Month: July 2025

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

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

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

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

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

Does Online Access to Medical Records Help Patients and Improve the Quality of Healthcare?

There was a lot of discussion in the government’s 10 year health plan about digital interventions such as giving people online access to their medical records. But does this improve healthcare delivery and clinical outcomes? This was the topic of our recent systematic review published in the journal BMJ Quality and Safety. We found that giving people online access to their medical records increased self-reported patient-centredness and improved some aspects of patient safety. But many questions about the benefits of online access remain unanswered.

The Good News: Empowering Patients

On the positive side, we found clear evidence that giving people online access to their medical records increased self-reported patient-centeredness. What does that mean in simple terms? Patients felt more involved, informed, and in control of their own care. This shift from a passive recipient to an active participant is a cornerstone of modern healthcare and is a significant win for patient empowerment.

We also found that this digital access improved some aspects of patient safety. While the full scope of this finding is still being explored, it suggests that when patients can review their own records, they may be able to spot potential errors or inconsistencies, acting as an extra layer of oversight.

The Reality Check: More to Learn

While these findings are encouraging, our review made it clear that the story is far from over. Despite the positive results, many questions about the broader benefits of online access remain unanswered. We still need more research to fully understand the long-term impact on overall clinical outcomes, patient-provider relationships, and potential unintended consequences.

The transition to a digital healthcare system is a complex one, and it’s important that we continue to base our decisions on robust evidence. While online access to medical records holds great promise for a more informed and empowered patient population, our work shows we are only at the beginning of this journey.

Is the Government’s 10-Year Health Plan for England a Prescription for Success?

The government’s recently published 10-Year Health Plan outlines a strategic vision for the National Health Service (NHS) in England, focusing on shifting care from hospitals to community settings, making greater use of digital technology like the NHS App to improve the efficiency and accessibility of health services, and prioritising preventive care over reactive treatment. While these objectives are commendable, they have been present in government plans spanning the last three decades, raising concerns about how successfully they will be implemented.

Although very welcome, the increases in NHS funding in the plan are not as large as those seen under the previous Labour government from 1997-2010. This disparity in financial commitment could significantly impact the scope and pace of the proposed reforms if not matched by substantial increases in NHS efficiency and productivity.

Furthermore, a heavy reliance on digital solutions, risks excluding vulnerable populations. Elderly individuals or those with limited IT skills may find themselves marginalised, exacerbating existing health inequalities. Additionally, an overly centralized, top-down approach to control of the NHS could stifle local innovation in the diverse health and care landscape in England.

To ensure the plan’s success and avoid the failures of previous long-term NHS plans, it is essential that the ambitious objectives in the plan are supported by the appropriate contractual changes and the required workforce developments. Without these foundational elements, the 10-Year Health Plan risks becoming another repeat of well-intentioned, but ultimately unfulfilled, past government promises about transforming the NHS in England.

We Should Celebrate – Not Discourage – Overseas Students in the UK

As a university academic, I am disheartened by the way some politicians and sections of the media portray overseas students. Rather than acknowledging the many economic, cultural, and academic benefits these students bring to the UK, they are too often depicted as a burden. This is a narrative that is not only misleading but potentially damaging.

International students choose to come to the UK because of the global reputation and quality of our universities. Despite the very high tuition fees they are charged, they continue to enrol in large numbers. These students bring with them diverse perspectives, enrich our academic communities, and foster global networks that benefit British research, innovation, and diplomacy.

The financial contribution of international students is also well established. They help sustain many of our universities, support thousands of jobs across the country, and contribute billions to the UK economy each year. Beyond that, they play an integral role in cultural exchange, helping to make our campuses and our society more open, inclusive, and outward-looking.

Yet, education is a global market. These students have choices. If they begin to feel unwelcome in the UK — whether this is due to hostile political rhetoric, restrictive visa policies, or a lack of post-study opportunities — they will go elsewhere for their university education. Other countries are competing aggressively for their presence, and the UK risks losing out not just on tuition income, but on talent, innovation, and global goodwill.

It is time for a more constructive and respectful discourse around international students. We should remember that recognises international students are not a problem to be solved, but as are an important part of what makes our universities world-leading and culturally enriching for all their students.

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.