Professor Azeem Majeed
@Azeem_Majeed
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I am Professor of Primary Care & Public Health, and Head of the Department of Primary Care & Public Health at Imperial College London. Own views.
Joined May 2013
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In my general practice, we switched from 10 minute to 15 minute appointments, which made a big difference in how well our doctors kept to time. They were happier and less stressed because they were not always running late, and their patients were also happier.
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I am not a close observer of the Royal Family but even I have been struck by the abuse and vitriol directed at Meghan Markle, the Duchess of Sussex. This kind of sustained hate directed at one person can be very detrimental for their mental health & wellbeing and needs to stop.
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Patient: I wish Dr Majeed was still working here. He was terrific when my mother was seriously unwell 20 years ago.
Me: I am Dr Majeed.
Patient: No, you can't be Dr Majeed. He was a lot younger looking than you.
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An overseas friend asked what it was like living in the UK at the moment. I said it was like being on the Titanic and seeing the iceberg but realising no one was making any great effort to avoid colliding with it.
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The government is ending its Covid-19 Plan B measures in England & face masks will no longer be mandatory, My advice as a doctor & public health specialist is that people should continue to wear face masks (ideally a FFP2 mask) when in indoor spaces outside their home.
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As a doctor and medical professor, I strongly advise people ***NOT*** to give prescription drugs to family members and friends who are unwell. Please leave the practice of medicine to people who are appropriately qualified.
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I was explaining to a student recently how we did literature searches in the 1980s and 1990s.
We had to look up articles in a printed copy of Index Medicus, and then pushed a trolley around the library to collect the journals so we could photocopy the articles.
We also had to
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Patient: I'd like to see a GP.
Receptionist: You can't see a GP but can see a physician associate, pharmacist, physiotherapist, social prescriber, care navigator, advanced care practitioner, mental health worker or lifestyle adviser.
Patient: I just want to see a GP.😥
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NHS Manager: Our staff have high levels of stress and burnout. What can we do about this?
Me: How about improving their working environment and reducing the intensity of their work?
NHS Manager: We will organise a Wellness Seminar they can attend in their own time instead.
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I used to tell my PhD students that a PhD was a marathon and not a sprint. Now that Eliud Kipchoge has run a marathon in under 2 hours, I will need to think of something else to tell them.
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I’ve just been notified that the Post Covid Assessment Clinics at the NHS Trusts that the patients of my NHS general practice use have been suspended. Local general practices have been asked not to send any new referrals requests for patients with ongoing post-Covid-19 symptoms.
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One thing they don’t teach you in medical school is the “clap eyes sign”. It’s when a patient enters your clinic room and as soon as you clap eyes on them, you realise they have a serious medical problem. You won’t find it in any textbook but it is important in clinical medicine.
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I’m wondering if there is any UK employer who would be happy to have a member of staff back in the workplace a day after they had a positive Covid-19 test? What measures will employers take to protect their staff and customers once Covid-19 measures end?
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Arrived at my general practice this morning to learn that one of our triple-vaccinated doctors had just been diagnosed with Covid-19 and will be entering a 10-day isolation period. Sadly, this will be an increasingly common occurrence among NHS staff as Omicron spreads further.
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I was explaining to a student how we did literature searches in the 1990s. We had to look up articles in a printed copy of Index Medicus & then pushed a trolley around the library to collect the journals so we could photocopy the articles. There was an incredulous look in her eye
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The threat of a GMC referral should never be used by NHS managers to bully or intimidate doctors. A referral to the GMC should only be done for the severest breaches of professionall standards. And there should be severe sanctions on NHS managers who make inappropriate referrals.
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I was up at 4am this morning to give a lecture on England's Covid-19 strategy to an audience at a scientific meeting in Malaysia. They struggled to understand our government's reluctance to bring in legal mandates in areas such as wearing face masks and vaccine passports.
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Good to speak to
@toryboypierce
on
@LBC
today. The decision to delay the second dose of Pfizer Covid-19 vaccine from 3 weeks to 3 months is not supported by the manufacturer. The Pfizer vaccine is designed to be given as two doses 3 weeks apart. Other dosing regimes are untested.
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I’ve been trying to order some lateral flow tests for Covid-19 from the government website without success for the last few days. NHS guidance is that healthcare workers test themselves for Covid-19 twice weekly. But this is impossible to do if we can’t obtain the tests.
