Blog posts

Does Online Access to Medical Records Help Patients and Improve the Quality of Healthcare?

There was a lot of discussion in the government’s 10 year health plan about digital interventions such as giving people online access to their medical records. But does this improve healthcare delivery and clinical outcomes? This was the topic of our recent systematic review published in the journal BMJ Quality and Safety. We found that giving people online access to their medical records increased self-reported patient-centredness and improved some aspects of patient safety. But many questions about the benefits of online access remain unanswered.

The Good News: Empowering Patients

On the positive side, we found clear evidence that giving people online access to their medical records increased self-reported patient-centeredness. What does that mean in simple terms? Patients felt more involved, informed, and in control of their own care. This shift from a passive recipient to an active participant is a cornerstone of modern healthcare and is a significant win for patient empowerment.

We also found that this digital access improved some aspects of patient safety. While the full scope of this finding is still being explored, it suggests that when patients can review their own records, they may be able to spot potential errors or inconsistencies, acting as an extra layer of oversight.

The Reality Check: More to Learn

While these findings are encouraging, our review made it clear that the story is far from over. Despite the positive results, many questions about the broader benefits of online access remain unanswered. We still need more research to fully understand the long-term impact on overall clinical outcomes, patient-provider relationships, and potential unintended consequences.

The transition to a digital healthcare system is a complex one, and it’s important that we continue to base our decisions on robust evidence. While online access to medical records holds great promise for a more informed and empowered patient population, our work shows we are only at the beginning of this journey.

Is the Government’s 10-Year Health Plan for England a Prescription for Success?

The government’s recently published 10-Year Health Plan outlines a strategic vision for the National Health Service (NHS) in England, focusing on shifting care from hospitals to community settings, making greater use of digital technology like the NHS App to improve the efficiency and accessibility of health services, and prioritising preventive care over reactive treatment. While these objectives are commendable, they have been present in government plans spanning the last three decades, raising concerns about how successfully they will be implemented.

Although very welcome, the increases in NHS funding in the plan are not as large as those seen under the previous Labour government from 1997-2010. This disparity in financial commitment could significantly impact the scope and pace of the proposed reforms if not matched by substantial increases in NHS efficiency and productivity.

Furthermore, a heavy reliance on digital solutions, risks excluding vulnerable populations. Elderly individuals or those with limited IT skills may find themselves marginalised, exacerbating existing health inequalities. Additionally, an overly centralized, top-down approach to control of the NHS could stifle local innovation in the diverse health and care landscape in England.

To ensure the plan’s success and avoid the failures of previous long-term NHS plans, it is essential that the ambitious objectives in the plan are supported by the appropriate contractual changes and the required workforce developments. Without these foundational elements, the 10-Year Health Plan risks becoming another repeat of well-intentioned, but ultimately unfulfilled, past government promises about transforming the NHS in England.

We Should Celebrate – Not Discourage – Overseas Students in the UK

As a university academic, I am disheartened by the way some politicians and sections of the media portray overseas students. Rather than acknowledging the many economic, cultural, and academic benefits these students bring to the UK, they are too often depicted as a burden. This is a narrative that is not only misleading but potentially damaging.

International students choose to come to the UK because of the global reputation and quality of our universities. Despite the very high tuition fees they are charged, they continue to enrol in large numbers. These students bring with them diverse perspectives, enrich our academic communities, and foster global networks that benefit British research, innovation, and diplomacy.

The financial contribution of international students is also well established. They help sustain many of our universities, support thousands of jobs across the country, and contribute billions to the UK economy each year. Beyond that, they play an integral role in cultural exchange, helping to make our campuses and our society more open, inclusive, and outward-looking.

Yet, education is a global market. These students have choices. If they begin to feel unwelcome in the UK — whether this is due to hostile political rhetoric, restrictive visa policies, or a lack of post-study opportunities — they will go elsewhere for their university education. Other countries are competing aggressively for their presence, and the UK risks losing out not just on tuition income, but on talent, innovation, and global goodwill.

