An online memorial wall for health and care workers who have died by suicide has been launched by NHS Practitioner Health.Since 2011 more than 2500 healthcare workers in the UK have died by suicide, an average of four a week.1According to some estimates one doctor dies by suicide every three weeks in the UK.2The online memorial wall aims to serve as a permanent space for colleagues, friends, and families to share photographs and memories of health and care workers who have taken their own lives. 3NHS Practitioner Health is a specialist mental health and addiction service for doctors. In addition to the memorial wall it has launched a new webpage dedicated to providing messages of hope.Helen Garr, medical director at NHS Practitioner Health, said she believed the online memorial wall—launched on the third annual National Suicide Memorial Day for Health and Care Workers—is the first of its kind.“Through our work...

The cost implications of the US-UK drug pricing deal must be rapidly investigated by the UK’s public spending watchdog, the heads of six different parliamentary committees have urged.The UK signed a drug trade deal with the US in December 2025 to reduce the effect of tariffs put in place by US president Donald Trump.1As part of the deal, ministers agreed to raise the cost effectiveness thresholds used by the National Institute for Health and Care Excellence (NICE). These thresholds will rise from £20 000 to £30 000 per quality adjusted life year (QALY) to £25 000 to £35 000 per QALY.But the deal has proved controversial, with an analysis published in The BMJ calculating that changes implemented as part of the deal could lead to 229 000 excess deaths over the next decade, as around £45bn in NHS funding would be diverted from existing services by 2036 to cover the...

Corfield and colleagues point out that undetected fetal growth restriction is both an ultrasonography problem and a maternity safety problem.1 The issue is not only the growth chart but also whether maternity services recognise possible placental failure early enough, respond, and learn from near misses.Fetal growth trajectory needs more attention. Size at a single scan can be misleading. Larsen et al studied 5319 pregnancies, finding that a fall of at least 50 centiles in the second half of pregnancy was associated with four times the adjusted odds of perinatal mortality.2 This was seen even when the final estimated fetal weight or abdominal circumference remained at or above the 10th centile. When reduced growth and smallness were both present, the adjusted odds rose to 7.71. A fetus can therefore look “not small” but still be at risk. Electronic alerts for slowing growth should be part of routine care.Risk is not limited...

AbstractObjectiveTo compare the risk of renal deterioration under treatment with glucagon-like peptide-1 (GLP-1) receptor agonists or sodium-glucose contransporter-2 (SGLT-2) inhibitors versus other second line treatments in people with type 2 diabetes with and without albuminuria (albumin to creatinine ratio ?30 mg/g).DesignTarget trial emulation.SettingsLinkage of electronic health records and claims data from 10 health systems and two national health insurance plans—data from BESTMED (observational evaluation of second line therapy medications in diabetes) study.ParticipantsPeople with type 2 diabetes and moderate cardiovascular risk and estimated glomerular filtration rate ?45 mL/min/1.73 m2 on metformin monotherapy who started treatment with a GLP-1 receptor agonist or SGLT-2 inhibitor, a sulfonylurea, or a dipeptidyl peptidase-4 (DPP-4) inhibitor after metformin between 2014 and 2022.Main outcome measureDeterioration of kidney function defined as doubling of serum creatinine or estimated glomerular filtration rate <15 mL/min/1.73 m2.ResultsAmong 75 455 eligible people (61 583 (81.76%) without albuminuria), median age was 60 years (interquartile range 51-68), 36 231 (48%) were women, median haemoglobin A1c was 7.8% (interquartile range 7.3-8.5%), and median estimated glomerular filtration rate was 92 mL/min/1.73 m2 (interquartile range 77-102). People were followed for a median of 32 months (interquartile range 18-57). The estimated five year risk of the renal outcome was 2.4% (95% confidence interval 2.1% to 2.7%) for people taking GLP-1 receptor agonists or SGLT-2 inhibitors versus 2.1% (1.8% to 2.6%) for people taking DPP-4 inhibitors among those without albuminuria; and 3.2% (2.3% to 4.1%) versus 5.4% (4.2% to 6.7%), respectively, among people with albuminuria. The estimated five year risk ratio comparing the GLP-1 receptor agonist or SGLT-2 inhibitor group with the DPP-4 inhibitor group was 1.10 (95% confidence interval 0.90 to 1.38) among people without albuminuria and 0.60 (0.42 to 0.82) among people with albuminuria.ConclusionsCompared with DPP-4 inhibitors, GLP-1 receptor agonists and SGLT-2 inhibitors reduce the risk of deterioration of renal function in people with albuminuria. Little evidence of renal benefit among people without albuminuria was observed over the study follow-up period.

More than half of integrated care systems (ICSs) in England don’t have enough capacity to accurately diagnose childhood asthma in line with current guidelines, a survey has found.National clinical guidelines emphasise that doctors should not make a diagnosis of asthma in children based on symptoms alone.The 2024 joint guidelines, published by the National Institute for Health and Care Excellence (NICE), the British Thoracic Society, and the Scottish Intercollegiate Guidelines Network, recommended that the measurement of fractional exhaled nitric oxide (FeNO) levels should be the first line diagnostic test in children with a history of asthma.12Asthma should be diagnosed if the FeNO level is 35 parts per billion or more, the guidelines state.However, the charity Asthma + Lung UK has found that the availability of FeNO testing is “patchy,” with many areas either not commissioning enough to cover the whole area or not enough to meet demand.The charity surveyed all of...

A saliva based diagnostic test, called Endotest, can be used in primary care when endometriosis is suspected, the UK National Institute of Health and Care Excellence (NICE) has recommended in updated draft guidance.1An original version of the draft guidance, published in July, recommended two non-invasive tests to speed up the diagnosis of endometriosis, Endotest and Endosure.2However, after consideration of consultation responses alongside the original evidence base, the committee has now concluded that the evidence for Endosure remains too limited to be recommended.Endosure attempts to detect endometriosis by using sensor pads on the abdomen to measure electrical signals in the gut.More research is also needed before two blood tests, DotEndo and Endomkit, can be considered for NHS funding, NICE added.Endotest is a test that detects a biomarker signature of endometriosis in saliva. The saliva sample must be sent to a lab for analysis. NICE recommends its use in primary care when...

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...