The Erosion of Primary Care Purpose: A Critical Examination of the British Government’s Approach

The landscape of primary care in the United Kingdom has experienced transformative shifts in recent years, leading to profound implications for healthcare professionals and patients alike. This post aims to scrutinise the governmental strategies guiding primary care and illuminate the potential erosion of its foundational purpose. Drawing from my experience as an NHS clinician with a commitment to socialist principles, I critically examine these changes and discuss their ramifications for all stakeholders in the healthcare system.
The Importance of Primary Care:Primary care stands as the cornerstone of a robust healthcare system. It is the initial interaction point for individuals seeking medical assistance and offers a spectrum of services from preventive measures and disease management to orchestrating specialised care. Moreover, primary care is pivotal in enhancing public health, curtailing healthcare expenditures, and elevating patient outcomes across the board. According to a study published by the King’s Fund, strong primary care systems are linked with improved health outcomes and lower disparities between different socioeconomic groups.
Government Policies and Their Impact:Recent policies implemented by the British government have sparked widespread apprehensions regarding the trajectory of primary care. The drive towards austerity and an increasing emphasis on privatisation have shifted priorities, potentially diluting the integral role primary care plays within the health ecosystem. Critics argue that such policies divert attention from patient care towards cost-efficiency and market-driven models of health service delivery.
Underfunding and Workforce Shortages:A significant challenge plaguing primary care is chronic underfunding. Reports from the Health Foundation in 2023 indicated a real-terms decrease in primary care funding per capita over the past decade, despite rising patient demands. This underinvestment has strained the existing infrastructure and hampered the development of a resilient workforce. According to the British Medical Association (BMA), there was a deficit of nearly 6,000 GPs in 2024 alone, leading to prolonged wait times, diminished care accessibility, and potential degradation in service quality. These shortages are exacerbated by the high levels of burnout reported among primary care staff, further compromising the sustainability of healthcare services.
Fragmentation and Loss of Continuity:Market-driven reforms have fragmented primary care services, disrupting the continuity of care that is essential for effective medical practice. The proliferation of private clinics and urgent care centers has fragmented patient care pathways, eroding the personalised care model that is fundamental to primary care. Such fragmentation complicates the patient-provider relationship, crucial for a comprehensive healthcare approach. A 2022 report from the NHS Confederation highlighted that fragmentation leads to inefficient utilisation of healthcare resources and could result in poorer health outcomes for patients.
Commercialisation and Profit-Driven Care:An increasing tilt towards commercialisation has introduced a profit-over-patient ethos in primary care settings. The involvement of private entities in primary care under Public-Private Partnership (PPP) models has been criticised for prioritising financial returns over patient care. Reports from the National Audit Office have critiqued several PPPs for not providing value for money, reflecting a misalignment with primary care’s patient-centered ethos. The emphasis on profitability can detract from the quality of care and lead to healthcare practices that do not necessarily align with the best interests of patients.
The Role of Socialism in Reclaiming Primary Care’s Purpose:From a socialist perspective, healthcare is a fundamental right that should be accessible, equitable, and patient-centric. To address the erosion in primary care, there is an urgent need to re-align its operations with these core values. This entails robust government funding, strategic workforce expansions, and a holistic integration of primary care services within the broader health system. Emphasising cooperative practices, patient empowerment, and comprehensive care can ensure that primary care meets the diverse needs of the community.
Conclusion:The gradual erosion of primary care’s purpose in the UK is a pressing issue that requires immediate and thoughtful action. By critically evaluating the government’s approach to primary care, it becomes possible to understand the multifaceted challenges confronting providers and patients. To reclaim the foundational goals of primary care, a collective endeavour rooted in socialist values of equality and comprehensive welfare is indispensable. Together, we can strive towards a health system that not only upholds the principles of socialism but also secures the health and prosperity of every community member.
Reference The King’s Fund - Provides research and analysis on the effectiveness of primary care and its impact on public health. (https://www.kingsfund.org.uk/)
The Health Foundation - Offers insights into funding trends and challenges in the NHS, including issues specific to primary care. (https://www.health.org.uk/)
British Medical Association (BMA) - Publishes annual reports on GP workforce shortages and the state of primary care in the UK. (https://www.bma.org.uk/)
NHS Confederation - Reports on system-wide issues such as the fragmentation of healthcare services and its impacts. (https://www.nhsconfed.org/)
National Audit Office (NAO) - Provides assessments of public spending, including evaluations of Public-Private Partnerships in healthcare. (https://www.nao.org.uk/)
Medscape and BMJ (British Medical Journal) - These medical journals often publish articles and studies related to chronic underfunding, workforce issues, and policy impacts in healthcare systems. (https://www.medscape.com/, https://www.bmj.com/)

