Medical Centre

 As artificial intelligence (AI) become increasingly embedded in routine healthcare - supporting tasks such as triage, documentation, interpretation of investigation, diagnosis and patient communication - it introduces new patient safety risks through incorrect outputs (“hallucinations”) that should be treated as safety errors rather than technical glitches. In our article in the Journal of Patient Safety , we argue that primary care must extend its established safety culture to AI by systematically detecting, classifying, reporting, and learning from AI-related errors using principles already applied to human error, such as audit, governance, and incident reporting.  We highlight evidence that AI-generated clinical text can contain omissions, fabrications, or unsafe recommendations that may not be apparent to clinicians and patients and that risk becoming “silent errors” in electronic health records. These errors can then contribute to cognitive offloading if clinicians over-...

Influenza remains a major cause of preventable illness each winter and continues to place significant pressure on NHS general practices, urgent care services, and hospitals. This has been particularly evident this winter, with flu rates much higher than we would normally expect for this time of year.  As of mid-December 2025, UKHSA surveillance shows influenza positivity in primary-care sentinel samples running well above most pre-COVID seasons, and hospital and ICU admissions for confirmed influenza are rising sharply — especially among adults aged 65 and over and those with long-term medical conditions. In general practice, we see first-hand how flu can lead to severe complications, particularly in older adults, people with underlying conditions, and those who are immunocompromised. Vaccination remains the single most effective way to reduce the risk of severe illness, hospitalisation, and death from flu. Interim data for the 2025–26 season suggest that vaccination is already red...

Our article in the Journal of the Royal Society of Medicine argues that safe and effective AI in healthcare must incorporate mechanisms that emulate human judgement - down-weighting old, inaccurate or superseded information and prioritising what is recent, clinically relevant and reaffirmed - so that AI supports, rather than disrupts, high-quality patient care.  Clinicians constantly revise, reinterpret and filter past information so that only what is relevant, accurate and timely shapes present-day management decisions; medical records function as dynamic “working tools” rather than fixed archives. By contrast, many AI systems lack this capacity for selective forgetting and often treat all historical data as equally meaningful.  This can lead to outdated or low-confidence diagnoses being repeatedly resurfaced, persistent labels influencing clinical expectations, and irrelevant, long-resolved events cluttering summaries and decision-support outputs. Such indiscriminate recall...

The UK government’s forthcoming review of mental health and neurodevelopmental diagnoses presents an opportunity to improve the healthcare and benefits system if the potential risks are averted. Rising rates of conditions such as ADHD, autism, and anxiety disorders have raised questions about whether we are seeing a genuine increase in need or greater awareness and possible over-diagnosis. A thoughtful, evidence-based review could help bring much-needed clarity. But if mishandled, it could deepen inequalities and undermine support for those who need it most. Done well, the review could improve diagnostic quality and reduce the postcode lottery that too often defines access to assessment and treatment. Clearer clinical standards and properly funded services would allow professionals to make more accurate diagnoses, shorten long waiting lists, and better match interventions to individuals’ needs. This is an outcome everyone should welcome. But the review must not become a vehicle for re...

The announcement of a new UK-US pharmaceuticals deal is an important change in the UK’s approach to how new medicines are evaluated, priced and adopted. Faster access to innovative treatments for conditions such as cancer will be welcomed by patients and professionals. The increased investment in medicines may also help the UK attract more clinical research.  However, the impact of the proposals will depend on implementation. Raising NICE’s cost-effectiveness thresholds will increase overall NHS spending on medicines. Without a corresponding investment in areas such as workforce, diagnostics and primary care, there is a risk that higher drug spending could divert resources from other parts of the NHS. A more flexible pricing environment could also reduce the UK’s future negotiating leverage with industry. Maintaining NICE’s independence will be essential to maintain both public and professional confidence in its decision-making. The changes have could benefit patients and strength...

