Author: Azeem Majeed

I am Professor of Primary Care and Public Health, and Head of the Department of Primary Care & Public Health at Imperial College London. I am also involved in postgraduate education and training in both general practice and public health, and I am the Course Director of the Imperial College Master of Public Health (MPH) programme.

Evaluating NHS policies in political manifestos

As we approach a general election in the UK, the different political parties are all now starting to present their proposed health policies. It is crucial for the public, journalists and health professionals – and also for politicians from other political parties – to rigorously scrutinise these proposals. This assessment should be based on key criteria to determine their effectiveness and value for money. The following essential questions should be considered when doing this:

 

1. Will This Policy Improve Patient Experience?

Accessibility: Does the policy make healthcare services more accessible to patients, including underserved populations such as poor and ethnic minorities?

Quality of Care: Will the policy enhance the quality of care patients receive, including aspects such as safety, effectiveness, and patient-centeredness?

Patient Satisfaction: How will the policy impact patient satisfaction and overall experience with the NHS?

Equity: Does the policy address health disparities and ensure equitable care for all patients leading to a reduction in health inequalities?

 

2. Will the Policy Improve Clinical Outcomes?

Evidence-Based: Is the policy based on robust clinical evidence and best practices that are proven to improve health outcomes?

Prevention: Does the policy include preventive measures that can reduce the incidence of diseases and improve long-term health?

Integration of Services: Will the policy enhance the integration of services across primary, secondary, and tertiary care, facilitating better coordination and continuity of care?

Innovation: Does the policy encourage the adoption of innovative technologies and treatments that can lead to better clinical outcomes?

 

3. Will the Policy Improve NHS Efficiency?

Resource Utilisation: Does the policy promote efficient use of NHS resources, including workforce, equipment, and facilities?

Streamlining Processes: Will the policy streamline administrative and clinical processes, reducing waste and duplication of efforts?

Capacity Management: Does the policy address issues related to capacity management, such as reducing waiting times and optimizing bed usage?

Data and IT Systems: Will the policy enhance the use of data and IT systems to improve efficiency and support clinical decision-making?

Appropriate Skill-Mix: Does the new service use NHS staff appropriately and are there sufficient trained staff to deliver the programme?

 

4. Is the Policy Cost-Effective?

Cost-Benefit Analysis: Has an adequate cost-benefit analysis been carried out to evaluate the economic impact of the policy?

Sustainable Funding: Is there a sustainable funding model in place to support the implementation and maintenance of the policy?

Long-Term Savings: Will the policy result in long-term savings by preventing costly health complications and improving overall public health?

Allocation of Funds: Are the proposed funds allocated in a way that maximises health benefits relative to the investment?

Alternative Investment: Would investment in an existing service such as NHS general practices be more cost-effective than setting up a new service?

 

5. Conclusion

At a time when government finances in the UK are under severe pressure, it is essential to ensure that health policies not only address immediate healthcare needs but also contribute to sustainable improvements in patient experience, clinical outcomes, and NHS efficiency.

By asking these critical questions, the public, media, politicians, health professionals, and other stakeholders can better evaluate the viability and impact of proposed health policies. This approach ensures that public resources are used effectively to achieve the best possible health outcomes at a reasonable cost.

Structured medication reviews for patients with multimorbidity and polypharmacy

Polypharmacy, or the use of multiple medications simultaneously, is a growing concern, especially among older people. Nearly one-third of people aged over 65 years of age in the UK take five or more medications daily. This is because people are living longer and often have multiple chronic illnesses that require medication.

The Risks of Polypharmacy

When people take many medications, there’s a risk that some may not be necessary or might even be harmful. This can lead to:

  • A heavy burden of managing multiple medications daily, which is time-consuming and stressful for patients.
  • Difficulty in sticking to complex medication routines, especially for people with low health literacy or poor English language skills.
  • Increased chances of adverse drug reactions and interactions, leading to potential harm and is severe cases to hospital admission.

Given these risks, optimizing medication use is crucial, especially for those with multiple health issues.

