Author: Azeem Majeed

I am Professor of Primary Care and Public Health, and Head of the Department of Primary Care & Public Health at Imperial College London. I am also involved in postgraduate education and training in both general practice and public health, and I am the Course Director of the Imperial College Master of Public Health (MPH) programme.

What role should general practitioners play in a modern health system?

Health systems across the world are faced with many challenges – such as rising patient expectations, increased workload, ageing populations, and an increased number of people with long-term conditions. At the same time, health systems also face significant financial problems. Consequently, governments, other funders of healthcare and patients expect more from their doctors without necessarily offering them additional resources.

As the first point of contact with patients, what role should general practitioners (in some countries, referred to as primary care physicians or family practitioners) play in meeting these challenges? General practitioners (GPs) have to deal daily with large numbers of patients, cope with a very wide range of clinical problems, meet performance targets, and provide continuity of care. At the same time, GPs also have to provide easy access to health services, show they are addressing issues such as the rise of antimicrobial resistance; and play a public health role in addressing unhealthy lifestyles and improving the uptake of preventive programmes such as screening and immunization.

Can GPs meet all these challenges? What support do GPs need to meet them? Could more be done to support GPs by non-medical health professionals? What do patients expect from their GPs? Does the training and continuous professional development of GPs need to change? How do we make use of staff from other professional groups such as nurses, pharmacist and healthcare assistants? How should we fund primary care services? These are important questions that we will aim to examine in future work at Imperial College London.

Real World Data and Pharmacoepidemiology in Europe: What are the implications of Brexit?

I am in Vienna this week for the Annual Meeting of the European Epidemiological Forum, which this year is on the topic of “Real World Data and Pharmacoepidemiology in Europe”. It’s been a good opportunity to catch up on biomedical research using ‘Big Data’. There is a lot of work going on in this field that will have a big impact on health. There was also some sadness among European colleagues about Brexit and uncertainty about the future role academics and companies from the UK will play in European research collaborations. At the meeting, I was asked to give one of the keynote presentations on the topic of Brexit and how it might affect the UK contribution to research on areas such as pharmaco-epidemiology. In my talk, I outlined some of the current uncertainties for UK researchers and the what the future might look like for the UK’s universities, NHS and life sciences sector, depending on the type of Brexit we negotiate with the other countries of the European Union.

Public Health and Primary Care in England: What does the future look like?

I spoke at a joint training day for primary care and public health registrars in London on the topic of Public Health and Primary Care in England: What does the future look like?

The key points from my presentation were:

  • Some new NHS investment – but investment is very low by historical standards
  • Will the new models of healthcare delivery deliver the £22 billion efficiency savings the Treasury expects?
  • What impact will contractual changes have? Junior doctors, consultants, GPs, public health consultants
  • Can primary care attract and retain enough doctors?
  • What impact will cuts in public health budgets have on health improvement programmes and on careers in the specialty?

My presentation can be viewed on Slideshare.

Impact of the National Health Service Health Check Programme on cardiovascular disease risk

Our analysis of impact of the NHS Check programme on cardiovascular disease risk was published in the Canadian Medical Association Journal in May 2016. The programme had statistically significant but clinically modest impacts on the risk for cardiovascular disease (CVD) and individual risk CVD factors, although diagnosis of vascular disease increased.

Overall program performance was substantially below national targets, which highlights the need for careful planning, monitoring and evaluation of similar initiatives internationally. The effect of the programme on CVD risk was the equivalent of one CVD event (e.g. heart attack) prevented for every 4,762 people who attended a health check in a year.

For the NHS health check scheme to be effective, it needs to be better planned and implemented – our work will help highlight how this can be done. In future we plan to evaluate whether particular groups – for instance older patients – have greater health benefits from the check than younger patients. It would also be interesting to investigate the reasons why the health check produced such modest benefits. For instance, to evaluate the advice patients are given during the health check.

The article was covered by a number of media outlets including The Guardian, Daily Mirror, Daily Mail, Science Daily, Independent, Times, Western Daily Press, Pulse, GP, Sun, BMJ, OnMedica, Nursing Times and BT.

How do I encourage a patient to see a pharmacist?

We are employing a pharmacist to help with treatment reviews and to see minor acute illness but we are finding resistance from some patients to seeing him, with receptionists reporting that patients are requesting appointments with ‘a proper doctor’ instead. How do we respond?

Pharmacists offer many potential benefits to general practices. They can free up doctors’ time, deliver cost-savings to the NHS through more rational prescribing, and improve the quality of patient care. For example, pharmacists can improve patients’ understanding of their medication and their adherence to their drug regime. An increasing number of general practices are now using pharmacists and their role will be further expanded when the GP Forward View is implemented. However, some patients may be unwilling to see a pharmacist and insist on seeing a doctor.

