Medical Centre

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...

 As artificial intelligence (AI) become increasingly embedded in routine healthcare - supporting tasks such as triage, documentation, interpretation of investigation, diagnosis and patient communication - it introduces new patient safety risks through incorrect outputs (“hallucinations”) that should be treated as safety errors rather than technical glitches. In our article in the Journal of Patient Safety , we argue that primary care must extend its established safety culture to AI by systematically detecting, classifying, reporting, and learning from AI-related errors using principles already applied to human error, such as audit, governance, and incident reporting.  We highlight evidence that AI-generated clinical text can contain omissions, fabrications, or unsafe recommendations that may not be apparent to clinicians and patients and that risk becoming “silent errors” in electronic health records. These errors can then contribute to cognitive offloading if clinicians over-...

Influenza remains a major cause of preventable illness each winter and continues to place significant pressure on NHS general practices, urgent care services, and hospitals. This has been particularly evident this winter, with flu rates much higher than we would normally expect for this time of year.  As of mid-December 2025, UKHSA surveillance shows influenza positivity in primary-care sentinel samples running well above most pre-COVID seasons, and hospital and ICU admissions for confirmed influenza are rising sharply — especially among adults aged 65 and over and those with long-term medical conditions. In general practice, we see first-hand how flu can lead to severe complications, particularly in older adults, people with underlying conditions, and those who are immunocompromised. Vaccination remains the single most effective way to reduce the risk of severe illness, hospitalisation, and death from flu. Interim data for the 2025–26 season suggest that vaccination is already red...

Our article in the Journal of the Royal Society of Medicine argues that safe and effective AI in healthcare must incorporate mechanisms that emulate human judgement - down-weighting old, inaccurate or superseded information and prioritising what is recent, clinically relevant and reaffirmed - so that AI supports, rather than disrupts, high-quality patient care.  Clinicians constantly revise, reinterpret and filter past information so that only what is relevant, accurate and timely shapes present-day management decisions; medical records function as dynamic “working tools” rather than fixed archives. By contrast, many AI systems lack this capacity for selective forgetting and often treat all historical data as equally meaningful.  This can lead to outdated or low-confidence diagnoses being repeatedly resurfaced, persistent labels influencing clinical expectations, and irrelevant, long-resolved events cluttering summaries and decision-support outputs. Such indiscriminate recall...

The UK government’s forthcoming review of mental health and neurodevelopmental diagnoses presents an opportunity to improve the healthcare and benefits system if the potential risks are averted. Rising rates of conditions such as ADHD, autism, and anxiety disorders have raised questions about whether we are seeing a genuine increase in need or greater awareness and possible over-diagnosis. A thoughtful, evidence-based review could help bring much-needed clarity. But if mishandled, it could deepen inequalities and undermine support for those who need it most. Done well, the review could improve diagnostic quality and reduce the postcode lottery that too often defines access to assessment and treatment. Clearer clinical standards and properly funded services would allow professionals to make more accurate diagnoses, shorten long waiting lists, and better match interventions to individuals’ needs. This is an outcome everyone should welcome. But the review must not become a vehicle for re...

The announcement of a new UK-US pharmaceuticals deal is an important change in the UK’s approach to how new medicines are evaluated, priced and adopted. Faster access to innovative treatments for conditions such as cancer will be welcomed by patients and professionals. The increased investment in medicines may also help the UK attract more clinical research.  However, the impact of the proposals will depend on implementation. Raising NICE’s cost-effectiveness thresholds will increase overall NHS spending on medicines. Without a corresponding investment in areas such as workforce, diagnostics and primary care, there is a risk that higher drug spending could divert resources from other parts of the NHS. A more flexible pricing environment could also reduce the UK’s future negotiating leverage with industry. Maintaining NICE’s independence will be essential to maintain both public and professional confidence in its decision-making. The changes could benefit patients and strengthen th...

In an article published in the journal Frontiers in Medicine , we argue that medical education must broaden its focus: rather than treating infrastructure such as housing, transportation, energy, water supply as only a public-health or social background issue, trainees should regard infrastructural deficiencies as direct clinical determinants of patient health.  We highlight concrete examples (e.g., missed appointments due to transport failures, disrupted dialysis from electricity outages, contaminated water causing toxicity) showing how infrastructure can precipitate or worsen clinical problems. We propose educational innovations: embedding infrastructure-related history-taking, case-based learning driven by infrastructural triggers, community placements in underserved areas, and interdisciplinary learning (with urban planners, engineers, public health) to equip future clinicians with “systems-citizen” skills and advocacy capability.  The goal is to reframe clinical practice ...

