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The primary care response to COVID-19 in England’s National Health Service In a recent article in Journal of the Royal Society of Medicine, Prof Azeem Majeed discusses the primary care response to Covid-19 in England. The first case of COVID-19 in England was identified at the end of January 2020. Cases increased during February, and by early March, it became apparent that England faced a large COVID-19 epidemic. This led to the Department of Health and Social Care and NHS England (the bodies that respectively fund and manage the NHS in England) to recommend radical changes to the provision of NHS primary care services. For most general practices, these changes COVID-19 infection increases rapidly and began to be implemented in the week starts to overwhelm the health system, or beginning 16 March 2020. As a first step, if second and subsequent waves of general practices switched from the infection occur. Other challenges include traditional model of face-to-face service providing medical care for people who are provision to one where all patients were self-isolating at home because of their age initially assessed through a telephone or a or because of underlying medical video call. Patients were encouraged to problems that increase their risk of register for online booking of these complications and death if they contract a appointments if they had not already COVID-19 infection. There are also done this. problems that will arise from the cutting back of many specialist hospital services, All patients requesting advice spoke first which will have negative effects on health to a health professional, usually general outcomes if restrictions in health services practitioners. The aim was to deal with as remain in place for a prolonged period. many queries as possible by telephone or a video call. Patients who required a face- Overall, primary care in England has to-face appointment were booked to be responded well to the COVID-19 seen in later that day. This ensured that pandemic, making radical changes to how patients were largely managed on the primary care services are delivered in a same day they sought medical advice. very short period of time. Key to allowing These changes have resulted in around this to happen is the commitment by the three-quarters of patients being managed UK government to support general remotely compared to the same time last practices financially to prevent the loss of year when only one-quarter were, with income that has occurred to primary care the total volume of primary care activity practices in countries such as the USA. falling by about 25%. However, the future will remain challenging for primary care teams in We have seen rapid changes in primary England until such time as a vaccine or care in England, but challenges remain, effective drug treatment can be found for particularly if the number of people with COVID-19. Read the full article
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#TALK EVIDENCE COVID-19 update - surgisphere data, and protests in a pandemic By BMJ Group In June we were asking questions about surgisphere data, and how it might have got into such high impact journals. We’re also discussing the protests around the world about structural racism - and how they intersect with the Covid- 19 pandemic. Sonia Saxena, Professor of Primary Care at Imperial College London gives her verdict on the Public Health England report into this disproportionate effect of Covid-19 on ethnic minorities in the UK, and pushes back against it being a biological instead of a sociological determination. Listen to except Full talk on Spotify Further Reading
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In an article published in the Journal of the Royal Society of Medicine Professor Azeem Majeed discusses the wider impact of COVID-19 on health systems and the potential for changes to health services to increase health inequalities. “We report a 44% decrease in emergency department attendances in England in March 2020. We must not overlook the importance of good infection control for outsourced NHS staff such as cleaners, security guards and caterers. They can acquire COVID-19, thereby putting themselves at risk, and transmit COVID-19 to patients and other NHS staff”. READ THE FULL ARTICLE
FRONTLINE INSIGHTS Sonia Saxena - Professor of Primary Care at Imperial College London and a GP at Chartfield Surgery in Wandsworth, is supporting primary care services I feel my first duty is to the community I have served as a GP for over 25 years. Everyone has risen admirably to the challenges COVID-19 has thrown at us in our practice in south-west London. I am seeing both ‘hot cases’ in our practice and continuing usual care. We have adapted to new ways of At the same time, I lead the Child working with people at home and Health Unit at the School of Public physically distanced staff rounds, Health at Imperial. The initial weeks cascading communications and a were difficult for some of my staff general willingness to do the right and students to grasp what was thing, whatever that is. really happening. I think they variously went through shock,
anger, denial and eventually some about health impacts and link with form of acceptance. We quickly UK and European partners to join organised ourselves with weekly public health efforts to combat the crisis meetings, mid-week teatime virus' effects. So far, we have catch-ups and morale-building published several thought pieces on activities. policy, and hope to continue with several projects in progress. We have launched the Imperial Child Health COVID investigation I feel privileged to work alongside working group. Our focus is to my practice team and I am proud of ensure that my research children and teams for young people’s pulling health is not together compromised and being during the productive pandemic and in difficult its aftershocks. working Especially with conditions. I containment feel a great and school Above: the team at Chartfield socially distance optimism closure, they Below: the Child Health Unit morale-building ‘cocktail for the have lost their hour’ lessons that voice and we all have become learned invisible to about much of the ourselves, research and our values policy agenda. and priorities. The main thrust Above all, of our work was this sharp to deploy our shock will existing team to teach the brainstorm priorities for urgent next generation how to be resilient child health research, apply for real- and bounce back. time data to inform our hypotheses Read more 'Frontline insights: The Imperial academics at the centre of the NHS response to COVID-19'
