Lindsey Davies: Q&A - Royal College of Physicians
Lindsey Davies: Q&A - Royal College of Physicians
Lindsey Davies: Q&A - Royal College of Physicians
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Interviews Features News Events<br />
June 2011<br />
Membership magazine <strong>of</strong> the <strong>Royal</strong> <strong>College</strong> <strong>of</strong> <strong>Physicians</strong><br />
<strong>Lindsey</strong><br />
<strong>Davies</strong><br />
Public health is on the agenda<br />
– we speak to the president <strong>of</strong><br />
the Faculty <strong>of</strong> Public Health<br />
The nudge theory<br />
Can behavioural insights<br />
promote healthier lifestyles and<br />
reduce health inequalities
Commentary Community<br />
RCP membership magazine now online<br />
Comment on columns from RCP committees<br />
Read our <strong>of</strong>ficer columns online<br />
Lead features available online<br />
Log in to the RCP website and access<br />
Commentary online. Commentary<br />
Community <strong>of</strong>fers fellows and members news, features and regular updates from RCP<br />
<strong>of</strong>ficers, committees, and from the regions. Exclusive features are also published online for<br />
RCP fellows and members. This month read international sponsorship scheme prize winner<br />
Dr Manoji Gunathilake’s experiences <strong>of</strong> working in the UK.<br />
Commentary Community allows you to directly comment on news stories,<br />
lead features and columns to share your views with the RCP and other fellows and<br />
members. Log in to the RCP website and have your say on what we are doing right now.<br />
Read our full interview with Pr<strong>of</strong>essor <strong>Lindsey</strong> <strong>Davies</strong> online<br />
‘I should have said at the start that a lot <strong>of</strong> people don’t understand what public health<br />
really is and that is important to get in mind. Some people have the mistaken opinion<br />
that public health is all about prevention, which is partly true, but it is by no means<br />
completely right. Public health is the science and art <strong>of</strong> improving health...’<br />
Pr<strong>of</strong>essor <strong>Lindsey</strong> <strong>Davies</strong>, president <strong>of</strong> the Faculty <strong>of</strong> Public Health
Contents<br />
Commentary<br />
Membership magazine <strong>of</strong> the <strong>Royal</strong> <strong>College</strong> <strong>of</strong> <strong>Physicians</strong><br />
Olympic doctors<br />
Commentary counts down to the<br />
London 2012 Olympic Games<br />
18<br />
Editor in chief<br />
Pr<strong>of</strong>essor Robert Allan<br />
Editor<br />
Emma Tennant<br />
Associate editor<br />
Dr Venkat Mahadevan<br />
Head <strong>of</strong> publications<br />
Orla Fee<br />
Managing editor (serials)<br />
Dail Maudsley<br />
Production<br />
Suzanne Fuzzey<br />
Designer<br />
James Partridge<br />
Artwork<br />
Bill McConkey<br />
Display sales<br />
Ben Nelmes<br />
ben.nelmes@redactive.co.uk<br />
Recruitment sales<br />
Giorgio Romano<br />
giorgio.romano@redactive.co.uk<br />
Articles published in Commentary<br />
reflect the opinions <strong>of</strong> the authors and<br />
do not necessarily represent the view<br />
<strong>of</strong> the <strong>Royal</strong> <strong>College</strong> <strong>of</strong> <strong>Physicians</strong><br />
Images©<strong>Royal</strong> <strong>College</strong> <strong>of</strong><br />
<strong>Physicians</strong> unless otherwise stated.<br />
Cover image©Jonathan Perugia<br />
4 President’s message<br />
5 News&views<br />
Features<br />
10 <strong>Lindsey</strong> <strong>Davies</strong>: Q&A<br />
Commentary speaks to Pr<strong>of</strong>essor<br />
<strong>Lindsey</strong> <strong>Davies</strong>, president <strong>of</strong> the<br />
Faculty <strong>of</strong> Public Health<br />
14 In focus: public health<br />
A public health doctor, a GP and<br />
a consultant physician give their<br />
views on public health<br />
Regulars<br />
22 Olympian plants<br />
A look at the use <strong>of</strong> plants in the<br />
ancient Olympics<br />
23 Re-framing disability<br />
A retrospective look at the RCP’s<br />
exhibition on disability<br />
24 2012 fellowship<br />
nominations<br />
Find out how to become a fellow<br />
<strong>of</strong> the RCP<br />
25 Letters to the editor<br />
26 Events diary<br />
28 Education<br />
16<br />
5<br />
Write to us<br />
If you would like to respond to<br />
any <strong>of</strong> the articles featured in<br />
Commentary, or share your views<br />
on RCP matters, please write to:<br />
Pr<strong>of</strong>essor Robert Allan, Commentary<br />
11 St Andrews Place, Regent’s Park,<br />
London NW1 4LE<br />
Publication at RCP discretion – your<br />
correspondence may be edited<br />
Commentary is published bi-monthly<br />
by the <strong>Royal</strong> <strong>College</strong> <strong>of</strong> <strong>Physicians</strong><br />
Registered charity no 210508<br />
©<strong>Royal</strong> <strong>College</strong> <strong>of</strong> <strong>Physicians</strong><br />
Printed by Warners (Midlands) Plc<br />
16 Putting the nudge<br />
in motion<br />
Commentary investigates<br />
behavioural insight to improve<br />
healthy lifestyles and reduce<br />
health inequalities<br />
18 Countdown to<br />
London 2012<br />
Dr Ian McCurdie talks Olympic<br />
athletes, working in the British<br />
Army, and ballet dancers in the<br />
first <strong>of</strong> our new series on the<br />
London 2012 Olympics<br />
14
President’s message<br />
Comment Write to us...<br />
Respond to any <strong>of</strong> the articles featured or share your views on<br />
RCP matters. Email us at: letters.commentary@rcplondon.ac.uk<br />
All eyes on public health<br />
‘This is an extremely important issue, and I am sure that you, like me, are<br />
frustrated at the seemingly inexorable rising tide <strong>of</strong> hospital admissions<br />
related to alcohol, tobacco, obesity and other public health harms’<br />
Not a day goes by without<br />
major developments and<br />
changes in the proposed NHS<br />
reforms. Since I last wrote in<br />
Commentary, the landscape has changed<br />
considerably, and we are now part way<br />
through an unprecedented pause in the<br />
Health and Social Care Bill to allow for the<br />
government’s ‘listening exercise’.<br />
The coalition’s ears on the ground<br />
materialised in the form <strong>of</strong> 44 health<br />
pr<strong>of</strong>essionals brought together under<br />
the moniker <strong>of</strong> the ‘NHS Future Forum’.<br />
Pr<strong>of</strong>essor Steve Field FRCP is chairing<br />
the Forum, and Kathy McClean FRCP is<br />
the Forum’s lead for clinical advice and<br />
leadership. In addition to submitting<br />
a written response to the Forum, we<br />
have welcomed both Steve and Kathy<br />
to a meeting at the RCP, while Forum<br />
representative and community pharmacist,<br />
Ash Soni, recently attended our West<br />
Midlands regional update. We put some<br />
<strong>of</strong> your questions about the reforms to<br />
Pr<strong>of</strong>essor Steve Field and his responses<br />
can be read in the online Commentary<br />
Community: www.rcplondon.ac.uk/<br />
commentary.<br />
As with so many areas <strong>of</strong> healthcare,<br />
it is clear in my mind that integration is<br />
key. As well as calling for the involvement<br />
<strong>of</strong> hospital clinicians in commissioning<br />
decisions, I strongly believe that public<br />
health experts must have a voice in how<br />
services are commissioned. The RCP has<br />
also recommended that secondary care<br />
specialists become a mandatory part<br />
Has the government put all <strong>of</strong> its eggs in the<br />
nudge theory basket, and shied away from<br />
regulation to persuade the public that the<br />
healthy option is the best option Page 16<br />
<strong>of</strong> local authority Health and Wellbeing<br />
Boards, and specifically involved in setting<br />
local priorities and in commenting on the<br />
extent to which consortia have reflected<br />
these priorities.<br />
In this issue <strong>of</strong> Commentary there is a<br />
focus on public health, and what the future<br />
holds for its provision. This is an extremely<br />
important issue, and I am sure that you,<br />
like me, are frustrated at the seemingly<br />
inexorable rising tide <strong>of</strong> hospital admissions<br />
related to alcohol, tobacco, obesity and<br />
other public health harms. If we are to<br />
‘As well as calling for the involvement <strong>of</strong> hospital<br />
clinicians in commissioning decisions, I strongly<br />
believe that public health experts must have a<br />
voice in how services are commissioned’<br />
reduce healthcare costs in the future, we<br />
must improve the health <strong>of</strong> the nation –<br />
already the benefits <strong>of</strong> less smoking are<br />
showing through.<br />
In addition to the proposed new<br />
public health structure, the reforms have<br />
introduced an entirely new approach to<br />
tackling public health. The government<br />
has put all <strong>of</strong> its eggs in the nudge<br />
theory basket, and in doing so has shied<br />
away from regulation in favour <strong>of</strong> gently<br />
persuading the public that the healthy<br />
option is the best option. You can read what<br />
health experts really think to the efficacy<br />
<strong>of</strong> this new approach <strong>of</strong> less regulation and<br />
more behavioural insight on page 16.<br />
I appreciate that public health legislation<br />
may lead to headline-grabbing accusations<br />
<strong>of</strong> a ‘nanny state’, but I am unconvinced <strong>of</strong><br />
the merits <strong>of</strong> ‘nudge’. As I said in a letter to<br />
Andrew Lansley, all improvements in public<br />
health, from John Snow and the Clean<br />
Air Act to the recent smoking legislation,<br />
have been achieved by legislation. For this<br />
reason, we and five other organisations<br />
decided not to sign up to the government’s<br />
responsibility deal – it could have done so<br />
much more! n<br />
Sir Richard Thompson<br />
President<br />
Read more...<br />
Three expert views<br />
on public health; p14<br />
Commentary asks the views <strong>of</strong><br />
three experts – a public health<br />
doctor, a GP and a consultant –<br />
about the future <strong>of</strong> public health.<br />
You can read the full report online<br />
at Commentary Community and<br />
comment on their opinions:<br />
www.rcplondon.ac.uk/commentary<br />
4 Commentary n June 2011 n www.rcplondon.ac.uk
News<br />
Comment Write to us...<br />
Respond to any <strong>of</strong> the articles featured or share your views on<br />
RCP matters. Email us at: letters.commentary@rcplondon.ac.uk<br />
News&views<br />
www.rcplondon.ac.uk/news<br />
RCP Lords’ Lunch<br />
President Sir Richard Thompson says quality<br />
should be at the heart <strong>of</strong> the Health Bill<br />
The RCP hosted its annual Lords’ Lunch on 1 April with guests<br />
including Baroness Northover, the government whip on the Health<br />
Bill, Baroness Thornton, opposition spokesperson on health, and<br />
Lord Turnberg, a former president <strong>of</strong> the RCP. Over 20 fellows and<br />
members discussed with RCP <strong>of</strong>ficers and staff current health policy<br />
issues affecting the RCP.<br />
First on the agenda were the government’s reforms to the health<br />
service in England. Sir Richard Thompson, RCP president, outlined<br />
the changes the RCP wants to the Bill: to put quality at its heart,<br />
to ensure secondary care clinicians are involved in commissioning,<br />
and to prevent fragmentation while ensuring integration. Dr<br />
Andrew Goddard, RCP medical workforce director, presented data<br />
on workforce and the government’s proposed reforms to medical<br />
education and training. Baroness Thornton later blogged: ‘On<br />
Friday a group <strong>of</strong> Peers, from across the House, had lunch with<br />
the <strong>Royal</strong> <strong>College</strong> <strong>of</strong> <strong>Physicians</strong>. I was particularly struck by the<br />
problems <strong>of</strong> workforce recruitment and training. If it takes 15 years<br />
to produce the best consultants how will that be achieved with the<br />
fragmentation <strong>of</strong> the Health Service that this legislation brings’<br />
The RCP is continuing to work with these peers to positively influence<br />
government policy making. n<br />
Image©Shutterstock<br />
The RCP wants the Health Bill to be amended to ensure<br />
an integrated health service without fragmentation<br />
Get involved with the RCP’s plans<br />
for the London 2012 Olympic Games<br />
Image©Shutterstock<br />
London 2012 at RCP<br />
Get involved with the London 2012<br />
Olympic Games at the RCP<br />
The RCP is planning a series <strong>of</strong> events to coincide with the<br />
London 2012 Olympics. We are asking fellows and members<br />
with a connection to the games or elite sports to get in<br />
touch to discuss ideas and see how you can get involved.<br />
In addition to a planned exhibition on human anatomy,<br />
suggestions have included a public walking or cycling tour<br />
between medical museums, an Olympic-themed open<br />
day, and a performance-enhancing drugs tour <strong>of</strong> the RCP<br />
Medicinal Garden. If you would like to get involved with the<br />
RCP’s Olympic plans or put forward an idea for an event,<br />
please get in touch at: policy@rcplondon.ac.uk. n<br />
www.rcplondon.ac.uk n June 2011 n Commentary 5
News<br />
Comment Write to us...<br />
Respond to any <strong>of</strong> the articles featured or share your views on<br />
RCP matters. Email us at: letters.commentary@rcplondon.ac.uk<br />
Image©Shutterstock<br />
The Bill takes a break<br />
‘Specialists and public health doctors must be involved at the highest level <strong>of</strong> governance<br />
in consortia’ says the RCP, as the Health and Social Care Bill takes a pause to ‘listen’<br />
The NHS Future Forum, tasked with<br />
examining possible improvements to<br />
the Health and Social Care Bill, has been<br />
established by the prime minister, David<br />
Cameron, and the deputy prime minister,<br />
Nick Clegg, with the health secretary,<br />
Andrew Lansley. The forum is chaired by<br />
Pr<strong>of</strong>essor Steve Field, past chair <strong>of</strong> the <strong>Royal</strong><br />
<strong>College</strong> <strong>of</strong> General Practitioners. It will<br />
focus on four areas <strong>of</strong> reform: the role <strong>of</strong><br />
choice and competition; accountability and<br />
patient and public involvement; training<br />
and the workforce; and the range <strong>of</strong> health<br />
pr<strong>of</strong>essionals involved in commissioning<br />
decisions. The RCP will be engaging with<br />
the Future Forum throughout the Bill’s<br />
two-month pause and will respond to the<br />
<strong>of</strong>ficial consultation at the end <strong>of</strong> May.<br />
The Bill left the Commons committee<br />
stage on 31 March after minimal,<br />
predominantly technical, amendments.<br />
There have been no changes to the ‘duty<br />
to obtain appropriate advice’ placed on<br />
consortia and the NHS Commissioning<br />
Board – an area <strong>of</strong> particular interest to<br />
the RCP. In terms <strong>of</strong> concessions, the most<br />
