Medical Centre

  Public health and NHS topics discussed at our clinical meeting today at Dr Curran and Partners in Clapham, London. 1. Infectious diseases update After high rates of infectious diseases such as Covid-19, influenza and Streptococcus A towards the end of 2022, we are seeing signs of falls in all these infections. This should help the NHS locally and nationally. However, Covid-19 remains a threat and it is very likely we will experience periods during 2023 when Covid-19 infections are high.  a. Covid-19 statistics b. Hospital admission rates in England: Covid-19 and influenza c. Weekly scarlet fever notifications in England 2. New JCVI recommendations on Covid-19 vaccine boosters The JCVI has recommended that Covid-19 booster vaccinations should be offered in the Spring and Autumn this year for selected groups of patients at high risk. In the Spring, this is likely to be similar to the programme in 2022 (i.e. the very elderly and immunocompromised). In the Autumn, it is likely...

Our study published today in the British Journal of General Practice shows how the uptake of flu vaccination in pregnancy varies with age, ethnicity and socio-economic deprivation. Pregnant women are at an increased risk from influenza (flu), yet uptake of  Seasonal influenza vaccination (SIV) during pregnancy remains low, despite increases since 2010. Getting the flu vaccine when pregnant is important, because it reduces the risk of severe disease, complications and adverse outcomes for both mother and child such as pre-term birth. However, uptake was lower among women living in more deprived areas, women who were younger or older than average, Black women and those with undocumented ethnicity.  Although the flu vaccine is safe and recommended for pregnant women, misconceptions about safety play a role in pregnant women not being vaccinated and flu vaccination levels among pregnant women are suboptimal worldwide.  In the UK, since 2010, the Joint Committee on Vaccinatio...

Clinical update for Dr Curran and Partners (Manor Health Centre, Lambeth) for the week of 19 January 2023  1. Covid-19 statistics update After a peak in December, Covid-19 cases, hospital admissions and deaths have begun to decline in January 2023. We are though likely to see further waves of infection later in the year. 2. Covid-19 vaccine boosters Uptake of Covid-19 boosters has plateaued at a lower level than we hoped for. In England, around 64.4% of people aged 50 and over have received a booster in the current campaign. In Lambeth, only 40% of people aged 50 and over have received a Covid-19 booster, well below the national average. Please encourage patients to attend for a booster if they are eligible. 3. Covid-19 treatments Some people at highest risk of becoming seriously ill from COVID-19 are eligible for antiviral treatments on the NHS. These include some patients with cancer, blood conditions, kidney disease, liver disease and autoimmune conditions, among others.  G...

Appointment lengths in primary healthcare should be flexible to accommodate the needs of each individual patient. This allows for personalized care and ensures that patients receive the appropriate amount of time and attention from their clinician.  It also allows for more efficient use of clinic time as appointments can be scheduled based on the specific needs of each patient rather than a one-size-fits-all approach. Offering flexible appointment lengths can improve patient satisfaction and build trust in the healthcare system. It can be challenging for doctors and other clinical staff to give more time to patients and increase appointment lengths when they are also required to see more patients given the demand for appointments and the shortages of key healthcare workers. Implementing digital technologies such as electronic medical records and online appointment booking, can help to streamline the appointment process and allow clinical staff to see more patients without sacrifici...

 In the fields of clinical medicine and public health, it is important to recognize and acknowledge the inherent uncertainties that exist. This is because these fields deal with complex systems that have a high degree of uncertainty and imprecision. This uncertainly can be in the diagnosis and treatment of individual patients, or in the implementation of public health policies. It is crucial for medical professionals and public health officials to communicate these uncertainties accurately and transparently.  This can help prevent the spread of misinformation and can also help individuals make informed decisions about their health and the use of interventions such as screening or vaccination. Furthermore, it is important to recognize that not all sources of information are equal. It is important to critically evaluate the evidence behind any claims being made. This is especially important in the era of social media, where anyone can share their opinions and ideas, regardless o...

 A real change is on the horizon. In October 2021, Facebook announced that it would rebrand itself as ‘Meta’, and this generated high levels of public interest in the metaverse for the first time. Definitions for the metaverse vary and there is still much uncertainty in its eventual future manifestation. It is perhaps best defined as a fully immersive parallel digital reality where users will be able to interact at a scale previously unimagined. The advent of the metaverse could have transformational impact on every aspect of human life, from our social interactions to what we ascribe real value to. Just as the Internet has completely transformed health, the metaverse will redefine virtual and physical possibilities in health.2 This will have major implications for our health and for healthcare delivery. The coming of age of the metaverse is in due largely to the maturation of technological advances in artificial intelligence and devices that enable the delivery of mixed, augmented...

  Primary Care Clinical Update 8 December 2022   1. Group A Streptococcal infections There has been an increase Group A Streptococcal (GAS) infections in recent months, which has led to at least 15 deaths in children since September. Although GAS rates are higher than expected for this time of year, they have been higher at periods over the last decade as shown in the graph below from the UKHSA.  GAS causes a range of infections including Scarlet Fever and also more severe invasive disease. For more information on management, see: Scarlet fever: a guide for general practitioners. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649319/ The Centor score can be used to assess the probability of an illness being GAS pharyngitis: Tonsillar exudates, tender anterior cervical adenopathy, absence of cough, history of fever (>38 °C). Penicillin V (or Amoxicillin) is the preferred treatment unless contra-indicated in which case an alternative such as a cephalosporin or clar...

