Public Health and Primary Care Public Health and Primary Care

Public Health and Primary Care Rotation at Norwich Medical School

This rotation for three F2s each year includes two posts of 4 months each in academic public health, and one of 4 months in academic primary care.

Public Health and Health Services Research Theme

The Theme has four groups (Primary Care and Health Services, Epidemiology & Public Health, Health Economics and the Clinical Trials Unit). It also includes the NIHR Research Design Service for East of England and Health Economics Consulting.

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, including shared decision making and the analysis of primary care data, and the organisation of care and management of long term conditions. Conditions of interest include diabetes, cardiovascular risk factors, smoking and addiction, musculoskeletal disease, HIV, tuberculosis, and respiratory disease. Much of our research entails investigating, or trying to change, the behaviour of members of the general population, patients, professionals and organisations.

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 collaborate on the Global Burden of Disease study, and on large cohort studies such as the English Longitudinal Study of Ageing. 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.

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 Primary Care and Health Services Research Group. 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

Supervision

The public health F2 post holder will work with Professors Nick Steel or Max Bachmann, often under the supervision of a research fellow, public health lecturer, or academic clinical fellow. The primary care F2 post holder will work with Professor Amanda Howe, with day to day supervision from Dr Jamie Dalrymple.

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 from previous F2 post-holders

Previous work undertaken by UEA F2’s 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 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:

Publications:

  • Steel N, Fleetcroft R, Hassan Y. Prescribing statins in general practice: who decides? British Journal of General Practice 2017; 67 (659): 246-247; doi: 10.3399/bjgp17X690953
  • Hassan Y, Ford J, Steel N, Sheldon J, Fleetcroft R. Why are statin prescribing guidelines for primary prevention not always followed in primary care? British Journal of General Practice 2016 Sep; 66 (651): 536-537; doi: 10.3399/bjgp16X687481
  • Verma P, Ford J, Stuart A, Howe A, Everington S, Steel N. A systematic review of strategies to recruit and retain primary care doctors. BMC Health Services Research 2016; doi: 10.1186/s12913-016-1370-1 (http://rdcu.be/wBRy)
  • 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
  • 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 Behavioural Therapy preparation for alcohol detoxification. Journal of Substance Use, online from Nov 2014 (doi: 10.3109/14659891.2014.894590)
  • 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

Conference Presentations:

  • Parry L, Steel N, Ford J. Slowing of life expectancy in the UK: Global Burden of Disease Study 2016. Accepted for The Lancet Public Health Conference 2018
  • Koopmans I, Ford J, Steel N. Risks of skin cancer in older adults: analysis of the English Longitudinal Study of Ageing. The Lancet 2017;390:S54; doi: 10.1016/S0140-6736(17)32989-6
  • 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