In an article published in the journal Frontiers in Medicine , we argue that medical education must broaden its focus: rather than treating infrastructure such as housing, transportation, energy, water supply as only a public-health or social background issue, trainees should regard infrastructural deficiencies as direct clinical determinants of patient health.  We highlight concrete examples (e.g., missed appointments due to transport failures, disrupted dialysis from electricity outages, contaminated water causing toxicity) showing how infrastructure can precipitate or worsen clinical problems. We propose educational innovations: embedding infrastructure-related history-taking, case-based learning driven by infrastructural triggers, community placements in underserved areas, and interdisciplinary learning (with urban planners, engineers, public health) to equip future clinicians with “systems-citizen” skills and advocacy capability.  The goal is to reframe clinical practice ...

I spoke to GP Registrars on the Imperial College GP Training Scheme about the evolution of medical records in primary care. This is a journey that mirrors the broader transformation of healthcare itself. The story begins in 1911 , with the introduction of the Lloyd George Envelope following the National Insurance Act. These brown paper envelopes (named after the then Chancellor and future Prime Minister, David Lloyd George), each containing a patient’s handwritten medical notes and printed correspondence, became the standard for decades. They were simple, portable, and remarkably durable but also limited by their physical nature. Searching for information meant literally leafing through these paper records, and continuity of care relied on legibility and the clinician’s diligence in recording. The late 20th century brought a revolution: the computerisation of general practice . Early adopters in the 1980s and 1990s began using systems like EMIS and Vision, digitising the record and ...

There has been recent discussion about the need to revise drug pricing frameworks within the United Kingdom's National Health Service (NHS), particularly amid the ongoing transatlantic trade frictions involving potential tariffs from the United States administration. Elevating the cost-effectiveness threshold applied by the National Institute for Health and Care Excellence (NICE) by 25 percent from its established range of £20,000 to £30,000 per quality-adjusted life year (QALY) would increase access for NHS patients to innovative treatments that were previously excluded on grounds of excessive cost relative to their clinical benefits.  However, this change would also put increased pressure on the NHS budget. It is difficult to quantify the extra spending that might result from a wider range of drugs becoming available for use in the NHS through this change but any extra spending on these treatments would have to be matched by reductions in spending on other health services. Effect...

As the world continues to grapple with the aftermath of the COVID-19 pandemic, Long Covid has emerged as a significant public health challenge. Characterised by persistent symptoms like fatigue, brain fog, shortness of breath, and joint pain lasting weeks, months or even years after an infection, Long Covid affects millions globally. Yet, one major hurdle in understanding and addressing this condition is its under-recording in electronic medical records (EMRs). Accurate coding of Long Covid in EMRs is essential for studying its epidemiology, improving patient care, and managing its impact on healthcare systems and on societies. Electronic medical records are at the core of modern health systems and have largely replaced the more traditional paper-based records used by healthcare providers for many decades. Electronic medical records are used to track patient diagnoses, treatments, and clinical outcomes. When Long Covid is not properly coded, it becomes difficult to use this data to c...

Polypharmacy, commonly defined as the concurrent use of five or more medications, is a growing challenge in modern healthcare, especially among older adults with multiple long-term conditions. While advances in medicine have improved disease management, they have also led to an unintended consequence: a rising medication burden that can harm patient well-being.  Our recent study published in Clinical Practice explores how reframing polypharmacy as a chronic condition can empower future doctors to manage it more effectively. For example, polypharmacy substantially increases the risk of adverse drug reactions (ADRs). This underscores the urgent need for a shift in how we approach medication management.  Traditional medical education focuses on treating individual diseases, often leading to prescribing cascades where one drug’s side effect triggers another prescription. This cycle complicates care and worsens outcomes. We designed a three-phase educational intervention for final-...

What Makes a Good Doctor? This is the question that Waseem Jerjes and I explore in the Journal of the Royal Society of Medicine . It is a key question that underpins the architecture of medical education, clinical practice, regulation, and professional identity. It cannot be answered by regulators, educators, or employers in isolation. It must be answered together – by doctors and patients – revisited throughout a career, and adapted as society and the profession change. Without that shared reflection, the danger is not simply disillusionment, but the erosion of the moral foundations of clinical work. As we enter an era when diagnosis will increasingly involve artificial intelligence and when performance metrics reward volume over value, reclaiming this question as a professional one is imperative. The integrity of our institutions – and of the practitioners within them – depends on reimagining excellence in inclusive, relational terms. A good doctor is not a flawless technician or a f...

