© Brain Heart by Emilio Garcia - some rights reserved December 2018 USING OUR HEARTS ANDMINDS
December 2018We were very pleased to learn that members of thedepartment were successful in winning two teachingawards. Dr Sonia Kumar and the Undergraduate GPTeaching Team won the Collaborative Award forTeaching Excellence (CATE). This is a national awardfrom the Higher Education Academy (part ofUniversities UK) that recognises and rewardscollaborative work that has had an impact on teachingand learning. The award recognises the team’s vision for medical education tobecome truly inclusive, making a transformational and sustainable differenceto the health and wellbeing of patients, their families and communities. DrMatthew Harris won an award from Imperial College’s Excellence Fund forLearning and Teaching Innovation. Dr Harris and his colleagues will use theaward to examine our teaching programmes for examples of bias; and toensure that our courses are more equitable and balanced, leading to a bettereducational experience for our Professor Azeem Majeedstudents Head of Department of Primary Care and Public Health Imperial College London We welcome feedback on the ARCHIVE PRIVACY NOTICE newsletter and are taking submissions for future issues. Email your news, events,achievements and stories to [email protected] PCPH eMagazine Team Subscribe Unsubscribe Javier Gallego Mehrosa MemoodCopyright © 2018 Department of Primary Care & Public Health, Imperial College London
Photo by Jonathan Cohen – Creative CommonsIn an article published in the British Medical Journal, Prof AzeemMajeed discusses the health outcomes achieved by the NHS in theUK and how these compare with other European countries. Healthoutcomes in the UK have improved substantially since the NHS wasestablished in 1948. The NHS also performs well in manyinternational comparisons on measures such as efficiency, equity,and access.Despite these achievements, Prof Majeed concludes that newhowever, problems with health health policies in the UK should helpoutcomes remain. Moreover, other the NHS to focus on improvingEuropean countries have also health outcomes and that politicallyimproved their health outcomes in expedient schemes that are notrecent decades, often at a faster evidence-based – such as extendedrate than the UK. Consequently, the opening hours in primary care –UK now lags behind many other should be abandoned. ContinuedEuropean countries in key health progress is also needed on wideroutcomes in areas such as child determinants of health such ashealth and cancer survival. poverty, housing, education, employment, and the environment.
Professor Kausik Ray has been named as oneof 7 authors in SPH in Clarivate's global 2018list of the most cited authors, putting him inthe top 1% globally in clinical medicine.Prof Ray has over 40,000 citations by Prof Ray and his group impactsaccording to google scholar, clinical guidelines and public health.published in all the top tier medical When asked, Prof Ray said, \"It's aand cardiovascular journals during huge honour and hopefully will helpthe last decade, in which he has PCPH during the next REF (Researchtried to answer important clinical Excellence Framework)\".questions. Much of the work doneThe Imperial Centre for Cardiovascular Disease Prevention led by Prof Rayfocuses on 4 areas:1) Registries and Cohort Studies2) Observational studies utilising real world/ big data3) Randomised Controlled Trials 4) Systematic reviews and meta-analysesKey studies and achievements include; the FH Studies Collaboration (FHSC), theonly global registry of Familial Hypercholesterolaemia (affecting 1:250individuals), involving 70 countries; The TOGETHER studyrecruiting 146 practices from North London to link healthcheck data from EMIS through NHS digital to create a200,000 cohort to study risk factor burden and CVoutcomes across London; the Da Vinci study whichhas recruited 6000 participants across 18 countries inEurope assessing cholesterol management.Additionally, Prof Ray was National Lead investigatoron 3 trials of novel therapies which reported in theNEJM and Lancet within the last 3 months. View the list
Department NewsSchool of Public Health Research Azeem Majeed or Helen Ward to discuss whether the PhD idea fits within the SPHRThe NIHR SPHR now has a new website! programme, or whether there is potentialOver the last year, the website has been for it to be worked into a proposal so thatcompletely revamped with more it does.comprehensive content and details aboutthe SPHR programme. Not only are there President’s Award for Excellencenow more details about the researchhappening within SPHR, but it is regularly Matthew Harris, Clinical Senior Lecturer inupdated with news and events happening Public Health Medicine, has been awardedwith all of the SPHR member institutions. a ‘President’s Award for Excellence in Teaching’ and has received funding for aWe have had three new PhD students one year project to ‘decolonize’ thestart this autumn. Rosie Jenkins is looking Masters in Public Health curriculum. Theat the impact of economic recession and project will: review the reading materialausterity measures on nutritional intake provided on the MPH to ascertainand associated health outcomes in the UK. whether certain perspectives are beingJennie Parnham is evaluating the impact privileged over others; developof the Healthy Start programme on educational workshops with faculty tocardio‐metabolic outcomes. Tishya reflect on teaching practices in thisVenkatraman is scoping the impact of ‘The regard; launch a student essayDaily Mile’ on wellbeing, academic competition to describe frugal healthcareattainment and physical health of primary innovations that could be usefullyschool children in England. Next our PhD adopted in the NHS; and an implicitstudents are off to Newcastle to meet the association test for faculty and staff tofull SPHR PhD team! examine their own unconscious biases around research from low-incomeWe also have a fourth fully-funded countries.studentship available, to begin by March2019. Applications are invited from The award brings to the fore theindividuals with a strong academic record importance of diversity in our teachingwho wish to develop a career in public and our research, not only in terms ofhealth research. Proposals must fit closely social diversity but also in terms ofwithin the parameters of the SPHR cognitive diversity. We all often rely tooprogramme. Please contact Chris Millet, much on scientific research fromEszter Vamos, Sonia Saxena, institutions in the so-call Global North, and research from partners in low- and middle-income countries may be given shorter shrift quite unfairly. However global health requires global perspectives. This award will shine a light on our own teaching and our own biases and examine what we can do about it, striving for a
more equitable, balanced and fair Development Conference and see whoeducation for our students. won the best presentation awards.NIHR CLAHRC Career Development WATCCH – Widening Access toConference Community Careers in HealthcareThe second NIHR CLAHRC Career This summer the Department of PrimaryDevelopment Conference took place in Care and Public Health ran the secondOctober. The conference was organised year of the Widening Access toby the NIHR London CLAHRCs with the Community Careers in Healthcareobjective to enable early career (WATCCH) programme. This is aresearchers to connect and learn about programme for 16-17 year olds fromfurther career development in health and London secondary schools, from diversesocial care research. and deprived backgrounds, who have an interest in careers in communityOver 90 people attended the conference healthcare. The programme gives pupilswhich had a mix of 2 plenary sessions, 5 an opportunity to get vital workskills workshops, 12 oral delegate experience in healthcare and providespresentations, 13 poster delegate support with the application process. Thispresentations and 36 careers clinics. is needed, now more than ever, whenRunning parallel to the breakout sessions OFFA data shows that in 2016 entry ratethe career clinics gave early career to ‘higher tariff universities’ for 18 yearresearchers an opportunity to have 1:1 olds from the most disadvantagedtime with a senior academic researcher backgrounds was just 3.6%. The WATCCHfor helpful advice on career prospects programme doubled in numbers this yearwithin NIHR and the wider NHS and to accommodate 40 pupils and was onceacademic landscape. again oversubscribed with high calibre applicants.The conference provided an opportunity In an era where the NHS workforce isfor early career researchers to present facing a recruitment crisis, this schemeand showcase their research to peers and supports applicants fromsenior researchers, through a range of underrepresented backgrounds in theirposter and oral presentations and awards, journey to careers in healthcare.were presented for Best PosterPresentation and Best Oral Presentation. Supporting these students is vital in order to create a diverse workforceVisit the CLAHRC NWL Blog to read more which better reflects the patientsabout the NIHR CLAHRC CAREER we care for.
