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Primary Care in the Republic of Macedonia

Earlier this year, the Department of Primary Care & Public Health at Imperial College hosted a visit from a delegation from the Ministry of Health in the Republic of Macedonia. During the visit, academics in the department discussed the primary healthcare system in the Republic of Macedonia and ways in which the Department of Primary Care & Public Health could support both undergraduate and postgraduate training in primary care. The Republic of Macedonia faces major challenges in improving its health system and the development of high-quality primary care services is seen as a key step in achieving improved access to healthcare.

Amputations in People with Diabetes

A recent article in the journal Diabetes Research and Clinical Practice examined trends in lower extremity amputations in people with and without diabetes in England during the period 1996-2005. The study, which was reported on the BBC News Website, found that although overall numbers of amputations fell, the number occurring in people with type 2 diabetes increased. This may be because the prevalence of type 2 diabetes increased over this period and because surgeons are intervening earlier to prevent more serious damage to the feet and legs of people with type 2 diabetes.

Research Design Services London

Research Design Service (RDS) London is part of the NIHR and provides help to those preparing research proposals for submission to the NIHR for applied health or social care research. With centres based at King's College London, Imperial College London, Queen Mary and University College London, it is focused on supporting applications for funding from NHS researchers and those working in partnership with the NHS. Priority is given to those applying for NIHR Research for Patient Benefit (RfPB) and Programme Grant funding. Advice is provided free of charge and is available through use of online resource and consultations with experts.

Diabetes Research Network

One of my professional roles is acting as Associate Director (Primary Care) for the Diabetes Research Network. Diabetes is one of the most common chronic diseases that primary care professionals treat, affecting nearly 4% of the population of England. A key aim for Diabetes Research Network will be to encourage general practitioners, practice nurses and other primary care professionals to take part in its activities and to help recruit patients for clinical trials and other studies. A recent article in the journal Primary Care Diabetes discusses how primary health care professionals and the Diabetes Research Network can work together.

Metformin preferred as first line treatment for type 2 diabetes

A study from Imperial College, LSHTM and the University of Leicester published online in the BMJ this week compared the safety of drugs used for the treatment of type 2 diabetes. The findings of the study confirm that Metformin remains the first choice drug for the treatment of type 2 diabetes. Patients taking sulphonylureas were more likely to suffer from heart attacks and heart failure or to die, compared to people taking Metformin. Doctors should therefore consider Metformin as their first choice when treating people with type 2 diabetes, as recommended by national guidelines from NICE. The study was reported by a number of media outlets, including the Guardian, Telegraph and NHS Choices.

MPH Session on Primary Care Data

I gave a seminar on electronic primary care records last week on the Imperial College MPH programme, as part of the module on health information. The seminar covered the uses of data from primary care records to support public health, epidemiological, health services and clinical research. As more general practitioners use electronic primary care records, the scope for secondary uses of the data derived from them will increase. Further information is available from two of my publications on primary care data, published by the Eastern Region Public Health Observatory and in Health Statistics Quarterly.

NHS Choices

NHS Choices is a service that aims to give patients and the public information about their health and healthcare. The service is intended to help patients and the public make decisions choices about their health, from lifestyle factors such as smoking, drinking and exercise, through to the practical aspects of finding and using NHS services in England. My practice now has a page on NHS choices, which we have now updated. In coming months, we will be aiming to make more use of the facilities available via NHS Choices to support our patients.

Should the QOF focus on outcome targets?

The Quality & Outcomes Framework (QOF) is now well established in primary care. With control of the framework now lying with the National Institute for Health & Clinical Excellence (NICE), we can expect a greater focus on the clinical effectiveness and cost effectiveness of quality indicators. In the early years of the QOF, a large proportion of target payments were awarded for achieving process measures, such as measuring blood pressure or HbA1c. Achievement of such process measures is now very high, with little room for improvement in many practices and limited potential for further health gain.