The use of weight-loss drugs such as GLP-1 receptor agonists (e.g., semaglutide, tirzepatide) has increased rapidly in recent years. These drugs can help some people achieve significant weight reduction, but they are not suitable for everyone and require careful counselling before starting treatment. By discussing benefits, risks, practicalities, and  uncertainties, clinicians can help patients make informed, realistic decisions about their treatment. Key points to discuss with patients 1. Indications and eligibility These drugs are usually licensed for adults with a specific BMI. They should be used alongside lifestyle interventions such as dietary change, increased physical activity, and behaviour modification. 2. Potential side effects – some can be serious Common adverse effects include nausea, vomiting, diarrhoea, and abdominal discomfort. Less common but more serious risks include gallstones, pancreatitis and visual problems. Patients should know what to watch for a...

I welcome the Government’s commitment to expanding urgent care provision in community settings. This approach has the potential to ease pressure on emergency departments and enable ambulance services to focus more effectively on patients who require rapid assessment and conveyance. However, as I discuss in the BMJ , the current Emergency Care Plan underestimates the central role that NHS general practice can and should play. Primary care is often the first point of contact for patients with urgent needs, and with appropriate support, it can manage many conditions effectively without referral to other parts of the system. There is also a risk that investing in a wide array of separate interventions—such as urgent treatment centres, community response teams, and virtual wards—without clear coordination could further fragment care. This may reduce continuity, lead to duplication, and ultimately result in less efficient use of NHS resources. Direct investment in NHS general practice—partic...

The Special Allocation Scheme (SAS) aims to protect NHS staff and other patients from individuals who are violent, aggressive, or pose a serious threat, while at the same time ensuring that these patients continue to receive essential primary care services in a secure environment. The decision to refer a patient to the Special Allocation Scheme is a significant one and rightly requires careful clinical and ethical consideration. However, in practice, such decisions often need to be made rapidly and under stressful or unpredictable circumstances, such as following a serious verbal or physical assault on a member of staff. Updated guidance from NHS England and the additional requirements introduced by some Integrated Care Boards (ICBs), including the need for written confirmation that all alternative approaches have been considered, are well-intentioned. These measures are designed to ensure that referrals to the Special Allocation Scheme are proportionate, lawful, and respectful of pat...

 Our recent article in the Journal of the Royal Society of Medicine discusses the potential role of AI-enabled ambient voice technology in healthcare and the implications for doctors and patients. While interest in ambient voice technology , particularly in primary care, continues to grow, evidence regarding its feasibility, acceptability and real-world impact in primary care remains limited. This includes data on cost, staff training and implementation (including integration with current electronic medical record systems).  Questions also remain about how ambient voice technology  handles complex consultations, including with non-native English speakers, and its broader integration into routine practice. As ambient voice technology  develops, further research is needed to assess its usability, acceptability, feasibility, cost-effectiveness and unintended effects on clinical interactions and decision-making. If demonstrated to be effective, ambient voice technology...

The aims of the government’s 10 year health plan – such as the shift from prevention to cure – are not new and have been priorities in many other health plans over the last 35 years. The question we need to ask is why have previous plans failed in achieving these objectives? The short-term electoral cycle prioritises funding for immediate, visible hospital crises over long-term strategies whose benefits are not seen for years. This is compounded by a health system that is designed to reward the treatment of sickness, not the promotion of wellness.  The persistent fragmentation between the NHS, public health and social care, and pressures from an ageing population and widening health inequalities have created a reactive environment where long-term strategic goals are perpetually sacrificed to manage immediate demands. The UK government and NHS staff do not lack insight into what improves health. Unless we redesign the incentives, protect public‑health budgets and hold every departme...