‘Smoke’ © Carolina ValtuilleCreative Commons
Evaluation of banningcigarettes displayon inshops
Removing displays of tobacco products from shops mayhave reduced the proportion of children buying cigarettesby 17 per cent.These are the findings of a new study from Imperial College London. Theresearch: - the first analysis of the impact of the 2015 tobacco display ban inEngland, assessed survey responses from 18,000 11-15 year-olds from acrossEngland between 2010 and 2016.The findings suggest tobacco display would have started in childhood,bans may have an important role in explained Dr Anthony Laverty, leadreducing the number of child smokers. author of the research from the School of Public Health at Imperial: “We knowHowever, the study also revealed more that smoking kills one in every twoworrying findings, and suggested more smokers, and that children who smokethan two in three child smokers had not are likely to continue smokingbeen refused cigarettes when they last throughout their lifetime, seriouslyattempted to buy them - a figure that increasing their risk of disease.remained unchanged between 2010-2016. We also know seeing cigarettes displayed in shops is linked to smoking,Furthermore, the majority of child especially among children. This researchsmokers said it was easy to buy shows that removing displays madecigarettes in shops. This rose slightly tobacco less visible to children, and thatfrom 61 per cent in 2010 to 65% in 2016. fewer of them bought cigarettes there.In 2015 the display of cigarettes was Most countries worldwide still allowbanned in all shops in the UK. Before cigarettes to be advertised andthis, 57% of children who smoked displayed in shops. This researchregularly bought their cigarettes in provides evidence that the introductionshops. of display bans will be an effective measure against children smoking – andHowever, the latest study published in could help save them from starting athe journal Tobacco Control, revealed deadly habit”.this fell to 40% by 2016. NHS datasuggests just over one in 20 children The researchers analysed data from thesmoked in England in 2016, a decline Smoking, Drinking and Drug Use Surveyfrom just under one in ten in 2010. from 2010 to 2016. This anonymous questionnaire quizzes 11-15 year-oldThere are currently 9 million adult children across England and issmokers in the UK, and many of these conducted at schools under exam conditions. The findings also showed that among the children who smoked,
the most common source of cigarettes ‘twowas from friends, followed by shops. inThis remain unchanged between 2010-2016. three childInterestingly, there was no increase in smokerschildren reporting they had purchasedcigarettes from illegal sources. The hadproportion of children who said they nothad bought cigarettes from street beenmarkets remained steady at under 10 refusedper cent between 2010 and 2016. cigarettes whenThe team acknowledged that other theymeasures were put in place between last2010-2016 that may have helped reduce attemptedsmoking rates, such as the ban oncigarette vending machines and higher totaxes. buy them’Dr Laverty said: “During this time adultsmoking rates have fallen, and highertaxes have increased the price oftobacco. All these factors have a role toplay, and these findings suggestremoving cigarette displays are animportant component. Smoking ratesfall fastest when complimentarymeasures are put in place”. He alsoadded, “These results are encouragingbut more work is needed to ensureeffective tobacco control. Our findingssuggest it is still too easy for children topurchase cigarettes in shops.Enforcement is important, butGovernment cuts have meant thatcouncils have seen a 56 per centreduction in trading standards officersbetween 2009 and 2016. A licensingsystem for tobacco retailers needs to beintroduced - similar to that seen foralcohol - which could be paid forthrough a levy on tobacco industrysales”. Photo: Smoke © John Perivolaris Creative Commons
Conference Report Credit: ra2 studio – Fotolia.com Creative Commons
Impact on mental health and psychological wellbeingThe bidirectional association of mental wellbeing and weight is anexciting new topic, gaining traction in the research community. Asthis conference exemplified, the evidence so far is clear in pointingto some distinct and important relationships between what we eat,our intestinal microbiome health and our mental and physicalwellbeing. Fascinating presentations by Tim Spector, Gerald Carkand Phil Burnet amongst others were attended by a variedaudience of researchers, clinicians, writers and interested students.Whilst a varied number of topics the growing literature on thiswere covered; from dietary patterns dietary pattern as a powerful choiceto surgery in treating obesity, for prevention of disease.omega 3 trials to prebiotics in RCTsfor schizophrenia, the overarching Understanding our intestinalmessage from the results presented microbiome and its metaboliteswas clear: caring for our gut offers a whole new landscape ofpositively impacts mental health. opportunities for prevention andWith a focus on bettering gut health treatment of mental healththrough a varied, fibre rich diet with conditions, as well as overall health.a good source of Omega 3s, the The future of personalisedimprovements in mental health treatments will include tailoredwere seen not only in those with interventions to improve gutmental illness, but also in the microbiome health, its ability togeneral population, as highlighted in effectively metabolise nutrients andthe presentation given by Camille endogenous precursors such asLassale reporting on the recent tryptophan and helping patients bymeta-analysis published in Nature. empowering them with theThe findings from this meta-analysis knowledge to make the right dietaryshow a 33% risk reduction for and lifestyle choices for their owndepression in populations following unique, as Tim Spector called it,the Mediterranean diet, adding to “Microbial Garden”.
