Medical Centre

The COVID-19 pandemic has had a dramatic effect on people’s lives globally. For academics working in fields such as primary care and public health, the pandemic led to major changes in professional roles as I discuss in an article published in the JRSM. Universities across the United Kingdom closed their campuses in March 2020 and switched to remote working. Staff began to work from home and teaching of students moved online. University staff rapidly had to put in place systems for teaching, monitoring and assessing students remotely. For many universities, these changes will be in place until the end of 2020, with no return to a more normal mode of working until January 2021 at the earliest. DOI:  https://doi.org/10.1177/0141076820947053  

The ‘lockdown’ of the United Kingdom on 23 March had pronounced impacts on travel patterns as we discussed in our recent JRSM paper. As many millions of people moved to either working at home or were furloughed from their jobs, there were large decreases in trips to workplaces alongside even steeper decreases in recreational journeys. Transport is an often overlooked influence on the health of populations and health inequalities, affecting physical activity, road traffic incidents and air pollution, in addition to being a major contributor to climate change. There is ongoing uncertainty around the longer-term trajectory of COVID-19, including risks of a second wave, meaning that the medium-term changes to transport and society are hard to predict. Nevertheless, the current easing of the lockdown in England presents both opportunities and threats to the health impacts of transport. DOI:  https://doi.org/10.1177/0141076820938997

Primary Care Networks (PCNs) are a new organisational hierarchy with wide-ranging responsibilities introduced in the National Health Service (NHS) Long Term Plan. The vision is that PCNs should represent ‘natural’ communities of general practices (GP practices) collaborating at scale and covering a geography that fits well with practices, other healthcare providers and local communities. Our study published in BMJ Open aims to identify natural communities of GP practices based on patient registration patterns using Markov Multiscale Community Detection, an unsupervised network-based clustering technique to create catchments for these communities. With PCNs expected to take a role in population health management and with community providers expected to reconfigure around them, it is vital to recognise how PCNs represent their communities. Our method may be used by policymakers to understand the populations and geography shared between networks. DOI:  10.1136/bmjopen-2019-036504

In a recent article , I discuss the primary care response to Covid-19 in England. The first case of COVID-19 in England was identified at the end of January 2020. Cases increased during February, and by early March, it became apparent that England faced a large COVID-19 epidemic. This led to the Department of Health and Social Care and NHS England (the bodies that respectively fund and manage the NHS in England) to recommend radical changes to the provision of NHS primary care services. For most general practices, these changes began to be implemented in the week beginning 16 March 2020. As a first step, general practices switched from the traditional model of face-to-face service provision to one where all patients were initially assessed through a telephone or a video call. Patients were encouraged to register for online booking of these appointments if they had not already done this.  All patients requesting advice spoke first to a health professional, usually general practition...

My editorial in the British Medical Journal compares the response to Covid-19 in South Korea and the UK. Early adoption of a “test, trace, isolate and treat” strategy was the key to South Korea’s success in suppressing Covid-19. On 29 February 2020, South Korea, a country of similar population size to England, recorded 909 news cases of COVID-19. Only 55 new cases of COVID-19 were recorded in England on 29 February. By mid-May, despite several weeks of a “lockdown” and although numbers had declined from the peak in April 2020, the United Kingdom was still recording over 3,000 news cases each day. The key difference between the United Kingdom and South Korea was the rapid adoption by South Korea of a “test, trace, isolate and treat” strategy whereby suspected cases were tested; contacts identified; strict isolation enforced; and free treatment given to those infected.  Read the full article in the British Medical Journal . doi: https://doi.org/10.1136/bmj.m2084  

My article in the Journal of the Royal Society of Medicine discusses the wider impact of COVID-19 on health systems and the potential for changes to health services to increase health inequalities. We report a 44% decrease in emergency department attendances in England in March 2020. We must not overlook the importance of good infection control for outsourced NHS staff such as cleaners, security guards and caterers. They can acquire COVID-19, thereby putting themselves at risk, and transmit COVID-19 to patients and other NHS staff. Read the full article in the J ournal of the Royal Society Medicine . DOI:  https://doi.org/10.1177/0141076820925230

My editorial in the British Journal of General Practice discusses how we can protect healthcare workers during the Covid-19 pandemic. Some of the key steps we can take include: 1. Maximise remote working 2. Implement good infection control 3. Use PPE effectively. 4. Risk assessment for staff based on age and medical history Too many health and care workers have died and we must take urgent action to protect them. When we protect staff, we also protect patients because we reduce the risk of hospital acquired infection. Read the full article in the British Journal of General Practice . DOI: https://doi.org/10.3399/bjgp20X709925

