Medical Centre

An article published in the BMJ by Allyah Abbas-Hanif, Neena Modi and myself discusses the long term implications of Covid-19 in pregnancy. Covid-19 in pregnancy increases the risk of severe complications for both mother and baby. The long term implications are unknown, but emerging signals warn of substantial public health threats. To counter high vaccine hesitancy in pregnancy we must end the default exclusion of pregnant women from the rigorous regulated drug development process and implement systematic, long term, population-wide surveillance of infected and non-infected people. The full article can be read in the British Medical Journal . 

Thanks to Covid-19 vaccination, we have seen a substantial weakening of the link between Covid-19 infections and hospitalisations / deaths in the UK. But we don't yet know how well this protection from serious illness and death will persist in the longer-term. We are also seeing "vaccine fatigue" set in with many people not keen on booster vaccines. For the UK, the future challenges will include determining how frequently and in what groups Covid-19 booster vaccines are needed; ensuring a high take-up of vaccinations in all eligible groups; and having vaccines that are updated when necessary to protect against new variants. We have already had one additional booster vaccination programme in the UK this year; which targeted people 75 and over, residents of care homes, and people who are immunocompromised. A larger booster programme is planned for later this year that will target a wider range of people, including NHS staff. Although some people are very optimistic about th...

Earlier this month, a case of Monkeypox was reported in London, followed by reports of further cases in the UK and in many other countries. Understandably, people are anxious whenever an outbreak of an unusual infectious disease occurs, likely more so because of their experiences during the Covid-19 pandemic. Although we need to take the disease seriously, Monkeypox is much less of a threat to global health than Covid-19 and won’t have the same impact on societies or lead to the type of control measures we have seen for Covid-19 over the past two years. The virus that causes Monkeypox is found primarily in small animals, like rodents, in parts of West and Central Africa – but was first identified in monkeys (hence the name). It can sometimes spread to humans and because of international travel, then spread to other parts of the world. But unlike Covid-19, which is easily transmissible and has caused huge waves of infection globally, Monkeypox spreads much more slowly, requiring close c...

Whether it be a simple telephone call or more sophisticated video conferencing systems, virtual care tools have been in use in primary care settings worldwide in one form or another throughout the past two decades. Over time, these tools have grown in availability, matured in their capabilities, but played a largely supportive role as an alternative option to traditional face-to-face consultations. This all changed in early 2020 with the onset of the COVID_19 pandemic. The COVID-19 pandemic presented a unique opportunity globally which put virtual care tools at the forefront of primary care delivery. The need for social distancing to limit disease transmission resulted in virtual care tools becoming the primary means with which to continue providing primary care services. Hence, our study’s goal was to capture the spectrum of GP experiences using virtual care tools during the initial months of the pandemic so as to better understand the perceived benefits and challenges, and explore wh...

In this concise guide, Dr Sophie Farooque – a Consultant in Allergy at St. Mary’s Hospital in London and one of the UK’s leading experts on the treatment of allergic disorders – gives an excellent overview of allergies that will be a very useful guide for the public and also for health professionals.  Allergic disorders have increased substantially in prevalence in recent decades. This is shown in our personal experience as well as by research on the epidemiology of allergic disorders. When I was in school, problems such as hay fever and food allergy were all uncommon in my classmates. This in contrast to now, when many families will have a member who suffers from an allergic disorder. In milder cases, these disorders can be irritating and reduce people’s quality of life. But in more severe cases, they can lead to hospitalisation and sometimes even to death.  Hence, some knowledge of allergies and how they can be managed is very helpful to families who have a member who suffer...

Colorectal cancer is one of the most common cancers and most common cause of cancer deaths worldwide. Despite the availability of screening, disparities in survival from colorectal continue in certain ethnic minority groups. This may, in part, be secondary to low take-up of bowel cancer screening. Different ethnic groups may have different cultural and health beliefs, different levels of education, understanding and acculturation that negatively impacts upon their use of faecal testing and endoscopic procedures. In a systematic review published in the journal Perspectives in Public Health , we examined studies that had investigated ethnic differences in the uptake of colorectal cancer screening. We found that disparities in colorectal cancer screening are multifactorial and complex in their origin and that ethnicity plays an important role. Although seemingly intuitive, this is the first systematic review that summarises the association between uptake of screening in specific ethnic gr...

In the USA, over one-third of adults self-diagnose their conditions using the internet, including queries about urgent (ie, chest pain) and non-urgent (ie, headache) symptoms. The main issue with self-diagnosing using websites such as Google and Yahoo is that user may get confusing or inaccurate information, and in the case of urgent symptoms, the user may not be aware of the need to seek emergency care. In recent years, various online symptom checkers (OSCs) based on algorithms or artificial intelligence (AI) have emerged to fill this gap Online symptom checkers are calculators that ask users to input details about their symptoms of sickness, along with personal information such as gender and age. Using algorithms or AI, the symptom checkers propose a range of conditions that fit the symptoms the user experiences. Developers promote these digital tools as a way of saving time for patients, reducing anxiety and giving patients the opportunity to take control of their own health. The di...