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COVID19 has required innovative responses to address pressing needs in the UK and elsewhere. Some extraordinary examples include the repurposing of technologies from other industries, reusing of obsolete technologies, and the rapid development and scaling of new technologies. India and Pakistan are refitting their rolling stock of trains to become hospital wards for patients with COVID-19. China constructed a 1,000-bed hospital in 10 days. Distilleries have pivoted to produce millions of bottles of hand sanitizer. Nations that uphold free choice, movement and competition have suddenly foregone many fundamental values and privileges. For example, in addition to enacting widespread social-distancing measures, the UK, in a landmark deal, has commissioned all of its private-sector hospitals for use by the National Health Service, at cost, expanding capacity by 8,000 beds. FRUGAL INNOVATION IN THE COVID-19 ERA These are all features of frugal innovation and in this article by Matthew Harris with colleagues from Jabalpur, India, the Royal Free Hospital and Queen Marry University London (QMUL), appearing in Nature Medicine, several such examples are detailed. They argue that this kind of frugal innovation, common practice for decades in low-resource settings, is the way forward for the NHS – doing more, with less, for many. Read the full article
CAN THE UK EMULATE THE SOUTH KOREAN APPROACH TO COVID-19? In Professor Azeem Majeed’s editorial in the British Medical Journal, he compares the response to Covid-19 in South Korea and the UK. Early adoption of a ‘test, trace, isolate and treat’ strategy was the key to South Korea’s success in suppressing Covid-19. On 29 February 2020, South Korea, a country of similar population size to England, recorded 909 new cases of COVID-19. Only 55 new cases of COVID-19 were recorded in England on 29 February. By mid-May, despite several weeks of a ‘lockdown’ and although numbers had declined from the peak in April 2020, the United Kingdom was still recording over 3,000 news cases each day. The key difference between the United Kingdom and South Korea was the rapid adoption by South Korea of a ‘test, trace, isolate and treat’ strategy whereby suspected cases were tested; contacts identified; strict isolation enforced; and free treatment given to those infected. READ THE FULL ARTICLE
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HOME & AWAY Consultative meeting in Cairo, Sheraton Hotel, Dec 17-18 2018: Initiating the project NEW WHO CC PUBLICATION WITH MENA HEALTH POLICY FORUM AND UNFPA The WHO CC released a new publication in June on ‘Sexual and Reproductive Health Matters: A comprehensive review of the status of the integration of sexual and reproductive health services in primary care of 11 Arab countries’. Different approaches are used for of SRH into PHC in 11 Arab countries in integration of sexual and reproductive 2017–2018. Desk reviews were health (SRH) services at the primary conducted, using published program health care (PHC) level, aiming at reports and national statistics. Data providing comprehensive services from country reports were compiled to leaving no one behind. This paper aims present a regional assessment, to assess gaps in the delivery of SRH in challenges and recommendations. SRH PHC services, identifying challenges services are partially integrated in PHC. and proposing action towards universal Family planning is part of PHC in all health coverage in Arab countries. The countries except Libya, where only United Nations Population Fund, Arab counselling is provided. Only Morocco, States Regional Office (UNFPA/ASRO), Tunisia and Oman provide in partnership with Middle East and comprehensive HIV services at PHC North Africa Health Policy Forum (HPF), level. Jordan, Libya and Saudi Arabia launched an assessment of integration rely mainly on referral to other
facilities, while most of the integrated ensure proper allocation of resources. family planning or HIV services in A presented regional integration Sudan, Morocco and Oman are framework needs further efforts for provided within the same facilities. addressing the actions entailed. Action is required at the policy, organisational and operational levels. This was a collaborative effort with the Prioritisation of services can guide the Middle East and North Africa Health development of essential packages of Policy Forum and The United Nations SRH care. Developing the skills of the Population Fund (UNFPA). The abstract PHC workforce in SRH services and the is available in English, French and adoption of the family Spanish. medicine/general practice model can READ ARTICLE 10th ANNIVERSAY OF THE GENEVA TRIP TURNS ‘VIRTUAL’ On its 10th edition, the well-established educational trip to Geneva, organised every year by the WHO CC for master’s students, had to change its ‘appearance’. On 15 and 16 June, WHO CC ran the virtual version of the experience. Sadly, it was not possible to re-create the social and scenic aspects of the trip, but we managed to deliver the sessions from WHO, GAVI and ICRC (International Committee of the Red Cross) experts online. ‘Every cloud has a silver lining’, and been very positive and very there was definitely one here as we encouraging. The programme opened were able to open the experience up to with David Nabarro a WHO expert on the entire cohort and include the COVID-19 and unsurprisingly COVID -19 online GMPH students too! As well as a was an overarching theme across all great attendance, there were many sessions. The sessions concluded with questions and sessions were very lively. the HR session that provided insights The feedback received to date has into internship process at the WHO. WHO CC PUSHING FOR AN INFORMED COVID-19 LOCKDOWN EXIT STRATEGY During April, in the middle of the Coronavirus crisis, the WHO CC went one step ahead of the curve and started thinking about how to exit lockdown. This led to a commentary published in May by the WHO in Eastern Mediterranean Health Journal, which has already been consulted by various countries. READ OFFICIAL PUBLICATION VERSIONS IN OTHER LANGUAGES
