Tag: Primary Care

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.

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? https://journals.sagepub.com/doi/full/10.1177/0141076818756618

2. Impact of integrating pharmacists into primary care teams on health systems indicators: a systematic review. https://bjgp.org/content/69/687/e665.full

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.

How can the NHS provide personalised care to patients?

The objective for the NHS in England to provide high-quality, personalised care for all patients is a vision that requires a transformative approach to healthcare delivery. This shift signifies a move from the primarily finance and target-driven models of healthcare delivery that we have now to ones that are more patient-centred, emphasising the importance of individual patient needs and outcomes as well as the well-being of NHS staff.

In the international context, healthcare systems around the world are grappling with similar challenges: how to deliver care that is both high-quality and cost-effective, while also addressing the needs of an aging population and the rise of chronic diseases. Many countries are looking towards patient-centred care as a solution.

The World Health Organization (WHO) has also advocated for patient-centred care as part of its strategy to strengthen healthcare systems globally. It emphasizes that patient-centred approaches can lead to better health outcomes, more cost-effective services, and higher patient and staff satisfaction.

However, health systems globally faces unique challenges in implementing such care. For the NHS to adopt a patient-centred model successfully, it can draw on the lessons learned from these international experiences, adapting best practices to fit the unique context of the UK healthcare system. The global shift towards patient-centred care is not a fleeting trend but a response to the clear evidence that such approaches work. By adopting and adapting these international best practices, the NHS can continue to be a leader in healthcare delivery, providing care that is not only effective and efficient but also equitable and respectful of patients’ needs and values.

A more holistic approach to health care delivery would involve:

1. Patient-Centred Care: Tailoring treatment plans to the individual needs and preferences of patients, and ensuring that they are active participants in their own care. This would also involve respecting patient autonomy and decision-making.

2. Staff Well-being: Recognizing that the health and well-being of NHS staff are crucial to patient care. This would involve providing support systems, adequate staffing levels, and addressing burnout and job stress.

3. Quality Over Quantity: Instead of focusing just on meeting quotas and targets, the emphasis should be on the quality of care provided. This could mean more time for patient consultations, and follow-ups, and ensuring that treatments and interventions are evidence-based and help improve health outcomes for patients.

4. Integrated Care: Ensuring continuity of care across different services and providers, which require effective communication and collaboration among primary care, hospitals, mental health, community services, and social care.

5. Preventive Care: Shifting the focus of the NHS towards prevention and early intervention, which can improve long-term health outcomes and reduce the need for more intensive and expensive treatments later.

6. Accessibility and Inclusivity: Making healthcare services accessible to all sections of the population, particularly marginalised groups, thereby addressing health inequalities, and ensuring that healthcare is more equitable.

7. Investment in Staff Training: To deliver personalised care, there is a need for continuous professional development and training for NHS staff, equipping them with the skills to adapt to a more holistic and patient-focused approach.

8. Feedback and Improvement: Regularly collecting and acting on feedback from both patients and staff to improve services and care quality.

9. Technology and Innovation: Leveraging technology to improve patient care, such as through telemedicine, while also ensuring that it does not replace the human touch which is essential in providing compassionate care.

10. Mental Health Focus: Recognizing the mental health component as integral to overall health, ensuring that mental health services are as accessible and well-funded as physical health services.

To achieve this vision requires not only structural and policy changes within the NHS but also a cultural shift that values and prioritises the holistic well-being of patients and healthcare workers alike. This transformation can lead to a more sustainable health service that is better equipped to meet the current and future health needs of the population; such as addressing the health needs of older people and those with complex multimorbidity.

The path to a more patient-centred NHS is both a necessary and achievable evolution in healthcare delivery in England. By embracing a model that places the patient at the heart of care, values the well-being of healthcare staff, and integrates innovation with compassionate services, the NHS can not only enhance the health of individuals but also the health of our society.

