Medical Centre

The Government has announced it will create over 100 new community mental health centres across England, which will work alongside GPs and other NHS organisations/ The centres will offer offer walk-in support as well as seeing patients referred from elsewhere in the NHS. GPs have long called for faster access to specialist mental health support for patients, so the expansion of community mental health services is a welcome development. If these new centres improve access to multidisciplinary teams, reduce waiting times and provide more integrated care, they can improve patient outcomes while reducing pressure on both general practice and specialist mental health services. Close collaboration between GPs, mental health professionals, social care and the voluntary sector will be essential because many people with mental health problems also have wider social and physical health needs. The success of these centres will depend on how they are implemented. They need to be adequately staffe...

There is an important distinction between a treatment being cost-effective and it being affordable for the NHS as illustrated by the example of tirzepatide. NICE has concluded that tirzepatide is cost-effective in appropriately selected patients because of the health gains it delivers through reductions in obesity-related disease and its complications. However, the overall budget impact is a separate question. When millions of people could potentially be eligible for treatment, even a cost-effective intervention can create major financial pressures for the NHS. We are still at a relatively early stage of implementation, yet tirzepatide has already become one of the NHS's highest-cost medicines. If access expands in line with NICE guidance over the coming years, expenditure will increase substantially unless drug prices fall significantly, prescribing criteria change or treatment strategies evolve. Another important issue is that we still have key unanswered questions about long-ter...

Meningococcal group B (MenB) infections are rare but can have devastating consequences. The decision to offer a targeted two-dose vaccination programme to Year 13 students and young people entering university or residential further education reflects concerns about recent outbreaks of meningococcal disease and the higher risk of transmission when large numbers of young adults mix closely for the first time in shared accommodation. The MenB vaccine has a well-established safety record, and evidence from the UK infant immunisation programme has shown substantial reductions in disease among vaccinated children. A targeted programme for those entering higher-risk settings is therefore a reasonable precautionary measure while further evidence is gathered on whether the recent increase in clusters represents a temporary fluctuation in disease patterns or a more sustained change in the epidemiology of MenB infection. The success of the programme will depend on achieving high uptake and ensuri...

It was a great pleasure to welcome GPs from across the UK to Imperial College’s Annual GP Teachers Conference today. General practice has a key  role in the medical curriculum. It is where students see patients as individuals living with health conditions.  Primary care provides opportunities to learn about areas such as prevention and health promotion, the early diagnosis of illness, continuity of care, and the management of frailty and multimorbidity. These are increasingly important aspects of healthcare as populations globally age and the burden of long-term conditions increases. Students also gain insight into the wider determinants of health and the importance of working with patients, families and multidisciplinary teams to deliver person-centred care. These experiences are essential in preparing future doctors for the realities of modern clinical practice, whatever specialty they ultimately choose. This teaching takes place against the backdrop of a very challenging en...

Primary care access is often judged by appointment supply, waiting times, and utilisation, yet patients experience access as a series of small obstacles that accumulate into delay, drop-off, and avoidable deterioration. Building on existing literature on administrative burden, treatment burden, digital exclusion, and telemedicine inequity, this commentary proposes the Access Friction Index (AFI) as a practical framework for measuring the real-world effort required to convert a health need into timely assessment, follow-up, and treatment. Drawing on recent evidence from the UK, US and other settings, it links access friction to inequities for vulnerable groups, missed screening, medication non-adherence, unplanned return visits, and avoidable hospital use. It also outlines how routine service data and electronic records could be used to identify friction hotspots—including repeated contact, mode switching, handoffs, results handling failures, and delayed pathway closure—and how primary ...

The 10-Year Health Plan for England aspires to create ‘the most digitally accessible health system in the world by 2028’ with the NHS App positioned as the primary gateway to the NHS. This is an ambitious and it is encouraging to see health inequalities given prominence in the plan’s executive summary. However, extensive evidence, including evaluations of the NHS App specifically, shows significant disparities in who is able and likely to use digital health technologies. Without addressing these broader social and structural determinants of digital access and use, an overreliance on the NHS App risks deepening existing health inequalities and failing to improve population health for all. Although the NHS App has been been broadly adopted, it risks widening health disparities unless the health service or community groups can support patients to access and use the App appropriately. There must be clear value from using the NHS App and its features for patients, alongside equitable opport...

