OnOn 28 September 2017, I attended the Annual Institute of Global Health Innovation Lecture: Artificial General Intelligence and Healthcare, delivered by Dr Demis Hassabis, co-founder and CEO of Google DeepMind. Artificial intelligence is the science of making machines smart argued Dr Hassabis, so how can we make it improve the healthcare sector? Dr Hassabis then went on to describe the work that DeepMind was carrying out in healthcare in areas such as organising information, deep learning to support the reporting of medical images (such as scans and pathology slides), and biomedical science. Dr Hassabis also discussed the challenges of applying techniques such as reinforcement learning in healthcare. He concluded that artificial intelligence has great scope for improving healthcare; for example, by prioritising the tasks that clinicians had to carry out and by providing decision support aids for both patients and doctors.
A study from my research group published in JRSM Open examined why some children do not attend their hospital outpatient appointments. The study found that the commonest reason for non-attendance is unawareness of the appointment due to incorrect contact details being held by the hospital. Potential strategies for reducing non-attendance at paediatric clinics include developing a confirmation or reminder system and improved communication with parents.
This popular study tour for Imperial MPH students is organised annually in collaboration with WHO Geneva. As part of the tour participants were introduced to the work of Médecins Sans Frontières, The UN High Commission for Refugees, the Red Cross, The UN, and WHO and its regional offices. MPH students have had the opportunity to meet with large numbers of senior colleagues in these key international organisations and learn about the nature of their work. The 3 day study tour was very busy, full of learning experience and fun.
The Annual Teachers’ Conference took place on Friday 9 June 2017 Celebrating the Student and Teacher Partnership. About 100 delegates joined together to network, offer peer support and learn through conversation, lectures and a series of workshops. A brief overview of the key themes and reflections from the day follows.
Dr Sonia Kumar, Director of Undergraduate Primary Care Education, opened by sharing a story of coming across an old man with a bike puncture while out with her husband. While her husband repaired the puncture they got to know a little of his life; how his wife had died and he now lived in sheltered accommodation with cycling being an important way for him to get out and about. Later that day Sonia was reflecting on how hearing his story had made her feel sad and sorry for his changed circumstances, whereas Dev, Sonia’s husband, had taken away a different impression – a wonderful life where he continued to be cared for, maintaining his independence and a lifelong hobby in the form of his bike. And so with teaching, sometimes the student – teacher agenda and perspective to a situation can be different and recognising this is key to a successful teaching partnership.
A Vision for the Future
Professor Val Wass spoke to the subject “Doctors Without Borders”, drawing on her life experience as a GP, medical school dean, RCGP International lead and recent publication on By choice – not by chance: supporting medical students to careers in general practice for NHS Health Education England. She highlighted four important barriers (Generation Gap, Societal Borders, Specialty Borders and Self-Knowledge) we need to recognise in how we deliver education to support students to flourish in their future.
Reflecting with students
The student prizes showcased a huge amount of creativity with videos, paintings, interviews allowing us all to reflect on how healthcare delivery and our own attitudes shape the patient experience. One sensed a huge injection of energy and inspiration into the room, affirming to the audience members their inner calling of ‘this is why I want to teach’, and lots of reflections for teachers of their own practice – a true teacher-student partnership. This creative animation by a pair of students who got to know a patient over a number of months as she navigated the NHS and her own identity is highly recommended.
Professor Salman Rawaf was appointed by WHO Europe as a member of the newly formed Advisory Group on Primary Health Care. The first meeting of all Members was attended by the Regional Director Dr Zsuzanna Jakab and Kazakhstan’s Minister of Health, Dr Alexey Tsoy. Professor Rawaf gave a presentation on integration of public health and primary care services and highlighted the role of Healthy Living Centres in the UK. He also described some possible models for the integration using the experience of countries around the globe. The WHO European Centre for Primary Health is leading the work across the 53 member states of WHO Europe.
