Medical Centre

Virtual consultations have increased in healthcare in recent years, especially since the onset of the COVID-19 pandemic. While telehealth offers many benefits for patients, such as convenience and increased accessibility, questions surrounding its impact on the quality of primary care persist. Our recent systematic review " The Impact of Virtual Consultations on the Quality of Primary Care " offers valuable insights into this timely and topical issue in healthcare delivery.  The primary goal of the study was to evaluate how virtual consultations are influencing the quality of primary care. The study was comprehensive, covering various diseases and utilizing six databases for identifying studies. It employed a rigorous screening process to ensure that only pertinent data was included. Key Findings The review included 30 studies comprising 5,469,333 participants. The results were quite revealing: 1. Effectiveness: Virtual consultations were as effective, or even more so, than t...

The Secretary of State for Health and Social Care, Steve Barclay, has confirmed the UK government is considering plans to allow patients in England to bypass their GP and directly access some diagnostic tests for suspected cancer. The clinical and cost-effectiveness of these new diagnostic pathways must be compared with alternative solutions such as investing more in core NHS general practice services. My article in the British Medical Journal discusses some of the key issues and challenges in implementing this radical new policy.

 A new article in the British Medical Journal from Carol Chan, Ana Neves and myself looks at the importance of implementation and training in the use of electronic health records (EHRs) in healthcare. The introduction of EHRs has been one of the most significant changes in how healthcare is delivered in recent decades. But while EHRs have brought many benefits to the NHS, for patients and clinicians, they have also created substantial challenges that must be addressed.

The health risks to refugees and asylum seekers have become very topical with the identification of Legionella on the Bibby Stockholm barge Refugees and asylum seekers will often come from countries that have high rates of infections such as tuberculosis and hepatitis B / C (among others). Refugees and asylum seekers will also often not be vaccinated to UK standards. A comprehensive health screen is essential when they enter the UK to identify and treat any infections they might have (as well as other significant medical problems such as diabetes and mental health issues).  It’s also essential to offer any missing vaccines to bring them in line with UK vaccination standards; and address any physical and mental health problems they have; and ensure they have access to good NHS primary care services to deal with new and ongoing medical problems. Legionella is sometimes found in the water systems of larger buildings, particularly those with older systems where water can pool at the te...

1. Measles The UKHSA has warned that unless MMR vaccination rates improve, London could experience a large measles outbreak. Measles is potentially a very serious illness with important complications - but is preventable though vaccination.  Please ensure patients and their families are up to date with their vaccinations. Please also check the vaccine status of new patients - particular migrants - and enter details onto the medical record of any vaccines given elsewhere. https://www.gov.uk/government/news/london-at-risk-of-measles-outbreaks-with-modelling-estimating-tens-of-thousands-of-cases 2. Shingles vaccination The shingles vaccine programme is being expanded. From September, GP practices will offer: - Those aged 70-79, 1 dose of Zostavax or 2 doses of Shingrix - People aged 50+ with a weak immune system, 2 doses of Shingrix - Those turning 65 & 70, two doses of Shingrix vaccine. For further details, see https://www.gov.uk/government/publications/shingles-...

The harsh reality of climate change is becoming increasingly apparent, with extreme temperatures emerging as an increasing global phenomenon. One of the most conspicuous manifestations of this climatic shift is the occurrence of heatwaves. These bouts of extreme heat aren't just uncomfortable, they also pose significant health risks and can increase death rates; particularly amongst the most vulnerable people in societies - such as the elderly, children, and individuals with pre-existing health conditions. Heatwaves don't just affect the health of individuals; they also put enormous strain on healthcare systems. In times of extreme temperatures, the influx of patients seeking medical help for heat-related illnesses increases drastically. Often, other factors linked with extreme heat, like water shortages and poor air quality, exacerbate the situation, leading to an even greater health crisis. The ability to effectively manage these health threats often comes down to the resourc...

Multimorbidity, the coexistence of multiple chronic conditions within an individual, is a growing global health challenge affecting a significant portion of the population. Patients with multimorbidity often face complex healthcare needs, leading to increased unplanned healthcare utilization. In an effort to address this issue, community-based interventions have emerged as potential solutions for providing continued care outside of traditional hospital settings. Our systematic review published in the Journal of the Royal Society of Medicine aims to summarize the impact of these interventions on unplanned healthcare use in patients with multimorbidity. The Burden of Multimorbidity With the prevalence of multimorbidity increasing, affecting approximately one-third of the global population, it is crucial to find effective strategies to manage this complex condition. The challenges posed by multimorbidity often result in frequent emergency department visits and hospital admissions, placin...