It is time for a more constructive and respectful discourse around international students. We should remember that recognises international students are not a problem to be solved, but as are an important part of what makes our universities world-leading and culturally enriching for all their students.

The future of the NHS GP Quality and Outcomes Framework in England

My new editorial in the BMJ discusses the GP Quality and Outcomes Framework (QOF). My conclusion is that QOF in England requires selective reform rather than wholesale abolition. While QOF initially improved recorded quality of care through financial incentives,  these gains are not always sustained long-term and may not reflect true clinical improvements.

Policymakers should be encouraged to retain the most effective elements — particularly those related to early detection and management of long-term conditions — while removing less useful or overly bureaucratic aspects. Going forward, QOF should be integrated into a broader strategy that supports sustainable quality improvement, continuity of care, and minimised administrative burden, using developments in information technology to support better outcomes and reduce health inequalities.

Majeed A, Molokhia M. Impact of pay for performance in primary care. BMJ 2025; 389 :r1171 doi:10.1136/bmj.r1171

Why we need a new funding model for NHS general practice In England

A properly weighted and adequately resourced funding model for general practices n England is essential if we are to reduce health inequalities and ensure high-quality primary care for all. The announcement of a review of the Carr-Hill Formula is therefore very welcome and long overdue.

The current NHS funding formula for general practice in England has not kept pace with changing population needs and does not sufficiently account for levels of deprivation or the complexity of care required in more disadvantaged communities. We know that general practices in deprived areas face higher levels of multimorbidity, greater social complexity, and significantly greater demand. Yet NHS funding for primary care has not adequately reflected these realities.

It is also essential that any changes to the Carr-Hill Formula are accompanied by an overall increase in funding for NHS general practice in England. Simply redistributing a fixed pot of funding risks creating new pressures in other areas that have funding taken away from them, and further destabilising primary care services that are already stretched. We need to increase overall investment in general practice so that patients in deprived communities receive the care they need without compromising provision elsewhere.

Assisted Dying: Serious Practical Questions Remain Unanswered

MPs who voted in support of assisted dying — and indeed many doctors and other healthcare professionals who support such measures — may not have fully considered the profound practical challenges this would present for the NHS and for medical education and training.

Implementing an NHS-based assisted dying service would be a vast and complex undertaking. At present, the NHS is neither prepared nor equipped to deliver such a service in a safe, equitable, and ethical way. There is no public funding allocated for assisted dying. As Secretary of State Wes Streeting has rightly pointed out, any future funding would inevitably have to come at the expense of other health services that are already under considerable strain.

Beyond funding, the educational and professional implications for the medical workforce have barely been addressed. There has been no clear plan for how assisted dying would be integrated into undergraduate medical education or postgraduate clinical training — nor how issues of conscientious objection, professional standards, and clinical governance would be handled in practice. Integrating assisted dying into undergraduate education and postgraduate training would require new frameworks, ethical guidelines, and practical training modules. Developing these educational and training programmes would take years and require significant investment, with no clear plans for this currently in place.

The complexity of implementation—financially, educationally, and ethically—suggests that any move toward assisted dying would require far more planning than current discussions reflect. Without addressing these fundamental questions, any move toward legalising assisted dying risks creating more problems than it solves. Policymakers, healthcare leaders, doctors, other healthcare professionals and the public deserve a much fuller and more honest debate about what such a profound change would truly require.

Balancing Free Speech and Institutional Responsibility in England’s Universities

The Office for Students (the independent regulator of higher education in England) has suggested that students should be prepared to be “shocked and offended” at university as part of the educational process. This policy seeks to promote freedom of expression and open debate within academic settings. However, implementing such an approach poses significant challenges for both university staff and students. Institutions must not only consider the legal boundaries surrounding freedom of expression in the UK but also manage the practical and ethical complexities involved in fostering an environment that encourages robust discussion while protecting the rights and well-being of all members of the university community.