This course was developed and run jointly between the Zagreb Institute of Culture of Health and the WHO Collaborating Centre, at the Centre for Advanced Academic Studies in Dubrovnik. More than 40 health professionals from across Croatia took part in this intensive course over 5 days. The modular format of the course allowed participants to choose the sessions which are relevant to their needs. The course was organised and led by Professor Rawaf from Imperial College London, and Professor Marijana Bras and Professor Velijko Dordevic of University of Zagreb. We plan to run the course annually at the Centre for Advanced Academic Studies.
This summer, the WHO Collaborating Centre delivered the well-established Advanced Leadership and Health Management course in London for delegations from China and the Gulf Region. The participants came from various health professional background with responsibilities to lead in their health systems.
Colleagues from China are mainly from hospital management, some from hospitals with over 4000 beds. The WHO Collaborating Centre Advanced Leadership and Management for healthcare course is a one-week intensive training addressed to health professionals. The content of the course is built around the WHO framework and aims to help participants become more successful leaders in complex knowledge-based health systems around the world.
Dr Andy McKeown, Co-Course Director (Year5 MB BS Course Lead) and Dr Shivani Tanna (Year 3 GP Course Lead) have both received President’s Awards for Excellence in Teaching for 2017. These awards follow three similar awards received by our academic GPs in 2016 and showcase the fantastic teaching being delivered by the Department of Primary Care and Public Health.
On Thursday 21 September 2017, our Master of Public Health (MPH) students presented their research projects. This was the last assessment for the 2016-17 course. We had a wide-range of presentations on very topical issues in global health and health policy.
- Overcoming Cost-Related Barriers to Universal Access for Key HIV Anti-Retroviral Medicines
- Barriers to and experiences of accessing maternity services in the UK: A qualitative study with migrant women
- Should the UK Reconsider its Childhood Varicella Vaccination Policy: A Review of Evidence from the European Union
- Association between maternal iron intake in pregnancy and offspring blood pressure – a longitudinal study with over 20 years of follow-up
- HPV Vaccination: Should the UK be adopting a gender-neutral policy?
- The impact of Pharmacist integration into Primary care teams on health systems indicators: A systematic review
- Type II Diabetes Prevention in the GCC: A Systematic Review
- Anal intercourse as a risk factor for HIV acquisition in heterosexual women: a systematic review and meta-analysis
- Alcohol-related violence in the borough of Southwark: exploring the effect of licensed premises
- eLearning in geriatrics education for medical undergraduates and professionals: A systematic review of the impact on knowledge, skills, attitudes and satisfaction
- Local Air Quality Management in the United Kingdom: Does the designation of Air Quality Management Areas result in a significant reduction in ambient air pollution?
- The impact of Indonesia tobacco control strategy on trends in cigarette smoking behaviour among Indonesian adults, 2007-2014
- Prevalence and correlates of water pipe tobacco smoking among adolescents in 57 countries
- Risk factors for Epstein-Barr Virus associated lymphomas in different global settings: A Systematic Review
- Relationship between annual cycles in healthcare and their impact on the ability of QI projects to make progress towards achieving their improvement goals
- Maternal occupation, anthropometry, and smoking as determinants of offspring risk of asthma and allergy
- Night-time use of screen-based media devices: Relationships with adolescents’ sleep hygiene and health-related quality of life
- Affordability and illicit trade of cigarettes in the European Union: A cross-sectional analysis
- Are mHealth apps a trustworthy source for children and adolescents for health promotion? A systematic review and field study.
- DFID’s value for money framework: A practical approach for development assistance in health
- Exploring the acceptability of repeat whole-school national child measurements amongst those receiving and supporting delivery of the programme
- “When the Dust Settles”: A qualitative study of the factors that constitute type 1 context under the MUSIQ framework in quality improvement and implementation science projects
- Improving diagnosis and management of atrial fibrillation in Hounslow: an evaluation of a quality improvement initiative in primary care
- A longitudinal analysis of changes in weight status of primary school aged children
- A study of association between growth rate and body composition at term in extreme preterm infants
- An assessment of impact of national HIV – related policies on access to antiretroviral treatment (ART) in Ukraine
- The interface between elements of telehealth intervention and the context: A narrative review countries.
