As the UK Covid-19 Inquiry progresses, the actions of national government and its agencies have been scrutinised and widely criticised. But we are also learning more about how the pandemic was managed at a local level.Daszkiewicz concludes that the knowledge and expertise of local stakeholders often went ignored.1 But this didn’t stop local directors of public health and their partners making a major difference.Take contact tracing, for example. In many locations characterised by deprivation and ethnic diversity, the national “test and trace” system failed to reach enough infected people. Despite initially struggling to obtain the data needed from the national system, many directors of public health created their own local contact tracing services. In Sandwell, the service recruited staff fluent in the main languages spoken locally. It also eliminated any dependence on local people having regular internet access. This substantially increased engagement rates among those needing to isolate.2On vaccination, many...

GP records for over 3 million patients are to be shared with researchers as part of a drive to improve the diagnosis, treatment, and prevention of major diseases.Data will be shared with three large national research studies— Genomics England, Our Future Health, and UK Biobank—where participants in these trials have given consent.The move is a new legal direction from the health secretary Wes Streeting which hands NHS England responsibility for sharing coded GP data securely and directly with the three approved projects.Patients not participating in any of the three trials will not have their GP data shared.Until now, sharing patients’ GP data outside of the NHS has not been permitted, apart from during the covid pandemic when an exemption was made.The government said that giving researchers access to the data will help “map the nation’s health” and examine the underlying causes of and develop new treatments for diseases like cancer,...

NHS patients are receiving remote care from GPs based overseas under a pilot scheme that claims to reduce clinical admin for UK practices.Doctors based in countries including Australia, India, and Malaysia are providing virtual appointments to UK patients as part of the trial.The scheme, run by private company Asterix Health, recruits overseas doctors and matches them for remote work with UK surgeries (see box).The GPs—who are registered with the General Medical Council—carry out tasks such as reviewing test results and conducting phone consultations with patients based in the UK.Asterix Health is working with seven UK surgeries which it said “are struggling to cope with the increasing demands of clinical administrative tasks.” It is currently employing eight doctors to provide care to patients at these surgeries.The scheme follows a pledge in the government’s 10 year plan to “explore opportunities to deploy UK registered professionals working in other countries to provide remote...

The competing interest statement of this editorial by Robert Howard (BMJ 2024;386:q2044, doi:10.1136/bmj.q2044) has been amended to note that he was an unpaid member of the scientific board of Synaptogenix.

The competing interest statement of this editorial by Robert Howard and Helen Kales (BMJ 2023;382:p1852; doi:10.1136/bmj.p1852) has been amended to note that Robert Howard was an unpaid member of the scientific board of Synaptogenix.

NHS cost cutting measures are undermining national efforts to reduce waiting times for cancer care and elective treatment, health leaders have said.It comes amid reports of a surge in recruitment bans in cancer units and operations being cancelled until the new financial year to allow NHS organisations to reduce their deficits.New figures released by the Royal College of Radiologists show that the number of NHS radiology departments and cancer centres imposing recruitment freezes on consultants doubled in the past year.In 2025, half (31 of 60) of specialist cancer treatment centres in the UK were unable to hire clinical oncologists because of recruitment freezes imposed by trusts to save money. This compared with 13 centres (23%) in 2024.The recruitment bans come despite widespread delays in cancer diagnoses and treatment, exacerbated by shortages of these doctors.The preliminary data from the college’s annual workforce census, to be published in the summer, also show...

The fate of a controversial US funded trial of a neonatal hepatitis B vaccine remains unclear, with different authorities claiming it is cancelled, suspended, or going ahead.The study aimed to look for any negative effects of the vaccine and would have been led by two Danish researchers, Peter Aaby and Christine Stabell Benn, whose work has been cited by the US health secretary and vaccine sceptic Robert F Kennedy Jr.However, the Africa Centres for Disease Control (Africa CDC) says it has now been cancelled. The organisation said this was because it exploited shortages of vaccine in Guinea-Bissau, the west African country where the trial was to be conducted, to find a study population in whom the shot, normally given at birth, was delayed to six weeks.Despite Africa CDC’s statement the US health department, the principal funder of the trial, told The BMJ it was proceeding.However, Guinea-Bissau’s health minister has now...

It started with delays. Patients queued for hours outside pharmacies from dawn and routine surgeries were regularly postponed. Then came shortages. Shelves of basic drugs emptied, insulin and cancer drugs ran out, and critically ill patients were turned away from hospitals.Now, there are closures. Maternity wards and neonatal units are shutting their doors. Emergency departments are overwhelmed and training programmes for specialist doctors are being cancelled.1The tragedy is that all this was “completely avoidable,” says Andrés Vecino, who studies the economics of Latin American healthcare systems at Johns Hopkins Bloomberg School of Public Health in the US.“Millions of lives have been put at risk and people are dying,” he says. “There are so many lessons to be learnt.”A broken modelFor the past two decades Colombia’s healthcare system had been hailed as an example for the rest of Latin America to follow. The World Health Organization and the World Bank both...

