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Research Department of Primary Care and Population Health Blog



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Supporting carers of someone living with dementia during the coronavirus pandemic

Nathan Davies28 July 2020

In this post Dr Kirsten Moore, Marie Curie Palliative Care Research Department, UCL talks about dementia and supporting those living with demenita during the coronavirus pandemic.

Who is dying with Covid-19?

In April this year Covid-19 (coronavirus) became the most common cause of death in the UK. Office for National Statistics data showed that most deaths caused by the virus in England and Wales were among older people and those with underlying health conditions.

One fifth of people dying with coronavirus had dementia, making it the most common pre-existing condition. Also, the death rate from dementia was significantly higher in April than the previous five-year average.

How is COVID-19 impacting family and carers?

In the UK 700,000 family members and friends support someone living with dementia, providing 44% of the cost of care for people living with dementia1. Being a carer can negatively impact finances, stress and physical and emotional health. In our recent publication   we highlight some of the end of life care challenges that coronavirus has created for families caring for a frail older person or someone with dementia.

A diagnosis of dementia often leads to reduced social interaction for both the person with dementia and their family carer. Social distancing and lockdown measures are increasing this isolation and loneliness. Carers may have additional worries supporting the person with dementia who may not understand the importance of shielding and keeping socially distant from others.

End of life discussions and planning

When a person with dementia lacks capacity to make decisions, families may be faced with difficult decisions about whether to send their relative with dementia to hospital or a care home for care, or whether to provide end of life care at home where they can be present with their relative. Alternatively, they may have these decisions taken out of their hands due to procedures and guidelines adopted to contain the spread and impact of coronavirus.

In advanced dementia communication may be limited for many months. Having discussions in the early stages of dementia gives someone with the condition an opportunity to express their preferences about end of life care.

There are many benefits to discussing our end of life wishes with our family and those who are important to us. They allow us to share how we want to be cared for and who we want involved in decision making if we can no longer make or communicate decisions.

These discussions can also help family feel more confident in making decisions if the person living with dementia lacks capacity. When family members are unsure what a person wanted at the end of life, they may worry they have made the wrong decisions or feel guilty if the person had an uncomfortable death.

However, these conversations are not easy. Discussing end of life is something most of us tend to avoid. It is difficult to face our own mortality. These conversations are also difficult because we don’t know what is likely to happen or what sort of decisions we, or our families, may be faced with. Often discussions tend to focus on resuscitation status, place of death or whether someone should be taken to hospital.

People who have dementia may find it difficult to imagine situations that they have not yet faced, such as difficulties swallowing and talking.

How can we support carers?

Simply keeping family carers involved and informed is an important way healthcare professionals, hospitals and care homes can support family carers. This may involve having conversations about place of care and end of life care.

There are numerous guides about difficult conversations, such as this Marie Curie blog. There is no one-size-fits-all approach, but the most difficult part is often starting the conversation. Healthcare professionals may be worried about raising end of life topics, that they may not have all the answers or that the family may not want to have these discussions. Carers, however, usually prefer an open and honest conversation, including being told that there may be uncertainty or no clear answers.

Being responsive to whether the carer is ready to have a conversation is important. There may be a pressing need for a conversation, but if discussions are raised at an earlier point in the dementia trajectory then it can give the carer more time to prepare themselves for discussing end of life.

What can carers do?

Family and carers may feel that if a conversation about end of life is needed, it will be raised by healthcare professionals. However, this may not always happen. Carers should feel reassured that if they have questions about the care of their friend or relative, that they should feel able to ask healthcare professionals for information and advice.

You may find it helpful to talk decisions out loud or write down a list of pros and cons. These simple strategies can help you clarify what is important or where you need more information or advice. It is important to get information from reliable and trusted sources. Make use of helplines such as the Marie Curie, Dementia UK or Alzheimer’s Society helplines.

Having a family member who understands how dementia progresses has been linked to a more comfortable death for care home residents. Keep in mind the best interests of the person with dementia if they lack capacity to make their own decisions. Think about their values and what would be important to them. It may not be realistic to follow all their wishes, so do not feel guilty if this cannot be achieved.

Developing a decision aid

To help guide families and carers in making some of the complex and challenging decisions raised here, our team at the Marie Curie Palliative Care Research Department at University College London are developing a decision aid.
We will be exploring the questions that people are asking Marie Curie and the Alzheimer’s Society to work out the biggest challenges facing people with dementia and their families during the pandemic.

