Category: NHS

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.


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.

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.

Community health and wellbeing workers: a solution for improving health and care in England

In the quest to refine healthcare delivery in England, this innovative approach, inspired by Brazil’s successful community healthcare model, is a promising solution to the challenges faced by the NHS. The strategy focuses on the deployment of Community Health and Wellbeing Workers (CHWWs) to foster more efficient, localised healthcare services. Our recent article in the British Journal of General Practice discusses the potential of this model and how it could revolutionise healthcare in communities across England.

The Inspiration from Brazil

Brazil’s community healthcare model stands as a testament to the power of grassroots health initiatives. Over the past two decades, this approach has led to significant improvements in health outcomes, including reductions in cardiovascular mortality, hospital admissions, and health inequalities. The core of Brazil’s success lies in the integration of CHWWs into the healthcare system. These workers serve as pivotal links between GPs, community services, local authorities, and the communities they serve, especially in marginalized areas.

Pilot Program in Westminster

A pilot program in Westminster tested the feasibility of this model in England. The results were promising, showing increased vaccination and screening rates, along with a 7% drop in unscheduled GP visits in the first year alone. This indicates that CHWWs not only meet the existing demand for healthcare services but also successfully reach those in need of care who might not seek it out.

Addressing the Workforce Crisis

Beyond improving healthcare delivery, training and employing CHWWs offer a strategic solution to the current NHS workforce crisis. By upskilling volunteers and providing them with pathways to employment within the NHS, this initiative could significantly alleviate workforce shortages. Moreover, the role of a CHWW, demanding cultural competence, a non-judgmental attitude, and strong problem-solving skills, represents an attractive career opportunity for individuals passionate about community service.

Potential Impact in England

The adaptation of Brazil’s community health worker model to the English context could yield even greater benefits due to the wider availability of services. Acting as catalysts between healthcare, social care, and public health, CHWWs could play a crucial role in improving population health status and outcomes. The initial successes observed in Westminster suggest that a nationwide deployment of CHWWs could lead to considerable savings within public health, social care, and NHS budgets, alongside notable improvements in public health.

Funding and Support

For the CHWW initiative to be sustainable, securing long-term and reliable funding is essential. Proposals suggest adding to the fixed part of the Public Health Grant as a viable funding source. This approach aligns with the broader goal of creating an English family health strategy, which is both a feasible and cost-effective solution to current healthcare challenges.


The introduction of Community Health and Wellbeing Workers in England represents a forward-thinking solution to improving healthcare accessibility and efficiency. Inspired by Brazil’s model, this approach offers a holistic and integrated strategy to address the pressing challenges of the NHS, including strained budgets, workforce shortages, and the need for improved public health outcomes. With appropriate funding, support, and expansion across the country, CHWWs have the potential to significantly enhance the healthcare landscape in England, making it more responsive to the needs of its diverse populations.

Streamlining Hypertension Care with the BP@Home Programme

The rapid shift towards digital health solutions, propelled by the COVID-19 pandemic, has underscored the critical need for innovative approaches to healthcare delivery in the UK’s NHS. The BP@Home initiative, as explored in our recent study published in the journal PLOS ONE, stands out as a beacon of such innovation, aiming to revolutionise hypertension management in primary care settings across London.

The initiative, a response to the pandemic-induced transition to remote healthcare, supports patients with hypertension in self-monitoring their blood pressure at home. This programme not only aims to maintain continuous care for high-risk patients but also addresses a long-standing challenge of hypertension management — a leading contributor to cardiovascular diseases globally – in trying to improve blood pressure control.

Barriers and Facilitators to BP@Home Implementation

Despite its promise, the BP@Home initiative faces significant hurdles, primarily stemming from resource constraints — including IT, human, and financial resources. Healthcare professionals (HCPs) involved in the program highlighted several barriers, such as the distribution and tracking of blood pressure monitors, a lack of clear guidance on their use, and the substantial workload without commensurate financial incentives.

Conversely, the study also identified facilitators that could smooth the path for BP@Home’s implementation. These include robust communication channels, task-sharing among healthcare teams, and the integration of the programme into daily clinical practice. Moreover, providing blood pressure monitors on prescription and leveraging the role of pharmacists emerged as practical strategies to address logistical challenges.

Towards a More Equitable and Efficient Healthcare Delivery

The insights garnered from the study illuminate the complex dynamics of implementing a remote healthcare initiative within an already stretched healthcare system. The recommendations put forth — centred on project management, logistics, engagement of primary care networks & practices, and patient engagement — offer a roadmap for overcoming the identified barriers.