Medication Reviews (MRs)

One way to address the problems of polypharmacy is through medication reviews. This process involves a detailed assessment of a patient’s medications to ensure they are appropriate, safe, and effective. However, studies show mixed results on their effectiveness. While they may improve medication-related outcomes, they don’t always significantly impact overall health or quality of life.

The Rise of Structured Medication Reviews (SMRs)

Recognising the limitations of traditional medication reviews, structured medication reviews (SMRs) have been introduced. SMRs offer a more comprehensive approach, focusing on:

  • Tailoring medication plans to the individual needs, preferences, and circumstances of the patient.
  • Including patients and their families in decision-making about their medications.
  • Often involving a multidisciplinary team for complex cases to ensure a thorough review.

The Impact of COVID-19 and Technology

The COVID-19 pandemic accelerated the use of technology in healthcare, including remote care options like phone, video, or online consultations. This shift aims to provide convenient, rapid access to healthcare and could improve the delivery of medication reviews. However, it’s still unclear how effective remote SMRs are compared to in-person reviews.

The Need for Further Research

While SMRs show promise, more research is needed to understand:

  • How well SMRs work for different patient populations, especially those in primary care.
  • The impact of remote delivery of SMRs on patient outcomes.
  • How SMRs can best be implemented to improve health outcomes for those with complex medical needs.

Conclusion

Structured Medication Reviews represent a significant advance in managing polypharmacy, aiming to tailor medication plans to individual needs and involving patients in the process. However, ongoing research and adaptation, especially with the rise of remote healthcare, are necessary to maximise their benefits and ensure they meet the needs of diverse patient populations in the UK and elsewhere.

Structured medication reviews for adults with multimorbidity and polypharmacy in primary care: a systematic review protocol. https://bmjopen.bmj.com/content/14/5/e082825.full

A New Era in Alzheimer’s Disease: Promising Advances in Diagnosis and Treatment

Alzheimer’s disease (AD) is a devastating condition affecting millions of people worldwide, with a significant impact on patients, families, and healthcare systems. Recent breakthroughs in diagnosis and treatment are offering new hope. Let’s explore these exciting developments and what they mean for the future of Alzheimer’s care based on our recent article in the The Journal of Prevention of Alzheimer’s  Disease.

The Rising Challenge of Alzheimer’s Disease

Globally, Alzheimer’s disease is the most common cause of dementia, contributing to the majority of late-onset dementia cases. With an aging population, the number of people affected by Alzheimer’s is expected to rise, even if the age-specific rates of incidence and prevalence remain stable. This increase poses a significant challenge to healthcare systems, families and carers.

Current Diagnostic Pathways

Traditionally, diagnosing Alzheimer’s involves a combination of clinical assessments, imaging studies, and cerebrospinal fluid (CSF) tests. While these methods are effective, they are also invasive, costly, and not widely accessible. This has created a barrier to early and accurate diagnosis, particularly in primary care settings.

A Breakthrough in Diagnosis: Blood-Based Biomarkers

One of the most exciting developments in Alzheimer’s research is the emergence of blood-based biomarkers. These biomarkers can detect the pathological signs of Alzheimer’s disease, such as amyloid and tau protein levels, through a simple blood test. This innovation offers a less invasive, more scalable, and cost-effective diagnostic tool, potentially revolutionizing the way Alzheimer’s is diagnosed and managed.

Key Benefits of Blood-Based Biomarkers:

  • Non-Invasive: Unlike lumbar punctures and PET scans, blood tests are much less invasive and easier to administer.
  • Accessibility: Blood tests can be conducted in both primary and specialist care settings, making early diagnosis more accessible.
  • Cost-Effective: These tests are expected to be more affordable than current diagnostic methods, reducing the financial burden on healthcare systems.

Advancements in Treatment: Monoclonal Antibody Therapies

Recent trials of novel disease-modifying therapies (DMTs) using anti-amyloid monoclonal antibodies, such as Lecanemab and Donanemab, have shown promising results. These therapies target and reduce amyloid plaques in the brain, which are characteristic of Alzheimer’s disease. Administered early in the disease course, these treatments have the potential to slow cognitive decline and improve quality of life.

