Medical Centre

Pay for performance programmes are being adopted in a growing number of countries as a quality improvement tool. In 2004, the United Kingdom introduced the Quality and Outcomes Framework (QOF) which primarily aimed to improve the management of common chronic conditions, such as diabetes and stroke, in primary care. The Department of Health in England is now considering allowing more flexibility in local pay for performance schemes, such as the introduction of higher payments for meeting tougher performance targets. Research carried out at Imperial College London suggests that such local pay for performance schemes can improve target achievement by general practices but have no significant impact on the overall quality of clinical care. The study was funded by the NIHR and the NW London Collaboration for Leadership in Applied Health Research and Care (CLAHRC) and published in the journal PLoS One . In the study, which was carried out by a team from the Department of Public Health a...

Online access to medical records by patients has the potential to promote patient-centred care and improve patient satisfaction.  Online services may also offer patients greater convenience although concerns remain about privacy and confidentiality. However, online access and services may also prove to be an additional burden for healthcare providers who are already under considerable workload pressures. In a study published in the British Journal General Practice , I and colleagues form other UK universities assessed the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care. We carried out a systematic review that focused on all studies about online record access and transactional services in primary care. We identified 176 studies, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved sat...

The UK-Ireland node of the InnoLife Consortium met on Friday 30 January 2015 at 58 Princes Gate, South Kensington, London. InnoLife is a consortium of more than 50 core partners (and in addition 90 associate organisations) of leading businesses, research centres and universities from 9 European Union countries that has been selected by the European Institute of Innovation and Technology (EIT) as the Knowledge and Innovation Community (KIC) for EIT Health.

A group photo from the recent School of Public Health Away Day in Windsor

Electronic learning could enable millions more students to train as doctors and nurses worldwide, according to research carried out by the Department of Primary Care and Public Health at Imperial College London. A review commissioned by the World Health Organization (WHO) and carried out by Imperial College London researchers concludes that eLearning is likely to be as effective as traditional methods for training health professionals. eLearning, the use of electronic media and devices in education, is already used by some universities to support traditional campus-based teaching or enable distance learning. Wider use of eLearning might help to address the need to train more health workers across the globe. According to a recent WHO report, the world is short of 7.2 million healthcare professionals, and the figure is growing. The Imperial team, led by Dr Josip Car, carried out a systematic review of the scientific literature to evaluate the effectiveness of eLearning for underg...

In a letter published in the January 2014 edition of the British Journal of General Practice , medical students Fahmida Mannan and Zain Chaudhry from the Imperial College London School of Medicine discuss how the NHS and medical schools can encourage students to consider general practice as a career option. They suggest the focus in medical schools should shift towards improving the quality of general practice placements and promoting the integration of primary care and specialist teaching, rather than consuming more time in an already overstretched curricula. They also consider that prestige has never been the main incentive for pursuing a specialty. Their own experience is that many medical students are attracted to a career in general practice because of other factors, such as a good work–life balance, continuity of care and career flexibility. With many GPs now concerned about their workload, this inevitably influences students and junior doctors in their career choices. ...

The results of the 2014 Research Excellence Framework (REF) were published today. The REF is carried out to assess the quality of research in UK universities. The Times Higher Education Supplement's analysis ranked Imperial College as having the highest REF score among major UK universities. Among the 'Public Health, Health Services and Primary Care', category, Imperial College achieved a 57% 4-star rating, which was the joint highest in the UK (along with Oxford University).

I am at a World Health Organization meeting in Cairo where we will be discussing how we can strengthen health systems so that they are able to cope with the rising burden of non-communicable diseases such as diabetes and hypertension; as well as the challenges posed by infectious diseases such as Ebola. I’ll be giving one of the key note speeches as well as chairing one of the sessions.