Student NewsIn September our MPH students presented their research projects. Thiswas their last assessment for the 2017-18 course. We had a wide-rangeof presentations on very topical issues in global health and healthpolicy. The following project topics may help prospective students asthey can see the kind of dissertations that our students complete. 1. Systematic review on the association between Chronic Hepatitis B infection and Malaria; and report on Hepatitis B control strategy in The Gambia 2. Perceptions of need among parents of children with a developmental delay from black, Asian and minority ethnic (BAME) backgrounds and their experiences of accessing support services 3. A systematic review of risk factors of knife carrying, usage, and stabbing among young people in United Kingdom. 4. Perceived context and its role in quality improvement initiatives 5. The Quality of Diabetes and Hypertension Care among Palestine Refugees in the Middle East: A Cross-sectional Analysis 6. Associations between air pollution and birthweight in the Avon Longitudinal Study of Parents and Children (ALSPAC) study SEE FULL LIST
North Yorkshire GP Trainee FellowshipBy Puja VermaIt was after squeezing into another packed London tube on a Fridayevening that I saw the email ping into my mobile phone. ‘Cumbrian andNorth Yorkshire GP Trainee Fellowships for ST3s’. The opportunity totransfer your training for 4-6 months in one of the most beautiful partsof the UK, a quick google of Saltburn- by –the- Sea and I was instantlysold.I transferred my training from a North East semi-rural setting hasImperial GP Speciality Training provided me with differentScheme- (Marylebone Health challenges and experiences. I seeCentre) to Durham and Tees Valley more minor injuries (the practice isVTS- (Huntcliff Surgery, Saltburn) in several miles awayApril, and have loved every minute. from an A & EMy Practice Huntcliff surgery was a department) andstone’s throw from the beach, and a unfortunatelyshort drive to the breath-taking downturn in localNorth Yorkshire Moors. heavy industry has also meant that I seeWork life balance is emphasised by my fair share ofthe practice and I have been able to stress relatedfind time to join a running club, Tai problems and socialChi and walk every day. I’m cycling consequences ofto home visits and enjoying a much unemployment.more outdoor lifestyle. Overall, I absolutelyI’m also really enjoying working in a love life as a rural GPclose-knit community; it’s not and would definitelyunusual to bump into my patients in consider it in thethe bank, or supermarket. future! I wouldObserving how my trainers interact encourage allwith their patients around the town, London GP TraineesI have learnt to love working in a to think aboutsmall place where everyone knows applying for theyou and you may well be a friend as fellowship and seewell as a doctor. what amazing opportunities it canBut it isn’t all ‘lemon tops’ and bring!‘Parmo’s’ on the beach. Working in
Reimaging Global Health: Self-Care in the 21st CenturyBy Austen El-Osta, Acting Director, SCARUThe Self Care Academic Research Unit (SCARU) was invitedto participate in the Wilton Park Dialogue entitled,‘Reimagining global health: self-care interventions andimplications for healthcare’. The 3-day conference inSussex was chaired by Wilton Park Director, Robin Hart, 10-12 September, and included representation from WHOGeneva, the United Nations University, the BMJ, the WorldBank and the Children’s Investment Fund Foundation.
Photo: The Dot Matrix © Chris Hearne Creative commons
The thought-leadership dialogue focused on the implications of the growing movementtowards self-care interventions that are increasingly being accessed outside thetraditional health sector. The aim of these round-table discussions was to inform thescope of WHO normative guidelines on self-care interventions, as they are developed.Self-care is a field that is rapidly advancing on many fronts and could have the potential toincrease coverage of evidence-based, quality health interventions, thereby, providing choiceand empowering people to make decisions in relation to their health and well-being.Discussions focused on places of access of self-care interventions, including at home, viapharmacies and through digital and mobile technologies, which are now an importantsource of services, information and interventions.Therefore, changing the expectations with regards tohealth and health seeking behaviour’s. The meetingconsidered self-care from a variety of perspectives andin the context of non-communicable diseases (NCDs),also learning lessons from mental Health.A new point of departure for self-care thinkingAn Open Letter from David Webber, President of theInternational Self Care Foundation (ISF), was shared atthe conference illustrating the widely cited 7 Pillars ofSelf Care framework which underpins self-careactivities for disease prevention as well as to promoteself-management of long-term conditions by sustainedand positive behaviour change.SCARU highlighted several research & developmentpriorities for self-care in the conference, andshowcased the newly synthesized ‘Self-Care Matrix’,which consolidates extant definitions and models ofself-care. The Self Care Matrix schema (figure 1) can beused to conceptualize self-care in its totality. TheMatrix is a practical framework that is intended for useby all self-care stakeholders, including commissionersof health and wellbeing services to guide thedevelopment, commissioning and evaluation of self-care interventions in the contemporary setting. Photo: What is the Matrix? © Manel Tarralba Creative commons
WHO is global champion for self-careThe WHO announced they are developing normative guidelines to support countries forself-care interventions, including for sexual and reproductive health and rights (SRHR) in thecontext of the WHO’s ‘triple billion’ goals to make a measurable difference to people’shealth at country level, with the following three objectives: one billion more people withhealth coverage, one billion lives improved and one billion more people made safer. Seeds of change The world has been celebrating International Self Care Day (on 24 June) since 2011, but more needs to happen for self-care to become the expectation for 21st century living. Individuals, groups, communities, policy makers, commissioners of health and wellbeing and politicians need to start talking more about self-care. To support this vision, Imperial SCARU invited a senior delegation from WHO International led by Dr Manujlaa Narasimhan to a meeting in London to discuss the self-care agenda. SCARU will also meet with Professor Anuar Zaini (Chair, Malaysia Global Health Consortium). Meetings will include David Webber, President of the International Self-Care Foundation and Pete Smith (Co-Chair of Self Care Forum) to discuss potential scope for collaboration on progressing the self-care agenda. Meanwhile, the UK is gearing up to deliver its 7th consecutive Self-Care Week organised by the Self Care Forum. This year’s Self Care Week (12-18 November) is themed ‘Choosing Self-Care for Life’ and focuses on embedding support for self-care across communities, families and generations to help people choose self-care for a healthier, happier life. Self-care is quickly becoming recognised as a priority & necessity- not a luxury- in the work that we do. Figure 1: Schema illustrating the link between the 4 dimensions of self-care: (1- Self-Care Activities, 2- Self-Care Behaviours, 3- Self Care Context & reliance on resources, and 4- Environmental barriers & drivers to self-care).
Heart stories from Dept. Primary Care &Public Health © Brain Heart by Emilio Garcia - some rights reserved
Diagnosis of heart failure in primary care: are wefollowing NICE guidelines?Heart failure is a serious chronic disease, representing a significant burden onpatients and healthcare systems. Early identification is key to effectivemanagement. National Institute for Health and Care Excellence (NICE)provides recommendations on investigation and referral of patients withsymptoms suggestive of heart failure, but it is unclear how these arefollowed in primary care practice. Researchers at PCPH have used linkedprimary and secondary care data sets (the Clinical Practice Research Datalink(CPRD) and Hospital Episode Statistics (HES)) to describe the journey ofpeople with heart failure from initial presentation through to diagnosis andinitial management.Initial findings of this work were published exceeded those recommended by NICE,in Heart last year: few patients receive suggesting a need for more timelyinvestigations and referrals recommended management of these patients in primaryby NICE, suggesting significant missed care. Patients who were female, older,opportunities in timely diagnosis. The with higher deprivation score, moreresults of further analysis to understand comorbidities and fatigue as their onlythe timeframe within which recorded symptom, all took significantlyrecommended investigations and referrals longer to achieve investigation, referral ortake place were reported in an oral diagnosis. Further work is in the pipeline,presentation at the Royal College of which is looking at the variations in initialGeneral Practitioners Annual Conference management of patients presenting within Glasgow, in October 2018. symptoms suggestive of heart failure by GP practice. It will also look at the impactDani Kim explained to RCGP delegates of different pathways to diagnosis onthat less than 40% of patients followed a subsequent significant patient outcomesNICE recommended pathway to diagnosis including hospital admission and death.following presentation with symptoms Findings of this work are also nowsuggestive of heart failure. Of those who informing NICE in their current guidelinedid, median times from presentation to revision.investigation or referral considerablyBottle A, Kim D, Aylin P, Cowie M, Majeed A, Hayhoe B. Routes to diagnosis of heart failure: observational study using linked data inEngland. Heart 2018;104:600–5. doi:10.1136/heartjnl-2017-312183Kim D, Hayhoe B, Aylin P, Majeed A, Cowie M, Bottle A. Heart failure in primary care: opportunities for faster diagnosis and care. Oralpresentation. Royal College of General Practitioners Annual Conference, Scottish Event Campus, Glasgow, October 2018.