We will then work with family carers, healthcare professionals and use existing research to develop a decision aid. The decision aid will help carers think about their current circumstances and provide relevant information to help inform their decision making.


1. Prince, M., Knapp, M., et.al. (2014). Dementia UK Update (2nd edition).


This blog was originally posted on the Marie Curie website, taken with permission from Marie Curie and Kirsten Moore. https://www.mariecurie.org.uk/blog/supporting-carers-dementia/277479

Signposting patients to sexual health online – don’t forget the health (or the sex)

Nathan Davies22 May 2020

In this post Julia Bailey discusses the impact of Covid-19 on sexual health services and discusses sexual health online. 

The Covid-19 pandemic has prompted an unprecedented shift to remote health services as a response to social distancing for patient and practitioner safety. Sexual health clinic capacity has been cut as staff have been deployed to other parts of the health service, and patients are now asked to contact health services by phone or video-link, with clinic visits reserved for a small proportion of people who need to be seen (FSRH guidance). People can also access online sexual health services for STI testing (+/- contraception), in areas where this service is provided.

The shift to remote consultations is likely to make it more difficult to offer holistic healthcare and health promotion. For example, patients welcome opportunities to discuss sexual wellbeing beyond physical health (e.g. sexuality, sexual difficulties, sexual pleasure), but picking up on this will be more challenging with less opportunity to notice non-verbal cues and to establish trust (e.g. whilst examining).

Resources via the Internet and mobile phone can offer private, convenient access to information, which may be particularly welcome for topics which can be difficult to discuss (e.g. sex, sexuality, sexual difficulties). Online sexual health services can offer efficient STI testing and treatment, but do not usually offer evidence-based sexual health promotion. Interactive (i.e. tailored) digital interventions are effective for learning and sexual behaviour change, and could be incorporated into online sexual health pathways.

There is no nationally commissioned digital sexual health programme, and digital innovation varies widely across the UK. There are thousands of health apps and websites, but only a tiny minority have been rigorously evaluated and it is difficult to know which to recommend – the NHS apps library curates trustworthy resources.

Digital sexual health resources for patients – some suggestions:

Before (or instead of) appointments:

After a diagnosis/ongoing support:

Tips for writing patient materials

  • Don’t reinvent the wheel! Check what’s already available
  • Involve target users to make sure material meet their needs, priorities and preferences
  • Draw on principles of evidence-based sexual health promotion
  • Address barriers to access, e.g. audio and video formats; material in first languages
  • Address groups whose needs are often overlooked (e.g. women who have sex with women, trans, non-binary, intersex, and disabled people).


The post-pandemic ‘new normal’ will include digital health. There are some excellent online sexual health information resources available, and there is currently an unprecedented opportunity to offer evidence-based, tailored sexual health promotion to complement online and clinician-delivered sexual health services.


(This post was originally posted on the BMJ Sexual and Reproductive Health website who have provided permission to repost)

Dementia research behind the Scenes: Experience of an A-level student in an academic department

Nathan Davies27 September 2019

Vennie working with Nathan Davies learning about our dementia projects

We have a fantastic post below from Vennie an A-level student aspiring to study Medicine at university. She visited the department and shadowed some of our academics in their various projects in July. In this post talks about her experience and what she took away from it. 

Dementia is an increasing problem especially with the growing older population in the UK. The awareness of dementia is rising, especially through the use of media and organised events such as Memory Walks. However, how much do we know about dementia?

Well, in simple words, dementia is the ongoing decline in the brain. This is only an umbrella term for 200+ different sub-types of dementia that exists, some of which you may have heard off. For example the most common two are Alzheimer’s disease and vascular dementia.

During my placement in the Research Department of Primary Care and Population Health at the Royal Free Hospital, I was able to shadow members of the team that are involved at different levels of research projects.

I discovered that there are many stages which make up the process of a research project. Starting with the planning and design of the research project, ethics, and recruitment through to finally analysing and presenting the results produced. Alongside all this and integrated throughout are processes to ensure the results are implemented into clinical practice and policy, to make a difference. I learnt about the different types of studies such as qualitative studies and large clinical trials. Due to the involvement of human participants including often patients from the NHS in the studies the department runs, a major part of the research process is the ethical application and review. The purpose of the review is to establish if the project has more benefit than risk to the person and their family as well as is the project being conducted sensitively. For all of this to happen, it may take 5 to 20 years to see a difference in practice and policy.

