3. Primary Care & Public Health
Neuadd Meirionnydd
South East Wales Trials Unit
Wales Cancer Trials Unit
& Cancer RRG
ParIcipant Resource Centre
Epidemiology & Screening RRG
Central PCAPH admin
Postgraduate teaching
Undergraduate teaching
Wales School for Primary Care
Decision making laboratory
Clinical Epidemiology IRG
Postgraduate research
4. Mission statement
Our mission is to promote well‐being and dignity by reducing the
populaIon burden of disease and improving health care through
high quality research, teaching, clinical service and innovaIon and
engagement.
Our core aims are to:
• Provide excellent educaIon and training for health care
professionals
• Use our mulIdisciplinary, integrated research environment to:
– Promote healthier communiIes
– Develop relaIonship based, holisIc, cost effecIve individual care
– Contribute to the understanding and reducIon of health inequaliIes,
parIcularly in Wales
5. Achievements..
• 180 people
• 165 teaching pracIces
• Best rated teaching in the curriculum
• 65% 3* and 4* in RAE 2008 (=second best health
submission form Wales)
• Research income since 2008 nearly £15M;
highest of all groups in School of Medicine
• Total Value since 2008 £26.5M
• >50 ongoing studies
• Involved in winning infrastructure grants >£30M
6. Theme
• Understanding unhelpful/harmful variaIon in
the causes of ill health and health care
delivery
• Developing and evaluaIng intervenIons to
address this with people/paIents are the
centre
• Locally relevant, internaIonally applicable
• InternaIonally excellent
13. Primary care: four pillars
1. First contact for each new health need
2. Long term (person‐(not disease) focused
3. Comprehensive for most health care needs
4. Coordinated care when it must ne sought
elsewhere
14. The evidence…
• Heath is beier in areas with more primary
care physicians
• All cause mortality less
• Beier HRQL
• Less low birth weight
• People who receive care from primary care
physicians are healthier
• The characterisIcs of primary are associated
with beier health
15. Mechanisms
• Greater access to needed services
• Beier quality of care
• Greater focus on prevenIon
• Earlier management
• PrevenIon of unnecessary and potenIally
harmful specialist care
16. Primary Care in 11 countries
Primary Expenditure Health Medicines Average
Care per head indicators prescribed rank for
ranking per head outcomes
US 11 11 8 7 8.5
UK 1 2 9.5 4 5.4
• Starfield B, Lancet
1994;3441129-1133
• 1 is best, 11 worst
17. IdenIfying unhelpful variaIon
Sectional
page 95 Proceedings of the Royal Society of Medicine
Soit'1219 Vol. XXXI
$ectioII of Eptibemii0o[ogp anb !tate IDebicinie
President-Sir ARTHUR MACNALTY, K.C.B., M.D.
[May 27, 1938]
The Incidence of Tonsillectomy in School Children
J. ALISON GLOVER, O.B.E., M.D., F.R.C.P., D.P.H.
THE rise in the incidence of tonsillectomy is one of the major phenomena of modern
surgery, for it has been estimated that 200,000 of these operations are performed
annually in this country and that tonsillectomies form one-third of the number of
operations performed under general ancesthesia in the United States. There are,
moreover, features in the age, geographical and social distribution of the incidence,
so unusual as to justify the decision of the Section of Epidemiology to devote an
evening to its discussion.
HISTORY
It seems unnecessary to review the history of operative treatment of the tonsil,
and I will confine myself to pointing out that while it was natural that, in pre-
anaesthetic and pre-Listerian days, the incidence of operation should be very small,
it is astonishing to find how recent is the great vogue of the operation. For many
years after the introduction of aneesthesia and aseptic surgery the incidence remained
low. In 1885 that great physician Goodhart [14] said, " It is comparatively seldom
that an operation is necessary, and fortunately so, for parents manifest great repug-
nance to it. Children grow out of it, and at 14 or 15 years of age the condition ceases
to be a disease of any importance ". These words were repeated in several subsequent
editions.
