A scalable programme of additional psychological support for NHS workers will be rolled out in the event of a future pandemic, the government says. Officials made the commitment in its response to module 3 of the UK Covid-19 inquiry.1In the third phase of the national inquiry, published in March, its chair Heather Hallett said that the NHS “teetered on the brink of collapse” but was saved by the “superhuman” efforts of doctors and other healthcare staff.2 But this enormous effort came at great personal cost to healthcare workers and their families as they were obliged to work under “intolerable pressure for months on end,” Hallett said.Her report found that the mental health of healthcare staff “was severely impacted, with many exhibiting signs of post-traumatic stress disorder, while burnout was common.”One of Hallett’s recommendations was that the government should put in place plans to deliver effective support for healthcare workers at...

The group UK Lawyers for Israel (UKLFI) has urged the government to investigate and potentially proscribe the medical charity Doctors Without Borders (Médecins Sans Frontières, or MSF) under terrorism laws, according to media reports.UKLFI, a group of lawyers who campaign for Israel, reportedly wrote to the Home Office, Charity Commission, and the Fundraising Regulator alleging that MSF had previously employed people with ties to Palestinian terrorist organisations.It further alleged that the charity did not have adequate safeguards in place to ensure charitable resources were not “exploited by terrorist organisations.”A UKLFI spokesperson told the Telegraph, “We are not questioning legitimate humanitarian medical work. But humanitarian status cannot place an organisation beyond proper scrutiny.“We have therefore asked the Charity Commission and Fundraising Regulator to investigate MSF UK and have submitted our evidence to the home secretary for consideration under the Terrorism Act.”1MSF has strongly denied the allegations and claimed it is the...

Immigration status will be used as a proxy for significant NHS experience for the 2027 cycle of specialty training applications, the government has announced.1New regulations confirm that interim arrangements used for implementing the Medical Training (Prioritisation) Act in 2026 will roll over for another year while further analysis and impact assessments of the policy are undertaken.The act, which officially became law on 5 March 2026,2 was introduced to prioritise UK graduates over international medical graduates (IMGs) for postgraduate medical training places to tackle high rates of competition.It gives priority to people who graduated in the UK or Ireland, IMGs who studied in Iceland, Norway, Lichtenstein, and Switzerland, and individuals who have completed or are completing the UK foundation programme or the relevant previous stage of a UK specialty training programme.The act also provides powers for additional groups of applicants with “significant NHS experience” to be prioritised for speciality training.For the...

Titcombe calls for acknowledgment that normal childbirth is being pursued at the expense of safety and notes that this was not discussed explicitly in the Ockenden report.1 The term “normal birth ideology” is being avoided for a reason—it implies that to support or aim for a normal or physiological birth is a bad thing. Although unintended, it has had the effect of belittling midwifery skills and led to women who want and value a vaginal birth moving away from the NHS as they do not feel supported.The current reviews contain many examples of failed escalation or missing red flags during normal birth—this has clearly been a cause of harm and needs to be tackled. But that should not lead to safe vaginal birth being undervalued or unsupported. If this happens, then two problems arise. First, the skills in supporting physiological vaginal birth become lost along with the skills in recognising...

The multi-specialty recruitment assessment (MSRA) is widely used to shortlist doctors in the UK for specialty training. This exam was initially introduced for general practice (GP) applicants, but a number of specialties, including anaesthetics, emergency medicine, radiology, and surgery now use it as a key—or even the sole—criterion for deciding which applicants to interview.1 How can a single exam be an appropriate screening tool for 11 different specialties? It doesn’t make sense that specialties as different as psychiatry and anaesthetics use the same exam for recruitment despite requiring completely different skill sets. The MSRA’s use has become a marker of an oversubscribed system that is prioritising administrative convenience over testing candidates’ competence and suitability to a specialty.The one-size-fits-all nature of the MSRA allows candidates to apply to multiple specialties simultaneously. A strong overall score may secure a candidate several interview invitations, even in specialties where the applicant has limited portfolio...

UK maternity care is at a turning point after successive reviews into services locally and nationally. It has the opportunity to tackle the underlying drivers of failures and poor care. Many of these were identified in the recent review of Nottingham University Hospitals NHS Trust.1 They are systemic in nature—racism, lack of governance, failures in leadership, underresourcing, toxic workplace culture—but also clinical. In Nottingham, factors contributing to the many failures to escalate were not ideological but rather contextual and structural.Focusing on “normal birth ideology”2 as the root cause of failures in care takes attention away from the pressing systemic issues that must be tackled and denigrates the midwifery profession and physiological birth skills. Midwifery led models of care are recognised by the World Health Organization as proved, cost effective solutions to maternal and neonatal mortality globally.3 Continuity of care has an important role in the provision of safe, personalised care,...

