Spring 2018
The biology of being sedentary
Marginal Voices: A quest to improve mental health diagnosis among the deaf community
Clinical pharmacists in Primary Care: A safe solution to the workforce crisis? Should doctors be criminalised?
Building a coaching culture across the medical school and beyond
Spring 2018
In 2018, the National Health Service (NHS) celebrates its 70th anniversary. With the creation of the NHS in 1948, universal health coverage was finally implemented in the UK, with the NHS replacing the previous patchy health coverage schemes that had left many people with limited access to health services. Although the NHS has achieved much since 1948, in recent years we have seen the NHS facing new challenges such as the very slow real-terms per capita increase in NHS spending since the global financial crisis in 2008. In this edition of our newsletter, you can read about the work we are doing to help the NHS continue to deliver comprehensive and high-quality healthcare to the residents of the UK. This includes our work on the use of video-consultations and on using professional groups such as pharmacists to take on some of the work currently carried out by doctors.
Professor Azeem Majeed
Head of Department of Primary Care and Public Health Imperial College London
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Copyright © 2018 Department of Primary Care & Public Health, Imperial College London In the News
Photo: Doctor by MIKI Yoshihito - Creative Commons
A study published in the journal BMJ Quality and Safety concluded that extending GP opening hours will not ease the rising burden on Accident and Emergency departments. The observational study was led by Imperial College London. Lead author Dr Thomas Cowling from Imperial College's Department of Primary Care and Public Health and colleagues compared patients' experiences of GP surgeries with the number of Accident and Emergency visits in their areas in England from 2011- 2012 to 2013-2014. They examined reports from NHS England's annual GP Patient Survey, and included patients registered to 8,124 GP surgeries.
They measured levels of patient satisfaction using The study suggests that better satisfaction with three factors: the ease of making an appointment, GP hours, for example because of extended opening hours, and overall opening hours, does not experience. They then "The government must find affect the number of visits matched these responses with alternative ways to handle made to A&E in their A&E departments in their area geographical area. to observe any correlation current pressures on Accident However, making the with the number of visits to and Emergency departments. appointment booking A&E. Overall, areas where This could include for example process easier for patients patients were happier with was associated with the ease of making improving access to GP slightly fewer A&E visits in appointments, which could be appointments during normal that area. The research for example by using online opening hours rather than supports finding booking systems, saw slightly spending scarce NHS resources alternative options for fewer visits to A&E easing the burden on departments. However, on extended opening schemes." Accident and Emergency satisfaction with surgery Senior Author Professor Azeem Majeed departments, and casts opening hours and overall doubt on the patient experience seemed to have no impact on Government's proposals to extend GP surgery A&E visit rates. hours to ease the burden.
Times Belfast Telegraph OnMedica Pulse Daily Mail Eureka Alert
Evaluating health system in Brazil covered the environmental problems Iraq
Prof Christopher Millett, Dr Matthew is facing such as, Lack of Water, Desertification, Pollution, and the Harris and Dr Thomas Hone were recently environmental effect on Health in Iraq. awarded funding by the MRC/Newton It aimed at: Fund for collaborative research in Brazil. This was part of the Brazil CONFAP-MRC 1. Showing the current situation of Call for Health Systems Research Mental Health in Iraq. 2. Addressing the challenges that the Networks. The research project aims to Mental Health system is currently evaluate the health system and health facing. impacts of a major expansion of primary 3. Finding guidelines for the Iraqi care doctors in the country. The Mais government to improve the Medicos programme has imported over Mental Health system. 14,000 Cuban doctors into Brazil to work Professor Salman Rawaf and Dr Mays in primary care in underserved areas. Such Raheem (pictured) were both keynote a large expansion of human resources for speakers. Professor Salman gave a talk health in a middle-income country is entitled, ‘The Environment and Health in remarkable and likely to have major Iraq: what is next?’ Dr Mays Raheem effects. To-date, little has been published presented, ‘What we do not know about Mental Health in Iraq’. Both presentations on the impact of this programme. The were very well received. research will involve qualitative and quantitative research located in the Federal District and the state of Paraiba, in conjunction with Brazilian investigators based at the University of Brasilia and the Federal University of Paraiba. Research starts in April until Oct 2020. This will be a great opportunity for researchers at PCPH and the wider college to strengthen their relationships with Brazil.
Contributing to improvements in Public Health in Iraq
On the 18 February 2018 the Iraqi Environment and Health Society UK organised a conference ‘Degradation of the Environment in Iraq and its Impact on Public Health’. The conference was held at University College London (UCL) and
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Sandpits event with SPHR in Cambridge
The Sandpit event, held 13 -14 December, was attended by wide representation from across the SPHR (School for Public Health Research) members; 50 academic members of the School were joined by 13 national and 9 local policy or practice representatives. Much was achieved in the spirit of collaboration. There were three separate sandpit groups, one focussing on each of the agreed research programmes:
1. Children and Young People. 2. Public Mental Health 3. Places and Communities..
Potential research questions/plans were formulate innovative ideas about major developed by the groups, which where than European Healthcare challenges. shared with the wider audience. There was consideration to the three cross-cutting Dr Grazia Antonacci is a research associate in themes (Health Inequalities, Changing Healthcare Management at the NIHR CLAHRC Behaviour at Population Level and Equitable NWL and Imperial College London, School of and Efficient Public Health Systems). Public Health and Business School. She is also Moving forward, they need to reflect on the a member of the Centre for Health Economics outputs from the Sandpit and move to the and Policy Innovation. Her interest include next stage by agreeing the research the design implementation and sustainability programmes for SPHR over the next four of innovation in healthcare system. Grazia is years, what the key research questions are currently involved in research on the and to agreeing the programme of work introduction of approaches and technologies within each research theme. designed to improve the quality of health and healthcare services. Before joining CLAHRC CLAHRC Research Associate, Grazia NWL and Imperial College, she worked in a Antonacci, appointed to European pharmaceutical and consulting firm as well as Health Parliament in the administration of an Italian research hospital (8years), IRCCS Casa Sollievo della On 17 October 2017 the third edition of the Sofferenza (FG). Her Education includes a European Health Parliament (EHP) was European PhD in Enterprise Engineering officially launched in Brussels. Dr Grazia (healthcare management), a postgraduate Antonacci was selected to join the parliament Degree in Management of Healthcare along with 55 young professionals Organisation and a MSC in Management representing European Members States. The Engineering. ambition is to reinvent European Healthcare by enabling young professionals from For more information on the role of the EHP different backgrounds to debate and continue to the Imperial College Business School article. SAPC
Madingley Hall Conference 2018
The Imperial College GP teaching team were well represented at this year’s Society for Academic Primary Care (SAPC) regional conference held on 25 & 26 January in Madingley Hall, Cambridge. Presentations from the team were positively received and included some of the following highlights: MADINGLEY 2018 Clockwise from top left: Ali Dhankot, Senita Mountjoy, Laura Storm, Maham Stanyon, Ellie Gunning, Ravi Parekh, Emma Keeling, Sonia Kumar, Jenna Mollaney
MADINGLEY 2018 Sonia Kumar and Arti Maini presented the Ravi Parekh and Shivani Tanna presented educational Communities of Practice (eCoP) findings from research with GP tutors stating model that they developed together with Jo that, “Madingley was a great opportunity to Horsburgh (Lead for Educational Research). showcase the research we have carried out This model has been designed to support staff looking at the key barriers and motivators for to develop evidence-based, innovative community GP tutors taking on students in curricula while in turn contributing to the their GP Practice. One of the key areas that evidence base. The eCOP model offers an came out of the research, was the idea of approach to management of change in service learning, by trusting our students and medical education and in other organisational preparing them before entering their clinical settings seeking to develop as learning placements, the students are able to provide organisations. a service for the patients in the GP practice and 'learn through doing". Encouraging this Senita Mountjoy, Ellie Gunning and Laura model can allow for the GP surgery to have a Storm presented work on the novel ‘Virtual motivated and conscientious member of the Toddler’ session for teaching child team, and allows for the students to learn real development to medical students. The session life clinical practice through their patients. " employs facilitated e-learning; blended learning, to take students through child development assessments. Results of the qualitative research showed that students For further details about any of these value the session and the experiential learning projects, please contact Jo Horsburgh opportunity, enabling them to improve their (Lead for Educational Research) confidence in child developmental examinations. Most importantly, their responses suggested that this approach could be utilised effectively in other areas where it is challenging to access patients.
