Public Health and Primary Care Public Health and Primary Care

Department of Population Health and Primary Care

The Department has four groups (Primary Care, Health Evidence, Health Economics, Epidemiology and Medical Statistics). It also includes the NIHR Research Design Service for East of England and Health Economics Consulting, and is deeply involved in the Norwich Clinical Research and Trials Unit based in Norwich Medical School and the Norfolk and Norwich University Hospital. Max Bachmann is the head of department.

Our research typically involves members of several groups, combining state-of-the art research methods with expert knowledge in several clinical, public health and health service fields. In our research collaborations beyond the department we provide methodological expertise, especially in interdisciplinary health services research, health economics, clinical trials, clinical epidemiology and medical statistics. Our research addresses a wide range of clinical, health service and public health problems. We have particular strengths in research on the organisation and delivery of primary health care, diabetes, cardiovascular risk factors, obesity, smoking and addiction, musculoskeletal disease, HIV, tuberculosis, respiratory disease, mental health and diagnostic screening. Much of our research entails investigating, or trying to change, the behaviour of members of the general population, patients, professionals and organisations.

The Department currently has over £14 million in external research funding. We lead or collaborate on many clinical trials, with an emphasis on large scale pragmatic trials of complex health care interventions, often based in primary care, and usually including economic and qualitative research components. We also carry out evidence synthesis and meta-analytic studies which, in addition to influencing health policy and clinical practice, help identify gaps in current knowledge and priorities in future research.

Public Health and Primary Care Rotation

This rotation for three F2s each year includes two posts of 4 months each in academic primary care, and one of 4 months in academic public health. All posts will include one clinical day per week with Dr Young and partners in North Walsham. This incorporation of a clinical component means that the F2 has exposure to general practice as well as academic public health/primary care, and will be able to maintain their clinical skills during this placement.

Key research knowledge and skills covered:

  • basic study design and critical appraisal

  • literature searching and review writing

  • basic data handling and statistical methods

  • report writing

The application of knowledge and skills is demonstrated as follows:

  • You will undertake approximately two projects during your placement. These projects may include the opportunity to undertake literature review tasks, systematic review, data analysis, and report writing. In general, these will involve attaching the F2 to on-going studies undertaken within the Population Health and Primary Care Group’s research team. The aim is to complete 1-2 reports of which at least one should be prepared for publication and one for a conference presentation.

  • You will participate in the monthly Journal Club in association with the Norfolk NHS Public Health F2. You would be expected to present at least once at this journal club.

  • Presentation of work undertaken to the Regional Public Health F2 group (this group meets monthly for a half-day training session in Cambridge).

  • Teaching on our innovative MB BS programme, as follows (all delivered after suitable training):

  • Acting as a PBL tutor on our undergraduate programme for one rotation (8 half-day sessions) or working as a Consultation Skills tutor

  • Potential to undertake clinical skills teaching work – including prescribing seminars, or Clinical Case Based Discussions (so-called ‘long-case teaching) with year 3-4 Undergraduate students

  • Potential to undertake research methods seminars to approximately 30-40 students; all material is pre-planned by the research methods team and covers:

    • literature searching

    • descriptive statistics
      [note this teaching is designed to consolidate your own learning in these areas]

  • assessment experience, in particular as an OSCE assessor

Primary Care Post

Our research combines clinical, epidemiological and social sciences to extend knowledge that addresses the core challenges of primary care. Our interests are in health and ill-health in the context of people’s wider lives, using quantitative and qualitative research methods at the level of both individual patients and populations. Some current research areas are: the epidemiology of receipt of health care by older adults in the English Longitudinal Study of Ageing, access to primary health care and reducing hospital admissions, and the relevance of NICE guidelines to primary care.

You will be supervised by a member of our group, normally Dr Nick Steel or Dr Bob Fleetcroft, and will contribute to a research project in the department, working with our clinical and social science academics, NIHR Doctoral Fellow (Dr John Ford), Academic Clinical Fellows, and GP Research Fellows. We have strong links with the local NHS and there are opportunities to evaluate, present and publish interventions, with recent examples being referral management, case management, and obesity services.

Examples of work undertaken & outputs from previous F2 post-holders

Conference Presentations:

  • Verma P*, Stuart A, Howe A, Everington S, Steel N. Strategies to recruit and retain general practitioners. Society for Academic Primary Care, July 2015, Oxford (F2 awarded ‘best newcomer’)

  • Cheema K, Hardcastle A, Fleetcroft R, Steel N*. Meta-analysis of the estimated placebo effect in primary prevention of cardiovascular mortality. Society for Academic Primary Care, July 2014, Edinburgh

  • MacKay JW, Steel N, Fleetcroft R ‘What is the relationship between absolute risk of cardiovascular disease and benefit from statin therapy?’ Society for Academic Primary Care 2012

Peer-Reviewed Publications:

  • Jennings A, Hughes C, Kumaravel B, Bachmann M, Steel N, Capehorn M, Kamalpreet C. Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care. Clinical Obesity 2014;4:254-66; doi: 10.1111/cob.12066

  • Vedavanam S, Steel N, Broadbent J, Maisey S, Howe A. Recorded quality of care for depression in general practice - an observational study. British Journal of General Practice 2009;59:94-98

Book Chapters:

  • Karaczun M, Abdelhamid A, Maisey S, Steel N. The Quality of Asthma Care within Primary Care. In Martin C, Preedy V (eds) Scientific Basis of Healthcare Asthma. Enfield, New Hampshire: Science Publishers, 2012

Public Health Post

The public health F2 appointment will work with Professor Richard Holland under day-to-day supervision of his Research Fellow (Dr Caitlin Notley), or one of our Public health lecturers or Academic Clinical Fellows. Our team’s work includes clinical trials, systematic reviews, and economic evaluation particularly in Pharmacy Practice and Substance misuse.  In addition, training and experience is provided in NHS public health.  The team’s recent projects include a £2m NIHR programme grant investigating development of Pharmacist prescribing in Care Homes, qualitative work related to smoking cessation, and needs assessment and evaluation work with Norfolk Constabulary.

Key public health skills covered:

  • Health needs assessment

  • Health protection and communicable disease (up to 5 days with Health Protection Unit)

  • Health promotion (e.g. opportunity for experience with the smoking cessation team or work with the Public Health team at Norfolk County Council, if desired).

Examples of work undertaken & outputs

Previous work undertaken by UEA F2’s in public health has included analysis of data from RCTs, cross-sectional studies, and health needs assessment work. Work has encompassed topics in heart Failure, osteoporosis, substance misuse, and most recently work with those in police custody. Previous F2s have used both quantitative and qualitative research methods and have succeeded in gaining publications or conference abstracts from their attachments:

  • Holland, R., Rechel, B., Stepien, K., Harvey, I., and Brooksby, I. Patients' self-assessed functional status in heart failure by New York Heart Association class: a prognostic predictor of hospitalizations, quality of life and death. J Card Fail, 16: 150-6.

  • Kidd A, Honney K, Myint P, Holland R, Bowker L. Does medical futility matter in ‘do not attempt CPR’ decision-making? IJCP 2014 Volume 68, Issue 10, pages 1190–1192, October 2014

  • Croxford A, Notley C, Maskrey V, Holland R, Kouimtsidis C. An exploratory qualitative study seeking participant views evaluating group Cognitive BehaviouralTherapy preparation for alcohol detoxification.  Journal of Substance Use, online from Nov 2014 (doi: 10.3109/14659891.2014.894590)