Research led by the University of Southampton and King’s College London examined the experiences of parents navigating waiting lists for ADHD diagnosis with Child and Adolescent Mental Health Services (CAMHS) in the UK.

NHS data for the end of September 2025 shows that of those children (up to 17 years old) waiting for an assessment with the service, over 63 percent spent more than a year on the list, and a third of these were waiting over two years.

“CAMHS are experiencing  enormous demand to offer timely support to young people. Staff working in these services are under huge pressure, and in-turn, parents and their children, are also suffering – with some concern that long wait times could exacerbate ADHD symptoms,” explains lead author Dr Ellen Hedstrom.

She adds: “Through our study, we wanted to better understand how parents experience the time between their child’s referral, an ADHD assessment, and a diagnostic outcome. Also, what impact this has on them and their child.”

Study findings are published in the journal Health Expectations.

The researchers conducted anonymised interviews with a total of 41 parents of children aged between five and 11 years old. Their wait times ranged between seven months and over two years. Thirty percent of participants fell between an 18 and 24 month wait, and ten percent over two years. About 50 percent of children hadn’t had their initial ADHD assessment at the time of interview.

Strong feedback was given to the research team by parents. Many of felt that:

• Communication about wait time status was either non-existent or unsatisfactory.

• Lengthy wait times negatively impacted the mental health and wellbeing of both themselves and their child.

• Uncertainty led them to feelings of powerlessness, anxiety and being forgotten.

• Finding a crisis care contact was a struggle, or that support they’d accessed was inadequate.

• There’s pressure to get a diagnosis because it can be essential to access support or treatment, for example at school.

Many parents believed there was a disparity between the support they felt they needed and the support they received.

As one parent, Jayne, put it: “It’s hard because there is no support, at the moment, until you get that diagnosis and you’re forever in limbo.”

Another, Jaz, said: “We’ve wasted over 2 years of her education, it is a huge percentage. And in that time, she was just getting further and further behind.”

Others were grappling with whether they should try and find the money to go private, as in the case of Sarah: “We are struggling a bit and it would be nice to know whether we should be trying to save up to get him seen privately, if it’s gonna be years and years, then that’s what we’d do. If it’s gonna be another 6 months, then we’ll wait.”

At the same turn, there was also empathy for health care staff and understanding that clinical services are under enormous strain. Some parents said they wanted to place as few demands as possible on staff, due to this.

Parents’ suggestions for improvement included regular updates of their status on the waiting list, including confirmation of wait times; a digitised system where parents could logon, check any progress, or book appointments; also, the idea of a named key-worker who they could turn to for help and support while waiting. Parents also expressed the need for help with skills and strategies for themselves to manage the behaviour of their children.

Meanwhile, the authors of the study point to a recent successful local authority scheme which piloted a neurodiversity tool – offering early profiling from trained professionals. This gave parents and schools  knowledge for early intervention to help children while they wait for formal diagnosis.

“Many tools and platforms already exist, or could be developed to meet the needs of CAMHS,” concludes Dr Hedstrom. “This would not only give parents more autonomy in the way that they manage their time on a wait list and how they access much-needed information, but also alleviate the burden on mental health services, resulting in a more efficient service.”

1. The paper, ‘Until You Get the Diagnosis You’re Forever in Limbo’—Parents’ Experiences of Waiting for an Attention-Deficit/Hyperactivity Disorder Assessment With Child and Adolescent Mental Health Services, is published in the journal Health Expectations – DOI: 10.1111/hex.70569 and can be read here: https://onlinelibrary.wiley.com/doi/10.1111/hex.70569
2. For interviews contact, Steve Williams, Media Manager, University of Southampton. +44 23 80593 212
3. The University of Southampton drives original thinking, turns knowledge into action and impact, and creates solutions to the world’s challenges. We are among the top 100 institutions globally (QS World University Rankings 2026). Our academics are leaders in their fields, forging links with high-profile international businesses and organisations, and inspiring a 25,000-strong community of exceptional students, from over 135 countries worldwide. Through our high-quality education, the University helps students on a journey of discovery to realise their potential and join our global network of over 300,000 alumni. www.southampton.ac.uk
4. For more about KCL visit: https://www.kcl.ac.uk/

DIY test kits for human papillomavirus (HPV) – a group of viruses responsible for more than 90% cervical cancer cases – will be offered to women across the UK who have delayed or been unable to attend their traditional screenings.