National and global spread of COVID-19 is accelerating. To reduce COVID-19-related hospitalisations, intensive care unit admissions and deaths, we recommend that those aged between 60 and 69 years are particularly stringent when implementing public health measures such as social distancing and personal hygiene. In the absence of government guidance, people in this group can make their own informed decisions on how to minimise their risks of COVID-19 infection. This can include using precautionary measures to reduce the risk of infection in a similar manner to that recommended by the UK government for people aged 70 years and over. Read the article in the Journal of the Royal Society of Medicine . DOI:  https://doi.org/10.1177/0141076820921107

Testing people for Covid-19 infection is an essential component of our strategy to control the global Covid-19 pandemic. These tests come in two main groups: antigen tests and antibody tests. The antigen test is to determine if you currently have Covid-19 infection. This requires swabs to be taken from your nose and throat to look for the presence of the SARS-CoV-2 virus that causes Covid-19 infection. In the UK, this test is mainly limited to hospital patients and NHS staff. There are now plans to extend testing to staff working in care homes. We will also need to expand testing to people in the community who do not require hospital treatment. The antibody test to determine if you have had a previous Covid-19 infection. This is done through a blood test that is then assessed for the presence of antibodies to SARS-CoV-2. We believe that once people have been infected and develop antibodies, they should be protected from a repeat infection. Because Covid-19 is a new disease, we d...

During the Covid-19 pandemic, parents may be concerned about taking their children to a general practice or child health clinic to receive their immunisations. If your child is due for their immunisations, please do attend for this. Immunisation is a safe and effective procedure that protects your children from vaccine-preventable disease.

How will the Covid-19 (coronavirus) epidemic in the UK develop? In February 2020, there were sporadic cases across the UK and in March 2020, we saw a more sustained increase in cases. Based on current trends, the total cumulative number of cases of COVID-19 in UK could reach 47,989 (95% CIs 33,961 to 67,743) in another 10 days, using data published on 19 March 2020. We have assumed that each day's cases are a fixed proportion of the total cases up to the day before. It is also assumed the rate will not change in the next 10 days; e.g., it is not going to be influenced by new interventions, increased self-isolation and other factors. To estimate confidence intervals, we used the prediction confidence intervals from the linear regression model (using logarithm of "cumulative number of cases" as response) to perform Monte Carlo simulations to generate samples from the corresponding normal distribution. Subsequently, we applied the reverse transformation (exponential) ...

How will the Covid-19 (coronavirus) epidemic in the UK develop? In February 2020, there were sporadic cases across the UK and in March 2020, we saw a more sustained increase in cases. Based on current trends, the total cumulative number of cases of COVID-19 in UK could reach  21,264 (95% CIs: 14881 to 30459 ) in another 10 days, using data published on 15 March 2020. We have assumed that each day's cases are a fixed proportion of the total cases up to the day before. It is also assumed the rate will not change in the next 7 days; e.g., it is not going to be influenced by new interventions, increased self-isolation and other factors. To estimate confidence intervals, we used the prediction confidence intervals from the linear regression model (using logarithm of "cumulative number of cases" as response) to perform Monte Carlo simulations to generate samples from the corresponding normal distribution. Subsequently, we applied the reverse transformation (exponential)...

How will the Covid-19 (coronavirus) epidemic in the UK develop? In February 2020, there were sporadic cases across the UK and in March 2020, we saw a more sustained increase in cases. Based on current trends, the total cumulative number of cases of COVID-19 in UK could reach 17,240 (95% CIs: 11,823 to 25,270) in another 10 days, based on data published on 14 March. We have assumed that each day's cases are a fixed proportion of the total cases up to the day before. It is also assumed the rate will not change in the next 7 days, e.g., it is not going to be influenced by new interventions, increased self-isolation and other factors. To estimate confidence intervals, we used the prediction confidence intervals from the linear regression model (using logarithm of "cumulative number of cases" as response) to perform Monte Carlo simulations to generate samples from the corresponding normal distribution. Subsequently, we applied the reverse transformation (exponential) to...

How will the Covid-19 (coronavirus) epidemic in the UK develop? In February 2020, there were sporadic cases across the UK and in March 2020, we saw a more sustained increase in cases. Based on current trends, the total cumulative number of cases of COVID-19 in UK could reach 5,895 (95% CIs: 4,046 to 8,400) in another 7 days. We have assumed that each day's cases are a fixed proportion of the total cases up to the day before. It is also assumed the rate will not change in the next 7 days, e.g., it is not going to be influenced by new interventions, increased self-isolation and other factors. To estimate confidence intervals, we used the prediction confidence intervals from the linear regression model (using logarithm of "cumulative number of cases" as response) to perform Monte Carlo simulations to generate samples from the corresponding normal distribution. Subsequently, we applied the reverse transformation (exponential) to the simulated samples and calculated th...