Ali Dhankot, Noreen Ryan and Josh Gaon presented their novel teaching session designed to teach leadership to medical students based on the Medical Leadership Competency Framework. This session uses a simulated disaster scenario (a suspected terrorist attack) to engage students in leadership skills. They are currently in the process of evaluating the outcomes using focus groups.
Data from the WATCCH (widening access to careers in community healthcare) project was presented by Farah Jamil. Thematic analysis of focus groups with Year 12 students recruited to a summer placement highlighted an obvious work experience gap in General Practice. However, greater awareness was shown by the students of the range of healthcare professional roles, which allowed for better decision making about their future careers. Maham Stanyon reflects on her experience of admission to healthcare professions attending the conference: from students from disadvantaged “Madingley is always a treat, friendly backgrounds lead by Dr Jamil, who faces and a lovely welcoming displayed some of the incredible atmosphere to novice presenters like creative work the students did myself. A diverse range of reflecting on their experiences during presentations this year, with the programme. I was overwhelmed particular highlights including a taste and heartened by the team support of the innovative leadership and during my presentation, an professionalism session from year 5 exploration of the use of educational run by Drs Ryan, Dhankot and Gaon communities of practice to aid that has students participating in a international trainees in learning the disaster scenario and an update from academic 'hidden curriculum'; the ground-breaking Year 3 Medicine particularly as this project moves into In the Community course from Drs the unchartered waters, combining Tanna and Parekh, showcasing some sociological principles, anthropology of the fantastic early results from with educational research. Overall a their data. Further highlights included wonderful two days, filled with an evaluation of the WATTCH project, exciting discussions, new possibilities a project looking at increasing and old friends.”
Fellowship Programme for Healthcare Improvement Rowan Myron, Catherine French, Paul Sullivan, Ganesh Sathyamoorthy, James Barlow & Linda Pomeroy
Improving the quality of healthcare involves collaboration between many different stakeholders. Collaborative learning theory suggests that teaching different professional groups alongside each other may enable them to develop skills in how to collaborate effectively, but there is little literature on how this works in practice.
Further, though it is recognised that the Fellowship, which included bringing patients play a fundamental role in multiple perspectives to discussions of quality improvement, there are few real world problems, was valued by examples of where they learn together participants who reflected on the safe, with professionals. To contribute to egalitarian space created by the addressing this gap, we review a programme. Participants (healthcare collaborative fellowship in Northwest professionals and patients) found this London, designed to build capacity to way of learning initially challenging yet improve healthcare, which enabled ultimately productive. Despite the patients and professionals to learn pedagogical and practical challenges of together. Using the lens of collaborative developing a collaborative programme, learning, we conducted an exploratory this study indicates that opening up study of six cohorts of the year long previously restricted learning programme (71 participants). Data was opportunities as widely as possible, to collected using open text responses include patients and carers, is an from an online survey (n = 31) and semi- effective mechanism to develop structured interviews (n = 34) and collaborative skills for quality analysed using an inductive open coding improvement. approach. The collaborative design of Full Article
Professionals learning together with patients: An exploratory study of a collaborative learning
MEDIA MENTIONS MEDIA
An article entitled ‘The impact of private online video consulting in primary care’, by Louis Peters,
Geva Greenfield, Azeem Majeed and Benedict Hayhoe was published in Journal of the Royal Society of Medicine and has received extensive media coverage.
several questions. A particular concern, given continued development of antimicrobial
resistance, is that some companies appear to use ease of access to treatment with antibiotics as an advertising strategy. The article examines online video consulting with private general practitioners in the UK, considering its potential impact on patients Workforce and resource pressures in the UK and the National Health Service, and its National Health Service mean that it is particular relevance to antimicrobial currently unable to meet patients’ stewardship. expectations of access to primary care. In an
era of near-instant electronic communication, Questions remain about the safety of online with mobile online access available for most consulting and of the working practices of shopping and banking services, many people some private companies. Appropriate expect similar convenience in healthcare. regulation is essential to ensuring that these Consequently, increasing numbers of web- services offer safe and effective care to based and smartphone apps now offer same- patients. This will require a carefully tailored day ‘virtual consulting’ in the form of Internet approach on the part of regulators such as the video conferencing with private general Care Quality Commission. For example, it has practitioners. not been necessary to develop standards on
advertising when assessing National Health While affordable and accessible private Service general practices, but this will be primary care may be attractive to many essential in monitoring the actions of private patients, the existence of these services raises online general practice services.
Key messages
1. Offering rapid, affordable access to primary care advice, private online GP consulting services are expanding 2. Concerns about safety and working practices (including antibiotic prescribing) should urgently be addressed 3. Increasing online access to healthcare is an NHS priority, and there may be opportunity for the NHS to engage with private providers
Full Article Pulse GP The Sun
Imperial
College
EIT
Health
Innovation
Day
EIT Health is a consortium of more than 50 core partners and 90 associate partners from leading businesses, research centres and universities from across 14 EU countries. The goal of EIT Health is to contribute to increasing the competitiveness of European industry, improve the quality of life of Europe’s citizens and the sustainability of healthcare systems. Imperial College London is the lead partner in EIT Health’s Innovation Day Programme aiming to inspire and train students in the field of healthcare innovation. The Imperial Innovation Day began bright and early with a coffee reception at 8:30am. Seventy-six participants signed in and mingled before heading into the Lecture Theatre to be welcomed by Dr Filippos Filippidis. Professor Helen Ward gave a brief history of EIT activities and the next guest speaker was Rosemary Gallagher who focused on EIT Health and future potential opportunities. Dr Somai Melek gave a macro view of current challenges in healthcare before introducing the case challenges for the day, sourced from CARE Campus. Following from this the expert panel of five senior citizens took their places and led a discussion focusing on unmet needs and challenges for elderly care giving.
Thereafter, the hands on work started with a Participants were encouraged to go out and Design Thinking session and students moved to conduct short interviews to try and gain some the workshop area where they had been insight, as well as making use of advice from the allocated into teams of five. Guided by expert citizens. Both the teams and the expert Jacqueline de Castillo the teams hit the ground citizens were incredibly engaged and running and immediately started throwing ideas enthusiastic about the challenge and really around and building up their whiteboards with enjoyed the opportunity to exchange ideas. infinite post-it notes. Teams were strongly encouraged to make prototypes no matter how basic and all of
these processes were guided and overseen by scores were aggregated and the top five teams eleven hardworking facilitators. The time for were shortlisted to take part in the final pitches. lunch arrived and students were so focused and keen that most had to be strongly urged to The finalists were announced and came up to actually take a lunch break! present to the entire group as well as answering questions from the panel of assessors. The Pitch coaching took place after lunch and teams Awards Ceremony saw three very deserving and were then given a final opportunity to develop proud teams pick up their Gold, Silver and their solutions and create their pitches. After a Bronze Awards and gift vouchers. There was a short break with a lot of coffee, teams were very exciting atmosphere and everybody split into three rooms to present their first involved felt the day had been inspirational and round pitches. Three of the assessors were in incredibly rewarding. As everyone headed off to each of these rooms scoring the teams. After the Student Union to celebrate a constructive this the whole group congregated back in the and exciting day, there was a definite feeling of Lecture Theatre for an inspirational talk from Dr accomplishment and success after a day filled Nicholas Andreou describing Locum's Nest with innovation! healthcare start-up journey. During this time MARGINAL VOICES MARGINAL
A quest to improve mental health
diagnosis among the Deaf community in the UK
Written by MPH Student Ms Reda Misghina
Each year in the UK, at least 1 in 4 people experience a mental health problem. When faced with a mental health illness, we often hear the words ‘it helps to talk about it’. The tool of communication in Deaf individuals makes it so that ‘talking’ takes a different format in their ability to convey thought. Various misconceptions about Deafness and the obstacles faced to access mental health services must then be conceptualised differently.
Deafness as an identity In the UK, around 10 million people are considered to be Deaf. The heterogeneous forms of what it means to be Deaf renders it a complex subject. Forms of identification is an interesting factor. For example, there is a distinction between a deaf person (lower case ‘d’) which refers to those with severe hearing problems or who became hard of hearing later in life, compared to a Deaf person (capital ‘D), referring to people that were born deaf or became so soon after birth.
Deafness and mental health The size of the problem of Deaf people with mental health issues is currently unknown. There are various estimates that will paint a picture of the extent of its severity but reliable evidence is either preliminary or out of date. It has been widely acknowledged that Deaf people are twice as likely to have mental health issues as hearing people and 40% of Deaf people will experience a mental health issue at some point in their lives.