Announced as part of the NHS 10-Year Health Plan, the kits contain a vaginal swab similar to a long cotton-wool bud. The scheme is due to be rolled out later this year. Traditional screenings, commonly known as ‘smear tests,’ are generally conducted in person at GP clinics.

The new scheme aims to tackle barriers that discourage women from attending in-person screenings, such as discomfort, embarrassment and cultural sensitivities. While there are currently no plans to routinely offer them as an option for physically Disabled women, at-home kits will be offered to women who are under-screened or have never been screened.

Disabled women often face unique barriers to traditional cervical screening, such as challenges in getting to appointments, a lack of accessible clinic facilities, difficulties in getting into the required position for the test, and a lack of understanding from healthcare providers.

The National Institute for Health and Care Research (NIHR)-funded study, which surveyed 1,493 UK-based women and people with a cervix with physical disabilities or impairments, found a broadly positive response to at-home testing:

• 63 per cent said they would be able to perform the test themselves.
• Over half would choose a home-testing kit over an in-person screening if given the choice.

Sue Sherman, a Professor of Psychology from the University of Sheffield, said: “Physically Disabled women face significant barriers when it comes to accessing healthcare, and cervical screening is no different.

“Our study is the first of its kind to explore the attitudes of physically Disabled women and people with a cervix to self-testing as an alternative to clinician-led cervical screening.

“Our research indicates that many physically Disabled women – particularly those who have delayed, missed or never attended a screening – would find this option easier and preferable.

“Ultimately, introducing self-testing will move us closer to ensuring that everyone has access to potentially life-saving screening, regardless of their physical condition.”

Contributor to the study Alycia Hirani, who lives with Osteogenesis Imperfecta (colloquially known as ‘brittle bone disease’), said: “Disabled women deserve choice in healthcare. Expanding testing options and knowledge of alternatives like HPV screening can give so much more access, autonomy and can be life-saving to so many people.”

The study also found that over 70 per cent of the women surveyed had concerns about performing the test correctly. To help address this, researchers recommend

tailored instructions catering to different physical needs and improved training for clinicians to ensure equitable screening access for all.

Read the study in full in the Journal of Medical Screening.

Past scholarly research has found that most Americans say they support mental health policies. Jake Haselswerdt, an associate professor of political science in Mizzou’s College of Arts and Science, wanted to take the topic a step further by asking whether mental health policies actually matter when people choose to vote for a political candidate.

Drawing on a nationally representative sample of 1,000 adults from the 2024 Cooperative Election Study, Haselswerdt asked participants to choose between competing priorities. The results showed that even small differences could sway voters, and mental health was often the issue that tipped the scale in a candidate’s favor.

The results indicate mental health issues influence political decision making in substantive ways, Haselswerdt said.

“I assumed mental health would rank below topics that typically dominate public discussion, like border security,” he said. “But that’s not what I found. I found that people consider this to be as important as other issues that get a lot more news coverage.”

Mizzou’s study comes during a time when concerns about Americans’ mental well-being remain elevated across the country. Recent polling from the National Alliance on Mental Illness shows one in six adults reporting poor mental health, largely influenced by the cost of living, personal health concerns and the demands of daily life.

Haselswerdt said the findings point to a significant and often under-recognized opportunity for policymakers to take stronger action on mental health policies.

“If there’s one takeaway, it’s that political leaders should pay more attention to addressing the deepening mental health crisis in America,” he said.

The study, “Who cares about mental health? Benchmarking the issue importance of mental health for American voters” was published in PLOS One.

Why it matters: As hospitals close in some areas, practices consolidate and telehealth expands, older adults may tolerate long trips for care — but not equally. The study suggests socioeconomic status affects willingness to travel.

What’s new: A study published recently in JAMA Network Open finds that many Americans age 65 and older are willing to travel more than an hour for routine or specialized medical care.

What happened: Researchers at the USC Dornsife Center for Economic and Social Research (CESR) surveyed a nationally representative group of older adults.

• Questions centered on how long respondents currently travel for care and how much farther they would be willing to go before deciding to delay or skip an appointment.

Results: On average, respondents would tolerate about an hour or more of travel time, particularly for specialty care.

Growth of telehealth may be impacted by how willing patients are to take long trips for in-person care versus receiving remote clinical care. (Image source: iStock.)

• For primary care visits, they would travel 68 minutes.
• For a diagnostic test, such as an MRI, 113 minutes.
• For a specialist visit, 128 minutes.

