Imperial College London Primary Care

Dr Elizabeth Muir has accepted an appointment to lead a programme of work supporting Imperial College's School of Medicine’s ‘Year of Feedback’. The purpose of this project is to identify and deliver improvements to the feedback provided to our students throughout the undergraduate Medicine programmes. Dr Muir is a Clinical Senior Lecturer in the Department of Primary Care and Public Health and a General Practitioner. She is also Theme Leader for Foundations of Clinical Practice and co-leads the Problem Based Learning teaching.

As part of the forthcoming Dermatology GP course for fifth year medical students a Imperial College London, we have developed an exciting and innovative workshop with the aim of improving students’ observation skills in dermatology using arts-based teaching. Dr Jamila Sherif gives an update on the aims of the workshop. The arts can help us to slow perception, learn to look closely at the whole picture and see things anew. It is collaboration between arts-educators and medical educators, which in itself give rise to mutual learning and unique insights. An arts-based approach to teach clinical observation skills has been integrated into some US medical schools for over a decade. A literature review identified papers that have evaluated student learning though art and proposed systematic observation of paintings can be used to aid development of visual observation skills. We have drawn on and developed this work, trying to design a session that focuses not only on visual but tactile ...

Dr Beena Gohil Winner of the 2014 Year 5 GP Teacher of the Year Award gives her views about teaching medical students in Primary Care. Introduction I have been a GP since 2002 (following several years of indecision where I did a couple of years of hospital medicine, followed by anaesthetics before realising where I actually wanted to be!). I have always practised in the Ealing area of London, and have been in the same practice since 2002. What inspired you to start teaching? I was inspired to start teaching after hearing feedback from other teachers about how rewarding teaching medical students could be. How does teaching fit in with your clinical practice? Teaching year 5 students fits in reasonably well, as I ensure that I have blocks within the clinic session for whoever is teaching them, ensuring that the student has time to discuss the patient they have seen and to then discuss diagnoses and management. We discuss their timetable on day 1 and try to ensure that any outst...

Medical student Nell Freeman from Imperial College London describes how the third year of the medical course can be tough for students and how the GP who was her Clinical Methods Teacher was a role model to her and taught her much more than just clinical history and examination techniques. "I hadn’t anticipated the emotional challenge of medicine. I found – narcissistically – that patients I could closely identify with, I carried home with me. I didn't quite know what to do with these emotions.  I watched my GP teachers, some of whom had relationships with their patients for more than 20 years, being able to professionally help them navigate their health challenges while still maintaining a very personal, human connection with them, but then being able to close the door and open it again to a new patient. Our teacher let us debrief about our experiences and discuss these challenges. I think the challenge of the third year at Imperial College is learning to accept how ...

Senior GP Teaching Fellow Dr Graham Easton from the Department of Primary Care and Public Health  at Imperial College London recently visited Ghana on behalf of the BBC World Service to host a debate on whether failed health systems in Africa make global epidemics - such as the recent Ebola outbreak - inevitable. The debate explores why the Ebola outbreak was able to spread so extensively, and look at wider lessons to be learnt about containing local epidemics in today’s globalised world. Summary of debate BBC iPlayer Recording - available for a limited period

Coaching for Health Project Launch Event The Department of Primary Care and Public Health at Imperial College has received funding from HENWL for an educational project which involves Year 3 medical and nursing undergraduate students jointly overseeing a caseload of patients with chronic conditions at high risk of hospital admission in the community. Students will be given health coaching skills which is new to the undergraduate curriculum. On the 12 th and 13 th of September 2014 the project was launched. Year 3 medical undergraduates on the MB BS course at Imperial College and Bucks nursing students were trained in health coaching skills. Evaluation of the project will be looking at the value of undergraduate interprofessional learning and whether health coaching can promote patient enablement. We had a very sunny day and students could practice their coaching skills in the sun.   We did some small group work where students could meet their GPs and ...

Andre Kubler PhD, a Final Year Medical Student at Imperial College London, describes how his academic placement in general practice changed his views about primary care "GP-negativity’ is a common condition, characterized by a lack of respect for general practice and its practitioners. It results largely from the media’s portrayal of GPs as ‘money-grabbing, cancer-missing, part-time doctors’. Medical students are at particular risk of developing this condition because they spend the majority of their time with authoritative hospital physicians that criticize their generalist colleagues. I was ‘GP-negative’ but my 3-week rotation in general practice cured me. I was healed through professional treatment: I was welcomed to the practice and introduced to each member. I was given access to online notes, and invited to meetings. I was told to prepare for my clinics, asked my opinions and welcomed to over-booked clinics. I was treated as a member of the practice; and for the fi...

