Lindsey Davies: Q&A - Royal College of Physicians

Interviews Features News Events 

June 2011 

Membership magazine of the Royal College of Physicians 

Lindsey 

Davies 

Public health is on the agenda 

– we speak to the president of 

the Faculty of Public Health 

The nudge theory 

Can behavioural insights 

promote healthier lifestyles and 

reduce health inequalities

Commentary Community 

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Read our officer columns online 

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Log in to the RCP website and access 

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Community offers fellows and members news, features and regular updates from RCP 

officers, committees, and from the regions. Exclusive features are also published online for 

RCP fellows and members. This month read international sponsorship scheme prize winner 

Dr Manoji Gunathilake’s experiences of working in the UK. 

Commentary Community allows you to directly comment on news stories, 

lead features and columns to share your views with the RCP and other fellows and 

members. Log in to the RCP website and have your say on what we are doing right now. 

Read our full interview with Professor Lindsey Davies online 

‘I should have said at the start that a lot of people don’t understand what public health 

really is and that is important to get in mind. Some people have the mistaken opinion 

that public health is all about prevention, which is partly true, but it is by no means 

completely right. Public health is the science and art of improving health...’ 

Professor Lindsey Davies, president of the Faculty of Public Health

Contents 

Commentary 

Membership magazine of the Royal College of Physicians 

Olympic doctors 

Commentary counts down to the 

London 2012 Olympic Games 

18 

Editor in chief 

Professor Robert Allan 

Editor 

Emma Tennant 

Associate editor 

Dr Venkat Mahadevan 

Head of publications 

Orla Fee 

Managing editor (serials) 

Dail Maudsley 

Production 

Suzanne Fuzzey 

Designer 

James Partridge 

Artwork 

Bill McConkey 

Display sales 

Ben Nelmes 

ben.nelmes@redactive.co.uk 

Recruitment sales 

Giorgio Romano 

giorgio.romano@redactive.co.uk 

Articles published in Commentary 

reflect the opinions of the authors and 

do not necessarily represent the view 

of the Royal College of Physicians 

Images©Royal College of 

Physicians unless otherwise stated. 

Cover image©Jonathan Perugia 

4 President’s message 

5 News&views 

Features 

10 Lindsey Davies: Q&A 

Commentary speaks to Professor 

Lindsey Davies, president of the 

Faculty of Public Health 

14 In focus: public health 

A public health doctor, a GP and 

a consultant physician give their 

views on public health 

Regulars 

22 Olympian plants 

A look at the use of plants in the 

ancient Olympics 

23 Re-framing disability 

A retrospective look at the RCP’s 

exhibition on disability 

24 2012 fellowship 

nominations 

Find out how to become a fellow 

of the RCP 

25 Letters to the editor 

26 Events diary 

28 Education 

16 

5 

Write to us 

If you would like to respond to 

any of the articles featured in 

Commentary, or share your views 

on RCP matters, please write to: 

Professor Robert Allan, Commentary 

11 St Andrews Place, Regent’s Park, 

London NW1 4LE 

Publication at RCP discretion – your 

correspondence may be edited 

Commentary is published bi-monthly 

by the Royal College of Physicians 

Registered charity no 210508 

©Royal College of Physicians 

Printed by Warners (Midlands) Plc 

16 Putting the nudge 

in motion 

Commentary investigates 

behavioural insight to improve 

healthy lifestyles and reduce 

health inequalities 

18 Countdown to 

London 2012 

Dr Ian McCurdie talks Olympic 

athletes, working in the British 

Army, and ballet dancers in the 

first of our new series on the 

London 2012 Olympics 

14

President’s message 

Comment Write to us... 

Respond to any of the articles featured or share your views on 

RCP matters. Email us at: letters.commentary@rcplondon.ac.uk 

All eyes on public health 

‘This is an extremely important issue, and I am sure that you, like me, are 

frustrated at the seemingly inexorable rising tide of hospital admissions 

related to alcohol, tobacco, obesity and other public health harms’ 

Not a day goes by without 

major developments and 

changes in the proposed NHS 

reforms. Since I last wrote in 

Commentary, the landscape has changed 

considerably, and we are now part way 

through an unprecedented pause in the 

Health and Social Care Bill to allow for the 

government’s ‘listening exercise’. 

The coalition’s ears on the ground 

materialised in the form of 44 health 

professionals brought together under 

the moniker of the ‘NHS Future Forum’. 

Professor Steve Field FRCP is chairing 

the Forum, and Kathy McClean FRCP is 

the Forum’s lead for clinical advice and 

leadership. In addition to submitting 

a written response to the Forum, we 

have welcomed both Steve and Kathy 

to a meeting at the RCP, while Forum 

representative and community pharmacist, 

Ash Soni, recently attended our West 

Midlands regional update. We put some 

of your questions about the reforms to 

Professor Steve Field and his responses 

can be read in the online Commentary 

Community: www.rcplondon.ac.uk/ 

commentary. 

As with so many areas of healthcare, 

it is clear in my mind that integration is 

key. As well as calling for the involvement 

of hospital clinicians in commissioning 

decisions, I strongly believe that public 

health experts must have a voice in how 

services are commissioned. The RCP has 

also recommended that secondary care 

specialists become a mandatory part 

Has the government put all of its eggs in the 

nudge theory basket, and shied away from 

regulation to persuade the public that the 

healthy option is the best option Page 16 

of local authority Health and Wellbeing 

Boards, and specifically involved in setting 

local priorities and in commenting on the 

extent to which consortia have reflected 

these priorities. 

In this issue of Commentary there is a 

focus on public health, and what the future 

holds for its provision. This is an extremely 

important issue, and I am sure that you, 

like me, are frustrated at the seemingly 

inexorable rising tide of hospital admissions 

related to alcohol, tobacco, obesity and 

other public health harms. If we are to 

‘As well as calling for the involvement of hospital 

clinicians in commissioning decisions, I strongly 

believe that public health experts must have a 

voice in how services are commissioned’ 

reduce healthcare costs in the future, we 

must improve the health of the nation – 

already the benefits of less smoking are 

showing through. 

In addition to the proposed new 

public health structure, the reforms have 

introduced an entirely new approach to 

tackling public health. The government 

has put all of its eggs in the nudge 

theory basket, and in doing so has shied 

away from regulation in favour of gently 

persuading the public that the healthy 

option is the best option. You can read what 

health experts really think to the efficacy 

of this new approach of less regulation and 

more behavioural insight on page 16. 

I appreciate that public health legislation 

may lead to headline-grabbing accusations 

of a ‘nanny state’, but I am unconvinced of 

the merits of ‘nudge’. As I said in a letter to 

Andrew Lansley, all improvements in public 

health, from John Snow and the Clean 

Air Act to the recent smoking legislation, 

have been achieved by legislation. For this 

reason, we and five other organisations 

decided not to sign up to the government’s 

responsibility deal – it could have done so 

much more! n 

Sir Richard Thompson 

President 

Read more... 

Three expert views 

on public health; p14 

Commentary asks the views of 

three experts – a public health 

doctor, a GP and a consultant – 

about the future of public health. 

You can read the full report online 

at Commentary Community and 

comment on their opinions: 

www.rcplondon.ac.uk/commentary 

4 Commentary n June 2011 n www.rcplondon.ac.uk

News 




News&views 

www.rcplondon.ac.uk/news 

RCP Lords’ Lunch 

President Sir Richard Thompson says quality 

should be at the heart of the Health Bill 

The RCP hosted its annual Lords’ Lunch on 1 April with guests 

including Baroness Northover, the government whip on the Health 

Bill, Baroness Thornton, opposition spokesperson on health, and 

Lord Turnberg, a former president of the RCP. Over 20 fellows and 

members discussed with RCP officers and staff current health policy 

issues affecting the RCP. 

First on the agenda were the government’s reforms to the health 

service in England. Sir Richard Thompson, RCP president, outlined 

the changes the RCP wants to the Bill: to put quality at its heart, 

to ensure secondary care clinicians are involved in commissioning, 

and to prevent fragmentation while ensuring integration. Dr 

Andrew Goddard, RCP medical workforce director, presented data 

on workforce and the government’s proposed reforms to medical 

education and training. Baroness Thornton later blogged: ‘On 

Friday a group of Peers, from across the House, had lunch with 

the Royal College of Physicians. I was particularly struck by the 

problems of workforce recruitment and training. If it takes 15 years 

to produce the best consultants how will that be achieved with the 

fragmentation of the Health Service that this legislation brings’ 

The RCP is continuing to work with these peers to positively influence 

government policy making. n 

Image©Shutterstock 

The RCP wants the Health Bill to be amended to ensure 

an integrated health service without fragmentation 

Get involved with the RCP’s plans 

for the London 2012 Olympic Games 


London 2012 at RCP 

Get involved with the London 2012 

Olympic Games at the RCP 

The RCP is planning a series of events to coincide with the 

London 2012 Olympics. We are asking fellows and members 

with a connection to the games or elite sports to get in 

touch to discuss ideas and see how you can get involved. 

In addition to a planned exhibition on human anatomy, 

suggestions have included a public walking or cycling tour 

between medical museums, an Olympic-themed open 

day, and a performance-enhancing drugs tour of the RCP 

Medicinal Garden. If you would like to get involved with the 

RCP’s Olympic plans or put forward an idea for an event, 

please get in touch at: policy@rcplondon.ac.uk. n 

www.rcplondon.ac.uk n June 2011 n Commentary 5

News 





The Bill takes a break 

‘Specialists and public health doctors must be involved at the highest level of governance 

in consortia’ says the RCP, as the Health and Social Care Bill takes a pause to ‘listen’ 

The NHS Future Forum, tasked with 

examining possible improvements to 

the Health and Social Care Bill, has been 

established by the prime minister, David 

Cameron, and the deputy prime minister, 

Nick Clegg, with the health secretary, 

Andrew Lansley. The forum is chaired by 

Professor Steve Field, past chair of the Royal 

College of General Practitioners. It will 

focus on four areas of reform: the role of 

choice and competition; accountability and 

patient and public involvement; training 

and the workforce; and the range of health 

professionals involved in commissioning 

decisions. The RCP will be engaging with 

the Future Forum throughout the Bill’s 

two-month pause and will respond to the 

official consultation at the end of May. 

The Bill left the Commons committee 

stage on 31 March after minimal, 

predominantly technical, amendments. 

There have been no changes to the ‘duty 

to obtain appropriate advice’ placed on 

consortia and the NHS Commissioning 

Board – an area of particular interest to 

the RCP. In terms of concessions, the most 

significant change relates to the tariff. 

There were also some small amendments 

to Monitor’s role. Four days after the Bill 

left the committee stage, Andrew Lansley 

announced that it would take a ‘natural 

break’, lasting two to three months, in 

its progress through parliament – an 

unusual step. David Cameron and Nick 

Clegg were enlisted, along with Andrew 

Lansley, to listen to concerns and explain 

reforms during this period, leading to the 

establishment of the Future Forum. The 

RCP has been fully engaged in this exercise 

and met the Future Forum on a number 

of occasions. 

