By Nathan M Davies, on 5 October 2017
“We trained hard—but it seemed that every time we were beginning to form up into teams we were reorganised. I was to learn later in life that we tend to meet any new situation by reorganising, and what a wonderful method it can be for creating the illusion of progress while actually producing confusion, inefficiency, and demoralisation.” (Petronius Arbiter 27-66 AD)
As a member of the Improvement Science team (ISL) for the past few months I’ve been evaluating the delivery of integrated care in East London. Integrated care refers to care that is person-centred and co-ordinated across health and social care, so providers, commissioners and local authorities need to work together to deliver the different elements of care that a person needs. In 2013 WEL (Waltham Forest and East London) was launched as one of the 14 Pioneer Programmes of Integrated Care bringing together commissioners, providers and local authorities covering the area served by Barts Health NHS Trust.
When I started this job last May, the ISL team had already carried out a two-year evaluation of WEL, which highlighted a disconnect between strategic thinking and service design on the one hand, and the delivery of integrated care on the other hand. This is hardly surprising. We know as many as 70 percent of change programmes do not achieve their intended outcomes. A lack of commitment (patience?) to see a programme through to the end and high turnover of management might be part of the problem.
Very soon I realised that WEL no longer enjoyed much attention. There were new programmes, new acronyms, new objectives, and with them different pressures, different actors, and different priorities: TST (Transforming Services Together), STP (Sustainability and Transformation Partnerships), ACS (Accountability care Systems)… Petronius Arbiter’s quote came to mind, “it seemed that every time we were beginning to form up into teams we were reorganised…” (The fact that this quote might have been misattributed doesn’t make it less painfully relevant).
Where do we look to see organisation change?
Within a very crowded policy context, I faced a dilemma: how could I build on the findings of the previous phase of the WEL evaluation if WEL was no longer a priority? It felt important to look at the impact that all this change at the strategic level is actually having on frontline work, to unpick the gap that my predecessor identified between strategic thinking and operational delivery. It is at the frontline level, after all, that change is meaningful, when it happens. But how does it happen?
The literature on organisational management is quite clear on the matter: change is often evolutionary rather than the result of radical restructuring (Hodgson, G, 2008). Organisation-level change is hardly ever linear and often has an emergent element (Dawson 1996). It tends to happen by ‘drift’ rather than by design. By looking at organisational routines we might then have a chance at unpacking the grammar of organisation change, so to speak. Routines are recurrent, collective, and interactive behaviour patterns, which help coordinate work (Becker 2004). This new phase of the WEL evaluation will then focus on frontline professionals’ routines in the three WEL boroughs and look at how health and social services staff work together to deliver more coordinated care. The aim is to shed some light on patterns of resistance to change and sustainability of change towards integrated care and understand the impact of organisational development on the ground.
I am a researcher-in-residence, which in practical terms means that I’m embedded in the organisations I’m evaluating. I work closely with stakeholders across three boroughs with the aim to coproduce learning that is relevant and timely, and so increase the chances that evidence might inform programme developments. This role raises a number of challenges, including maintaining objectivity, but it also gives me regular access to management and frontline professionals, as well as key operational meetings. This gives me a vantage point to understand better their organisational routines, how these professionals work with colleagues across different organisations, and what challenges they face on a day-to-day basis.
Based on my initial scoping work, it is clear that the rhetoric on integrated care is powerful, but so are the blockers on the ground, namely a lack of staff and resources (particularly within social services) and an increased fragmentation of services, after the separation of commissioner and provider functions.
For all the rhetoric, is care really more integrated or actually more fragmented? I hope that my work in the next few months can contribute to finding some answers.
Becker MC (2004) Organizational routines: a review of the literature. Industrial and Corporate Change 13:643-77.
Dawson, S. J. N. D. (1996) Analysing Organisations. Hampshire: Macmillan
Hodgson, Geoffrey M. (2008). ‘An Institutional and Evolutionary Perspective on Health Economics’, Cambridge Journal of Economics, 32(2): 235-56.
By Nathan M Davies, on 27 September 2017
In this post, Daniel Aggio, a PhD student at PCPH, discusses some of his PhD work that was recently published in BMJ Open and has had widespread media coverage in the UK and across the pond in America.
There is a considerable body of research suggesting that physical activity tracks from childhood into adulthood. In other words, being an active child means you are more likely to be active as an adult. Something that has been less explored is how physical activity tracks during the transition to old age, an important period when many major life events are likely to occur.