This shift, grounded in the principles of accessibility, prevention, and personalised treatment, can forge a stronger, more resilient healthcare system that is equipped to meet the diverse and complex needs of the population in the 21st century. The future of the NHS, therefore, lies not only in numbers and targets, but in the quality of care and the health outcomes of its patients and the national population, marking a return to the core values that have long been the foundation of the NHS.

The UK government must be more proactive about addressing drug shortages

In a letter published in the British Medical Journal, I discuss why the UK government must be more proactive about drug addressing shortages in the NHS.

The lack of drugs such as methylphenidate required for the treatment of attention deficit/hyperactivity disorder (ADHD) is the latest of many medication shortages we have seen in the UK in recent years.1 These shortages are now too frequent and waste the time of NHS staff such as general practitioners and pharmacists who have to spend time counselling patients and sourcing alternative drugs instead of focusing on more relevant work. They are also very stressful for patients who risk going without key drugs with potentially adverse consequences for their health. For people with ADHD, for example, this could mean going without medication that they require to function effectively at work and school and in their personal relationships.

We need a much more proactive approach from the government, which needs to work with drugs manufacturers and wholesalers to ensure that the NHS has adequate supplies of key drugs to prevent such problems occurring in the future. This could include better data on drug supply and demand to identify problems before they occur; improving local manufacturing capacity in the UK for essential drugs needed by the NHS; price incentives for suppliers; and international collaboration to ensure continuity of drug supply. Moreover, immediate support mechanisms should be put in place for primary care teams grappling with the increased workload caused by these shortages. Patients too could benefit from help such as national helplines or online support to allow them to cope better with the consequences of drug shortages.

Until we see active intervention by government, working in partnership with the NHS and industry, patients in the UK will continue to be affected and the time of NHS staff will continue to be wasted because of drug shortages.

Digital Tools for Enhancing Infectious Disease Screening in Migrants

The European Centre for Disease Control (ECDC) has highlighted a stark reality: migrants in Europe are disproportionately affected by undiagnosed infections, including tuberculosis, blood-borne viruses, and parasitic infections. Many migrants also fall into the category of being under-immunised. The call to action is clear — innovative strategies must be developed to deliver integrated multi-disease screening within primary care settings. Despite this call, the United Kingdom’s response remains fragmented. Our recent in-depth qualitative study published in the Journal of Migration and Health delves into the current practices, barriers, and potential solutions to this pressing public health issue.

Primary healthcare professionals from across the UK participated in two phases of this qualitative study through semi-structured telephone interviews. The first phase focused on clinical staff, including general practitioners, nurses, healthcare assistants, and pharmacists. The second phase targeted administrative staff, such as practice managers and receptionists. Through these interviews, a complex picture emerged, revealing a primary care system capable of effective screening but hamstrung by inconsistency and lack of standardized approaches. Many practices lack a systematic screening process, resulting in migrant patients not consistently receiving care based on established NICE/ECDC/UKHSA guidelines.

The barriers to effective infectious disease screening are multifaceted, stemming from patient, staff, and systemic levels. Clinicians and administrative staff pinpointed the stumbling blocks: overly complex care pathways, a lack of financial and expert support, and the need for significant administrative and clinical time investments. Solutions proposed by respondents include appointing infectious disease champions among patients and staff, providing targeted training and specialist support, simplifying care pathways, and introducing financial incentives.

Enter Health Catch-UP!., a collaboratively developed digital clinical decision-making tool designed to support multi-infection screening for migrant patients. The primary care professionals involved in the study responded enthusiastically to this digital innovation. They recognized its potential to systematize data integration and support clinical decision-making, thereby increasing knowledge, reducing missed screening opportunities, and normalizing infectious disease screening for migrants in primary care.