Challenges and Considerations:

  • Cost: The high cost of these therapies presents a significant challenge, especially given the large number of potential patients.
  • Infrastructure: Implementing these therapies requires substantial investment in healthcare infrastructure, including diagnostic and treatment capacity.
  • Training: Healthcare professionals need training to administer these new treatments and manage potential side effects.

Readiness of Healthcare Systems

Adopting these new diagnostic tools and therapies on a large scale will require healthcare systems to overcome several hurdles. Increased diagnostic capacity, additional training for healthcare workers, and greater public awareness are essential steps. Additionally, ensuring these treatments are affordable will be crucial for their widespread adoption.

The Future of Alzheimer’s Care

The integration of blood-based biomarkers and monoclonal antibody therapies marks a new era in Alzheimer’s care. These advancements hold the promise of earlier diagnosis, more effective treatments, and improved outcomes for patients. However, realizing this potential will require coordinated efforts to address the financial, logistical, and educational challenges involved.

Conclusion

The fight against Alzheimer’s disease is entering an exciting phase with the development of innovative diagnostic tools and treatments. By investing in these advancements and addressing the challenges, we can hope for a future where Alzheimer’s is diagnosed earlier and managed more effectively, improving the lives of millions affected by this debilitating disease.

See https://link.springer.com/article/10.14283/jpad.2024.83 for article.

Semaglutide and Cardiovascular Disease: Looking Critically at Absolute Risk Reduction, Cost-Effectiveness and Safety

The recent media coverage on semaglutide’s potential in reducing the risk of cardiovascular disease (CVD) has raised hopes and questions alike. While the drug has shown promise in reducing cardiovascular risk, it’s crucial to look beyond the relative risk reduction figures often highlighted in the news.

To truly understand the impact of semaglutide, we must delve into the absolute risk reduction, cost-effectiveness, and long-term safety data. While the reported relative risk reduction is significant, it’s crucial to consider the absolute risk reduction to accurately assess the semaglutide’s effectiveness and calculate the number needed to treat (NNT) to prevent one adverse CVD event.

These principles can be used to look at how any drug should be used in healthcare system’s such as the UK’s NHS. What are the key considerations?

Relative Risk Reduction (RRR): Indicates the percentage reduction in risk between the treatment group and the control group.

Absolute Risk Reduction (ARR): Measures the actual difference in event rates between the treatment and control groups, offering a clearer view of the treatment’s real-world impact.

Number Needed to Treat (NNT): NNT is derived from the ARR and indicates how many patients need to be treated to prevent one adverse event. It is calculated as NNT = 1/ARR.

Relative risk reduction (RRR), a commonly reported statistic in research articles and press releases, can sometimes exaggerate a drug’s benefits. Absolute risk reduction (ARR), on the other hand, provides a clearer picture of the actual difference in risk between those taking the medication and those who are not. This is crucial because a seemingly impressive RRR might translate to a small ARR, especially in low-risk populations.

The number needed to treat (NNT), derived from the ARR, tells us how many patients need to be treated to prevent one adverse event. A lower NNT indicates a more effective treatment. Understanding the NNT in different risk groups is essential for making informed decisions about treatment and resource allocation.

Importance in Different Risk Populations:

High-risk patients often show more substantial absolute benefits from treatments. In lower-risk patients, the ARR might be smaller, leading to a larger NNT, which influences cost-effectiveness and decisions about resource allocation.

Cost-Effectiveness: Assessing the economic viability of semaglutide involves comparing the cost of the drug against the healthcare savings from prevented CVD events. While semaglutide shows potential in CVD prevention, its cost-effectiveness is a significant factor, particularly for healthcare systems with limited budgets. Thorough health economics studies are needed to weigh the drug’s cost against the potential savings from prevented CVD events. This will help determine if the benefits justify the expense, especially for widespread use.

Hence, health economics studies are essential to determine if the benefits justify the expense, particularly in public health systems with budget constraints.

Side Effects and Safety Profile: Understanding the adverse effects of semaglutide is critical. Long-term safety data, as well as information on the severity and frequency of side effects, must be evaluated. Balancing the benefits of CVD risk reduction against potential harms from side effects is necessary for informed decision-making.