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If I ever wanted to write an academic case study on the malign effects of social media and the potential impact of online abuse on someone’s mental health and wellbeing, I need to look no further than the example of Meghan Markle, the Duchess of Sussex.
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We are seeing an increasing number of previously healthy people with long-term heart, lung, neurological and mental health problems following Covid-19 infection. Focusing on deaths only does not give us the true global impact of this illness and what its final effects will be.
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One assumption I commonly see on Twitter is that children have not had a serious Covid-19 infection because they did not require inpatient hospital treatment. In my medical practice, we have seen many children who have had a prolonged illness that was treated in the community.
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When GP referrals are rejected by specialist teams, a copy of the rejection letter should be sent to the patient with details of the person in the specialist team they can contact to obtain further information about the rejection. It shouldn’t be left to GPs to explain this.
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NHS staff are required to test regularly for Covid-19 using lateral flow devices. And yet, many are struggling to obtain tests because of the increase in demand for them from the public. We need tests to be supplied directly to the NHS for distribution to clinical staff.
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When the government say their Covid-19 strategy is “led by the science” but then refuse to publish the minutes or membership of the Scientific Advisory Group for Emergencies (SAGE) or allow the members of SAGE to debate with its critics publicly, that’s dogma, not science.
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I’ve seen discussion on Twitter about children being hospitalised for Covid-19 having only a “mild illness”. What might seem “mild” to a hospital team won’t be mild to the child and their family, for whom a hospital admission will be a very stressful & uncomfortable experience.
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A common medical myth is that NHS prescription lengths should be 28 days. This is nonsense. Prescription lengths should be tailored to the drug and the patient. For many drugs and for patients with stable medical conditions, longer prescription lengths are entirely appropriate.
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One of the things about the NHS that has always surprised me is why NHS England is willing to pay NHS Trusts and private companies more for providing a service than they are willing to pay general practices for providing the same service.
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Me: I'll be on BBC News later today.
Mum: That's nice. I'm looking forward to watching you.
Post-Interview
Me: What did you think of my interview?
Mum: You wore the same shirt as you did for your last interview. Wear a different one next time. And your tie wasn't straight.
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I am hearing from many adult patients who are reporting that in recent weeks they have had Covid-19 outbreaks in their households where the index case was a school-aged child. This isn’t something that parents were reporting as much earlier in the pandemic.
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If you are a parent or grandparent of school age children, you can take all the infection control measures possible when you are outside your home; but the biggest risk of infection for you is when you are at home with your children because of their high Covid-19 rates.
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I often see calls on Twitter for doctors & other NHS staff to be “more resilient”. We are already highly-resilient, often working under very difficult & stressful circumstances. What we need are good working conditions along with better support from NHS management and the public.
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There are now more than 8,000 patients with Covid-19 in hospitals in the UK, the highest level for nearly six months. This is not a good place for the NHS and the UK to be while we are still in summer and yet to face the usual Autumn and Winter increase in respiratory infections.
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If we had not experienced >10 years of underinvestment in primary care services, we would now have had a solid infrastructure to deliver our Covid-19 vaccination programme. Instead, we have negotiations about what "non-essential work" primary care teams can delay providing.
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Patient: I remember my family doctor in the 1990s. He was an excellent clinician, very up to date and always willing to fit me into his clinic if I had an acute problem. Where have doctors like him gone?
Me: I was your family doctor in the 1990s.
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Patients often ask me what kind of face mask they should wear. My advice is to use a higher-quality non-valved FFP2 mask. This provides a tighter fit & provides better filtration than a standard surgical mask. Important advice now that Covid-19 case numbers in the UK are so high.
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£12 billion has spent on Test and Trace in England, much of it on private companies. These funds could have built up local public health and NHS teams. This would have created a system that could have been used for future waves of Covid-19 and any new pandemics.
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One important lesson I learned early in my use of social media is there is nothing to be gained by arguing with people who are abusive, idiots or very ill-informed. Move on past them and free up your time for more useful interactions that benefit you and your audience.
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I am hearing about people carrying out multiple lateral flow tests in a single day. The tests are in short supply in many parts of England and this kind of practice will exacerbate supply problems, including for key workers such as NHS staff. Please use the tests responsibly.