On 1st September 2014, Professor Ala Alwan, the WHO Regional Director for the Eastern Mediterranean visited the Department of Primary Care and Public Health at Imperial College London. Before taking up his current post in February 2012, Professor Alwan was WHO Assistant Director-General for Non-Communicable Diseases and Mental Health. We discussed a range of topics, including health system development, training of health professionals, and supporting the prevention, early diagnosis and management of conditions such as diabetes. The Department of Primary Care and Public Health and our WHO Collaborating Centre for Public Health Education and Training will be supporting a conference on primary care in the Eastern Mediterranean Region to be held in Cairo, Egypt in November to take forwards this proposed work. 

A cross-sectional survey published in BMJ Open found poor infant feeding practices in a rural county, Zhao County, in Hebei Province, China. Early initiation of breastfeeding was only 22.4%, exclusive breastfeeding for 6 months was less than 10% and continued breastfeeding up to the age of two was just 38.2%. Only 32.5% of children were given iron-rich or iron-fortified foods. The leading sources of infant feeding information were family members, neighbours, friends and popular media. Only around 20% of the information came from health facilities and nearly none came from communities. Household property data showed that 99.9% of households owned televisions and 99.4% owned mobile phones. In addition, 61.2% of the households owned computers, with 54.8% having access to the internet. The authors concluded that few caregivers of children in Zhao County received feeding information during pregnancy and after delivery. Moreover, their feeding knowledge and practices were poor. Mul...

On Friday 13 June 2014, Imperial College London held its Annual GP Teachers Conference, organised by the Department of Primary Care & Public Health. We had some distinguished speakers including Dr Roger Neighbour and Dr Martin Lupton. There were also a range of workshops. The event was attended by over 100 GPs from across the UK. The winners of our 2014 Teaching Prizes were also announced at the event. Dr Anju Verma and Dr Caroline Collins, GP Teaching Fellows, at the start of the day  Dr Jo Harris and Dr Sonia Kumar discussing their plans for the day The delegates waiting for the start of the conferenc Dr Graham Easton discussing the highlights of the morning session over lunch A poster on our new case management project Some of the pictures taken by our students in their Year 6 placements  A health education poster designed by our students Dr Martin Lupton speaking about the medical school's plans for undergraduate education ...

The Department of Primary Care and Public Health at Imperial College London hosted visit today from a senior delegation from the Ministry of Health in the Republic of Kazakhstan. The aim of the visit was to brief the delegation about primary health care in the UK, including the education of medical students and the training of primary care physicians (general practitioners). We had a stimulating discussion about whether some aspects of primary care in the UK could be used in Kazakhstan. Among the speakers from the department wee Professor Azeem Majeed, Dr Sonia Kumar, Dr Sami Hasan, Dr Graham Easton and Professor Salman Rawaf. The delegation from Kazakhstan was accompanied by Professor Rory Shaw, the Medical Director of UK Trade and Investment.

Congratulations to all the winners of our 2014 Undergraduate Medical Student and GP Teacher prizes. STUDENT PRIZES Year 1 Essay Prize: David Kockerling Year 5 North West Thames Provost Prize Patient Project Prize: Joseph Barker Year 6 Adam Snape Audit Prize: Harriet Davidson and Frances Dixon Year 6 Grant Blair Portfolio Prize: T hulasi Naveenam and Sarah Morton GP TEACHER PRIZES Year 1: Dr Tanya Carthy Year 3: Dr Paul Reynolds Year 5: Dr Elizabeth Pearson and Dr Beena Gohil Year 6: Dr Reshma Rasheed and Dr David Lukey Best New Teacher: Dr Siobhan Steel COMMENTS ON STUDENTS Year 5 North West Thames Provost Prize "An incredibly thorough researched review of a patientwith complex medical problems by Joseph Barker. He identified practical, achievable areas of improvement to patient care that could be actioned, as well as a mature patient centred approach in his application of guidelines and consideration of both the patient and carer's needs. Upo...

The Undergraduate GP Teaching Unit in the Department of Primary Care & Public Health at Imperial College London has been discussing the issue of patient consent in consultations where medical students are present. This has come about as a recommendation from the CQC to have written consent for an observer to be present in the consultation. All Imperial College GP teachers are sent our approved consent documents at the start of a GP student placement. This includes a poster for the waiting room, a patient information leaflet and a patient consent form. We have liaised with other medical schools in thinking about how to approach the issue of consent. The majority view is that written consent on every patient would be unnecessary and cumbersome in terms of paperwork. We do though have consent forms if you wish to use these for now and if the CQC does insist that they become a mandatory requirement when medical students are present during a consultation. The minimum requirements t...