To overcome this resistance, it is essential that all staff are briefed about the role of the pharmacist and what to say to patients who express concerns about seeing him. This process should start before the pharmacist is in post, as should a discussion of the role of the pharmacist with the practice’s Patient Participation Group. The staff briefing should reinforce points such as pharmacists being highly trained professionals; pharmacists who work in primary care will have undergone additional training such as an Independent Prescribing Course; by taking on work such as medication reviews and the management of minor illnesses, pharmacists can allow doctors to spend more time with complex patients; and that pharmacists can always seek advice from a doctor when needed. You could also include this information on your practice website, in any induction pack given to new patients and in your practice newsletter.

If some patients remain reluctant to see a pharmacist, they could speak to a more senior member of the practice team such as the practice manager or deputy manager. If however a patient remains unconvinced by these explanations, I would let them see a doctor. Attitudes towards pharmacists will change over time and patients will eventually come to understand that they are highly skilled professionals who have a valuable role to play in primary care.

You can read my article, and also those of some other doctors, in Pulse.

Healthcare use among preschool children attending GP-led urgent care centres

Urgent care centres (UCCs) were developed with the aim of reducing inappropriate emergency department (ED) attendances in England. We aimed to examine the presenting complaint and outcomes of care for young children attending two general practitioner (GP)-led UCCs in West London with extended opening times. The findings were published in BMJ Open.

Only 3% of all attendances to the GP-led UCCs were among preschool children over a 3-year period, with nearly a quarter of them being repeat attenders. Although the large majority of children attending were registered with a GP, over two-thirds attended out of hours. The most common reason for attending the GP-led UCC was for a respiratory disease, mainly an upper respiratory tract infection. The most commonly prescribed medications were for infections. Only one in five preschool children who attended required a referral to a paediatrician or an emergency doctor.

Two-thirds of preschool children attending GP-led UCCs do so out of hours, despite the majority being registered with a GP. The case mix is comparable with those presenting to an ED setting, with the majority managed exclusively by the GPs in the UCC before discharge home. Further work is required to understand the benefits of a GP-led urgent system in influencing future use of services especially emergency care.

Development of a questionnaire to evaluate patients’ awareness of CVD risk in England’s NHS Health Check Programme

Cardiovascular disease (CVD) is a major cause of disability and premature mortality worldwide. In England, it accounts for a third of deaths and costs the National Health Service (NHS) and the UK economy £30 billion annually.

The National Health Service (NHS) Health Check is a CVD risk assessment and management programme in England aiming to increase CVD risk awareness among people at increased risk of CVD. There was previously no tool to assess the effectiveness of the programme in communicating CVD risk to patients. In research published in the journal BMJ Open, we describe how we developed a questionnaire examining patients’ CVD risk awareness for use in health service research evaluations of the NHS Health Check programme.

We developed an 85-item questionnaire to determine patients’ views of their risk of CVD. The questionnaire was based on a review of the relevant literature. After review by an expert panel and focus group discussion, 22 items were dropped and 2 new items were added. The resulting 65-item questionnaire with satisfactory content validity (content validity indices≥0.80) and face validity was tested on 110 NHS Health Check attendees.

Following analyses of data, we reduced the questionnaire from 65 to 26 items. The 26-item questionnaire constitutes four scales: Knowledge of CVD Risk and Prevention, Perceived Risk of Heart Attack/Stroke, Perceived Benefits and Intention to Change Behaviour and Healthy Eating Intentions. Perceived Risk (Cronbach’s α=0.85) and Perceived Benefits and Intention to Change Behaviour (Cronbach’s α=0.82) have satisfactory reliability (Cronbach’s α≥0.70). Healthy Eating Intentions (Cronbach’s α=0.56) is below minimum threshold for reliability but acceptable for a three-item scale.

This is the first study that describes the development of a short, validated questionnaire with satisfactory content and face validity and reliability examining CVD risk awareness among the NHS Health Check attendees. The ABCD Risk Questionnaire may be used for evaluating the accuracy of perceived CVD risk, general knowledge of CVD and intention to change behaviour regarding diet and exercise among NHS Health Check attendees.

Agreement between perceived and predicted CVD risk suggests that the tool performs well in assessing perceived CVD risk. As the questionnaire was developed using both an expert panel and a patient focus group, it ought to be relatively easy to understand for both patients and clinicians. If NHS Health Check recommendations change over time, it may need to be updated. The resulting questionnaire, with its satisfactory reliability and validity, may be used in assessing patients’ awareness of CVD risk among NHS Health Check attendees.