Like the NHS itself, postgraduate medical education in England seems to be in a perpetual state of crisis. John Tooke, in his 2008 forensic review of the Modernising Medical Careers debacle, laid considerable blame for the system’s difficulties on the dichotomy between “training/education” and “service/work.”1 Tooke warned that, unless the resulting confusions and tensions were resolved, the same problems would continue to recur in the NHS.One might have hoped that NHS England’s Medical Training Review: Phase 1 Diagnostic Report, led by Chris Whitty and Steve Powis and published in October 2025, would finally provide a resolution.2 However, it seems likely that it will only perpetuate the problem.The training/service dichotomyThe distinctions between “training,” “education,” and “service” were introduced into postgraduate medical training by Kenneth Calman’s review in 1993.3 Calman recognised that the traditional model of apprenticeship training in medicine was predicated on the supervision of work by an expert (the consultant),...

I’m early in my career. How can I get involved?“Start by exploring what’s available, such as foundation posts with research time, taster programmes, or departmental audit projects,” says Rosalind Smyth, vice president (clinical) at the Academy of Medical Sciences.She highlights structured schemes like the National Institute for Health and Care Research (NIHR) integrated academic training programme,1 which allocates academic clinical fellowships and clinical lectureships to doctors and dentists looking to pursue clinical academic careers in England.Smyth says, however, that there isn’t one single path doctors have to follow. “What matters isn’t following a prescribed path but finding opportunities that align with your interests and developing them systematically.”Funders such as NIHR,2 Wellcome,3 and the Medical Research Council (MRC) “offer clinical fellowships at all different stages of the research pathway,” she says.One way to get started is by speaking to “clinical academics in your specialty and consider joining events like the Academy...

General practice consultations are getting more complicated.1 In the 40 plus years since I qualified, medicine has changed considerably. Many patients who previously would have died, now survive—those with, for example, some cancers or ischaemic heart disease. In many cases, they live productive lives for another 15 years or more before ultimately dying with dementia. Undoubtedly this has increased the complexity of cases I see, in addition to the fact that the “simple” attendances for patients requesting the contraceptive pill or those with an upper respiratory tract infection are now seen by clinical colleagues.Doctors are, therefore, at high risk of “complexity fatigue,” especially given the high expectations of patients, politicians, and the professions including regulators. I know that I need to see fewer patients for longer to deal with their often multiple problems, but yet again we are being asked to prioritise access, when the evidence is clear that continuity...

Wood burning stoves could carry health warnings like those on cigarettes or alcohol under new plans announced by the government.Ministers are also considering imposing stricter limits on the emissions produced by new stoves, which would reduce the current cap by 80. But because the plans apply only to new models campaigners say they “fall well short” of protecting the public against the health risks.One expert said that even using a newer “eco” stove, which supposedly emits less pollution, was similar to smoking a “low tar cigarette.”Wood burning has been linked to increased risks of heart and lung disease, lung cancer, strokes and adverse pregnancy conditions and is one of the main sources of fine particulate matter (PM2.5).12Chris Witty, England’s chief medical officer, has previously warned of the growing popularity of wood burning stoves in cities, and recent research indicates that around one in 10 homes in England and Wales now...

NHS hospitals in England have been told to “urgently review” the safety of their home birth services following a coroner’s report into the deaths of a mother and baby in Manchester.The recommendation from NHS England comes after the senior coroner for Manchester North published a prevention of future deaths report in November 2025 after the deaths of Jennifer Cahill and her baby daughter Agnes following a home birth.1Jennifer died after a haemorrhage during labour and Agnes had the umbilical cord wrapped around her neck and was not breathing when she was delivered.The coroner, Joanne Kearsley, said Cahill had not made an informed decision to have a home birth and was not given all the relevant information about her risks.Kearsley found that Cahill wrongly believed she was low risk when she should have been classed as high risk as she had had a postpartum haemorrhage after her first delivery in hospital.The...

Medical and public concern about a controversial UK trial of puberty blockers is on the rise, as are efforts to derail it.The clinical Pathways trial is due to begin recruiting children and adolescents with gender incongruence this month to measure the impact of puberty blockers on their quality of life and emotional wellbeing.But disquiet about the study and its potential long term effects on children prompted a special meeting of clinicians, academics, and medical ethics experts at the House of Lords on 15 January. They called for the trial to be paused to allow alternative research studies to take place before considering puberty suppression in children.A clinical trial of puberty blockers was one of 32 recommendations in the landmark Cass review on gender identity services for young people,1 and research teams at King’s College London and the South London and Maudsley NHS Foundation Trust were granted approval last November to...