There was a lot of discussion in the government’s 10 year health plan about digital interventions such as giving people online access to their medical records. But does this improve healthcare delivery and clinical outcomes? This was the topic of our recent systematic review published in the journal BMJ Quality and Safety . We found that giving people online access to their medical records increased self-reported patient-centredness and improved some aspects of patient safety. But many questions about the benefits of online access remain unanswered.  The Good News: Empowering Patients On the positive side, we found clear evidence that giving people online access to their medical records increased self-reported patient-centeredness. What does that mean in simple terms? Patients felt more involved, informed, and in control of their own care. This shift from a passive recipient to an active participant is a cornerstone of modern healthcare and is a significant win for patient empowerm...

The government's recently published 10-Year Health Plan outlines a strategic vision for the National Health Service (NHS) in England, focusing on shifting care from hospitals to community settings, making greater use of digital technology like the NHS App to improve the efficiency and accessibility of health services, and prioritising preventive care over reactive treatment. While these objectives are commendable, they have been present in government plans spanning the last three decades, raising concerns about how successfully they will be implemented. Although very welcome, the increases in NHS funding in the plan are not as large as those seen under the previous Labour government from 1997-2010. This disparity in financial commitment could significantly impact the scope and pace of the proposed reforms if not matched by substantial increases in NHS efficiency and productivity. Furthermore, a heavy reliance on digital solutions, risks excluding vulnerable populations. Elderly ind...

As a university academic, I am disheartened by the way some politicians and sections of the media portray overseas students. Rather than acknowledging the many economic, cultural, and academic benefits these students bring to the UK, they are too often depicted as a burden. This is a narrative that is not only misleading but potentially damaging. International students choose to come to the UK because of the global reputation and quality of our universities. Despite the very high tuition fees they are charged, they continue to enrol in large numbers. These students bring with them diverse perspectives, enrich our academic communities, and foster global networks that benefit British research, innovation, and diplomacy. The financial contribution of international students is also well established. They help sustain many of our universities, support thousands of jobs across the country, and contribute billions to the UK economy each year. Beyond that, they play an integral role in cultura...

My new editorial in the BMJ discusses the GP Quality and Outcomes Framework (QOF). My conclusion is that QOF in England requires selective reform rather than wholesale abolition. While QOF initially improved recorded quality of care through financial incentives,  these gains are not always sustained long-term and may not reflect true clinical improvements. Policymakers should be encouraged to retain the most effective elements — particularly those related to early detection and management of long-term conditions — while removing less useful or overly bureaucratic aspects. Going forward, QOF should be integrated into a broader strategy that supports sustainable quality improvement, continuity of care, and minimised administrative burden, using developments in information technology to support better outcomes and reduce health inequalities. Majeed A, Molokhia M. Impact of pay for performance in primary care . BMJ 2025; 389 :r1171 doi:10.1136/bmj.r1171

A properly weighted and adequately resourced funding model for general practices n England is essential if we are to reduce health inequalities and ensure high-quality primary care for all. The announcement of a review of the Carr-Hill Formula is therefore very welcome and long overdue. The current NHS funding formula for general practice in England has not kept pace with changing population needs and does not sufficiently account for levels of deprivation or the complexity of care required in more disadvantaged communities. We know that general practices in deprived areas face higher levels of multimorbidity, greater social complexity, and significantly greater demand. Yet NHS funding for primary care has not adequately reflected these realities. It is also essential that any changes to the Carr-Hill Formula are accompanied by an overall increase in funding for NHS general practice in England. Simply redistributing a fixed pot of funding risks creating new pressures in other areas tha...

MPs who voted in support of assisted dying — and indeed many doctors and other healthcare professionals who support such measures — may not have fully considered the profound practical challenges this would present for the NHS and for medical education and training. Implementing an NHS-based assisted dying service would be a vast and complex undertaking. At present, the NHS is neither prepared nor equipped to deliver such a service in a safe, equitable, and ethical way. There is no public funding allocated for assisted dying. As Secretary of State Wes Streeting has rightly pointed out, any future funding would inevitably have to come at the expense of other health services that are already under considerable strain. Beyond funding, the educational and professional implications for the medical workforce have barely been addressed. There has been no clear plan for how assisted dying would be integrated into undergraduate medical education or postgraduate clinical training — nor how issue...