One day after the pause in the passage 

of legislation was announced, the Health 

Select Committee published their followup 

inquiry report into commissioning. The 

report focuses on the proposed structural 

arrangements for commissioning under the 

reforms. Many of the recommendations 

reflect the RCP’s evidence submission, with 

key recommendations including: 

n Secondary legislation should require 

hospital doctors and nurses to sit on local 

commissioning bodies. 

n Public health specialists should sit on 

local commissioning bodies. 

n Local commissioning bodies should 

not be called GP consortia, but should 

be referred to as NHS commissioning 

authorities. 

The RCP’s submitted evidence was 

extensively quoted in the Health Select 

Committee report: ‘In their evidence to us, 

the Royal College of Physicians (RCP) told 

us that they would like to see an approach 

termed “commissioning without walls” 

where a broad spectrum of clinicians is 

involved in the commissioning process’. 

The Health Select Committee stated that 

the RCP feels that the provisions of the Bill 

are too loose and that it leaves clinician 

involvement as a matter dependent on 

local relationships. ‘The RCP is calling for a 

tighter requirement in the Bill for the NHS 

Commissioning Board and consortia to 

involve a full range of health professionals. 

[We propose] a duty to involve specialists. 

As it stands, we fear that the duty to obtain 

appropriate advice may become a tick 

box exercise, which has the potential to 

damage patient care.’ 

Sir Richard Thompson, RCP president, 

has written to the Health Select Committee 

welcoming their report. The RCP will 

continue to follow up progress of the Bill 

with key parliamentarians. 

The full version of this article is 

available on Commentary Community: 

www.rcplondon.ac.uk/commentary. 


News 

The HIU 10 years on 

Tasked with improving the quality of patient records, the 

RCP Health Informatics Unit celebrates 10 years 

The RCP’s Health Informatics Unit (HIU) 

was established in 2000 with a mission 

to improve the quality of patient records, 

specifically to support better, safer patient 

care and to yield more reliable aggregate 

data for other purposes. 

Since its inception, the HIU has reviewed 

the evidence base and laid the foundations 

for good record-keeping practice, supported 

by a sophisticated portfolio of educational 

activities. 

It set up the Information Library in 2004 

which worked with physicians across the UK 

to review the data held in hospital episode 

statistics (HES), such as the patient episode 

database for Wales, and to encourage 

better record-keeping and engagement in 

the coding process. The data concluded 

that HES were not sufficiently detailed 

or accurate to support appraisal and 

revalidation, and that the future lay with 

more structured, standardised patientfocused 

records. 

This work has been taken forward 

through large-scale collaborations 

and consultations. The programme led 

to the publication by the Academy of 

Medical Royal Colleges of standards for 

admission record and handover and 

‘The data concluded that hospital episode 

statistics were not sufficiently accurate. The 

future lay with standardised patient records’ 


HIU has reviewed the evidence base and laid the 

foundations for good record-keeping practice 

discharge communications, supported by 

an e-learning package and audit tools. It 

has been a challenging first 10 years, but 

the HIU says that there is still much more 

work to be done. n 

Thanks are due to all the staff 

– medical, nursing, administrative and 

secretarial – who worked with the HIU and 

to our colleagues who contributed through 

advisory groups, piloted our outputs, and 

gave us their views and ideas. In particular, 

special thanks go to Robin Mann and Giles 

Croft for their support of the HIU, and to 

John Williams, director and founder of 

the HIU, and Iain Carpenter and Mala 

Bridgelal-Ram for taking the work forward. 

A decade for PACES 

40,000 assessments and 3,000 

examiners later, the MRCP(UK) 

practical assessment of clinical 

examination skills (PACES) celebrates 

its 10th birthday this year. 

PACES marked a significant 

development in the assessment 

of doctors training in medicine. It 

introduced the independent marking 

system of 10 examiners assessing 

each candidate across a standardised 

range of clinical cases over a two-hour 

period. For the first time, candidates 

were observed and assessed for 

their patient communication skills. 

Unlike many other postgraduate 

examinations, real patients continued 

to participate in the majority of the 

assessment stations. 

The structure of PACES proved easily 

exportable to centres across the UK 

and globally and the examination 

has proved popular with examiners, 

hosts and candidates. In the 10 years 

since its introduction over 40,000 

candidate assessments have taken 

place at around 100 UK centres and 

nine international, with over 3,000 

fellows of the three royal colleges 

participating as examiners. 

A variety of further initiatives have 

also been introduced. These include 

the standardisation of case material 

for the communications stations and 

a formalised system of examiner 

calibration, redesign of one of the five 

stations, and the introduction of a 

skills-based marking system. 

The MRCP(UK) believes that both 

well-developed bedside clinical skills 

and detailed factual knowledge are 

key to delivering high-quality patient 

care. PACES continues to ensure that 

these skills are given top priority. n 


News 




News in brief 

NHS trusts fail to 

tackle staff obesity 

A report published by the RCP and the 

Faculty of Occupational Medicine has 

revealed that only 15% of NHS trusts 

have a policy or plan to help combat 

staff obesity. The findings come from 

the first national audit within the NHS 

of the National Institute for Health 

and Clinical Excellence (NICE) public 

health guidance for the workplace 

(Commentary April 2011). 

Implementation for NICE guidance 

was recommended by the Boorman 

review. A Department of Health 

report published in 2009 estimated 

that approximately 700,000 NHS 

staff would be classified as obese 

or overweight. n 

Building institutions 

through equitable 

partnerships 

The RCP recently hosted a major 

international conference on global 

health with a focus on the need for 

more equitable partnerships. 

Speaking before the event, Professor 

Philippa Easterbrook, RCP associate 

international director for global 

health, said: ‘This conference provides 

a space to reflect on lessons learnt, 

and listen to our partners in the 

south as to what is needed to build 

relevant, equitable, and sustainable 

partnerships for the future’. n 

International special issue: 

August Commentary will bring you 

more news on our global health 

conference and international matters. 

FallSafe care bundle seeks to 

reduce inpatient falls 

RCP leads on prevention and management of falls in 

hospitals and fall impact assessment 

FallSafe is a quality improvement project 

that aims to introduce best practice in 

the prevention and management of 

falls in clinical hospital wards and assess 

the impact on the number of falls. Led 

by the RCP in partnership with the south 

central strategic health authority, with 

funding from the Health Foundation, the 

two-year project will run in 16 hospitals 

across the south central region. Launched 

in April 2010, FallSafe has introduced a 

care bundle based on the best evidence 

from previous studies to reduce hospital 

inpatient falls. 

Multifactorial falls prevention strategies 

can reduce inpatient falls by about 15%. 

While activities such as Formula One racing 

and air travel have been made relatively 

safe for those who take part, being a 

hospital inpatient continues to carry a 

significant risk of preventable harm. In 

2009–10, almost 83 people died and 1,065 

suffered severe harm as a consequence of 

a fall in hospital that was reported to the 

National Patient Safety Agency. 

Hospital inpatients on clinical wards have a significant 

risk of preventable harm from a fall 

All participating wards have appointed 

a nurse to take on the role of FallSafe 

project lead, who will receive extensive 

training on aspects of falls prevention, 

incident investigation, improvement 

science, and patient involvement, and take 

on responsibility for supervision of a falls 

reduction programme on the ward. The 

project lead will champion the cause of 

falls prevention on the ward by introducing 

the bundle of care and recording inpatient 

experience as well as collecting and 

monitoring falls data. The care bundle 

elements have been introduced gradually 

over the first year of the project, and data 

on their implementation and on inpatient 

fall rates will continue to be gathered until 

the end of the project in March 2012. n 

More information is available 

at: www.rcplondon.ac.uk/resources 

or email: Adam Darowski, associate 

director, adam darowski@orh.nhs.uk 

or Lisa Byrne, FallSafe project manager, 

lisa.byrne@rcplondon.ac.uk. 



News 

EU rules on alcohol labelling 

EU rules that labelling for fresh orange juice must include 

nutritional information but alcoholic drinks are exempt 

A gap in EU legislation for labelling means 

that nutrition and ingredient information 

will apply to fresh orange and apple juice 

but not to alcoholic drinks. 

Despite the fact that alcohol may 

cause 10% of EU cancers and is widely 

acknowledged to be an addictive substance 

with dose-dependent multi-organ toxicity, 

the EU governing body has ruled that 

alcoholic drinks will be exempted from 

nutrition and ingredient legislation on 

food and drink labelling. In response to 

this, Nick Sheron, RCP representative for 

the EU Alcohol and Health Forum, says 

‘The EU governing body has ruled that 

certain products will be exempted from 

legislation on the grounds that they contain 

an addictive, carcinogenic toxin. Lewis 

Carroll would have been quite at home 

in the EU parliament, but this denial of 

information is a chilling reminder of the 

lobbying power of the drinks industry, and 

is reminiscent of the darkest behaviour of 

the tobacco industry’. 

The issue of alcohol labelling was also 

addressed by the EU Alcohol and Health 

Forum, which plays a key role in the 

EU Alcohol Strategy. The RCP raised its 

concerns to the forum that it was unlikely 

that the drinks industry would voluntarily 

agree to a label which said ‘alcohol 

causes cancer’ and that lobbying for 

legislation for responsible labelling on 

alcohol must continue. 

The United Nations is holding a 

summit on non-communicable diseases in 

September this year. Non-communicable 

diseases of the 21st-century related to 

unhealthy behaviours include tobacco, 

alcohol and obesity. ‘If big retailers and 

their suppliers worked as hard at having 

healthy customers as they do on their shortterm 

profitability, then everyone in society 

would benefit, including their stakeholders,’ 

says Nick Sheron. ‘The challenge for global 

policy makers over the next 100 years 

will be to find inventive new instruments 

that will facilitate this vision. Given the 

experience with alcohol labelling, we have 

some way to go.’ n 

Nick Sheron, RCP representative for 

the EU Alcohol and Health Forum, is a 

trustee of the UK Drinkaware Trust, which 

is funded entirely by the drinks industry 

with an independent board of trustees. 

Drinkaware’s website features balanced 

health information, including alcohol 

and cancer: www.drinkaware.co.uk/facts/ 

factsheets/alcohol-and-cancer. 


Free movement of 

doctors in the EU 

The RCP has responded to a European 

Commission consultation on the 

EU directive on the Recognition of 

Professional Qualifications. 

The directive provides minimum 

standards of medical training and 

a system of automatic recognition 

of qualifications for EU-trained 

doctors, dentists, nurses, midwives 

and pharmacists who wish to work in 

another EU member state. 