In a study published in the journal Nicotine and Tobacco Research , we evaluated the secondary effectiveness outcomes for Quit Genius, a digital clinician-assisted cognitive behavioural therapy (CBT) intervention for smoking cessation. Adult smokers (N=556) were randomly assigned to Quit Genius (n=277), a digital, clinician-assisted CBT intervention or Very Brief Advice (VBA) to stop smoking, an evidence-based, 30-second intervention designed to facilitate quit attempts, coupled with referral to a cessation service (n=279). Participants were offered combination nicotine replacement therapy (patches and gum) tailored to individual nicotine dependence. Analyses (N=530), by intention-to-treat, compared Quit Genius and VBA at 4, 26, and 52 weeks post-quit date.  The primary outcome was self-reported seven-day point prevalence abstinence at 4 weeks post-quit date. Consecutive seven-day point-prevalence abstinence, defined as abstinent at two or more consecutive timepoints, was examined ...

The National Health Service (NHS) 111 helpline was set up to improve access to urgent care in England, efficiency and cost-effectiveness of first-contact health services. Following trusted, authoritative advice is crucial for improved clinical outcomes. In paper published in the journal PLOS ONE , we examined patient and call-related characteristics associated with compliance with advice given in NHS 111 calls.  The importance of health interactions that are not face-to-face has recently been highlighted by COVID-19 pandemic. In this retrospective cohort study, NHS 111 call records were linked to urgent and emergency care services data. We analysed data of 3,864,362 calls made between October 2013 and September 2017 relating to 1,964,726 callers across London. A multiple logistic regression was used to investigate associations between compliance with advice given and patient and call characteristics.  Caller’s action is ‘compliant with advice given if first subsequent service ...

Our new article in Lancet Infectious Diseases discusses why some migrants in Europe are at risk of under-immunisation and show lower vaccination uptake for routine and COVID-19 vaccines. Addressing this issue is critical if we are to address vaccination inequities and meet the goals of WHO's new Immunisation Agenda 2030.  We carried out a systematic review exploring barriers and facilitators of vaccine uptake (categorised using the 5As taxonomy: access, awareness, affordability, acceptance, activation) and sociodemographic determinants of under-vaccination among migrants in the EU and European Economic Area, the UK, and Switzerland.  We identified multiple access barriers—including language, literacy, and communication barriers, practical and legal barriers to accessing and delivering vaccination services, and service barriers such as lack of specific guidelines and knowledge of health-care professionals—for key vaccines including measles-mumps-rubella, diphtheria-pertussis-t...

Multimorbidity, the co-occurrence of two or more chronic conditions, is increasing in prevalence and affecting approximately a third of all adults globally. In the UK, the prevalence of individuals with four or more long-term conditions is projected to increase to 17% by 2035, compared to 9.8% in 2015. Approximately two thirds of this population will have a mental illness such as depression , which is in turn strongly associated with the incidence of a multitude of long-term conditions.  As the number of physical conditions a person increases, the odds of having a mental health disorder increase by almost double for one condition, and six times for more than five conditions. The presence of a mental health comorbidity such as depression is associated with poorer clinical outcomes and quality of life, compared to individuals with physical conditions only. In an article published in the journal PLOS ONE , we summarised the current evidence on the association between depression and un...

Throughout the pandemic, the UK’s covid-19 data systems have been guiding global as well as local policies. The well-established health information systems combined with the more recently established National Immunisation Management System in England provided timely information on infections, emergence of new variants, and the value of different interventions. But one of the most important contributions from the UK came from the ability to rapidly track vaccine effectiveness.  Vaccination is the best method for societies to reduce the severity of illness and number of deaths from covid-19; and to start to return to a more normal way of living, working , and studying.[1] But vaccination programmes need to be evidence-based, so that vaccines and healthcare resources are used appropriately, and there is equitable vaccine delivery. The covid-19 pandemic has shown the importance of data from medical records and the National Immunisation Management System in guiding national vaccinati...

There was no mention from the Chancellor, Rishi Sunak, in his speech on Wednesday 23 March 2022 about the continued funding of Covid-19 testing for NHS staff in England. We need the government to clarify this urgently and confirm whether twice weekly testing of healthcare workers will continue or stop in April 2022. Under current guidance, NHS staff are required to test for Covid-19 twice weekly and report their results before coming to work. If testing is to continue from April onwards, then the NHS will have to find this funding from its existing budgets, reducing funding for other areas of care. There has been discussion about staff paying for their own testing. My view is that if testing is required by NHS employers, they will need to fund the tests. Staff cannot be asked to fund their own tests if this is a condition of their employment. Ending regular Covid-19 testing of NHS will increase the risk of infection spreading to vulnerable patients. But there are also costs associated ...