significant change relates to the tariff.<br />
There were also some small amendments<br />
to Monitor’s role. Four days after the Bill<br />
left the committee stage, Andrew Lansley<br />
announced that it would take a ‘natural<br />
break’, lasting two to three months, in<br />
its progress through parliament – an<br />
unusual step. David Cameron and Nick<br />
Clegg were enlisted, along with Andrew<br />
Lansley, to listen to concerns and explain<br />
reforms during this period, leading to the<br />
establishment <strong>of</strong> the Future Forum. The<br />
RCP has been fully engaged in this exercise<br />
and met the Future Forum on a number<br />
<strong>of</strong> occasions.<br />
One day after the pause in the passage<br />
<strong>of</strong> legislation was announced, the Health<br />
Select Committee published their followup<br />
inquiry report into commissioning. The<br />
report focuses on the proposed structural<br />
arrangements for commissioning under the<br />
reforms. Many <strong>of</strong> the recommendations<br />
reflect the RCP’s evidence submission, with<br />
key recommendations including:<br />
n Secondary legislation should require<br />
hospital doctors and nurses to sit on local<br />
commissioning bodies.<br />
n Public health specialists should sit on<br />
local commissioning bodies.<br />
n Local commissioning bodies should<br />
not be called GP consortia, but should<br />
be referred to as NHS commissioning<br />
authorities.<br />
The RCP’s submitted evidence was<br />
extensively quoted in the Health Select<br />
Committee report: ‘In their evidence to us,<br />
the <strong>Royal</strong> <strong>College</strong> <strong>of</strong> <strong>Physicians</strong> (RCP) told<br />
us that they would like to see an approach<br />
termed “commissioning without walls”<br />
where a broad spectrum <strong>of</strong> clinicians is<br />
involved in the commissioning process’.<br />
The Health Select Committee stated that<br />
the RCP feels that the provisions <strong>of</strong> the Bill<br />
are too loose and that it leaves clinician<br />
involvement as a matter dependent on<br />
local relationships. ‘The RCP is calling for a<br />
tighter requirement in the Bill for the NHS<br />
Commissioning Board and consortia to<br />
involve a full range <strong>of</strong> health pr<strong>of</strong>essionals.<br />
[We propose] a duty to involve specialists.<br />
As it stands, we fear that the duty to obtain<br />
appropriate advice may become a tick<br />
box exercise, which has the potential to<br />
damage patient care.’<br />
Sir Richard Thompson, RCP president,<br />
has written to the Health Select Committee<br />
welcoming their report. The RCP will<br />
continue to follow up progress <strong>of</strong> the Bill<br />
with key parliamentarians.<br />
The full version <strong>of</strong> this article is<br />
available on Commentary Community:<br />
www.rcplondon.ac.uk/commentary.<br />
6 Commentary n June 2011 n www.rcplondon.ac.uk
News<br />
The HIU 10 years on<br />
Tasked with improving the quality <strong>of</strong> patient records, the<br />
RCP Health Informatics Unit celebrates 10 years<br />
The RCP’s Health Informatics Unit (HIU)<br />
was established in 2000 with a mission<br />
to improve the quality <strong>of</strong> patient records,<br />
specifically to support better, safer patient<br />
care and to yield more reliable aggregate<br />
data for other purposes.<br />
Since its inception, the HIU has reviewed<br />
the evidence base and laid the foundations<br />
for good record-keeping practice, supported<br />
by a sophisticated portfolio <strong>of</strong> educational<br />
activities.<br />
It set up the Information Library in 2004<br />
which worked with physicians across the UK<br />
to review the data held in hospital episode<br />
statistics (HES), such as the patient episode<br />
database for Wales, and to encourage<br />
better record-keeping and engagement in<br />
the coding process. The data concluded<br />
that HES were not sufficiently detailed<br />
or accurate to support appraisal and<br />
revalidation, and that the future lay with<br />
more structured, standardised patientfocused<br />
records.<br />
This work has been taken forward<br />
through large-scale collaborations<br />
and consultations. The programme led<br />
to the publication by the Academy <strong>of</strong><br />
Medical <strong>Royal</strong> <strong>College</strong>s <strong>of</strong> standards for<br />
admission record and handover and<br />
‘The data concluded that hospital episode<br />
statistics were not sufficiently accurate. The<br />
future lay with standardised patient records’<br />
Image©Shutterstock<br />
HIU has reviewed the evidence base and laid the<br />
foundations for good record-keeping practice<br />
discharge communications, supported by<br />
an e-learning package and audit tools. It<br />
has been a challenging first 10 years, but<br />
the HIU says that there is still much more<br />
work to be done. n<br />
Thanks are due to all the staff<br />
– medical, nursing, administrative and<br />
secretarial – who worked with the HIU and<br />
to our colleagues who contributed through<br />
advisory groups, piloted our outputs, and<br />
gave us their views and ideas. In particular,<br />
special thanks go to Robin Mann and Giles<br />
Cr<strong>of</strong>t for their support <strong>of</strong> the HIU, and to<br />
John Williams, director and founder <strong>of</strong><br />
the HIU, and Iain Carpenter and Mala<br />
Bridgelal-Ram for taking the work forward.<br />
A decade for PACES<br />
40,000 assessments and 3,000<br />
examiners later, the MRCP(UK)<br />
practical assessment <strong>of</strong> clinical<br />
examination skills (PACES) celebrates<br />
its 10th birthday this year.<br />
PACES marked a significant<br />
development in the assessment<br />
<strong>of</strong> doctors training in medicine. It<br />
introduced the independent marking<br />
system <strong>of</strong> 10 examiners assessing<br />
each candidate across a standardised<br />
range <strong>of</strong> clinical cases over a two-hour<br />
period. For the first time, candidates<br />
were observed and assessed for<br />
their patient communication skills.<br />
Unlike many other postgraduate<br />
examinations, real patients continued<br />
to participate in the majority <strong>of</strong> the<br />
assessment stations.<br />
The structure <strong>of</strong> PACES proved easily<br />
exportable to centres across the UK<br />
and globally and the examination<br />
has proved popular with examiners,<br />
hosts and candidates. In the 10 years<br />
since its introduction over 40,000<br />
candidate assessments have taken<br />
place at around 100 UK centres and<br />
nine international, with over 3,000<br />
fellows <strong>of</strong> the three royal colleges<br />
participating as examiners.<br />
A variety <strong>of</strong> further initiatives have<br />
also been introduced. These include<br />
the standardisation <strong>of</strong> case material<br />
for the communications stations and<br />
a formalised system <strong>of</strong> examiner<br />
calibration, redesign <strong>of</strong> one <strong>of</strong> the five<br />
stations, and the introduction <strong>of</strong> a<br />
skills-based marking system.<br />
The MRCP(UK) believes that both<br />
well-developed bedside clinical skills<br />
and detailed factual knowledge are<br />
key to delivering high-quality patient<br />
care. PACES continues to ensure that<br />
these skills are given top priority. n<br />
www.rcplondon.ac.uk n June 2011 n Commentary 7
News<br />
Comment Write to us...<br />
Respond to any <strong>of</strong> the articles featured or share your views on<br />
RCP matters. Email us at: letters.commentary@rcplondon.ac.uk<br />
News in brief<br />
NHS trusts fail to<br />
tackle staff obesity<br />
A report published by the RCP and the<br />
Faculty <strong>of</strong> Occupational Medicine has<br />
revealed that only 15% <strong>of</strong> NHS trusts<br />
have a policy or plan to help combat<br />
staff obesity. The findings come from<br />
the first national audit within the NHS<br />
<strong>of</strong> the National Institute for Health<br />
and Clinical Excellence (NICE) public<br />
health guidance for the workplace<br />
(Commentary April 2011).<br />
Implementation for NICE guidance<br />
was recommended by the Boorman<br />
review. A Department <strong>of</strong> Health<br />
report published in 2009 estimated<br />
that approximately 700,000 NHS<br />
staff would be classified as obese<br />
or overweight. n<br />
Building institutions<br />
through equitable<br />
partnerships<br />
The RCP recently hosted a major<br />
international conference on global<br />
health with a focus on the need for<br />
more equitable partnerships.<br />
Speaking before the event, Pr<strong>of</strong>essor<br />
Philippa Easterbrook, RCP associate<br />
international director for global<br />
health, said: ‘This conference provides<br />
a space to reflect on lessons learnt,<br />
and listen to our partners in the<br />
south as to what is needed to build<br />
relevant, equitable, and sustainable<br />
partnerships for the future’. n<br />
International special issue:<br />
August Commentary will bring you<br />
more news on our global health<br />
conference and international matters.<br />
FallSafe care bundle seeks to<br />
reduce inpatient falls<br />
RCP leads on prevention and management <strong>of</strong> falls in<br />
hospitals and fall impact assessment<br />
FallSafe is a quality improvement project<br />
that aims to introduce best practice in<br />
the prevention and management <strong>of</strong><br />
falls in clinical hospital wards and assess<br />
the impact on the number <strong>of</strong> falls. Led<br />
by the RCP in partnership with the south<br />
central strategic health authority, with<br />
funding from the Health Foundation, the<br />
two-year project will run in 16 hospitals<br />
across the south central region. Launched<br />
in April 2010, FallSafe has introduced a<br />
care bundle based on the best evidence<br />
from previous studies to reduce hospital<br />
inpatient falls.<br />
Multifactorial falls prevention strategies<br />
can reduce inpatient falls by about 15%.<br />
While activities such as Formula One racing<br />
and air travel have been made relatively<br />
safe for those who take part, being a<br />
hospital inpatient continues to carry a<br />
significant risk <strong>of</strong> preventable harm. In<br />
2009–10, almost 83 people died and 1,065<br />
suffered severe harm as a consequence <strong>of</strong><br />
a fall in hospital that was reported to the<br />
National Patient Safety Agency.<br />
Hospital inpatients on clinical wards have a significant<br />
risk <strong>of</strong> preventable harm from a fall<br />
All participating wards have appointed<br />
a nurse to take on the role <strong>of</strong> FallSafe<br />
project lead, who will receive extensive<br />
training on aspects <strong>of</strong> falls prevention,<br />
incident investigation, improvement<br />
science, and patient involvement, and take<br />
on responsibility for supervision <strong>of</strong> a falls<br />
reduction programme on the ward. The<br />
project lead will champion the cause <strong>of</strong><br />
falls prevention on the ward by introducing<br />
the bundle <strong>of</strong> care and recording inpatient<br />
experience as well as collecting and<br />
monitoring falls data. The care bundle<br />
elements have been introduced gradually<br />
over the first year <strong>of</strong> the project, and data<br />
on their implementation and on inpatient<br />
fall rates will continue to be gathered until<br />
the end <strong>of</strong> the project in March 2012. n<br />
More information is available<br />
at: www.rcplondon.ac.uk/resources<br />
or email: Adam Darowski, associate<br />
director, adam darowski@orh.nhs.uk<br />
or Lisa Byrne, FallSafe project manager,<br />
lisa.byrne@rcplondon.ac.uk.<br />
Image©Shutterstock<br />
8 Commentary n June 2011 n www.rcplondon.ac.uk
News<br />
EU rules on alcohol labelling<br />
EU rules that labelling for fresh orange juice must include<br />
nutritional information but alcoholic drinks are exempt<br />
A gap in EU legislation for labelling means<br />
that nutrition and ingredient information<br />
will apply to fresh orange and apple juice<br />
but not to alcoholic drinks.<br />
Despite the fact that alcohol may<br />
cause 10% <strong>of</strong> EU cancers and is widely<br />
acknowledged to be an addictive substance<br />
with dose-dependent multi-organ toxicity,<br />
the EU governing body has ruled that<br />
alcoholic drinks will be exempted from<br />
nutrition and ingredient legislation on<br />
food and drink labelling. In response to<br />
this, Nick Sheron, RCP representative for<br />
the EU Alcohol and Health Forum, says<br />
‘The EU governing body has ruled that<br />
certain products will be exempted from<br />
legislation on the grounds that they contain<br />
an addictive, carcinogenic toxin. Lewis<br />
Carroll would have been quite at home<br />
in the EU parliament, but this denial <strong>of</strong><br />
information is a chilling reminder <strong>of</strong> the<br />
lobbying power <strong>of</strong> the drinks industry, and<br />
is reminiscent <strong>of</strong> the darkest behaviour <strong>of</strong><br />
the tobacco industry’.<br />
The issue <strong>of</strong> alcohol labelling was also<br />
addressed by the EU Alcohol and Health<br />
Forum, which plays a key role in the<br />
EU Alcohol Strategy. The RCP raised its<br />
concerns to the forum that it was unlikely<br />
that the drinks industry would voluntarily<br />
agree to a label which said ‘alcohol<br />
causes cancer’ and that lobbying for<br />
legislation for responsible labelling on<br />
alcohol must continue.<br />
The United Nations is holding a<br />
summit on non-communicable diseases in<br />
September this year. Non-communicable<br />
diseases <strong>of</strong> the 21st-century related to<br />
unhealthy behaviours include tobacco,<br />
alcohol and obesity. ‘If big retailers and<br />
their suppliers worked as hard at having<br />
healthy customers as they do on their shortterm<br />
pr<strong>of</strong>itability, then everyone in society<br />
would benefit, including their stakeholders,’<br />
says Nick Sheron. ‘The challenge for global<br />
policy makers over the next 100 years<br />
will be to find inventive new instruments<br />
that will facilitate this vision. Given the<br />
experience with alcohol labelling, we have<br />
some way to go.’ n<br />
Nick Sheron, RCP representative for<br />
the EU Alcohol and Health Forum, is a<br />
trustee <strong>of</strong> the UK Drinkaware Trust, which<br />
is funded entirely by the drinks industry<br />
with an independent board <strong>of</strong> trustees.<br />
Drinkaware’s website features balanced<br />
health information, including alcohol<br />
and cancer: www.drinkaware.co.uk/facts/<br />
factsheets/alcohol-and-cancer.<br />
Image©Shutterstock<br />
Free movement <strong>of</strong><br />
doctors in the EU<br />
The RCP has responded to a European<br />
Commission consultation on the<br />
EU directive on the Recognition <strong>of</strong><br />
Pr<strong>of</strong>essional Qualifications.<br />
The directive provides minimum<br />
standards <strong>of</strong> medical training and<br />