Going beyond the language fix Translating the conceptual theory of the Deaf identity and Deaf mental health into practice as a public health matter is a challenge yet to be fully met. Community-based mental health for the Deaf community has been led by charities acting on behalf of primary and secondary mental health services. Currently, SignHealth is the only Deaf health charity that offers a psychological therapy service for Deaf people with ‘BSL Healthy Minds’. This essential service has helped connect patients to a Deaf therapist, or a hearing but fluent BSL user done in the effort of addressing the gap found in primary mental health.
Conclusion In order to close the gap between mental health issues and medical services it is paramount to conduct interventions at a local level and start to implement BSL friendly psychological services at a national level. Recognising the cultural distinctiveness of the Deaf community is a pre-requisite to how medical and public health professionals can assess their need for effective response.
This essay was awarded a prize by the Royal Society for Public Health. Full Essay
This year’s School of Public Health Away Day was held in January at Queen’s Club in West London. Academic staff and Departmental Managers from across the entire School met to discuss upcoming developments and opportunities. Deborah Ashby (Interim Head of the School) introduced the day and gave a general update on SPH. There were presentations from Professors Helen Ward and Paul Aylin on the School’s education offering, including the newly launched MSc in Health Data Analytics, and plans for our new Global Master of Public Health course were announced. The afternoon was an opportunity to have discussions on a number of Athena SWAN topics as the School works towards resubmitting its silver application this autumn, and this was led by Professor Steven Riley. There were also talks on the vision for the Faculty of Medicine and the School of Public Health’s move to White City and another discussion session, on REF 2021, led by Professors Neil Ferguson and Paul Elliott.
Photo by Photo Professors Azeem Majeed and Raanan Gillon joined the discussion regarding the tragic case of 6 year old Jack Adcock, who died from sepsis in 2011, and reached Connor Tarter
what may be its final punitive phase, with the erasure of a trainee paediatrician
– from the medical register.
CreativeCommons
Azeem Majeed and Raanan Gillon contribute to Bawa-Garba debate
Professors Azeem Majeed and Raanan Gillon joined the discussion regarding the tragic case of 6 year old Jack Adcock, who died from sepsis in 2011, and reached
what may be its final punitive phase, with the erasure of a trainee paediatrician from the medical register.
In a rapid response letter to a sepsis that resulted in death BMJ editorial on ‘criminalising that they were justly doctors’, Prof Azeem Majeed convicted? Or were they with co-author Paul Morgan, involved in just one of many argues that the real lesson of cases where sub-optimal the Bawa-Garba case should management of sepsis have been the enormous public contributed to death? health toll of sepsis and the difficulty of diagnosing it, and NICE guidance NG51 and certainly not ‘the conviction of Quality Standards QS161 have ‘Given the scale of mortality from sepsis Given the scale of mortality from and the many delays and errors so often sepsis and the many delays and seen in its management, why then were Dr errors so often seen in its Bawa-Garba and Ms Amaro convicted of management, why then were Dr gross negligence manslaughter?’ Bawa-Garba and Ms Amaro health professionals’. only recently set out the convicted of gross negligence expectations of what best manslaughter? They point out that NHS practice in sepsis care should England estimates an annual look like – several years after death total of some 37,000 the convictions of Dr Bawa- from sepsis. Given the scale of Garba and Ms Amaro. mortality from sepsis and the many delays and errors so They also argue that ‘We need often seen in its management, an objective review of sepsis why then were Dr Bawa-Garba deaths to identify the and Ms Amaro convicted of contribution of sub-optimal gross negligence management to the death and manslaughter? Was their identify lessons for the future management of Jack Adcock so in a non-judgmental manner, far out of line from the and not the prosecution of management of other cases of health professionals, if we are to improve clinical outcomes judgment was consistent with for patients with sepsis’. the guidance and that he very much hopes the judgment will Raanan, in an article-length be appealed. He also argues letter, argues that the GMC that in future the GMC should should not have referred the separate convictions based on Tribunal judgment (suspending remediable medical Dr Bawa-Garba for a year and incompetence – even if this requiring review before the was very severe and fatal – but suspension was lifted) to the where no additional ‘heinous’ High Court and that the Court’s behaviour or attitudes were upholding of the GMC’s desire involved, from other to strike off Dr Bawa-Garba convictions. from the medical register should be appealed. He argues The GMC’s course in such cases that the conclusion in that should be to withdraw the judgment simply does not doctor’s license to practise and follow from the premises on facilitate and encourage which the judgment states that remedial training so that the conclusion is based. In essence doctor can be returned to safe the judgment states that the medical practice as soon as Tribunal’s judgment was not possible, with the public thus consistent with the extensive regaining the services of a published guidance to medical doctor. In this way the GMC practitioner tribunals, and in would, in such cases, fulfil its particular that it was triple legal obligation of inconsistent with several protecting the safety of specified paragraphs of that patients, maintaining medical guidance. standards and maintaining public trust. Raanan argues that there is a straightforward Read the BMJ editorial counterargument to show how, Read the full letters of response by choosing on the contrary, the Tribunal’s the ‘Responses’ tab and scrolling down to Azeem and Raanan’s letters.
Many people at Imperial will have heard something about coaching - a powerful approach to support learning and development which has been expanding in recent years in both education and health. As part of their drive in leading excellence in medical education, Dr Arti Maini and Dr Sonia Kumar from the Undergraduate Primary Care Teaching team have been leading on developing a coaching culture across the Medical Techby Mentors Caleb_All Dave 2012_Photo School at Imperial (supported through Medical School Innovation funding). In addition to her educational role as Deputy Director for Undergraduate Primary Care Education at Imperial, Arti is an accredited coach, coach trainer and supervisor and co-author of the book ‘Coaching for Health’. She works as a coach for the Imperial Coaching Academy and sits on its strategy group.
A large number of educators have been from the Imperial College Academic Health trained in this coaching approach: the Science Centre. All those trained are able to undergraduate primary care teaching team, access ongoing coaching supervision to
CreativeCommons_BW Imperial’s academic GP VTS, community GP support their learning. Work is in progress tutors, personal tutors and the Career with Imperial’s Ed Tech team to develop
Champion network and research facilitators innovative digital learning modules in coaching for education and health so watch “I guess if you have an issue it makes it easier this space! to deal with because you now have like a structure of exactly...you know the exact Arti is now working closely with the EDU structure of how to solve your own problems offering coaching courses that are formally essentially”. accredited by the Royal College of Physicians. “I've noticed quite significant transformation The coaching programme has attracted in the way I interact with people. I'm much attention nationally and internationally and more receptive and I think I listen more. I medical schools across the UK and Canada are find... Well we are listening in conversation keen to learn more about our approach. but I find a lot of the time we aren't listening. So the quality of listening has gone up…it just Examples of quotes from faculty include: makes the conversation a lot better”. “The session felt tailored and it was good to be able to practice. For me it worked Going forward, the Undergraduate Primary perfectly and exceeded my expectations”. Care team are developing health coaching to “The most surprising thing about the course incorporate a socially accountable ethos, was how transformative it was”. building in ‘service learning’ approaches “This has radically changed my view of the across its courses. Students in Year 3 and Year power of language and I don’t think I 5 who have trained in health coaching skills appreciated it until doing this course”. have started working with patients from “I can see multiple scenarios for the coachee- diverse local communities, holding centred approach to empowering conversations to support them coaching/teaching/training”. with their issues around health and lifestyle. “The course has reinforced my understanding of how beneficial a tool this They look forward to develop the health can be and developed my skills significantly”. coaching courses further over the coming year as they will continue to work with the In parallel to training medical educators, Arti department’s Self Care Academic Research has also been busy training medical students Unit (SCARU), Imperial’s community in Year 3 and Year 5 in health coaching skills engagement team at the new White City (supported through funding from HENWL). campus, with White City Enterprise and the Evaluation so far has been very positive Dalgarno Trust in North Kensington and Dr demonstrating positive impact for patients Paquita de Zulueta who leads the Grenfell and for the students themselves. Arti has Clinical Outreach Team. been working with the Head of Academic Support for the Early Years to explore how They will be offering a new Special Choice coaching may best be used to maximise the Placement on Health Promotion in 2018-19 successfulness of learning approaches. where students from Year 5 will have the opportunity to learn health coaching skills and Examples of quotes from students are: put them into practice in making a real “I think patients… feel quite empowered. meaningful difference to local communities. They're sort of very motivated about what to do next and it's nice to see that you've sort They are currently evaluating the student of left them with that sense that they can health coaching training through change what they want”. questionnaires and focus groups and interim “I think it makes the medical student more findings suggest a positive impact on patients, valuable to, you know, the hospital or the host GP practices and on the students GP”. themselves. Over the coming year we will be “It’s just generally my motivation seems to looking at how to increase patient be increased”. involvement in health coaching course evaluation and research.