What they’re saying: “This shows older adults place a high value on access to care,” said Soeren Mattke, professor (research) of economics, director of the Brain Health Observatory at CESR and study senior author. “They are often willing to travel significant distances before delaying or forgoing care.”

Yes, but: The averages mask important differences.

• Older adults in poorer health, those living in large metropolitan areas and those who had previously struggled with transportation were less willing to travel long durations.
• In contrast, those with higher incomes, more education and reliable access to a car reported greater willingness to spend more time traveling.

Study first author Jeremy Burke, senior economist at CESR, said those gaps matter for health equity.

• “If someone is already dealing with health challenges or transportation barriers, even modest increases in travel time can become a real obstacle,” Burke said. “Those are the patients most at risk of delaying care.”

The big picture: Health systems are consolidating, with some services moving into regional hubs rather than neighborhood clinics. Policymakers often debate how far is “too far” for patients to travel, especially for older adults.

• This study suggests that distance alone isn’t the full story. The type of visit, transportation options and personal resources all shape decisions.

The findings also have implications for telehealth.

• Virtual visits can reduce travel burdens, but they may not fully replace in-person care, especially for diagnostic tests or specialist consultations that require equipment or physical exams.
• “Telehealth is an important tool, but it’s not a cure-all,” Mattke said. “We still need to think carefully about where services are located and how patients physically get there.”

What else? Transportation policy plays a role, too. Programs that offer ride services, improved public transit or partnerships with community organizations could make a meaningful difference for vulnerable seniors.

Between the lines: Older adults living in big cities were less willing to travel long durations.

• This might boil down to traffic, parking and other travel complexities, which make even short drives feel burdensome.
• But rural residents, who often already travel long distances for care, appeared more accepting of extended trips.

Bottom line: Many older Americans are willing to travel surprisingly long distances for medical care — but willingness depends on health, resources and access to transportation.

• As care delivery models evolve, understanding those differences may help health systems and policymakers design services that better match patients’ needs and circumstances.

About the study

The findings are based on data from the Understanding America Study, a nationally representative internet panel administered by CESR. For this study, researchers surveyed a representative sample of 2,650 adults age 65 or older between April 23 and June 8, 2025, about their willingness to travel for primary care, specialty care and one-time diagnostic appointments.

In addition to Mattke and Burke, authors on the study include USC Dornsife researchers Tabasa Ozawa, Ying Liu and Wei Ye, all from the USC Brain Health Observatory based at USC Dornsife.

The study was funded by National Institute on Aging grants 1R01AG083189 and 1U01AG077280.

In a paper, published today in the British Journal of Psychiatry, a group of experts led by Professor Samuele Cortese from the University of Southampton say there is no robust evidence that ADHD is over-diagnosed in the UK.

The new paper refutes the view that ‘nowadays everyone has ADHD’ which is gaining traction in public discourse and has been amplified by some leading politicians, as demand rises for NHS assessments and services.

Bringing together academics, clinicians, people with lived experience and carers, the group say this narrative risks misleading the public and policymakers and overshadows a more pressing concern – unmet need.

Professor Cortese said: “Rather than focusing on increases or decreases in diagnostic rates, attention should be directed toward the extent to which those with ADHD are being adequately diagnosed and treated.

“While misdiagnosis and inappropriate diagnosis do occur, the available evidence indicates that under diagnosis and under treatment remain the predominant challenges.”

When standardised diagnostic criteria are applied, the prevalence of ADHD internationally is around 5 per cent in children and 3 per cent in adults.

While prevalence has increased over time, NHS administrative data in England remains substantially below these expected levels, suggesting that many people with ADHD are living without a diagnosis and adequate support.

The group acknowledge that misdiagnosis can occur in some cases, particularly where assessments rely heavily on self-reporting or where alternative conditions are not fully considered.

Professor Tamsin Ford, Head of the Department of Psychiatry at the University of Cambridge, a coauthor on the paper, commented: “While many more people with ADHD are being recognised and treated, we are failing to support many more. Overdiagnosis is not a problem, but misdiagnosis may be as people are driven into the private sector by long waits; and sadly, missed diagnoses remain common.”

The researchers stress that the absence of biological diagnostic markers means that thorough, multidisciplinary clinical assessment is essential. Field trials show that when clinicians are properly trained, an ADHD diagnosis is among the most reliable for a mental health condition.