Chewing Away the Pandemic: The Breakthrough COVID-Neutralising Gum

As we continue to adapt to life with COVID-19, a new weapon in the fight against the pandemic is sticking its way to the forefront—literally. Scientists at the University of Pennsylvania have unveiled a chewing gum that can neutralize the COVID-19 virus in the saliva, potentially reducing the risk of transmission. This isn't just a fresh breath mint; it's a fresh perspective on pandemic control measures.

This novel idea comes from the laboratory of Henry Daniell at Penn’s School of Dental Medicine, who has been working on plant-based protein research long before the pandemic's onset. Their focus pivoted to our current global crisis, leading to a fascinating discovery: a gum that can tackle the virus where it's most prevalent—our mouths.
The science is impressive: angiotensin-converting enzyme 2 (ACE2) proteins, grown in plants and extracted in the lab, are used to create this groundbreaking gum. These proteins are the virus's preferred host receptors in the human body, making them the ideal candidate for a COVID-19 countermeasure. Daniell's previous research on a hypertension treatment inadvertently set the stage for this innovative approach to viral defense.
The potential applications are exciting and far-reaching. For instance, in dental care, where procedures necessitate the removal of masks, this gum could serve as an extra layer of protection for both patients and healthcare providers. The pre-appointment chew could become a new routine, offering peace of mind along with dental health.
The implications extend beyond professional settings, with possible benefits for daily interactions, especially in those critical moments where social distancing is not possible. Furthermore, the accessible nature of chewing gum as a delivery system could serve as an alternative or complement to vaccinations, particularly appealing to those hesitant about vaccines.
Daniell's team has published data showing a significant decrease in the amount of the virus after using the gum. With a compelling combination of convenience and science, this chewing gum could soon become a staple in our collective toolkit against COVID-19.
It's rare to find a pandemic response that can be packaged so neatly and enjoyably—perhaps in the future in the delightful form of Dubble Bubble. It's this kind of innovation that makes the future of public health not only look promising but also, potentially, a little sweeter. Keep your masks on, your hands clean, and maybe soon, your chewing gum armed against COVID-19.

New COVID Variant on WHO's Radar Causing Itchy Eyes in Kids - Times of India

A new COVID-19 variant that recently landed on the World Health Organization's radar may cause previously unseen symptoms in children, according to a new report. 

While the variant, called "Arcturus," hasn't yet made the CDC's watchlist, a prominent pediatrician in India is seeing children with "itchy" or "sticky" eyes, as if they have conjunctivitis or pinkeye, according to  The Times of India. 

The new itchy eye symptom is in addition to kids having a high fever and cough, Vipin Vashishtha, MD, said on Twitter, noting that pediatric COVID cases have picked up there for the first time in 6 months.

The country has also seen a rise in another virus among children with similar symptoms, called adenovirus. COVID and adenovirus cannot be distinguished without testing, and many parents don't want to have their children tested because the swabs are uncomfortable, The Times of India reported. One doctor told the newspaper that among every 10 kids with COVID-like symptoms, two or three of them had tested positive on a COVID test taken at home.

Health officials in India are doing mock drills this week to check how prepared the country's hospitals are as India sees cases rise, the BBC reported. India struggled during a COVID-19 surge in 2021, at which time sickened people were seen lying on sidewalks outside overflowing hospitals, and reports surfaced of a black market for private citizens to buy oxygen. 

Arcturus (formally, Omicron subvariant XBB.1.16) made news 2 weeks ago as it landed on the WHO's radar after surfacing in India. A WHO official called it "one to watch." The Times of India reported that 234 new cases of XBB.1.16 were included in the country's latest 5,676 new infections, meaning the subvariant accounts for 4% of new COVID cases.

Intermittent Fasting Plus Early Eating May Prevent Type 2 Diabetes

Individuals at increased risk of type 2 diabetes may be able to reduce their risk via a novel intervention combining intermittent fasting (IF) with early time-restricted eating, indicate the results of a randomized controlled trial.

The study involved more than 200 individuals randomized to one of three groups: eat only in the morning (from 8:00 AM to noon) followed by 20 hours of fasting 3 days per week and eat as desired on the other days; daily calorie restriction to 70% of requirements; or standard weight loss advice.