By contrast, control of key risk factors, such as blood pressure in people with hypertension, or HBA1c in people with diabetes, could still be improved considerably. But changing patients' behaviour or optimising their management to achieve such improvements is difficult and imposes a considerable workload on primary care. So it is logical to consider increasing the financial ince…

WHO Meeting on Technology and Patient Safety

Information technology has great potential to improve the quality and safety of healthcare. However, this potential has not yet been fully realised and considerable work remains to be done in this field. Earlier this year, the World Health Organization held a meeting on technology and patient safety. I chaired one of the four working groups, which were comprised of members from across the world. My working group has now completed its report, which is currently undergoing peer review.

IEF Saharawi Refugee Event

The International Educational Fund held a successful event to raise funds for their project to aid Saharawi refugee children living in Algeria. Amongst the speakers at the event were myself, Professor Alan Fenwick, Professor Sir Roy Anderson, Professor Sir Magdi Yacoub, Professor Yahia Zoubir and Ms Danielle Smith. Pictured above are Sir Roy Anderson, Alan Fenwick, Suha Bachir (the current chair of the IEF) and myself along with some of the other executive members of the IEF. Congratulations to the IEF for all the hard work they put in to make this event successful.

Academic Clinical Fellow Posts in Public Health

Three Academic Clinical Fellow Posts in Public Health linked to Imperial College are currently being advertised. For further details of the application process, please see the London Deanery website. The job description is also available on the London Deanery Website. The deadline for applications is December 4th 2009. The posts offer the opportunity to undertake public health training with an academic focus and dedicated time for research. Please note, these posts are only open to medically qualified candidates with full GMC registration.

IEF Project Launch Event

The IEF will launch a project for Saharawi refugees on November 11th 2009. Th IEF will provide computers for local schools working alongside a blind school, helping them receive specialist equipment, You can purchase tickets to attend at the IEF's Sahara Project Just Giving page.

Congratulations to Adeel Iqbal and the IEF

Former chairman and founder of the International Education Fund, Adeel Iqbal, received Imperial College's prestigious 'Student Award for Outstanding Achievement'. Adeel and his dedicated team invested much energy and enthusiasm into developing an organisation which brings together the talents of enthusiastic students to bring about positive academic changes in third world countries. Amongst Adeel's major achievement has been partnering with a school for blind children in Kashmir. The IEF is growing rapidly and is now under the leadership of fifth year medical student Suha Bachir who is launching a project to help refugee children in the Western Sahara, Africa. This project is to be launched on the 11th November 2009 at Imperial College Business School.

Medics at Imperial College Business School

Many doctors now play a major role in managing health services, both in the UK and elsewhere. To help them acquire the skills they need, a number of masters courses are available. Medics at Imperial College Business School is a new student club formed to act as a networking portal for doctors enrolled onto the various MSc and MBA courses at the Business School and the MPH Programme in the Faculty of Medicine. It will provide a common ground for medics looking to diversify their career and take-up challenging roles both inside and outside of clinical medicine. The group plans to invite alumni and other guest speakers to the business school to share their experiences and also invite companies working in the healthcare sector for campus presentations and networking sessions. In the long term, it will become a connecting link between the business school and the medical profession by organizing talks to discuss issues that matter the most to healthcare. The group held a successful evening …

Increasing hospital admissions for haemochromatosis in England

Haemochromatosis is a genetic disorder in which affected people absorb an excessive amount of iron from the diet. The iron is then deposited around the body, mainly the liver, but also in the pancreas, heart, skin, endocrine glands, and joints. These iron deposits can cause serious organ damage and lead to major medical complications. In a recent paper on haemochromatosis in which I was a contributing author, Dr Jin-Yong Kang from St. George’s Hospital and colleagues investigated time trends for hospital admissions resulting from haemochromatosis in England from 1989/90 to 2002/03 and mortality from 1979 to 2005.

We found that although haemochromatosis was an uncommon cause for hospital admission, age standardised inpatient admission rates increased over the study period by 269% in males and by 290% in females. The increase in age standardised day-case admission rates was even higher (males: 1,155%; females: 1,924%). Haemochromatosis was not commonly recorded as a cause of death. The …

Why I Work Here - Featured on the Imperial College Employment Page

An interview I did with Alex Platt of the Imperial College Reporter is featured on the Imperial College Employment Page. The article describes a typical day at work for me. My work is quite diverse and includes research, writing, teaching, management and clinical duties. A lot of my time is spent supporting junior researchers and PhD students and dealing with students and lecturers on the Imperial College MPH programme, for which I am the Course Director. For information on research projects, take a look at my Imperial College Publications page.