In order for, this project to be successful, a range of people are required to take part, which in turns bring a variety of skills into the mix. These individuals may include designers, programmers, clinicians, psychologists, sociologists, statisticians, qualitative researchers, and importantly patients and their family themselves. A few of the most prominent skills are communication, teamwork, determination and resilience. For example, a project with Dr Davies and Prof Rait I observed on producing a support package for people with dementia and their families, communication has a massive role to play. The project uses workshops with people with dementia, their family and professionals to develop the support package. There is a need for clear communication between the ranges of people for this project to progress smoothly. The communication may come in the form of discussion-based in meetings, emails and many other ways. Therefore, teamwork is essential as each person will have a special role in the project. Finally, determination and resilience are required from every member of the team as there will be challenges along the way, which could be out of your control that must be overcome. For example, if the project does not meet the criteria of the ethics committee it may be returned to the researcher, and his or her team must go back and amend the plan.

In conclusion, research of any kind similar to this project requires a range of people to be involved with a variety of skills that are vital for the research to work. This work experience has been a fascinating and exciting opportunity for me to experience what goes on behind the scenes of a research project.

Accessing GP appointments- a disaster waiting to happen or hope on the horizon?

Nathan Davies16 May 2019

In this post Ruth Abrams and Sophie Park reflect on the current pressures facing GPs and NHS today.

In a recent expose called ‘GPs: Why Can’t I Get an Appointment?’, a Panorama documentary, which aired on BBC1 on Wednesday 8th May, emphasised the current limits of and pressures on the NHS system. The programme featured interviews with overworked GPs and allied healthcare professionals, painting a rather bleak picture. Practices are merging and closing at an ever increasing rate. Patient loads increase as patient lists are subsumed. Patient multi-morbidities have increased the need for chronic conditions to be monitored with regular GP appointments. Yet on average patients wait a minimum of two weeks for a routine appointment. Early retirement and a limited flow of trainees into General Practice also contribute to the strain, making practice sustainability difficult to envisage. Inevitably, pressure and frustration are being felt amongst both patient groups and the primary care workforce.

Whilst those researching, working in and experiencing primary care within the UK will already be familiar with these factors, what has become a pressing concern since the 2015 publication of the BMA’s, National survey of GPs: The future of General Practice, is patient safety. At present only the most urgent of cases are seen quickly in General Practice. Yet still an unsafe number of patients are seen by any one GP in a day. This high demand placed upon GPs makes for little time to reflect on cases.

Enter- the release of the new GP contract and the NHS long term plan which intend to employ a multi-disciplinary army of healthcare professionals. Within this new way of working, workloads will be shared amongst staff, with greater efforts being made for both integration and collaboration. A typical GP’s day will begin to look very different. Micro-teams will have time to discuss patient cases, a GP’s time can once again be focused on the professional tasks only they can undertake and overall there begins to be a healthier outlook to teamwork.

Some promote this utopian vision of General Practice working unquestioningly. Pots of money, such as those made available through the Prime Minister’s Fund, have encouraged new ways of working with very limited evidence base. Yet one aspect seemingly unaddressed within the new plans is the disparity across patient access and levels of deprivation within the UK. In a recent report by the Health Foundation, GPs working in higher deprived areas see more patients compared to their counterparts. These are areas where recruitment of this new workforce will inevitably be harder. This raises questions about how best to incentivise recruitment so that patient access to care remains equal for all.

There is also a certain feel that these plans are being done to, rather than with GPs. We need only reflect back a few short years to the junior doctor protests to recall that in order for patient safety to happen, workforce perspectives must be accounted for. In order for the NHS to remain as successful as it has been and for the principles of Astana declaration to be realised, GP engagement rather than negation needs to remain central to all future planning activities.

Unequal access to care and a disruption to professional identities present major issues. But doing nothing is no longer an option. At a time when the NHS is so often synonymous with the words crisis and strain rather than success, a Utopian vision for both staff and patients may be both timely and necessary. Reifying this however, becomes a different matter all together.

Can a self-management intervention facilitated by peer support workers reduce readmission rates to acute care for people discharged from crisis resolution teams

Nathan Davies23 August 2018

In this post Louise Marston talks about their recent study published in The Lancet on peer support for reducing readmission among people to acute care for people discharged from crisis resolution teams, which provide intensive home treatment following a crisis.

CORE (CRT Optimisation and RElapse prevention) has been a big part of my working life for a number of years.  It was an NIHR funded programme grant from 2011 to 2017.  One of the work packages was an individually randomised controlled trial supported by Priment Clinical Trials Unit.  The results were published in The Lancet recently.

Why did we do this study?