The IF plus early time-restricted eating intervention was associated with a significant improvement in a key measure of glucose control versus calorie restriction at 6 months, while both interventions were linked to benefits in terms of cardiovascular risk markers and body composition, compared with the standard weight loss advice.

However, the research, published in Nature Medicine, showed that the additional benefit of IF plus early time-restricted eating did not persist, and less than half of participants were still following the plan at 18 months, compared with almost 80% of those in the calorie-restriction group.

"Following a time-restricted, IF diet could help lower the chances of developing type 2 diabetes," said senior author Leonie K. Heilbronn, PhD, University of Adelaide, South Australia, in a press release.

This is "the largest study in the world to date, and the first powered to assess how the body processes and uses glucose after eating a meal," with the latter being a better indicator of diabetes risk than a fasting glucose test, added first author Xiao Tong Teong, a PhD student, also at the University of Adelaide.

"The results of this study add to the growing body of evidence to indicate that meal timing and fasting advice extends the health benefits of a restricted-calorie diet, independently from weight loss, and this may be influential in clinical practice," Teong added.

Adherence Difficult to IF Plus Early Time-Restricted Eating

Asked to comment, Krista Varady, PhD, said that the study design "would have been stronger if the time-restricted eating and IF interventions were separated" and compared.

"Time-restricted eating has been shown to naturally reduce calorie intake by 300-500 kcal/day," she told Medscape Medical News, "so I'm not sure why the investigators chose to combine [it] with IF. It...defeats the point of time-restricted eating."

Varady, who recently coauthored a review of the clinical application of intermittent fasting for weight loss, also doubted whether individuals would adhere to combined early time-restricted eating and IF. "In all honesty, I don't think anyone would follow this diet for very long," she said.

She added that the feasibility of this particular approach is "very questionable. In general, people don't like diets that require them to skip dinner with family/friends on multiple days of the week," explained Varady, professor of nutrition at the University of Illinois, Chicago.  "These regimens make social eating very difficult, which results in high attrition."

"Indeed, evidence from a recent large-scale observational study of nearly 800,000 adults shows that Americans who engage in time-restricted eating placed their eating window in the afternoon or evening," she noted.

Varady therefore suggested that future trials should test "more feasible time-restricted eating approaches," such as those with later eating windows and without "vigilant calorie monitoring."

"These types of diets are much easier to follow and are more likely to produce lasting weight and glycemic control in people with obesity and prediabetes," she observed.

A Novel Way to Cut Calories? 

The Australian authors say there is growing interest in extending the established health benefits of calorie restriction through new approaches such as timing of meals and prolonged fasting, with IF — defined as fasting interspersed with days of ad libitum eating — gaining in popularity as an alternative to simple calorie restriction.

Time-restricted eating, which emphasizes shorter daily eating windows in alignment with circadian rhythms, has also become popular in recent years, although the authors acknowledge that current evidence suggests any benefits over calorie restriction alone in terms of body composition, blood lipids, or glucose parameters are small.

To examine the combination of IF plus early time-restricted eating, in the direct trial, the team recruited individuals aged 35-75 years who had a score of at least 12 on the Australian Type 2 Diabetes Risk Assessment Tool but did not have a diagnosis of diabetes and had stable weight for more than 6 months prior to study entry.

The participants were randomized to one of three groups:IF plus early time-restricted eating, which allowed consumption of 30% of calculated baseline energy requirements between 8:00 AM and midday, followed by a 20-hour fast from midday on 3 nonconsecutive days per week. They consumed their regular diet on nonfasting days.Calorie restriction, where they consumed 70% of daily calculated baseline energy requirements each day and were given rotating menu plans, but no specific mealtimes.Standard care, where they were given a booklet on current guidelines, with no counseling or meal replacement.

There were clinic visits every 2 weeks for the first 6 months of follow-up, and then monthly visits for 12 months. The two intervention groups had one-on-one diet counseling for the first 6 months. All groups were instructed to maintain their usual physical activity levels.

Two hundred and nine individuals were enrolled between September 26, 2018 and May 4, 2020. Their mean age was 58 years, and 57% were women. Mean body mass index (BMI) was 34.8 kg/m².

In all, 40.7% of participants were allocated to IF plus early time-restricted eating, 39.7% to calorie restriction, and the remaining 19.6% to standard care.

The results showed that IF plus early time-restricted eating was associated with a significantly greater improvement in the primary outcome of postprandial glucose area under the curve (AUC) at month 6 compared with calorie restriction, at –10.1 mg/dL/min versus –3.6 mg/dL/min (P = .03).