While supporting EU efforts to 

encourage the free movement of 

doctors, the RCP has raised a number 

of concerns including the lack of 

account taken of national initiatives 

on revalidation and continuing 

medical education. It is also concerned 

about the directive’s current focus 

on duration of training rather than 

competence and skills acquired. n 

More information is available 

at: www.rcplondon.ac.uk/news/ 

rcp-responds-eu-consultation-freemovement-professionals 

‘While supporting EU 

efforts to encourage 

the free movement 

of doctors, the 

RCP has raised a 

number of concerns 

including the lack 

of account taken of 

national initiatives 

on revalidation and 

continuing medical 

education’ 


Q&A: Lindsey Davies 

Image©Jonathan Perugia

Lindsey Davies: Q&A 




Lindsey 

Davies 

Commentary speaks to Faculty of Public Health president, Lindsey Davies 

‘If you want to take staff, professionals and the public with you in any programme 

of change you have to paint a compelling vision. The problem at the moment is that 

nationally the picture is not very clear. People don’t feel that they are behind a clear vision’ 

The white paper Healthy lives, healthy 

people: our strategy for public health in 

England outlines a new vision for public 

health, but will it tackle the big challenges 

Commentary speaks to Professor Lindsey 

Davies, president of the Faculty of Public 

Health. Appointed president in July 2010, 

Lindsey was the former Department of 

Health (DH) national director of pandemic 

influenza preparedness, regional director 

of public health for the east midlands, 

interim regional director of public health for 

London and health adviser to the Greater 

London Authority. 

QWhat are the challenges to public 

health doctors arising from the 

NHS reforms 

APublic health is a multi-disciplinary 

specialty, thus some people who 

work at consultant level in public health 

are doctors and some are not. But the 

issues are the same for all. From the 

public health point of view there are 

huge challenges for consultants and for 

directors of public health (DPH), because 

the main organisations who employ 

them – the strategic health authorities 

(SHAs) and primary care trusts (PCTs) – 

are disappearing. They are trying to keep 

their mind on the day job while working 

out how to cope with huge cuts to their 

organisation. If plans go through these 

organisations will soon disappear. So that is 

the big challenge – to stay focused on the 

people who need their support and help. 

At the same time, the plan is that DPHs 

are moved to local authorities and that 

they have a team to support them. They 

will have a ring-fenced budget for public 

health and Public Health England will be 

set up as a new national organisation to 

support local authorities and the NHS – we 

hope. However, if you read the white paper 

it is not at all clear who will be employing 

DPHs or how many there will be or where 

DPHs will be positioned within local 

authorities. It is also not clear how people, 

like DPHs and their teams, will continue to 

do the health service work at the moment 

within PCTs, influencing the health service 

and making sure that services are equitable, 

appropriate and cost effective. 

So taking all those things together, the 

challenges are: where are we going to be 

and what are our jobs going to look like 

Can we really be sure that we are going 

to be able to deliver the three domains of 

public health across the whole population: 

protecting people’s health, encouraging 

healthy lifestyles, and ensuring that people 

have access to the services they need 


Q&A: Lindsey Davies 

Image©Jonathan Perugia 

The opportunities are amazing. 

Providing we can make sure that public 

health expertise is still available to the 

health service, including GPs and hospital 

consultants, then a DPH should be able to 

influence every aspect of the population’s 

health. And improving health and wellbeing 

will be a major part of a local 

authority’s work. You could make transport 

improve health, you could have housing 

improve health – that is really exciting. 

What are the major opportunities 

Q and threats of transferring public 

health from primary care trusts to local 

authorities For example, the opportunities 

to integrate public health into core 

business-like planning decisions, the risk 

of a lack of infrastructure, loss of expertise 

and support staff, particularly against a 

backdrop of efficiency savings and public 

sector funding cuts. 

AAll of those. I think you have got 

a nice list there. The risk that we 

haven’t talked about is the risk to health 

professionals. If you move to a local 

authority the job will be different and 

people are nervous about losing their NHS 

terms and conditions. I know that’s not 

the sort of thing for a royal college to get 

involved in – and the faculty is not a trade 

union – but actually, I really do care. People 

might leave or retire early, because it is not 

what they want to do or where they want 

to be. I am concerned that you won’t have 

the experienced people to do the jobs. If 

you look back at previous re-organisations, 

we’ve lost a significant percentage of staff 

in each one and they are always the most 

experienced people. 

Another risk is relationships. Public health 

doctors don’t manage large numbers of 

staff and can’t tell people what to do. It’s 

all about influencing, knowing who’s who, 

what’s what and knowing what levers to 

pull in your local authority to get things 

done. Whether it’s managing an outbreak, 

improving the environment or changing 

policy, you have to get on with people and 

know them. These relationships develop 

over time – you can’t just magic them into 

place. Building relationships through this 

‘I would ban transfats tomorrow. If there was 

a germ that was killing as many people in a 

year then people would be hysterical about it!’ 

transition period is important and the risk is 

that you break the existing relationships. 

It takes years to get that right. 

How can public health doctors – and 

Q the profession in general – adapt to 

meet the challenges ahead 

APublic health doctors should be 

building local relationships with people 

or strengthening existing ones. We also 

need to acknowledge that local authorities 

function differently to health services. Some 

doctors have experience of this, but others 

won’t. So the ones that do need to help 

their colleagues to adapt and those who 

don’t need to work alongside or shadow 

people in local authorities – get to know 

them and establish relationships. 

It is also important that we don’t lose 

relationships with GPs. Public health doctors 

and other clinicians (because it is no good 

if you have one without the other) need to 

get into the GP consortia to work alongside 

them and support them. We can bring the 

expertise of working with large populations 

that GPs don’t have. GPs know their 

practices but as individuals rather than as a 

big group. They are not used to prioritising 

in the same way that we are. We are used 

to dealing with big groups and populations, 

so we can really help GPs in this area. 

QHow do you see the relationship 

between public health doctors 

and hospital specialists in terms of 

improving public health Are there missed 

opportunities at present 

Yes, I think there are lots of missed 

A opportunities. This is partly because 

a lot of public health doctors and nonmedical 

health professionals haven’t been 

close to the acute hospital sector for a long 

time. They may be out of touch because 

they have focused on health improvement, 

but equally there are many hospital doctors 

who don’t know what public health doctors 

do or how we do it. 

It is always encouraging to me that when 

you do get a group of public health doctors 

and clinicians together that they find, to 

their surprise, they have a lot to talk about. 

How you construct those opportunities 

varies according to what is available locally, 

but you can’t beat, for example, medical 


Lindsey Davies: Q&A 




directors and DPHs, talking about how 

they can help each other. Quite often new 

insights and pathways of care develop – it 

is a great opportunity for a public health 

specialist to work alongside a clinician. 

What lessons can we learn about 

Q major reforms from the past such as 

the 1990 health reforms that introduced 

GP fund-holding 

AThat’s huge. I think I’d go back to 

relationships. In any big change you 

lose experienced people because they 

find it one change too many. We have 

to try and avoid that. But if you disrupt a 

relationship it could take years to re-build. 

If you want to take staff, professionals 

and the public with you in any programme 

of change you have to paint a compelling 

vision – and they have to want to do it. The 

problem at the moment is that nationally 

the picture is not very clear. People don’t 

feel that they are behind a clear vision. 

Hopefully, after this discussion we will have 

something that we can really sign up to and 

move forward with enthusiasm. But we are 

not there yet. 

QWhere do you think public health 

should be focusing its efforts over the 

next decade 

ABasically, the health needs of the 

population and we know what they 

are – huge chronic diseases, infection, 

new diseases emerging, and disasters 

around the corner for which we need to be 

ready. We also know that there are huge 

inequalities in health and inequalities 

in access to health services. One of the 

challenges for public health is to go back to 

those three domains [protecting people’s 

health, improving health, and making sure 

that the right health services are in place] 

and make progress in these areas in the 

next couple of decades. 

I’d like to think that we have got really 

good surveillance in place across the 

country to spot nasty things before they 

happen. I’d like to think that every health 

service and social care provider has really 

good emergency plans in place. 

QSo do you think that we responded 

well to the recent flu pandemic that 

we had last year 

ALast year’s flu pandemic – I think we 

responded quite well, I was in charge! 

[smiles] I was the flu tzar at the DH before 

becoming president of the Faculty of Public 

Health. For three years I was planning for 

a pandemic and then suddenly, just when 

plans were nearly in place, one arrived! We 

got a great test of whether our plans were 

right or not – including the flu line, which 

was my idea – and I think we did do pretty 

well. We learned some good lessons and 

that’s looking really strong now. 

It is so important that we get that 

[health protection] right, whether it’s for a 

pandemic or not. We need to keep looking 

hard at health services and ask if they are 

meeting the needs of the population or 

not. We need to be prepared to make big 

changes. Look at diabetes, for example. 

Most diabetics are not in hospitals and yet 

most diabetes consultants are in hospitals 

– well that’s not right is it A lot of them 

are in the community, but we would like 

to see more of those who understand and 

can treat the disease working where the 

patients really are. There are lots of things 

that we can do to improve health services. 

Mental health is one I haven’t 

mentioned at all, but that is huge. I’d love 

to see better mental health services – public 

mental health services and prevention 

as well as cure. We also need to look at 

lifestyles – smoking, obesity and alcohol 

are the major health challenges. If we 

can get a focus on those three that would 

make a real difference. That means eating 

healthily, more exercise, less smoking and 

less drinking. 

QWhat is your view on the current 

government’s focus on ‘nudging’ 

people into healthy behaviours 

AWell, I think they have all got a place. 

Any serious campaign or action to 

make a difference to public health needs 

a holistic approach. You are never going 

to make an impact on a health issue – 

tobacco, alcohol, eating – by just sending 

out a bit of information or by providing 

nice parks. You need to have a range of 

things in place. I think smoking is a good 

example. People need information that 

helps them understand that smoking 

harms. They also need support to help 

them to stop smoking and regulation to 

adjust their environment to make it more 

difficult for them to smoke, or for people to 

be affected by that tobacco smoke. 

Information, regulation and nudging 

in the environment all have a role to play. 

Healthy eating, for example – I would ban 

transfats tomorrow. If there were a germ 

or a bacterium in food that was killing 

as many people as we think are killed by 

eating transfats in a year then people 

would be hysterical about it! 

QIs there cause for optimism in the 

public health community 

AI think there is. We have a government 

which is saying that public health is 

important – and they are saying it louder 

than any government has before. They are 

saying that they really care about public 

health and that they really want to make a 

difference. That’s brilliant. They have made 

more people more aware, not least across 

the health professions. 

Our ambition as a public health specialty 

is to do ourselves out of business! We want 

everybody doing public health things and 

then there would not need to be so many 

of us. But I shouldn’t say that, should I! 

We see public health as something that 

everyone can do. n 

Read more online... 