This study utilises data from the British Regional Heart Study, a prospective cohort study involving over 7000 middle-aged men recruited between 1978 and 1980 from 24 towns across Britain. One of the main assets of the British Regional Heart study is the lengthy follow up data, including measures of physical activity throughout the transition to old age. By exploiting these data, we were able to explore how physical activity tracks during this period and identify the types of activity in midlife that are most likely to predict an active lifestyle in later life.
It did not come as much of a surprise to find that being active in midlife more than doubled the odds of being active in old age, but we were struck by how strongly midlife sport participation, and particularly if it was initiated earlier in life, predicted being active in old age. For example, men who had played sports for 25 years or more were nearly 5 times as likely to be physically active in later life compared with men who did not play sports. But even taking up sport relatively late in midlife (i.e. less than 4 years ago) significantly increased the odds of being active in old age. Higher levels of walking and recreational activity in midlife also increased the odds of being active in later life, but they were not as strongly associated as sport participation. Until we carry out more research we can only speculate as to why this is the case. Plausibly, people who keep up sport may simply do so because they enjoy it. We also suspect that sport plays a pivotal role in the development and maintenance of key motor skills, which may prove vital in later life.
Although sport participation may be more stable and more likely to predict activity in later life than other types of activity, walking was the most likely to increase during later life, possibly because retirement might free up more time and functional declines may limit capability for more intense activities. From a public health perspective, promoting walking may be more feasible in later life as we show that many older adults are already increasing their walking during the transition to old age.
Being active in midlife, particularly playing sport, is important for maintaining an active lifestyle into old age. Sport participation may be crucial for establishing lifelong physical activity and should be promoted throughout the lifecourse, especially in early life. Strategies to increase physical activity in later life may also need to target other forms of activity that can be widely adopted, such as walking.
Click here to read the full published article.
By Nathan M Davies, on 22 September 2017
Very topical in the news right now are the recruitment rates of trainees into the specialties of general practice and psychiatry. In the post Amber Appleton Amber an NIHR Academic Clinical Fellow and GPST4 talks about her experience of choosing general practice and the experiences of other trainees.
When I began as a GP Academic Clinical Fellow (ACF), I wanted to do something different and was keen to conduct my own research project. I had the idea for it not that long ago when I applied for my current GP training post, and at the same time I also applied for psychiatry training. I struggled to choose between these two specialties, and although I did not choose psychiatry my interest has never dwindled. I still remember the day I became interested in psychiatry as a medical student when I was taught by an inspiring psychiatrist. Because of this, I wanted to find out what made others choose psychiatry and to explore whether it was also related to their medical school teaching experiences.
By designing and seeing through my own project, the research, teamwork, organisation and communication skills I have gained from the experience have been profound. Marta Buszewicz has supervised me along with Surinder Singh, both of whom have provided invaluable support and guidance throughout the project, which has really nurtured my learning throughout my ACF post.
So, to give a bit of background to the rationale behind the project…
One in four people in the UK will experience a mental health problem each year. The first person they may talk to is their GP who sees most of the people with mental health problems in the community, and then those with the most complex or severe cases may be referred to a psychiatrist if indicated. The overlap between psychiatry and general practice is especially significant as approximately a third of GP consultations are for mental health problems.
As a result, both GP and psychiatry are essential for ensuring good patient care and there is an on going need to recruit competent doctors into these specialties – throughout the UK. Unfortunately, both psychiatry and general practice have been experiencing real recruitment problems with one in three training posts in both GP and psychiatry currently left vacant.
I was interested in exploring some of the factors before, during and after medical school, which ultimately result in trainees choosing a career in psychiatry. I was hoping that this information might help to improve the way these specialties are taught at medical school, which could encourage more doctors to sign up to this important specialty and also potentially improve attitudes amongst all future doctors towards mental health problems.
I designed a web-based survey to explore the views of psychiatry trainees nationally, followed by conducting qualitative in-depth interviews with a group of 21 purposively sampled London psychiatry trainees. The whole research team analyzed the interview findings.
Many trainees said their attitudes had changed after being taught psychiatry at medical school and that the placement influenced their career choice, although the quality of the teaching was very important and some people had not had such good experiences. A significant number of those interviewed described how doing a Foundation job in psychiatry (a 4 month post in the first two years after graduating from medical school) had had a significant impact on their career choice. Currently only around half of junior doctors do a Foundation year post in psychiatry, but this is under review. Most trainees felt positive about the idea of teaching about physical and mental health problems together during the curriculum, rather than separately (as has quite recently been introduced at UCL Medical School), but it was thought very important that this shouldn’t dilute the amount of psychiatry teaching overall.