“Similar to physiological traits, such as blood pressure or weight, ADHD symptoms are distributed along a continuum,” says coauthor Professor Chris Hollis from the University of Nottingham. “But as with hypertension or obesity, there are diagnostic severity thresholds that determine health risks and what interventions should be used. Similarly, in ADHD a risk-stratified stepped-care approach may be useful.”

Professor Cortese and colleagues highlight significant pressure on UK services, with long waiting times and growing demand, especially among adults who were not diagnosed in childhood.

They point to figures showing that around 27 per cent of children and young people diagnosed with ADHD reported waiting one to two years, while 14 per cent waited two to three years.

Evidence shows that untreated ADHD is associated with serious long-term risks, while effective treatments are available, backed by strong evidence, and generally well tolerated.

“The costs of untreated ADHD are often overlooked,” says Professor Cortese. “They include increased risk of academic failure, suicidal behaviour, substance abuse, criminality, injury and death. The failure to provide treatments which have been shown to reduce these risks represents a major ethical issue that needs to be urgently addressed.”

The authors call for improved funding, workforce training and a more balanced, evidence-based conversation to ensure accurate diagnosis while expanding access to care for those who need it.

The researchers are supported by the National Institute for Health and Care Research (NIHR), UK Research and Innovation (UKRI) and the Office for Life Sciences.

ADHD (over) diagnosis: fiction, fashion, and failure is published in the British Journal of Psychiatry and is available online.

Contact

Steve Williams, Media Manager, University of Southampton, press@soton.ac.uk or 023 8059 3212.

1. In 2018, the administrative prevalence was 2.5% in boys and 0.7% in girls, and 0.7% in men and 0.2% in women, respectively. Current post-pandemic administrative prevalence data are unavailable.
2. Figures on wait list times come from an online survey of 7,340 people, conducted by the House of Commons Petitions Committee between 2021 and 2022.
3. ADHD (over) diagnosis: fiction, fashion, and failure is published in the British Journal of Psychiatry here:ADHD (over) diagnosis: fiction, fashion and failure | The British Journal of Psychiatry | Cambridge Core
4. For interviews, please contact press@soton.ac.uk or 023 8059 3212.

The Simplified Adolescent Factors for Endometriosis (SAFE) score uses a questionnaire to identify at-risk patients and fast track specialist referrals for further investigation.

Professor Gita Mishra AO, Centre Director of UQ’s Australian Women and Girls’ Health Research Centre, said the test could prevent years of waiting for a diagnosis.

“The test uses 6 questions to detect girls or young women at risk of endometriosis and in need of further assessment,” Professor Mishra said.

“Identifying which patients should be referred and treated is challenging and improving how patients are diagnosed is a major priority.

“By detecting endometriosis earlier – ideally in adolescents as soon as they begin their periods – we hope the tool will reduce the average 6-8-year diagnostic delay so we can start treatment as early as possible.’’

Endometriosis is an often-crippling condition where tissue, similar to the inner lining of the uterus, grows outside of it.

The condition has no cure and affects up to 11 per cent of Australian women of reproductive age.

Using the questionnaire, young women are asked if they experience pelvic pain often, if they’ve sought treatment for pelvic pain, taken painkillers for pelvic pain, experienced heavy menstrual bleeding or painful periods, and have a family history of endometriosis.

The SAFE score works on a point‑based system and would help guide referrals in primary care.

The more risk factors identified, the higher a woman’s score and the greater likelihood of the condition.

The tool was designed using data from more than 9000 women from the Australian Longitudinal Study on Women’s Health, with researchers identifying risk factors for endometriosis.

“This simple tool can be used in women of any age, but we have carefully chosen age-appropriate questions to target adolescents,” Professor Mishra said.

“Long delays in diagnosis can be due to unclear symptoms, lack of awareness, misdiagnosis, and normalisation of menstrual pain which impacts quality of life.

“The condition often involves surgery to confirm diagnosis, although experts are working to change this so the condition can be picked up through ultrasound or MRI.

“We need to be able to detect endometriosis early because our research found most women were diagnosed in their late twenties, often when they are trying to fall pregnant.

“Early diagnosis is critical because it can change treatment of fertility issues later on.

“The usual treatment route is ovulation induction, but this is not as effective as IVF for women with endometriosis.’’

Next steps will evaluate the tool in clinical settings, assess its practicality in Brisbane GP, endometriosis and pelvic pain clinics, and explore if an app can be developed.

March is Endometriosis Awareness Month, signified internationally by the colour yellow.