Read and comment on our full-length 

interview with Professor Lindsey 

Davies online at Commentary 

Community, including her views on 

social determinants of health and 

on epidemiological research. n 


Feature 

In focus: 

public 

health 


NHS reforms have shifted all eyes to the public health agenda and in particular health 

inequalities. Commentary asks three experts for their views – a public health doctor, a GP 

and a consultant. The full report is available online at www.rcplondon.ac.uk/commentary 

We live in a starkly unequal 

society. Our life expectancy at 

birth, our early development, 

educational attainment, chance 

of employment and chance of 

living in a favourable environment 

depend heavily on socio-economic 

status. Therefore, it is little surprise 

that differences in socio-economic 

status lead to inequalities in health. 

This has recently been elegantly 

described and demonstrated by 

Michael Marmott. 

This is not new knowledge. 

Douglas Black published his report 

on inequalities in health in 1980. In 

the 30 years since then inequalities 

in health and wealth have widened. 

We know that health inequalities 

are more dependent on relative 

poverty than absolute poverty, 

so they are not readily amenable 

to society’s preferred means of 

getting itself out of trouble – 

economic growth. 

Dr Richard Jarvis 

Consultant in health 

protection, Cheshire 

and Merseyside Health 

Protection Unit 

While it is refreshing to see 

mention of health inequalities 

as a driver of the government’s 

proposals for the NHS and a new 

public health system, it is difficult 

to know how the positive aspects 

will not be undermined by cuts 

made too hard, too fast, and in the 

wrong places. 

So what aspect of the proposals 

might help reduce inequalities 

in health The placement of 

directors of public health (DPHs) 

in local authorities should enable 

them to influence local decisions 

about adult social care, children’s 

services, education, environmental 

protection, transport and planning. 

All these have a bearing on 

inequalities even though this is not 

their prime focus. This potential 

will not be realised unless we can 

solve problems inherent in the 

Health Bill around how the DPH 

can act as a professional adviser 

to a political body; who, and with 

what qualifications, the local 

authority can appoint as their DPH; 

how the public health budget can 

be protected while simultaneously 

giving the DPH influence into 

other funding streams; and around 

variability of approach between 

local authorities. 

But what about ‘nudging’ and 

the idea that lifestyle problems are 

all amenable to individual choice 

In a perfect world where there is 

infallible information on which 

to base choice, where everyone 

has equal access to high-quality 

education, and physical and 

financial resources, this might be 

a reasonable assumption. But in 

today’s unequal society, choice, 

and therefore responsibility for 

health, is denied to those who 

most need to exercise it. Nudging 

is but one tool to use – we rely on it 

solely at our peril. n 


Feature 




Around 70% of the UK population 

consults their GP every year, 

which is very important in terms of 

how much we can do to influence 

public health. GPs have a vital 

role to play in health promotion, 

disease prevention and in reducing 

health inequalities. Increasing 

attention is now paid to these 

topics in undergraduate curricula 

and in postgraduate training for 

general practice. 

There is also an increased 

awareness of the challenges 

of health inequalities and the 

provision of equable access to 

primary care services, as stressed 

by the Darzi report. Primary care 

teams can target the patients 

who need additional information 

about how best to use primary 

care services. We get to know 

our patients well, and develop an 

understanding of what action to 

take in different sectors and how to 

tailor health services for individuals. 

Professor Roger Davies 

Editor, British Journal 

of General Practice, 

emeritus professor 

of general practice, 

King’s College London, 

Royal College of 

General Practitioners 

There is evidence that the Quality 

and Outcomes Framework has 

reduced health inequalities, 

because it has encouraged GPs 

to focus on the whole practice 

population and to achieve targets 

for the majority of their patients. 

The proposed NHS reforms 

raise many challenges. One 

is to ensure that the National 

Outcomes Framework does not 

exacerbate health inequalities. 

This is something that the Royal 

College of General Practitioners 

is very concerned about. A 

move to private healthcare has 

the potential to worsen health 

inequalities because the more 

affluent and articulate members of 

society are likely to come off best. 

There are real opportunities 

for GP consortia to commission 

services in a way that is 

appropriate to the populations 

they serve. Working in partnership 

with public health and social care 

organisations, there would be 

nothing to prevent GP-led services 

from promoting health and 

reducing health inequalities. 

There are many examples of 

excellent group practice working, 

even in the inner city. At the 

Bromley by Bow Centre in the east 

end of London, for example, a wide 

range of care is integrated on one 

site, with mental health patients 

running a café and elderly Bengali 

men training in IT alongside a 

large group practice. This is a 

particularly inspiring example, 

but if this can be achieved at 

one practice then it should be 

possible elsewhere. 

If GPs are to be given a major 

role in commissioning in the future, 

they will need to work closely with 

colleagues in public health and 

secondary care, as well as the 

welfare and social care sectors, to 

assess needs and deliver effective 

services. n 

I believe that all doctors should 

have an eye on the public health 

agenda. Specialty-based training 

for physicians should not drive 

neglect of responsibilities for 

prevention, but fuel a wider 

responsibility for improving 

population health. If there was 

one aspect of training I would 

change it would be to ensure 

exposure to public health for all 

specialty trainees and exposure 

to an ‘ology’ for all public health 

trainees. The NHS needs to treat 

populations and individuals so that 

both arenas work well together. 

The major restructuring of the 

NHS risks a loss of much of the 

corporate memory and many 

of the relationships that have 

been built to enable the NHS 

to play its part in addressing 

social determinants of health 

and inequalities. There is a risk 

that moving public health into 

local authorities will challenge 

the ability of individual clinicians 

to influence public health, unless 

bridges into health service delivery 

organisations (and to clinicians) are 

retained. Therefore, it is imperative 

that as clinicians, we take a keen 

interest in the reforms. 

On a positive note, a stronger link 

with social care and across other 

government agencies will, if public 

health directors and clinicians are 

able to influence it, allow us to 

prioritise the social determinants 

of health agenda. 

Clinicians need to contribute to 

partnerships working across public 

health, primary care and secondary 

care to promote public health and 

address health inequalities. We 

may now be able to have stronger 

access into social care and local 

government to really impact on 

social determinants of health. The 

structures Image©Shutterstock 

that have traditionally 

Dr Kiran Patel 

Consultant cardiologist 

and honorary senior 

lecturer, Sandwell and 

West Birmingham 

NHS Trust, and clinical 

director (QIPP), 

NHS West Midlands 

Strategic Health 

Authority 

allowed cross-sector and interorganisational 

working are in a 

state of flux, so we must ensure 

bridges are built to maintain 

existing partnerships and to 

link to other partnerships. The 

fragmentation of providers creates 

the risk that competition might 

trump collaboration for large-scale 

service developments. Clinicians 

must challenge areas of reform 

that risk widening inequalities. As 

providers we are advocates for our 

patients, but as commissioners GPs 

are advocates for their patients 

and their populations. Provider 

clinicians must work with GPs to 

ensure that we deliver services to 

address inequalities and improve 

the health of all. Smoking cessation 

is as important as angioplasty of 

the coronary arteries and we must 

not forget that. It is not one or the 

other, but both which will improve 

health outcomes. n 


Feature 


Nudging, as opposed to nannying, is a 

key part of the coalition government’s 

approach to public health. ‘It is simply not 

possible to promote healthier lifestyles 

through Whitehall diktat and nannying 

about the way people should live’, says 

Andrew Lansley, secretary of state for 

health, in his foreword to the public health 

strategy for England. 1 

So nannying, roughly translated as 

regulation and legislation, is out; and 

nudging, or changing people’s habits 

without regulation, is in. The new favoured 

method of changing people’s habits is 

to use behavioural insights, derived from 

behavioural science and economics, and 

in particular from the US book, Nudge, 

by Thaler and Sunstein. 2 A Behavioural 

Insights Team (commonly known as 

the ‘nudge unit’) has been set up in 

the Cabinet Office to drive forward this 

approach. In ‘Applying behavioural insight 

to health’ 3 the nudge unit sets out a range 

of existing and proposed interventions 

in public health. Most of them involve 

partnership with the private or voluntary 

sector, and are designed to be tried out 

and devolved to local communities for them 

to implement. 

We asked three experts in public health 

to comment on the specific interventions 

proposed in three main areas – obesity, 

smoking and alcohol – and to give their 

views on the unit’s overall approach. 

Reducing obesity 

Several of the nudge unit’s proposals to 

encourage more physical activity involve 

using new technology, such as Nike iPhone 

apps that can track your run and show your 

speed, incentives for children to walk to 

school using swipe card technology, and 

‘active’ video gaming such as Nintendo 

Wii which involves some body movement. 

Professor Peter Kopelman, RCP special 

adviser on obesity, is not impressed by 

these ideas: ‘We’re looking at a spiralling 

obesity prevalence in people on low 

incomes so whatever we advocate has to 

be affordable – these are luxuries those 

people can’t afford’. 

Another proposal is to work with the 

food industry to get restaurants and fast 

food chains to provide calorie information 

about their meals, so that ‘people can be 

empowered to make a healthier choice’. 

‘Where is the evidence for this I’m not 

aware of any,’ says Kopelman. ‘Also, that 

approach could encourage food faddism, 

because you’d be affecting not only 

overweight people but also people who 

are super conscious of their weight.’ 

‘The causes of obesity are embedded in 

an extremely complex biological system, 

set within an equally complex societal 

framework’, he says, and therefore a 

collection of disparate unconnected 

measures are unlikely to address a 

problem of that scale. ‘This type of policy 

is only as good as the electoral term of 

the government supporting it, whereas 

effective public health strategy has to go 

Putting 

the nudge 

in motion 

The government wants to use behavioural insights to promote healthier lifestyles and reduce 

health inequalities, but how effective is ‘nudging’ Commentary asks three experts in public 

health for their thoughts on nudging people in the right direction 


Feature 




right across government, go across 

politics and be sustainable over the long 

term.’ As proposed in the Foresight 

report, 4 he believes that an agreed strategy 

– involving the health sector, education, 

transport, town and country planning, 

industry and the voluntary sector – 

implemented using focused initiatives 

and legislation, is the only way to address 

the escalating health problems caused 

by obesity. 

Reducing alcohol misuse 

The nudge unit’s intervention on alcohol 

uses the concept that people are strongly 

influenced by what others do (norms). 

Students, though, overestimate the 

amount of binge-drinking their fellow 

students indulge in, so ‘social norming’ 

aims to correct that misperception by 

using posters and publicity to point out the 

reality, and therefore reduce the pressure 

to drink. In autumn 2011 the charity 

Drinkaware and the Welsh Assembly 

Government will use the social norming 

approach in a one-year trial in five Welsh 

universities, backed up by guidance for the 

universities on appropriate alcohol policies, 

the provision of support services and so on. 

In response to this, Professor Sir Ian 

Gilmore, RCP special adviser on alcohol, 

says that any new approaches that 

prove to be effective in tackling alcohol 

misuse are welcome. However, ‘there is a 

tendency’, he says, ‘for theories to come 

into vogue and go out again’ and it could 

be a mistake to predicate a large part of 

government policy on one such theory. 