The BP@Home initiative, by incorporating a person-centred approach and maintaining flexibility in patient engagement (including non-digital options), paves the way for a healthcare model that is not only responsive to the current COVID-19 pandemic but is also resilient in the face of future healthcare challenges.

A Call to Action for Future Healthcare Innovations

The successful implementation of BP@Home and similar initiatives requires a concerted effort from all stakeholders involved — from policy makers and healthcare managers to frontline health care professionals and patients . It highlights the importance of adapting healthcare delivery to meet the evolving needs of the population, leveraging technology to bridge the gap between patients and providers, and ensuring equitable access to healthcare services.

As we move forward, the lessons learned from BP@Home can inform the development of future healthcare innovations, emphasising the need for a healthcare system that is adaptable, patient-centric, and equitable. It is through such initiatives that we can hope to achieve a more sustainable and effective healthcare delivery model, capable of addressing the multifaceted health challenges of the 21st century.

Bridging the Equity Gap in AI Healthcare Diagnostics

In an era where artificial intelligence (AI) is rapidly reshaping the landscape of healthcare diagnostics, our recent BMJ article sheds light on a critical issue: the equity gap in AI healthcare diagnostics. The UK’s substantial investment in AI technologies underscores the nation’s commitment to enhancing healthcare delivery through innovations. However, this evolution brings to the forefront the need for equity: defined as fair access to medical technologies and unbiased treatment outcomes for all.

AI’s potential in diagnosing clinical conditions like cancer, diabetes, and Alzheimer’s Disease is promising. Yet, the challenges of data representation, algorithmic bias, and accessibility of AI-driven technologies loom large, threatening to perpetuate existing healthcare disparities. Our article highlights that the quality and inclusivity of data used to train AI tools are often problematic, leading to less representative data and biases in AI models. These biases can adversely affect diagnostic accuracy and treatment outcomes, particularly for people from ethnic minority groups and women, who are often under-represented in medical research.

To bridge this equity gap, we advocate for a multi-dimensional systems approach rooted in strong ethical foundations, as outlined by the World Health Organization. This includes ensuring diversity in data collection, adopting unbiased algorithms, and continually monitoring and adjusting AI tools post-deployment. We also suggest establishing digital healthcare testbeds for systematic evaluation of AI algorithms and promoting community engagement through participatory design to tailor AI tools to diverse health needs.

A notable innovation would be the creation of a Health Equity Advisory and Algorithmic Stewardship Committee, spearheaded by national health authorities. This committee would set and oversee compliance with ethical and equity guidelines, ensuring AI tools are developed and implemented conscientiously to manage bias and promote transparency.

The advancement of AI in healthcare diagnostics holds immense potential for improving patient outcomes and healthcare delivery. However, realising this potential requires a concerted effort to address and mitigate biases, ensuring that AI tools are equitable and representative of the diverse populations they serve. As we move forward, prioritising rigorous data assessment, active community engagement, and robust regulatory oversight will be key to reducing health inequalities and fostering a more equitable healthcare landscape through the use of AI in healthcare diagnostics.

Understanding the Impact of COVID-19 on Emergency Hospital Admissions in Older Adults with Multimorbidity and Depression

During the COVID-19 pandemic, healthcare systems worldwide grappled with unprecedented challenges, particularly in managing vulnerable populations. Among these, older adults with multimorbidity and depression faced heightened risks, underscoring the need for targeted healthcare interventions to improve their health outcomes. Our recent study published in PLOS ONE offers helpful insights into this issue, focusing on unplanned emergency hospital admissions among patients aged 65 and older with multimorbidity and depression in Northwest London during and after the COVID-19 lockdown.

The study used retrospective cross-sectional data analysis, leveraging the Discover-NOW database for Northwest London. It included a sample of 20,165 registered patients aged 65+ with depression, analysing data across two periods: during the COVID-19 lockdown (23rd March 2020 to 21st June 2021) and an equivalent-length post-lockdown period (22nd June 2021 to 19th September 2022). Using multivariate logistic regression, we examined the impact of sociodemographic and multimorbidity-related characteristics on the likelihood of at least one emergency hospital admission during each period.

Key Findings:

– Men had a higher risk of emergency hospitalisation compared to women in both periods, with a noticeable increase post-lockdown.

– The risk of hospitalisation significantly increased with age, higher levels of deprivation, and a greater number of comorbidities across both periods.

