Category: NHS

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.

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.

The Covid-19 pandemic five years on

As we reach the fifth anniversary of the onset of the Covid-19 pandemic, this moment provides an opportunity for reflection on the many challenges faced by healthcare workers like me during the early days of the pandemic. At that time, the SARS-CoV-2 virus was a largely unknown entity. Clinical guidelines were still under development and personal protective equipment (PPE) was scarce. For those on the NHS frontline, the experience was marked by a mix of anxiety, urgency, and dedication to the patients we were trained to serve.

Unfamiliar Territory 

In the initial stages, Covid-19 was a “novel” infection. There was a scarcity of data on the illness, and the disease was manifesting in ways that were not entirely well understood. As primary care physicians, we were suddenly thrust into the realm of the unknown, treating patients with undifferentiated respiratory illnesses that did not yet have well-defined and evidence-based treatment protocols.

The Personal Risk Factor 

One of the most daunting aspects of those early days was the awareness of personal risk. It became apparent that healthcare workers were at a significantly higher risk of contracting the disease through their exposure to infected individuals. One thing struck me and others very profoundly was the pattern among the first NHS staff who died due to Covid-19. Many of them were like me: male, over 50, and from ethnic minority groups. This resemblance was not just a statistical observation; it was a stark reminder of my own clinical vulnerability and that of many of my colleagues.

Ethical Duty vs. Personal Safety 

Yet, despite these risks, we had patients to treat. Faced with an ethical duty to provide care, healthcare workers had to weigh this against the risks to their own health. It was an emotionally and ethically complex position to be in. While the fear and anxiety were real, they had to be balanced against our professional obligations to our patients and the NHS. It was a test of not just our medical skills but also our commitment to the Hippocratic Oath.

The Importance of Resilience 

The job had to be done, and so we donned our PPE, took the necessary precautions, and went to work. This resilience is a testament to the dedication of healthcare workers globally who stood firm in their commitment despite the many unknowns in early 2020. The role of healthcare providers in those critical moments was instrumental in broadening our understanding of the virus, which subsequently guided future public health responses, medical treatments and vaccination.

Ongoing Challenges 

The situation has evolved and we now know much more about Covid-19. We now also have vaccines that reduce the risk of serious illness, hospitalisation and death. Yet the lessons of those early days continue to resonate. Healthcare providers still face risks, both physical and emotional, particularly as new variants of the SARS-CoV-2 virus emerge. The Covid-19 story is not over, particularly for those people who suffer recurrent infections or with Long Covid but the experiences of the past provide a foundation upon which we build our ongoing responses.

The broader implications of healthcare workers’ experiences during the Covid-19 pandemic extend far beyond individual resilience and sacrifice. These experiences have exposed critical vulnerabilities in global health systems, highlighting the urgent need for better preparedness, clearer communication strategies and equitable access to protective resources. Furthermore, the pandemic underscored profound health inequalities, notably the increased risks faced by poorer people, ethnic minority groups and the elderly. Recognising these inequalities provides an impetus for policy makers and healthcare leaders to implement structural changes, fostering a more robust, responsive, and inclusive approach to future public health emergencies.

Conclusions 

As we navigate the ongoing challenges posed by Covid-19, reflecting on where we began and the progress we have made since early 2020 is essential. The evidence presented in the Covid-19 Inquiry serves as a timely reminder of healthcare workers’ immense bravery, resilience, and sacrifice globally. While anxiety was palpable, commitment to patient care remained unwavering. Looking ahead, it’s vital we learn from these experiences, investing in preparedness, communication, and systems that protect both patients and those who care for them, ensuring we’re better equipped for future health crises.

Medical Journals Should Use the Term “Public Health and Social Measures”

The COVID-19 pandemic brought many terms into the spotlight, one of which was “non-pharmaceutical interventions” (NPIs). Used widely in academic papers, public health guidelines, and media reports, NPIs became a catch-all phrase for measures like contact tracing, quarantine, and hand hygiene; essentially anything that wasn’t a drug or vaccine. However, BMJ Editor Kamran Abbasi and I argue in our editorial it is time to end the use of this term in favour of “public health and social measures.” Here’s why this shift matters.

The Problem with Defining by Negation

The term “non-pharmaceutical interventions” defines these strategies by what they aren’t rather than what they are. This framing is inherently limiting. Imagine calling surgery a “non-drug intervention”—it sounds absurd because surgery stands on its own as a complex, evidence-based practice. Similarly, public health measures like sanitation or hand hygiene aren’t just stopgaps until a drug or vaccine becomes available. They are powerful tools with scientific grounding, often critical in the early stages of a health crisis and remain valuable even after pharmaceutical options emerge. By labelling them as “non-pharmaceutical,” we risk undervaluing their role and complexity.

A Misleading Hierarchy

The NPI label also subtly suggests that these interventions are second-rate compared to drugs or vaccines. This perception can lead to serious consequences: underfunding, limited evaluation and a reluctance to fully integrate them into health strategies. Yet, history shows that measures like clean water systems or contact tracing can have major impacts of public health; sometimes more effective than any medication. The implied inferiority of NPIs feeds into a biomedical bias, prioritising technological fixes over holistic approaches that address behaviour, culture, and social determinants like poverty or housing.

Missing the Social Dimension

Another flaw in the term “non-pharmaceutical” is its failure to reflect the social and behavioural core of these measures. Hand-washing campaigns do not succeed through science alone. They depend on people’s willingness to adapt, shaped by trust, norms, and socioeconomic context. Calling them “non-pharmaceutical” strips away this human element, reducing them to technical fixes rather than collective efforts. This oversight can widen health inequities, as solutions that ignore social factors often fall short for vulnerable populations.

Clarity for the Public

Communication is critical in a health crisis, and “non-pharmaceutical interventions” may not mean much to the average person. It is jargon that obscures rather than enlightens. In contrast, “public health and social measures” is straightforward. It signals that these actions protect communities and require shared effort. When people understand what is at stake and why it matters, they are more likely to follow the advice they have been given.

A Call for Change

We propose “public health and social measures” as a term that captures the full scope of these interventions; their diversity, their evidence base and their reliance on social dynamics. It aligns with the World Health Organization’s recommendations and encourages a broader view of health, one that integrates biology with environment and society. The BMJ is aiming to lead by example, committing to this terminology across its content. We urge other journals, reviewers, and health professionals to follow this example.

Why It Matters Now

As we face ongoing and future health challenges – such as pandemics, climate-related crises or an increase in chronic diseases – this shift is not just semantic. It is about ensuring these measures get the research, funding and respect they deserve. By reframing them as “public health and social measures,” we elevate their status, improve public understanding, and foster interdisciplinary solutions that address public health challenges effectively.