The research is published in eClinicalMedicine.

The findings were published on March 9, 2026 in the CMAJ/Canadian Medical Association Journal.

“Our findings may reflect improved recognition and treatment of ADHD in adulthood; however, the speed and scale of this growth also raises important questions about how diagnoses are being made, and if this prescribing is always appropriate,” said Dr. Tara Gomes, program director of the Ontario Drug Policy Research Network at St. Michael’s Hospital, Unity Health Toronto and an ICES scientist, Toronto, Ontario.

As background, the researchers noted that, historically, stimulants have been prescribed mainly for pediatric cases of ADHD and some other conditions. But in the past 20 years, ADHD diagnoses and stimulant prescriptions have increased among adults, and data shows that this change accelerated after the start of the pandemic.

“We sought to examine patterns of stimulants dispensed to adults in Ontario and characterize adults who initiated such therapy before and during the pandemic,” the authors said.

The investigators used a regional database to identify monthly rates of new stimulant dispensations among adults in Ontario between January 2016 and June 2024

They found that among 327,053 adults who initiated stimulant therapy, the median age was 31 years and 55.4% were female.

When compared with stimulant prescribing before the COVID-19 pandemic, new adult users during the pandemic were more likely to be aged 25 to 34 years (26.5% v. 32.8%) and female (48.0% v. 59.0%). And the drugs were less likely to be prescribed by psychiatrists (25.5% v. 18.0%).

The rate of new stimulant dispensations rose from 0.16 to 0.44 new monthly dispensations per 1000 people between January 2016 and June 2024.

“Many of these findings are consistent with trends in stimulant prescribing observed globally in the post-pandemic era and are likely influenced by greater awareness of adult ADHD and improved access to care following a historical pattern of underdiagnosis of ADHD in adulthood — particularly among women,” said coauthor Dr. Mina Tadrous, associate professor, Leslie Dan Faculty of Pharmacy, University of Toronto. “However, the rising impact of social media influencers on ADHD awareness in young adults, as well as the rapid evolution of virtual health services that support online assessments and treatment, may also be contributing to misdiagnoses and potential harm.”

The authors concluded, “In Ontario, rates of new prescriptions for stimulants dispensed to adults accelerated rapidly during the COVID-19 pandemic. Monitoring and evaluation are needed to ensure appropriateness of use and safeguard against potential harms.”

The emergence of online healthcare via mobile apps has brought about changes in the availability of and demand for health care. The current study, published in The Economic Journal, analyzes the consumption patterns of 19- and 20-year-olds.

The study is based on data from young people in the regions of Stockholm and Västra Götaland. During the study period, 1 9-year-olds were not charged a co-pay for online consultations, while 20-year-olds had to pay a fee..

Price sensitivity among patients was evident. Those who had turned 20 had on average half the number of online consultations compared to 19-year-olds. Women generally had higher consultation rates than men, and experienced a sharper decline once they turned 20.

The value of easing worries

“People often seek online healthcare for simple ailments, a type of care for which price generally matters more,” says Gustav Kjellsson, a researcher in health economics at the University of Gothenburg. “This doesn’t necessarily mean that it is unwarranted care. It’s important to bear in mind that without access to medical expertise, it is difficult to determine which healthcare needs you actually have. Easing people’s worries also has a value.”

The researchers estimate that 45% of the online consultations by 19-year-olds substituted a physical visit, while the remaining 55% represented care that would not have taken place without easy access to online care.

“These often relate to respiratory infections, skin conditions, and healthcare related to sexual and reproductive health, such as contraceptive management, which would typically be handled by a midwife,” he continues. “What we are seeing is a shift toward more care provided by doctors.”

Cost-neutral increase in volume

The researchers found no measurable negative medical effects from the shift toward more online and fewer in-person consultations, either on follow-up care or complication rates. A secondary finding is that young men, who are generally less inclined to seek healthcare, increased their visits to youth clinics.

“This may be an effect of an initial online doctor consultation,” says Gustav Kjellsson. “Accessibility may make it easier to seek help for conditions that are sensitive in nature, such as sexually transmitted diseases.”

The Swedish debate on online doctors involves quality of healthcare, resource allocation, the extent to which the burden on primary care is relieved, and not least how the regions reimburse private online doctor consultations. Against this background, there is another finding in the study that the researchers say stands out: The increased consumption of healthcare among 19- and 20-year-olds did not result in higher total production costs.“Interestingly, our estimates indicate that the increased volume of healthcare is more or less cost neutral. The regions’ costs for digital healthcare are not primarily due to production costs, but to the reimbursement models of private online consultation.”