As one of the largest organisations in the world, employing around 1.5 million people, and the provider of publicly funded healthcare in the UK, the National Health Service (NHS) should be a role model in workplace health. It should be providing employers with guidance and good practice that can be replicated elsewhere. However, currently the NHS performs poorly on many measures of staff health. For example, sickness absence rates among NHS staff are higher than the average for both the UK public sector and private sector. The health of NHS staff is a key factor in determining how well the NHS provides healthcare to patients. Improving workplace health and the support available to staff with health problems — such as enabling them to return to work after absence due to sickness — should be priorities for the NHS. The importance of good working environments in the NHS was emphasised in a 2019 General Medical Council report. The report noted that workplace pressures are associated w...

The Covid-19 (Coronavirus) infection is spreading more widely. The best way to protect yourself, your family and your work colleagues is through preventive actions such as regular handwashing, using disposable tissues when you cough and sneeze, and staying at home when you are unwell. Remember also not to touch your nose, mouth or eyes unless you have washed your hands recently. Many of my patients are informing me they are unable to buy hand sanitizer because pharmacies and supermarkets have no stock as people have been buying large amounts because of concerns about coronavirus (Covid-19) infection. Don’t bother buying hand sanitizer. Use soap and warm water instead. Washing your hands with soap and water is usually more effective than using hand sanitizers at removing germs, and is also better at preserving the "good" bacteria on your hands. Soap and water is also a lot cheaper than sanitizer. Finally, one person has recently died from coronavirus infection in the UK. ...

We have seen varying estimates of the case fatality rate from Covid-19 (Coronavirus) infection. The case fatality rate is the percentage (or proportion) of patients with a disease who die. We should be cautious about accepting the estimates that have been published in medical journals as valid because many people will have undiagnosed infections. This is particularly likely in children, who often have mild symptoms (or no symptoms) when they contract a viral infection. Hence, the reported case fatality rates we have seen published in medical journals will overestimate the true death rate. As testing for Covd-19 infection becomes more widespread, we will get better estimates of the true infection rate in the population from the virus, and hence better estimates of the complication rate and death rate from the illness. In England, the new testing programme in people with respiratory tract infections announced by Public Health England will provide some of ths information.

An editorial published in the BMJ by Paul  Morgan and me discusses the importance of getting the balance right in the diagnosis and treatment of sepsis. Public and professional understanding of sepsis has increased greatly in recent years. This has led to campaigns to diagnose sepsis early in the clinical course of the illness and to start treatment with antibiotics and fluid replacement promptly. Examples include the Survive Sepsis campaign, which led to the creation of the UK Sepsis Trust, and the establishment of the Global Sepsis Alliance and World Sepsis Day. But could this pressure to improve sepsis management be counterproductive and lead to overdiagnosis of sepsis? doi: https://doi.org/10.1136/bmj.l6700

In many health systems, primary care physicians (sometimes referred to as general practitioners or family physicians) regulate access to specialist medical services and investigations. This process is sometimes described as "gatekeeping" and is a response to a shortage of specialists and a need to control healthcare spending. In gatekeeping systems, patients are required to visit a GP or primary care physician to authorise access to specialty care. However, the effectiveness of gatekeeping remains unclear. In a systematic review published in the British Journal of General Practice , we examined the impact of gatekeeping on areas such as the quality of health care, healthcare spending and use, and health-related and patient-related outcomes. We found an an association between gatekeeping and better quality of care, especially in terms of preventive care, and appropriate referral for specialty care and investigation. However, we found one study that reported unfavourable o...

There is growing appreciation that the success of digital health – whether digital tools, digital interventions or technology-based change strategies – is linked to the extent to which human factors are considered throughout the design, development and implementation. A shift in focus to individuals as users and consumers of digital health highlights the capacity of the field to respond to recent developments, such as the adoption of person-centred care and consumer health technologies. In an article published in the journal  BMC Medicine , we argue that this project is not only incomplete, but is fundamentally ‘uncompletable’ in the face of a highly dynamic landscape of both technological and human challenges. These challenges include the effects of consumerist, technology-supported care on care delivery, the rapid growth of digital users in low-income and middle-income countries and the impacts of machine learning. Digital health research will create most value by retaining ...