Why is Atrial Fibrillation (AF) a problem inHounslow borough?AF is the most common sustained cardiac arrhythmia in the UK. 1.4 millionpeople are affected with AF in England, with up to 425,000 peopleundiagnosed and untreated, 4,949 of which are based in Hounslow borough,West London. AF Prevalence in Hounslow during 2015/2016 was lower thanexpected at approximately 0.95% rather than the expected prevalence ofapproximately 1.62%. Patients with AF are 5 times more likely to sufferstrokes.AF-related StrokeHounslow has a higher than average AF- The estimated cost per AF-related strokerelated stroke rate in its population of is £12,228 in the first year excluding social304,686 residents. SSNAP 2014 data for care costs. Without preventativeHounslow CCG, shows AF patients not treatment, 5% of patients with AF willanticoagulated before their stroke, after have a stroke each year.discharge there was 47% mortality andsevere disability in 20% of cases. These A health economic evaluation ofstatistics in conjunction with the community-based screening in Australiaforecasted 3% increase in the Hounslow reported that the AliveCor system waspopulation over the age of 45 by 2021 and cost effective in detecting AF andadditional 3160 residents over the age of preventing stroke, with an ICER of £2,79975, reinforce the need to address the when compared with standard diagnosticproblem of undiagnosed AF in the assessment for AF, which includedborough. consultation with a GP and a specialist, and a 12 lead ECG (NICE.org.uk).Hounslow AF Quality Improvement (QI) Project ScreeningThe QI team focussed on their aim of improving the quality of care andhealthcare outcomes (including stroke prevention) for people with or at risk ofAF in Hounslow CCG by April 2017. Using the NIHR CLAHRC NWL’s systematicapproach, interventionsincluded:
1. A primary care clinical template to improve compliance with National Institute for Health and Care Excellence (NICE) guidance and patient-centred anticoagulation choices;2. Deployment of the AliveCor Kardia mobile Electrocardiogram (ECG) device 52 Hounslow GP practices coupled with the creation of an AF ‘at risk’ register and patient status alert on the GP practice information system (SystmOne, The Phoenix Partnership, Hosforth, UK) to identify those at high risk of AF to facilitate opportunistic screening;3. Community awareness and screening campaigns were also held in areas where Geographical Information Systems mapping of observed versus expected AF prevalence indicated greater numbers of undiagnosed AF patients.4. Digital postcards have been produced, as a resource for patient education.Using routinely collected data on stroke in AF patients without anticoagulation, if the additional 138 AFregistered patients, 2016 to 2017, the patients were not anticoagulated, 10.5 of these patients would be expected to havepercentage of ‘at risk’ patients screened a stroke within a year. Based on a 64% reduction in the risk of stroke for AFincreased from 5.1% to 13.7%, 479 patients on anticoagulation when compared to placebo, it is estimated thatpatients were newly diagnosed with AF, if all the 138 additional AF patients were anticoagulated, approximately 6.9 ofrepresenting an estimated additional 138 these patients would have a stroke within a year. The potential additional 4.4patient diagnoses each year. Based on a strokes prevented each year (through5% risk of anticoagulation) in this scenario equates to a yearly potential saving of £54,289.81 (set up and running cost not included). Community Champions Community champions are patients, religious leaders and other volunteers, who have built capacity in the community for increasing the number of people screened over the last year to 1494 in the community alone. HQIP published a case study sharing this community approach to awareness and screening.
NIHR – In October we celebrated the 10th anniversary for the National Institute for Health Research – Research Design Service London (NIHR – RDS London). RDS London is a collaborative project, led by King’s College London, in partnership with Imperial College London, University College London and Queen Mary University. RDS London provides advice and guidance to clinicians and academics who are preparing research proposals for submission to peer-reviewed funding competitions. It is focused on supporting applications for funding from NHS researchers and those working in partnership with the NHS. Using expertise in applied research methods in health and social care, RDS LondonRDSoffers advice and support in all areas of grant applications including; Literature review, research design and methods, patient and public involvement (PPI), health economics and statistics. The service has been running successfully for over a decade and the event was an opportunity to re-launch some new initiatives to cover the next few years. The re-launch event was held at City
RDS The service has been running successfully for over a decade and the eventnwas an opportunity to re-launch some new initiatives to cover the next few years. The re-launch event was held at City hall with breath-taking views of the River Thames and its beautiful monuments along the riverside. NIHR - RDS invited guest speakers who shared their success stories with RDS and how they had been awarded funding for their projects with help of the service. The deputy director for RDS, Dr Peter J Lovell, shared his plans and objectives for the next 5 years. Following the event, a dinner was held at a nearby restaurant. Team members across the four universities were brought together to celebrate this milestone along with Laura Vanderbloemen (pictured far left) and Mehrosa Memood from the PCPH RDS unit.
COMPASSION STUDIESA socially accountable way forward forhealth promotion in the local community
In September 2018, the Undergraduate Primary Care Educationteam launched an innovative new 4-week Specialty ChoicePlacement (SCP) in Health Promotion for medical students in year5 of their course. This was led by Dr Arti Maini and Dr BhaktiVisani.