a system <strong>of</strong> automatic recognition<br />
<strong>of</strong> qualifications for EU-trained<br />
doctors, dentists, nurses, midwives<br />
and pharmacists who wish to work in<br />
another EU member state.<br />
While supporting EU efforts to<br />
encourage the free movement <strong>of</strong><br />
doctors, the RCP has raised a number<br />
<strong>of</strong> concerns including the lack <strong>of</strong><br />
account taken <strong>of</strong> national initiatives<br />
on revalidation and continuing<br />
medical education. It is also concerned<br />
about the directive’s current focus<br />
on duration <strong>of</strong> training rather than<br />
competence and skills acquired. n<br />
More information is available<br />
at: www.rcplondon.ac.uk/news/<br />
rcp-responds-eu-consultation-freemovement-pr<strong>of</strong>essionals<br />
‘While supporting EU<br />
efforts to encourage<br />
the free movement<br />
<strong>of</strong> doctors, the<br />
RCP has raised a<br />
number <strong>of</strong> concerns<br />
including the lack<br />
<strong>of</strong> account taken <strong>of</strong><br />
national initiatives<br />
on revalidation and<br />
continuing medical<br />
education’<br />
www.rcplondon.ac.uk n June 2011 n Commentary 9
Q&A: <strong>Lindsey</strong> <strong>Davies</strong><br />
Image©Jonathan Perugia
<strong>Lindsey</strong> <strong>Davies</strong>: Q&A<br />
Comment Write to us...<br />
Respond to any <strong>of</strong> the articles featured or share your views on<br />
RCP matters. Email us at: letters.commentary@rcplondon.ac.uk<br />
<strong>Lindsey</strong><br />
<strong>Davies</strong><br />
Commentary speaks to Faculty <strong>of</strong> Public Health president, <strong>Lindsey</strong> <strong>Davies</strong><br />
‘If you want to take staff, pr<strong>of</strong>essionals and the public with you in any programme<br />
<strong>of</strong> change you have to paint a compelling vision. The problem at the moment is that<br />
nationally the picture is not very clear. People don’t feel that they are behind a clear vision’<br />
The white paper Healthy lives, healthy<br />
people: our strategy for public health in<br />
England outlines a new vision for public<br />
health, but will it tackle the big challenges<br />
Commentary speaks to Pr<strong>of</strong>essor <strong>Lindsey</strong><br />
<strong>Davies</strong>, president <strong>of</strong> the Faculty <strong>of</strong> Public<br />
Health. Appointed president in July 2010,<br />
<strong>Lindsey</strong> was the former Department <strong>of</strong><br />
Health (DH) national director <strong>of</strong> pandemic<br />
influenza preparedness, regional director<br />
<strong>of</strong> public health for the east midlands,<br />
interim regional director <strong>of</strong> public health for<br />
London and health adviser to the Greater<br />
London Authority.<br />
QWhat are the challenges to public<br />
health doctors arising from the<br />
NHS reforms<br />
APublic health is a multi-disciplinary<br />
specialty, thus some people who<br />
work at consultant level in public health<br />
are doctors and some are not. But the<br />
issues are the same for all. From the<br />
public health point <strong>of</strong> view there are<br />
huge challenges for consultants and for<br />
directors <strong>of</strong> public health (DPH), because<br />
the main organisations who employ<br />
them – the strategic health authorities<br />
(SHAs) and primary care trusts (PCTs) –<br />
are disappearing. They are trying to keep<br />
their mind on the day job while working<br />
out how to cope with huge cuts to their<br />
organisation. If plans go through these<br />
organisations will soon disappear. So that is<br />
the big challenge – to stay focused on the<br />
people who need their support and help.<br />
At the same time, the plan is that DPHs<br />
are moved to local authorities and that<br />
they have a team to support them. They<br />
will have a ring-fenced budget for public<br />
health and Public Health England will be<br />
set up as a new national organisation to<br />
support local authorities and the NHS – we<br />
hope. However, if you read the white paper<br />
it is not at all clear who will be employing<br />
DPHs or how many there will be or where<br />
DPHs will be positioned within local<br />
authorities. It is also not clear how people,<br />
like DPHs and their teams, will continue to<br />
do the health service work at the moment<br />
within PCTs, influencing the health service<br />
and making sure that services are equitable,<br />
appropriate and cost effective.<br />
So taking all those things together, the<br />
challenges are: where are we going to be<br />
and what are our jobs going to look like<br />
Can we really be sure that we are going<br />
to be able to deliver the three domains <strong>of</strong><br />
public health across the whole population:<br />
protecting people’s health, encouraging<br />
healthy lifestyles, and ensuring that people<br />
have access to the services they need<br />
www.rcplondon.ac.uk n June 2011 n Commentary 11
Q&A: <strong>Lindsey</strong> <strong>Davies</strong><br />
Image©Jonathan Perugia<br />
The opportunities are amazing.<br />
Providing we can make sure that public<br />
health expertise is still available to the<br />
health service, including GPs and hospital<br />
consultants, then a DPH should be able to<br />
influence every aspect <strong>of</strong> the population’s<br />
health. And improving health and wellbeing<br />
will be a major part <strong>of</strong> a local<br />
authority’s work. You could make transport<br />
improve health, you could have housing<br />
improve health – that is really exciting.<br />
What are the major opportunities<br />
Q and threats <strong>of</strong> transferring public<br />
health from primary care trusts to local<br />
authorities For example, the opportunities<br />
to integrate public health into core<br />
business-like planning decisions, the risk<br />
<strong>of</strong> a lack <strong>of</strong> infrastructure, loss <strong>of</strong> expertise<br />
and support staff, particularly against a<br />
backdrop <strong>of</strong> efficiency savings and public<br />
sector funding cuts.<br />
AAll <strong>of</strong> those. I think you have got<br />
a nice list there. The risk that we<br />
haven’t talked about is the risk to health<br />
pr<strong>of</strong>essionals. If you move to a local<br />
authority the job will be different and<br />
people are nervous about losing their NHS<br />
terms and conditions. I know that’s not<br />
the sort <strong>of</strong> thing for a royal college to get<br />
involved in – and the faculty is not a trade<br />
union – but actually, I really do care. People<br />
might leave or retire early, because it is not<br />
what they want to do or where they want<br />
to be. I am concerned that you won’t have<br />
the experienced people to do the jobs. If<br />
you look back at previous re-organisations,<br />
we’ve lost a significant percentage <strong>of</strong> staff<br />
in each one and they are always the most<br />
experienced people.<br />
Another risk is relationships. Public health<br />
doctors don’t manage large numbers <strong>of</strong><br />
staff and can’t tell people what to do. It’s<br />
all about influencing, knowing who’s who,<br />
what’s what and knowing what levers to<br />
pull in your local authority to get things<br />
done. Whether it’s managing an outbreak,<br />
improving the environment or changing<br />
policy, you have to get on with people and<br />
know them. These relationships develop<br />
over time – you can’t just magic them into<br />
place. Building relationships through this<br />
‘I would ban transfats tomorrow. If there was<br />
a germ that was killing as many people in a<br />
year then people would be hysterical about it!’<br />
transition period is important and the risk is<br />
that you break the existing relationships.<br />
It takes years to get that right.<br />
How can public health doctors – and<br />
Q the pr<strong>of</strong>ession in general – adapt to<br />
meet the challenges ahead<br />
APublic health doctors should be<br />
building local relationships with people<br />
or strengthening existing ones. We also<br />
need to acknowledge that local authorities<br />
function differently to health services. Some<br />
doctors have experience <strong>of</strong> this, but others<br />
won’t. So the ones that do need to help<br />
their colleagues to adapt and those who<br />
don’t need to work alongside or shadow<br />
people in local authorities – get to know<br />
them and establish relationships.<br />
It is also important that we don’t lose<br />
relationships with GPs. Public health doctors<br />
and other clinicians (because it is no good<br />
if you have one without the other) need to<br />
get into the GP consortia to work alongside<br />
them and support them. We can bring the<br />
expertise <strong>of</strong> working with large populations<br />
that GPs don’t have. GPs know their<br />
practices but as individuals rather than as a<br />
big group. They are not used to prioritising<br />
in the same way that we are. We are used<br />
to dealing with big groups and populations,<br />
so we can really help GPs in this area.<br />
QHow do you see the relationship<br />
between public health doctors<br />
and hospital specialists in terms <strong>of</strong><br />
improving public health Are there missed<br />
opportunities at present<br />
Yes, I think there are lots <strong>of</strong> missed<br />
A opportunities. This is partly because<br />
a lot <strong>of</strong> public health doctors and nonmedical<br />
health pr<strong>of</strong>essionals haven’t been<br />
close to the acute hospital sector for a long<br />
time. They may be out <strong>of</strong> touch because<br />
they have focused on health improvement,<br />
but equally there are many hospital doctors<br />
who don’t know what public health doctors<br />
do or how we do it.<br />
It is always encouraging to me that when<br />
you do get a group <strong>of</strong> public health doctors<br />
and clinicians together that they find, to<br />
their surprise, they have a lot to talk about.<br />
How you construct those opportunities<br />
varies according to what is available locally,<br />
but you can’t beat, for example, medical<br />
12 Commentary n June 2011 n www.rcplondon.ac.uk
<strong>Lindsey</strong> <strong>Davies</strong>: Q&A<br />
Comment Write to us...<br />
Respond to any <strong>of</strong> the articles featured or share your views on<br />
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directors and DPHs, talking about how<br />
they can help each other. Quite <strong>of</strong>ten new<br />
insights and pathways <strong>of</strong> care develop – it<br />
is a great opportunity for a public health<br />
specialist to work alongside a clinician.<br />
What lessons can we learn about<br />
Q major reforms from the past such as<br />
the 1990 health reforms that introduced<br />
GP fund-holding<br />
AThat’s huge. I think I’d go back to<br />
relationships. In any big change you<br />
lose experienced people because they<br />
find it one change too many. We have<br />
to try and avoid that. But if you disrupt a<br />
relationship it could take years to re-build.<br />
If you want to take staff, pr<strong>of</strong>essionals<br />
and the public with you in any programme<br />
<strong>of</strong> change you have to paint a compelling<br />
vision – and they have to want to do it. The<br />
problem at the moment is that nationally<br />
the picture is not very clear. People don’t<br />
feel that they are behind a clear vision.<br />
Hopefully, after this discussion we will have<br />
something that we can really sign up to and<br />
move forward with enthusiasm. But we are<br />
not there yet.<br />
QWhere do you think public health<br />
should be focusing its efforts over the<br />
next decade<br />
ABasically, the health needs <strong>of</strong> the<br />
population and we know what they<br />
are – huge chronic diseases, infection,<br />
new diseases emerging, and disasters<br />
around the corner for which we need to be<br />
ready. We also know that there are huge<br />
inequalities in health and inequalities<br />
in access to health services. One <strong>of</strong> the<br />
challenges for public health is to go back to<br />
those three domains [protecting people’s<br />
health, improving health, and making sure<br />
that the right health services are in place]<br />
and make progress in these areas in the<br />
next couple <strong>of</strong> decades.<br />
I’d like to think that we have got really<br />
good surveillance in place across the<br />
country to spot nasty things before they<br />
happen. I’d like to think that every health<br />
service and social care provider has really<br />
good emergency plans in place.<br />
QSo do you think that we responded<br />
well to the recent flu pandemic that<br />
we had last year<br />
ALast year’s flu pandemic – I think we<br />
responded quite well, I was in charge!<br />
[smiles] I was the flu tzar at the DH before<br />
becoming president <strong>of</strong> the Faculty <strong>of</strong> Public<br />
Health. For three years I was planning for<br />
a pandemic and then suddenly, just when<br />
plans were nearly in place, one arrived! We<br />
got a great test <strong>of</strong> whether our plans were<br />
right or not – including the flu line, which<br />
was my idea – and I think we did do pretty<br />
well. We learned some good lessons and<br />
that’s looking really strong now.<br />
It is so important that we get that<br />
[health protection] right, whether it’s for a<br />
pandemic or not. We need to keep looking<br />
hard at health services and ask if they are<br />
meeting the needs <strong>of</strong> the population or<br />
not. We need to be prepared to make big<br />
changes. Look at diabetes, for example.<br />
Most diabetics are not in hospitals and yet<br />
most diabetes consultants are in hospitals<br />
– well that’s not right is it A lot <strong>of</strong> them<br />
are in the community, but we would like<br />
to see more <strong>of</strong> those who understand and<br />
can treat the disease working where the<br />
patients really are. There are lots <strong>of</strong> things<br />
that we can do to improve health services.<br />
Mental health is one I haven’t<br />
mentioned at all, but that is huge. I’d love<br />
to see better mental health services – public<br />
mental health services and prevention<br />
as well as cure. We also need to look at<br />
lifestyles – smoking, obesity and alcohol<br />
are the major health challenges. If we<br />
can get a focus on those three that would<br />
make a real difference. That means eating<br />
healthily, more exercise, less smoking and<br />
less drinking.<br />
QWhat is your view on the current<br />
government’s focus on ‘nudging’<br />
people into healthy behaviours<br />
AWell, I think they have all got a place.<br />
Any serious campaign or action to<br />
make a difference to public health needs<br />
a holistic approach. You are never going<br />
to make an impact on a health issue –<br />
tobacco, alcohol, eating – by just sending<br />
out a bit <strong>of</strong> information or by providing<br />
nice parks. You need to have a range <strong>of</strong><br />
things in place. I think smoking is a good<br />