The recent increase in Covid-19 rates in the UK is concerning although, to some extent, an increase in rates was expected now that control measures have ended in England, with the other three UK countries also ending most control measures as well.  We are also seeing signs of increased NHS pressures with more presentations of people with suspected or confirmed Covid-19 in primary care and hospital admissions increasing. The number of NHS staff off work due to Covid-19 is also adding to NHS pressures. A key message for the public is that vaccination is essential. Many people have not come forwards for a booster vaccine, particularly in London and other large cities. Three doses of vaccine are essential to reduce the risks of serious illness and death from Covid-19. A second booster programme is also now starting for the most vulnerable people in our society: people aged 75 years and over this living in care home and people who are immunocompromised. The additional booster will provi...

I have much bigger healthcare concerns than getting COVID-19, and the NHS doesn’t help me with them. Why should I bother to help them by getting this vaccine? This is a question that some people often ask. By getting the Covid-19 vaccine, you are protecting yourself as well as reducing pressures on the NHS. Over 10 billion Covid-19 vaccines have been giving globally; and they have proven to be very safe and effective. The number of Covid-19 cases in the UK remains very high. Vaccines are protecting us and without them, we would be seeing many more people who are seriously ill or dying from Covid-19.  By getting vaccinated against Covid-19, you are substantially reducing your risk of a serious illness that may lead to you requiring hospital treatment or even dying. Even if you don’t need hospital treatment, Covid-19 can still be an unpleasant illness that can make you unwell for a few weeks or leave you with long-term complications.  The risks from Covid-19 are particularly hig...

On 24 February 2022, the UK government removed the legal requirement for people in England to self-isolate after a positive covid-19 test result, with the other UK nations also easing restrictions.1 In doing so, the UK is acting ahead of many of its international peers to embark on a “vaccines only” strategy, hoping that existing immunity in the population will allow a “return to normal.” This view is in sharp contrast to public opinion. In a recent poll by market research company YouGov, only 17% of respondents thought that ending mandatory self-isolation was appropriate.2 The removal of legal restrictions makes the people of England part of an experiment in which much remains uncertain.3 This is acknowledged by chief government advisers Chris Whitty and Patrick Vallance, who accompanied Boris Johnson’s announcement with a warning that rates of covid-19 infection and hospital admission remain high.4 Of equal concern, the government’s announcement also introduced plans to scale back tw...

The rise in demand for healthcare by an ageing population together with budgetary constraints has put great pressure on the availability of adult social care (ASC). In response, healthcare organisations and researchers have developed practices of care and support, focusing on prolonging functional independence  This is done through exploring possible risk factors associated with unplanned outcomes, typically readmissions to hospital or through the use of predictive models to forecast outcomes.  Predictive models are widely used by health care providers in the UK and US due to their potential to inform early interventions. However, equivalent models for predicting new onset of long-term ASC, defined as need for help with tasks of daily living in the community or in care homes, are rare, particularly those using administrative data. In this study published in Age and Ageing , we describe risk factors for long-term ASC in two inner London boroughs and develop a risk prediction mo...

The intense micromanagement of general practices by NHS England since the start of the Covid-19 pandemic in early 2020 has shattered the illusion that NHS general practitioners are truly “independent”. For example, during the pandemic, NHS general practices have often received weekly updates from NHS England on how they should provide primary care services.[1] The opening hours and working arrangements of general practices are also highly regulated by NHS England. And general practitioners are not independent contractors in the same way that professionals working in other fields or indeed primary care physicians working overseas would recognise. General practitioners are not even able to offer private medical services to their patients in the same way as NHS Trusts or dentists are able to do. In effect, they have all the disadvantages of being self-employed contractors and none of the benefits of being NHS employees. For more than a decade, primary care in England has suffered from und...

General practice or family medicine has historically been lauded as the “jewel in the crown” of the English National Health Service (NHS). General practice, at the heart of primary care, has continued to contribute to the high ranking of the NHS in international comparisons and evidence from several decades of research has shown that general practice in the UK has improved the nation's health. Furthermore, it has provided equitable, cost-effective, and accessible care for all with the flexibility to adapt rapidly to a changing society and political climates, such as during the COVID-19 pandemic when there was rapid implementation of remote consultation models. However, this much-admired public sector service has recently come under unprecedented political and media spotlight instigated by the pressures of the current pandemic on the NHS. This coupled with collapsing morale among general practitioners (GPs), a shrinking GP workforce, inexorable demands, increasing workload, and decr...

The government has just announced that all covid-19 restrictions in England are set to end. Boris Johnson, the UK prime minister, told MPs that he plans to remove the remaining restrictions, including the legal requirement to self isolate for people infected with covid-19. Instead of legislation, voluntary guidance will “advise” people with covid-19 not to attend workplaces. Employers will once again need to develop and implement new rules for their workplaces when the legal requirement to self isolate with covid-19 comes to an end. They should consider carefully how to develop and implement new policies fairly and safely in the workplace so that staff and customers—particularly those who are clinically vulnerable—are not put at risk. Presenteeism occurs when employees go to work despite not being well enough to perform their duties. The NHS is the largest employer in England and the NHS Staff Survey showed a drop in presenteeism in 2020 compared to preceding years.1 This is likely an ...