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Message to local government: If an elderly or disabled patient informs you that they are too weak to push their wheelie bin out onto the street and they need someone to do it for them, please believe them. Please don’t ask them to contact their GP to get a letter to confirm this.
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One of the key lessons from the emergence of the new B.1.1.159 variant in Southern Africa is that if we don’t address the enormous global inequity in access to Covid-19 vaccines, other variants may emerge that are highly infectious or against which vaccines work less well.
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I am increasingly hearing rhetoric from politicians and NHS managers about the need to remove “simpler patients” from doctors; thereby allowing them to focus on “complex patients”. But for doctors, seeing an unending stream of complex patients is professionally very challenging.
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Any referral from a GP that is rejected by an NHS Trust should be signed by a named clinician or manager who takes responsibility for the decision. Too many rejection letters are anonymous and don't include the details of the person who rejected the referral.
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Private schools in England saw the biggest rise in A Level Grade A results. I'm hearing about many state school students from poorer backgrounds who had their results downgraded. So disheartening and unfair for these students.
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Looking at the salaries of senior GMC staff, it’s very clear they are grossly overpaid to run an organisation whose core function is essentially to maintain a database of doctors licensed to practise medicine in the UK. And no way should they be getting private medical insurance.
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The measles, mumps & rubella vaccination target for 5 year olds in England has been met for the first time. Well done parents & NHS staff.
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One concern I hear repeatedly from junior doctors is that they are often lower paid and less well-treated by NHS employers than non-medical clinicians who are not as well-qualified as them. It’s one of the key factors lowering the morale of the medical profession in England.
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I received a bill today from the GMC for the annual £455 registration fee. Once again, I wonder why I am paying for an organisation that I have no say in how it is run, for which I can’t elect any of its senior officers and which is largely an arm of the government & NHS England.
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Why is the Covid-19 test-and-trace system drafting in management consultants from the private sector rather than experienced public health, medical and healthcare management professionals?
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NHS England’s “plan” for extended GP opening hours: The same number of staff offering the same number of appointments but offering them over a longer period at a higher cost per appointment. How is this going to improve access to primary care services and health outcomes?
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A number of patients have informed me they have tested positive for Covid-19 despite being full vaccinated. Often, their infection was passed on from a younger family member. It’s a reminder that the pandemic is still very active and people should take appropriate precautions.
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Unlike some departments in NHS hospitals, my university department does not put locks on its kitchen appliances to prevent “unauthorised use”. And we provide free tea and coffee for all our staff. It’s important to make your team feel welcome and take steps to improve morale.
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GPs are being asked to see patients with dental problems, often after they have contacted NHS 111, because of a lack of dental services. GPs are not dentists & NHS 111 should not be doing this. It’s the responsibility of NHS England to provide care for these patients, not GPs.
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Me: Do you smoke?
Patient: No
Me: Have you ever smoked in the past?
Patient: Yes
Me: When did you stop smoking?
Patient: Yesterday, when I made the appointment to see you.
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As a clinician & medical educator, what are my views on the apprenticeship scheme for training doctors that NHS England & the GMC want to introduce?
I think it's a ludicrous idea. There are much better ways of training more doctors & retaining them in the NHS we can implement.
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Positive news that children aged 5-11 in Wales and Scotland will be offered Covid-19 vaccination. But no update yet about children in England. And it would have been better if the JCVI advice on vaccination in this group had been published rather than leaked to the press.
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There are some positive proposals in the NHS England Workforce Plan. But I disagree with training doctors via apprenticeships. When I speak to senior academic clinicians overseas, they say this will make doctors in the UK the laughing stock of the global medical community.
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When the government say their decision to end Covid-19 regulations in England later this month is “led by the science” but their plans are not supported by the vast majority of academics, clinicians and public health specialists, that’s political dogma, not science.
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A common scenario in NHS primary care: A patient with a mental health problem is too complex or unwell to be managed in the community. But when they are referred to a specialist mental health team, they “don’t meet the criteria for the service” leaving them unsupported.
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I have been advising my patients about the importance of Vitamin D for their health. Because we are in lockdown and spending a lot of time indoors, Vitamin D levels can become low. Make sure you take Vitamin D supplements if you are not getting a lot of sun exposure.
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I am talking to some medical students.