AbstractObjectiveTo directly test the generalisability of cardiovascular disease (CVD) risk predictor effects across populations in a high income versus non-high income country, derive comparable risk equations, and identify more effective strategies for prediction across populations.DesignPopulation based cohort study.SettingPrimary prevention cohorts in New Zealand and China.ParticipantsEquivalent New Zealand and Chinese cohorts of people aged 30-74 years with diabetes and no CVD based on electronic health records.Main outcome measuresCountry specific five year equations were derived using standardised methods to predict first cardiovascular events; predictor hazard ratios were compared. New Zealand equations were applied to the Chinese cohort, with performance assessed before and after standard recalibration, followed by the updating of predictor hazard ratios that differed statistically significantly.ResultsBetween 2004 and 2018, 47?958 New Zealand participants had 5622 (11.7%) first CVD events. Between 2010 and 2018, 46?558 Chinese participants had 3650 (7.8%) first CVD events. Sex specific equations included 16 predictors. Hazard ratios for most predictors were similar between New Zealand and Chinese equations but differed markedly for age (eg, women: 1.61, 95% confidence interval 1.51 to 1.71 per 10 years in New Zealand, 2.51 (2.32 to 2.72) per 10 years in China). Standard recalibration of New Zealand equations did not improve calibration in the Chinese cohort (expected to observed ratio: 0.938 in men, 0.809 in women). Replacing New Zealand age coefficients with Chinese coefficients noticeably improved calibration (expected to observed ratio 1.027 in men, 1.025 in women).ConclusionsApplying a high income country derived CVD risk prediction equation to a population from a non-high income country with diabetes may introduce systematic errors, primarily driven by differences in the effect of age. Moving beyond simple recalibration to updating key predictor coefficients, particularly age, should be considered for more accurate risk stratification. This study highlights potential limitations of high income country equation updating practices and proposes a feasible approach to improve their accuracy when used in populations from non-high income countries.

New data have highlighted the serious risks to young people from meningitis B, which was responsible for almost all invasive meningococcal disease cases in 15 to 24 year olds last year.The UK Health Security Agency (UKHSA) data show that meningitis B was responsible for 93 of 96 cases of invasive meningococcal disease cases in this age group in England during 2025 to 2026.The UKHSA’s Invasive Meningococcal Disease (IMD) Report for England also shows that the bacterium was the leading cause of meningococcal disease across almost all age groups under 25, including infants (34 of 37) and 1 to 4 year olds (35 of 35).1Overall, 26 deaths were recorded among the 348 confirmed cases of total invasive meningococcal disease during the year.An outbreak in March in Kent was linked to 21 cases in students and other young people in the Canterbury area, and this was followed by two further outbreaks in...

The government could drop or modify plans to abolish Healthwatch England in order to retain an independent voice for patients, a minister has indicated.Karin Smyth, health minister, said that the government would review the plans to ensure that they “deliver for patients and service users,” after a debate on proposed amendments to the Health Bill this week.Healthwatch was launched in 2012 as a statutory independent voice of patients to ensure that the NHS at the national and local level is accountable to its users.The bill, published in May, set out plans to abolish Healthwatch England and local Healthwatch networks in their current form to “simplify the patient safety landscape.”12 But critics, including some MPs during the debate, have warned that the move risks removing a vital mechanism for giving patients and communities a say in decision making.3What did the minister say about Healthwatch’s future?MPs discussed4 two suggested amendments to the...

Ikigai is the Japanese concept of “what makes life worth living.” It might otherwise be described as a sense of fulfilment by pursuing one’s passions. Ikigai helped Milo Kato to feel reinvigorated and heal after an acute hospital admission for schizophrenia (doi:10.1136/bmj-2026-100399).1 Kato overcame the stigma of the lay definition of the condition, as a “split mind,” by achieving a better understanding of its scientific definition.We delve deep into the science of schizophrenia in our State of the Art review that examines advances in pathophysiology, management, and precision medicine (doi:10.1136/bmj-2026-635470).2 While the lifetime prevalence of schizophrenia is around 0.5%, lifespans are shortened by 15-20 years. The reasons include lifestyle, cardiometabolic changes related to long term drug treatment, and “unidentified intrinsic biological vulnerability.” The pathophysiology of schizophrenia is heterogeneous, and drug treatment doesn’t improve symptoms in a third of people. Cognitive behavioural therapy can be helpful.In an accompanying editorial, Das-Munshi and...