A key aim of our undergraduate medical Austen El Osta, departmental researcheducation work is to develop doctors who manager and chair of the Self Care Academicare equipped to meet the needs of patients Research Unit (SCARU). The students alsoand communities, and the 21st century completed an in-house introductory healthhealthcare landscape is shaped by wide- coaching course run by Arti Maini. They putranging factors including shifting population this learning into practice experientially bydemographics, the impact of social being based for the majority of their time withdeterminants of health and an increase in The Dalgarno Trust. This placement providedlifestyle-related conditions. Novel a valuable authentic learning experienceapproaches to health promotion are needed, where the students meaningfully contributedand with a population rich in diversity and to the local community, gaining experience inmany socio-economic barriers right on our team working, inter-professional working,doorstep in North Kensington, we were keen community-building, health promotion,to explore what socially accountable medical quality improvement and leadership.education might offer. Could medicalstudents learn effectively through working in Through an initial jointthe community with departmental support, conversation betweenand in the process make a positivecontribution to local residents? ourselves, the students and the staff at The Dalgarno Trust, we learned of some of the keyOver the last few years, The healthcare challenges they see in theirDepartment of Primary population, relating to childhood obesity,Care and Public reduced physical activity levels, long termHealth at conditions such as diabetes, sexual health,Imperial mental health, domestic violence and lowhas levels of health literacy.developedstrong links With 82% of the residents attending thewith The centre being female, reaching the local maleDalgarno population has been an ongoing issue for TheTrust, a Dalgarno Trust. A Men’s Mental Health groupcommunity organisation serving North had recently started up at The Dalgarno Trust,Kensington. They run projects that support and our students participated in this in thisand promote health, well-being and inclusion initiative, providing an ideal opportunity forfor local residents of all ages. They sit intergenerational discussion with multipleamongst a population where 42% of residents interactions over the 4 weeks. They exploredare from BME backgrounds, 20% have long barriers faced by men from diverseterm limiting illness and 42% are unemployed backgrounds, and staff at The Dalgarno Trust(according to the last census). English is notthe first language for over 1 in 5 residents.The two students in our first cohort spentsome time with us in the department learningabout frameworks in health promotion, self-care, social determinants of health and thesignificance of the language we use inhealthcare, role of the media and the role ofhealth literacy. Tutorials in these areas werefacilitated by the two course leads and byChristine Douglass, our new departmentalsenior fellow in social accountability, and
also saw this as a successful step forward in impacts of this type of abuse, and how wereducing the stigma around mental health and look out for and handle this as health carein helping men feel more confident about professionals.approaching health professionals for support. Over the four weeks, the studentsDuring their time at the Dalgarno Trust, the interviewed several men accessing thestudents helped with the food bank, Dalgarno Trust to further identify attitudesinteracting with local residents and gaining and barriers to healthcare and self-care. Theirimportant insights into the challenges faced motivation for this project was throughby them. They were also able to draw on learning of the stark difference in lifetheir newly learned skills in health coaching to expectancy between men and women in thespeak with several residents about issues that borough. They will present their findings at awere important to them that they were Men’s’ Health conference for 70-80 localstruggling to change and supporting them to residents being held by The Dalgarno Trust inidentify a way forward to achieve the goals February 2019, and staff will facilitate small group work with local residents to identity that mattered most to them. possible steps to address the barriers and The tutorial with challenges identified. Over the course of their Christine 4-week placement, the students have beenDouglass enabled the students to think working with staff at the Dalgarno Trust todifferently about health-related terminology. generate ideas for topics to cover atThey were able to reflect on how terms such the conference, informed byas ‘user’ or ‘service-user’ were adopted by their conversations withstaff at the Dalgarno Trust, and through local residents. They areconversation with the staff, the term keen to‘resident’ emerged as a better alternative continueterm. The staff have decided to now use this theirterm as a result! involvement with the Men’s HealthAs part of this placement, we organised for Conference, and will bethe students to watch an acclaimed local play attending the event inabout the subject of sexual violence. This wasa powerful experience and generated much February, as well as contributing to thethought-provoking discussion. It allowed both Winter Health Campaign run by The Dalgarnostaff and students to think more broadly Trust.about stereotyping, mental and physical Our students reported developing a greater level of compassion and understanding of health promotion and barriers to self-care, particularly in a very socially deprived local population and reflected on the importance of this in the current healthcare context and in their future roles as doctors. They also felt very inspired by the notion that they could make some difference as medical students right now - learning effectively through serving and positively contributing to the health and wellbeing of the local community.We are very much looking forward to the next set of students starting the placement later thismonth, as we continue to build our relationship with the Dalgarno Trust and with the localcommunity through our medical students and socially accountable medical educationapproach.
LOL-lab aims to break down barriersbetween Imperial’s academics and localpeople, creating a platform where theycould come together, interact and supporteach other. Participants were given aunique insight into the art of making peoplelaugh as they developed their own jokes,perfected their comic timing, and built uptheir confidence. The programme came to aside-splitting climax with a charity comedynight at The Queen’s Tavern pub in WhiteCity, which raised more than £400 forHammersmith & Fulham Mind.LOL-lab was piloted last year by the NIHRImperial Biomedical Research Centre (BRC)Patient Experience Research Centre (PERC),a part of Imperial’s School of Public Health.PERC aims to promote communicationbetween patients, researchers and clinicalstaff to help drive improvements inhealthcare. This year LOL-lab was expandedto include academics and students fromacross the College, as well as local residentsfrom White City.The programme was founded by Dr NathanGreen, Research Fellow in Imperial’s Schoolof Public Health, and supported by localstand-up comedian Nina Joshi-Ramsey. DrGreen joked: “There were two types ofpeople at LOL-lab: scientists, local peopleand people who can’t count”. Localresident Sandra Anlin participated on theprogramme. She said: “I knew that I canwrite humorously but didn't know if I couldwrite a funny stand-up routine. Threeworkshops with the amazing Simon Wattand two sessions with support from Nathanand Nina later, it would seem I can!”\"Imperial really are changing lives in allsorts of unexpected ways!\"Will Kendall, Societal Engagement Officer at
\"Imperial really are changinglives in all sorts of unexpectedways!\"Will Kendall (pictured bottom left), SocietalEngagement Officer at the School of PublicHealth, organised this year’s programme alongwith Priya Pallan from the White CityCommunity Engagement team. He said: “LOL-lab is an excellent and innovative way ofimproving communication between academicsand the public. Comedy is a medium forbreaking down barriers and getting peopletalking to one another about things incommon”.Woman playing ukulele while participating inLOL-lab, “An aspect of this year’s event that Ireally enjoyed was hearing residentsdiscussing their perspectives on scientists andthe world of research in general. We believethe public have a right to be involved inhealthcare and biomedical research and I hopethis is the start of a relationship we can buildbetween the College and the White Citycommunity”.Earlier this year, Imperial launched anambitious fundraising campaign to support thedevelopment of a new, innovative andinterconnected School of Public Health at theCollege’s White City Campus, which will bringcutting-edge research expertise and evidence-based solutions to the public health challengesthat affect the local community.If you would like to explore working withthe Community Engagement Team inWhite City, please email us.