example. People need information that<br />
helps them understand that smoking<br />
harms. They also need support to help<br />
them to stop smoking and regulation to<br />
adjust their environment to make it more<br />
difficult for them to smoke, or for people to<br />
be affected by that tobacco smoke.<br />
Information, regulation and nudging<br />
in the environment all have a role to play.<br />
Healthy eating, for example – I would ban<br />
transfats tomorrow. If there were a germ<br />
or a bacterium in food that was killing<br />
as many people as we think are killed by<br />
eating transfats in a year then people<br />
would be hysterical about it!<br />
QIs there cause for optimism in the<br />
public health community<br />
AI think there is. We have a government<br />
which is saying that public health is<br />
important – and they are saying it louder<br />
than any government has before. They are<br />
saying that they really care about public<br />
health and that they really want to make a<br />
difference. That’s brilliant. They have made<br />
more people more aware, not least across<br />
the health pr<strong>of</strong>essions.<br />
Our ambition as a public health specialty<br />
is to do ourselves out <strong>of</strong> business! We want<br />
everybody doing public health things and<br />
then there would not need to be so many<br />
<strong>of</strong> us. But I shouldn’t say that, should I!<br />
We see public health as something that<br />
everyone can do. n<br />
Read more online...<br />
Read and comment on our full-length<br />
interview with Pr<strong>of</strong>essor <strong>Lindsey</strong><br />
<strong>Davies</strong> online at Commentary<br />
Community, including her views on<br />
social determinants <strong>of</strong> health and<br />
on epidemiological research. n<br />
www.rcplondon.ac.uk n June 2011 n Commentary 13
Feature<br />
In focus:<br />
public<br />
health<br />
Image©Shutterstock<br />
NHS reforms have shifted all eyes to the public health agenda and in particular health<br />
inequalities. Commentary asks three experts for their views – a public health doctor, a GP<br />
and a consultant. The full report is available online at www.rcplondon.ac.uk/commentary<br />
We live in a starkly unequal<br />
society. Our life expectancy at<br />
birth, our early development,<br />
educational attainment, chance<br />
<strong>of</strong> employment and chance <strong>of</strong><br />
living in a favourable environment<br />
depend heavily on socio-economic<br />
status. Therefore, it is little surprise<br />
that differences in socio-economic<br />
status lead to inequalities in health.<br />
This has recently been elegantly<br />
described and demonstrated by<br />
Michael Marmott.<br />
This is not new knowledge.<br />
Douglas Black published his report<br />
on inequalities in health in 1980. In<br />
the 30 years since then inequalities<br />
in health and wealth have widened.<br />
We know that health inequalities<br />
are more dependent on relative<br />
poverty than absolute poverty,<br />
so they are not readily amenable<br />
to society’s preferred means <strong>of</strong><br />
getting itself out <strong>of</strong> trouble –<br />
economic growth.<br />
Dr Richard Jarvis<br />
Consultant in health<br />
protection, Cheshire<br />
and Merseyside Health<br />
Protection Unit<br />
While it is refreshing to see<br />
mention <strong>of</strong> health inequalities<br />
as a driver <strong>of</strong> the government’s<br />
proposals for the NHS and a new<br />
public health system, it is difficult<br />
to know how the positive aspects<br />
will not be undermined by cuts<br />
made too hard, too fast, and in the<br />
wrong places.<br />
So what aspect <strong>of</strong> the proposals<br />
might help reduce inequalities<br />
in health The placement <strong>of</strong><br />
directors <strong>of</strong> public health (DPHs)<br />
in local authorities should enable<br />
them to influence local decisions<br />
about adult social care, children’s<br />
services, education, environmental<br />
protection, transport and planning.<br />
All these have a bearing on<br />
inequalities even though this is not<br />
their prime focus. This potential<br />
will not be realised unless we can<br />
solve problems inherent in the<br />
Health Bill around how the DPH<br />
can act as a pr<strong>of</strong>essional adviser<br />
to a political body; who, and with<br />
what qualifications, the local<br />
authority can appoint as their DPH;<br />
how the public health budget can<br />
be protected while simultaneously<br />
giving the DPH influence into<br />
other funding streams; and around<br />
variability <strong>of</strong> approach between<br />
local authorities.<br />
But what about ‘nudging’ and<br />
the idea that lifestyle problems are<br />
all amenable to individual choice<br />
In a perfect world where there is<br />
infallible information on which<br />
to base choice, where everyone<br />
has equal access to high-quality<br />
education, and physical and<br />
financial resources, this might be<br />
a reasonable assumption. But in<br />
today’s unequal society, choice,<br />
and therefore responsibility for<br />
health, is denied to those who<br />
most need to exercise it. Nudging<br />
is but one tool to use – we rely on it<br />
solely at our peril. n<br />
14 Commentary n June 2011 n www.rcplondon.ac.uk
Feature<br />
Comment Write to us...<br />
Respond to any <strong>of</strong> the articles featured or share your views on<br />
RCP matters. Email us at: letters.commentary@rcplondon.ac.uk<br />
Around 70% <strong>of</strong> the UK population<br />
consults their GP every year,<br />
which is very important in terms <strong>of</strong><br />
how much we can do to influence<br />
public health. GPs have a vital<br />
role to play in health promotion,<br />
disease prevention and in reducing<br />
health inequalities. Increasing<br />
attention is now paid to these<br />
topics in undergraduate curricula<br />
and in postgraduate training for<br />
general practice.<br />
There is also an increased<br />
awareness <strong>of</strong> the challenges<br />
<strong>of</strong> health inequalities and the<br />
provision <strong>of</strong> equable access to<br />
primary care services, as stressed<br />
by the Darzi report. Primary care<br />
teams can target the patients<br />
who need additional information<br />
about how best to use primary<br />
care services. We get to know<br />
our patients well, and develop an<br />
understanding <strong>of</strong> what action to<br />
take in different sectors and how to<br />
tailor health services for individuals.<br />
Pr<strong>of</strong>essor Roger <strong>Davies</strong><br />
Editor, British Journal<br />
<strong>of</strong> General Practice,<br />
emeritus pr<strong>of</strong>essor<br />
<strong>of</strong> general practice,<br />
King’s <strong>College</strong> London,<br />
<strong>Royal</strong> <strong>College</strong> <strong>of</strong><br />
General Practitioners<br />
There is evidence that the Quality<br />
and Outcomes Framework has<br />
reduced health inequalities,<br />
because it has encouraged GPs<br />
to focus on the whole practice<br />
population and to achieve targets<br />
for the majority <strong>of</strong> their patients.<br />
The proposed NHS reforms<br />
raise many challenges. One<br />
is to ensure that the National<br />
Outcomes Framework does not<br />
exacerbate health inequalities.<br />
This is something that the <strong>Royal</strong><br />
<strong>College</strong> <strong>of</strong> General Practitioners<br />
is very concerned about. A<br />
move to private healthcare has<br />
the potential to worsen health<br />
inequalities because the more<br />
affluent and articulate members <strong>of</strong><br />
society are likely to come <strong>of</strong>f best.<br />
There are real opportunities<br />
for GP consortia to commission<br />
services in a way that is<br />
appropriate to the populations<br />
they serve. Working in partnership<br />
with public health and social care<br />
organisations, there would be<br />
nothing to prevent GP-led services<br />
from promoting health and<br />
reducing health inequalities.<br />
There are many examples <strong>of</strong><br />
excellent group practice working,<br />
even in the inner city. At the<br />
Bromley by Bow Centre in the east<br />
end <strong>of</strong> London, for example, a wide<br />
range <strong>of</strong> care is integrated on one<br />
site, with mental health patients<br />
running a café and elderly Bengali<br />
men training in IT alongside a<br />
large group practice. This is a<br />
particularly inspiring example,<br />
but if this can be achieved at<br />
one practice then it should be<br />
possible elsewhere.<br />
If GPs are to be given a major<br />
role in commissioning in the future,<br />
they will need to work closely with<br />
colleagues in public health and<br />
secondary care, as well as the<br />
welfare and social care sectors, to<br />
assess needs and deliver effective<br />
services. n<br />
I believe that all doctors should<br />
have an eye on the public health<br />
agenda. Specialty-based training<br />
for physicians should not drive<br />
neglect <strong>of</strong> responsibilities for<br />
prevention, but fuel a wider<br />
responsibility for improving<br />
population health. If there was<br />
one aspect <strong>of</strong> training I would<br />
change it would be to ensure<br />
exposure to public health for all<br />
specialty trainees and exposure<br />
to an ‘ology’ for all public health<br />
trainees. The NHS needs to treat<br />
populations and individuals so that<br />
both arenas work well together.<br />
The major restructuring <strong>of</strong> the<br />
NHS risks a loss <strong>of</strong> much <strong>of</strong> the<br />
corporate memory and many<br />
<strong>of</strong> the relationships that have<br />
been built to enable the NHS<br />
to play its part in addressing<br />
social determinants <strong>of</strong> health<br />
and inequalities. There is a risk<br />
that moving public health into<br />
local authorities will challenge<br />
the ability <strong>of</strong> individual clinicians<br />
to influence public health, unless<br />
bridges into health service delivery<br />
organisations (and to clinicians) are<br />
retained. Therefore, it is imperative<br />
that as clinicians, we take a keen<br />
interest in the reforms.<br />
On a positive note, a stronger link<br />
with social care and across other<br />
government agencies will, if public<br />
health directors and clinicians are<br />
able to influence it, allow us to<br />
prioritise the social determinants<br />
<strong>of</strong> health agenda.<br />
Clinicians need to contribute to<br />
partnerships working across public<br />
health, primary care and secondary<br />
care to promote public health and<br />
address health inequalities. We<br />
may now be able to have stronger<br />
access into social care and local<br />
government to really impact on<br />
social determinants <strong>of</strong> health. The<br />
structures Image©Shutterstock<br />
that have traditionally<br />
Dr Kiran Patel<br />
Consultant cardiologist<br />
and honorary senior<br />
lecturer, Sandwell and<br />
West Birmingham<br />
NHS Trust, and clinical<br />
director (QIPP),<br />
NHS West Midlands<br />
Strategic Health<br />
Authority<br />
allowed cross-sector and interorganisational<br />
working are in a<br />
state <strong>of</strong> flux, so we must ensure<br />
bridges are built to maintain<br />
existing partnerships and to<br />
link to other partnerships. The<br />
fragmentation <strong>of</strong> providers creates<br />
the risk that competition might<br />
trump collaboration for large-scale<br />
service developments. Clinicians<br />
must challenge areas <strong>of</strong> reform<br />
that risk widening inequalities. As<br />
providers we are advocates for our<br />
patients, but as commissioners GPs<br />
are advocates for their patients<br />
and their populations. Provider<br />
clinicians must work with GPs to<br />
ensure that we deliver services to<br />
address inequalities and improve<br />
the health <strong>of</strong> all. Smoking cessation<br />
is as important as angioplasty <strong>of</strong><br />
the coronary arteries and we must<br />
not forget that. It is not one or the<br />
other, but both which will improve<br />
health outcomes. n<br />
www.rcplondon.ac.uk n June 2011 n Commentary 15
Feature<br />
Image©Shutterstock<br />
Nudging, as opposed to nannying, is a<br />
key part <strong>of</strong> the coalition government’s<br />
approach to public health. ‘It is simply not<br />
possible to promote healthier lifestyles<br />
through Whitehall diktat and nannying<br />
about the way people should live’, says<br />
Andrew Lansley, secretary <strong>of</strong> state for<br />
health, in his foreword to the public health<br />
strategy for England. 1<br />
So nannying, roughly translated as<br />
regulation and legislation, is out; and<br />
nudging, or changing people’s habits<br />
without regulation, is in. The new favoured<br />
method <strong>of</strong> changing people’s habits is<br />
to use behavioural insights, derived from<br />
behavioural science and economics, and<br />
in particular from the US book, Nudge,<br />
by Thaler and Sunstein. 2 A Behavioural<br />
Insights Team (commonly known as<br />
the ‘nudge unit’) has been set up in<br />
the Cabinet Office to drive forward this<br />
approach. In ‘Applying behavioural insight<br />
to health’ 3 the nudge unit sets out a range<br />
<strong>of</strong> existing and proposed interventions<br />
in public health. Most <strong>of</strong> them involve<br />
partnership with the private or voluntary<br />
sector, and are designed to be tried out<br />
and devolved to local communities for them<br />
to implement.<br />
We asked three experts in public health<br />
to comment on the specific interventions<br />
proposed in three main areas – obesity,<br />
smoking and alcohol – and to give their<br />
views on the unit’s overall approach.<br />
Reducing obesity<br />
Several <strong>of</strong> the nudge unit’s proposals to<br />
encourage more physical activity involve<br />
using new technology, such as Nike iPhone<br />
apps that can track your run and show your<br />
speed, incentives for children to walk to<br />
school using swipe card technology, and<br />
‘active’ video gaming such as Nintendo<br />
Wii which involves some body movement.<br />
Pr<strong>of</strong>essor Peter Kopelman, RCP special<br />
adviser on obesity, is not impressed by<br />
these ideas: ‘We’re looking at a spiralling<br />
obesity prevalence in people on low<br />
incomes so whatever we advocate has to<br />
be affordable – these are luxuries those<br />
people can’t afford’.<br />
Another proposal is to work with the<br />
food industry to get restaurants and fast<br />
food chains to provide calorie information<br />
about their meals, so that ‘people can be<br />
empowered to make a healthier choice’.<br />
‘Where is the evidence for this I’m not<br />
aware <strong>of</strong> any,’ says Kopelman. ‘Also, that<br />
approach could encourage food faddism,<br />
because you’d be affecting not only<br />
overweight people but also people who<br />
are super conscious <strong>of</strong> their weight.’<br />
‘The causes <strong>of</strong> obesity are embedded in<br />
an extremely complex biological system,<br />