One of the main barriers trainees described that they had to overcome when choosing psychiatry was stigma from colleagues/peers and family members. One respondent described the response she received when speaking openly about considering applying for a career in psychiatry.
P5 Female ST7:
I said: “I’m thinking of actually applying for psychiatry as well as general practice.” And she (Foundation year two supervisor) said: “What a shame.”
The “badmouthing of general practice and psychiatry” has been highlighted in a recent BJGP paper (1) as a subtle but important factor influencing graduates’ career choices: quite simply why would a junior doctor choose a specialty looked down upon by other members of their profession?
The psychiatry trainees interviewed had attended a range of UK medical schools and provided a range of recommendations for improving the way psychiatry is taught at medical school, as well as suggesting other strategies to improve recruitment to the specialty.
Summary of the key findings:
- Medical school placements in psychiatry should be introduced early and integrated throughout the curriculum to help prevent negative attitudes developing.
- Positive role models and mentors were described as key and there should be greater visibility of prominent psychiatrists within medical schools.
- Barriers to choosing psychiatry that were described included: the stigma still associated with mental illness and feeling ‘not a proper doctor’, as well as the emotional stress and responsibility involved with decision making in psychiatry.
- Outreach projects into secondary schools
- Buddy schemes and mentors should be offered widely
- Negative attitudes at medical school towards specialties such as psychiatry and general practice need to be challenged
- More Foundation posts should be offered in psychiatry
Recruitment into the twin specialties of psychiatry and GP continues to be problematic and the key messages from this paper suggest that appropriate interventions are needed at all stages, i.e. before, during and after students’ time in medical school.
The full published paper is now available from BMC Psychiatry
- Baker, M., Wessely, S., & Openshaw, D. (2016). Not such friendly banter? GPs and psychiatrists against the systematic denigration of their specialties. Br J Gen Pract 2016; 66 (651): 508-509.
By Nathan M Davies, on 18 July 2017
I am a foundation year 2 (FY2) doctor; this means I am in my second year of working as a doctor after finishing medical school. Foundation doctors undertake 4-monthly placements, rotating around different hospital departments, general practice or other community posts. The aim is to provide newly-qualified doctors with rich and varied experiences before we apply for speciality training posts.
I was fortunate enough to have secured a place on an academic foundation programme, which meant that one of my 4-month placements was designated to be a research post. With these bespoke academic placements, there is a lot of flexibility with what you can pursue depending on your areas of interest. My future career plans are to become an academic GP, with research interests in public health; and thus it was a great privilege for me to be able to spend my research placement within UCL’s PCPH department. With such a plethora of leading research groups within PCPH, I was spoilt for choice; however considering my main passion for cardiovascular disease and diabetes, I decided to join with the British Regional Heart Study (BRHS) research group.
The BRHS research group are a very friendly, helpful, supportive and fun team to work with. Not only was the placement overwhelmingly productive, but I had an enjoyable four months too. Whoever said research is boring……we had several social trips out for lunch, lots of food and lots of laughs!
The BRHS has a wealth of data from an original cohort of 7735 middle-aged men aged 40-59 years from 24 British towns, initially recruited in 1978-1980. These men have been regularly followed-up for morbidity and mortality since including a physical re-examination in 1998-2000 when aged 60-79 years. My research project investigated the prospective association of individual socioeconomic position and neighbourhood-level socioeconomic deprivation with incident type 2 diabetes mellitus in older British men (60-79 years). We found that diabetes risk was higher in lower social classes and in areas of greater socioeconomic deprivation. For manual social class this was mostly explained by body mass index and triglycerides. For neighbourhood-level socioeconomic deprivation it was largely explained by body mass index and to a lesser extent, other lifestyle factors (smoking, alcohol, physical activity, diet etc.). Our results support the need for public health campaigns specifically targeting obesity as a fundamental means towards preventing type 2 diabetes and reducing socioeconomic inequalities in older adults.
Completing the project during the placement was a big achievement in itself, as I had never used sophisticated statistical software before; yet under the guidance of my supervisors, I was able to write and run my own codes by the end of the project. I also started to write up the first draft of my project as a scientific paper. This was my first experience of writing a research paper. Writing the draft enabled me to develop skills in literature searching and the ability to read and critically appraise evidence. By the end of the four months, I successfully submitted my abstract to an international Public Health conference in Canada, and so I will be presenting our work there in June 2017.
