 and 2018. Annual mean levels of eight routinely measured cardio-metabolic factors were extracted from the Clinical Practice Research Datalink. Multivariable multilevel piecewise and non-piecewise growth curve models assessed retrospective trajectories of cardio-metabolic factors by dementia status from up to 19 years preceding dementia diagnosis (dementia) or last contact with healthcare (no dementia).  23,546 patients developed dementia; mean (SD) follow-up was 10.0 (5.8) years. In the dementia group, mean systolic blood pressure increased 16–19 years before dementia diagnosis compared with patients without dementia, but declined more steeply from 16 years before diagnosis, while diastolic blood ...