– Asian and Black ethnicities showed a statistically significant protective effect compared to White patients during the post-lockdown period only.

The study’s conclusions highlight the need for proactive case reviews by multidisciplinary teams, especially for men with multimorbidity and depression, patients with a higher number of comorbidities, and those experiencing greater deprivation. The findings underscore the importance of understanding the specific healthcare needs of vulnerable populations during health crises like the COVID-19 pandemic to prevent unplanned admissions, improve health outcomes and reduce pressures on health systems.

This research not only contributes to the body of knowledge on healthcare use during the COVID-19 pandemic but also provides valuable insights for healthcare providers, policymakers, and researchers on the care of older adults with multimorbidity and depression. The findings emphasise the importance of tailored healthcare strategies to address the complex health needs of these patients, thereby ensuring that healthcare systems are better prepared for future public health emergencies.

Exploring the Impact of Diagnostic Timeframes on Multimorbidity Prevalence in England

Our study in published in BMJ Medicine in February 2024 examined the effect of defining timeframes for long-term conditions on the prevalence of multimorbidity in England, and on the role played by sociodemographic factors. Using primary care electronic health records from the Clinical Practice Research Datalink Aurum, the study included over 9.7 million adults registered in England as of 1 January 2020, focusing on 212 long-term conditions.

Key Findings

Varying Prevalence Rates: The prevalence of multimorbidity, defined as the coexistence of two or more long-term conditions, varied widely based on the timeframe used for definition. It ranged from 41% with stricter criteria (requiring three codes within any 12-month period) to a 74% when a single diagnostic code was deemed sufficient. Using conditions marked as active problems resulted in the lowest prevalence rate at 35%.

Sociodemographic Influences: The study revealed that younger individuals, certain minority ethnic groups, and those living in areas of lower socioeconomic deprivation were more likely to be reclassified as not multimorbid under timeframes that required more than one diagnostic code. This suggests that these groups are disproportionately affected by the criteria used to define long-term conditions.

Implications for Healthcare Policy and Research: The substantial variation in multimorbidity prevalence underscores the challenges in directly comparing estimates of multimorbidity between studies. It highlights the need for clear rationales behind the choice of timeframe and suggests a potential bias introduced by definitions requiring multiple codes. We recommended that researchers provide their reasoning for the timeframe choice and consider sensitivity analyses to explore the impact on different patient groups.

Addressing Multimorbidity in Healthcare

The findings emphasize the complexity of measuring multimorbidity and the influence of methodological decisions on prevalence estimates. This has important implications for healthcare policy, practice, and research; stressing the importance of adopting a nuanced approach to understanding and addressing the needs of people with multiple health conditions. It calls for a balance between the granularity of condition definitions and the practicality of healthcare delivery, ensuring that healthcare systems can adequately respond to the nuanced needs of its diverse patient population.


The study serves as a critical reminder of the dynamic nature of health conditions and the need for healthcare systems to adapt their approaches to effectively manage multimorbidity. It opens avenues for further research into optimising care for individuals with multiple long-term conditions, ultimately aiming to enhance clinical outcomes, patient experience quality of life, and healthcare efficiency.

Tackling Sickness Absence in the NHS: The Importance of Staff Well-being on Healthcare Delivery

The National Health Service (NHS) in England requires the ability to maintain adequate staffing levels across all professional groups. A crucial aspect of this challenge is managing sickness absence rates among NHS staff, which not only impacts patient care and operational costs but also plays a pivotal role in workforce retention and overall healthcare efficacy. Our recent paper in the Journal of the Royal Society of Medicine discusses this important challenge for the NHS.

Recent data published by NHS Digital indicates a worrying trend: sickness absence rates have been on a steady rise across all NHS staff groups since 2009, with a notable surge during the COVID-19 pandemic. This trend has resulted in absence rates remaining elevated above pre-pandemic levels, signaling a potential crisis in staffing and healthcare delivery.

The Dynamics of Sickness Absence Rates

Before the pandemic, monthly sickness absence rates typically varied between 4% and 5%, with expected seasonal variations. However, the pandemic era saw these rates spike to around 6%, and even after the lifting of most COVID-19 restrictions, they have hovered between 5% and 6%. In comparison, the general UK workforce has exhibited more stable sickness absence rates, with NHS employees displaying approximately double the absence rates of their counterparts in other sectors. This disparity underscores the unique pressures faced by NHS staff, including high-stress environments and demanding physical work conditions.