What I really liked about this placement was the flexibility. The BRHS team were very accommodating, so I was able to pursue various interests alongside my primary goal of completing the research project. For example, I wanted to develop my teaching skills, and so I attended a formal “Training to Teach” course and then used the skills I had learnt to teach 4th year UCL medical students together with GP trainees. Additionally, as my future career plans are towards general practice, I was able to arrange some GP taster sessions during my placement, which allowed me to gain further experience.
Believe it or not, this is just a highlight of some the things I was able to achieve during my 4-month placement with the BRHS team! This list could go on, but I want to just take this opportunity to say a massive thank you to all the members of the team who supported me and enabled me to make the most out of the time I had. For any future FY2 doctors, who are searching for a rich and varied academic placement, with a strong research focus, but with the flexibility to allow for the pursuit of other interests too, I cannot think of any group more suitable than PCPH’s British Regional Heart Study group.
By Nathan M Davies, on 22 June 2017
In this post Surinder Singh, Course Director for the iBSc in Primary Health Care gives us na update with some great feedback from past and present students.
We have just just “graduated” the twentieth cohort of students undertaking the Department’s integrated BSc in Primary Health Care (iBSc). After their first two years at UCL all medical students undertake an iBSC year which allows them to pursue an individual subject, of their choice, in considerable depth, with a strong emphasis on undertaking an extended research study. This is a fundamental element of the medical school’s mission to produce “scientifically-literate” clinicians. (http://www.ucl.ac.uk/medicalschool/staff-students/course-information/year-3).
Ever since 1997 one of the iBSc options at UCL has been the iBSc in Primary Health Care. This was the first primary care iBSc in the UK and each year we recruit a small but dynamic cohort of usually 10-14 students.
Over the last twenty years we have produced almost two hundred graduates, most of whom are now practising clinicians throughout the UK and abroad. The original Course Director was Melvyn Jones who subsequently handed over to current lead Surinder Singh.
The iBSc consists of six modules encompassing individual patient care, the consultation in primary care as well as health of the population and critical appraisal – now jointly taught with the iBSc in Paediatrics. The single largest module is Research* – led by Richard Meakin. This is a module which students find sometimes challenging, usually fascinating and always rewarding. It is also the component where we are particularly keen to involve PCPH researchers and research students as project supervisors. So please contact Surinder or Richard if you would like to get involved or have a small project in which you think a bright and well-motivated student could contribute in return for your supervision.
A short video about the iBSc and a list of all projects and abstracts/scientific papers are on the iBSc website.
Two recent graduates have kindly sent us the following comments about their experiences of the iBSc in Primary Health Care for this blog:
Student Rajit Randhawa writes:
“As far as I am aware primary healthcare is only amongst a few iBScs to offer patient contact – one day a week throughout the year. Not only does this help tie in the theoretical learning about consultation models and patient-belief systems, it most definitely prepares us for the 4th year clinics and in my opinion, is a truer placement than the 5th year GP placement because we actually see continuity of care over a prolonged period. In my time at my medical practice I clerked and examined many patients, performed basic procedures such as flu jabs, and even had the opportunity to write up an inquest into a patient’s death in addition to doing more routine tasks such as home and hospital visits”
And of the teaching during the year:
“I cannot think of a single session where I thought the teaching was overbearing or too complex. Tutorials can be up to three hours but it’s not as bad as that since the format lends itself to promoting healthy and productive discussion between different groups of students. As someone who was often happy to sit silently I now appreciate being driven out of my comfort zone, and it has helped to develop my confidence speaking to larger groups”
Another graduate of the course, Joht Chanda– now a junior doctor wrote:
“I am currently finishing my Foundation Year 1 in the West Midlands. During medical school at UCL I was fortunate to get onto the iBSc in primary care and population health after my pre-clinical years. I wasn’t sure what to expect before starting the course, however the lessons I went onto learn, were extremely positive in shaping where my career is currently going.
The iBSc was the first opportunity I ever had to try taking part in research. Academia was not something I had ever considered before, as in my head I thought it usually consisted of lab work and being told what to do (two things I can’t stand!).
However, in comparison to the other courses available, this iBSc was one of few to give you an opportunity to run a research project from start to finish, even applying for our own ethics (I can say happily now, but not so much back then!). Although seemingly daunting at the time, the task of designing my own project was possibly one of the most useful I was able to complete during medical school. It meant that in the proceeding clinical years, I had a solid grounding in research methods and was able to start taking on work myself that others in my year group wouldn’t have the knowledge of where to start.