The conclusion is unequivocal: current implementation of infectious disease screening in migrant populations within UK primary care is suboptimal. Yet, there is hope. Digital tools like Health Catch-UP! could revolutionize disease detection and the effective implementation of screening guidance. However, for such digital innovations to succeed, they must be robustly tested and adequately resourced. It’s not just about having the right tools but also ensuring the entire healthcare system is aligned to support their deployment. With the right commitment, we can ensure that migrants receive the care they need and deserve, safeguarding both their individual health as well as public health in the UK.

New Awareness Campaign to Help Reduce Hospital Admissions for Urinary Tract Infections

A new campaign from NHS England and the UKHSA aims to raise awareness about the prevalence and risks of urinary tract infections (UTIs), particularly among older people and carers, and to reduce hospital admissions related to UTIs.

The campaign offers advice on preventive measures. It emphasizes the importance of staying hydrated, going to the toilet as soon as the need arises, and maintaining hygiene in the genital area. Resources, including posters, are being made available to healthcare services, charities, royal colleges, and care homes to disseminate this information as widely as possible.

The guidance comes ahead of a potentially busy winter season for the NHS, a time when the health service is usually under increased pressure. As part of a larger effort to manage healthcare resources, the campaign encourages the use of alternative services like NHS 111, community pharmacists, and urgent care walk-in centres for less critical cases. This is in line with the broader NHS plan of expanding out-of-hospital care options, including “hospital at home” services and urgent community response teams.

UTIs are particularly dangerous for older adults. Prompt action and early treatment are stressed as critical for managing UTIs and preventing severe outcomes like sepsis or death.

The campaign is part of a larger effort to prepare for increased demand during the winter months and aims to improve public awareness and self-care measures to reduce the need for hospital admissions.

What issues do NHS clinicians need to consider in using this guidance?

1. It is more difficult to diagnose UTIs in older people. Younger people (who will nearly all be women) will usually present with the “classical” symptoms of  UTI – such as frequency, dysuria, urgency and haematuria. Older people can have these symptoms but they can also present with problems such as confusion, agitation, functional decline or lethargy where there is a large overlap with other conditions; making diagnosis more challenging.

2. Another challenge in older people is that some will have asymptomatic bacteriuria (i.e. bacteria in the urine that are not causing problems). When the bacteria are detected, doctors will often treat the patient with antibiotics when the medication may not be needed.

3. Spotting infections early requires knowledge of the symptoms and signs and how these differ in younger and older people. There is also a need to be aware of the complications of UTIs such as sepsis or pyelonephritis and to treat these early.

4. Doctors and patients need to balance the benefits of early diagnosis treatment with the risks of overtreatment with antibiotics. Not all UTIs need antibiotic treatment and some may resolve without it. Overuse of antibiotics contributes to antibiotic resistance as well as putting patients at risk of side effects.

5. Finally, these kind of single issue campaigns will be of limited value unless there is adequate capacity in the NHS for patients to be assessed promptly. Otherwise, patients will end up waiting a long time for appointments with the risk their condition may worsen while waiting for treatment.

Evaluating the Uptake of the NHS App in England

Our new study published in the British Journal of General Practice examines uptake of the NHS App in England. The NHS App was launched in January 2019 as a “front door” to digitally enabled health services, allowing patients to access their personal health information online. With the advent of the COVID-19 pandemic, the app saw a significant increase in downloads, especially with the introduction of the COVID Pass feature. However, the uptake of the app has revealed some important trends and inequalities that need to be addressed.

The Study

A comprehensive observational study used monthly NHS App user data at general-practice level in England from January 2019 to May 2021. Different statistical models were applied to assess changes in the level and trend of use of various functionalities of the app, particularly before and after the first COVID-19 lockdown.