In my witness statement for Module 10 of the UK Covid-19 Inquiry, I discuss the pandemic's impact through from the perspectives of  primary care and public health, drawing on my extensive experience as a senior academic at Imperial College London and as a practising GP and NHS Public Health Specialist.  I emphasise that the pandemic disproportionately affected people who were clinically vulnerable, the disabled, ethnic minority communities and those living in deprived areas. The pandemic highlighted how structural inequalities, multigenerational housing, and employment in high-risk frontline roles exacerbated health disparities.  My statement also critiques the weakening of public health infrastructure - particularly for the control of infectious diseases - and the lack of integrated health data systems to identify at-risk groups such as the clinically vulnerable. I also advocated for a more robust preventive healthcare model that prioritises community-based primary care ...

An ageing population, multimorbidity, frailty and polypharmacy are all contributing to an increase in the complexity of patients managed by the NHS in the UK and by health systems in other countries. Moreover, the interaction of these factors can lead to a “complexity cycle” which further increases the risks to patients and the pressures on the NHS. The convergence of these factors has shifted the NHS landscape from managing isolated illnesses to navigating patients with multiple complex health needs. This complexity arises because frail patients with multiple long-term conditions often require numerous medications, which significantly increases the risk of adverse drug interactions and hospitalisations.  Consequently, the NHS is aiming to move away from traditional, single-disease specialist models toward integrated, person-centred care that prioritises holistic assessment and strategic deprescribing to maintain patient independence and safety. To support this transition, we also ...

Managing uncertainty is a core skill in primary care and other frontline clinical specialties such as emergency medicine where patients frequently present with early, evolving or non-specific symptoms that do not fit clear diagnostic categories. Rather than eliminating uncertainty, safe practice depends on recognising it, communicating transparently with patients and colleagues, and managing risk over time.  This is especially important for serious illnesses that may initially present with vague or common symptoms where premature or inappropriate reassurance can delay diagnosis. An example is ovarian cancer which can present with symptoms such as abdominal pain and bloating; and where there is overlap with other, less serious illnesses such as irritable bowel syndrome/ Safe management in patients with such presentations begins with a structured clinical assessment that considers red flags, comorbidities and the patient’s clinical and social contexts; alongside an explicit acknowled...

 I was recently asked by the BMJ to offer comments for an article advising doctors how they could improve their research skills and get involved in research. Integrating research into a clinical career offers a pathway to professional fulfilment, intellectual growth, and the opportunity to influence patient care on a broader scale.  While the prospect of balancing clinical duties with academic pursuits can be daunting due to time constraints and the need for specialised skills, there are numerous entry points available for clinicians at every stage of their career. From early-career networking and trainee-led collaborations to structured fellowships and leadership roles in national trials, the research landscape is designed to accommodate various levels of involvement. By developing core competencies, seeking out mentorship, and identifying practical questions within their own daily practice, clinicians can successfully navigate the challenges of a dual career and contribute ...

 The Parliamentary Health and Social Care Committee states that the Government’s vaccination strategy is ‘a failure’ and should be replaced with a new plan. Vaccination rates in the UK have been falling since around 2012 when pressures on GP services began to increase. A key part of the solution to improving childhood vaccination rates in not to create new services like “family hubs” but to invest in core general practice services to increase primary care capacity. This needs to be combined with greater incentives for childhood vaccination. A successful vaccination strategy must strengthen and not sideline general practice. Without substantial reinvestment in general practice and improved incentives, any new structures will struggle to reverse the long-term decline in childhood vaccination coverage in the UK. GPs provide continuity, trusted relationships, accurate records, recalls, and opportunistic vaccination; all of which are  essential for high uptake. When GP capacity is ...

General practitioners and emergency medicine doctors in the UK are increasingly encountering patients who return from overseas with complications following medical procedures. These cases can often be  challenging to manage. Frequently, there is limited or no access to operative notes, discharge summaries, or detailed information about the techniques and materials used, making clinical assessment and safe follow-up difficult. The complications themselves are often complex, including serious infections, wound breakdown, thromboembolic events, and implant-related problems. Many require urgent specialist input. GPs are typically the first point of contact and must manage patient distress, clinical uncertainty, and risk, while navigating referral decisions in the absence of clear guidance or established care pathways. For patients, the lower cost of surgical procedures overseas can be an appealing alternative to private care in the UK. However, this often comes at the expense of struct...