There is currently considerable media coverage and some public anxiety in the UK about Group A streptococcal (GAS) infections. Journalists who write about cases of infectious diseases need to understand the principles of the Poisson distribution. Events such as infections can sometimes cluster in time or space due to chance, and not because there is an underlying cause behind the cluster of cases. Some journalists and doctors are stating that the cases of Group A streptococcal infections we are currently seeing in the UK are from lower levels of immunity because of Covid-19 control measures over the last 2.5 years. This is not necessarily the case and needs further investigation. The UK has experienced large outbreaks of Group A streptococcal infections in the past. For example, the UK had a large outbreak of Group A streptococcal infections between September 2015 and April 2016 (the largest since 1969), resulting in PHE issuing an alert.  The current cluster of Group A streptococc...

Writing in the Journal of the Royal Society of Medicine , myself, Austen El-Osta and Chris Rowe set out a vision for building sustainable, self-driven healthcare spanning primary care, secondary care and the wider health and social care system has been set out by medical innovators. Self-driven healthcare (SDH) is an umbrella term introduced by Innovate UK, the UK’s national innovation agency, to conceptualise aspects of healthcare delivery that can support people in becoming more engaged in managing their own health and wellbeing, rather than being passive receivers of healthcare. In our paper, we describe an SDH ecosystem that supports individuals to take more ownership of their health and wellbeing and in recording their own data (e.g. weight, blood pressure) using a phone app, tablet, computer or Bluetooth device. This self-generated data would then be uploaded onto a secure online SDH portal which holds all their health records, including those generated in the wider healthcare sy...

Topics I presented in my practice’s clinical meeting today: 1. ADHD referral update a. ADHD referrals are rejected by a clinician in the specialist team if thought to be unsuitable for the service but sometimes this is a team decision, so they prefer not to give a specific name on the rejection letter. b. They don’t have the ability to “pause” referrals. Hence, if key information is missing, a referral is rejected as they can’t put it on hold. c.   When making a referral, ensure that the key diagnostic criteria are all included. These should be in the referral form but are also available online. https://selondonccg.nhs.uk/wp-content/uploads/2022/09/SEL-ICS-Adult-ADHD-referral-criteria-v1-2022.pdf d. Private patients and overseas patients. Consultant Connect can be used to get advice quickly and this can allow medication to be continued if indicated for patients with a confirmed diagnosis. Consultant Connect for the ADHD service is currently under-used by local GPs. e. ...

A recent article in the British Medical Journal discusses work-related stress and burnout in healthcare workers. These are important problems in the NHS workforce in the UK a well as amongst healthcare workers in other countries. Addressing the underlying cause, which may relate to factors such as workplace demand, relationships, and support is necessary for sustained recovery and full engagement with work. Healthcare workers may experience guilt or shame due to stigma, preventing them from seeking help if they experience work related mental illness. Time off work and workplace changes to control the triggers may be necessary to allow recovery and sustainable return to work. Healthcare workers experiencing work related stress can seek support from colleagues, their own GP, occupational health, and specialised services for healthcare workers such as local mental health and wellbeing hubs and NHS Practitioner Health.

Our recent article in the Journal of the Royal Society of Medicine   discuses the diagnosis and management of Monkeypox in UK primary care settings but is also relevant to primary care clinicians working in other countries outside West and Central Africa that have  seen Monkeypox cases in 2022. Since its discovery in 1958 in monkeys, the Monkeypox virus has been rarely found outside west and central Africa until the current global outbreak. The first human case of the virus was in an infant from the Democratic Republic of Congo (DRC) in 1970; the infection has since spread to other regions, primarily in Africa. The first case of the current outbreak was confirmed on 6 May 2022, in the UK and was linked to travel to Nigeria. Two subsequent UK cases were detected a week later; however, neither affected individuals reported contact with the primary case in the UK nor travel to Africa.  On 23 July 2022, the World Health Organization (WHO) declared the current Monkeypox outbre...

Much of the discussion about vaccination is on Covid-19 and flu vaccines or vaccines for children. But there are also other important vaccines for adults – such as for shingles - where there is scope to increase uptake and improve health outcomes for older people and the immunocompromised.  Shingles is caused by the reactivation of latent varicella zoster virus (VZV); sometimes decades after the primary chickenpox infection. For some people – particularly the elderly and the immunocompromised – shingles can be a very unpleasant illness with significant complications. In the UK, two vaccines are licensed for shingles: Zostavax which contains live, attenuated virus and which is given as a single dose. Shingrix which is a recombinant vaccine and which his given in two doses.  The main target group for shingles vaccination in the UK is people aged 70-79 years. Most people in this group will receive the Zostavax vaccine. People in this age group who are immunocompromised should rec...