Integrating a nationally scaled workforce of community health workers inprimary careSystematic integration of community health workers at scale couldhelp tackle the growing workload crisis in NHS primary care, whilstsimultaneously addressing problems of service fragmentation andsystem complexity. Researchers from PCPH with visiting colleaguesfrom Australia and New Zealand carried out a modelling study,published in the Journal of the Royal Society of Medicine. Based onBrazil’s Family Health Strategy, this estimated the likely costs andbenefits of deploying community health workers throughout NHSprimary care in England. His Hands © Jack Flanagan – Creative Commons
The study points to a 2017 UK Community health workers could havegovernment select committee important beneficial effects on healthreport, which stated that the outcomes: “Their ability to liaiseabsence of any comprehensive closely with GPs, identify problemsnational long-term strategy to early and support chronic diseasesecure an appropriately skilled and monitoring indicates potential tocommitted workforce represents reduce unnecessary workload burdenthe biggest internal threat to the on GPs, improving access whilelong-term sustainability of the NHS. reducing use of acute and secondary care services”.Community health workers in Brazilhave basic training in disease Conservative modelling suggests thatidentification and monitoring, 110,585 community health workersimmunisation, screening support and would be needed to cover the generalhealth promotion, and provide support practice population in England, costingfor 70% of Brazil’s 200 million the NHS £2.22bn annually. Assuminginhabitants. Each is responsible for a they could successfully refer 20% ofdefined group of households in their eligible unscreened or unimmunisedlocal area, visiting all their households individuals, an additional 753,592at least once per month. Community cervical cancer screenings, 365,166health workers liaise proactively with breast cancer screenings and 482,924primary care services to ensure early bowel cancer screenings could beand effective resolution of health and expected. A total of 16,398 additionalsocial care issues. children annually could receive their MMR vaccination at 12 months andBenedict Hayhoe and Matt Harris 24,716 their MMR at five years of age.wrote: “Numerous interventions andgovernment initiatives over some 20 The team acknowledges that theyears have failed to result in actual impact of community health workerssystem-wide integrated care. A scaled in the UK may be smaller than in Braziland integrated community health overall, given differences in baselineworker workforce, offering proactive, health provision. However, they arguepreventative and holistic community- that this study provides a compellingbased care, may have the potential to case for pilot studies to explore thesucceed in achieving these aims where feasibility of a comprehensive,previous efforts have failed”. universal system of community health workers, integrated into primary care in the UK NHS.Hayhoe B, Cowling TE, Pillutla V, Garg P, Majeed A, Harris M. Integrating a nationallyscaled workforce of community health workers in primary care: a modelling study. J R SocMed 2018;:014107681880344. doi:10.1177/0141076818803443
Child health in England Falling behind otherEuropean countriesA new report warns child health is lagging behind other European countries,with child mortality potentially 140% higher than other nations by 2030.The ‘Child health in 2030 in England: these trends and mean that children incomparisons with other wealthy countries’ England are given the same opportunities forreport, published on the 15th of October 2018 a healthy life as children in other wealthyby the Royal College of Paediatrics and Child countries”.Health (RCPCH), and co-authored by anImperial researcher, compares England with \"Recent policies - for example on integratedEuropean and other western countries known care and mental health - are an importantas the EU15+. step in the right direction, but we also need real ambition and commitment from policyUsing long-term historical data to project makers at all levels to make children andoutcomes for children and young people’s young people a priority\".health in 2030, it concludes that whilstEngland is middle of the pack for some Worrying findingsoutcomes, on the majority England is likely tofall further behind other wealthy countries Poverty lies at the root of many risk factorsover the next decade. for infant mortality as well as other major child health challenges. Children and youngInfant mortality in England and Wales rose in people working with the RCPCH have2015 and again in 2016, reversing the 100- identified poverty as a major area of concern,year decline in one of the key indicators of particularly with regards to its impact onpopulation health. This report reveals that mental health and nutrition.even if infant mortality begins to decline againat its previous rate, infant mortality rates Professor Russell Viner, report author andcould be 80% higher than the average across President of the Royal College of Paediatricsthe EU15+ in 2030. If mortality continues the and Child Health (RCPCH), said: “Child povertycurrent ‘stall’ then it will be 140% higher in is predicted to increase over the next decade,2030. which, if true, may make our predictions under-estimates. Children living in poverty areDr Dougal Hargreaves, co-author of the report more likely to be obese, have mental healthfrom Imperial's PCPH said: “Our report issues and die early.highlights how serious the state of children'shealth in England will be by 2030 if alarming “We welcome the opportunity provided bycurrent trends continue in areas such as infant NHS England to work with them on proposingmortality, childhood obesity, and mental how we can improve children and younghealth problems. But there's nothing fixed or people’s health in their Long-Term Plan. Thisinevitable about these projected trends. If Plan must set out a clear vision for deliveringexpected increases in child poverty aren't world class health and wellbeing outcomes foraddressed, then the actual outcomes in 2030 our next generation”.could be significantly worse than we report.On the other hand, a coordinated and The report also highlights where England isambitious national strategy for children and predicted to perform to the EU15+ average.young people's health could reverse many of Areas include Self-reported injuries, smoking and diabetes control. Full Story
Research RoundupPhoto by Dima VPharmacists in primary care: a establish the impact of pharmacist solution to workload and integration on health system workforce pressures? indicators (utilization and cost). They reported their findings in an Rising demand and lack of oral presentation at the ‘Royal investment is leading to increasingly College of General Practitioners unmanageable workload for NHS Annual Conference’ in Glasgow, in primary care clinicians, with October 2018. recruitment and retention of GPs a Pharmacists based in primary care growing problem. Despite practices have a clear role in Government promises, increases in improving prescribing safety, but the GP workforce are unlikely to be they can also make important achievable, so new models of care contributions to other patients need to be considered. One option facing aspects of routine primary to address this problem is the care, such as chronic disease integration of pharmacists in management and treatment of primary care practices. minor illness. This review, which examined 28 studies from 7 Having previously published a countries, highlighted the potential discussion article on this subject in for pharmacists integrated in the Journal of the Royal Society of primary care to save GP Medicine with a visiting researcher appointments, with studies showing from Thailand, researchers at PCPH significant decreases in GP carried out a systematic review to appointment rates. Any substitution of appointments with pharmacists for GP appointments is likely to have a clear cost advantage. The study also identified an increase in overall primary care use, which may indicate improved access to primary care through pharmacist integration; this may explain an additional important finding of reduced emergency department use. However, no studies reported