GPs should not prescribe semaglutide (Wegovy) for cardiovascular risk unless they have a written guarantee for funding, the BMA has said.In March the National Institute for Health and Care Excellence (NICE) said that GPs could prescribe semaglutide—a GLP-1 receptor agonist similar to tirzepatide (Mounjaro)—to adults with a body mass index (BMI) of 27 or over who had previously had a heart attack or stroke or have peripheral arterial disease, alongside lifestyle changes.1This guidance on preventing heart attacks and strokes advised that semaglutide should be offered by prescribers on top of patients’ current treatments, such as statins.But the BMA has issued new guidance2 to GPs emphasising that prescribing the jabs for reducing cardiovascular risk is not automatically a core responsibility for practices under the General Medical Services contract and does not form part of the cardiovascular disease indicators under the Quality and Outcomes Framework.As such, GPs should prescribe semaglutide for cardiovascular...

AbstractObjectiveTo identify and prioritise potentially inappropriate prescribing cascades based on population prevalence, incidence, and temporal association between the initial and subsequent drug.DesignPopulation level retrospective cohort study.SettingHealth administrative data from a source population of community dwelling older adults in Ontario, Canada.Participants2 297 942 community dwelling older adults alive on 1 January 2022.Main outcome measures65 potentially inappropriate prescribing cascades were identified through a 2025 international expert Delphi consensus. For each prescribing cascade, the analytic cohort comprised incident users of the initial and subsequent drug combination during the accrual period. The population prevalence of the drug starting the prescribing cascade and the incidence of the initial and subsequent drug combination were measured, and the strength of the temporal association between the initial and subsequent drug was evaluated using adjusted sequence ratios derived from prescription sequence symmetry analyses. Prioritised cascades were those with a population drug prevalence of the initial drug ?5%, prescribing cascade incidence of ?1%, and adjusted sequence ratio >1, with the lower limit of the 95% confidence interval (CI) above the corresponding threshold for each measure. Results were stratified by sex.ResultsThe cohort comprised 2 297 942 people (54.3% female) aged ?66 years. Twenty four prescribing cascades (37%) met all three prioritisation criteria. From the prioritised list, cardiovascular drugs were the most prevalent drugs starting the prescribing cascade (drug class range 19.0-65.9%). The highest incidence cascades were iron supplement to laxative (11.9%, 95% CI 11.7% to 12.1%), hydroxymethylglutaryl coenzyme A reductase inhibitor to pain reliever (10.9%, 10.7% to 11%), and cholinesterase inhibitor to sleep agent (10.3%, 9.9% to 10.7%). Temporal association, reported as adjusted sequence ratios, was highest for corticosteroid to antipsychotic (2.55, 95% CI 2.47 to 2.64), laxative to antidiarrheal (2.53, 2.43 to 2.65), and cholinesterase inhibitor to antiemetic drug treatment (2.24, 1.90 to 2.65). The adjusted sequence ratios were consistent when stratified by sex except for the selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor to overactive bladder drug cascade, which was stronger for male older adults (1.21, 1.10 to 1.33) than for female older adults (1.02, 0.96 to 1.09).ConclusionsThis prioritised list of 24 potentially inappropriate prescribing cascades could inform prescribing and deprescribing initiatives and policy development to improve drug safety in older adults at individual patient and population levels.

Three quarters of A&E staff experience or witness violence and aggression in their department on a daily or weekly basis, a survey has indicated.Long waits, overcrowding, and corridor care are making an existing problem worse, the Royal College of Emergency Medicine (RCEM) warned in a new report.1These conditions exacerbate patient frustration, reduce privacy, and place staff under greater pressure, which all combine to make incidents more likely, the RCEM said.The latest performance figures from NHS England show there were 47 000 patients waiting over 12 hours for an emergency admission in July 2026. On average around 2300 patients received corridor care per day.2A recent BMJ investigation found that eight in 10 trusts are caring for emergency department patients in corridors or other unsuitable places.3Stories of lengthy waits and corridor care are also frequently making headlines in the media. For example, the BBC recently reported that a woman with suspected meningitis...

A Bristol GP jailed for damaging petrol pumps in a climate protest has seen his suspension from the UK medical register extended after refusing to concede his actions were wrong.Patrick Hart took part in numerous climate protests before disabling and damaging petrol pumps at an Esso station in Essex with a hammer and paint in 2022.He was sentenced to 12 months in prison for criminal damage in January 2025.While in prison, he was visited by the UN special rapporteur on environmental defenders, Michel Forst, who condemned the UK’s punitive approach to climate protesters as “blatantly disproportionate.”1The UN envoy also accused medical regulator the General Medical Council (GMC) of “persecution or harassment of Dr Hart” and “astonishingly paradoxical reasoning” for referring him to the medical practitioners tribunal that would later suspend him.It would be “punishing him for a second time,” said Forst, “for having taken action to address what the GMC...