New research reveals 41% increase in children’s short stay hospital admissions

The number of children being admitted to hospitals in England for short stays increased by 41 per cent between 1996 and 2006, according to research published in PLoS One today by Dr Sonia Saxena and Alex Bottle from Imperial College London. The authors of the study say this increase may be linked to a shortfall in out-of-hours primary care services, but further research is needed before any firm conclusions can be drawn from the study. Other explanations include a change in hospital admission practices or in health-seeking behaviour by parents. The article was featured in the Daily Telegraph.

Health Disparities and Community Participation

Health disparities have been a longstanding feature of England’s NHS. In particular, socioeconomic and ethnic disparities remain in England despite numerous initiatives to abolish them. Initiatives to mitigate or overcome these disparities were discussed in a recent article on community participation published by myself and two colleagues in the October 2009 edition of the Journal of Ambulatory Care Management. These health disparities are the end result of complex, wide-ranging societal, healthcare-related, environmental, genetic, and individual factors. People who experience poverty, material disadvantage, poor housing, lower educational achievement, unemployment or insecure employment, or homelessness are more likely to suffer poorer health outcomes and an earlier death than the rest of the population. Hence, action to address these disparities has to be multisectoral, involving different government departments, local health services and local government, and community and charitab…

NW London CLRN Primary Care Meeting

One of the organisations I work with is the North-West London Comprehensive Local Research Network (CLRN). The North-West CLRN is one of 25 CLRNs across England which form part of the NIHR Comprehensive Clinical Research Network (CCRN). The CCRN provides support for clinical trials and other well designed studies in all areas of disease and clinical need. A key role for the CLRN is providing infrastructure support for studies on the NIHR Portfolio. Part of this infrastructure support is in primary care. On October 7th 2009, the CLRN held a meeting with some of the local GPs and other primary care staff who collaborate with the CLRN.

One of the key points arising from the meeting was the need to get more NIHR portfolio studies active in primary care in NW London. IT issues were also discussed, particularly the need for expertise to run queries on GP Electronic Patient Record Systems such as EMIS and Vision. The need to continue reimbursement of practice expenses and also to offer addit…

New Practice Website

My general practice at the Manor Health Centre in Clapham, London has set up a new practice website, viewable at www.claphamhealth.nhs.uk. The old website will remain viewable for some time but will eventually be shut down. Maintaining a 'bespoke' website became too difficult for me with all my other commitments. My practice has therefore contracted with a company that specialises in general practice websites, Websites4GPs. The advantage of this is that Websites4GPs maintains many practice websites and provides common content for them, as well as online services such as EMIS Access and repeat prescription ordering. The new website also operates a Content Management System, meaning that updates can be carried out by managerial and administrative staff in the practice without requiring knowledge of HTML or website design programs such as Microsoft FrontPage.

Pay for performance and comorbidity

While the use of pay for performance as a quality improvement tool in health care is increasing, little is known about the impact of these programs on the quality of care delivered to patients with multiple conditions. Pay for performance schemes, such as the Quality and Outcomes Framework in the UK, could impact the quality of care delivered to patients with complex medical problems in several ways. A study published by myself and colleagues in the Journal of the Royal Society of Medicine suggested that introduction of pay-for-performance in primary care in the UK has not had a negative impact on the quality of care delivered to patients with multiple medical conditions. Rather, patients with co-morbid medical conditions seem to have benefited more than those without co-morbidity. This is reassuring given that previous studies have found that patients with multiple medical conditions are more likely to be excluded from performance reporting in pay for performance programs. Our findin…

Hospital Mortality following Trainee Doctors' First Day at Work

A paper published in PLoS One by Dr Min Hua Jen and colleagues (including myself) in PLoS One investigated the commonly held assumption that early August is an unsafe period to be admitted to hospital in England, as newly qualified doctors start work in NHS hospitals on the first Wednesday of August. We found evidence that this might indeed be the case and that patients admitted on this day have a slightly higher death rate in English hospitals compared with patients admitted on the previous Wednesday. This finding needs further investigation to understand why it is present, whether it is real, or somehow an artifact of the data. The article was widely featured in the media, including the BBC and Guardian.