the actual or perceived workload admissions. The study trackedburden of GPs, and it is possible 319,730 children in England fromthat training, supervision and birth for 13 years from 2000 tosupport of pharmacists in GP 2013.practices may initially increase GPworkload. Based on these findings, they estimate that up to 13,500 childrenBenedict Hayhoe, Geva Greenfield a year in England may be missingand colleagues pointed out that out on vaccines, and 83,000 may berecent successful piloting of missing development checks.pharmacists in primary care, and Infants who did not receive theirresultant ongoing funding for their vaccinations were twice more likelyintegration in practices in England to be have an emergency hospitalpresents an ideal opportunity for admission than children whofurther evaluation at scale of this received their vaccinations. Youngimportant intervention. children normally have a one in four risk of being admitted to hospital inKomwong D, Greenfield G, Zaman H, Majeed their first year of life – the researchA, Hayhoe B. Clinical pharmacists in primary team revealed that for infants whocare: a safe solution to the workforce crisis? J do not receive their vaccinations,R Soc Med 2018;111:120–4. this risk increases to one in two.doi:10.1177/0141076818756618 The study, funded by the NationalHayhoe B, Acuyo Cespedes J, Foley K, Majeed Institute of Health Research (NIHR),A, Ruzangi J, Greenfield G. Pharmacists in also found preschool children whoprimary care: a solution to workload and did not complete their vaccinationsworkforce pressures? Oral presentation. Royal were six times as likely to beCollege of General Practitioners Annual admitted to hospital with a vaccine-Conference, Scottish Event Campus, Glasgow, preventable infectious illness suchOctober 2018. as measles.Impact of preventive primary Cecil E, Bottle A, Ma R, Hargreaves DS, Wolfecare on children’s unplanned I, Mainous, AG III, et al. Impact of preventivehospital admissions; primary care on children’s unplanned hospitalpopulation-based birth cohort admissions; population-based birth cohortstudy of UK children 2000-2013 study of UK children 2000-2013. BMC Med 2018. (published online on 17 SeptemberLizzie Cecil and colleagues recently 2018)published the largest ever analysisexamining how infant vaccinationsand NHS development checks inprimary care are linked to children’srisk of emergency hospital
Mental health and well-being specialist Child and Adolescenttrends among children & Mental Health Services (CAMHS)young people in the UK (only around 3 in 10 children and young people with a diagnosableDougal Hargreaves, working with mental health conditions receivecolleagues at UCL, Exeter University specialist support); second, Aand the Nuffield Trust published the holistic, population-based approachfirst national analysis of the to addressing public mental healthprevalence of mental health (a key strand of the NIHR School ofproblems among children and Public Health that Imperial is partyoung people in the UK since 2004. of) is needed to allow preventionThey analysed data from 140,830 and early intervention, reducing theparticipants aged between 4 and 24, need for specialist services.across 36 national surveys inEngland, Scotland and Wales. Dougal Hargreaves’ article in Psychological Medicine also formed the basis of a ChannelThey found a striking, six-fold 4 News report on mental health amongincrease between 1995 and 2014 in children and young people.the number of children and youngpeople in England who reported A survey of FH care over 60having a long-standing mental countries in the worldhealth condition (from 0.8% to4.8%). And among young adults The EAS FH Studies Collaboration’sbetween 16 and 24, there was an new publication, ‘Overview of theeven larger, 10-fold increase – from current status of Familial0.6% to just under 6%. Hypercholesterolaemia care in over 60 countries - the EAS FamilialThere was no consistent change in Hypercholesterolaemia Studiesemotional and behaviour difficulties Collaboration (FHSC)’, was acceptedover most of that time, but there for publication in Atherosclerosis atwere early signs of increasing the beginning of September 2018mental health symptoms and [1].reduced wellbeing among youngadults in more recent years (from Previous FHSC Articles, ‘FH: a global2011 onwards). call to arms’ [2] and the FHSC methods paper [3] of 2016, haveWhile the causes and interpretation been very well received by theof these findings are complex, they academic public in the past years,argue that a two-pronged approach being in the top ten of the mostis needed: first to improve access to cited articles in Atherosclerosis since 2015 (9th place and 3rd place
respectively), which supports the Where disparate reports wereimpact and interest raised by the previously present in literature, thisFHSC. article summarises and comments over the general situation of FH careThis article offers the first and only in the world, highlighting keyopportunity to provide a large information previously notoverview of the current situation discernible. The news of the articleand initiatives around FH across has been disseminated by mediaover 60 countries worldwide, and Imperial College press release,allowing a global overview and coverage that allowed clinicianscross-country comparison. It currently not involved in FHSC tosummarises available information, reach out and enquire on how togaps in knowledge, variations from join the collaboration.one region/country to another, andinitiatives currently ongoing related 1. EAS Familial Hypercholesterolaemiato FH. The realisation of this Studies Collaboration.manuscript has been a long and Atherosclerosis, 2018 Oct;277:234-committing process led by the FHSC 255.Team of retrieving and collatingcountry reports sent by FHSC 2. Vallejo-Vaz, Antonio J. et al.investigators from all over the Atherosclerosis, 2015 Nov;243(1):257-world. 9. 3. EAS Familial Hypercholesterolaemia Studies Collaboration. Atherosclerosis Supplements 2016;22:1-32.
Media MentionsAttempting to stem the rise of antimicrobial resistance byreducing inappropriate antibiotic prescribing in primarycareBy Sabine Bou-Antoun – Research Postgraduate, PCPHOur paper, funded by the National Institute for Health Research (NIHR), andin collaboration with Public Health England (PHE), has been published in theJournal of Antimicrobial Chemotherapy.The research assesses the impact of the interest reiterated that: “AntimicrobialQuality Premium, a national incentivised resistance is a growing global threat.initiative, which in 2015/16 included a Infections are becoming increasinglymeasure for CCGs to reduce the rate of difficult to treat with antibiotics. Asantibiotic prescribing in primary care in bacteria develop resistance to the drugsEngland. The analyses revealed that aside we use they could render many of the lastfrom the expected seasonal peaks and line treatments we have ineffective”.troughs associated with winter and (Professor Paul Aylin)summer periods, the number of patientsprescribed antibiotics by their GP for It is therefore, “important to reducecommon respiratory infections, for which unnecessary and inappropriate antibioticantibiotics are generally not needed, prescribing as it is a known driver ofdecreased by 3% (or 14.65 prescriptions antibiotic resistance,” (Ms Sabine Bou-per 1,000 RTI consultation) following the Antoun). As part of a national strategy tointroduction of the national initiative. tackle antibiotic resistance, the Quality Premium is one of a range of successfulThe rate of broad-spectrum antibiotic interventions used to support GPs toprescribing for respiratory tract infections reduce levels of prescribing. Evaluation ofconcurrently showed a decrease this initiative and continued reduction incoinciding with the introduction of the the levels of inappropriate prescribing isQuality Premium. Notably the antibiotic required and beneficial if we are toprescribing reductions were particularly prevent further increases in drug-resistantseen for sore throat consultations and infections and be able to identify the bestwithin the ‘children’ age group; children ways to do this.are more prone to coughs and respiratoryinfections, and anxious parents are more “National-level schemes such as these arelikely to take them to the doctor. important tools in our efforts to reduce antibiotic prescribing, but it is critical thatThe publication of this work received these interventions are objectively andpress interest, with the Telegraph expertly evaluated”. (Professor Alisonpublishing an online piece, as well as a Holmes)section in the Daily Telegraph. The pressTelegraph Medicalxpress Imperial News Online My Science Gov UK
Photo: E.coli Bacteria by NIAID - Creative Commons
By Maria WoringerThe PCPH newsletter is an excellent way to promote ourdepartment’s work. It highlights awards, achievements and recentdevelopments across the teams that make up PCPH. Yet I wonderwhether it could do more to illustrate the strengths of ourdepartment by sharing the news of all ongoingresearch activities? What would you think ofincluding all ongoing work as part ofa classifiedannouncementsection of the PCPHnewsletter? Couldyou describe yourcurrent progress to datein under 100 words?Say you are or published itsevaluating a novel findings? Combining expertiseintervention for of both teams may make you morepatient self-care successful in securing future funding.developed by anotherorganization. Your team Having worked for 6 months in 2014 in thedeveloped methodology for Collaboration for Leadership in Appliedthe evaluation of a novel tool in a Research and Care (CLAHRC) North Westpopulation of interest. This may also London (37 staff and 5 PhD students), Ibe a good time to apply for funding to attended regular meetings where ongoingcontinue further research. How would research across allyou know whether there are people inyour department with whom you couldcollaborate to take your research tothe next level? Perhaps another teammay have developed newinterventions geared for self-care buthas not yet evaluated the intervention