Semaglutide’s long-term safety profile is still under investigation. While initial studies are promising, continued monitoring is crucial to identify any potential side effects or risks associated with prolonged use. Balancing the benefits of CVD risk reduction against potential harms is essential for responsible decision-making.

The Road Ahead: Research and Evidence

To fully harness the potential of semaglutide in CVD management, we need more comprehensive data. This includes detailed reporting of ARR in diverse patient populations, robust cost-effectiveness analyses in various healthcare settings, and long-term studies to monitor safety and efficacy. While semaglutide shows promise in the treatment of CVD, more comprehensive data is required to fully understand its impact, particularly in areas such as the ARR in different patient populations (such as those at low risk of CVD)to calculate precise NNT values.

Conclusion: Semaglutide shows promise as a valuable tool in the fight against cardiovascular disease. However, it is essential to maintain a critical eye. By focusing on metrics such as absolute risk reduction, cost-effectiveness, and long-term safety data, we can make informed decisions that prioritise patient well-being and responsible resource allocation. As research continues, we will gain a clearer understanding of semaglutide’s role in CVD prevention and treatment, paving the way for its appropriate use by healthcare systems across the world.

Preserving the Essence of NHS Primary Care

In some parts of England, proposals are emerging to divide NHS primary care services into separate pathways for acute, same-day care and long-term, complex care. While this approach aims to manage the growing workload in general practice, it raises significant concerns about potential negative impacts on patient care and NHS efficiency. We discuss the implications of these proposals in an article published in the British Medical Journal.

The Holistic Strength of General Practice

One of the key strengths of general practice lies in its holistic approach, where GPs offer continuous and comprehensive care. This continuity allows GPs to maintain a thorough understanding of a patient’s medical history, lifestyle, and psychological aspects, leading to effective and cost-efficient care. Fragmenting services by separating acute and long-term care threatens this holistic approach and can undermine the management of chronic conditions, which often include acute episodes linked to ongoing health issues.

Risks of Fragmentation

Missed Diagnoses: Acute symptoms can sometimes signal more severe underlying conditions. For instance, a chronic cough could indicate serious diseases like lung cancer or tuberculosis. Fragmented services reduce opportunities for comprehensive health evaluations, increasing the risk of missed diagnoses and neglecting critical health promotion activities.

Increased Costs and Confusion: Splitting primary care services could lead to higher healthcare costs due to duplicated services and administrative overheads. Vulnerable groups, such as older adults and non-native English speakers, may find the fragmented system confusing, further hindering their access to appropriate care.

Impact on GP Training: The separation of services could negatively affect the education of GP registrars and ongoing professional development. Exposure to both acute and complex cases is essential for developing well-rounded, competent GPs. Limited supervision in “acute care hubs” may not provide the diverse learning experiences necessary for effective training.

Advocating for Integrated Care

To maintain the effectiveness and efficiency of primary care, it’s essential to focus on integrated care models rather than fragmented services. Integrated care ensures that both acute and long-term health needs are addressed within a cohesive system, leading to better health outcomes and more efficient resource use.

Multidisciplinary Teams: Incorporating multidisciplinary team members such as district nurses, therapists, social workers, pharmacists, care coordinators, and social prescribers can help address a full spectrum of health issues, fostering stronger patient-provider relationships and improving patient satisfaction.

Reducing Administrative Burden: Training non-clinical staff to handle administrative tasks can free up GPs to focus more on patient care. Additionally, improving the integration of health records across primary and secondary care can reduce data entry duplication and enhance record accuracy.

Conclusion

To preserve the essence of primary care and its patient-centred approach, efforts should be directed towards strengthening integrated care models, enhancing general practice capacity, and improving service efficiency. By avoiding the pitfalls of fragmented services, we can ensure that primary care continues to meet the evolving health needs of the population without compromising quality, cost, or continuity of NHS care.

Study Reveals Critical Gaps in Catch-Up Vaccinations Among UK Migrants

In our study published in the journal BMC Medicine, we report significant vulnerabilities to infectious diseases among UK migrants due to under-vaccination for diseases preventable through routine immunisations – such as measles, mumps, rubella, and polio. Our mixed-methods study, conducted between May 2021 and September 2022 across several London-based general practices, sheds light on the urgent need for improved healthcare strategies that ensure migrants receive necessary catch-up vaccinations.