The drink industry, of course, already 

uses very powerful nudges, in the form 

of advertising, discounted pricing and 

special offers, to encourage people 

to drink. ‘We also heard recently that 

Heineken is going to be the beer of the 

2012 Olympic Games, so from now on 

a beer is going to be associated with 

sports and great sporting prowess. Is that 

nudge If so, I’d say it’s nudging people 

in the wrong direction.’ To counterbalance 

unhealthy nudges that are already in the 

environment, thanks largely to industry, 

we may need something stronger than 

behavioural nudges for individuals. ‘The 

‘We also heard recently that Heineken is going 

to be the beer of the 2012 Olympic Games, so 

from now on a beer is going to be associated with 

sports ... Is that nudge If so, I’d say it’s nudging 

people in the wrong direction’ Sir Ian Gilmore 

most effective way of changing the 

environment often requires legislation – 

something this government is not prepared 

to do,’ says Professor Gilmore. 

Reducing harm from smoking 

The new proposed smoking cessation 

trial will be a collaboration between the 

unit, the Department of Health and Boots 

UK. It will use the behavioural ideas of 

commitment – ‘known to be a powerful 

force in behaviour change’, particularly 

when involving loved ones – and incentives 

(possibly in the form of Boots reward card 

points) to help smokers quit the habit. 

Although the detail of the intervention is 

not yet clear, Professor John Britton, chair 

of the RCP Tobacco Advisory Group, has 

strong reservations about it: ‘If this is a 

“Quit and win” type of approach, it has 

been tried and tested and shown not 

to work’. 

Andrew Lansley says in his public 

health strategy that he intends to cut the 

proportion of adults who smoke in England 

from 21.2% to 18.5% or less by the end of 

2015, roughly a 0.5% cut per year. Britton 

says that initiatives to help individuals 

stop smoking, like the Boots trial, have a 

minimal impact on smoking prevalence in 

the whole population. ‘If you want a lot 

of people to give up smoking, you have to 

drive that centrally by measures that touch 

all smokers, such as media campaigns, 

taking tobacco out of sight in shops, and 

enforcing plain packaging.’ 

‘Evidence from states in the USA shows 

that if you want to achieve a yearly 0.5% 

fall in the number of smokers, you have to 

do everything – keep raising prices, keep 

investing in public awareness campaigns, 

bring in new legislation, provide cessation 

services – and you have to keep coming up 

with new ideas because each of them has 

an impact on prevalence.’ 

A unanimous view 

All our experts agreed in principle that 

ideas from behavioural science may 

provide useful additional tools for 

improving public health, but many of the 

interventions proposed by the nudge unit 

have little or no evidence base. A rounded 

comprehensive approach, they said, is 

the only way to tackle these major public 

health issues of our time. n 

References 

1 Department of Health. Healthy lives, 

healthy people: our strategy for public 

health in England. London: DH, 2010. 

2 Thaler RH, Sunstein CR. Nudge: 

improving decisions about health, wealth, 

and happiness. Yale: Yale University Press, 

2008. 

3 Cabinet Office Behavioural Insights 

Team. Applying behavioural insight to 

health. London: Cabinet Office Behavioural 

Insights Team, 2010. 

4 Foresight. Tackling obesities: future 

choices – project report. London: Stationery 

Office, 2007. 

With thanks to 

Professor John Britton, chair, RCP 

Tobacco Advisory Group; professor of 

epidemiology, University of Nottingham 

Professor Sir Ian Gilmore, chair, Alcohol 

Health Alliance UK; past president, RCP; 

liver specialist, Royal Liverpool Hospital 

Professor Peter Kopelman, principal, 

St George’s, University of London; 

science adviser, Office of Science and 

Innovations Foresight Obesity Project. 

Joanna Reid, 

RCP managing editor 



Illustration © Bill McConkey 

In the first of our six-issue countdown to London 2012, 

Commentary speaks to Dr Ian McCurdie, chief medical officer of 

the British Olympic team, about being an Olympic doctor 






‘When I was at school I enjoyed sports. If I were a journalist I would have 

been a sports journalist or a sports photographer’ 

The London 2012 Olympic Games will be big. 

The Athletes’ Village in the Olympic Park will 

host around 17,000 athletes and officials, and 

the Games will feature 26 sports at venues in 

the Olympic Park, across London and outside 

of the city. The Olympic Flame will travel 

around the UK for 70 days before arriving 

in London the weekend before the Games. 

There will be street parties and celebrations 

– the 2012 Olympics will be an historic event 

for the city. Commentary starts a six-issue 

countdown to London 2012 with an interview 

with Dr Ian McCurdie, chief medical officer, 

Team GB. 

What were the highlights of being 

Q part of the Beijing Olympics 

I don’t think we anticipated winning 

A so many medals and doing quite as 

well. Before Beijing we set a target to get 

fourth in the medal table in London and on 

the last Friday in Beijing we were third, but 

then Russia won a couple of golds over the 

weekend and we finished fourth. 

Beijing was so big. The Olympic festival 

is massive but Beijing was huge in terms 

of buildings and numbers – the venues 

were spectacular. That and our team’s 

performance were the highlights. 

As an Olympic doctor did you feel 

Q that you shared in the success of the 

British team 

Yes, as part of one big team. We had 

A 311 athletes in Beijing and around 

200 support staff from coaches, managers, 

physios and others. The biggest impact on 

sports performance is illness or injury. If 

an athlete gets injured in the run up to the 

Games that could be the end of their Olympic 

hopes. There is only so much that you can 

do to restore full function after injury, so you 

need to try to prevent athletes from getting 

injured. This is a challenge in the last weeks 

of training. 

But the thing that is eminently preventable 

is illness. Illness in one athlete or the squad 

can have a massive impact on the team’s 

performance. From injury you might lose 

one rower in a boat, but from illness you 

could lose them all. I don’t mean bird flu 

like we had in the lead up to Beijing; there 

is always something brewing, like in Sydney 

we had a potential seasonal flu epidemic. 

Even a snivelly nose, a cough or cold, for an 

Olympic athlete can take the edge off their 

performance and stop them achieving 100%. 

Part of the overall medical provision is to 

keep people in optimum health – not just the 

athletes, but also the people around them. 

Do Olympic athletes live inside a 

Q bubble at the Games 

That is exactly the phrase that 

A people use, ‘the bubble’. It is mainly 

a security bubble, but you are literally in a 

different world. 

What steps can you take to make 

Q sure an Olympic athlete doesn’t 

catch a cold 

Most of it is educational, but there are 

A certain practical steps to take. In Beijing 

we issued every athlete their own hand gel 

dispenser and there were automatic hand 

gel dispensers outside every accommodation 

block. The dining hall is the central hub of any 

Olympic village. Around 15,000 people lived 

in the Olympic village in Beijing and they all 

ate in one place – a self-service canteen with 

everything from salads and healthy food to 

fast food. It was free and open 24 hours a day 

– unlimited food of any variety 24/7, which in 

itself was a potential problem. The dining hall 

produced around 60,000 meals a day and 

you had people from 205 different countries 

picking up cutlery from trays and bread rolls. 

The potential risk of spreading bugs was 

huge, education and using hand gel was vital. 

All the athletes coming into the village 

would get briefed about security and where 

things are. As a doctor I would talk to them 

about hydration, hand gel and keeping clean. 


I used this phrase that my grandmother 

would say: ‘Coughs and sneezes spread 

diseases’. If athletes felt unwell, they were 

encouraged to report symptoms early. 

So what are the challenges of 

Q working with athletes compared to 

regular people 

Small things make big differences – 

A that’s the key. The differences between 

success and failure for an Olympic athlete 

are minute. Anything that takes the edge 

off performance is crucial and you have to 

understand the importance of that if you are 

looking after these people. There is no margin 

for error or compromise. 

There is a lovely statistic from the Athens 

2004 Olympics about the difference between 

winning gold and silver. In Athens we won 

gold in the coxless four [rowing event] with 

Steven Redgrave, Kelly Holmes won two 

golds in the 800-metre and 1,500-metre run, 

Chris Hoy won a gold in the kilometre, and 

the mens’ 4x100-metre relay won one gold. 

If you take these five races and look at the 

difference in time between winning a gold or 

a silver, the sum of those times is just over half 

a second. Across five events, the difference 

between winning gold and silver was half a 

second. That’s how close it is. If we were half 

a second slower that would have been five 

silvers. 

How did your years of working with 

Q the British army and the Royal Ballet 

prepare you for being an Olympic doctor 

I was a doctor in the army for 23 years 

A and looked after soldiers. Soldiers need 

to be physically fit and robust to do their job. 

If they are ill or unfit then they are not fully 

functional. So the concept of being a doctor 

to try and improve people’s physical function 

to return them to high levels of activity was 

something I grew up with in my medical 

career. As you might imagine, working in the 

army has lots of parallels with working for 

the Olympics. The idea of sport and exercise 

medicine (SEM) and military medicine, or 



rehabilitation medicine which is my specialty, 

are very similar. 

But the same applies outside the 

military and outside sport. For example, a 

businessman plays squash twice a week and 

gets injured and can’t play squash. He gets 

a bit less fit, a bit frustrated, and his general 

health and psychological health is not as 

good. The principle of managing someone 

who has an injury that has compromised 

their function is the same, only the context 

is different. Whether they are a soldier, 

an Olympic athlete, a ballet dancer or a 

businessman who plays squash – you are 

trying to return them to that level or that 

higher level of function that is right for them. 

How does the challenge of 

Q rehabilitation between a ballet 

dancer and an elite athlete compare 

Ballet is interesting because ballet 

A dance medicine is probably less evolved 

than sports medicine in some areas, but it 

is catching up fast. The concept of trying to 

improve conditioning and robustness, and 

trying to prevent injuries in dancers is more 

commonplace than it used to be. 

With any rehabilitation programme there 

are two big challenges. One is the immediate 

return – the urgency to put someone, a 

professional footballer or soldier, back on the 

field to do what they need to do. The other is 

the long-term consequences of an injury and 

the risk of early return. You can get a ballet 

dancer back on the stage fast or a footballer 

back on the pitch quickly, but people are 

increasingly concerned that this need must be 

mindful of the long-term consequences. 

We all know professional dancers and 

athletes whose careers don’t last long 

because they suffer long-term problems, 

but this is getting better because the 

management of injuries has improved. 

Is there much collaboration between 

Q international medical teams at the 

Olympics 

We are friendly with most of the 

A big nations like the Australians, the 

Americans, the Canadians and the New 

Zealanders, because we know each other 

20 Commentary n June 2011 n www.rcplondon.ac.uk 

from the global world of SEM. We talk to 

each other, we swop stories. But we don’t 

look after each other’s athletes because that 

wouldn’t be acceptable. I wouldn’t treat a 

New Zealand athlete, for example, unless it 

was a Samaritan act. We don’t collaborate 

formally in our work, but we all have the same 

challenges and issues; we discuss those. 