If you would like to find out more about the coaching-related work being carried out by our department, please contact Arti Maini or Sonia Kumar. student news
Megan Hutchinson: Why I'm choosing general practice By Megan Hutchinson, fifth year medical student at Imperial College London Why be a GP? A career in general practice stands out for many reasons. From the working environment to the day- to-day cases, becoming a GP has many attractions.
The main appeal to me is the wide range of full circle back to the community, having patients you come into contact with. From followed and supported them the whole way. coughs and colds, to two-week waits and chronic conditions, you never know what will Being patients’ main doctor also allows GPs a walk in next. deeper insight into their lives. Not only are GPs privileged to have such an intimate view, And for cynics who claim that 'GP is an but by forming long-term relationships they endless parade of the mundane and understand their patients better; adapting repetitive’, for me no two patients are ever their approach in the knowledge of character, the same. Different demographics, health religious or cultural views and past medical beliefs and presentations mean that even the history. common cold becomes new with every history. But it's not all about the patients. As a GP you have the chance to build and adapt your Secondly, as doctors we strive to help our career throughout your entire working life. patients and improve outcomes. How better From public health to specialty accreditations, to achieve this than to stop disease before it the opportunities are endless. Work with NHS starts? Primary care means primary 111, start a new outreach project or volunteer prevention; empowering patients to take your time overseas - just like their patients, no control of their health and make positive two GPs are identical. And by working and changes. I enjoy educating patients - sharing living in the same community, you get to see knowledge, directing them to resources and the difference you make. enabling them to make informed choices are all essential for people to take ownership of Finally, the close-knit interdisciplinary teams their wellbeing. formed in general practice only add to the job. In hospitals staff often rotate between GP-patient relationship placements, but in the community teams tend to be more stable. This means you can form But preventive medicine isn’t the only way long-lasting relationships and always have GPs affect health. As the primary access point, someone to ask for help or to discuss difficult GPs and the GP-patient relationship are cases with. central to how the public interact with the entire NHS. Rapport and trust are the General practice encompasses all the reasons cornerstones to patient adherence and I chose to practice medicine - interacting with engagement in services; with a strong patients, daily variety and the ability to shape relationship, patients are more likely to my career to my interests. No other medical present earlier and follow advice, thus specialty seems to offer such a improving outcomes. comprehensive career, and I cannot imagine myself pursuing any other path. Additionally, being the first professional most people present to, your actions shape their patient journey - and you'll see them come Read the shortlisted entries for this year's ‘Choosing General Practice’ competition on GP Online
In a paper published in the Journal of the Royal Society of Medicine, we discuss the role that clinical pharmacists could play in primary care.
Primary care in the United Kingdom’s the general practitioner workforce, NHS is in crisis. Systematic but general practitioners take at least underfunding, with specific neglect of 10 years to train and declining primary care compared to other numbers of medical graduates clinical specialties, has combined with internationally suggests a limited pool ever-rising demand and for recruitment. In this article, we administrative workload to place a discuss integration of clinical now dwindling workforce under pharmacists in general practices as a unsustainable pressure. potential solution to these problems.
A major factor in the growing Pharmacists have been working in workload in primary care is primary care teams for some time in prescribing. An aging population and non-patient-facing roles. Areas in higher prevalence of chronic diseases which they support practices include is leading to increased case auditing for performance targets, complexity and polypharmacy, and implementation of enhanced services, consequently greater potential for preparation for inspections by the prescribing errors. Nearly 5% of all Care Quality Commission, training prescriptions in general practices in staff in repeat prescribing and England have prescribing or providing medicines information for monitoring errors, while in some other clinicians. However, these roles areas up to half of the prescriptions currently vary from practice to are prone to error. Although most practice. The widespread integration errors are of mild or moderate of pharmacists in both patient-facing severity, they can be life-changing for and non-patient-facing roles therefore patients and costly for healthcare has the potential to have impact in systems, accounting for around 3.7% three key areas: safety of prescribing; of preventable hospital admissions. improved health outcomes; and access to primary care through Workload and time pressures reduction of general practitioner exacerbate prescribing errors. workload. Concerns about workload and access in primary care have led the UK Government to pledge increases in Full Story
Working within community and social care settings is core to CLAHRC NWL. Whilst evident in all themes, two notable research projects are highlighted. A shared finding across these projects is the importance of having care networks in place. David Sunkersing discusses his work in the ‘Frailty’ theme exploring patient networks. Sophie Spitters covers healthcare professional networks as part of her work in the ‘Early Years’ theme.
Frail individuals’ care networks David Sunkersing
Ongoing research within the Frailty theme has illustrated the importance of the care support network of an individual – and, indeed, the interplay between physical, social, mental and environmental domains. One project at CLAHRC NWL seeks to greater understand the holistic and proactive approaches used in the care of a frail individual, the importance of the ‘patient network’ (e.g. family, friends, physio) – and aims to understand its impacts from both a patient and healthcare professional perspective.
Looking at these networks in more detail, we find that amongst the healthcare professionals in these networks, a variation in assessments used to assess frail individuals exists. Though recently published guidelines emphasise the importance of assessing frailty in individuals with existing comorbidities (1), a lack of standardisation and a consequent variation in assessment practices and support given across healthcare settings and professions exists (2,3). Establishing the assessment practices for frail individuals – and whether existing networks of an individual can be leveraged to maximise the management of their frailty, are areas that both require further research. As such, research into these two areas has been conducted in the community setting, acute care setting and longer-term care setting.
Ultimately, identifying, assessing and managing frailty can present many challenges; understanding that frailty is a complex, long term condition can aid in providing approaches that will contribute towards healthy ageing and capability across the life course.
Healthcare professional networks Sophie Spitters
In the Early Years theme, ongoing research highlights the importance of networks between healthcare professionals. I follow a series of improvement projects that aim to improve the care for children with allergic diseases. All project teams started off with similar ideas. They wanted to improve the patient journey in the healthcare system and they wanted to implement nurse-led clinics in the community to do so. However, they encountered difficulties and saw opportunities that led them to change the plan. Some changes were small, some were rather hefty (4).
However, when asking people about their projects, I noticed one thing kept coming up. People kept mentioning the value of the interactions they had with different professionals; the value of relationships.
The relationships that were established across the allergy improvement projects came in different shapes and forms. In one project specialist doctors met up with GPs during lunch time to discuss queries about the allergic diseases of patients in general practice. In another project,
school nurses shared concerns about the asthma of their pupils via phone with specialist nurses. They would give guidance on what to do or suggest to refer the child to their community clinic. A third project implemented multidisciplinary clinics in secondary care, run by consultants, nurses and dieticians together. This way, patients could get their tests, medication and education all in the same appointment. And healthcare professionals could easily check-in with their colleagues.
These relationships make a network of healthcare professionals who look after children with
allergic diseases. Through this network, expertise is shared and actions are coordinated, which supports better care and better experience for patients.
The English poet John Donne once said, “No man is an island”. In support of this statement, our work in community and social care settings demonstrates that proactive use and development of networks, whether that be a patient or healthcare professional network, offers many benefits.