Mental Health at the Forefront

A significant finding from the NHS England data is the high prevalence of mental ill health, particularly anxiety and depression, as a leading cause of sickness absence among NHS staff. This contrasts with the broader employment landscape, where other illnesses predominate. The data suggests that NHS staff are substantially more likely to take leave for mental health reasons, a situation likely exacerbated by the demanding conditions of NHS work environments.

Variations and Implications for Policy

Sickness absence rates vary across different professional groups within the NHS, with doctors generally showing lower rates than other groups such as nursing, ambulance, and allied health professionals. This variance highlights the need for a nuanced approach to addressing sickness absence, considering factors such as role flexibility, work conditions, and the potential for presenteeism.

Addressing these issues requires more than reactive measures; it demands a proactive strategy that includes improving access to occupational health services, mental health resources, and implementing systemic changes to address the root causes of high sickness absence rates. The NHS workforce plan looks to the national Growing Occupational Health and Wellbeing Strategy for solutions, but there is a clear need for more comprehensive, data-driven approaches that tackle the underlying factors contributing to workforce strain.


Ultimately, understanding and mitigating the reasons behind elevated sickness absence rates – particularly those related to mental health and varying across professional groups – will be crucial for closing the gap between the NHS and the broader UK workforce. This effort will not only enhance workforce well-being but also ensure the sustainability of high-quality healthcare delivery within the NHS.

How can we make a success of Pharmacy First?

Pharmacies in England to begin treating patients for seven common conditions. How can we work successfully across the health and care system to make a success of Pharmacy First?

1. The Pharmacy First scheme aims to provide convenient access to healthcare through community pharmacies. Patients with minor ailments or common conditions can seek advice and treatment directly from their local pharmacy instead of visiting a general practice, urgent care centre or emergency department. The conditions covered by the scheme may vary depending on local funding arrangements and participation of pharmacies.

2, A potential problem with Pharmacy First is pharmacists misdiagnosing a patient’s condition. It may also lead to delays in patients seeing doctors when medical assessment is needed. To mitigate these risks, appropriate safeguards and referral pathways should be established, ensuring timely medical assessment when necessary. The scheme will also increase the workload of pharmacies, thereby reducing the time available for other areas of work.

3. To ensure the successful implementation of Pharmacy First, it is essential to develop strong partnerships between key partners in the scheme such as pharmacies, general practices, and integrated care boards. Good communication to share information, updates about the scheme and best practice among all organisations involved is also needed; as is ensuring clear roles and responsibilities for all partners in the scheme.

4. The use of guidelines and protocols that outline the specific tasks, workflows, and processes involved in the scheme will ensure that all partners are aware of their responsibilities. This will keep partners well-informed about their responsibilities and help maintain consistent standards. Comprehensive training and educational resources for community pharmacists and other pharmacy staff are also needed, including continuous professional development and regular audits of clinical practice.

5. The NHS needs to integrate IT systems between pharmacies and general practices to facilitate efficient and accurate transfer of patient information, and to ensure good continuity of care. Additionally, the use of digital technologies and telehealth solutions should be explored to enhance follow-up and patient monitoring when required.

5. As Pharmacy First is relatively new, robust performance monitoring and evaluation are needed to assess its costs, clinical effectiveness, effects on other parts of the NHS and impact on patient satisfaction. This requires the development of key performance indicators to measure the scheme’s outcomes in these areas, enabling evidence-based decision-making and continuous quality improvement.

6. Improving public awareness and engagement is crucial. Implementing media campaigns to inform the public about the scheme’s availability and benefits will help drive its adoption. Furthermore, proactive engagement with patients, community groups, and other stakeholders, particularly those from underserved groups, will ensure inclusivity and provide valuable feedback for ongoing improvement of the scheme.


1. Clinical pharmacists in primary care: a safe solution to the workforce crisis?

2. Impact of integrating pharmacists into primary care teams on health systems indicators: a systematic review.

Strategies to Address Drug Shortages in the UK’s NHS

In recent years, the UK has repeatedly suffered from shortages of many key drugs. As well as creating extra work for doctors and pharmacists, these shortages are also very stressful for patients. The government has recently published details of how it might address this issue. We need effective implementation of these plans as well. In particular, we need a combination of a strong UK manufacturing base to produce the drugs the NHS needs along with secure contracts with overseas suppliers.

Developing a robust domestic manufacturing base for pharmaceuticals offer several benefits. It reduces reliance on international supply chains, which can be vulnerable to global events, trade disputes, and logistical challenges. UK manufacturing can also facilitate quicker responses to the UK’s health needs and stimulate economic growth and job creation within the UK. However, building such infrastructure requires substantial investment, time, and expertise.