Me: When I was a medical student and wanted copies of academic articles, I had to wheel a trolley round the library, collect the journals and take them to a photocopier.
Medical students: We have no idea what you are talking about.
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When people discuss the salaries of junior doctors, they often overlook the many "hidden" costs that they have to pay for. This includes student loans, examination fees, GMC registration, medical insurance, training courses, textbooks, equipment and relocation expenses.
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One of the ironies of the far-right demonstrations we are currently seeing in parts of the UK is that any demonstrator who is injured and requires medical treatment is very likely to be treated by a healthcare professional who is either an immigrant or from an ethnic minority.
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The government announced today it has abandoned the publication of data on the number of people being tested for Covid-19 in England. Person-based information on testing is essential for tracking infection rates in the community and its absence hinders the response to Covid-19.
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Me: My NHS infection control training expired yesterday.
Infection control team: You are forbidden from seeing any patients until you have taken the course.
Me: A patient is asking if he can bring his pet llama onto the ward.
Infection control team: Yes, of course. Any time.
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The GMC’s updated Good Medical Practice guidance on professional medical practice now includes an explicit obligation for doctors to be kind. I’m wondering how the GMC will measure kindness; and where they will draw the line between being kind and being cruel and callous.
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Me having a telephone call with a patient.
Me: I am sorry to hear you are unwell. Would you like to come to the surgery to see me later today?
Patient: No doctor. I haven't got any petrol. I'm perfectly happy with a telephone consultation.
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The message states “If patients present with post covid symptoms, GPs are asked to follow the Primary Care assessment steps published in the Clinical Reference Guidance for London for the Post-COVID Syndrome Pathway and to use Post Covid Advice & Guidance."
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NHS organisations are using use mindfulness & breathing techniques to reduce feelings of being overworked among their staff. I think they'll find that actually cutting staff workload is much more effective at reducing the feeling of being overworked than any other intervention.
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A recent article claimed that no one would notice if GPs went on strike. Here are some statistics about general practice in England:
- 25 to 30 million consultations each month
- Around one billion prescriptions issued each year
- Giving the majority of Covid-19 vaccinations
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Speaking as a doctor, when someone coughs over you and then says "Don't worry, it's not covid", that isn't any reassurance. I don't want to be infected with whatever virus they are carrying; whether it's SARS-CoV-2, another coronavirus, flu, adenovirus, RSV or another virus.
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One thing I have learned on Twitter today is that you can't argue with stupid. Just mute and move on.
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Our new article in
@bmj_latest
discusses how to safely return to exercise after a Covid-19 infection. Only start to exercise again after at least 7-days free of symptoms, and begin with at least two weeks of minimal exertion.
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I’ve just received a letter from NHS England telling me that “we need to work together, as a system, to address wicked problems”. I’m looking forward to hearing more from NHS England about what a “wicked problem” is and whether we need a naughty step to deal with it.
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This is a very foolish decision by the House of Commons Speaker. There are now > 30,000 Covid-19 cases daily in the UK. Parliament should be setting an example by supporting working practices that reduce the risk of infection, and which protect vulnerable MPs and their staff.
As the House returns in full next week, I would like to remind everyone that provisions which allowed for hybrid participation in the Chamber are no longer in place. The business of the House in the Chamber will resume as it was pre-pandemic.
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NHS England: GPs need to refer more patients to specialists. Too many patients with long-term conditions are undiagnosed or diagnosed too late.
Also NHS England: GPs are referring too many patients to specialists. So we will bring in measures to reduce the number of referrals.
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As a doctor and medical educator, my view is that the GMC is misguided in trying to produce combined standards on Good Medical Practice for doctors and physician associates. These are distinct groups with different professional roles and each should have their own guidance.
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Tried to order some lateral flow tests today but got a message saying “Sorry, there are no home delivery slots left for these tests right now”. The government needs to prioritise requests from NHS staff & other key workers who need to test regularly for occupational reasons.
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In some cases, children also developed complications such as secondary infection that required additional treatment. So not being admitted to hospital does not mean that a child did not have a serious illness that disrupted their life and that of their family members.
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Many people assume that if doctors are not seeing patients, they are not working. They are unaware of all the work that is done by telephone and other remote consultation methods; and the vast amount of clinical correspondence and administrative work that doctors deal with.