References
1. National Institute for Health and Care Excellence. [Online]. Multimorbidity: clinical assessment and management. 2016. [Last accessed 31 August 2017]. Read 2. Sunkersing, D., Reed, J., Martin, F. and Bell, D. Frailty: Assessment and Communication within a Care Home Setting. Poster presented at: Past, Present and Future of Medicine: Society for Acute Medicine and the Royal College of Physicians of Edinburgh Conference; 2016 September 12-13; Edinburgh, United Kingdom. 3. NHS Improvement. [Online]. Rapid Improvement Guide to: Identifying and managing frailty at the front door. 2016. [Last accessed 31 August 2017]. Read 4. Spitters, S.J.I.M., Reed, J. and Warner, J.O. Tailoring Interventions in the diffusion of an allergy program. Poster presentation at: International Forum on Quality and Safety in Healthcare; 2017 April; London, United Kingdom. Read
By David Salman Academic Clinical Fellow in Primary Care PCPH, Imperial College London Supervisors: Prof Azeem Majeed, Prof Alison McGregor
I am an ST2 academic clinical fellow (ACF) trainee in primary care at Imperial College, and aim to develop both an academic and clinical special interest in sports and exercise medicine alongside general practice. My current research interest is to better understand why sedentary lifestyles are so harmful. The aims of this are both to develop an increasing body of robust evidence to help influence change away from societies and lifestyles geared towards being sedentary, but also to better understand how individuals in certain circumstances, such as suffering from disabilities or being hospital or bed-bound, may be affected and how they can be helped. Being sedentary is an independent risk underpinning the harm it causes. Being a factor for all-cause mortality and multi- multisystem disease, its effects are system morbidity, from cardiovascular widespread, encompassing humoral, disease, diabetes and obesity, to depression immune, genetic, mechanobiological and and cancer. (This has been known since the metabolomics systems. The study of 1950’s, when Jerry Morris produced his metabolism and metabolites (metabolomics) landmark study demonstrating an increase provides information on the interplay in cardiovascular mortality in bus drivers between intrinsic (genetic output) and when compared to conductors.) Moreover, extrinsic (environmental input) factors, and the effects of being sedentary are only as such would allow us to understand the partially compensated by physical activity, complex gene-environment interactions meaning that being sedentary is an actively occurring in the field of physical activity and harmful process. Despite this, in the UK health. Metabolic signatures already allow approximately a quarter of women and a us to distinguish cancerous from benign fifth of men do less than 30 minutes physical tissue and the microbiome signature of activity a week, and around 80% of children athletes is markedly different from those of are not achieving recommended levels of sedentary individuals. My current work physical activity. To change this situation will spanning both the PCPH (Azeem Majeed) require more than providing information on and the musculoskeletal lab (Alison physical activity levels to people. A McGregor) seeks to explore the metabolic concerted effort is needed to increase signatures of sedentary and active access to facilities and to change the way individuals as part of a wider study of people travel and work. biomarkers of osteoarthritis. I hope to use this preliminary data to apply for post- Furthermore, we do not comprehensively doctoral funding in the future, and understand what constitutes ‘being hopefully, one-day, to help contribute to a sedentary’, and the biological processes society that promotes physical activity.
NIHR CLAHRC NWL Improvement Leader Fellowship Study Visit to Sweden Between 26 Feb and 1 March 2018 a group of 7 Improvement Leader Fellows from NIHR CLAHRC NWL attended an international conference in Jonkoping, Sweden for a study visit…
The study visit was a chance for Fellows to take time away from the busy ‘coal-face’ of delivery Sunita Sharma spoke on her improvement and normal clinical commitments. The work in Chelsea and Westminster Jonkoping Microsystem Festival is an unusual maternity services, which focuses on conference. It brings together a range of adopting design thinking approach to international clinicians and those interested in inpatient postnatal care in a busy National improving healthcare. The conference had Health Service hospital. several exciting plenary speakers. The NIHR CLAHRC NWL Fellows and team heard from Sunita created this drawing image which Stefan Liljegren, who “spoke powerfully” on his summarises her experience in Jonkoping. experience of leading one of the first Ebola hospitals in West Africa during the crisis in 2014. “His reflection on working in such overwhelming frontline chaos whilst still improving care was remarkable” - Rowan Myron.
Fellows also heard from Chris Dancy about the intersection of health and technology (and how we are all becoming cyborgs).
A number of the NIHR CLAHRC NWL fellows were accepted to speak at the conference.
Two further NIHR CLAHRC NWL Fellows were on the team who won ‘Highest Performing Team’ and
‘People’s Choice’ award, as judged by Nigel Edwards (CEO of Nuffield Trust) and Goran Henricks, CEO of Qulturum.
Tai Frater, Occupational therapist, Brunel University, spoke on her work with
the Children’s Trust and her project on shared decision making with children with traumatic brain injury.
“It was a huge honour to present my CLAHRC fellowship project at the Clinical Microsystems Festival in Jonkoping Sweden. My small but perfectly formed audience were very interested in my work on supporting children with brain injuries to participate in healthcare decisions and helped me consider future directions for my project. I was also able to share ideas with a brain tumour team who were developing their service to be more
patient-centred. All in all a very special experience.”
Ammu Matthew, Cardiac Nurse, West Middlesex University Hospital, spoke about the improvements implemented at West Middlesex University Hospital in the Heart Failure improvement project funded by NIHR CLAHRC NWL.
“The Microsystem festival Sweden visit and the opportunity to present my QI work on 'virtual clinic review of Heart Failure patients improve coding accuracy ' was an incredible experience. To be able to communicate the work we do to international colleagues and to know their perspective and similar work at their part of the world was truly amazing.”
A group of the NIHR CLAHRC NWL fellows participated in the Hackathon during the conference, one of which was on the winning team.
The NIHR CLAHRC NWL Fellows and team members would like to leave you with a little shared learning: “We learned quite a lot about the Swedish tradition of Fika (fee-kah) which centres on taking the time to have a break, have coffee, but the main point is to connect with your colleagues, learn about their work and their world. The benefits of taking this time was well documented at the conference and created great opportunities for unexpected networking.” Dr Rowan Myron If you’d like to know more about the presented on the NIHR NIHR CLAHRC NWL fellows and their CLAHRC NWL improvement Leader projects more details can be found on the Fellowship and the CLAHRC NWL website. recently published paper on the evaluation of the If you’d like to know more about the fellowship (for more Microsystems Festival and the innovative information see the paper). work going on in Sweden you can find it on their website.
Predictors of outcomes for patients with Health Research and Care (CLAHRC) common mental health disorders receiving programme for North West London. psychological therapies in community settings: a systematic review Many studies have demonstrated the frequency of alcohol problems amongst Psychological therapies are increasingly patients in hospital wards. These patients, delivered in community care settings. In who are often admitted with problems not existing literature, patient, disorder and related to their alcohol use, do not usually service variables are known to have a require specialist treatment by hepatologist significant impact on the recovery outcomes or gastroenterologists and may miss an for patients undergoing psychological opportunity to have their alcohol use treatment in secondary care. The aim of this addressed. review is to establish which predictors have a The benefit of multi-contact BA in primary significant impact on recovery from common care has been demonstrated as an effective mental health disorders in community public health strategy. The public health settings. It was identified that key predictors white paper ‘Healthy Lives, Healthy People’ for recovery in a community settings from (2010) advocates ‘a more innovative, five countries. The evidence currently integrated and dynamic approach to available for this setting is limited, so this improving public health.’ review serves as a starting point to highlight Authors: Susannah R Woodrow, Stuart A key factors that warrant further investigation. Green, Karen J Phekoo, Vijay PB Grover, Authors: Amati, F., Banks, C., Greenfield, G., & James Lovendoski, Mike Anderson, Owen Green, J. Bowden-Jones, Matthew R Foxton
Journal of Public Health JRSM Open
An identification and brief advice Navigating the sustainability landscape: a programme for low-risk alcohol systematic review of sustainability consumption in an acute medical setting: an approaches implementation study Improvement initiatives offer a valuable This article presents an independent research mechanism for delivering and testing commissioned by the National Institute for innovations in healthcare settings. Many of Health Research (NIHR) under the these initiatives deliver meaningful and Collaboration for Leadership in Applied necessary changes to patient care and outcomes. However, many improvement Global Lessons in Frugal Innovation to initiatives fail to sustain to a point where their Improve Health Care Delivery in the United full benefits can be realized. This has led States many researchers and healthcare practitioners to develop frameworks, models Dr Matthew Harris, Clinical Senior Lecturer in and tools to support and monitor Public Health, published a series of articles sustainability. This work aimed to identify examining frugal and reverse innovation in what approaches are available to assess and healthcare with Imperial College co-authors influence sustainability in healthcare and to Dr Yasser Bhatti, Hillary Watt, Joachim Marti describe the different perspectives, and Prof Ara Darzi, and colleagues from Duke applications and constructs within these University, UCLA and NYU. The first study approaches to guide their future use. titled ‘Global Lessons In Frugal Innovation To Therefore, choosing a sustainability method Improve Health Care Delivery In The United can pose a challenge because of the diverse States’ was funded by the US Commonwealth approaches reported in the literature. This Fund and published in Health Affairs in review provides a valuable resource to November. It describes five case studies of researchers, healthcare professionals and frugal innovations from low- and middle- improvement practitioners by providing a income countries of potential applicability in summary of available sustainability the US. approaches and their characteristics. Authors: Lennox, L., Maher, L., & Reed, J Health Affairs