The Quality and Outcomes Framework (QOF) was introduced in 2004 as part of a new NHS GP contract with the aim of financially rewarding general practices for delivering evidence-based standards of care. While initially unique internationally, the QOF in the UK is now facing uncertainty, with calls to cut it back or abolish it due to various challenges faced by the NHS. In an article published in the journal BJJP Open , Mariam Molokhia and I discuss the role of the QOF in England's NHS and argue for its importance in improving health outcomes and addressing public health challenges. The Importance of Comprehensive Health Services Primary care plays a vital role in providing comprehensive health services, covering both acute and long-term conditions. Beyond immediate patient needs, the focus should be on prevention, early diagnosis, and management of chronic diseases that contribute significantly to ill health, reduced quality of life, and increased NHS workload. Amid the COVID-19 pan...

Our ability to engage in self-care practices plays a crucial role in promoting overall well-being and preventing and managing non-communicable diseases. To support individuals in assessing their self-care capabilities, many measurement tools have been developed. However, a comprehensive review specifically focusing on non-mono-disease specific self-care measurement tools for adults has been lacking. Our  scoping review in the journal BMC Public Health aims to identify and characterise such tools, including their content, structure, and psychometric properties. Shifting Emphasis and Methods The review encompassed a thorough search of Embase, PubMed, PsycINFO, and CINAHL databases, covering a wide range of MeSH terms and keywords from January 1950 to November 2022. The inclusion criteria involved tools that assess health literacy, capability, and performance of general health self-care practices, targeting adults. Tools exclusive to disease management or specific medical settings we...

1. Covid-19 vaccination for children aged 6 months to 4 years Vaccination for a small group of high-risk children aged 6 months – 4 years is starting. It is not clear yet how this group will be identified and who will be responsible for contacting parents and carers. See below for JCVI’s recommended groups for vaccination. It’s likely that take-up of vaccine in this group will be very low, particularly in areas such as London. 2. Covid-19 vaccination for adults The offer of first and second doses of vaccine ends in June 2023; after which it is very likely that vaccination will only be available for higher-risk groups. The Spring booster programme for people in very high-risk groups is also ending. We await guidance of which groups will be eligible for a booster vaccine in the Autumn. 3. Mpox (monkeypox) There has been an increase in cases of mpox in London in recent weeks. Be aware of the clinical features of mpox as discussed in this BMJ article. Human monkeypox: diagnosis an...

Data published today   by the Office for National Statistics shows that the number of people who are not working due to long term sickness has risen to a record high. From previous research, we know that the most common medical problems that can prevent individuals from working include mental health issues such as depression, stress, and anxiety, as well as musculoskeletal disorders like back pain. In addition, cardiovascular diseases, respiratory conditions, cancer, and neurological disorders are among the many other medical conditions that can significantly impact a person's ability to work.   We have also seen higher death rates than usual in recent years in the UK; which probably reflects an increase in the number of people with long-term medical problems and their severity. A parallel challenge is demographic change to an older population, given that the  disability employment gap  increases with age. Trying to reverse the trend in the number of people in t...

 Postgraduate students in universities across the UK will currently be undertaking their summer research projects. How can academics successfully support their students and ensure they have a good learning experience and successfully complete their research project? The first meeting with the student sets the foundation for a successful supervisory relationship. It’s essential for academics to establish clear expectations, foster effective communication, and provide the necessary guidance to support the student during their research project. 1. Introduction & Background: Begin the meeting by introducing yourself and providing an overview of your research expertise and experience. Ask the student to introduce themselves and their background, including their research interests and motivations for pursuing the project. 2. Research Project Overview: Provide a detailed overview of the research project, including its objectives, scope, and any specific research questions that need to...

Wastewater surveillance is a technique that can be used to detect and track the spread of infectious diseases, including Covid-19. Wastewater is a rich source of genetic material from the people who use facilities in locations such as schools. By testing wastewater for the presence of viruses, public health officials can get an early warning of an outbreak before it becomes widespread. Our recent study published in the journal PLOS One found that wastewater surveillance can be used to detect Covid-19 with high accuracy. The study, which was conducted in England collected wastewater samples over a period of six months. We found that wastewater samples from areas with high rates of Covid-19 infection had significantly higher levels of SARS-CoV-2 genetic material than samples from areas with low rates of infection. We also found that wastewater surveillance can be used to track the spread of new variants of SARS-CoV-2. We were able to identify the Alpha and Delta variants in wastewater s...

Our recent article in the Journal of Primary Care & Community Health discusses burnout, a psychological response to chronic workplace stress that is particularly common in healthcare workers and which has been made worse by the impact of the Covid-19 pandemic. Burnout is caused by factors such as increasing workload, inadequate support from employers and colleagues, and a stressful work environment. It has negative effects on both patients and healthcare professionals, including reduced patient satisfaction, an increase in medical errors, and decreased quality of care. Addressing burnout requires a multi-pronged approach involving individual and organisational-level strategies.  Managing people’s workload, providing individual-focused interventions like stress management, and offering professional development opportunities can help reduce burnout. Supportive leadership, peer support, and a healthy work-life balance are also important. Organisational culture and leadership play...