The Dr Foster Unit (DFU) in the Department of Primary Care & Public Health has received funding for two exciting new projects. The first is a one-year NIHR funded project for £100,000 which will quantify the risk of non-obstetric surgery during pregnancy, allowing mothers, surgeons and anaesthetists to make better informed decisions and provide answers to questions regarding the risks involved. The second grant is also from the NIHR. This two-year grant of nearly £650,000 aims to improve the understanding of the Unit’s national hospital mortality surveillance system. It involves evaluating the impact of the alerts in reducing avoidable mortality within English NHS hospitals. Dr Rajvinder has joined the Centre for Patient Safety stream of the Unit. Her work involves developing and piloting patient safety indicators in primary care.

Dr Elizabeth Pearson from the the Fulham Medical Centre gives her perspectives on teaching medical students  I have been a partner for 10 years in a small practice with 7,000 patients in Fulham. I started undergraduate teaching almost as soon as I qualified as I felt that students get such a short time in general practice and wanted to be part of making it a positive experience. What inspired you to start teaching? We all remember a good teacher and when I was training at the Royal Free I had a fantastic placement with a GP in Yorkshire. Even though it was only for 3 weeks it made me change my career choice from surgeon to GP! While working in the hospitals I got fed up with doctors speaking down to GPs and complaining about them referring everything etc. Some of my friends went into General Practice as they couldn't be bothered to stick at hospital work which really irritated me as I never saw it is as a negative fall-back option but a positive career choice which can be re...

Dr Sonia Kumar, Director of Undergraduate Primary Care Education at Imperial College London, has secured a grant from Health Education North West London (HENWL) to fund an innovative one year pilot teaching project. The Community Provider Network (CPN) project involves pairing thirty medical students with thirty nursing students, in primary care, to oversee the management of a group of patients with chronic conditions at high risk of emergency hospital admission. The aims are to use health coaching by nursing and medical students to improve health outcomes in these patients, optimise their management in primary care settings, and reduce the burden on acute services. We will recruit 20 to 30 practices for this CPN pilot and practices would host a pair of students for up to 6 months. Students will be assigned 4 to 6 patients with chronic problems at high risk of complications and of using acute services. Students will visit each patient about once a week and GPs would guide studen...

Imperial College London now has an Undergraduate General Practice Society. With the existence of multiple other medical specialty societies, as well as an active, high-achieving Primary Care Department, the need for a General Practice society was clear to medical students, to ensure more Imperial College medical students consider General Practice as a career. Operating under the name ICGPS (or ‘GPsoc’ as they like to be called), the society is a group of enthusiastic medical students. Working with the Department of Primary Care, ICGPS aims to host events as well as inform members of relevant external events. The society held its first event on 26 March 2014. Further information about the society can be found on its Facebook Page . If you have any suggestions for events, or would like ICGPS to advertise relevant events, please contact: gp.careers@ic.ac.uk . The ICGPS Committee comprises Josephine Emmanuel, Shanil Shivji, Alexis Nelson, Mouni Islam, Tobi Obisanya.

A planned study in China will aim to assess the effectiveness of a smart phone-based app (Expanded Program on Immunization app, or EPI app) on improving the coverage of children's immunization. Although good progress has been achieved in expanding immunization of children in China, disparities exist across different provinces. Information gaps both from the service supply and demand sides hinder timely vaccination of children in rural areas. The rapid development of mobile health technology (mHealth) provides unprecedented opportunities for improving health services and reaching underserved populations. However, there is a lack of literature that rigorously evaluates the impact of mHealth interventions on immunization coverage as well as the usability and feasibility of smart phone applications (apps).  This cluster randomized trial will take place in Xuanhan County, Sichuan Province, China. Functionalities of the app include the following: to make appointments automatica...

On 17 March 2014, Dr Matthew Harris (Clinical Lecturer) gave a keynote presentation on the UK primary care system and NHS structure and governance at Windsor Castle to a high level delegation of Brazilian State Secretaries for Health at the invitation of UKTI, Healthcare UK and the Department of Health. The symposium was attended by Jane Ellison MP, Parliamentary Under Secretary for Public Health, Nick Tomlinson Department of Health International Division, and Howard Lyons Director of Healthcare UK.

There has been much discussion recently regarding banning smoking inside cars carrying children, in the lead up to MPs voting to legislate against it by 376 to 107 votes. The decision comes after recommendation of the move by the Royal College of Physicians and a letter in the British Medical Journal signed by 584 physicians calling for a ban.   The vote by MPs allows, but does not require, ministers to bring in the ban, and the shadow health minister has called on minsters not to delay in implementing the move. The move has predictably been opposed by organisations such as the tobacco industry funded Freedom Organisation for the Right to Enjoy Smoking Tobacco and the move is apparently opposed by the Deputy Prime Minister . However, in addition to the well-publicised health benefits , the move will also reduce health inequalities.  Analysis of the Smoking, Drinking and Drug Use Survey of 11 to 15 year olds surveyed in 2012 found that overall 37.0% of these children ...