set within an equally complex societal<br />
framework’, he says, and therefore a<br />
collection <strong>of</strong> disparate unconnected<br />
measures are unlikely to address a<br />
problem <strong>of</strong> that scale. ‘This type <strong>of</strong> policy<br />
is only as good as the electoral term <strong>of</strong><br />
the government supporting it, whereas<br />
effective public health strategy has to go<br />
Putting<br />
the nudge<br />
in motion<br />
The government wants to use behavioural insights to promote healthier lifestyles and reduce<br />
health inequalities, but how effective is ‘nudging’ Commentary asks three experts in public<br />
health for their thoughts on nudging people in the right direction<br />
16 Commentary n June 2011 n www.rcplondon.ac.uk
Feature<br />
Comment Write to us...<br />
Respond to any <strong>of</strong> the articles featured or share your views on<br />
RCP matters. Email us at: letters.commentary@rcplondon.ac.uk<br />
right across government, go across<br />
politics and be sustainable over the long<br />
term.’ As proposed in the Foresight<br />
report, 4 he believes that an agreed strategy<br />
– involving the health sector, education,<br />
transport, town and country planning,<br />
industry and the voluntary sector –<br />
implemented using focused initiatives<br />
and legislation, is the only way to address<br />
the escalating health problems caused<br />
by obesity.<br />
Reducing alcohol misuse<br />
The nudge unit’s intervention on alcohol<br />
uses the concept that people are strongly<br />
influenced by what others do (norms).<br />
Students, though, overestimate the<br />
amount <strong>of</strong> binge-drinking their fellow<br />
students indulge in, so ‘social norming’<br />
aims to correct that misperception by<br />
using posters and publicity to point out the<br />
reality, and therefore reduce the pressure<br />
to drink. In autumn 2011 the charity<br />
Drinkaware and the Welsh Assembly<br />
Government will use the social norming<br />
approach in a one-year trial in five Welsh<br />
universities, backed up by guidance for the<br />
universities on appropriate alcohol policies,<br />
the provision <strong>of</strong> support services and so on.<br />
In response to this, Pr<strong>of</strong>essor Sir Ian<br />
Gilmore, RCP special adviser on alcohol,<br />
says that any new approaches that<br />
prove to be effective in tackling alcohol<br />
misuse are welcome. However, ‘there is a<br />
tendency’, he says, ‘for theories to come<br />
into vogue and go out again’ and it could<br />
be a mistake to predicate a large part <strong>of</strong><br />
government policy on one such theory.<br />
The drink industry, <strong>of</strong> course, already<br />
uses very powerful nudges, in the form<br />
<strong>of</strong> advertising, discounted pricing and<br />
special <strong>of</strong>fers, to encourage people<br />
to drink. ‘We also heard recently that<br />
Heineken is going to be the beer <strong>of</strong> the<br />
2012 Olympic Games, so from now on<br />
a beer is going to be associated with<br />
sports and great sporting prowess. Is that<br />
nudge If so, I’d say it’s nudging people<br />
in the wrong direction.’ To counterbalance<br />
unhealthy nudges that are already in the<br />
environment, thanks largely to industry,<br />
we may need something stronger than<br />
behavioural nudges for individuals. ‘The<br />
‘We also heard recently that Heineken is going<br />
to be the beer <strong>of</strong> the 2012 Olympic Games, so<br />
from now on a beer is going to be associated with<br />
sports ... Is that nudge If so, I’d say it’s nudging<br />
people in the wrong direction’ Sir Ian Gilmore<br />
most effective way <strong>of</strong> changing the<br />
environment <strong>of</strong>ten requires legislation –<br />
something this government is not prepared<br />
to do,’ says Pr<strong>of</strong>essor Gilmore.<br />
Reducing harm from smoking<br />
The new proposed smoking cessation<br />
trial will be a collaboration between the<br />
unit, the Department <strong>of</strong> Health and Boots<br />
UK. It will use the behavioural ideas <strong>of</strong><br />
commitment – ‘known to be a powerful<br />
force in behaviour change’, particularly<br />
when involving loved ones – and incentives<br />
(possibly in the form <strong>of</strong> Boots reward card<br />
points) to help smokers quit the habit.<br />
Although the detail <strong>of</strong> the intervention is<br />
not yet clear, Pr<strong>of</strong>essor John Britton, chair<br />
<strong>of</strong> the RCP Tobacco Advisory Group, has<br />
strong reservations about it: ‘If this is a<br />
“Quit and win” type <strong>of</strong> approach, it has<br />
been tried and tested and shown not<br />
to work’.<br />
Andrew Lansley says in his public<br />
health strategy that he intends to cut the<br />
proportion <strong>of</strong> adults who smoke in England<br />
from 21.2% to 18.5% or less by the end <strong>of</strong><br />
2015, roughly a 0.5% cut per year. Britton<br />
says that initiatives to help individuals<br />
stop smoking, like the Boots trial, have a<br />
minimal impact on smoking prevalence in<br />
the whole population. ‘If you want a lot<br />
<strong>of</strong> people to give up smoking, you have to<br />
drive that centrally by measures that touch<br />
all smokers, such as media campaigns,<br />
taking tobacco out <strong>of</strong> sight in shops, and<br />
enforcing plain packaging.’<br />
‘Evidence from states in the USA shows<br />
that if you want to achieve a yearly 0.5%<br />
fall in the number <strong>of</strong> smokers, you have to<br />
do everything – keep raising prices, keep<br />
investing in public awareness campaigns,<br />
bring in new legislation, provide cessation<br />
services – and you have to keep coming up<br />
with new ideas because each <strong>of</strong> them has<br />
an impact on prevalence.’<br />
A unanimous view<br />
All our experts agreed in principle that<br />
ideas from behavioural science may<br />
provide useful additional tools for<br />
improving public health, but many <strong>of</strong> the<br />
interventions proposed by the nudge unit<br />
have little or no evidence base. A rounded<br />
comprehensive approach, they said, is<br />
the only way to tackle these major public<br />
health issues <strong>of</strong> our time. n<br />
References<br />
1 Department <strong>of</strong> Health. Healthy lives,<br />
healthy people: our strategy for public<br />
health in England. London: DH, 2010.<br />
2 Thaler RH, Sunstein CR. Nudge:<br />
improving decisions about health, wealth,<br />
and happiness. Yale: Yale University Press,<br />
2008.<br />
3 Cabinet Office Behavioural Insights<br />
Team. Applying behavioural insight to<br />
health. London: Cabinet Office Behavioural<br />
Insights Team, 2010.<br />
4 Foresight. Tackling obesities: future<br />
choices – project report. London: Stationery<br />
Office, 2007.<br />
With thanks to<br />
Pr<strong>of</strong>essor John Britton, chair, RCP<br />
Tobacco Advisory Group; pr<strong>of</strong>essor <strong>of</strong><br />
epidemiology, University <strong>of</strong> Nottingham<br />
Pr<strong>of</strong>essor Sir Ian Gilmore, chair, Alcohol<br />
Health Alliance UK; past president, RCP;<br />
liver specialist, <strong>Royal</strong> Liverpool Hospital<br />
Pr<strong>of</strong>essor Peter Kopelman, principal,<br />
St George’s, University <strong>of</strong> London;<br />
science adviser, Office <strong>of</strong> Science and<br />
Innovations Foresight Obesity Project.<br />
Joanna Reid,<br />
RCP managing editor<br />
www.rcplondon.ac.uk n June 2011 n Commentary 17
London 2012 Olympics<br />
Illustration © Bill McConkey<br />
In the first <strong>of</strong> our six-issue countdown to London 2012,<br />
Commentary speaks to Dr Ian McCurdie, chief medical <strong>of</strong>ficer <strong>of</strong><br />
the British Olympic team, about being an Olympic doctor<br />
18 Commentary n June 2011 n www.rcplondon.ac.uk
London 2012 Olympics<br />
Comment Write to us...<br />
Respond to any <strong>of</strong> the articles featured or share your views on<br />
RCP matters. Email us at: letters.commentary@rcplondon.ac.uk<br />
‘When I was at school I enjoyed sports. If I were a journalist I would have<br />
been a sports journalist or a sports photographer’<br />
The London 2012 Olympic Games will be big.<br />
The Athletes’ Village in the Olympic Park will<br />
host around 17,000 athletes and <strong>of</strong>ficials, and<br />
the Games will feature 26 sports at venues in<br />
the Olympic Park, across London and outside<br />
<strong>of</strong> the city. The Olympic Flame will travel<br />
around the UK for 70 days before arriving<br />
in London the weekend before the Games.<br />
There will be street parties and celebrations<br />
– the 2012 Olympics will be an historic event<br />
for the city. Commentary starts a six-issue<br />
countdown to London 2012 with an interview<br />
with Dr Ian McCurdie, chief medical <strong>of</strong>ficer,<br />
Team GB.<br />
What were the highlights <strong>of</strong> being<br />
Q part <strong>of</strong> the Beijing Olympics<br />
I don’t think we anticipated winning<br />
A so many medals and doing quite as<br />
well. Before Beijing we set a target to get<br />
fourth in the medal table in London and on<br />
the last Friday in Beijing we were third, but<br />
then Russia won a couple <strong>of</strong> golds over the<br />
weekend and we finished fourth.<br />
Beijing was so big. The Olympic festival<br />
is massive but Beijing was huge in terms<br />
<strong>of</strong> buildings and numbers – the venues<br />
were spectacular. That and our team’s<br />
performance were the highlights.<br />
As an Olympic doctor did you feel<br />
Q that you shared in the success <strong>of</strong> the<br />
British team<br />
Yes, as part <strong>of</strong> one big team. We had<br />
A 311 athletes in Beijing and around<br />
200 support staff from coaches, managers,<br />
physios and others. The biggest impact on<br />
sports performance is illness or injury. If<br />
an athlete gets injured in the run up to the<br />
Games that could be the end <strong>of</strong> their Olympic<br />
hopes. There is only so much that you can<br />
do to restore full function after injury, so you<br />
need to try to prevent athletes from getting<br />
injured. This is a challenge in the last weeks<br />
<strong>of</strong> training.<br />
But the thing that is eminently preventable<br />
is illness. Illness in one athlete or the squad<br />
can have a massive impact on the team’s<br />
performance. From injury you might lose<br />
one rower in a boat, but from illness you<br />
could lose them all. I don’t mean bird flu<br />
like we had in the lead up to Beijing; there<br />
is always something brewing, like in Sydney<br />
we had a potential seasonal flu epidemic.<br />
Even a snivelly nose, a cough or cold, for an<br />
Olympic athlete can take the edge <strong>of</strong>f their<br />
performance and stop them achieving 100%.<br />
Part <strong>of</strong> the overall medical provision is to<br />
keep people in optimum health – not just the<br />
athletes, but also the people around them.<br />
Do Olympic athletes live inside a<br />
Q bubble at the Games<br />
That is exactly the phrase that<br />
A people use, ‘the bubble’. It is mainly<br />
a security bubble, but you are literally in a<br />
different world.<br />
What steps can you take to make<br />
Q sure an Olympic athlete doesn’t<br />
catch a cold<br />
Most <strong>of</strong> it is educational, but there are<br />
A certain practical steps to take. In Beijing<br />
we issued every athlete their own hand gel<br />
dispenser and there were automatic hand<br />
gel dispensers outside every accommodation<br />
block. The dining hall is the central hub <strong>of</strong> any<br />
Olympic village. Around 15,000 people lived<br />
in the Olympic village in Beijing and they all<br />
ate in one place – a self-service canteen with<br />
everything from salads and healthy food to<br />
fast food. It was free and open 24 hours a day<br />
– unlimited food <strong>of</strong> any variety 24/7, which in<br />
itself was a potential problem. The dining hall<br />
produced around 60,000 meals a day and<br />
you had people from 205 different countries<br />
picking up cutlery from trays and bread rolls.<br />
The potential risk <strong>of</strong> spreading bugs was<br />
huge, education and using hand gel was vital.<br />
All the athletes coming into the village<br />
would get briefed about security and where<br />
things are. As a doctor I would talk to them<br />
about hydration, hand gel and keeping clean.<br />
Image©Shutterstock<br />
I used this phrase that my grandmother<br />
would say: ‘Coughs and sneezes spread<br />
diseases’. If athletes felt unwell, they were<br />
encouraged to report symptoms early.<br />
So what are the challenges <strong>of</strong><br />
Q working with athletes compared to<br />
regular people<br />
Small things make big differences –<br />
A that’s the key. The differences between<br />
success and failure for an Olympic athlete<br />
are minute. Anything that takes the edge<br />
<strong>of</strong>f performance is crucial and you have to<br />
understand the importance <strong>of</strong> that if you are<br />
looking after these people. There is no margin<br />
for error or compromise.<br />
There is a lovely statistic from the Athens<br />
2004 Olympics about the difference between<br />
winning gold and silver. In Athens we won<br />
gold in the coxless four [rowing event] with<br />
Steven Redgrave, Kelly Holmes won two<br />
golds in the 800-metre and 1,500-metre run,<br />
Chris Hoy won a gold in the kilometre, and<br />
the mens’ 4x100-metre relay won one gold.<br />
If you take these five races and look at the<br />
difference in time between winning a gold or<br />
a silver, the sum <strong>of</strong> those times is just over half<br />
a second. Across five events, the difference<br />
between winning gold and silver was half a<br />
second. That’s how close it is. If we were half<br />
a second slower that would have been five<br />
silvers.<br />
How did your years <strong>of</strong> working with<br />
Q the British army and the <strong>Royal</strong> Ballet<br />
prepare you for being an Olympic doctor<br />
I was a doctor in the army for 23 years<br />
A and looked after soldiers. Soldiers need<br />
to be physically fit and robust to do their job.<br />
If they are ill or unfit then they are not fully<br />
functional. So the concept <strong>of</strong> being a doctor<br />
to try and improve people’s physical function<br />
to return them to high levels <strong>of</strong> activity was<br />
something I grew up with in my medical<br />
career. As you might imagine, working in the<br />
army has lots <strong>of</strong> parallels with working for<br />
the Olympics. The idea <strong>of</strong> sport and exercise<br />
medicine (SEM) and military medicine, or<br />
www.rcplondon.ac.uk n June 2011 n Commentary 19
London 2012 Olympics<br />
rehabilitation medicine which is my specialty,<br />
are very similar.<br />
But the same applies outside the<br />
military and outside sport. For example, a<br />
businessman plays squash twice a week and<br />
gets injured and can’t play squash. He gets<br />
a bit less fit, a bit frustrated, and his general<br />
health and psychological health is not as<br />