What were the biggest lessons 

Q that you learned from the Beijing 

Olympics and how would you take them 

forward to London 2012 

That’s a good question. There are a lot 

A of things that will be different about 

London and, to some extent, a lot of the 

lessons learned from Beijing don’t apply or 

are not transferable to London. These include 

managing travel, acclimatisation, and being 

in a new, strange, non-English speaking 

environment. So most of the challenges at 

an Olympic Games are related to keeping a 

group of athletes healthy on the other side 

of the world in a very stressful and fairly 

unusual setting. 

London presents completely different 

challenges that don’t relate to 

acclimatisation, environment and foreign 

languages. One of the biggest challenges will 

be the expectation on the home team – it will 

be huge. This could be a really positive thing 

or it could be negative. Managing expectation 

is critical. 

We talked about the bubble – when you 

are in the Olympics in Beijing, Athens or 

Sydney you are in a bubble and you have 

no idea of what is going on back home. The 

foreign press and the British press are there, 

but you feel removed from the buzz of what 

is in the papers. In London, that is just going 

to be all over the place. Family and friends 

will also be able to say to athletes ‘Oh, I’m 

coming down to see you in competition 

tomorrow’, whereas before they could only 

watch on TV from the other side of the world. 

The ability of family and friends to easily 

contact and communicate with athletes while 

‘There is a lovely statistic from the Athens 2004 

Olympics ... Across five events, the difference 

between winning gold and silver was half a 

second. That’s how close it is’





‘Whether they are a soldier, an Olympic athlete, a 

ballet dancer or a businessman who plays squash 

– you are trying to return them to that level or that 

higher level of function that is right for them’ 

they are trying to focus on the Games will be 

quite a challenge. 

From a medical point of view, you can keep 

a close eye on what is going on – who’s ill, 

who’s injured, how to manage them – when 

you are in the bubble. In London there will 

be a similar system, but it will be easier for 

athletes to move in and out of the bubble. 

Do Olympic doctors practise what 

Q they preach in terms of sport and 

exercise 

I would hope so! Doctors in SEM should. 

A Most doctors who are involved in SEM 

are in it because they enjoy sport. When I 

was a doctor in the army I was interested in 

my job and when I was at school I enjoyed 

sports. If I were a journalist I would have been 

a sports journalist or a sports photographer. 

So generally, people are not in the specialty 

unless they are passionate about sport. As a 

result, they would normally practise what they 

preach or at least be completely convinced of 

the benefits of SEM. 

There is a concept that has migrated 

Q from the USA that exercise is a drug. 

Should doctors prescribe exercise 

The American College of Sports 

A Medicine has trademarked the phrase 

‘exercise is medicine’, which is essentially the 

idea that exercise could be used to improve 

health and performance from an Olympic 

athlete to our squash-playing businessman. 

We know that exercise can improve health in 

healthy people, we know that there are loads 

of different diseases whose incidence can be 

reduced by remaining active – cardiovascular 

disease, most cancers, chronic diseases. 

Inactivity is a real killer – I think that message 

isn’t quite out there yet, but it is getting there. 

There is also an increasing body of research 

to show that you can use exercise to improve 

certain disease – diabetes, depression, 

arthritis. I am a trained rheumatologist and 

people intuitively say, ‘Oh if I’ve got arthritis, 

I’d better look after my joints and not 

exercise’, which is completely wrong. There is 

a lot of research to show that if you exercise 

your joints they will become better nourished, 

healthier, and both function and symptoms 

will improve. So people with disease could 

have exercise as part of their medicine and 

people without disease can use exercise as 

a preventative and to stay healthy. The idea 

of exercise prescription is something that we 

haven’t fully grasped, but it is growing. 

How far has SEM progressed as a 

Q specialty 

A long way but nowhere near far 

A enough. There are training programmes 

in SEM for a large number of specialist 

trainees around the country right now. What 

we haven’t got to yet, and this is the crunch, 

is the workforce. There are not enough jobs 

– consultant jobs – at primary or secondary 

care level for all these trainee doctors. 

Do you think the London 2012 

Q Olympics will generate more jobs 

The hope is that the whole Olympic 

A experience and the legacy that it leaves 

will raise people’s awareness about exercise 

and sport – probably indirectly. Most of what 

we do in SEM covers two areas: looking after 

injuries and exercise prescription. But the 

services are not out there because there are 

not the departments and jobs to do this. 

That is what the specialty will need to move 

forward. 

The work is in trying to convince the 

purchasers – the primary care trusts and GP 

consortia – that using SEM is an efficient way 

of managing people with musculoskeletal 

problems and to improve their health. For 

example, less than 10% of sports injuries 


actually need surgery, but the traditional 

model is often to send a patient to an 

orthopaedic surgeon. There are a lot of 

orthopaedic surgeons that see injuries that 

don’t need surgery; these could be better 

managed by SEM. 

Finally, do you have any predictions 

Q for London 2012 

I think it will be fantastic. I think the 

A British team will perform well. Most 

people say that the success of a home 

Olympics is related to how well the home 

team performs. In 50 years people won’t look 

back on 2012 and say ‘There were fantastic 

stadiums!’ but they will say ‘Didn’t the British 

team do well’. If the British team do well there 

will be a much stronger legacy and people 

will remember the London Olympics for years 

to come. 

I have no doubt we will do well. I think it 

will be fantastic for everyone involved. I keep 

saying to people ‘Go to London’, even if you 

haven’t got a ticket, get into London. There 

will be art, street theatre, music, big screens, 

branding everywhere. It will be like a big 

carnival for two weeks. No one will be working! 

My prediction is that as a team, we will 

perform really well, but the success of the 

Olympics is about much more than what 

happens on the field of play. It will be about 

everything that goes with it and about the 

legacy that it leaves. It will be spectacular. n 

Dr Ian McCurdie MBBS 

MSc (SportsMed) FRCP MRCGP 

DRCOG FFSEM(UK) 

Consultant in 

rheumatology and rehabilitation 

medicine; director of medical services for 

the British Olympic Association; chief 

medical officer, Team GB. 

Read our full interview with Dr Ian 

McCurdie online at Commentary 

Community. 

Next issue: our Olympic series continues with 

a feature from Dr Cordelia Coltart on the risk 

of infectious diseases at the Games. 


Regulars 




Medicinal Garden 

Image©Henry Oakeley 

Olympian plants 

From lizard meat to olive oil mixed with salt, Dr Henry 

Oakeley FRCP looks at plants and the ancient Olympics 

Olympics. Theophrastus’s Enquiry into 

Plants (c319 BC) makes no mention of 

any, while Dioscorides’ Materia Medica 

(c80 AD) lists some plants that might 

have been used. He recommended Rheum 

palmatum, ‘from above the Bosphorus’ 

(Bk3, Ch2) for loss of energy; ‘oil of sweet 

bay’ extracted by boiling the berries of 

Laurus nobilis and scooping up the oil 

so liberated (Bk 1, Ch40) and flowers of 

dill, Anethum graveolens, marinated in 

olive oil (Bk 1, Ch50) to be rubbed on to 

‘lessen weariness’. The dried berries of the 

honeysuckle, Lonicera etrusca, marinated in 

wine were recommended ‘to abate fatigue’ 

(Bk 4, Ch14), but – as Dioscorides noted – 

its effects were also toxic. The concept of 

adding salt to one’s diet to compensate 

for electrolyte loss and to reduce cramps is 

‘Anabolic steroids, which can be made from 

yams (Dioscorea species) gained notoriety in 

1988 when Benjamin Johnson was stripped of 

his 100-metre gold medal for use of stanazolol’ 

Since the ancient Olympic Games athletes 

have sought innovative ways to improve 

their performance. Wrestlers used olive 

oil (from Olea europaea) to make their 

bodies slippery; today’s swimmers wear 

specialised swimwear to reduce drag. 

Modern athletes take high protein followed 

by high carbohydrate diets, entirely legally, 

to improve performance; the ancient Greeks 

ate lizard meat in the forlorn hope of a 

similar effect. Plants also played a symbolic 

role in the ancient Olympics. Winners of the 

ancient Olympics received a crown of bay 

leaves (Laurus nobilis), sometimes called 

bay laurel and now used mainly as a spice 

in stews, but whose sap may well have 

given them an allergic rash. 

The modern Olympic Games have been 

marred by athletes taking performanceenhancing 

drugs. The winner of the 

1904 marathon took strychnine, which is 

extracted from the seeds of the tropical 

plant genus Strychnos and brandy 

from grapes (Vitis vinifera). A cyclist 

on amphetamines, synthesised from 

ephedrine, present in the sap of the 

primitive Ephedra, died in the 1960 

games. Anabolic steroids, which can be 

made from yams (Dioscorea species) 

gained notoriety in 1988 when Ben 

Johnson was stripped of his 100-metre 

gold medal for use of stanazolol. 

There is no evidence for performanceenhancing 

drug use in the ancient 

relatively new, but 

two millennia ago salt was mixed 

with olive oil as a skin lotion to combat 

weariness (Bk5, Ch109). Of all Dioscorides’ 

performance-enhancing remedies, only 

a decoction of Theban grapes (Phoenix 

dactylifera) in hydromel – mead, an 

alcoholic drink made from fermented honey 

– would, by reason of its sugar and alcohol 

content have been effective in improving 

performance (Bk 1, Ch 109). n 

Dr Henry Oakeley FRCP, 

RCP garden fellow 


Regulars 




History 

www.rcplondon.ac.uk/heritage 

Re-framing disability 

‘There is a real thing about mending people. I keep saying: 

“I ain’t broke, you don’t need to fix me”’ 

These are the words of Jamie Beddard, a 

disabled focus group participant, who took 

part in our exhibition ‘Re-framing disability’. 

The exhibition reflects the views of the 27 

disabled participants, who came together 

to discuss the College’s historical portraits 

of disabled people and their identity as 

disabled people. Discussions invariably 

raised relationships with the medical 

profession, both historically and today. 

The historical print above is of 14-yearold 

Sarah Hawkes, three years after she 

received a blow to her neck which caused 

her limbs to contract. Hawkes had been 

a servant in Essex, but, no longer able to 

earn her living, she came to London in 

1831 to exhibit. It is unlikely that Hawkes 

exhibited her naked body to the public – 

this image was created for medical readers. 

Hawkes was treated by Dr Edward Harrison 

(1766–1838), who began his treatment 

on 15 November 1831; by 29 November 

1832 Hawkes was able to walk. In a letter 

to surgeon Sir Benjamin Collins Brodie in 

1836, Harrison wrote that he straightened 

Hawkes’s backbone by means of massage, 

splints, stretching and lying flat. 

Penny Pepper, a focus group participant, 

commented on the image: ‘It’s about 

highlighting [Sarah Hawkes’s] deformity 

with no conscious effort to remember the 

human being. That’s [still] the approach 

that medical photography takes, at least 

in my childhood. Being naked in front 

of a growth chart when you’re 10… just 

how much that takes away from you as 

an individual’. 