Thomas Cowling from the Department of Primary Care & Public Health at Imperial College London won the Early Career Researcher Award at the 2014 South-East England Regional Society of Academic Primary Care (SAPC) Meeting. The meeting was held at Madingley Hall near Cambridge from January 30-31. Tom's research was funded by the National Institute for Health Research (NIHR) and is part of his Doctoral Research Training Fellowship. Tom's presentation was "Access to General Practice and Attendances at A&E Departments in England". The picture to the left shows Tom receiving his award from Professor David Mant from the University of Oxford.

Dr Matthew Harris, Clinical Lecturer in Public Health, has been successful in his application for a 2014-15 Harkness Fellowship in Health Care Policy and Practice. Dr Harris will be based at New York University for the duration of his fellowship. 

Recent research using the Health Survey for England has estimated that 5.4% of the adult English population, or 2.1 million people, are eligible for bariatric surgery . The surgery is often the last resort for people who have attempted to lose weight in other ways and who are dangerously obese.  People with a Body Mass Index (BMI) of 40 or above are eligible , as are people with a BMI of between 35 and 40 who have a condition which would be improved if they lost weight. These conditions include problems such as diabetes and high blood pressure, as well as arthritis and coronary heart disease. The paper found that about 4% of the population have a BMI between 35 and 40, and have one of these conditions, while another 1.4% people have a BMI of over 40. The surgery is known to be more effective in terms of losing weight than other strategies but the numbers of people undergoing it are far lower than this estimate of the numbers eligible. Although they have been rising rapidl...

Dr Jo Harris has been appointed as the Deputy Director in Primary Care Education in the Department Primary Care & Public Health at Imperial College London. Dr Harris comments on her new role: " I am excited to be taking on the post of Deputy Director in Primary Care Education at Imperial College London, although quite daunted to be filling the shoes of Graham Easton who has been ably performing the role for the last three years. I am a general practitioner in Hammersmith and although quite new to the department I have been teaching Imperial students for 15 years. In fact I attended this medical school as a student myself so the Reynolds Building has felt like home longer than I care to remember! I am also Deputy Head of the Final Year Undergraduate Teaching at Imperial College London and together with roles in clinical communication and admissions, feel ideally placed to link the work of the Department of Primary Care with the medical school as a whole. I have recently ...

We recently ran a competition for the medical students to tell us about their top medical role models in 3 minutes. The competition was overseen by Dr Ros Herbert, GP Teaching Fellow in the Department of Primary Care & Public Health. We had videos, poems and drawings and we were incredibly impressed by the creativity of the entries. The winners were Megan Hutchingson, Lottie Whittington, Graeme Downes, Alexandra Ho and Nell Freeman. Two of the students wrote about inspirational GPs. Nell Freeman wrote about Dr Rachel Baggley, a GP who does a lot of international HIV work. "Dr Rachel Baggley is my medical role model. I met her when she was head of HIV programmes at Christian Aid and often travelling back and forth to Zimbabwe, DRC, and other conflict zones and areas of great need. She was known throughout the organization (and beyond) as someone passionate, hugely committed and KIND. She made great efforts to give younger people career opportunities that they might never h...

Medical Students’ attitudes towards General Practice and factors affecting career choice: a questionnaire study. GPs are not being recruited at rates necessary to sustain the GP workforce in England. Few newly qualified doctors specify that they want to be GPs and many choose the career late after considering other hospital specialities. The aims of this research project, which is being carried out by Dr Mydhili Chellappahy (GP Teaching Fellow), are to determine current medical students’ attitudes towards a career general practice and to identify influences on career choice and challenges to general practice recruitment. Students were recruited from all years at Imperial College Medical School. An online anonymous survey was set up and participants followed a web link to access the survey. Participants responded to a series of statements about general practice and career choice, using a Likert scale to show their degree agreement with each statement. There was also a free text opt...

The current issue of the “Journal of Global Health” features a series on mHealth (the use of  mobile devices in healthcare) . mHealth  has the potential to play an important role in low– and middle–income countries in a wide range of areas. A particular area with great potential to improve global health is using mHealth for data collection. New ideas for mHealth implementation  in this area are to validate and conduct household surveys, to monitor large–scale programs, and to measure the global burden of disease.  The first article in the mHealth Series includes the aims and objectives of an mHealth project, the field site in China, and the detailed methods of two studies.  In the second article , a conceptual model for measuring maternal, newborn and child health coverage by text messaging in China is proposed.  In the third article , the feasibility of using text messaging to collect information on infant and young child feeding practice in rural Chi...