When a lack of proper medication reconciliation (MedRec) led to a sharp deterioration in her father’s health Dr Rita Shane (Vice President and Chief Pharmacy Officer at Cedars Sinai Medical Center, Los Angeles, California) promised herself that she would ‘fix’ the problem before she retired. Just 20 years later she succeeded – MedRec by pharmacy staff became a legal requirement in California.

In 1998 Dr Shane’s father underwent a craniotomy for a brain metastasis associated with lung cancer. He developed “intractable agitation” and was transferred to a geriatric-psychiatric unit where his condition became much worse. When Dr Shane asked about his medication it became apparent that the steroids that he had been prescribed after the craniotomy had been abruptly discontinued when he was transferred.  “I knew you can’t just ‘cold turkey’ discontinue a steroid in a patient. Ultimately, I had him transferred back to Cedars Sinai because he ended up febrile. He was getting a decubitus [ulcer] and I was concerned that he would die of sepsis in a gero-sych unit due to what I considered an iatrogenic issue”, she says.

Medication reconciliation is often viewed as a simple clerical task. In fact, making an accurate record of current medication is an important procedure because the list becomes the basis for future prescribing decisions. Dr Shane has spearheaded a decades-long campaign to transform this process, arguing that pharmacy staff – pharmacists and technicians – are the only professionals with the specific expertise required to ensure medication safety during transitions of care. This effort recently culminated in California law SB 1254 and subsequent regulatory changes that mandate pharmacy-led MedRec for high-risk patients at both admission and discharge.

The “poly problem” and iatrogenic risk

One important reason for specialised pharmacy intervention is what Dr. Shane calls the “poly problem”: poly-disease, poly-doctor, and poly-pharmacy. As patients over 65 tend to have multiple chronic conditions, they often receive prescriptions from multiple providers and pharmacies. This fragmentation can create a chaotic medication history. In many ambulatory settings, medication histories are entered into the electronic health record (EHR) by medical assistants who, while vital to practice support, may lack in-depth training in pharmacology. These entries then become the “source of truth” for hospital admissions. For example, “When we first implemented our electronic health record, we would see orders like “methotrexate daily” [instead of weekly] that the pharmacist would intercept – and that’s really just a lack of knowledge and skills on the part of people that are transcribing orders without the benefit of the clinical knowledge”, she notes. Dr. Shane compares a medication order to a complex sentence: it requires the correct drug, dose, dosage form, route, rate, and duration. The pharmacist serves as a guardian angel over this process, making sure that orders are complete and accurate in the context of the whole patient, she says.

The evidence: Why pharmacy ownership matters

The push for legislative change was based on rigorous research evidence. Dr. Shane and her team conducted a randomised controlled trial in the emergency department, comparing “usual care” (medication histories taken by busy physicians or nurses) with those taken by trained pharmacy staff. The results were stark: pharmacists and technicians were significantly more accurate, identifying up to eight errors per high-risk patient.

The business case for pharmacy-led MedRec

For healthcare administrators, the argument for pharmacy-led MedRec extends beyond clinical outcomes to financial sustainability. Adverse drug events (ADEs) are a primary driver of increased hospital costs and. Data indicates that an ADE can increase a patient’s length of stay (LOS) – and therefore hospital costs – by an average of 3.1 days. At the time of the evaluation, the cost of a single admission or readmission due to these errors was estimated at $12,000 to $14,000.

By leveraging pharmacy technicians to transcribe histories accurately into the EHR, hospitals can achieve significant savings while allowing nurses and physicians to practice at the highest level of their licenses. One organisation demonstrated savings of $830,000 by utilising technicians for this function. Furthermore, reducing the 40 minutes of nursing time typically spent per patient on medication histories provides a major relief to frontline clinical staff.

All of this information was brought together in an infographic that was used to educate the State Board of Pharmacy and the California legislature about the problem. “Timing is everything” says Dr Shane and it turned out that one of the California senators was a pharmacist and he enthusiastically supported Dr Shane’s initiative. After a number of hearings, the bill was signed into law in September 2018, just two years and four days after her father’s death. “It was an exciting journey and really an outstanding opportunity to educate legislators”, she recalls. Moreover, during her discussions with legislators, “Everyone seemed to have an example of a family member having a problem with an inaccurate medication list – and that brought it home”, she adds.