The focus on cure, not understanding, 

often resulted in unproductive relationships 

between doctors and disabled people. 

Partly as a result of this, the ‘social model 

of disability’ was developed in the 1970s 

by disability activists. This model rejects a 

wholly medicalised definition of disability 

and emphasises the need for society to 

change and remove the barriers restricting 

disabled people. Dr Thomas Wells, an 

oncologist at Weston General Hospital 

and paraplegic, co-founded the Bristol 

University Medical School disability course 

and gives an annual lecture to medical 

students on how doctors should relate 

to people with impairments. ‘[Being 

disabled] has made me more aware of 

the importance of a patient being given 

an element of the decision making… A 

big aspect of medical care isn’t always 

about giving the medical treatment; it’s 

about listening, making someone feel that 

they’ve been heard.’ 

We would like to hear from medical 

professionals who have a view on this issue 

at heritage@rcplondon.ac.uk. ‘Re-framing 

disability’ runs until 8 July 2011: www. 

rcplondon.ac.uk/re-framing-disability. n 

Bridget Telfer, RCP audience development 

coordinator 


Regulars 




Membership 

www.rcplondon.ac.uk 

New member benefits 

The RCP Affinity scheme is a new 

member-only benefits package which 

will offer you extra value from your 

membership via discounts on a range 

of professional and personal services 

and products. RCP Affinity will cover 

the following categories: business, 

advice, travel, insurance, and home 

and lifestyle. You can expect to 

benefit from discounts on books 

(Foyles), work shirts and blouses 

(TM Lewin), travel and holidays 

and much more. 

Most of the RCP Affinity benefits 

will carry either a ‘National Price 

Promise’ or a ‘Provider Price Promise’. 

‘National Price Promise’ indicates 

that RCP members are getting the 

best rates in the UK for a given 

product or service. ‘Provider Price 

Promise’ indicates that RCP members 

are getting the best rates that the 

provider in question gives any group. 

The benefits are designed to help 

you save, and are a real extra benefit 

to holding RCP membership. The 

scheme will soon be available on the 

RCP members’ area of the website, 

so you can access it anytime. 

RCP Affinity will offer 

you extra value from 

your membership via 

discounts on a range 

of professional and 

personal services and 

products from books 

to travel and holidays 

2012 fellowship 

nominations 

The RCP supports over 14,000 fellows based in over 90 

countries. Find out how to become a fellow or how to 

nominate a colleague 

Each March the RCP Council elects a new 

group of fellows who have distinguished 

themselves in the practice of medicine, 

medical science or medical literature – 

which includes consultants in the NHS. 

Fellows help the RCP to achieve its main 

objectives by championing the values of 

the medical profession, promoting patientcentred 

care, influencing the healthcare 

agenda and improving standards in clinical 

practice in the UK and internationally. 

Existing RCP fellows have the right to 

nominate new fellows to the RCP. 

Nominations 

There is no examination involved, and it 

is not possible to nominate yourself or to 

apply for fellowship. Individuals can be 

considered for fellowship in two ways: 

n Individual nomination: an individual 

can be proposed by an existing fellow 

of the RCP. That fellow must complete a 

proposal form which can be obtained from 

the fellowship administrator. The form 

requires proposers to describe candidates 

in accordance with a set of defined criteria, 

to enable more objective judgement. This 

is the route by which most doctors, as well 

as those in non-mainstream specialties or 

residing overseas will be considered. 

The closing date for proposals is 

1 September 2011 and the election is held 

in March 2012. An individual who is not 

elected in one year can be proposed again 

in following years by following the 

same route as before. 

n Criteria procedure: if they are not 

nominated individually, when a doctor has 

been a member of the RCP (ie has passed 

MRCP(UK)) for at least four years, and a 

consultant in a physician specialty for at 

least three years, completion of their census 

form ensures that they will appear on a 

report of doctors who will be automatically 

considered for fellowship by Council. 

RCP fellows benefit from: 

n The right to vote in RCP elections 

and to stand as a candidate 

n The right to propose colleagues 

for fellowship 

n The right to attend the Annual General 

Meeting and take part in RCP governance 

n The opportunity to sit on NHS 

advisory appointments committees 

and be considered for several other 

RCP committees 

n Access to committee reports via 

My RCP – the private area of the website 

n The use of FRCP post nominal. 

More information on the 

proposal process and fellowship 

benefits can be found online. We also 

provide advice if you are thinking 

about nominating someone overseas 

but have concerns about their ability 

to pay: www.rcplondon.ac.uk/join/ 

fellowship. For a proposal form, 

please contact: fellowshipqueries@ 

rcplondon.ac.uk. n 


Regulars 




Letters to the editor 

The RCP published a survey on the management of care for very ill patients in England, Wales and 

Northern Ireland in December 2010. Commentary April 2011 also reported on the various work streams 

on acute care underway at the RCP. Here’s what you had to say 

Dear Commentary, 

In your recent issue (April 2011) you 

highlight the deficiency in the provision of 

consultant-led care by acute physicians at 

weekends, which was identified in the RCP 

survey in December 2010. This issue has 

been brought into sharp focus with the 

advent of consecutive four-day weekends 

in late April. The Society of Acute Medicine 

(SAM) strongly supports the need to move 

towards a seven-day consultant-led service, 

and there are data which suggest that 

mortality for patients admitted outside 

‘normal working hours’ may be higher. 

One of the main limiting factors in 

providing this level of care remains the 

numbers of consultants in acute medicine 

currently working in the UK. This situation 

is improving slowly: significant numbers 

of trainees will attain a certificate of 

completion of training in acute medicine 

during 2011–12. This gives an ideal 

opportunity for trusts to develop or 

expand their acute medical consultant 

team so that a greater number of hours 

of consultant-led care can be provided 

on the acute medical unit. A recent 

survey undertaken by SAM indicates 

that many existing acute physicians and 

trainees strongly support a move towards 

greater seven-day working. Over 80% of 

respondents indicated that they would be 

willing to consider the public holiday on 

29 April as a ‘normal working day’. Many 

free text comments indicated strong views 

regarding the need to provide seven-day 

working practices in acute specialties, both 

in hospital and primary care. These views 

need to be aired more openly with the 

engagement of all royal colleges. 

Acute illness is a seven-day problem 

and our modern health service needs to 

be able to respond in the same timely 

fashion irrespective of the day on which a 

patient presents. 

Chris Roseveare BM FRCP 

The SAM survey is available on their website: 

www.acutemedicine.org.uk 

Log in to Commentary 

Commentary Community brings you 

more news and features this month 

including the full interviews with 

Professor Lindsey Davies (p10) and 

Dr Ian McCurdie (p18), and more views 

from our public health experts (p14). 

We have an article from international 

sponsorship scheme prize winner, 

Dr Manoji Gunathilake, about her 

experiences of working in the UK, and 

columns from our regional advisers. 

Visit our online magazine to comment 

on these features and officer columns: 

www.rcplondon.ac.uk/commentary. n 


Events diary 

Events diary 

www.rcplondon.ac.uk/events 

Conferences 2011 

June 

Clinical decision making in 

gastroenterology and hepatology: 

the trials and tribulations of 

digestive diseases 

Wednesday 8 June 

Joint conference with the British 

Society of Gastroenterology and British 

Association for the Study of the Liver 

September 

Osteoarthritis: a holistic approach 

Tuesday 13 September 


Society for Rheumatology 

Endocrine update 

Monday 26 September 

October 

Cardiology update 

Tuesday 11 October 


Cardiovascular Society 

Acute and general medicine for 

the physician 

Monday 24–Wednesday 26 October 

November 

West African College of Physicians 

Annual General and Scientific Meeting 

in partnership with the Royal College of 

Physicians (in Banjul, the Gambia) 

Sunday 6–Thursday 10 November 

Mending the patient with hip fracture: 

NICEly does it 

Thursday 10 November 

December 

Healthcare infections 

Thursday 8 December 

Lectures 2011 

Lectures are usually held on the 

occasion of a conference or RCP 

update in medicine 

June 

HIV and the lung 

Tuesday 7 June, 14.00 

Professor RF Miller 

Regional lecture (in Cambridge) 

COPD – treat the legs 

Tuesday 28 June, 11.45 

Dr N Hopkinson 

Regional lecture (in Nottingham) 

July 

Evidence-based management 

of sepsis in young people 

Tuesday 12 July, 12.00 

Dr S Nadel 

Teale lecture (in Watford) 

September 

New paradigms in the prevention of 

cardiovascular disease 

Wednesday 7 September, 15.00 

Dr DS Wald 

Regional lecture (in Bristol) 

Promoting the public’s health: 

lessons from East and West 

Thursday 22 September, 12.00 

Professor SM Griffiths OBE 

Milroy Lecture 

Why examine the chest 

Thursday 29 September, time tbc 

Dr WJM Kinnear 

Tudor Edwards Memorial lecture 

(in Sheffield) 

October 

Ablation therapy for atrial fibrillation – 

does it work and is it cost effective 

Wednesday 5 October, time tbc 

Professor RJ Schilling 

Oliver-Sharpey lecture (in Liverpool) 

Systemic vasculitis – when to consider, 

how to diagnose, how to treat and 

monitor 

Wednesday 12 October, 12.00 

Dr DP D’Cruz 

Regional Lecture (in Birmingham) 

Divided we fail 

Tuesday 18 October, 17.30 

Dr IC Heath CBE 

Harveian Oration 

Halving premature deaths from 

vascular disease 

Monday 24 October, 12.30 

Professor Sir Richard Peto FRS 

Lord Rayner Memorial Lecture 

Cardiovascular magnetic resonance 

– what does it have to offer 

Thursday 27 October, 15.00 

Dr S Petersen 

Regional lecture (in Belfast) 

The critical role of kisspeptin in 

human fertility 

Monday 31 October, 17.15 

Dr WS Dhillo 

Goulstonian Lecture 

Contact details 

Conference programmes and booking forms are available on 

our website at: www.rcplondon.ac.uk/events 

Further information about the lecture programme is also available 

on our website at: www.rcplondon.ac.uk/events 

Conference Department, Royal College of Physicians 

11 St Andrews Place, Regent’s Park, London NW1 4LE 

Tel: +44 (0)20 3075 1252/1300/1436 

Fax: +44 (0)20 7224 0719 / Email: conferences@rcplondon.ac.uk 


Events diary 

Teach-in programme 2011 

Teach-ins provide an update on advances in clinical practice for 

doctors in training, consultant physicians, GPs and other doctors 

wishing to continue their medical education. Attendance is free 

of charge. 

7 June Acute pulmonary infection 

5 July Acute GI and hepatic medicine 

4 October Eyes and skin: all you need to know 

1 November Peri operative medicine or what to do when 

you are called to the surgical ward 

Further information and detailed programmes are 

available online at: www.rcplondon.ac.uk/teachins 

Teach-in sessions are now webstreamed live and archived on the 

RCP website. Access is free of charge by logging on to: 

www.rcplondon.ac.uk/webstreamed-events 

RCP updates in medicine and 

annual visits 2011 

The RCP holds a series of open forum sessions to promote 

good communication and discuss professional issues with 

fellows and members in England, Wales and Northern Ireland. 