good. The principle <strong>of</strong> managing someone<br />
who has an injury that has compromised<br />
their function is the same, only the context<br />
is different. Whether they are a soldier,<br />
an Olympic athlete, a ballet dancer or a<br />
businessman who plays squash – you are<br />
trying to return them to that level or that<br />
higher level <strong>of</strong> function that is right for them.<br />
How does the challenge <strong>of</strong><br />
Q rehabilitation between a ballet<br />
dancer and an elite athlete compare<br />
Ballet is interesting because ballet<br />
A dance medicine is probably less evolved<br />
than sports medicine in some areas, but it<br />
is catching up fast. The concept <strong>of</strong> trying to<br />
improve conditioning and robustness, and<br />
trying to prevent injuries in dancers is more<br />
commonplace than it used to be.<br />
With any rehabilitation programme there<br />
are two big challenges. One is the immediate<br />
return – the urgency to put someone, a<br />
pr<strong>of</strong>essional footballer or soldier, back on the<br />
field to do what they need to do. The other is<br />
the long-term consequences <strong>of</strong> an injury and<br />
the risk <strong>of</strong> early return. You can get a ballet<br />
dancer back on the stage fast or a footballer<br />
back on the pitch quickly, but people are<br />
increasingly concerned that this need must be<br />
mindful <strong>of</strong> the long-term consequences.<br />
We all know pr<strong>of</strong>essional dancers and<br />
athletes whose careers don’t last long<br />
because they suffer long-term problems,<br />
but this is getting better because the<br />
management <strong>of</strong> injuries has improved.<br />
Is there much collaboration between<br />
Q international medical teams at the<br />
Olympics<br />
We are friendly with most <strong>of</strong> the<br />
A big nations like the Australians, the<br />
Americans, the Canadians and the New<br />
Zealanders, because we know each other<br />
20 Commentary n June 2011 n www.rcplondon.ac.uk<br />
from the global world <strong>of</strong> SEM. We talk to<br />
each other, we swop stories. But we don’t<br />
look after each other’s athletes because that<br />
wouldn’t be acceptable. I wouldn’t treat a<br />
New Zealand athlete, for example, unless it<br />
was a Samaritan act. We don’t collaborate<br />
formally in our work, but we all have the same<br />
challenges and issues; we discuss those.<br />
What were the biggest lessons<br />
Q that you learned from the Beijing<br />
Olympics and how would you take them<br />
forward to London 2012<br />
That’s a good question. There are a lot<br />
A <strong>of</strong> things that will be different about<br />
London and, to some extent, a lot <strong>of</strong> the<br />
lessons learned from Beijing don’t apply or<br />
are not transferable to London. These include<br />
managing travel, acclimatisation, and being<br />
in a new, strange, non-English speaking<br />
environment. So most <strong>of</strong> the challenges at<br />
an Olympic Games are related to keeping a<br />
group <strong>of</strong> athletes healthy on the other side<br />
<strong>of</strong> the world in a very stressful and fairly<br />
unusual setting.<br />
London presents completely different<br />
challenges that don’t relate to<br />
acclimatisation, environment and foreign<br />
languages. One <strong>of</strong> the biggest challenges will<br />
be the expectation on the home team – it will<br />
be huge. This could be a really positive thing<br />
or it could be negative. Managing expectation<br />
is critical.<br />
We talked about the bubble – when you<br />
are in the Olympics in Beijing, Athens or<br />
Sydney you are in a bubble and you have<br />
no idea <strong>of</strong> what is going on back home. The<br />
foreign press and the British press are there,<br />
but you feel removed from the buzz <strong>of</strong> what<br />
is in the papers. In London, that is just going<br />
to be all over the place. Family and friends<br />
will also be able to say to athletes ‘Oh, I’m<br />
coming down to see you in competition<br />
tomorrow’, whereas before they could only<br />
watch on TV from the other side <strong>of</strong> the world.<br />
The ability <strong>of</strong> family and friends to easily<br />
contact and communicate with athletes while<br />
‘There is a lovely statistic from the Athens 2004<br />
Olympics ... Across five events, the difference<br />
between winning gold and silver was half a<br />
second. That’s how close it is’
London 2012 Olympics<br />
Comment Write to us...<br />
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‘Whether they are a soldier, an Olympic athlete, a<br />
ballet dancer or a businessman who plays squash<br />
– you are trying to return them to that level or that<br />
higher level <strong>of</strong> function that is right for them’<br />
they are trying to focus on the Games will be<br />
quite a challenge.<br />
From a medical point <strong>of</strong> view, you can keep<br />
a close eye on what is going on – who’s ill,<br />
who’s injured, how to manage them – when<br />
you are in the bubble. In London there will<br />
be a similar system, but it will be easier for<br />
athletes to move in and out <strong>of</strong> the bubble.<br />
Do Olympic doctors practise what<br />
Q they preach in terms <strong>of</strong> sport and<br />
exercise<br />
I would hope so! Doctors in SEM should.<br />
A Most doctors who are involved in SEM<br />
are in it because they enjoy sport. When I<br />
was a doctor in the army I was interested in<br />
my job and when I was at school I enjoyed<br />
sports. If I were a journalist I would have been<br />
a sports journalist or a sports photographer.<br />
So generally, people are not in the specialty<br />
unless they are passionate about sport. As a<br />
result, they would normally practise what they<br />
preach or at least be completely convinced <strong>of</strong><br />
the benefits <strong>of</strong> SEM.<br />
There is a concept that has migrated<br />
Q from the USA that exercise is a drug.<br />
Should doctors prescribe exercise<br />
The American <strong>College</strong> <strong>of</strong> Sports<br />
A Medicine has trademarked the phrase<br />
‘exercise is medicine’, which is essentially the<br />
idea that exercise could be used to improve<br />
health and performance from an Olympic<br />
athlete to our squash-playing businessman.<br />
We know that exercise can improve health in<br />
healthy people, we know that there are loads<br />
<strong>of</strong> different diseases whose incidence can be<br />
reduced by remaining active – cardiovascular<br />
disease, most cancers, chronic diseases.<br />
Inactivity is a real killer – I think that message<br />
isn’t quite out there yet, but it is getting there.<br />
There is also an increasing body <strong>of</strong> research<br />
to show that you can use exercise to improve<br />
certain disease – diabetes, depression,<br />
arthritis. I am a trained rheumatologist and<br />
people intuitively say, ‘Oh if I’ve got arthritis,<br />
I’d better look after my joints and not<br />
exercise’, which is completely wrong. There is<br />
a lot <strong>of</strong> research to show that if you exercise<br />
your joints they will become better nourished,<br />
healthier, and both function and symptoms<br />
will improve. So people with disease could<br />
have exercise as part <strong>of</strong> their medicine and<br />
people without disease can use exercise as<br />
a preventative and to stay healthy. The idea<br />
<strong>of</strong> exercise prescription is something that we<br />
haven’t fully grasped, but it is growing.<br />
How far has SEM progressed as a<br />
Q specialty<br />
A long way but nowhere near far<br />
A enough. There are training programmes<br />
in SEM for a large number <strong>of</strong> specialist<br />
trainees around the country right now. What<br />
we haven’t got to yet, and this is the crunch,<br />
is the workforce. There are not enough jobs<br />
– consultant jobs – at primary or secondary<br />
care level for all these trainee doctors.<br />
Do you think the London 2012<br />
Q Olympics will generate more jobs<br />
The hope is that the whole Olympic<br />
A experience and the legacy that it leaves<br />
will raise people’s awareness about exercise<br />
and sport – probably indirectly. Most <strong>of</strong> what<br />
we do in SEM covers two areas: looking after<br />
injuries and exercise prescription. But the<br />
services are not out there because there are<br />
not the departments and jobs to do this.<br />
That is what the specialty will need to move<br />
forward.<br />
The work is in trying to convince the<br />
purchasers – the primary care trusts and GP<br />
consortia – that using SEM is an efficient way<br />
<strong>of</strong> managing people with musculoskeletal<br />
problems and to improve their health. For<br />
example, less than 10% <strong>of</strong> sports injuries<br />
Image©Shutterstock<br />
actually need surgery, but the traditional<br />
model is <strong>of</strong>ten to send a patient to an<br />
orthopaedic surgeon. There are a lot <strong>of</strong><br />
orthopaedic surgeons that see injuries that<br />
don’t need surgery; these could be better<br />
managed by SEM.<br />
Finally, do you have any predictions<br />
Q for London 2012<br />
I think it will be fantastic. I think the<br />
A British team will perform well. Most<br />
people say that the success <strong>of</strong> a home<br />
Olympics is related to how well the home<br />
team performs. In 50 years people won’t look<br />
back on 2012 and say ‘There were fantastic<br />
stadiums!’ but they will say ‘Didn’t the British<br />
team do well’. If the British team do well there<br />
will be a much stronger legacy and people<br />
will remember the London Olympics for years<br />
to come.<br />
I have no doubt we will do well. I think it<br />
will be fantastic for everyone involved. I keep<br />
saying to people ‘Go to London’, even if you<br />
haven’t got a ticket, get into London. There<br />
will be art, street theatre, music, big screens,<br />
branding everywhere. It will be like a big<br />
carnival for two weeks. No one will be working!<br />
My prediction is that as a team, we will<br />
perform really well, but the success <strong>of</strong> the<br />
Olympics is about much more than what<br />
happens on the field <strong>of</strong> play. It will be about<br />
everything that goes with it and about the<br />
legacy that it leaves. It will be spectacular. n<br />
Dr Ian McCurdie MBBS<br />
MSc (SportsMed) FRCP MRCGP<br />
DRCOG FFSEM(UK)<br />
Consultant in<br />
rheumatology and rehabilitation<br />
medicine; director <strong>of</strong> medical services for<br />
the British Olympic Association; chief<br />
medical <strong>of</strong>ficer, Team GB.<br />
Read our full interview with Dr Ian<br />
McCurdie online at Commentary<br />
Community.<br />
Next issue: our Olympic series continues with<br />
a feature from Dr Cordelia Coltart on the risk<br />
<strong>of</strong> infectious diseases at the Games.<br />
www.rcplondon.ac.uk n June 2011 n Commentary 21
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Medicinal Garden<br />
Image©Henry Oakeley<br />
Olympian plants<br />
From lizard meat to olive oil mixed with salt, Dr Henry<br />
Oakeley FRCP looks at plants and the ancient Olympics<br />
Olympics. Theophrastus’s Enquiry into<br />
Plants (c319 BC) makes no mention <strong>of</strong><br />
any, while Dioscorides’ Materia Medica<br />
(c80 AD) lists some plants that might<br />
have been used. He recommended Rheum<br />
palmatum, ‘from above the Bosphorus’<br />
(Bk3, Ch2) for loss <strong>of</strong> energy; ‘oil <strong>of</strong> sweet<br />
bay’ extracted by boiling the berries <strong>of</strong><br />
Laurus nobilis and scooping up the oil<br />
so liberated (Bk 1, Ch40) and flowers <strong>of</strong><br />
dill, Anethum graveolens, marinated in<br />
olive oil (Bk 1, Ch50) to be rubbed on to<br />
‘lessen weariness’. The dried berries <strong>of</strong> the<br />
honeysuckle, Lonicera etrusca, marinated in<br />
wine were recommended ‘to abate fatigue’<br />
(Bk 4, Ch14), but – as Dioscorides noted –<br />
its effects were also toxic. The concept <strong>of</strong><br />
adding salt to one’s diet to compensate<br />
for electrolyte loss and to reduce cramps is<br />
‘Anabolic steroids, which can be made from<br />
yams (Dioscorea species) gained notoriety in<br />
1988 when Benjamin Johnson was stripped <strong>of</strong><br />
his 100-metre gold medal for use <strong>of</strong> stanazolol’<br />
Since the ancient Olympic Games athletes<br />
have sought innovative ways to improve<br />
their performance. Wrestlers used olive<br />
oil (from Olea europaea) to make their<br />
bodies slippery; today’s swimmers wear<br />
specialised swimwear to reduce drag.<br />
Modern athletes take high protein followed<br />
by high carbohydrate diets, entirely legally,<br />
to improve performance; the ancient Greeks<br />
ate lizard meat in the forlorn hope <strong>of</strong> a<br />
similar effect. Plants also played a symbolic<br />
role in the ancient Olympics. Winners <strong>of</strong> the<br />
ancient Olympics received a crown <strong>of</strong> bay<br />
leaves (Laurus nobilis), sometimes called<br />
bay laurel and now used mainly as a spice<br />
in stews, but whose sap may well have<br />
given them an allergic rash.<br />
The modern Olympic Games have been<br />
marred by athletes taking performanceenhancing<br />
drugs. The winner <strong>of</strong> the<br />
1904 marathon took strychnine, which is<br />
extracted from the seeds <strong>of</strong> the tropical<br />
plant genus Strychnos and brandy<br />
from grapes (Vitis vinifera). A cyclist<br />
on amphetamines, synthesised from<br />
ephedrine, present in the sap <strong>of</strong> the<br />
primitive Ephedra, died in the 1960<br />
games. Anabolic steroids, which can be<br />
made from yams (Dioscorea species)<br />
gained notoriety in 1988 when Ben<br />
Johnson was stripped <strong>of</strong> his 100-metre<br />
gold medal for use <strong>of</strong> stanazolol.<br />
There is no evidence for performanceenhancing<br />
drug use in the ancient<br />
relatively new, but<br />
two millennia ago salt was mixed<br />
with olive oil as a skin lotion to combat<br />
weariness (Bk5, Ch109). Of all Dioscorides’<br />
performance-enhancing remedies, only<br />
a decoction <strong>of</strong> Theban grapes (Phoenix<br />
dactylifera) in hydromel – mead, an<br />
alcoholic drink made from fermented honey<br />
– would, by reason <strong>of</strong> its sugar and alcohol<br />
content have been effective in improving<br />
performance (Bk 1, Ch 109). n<br />
Dr Henry Oakeley FRCP,<br />
RCP garden fellow<br />
22 Commentary n June 2011 n www.rcplondon.ac.uk
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History<br />
www.rcplondon.ac.uk/heritage<br />
Re-framing disability<br />
‘There is a real thing about mending people. I keep saying:<br />
“I ain’t broke, you don’t need to fix me”’<br />
These are the words <strong>of</strong> Jamie Beddard, a<br />
disabled focus group participant, who took<br />
part in our exhibition ‘Re-framing disability’.<br />
The exhibition reflects the views <strong>of</strong> the 27<br />
disabled participants, who came together<br />
to discuss the <strong>College</strong>’s historical portraits<br />
