Category: NHS

Talking to Patients About Weight-Loss Drugs

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 and when to seek urgent medical advice.

3. Loss of muscle mass as well as fat
Treatment often leads to loss of both fat and lean tissue (muscle). Reduced muscle mass can affect strength, mobility, and metabolic rate. Encourage resistance exercise and adequate protein intake to help maintain muscle.

4. Long-term safety and unknowns
While clinical trials show substantial short- to medium-term benefits, we do not yet have decades of safety data for newer agents. Patients should be aware that some long-term effects remain unknown.

5. Need for sustained treatment
For many, continued use is required to maintain weight loss. This raises issues around cost, availability, and the practicality of long-term therapy.

6. Likelihood of weight regain after stopping treatment
Most people regain much of the weight lost when medication is discontinued unless lifestyle measures are sustained.

7. Impact on mental health and eating behaviour
Changes in appetite can be beneficial but, rarely, may lead to problematic eating patterns. Monitoring for disordered eating is important.

8. Contraindications and drug interactions
Caution is needed in people with a history of pancreatitis, certain gastrointestinal diseases, or relevant endocrine tumours. Review other medications for potential interactions.

9. Monitoring requirements
Ongoing follow-up is essential to assess weight, metabolic health, nutritional status, muscle mass, and side effects.

The NHS Emergency Care Plan underestimates the role of general practice

I welcome the Government’s commitment to expanding urgent care provision in community settings. This approach has the potential to ease pressure on emergency departments and enable ambulance services to focus more effectively on patients who require rapid assessment and conveyance.

However, as I discuss in the BMJ, the current Emergency Care Plan underestimates the central role that NHS general practice can and should play. Primary care is often the first point of contact for patients with urgent needs, and with appropriate support, it can manage many conditions effectively without referral to other parts of the system. There is also a risk that investing in a wide array of separate interventions—such as urgent treatment centres, community response teams, and virtual wards—without clear coordination could further fragment care. This may reduce continuity, lead to duplication, and ultimately result in less efficient use of NHS resources.

Direct investment in NHS general practice—particularly at a time when many GPs are underutilised or struggling to find substantive roles—would strengthen clinical capacity where it is most needed. Enhancing the ability of general practice to manage both acute presentations and long-term conditions more effectively would support whole-system resilience and reduce downstream demand across urgent and emergency care.

Balancing Patient Safety and Human Rights: Implementing the Special Allocation Scheme in Primary Care

The Special Allocation Scheme (SAS) aims to protect NHS staff and other patients from individuals who are violent, aggressive, or pose a serious threat, while at the same time ensuring that these patients continue to receive essential primary care services in a secure environment. The decision to refer a patient to the Special Allocation Scheme is a significant one and rightly requires careful clinical and ethical consideration. However, in practice, such decisions often need to be made rapidly and under stressful or unpredictable circumstances, such as following a serious verbal or physical assault on a member of staff.

Updated guidance from NHS England and the additional requirements introduced by some Integrated Care Boards (ICBs), including the need for written confirmation that all alternative approaches have been considered, are well-intentioned. These measures are designed to ensure that referrals to the Special Allocation Scheme are proportionate, lawful, and respectful of patients’ rights; particularly for those with protected characteristics under the Equality Act 2010, or those with complex health needs and vulnerabilities. Such safeguards are important to prevent inappropriate exclusion from general practice services and to maintain fairness and transparency in the use of this scheme.

Nevertheless, there is a risk that these requirements could prove challenging to implement, particularly in urgent situations where staff safety is at risk and swift action is needed. Primary care teams already operate under considerable time, clinical, and administrative pressures, and the addition of further bureaucratic steps, however well-meaning, could inadvertently delay appropriate referrals or discourage practices from using the Special Allocation Scheme even when it is clearly warranted. This could, in turn, compromise the safety of staff and other patients, undermining the purpose of the scheme.

A pragmatic and balanced approach is needed; one that upholds patient rights and ensures a fair process, while also enabling a timely and proportionate response to serious incidents. Ideally, the referral process should allow for immediate action in exceptional or high-risk situations, with more detailed documentation, justification, and review taking place once the immediate threat has been managed. Clear, practical protocols and access to legal or safeguarding advice may help practices navigate these decisions appropriately.

Support from ICBs and NHS England will be essential to help practices interpret and implement the requirements for referral to the Special Allocation Scheme in a consistent, safe, and effective manner. This should include training, practical guidance, and access to expert advice when needed. By doing so, we can ensure that the scheme continues to protect NHS staff and patients, while also respecting the dignity and rights of individuals who require care under difficult circumstances.

Reclaiming the primary care consultation for patients and clinicians: is AI-enabled ambient voice technology the answer?

Our recent article in the Journal of the Royal Society of Medicine discusses the potential role of AI-enabled ambient voice technology in healthcare and the implications for doctors and patients. While interest in ambient voice technology , particularly in primary care, continues to grow, evidence regarding its feasibility, acceptability and real-world impact in primary care remains limited. This includes data on cost, staff training and implementation (including integration with current electronic medical record systems).

Questions also remain about how ambient voice technology  handles complex consultations, including with non-native English speakers, and its broader integration into routine practice. As ambient voice technology  develops, further research is needed to assess its usability, acceptability, feasibility, cost-effectiveness and unintended effects on clinical interactions and decision-making. If demonstrated to be effective, ambient voice technology  could become a transformative tool in advancing the government’s 10 Year Health Plan for England.

Why after 35 Years of NHS plans, cure is still favoured over prevention?

The aims of the government’s 10 year health plan – such as the shift from prevention to cure – are not new and have been priorities in many other health plans over the last 35 years. The question we need to ask is why have previous plans failed in achieving these objectives?

The short-term electoral cycle prioritises funding for immediate, visible hospital crises over long-term strategies whose benefits are not seen for years. This is compounded by a health system that is designed to reward the treatment of sickness, not the promotion of wellness.

The persistent fragmentation between the NHS, public health and social care, and pressures from an ageing population and widening health inequalities have created a reactive environment where long-term strategic goals are perpetually sacrificed to manage immediate demands.

The UK government and NHS staff do not lack insight into what improves health. Unless we redesign the incentives, protect public‑health budgets and hold every department—not just the NHS—to account for population health, the next Ten‑Year Plan risks becoming another plan that does not improve the NHS or health outcomes in England.

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.

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.