These are attended by the president and RCP officers. 

Tuesday 7 June 

Tuesday 28 June 

Tuesday 12 July 

Wednesday 7 September 

Thursday 29 September 

Wednesday 5 October 

Wednesday 12 October 

Thursday 27 October 

Eastern (Cambridge) 

East Midlands North (Nottingham) 

North West London (Watford) 

South West (Bristol) 

North Trent/South Yorkshire 

(Sheffield) 

Mersey (Liverpool) 

West Midlands (Birmingham) 

Northern Ireland (Belfast) 

To view the dates and locations of upcoming RCP 

updates in medicine or regionally organised events visit: 


Fellowships and lectureships 

Linacre lecture 

Applications are invited to deliver the Linacre lecture 2012. 

Applicants must be fellows or members under the age 

of 40 on 30 September 2011. The lecture should include 

a proportion of original unpublished work in a balanced 

account of the subject suitable for a general medical 

audience. Work carried out in collaboration or under 

supervision will require prior approval of colleagues. 

Closing date for applications is 30 September 2011. 

Milroy lecture on state medicine and public health 

Applications are invited to deliver the Milroy lecture 2013. 

The lecturer is appointed by Council and the subject should 

be of relevance to state medicine and public hygiene, 

although the interpretation of this can be broad. A copy of 

Dr Milroy’s ‘suggestions’ on the subject of this bequest is 

available on request. 


Details on how to apply are avalaible at: www.rcplondon. 

ac.uk/education/funding-and-awards/lectures 

Applications should be submitted to: 

Academic Vice President, Royal College of Physicians, 

11 St Andrews Place, Regent’s Park, London NW1 4LE 

Tel: +44 (0)20 3075 1564 / Fax: +44 (0)20 7224 0719 

Email: trustfunds@rcplondon.ac.uk 

Samuel Leonard Simpson fellowships in endocrinology 

Applications are invited from suitably qualified UK 

endocrinologists for the Samuel Leonard Simpson fellowships 

in endocrinology. Their purpose is to enable endocrinologists 

to learn new techniques and acquire new experiences, ideas 

and stimulation through travel and the exchange of ideas. 


Application forms are available at: www.rcplondon.ac.uk/ 

trustfunds or email: trustfunds@rcplondon.ac.uk 

MRC/RCP/Dinwoodie Trust clinical research 

training fellowship 

One clinical research training fellowship will be awarded 

in 2012 to a clinically qualified professional to undertake 

up to three years research in the bio-medical sciences 

in a recognised UK institution. For full details please visit: 

www.mrc.ac.uk/index.htm and go to the Funding 

Opportunities section. MRC Fellowship Team, 

tel: +44 (0)1793 867017 email: mrcfellows@ssc.rcuk.ac.uk 


Education 

Education 

www.rcplondon.ac.uk/education 

Educational programmes 

The Education Department now distributes a monthly mailing list which provides information on educational programmes, including 

Doctors as Educators and commissioned workshops, as well as special events that delegates might be interested in attending. If you 

would like to be added to this mailing list, please email: education.courses@rcplondon.ac.uk 

Doctors as Educators 

The Doctors as Educators programme is a series of oneand 

two-day CPD-accredited workshops aimed at doctors 

from any specialty, including medicine, surgery and general 

practice, who have a role in supervision, training or education. 

Delivered by a team of in-house educationalists and expert 

clinicians, Doctors as Educators workshops enable delegates 

to acquire, develop and practise key skills that can be directly 

implemented in the workplace. 

Doctors as Educators features two internationally 

recognised awards: 

RCP Educator accreditation 

Popular with doctors from a wide range of specialties, this 

accreditation focuses on the teaching role of doctors and is 

practical for doctors of all grades. 

Delegates are also able to apply for AHEA status following 

completion of this programme. 

RCP Supervisor accreditation 

Aimed at doctors wishing to gain formal recognition for their 

role in educational supervision, this accreditation meets the 

General Medical Council’s requirements as set out in their 

‘Standards for Trainers’. 

CPD credits: our workshops are approved for external 

non-clinical CPD credits (one credit per hour) 

Price: £285 for one day / £520 for two days 

Information regarding Doctors as Educators workshops 

and both accreditations can be found on the RCP 

website: www.rcplondon.ac.uk/doctorsaseducators 

If you require any further details, please contact the 

training programmes team: email: education-courses@ 

rcplondon.ac.uk or tel: +44 (0)20 30751562/1563/1231 

Quality improvement for 

consultants 

The RCP is dedicated to keeping abreast of key NHS issues 

and assisting doctors in improving the quality of their clinical 

care by providing a variety of medical education workshops. 

With this in mind, the Education Department is pleased to 

announce the launch of a newly designed workshop, ‘Quality 

improvement for consultants’, on 3 October 2011. 

Today’s doctor must reconcile increasing demands, new and 

more expensive treatments, and financial constraints, but 

trying to achieve improvement to quality requires system 

changes. Our interactive one-day workshop has been designed 

specifically to enable educational supervisors to identify 

learning opportunities relating to quality improvement to 

support and guide their trainees. 

For further information on this workshop visit: 


RCP Educational Supervisor 

accreditation 

The RCP has developed a training and accreditation process 

which gives formal recognition to doctors who are educational 

supervisors and which meets the General Medical Council’s 

requirements for ‘Standards for Trainers’. Delegates will attend 

a two-day workshop covering key aspects of educational 

supervision and submit an assignment based on their own 

supervisory practice. This accreditation is suitable for doctors 

of all specialties who are currently educational supervisors or 

senior trainees who plan to be a consultant the following year. 

CPD credits: 10 / Price: £545 inc VAT 

For further information on this workshop visit: 

http://events.rcplondon.ac.uk/details.aspxe=2420 


Education 

MSc in Medical Leadership 

2011/2012 entry 

Applications are now open for the MSc in Medical Leadership. 

This unique programme is delivered jointly by the RCP, 

Birkbeck College and the London School of Hygiene & Tropical 

Medicine and is specifically designed to equip doctors with 

the skills and expertise they need in order to excel in senior 

management positions. 

The MSc is a blend of academic theory, practical case-studies 

and interactive sessions with high-profile medical leaders. 

This year’s students have benefited from an impressive range 

of speakers including Sir David Nicholson CBE and Dame 

Carol Black. Bursaries are available for this course, awarded to 

students on a basis of need and merit. 

To receive further information about this programme 

or express an interest in applying, please contact the 

programme coordinator Siobhan Sparkes-McNamara, 

email: siobhan.sparkes-mcnamara@rcplondon.ac.uk or 

tel: +44 (0)20 30751420. Places are limited and early 

application is advised. 

A blend of academic theory, practical 

case-studies and interactive sessions 

with high-proflie medical leaders. 

Bursaries are available for this course 

MSc in Medical Education 

2011/2012 entry 

The PG Certificate, Diploma and MSc in Medical Education are 

successful joint programmes between the RCP and University 

College London. 

The programme is designed exclusively for doctors wishing to 

develop their roles as educators. Participants are from a full 

range of specialties including surgeons, general practitioners, 

psychiatrists, and radiologists as well as physicians. Doctors 

who enrol in the programme are mainly specialty registrars, 

consultants or other career-grade doctors. 

Applications for the 2011/12 year are open and the 

closing date is 1 June 2011. This is a very popular 

programme and places are limited. If you would like 

to register your interest in the programme or have any 

questions please contact the programme coordinator, 

email: UCL@rcplondon.ac.uk or tel: +44(0)20 3075 1353. 

Designed exclusively for doctors 

who wish to develop their roles as 

educators, participants are from a 

range of specialties including surgeons, 

general practitioners, psychiatrists and 

radiologists as well as physicians 

MRCP Part 2 revision course 

27–29 June 2011 

This course is designed to prepare candidates for the 

MRCP(UK) Part 2 written exam. It is facilitated by doctors who 

are respected leaders in their specialties and have extensive 

experience in preparing candidates for the MRCP(UK), 

including Dr Beynon, Professor Sharma and Dr Bishop. 

Key features of the course: 

n Comprehensive coverage of the part 2 syllabus 

n Facilitated by clinicians who are experts at delivering 

MRCP(UK) exam revision courses 

‘This revision course has been 

extremely beneficial and has increased 

my confidence in sitting the exam 

– thank you’ 

n Course content to reflect current hot topics of the exam 

n Review of past question topics 

n Instruction on exam technique 

n One week of free access to the Medical Masterclass website 

For further information please contact: 

education-courses@rcplondon.ac.uk 


Royal College of Physicians 

Annual report 2010 

The general election of 2010 and the coalition 

government’s health policies have offered the 

opportunity to have public debate about the future 

of the NHS and to present ideas that should carry the 

NHS through the next decade. The RCP grasped the 

opportunity to reflect on and set out our vision of a 

modern health service and the policies we believe are 

needed to support it. For the first time, we pulled our 

policy goals together under one theme – leading 

for quality. 

This year our annual report has drawn together 

the diverse work streams of the RCP and set the 

theme for 2010 to improve the healthcare and the 

health of the population. The Annual report 2010 is 

now available online: www.rcplondon.ac.uk/about/ 

annual-report 

‘In retrospect, 2010 may be seen as a watershed year, 

not only for the RCP – as the president has changed 

– but more importantly for the NHS. We sought to 

represent you at the highest levels to ensure that the 

quality of patient care is maintained and improved’ 

Sir Richard Thompson, president 

‘As part of our continuing commitment to developing 

medical professionalism in the context of the demands 

of contemporary healthcare delivery, we have been 

expanding our education and training support in the 

field of medical leadership’ 

Martin Else, chief executive 

Image©Jonathan Perugia

Supporting physicians through education and training 

Improving standards in clinical practice 

Influencing the healthcare agenda 

Promoting patient-centred care 

Championing the values of the medical profession 

Supporting international activity 

Annual report 2010 available online at: 

www.rcplondon.ac.uk/about/annual-report

William Harvey House 

Regency splendour in the heart of London 

‘William Harvey House will provide comfortable, affordable 

accommodation in magnificent Regency buildings with every 

amenity for working, while attending a meeting or conference. 

The perfect stay for those wishing to redress their work–life balance 

and take advantage of the superb range of events in London’ 

Linda Luxon, treasurer 

The refurbishment of houses 9 and 10, re-named William Harvey House by the officers, 

has combined two important attributes of the RCP: its unique history and a valuable facility 

for fellows and members. More information will be available by June 2011. William Harvey House 

will re-open in September 2011, in the meantime discounted hotel accommodation may be 

booked by emailing our agents: res@hotelreservations.uk.com or calling: +44 (0)1268 572 003

Lindsey Davies: Q&A - Royal College of Physicians

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