21st Annual EAIE Conference

I attended the Annual Conference of the European Association for International Education (EAIE). This was held in Madrid, Spain, from September 16-19 2009. I spoke at a session chaired by Professor Yi-Ming Chen from the National Yang-Ming University, Taiwan. Also speaking in this session was Dr Dietlind Wünsche from the University of Heidelberg Office of International Relations, Germany.

Our session was titled Creating networks for health care programmes and students. We shared experience about setting up international collaborations for academics and students. I also spoke about the work of the International Education Fund, which is a student group that brings educational opportunities to children in developing countries.

Following my session, I had an opportunity to visit the exhibition hall and speak to representatives from a number of universities, including Sweden, Norway, Poland, Germany and Taiwan. I was impressed by the high-quality of the courses offered by many of these univ…

NW London CLAHRC

One of the projects I am working on is the Northwest London Collaboration for Leadership in Applied Health Research & Care (CLAHRC). The NW London CLAHRC is an alliance of academic and healthcare organisations working to develop and promote a more efficient, accelerated and sustainable uptake of clinically innovative and cost-effective research interventions into patient care. The CLAHRC is led by Professor Derek Bell, Professor of Acute Medicine at Imperial College, and is based at the Chelsea & Westminster Hospital. My role in CLAHRC is as co-director, with lead responsibility in primary care and public health projects.

iHealth Workshop

I attended a very interesting workshop today on iHealth, an EPSRC-funded project. Academics from Imperial College (Institute of Bioengineering, Department of Primary Care & Social Medicine, Department of Computing, Business School, Division of Surgery, Oncology, Reproductive Medicine & Anaesthesia) presented work from a pilot project in which we examined the use of information technology and electronic patient records to optimise chronic disease management.

International Education Fund

The International Education Fund (IEF) was established by students at Imperial College. the IEF believes in a world without illiteracy where every person enjoys the right to a quality education and a life of respect. The IEF works to facilitate the amelioration of global academic poverty and poor public health. Through promoting international collaborations, the IEF enablea delivery of structured education that aims to improve prospects within communities in the developing world. The IEF's next project will be for Saharawi refugees. The IEF will be providing computers for local schools working alongside a blind school, helping them receive specialist equipment, giving the blind a vision for the future. They will also provide healthcare education across the camps.

New 'super surgeries' at Charing Cross and Hammersmith hospitals

New super surgeries are set to be developed at Charing Cross and Hammersmith Hospitals to complement existing emergency care provision. The new super surgeries will be led by GPs and based alongside accident and emergency at both Charing Cross and Hammersmith Hospitals. The centres will provide initial assessment of patients self-presenting with urgent care needs and treatment for those whose condition is best treated by a primary care specialist such as a GP or nurse practitioner.

In addition, the super surgeries will build their own lists of registered patients and provide high quality planned primary care. An out-of-hours service for these patients and those registered at all other Hammersmith and Fulham GP practices will also be provided. A 24-hour telephone line will allow people to book appointments at the hospital-based practices, home visits and appointments with a range of community nursing services. Longer appointments can also be requested – a service that patients, particul…

Swine Flu Update

On 5 May 2009, I arrived at my south London general practice to discover that I was at the "epicentre" of the H1N1 outbreak in the UK. Two local schools had been closed because of diagnosed cases of swine flu among their pupils. However, by the time the new cases of swine flu had come to light, many people would have been exposed, some of them developing subclinical infection or minor symptoms and not seeking medical advice. Closing the schools may therefore not limit the spread of the H1N1 virus because exposed and potentially infected people are still carrying out normal social activities. Subsequent research from some of my colleagues at Imperial College suggests that school closure may be beneficial in flu outbreaks. I am more cautious about applying this evidence from areas very far from central London.

My local health protection unit was unable to screen people with symptoms who had been in contact with swine flu cases. General practitioners were instead asked to do thi…