The Office for Students (the independent regulator of higher education in England) has suggested that students should be prepared to be “shocked and offended” at university as part of the educational process. This policy seeks to promote freedom of expression and open debate within academic settings. However, implementing such an approach poses significant challenges for both university staff and students. Institutions must not only consider the legal boundaries surrounding freedom of expression in the UK but also manage the practical and ethical complexities involved in fostering an environment that encourages robust discussion while protecting the rights and well-being of all members of the university community. The first challenge for universities is that the UK does not allow full freedom of expression. There are many laws that limit what people in the UK can say, and these are often different from limits on freedom of expression in other countries. For example, the USA generally h...

Abolishing NHS England and reducing Integrated Care Board (ICB) staffing by 50% may appear substantial, but the projected savings - around £500 million annually if fully achieved - would represent only a modest increase (approximately 0.25%) in annual NHS funding in England, given the NHS England budget is approaching £200 billion per year. Evidence from past NHS reforms (like the 2012 Health and Social Care Act) shows mixed results; some efficiency gains but often offset by new layers of complexity elsewhere in NHS structures. Without parallel initiatives to streamline administrative processes, improve efficiency, and enhance clinical productivity, such structural changes to NHS England and ICBs alone will not significantly improve frontline clinical care or health outcomes. Administrative costs, while important to minimise, make up a relatively small proportion of the overall NHS budget. Genuine productivity gains will therefore require systematic reforms aimed at reducing unnecessar...

Emergency departments (EDs) are often the first point of contact for patients requiring urgent medical attention. With increasing patient volumes and limited resources, EDs face challenges in maintaining efficiency and ensuring timely care. A recent systematic review published in the Journal of Medical Internet Research by our research group explores the role of digital check-in and triage kiosks in addressing these challenges.   Key Findings from the Systematic Review The review analysed five studies conducted between 2019 and 2022 across Canada, the United States, and the United Kingdom, encompassing a total of 47,778 patients and 310,249 ED visits. These studies varied in design, including cross-sectional analyses, pilot studies, retrospective analyses, and randomised controlled trials, 1. Efficiency Improvements Digital kiosks have been associated with reduced patient wait times and improved patient flow within EDs. By streamlining the check-in and triage processes, th...

Dementia, including Alzheimer's disease, is a significant public health challenge in Europe, with nearly 14 million people currently affected. Despite available healthcare and social care services, utilisation of these services by people living with dementia remains suboptimal due to various barriers. Our recent systematic review published in BMC Geriatrics provides critical insights into these challenges, highlighting barriers across informational, organisational, cultural, stigma-related, financial, and logistical domains. Informational and Educational Barriers A lack of awareness and insufficient knowledge among caregivers and healthcare professionals stands out as a key barrier. Inadequate dissemination of dementia-related information contributes to difficulties in planning and accessing appropriate care. Enhancing educational resources and improving health literacy among caregivers and healthcare workers are essential for overcoming these challenges. Organisational Barriers F...

As we reach the fifth anniversary of the onset of the Covid-19 pandemic, this moment provides an opportunity for reflection on the many challenges faced by healthcare workers like me during the early days of the pandemic. At that time, the SARS-CoV-2 virus was a largely unknown entity. Clinical guidelines were still under development and personal protective equipment (PPE) was scarce. For those on the NHS frontline, the experience was marked by a mix of anxiety, urgency, and dedication to the patients we were trained to serve.  Unfamiliar Territory  In the initial stages, Covid-19 was a "novel" infection. There was a scarcity of data on the illness, and the disease was manifesting in ways that were not entirely well understood. As primary care physicians, we were suddenly thrust into the realm of the unknown, treating patients with undifferentiated respiratory illnesses that did not yet have well-defined and evidence-based treatment protocols.  The Personal Risk Factor...

The COVID-19 pandemic brought many terms into the spotlight, one of which was "non-pharmaceutical interventions" (NPIs). Used widely in academic papers, public health guidelines, and media reports, NPIs became a catch-all phrase for measures like contact tracing, quarantine, and hand hygiene; essentially anything that wasn’t a drug or vaccine. However, BMJ Editor Kamran Abbasi and I argue in our editorial  it is time to end the use of this term in favour of "public health and social measures." Here’s why this shift matters. The Problem with Defining by Negation The term "non-pharmaceutical interventions" defines these strategies by what they aren’t rather than what they are. This framing is inherently limiting. Imagine calling surgery a "non-drug intervention"—it sounds absurd because surgery stands on its own as a complex, evidence-based practice. Similarly, public health measures like sanitation or hand hygiene aren’t just stopgaps until a drug...