Implementation Science Explicit Bias Toward High-Income-Country Research: A Randomized, Blinded, Crossover Experiment of English Clinicians Improving patient safety for older people in acute admissions: implementation of the This study was funded by the Imperial-NIHR Frailsafe checklist in 12 hospitals across the Biomedical Research Centre and also UK published in Health Affairs in November, Checklists are increasingly proposed as a provides strong evidence for unconscious bias means to enhance safety and quality of care. in research evaluation. In a randomized, However, their use has been met with controlled, blinded crossover study, English variable levels of success. The Frailsafe clinicians were found to discount research project focused on introducing a checklist from low- and middle-income countries by with the aim to increase completion of key rating the research as less relevant and less clinical assessments and to facilitate likely to be recommended to colleagues, even communication for the care of older patients when the research article was unchanged. in acute admissions. However, the Frailsafe checklist highlighted limitations with frailty Health Affairs assessment in acute care and motivated teams to review routine practices. Further Measuring the bias against low-income work is needed to understand whether and country research: an Implicit Association how checklists can be embedded in complex, Test multidisciplinary care. Authors: Papoutsi, C., Poots, A., Clements, J., The third study, titled ‘Measuring the bias Wyrko, Z., Offord, N., & Reed, J. E. against low-income country research: an Implicit Association Test’, was funded by the Age & Aging US Commonwealth Fund and published in
Globalization and Health in December. It differences in healthcare commissioning and demonstrates how most people associate funding, European countries face comparable Good Research with Rich Countries, and Bad challenges such as ageing populations and Research with Poor Countries. Automatic, increases in chronic conditions and mental implicit associations such as these have health problems, all of particular relevance to implications for the spread of innovation and primary care. In a paper published in the new knowledge from low- and middle-income Journal of the Royal Society of Medicine, we countries. examined England’s current in-hours general practice services relative to those of The three articles advance a research agenda European countries in order to better around diffusion of innovation, promote low- contextualise the debate on extending cost, high-value innovation in high-income general practice opening hours. country health systems and challenge traditional attitudes towards research from We found that standard opening hours in resource-poor countries. England already exceed those of most other European countries, and patients in the UK The studies were featured in an article by are more satisfied with out-of-hours access to Reuters Health, a BMJ blog by former BMJ general practice than patients in many other editor Richard Smith, in an Imperial Today European countries. Achieving easier access special report and in a special invited to primary care services seven days per week presentation to the Editorial Board of the would require significant investment, and British Journal of General Practice. must compete with other NHS priorities; politically attractive priorities should not to have an undue influence in shaping resource Seven-day access to NHS primary care: how allocation. does England compare with other European countries? The existence of true patient demand for extension of general practice opening hours It is often assumed that providing easier in England is not yet fully established and access to community-based general practice evidence for a correlation between increasing during evenings and weekends can reduce in-hours provision and decreased emergency demand for emergency and other department use is inconclusive. Furthermore, unscheduled care services, promoting more the demand for services likely varies based on appropriate care and reducing the costs local demographics and disease burden; if associated with expensive hospital-based general practice opening hours were to be treatment. For example, in England’s NHS extended, those regions with the highest there is political pressure to expand general demand for care should be prioritised. practice surgeries’ opening hours to progress towards a ‘seven-day NHS’. Hence, we suggest that policy-makers in England should focus on improving access to When considering extension of primary care GP appointments during normal opening opening hours in England, it is useful to hours, instead of spending scarce NHS compare primary care access across other resources on very poor value for money countries in the European Union. Despite extended opening hours schemes.
Journal of the Royal society of Medicine
MPH News
On the back of their summer projects, Carolyn Sharpe (MPH 2016) and Talia Boshari (MPH 2017) were invited to a ministerial reception in the House of Commons by Home Office minister Victoria Atkins MP on 18 December 2017. The meeting provided an opportunity to showcase and network around the 30+ local initiatives being run through the Home Office’s Local Alcohol Action Areas 2 (LAAA2) project. Carolyn and Talia’s work was referred to in the Minister’s speech.
Carolyn and Talia spent their summer projects disorder: a manuscript is currently under in 2016 and 2017 respectively evaluating local development for peer review. Even before she policy implementation in the London Borough had submitted her dissertation in the of Southwark - as part of the LAAA2 summer, a copy had been requested by the programme. Carolyn’s work was published in national alcohol policy team at Public Health the Journal of Public Health in December 2017 England after her findings had been and analysed the effect of Cumulative Impact mentioned by the Home Office. Policy on alcohol availability - a nationally delegated power on which no quantitative Both Carolyn and Talia now work as policy evidence previously existed. Talia’s officers in local public health in London, subsequent work has identified types of bringing the skills they learned on Imperial’s licensed premises (those that serve alcohol) MPH to the job of improving health for local and their impact on alcohol related crime and residents.
REFERENCE: Sharpe CA, Poots AJ, Watt H, Franklin D, Pinder RJ et al., 2017, Controlling alcohol availability through local policy: an observational study to evaluate Cumulative Impact Zones in a London borough, J Public Health (Oxf)
Introducing two members of the CLAHRC NWL PHII Team: Yewande Adeleke – Information Officer for Public Health and Information Intelligence Theme
Yewande is currently working on a Health Foundation funded project to develop an online, interactive Measurement Plan Assessment Tool. This tool will support teams to design measures that are scientifically valid, feasible and promote successful improvement in quality of care. In addition to this, she delivers measurement training and support to five healthcare Quality Improvement teams across Northwest London. Prior to joining CLAHRC NWL, she was a Clinical Research Facilitator at the Imperial College London Neuroepidemiology and Ageing Research Unit, working on clinical studies aimed at better understanding risk and protective factors for age-related neurodegenerative diseases. She holds a BSc in Pathology and Microbiology with Study in Industry from the University of Bristol and a Master of Public Health from Imperial College London. Yewande has a keen interest in translational science and health service improvement. Dr Mable Nakubulwa – Research Associate for Public Health and Information Intelligence Theme
Mable is currently working on evaluating the effectiveness of public health interventions. Mable is an Associate Fellow of the Higher Education Academy. Prior to joining CLAHRC in 2016, she worked as a teaching fellow on the ‘Studying Psychology in Higher Education’ module and lab lead for 1st and 2nd year undergraduate ‘Research Methods and Advanced Statistics’ module at Aston University. She holds an M.A in Psychology and Statistics (University of Glasgow), M.Sc. in Foundations of Clinical Psychology (Bangor University), and a Ph.D. in Cognitive & Affective Neurosciences, where concepts from graph theory were adapted to support the characterisation of functional brain networks in atypical and delayed neurodevelopment, specifically Attention-Deficit/Hyperactivity Disorder (ADHD) and Dyslexia. Her interests are in applying advanced statistical approaches to improve our understanding of healthcare translational science.
CLAHRC NWL is committed to learning and development, by building capacity with the academic partners and facilitating knowledge exchange. One of the ways they do this is by having our expert team members teach on different modules at various universities across the country.
Yewande and Mable had the opportunity to do so at Buckinghamshire New University on 12 December 2017. They were asked to run a session introducing ‘Measurement of Improvement’ for the ‘Innovation Module’ for Imperial Partners.
A total of 19 students were enrolled on this course, with key learning outcomes being:
a) Understanding the main reasons why we measure b) Understanding the key steps involved in measurement for improvement c) Understanding variation and using this to inform decision making
Here was what they had to say about their teaching experience:
“Teaching at Buckinghamshire New University was an educational experience; we received interesting questions from students which gave us food for thought. For instance, students asked about impact of seasonality on control charts. Other questions included, how much baseline data is required for the SPC charts and how to deal with low denominator sizes. Talking to students reinforced the need for greater spread of knowledge around measurement for improvement at a more industrial scale. Furthermore, it was an opportunity to reflect on practices that we typically take for granted, but are often considered challenging for frontline staff despite being crucial for enabling success in Quality Improvement. When the word ‘measurement’ was uttered, visually one could tell this had a negative connotation amongst students. This is similar to what we experience working with novice healthcare QI teams. The students appeared to be willing to learn and were engaged with the content delivered. Also, repetition helped students to grasp the core concepts. We have received interest from staff to return in the New Year and provide guidance to students as they apply the measurement for improvement concepts to their own projects (i.e. business case assignment).”
The Model for Improvement is our guiding framework for accelerating improvement efforts.
PHII MORE INFO Be Secure: Encrypt sensitive information
Making the wrong choices when storing or sharing sensitive data can lead to data losses and leaks, resulting in serious repercussions for you and for Imperial College. Encrypting data is the best way to make information unreadable, meaning it can only be read using a digital key to unlock it, called decryption. You should encrypt all sensitive data before storing or sharing.