The first challenge for universities is that the UK does not allow full freedom of expression. There are many laws that limit what people in the UK can say, and these are often different from limits on freedom of expression in other countries. For example, the USA generally has fewer restrictions on freedom of expression than the UK.

UK laws aim to balance freedom of expression with other societal interests, such as public safety, national security, and the protection of individual rights. Some of the relevant laws include:

1. Public Order Act 1986

2. Communications Act 2003

3. Malicious Communications Act 1988

4. Defamation Act 2013

5. Counter-Terrorism and Border Security Act 2019

6. Online Safety Act 2023

7. Obscene Publications Act 1959

8. Equality Act 2010

Universities will have to consider whether the views that their staff and students express are in breach of any of these laws. Incorrect interpretation of the law by universities may expose them, and the staff or students expressing potentially illegal views, to legal action.

Beyond legal constraints, universities face additional challenges in enforcing internal policies. As responsible employers, universities will have policies to address issues such as bullying, harassment, and discrimination — particularly in relation to protected characteristics such as sex, ethnicity, and disability. Failing to protect individuals or groups could result in internal complaints, referrals to external bodies such as the Office for Students, and potentially legal action. The dividing line between what is legal and illegal may not be clarified until tested in court. For example, how does allowing students to be “shocked and offended” align or conflict with the legal duty to prevent harassment?

The government has not provided clear evidence that a major problem exists regarding staff and students being unable to express their views freely within UK universities. What we may see instead is an increase in complaints and legal challenges, which could consume significant institutional time and resources. Although the aims of the Office for Students may be well-intentioned, the practical challenges of implementing this policy are considerable. Universities must carefully navigate complex legal frameworks and their own institutional responsibilities to ensure both freedom of expression and protection from harm.

Without clearer guidance and stronger evidence of a significant underlying problem, there is a risk that universities will expend considerable time and resources responding to legal uncertainties and complaints. A more constructive and collaborative approach — one that supports universities in fostering open debate while upholding legal and ethical standards — may ultimately prove more effective in promoting freedom of expression within higher education.

Abolishing NHS England will make only modest savings

Abolishing NHS England and reducing Integrated Care Board (ICB) staffing by 50% may appear substantial, but the projected savings – around £500 million annually if fully achieved – would represent only a modest increase (approximately 0.25%) in annual NHS funding in England, given the NHS England budget is approaching £200 billion per year. Evidence from past NHS reforms (like the 2012 Health and Social Care Act) shows mixed results; some efficiency gains but often offset by new layers of complexity elsewhere in NHS structures.

Without parallel initiatives to streamline administrative processes, improve efficiency, and enhance clinical productivity, such structural changes to NHS England and ICBs alone will not significantly improve frontline clinical care or health outcomes. Administrative costs, while important to minimise, make up a relatively small proportion of the overall NHS budget. Genuine productivity gains will therefore require systematic reforms aimed at reducing unnecessary bureaucracy and optimising workforce deployment, alongside strategically investing in information technology and process improvements.

Reference

Majeed A. Abolishing NHS England will make only modest savings. BMJ 2025; 389 :r788 doi:10.1136/bmj.r788

Digital Kiosks in Emergency Departments: Can They Enhance Efficiency and Patient Care?

Emergency departments (EDs) are often the first point of contact for patients requiring urgent medical attention. With increasing patient volumes and limited resources, EDs face challenges in maintaining efficiency and ensuring timely care. A recent systematic review published in the Journal of Medical Internet Research by our research group explores the role of digital check-in and triage kiosks in addressing these challenges.

