Blog posts

Combining Clinical Practice with Research: What do I Need to Know?

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 meaningfully to the future of medicine

1. I’m early in my career. What are the first practical steps to get involved in research?

Identify a clinician or academic in your department or general practice who is active in research and ask if they have any ongoing projects where you could help. Joining a collaborative research network (like trainee-led groups) is another way to get involved in research.

2. I’m an experienced doctor—is it too late to get involved in research?

Absolutely not. Experienced clinicians can make an important contribution to research because they have a good understanding of topical clinical issues that that need addressing. For example, you can contribute to projects supported by the National Institute for Health and Care Research (NIHR). These studies often require local investigators who can help identify and recruit research participants and help with the collection of data. This can provide an entry into research as the NIHR can offer training, financial support for helping with research recruitment and the opportunity to join wider professional networks in your area.

3. I’m worried I don’t have time. How can I carve out protected time for research?

This is a key obstacle as clinicians will have busy jobs and may also be studying for professional exams in their spare time as well as having family or caring commitments. The most structured way is through NIHR-supported Integrated Academic Training (IAT) pathways like Academic Clinical Fellowships (ACFs) or Clinical Lectureships (CLs) in England). If you are not on a formal research training pathway, see if you can negotiate some research time. For example, some GP Vocational Training Schemes will allow trainees to spend a block of time in a local academic department. You can also look for an Out of Programme period to focus entirely on a project without clinical distractions.

4. What kinds of research roles are there?

Roles range from Clinical Research Fellow positions (often working toward a MSc degree or developing an application for a PhD fellowship) to Principal Investigators (leading a site for a trial). Research skills can also be learned from involvement in clinical audits o quality improvement projects. Although these are not classed as research they require similar skills in areas such as evidence synthesis, data collection, statistical analysis and writing up the results for publication in an academic journal or presentation at a conference.

5. Do I need a higher degree (MSc, MRes, MD, PhD), and when should I consider one?

You do not need a higher degree to participate in research or publish academic articles, but if you want to become an independent researcher or secure an academic position such as a clinical lectureship, a PhD or MD is needed. Consider an MSc, MPH or MRes early in your career to develop core research skills, and a PhD when you have a specific project you want to work on for a few years.

6. How can I find opportunities and funding?

Networking is essential. Attend departmental research meetings as well as local and national academic conferences. For funding, look at major bodies like the NIHR, MRC, or Wellcome Trust, as well as specialty-specific charities (e.g., British Heart Foundation). Many hospitals may also have some internal grants for small pilot projects or short-term research fellow roles.

7. How can I identify a good research question or choose an area of interest?

Look for at your daily clinical practice. Is there a treatment that doesn’t work well? A diagnostic delay you see repeatedly? Also keep up to date with the academic literature to see what research has been done and what research questions remain to be answered.

8. What skills should early-career clinicians focus on?

Knowledge of epidemiology, biostatistics and writing for publication are very helpful. Obtaining a Good Clinical Practice (GCP) certificate is also useful.

9. Will doing research impact my clinical training and career prospects?

In the longer term, research can enhance your career prospects, Furthermore, after completing specialty training, a clinical academic career can be very fulfilling professionally and reduce the stresses associated with full-time clinical work.

10. What are the positives and negatives of splitting my time?

  • Positives: Variety in your working week, the ability to influence future care for patients (rather than just the patient in front of you), intellectual stimulation and professional recognition.
  • Negatives: Being a clinical academic can sometimes feel you have two busy jobs. You have to be disciplined and ensure that the work within the clinical and research roles remains contained within the allocated time.

A New Vaccination Plan for England Must Start with Reinvesting in General Practice

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 side-line 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 stretched, these functions weaken and coverage falls as we have seen over the past decade.

The decline in our national vaccination rates is not therefore an inevitability; it is a direct consequence of a strained primary care system. We must stop looking for ‘quick fixes’ and new administrative layers and instead return to what has worked in the past: a well-funded and adequately-staffed General Practice system.

Managing Complications of Overseas Medical Procedures

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 structured follow-up, continuity of care, and access to the original operating team. Once complications arise, patients may find themselves without support from the healthcare provider who delivered the procedure.

The impact of these cases extends beyond general practice and is increasingly felt in NHS emergency departments. Patients may present acutely with sepsis, bleeding, wound failure, or suspected thromboembolic disease, often without any reliable documentation of the original procedure. This creates significant diagnostic and risk-management challenges for clinicians working in emergency departments, leading extensive investigations, senior clinician input, and sometimes to precautionary admission to an NHS hospital. These presentations add to the pressures on already overstretched emergency services.

These presentations place a significant additional burden on general practice. Consultations are typically longer and more complex, requiring careful documentation, risk management, and coordination with secondary care. This work is undertaken within already stretched services and is often compounded by medico-legal uncertainty. More broadly, the NHS absorbs the cost and workload of managing complications from procedures that were neither planned nor delivered within the UK healthcare system.

Together, these challenges highlight the need for improved patient awareness of the risks associated with overseas medical treatment, clearer clinical pathways for managing post-procedure complications, and greater recognition of the pressure placed on NHS services; including general practice, emergency departments, and specialist teams. Addressing these issues will be increasingly important as international medical travel continues to grow.