 1. Covid-19 vaccination : Spring booster campaign currently underway for high-risk groups. Offers of first and second Covid-19 vaccinations for low-risk people who are currently unvaccinated will come to an end after 30 June. 2.  Monkeypox (mpox) vaccination : Anyone who is eligible for mpox vaccine should come forward for vaccination. First doses of vaccine remain available until June for gay, bisexual and men who have sex with men (GBMSM) at highest risk from mpox with second doses available until the end of July. 3. Patient choice : Patients will be able to choose from up to five different providers through the NHS app when they are referred by a GP for specialist treatment. In practice, this may not have much impact because many patients will choose to be referred to the closest hospital; others will know what hospital they want to use; and most of the rest will rely on the judgement of their GP. 4. Pharmacist access to GP records : Community pharmacists will be able to a...

  This week, the government published its recovery plan for NHS general practice in England. Thanks to Pulse for the excellent summary. The key areas in the recovery plan include: 1. Patient triage Provide general practices with digital tools and care navigation training for ‘Modern General Practice Access’ and offer funding to practices that agree to adopt this approach before March 2025. 2. Information Technology Support general practices on analogue lines to move to digital telephony if they sign up by July 2023. Enable patients in over 90% of practices to see their records and practice messages, book appointments and order repeat prescriptions using the NHS App by March 2024. 3. Redirecting patients to pharmacy Launch Pharmacy First so that by end of 2023 community pharmacies can supply prescription-only medicines for seven common conditions. Expand pharmacy oral contraception and blood pressure services this year, subject to consultation. 4. Self-referral ...

 One of the most significant changes I have witnessed during my medical career is the introduction of electronic health records (EHRs). While they have brought many benefits to the NHS, patients and clinicians, they have also posed some challenges. On the positive side, EHRs have made medical records more legible, accessible and secure. Many doctors and patients will remember the era when a patient’s medical record was often “missing” when they attended for an outpatient appointment. This made the management of the patient more difficult as the clinician attending the patient did not have all the information they needed; usually requiring the patient to return at a later date when hopefully by which time their medical records would be found. With EHRs, in contrast, clinicians can access patient records from anywhere at any time, which has made it easier to provide care to patients in different locations. EHRs have also made it easier to conduct medical research, as they allow resea...

 A complaint I often hear from colleagues is that “the NHS has taken the joy out of medicine”. Modern healthcare delivery is increasingly seen by NHS staff and by patients as an industrial-type activity with strict performance targets. This has resulted in many healthcare professionals feeling that they have lost the much of the flexibility and autonomy that was once a defining characteristic of their professions. This feeling can also concern patients, as they may feel that they may not be receiving the personalised care and attention that they feel they need. The focus on targets, metrics and finances can create an environment where patients feel they are being treated as numbers rather than as individuals with unique needs and circumstances. It is important for politicians, NHS managers and clinicians to acknowledge these concerns and work to address them. While performance targets, metrics and financial monitoring are important tools for measuring the effectiveness of healthcar...

 I joined Twitter 10 years ago in May 2013. One of the lessons I've learned from social media is that too many people want “certainty”. But in public health and medicine, there often aren’t certainties; just probabilities of certain outcomes or unknowns due to a lack of evidence. This can be frustrating for people who are looking for clear answers, but science is a process of discovery, and there is always more to learn; either from new research or from summarising and synthesising evidence from current and past research. By looking at the existing evidence, we can make informed decisions about our health and the health of our communities. Uncertainty is a critical aspect of scientific inquiry and helps researchers refine their understanding of health-related issues over time. Uncertainty can arise due to factors such as incomplete data, limitations in research, or the complexity of the systems being studied. Another way to deal with uncertainty is to be open to new information. As...

 I am sometimes asked by junior researchers or by the public how the publication process for academic articles works. The academic peer review timeline varies depending on the journal, but it typically takes several months (sometimes even longer) from submission to publication. 1. Submission: You submit your paper to the journal. Make sure your paper is well-written, checked for spelling and grammatical errors, follows the journal's style and formatting requirements, and that you submit your paper to a journal that is a good fit for your work. 2. Initial screening: An editor at the journal reviews your paper to make sure it is within the scope of the journal & meets the journal's style and formatting requirements. Some articles are rejected at this stage, without external peer review (particularly, by larger journals). 3. Peer review: The editor sends your paper to one or more external experts in your field for review. Reviewers are asked to assess the originality, signific...