Letter to @thetimes emphasizing the importance of keeping immunisation high on the agenda Photo © freepik.com
“Sir, we must not allow the Covid-19 pandemic to lead to neglect of the health of the world's children by allowing immunisation rates to fall. The lockdown in many countries has led to closure of basic health services, fear from parents about the safety of attending those that are open, concerns from staff about their own safety, and confusion about provision of services. In the UK, immunisation remains a priority and services are open. However, we hear anecdotal reports of parents facing difficulties. All children should be immunised unless those attending have Covid-19 symptoms. Last year, before the pandemic, there were more measles deaths globally than at any time in the past l4 years, the UK lost its WHO ‘measles free’ status, and the expected reductions in immunisation this year are expected to increase the number of susceptible and vulnerable children around the world. This year we must ensure immunisation stays at the top of the agenda for children, lest they become victims of the pandemic as a result, of a health system that has become rightly focused on the more visible, crisis of the day. Professor Andrew J Pollard, Professor of Paediatric Infection and immunity, University of Oxford; Professor Russell Viner, President, Royal College of Paediatrics and Child Health; Professor Sonia Saxena, General Practitioner and Professor of Primary Care, Imperial College London; Dr Jonathan Leach OBE, General Practitioner and Joint Honorary Secretary Royal College of General Practitioners; Dr Cheryll Adams, Executive Director, Institute of Health Visiting; Professor Helen Bedford, Professor of Children's Health, University College, London; David Elliman, Clinical lead for National NIPE & NBS Screening Programmes, Public Health England; Professor Matthew Snape, Associate Professor in Vaccinology and General Paediatrics , University of Oxford; Dr Dougal Hargreaves , Clinical Senior Lecturer in Paediatrics & Population Health , University College London; Dr Liz Whittaker, Secretary of the British Paediatric, Allergy, Immunology and Infectious Disease Group; Dr Doug Brown, Chief Executive, British Society for Immunology; Professor Adam Finn , Professor of Paediatrics, University of Bristol; Professor Saul Faust , Professor of Paediatric Immunology and Infectious Diseases, University of Southampton; Professor Paul T. Heath, Professor of Paediatric Infectious Diseases, St. Georges, University of London”
SPOTLIGHT ON RDS & ICTU My name is Jack Elkes, I am a research statistician and I joined Imperial College London last year in a split role, spending 50% of my time as a general adviser with the Research Design Service (RDS) London team (pictured) and 50% as a research statistician at ICTU. RDS offer a free service that supports clinicians, health and social care professionals and academics to develop research proposals and grant applications.
As a general adviser I enjoy discussions with researchers about their ideas and ways to develop these into research questions. I am embedded within Imperial Clinical trials Unit (ICTU) at White City and work closely with the fantastic west London RDS team located in Primary Care and Public Health department at the Charing Cross Hospital. These combined roles, situated across the two departments, have provided the opportunity to build better internal links and communications between two important NIHR infrastructures. In the past there has been some overlap to ensure applicants get the right advice in of the work done for initial discussions a timely way. with clients at RDS and ICTU and confusion over when it is suitable to An example of this is in the recent NIHR include a CTU and what to do when a CTU academy calls for Fellowship and is unable to collaborate. However, by Advanced Fellowship applications, the having a linking role we have improved CTU was approached by several applicants cross-communication, which in-turn has asking for support. By meeting together to led to more efficient, effective and joined discuss these applicants, we were able to up advice when reviewing clients. quickly identify those who needed a more general discussion from an RDS adviser I work closely with ICTUs business instead and we were also more prepared development manager to discuss in doing so. Working with the CTU meant applicants that request CTU support. we had a better picture of the applicant Often many applicants who seek out the and their project which meant a much CTU directly would actually benefit far better starting discussion with them. more from a discussion with RDS first, which has been achieved through our This joint role has provided some the improved communication leading to opportunity to help harmonisation facilitated earlier signposting. CTUs are between the RDS and Imperial CTU not able to meet the requests of the many improving this important partnership for NIHR fellowship approaches it receives clients. I have only been in this role a year and they are also not always needed. With but as we build the relationship between large numbers of requests, it’s so infrastructures it’s clear there is plenty of important exciting development still to come.
Photo © International Labour Organization ILO – Creative Commons EVENTS COVID-19 – PLANNING NEXT PHASE OF THE PANDEMIC By Imperial College Academic Health Science Centre REGISTER Date and Time Tue, 11 August 2020 14:30 – 15:30 BST About this Event Imperial College Academic Health Science Centre (AHSC) is working at the forefront of research and patient care during the COVID-19 pandemic. In this online event, part of our series of AHSC Covid-19 seminars, two experts will talk about planning the next phase of the pandemic. The seminar will be live and open to all. Speakers: Professor Julian Redhead, Medical Director and Consultant in emergency medicine, Imperial College Healthcare NHS Trust. Professor Azra Ghani, Chair in Infectious Disease Epidemiology, Imperial College London. Please note that the event link will be sent to registrants the day before the event.
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