<strong>of</strong> disabled people and their identity as<br />
disabled people. Discussions invariably<br />
raised relationships with the medical<br />
pr<strong>of</strong>ession, both historically and today.<br />
The historical print above is <strong>of</strong> 14-yearold<br />
Sarah Hawkes, three years after she<br />
received a blow to her neck which caused<br />
her limbs to contract. Hawkes had been<br />
a servant in Essex, but, no longer able to<br />
earn her living, she came to London in<br />
1831 to exhibit. It is unlikely that Hawkes<br />
exhibited her naked body to the public –<br />
this image was created for medical readers.<br />
Hawkes was treated by Dr Edward Harrison<br />
(1766–1838), who began his treatment<br />
on 15 November 1831; by 29 November<br />
1832 Hawkes was able to walk. In a letter<br />
to surgeon Sir Benjamin Collins Brodie in<br />
1836, Harrison wrote that he straightened<br />
Hawkes’s backbone by means <strong>of</strong> massage,<br />
splints, stretching and lying flat.<br />
Penny Pepper, a focus group participant,<br />
commented on the image: ‘It’s about<br />
highlighting [Sarah Hawkes’s] deformity<br />
with no conscious effort to remember the<br />
human being. That’s [still] the approach<br />
that medical photography takes, at least<br />
in my childhood. Being naked in front<br />
<strong>of</strong> a growth chart when you’re 10… just<br />
how much that takes away from you as<br />
an individual’.<br />
The focus on cure, not understanding,<br />
<strong>of</strong>ten resulted in unproductive relationships<br />
between doctors and disabled people.<br />
Partly as a result <strong>of</strong> this, the ‘social model<br />
<strong>of</strong> disability’ was developed in the 1970s<br />
by disability activists. This model rejects a<br />
wholly medicalised definition <strong>of</strong> disability<br />
and emphasises the need for society to<br />
change and remove the barriers restricting<br />
disabled people. Dr Thomas Wells, an<br />
oncologist at Weston General Hospital<br />
and paraplegic, co-founded the Bristol<br />
University Medical School disability course<br />
and gives an annual lecture to medical<br />
students on how doctors should relate<br />
to people with impairments. ‘[Being<br />
disabled] has made me more aware <strong>of</strong><br />
the importance <strong>of</strong> a patient being given<br />
an element <strong>of</strong> the decision making… A<br />
big aspect <strong>of</strong> medical care isn’t always<br />
about giving the medical treatment; it’s<br />
about listening, making someone feel that<br />
they’ve been heard.’<br />
We would like to hear from medical<br />
pr<strong>of</strong>essionals who have a view on this issue<br />
at heritage@rcplondon.ac.uk. ‘Re-framing<br />
disability’ runs until 8 July 2011: www.<br />
rcplondon.ac.uk/re-framing-disability. n<br />
Bridget Telfer, RCP audience development<br />
coordinator<br />
www.rcplondon.ac.uk n June 2011 n Commentary 23
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Membership<br />
www.rcplondon.ac.uk<br />
New member benefits<br />
The RCP Affinity scheme is a new<br />
member-only benefits package which<br />
will <strong>of</strong>fer you extra value from your<br />
membership via discounts on a range<br />
<strong>of</strong> pr<strong>of</strong>essional and personal services<br />
and products. RCP Affinity will cover<br />
the following categories: business,<br />
advice, travel, insurance, and home<br />
and lifestyle. You can expect to<br />
benefit from discounts on books<br />
(Foyles), work shirts and blouses<br />
(TM Lewin), travel and holidays<br />
and much more.<br />
Most <strong>of</strong> the RCP Affinity benefits<br />
will carry either a ‘National Price<br />
Promise’ or a ‘Provider Price Promise’.<br />
‘National Price Promise’ indicates<br />
that RCP members are getting the<br />
best rates in the UK for a given<br />
product or service. ‘Provider Price<br />
Promise’ indicates that RCP members<br />
are getting the best rates that the<br />
provider in question gives any group.<br />
The benefits are designed to help<br />
you save, and are a real extra benefit<br />
to holding RCP membership. The<br />
scheme will soon be available on the<br />
RCP members’ area <strong>of</strong> the website,<br />
so you can access it anytime.<br />
RCP Affinity will <strong>of</strong>fer<br />
you extra value from<br />
your membership via<br />
discounts on a range<br />
<strong>of</strong> pr<strong>of</strong>essional and<br />
personal services and<br />
products from books<br />
to travel and holidays<br />
2012 fellowship<br />
nominations<br />
The RCP supports over 14,000 fellows based in over 90<br />
countries. Find out how to become a fellow or how to<br />
nominate a colleague<br />
Each March the RCP Council elects a new<br />
group <strong>of</strong> fellows who have distinguished<br />
themselves in the practice <strong>of</strong> medicine,<br />
medical science or medical literature –<br />
which includes consultants in the NHS.<br />
Fellows help the RCP to achieve its main<br />
objectives by championing the values <strong>of</strong><br />
the medical pr<strong>of</strong>ession, promoting patientcentred<br />
care, influencing the healthcare<br />
agenda and improving standards in clinical<br />
practice in the UK and internationally.<br />
Existing RCP fellows have the right to<br />
nominate new fellows to the RCP.<br />
Nominations<br />
There is no examination involved, and it<br />
is not possible to nominate yourself or to<br />
apply for fellowship. Individuals can be<br />
considered for fellowship in two ways:<br />
n Individual nomination: an individual<br />
can be proposed by an existing fellow<br />
<strong>of</strong> the RCP. That fellow must complete a<br />
proposal form which can be obtained from<br />
the fellowship administrator. The form<br />
requires proposers to describe candidates<br />
in accordance with a set <strong>of</strong> defined criteria,<br />
to enable more objective judgement. This<br />
is the route by which most doctors, as well<br />
as those in non-mainstream specialties or<br />
residing overseas will be considered.<br />
The closing date for proposals is<br />
1 September 2011 and the election is held<br />
in March 2012. An individual who is not<br />
elected in one year can be proposed again<br />
in following years by following the<br />
same route as before.<br />
n Criteria procedure: if they are not<br />
nominated individually, when a doctor has<br />
been a member <strong>of</strong> the RCP (ie has passed<br />
MRCP(UK)) for at least four years, and a<br />
consultant in a physician specialty for at<br />
least three years, completion <strong>of</strong> their census<br />
form ensures that they will appear on a<br />
report <strong>of</strong> doctors who will be automatically<br />
considered for fellowship by Council.<br />
RCP fellows benefit from:<br />
n The right to vote in RCP elections<br />
and to stand as a candidate<br />
n The right to propose colleagues<br />
for fellowship<br />
n The right to attend the Annual General<br />
Meeting and take part in RCP governance<br />
n The opportunity to sit on NHS<br />
advisory appointments committees<br />
and be considered for several other<br />
RCP committees<br />
n Access to committee reports via<br />
My RCP – the private area <strong>of</strong> the website<br />
n The use <strong>of</strong> FRCP post nominal.<br />
More information on the<br />
proposal process and fellowship<br />
benefits can be found online. We also<br />
provide advice if you are thinking<br />
about nominating someone overseas<br />
but have concerns about their ability<br />
to pay: www.rcplondon.ac.uk/join/<br />
fellowship. For a proposal form,<br />
please contact: fellowshipqueries@<br />
rcplondon.ac.uk. n<br />
24 Commentary n June 2011 n www.rcplondon.ac.uk
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Letters to the editor<br />
The RCP published a survey on the management <strong>of</strong> care for very ill patients in England, Wales and<br />
Northern Ireland in December 2010. Commentary April 2011 also reported on the various work streams<br />
on acute care underway at the RCP. Here’s what you had to say<br />
Dear Commentary,<br />
In your recent issue (April 2011) you<br />
highlight the deficiency in the provision <strong>of</strong><br />
consultant-led care by acute physicians at<br />
weekends, which was identified in the RCP<br />
survey in December 2010. This issue has<br />
been brought into sharp focus with the<br />
advent <strong>of</strong> consecutive four-day weekends<br />
in late April. The Society <strong>of</strong> Acute Medicine<br />
(SAM) strongly supports the need to move<br />
towards a seven-day consultant-led service,<br />
and there are data which suggest that<br />
mortality for patients admitted outside<br />
‘normal working hours’ may be higher.<br />
One <strong>of</strong> the main limiting factors in<br />
providing this level <strong>of</strong> care remains the<br />
numbers <strong>of</strong> consultants in acute medicine<br />
currently working in the UK. This situation<br />
is improving slowly: significant numbers<br />
<strong>of</strong> trainees will attain a certificate <strong>of</strong><br />
completion <strong>of</strong> training in acute medicine<br />
during 2011–12. This gives an ideal<br />
opportunity for trusts to develop or<br />
expand their acute medical consultant<br />
team so that a greater number <strong>of</strong> hours<br />
<strong>of</strong> consultant-led care can be provided<br />
on the acute medical unit. A recent<br />
survey undertaken by SAM indicates<br />
that many existing acute physicians and<br />
trainees strongly support a move towards<br />
greater seven-day working. Over 80% <strong>of</strong><br />
respondents indicated that they would be<br />
willing to consider the public holiday on<br />
29 April as a ‘normal working day’. Many<br />
free text comments indicated strong views<br />
regarding the need to provide seven-day<br />
working practices in acute specialties, both<br />
in hospital and primary care. These views<br />
need to be aired more openly with the<br />
engagement <strong>of</strong> all royal colleges.<br />
Acute illness is a seven-day problem<br />
and our modern health service needs to<br />
be able to respond in the same timely<br />
fashion irrespective <strong>of</strong> the day on which a<br />
patient presents.<br />
Chris Roseveare BM FRCP<br />
The SAM survey is available on their website:<br />
www.acutemedicine.org.uk<br />
Log in to Commentary<br />
Commentary Community brings you<br />
more news and features this month<br />
including the full interviews with<br />
Pr<strong>of</strong>essor <strong>Lindsey</strong> <strong>Davies</strong> (p10) and<br />
Dr Ian McCurdie (p18), and more views<br />
from our public health experts (p14).<br />
We have an article from international<br />
sponsorship scheme prize winner,<br />
Dr Manoji Gunathilake, about her<br />
experiences <strong>of</strong> working in the UK, and<br />
columns from our regional advisers.<br />
Visit our online magazine to comment<br />
on these features and <strong>of</strong>ficer columns:<br />
www.rcplondon.ac.uk/commentary. n<br />
www.rcplondon.ac.uk n June 2011 n Commentary 25
Events diary<br />
Events diary<br />
www.rcplondon.ac.uk/events<br />
Conferences 2011<br />
June<br />
Clinical decision making in<br />
gastroenterology and hepatology:<br />
the trials and tribulations <strong>of</strong><br />
digestive diseases<br />
Wednesday 8 June<br />
Joint conference with the British<br />
Society <strong>of</strong> Gastroenterology and British<br />
Association for the Study <strong>of</strong> the Liver<br />
September<br />
Osteoarthritis: a holistic approach<br />
Tuesday 13 September<br />
Joint conference with the British<br />
Society for Rheumatology<br />
Endocrine update<br />
Monday 26 September<br />
October<br />
Cardiology update<br />
Tuesday 11 October<br />
Joint conference with the British<br />
Cardiovascular Society<br />
Acute and general medicine for<br />
the physician<br />
Monday 24–Wednesday 26 October<br />
November<br />
West African <strong>College</strong> <strong>of</strong> <strong>Physicians</strong><br />
Annual General and Scientific Meeting<br />
in partnership with the <strong>Royal</strong> <strong>College</strong> <strong>of</strong><br />
<strong>Physicians</strong> (in Banjul, the Gambia)<br />
Sunday 6–Thursday 10 November<br />
Mending the patient with hip fracture:<br />
NICEly does it<br />
Thursday 10 November<br />
December<br />
Healthcare infections<br />
Thursday 8 December<br />
Lectures 2011<br />
Lectures are usually held on the<br />
occasion <strong>of</strong> a conference or RCP<br />
update in medicine<br />
June<br />
HIV and the lung<br />
Tuesday 7 June, 14.00<br />
Pr<strong>of</strong>essor RF Miller<br />
Regional lecture (in Cambridge)<br />
COPD – treat the legs<br />
Tuesday 28 June, 11.45<br />
Dr N Hopkinson<br />
Regional lecture (in Nottingham)<br />
July<br />
Evidence-based management<br />
<strong>of</strong> sepsis in young people<br />
Tuesday 12 July, 12.00<br />
Dr S Nadel<br />
Teale lecture (in Watford)<br />
September<br />
New paradigms in the prevention <strong>of</strong><br />
cardiovascular disease<br />
Wednesday 7 September, 15.00<br />
Dr DS Wald<br />
Regional lecture (in Bristol)<br />
Promoting the public’s health:<br />
lessons from East and West<br />
Thursday 22 September, 12.00<br />
Pr<strong>of</strong>essor SM Griffiths OBE<br />
Milroy Lecture<br />
Why examine the chest<br />
Thursday 29 September, time tbc<br />
Dr WJM Kinnear<br />
Tudor Edwards Memorial lecture<br />
(in Sheffield)<br />
October<br />
Ablation therapy for atrial fibrillation –<br />
does it work and is it cost effective<br />
Wednesday 5 October, time tbc<br />
Pr<strong>of</strong>essor RJ Schilling<br />
Oliver-Sharpey lecture (in Liverpool)<br />
Systemic vasculitis – when to consider,<br />
how to diagnose, how to treat and<br />
monitor<br />
Wednesday 12 October, 12.00<br />
Dr DP D’Cruz<br />
Regional Lecture (in Birmingham)<br />
Divided we fail<br />
Tuesday 18 October, 17.30<br />
Dr IC Heath CBE<br />
Harveian Oration<br />
Halving premature deaths from<br />
vascular disease<br />
Monday 24 October, 12.30<br />
Pr<strong>of</strong>essor Sir Richard Peto FRS<br />
Lord Rayner Memorial Lecture<br />
Cardiovascular magnetic resonance<br />
– what does it have to <strong>of</strong>fer<br />
Thursday 27 October, 15.00<br />
Dr S Petersen<br />
Regional lecture (in Belfast)<br />
The critical role <strong>of</strong> kisspeptin in<br />
human fertility<br />
Monday 31 October, 17.15<br />
Dr WS Dhillo<br />
Goulstonian Lecture<br />
Contact details<br />
Conference programmes and booking forms are available on<br />
our website at: www.rcplondon.ac.uk/events<br />
Further information about the lecture programme is also available<br />
on our website at: www.rcplondon.ac.uk/events<br />
Conference Department, <strong>Royal</strong> <strong>College</strong> <strong>of</strong> <strong>Physicians</strong><br />
11 St Andrews Place, Regent’s Park, London NW1 4LE<br />
Tel: +44 (0)20 3075 1252/1300/1436<br />
Fax: +44 (0)20 7224 0719 / Email: conferences@rcplondon.ac.uk<br />
26 Commentary n June 2011 n www.rcplondon.ac.uk
Events diary<br />
Teach-in programme 2011<br />