In 1888 I went to a preparatory boarding school of 50 boys, and then, in 1890, to a
public school of 650 boys. Though, as the son of a doctor and destined for the
profession myself, I took some interest in medical matters even then, I cannot recall
a single boy in either school who had undergone the operation. Both schools still
flourish, but the percentage of tonsillectomized boys is now in both alike about 50%,
and, as we shall see later, even this is nowadays a low figure for schools of these types.
Old photographs reveal little difference in appearance between the untonsillec-
tomized fathers and the tonsillectomized sons, and although the latter seem to grow
taller and heavier than we did, memory suggests that we were at least as resistant
to infection.
EARLY ESTIMATES OF THE NEED FOR OPERATION
It is difficult to estimate the number of operations previous to the introduction
of the School Medical Service. Any such estimate is derived either from estimates
of the number of children whose tonsils are said to " require immediate operations"
or from hospital records.
In 1903 the Report of the Royal Commission on Physical Training (Scotland) gave
the age-and-sex grouped results of the examination of 600 Edinburgh and 600 Aberdeen
school children, in tables, which showed well the two periods of physiological
AU G.-EPID. 1
25. Shared decision‐making: a meeIng
between experts
Joint
prescribing
decision
• InformaIon exchange is two‐way
• Clinician provides relevant informaIon about
treatment opIons
• PaIent provides informaIon about their lived
experience of the illness, their values, preferences,
lifestyle and knowledge about the treatment
Butler C et al. JAC 2001; 48:435–440
34. Family Nurse Partnership Programme
• A structured, intensive home
visiIng programme delivered by
Family Nurses to pregnant
teenagers
• Programme runs through
pregnancy and unIl baby’s second
birthday.
• Licensed programme developed
and tested in the USA with fidelity
measures to ensure replicaIon of
original research
36. Overview of the Trial
Study Outcomes
Outcome domain Primary Secondary
Pregnancy & birth • Changes in prenatal tobacco use • IntenIon to breaspeed
(maternal measure) • Prenatal aiachment
• Birth weight (child measure)
Child health & • Emergency aiendances / • Injuries & ingesIons
development admissions within two years • Breast feeding (iniIaIon
of birth & duraIon)
• Language development
Maternal life course • ProporIon of women with a • EducaIon
and economic self‐ second pregnancy within two • Employment
sufficiency years of first birth • Health status
• Social support
Paternal involvement
38. Previous Academic Fellows
On compleIon
Continued as GP in Further Academic
Academic Fellow Dates Publication? Teaching? Post Grad. Qualification
Valleys? Post?
Anne-Marie Cunningham 2001-03 MSc Pub Health
Liz Metcalf 2001-03 MSc Med Ed
Diane Owen 2002-04 MSc Pub Health
Josep Vidal-Alabal 2002-04 MSc Pub Health
Jo Davies 2002-05 Cert Med Ed
Kathy O’Brien 2003-05 Cert Med Ed
Nick Francis 2003-05 Fellowship App: PG Dip Epidemiology
Sandra Jones 2004-06 Cert Med Ed
Yolande Robles 2004-06 MSc Pub Health
Chantal Thomas 2005-07 Dip Med Ed
Jane Fryer 2005-07 MSc Med Ed
Della Williams 2005-06 Cert Med Ed
Naomi Cadbury 2005-07 Cert Med Ed
Rachel Andrew 2006 Cert Med Ed
Lisa Williams 2006-07 Cert Med Ed
Brechje Brocken 2007-08 Cert Med Ed
Jim Pink 2006-08 Cert Med Ed
Naomi Stanton 2007-08 Dip Pub Health
Lucy Morris 2007-09 Cert Med Ed DFSRH
Emma Melbourne 2007-09 Cert Med Ed
Nathan Francis 2008-2010 MSc Public Health -progressing
2008-
Bethan Stephens Cert Med Ed
2010
46. Same old same old (but with a beier
view)?
• Not a: silo, outpaIent‐verIcal, QoF driven model
• ConInuous, longitudinal integrated care, teaching and
research for whole populaIon
• Truly mulIdisciplinary: nursing, admin, palliaIve care,
learning disabiliIes, psychiatry, child health, obstetrics,
minor injuries
• Integrated with voluntary sector, social services, social care
and local authority, planning
• Begin with paIents problems
• Put on strei‐strip, catheterize, make diagnoses
• 24 hour care
• Community led/buy in