Crisis resolution teams work in the community to help prevent admission to acute care at times of mental health crisis.  Nationally, they have not resulted in a decrease in bed use.

Self-management is a way for people to actively manage a condition; recognising the signs of crisis and knowing how to manage symptoms and other aspects of their life.  Interventions may aid self-management, but might be more effective when facilitated and motivated by someone else.  Peer support workers have had similar experiences to the people they are supporting, so are able to be a role model for recovery.

Who did we enrol in the study?

We recruited people who had been on the caseload of mental health crisis resolution teams, been discharged from the crisis resolution team in the previous month and had capacity to consent to taking part.  We did not recruit those who were deemed to be high risk to them or others, were discharged out of the area or who could not understand English.

What was the intervention?

This was a self-management workbook, which was adapted from other resources in an earlier CORE work package, which was facilitated by a peer support worker in up to 10 sessions.  In these sessions, peer support workers were encouraged to help participants complete the workbook and to reflect and discuss their recovery plans.  Peer support workers were also employed to provide supportive listening and instil hope of recovery, through sharing strategies to aid recovery learnt through their own recovery journey.

What was the comparison?

Participants in the control group were sent the workbook in the post, but did not have access to a peer support worker and were not given further guidance on how to use the workbook.  They could also access usual care.

What did we find?

We found that those randomised to the peer support worker group were less likely to be readmitted to acute care in the year after they enrolled in the study compared with those who were randomised to the workbook alone (29% versus 38% respectively).  Time to admission was also significantly longer in the intervention group, as was satisfaction with mental health care and self-rated recovery at 4 month follow-up.

What does this mean?

The rate of readmissions was lower than expected overall.  However, peer support workers have the potential to help reduce readmissions further in people who have had a mental health crisis, giving them the opportunity for a sustained recovery.  It also means that the burden on acute services will be less; potentially giving savings to the NHS.

Satisfaction with care related to all mental health services; even so as this was statistically significant at four month follow-up suggesting that participants liked having a peer support worker, and uptake of the peer support worker intervention was good.  If peer support workers after mental health crisis were more widely available, this may go some way to improving Trust satisfaction ratings.


Johnson S, Lamb D, Marston L, Osborn D, Mason O, Henderson C, Ambler G, Milton A, Davidson M, Christoforou M, Sullivan S, Hunter R, Hindle D, Paterson B,  Leverton M, Piotrowski J, Forsyth R, Mosse L, Goater N, Kelly K, Lean M, Pilling S, Morant N, Lloyd-Evans B (2018) Peer-supported self-management for people discharged from a mental health crisis team: a randomised controlled trial Lancet 392 409-428 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31470-3/fulltext

#OPAL2018: Identifying and addressing shared challenges in conducting health and social care research for older people

Nathan Davies2 July 2018

In this post Rachael Frost from the Centre for Ageing and Population Studies discusses the fantastic achievement of being awarded a place on an international early career researcher workshop in Brazil.

I was recently lucky enough to be awarded a place on a Brazil-UK Researcher Links workshop: Identifying and addressing shared challenges in conducting health and social care research for older people (OPAL) in June 2018. Funded by the British Council, the Newton Fund and Sao Paolo Research Foundation (FAPESP), the workshop aimed to encourage collaboration among UK and Brazilian early career researchers and to develop joint research proposals to address some of the major challenges facing ageing research in both countries. As an early career researcher in the Centre for Ageing and Population Studies in PCPH, I was really excited about the opportunity to meet other early career researchers and share our experiences.

Brazil’s population is ageing rapidly, and in a much shorter time frame than many European countries. Whilst France had 150 years to adjust to a doubling in the proportion of the population aged over 60, Brazil has just 20 years. Dementia and frailty are on the rise in both Brazil and the UK. However, Brazil is approximately 35 times the size of the UK, and faces extra challenges in access to healthcare, particularly in rural areas (e.g. despite the size difference, the UK has almost ten times more GPs).

  Outside the Sao Paolo State University Faculdade de Medicina

The workshop was organised by Dr Kathryn Hinchliff-Smith, Dr Reena Devi and Associate Professors Adam Gordon and Alessandro Jacinto with teams from both the University of Nottingham and Sao Paolo State University. It brought together 13 UK early career researchers from a range of UK universities and 18 Brazilian early career researchers, in the small Brazilian city of Botucatu at the Sao Paulo State University School of Medicine. It was a long flight over (not helped by Adam telling us everything that went wrong with the plane the last time they flew out…), but well worth it when we got there!