Teach-ins provide an update on advances in clinical practice for<br />
doctors in training, consultant physicians, GPs and other doctors<br />
wishing to continue their medical education. Attendance is free<br />
<strong>of</strong> charge.<br />
7 June Acute pulmonary infection<br />
5 July Acute GI and hepatic medicine<br />
4 October Eyes and skin: all you need to know<br />
1 November Peri operative medicine or what to do when<br />
you are called to the surgical ward<br />
Further information and detailed programmes are<br />
available online at: www.rcplondon.ac.uk/teachins<br />
Teach-in sessions are now webstreamed live and archived on the<br />
RCP website. Access is free <strong>of</strong> charge by logging on to:<br />
www.rcplondon.ac.uk/webstreamed-events<br />
RCP updates in medicine and<br />
annual visits 2011<br />
The RCP holds a series <strong>of</strong> open forum sessions to promote<br />
good communication and discuss pr<strong>of</strong>essional issues with<br />
fellows and members in England, Wales and Northern Ireland.<br />
These are attended by the president and RCP <strong>of</strong>ficers.<br />
Tuesday 7 June<br />
Tuesday 28 June<br />
Tuesday 12 July<br />
Wednesday 7 September<br />
Thursday 29 September<br />
Wednesday 5 October<br />
Wednesday 12 October<br />
Thursday 27 October<br />
Eastern (Cambridge)<br />
East Midlands North (Nottingham)<br />
North West London (Watford)<br />
South West (Bristol)<br />
North Trent/South Yorkshire<br />
(Sheffield)<br />
Mersey (Liverpool)<br />
West Midlands (Birmingham)<br />
Northern Ireland (Belfast)<br />
To view the dates and locations <strong>of</strong> upcoming RCP<br />
updates in medicine or regionally organised events visit:<br />
www.rcplondon.ac.uk/events<br />
Fellowships and lectureships<br />
Linacre lecture<br />
Applications are invited to deliver the Linacre lecture 2012.<br />
Applicants must be fellows or members under the age<br />
<strong>of</strong> 40 on 30 September 2011. The lecture should include<br />
a proportion <strong>of</strong> original unpublished work in a balanced<br />
account <strong>of</strong> the subject suitable for a general medical<br />
audience. Work carried out in collaboration or under<br />
supervision will require prior approval <strong>of</strong> colleagues.<br />
Closing date for applications is 30 September 2011.<br />
Milroy lecture on state medicine and public health<br />
Applications are invited to deliver the Milroy lecture 2013.<br />
The lecturer is appointed by Council and the subject should<br />
be <strong>of</strong> relevance to state medicine and public hygiene,<br />
although the interpretation <strong>of</strong> this can be broad. A copy <strong>of</strong><br />
Dr Milroy’s ‘suggestions’ on the subject <strong>of</strong> this bequest is<br />
available on request.<br />
Closing date for applications is 1 September 2011.<br />
Details on how to apply are avalaible at: www.rcplondon.<br />
ac.uk/education/funding-and-awards/lectures<br />
Applications should be submitted to:<br />
Academic Vice President, <strong>Royal</strong> <strong>College</strong> <strong>of</strong> <strong>Physicians</strong>,<br />
11 St Andrews Place, Regent’s Park, London NW1 4LE<br />
Tel: +44 (0)20 3075 1564 / Fax: +44 (0)20 7224 0719<br />
Email: trustfunds@rcplondon.ac.uk<br />
Samuel Leonard Simpson fellowships in endocrinology<br />
Applications are invited from suitably qualified UK<br />
endocrinologists for the Samuel Leonard Simpson fellowships<br />
in endocrinology. Their purpose is to enable endocrinologists<br />
to learn new techniques and acquire new experiences, ideas<br />
and stimulation through travel and the exchange <strong>of</strong> ideas.<br />
Closing date for applications is 1 September 2011.<br />
Application forms are available at: www.rcplondon.ac.uk/<br />
trustfunds or email: trustfunds@rcplondon.ac.uk<br />
MRC/RCP/Dinwoodie Trust clinical research<br />
training fellowship<br />
One clinical research training fellowship will be awarded<br />
in 2012 to a clinically qualified pr<strong>of</strong>essional to undertake<br />
up to three years research in the bio-medical sciences<br />
in a recognised UK institution. For full details please visit:<br />
www.mrc.ac.uk/index.htm and go to the Funding<br />
Opportunities section. MRC Fellowship Team,<br />
tel: +44 (0)1793 867017 email: mrcfellows@ssc.rcuk.ac.uk<br />
www.rcplondon.ac.uk n June 2011 n Commentary 27
Education<br />
Education<br />
www.rcplondon.ac.uk/education<br />
Educational programmes<br />
The Education Department now distributes a monthly mailing list which provides information on educational programmes, including<br />
Doctors as Educators and commissioned workshops, as well as special events that delegates might be interested in attending. If you<br />
would like to be added to this mailing list, please email: education.courses@rcplondon.ac.uk<br />
Doctors as Educators<br />
The Doctors as Educators programme is a series <strong>of</strong> oneand<br />
two-day CPD-accredited workshops aimed at doctors<br />
from any specialty, including medicine, surgery and general<br />
practice, who have a role in supervision, training or education.<br />
Delivered by a team <strong>of</strong> in-house educationalists and expert<br />
clinicians, Doctors as Educators workshops enable delegates<br />
to acquire, develop and practise key skills that can be directly<br />
implemented in the workplace.<br />
Doctors as Educators features two internationally<br />
recognised awards:<br />
RCP Educator accreditation<br />
Popular with doctors from a wide range <strong>of</strong> specialties, this<br />
accreditation focuses on the teaching role <strong>of</strong> doctors and is<br />
practical for doctors <strong>of</strong> all grades.<br />
Delegates are also able to apply for AHEA status following<br />
completion <strong>of</strong> this programme.<br />
RCP Supervisor accreditation<br />
Aimed at doctors wishing to gain formal recognition for their<br />
role in educational supervision, this accreditation meets the<br />
General Medical Council’s requirements as set out in their<br />
‘Standards for Trainers’.<br />
CPD credits: our workshops are approved for external<br />
non-clinical CPD credits (one credit per hour)<br />
Price: £285 for one day / £520 for two days<br />
Information regarding Doctors as Educators workshops<br />
and both accreditations can be found on the RCP<br />
website: www.rcplondon.ac.uk/doctorsaseducators<br />
If you require any further details, please contact the<br />
training programmes team: email: education-courses@<br />
rcplondon.ac.uk or tel: +44 (0)20 30751562/1563/1231<br />
Quality improvement for<br />
consultants<br />
The RCP is dedicated to keeping abreast <strong>of</strong> key NHS issues<br />
and assisting doctors in improving the quality <strong>of</strong> their clinical<br />
care by providing a variety <strong>of</strong> medical education workshops.<br />
With this in mind, the Education Department is pleased to<br />
announce the launch <strong>of</strong> a newly designed workshop, ‘Quality<br />
improvement for consultants’, on 3 October 2011.<br />
Today’s doctor must reconcile increasing demands, new and<br />
more expensive treatments, and financial constraints, but<br />
trying to achieve improvement to quality requires system<br />
changes. Our interactive one-day workshop has been designed<br />
specifically to enable educational supervisors to identify<br />
learning opportunities relating to quality improvement to<br />
support and guide their trainees.<br />
For further information on this workshop visit:<br />
www.rcplondon.ac.uk/events<br />
RCP Educational Supervisor<br />
accreditation<br />
The RCP has developed a training and accreditation process<br />
which gives formal recognition to doctors who are educational<br />
supervisors and which meets the General Medical Council’s<br />
requirements for ‘Standards for Trainers’. Delegates will attend<br />
a two-day workshop covering key aspects <strong>of</strong> educational<br />
supervision and submit an assignment based on their own<br />
supervisory practice. This accreditation is suitable for doctors<br />
<strong>of</strong> all specialties who are currently educational supervisors or<br />
senior trainees who plan to be a consultant the following year.<br />
CPD credits: 10 / Price: £545 inc VAT<br />
For further information on this workshop visit:<br />
http://events.rcplondon.ac.uk/details.aspxe=2420<br />
28 Commentary n June 2011 n www.rcplondon.ac.uk
Education<br />
MSc in Medical Leadership<br />
2011/2012 entry<br />
Applications are now open for the MSc in Medical Leadership.<br />
This unique programme is delivered jointly by the RCP,<br />
Birkbeck <strong>College</strong> and the London School <strong>of</strong> Hygiene & Tropical<br />
Medicine and is specifically designed to equip doctors with<br />
the skills and expertise they need in order to excel in senior<br />
management positions.<br />
The MSc is a blend <strong>of</strong> academic theory, practical case-studies<br />
and interactive sessions with high-pr<strong>of</strong>ile medical leaders.<br />
This year’s students have benefited from an impressive range<br />
<strong>of</strong> speakers including Sir David Nicholson CBE and Dame<br />
Carol Black. Bursaries are available for this course, awarded to<br />
students on a basis <strong>of</strong> need and merit.<br />
To receive further information about this programme<br />
or express an interest in applying, please contact the<br />
programme coordinator Siobhan Sparkes-McNamara,<br />
email: siobhan.sparkes-mcnamara@rcplondon.ac.uk or<br />
tel: +44 (0)20 30751420. Places are limited and early<br />
application is advised.<br />
A blend <strong>of</strong> academic theory, practical<br />
case-studies and interactive sessions<br />
with high-pr<strong>of</strong>lie medical leaders.<br />
Bursaries are available for this course<br />
MSc in Medical Education<br />
2011/2012 entry<br />
The PG Certificate, Diploma and MSc in Medical Education are<br />
successful joint programmes between the RCP and University<br />
<strong>College</strong> London.<br />
The programme is designed exclusively for doctors wishing to<br />
develop their roles as educators. Participants are from a full<br />
range <strong>of</strong> specialties including surgeons, general practitioners,<br />
psychiatrists, and radiologists as well as physicians. Doctors<br />
who enrol in the programme are mainly specialty registrars,<br />
consultants or other career-grade doctors.<br />
Applications for the 2011/12 year are open and the<br />
closing date is 1 June 2011. This is a very popular<br />
programme and places are limited. If you would like<br />
to register your interest in the programme or have any<br />
questions please contact the programme coordinator,<br />
email: UCL@rcplondon.ac.uk or tel: +44(0)20 3075 1353.<br />
Designed exclusively for doctors<br />
who wish to develop their roles as<br />
educators, participants are from a<br />
range <strong>of</strong> specialties including surgeons,<br />
general practitioners, psychiatrists and<br />
radiologists as well as physicians<br />
MRCP Part 2 revision course<br />
27–29 June 2011<br />
This course is designed to prepare candidates for the<br />
MRCP(UK) Part 2 written exam. It is facilitated by doctors who<br />
are respected leaders in their specialties and have extensive<br />
experience in preparing candidates for the MRCP(UK),<br />
including Dr Beynon, Pr<strong>of</strong>essor Sharma and Dr Bishop.<br />
Key features <strong>of</strong> the course:<br />
n Comprehensive coverage <strong>of</strong> the part 2 syllabus<br />
n Facilitated by clinicians who are experts at delivering<br />
MRCP(UK) exam revision courses<br />
‘This revision course has been<br />
extremely beneficial and has increased<br />
my confidence in sitting the exam<br />
– thank you’<br />
n Course content to reflect current hot topics <strong>of</strong> the exam<br />
n Review <strong>of</strong> past question topics<br />
n Instruction on exam technique<br />
n One week <strong>of</strong> free access to the Medical Masterclass website<br />
For further information please contact:<br />
education-courses@rcplondon.ac.uk<br />
www.rcplondon.ac.uk n June 2011 n Commentary 29
<strong>Royal</strong> <strong>College</strong> <strong>of</strong> <strong>Physicians</strong><br />
Annual report 2010<br />
The general election <strong>of</strong> 2010 and the coalition<br />
government’s health policies have <strong>of</strong>fered the<br />
opportunity to have public debate about the future<br />
<strong>of</strong> the NHS and to present ideas that should carry the<br />
NHS through the next decade. The RCP grasped the<br />
opportunity to reflect on and set out our vision <strong>of</strong> a<br />
modern health service and the policies we believe are<br />
needed to support it. For the first time, we pulled our<br />
policy goals together under one theme – leading<br />
for quality.<br />
This year our annual report has drawn together<br />
the diverse work streams <strong>of</strong> the RCP and set the<br />
theme for 2010 to improve the healthcare and the<br />
health <strong>of</strong> the population. The Annual report 2010 is<br />
now available online: www.rcplondon.ac.uk/about/<br />
annual-report<br />
‘In retrospect, 2010 may be seen as a watershed year,<br />
not only for the RCP – as the president has changed<br />
– but more importantly for the NHS. We sought to<br />
represent you at the highest levels to ensure that the<br />
quality <strong>of</strong> patient care is maintained and improved’<br />
Sir Richard Thompson, president<br />
‘As part <strong>of</strong> our continuing commitment to developing<br />
medical pr<strong>of</strong>essionalism in the context <strong>of</strong> the demands<br />
<strong>of</strong> contemporary healthcare delivery, we have been<br />
expanding our education and training support in the<br />
field <strong>of</strong> medical leadership’<br />
Martin Else, chief executive<br />
Image©Jonathan Perugia
Supporting physicians through education and training<br />
Improving standards in clinical practice<br />
Influencing the healthcare agenda<br />
Promoting patient-centred care<br />
Championing the values <strong>of</strong> the medical pr<strong>of</strong>ession<br />
Supporting international activity<br />
Annual report 2010 available online at:<br />
www.rcplondon.ac.uk/about/annual-report
William Harvey House<br />
Regency splendour in the heart <strong>of</strong> London<br />
‘William Harvey House will provide comfortable, affordable<br />
accommodation in magnificent Regency buildings with every<br />
amenity for working, while attending a meeting or conference.<br />
The perfect stay for those wishing to redress their work–life balance<br />
and take advantage <strong>of</strong> the superb range <strong>of</strong> events in London’<br />
Linda Luxon, treasurer<br />
The refurbishment <strong>of</strong> houses 9 and 10, re-named William Harvey House by the <strong>of</strong>ficers,<br />
has combined two important attributes <strong>of</strong> the RCP: its unique history and a valuable facility<br />
for fellows and members. More information will be available by June 2011. William Harvey House<br />
will re-open in September 2011, in the meantime discounted hotel accommodation may be<br />
booked by emailing our agents: res@hotelreservations.uk.com or calling: +44 (0)1268 572 003