Mafi’s commentary suggests that reform of exception reporting risks reducing doctors to “shift workers paid by the minute.”1 As a resident doctor, I think this misrepresents the reforms and the reality of working in the NHS.Over the years, I have seen professionalism repeatedly conflated with unpaid labour. Foundation year 1 doctors are paid as little as £18.62 an hour to deliver safety critical care,2 and resident doctors’ pay has fallen by a fifth in real terms since 2008.3 Expecting doctors to work beyond contracted hours without recognition is not a mark of vocation, but of a system that relies heavily on goodwill. Exception reporting ensures that additional work is visible and acknowledged. This does not erode professionalism; it supports it by ensuring fair pay and attention to wellbeing.The reforms are described as offering a “small financial benefit,” but they represent a major contractual change. Employers must now provide access to...

Former neonatal nurse Lucy Letby will face no further charges of murder or attempted murder, the Crown Prosecution Service (CPS) has announced.The move has come as a surprise to the police force which had been investigating her.Letby is serving life in prison after being convicted for the murder of seven babies and the attempted murder of another seven at the Countess of Chester Hospital between June 2015 and June 2016.1She had been under investigation by police over further deaths and collapses of babies at the Countess of Chester and one death at the Liverpool Women’s Hospital, where she trained.In a rare move, Cheshire Constabulary revealed that it disagreed with the CPS decision not to charge Letby and believed that the evidence it submitted met the service’s charging standard.In a statement, the police force said, “We submitted files for charging decisions in relation to nine babies. We believed the evidence submitted...

????Indeed. Emoji use is rising in medical records, a new study says. US researchers found that by the final quarter of 2025, emojis were present in more than 10 notes in every 100 000, compared with fewer than two notes in every 100 000 between 2020 and 2024, the study published in JAMA Network Open reported.1????Is this allowed?!At Michigan Medicine—where 218.1 million notes from 1.6 million patients were scrutinised—clinicians aren’t supposed to use symbols in medical records. But it seems that some can’t resist using those little emotional cues.????What forms of communication were included?The study focused exclusively on emojis in medical records, not clinician texts. Overall, it identified 372 distinct emojis used in 4162 clinical notes. Portal messages to patients were the most common form of notes containing emojis (1477 notes (35.5%)), followed by phone call notes (1185 (28.5%)), encounter summaries (637 (15.3%)), progress notes (579 (13.9%)), patient instructions (265...

Online gambling has grown rapidly worldwide over the past 10 years. Discreetly accessible and available 24 hours a day, online products are taking the place of familiar gambling formats such as slot machines, casino table games, and in-person sports betting. Newer products such as cryptocurrency speculation, virtual betting, and daily fantasy sports, together with online analogues of established gambling products, have quickly expanded in both established and emerging gambling markets.1 As a result, the size of the globalonline gambling market rose from £20bn in 2017 to £65bn in 2024.2 Governments that legalise online gambling typically seek to balance the benefits of generating tax revenue against the risks for population harm. However, in many jurisdictions, including the UK, most US states, and Canada, governments often ask gambling providers to devise harm prevention strategies to comply with overly broad regulation. 3 Typically this requires “responsible gambling” to be promoted without explaining...

William WitheringMy list of medically related anniversaries for 2026 includes the 250th anniversary of the publication in 1776 of William Withering’s book The botanical arrangement of all the vegetables naturally growing in Great Britain.William Withering was born on 17 March 1741, in the town of Wellington in Shropshire, the second child of Edmund Witherings [sic] and Sarah Hector.Withering’s father was described in his will as an “Apothecary and Surgeon,” or just as “the apothecary of Wellington,”1 and there were also several physicians on his mother’s side of the family. His maternal grandfather was George Hector, who delivered Samuel Johnson, according to Johnson’s own account in his autobiography of his first 11 years.2 His maternal uncle, Brooke Hector, was a well known physician at Lichfield; and another uncle, George, and a cousin, Edmund, were surgeons. It is no surprise, therefore, that Withering’s father wanted him to train in the medical profession.The...

Surging norovirus cases are piling more pressure on NHS hospitals, with at least 10 trusts now declaring critical incidents owing to high demands and capacity issues.Norovirus cases in NHS hospitals in England increased by 57% to 567 in the week ending 11 January, up from 361 the previous week, NHS England reported.Separate surveillance data from the UK Health Security Agency (UKHSA) also show that norovirus cases are on the rise with cases increasing by 47% in the first two weeks of 2026, compared with the previous fortnight ending 28 December.1However, NHS England figures show that hospital admissions for flu have fallen again after a festive bounce back the week before.An average of 2725 patients were in a hospital bed with flu last week, a fall of 7% from 2924 the previous week.2Latest UKHSA prevalence data also show that flu cases in England continued to decrease last week—with the positivity rate...