As well as serving us copious amounts of tasty Brazilian food, the five day workshop included a talk each day from the workshop mentors. They discussed the context of ageing research in Brazil and the UK and the key challenges for each country. The early career researchers presented posters on current projects and future research interests, and took part in larger discussions of how the academic research context works in Brazil and the UK. We were also given a lunchtime tour of Botucatu’s hospital.

In addition to this, one of the main workshop aims was to develop international research ideas and grant proposals.

Our final day presentation

We were put in small groups, and spent a couple of days discussing our interests and ideas. It was sometimes a difficult balance trying to find a project that was both feasible and interesting to everyone in the group, however by the last day each group had formed clear plans for projects. We presented these ideas around dementia, frailty and palliative care to the rest of the group.

In addition to lots of hard work, we also made the most of fantastic opportunities to see round Botucatu. Although it was technically winter in Brazil, it was the same weather as an English summer. An enthusiastic group of us got up at 6am two days running to see the ‘base of the clouds’ (a beautiful sunrise view of miles of wilderness) and to have an early morning dip in a waterfall! We also managed to fit in evening piano concerts, coffee museum visits, acai berry ice cream and a fair few caiprinhas. Our Brazilian colleagues were fantastic and welcoming and showed us how to dance Brazilian style!

A pre-workshop waterfall visit

It was an amazing opportunity, and all our groups are planning to take our ideas forward with support from the workshop mentors. In addition to new proposals and collaborations, we also learnt a lot about each other’s countries (including a smattering of Portugese), and made new friends and colleagues in both Brazil and the UK. Obrigada, Brasil and hope to see you again soon!


A morning visit to the ‘base of the clouds’

Even modest amounts of activity from midlife are associated with significant health benefits

Nathan Davies22 June 2018

In this post Daniel Aggio talks about his recent trip to the American Heart Association’s conference in New Orleans, and the exciting findings on the effects of physical activity and risk factors for cardiovascular disease. 

In March this year, I was fortunate enough to attend the annual American Heart Association’s conference on Epidemiology and Prevention (EPI Lifestyle) in New Orleans. The overarching goal of the conference is to promote development and application of translational and population science to prevent heart disease and stroke. The conference theme this year was health promotion: risk prediction to risk prevention, with a large focus on behavioural strategies to promote and sustain healthy lifestyles. This conference was highly recommended by my supervisors and it turned out to be a fantastic experience. There were some inspirational speakers from the field of physical activity, such as Professor Andrea LaCroix, who presented her work on American older women showing that light physical activity is associated with a reduced risk of cardiovascular events in later life. This was particularly encouraging given that a recent paper from the British Regional Heart Study (BRHS) mirrored these findings in older men.

On the first day of the conference, I was presenting in one of the moderated poster sessions and what a lively session it turned out to be. The poster I was presenting was from my PhD work utilising 20-years of physical activity data from the BRHS, a prospective cohort study of middle-aged men transitioning into old age. In this study I used group-based trajectory modelling, a form of latent class growth analysis, to plot trajectories of physical activity and examine their associations with a range of cardiovascular risk factors in old age. The take home message was that although sustained high levels of activity proved optimal, in fact sustaining more modest amounts of activity from midlife was also associated with significant health benefits. The session was well attended and I received some tips and advice from one of the first researchers to utilise group-based trajectory modelling in physical activity research, Dr Tracie Barnett. Since returning to UCL, I entered this poster into the Faculty poster competition in which I was awarded the runner up spot. It was amazing to see my work being recognised with so much other great research going on in the Faculty.

EPI Lifestyle also had a strong programme of events for early career researchers, including a three-minute thesis competition and a session on identifying your niche in academic research. I was also invited to participate in a round table discussion on forging International Collaboration, where I represented the BRHS. Representatives from cohort studies from around the world were in attendance along with early career researchers looking to find out more about these studies and opportunities for collaborations. This was a great opportunity to learn about other cohorts, many of which I hadn’t come across before, and also to network with some of the leading investigators of these studies. More information about these cohorts can be found here.

Overall, EPI Lifestyle was an amazing experience where I learned some great science, but the highlight for me was the networking opportunity. I made some valuable contacts that gave me some great advice and will no doubt be useful connections in my future career.

From Bed Blocking to Delayed Transfer of Care

Nathan Davies20 December 2017

In this post Dr Catherine Jackman an ST6 inGeriatrics and General Medicine talks about the bed blocking we saw in the 1960s through to modern day ‘delayed transfer of care’ or becoming known once again as ‘bed blocking’. 