"To our knowledge, no [prior] studies have been powered for postprandial assessments of glycemia, which are better indicators of diabetes risk than fasting assessment," the authors underline.

IF plus early time-restricted eating was also associated with greater reductions in postprandial insulin AUC versus calorie restriction at 6 months (P = .04). However, the differences between the IF plus early time-restricted eating and calorie restriction groups for postmeal insulin did not remain significant at 18 months of follow-up.

Both IF plus early time-restricted eating and calorie restriction were associated with greater reductions in A1c levels at 6 months versus standard care, but there was no significant difference between the two active interventions (P = .46).

Both interventions were also associated with improvements in markers of cardiovascular risk versus standard care, such as systolic blood pressure at 2 months, diastolic blood pressure at 6 months, and fasting triglycerides at both time points, with no significant differences between the two intervention groups.

IF plus early time-restricted eating and calorie restriction were also both associated with greater reductions in BMI and fat mass in the first 6 months, as well as in waist circumference.

Calorie Restriction Easier to Stick to, Less Likely to Cause Fatigue 

When offered the chance to modify their diet plan at 6 months, 46% of participants in the IF plus early time-restricted eating group said they would maintain 3 days of restrictions per week, while 51% chose to reduce the restrictions to 2 days per week.

In contrast, 97% of those who completed the calorie-restriction plan indicated they would continue with their current diet plan.

At 18 months, 42% of participants in the IF plus early time-restricted eating group said they still undertook 2 to 3 days of restrictions per week, while 78% of those assigned to calorie restriction reported that they followed a calorie-restricted diet.

Fatigue was more common with IF plus early time-restricted eating, reported by 56% of participants versus 37% of those following calorie restriction, and 35% of those in the standard care group at 6 months. Headaches and constipation were more common in the intervention groups than with standard care.

The study was supported by a National Health and Medical Research Council Project Grant, an Australian Government Research Training Program Scholarship from the University of Adelaide, and a Diabetes Australia Research Program Grant.

No relevant financial relationships were declared.

Nat Med. Published online April 6, 2023. Full text

55 countries facing serious health worker shortages – World Health Organisation

The World Health Organisation has said that no less than 55 countries are struggling with serious health worker shortages as they continue to seek better-paid opportunities in wealthier nations.

They continue to seek better-paid opportunities in wealthier nations that have stepped up efforts to recruit them amid the COVID-19 pandemic.

According to WHO, African nations have been worst hit by the phenomenon, with 37 countries on the continent facing health worker shortages.

“Health workers shortage have threatened their chances of achieving universal health care by 2030 – a key Sustainable Development Goals pledge.’’

The actions of wealthy countries that belong to the Organisation for Economic Cooperation and Development come under scrutiny in the WHO alert, among other regions.

“Within Africa, it’s a very vibrant economy that is creating new opportunities,” Dr Jim Campbell, the Director responsible for health worker policy at WHO, said in a statement on Tuesday.

“The Gulf States have traditionally been reliant on international personnel and then some of the OECD high-income countries have really accelerated their recruitment and employment to respond to the pandemic and respond to the loss of lives, the infections, the absences of workers during the pandemic”.

To help countries protect their vulnerable healthcare systems, WHO has issued an updated health workforce support and safeguards list, which highlights nations with low numbers of qualified healthcare staff.

“These countries require priority support for health workforce development and health system strengthening, along with additional safeguards that limit active international recruitment,” the WHO insisted.

Supporting the call for universal healthcare for all countries in line with the SDGs, WHO Director-General, Dr Tedros Ghebreyesus, called on all countries to respect the provisions in the WHO health workforce support and safeguards list.

“Health workers are the backbone of every health system, and yet 55 countries with some of the world’s most fragile health systems, do not have enough and many are losing their health workers to international migration,” he added.

Although many countries do respect existing WHO guidelines on the recruitment of health care workers, the principle is not accepted wholesale, WHO warned.

“What we are seeing is that the majority of countries are respecting those provisions by not actively recruiting from these (vulnerable) countries,” Campbell said.

“But there is also a private recruitment market that does exist and we’re looking to them to also reach some of the global standards that are anticipated in terms of their practice and behaviour.”

Mechanisms also exist for governments or other individuals to notify WHO if they are “worried” about the behaviour of recruiters, the WHO official said.

The WHO health workforce support and safeguard list does not prohibit international recruitment but recommends that governments involved in such programmes are informed about the impact on the health system in countries where they source qualified health professionals.