Our recent article in the Journal of Patient Safety discusses the topic of missed appointments in healthcare. Missed appointments are often seen as an administrative inconvenience in healthcare; wasting appointments that could have gone to other patients. However, missed appointments are also a critical patient safety concern that can delay necessary interventions, worsen health outcomes, and erode trust between patients and clinicians. Instead of viewing them as patient noncompliance, we must shift our perspective to understand the underlying barriers that prevent people from attending their scheduled appointments. Understanding the Root Causes of Missed Appointments Patients miss appointments for a variety of reasons, many of which are outside their control. Socioeconomic challenges, work obligations, caregiving responsibilities, mental health issues, transportation difficulties, and previous negative experiences with the healthcare system all contribute to non-attendance. Disadva...

Living with Type 2 Diabetes (T2D) can feel like a full-time job. Regular check-ups, monitoring blood sugar levels, adjusting medications, and managing lifestyle changes all demand time and effort. For the 460 million people worldwide dealing with diabetes (a number projected to climb to 700 million by 2045), finding convenient and effective healthcare solutions is more critical than ever. Enter virtual consultations (VC); a modern approach to healthcare delivery that is transforming how people with T2D manage their condition. Our recent systematic review and meta-analysis published in the Journal of Diabetes Science and Technology sheds light on just how powerful this tool can be. Let’s examine the benefits of virtual consultations for people with T2D and why they’re becoming more important in the care of people with long-term conditions like T2D.  Convenience Without Compromise: Effectiveness Matches In-Person Care One of the key findings from the review is that virtual consultat...

NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...

Diversity, equity, and inclusion (DEI) are essential in clinical and public health research, ensuring discoveries and interventions benefit all sections of society; and enhancing the quality, relevance, and impact of research. Ensuring that diverse populations are represented appropriately within research is a scientific necessity. By embedding DEI principles into research design and execution, researchers can generate findings that are broadly applicable across the population while also addressing long-standing health disparities. DEI is needed in clinical and public health research because it improves the generalisability and relevance of research findings. Research outcomes must apply to the diverse populations they are intended to serve. By including participants from different racial, ethnic, gender, socioeconomic, and geographic backgrounds, studies can avoid biases that result from the narrower recruitment into research studies we often saw in the past. Without such diversity, r...

In recent days, there has been discussion about the "overheads" or "indirect" costs that universities add on to the cost of research projects. This has been driven by a decision by the US government to reduce the indirect costs of research on grants awarded by the US National Institutes of Health (NIH) from the current 60% to 15%. Comments from people such as Elon Musk has suggested these costs are wasteful and can therefore be easily cut from research grants. In this blog, I make the case for retaining a fair amount of indirect costs on research grants. Without the indirect costs that universities receive on government research grants, universities would struggle to provide the essential support and infrastructure required for high-quality research to take place. While direct research costs (such as staff salaries, laboratory equipment, travel and consumables) are essential, they are only part of the funding needed. Research relies heavily on a wide array of indire...

Effective management of hospital resources was a critical component of the response to the COVID-19 pandemic. With fluctuating waves of infection and emerging virus variants, accurately predicting the demand for hospital beds has proven to be a complex but essential task. Our recent study, led by Derryn Lovett and published in BMJ Health Care Informatics , evaluates a pragmatic approach to forecasting COVID-19-positive hospital bed occupancy using simple, accessible methods.  Why Predicting Bed Occupancy Matters During the COVID-19 pandemic, healthcare systems around the world faced unprecedented challenges, with surges in demand for acute care beds due to severe cases of the virus. The ability to predict future bed occupancy is vital for several reasons: Resource allocation: Effective forecasting helps healthcare leaders plan staffing, equipment needs, and additional capacity. Crisis management: Accurate predictions enable health systems to anticipate surges and manage ove...