I was invited to speak at the Best Practice 2014 Conference  where I spoke about the use of social media in healthcare, drawing upon my experience as an academic clinician. My lecture was well-attended with many delegates standing because all the seats had been taken. This illustrates doctors' interest in the use of social media and in particular its role in patient education, promoting the use of preventive activities such as immunisation and improving the quality of care that patients receive. You can view a copy of my presentation  at the event.

I was at St. Mary's Hospital earlier this week to attend a meeting with Professor Neil Poulter and the Imperial Clinical Trials Unit team. We discussed methods of boosting recruitment to clinical trials - particularly industry sponsored trials - and how hospitals and general practices could work together to achieve this objective. Research on new drugs is a key area for the UK both for the benefits it can bring for people's health and the NHS, and also for its economic benefits.

In a paper published in the Journal of the Royal Society of Medicine , a team from Imperial College London examined time trends in emergency hospital admissions via accident and emergency departments in England. The proportion of emergency hospital admissions in which patients were admitted via an A and;E department increased markedly in England between 2001–2002 and 2010–2011. There are several possible explanations for this trend. These include coding changes and the greater use of A and E departments to assess patients before they are admitted as emergencies. Changes in access to general practitioners - both during normal working hours and out of hours - may also have contributed to these changes. The findings of the study in the JRSM are similar to those from studies in the United States. Future health policy should address gatekeeping in A  and E departments and the provision of urgent care in general practice  New models of care such as urgent care services that em...

Increased taxation on tobacco products is an effective method of reducing tobacco use. In a study published in the Scandinavian Journal  Public Health , Filippos Filippidis and myself, along with colleagues from Harvard University, assessed support for increased taxation on tobacco products and other tobacco control measures among people aged ≥15 years in 27 European Union (EU) during the period 2009-2012. We obtained nationally representative data from the 2009 (n=26,788) and 2012 (n=26,751) cross-sectional Eurobarometer surveys. Estimates were compared using chi-square statistics. The effect of the relative change in gross domestic product (GDP) on the change in support for increased taxation during 2009-2012 was calculated using the Pearson correlation coefficient and linear regression models. We found that between 2009 and 2012, support for increased taxes on tobacco products declined (56.1% to 53.2%. However, support for other tobacco control measures increased significan...

The demand for urgent care is increasing, and the pressure on emergency departments is of significant concern. General practitioner (GP)-led urgent care centres are a new model of care developed to divert patients to more appropriate primary care environments. In a study published in the Emergency Medicine Journal , I along with colleagues from Imperial College London explored why patients with minor illnesses choose to attend an urban urgent care centre. We used a self-completed questionnaire among patients aged 18 years or over (N=649) who were triaged with a ‘minor illness’ on arrival at an urgent care centre co-located with an emergency department in London. The median age of participants was 29 years. 58% (649/1112) of patients attending the centre with minor illness during the study period took part. 72% of participants were registered with a GP; more women (59%) attended than men; and the majority of participants rated themselves as healthy (81%). Access to care (58%) was a k...

I attended a seminar on 11 September 2014 today on "Rebuilding Immunity After Treatment for Haematological Malignancies". The seminar was given by Professor Per Ljungman of the Karolinska University Hospital, Stockholm, Sweden. In the seminar, we discussed the use of vaccines to protect patients from infection following Haematopoietic Stem Cell Transplantation (HSCT) and after treatment for haematological malignancies. The levels of antibodies to diseases that can be prevented by vaccination decrease during the first few years after a stem cell or bone marrow transplant. The immunities acquired by the patient before the transplant are also generally lost. For this reason, this group of patients are advised to start a full course of vaccinations starting 3-6 months after they finish their cancer treatment.