Being self-sufficient meant I was able to strengthen my application for foundation years without having to rely on others for opportunities. Instead this self-sufficiency taught in the iBSc meant I was the person responsible for creating the opportunities. The iBSc supervisory team were extremely supportive and even helped me publish my project and present it at conferences; these were great stepping stones for the future as most career paths usually prefer some level of academic engagement.
I cannot explain quite how useful doing the course was for me and how thankful I am to have got on it, thinking back”.
Joht wrote a paper with Richard Meakin for BMJ Open and Rajit has produced a poster for a conference in 2017.
- J S Chandan & R Meakin: Do special constables in London feel that they are adequately prepared to meet their first aid responsibilities? A qualitative study
- Randhawa, J S Chandan, T Thomas, S Singh. Investigating the attitudes and views of general practitioners on the use of video consultations in primary health care. Poster accepted for conference on Telemedicine (UCL)
PLEASE DO GET IN TOUCH IF YOU WOULD LIKE TO GET INVOLVED
We are currently recruiting projects supervisors for the new cohort of eleven iBSc students starting in September 2017. If you are a PhD student/post doc and would like to get involved please do contact Surinder Singh or Richard Meakin
By Nathan M Davies, on 24 May 2017
This years winner of the Yvonne Carter Award is Nathan Davies.
Each year the RCGP and the Society for Academic Primary Care (SAPC) award the Yvonne Carter Award for Outstanding New Researcher, and each year the competition gets harder. This year panel members from the RCGP Scientific Foundation Board (SFB) and SAPC reviewed several high-quality applications from early career researchers.
Dr Nathan Davies, a Research Fellow at UCL, impressed all the panel members with the number of grants he has secured and projects he has collaborated on in the three years since completing his PhD. Here Nathan outlines his plans for the award, and talks about his career journey.
What is your main area of interest, and how did that develop?
My research currently focuses on end of life care for people with dementia and how we can improve the experience of care not only for patients, but also for families and others affected by dementia. I have a particular interest in making decisions at the end of life and supporting practitioners to make decisions with patients and their families; we know this is an area that practitioners find challenging and I hope that my research will support GPs with this.
My background is in Psychology. I worked in memory clinics and I noticed a pattern whereby we would see patients with mild to moderate stages of dementia, but they then fell off our radar. This got me thinking about what was happening in the wider context. There was also little support for those with later stages of dementia, which surprised me. Through my early work, I realised that most guidelines and research for example was very practitioner oriented with little input from family carers, who we know provide most support day to day and are experts through experience.
What does your research involve?
My PhD was a large piece of qualitative research; I carried out in depth interviews with 47 family carers. I wanted to find out what their experience of end of life care was, what do they see and what are their experiences? I realised that their priorities aren’t always the medical but usually centre around the psychosocial importance of end of life care – being treated with respect and dignity.
My post-doctoral work has focussed on two areas: 1) supporting practitioners make decision through the development of rules-of-thumb. These have been implemented in NHS sites and the Alzheimer’s Society have incorporated them into their end of life training programme; 2) supporting family carers at home with the development of an online support tool.
How will you use this award?
This award will allow me to expand my networks with lower income countries, and I’m specifically interested in working with Sri Lanka.
Sri Lanka has an increasing ageing population with the highest proportion of older adults in South Asia. This award will allow me to travel to Sri Lanka to carry out workshops with GPs and the Ministry of Health to provide education, awareness and an understanding of dementia and how they can support family carers. I will also hold workshops with family carers to not only provide them with support, but also to learn more about their approach to caring for people with dementia.
Based on your experience, what advice do you have for people who are interested in working in the research field?
You can’t underestimate the importance of networking in research. This means ensuring you are talking to people that do similar work, but also networking with those who have different research interests not necessarily in a directly related field. There is so much we can learn from each other.
Academia is changing and social media is becoming a huge part of what it means to be involved with research. I use Twitter to keep up to date with new research and key topics in the field of healthcare, but also to talk about the work that I’m doing. It’s also useful to blog about new research or publications to disseminate findings. You can’t rely on people reading academic papers anymore!
Make sure to get involved in lots of different events and networks across not just your research group or department, but also the wider institute and organisations such as the SAPC or RCGP.
Lastly, I would say to not be afraid to keep trying when you’re not successful – whether it’s a grant application or an unsuccessful publication, don’t get disheartened and go for it again!
By Nathan M Davies, on 12 May 2017
In this post Manuj Sharma talks about the mid-year meeting for the International Society of Pharmacoepidemioogy (ISPE) he recently attended at the Royal College of Physicians in London.