Key Findings

Between January 2019 and May 2021, the NHS App was downloaded 8,524,882 times and registered 4,449,869 users. Intriguingly, the app experienced a 4-fold increase in downloads after the introduction of the COVID Pass feature, which allows users to prove their COVID-19 vaccination status. However, the data also revealed disparities in app registration based on sociodemographic factors:

  • There were 25% fewer registrations in the most deprived practices.
  • Largest-sized practices had 44% more registrations.
  • Registration rates were 36% higher in practices with the highest proportion of registered White patients.
  • Practices with a larger proportion of 15–34-year-olds saw 23% more registrations.
  • Surprisingly, practices with the highest proportion of people with long-term care needs saw 2% fewer registrations.

What This Means

The findings indicate that while the NHS App has proven to be an useful tool, especially in the times of the Covid-19 pandemic, its usage is not uniform across various sociodemographic groups. This raises questions about accessibility and the digital divide, which could ultimately impact the quality of patient care and health outcomes.

Further Steps

While the app has clearly benefited a significant number of people, it’s crucial to understand the reasons behind these patterns of inequalities. Further research is essential to delve deeper into these trends and how they may affect the patient experience.

Understanding these dynamics can guide improvements to the app, making it more inclusive and effective for all users. Policymakers, developers, and healthcare providers need to work together to ensure that digital health services like the NHS App are accessible and beneficial to everyone, regardless of their socio-economic status or demographic background.


The NHS App has seen a considerable increase in usage since the onset of the Covid-19 pandemic, highlighting its essential role in modern healthcare. However, the unequal patterns in its uptake call for a focused approach to ensure it serves as an inclusive platform for all. Further research is crucial to uncover the underlying reasons for these disparities and to work towards a more equitable healthcare system.

Guidance for NHS staff on writing support letters for patients for applications for PIP or ESA.

Doctors and other NHS professionals in England are often asked to write in support of patients applying for benefits such as Personal Independence Payments (PIP) or Employment Support Allowance (ESA); which support people with disabilities and long-term health conditions.

These benefits are vital for people suffering from long-term health conditions and disabilities, offering them financial help that can significantly improve their wellbeing and quality of life. Given the critical nature of these benefits and the stringent criteria often applied during the assessment process, the letters we write can play an essential role in securing this much-needed support for our patients.

Here is some guidance on how to write a more effective and relevant letter of support based on my long experience as an NHS doctor in writing such letters.

1. Introduce yourself and describe your relationship to the patient, including how long you have known them and in what capacity. This will help establish your credibility as a reliable source of information in support of their application for a personal independence payment or another state benefit.

2. Provide a detailed description of the patient’s medical conditions, including any diagnoses they have received, how their medical conditions affect their daily life, and any symptoms they experience. Focus on the most relevant conditions to their application first. For example, if the patient is applying for PIP due to mobility problems, you should focus on their mobility impairments and how they affect their daily life and ability to work. Also include any medication they are taking and any past medical or surgical interventions.

3. If the patient is applying for Employment & Support Allowance (ESA), explain how their medical condition affects their ability to work. Describe any physical or cognitive limitations they have, or how their symptoms interfere with their ability to perform tasks required for their job. Aim to give precise descriptions of their conditions; for example if they have heart failure, what is the severity?

4. When describing how the patient’s condition impacts their daily life, focus on the activities of daily living that they have difficulty with. For example, you could mention if they have difficulty dressing, bathing, cooking, shopping, cleaning, or managing their finances. Also describe any problems the patients has in managing their health and their medical conditions.

5. Use specific examples to illustrate how the patient’s condition affects their daily life and ability to work. For example, you might describe a time when the patient experienced a symptom flare-up that prevented them from completing a task at home or attending work.

6. Emphasize the patient’s need for financial support through benefits such as PIP or ESA. Explain how this support would help them manage their condition and improve their quality of life. With the cost of living crisis, these benefits are now essential for many people.

7. Remember to keep the letter factual, polite, concise and to the point, and to focus on the patient’s medical conditions (both physical and mental health problems) and how they impact their ability to work and carry out essential daily activities.