Background

Migrants in the UK and Europe are often at increased risk of vaccine-preventable diseases (VPDs) due to incomplete childhood vaccinations and systemic marginalisation from health services. The COVID-19 pandemic further exacerbated these disparities, highlighting the critical gaps in vaccination coverage among adult and adolescent migrants. The study aimed to quantify these vaccination gaps and explore new strategies to improve vaccination uptake through better integration into primary care systems.

Study Insights

The “Vacc on Track” study involved 57 migrants from 18 countries, revealing a troubling landscape of under-vaccination:

  • 86% of the participants needed catch-up vaccinations for MMR.
  • 88% required catch-up for tetanus, diphtheria, and polio (Td/IPV).
  • Despite high referrals for catch-up vaccinations (93%), completion rates were dismally low, with only 12% completing the Td/IPV series and 64% completing the MMR.

Barriers and Facilitators

We identified numerous barriers to effective vaccination, including:

  • Lack of systematic approaches to catch-up vaccination upon migrants’ arrival.
  • Primary care staff’s limited awareness and implementation of vaccination guidelines.
  • Structural challenges such as limited appointment availability and follow-up.

Conversely, potential facilitators highlighted the importance of staff champions and community-based approaches to improve vaccination uptake. These insights suggest that primary care can play a pivotal role in reducing health inequalities by adopting more culturally competent and accessible vaccination strategies.

Conclusion

The study underscores a pressing public health issue: the need to better integrate catch-up vaccinations within primary care to protect vulnerable populations against VPDs. By strengthening existing pathways and enhancing staff training and resources, healthcare systems can make significant strides toward ensuring that all community members, regardless of their origin, are protected against preventable diseases.

Moving Forward

our findings emphasise the need for further research and larger trials to refine and implement effective strategies that ensure equitable healthcare access. As the UK continues to navigate the challenges posed by migration and health disparities, such studies are essential for informing policy and practice, aiming for a healthier, more inclusive society. This research not only highlights the gaps but also charts a course for future action, aiming to transform insights into impactful health interventions.

Assigning disease clusters to people with multiple long-term conditions

Our new study in the Journal of Multimorbidity and Comorbidity sheds light on the challenges of assigning disease clusters to people with multiple long-term conditions

In the world of healthcare, understanding how to manage and treat multiple long-term conditions (MLTC) is a significant challenge. our explores the effectiveness of different strategies for assigning disease clusters to people with MLTCs, aiming to improve our understanding of health outcomes.

The study, a cohort analysis using primary care electronic health records from England, involved a massive sample of over 6.2 million patients. It evaluated the performance of seven different strategies for grouping diseases into clusters, with the aim of predicting mortality, emergency department attendances, and hospital admissions.

What are Disease Clusters?

Disease clusters are groups of conditions that frequently occur together, which may represent underlying shared causes or risk factors. By identifying these clusters, researchers hope to tailor preventive and therapeutic strategies more effectively.

Findings from the Study

We found that while assigning patients to disease clusters could provide a structured way to understand MLTCs, none of the strategies were particularly effective at predicting health-related outcomes when compared to considering each disease individually. Specifically, the method that counted the number of conditions within each cluster performed the best among the cluster-based strategies, but still fell short compared to a disease-specific approach.

This highlights a critical limitation: diseases within the same cluster may not consistently relate to health outcomes, suggesting that the clusters, while useful for some research applications, might not be reliable for predicting patient outcomes.

Implications for Healthcare

The study underscores the complexity of treating individuals with MLTCs. It suggests that while clustering diseases can help in understanding some aspects of multimorbidity, relying solely on these clusters to predict health outcomes might oversimplify the nuances of individual patient conditions.

For healthcare providers and policymakers, these findings emphasize the need for personalized treatment plans that consider the unique combination of diseases each patient has, rather than applying broad cluster-based approaches.

Future Directions

The researchers recommend further exploration into how disease clusters can be used in conjunction with individual disease information to improve health outcome predictions and treatment strategies. This might include integrating machine learning techniques that can handle large datasets and complex variable interactions more effectively.