Pharmacoepidemiology itself comes across as quite a mouthful, but it simply refers to the study of the use and effects of medications in large numbers of people – focusing on both how effective and safe medications are. As such, research including both trials and observational studies focused on medication all come under the pharmacepidemiological heading.
A big point for discussion at this years conference was the impact of ever growing volumes of “real world” patient data and what it means for the field of pharmacoepidemiology going forward. “Real world” is any data collected outside of the constraints of conventional randomised trials. When it comes to medications, there are many who traditionally have looked at randomised controlled trials as the only means of getting to a clear unbiased answer but given so much data is now becoming accessible, can we really afford to ignore other study designs and methods?
The thoughts on what all this new patient data meant for the future of research into medication were sought from representatives from 3 key stakeholders, regulators, industry, and the NHS. The discussion was extensive but here are some of the major points that grasped my attention and gave, I felt, most food for thought…
The regulators were up first and their perspective was delivered by Dr Enrica Alteri, Head of Research and Development at the European Medicines Agency (EMA). She was quick to emphasise how the EMA have been advocating increasing use of “real world” data for some time.
The most interesting example provided of this was regarding an extension of licensing granted to a medication called Soliris® (eculizumab), used for paroxysomal nocturnal haemoglobinuria, a life threatening condition where red blood cells break apart prematurely. The original trials approved the medicine for use in particular patient group with history of blood transfusions while a registry based study using “real world data” was subsequently used to successfully extend the license of the medication for use in patients with other levels of disease severity. The path that any new treatment takes from development to decisions on approval and reimbursement can take over 20 years. So with new medicines being developed at a faster pace, there is a need to make this process more efficient to allow patients to safely access treatments sooner. The EMA is accepting of this type of licensing extension using “real world” data, provided of course, like with any trial, the study is conducted in a rigorous, robust manner!
The industry perspective came from Andrew Roddan, Vice President & Global Head of Epidemiology at GlaxoSmithKline who highlighted another important role for this data in drug development through identifying disease patterns and targets. He also emphasised that use of “real world” data and undertaking randomised trials did not have to be mutually exclusive. Andrew Roddan used The Salford Lung Study as an exciting example where professionals from eight organisations across Greater Manchester involving over 2,800 patients, 80 GP practices and 130 pharmacies collaborated to investigate effectiveness of a new inhaler, Relvar Ellipta® for COPD. The study was securely hosted within the NHS network, which integrated the electronic medical records of consenting patients across all of their everyday interactions with their GPs, pharmacists and hospitals. This linked database system allowed monitoring of patients’ safety in close to real-time with minimal intrusion into their daily lives. This also meant recruitment of a large group of patients was possible – including types often excluded in traditional respiratory trials. Not everywhere has the technological integration that is in place in Salford, but this was an exciting vision for where medicines development can go!
The final perspective, fittingly came from Dr Indra Joshi who gave her viewpoint from the NHS frontline, as a practising acute medicine physician. Dr Indra Joshi was excited by the increasing volumes of patient data emerging and believed it could greatly contribute to various aspects of pharmacoepidemiology while also improving patient care. She was, however, keen to remind everyone that patients must be involved each step of the way to ensure this data continues to become available. She also believes that despite advances there was still some way to go before we achieve the healthcare record integration needed to conduct studies to the quality of the Salford Lung Study throughout the UK.
The lively discussion and presentations from the stakeholders gave interesting perspectives on the future of growing volumes of patient data and what it meant for research into medication. Despite some differences there was overall agreement on a few points. While trials remain central to medication licensing decisions and establishing efficacy of treatments early on, there are multiple opportunities for “real world” data to add to this evidence base to support the process. A clear understanding of the strengths and limitations of the available “real world” data was key to realising where they can add most value. And finally, how important it is to ensure early and frequent engagement between all stakeholders for success. Next time, it would be great to hear the patient perspective as well!
By Nathan M Davies, on 9 May 2017
In this post Nathan Davies talks about his recent oversees visit and the importance of developing international collaborations.
Working as a researcher in academia, one of the great benefits we have is the ability to work with others from across the globe and travel to visit them; sharing our ideas, results and enthusiasm for the work that we do. And this is exactly what I have done recently in Hong Kong and Australia. But importantly it is not just a benefit but I think a vital part of academia, learning from other leading academics and health care systems.
In 2011 I started working on a European Commission funded study whic
h had a whole host of leading academics in both dementia and palliative care not just from Europe but even from Australia. It was at this point I met Prof Wendy Moyle from Griffith University, Brisbane, Australia who invited me to visit her and the team at Griffith. I did so back in 2015 and have just returned from my second visit.