Following the passage of SB 1254 (the bill in question) in 2018, a larger study involving 11 California hospitals (ranging from university-based to community hospitals) further validated these findings. Over a six-week period, the study captured approximately 16,000 errors across 2,300 medication histories. Notably, 94% of medication lists contained at least one error, and 25% of those errors were classified as serious or life-threatening. These findings were verified by independent physician reviews, ensuring that the severity of the errors was not overstated. Reflecting on the findings, Dr Shane says, “We demonstrated that we prevented significant harm in the state of California for the hospitals that implemented this new law”.

Closing the loop: MedRec at discharge

While the 2018 legislation focused on admission, Dr. Shane realised that the “back end” of the hospital stay remained a point of extreme vulnerability. She uses the analogy of a totally wrecked car (the patient) that is painstakingly repaired in a body shop (the hospital), only to be driven off a cliff at discharge because the final medication list was inaccurate.

Studies showed that even with accurate admission medication lists, patients still experienced an average of two medication errors at discharge. Approximately 20% of hospital admissions are medication-related, and at least 40% of patients have an error on their discharge medication list, she says. These errors, such as the inadvertent omission of anticoagulants or antibiotics, are then perpetuated by community pharmacists who, lacking access to patient records, have no way of recognising the mistakes.

To address this, Dr. Shane successfully advocated for a regulatory change through the California State Board of Pharmacy’s “sunset review” process. As of January 1, 2026, the law was expanded to include medication reconciliation at discharge for high-risk patients.

A new paradigm: The “high-alert patient”

Perhaps the most transformative concept proposed by Dr. Shane is the shift from focusing solely on high-alert medications to identifying the “high-alert patient”. This designation would apply to the most vulnerable individuals – those with multiple diseases and complex regimens – who should be “tagged” for prioritised pharmacist attention across all providers.

Dr. Shane’s vision is to see these California-led successes become a national standard. Through collaboration with the National Association of Boards of Pharmacy (NABP) and the Joint Commission, she continues to advocate for model legislation that designates pharmacy staff as the clear “owners” of the medication list. For health professionals, the message is clear: ensuring an accurate medication list is not a secondary task; it is a foundational element of patient safety that requires the specialised clinical lens of the pharmacy profession.

When they analyzed 2012–2024 information on 45,619 babies born at 24–32 weeks’ gestation at 1,111 hospitals in an international network, along with information from the UK National Neonatal Research Database and a literature review, investigators found that on average, less than half of infants had been exposed to preterm magnesium sulfate in middle-income countries, and approximately three-quarters in high-income countries. Even within high-income countries, there were large discrepancies in care. Preterm steroids were used more frequently with less variation, although treatment gaps were still apparent.

“Our study has highlighted the international disparities in how two key treatments to protect pre-term babies are implemented. These gaps aren’t because of a lack of evidence,” said corresponding author Hannah B. Edwards, MA, MSc, of the University of Bristol, in the UK. “Lessons can be learned from successful implementation programs like PReCePT, which has transformed use of magnesium sulphate in pre-term births in England. The bigger-picture goal should now be to ensure that no matter where a baby is born, their mother has access to the evidence-based treatments that offer the best start in life.”

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1002/ijgo.70832

Defined as the collective ability of a team to generate novel and useful ideas, team creativity has long been studied in business and organizational psychology. However, until now, it had not been explicitly examined or validated in primary health care.

“Primary care teams are under growing strain. Despite being central to delivering high-quality, patient-centered care, these teams face rising burnout and declining job satisfaction,” said Yuna Lee, PhD, assistant professor of Health Policy and Management at Columbia Mailman School, and first author. “Over the past two decades, many interventions have attempted to improve clinician well-being, but most have focused on individual resilience or workload. Our findings suggest that strengthening team-level conditions—specifically creativity—may simultaneously reduce burnout, enhance satisfaction, and improve care.”

The study was conducted within a large New York State health system serving approximately 12 million people, with 85,000 employees, 21 hospitals, and 890 outpatient care centers. The sample included approximately 400 primary care providers and team members.

Among survey respondents, 32 percent had worked in their practice for more than five years; 16 percent were physicians, and 24 percent were registered nurses. Eighty-two percent identified as female, and 56 percent identified as White.