What’s sensitive data? Sensitive Data can include research data, personal data and commercially- sensitive data. If in doubt, encrypt it!
How do I encrypt information and devices? It’s possible to encrypt documents, USB drives, laptops, mobile phones and emails. Find out how at the Be Secure website: Encrypt sensitive information.
Where can I save information securely? It’s best to use College’s recommended and backed-up central file storage and sharing options (H Drive, group space, One Drive for Business). Find out more about storage and sharing options available to you at the Be Secure website: Store sensitive information securely Share sensitive information securely
Information Security training 'Common Threats and How to Counter Them' covering Data Encryption, is just one of the modules in College's new Information Security Awareness training, available now for all staff to complete.
To access, follows steps at Information Security Awareness training
Contact: If you have any problems accessing the course, contact the ICT Service Desk.
School of Public Health Athena SWAN Lecture
Professor Deborah Ashby
In February this year the School of Public Health Athena SWAN Lecture was presented by Deborah Ashby, Interim Head of the School of Public Health at Imperial College London. Professor Ashby holds the Chair in Medical Statistics and Clinical Trials, and was Founding Co-Director of Imperial Clinical Trials Unit.
She is a Chartered Statistician and her research interests are in clinical trials, risk-benefit decision making for medicines, and the utility of Bayesian approaches in these areas. She led the benefit-risk work stream of the IMI-funded PROTECT project, bringing together academic, pharmaceutical, regulatory and patient expertise to determine best practice, and innovate on both underpinning methods and communication of the benefits and risks of medicines.
She chairs the HTA Commissioning Board, and is Deputy Chair of the HTA Programme for the National Institute for Health Research, and is Chair of the Population Research Committee for Cancer Research UK. She has sat on the Commission on Human Medicines and acts as adviser to the European Medicines Agency. Deborah was awarded the OBE for services to medicine in 2009, appointed an NIHR Senior Investigator in 2010, elected a Fellow of the Academy of Medical Sciences in 2012 and is currently President-Elect of the Royal Statistical Society.
Statistical theory, making epidemiological observations and carrying out incisive analyses to understand those observations, and designing and carrying out elegant clinical trials are all absorbing, challenging academic activities in their own right. However, sometimes we can be left wondering, “So what?” Using those underpinning sciences to make a tangible difference to people’s health sometimes means going the extra mile, and venturing into worlds beyond the ivory tower. Drawing on her experiences from the worlds of academia, drug regulation and research funding, Deborah looked at some examples that have made a difference, reflecting on both the scientific underpinnings, and the pathways to making an impact as well as her personal reflections on that journey.
Find out more about how the Imperial College School of Public Health achieved its Athena SWAN Silver Award for supporting the careers of women in science.
Recruiting for Work Experience Project WATCCH II- Widening Access to Careers in Community Healthcare
Once again, the Undergraduate Primary Care Education team here at PCPH, is running our work experience programme for the second year called WATCCH II – Widening Access to Careers in Community Healthcare II. There is a shortage of work experience in the health sector for pupils, particularly for those who have no connection to healthcare professionals. WATCCH II aims to open up work
experience opportunities in the healthcare sector by offering placements for sixth form pupils from disadvantaged backgrounds to shadow various allied healthcare professionals in general practices. These 16/17 year olds have completed their GCSEs with good grades, do not have placements elsewhere, and are the first in their family applying to university. It was a tremendous success last year and the pupils thoroughly enjoyed the project. They gained valuable knowledge and insight into their own personal skills, understanding the complex patient- clinical relationship and understanding the variety of healthcare roles on offer in the NHS. The experience greatly helped formulate career choices they wished to enter and plan the process on achieving their future careers. Their reflections are shown in this adjacent text map:
40 Pupils will be invited to
attend a pre-placement induction at Imperial College's Charing Cross Hospital Campus, and will then have a 3-day work experience session at a
general practice over the summer where they will observe a variety of allied healthcare professionals in the community, e.g. health visitors, phlebotomists, pharmacists, nurses and physiotherapists. This is an exciting opportunity for you to help change pupils' perceptions of wider healthcare careers, how primary care works and to allow them to utilise their experience with you in their application form.
If you are a GP or other allied healthcare professional interested in participating in the WATCCH project, find out more by emailing WATCCH this this . The . - ’
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STUDY TOUR: NHS
Last December, the WHO Collaborating Centre hosted a delegation from Georgia’s National Center for Disease Control and Public Health for a study tour to the UK NHS and Public Health in England to learn and exchange experiences and observations.
The delegation was led by the Director General of research hub at Imperial College NHS Trust. Study the National Centre for Disease Control and Public Tours were organised in collaboration with Health of Georgia, Dr Amiran Gamkrelidze. The Colleagues from the NHS and are a hugely valued participants visited Public Health England to meet opportunity for professionals from other countries colleagues from Health Improvement team, North to familiarise themselves with the organisational West London health protection team, local intricacies of the British National Health Service, authorities, Primary Care centre, British Medical which serves as an example to other health Journal, Faulty of Public Health and Public Health systems.
VISIT from Austrian students
For the past few years, February has been bringing very interesting visitors to the WHO Collaborating Centre: students from Austrian Carinthia University of Applied Sciences.
They were interested in the work of the WHO Collaborating Centre for Public Health Education and Training as well as Imperial College London in general. The links between WHO CC and Carinthia University of Applied Sciences have been tied from years of cooperation. WHO CC have hosted a number of interns from Austria who contributed excellent projects during their time with the Centre.
More information on the past Austrian students’ work
Learning from the UK Palliative Care system
WHO Collaborating Centre for Public Health Education and Training prides itself on organisation of study tours that respond to the participants’ needs and interests. In that vein, a study tour to Palliative Care system in the UK took place 7-9 Feburary 2018.
It was organised for Croatian representatives of in Sutton, Maggie’s Cancer Care Centre. They Health Centres, Medical School and Universities benefitted from the talks and presentations from across Croatia (Ljubuški, Effectus Finance and Law the Royal Marsden Hospital team; Jennifer Karno, School at the University of Zagreb, Clinical Hospital Senior Palliative Care Nurse at the ICL NHS Trust in Zagreb, Zagreb Medical School, Community and Dr. Catherine Urch, palliative care and special Health Centre in Dubrovnik, Medical Centre in pain management expert. They went back to Metković, University Hospital Centre in Split, Croatia enriched with observations, knowledge and University of Zagreb Medical School). Participants thoughts as well as inspired to implement changes paid visits to Trinity Hospice in Wandsworth, to the Croatian palliative care system. Ellenor Hospice in Dartford, St. Raphael’s Hospice
risk assessment programme (NHS health Check) Study Tour: NHS across England: a systematic review (E Dubois, A Majeed, S Rawaf)’ on behalf of Elizabeth Dubois. Last summer, the WHO Collaborating Centre hosted a delegation from China for a study tour to Dr Jie Shen witness first-hand the UK NHS. Dr Jie Shen, a medical Study Tours are organised in collaboration with doctor in Cognitive and Colleagues from the NHS and are a hugely valued Emotional Neuroscience opportunity for professionals from other from China, spent three countries to familiarise themselves with the months with Who organisational intricacies of the British National Collaborating Centre Health Service, which serves as an example to focusing on research other health systems. and attending relevant clinics within NHS. Introduction to Leadership and Communication in Medicine: August 7- Research on a Public Health Campaign 11, 2017, Dubrovnik, Republic of on Twitter at the EUSPR Conference
Croatia In september, Dr. Hossam Alakhrass, a doctoral student at PCPH, presented his research on a This course was developed and run jointly public health campaign on Twitter at the 8th between the Zagreb Institute of Culture of Health European Society for Prevention Research and the WHO Collaborating Centre for Public (EUSPR) Conference and Members’ Meeting in Health Education and Training, at the Centre for Vienna. Hossam’s contribution outlined how he is Advanced Academic Studies in Dubrovnik. using Twitter to encourage residents of Saudi
More than 40 health professionals from across Arabia to seek screening for Type II Diabetes.
Croatia took part in this intensive course over 5 According to the Saudi Arabian Ministry of Health, days. The modular format of the course allowed between 36% and 58% of diabetics in Saudi Arabia participants to choose the sessions which are (KSA) remain undiagnosed, and diabetes is relevant to their needs. The course was organised prevalent in the population. KSA is also the home and led by Professor Rawaf from Imperial College of more than 40% of active Twitter users in the London, and Professor Marijana Bras and Arab region, which constitutes a total of 2.4 Professor Velijko Dordevic of University of Zagreb. million users. For this reason, Twitter seemed a The course is planned to repeat on an annual natural fit for a public health campaign basis at the Centre for Advanced Academic encouraging undiagnosed Saudi Arabians to seek Studies. a Type II Diabetes screening.