Conclusion

This study provides valuable insights into the challenges and limitations of using disease clusters as a tool for managing MLTCs. It calls for a more nuanced approach that balances the simplicity of clustering with the complexity of individual patient profiles, ensuring that treatment strategies are both scientifically sound and tailored to meet individual needs.

For healthcare systems, continuing to invest in research that refines our understanding of MLTCs will be crucial for developing more effective and personalized approaches to treatment and care management in the future.

Bridging the Gap: Enhancing Catch-Up Vaccination Strategies for Migrant Populations in the UK

Among the many public health challenges facing the UK, the issue of equitable access to vaccinations stands out, particularly for adult migrants who might have missed critical immunisations due to disrupted healthcare services in their countries of origin or during the migration process. Our recent in-depth study published in Vaccine provides valuable insights into the experiences and perspectives of adult migrants regarding catch-up vaccinations and outlines strategies to improve their immunization coverage.

The study focused on adult migrants in the UK, including refugees, asylum seekers, undocumented migrants, and those without recourse to public funds. It used in-depth interviews to gather data on migrants’ experiences with and attitudes towards vaccination since arriving in the UK. Despite the UK having guidelines for offering catch-up vaccinations, the study revealed a significant lack of awareness and implementation at the primary care level.

One of the critical findings was that most participants were not routinely offered catch-up vaccinations nor asked about their vaccination history upon arrival. This oversight persists despite existing guidelines that advocate for such measures to prevent the spread of vaccine-preventable diseases (VPDs). Participants expressed a general positivity towards vaccinations when informed about them, although some hesitancy rooted in fears of side effects and distrust in the healthcare system due to past negative experiences.

The barriers to vaccination highlighted by the study include logistical challenges like language barriers, financial constraints, and a fundamental lack of trust in the healthcare system—often exacerbated by migrants’ fears of data sharing with immigration authorities. Moreover, the intense focus on COVID-19 vaccinations has overshadowed the need for routine and catch-up vaccinations, leading to what some describe as vaccination fatigue.

To address these challenges, our study proposes several strategies:

Enhanced Training and Incentives for Healthcare Providers: There’s a pressing need for training healthcare professionals about the importance of checking vaccination histories and actively offering catch-up vaccinations. Financial incentives might also encourage primary care providers to prioritize this activity.

Community Engagement and Tailored Communication: Building trust within migrant communities is crucial. This can be achieved by involving community leaders in health promotion activities and ensuring that vaccination campaigns are sensitive to cultural and individual needs.

Flexible Healthcare Services: Offering vaccinations in community settings and outside of standard clinic hours can make access to immunization more convenient for migrants who might struggle with traditional healthcare settings due to work or family commitments.

Implementing these strategies requires a multi-faceted approach, combining policy enforcement with grassroots initiatives to create an inclusive healthcare environment that recognizes the unique needs and challenges faced by migrants.

This comprehensive approach not only aims to protect vulnerable populations but also contributes to the broader public health goal of eliminating VPDs as a threat, ensuring that no community, especially not the migrant population, is left behind in our collective healthcare efforts. As the UK moves forward, it is crucial to integrate these strategies into routine healthcare practices to improve vaccination uptake and protect public health.

Walk This Way: How Counting Steps Can Lead to Better Health

Too many people in the UK are not physically active enough; leading to an increased risk of health problems. Counting the number of steps you take each day is a good way to monitor and increase your physical activity.

But how many steps should you take? 10,000 steps daily is a reasonable target for an active adult. For older people or those with medical conditions that limit their physical activity, a smaller number of steps may be sufficient.

The common recommendation of 10,000 steps per day is often used as a benchmark for a healthy activity level and it’s a good target for active adults looking to maintain or improve their overall health.

What about specific groups? For older adults, as mobility and energy levels can decrease with age, a lower step count might be a more realistic target and can still be beneficial. Even 6,000 to 8,000 steps per day can significantly benefit older adults. In fact, any amount of physical activity is beneficial.

For those with chronic health conditions, the appropriate number of daily steps can vary widely. It’s important for these individuals to set personalised goals that are challenging but attainable without exacerbating their medical conditions.

Try to find ways to incorporate more walking into your routine. Here are some ideas:

– Take the stairs instead of the elevator.