I spoke to GP Registrars on the Imperial College GP Training Scheme about the evolution of medical records in primary care. This is a journey that mirrors the broader transformation of healthcare itself. The story begins in 1911 , with the introduction of the Lloyd George Envelope following the National Insurance Act. These brown paper envelopes (named after the then Chancellor and future Prime Minister, David Lloyd George), each containing a patient’s handwritten medical notes and printed correspondence, became the standard for decades. They were simple, portable, and remarkably durable but also limited by their physical nature. Searching for information meant literally leafing through these paper records, and continuity of care relied on legibility and the clinician’s diligence in recording. The late 20th century brought a revolution: the computerisation of general practice . Early adopters in the 1980s and 1990s began using systems like EMIS and Vision, digitising the record and ...

There has been recent discussion about the need to revise drug pricing frameworks within the United Kingdom's National Health Service (NHS), particularly amid the ongoing transatlantic trade frictions involving potential tariffs from the United States administration. Elevating the cost-effectiveness threshold applied by the National Institute for Health and Care Excellence (NICE) by 25 percent from its established range of £20,000 to £30,000 per quality-adjusted life year (QALY) would increase access for NHS patients to innovative treatments that were previously excluded on grounds of excessive cost relative to their clinical benefits.  However, this change would also put increased pressure on the NHS budget. It is difficult to quantify the extra spending that might result from a wider range of drugs becoming available for use in the NHS through this change but any extra spending on these treatments would have to be matched by reductions in spending on other health services. Effect...

As the world continues to grapple with the aftermath of the COVID-19 pandemic, Long Covid has emerged as a significant public health challenge. Characterised by persistent symptoms like fatigue, brain fog, shortness of breath, and joint pain lasting weeks, months or even years after an infection, Long Covid affects millions globally. Yet, one major hurdle in understanding and addressing this condition is its under-recording in electronic medical records (EMRs). Accurate coding of Long Covid in EMRs is essential for studying its epidemiology, improving patient care, and managing its impact on healthcare systems and on societies. Electronic medical records are at the core of modern health systems and have largely replaced the more traditional paper-based records used by healthcare providers for many decades. Electronic medical records are used to track patient diagnoses, treatments, and clinical outcomes. When Long Covid is not properly coded, it becomes difficult to use this data to c...

Polypharmacy, commonly defined as the concurrent use of five or more medications, is a growing challenge in modern healthcare, especially among older adults with multiple long-term conditions. While advances in medicine have improved disease management, they have also led to an unintended consequence: a rising medication burden that can harm patient well-being.  Our recent study published in Clinical Practice explores how reframing polypharmacy as a chronic condition can empower future doctors to manage it more effectively. For example, polypharmacy substantially increases the risk of adverse drug reactions (ADRs). This underscores the urgent need for a shift in how we approach medication management.  Traditional medical education focuses on treating individual diseases, often leading to prescribing cascades where one drug’s side effect triggers another prescription. This cycle complicates care and worsens outcomes. We designed a three-phase educational intervention for final-...

What Makes a Good Doctor? This is the question that Waseem Jerjes and I explore in the Journal of the Royal Society of Medicine . It is a key question that underpins the architecture of medical education, clinical practice, regulation, and professional identity. It cannot be answered by regulators, educators, or employers in isolation. It must be answered together – by doctors and patients – revisited throughout a career, and adapted as society and the profession change. Without that shared reflection, the danger is not simply disillusionment, but the erosion of the moral foundations of clinical work. As we enter an era when diagnosis will increasingly involve artificial intelligence and when performance metrics reward volume over value, reclaiming this question as a professional one is imperative. The integrity of our institutions – and of the practitioners within them – depends on reimagining excellence in inclusive, relational terms. A good doctor is not a flawless technician or a f...

The use of weight-loss drugs such as GLP-1 receptor agonists (e.g., semaglutide, tirzepatide) has increased rapidly in recent years. These drugs can help some people achieve significant weight reduction, but they are not suitable for everyone and require careful counselling before starting treatment. By discussing benefits, risks, practicalities, and  uncertainties, clinicians can help patients make informed, realistic decisions about their treatment. Key points to discuss with patients 1. Indications and eligibility These drugs are usually licensed for adults with a specific BMI. They should be used alongside lifestyle interventions such as dietary change, increased physical activity, and behaviour modification. 2. Potential side effects – some can be serious Common adverse effects include nausea, vomiting, diarrhoea, and abdominal discomfort. Less common but more serious risks include gallstones, pancreatitis and visual problems. Patients should know what to watch for a...