On the way to Australia I made a quick but exciting pit-stop at Hong Kong Polytechnic University, where I was hosted by Prof Wai Tong Chien at the School of Nursing. In addition to presenting the work I have been doing as part of my NIHR School of Primary Care Research Fellowship, I met with members of the team to understand how cultural variations affect the provision of end of life care, for example a hot topic was the use of feeding tubes in people with dementia. But, it was also fantastic to see how Hong Kong uses the latest technology to train their new generation of aged care nurses, with specifically designed teaching labs.
Following Hong Kong I was in Australia for just over four weeks – although, I must admit it wasn’t all work and I did take a bit of time to have a holiday out there too. For the first part of the trip I was in Sydney and I met with various academics from three different universities; University of New South Wales, University of Sydney, and University of Technology Sydney. I presented some of the exciting work that we have been doing here in the UK, including my work on developing an online support tool for family carers of people with dementia, as part of my SPCR Fellowship. In Sydney I was particularly keen to hear about the digital interventions and trials which are currently underway which focus on supporting families and people with dementia. At UNSW I met with Prof Henry Brodaty and Dr Megan Heffernan who went through their Maintain Your Brain project which is about developing a website for use by teaching people how to manage modifiable risk factors for dementia. We were able to have a lengthy discussion regarding the design of websites but also the challenges of eHealth interventions in academic research, learning some valuable lessons for my own eHealth research. I was also able to meet with Associate Prof Lee-Fay Low who discussed her trial of CareToons which is an online program on management of behaviour changes for carers of people with dementia. These were great learning opportunities to bring back to my own work here in the UK.
Moving up the coast to Brisbane, I spent a week with Prof Moyle and her team meeting and learning a lot from different academics and clinical staff, including Prof Elizabeth Beattie, the Director for the Dementia Collaborative Research Centre: Carers and Consumers. I also visited a long term care facility Jeta Gardens. This was a great opportunity to learn not just about aged care in Australia but also to learn about the architectural design of aged care facilities.
Prof Moyle has a large group of PhD students from across Australia and the rest of the world. I was asked to provide a qualitative methods workshop to get the students thinking about what qualitative research is and how it can work with and alongside quantitative research. This was a great chance to learn about the PhD students’ work and to understand how they could see qualitative methods working within their work, much of which was clinical trials.
I can definitely say this was a fantastic opportunity to have early on in my research career and I left having developed some fantastic connections and learnt a lot not only about research methods and topics, but also about how aged care works in different countries. As part of this trip I am also now supervising a new PhD student studying at Griffith University, conducting a qualitative study exploring end of life care for older adults in Ghana. I will remain in contact with Prof Moyle who is now also a mentor in my future work and new fellowship.
I 100% encourage everyone especially early career researchers to think about who they want to work with outside of the department, not just nationally but also internationally, and don’t be afraid to go for it!
On the 21st July Dr Lee-Fay Low will be visiting us from Sydney giving a talk for our seminar series about her work on CareToons and several other projects she has been involved in, please do come along.
By Nathan M Davies, on 24 April 2017
This month Jane Wilcock explains the North London Research Design Service.
Here at PCPH we are a Hub covering the North London region of the London Research Design Service (RDS). Several members of the department are involved as RDS advisors along with colleagues from across UCL.
We offer support to any researcher or health and social care professional who are preparing a grant application to a national peer reviewed funding stream, e.g. NIHR, MRC, Wellcome Trust, charity or even educational grants from industry.
As skilled NIHR RDS advisors we will provide a review which considers all aspects of your application from identifying a suitable funding stream, developing your research question, importance and rationale for the research, the research team composition, as well as the study design.
Using a case managed approach we then facilitate input from specialist RDS advisors in health economics, statistics, qualitative research and health psychology. These specialists can work with you to further develop aspects of your research project.
We even provide mock panel interviews for shortlisted candidates.
“It was very helpful to have an initial general discussion with the RDS team about the overall focus for the call”.
Patient and Public Involvement (PPI) is an integral component of the advice given to those approaching RDS London. Support is given on an individual level, we want to ensure that researchers adopt good PPI practice. NIHR RDS London has an Enabling Involvement Fund to facilitate involvement of patients and the public in designing and developing a research proposal. This fund, has the potential to be very meaningful for researchers and patients and the public and the feedback and success rate in achieving funding so far been excellent.