The study makes three key contributions to health services research:

1. Establishes team creativity as a meaningful concept in primary care. This is the first study to show the importance of team creativity to well-being outcomes in a setting that requires optimal teamwork for high-quality, patient-centered care.
2. Introduces and validates a practical measurement tool for measuring team creativity in primary care teams.
3. Advances understanding of how the work life of health care professionals impacts their well-being and, subsequently, patient care.

“Our study highlights the pivotal role of creativity in primary care teams,” said Lee. “Drawing on decades of research in management, organizational behavior, and social psychology, we show that creativity is not just about innovation—it is closely tied to how clinicians experience their work. This has significant implications for how health systems approach burnout.”

Lee continues, “With state policymakers and health system leaders under pressure to improve outcomes while addressing workforce shortages, our findings suggest that fostering team creativity should be viewed as a strategic asset.

Co-authors are Nancy LaVine, Northwell Health and Department of Medicine, Lenox Hill Hospital; Cheryl Rathert, College for Public Health and Social Justice, Saint Louis University; Yulia Kogan, Population Health Analytics, Northwell Health; and Lusine Poghosyan, Stone Foundation and Elise D. Fish Columbia University Professor of Nursing and Professor of Health Policy and Management.

The study was supported by the Agency for Healthcare Research and Quality (Grant 5R03HS027502-02).

The British Medical Association (BMA) says that, by 2040, England should have one  full time equivalent (FTE) GP for every 1,000 patients, to ensure manageable workloads and patient safety.

But new data released last month shows that every one of England’s 42 ICBs is falling far short of meeting this safe threshold, explains Stephanie Santos Paulo.

Nationally, there is one FTE GP for every 2,220 patients, but ICB level data show some regions are facing a far more severe doctor drought than others. The highest reported patient to doctor ratios are in London, Bedfordshire, Luton and Milton Keynes, where there are more than 2,700 patients for every GP.

“No matter where a patient lives in England, the safe limit for patients is being exceeded, with patient demand far outstripping GP capacity,” said Katie Bramall, chair of the BMA’s GP Committee.

Victoria Tzortziou Brown, chair of the Royal College of GPs, added that the findings demonstrated the “troubling picture” of general practice under growing strain. “The pressures on general practice are clearly far beyond what is safe or sustainable,” she said.

But a Department of Health and Social Care (DHSC) spokesperson defended the government’s record on GP numbers, saying, “We currently have the highest number of fully qualified GPs since at least 2015 thanks to actions taken by this government.”

While it is true that England now has 648 more FTE GPs than six years ago, since then around 3.7 million more patients have been registered at GP practices. This represents a 6% rise in patient numbers, against a 2% increase in GPs, leaving practices more thinly spread.

What’s more, since 2019 the gap between the most and least stretched ICBs has hardly changed, suggesting that these workforce shortages are chronic.

Tzortziou Brown said the “stark disparities” between ICBs were worrying. “We know that areas facing higher deprivation often have the highest ratios of patients to GPs, as well as the most difficulty recruiting and retaining GPs,” she said.

A spokesperson for Bedfordshire, Luton and Milton Keynes ICB said, “We presently have over 140 GPs in training roles, many of whom we expect to contribute to improving our GP to patient ratio when they qualify.” But they acknowledged that a low number of GP vacancies could make it difficult for trainees to secure posts once they qualified.

The data underline what GP leaders describe as a paradox in the workforce crisis, with qualified GPs unable to find work while their employed counterparts struggle to keep pace with growing patient lists, writes Santos Paulo.

The DHSC says it has recruited more than 2,000 extra GPs in the past year, and health and social care secretary Wes Streeting has also pledged to expand training numbers further.

But expansion of GP training places would need to be considerable to keep up with growing demand, argues Santos Paulo. In 2025, there were 20,995 applications for 4,726 GP specialty training posts, a ratio of almost five applicants per post. This competition ratio has more than tripled since 2019, when there were just 1.34 applications per post.

She also points out that despite workforce pressures, the monthly number of GP appointments rose by more than 10 million between December 2018 and December 2025, reaching a record high last year.

The DHSC spokesperson said that GPs are “at the heart” of the government’s “historic shift” from hospital to community and will benefit from a growing share of NHS funding.

But Tzortziou Brown said the health secretary’s promises to support general practice and deliver “thousands more GPs” must be backed by a clear and robust 10 year workforce plan.

“General practice is the bedrock of the NHS,” she says. “With the right investment and meaningful initiatives to recruit and retain GPs we can turn this ar