While bolstering domestic production, it is also essential to maintain strong relationships with overseas drug suppliers. Diversifying the source of pharmaceuticals mitigates the risk of shortages due to domestic production issues. Secure, long-term contracts with foreign suppliers can help ensure a steady supply of essential drugs, but these agreements must be carefully managed to ensure they are resilient to global market and political fluctuations.

Relying on the “free market” and a laissez-faire attitude won’t be nearly enough to tackle the problem. Drug manufacturing and supply problems a major global health concern. The UK government should actively engage in international dialogues and collaborations to address wider challenges that impact drug availability.

Improving measles (MMR) vaccine uptake in primary care

The UKHSA has warned that the UK is seeing a surge in measles cases; putting at risk the health of children and others who are unvaccinated. What can primary care teams do to boost measles vaccine uptake in their patients and help bring the number of measles cases down?

In this post, I list some of the key steps in implementing measles (MMR) vaccination in your practice and raising vaccine uptake. This guidance can also be used by primary care providers in other countries.

1. Give one member of the practice team responsibility for leading the vaccination programme, supported by the wider practice team.

2. Ensure that all staff are informed about the programme; including who is eligible; and the benefits of vaccination for the individual patient, their family, the NHS and society. There are many free online programmes on vaccination and addressing vaccine hesitancy for health professionals. Ensure that vaccination is discussed regularly at team meetings to review progress and address challenges.

3. Prepare FAQs to common questions from patients. These are usually available on government websites such as those published by NHS England and the UKHSA. Ensure staff know where to look for these FAQs, which are essential in countering misinformation about MMR vaccination. Specific training is available in effective communication strategies to address vaccine hesitancy and misinformation during patient interactions.

4. Ensure medical records are as accurate as possible so that patients are not called for vaccination inappropriately. This is particularly important in large urban areas where population mobility is high and vaccine records may not always be up to date. Regular audits of medical records can help identify gaps in the recording of vaccine status.

5. A key time to record vaccine status and offer MMR vaccination is when patients register with a practice. Ensure that vaccine records are entered on the medical record correctly (including vaccines given overseas) and offer MMR vaccine to patients who are unvaccinated or unsure of their vaccine status.

6. Prime patients with information about MMR vaccination, including who is eligible; and the benefits of vaccination for the individual, their family and society.

7. Use multi-channel communication to inform patients. Consider using a variety of media to inform patients as well as direct contact through text messages, phone calls, emails and letters: posters, leaflets, social media, and the practice’s website. Different people prefer different methods of communication. Partnering with local schools, colleges and universities can also help in contacting patients.

8. Be culturally sensitive, particularly if your practice is located in a diverse area. Use materials that are linguistically and culturally appropriate to cater to diverse populations, especially those who may not be fluent in English or are from different cultural backgrounds. Collaborations with community organisations and voluntary groups can help practices to better reach and communicate with diverse groups of patients; including those least likely to be vaccinated.

9. Provide accessible clinics for MMR vaccination and also offer opportunistic vaccination to patients when they attend appointments at the practice for other reasons. To make it easier for working adults, consider extending clinic hours for vaccinations. Some areas may also offer mobile clinics or clinics in community centres that can further improve access to vaccination.

10. Monitor uptake in each target group. Contact those who have not come forwards for vaccination by text, email or telephone. Discuss the need for vaccination with patients in clinics. Implementing an automated system for sending reminders for upcoming vaccination appointments can be efficient and lead to increased attendance.

11. Some patients will receive MMR vaccines elsewhere in the NHS or overseas. Details of vaccinations at NHS sites should be sent to the practice automatically but this may not always be the case. Contact patients to check their vaccination status by text or email and enter vaccinations on their medical record if given elsewhere. This will improve the data the NHS uses to monitor vaccine uptake and also ensures that patients are not sent unnecessary reminders.

12. Incentivise staff to achieve targets; and work with the patient participation group and other local community groups to increase awareness of the benefits of vaccination and improve vaccine uptake.

13. Develop a way for patients to provide feedback about their vaccination experience. This could be a short survey sent by email or available at the clinic. The feedback can provide valuable insights for improving the programme in the future. Also consider a post-campaign evaluation to understand what worked well and what didn’t. This information can be also help for planning future campaigns.

14.The same principles can be applied to maximise uptake of other vaccination programmes delivered by the practice for both children and adults.