Embedding AI Error Detection Into Primary Care Safety Culture

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-trust AI outputs. To mitigate these risks, we call for routine AI oversight in practice (including review, sampling, and escalation), explicit clinician accountability for AI-influenced outputs, patient engagement in spotting discrepancies, and closer collaboration with AI developers.

Ultimately, AI errors are inevitable, and that embedding AI safety as a core, proactive design feature – rather than an afterthought – is essential to ensure AI enhances rather than compromises patient safety in primary care.

The role of vaccination, infection control measures and early treatment in curbing the impact of flu

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 reducing the risk of GP consultations and hospital admissions in older adults. In primary care, we also see the wider benefit of vaccination in helping to protect the NHS by reducing demand on GP appointments, out-of-hours services, and emergency care during the winter months.

General practices — working closely with community pharmacies — play a crucial role in delivering the flu vaccination programme, identifying eligible patients, reaching underserved groups, and offering trusted, personalised advice. Many patients value the opportunity to discuss vaccination with their GP or practice nurse, and these trusted relationships are central to addressing concerns, tackling vaccine hesitancy, and improving uptake. It is absolutely still worth vaccinating eligible patients now; protection begins within 10–14 days.

Alongside vaccination, simple practical measures remain important: good hand hygiene, staying at home when unwell, and seeking timely advice if symptoms worsen. For higher-risk patients who develop suspected influenza, antiviral treatment with oseltamivir or zanamivir is recommended if started within 48 hours of symptom onset — or later in severe illness or immunocompromised patients. Those eligible for antiviral treatment include people aged 65 and over, pregnant women, and individuals with long-term conditions or immunosuppression.

Flu should not be underestimated. For some patients it can be life-threatening, but many cases are preventable through vaccination, early treatment in high-risk groups, and sensible infection-prevention measures.

Relevance Over Recall: Rethinking How AI Uses Clinical Data

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 not only risks misdirecting clinical care, but also adds to information overload, exacerbates cognitive burden and contributes to clinician burnout. Importantly, it can also undermine patient trust when obsolete or stigmatising terms continue to shape interactions with the clinicians and the healthcare system.

Getting mental health diagnoses right without undermining access to care and disability rights

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 restricting access to treatment, reasonable adjustments, or disability benefits. The increase in diagnosed mental-health and neurodevelopmental conditions reflects, in large part, years of unmet need and increasing public willingness to seek help. Tightening diagnostic thresholds or narrowing eligibility criteria risks penalising individuals who already face significant barriers to care, particularly those from disadvantaged communities. It also risks pushing desperate families towards unregulated private providers.

Framing this issue as one of “too many diagnoses” is unhelpful. It risks stigmatising people who are already struggling and undermines recent progress in public understanding of neurodiversity and mental health. The question we should be asking is not “How do we reduce the numbers?” but “How do we ensure people receive timely, appropriate and equitable support?”

If the government wants to improve outcomes, the path forward is clear: strengthen diagnostic pathways, expand clinical capacity, invest in multidisciplinary teams, and safeguard the rights and protections that enable people to live well. Any attempt to use the review as justification for cuts, gatekeeping, or narrowing access would be a profound step backwards.

A better mental health system is one that supports people — not one that seeks to reduce the number who qualify for support. The review should be a catalyst for improvement, not an excuse for limiting care.

Balancing Innovation and Affordability: The New UK Approach to Drug Pricing

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 have could benefit patients and strengthen the UK’s life sciences sector. But they will require careful monitoring to ensure that the promised improvements in access, equity, and health outcomes are realised; whilst also managing the financial challenges for an already pressured NHS.

Teaching medical trainees to see societal infrastructure as a clinical issue

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 to include infrastructure as a proximal driver of disease, thereby reducing health inequities and enabling clinicians to engage meaningfully in structural interventions beyond traditional biomedical care.

From Lloyd George Envelopes to Artificial Intelligence: The Evolution of Medical Records in Primary Care

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 transforming how we document, code, and retrieve information on people’s healthcare. Over time, these systems became essential clinical tools by enabling prescribing safety checks, audit, population health management as well as research and quality improvement.

Today, almost every consultation, prescription, and referral is logged electronically. The electronic health record (EHR) has become the backbone of primary care. Yet, despite these advances, challenges remain: data fragmentation across systems, burdensome data entry, and limited interoperability between sectors.

Looking ahead, I believe we are on the verge of another major transformation. Artificial intelligence (AI) and machine learning have the potential to redefine how we record, understand, and act on health information. In the coming years, we can expect:

  • AI-assisted consultation notes, automatically generated from clinician–patient conversations.

  • Predictive analytics, helping us identify patients at risk of deterioration or with unmet health needs.

  • Natural language processing, allowing clinicians to query records using plain English.

  • Integrated patient data, linking information from hospitals, social care, and personal devices.

The shift from the Lloyd George envelope to intelligent digital systems represents more than just technological progress. It also reflects an ongoing effort to improve care, enhance safety, and make information work for both clinicians and patients.

As we look to the future, the challenge will be ensuring that these innovations support, rather than replace, the human connection that is at the heart of general practice. The tools may change rapidly, but our purpose remains the same: delivering compassionate, person-centred care grounded in good records and good professional relationships.