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In England, we currently have many GPs unable to find permanent posts whilst at the same time patients are struggling to get appointments with their own GP. The next government must invest in core GP services to expand capacity and give people the care the primary care they need.
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Many people are acting as though the pandemic is over. But we are still getting around 40,000 Covid-19 cases a day in the UK. Vaccines are helping to reduce the number of serious cases, hospitalisations and deaths but other measures are also needed to control the pandemic.
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I am a professor of primary care & public health, GP & public health consultant. I am fully vaccinated against Covid-19. I have been running vaccination programmes for my patients for > 20 years. Covid-19 vaccination is safe & effective in reducing the risk of serious illness.
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Every year, I have to pay a registration fee to the
@gmcuk
so I can remain on the medical register and practise medicine. And yet, I have no say in the running of the GMC. Like many doctors, I am very unhappy with the actions of the GMC. Where’s the accountability?
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NHS general practices in England are getting a large number of requests from patients to opt out of sharing their medical information for research and planning. This is yet another government policy that has led to an increase in the administrative workload of general practices.
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An annual Netflix Premium Plan (£192) is more than the total payment (£160) that general practices receive per patient registered with them from NHS England. There is a reason why NHS general practices are currently under so much pressure & patients increasingly frustrated.
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The annual NHS flu vaccination programme can’t be switched on and off like a tap. General practices need time to order vaccines, put in place patient appointment and reminder systems, book clinics, and arrange to vaccinate people who are housebound or clinically vulnerable.
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I’m listening to medical students present on how they would tackle a key public health challenge.
Students: We will be speaking about the prevention of type 2 diabetes in older people.
Me: Who do you define as an older person?
Students: Anyone over 40.
Me: 😭😭😭
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Disappointing to see that around 800 medical students, the highest ever total, are on the reserve list for foundation training this year after not being allocated a placement for FY1. Extra medical school places must be followed by an increase the number of training positions.
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I read in the press today today that 12-15 year olds in England will be able to get Covid-19 vaccinations at NHS vaccine clinics as well as in schools. Although this is good news, why is it that the media are informed about changes to NHS policies before NHS staff?
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Although they did not require hospital treatment, these children had a prolonged illness that was very unpleasant and stressful for them and for their families; as well as disrupting their education and the lives of their other family members.
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I have worked as an NHS GP since the 1990s. Not only has the number of patients per GP increased since I first started, the complexity and medico-legal risk of the clinical work has also increased, as have the administrative and regulatory burdens on NHS general practices.
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Repeat prescription lengths in general practice should not be 28 days by default for people with stable long-term conditions. Short prescription lengths are more inconvenient for patients & make medication adherence more difficult as well as increasing general practice workload.
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New guidance from NICE advises GPs to ask patients about gambling. To which we can add asking about weight, diet, exercise, smoking, alcohol, screening & immunisation. All of which must be done within 10-15 minutes. As well as dealing with the problem the patient presented with.
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My university, Imperial College, has gone through a rebranding and come up with a new logo. In my view, it looks terrible and is much worse than the logo it replaced (which at least mentioned we were a college and based in London). A complete waste of money.
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Good news about the decision to extend the Covid-19 vaccine booster programme to all adults. But it is VERY disrespectful of DHSC and NHS England to brief the press about proposed changes in the national vaccination programme before informing the NHS staff who are delivering it.
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One of the joys of Twitter is watching people who have little or no knowledge of a subject trying to "educate" people who are leading experts in their field.
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When I read some of the comments about the poor work facilities for junior hospital doctors, I struggle to understand why some problems can’t be solved easily by NHS managers. For example, how difficult can it be to ensure everyone has a locker and access to a PC to work on?
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US doctors: Primary care in the USA is in crisis because we have to see 10-20 patients each day, with only 30 minutes for each appointment.
UK GPs: 10-20 patients each day and 30 minutes for each appointment? Where do I sign up?
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GP services account for about 8% of the NHS budget in England. Cutting GP-led services won't generate much funding for the rest of the NHS. In contrast, restoring GP spending to 11% of the NHS budget - what it was 15 years ago - would have a dramatic effect on access to care.
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I was sceptical when I heard my medical practice was getting a social prescriber but having worked with her for a few months, she has made a real difference. She has helped guide many patients through the health, social care and benefits systems and improved their quality of life
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