Some doctors argue they should not be writing such letters as they detract from the time available from providing core medical services. But obtaining support from a PIP or ESA can improve a patient’s well-being, which ultimately is also beneficial for the NHS and society.

In England, the NHS is funding social prescribers to work with general practices and writing such letters of support is often delegated to these social prescribers who can take over this task from health professionals such as general practitioners and therapists.

Financial problems will have a big impact on people’ health and well-being and it is important that NHS staff do their best to support patients who have difficult financial circumstances because of their health problems.

Understanding and Managing Sport-Related Concussion in Primary Care

The importance of the global emphasis on physical activity for health cannot be understated. However, it is crucial to address one of the adverse effects of contact sports—specifically, sport-related concussions. Sport-Related Concussion is a traumatic brain injury caused by a direct blow to the head, neck, or body resulting in an impulsive force being transmitted to the brain.

Sport-Related Concussion can present with a wide range of signs and symptoms, and can affect a person’s thinking, concentration, memory, mood, and behaviour. These incidents are common and account for a significant number of emergency department visits. They also have some long-term risks, including cognitive and neurological problems.

Recent publications, like the consensus statement from the Concussion In Sport Group and the UK Government’s landmark concussion guidance, offer valuable insights in the management of Sport-Related Concussion. This blog – based on our recent article in the British Journal of General Practice – aims to provide guidance on recognising, diagnosing, and managing Sport-Related Concussion within the context of primary care.

 The Changing Landscape of Sport-Related Concussion

In 2016, over 1% of emergency department visits in England and Wales were attributed to concussions. Up to 60% of these involved children and adolescents. A 2021 UK House of Commons report criticised the current awareness level about Sport-Related Concussion in the UK’s NHS, indicating a need for better recording and treatment procedures.

 Recognising Sport-Related Concussion

Symptoms of Sport-Related Concussion can range from cognitive issues to mood changes. Anyone with a suspected concussion should be immediately removed from the field of play and assessed by an appropriate healthcare professional within 24 hours of the injury. Those working in sport will be aware of specialist assessment tools pertaining to individual sports that aid clinicians when diagnosing concussion. The UK Government guidance provides a list of ‘red flags’ that require immediate assessment.

Once Sport-Related Concussion has been recognised or diagnosed, a short period (24–48 hours) of relative rest is advised, where only light-intensity physical activity that does not, or only minimally, exacerbates symptoms is undertaken. Subsequently, a logical graduated return to school/work and then sport can be started, where progression through stages is dependent on minimal and transient (the CSIG advise <1 hour) exacerbation of symptoms.

Sport-specific assessment tools exist for diagnosing concussion, such as the Sport Concussion Assessment Tool (SCAT6). These tools are most effective within 72 hours of the injury and evaluate symptoms, cognitive function, and coordination.

 Managing Sport-Related Concussion in Primary Care

Primary care doctors play an essential role in managing Sport-Related Concussion. Initial management includes:

– Advising a short period of relative rest (24-48 hours)

– Reducing screen time and cognitive load

– No alcohol, solitary time, or driving within the first 24 hours

Patients with persistent symptoms beyond 28 days should be referred for a more comprehensive assessment. Gradual return to normal activities is advised, strictly adhering to symptom-dependent progress.

Challenges and Future Directions

The NHS’s limited specialist services for treating complex or prolonged sport-related concussion symptoms create a care gap. This could be bridged by experts in sports medicine or primary care doctors with extended roles in sports medicine. Emerging technologies like Inertial Measurement Units (IMUs) in mouthguards and salivary micro-RNA samples show promise for better recognition and understanding of sport-related concussion.


Sport-Related Concussion is important. Effective recognition and management by general practitioners can significantly contribute to an individual’s immediate and long-term health. It is also vital for local commissioners to implement appropriate care pathways for managing this condition. By acknowledging the complexities in management and investing in ongoing research, we can create a healthcare system that supports both the benefits of physical activity and the challenges it can sometimes bring.