A paper published in the Eastern Mediterranean Health Journal   reviews the current state of tobacco use, governance and national commitment for control, and current intervention frameworks in place to reduce the use of tobacco among the populations of the Gulf Cooperation Council (GCC) member states and Yemen. It further reviews structured policy-oriented interventions (in line with the MPOWER package of 6 evidence-based tobacco control measures) that represent government actions to strengthen, implement and manage tobacco control programmes and to address the growing epidemic of tobacco use. The findings of the review show that tobacco control in the GCC countries has witnessed real progress over the past decades. These are still early days but they indicate steps in the right direction. Future investment in implementation and enforcement of the Framework Convention on Tobacco Control, production of robust tobacco control legislation and the establishment of universally ava...

Epilepsy is one of the commonest neurological conditions and is associated with major adverse health outcomes and has a significant impact on a person's quality of life. In an article published in the journal Seizure , Michael Soljak and colleagues from Imperial College London examined the association of primary care factors with hospital admissions for epilepsy in England, 2004–2010. Hospital admission rates for epilepsy in England decreased from 2004–2005 to 2009–2010. Patient access to primary care appointments more than two days ahead, a measure of access to preventive care, and percentage of patients age 18 and over on drug treatment for epilepsy who have been seizure free for the last 12 months, were associated with a lower rate of admissions. However, the impact of these variables on admission rates is small compared to that of deprivation. The study provides further evidence that improved access to primary care could help reduce admission rates for long-term conditions...

I attended the National Summit on Quality in General Practice on 31 July 2014, which was held at the RCGP Headquarters in Central London. The event was organised by the RCGP, the Health Foundation, and the BMJ. Among the attendees were Dr Maureen Baker, Chair of the RCGP, Dr Fiona Godlee, Editor of the BMJ, and Dr Richard Vautrey from the BMA's General Practice Committee. The National Summit was facilitated by Judy Oliver. At the meeting, there were presentations and discussion on the current state of general practice in the UK, the challenges we need to overcome to provide high quality primary care services, the importance of adopting a patient-centred approach in the measurement of quality of care, and how we can make change happen in the current political and economic contexts. Delegates worked in groups to address these issues. Amongst my group were Anna Damerell, Richard Vautrey, Bryan Fisher, Nick Steele and Tom Duncan.We had a stimulating debate on the many challenges ...

As general practices in England come under increasing workload, funding, and contractual pressures, a new type of primary care organisation—the GP Federation—is becoming more common. The RCGP defines GP federations as practices “working together to share resources, expertise, and services.” In their simplest form, federations allow the general practices in one locality to share some administrative functions, and work together to bid collectively for NHS contracts. You can read the rest of this article on BMJ Blogs .

Statistics from the OECD show that the per capita use of statins in the UK is the highest in Europe and the second highest in all OECD countries. There are a number of reasons for this, which include the emphasis on evidence-based medicine in the training of UK doctors; the 2004 GP contract which introduced incentives for the management of long-term conditions such as coronary heart disease and diabetes; and the NHS Health Check programme which aims (amongst its objectives) to increase the use of statins for the primary prevention of cardiovascular disease (CVD) in people with a 20% or more 10-year risk of CVD. The National Institute for Health & Care Excellence (NICE) is now proposing to reduce the threshold for starting statins for the primary prevention of CVD from its current threshold of a 20% 10-year CVD risk to a 10% 10-year CVD risk. Although this could have significant benefits for the health of the population, there are three issues that need to be considered. These ...

In a response to an editorial published in the BMJ by Dr Fiona Godlee, I discuss the need for better information to be available on the side-effects of statins. This is a a key issue in the debate about trying to widen the use of statins because of the discordance between rates of side-effects of statins in clinical trials and in clinical practice. In clinical trials, the incidence of side effects from statins is low and similar in the intervention and placebo groups.[1] In contrast, observational studies using primary care databases report a much higher rate of potentially serious side effects (such as myopathy and renal failure) in people taking statins.[2, 3] Even these rates derived from clinical records may under-estimate the true incidence of side effects in people taking statins because not all patients with side effects will inform their doctor and not all doctors will enter a relevant diagnostic code in the patient’s electronic medical record. Many general practitioners ...