“We have found RDS feedback to be very useful after the rejection of this application first time round. We are particularly grateful for their suggestions on the ‘Health Economic’ and ‘Patient and Public Involvement’ aspects of our application. Overall the patient centred approach suggested by the RDS has certainly aided the development of our project and strengthened our final proposal”.
A new addition to our PPI support is our fast track lay-summary review service: researchers are benefiting from access to our dedicated network of public advisers, providing detailed input and advice on the lay summaries of their research proposals.
It is satisfying working for the NIHR RDS, feedback is extremely positive. Of the people who have come to RDS London for advice, 45% have submitted an application, and 50% of full submissions were funded.
“RDS London provided useful experience that helped us navigate our way through the application process. We found the service to be a very useful resource to help us challenge and improve many aspects of our study and grant application –and we are very grateful to them for the support”.
We always suggest approaching us as early as possible before submission – ideally three to six months (minimum four weeks) – so we can provide meaningful input into the research proposal: You can formally request individual support using our support request form
Or come to one of our drop in sessions on the first Tuesday of every month 11-13:00, see locations here
We look forward to working with you to support your funding applications.
Check out RDS website for more information and resources.
By Nathan M Davies, on 5 April 2017
In this post Tom Hartney, a PhD student at PCPH, talks about the Health Protection Research Unit and its recent Academy day.
The Health Protection Research Unit (HPRU) is a collaboration between universities, including University College London and Imperial College London, and Public Health England (PHE). This is part-funded by the National Institute of Health Research (NIHR) in order to promote high quality multi-disciplinary health research. It was set up in 2012, and supports the funding of PhD students to work on projects related to the HPRU’s research objectives.
These students make up the HPRU Academy – this isn’t a university in itself, but instead represents PhD students based across several universities, working in 10 research units each of which focuses on a different health issue (such as emerging infections or environmental hazards) or methodology (such as modelling or evaluation of interventions). This January saw the first HPRU Academy Retreat, which brought together students from across the country to present results from their work and hear about future plans and priorities for the Academy.
Myself and Josina Calliste from PCPH attended, both representing the HPRU in Blood Borne and Sexually Transmitted Infections. With 19 students giving oral presentations, as well as talks from academics and PHE staff, over two days, we knew this would be a packed schedule, but it gave us a chance to meet other students working on public health topics, to talk about our projects and find opportunities to work with them in future.
The format was divided into two types of talks, with those from students talking about their work making up the majority of the programme, and each day introduced and ending with talks from HPRU academics on the public health research landscape and aspects of methodology. The student presentations covered a huge breadth of healthcare topics, from the effects of traffic pollution to the risks from ticks in urban areas, with the research opportunities provided by genomic sequencing being a common theme. Given there was so much to cover, students somehow still managed to convey their enthusiasm for their chosen topic and explain their key results while sticking to time.
Professor Bernie Hannigan gave the PHE perspective on the Academy, emphasising its focus on applied research – identifying gaps in the evidence and addressing them with research outputs – as well as the need for researchers to think about how evidence influences public health policy & practice. Dr Satnam Sagoo, PHE’s Head of Education and Training, discussed routes to develop a career in public health, setting out the options available and ways to enhance transferable skills during the PhD process.
Karen Wilding from the University of Liverpool presented on research ethics and governance, a fundamental aspect of every research project. She described the variety of clinical research governance systems and frameworks, as well as the key considerations for ethics, and resources available for help and advice. Finally, Professor Jackie Cassell from Brighton and Sussex Medical School talked about getting patients and the public involved in research. She described ways to implement this at every stage of the lifespan of the doctorate, some of the challenges involved in healthcare research in general, and on transient and stigmatised conditions in particular. Imaginative approaches to public engagement were illustrated these using the example of an exhibition on scabies at the Eastbridge Hospital in Canterbury – originally a medieval hospital for pilgrims – set up in collaboration with the Textile Department of the University of Brighton.
To break things up the Retreat included interactive elements – firstly, in the form of an outbreak response exercise led by Dr Ruth Ruggles, Head of Public Health Training at PHE. Dr Ruggles used data from a real outbreak to put students in the role of public health response teams with crucial decisions to make as the outbreak developed. This culminated in a role played press conference, with volunteers fielding tricky questions from the audience on the media and public reaction to the outbreak. Also, students were able to vote online on their favourite talks and poster presentations, with prizes awarded by Professor Tom Solomon from the University of Liverpool on the final day.
Despite the challenge of packing so much into a two day schedule, the inaugural HPRU Academy retreat provided plenty of food for thought on how to use the expertise available within the Academy – here’s looking forward to next year’s event.