teams was openly shared and As you all know some research maydiscussed. The benefit of these take years to publish. Researchersmeetings was being kept up to date of need to be on a constant lookout forcurrent work at CLAHRC while putting new opportunities to work together. Not knowing what other teams may be faces to different research working on prior to publication may activities. Although PCPH mean that some opportunities for have regular collaborations and or grant departmental applications may be meetings to share missed. The more progress and learning, there is limited time people share what they devoted to discussing various are currently doing, the teams’ current research beyond better the chances of published papers. Due to the relatively large size and the spread of PCPH staff interested parties coming (130 staff and 36 PhD students) across together to collaborate on ICL, another approach to sharing current news progress of all research activities new grant applications. may be via the PCPH newsletter. The success of this department depends not only on brilliant minds, but also on interested parties choosing how best to combine their strengths. Reader – What do you think? Please share your thoughts with us. Contact Maria Woringer
TeachingUndergraduate Primary Care Team takes home covetedCATE AwardThe Collaborative Award for Teaching Excellence (CATE) recognises andrewards collaborative work that has had an impact on teaching and learning.Introduced in 2016, the Award, established by the Higher EducationAcademy, which is itself part of Universities UK, is open to all providers ofhigher education across the four nations of the UK.Since 2016, 30 teams have been Dr Kumar said, “The Undergraduaterecognised, with 12 of them being Primary Care Team’s story begins with aawarded funding to continue their vision for medical education to becomecollaborative projects and further their truly inclusive, making a transformationalimpact. and sustainable difference to the health
and wellbeing of patients, their families Examples of CAP projects include a pair ofand communities”. students who recognised the ethnic diversity of their local population, which“It is this that has directed our attention, meant that local patients were unable toenergy and drive as the team has grown understand any health-related literaturebeyond expectations over the past five which was being provided by the doctorsyears. Maximising the energy and talents due to their limited English language skills.of the full team, we all work to embrace After engaging the local clinicalour guiding principles of creativity, commissioning group and patient groups,community, collaboration and evidence- they developed an online website wherebased education in new exciting patient condition leaflets were translatedunpredictable ways”. into a variety of languages.“The team has created a multitude of The initiative has been so successful,courses and projects that are neighbouring areas are interested in thetransformational to medical students and students working with their communities.accountable to society, with education In another example, one pair of studentscreating a powerful space in which an identified a lack of uptake of the cervicalexciting symbiosis is starting to emerge smear screening program in their local GPwith students learning their curriculum practice population. After discussing thismeaningfully, acting as agents of change with patients, they identified a lack ofwithin our local community”. awareness amongst the patients as a key driver. They approached a local women’s“Winning the CATE is a momentous cancer charity, and a Gynaecologyoccasion for all of us in the team. Consultant from the local hospital toReceiving such an accolade and national deliver an educational evening whereacknowledgement for our work will serve local patients were invited to attend andas a potent catalyst for us to now evolve learn about gynaecological malignancieseven further, sharing our vision and way and how they can be prevented.of working with others”. The Director of Imperial’s Centre forWorking with students Higher Education Scholarship and Research (CHERS), Professor MartynOne of the highlights of the teaching Kingsbury, said, “The remarkable aspect ofteam’s efforts has been the development the Undergraduate Primary Careof ‘Community Action Projects’ (CAP) Education Team’s work is how they havealongside a student steering group. embraced established educational expertise, whilst also developing their3rd Year Medicine students are now own innovations. They have used this toencouraged to complete an authentic, great effect in a variety of authentic andpeer-assessed experiential project during truly transformative learning experiences.their 10-week community medicine Their practice and enthusiasm isattachment. In this CAP, students identify exemplary. Their work is increasinglya real-world problem within their local influential, and they are a key part of ourcommunity and they engage with mission to transform teaching andcommunity stakeholders, patient and learning at Imperial”.charity groups to design an interventionto address the challenge identified.
Social Accountability in Medical EducationThe Global Consensus for Social Accountability ofMedical Schools (GCSA) has articulated a requirementfor medical schools to, “respond to current and futurehealth needs and challenges in society, re-orientatetheir education, research and service prioritiesaccordingly, strengthen governance and partnershipswith other stakeholders and use evaluation andaccreditation to assess their performance andimpact”. At a time of undergraduate curriculumreview at Imperial, the Department of UndergraduatePrimary Care Education and Public Health, isprioritising Social Accountability (SA) in its curriculumdevelopment, teaching and research.In conjunction with The Training for reducing health inequity acrossHealth Equity Network (THEnet) the communities. Discussions included how toDepartment held a Think Tank to explore build equitable partnerships & meaningfulthe relevance of social accountability (SA) collaborations across multiplefor medical education in the UK. Executive stakeholders that simultaneously meetdirector and co-founder of THEnet, Björg community priorities and professionalPálsdóttir, and CEO, Professor André- standards.Jacques Neusy, provided an internationalperspective based on their extensive work The Department is continuing activein this field. Attended by delegates from collaboration with THEnet Schools andacross the UK, the Think Tank work groups planning an international conference onprovided an excellent opportunity to Social Accountability. Dr Christineactively debate the challenges of Douglass (pictured) has recently beenhealthcare and medical education in the appointed as Senior Social AccountabilityUK in the 21st century, with a focus on Teaching Fellow.ASME ReportThis year’s Association for the Study of Medical Education (ASME) took place in Newcastleupon Tyne in July. As part of a wider team of Undergraduate GP Teachers presenting amyriad of innovative work from the department, Andy McKeown and Ravi Parekhdelivered a presentation to ASME delegates on the Integrated Clinical Apprenticeship(ICA). This innovative Longitudinal Integrated Clerkship, delivered by the GP team in year5 of the MBBS, gives 24 students the opportunity to have a meaningful role in thehealthcare of patients with multiple conditions in primary care over a full year. The ICAstudents have the chance to follow these patients into secondary care, providing a uniqueopportunity to advocate for their patients where appropriate. By spacing and integratingauthentic teaching and learning, this innovative project is novel to the UK and is beginningto shape the path of undergraduate medical education, especially with our undergraduatecurriculum review in full swing at present!
The most significant findings of the mixed- described acting as a ‘bridge’ betweenmethods research within the first year of patients and clinicians and betweenthe course were that students were primary and secondary care. Theysignificantly more likely to be more described feeling empowered by havingempathetic, more able to manage an authentic role in patient care. This leaduncertainty and retained work the research team to question whetherempowerment at the end of the year students should have more clearly definedcompared to their counterparts who did paraprofessional roles as they transitionnot do the ICA. Students gained great from medical student to student doctor.insight into the patient pathway andLook out for more information on the Year 6 F-Zero course, comingin 2019! From Left: Andy McKeown, Elizabeth Muir & Ravi Parekh
Staff Success StoriesProfessor Sonia Saxena Inaugural LectureOn 10 October, Professor Sonia Saxena gave her inaugural lectureentitled, ‘Chickpeas of iron: How primary care can influence children’shealth’. Prof Saxena discussed her research into children’s health and herwork with the Child Health Unit.Professor Sonia Saxena and her Child Health evaluations of the latest nationwideUnit team believe in the value of NHS and programmes to reduce childhood pneumonia,routine data in revealing links between early obesity and health inequality in children’slife exposures to inequality, environmental access to GPs and health care. Asrisks and preventive care that affects life digitalisation opens up possibilities for newchances and later health in children and statistical analysis techniques, which will beyoung people. The key is to ask appropriate investigated by a new Child Health Centre atquestions of the data. In her inaugural Imperial College London, she also lookedlecture, Sonia charted her own journey from ahead to a future in which what has beenIndia to embarking on a career driven by the learnt could be applied on an internationalbelief that every child should have the same scale.opportunity regardless of circumstances. Shedescribed her team’s successes so far, such as
Search