- To generate understanding of parental choice in NHS services utilization for children under five in Hammersmith and Fulham borough
- Investigating the implementation process of preventative surgical site infections care bundles: a theory-driven evaluation
- Factors Influencing Infant Feeding Choices of HIV-infected Mothers in Botswana
- Risk factors for severe respiratory syncytial virus (RSV) infection in children
- Generic statins adoption and determinants in Finland’s evidence from 11 years national data
- Associations between psychological distress, HIV infection and use of HIV care services in East Zimbabwe between 2009 – 2013
- The prescribing patterns of prescription drugs: a 4-year observational study
- Out of cold chain Hepatitis B birth dose vaccination in the Asia-Pacific Region: Meta-analysis of evidence for effectiveness and qualitative synthesis of barriers to implementation
- Reviewing the association between ethnicity and paediatric health outcomes in the UK’s acute hospitals: a systematic review
- The association of bus subsidy cuts with bus use, active travel and regular walking among adults in England
- Genome-wide association reveals that common genetic variation in plasma BCAAs levels are associated with type 2 diabetes
- Diet, body size, physical activity and risk of colorectal cancer: an umbrella review of the literature evidence
- Latent tuberculosis infection screening of adult close contacts in London: a cost-utility analysis
- The association between glycaemic control and tuberculosis in diabetes (skype)
- Temporal changes in ethnic composition and cardiovascular disease rates in London
- The effectiveness of childhood varicella vaccination: a systematic review
- The health impacts of drought in the OECD: a systematic review
- Empagliflozin: systematic review of economic evaluations and a costing analysis
- The role of technology in integrated care for the elderly: a scoping review
- Assessing the informal healthcare sector regarding traditional birth attendants – How global recommendations influence functionality and practice
- Small for Gestational Age (SGA): using routine data to calculate gestational age specific birth weight reference for 10th centile for sex and ethnicity
- Safety issues in the introduction of mass treatment for HIV; pharmacovigilance for darunavir in adults and dolutegravir in pregnant Women.
- Self-reported antibiotic use, non-prescription antibiotic use and antimicrobial resistance in the European Union
- Piperonyl butoxide treated long lasting insecticide nets: a case for comparative effectiveness in vector tool evaluation
- Will the NHS be paperless by 2020? A mixed methods evaluation.
- Neutrophil counts and cancer prognosis: an umbrella review and meta-analysis
In a letter published in the British Medical Journal, I respond to comments from Dr David Shepherd and Dr Hendrik Beerstecher about an editorial I wrote on shortages of general practitioners in the NHS. Dr Shepherd argues that capitation-based funding for general practice can work if the total amount of funding was increase and better methods were used to allocate funds to general practices. Dr Beerstecher argues that there is a mismatch between the supply of general practitioners and demand for their services.
In my response, I state that that increasing the amount of funding for primary care would be a step forward. Moving from the current Carr-Hill formula for allocating budgets to general practices to a formula with more patient level clinical data would also be helpful. But case mix adjusted formulas such as the Johns Hopkins adjusted clinical groups (ACG) system have limitations—particularly when used for smaller populations such as those covered by the typical NHS general practice.
Furthermore, an entirely capitation based formula would not prevent the shift of unfunded work from specialist care to primary care, which is one of the major problems currently facing general practices and one that clinical commissioning groups in England seem unwilling or unable to tackle.
I agree with Dr Beerstecher about the mismatch between the supply of GPs in the NHS and demands for their services. I allude to this when I state that GP services might need to be scaled back to fit the public funding available. Demands on GPs could be reduced if practices had a more tightly defined contract with the NHS.
The current GP contract is vague and open ended, setting few limits on the quantity or range of services that GPs are expected to offer the NHS and their patients. Furthermore, government policy in recent years has been to encourage GPs to offer even more services and make themselves more available to patients—for example, by requiring GPs to open their practice for longer hours without a substantial increase in the GP workforce. These policies have led to higher demands on primary care.
GPs are also faced with patients expecting them to fill gaps in local health services. For example, patients with dental problems often present (inappropriately) to their GPs because of problems accessing dental services. These are all problems that need to be tackled by NHS commissioners.