– Park further away from your destination and walk the extra distance.

– Take walking breaks throughout the workday.

– Walk during your lunch break.

What are the benefits of step counting? 

1. Encourages Physical Activity: Regularly counting steps can motivate individuals to be more physically active. It provides a quantifiable measure of activity, making it easier to set goals and track progress.

2. Health Improvements: Increasing your daily step count has many health benefits, including a reduced risk of cardiovascular disease, improved mental health, weight loss or maintenance, and enhanced muscular strength and endurance.

3. Accessible and Inclusive: Walking is a low-impact, moderate-intensity exercise that most people can perform without needing expensive equipment or facilities, making it an accessible form of physical activity for many.

While 10,000 steps is a good general target, it’s important for each individual to adjust their goals based on their personal health status, fitness level, and medical advice. Some people may find it more practical to start with a lower number of steps and gradually increase the number of steps as their fitness improves.

Using tools like pedometers or smartphone apps can help track your steps. Many of these devices also provide additional features such as estimating the number of calories burned, distance travelled, and active minutes; all of which can help in creating a balanced and customised fitness plan. Many of my patients have found these tools helpful and they are definitely worth exploring.

Ultimately, the key is consistency and integration of physical activity into daily life. Whether it’s aiming for 5,000 steps or 10,000, the goal should be to stay active and improve or maintain your health.

Increasing measles, mumps, and rubella (MMR) vaccine uptake in primary care

Measles cases in the UK have increased recently; putting at risk the health of children who are unvaccinated.[1] What can primary care teams do to boost measles (MMR) vaccine uptake? I discuss some actions that general practices can take in a recent comment in the British Medical Journal.

Implementing an effective vaccination programme within a general practice requires a multifaceted approach; combining clear leadership, comprehensive staff training, patient education, and meticulous record-keeping. The collective effort of the entire practice team is essential for its success. Assigning a dedicated team member to lead the vaccination programme ensures focused oversight. It is crucial that all staff are well-informed about the vaccination programme, including eligibility criteria and the benefits of vaccination for individuals, families, the NHS, and society. This knowledge can be enhanced through free online training.[2]

Developing a set of Frequently Asked Questions based on official sources like NHS England and the UKHSA, and training staff in effective communication strategies, are key steps in addressing patient concerns and misinformation. Accuracy of medical records is essential, especially in urban areas with high population mobility, to avoid unnecessary vaccination reminders. Regular audits and updating vaccine status during patient registration can help maintain record accuracy.[3]

Effective patient communication about the MMR vaccine’s benefits requires using multiple channels, including text messages, emails, and social media, as well as during consultations, to ensure impact. Practices should also consider the cultural and linguistic diversity of their patients, using appropriate materials and partnering with community organisations to enhance outreach.

Accessible clinics are also essential. Vaccination should be offered during routine appointments and through additional channels like mobile clinics or community centres. Monitoring vaccine uptake and actively following up unvaccinated patients through reminders can significantly improve vaccination rates.[4]

For patients vaccinated outside the practice, it is important to verify and record their vaccination status. Motivating staff with incentives to meet vaccination targets and collaborating with community groups can further improve vaccine uptake.

References

1. Bedford H, Elliman D. Measles rates are rising again. BMJ 2024; 384 :q259 doi:10.1136/bmj.q259

2. NHS England Immunisation e-learning programme. https://www.e-lfh.org.uk/programmes/immunisation/

3. Carter J, Mehrotra A, Knights F, Deal A, Crawshaw AF, Farah Y, Goldsmith LP, Wurie F, Ciftci Y, Majeed A, Hargreaves S. “We don’t routinely check vaccination background in adults”: a national qualitative study of barriers and facilitators to vaccine delivery and uptake in adult migrants through UK primary care. BMJ Open. 2022 Oct 10;12(10):e062894. doi: 10.1136/bmjopen-2022-062894.

4. Williams N, Woodward H, Majeed A, Saxena S. Primary care strategies to improve childhood immunisation uptake in developed countries: systematic review. JRSM Short Rep. 2011 Oct;2(10):81. doi: 10.1258/shorts.2011.011112.