It has been revealed that the NHS paid almost £1bn over three years to private companies providing NHS services, mostly to help clear elective care backlogs.EveryDoctor, a grassroots advocacy group made up of UK doctors, published details of a Freedom of Information (FOI) request showing that 72 trusts had spent £993m since 2023 on “insourcing.”1Insourcing is when an NHS trust pays a private company to treat NHS patients, inside NHS buildings, usually run by NHS staff working extra shifts.The FOI request gathered responses from 72 of the 81 trusts contacted. Information requested covered the names of all insourcing providers used, the specific clinical specialties provided, and total expenditure per provider for the financial years 2023-24, 2024-25, and 2025-26.NHS England launched the Elective Recovery Fund in 2021 to help trusts clear the backlog left by the covid-19 pandemic. Under this approach, trusts were able to access more funding if they reached...

In this article by Myles and colleagues (BMJ 2026;394:e100407, doi:10.1136/bmj-2026-100407, published 19 August 2026), in the footnote to table 4, a P value was incorrectly reported as 0.001 when it should be 0.75. This section of the footnote should read “Comparison of difference between 25th and 10th centile was -2.9 (95% CI -9.3 to 15.2), P=0.75.” The article has been corrected.

A genetically modified kidney from a pig has worked in a patient with kidney failure for nine months—the longest period yet recorded—US doctors have reported.The transplant kept Tim Andrews, 66, free of dialysis for 271 days, and demonstrated for the first time that a pig kidney can be used as a temporary “bridge” until a human transplant becomes available, according to a case study report published in the Lancet.1Andrews had kidney failure caused by type 2 diabetes. He had just a 9% chance of receiving a human kidney within five years, against a more than 40% risk of dying or being removed from the waiting list for a transplant, the researchers noted.The pig kidney he received worked for nine months before it failed and was removed. After a short period of dialysis, he received another kidney from a deceased human donor.Researchers at Mass General Brigham hospital, Massachusetts—who carried out the...

The Royal College of General Practitioners (RCGP) has published its first dedicated research strategy, setting out a three year roadmap for 2026-29.1 It promises to strengthen research literacy; build and sustain academic careers and the evidence base in primary care; and support sustainable multidisciplinary research delivery, and it commits the RCGP to work with key stakeholders to achieve these objectives. The roadmap resonates with recent research strategies from the Royal Australian College of GPs,2 College of Family Physicians, Canada,3 and North American Primary Care Research Group,4 which provide similar recommendations to enhance primary care research.Research improves patient care56 and provides major economic benefits: for every £1 invested, research funded by the National Institute of Health and Care Research (NIHR) delivers over £13 in economic benefit in the UK.6 Historically, most research funding has been allocated to secondary care, despite most clinical contacts occurring in community settings.7 Only around 25% of...

An invasive species of mosquito that can transmit viral diseases such as dengue, Zika, and chikungunya has been discovered breeding in the UK for the first time.The UK Health Security Agency (UKHSA) has increased surveillance and trapping activities after invasive Aedes aegypti mosquitoes and larvae were detected at residential properties in east London.The agency said that the risk to the public remained low, as—despite recent heatwaves—the UK climate is too cold for the species to survive long term.It is the fourth time Aedes aegypti has been detected in the UK in recent years, but this is the first time that it has been identified breeding, health officials said.The species is typically found in tropical and subtropical regions and can transmit diseases including dengue, chikungunya, yellow fever, and Zika. It is not a vector for malaria.It has previously been known to “hitchhike” from its native range in vehicles, baggage, and imported...

A doctor in Guernsey revealed sensitive confidential medical information about one patient by taking a phone call while examining another patient, it has emerged.The breach of confidentiality was outlined in the latest report from Guernsey’s Office of the Data Protection Authority.1This case came to light after the healthcare provider that employed the doctor reported the breach to the data protection regulator.The doctor remained in the examination room throughout the conversation, where the identifying details of the patient on the phone and sensitive details of their health were heard by the patient being examined and by others in the room.“The information was heard by people who had no legitimate reason to receive it and who were unconnected to the care of the patient on the phone,” the Data Protection Authority’s report reads.“The breach involved the unauthorised disclosure of special category data and created a risk of distress and loss of privacy...