5th International Congress of Person- “It takes just one visit to find out your status,” centred Medicine, Zagreb 23-25 Oct said Dr. Alakhrass. He explained how he is using 2017 the Health Belief Model to guide the development of tweets to send out from the Twitter account he As part of the Congress Prof Rawaf visited Zagreb will use for the campaign, which is sponsored by University and met with Professor Damir Boras, the Saudi Arabian National Diabetes Prevention the Rector, and his deputy Professor Malden and Control Program. Janjanin (a well known musician). The conference in Vienna featured plenary Professor Rawaf delivered two talks on: sessions as well as parallel sessions and many ‘Population dynamic and medical advances posters. Many of the topics emphasized included shaping health agenda and practice’ and on prevention. One presentation focused on the ‘Evaluation of a national cardiovascular disease danger of e-cigarettes, and another looked at
Frugal Innovation in Healthcare delegation
opportunities for treating pain with cannabis. evaluation, and bidirectional learning Another project used the RE-AIM framework to opportunities. evaluate a public health intervention. There was an excellent rapport amongst all the Frugal Innovation in Healthcare delegates and it was discovered that they had amongst them a Karate Master, a concert violinist, In March, the Department hosted a senior a Chess grandmaster and a polymath! Dr Ruvaiz delegation from BRAC (Bangladesh), Integrated Haifa, President of the Sri Lankan Medical Health Services (Pakistan), the Sri Lankan Association said, "The meeting provided a unique Medical Association, University of Colombo, and platform to discuss -in detail- a wide range of the University of Lincoln, to develop research primary preventive and curative care delivery projects and identify funding opportunities in the options with a particular reference to South Asia. area of Frugal Innovation in healthcare. Furthermore the meeting helped crystallize the concept of 'Frugal Innovations' and its impact The workshop was led by Dr Matthew Harris, Prof from a healthcare delivery perspective on the Mala Rao and Dr Yasser Bhatti, with the communities we work in and the 'reversibility' of participation also of Prof Peter Childs (Dyson such innovation to the health system in the UK.” School of Engineering) and Prof James Barlow (Imperial Business School). The delegation spent We are grateful to the Imperial College London nearly a week at the Department, and was able to GCRF Community Building Fund for supporting visit a local GP Practice and the Imperial College this opportunity, and look forward to developing Enterprise Lab during their time in London. They further work with our overseas colleagues over explored shared interests in areas as diverse as the coming months. developing demonstrator sites for frugal innovations, intellectual property issues, Farewell to Professor Elio Riboli Head of the School of Public Health
In December 2017, Professor Elio Riboli stepped down from his role as Head of the School of Public Health. Professor Riboli became Divisional Head of Epidemiology, Public Health and Primary Care in 2006 and oversaw the establishment of the School of Public Health in January 2010. Since taking on leadership 11 years ago Professor Riboli has led the development of the School in both research and teaching whilst continually advancing and consolidating its high academic reputation, highlighted by the Research Excellence Framework (REF 2014) which ranked Imperial 1st for world-leading (4-star) research in Public Health, Health Sciences and Primary Care. Professor Elio Riboli has been a very supportive colleague and everyone in the department wishes him the best in his future career.
Left to right: Lefkos Middleton, Lyndsey Pallant, Matt Heger, Deborah Ashby, Elio Riboli, Neil Ferguson, Azeem Majeed, Helen Ward, Paul Elliot
Programme Lead for Patient and Public Engagement and Involvement What is your role within the department and how long have you been here?
I’m the Programme Lead for Patient and Public Engagement and Involvement for the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Northwest London which is a bit of a mouthful! I joined CLAHRC NWL in February 2009.
What does your role involve?
I support research improvement teams to involve patients, service users and carers across Northwest London in a range of clinical and community settings. I regularly teach with service users on MSc programmes. I work with research partners at the London School of Hygiene and Tropical Medicine to develop the evidence base for involvement and I mentor Fellows on the NIHR CLAHRC NWL Improvement Leader Programme. I contribute to NIHR activities focused on improving involvement including how we understand impact and I review publications for the journal Research Involvement and Engagement and for BMJ Quality and Safety.
What do you enjoy most about your role?
I really enjoy working with a wide variety of people from all backgrounds especially service users, patients and carers who are very influential in my personal practice and to our programme. Our team is diverse with different disciplines which I find very beneficial in terms of how we learn and understand challenges in healthcare. I enjoy facilitating, mentoring and teaching as this is a great way to test your own understanding and to keep grounded in the realities of front line care. I like getting out and about to see different organisations across NWL too.
Tell us about your favourite achievement
Early on in the CLAHRC NWL programme, we realised we needed to do things to change in how we interacted with service users, patients and carers. We took the risk to give Open Space Technology a try. This is a technique devised by Harrison Owen to enable people to tackle complex issues by holding an event around a theme rather than a fixed agenda and it encourages people to self-organise around issues that are most important to them. It felt very scary at the time but it proved to be a turning point in how we approach our work leading to our interest in co-production and the co-design of our Exchange Network with service users, patients, carers, clinicians, researchers and managers. This shows that involvement can be enjoyable and creative and doesn’t have to be about box-ticking.
What were you doing prior to this/ what’s your background?
My background in nursing. I trained at St Bartholomew’s Hospital in the City and at the Homerton Hospital in Hackney. Very different communities and places both of which have changed almost beyond recognition over the last 20 years. I specialised in cardiothoracic surgical care at the London Chest, John Radcliffe and Royal Brompton Hospitals where I was the Senior Nurse for User Involvement before joining NIHR CLAHRC NWL. I completed an MSc in Health Education and Health Promotion at King’s College London and keep my interest in public health.
Tell us about your outside interests
Spending so much time looking at a screen, I like to get outside and I enjoy walking including long distances paths. I’d recommend the London Loop and the Capital Ring which are on our doorstep. As an antidote to blue sky thinking, I’m a member of the Cloud Appreciation Society and you can catch me checking the clouds across the Heathrow flight path from my window on the 4th Floor of Chelsea and Westminster Hospital.
You’re marooned on a desert island – which 3 people (real or fictional, dead or alive), 3 tunes and luxury item would you choose to be marooned with?
I’d like to be marooned with Studs Terkel, the American Pulitzer prize winning oral historian and broadcaster This Exchange Network poster won ‘Best Poster’ at the who captured the stories of ordinary people. Comedian and Involve21 Conference, November 2017. writer Victoria Wood, whose humour reflects the people and places where I grew up in the North West of England. Meera Syal for her versatile talents in acting, singing, drama and comedy. For the music, I’d like Errol Gardner – Penthouse Serenade, jazz for optimism. Perhaps some eighties music for nostalgia. Something like Soft Cell – Tainted Love. I’d also need some contemporary sounds so First Aid Kit – Emmylou would fit the bill. And for a luxury, a bunch of fresh rosemary.
Round up of the latest talks and seminars held at PCPH
Dr Paquita de Zulueta – After Grenfell: NHS community outreach - Current challenges and opportunities. A GP's perspective
Dr Paquita de Zulueta, a GP who has been volunteering to help survivors in the Westway, gives us her first-hand account of the challenges that arose in the immediate aftermath of the Grenfell tragedy. She discusses issues around community response, psychological first aid and disaster preparedness. The complexities around immigration status even caused reluctance from at least three patients, to go to the hospital.
Paquita also discusses what we might learn, as health care professionals, from the way the response was orchestrated. The opportunities to improve and the long term psychological repercussions for many of the survivors. Watch this presentation
Rhiannon Lambert and Sophie Bertrand - Eating disorders from a psychological and nutritional aspect
Nutritionists Rhiannon Lambert and Sophie Bertrand discuss the many eating disorders that exist, how they manifest in the patient and what GPs can do to identify, support and treat people who they suspect may have or be developing an eating disorder. Watch this presentation
Dr David Salman - The Biology of Being Sedentary: an introduction
Sedentary lifestyles are an independent risk factor for: All cause mortality, Atherosclerosis, Several types of cancer including colon and breast, Diabetes, Obesity, Osteoporosis. Increased mortality from sedentary behaviours is only attenuated by high levels of daily physical activity. Dr David Salman discussed the scale of the problem in the UK as well as some of the things we might all do to minimise our sedentary behaviour. Watch this presentation
There are many more fascinating seminars ready for you to view on the PCPH Website (check out the Past Seminar Recordings section)