Key Findings from the Systematic Review

The review analysed five studies conducted between 2019 and 2022 across Canada, the United States, and the United Kingdom, encompassing a total of 47,778 patients and 310,249 ED visits. These studies varied in design, including cross-sectional analyses, pilot studies, retrospective analyses, and randomised controlled trials,

  1. Efficiency Improvements
    Digital kiosks have been associated with reduced patient wait times and improved patient flow within EDs. By streamlining the check-in and triage processes, these kiosks can expedite patient assessment and allocation to appropriate care pathways.
  2. Patient Safety and Accuracy
    The studies reviewed indicated that digital kiosks can accurately capture patient information and symptoms, aiding in effective triage decisions. However, the accuracy is contingent upon the design of the kiosk interface and the algorithms used for symptom assessment.
  3. Patient Satisfaction
    Patient responses to digital kiosks were generally positive, with many appreciating the privacy and autonomy provided during the check-in process. Nonetheless, some patients expressed a preference for human interaction, highlighting the need for a balanced approach.

Considerations for Implementation

While digital kiosks offer promising benefits, their successful integration into ED workflows requires careful planning:

  • Accessibility: Ensuring that kiosks are user-friendly for patients of all ages, languages, and technological proficiencies is crucial.
  • Integration with Existing Systems: Kiosks should seamlessly integrate with electronic health records and other hospital information systems to maintain continuity of care.
  • Staff Training: ED staff should be trained to assist patients with kiosk use and to interpret the data collected effectively.
  • Continuous Evaluation: Ongoing assessment of kiosk performance and patient outcomes is necessary to identify areas for improvement.

Conclusion

Digital check-in and triage kiosks present a valuable tool for enhancing efficiency and patient care in emergency departments. While they are not a panacea, when thoughtfully implemented, they can alleviate some of the pressures faced by EDs and contribute to improved patient experiences.

For a more detailed exploration of this topic, refer to our full article in the Journal of Medical Internet Research: Safety and Efficacy of Digital Check-in and Triage Kiosks in Emergency Departments: Systematic Review.

Barriers to Dementia Care Services in Europe: Key Insights and Ways Forward

Dementia, including Alzheimer’s disease, is a significant public health challenge in Europe, with nearly 14 million people currently affected. Despite available healthcare and social care services, utilisation of these services by people living with dementia remains suboptimal due to various barriers. Our recent systematic review published in BMC Geriatrics provides critical insights into these challenges, highlighting barriers across informational, organisational, cultural, stigma-related, financial, and logistical domains.

Informational and Educational Barriers

A lack of awareness and insufficient knowledge among caregivers and healthcare professionals stands out as a key barrier. Inadequate dissemination of dementia-related information contributes to difficulties in planning and accessing appropriate care. Enhancing educational resources and improving health literacy among caregivers and healthcare workers are essential for overcoming these challenges.

Organisational Barriers

Fragmented services and poor coordination among healthcare providers frequently hinder effective dementia care. Issues such as inconsistent care strategies, unclear roles, and insufficient resources exacerbate the difficulties faced by families and professionals alike. The Covid-19 pandemic has further intensified these problems, highlighting the urgency for integrated, person-centred care systems.

Cultural and Stigma-related Challenges

Societal stigma and cultural misunderstandings significantly impact dementia care, deterring individuals from seeking necessary help. Cultural sensitivity, improved community education, and targeted interventions can mitigate stigma-related issues, promoting better acceptance and utilization of dementia services.

Financial and Logistical Challenges

The economic burden of dementia care often strains family resources, compounded by complex administrative procedures and insufficient public funding. Additionally, logistical issues, including long waiting lists, transportation problems, and limited service availability, particularly in rural areas, create further barriers.

Policy Recommendations

To address these challenges, tailored, context-specific policies and integrated care pathways are necessary. European initiatives, such as Alzheimer Europe’s Strategic Plan and the Glasgow Declaration, underline the importance of inclusive strategies and active involvement of people with dementia in policy-making processes.

By addressing these identified barriers through coordinated actions, Europe can improve access to dementia care, enhancing the quality of life for individuals living with dementia and also for their caregivers.