“NHS bed-blocking rises 42% in a year…”

“NHS ‘bed-blocking’ rises for sixth month in a row”

“’Bed-blocking’ patient left waiting three and a half years to be discharged…”

At a time when the NHS faces unprecedented change and challenges there is barely a day which passes when the media doesn’t comment on bed blocking (or as it is called today – Delayed Transfer of Care) and the huge number of older patients unnecessarily ‘stuck’ in hospital.

Delayed transfer of care (DToC) refers to the long term occupation of hospital beds, often by older patients, who are medically fit to be discharged but are unable to leave due to a shortage of available care options elsewhere.  The consequences of this are significant; there is a huge added cost to the NHS, beds are not appropriately utilised and many other patients may wait long hours in A&E for a free bed on the ward.  DToC patients suffer physically, in terms of hospital acquired infections, and psychologically.  They are at risk of becoming institutionalised and, in addition to this, staff morale takes a hit.

Evidence would suggest however that this has been a problem the NHS has had to deal with for many years.  Geriatric medicine has evolved over the past 60 years and the provision of care available to our older population has changed, but bed blocking and DToC continues.

Departmental reports from the geriatric medicine department in Stoke in the 1960s-1970s comment on the challenge of patient demand exceeding the facilities available to provide adequate care.  At that time there were, on average, 700 long stay beds for elderly patients in the Stoke area.  They functioned as the equivalent of today’s care homes but often without recreational or rehabilitative facilities.  Patients would also be admitted for “holiday respite” so that their family could have “a well-earned rest”.  Despite requesting relatives sign a “contract” to state they would take the patients back home this often did not happen.  One report is of an 87 year old widow who was admitted as a “holiday spell” and a form guaranteeing re-acceptance was signed by a son.  After admission the patient was found to be active, alert and continent.  After a month long admission the family refused to accept her home and involved a solicitor.  The patient then had to join a long waiting list for local authority provided accommodation instead.

Another patient report from the long stay facility is of a 76 year old woman whose son wrote “mother and I have not got on very well for years.  She has led a very useless life…Naturally, I feel very bitter about this…As you are aware the proper authorities will provide for her if you will only apply to them.  I cannot do anything more in this matter.”  This patient again joined the waiting list, “blocking” the hospital bed in the meantime.

The length of stay of these patients on the wards could often exceed 1 year.  And, as is the case today, many died or deteriorated whilst awaiting local authority funded welfare housing or placements.

Fast forward 20 years to 1986, a BMJ paper entitled “Bed blocking in Bromley” reported that more than 1 in 10 of all acute patients were classified as bed blockers – rising to 1 in 5 of medical patients.   The authors commented “bed blocking seems inevitable in wards attempting to cope with the steadily increasing proportion of elderly patients”.   They defined bed blocking as patients who remained in hospital for 4 weeks or longer, and in the opinion of the medical staff, no longer required the facilities provided there.  Reasons suggested in this study were similar to those of the earlier reports i.e. social and administrative problems as well as relatives refusing to have patients home.

After the 1980s there was a change away from long stay geriatric wards and care of our older population is now integrated into the acute hospital setting.  Additionally there has been far more emphasis on social care with social workers very much integrated into the hospital teams.  Since 2003 local authorities have been fined if they fail to organise care in a timely fashion.

The late 1990s and early 2000s was a golden period when the government tried to transfer the focus of care into the community and social care expanded.  However, following the financial crisis of 2008, in 2010 the government introduced a period of austerity and the rate support grant to local authorities has been reduced every year.  So, with cuts to their budget, there has been less social care spend despite an increasing demand exacerbated by steadily rising patient numbers and a declining number of beds.  Inevitably this has increased pressure on hospitals to provide the necessary care and resulted in the return of “bed blocking”.

A solution to the recurring problem of bed blocking, or DToC, has not been developed by any government as yet.  A proper integration of Health and Social Care would seem to be needed with joint funding.  This would involve a major upheaval/reorganisation which, as the King’s fund reports, is extremely difficult in a time of decreasing budgets.

Dr Catherine Jackman


The PCPH iBSc in Primary Health Care: 1997-present

Nathan Davies22 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.



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

Nathan Davies, winner of this year’s RCGP/SAPC Yvonne Carter Award for outstanding new researcher

Nathan Davies24 May 2017

This years winner of the Yvonne Carter Award is Nathan Davies.

Each year the RCGP and the SocieNathan Davies Research Fellow PCPH (2)ty 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!

This post was originally published on the RCGP website.