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Sir Keir Starmer headed to Washington on Tuesday for his first foreign trip as Prime Minister, joining a Nato summit as President Joe Biden battled to defuse mounting doubts over his fitness to serve as he readied to welcome allies to a Nato summit.

Sir Keir was due to sit down on Wednesday for a White House meeting with Mr Biden on the margins of the three-day summit, and was also expected to meet Ukrainian President Volodymyr Zelensky on his first full week in office.

The president has several other bilateral sessions booked in addition to chairing the summit, and faces a major test in navigating a prime-time news conference at the close of the Nato gathering on Thursday evening.

The president’s aides were forced to deny that he was receiving regular visits from a neurologist, after it was revealed from visitor’s logs that an expert on Parkinson’s disease has visited the White House eight times in eight months.

The 32 Nato members were expected to formulate concerted backing for Ukraine, in part to guard against the risk of Mr Biden’s Republican rival Donald Trump yanking US support if he wins in November.

Emphasing his own administration’s unstinting support for Kyiv, the president headed into the summit trumpeting his accomplishments as he emulated Mr Trump’s habit of making unscheduled phone calls to live TV programmes.

The Democrat told MSNBC: “Who else do you think can step in here and do this? I expanded NATO. I solidified NATO.”

The president angrily rebuffed high-ranking Democratic lawmakers who have been calling on him to quit the White House race and give the Democrats time to salvage an alternative challenge to Mr Trump at their convention next month.

“I don’t care what those big names think,” Mr Biden said on the phone call, his voice rising. “If any of these guys don’t think I should run, run against me. Go ahead, announce for president. Challenge me at the convention.”

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The president echoed his determination to fight on in a strongly worded letter to Democrats in Congress and on a call with donors. First Lady Jill Biden meanwhile insisted that she was united with her husband in being “all in” for November.

But for critics including a growing number of Democratic lawmakers, such talk is evidence of hubris from an 81-year-old leader whose physical and mental struggles were on painful display during his first TV debate with Mr Trump, 78, on June 27.

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