DOI: http://dx.doi.org/10.1136/bmjopen-2016-014413

Meeting with Professor Jonathan Weber on community-based academic programmes

We were very pleased to host the Dean of the Faculty of Medicine, Professor Jonathan Weber, in the Department of Primary Care and Public Health on Wednesday 4 October 2017. Professor Weber met with some of the academic staff in the department to learn more about our research and teaching programmes. We had a good discussion about the more ‘social’ and community-based aspects of our work; such as our collaborations with the NHS, local government and voluntary organisations in the White City area of West London; and our work with medical students on areas such as health coaching and behavioural change. We also discussed how our academic work could support Imperial College’s plans for its Imperial West Campus, and creating opportunities for medical students to get involved in community-based research.

Applying for the 2018-19 Imperial College MPH Programme

Thank you for your interest in the Imperial College MPH programme. The 2018-19 MPH course starts in October 2018. Applications for entry will open in November 2017. We cannot tell you at this stage whether you will be eligible for the MPH because the decision is made by the Admissions Team when they have an opportunity to view your degree results and IELTS score (if relevant). We generally require a First Class or Upper Second Class degree from a good university or an international equivalent, or a medical degree. A good personal statement about why you want to undertake the MPH course is essential. Previous public health experience is also helpful. You should take the opportunity to find out more about public health, for example, from the FPH Website.

We have several international student societies at Imperial to provide students with some peer support away from their home country. Do check out the visa rules before you apply if you intend to stay in the UK after the MPH as these opportunities are now more limited than in the past.

The Imperial College MPH is mainly a quantitative, research-oriented programme. Our MPH students receive rigorous training in epidemiology and statistics. Hence, the programme will suit applicants who are mainly interested in developing their quantitative analytical and research skills. The course offers good grounding in research methods for those considering a PhD in public health or role in health services research related field. The MPH also presents a good opportunity for public health management training as it is provided in collaboration with the Imperial College Business School.

If you decide to apply, then it would be an advantage if you can describe any relevant research experience and/or training in epidemiology, maths, and statistics. We also need to see your CV in addition to the personal statement.

The Imperial MPH is now the largest Masters course at Imperial College and one of the largest MPH courses in the UK, offering an intensive immersion into public health policy and practice. Students that complete the Masters programme continue into positions in international development organisations, government bodies, research and consulting.

We offer two streams for the MPH Programme: MPH (Health Systems Stream) which covers the core skills of public health with a focus on high-income countries; and MPH (Global Health), which covers the essential core public health skills as well as orienting students towards a global health career. In 2017-18, we are also offering optional modules in Health Systems Development, Health Systems Policy and Financing, Contemporary Topics in International Health Policy, Anthropology in Public Health, Research Methods (covering Qualitative Research), Exposure Assessment and eHealth.

You can apply for the course online at https://apply.embark.com/grad/imperial/

The full-time programme is very intensive. Students must attend classes Monday to Friday and they are required to study full-time for 12 months. Students submit a 10,000 word research dissertation in late August and then undergo an oral examination on their project. Much of the teaching in the first term is shared with the MSc in Epidemiology Course, which is also run by the School of Public Health. The third term and summer months are largely dedicated to work on the research project.

You can find further information on the Imperial College MPH Website.

The MPH blog can be viewed at http://www.imperialmph.blogspot.com

Please see the College’s webpage for information on International Students, if applicable.

The fee for the MPH in 2018-19 for UK students and students from the European Union is around £10,000. The fee for students residing elsewhere in the world is around £30,600. You can email tuition.fees@imperial.ac.uk for further information on postgraduate fees.

We do offer some scholarships annually to help cover the course costs. Please let us know if you would like to be considered for one of these scholarships when you make your application. You can also find further information regarding funding opportunities at https://www.imperial.ac.uk/study/pg/fees-and-funding/scholarships/

Please see the link at the following website for frequently asked questions about admissions: http://www.imperial.ac.uk/study/. You may contact the Course Organiser, Dr Henock Taddese in case of any further queries: h.taddese@imperial.ac.uk

Because of the length of time it takes to process visa applications, it can be difficult for overseas students to obtain the necessary documents to start in October if they do not receive their offer by 31 July 2018.

Best wishes for your future and thank you for your interest in Imperial College and in our MPH Programme.

The Imperial College MPH Team

Dr Henock Taddese, Dr Matt Harris, Dr Filippos Filippidis, Professor Azeem Majeed

A warm welcome to the Imperial College Master of Public Health (MPH) class of 2017-18

We had a full house earlier this week for the introductory session for our new Master of Public Health (MPH) students. This year, we have 68 students on our MPH programme. The course provides a comprehensive introduction into key public health topics; such as epidemiology, biostatistics, health promotion, health protection, health behaviour, health policy, and health economics. There is a focus on the development of quantitative analytical skills for public health, epidemiology and health services research. We aim to provide a creative and supportive learning environment, and we hope all our students have a rewarding year.