Our new paper in the International Journal of Integrated Care reviews the role of multidisciplinary team (MDT) meetings in the management of multimorbidity in primary care. MDTs bring together professionals to work together to improve health outcomes for patients. MDT meetings are often recommended as a critical aspect of integrated care in guidance and opinion pieces, but it is not clear how and to what extent their use improves outcomes for patients with multimorbidity. Our review aimed to fill this knowledge gap. We found limited evidence that supports the implementation of MDT meetings in primary care settings for individuals with multimorbidity. There were also substantial problems with the methodological rigour of previous studies on MDT meetings in primary care. Although MDT meeting are a key strategy for delivering comprehensive integrated care, there is a lack of evidence concerning the efficacy of MDT meetings in primary care. The complexity of interventions meant that causa...

With England’s NHS under immense pressure even before the full onset of winter, here are some tips on how you can make the most of the NHS, use health services more appropriately, and obtain the care you and your family need to protect your health and wellbeing. 1. Attend for appointments for medication reviews and for the management of long-term conditions when invited. 2. Take-up the offer of Covid-19 and flu vaccinations if you are eligible. Make sure you are up to date with any other vaccinations you are eligible for. Attend for health screening appointments when invited. 3. Use the NHS app to book appointments, view your GP medical record and order repeat prescriptions. 4. Be aware of the range of options for NHS care – including opticians, pharmacists, self-referral services (e.g. podiatry, IAPT, smoking cessation), and NHS 111. 5. Use the NHS electronic prescription service so that your prescription is sent directly to a pharmacy. 6. For queries about hospital care, contact the ...

Our new study in JRSM Open led by Dr Raj Chandok and Dr Poonam Madar examines factors influencing Covid-19 vaccine hesitancy among South Asians in London. Vaccines have a key role in suppressing serious illnesses, hospitalisations and deaths from Covid-19. London has amongst the lowest Covid-19 vaccination rates in the UK and it’s important to understand the factors behind this so we can work better with local communities to address this key public health challenge. This includes looking at factors such as confidence in Covid-19 vaccines, complacency about the severity of illness arising from Covid-19, communication about vaccines in both the mainstream media and social media, and the context in which people live and work.

If you consult your doctor about bowel symptoms, they may speak about getting FIT. What is FIT? In this context, it is nothing to do with exercise or how far you can run. FIT stands for faecal immunochemical test, which aims to detect blood in your faeces. The test is highly sensitive.  People with lower bowel symptoms such as a change in their bowel habits will understandably be concerned about the possibility of bowel cancer. The risk of colorectal cancer in people with a negative FIT, a normal examination and normal full blood count is <0.1%. This is lower than the general population risk of colorectal cancer. So this combination of clinical findings allows your doctor to conclude that you are very unlikely to have bowel cancer. However, many people with lower GI symptoms still do not undergo FIT before referral to a specialist. Patients with a FIT of fHb <10μg Hb/g, a normal full blood count, and no ongoing clinical concerns do not need to be referred on a lower GI urgent...

Our new paper in the British Medical Journal reviews the implementation of the UK’s Covid-19 vaccination programme. The programme is essential in keeping down the number of serious cases, hospitalisations and deaths from Covid-19 and allowing society to function more normally.  Overall the programme performed well. But it’s important to address some common misconceptions about the programme. Firstly, the rapid implementation of the Covid-19 in vaccination in the UK was not due to Brexit. When the programme started, the UK had not finalised Brexit. Secondly, the vaccination programme was good and all those who supported the programme are to be congratulated for their efforts but it was not “world-leading” as some politicians have claimed. Many other countries have outperformed the UK in areas such as vaccine uptake.  One limitation of current vaccines is that although they are very successful in reducing the number of serious cases of covid-19, they are less effective in preve...

 The NHS is now starting to rollout flu vaccinations for eligible people. Although the public health focus since early 2020 has been very much on Covid-19, flu remains a major threat to vulnerable individuals and the NHS in the UK.  We have been fortunate that in the last few years, flu rates have been very low in the UK. However, there are signs from Australia that we may see much higher rates of flu in the UK this winter. Australia has seen its highest flu rates since the start of the Covid-19 pandemic and this may be a predictor of what the UK may face during our own winter. Because flu rates have been low in recent years, this means that people will have less immunity from a previous infection. The end of Covid-19 control measures – such as face masks and social distancing  - combined with the return of normal social activities also increase the likelihood of a large flu outbreak this winter. This makes flu vaccination essential – particularly for the elderly, the cli...

It’s the time of year when academics – including myself - are marking MSc and MPH dissertations. Once again, I see many errors in how students write their dissertations. What are these errors and how can students avoid them to make their dissertations more readable? Spend time planning the outline of your dissertation with chapter headings and subsection headings for each chapter. Decide what key tables, figures and graphs you need to include to reinforce what is in the main text of your dissertation. Many students assume that longer words are “more scientific” and therefore preferable than shorter words. For example, using terms like perspiration rather than sweat or haemorrhage rather than bleed. Imagine if Churchill had written his speeches in this “more scientific” way.  Use shorter sentences when possible. Longer sentences are more difficult to read and can lead to the examiner missing the key points you are trying to make. The same applies to paragraphs – don’t make them too ...