Millennium Trust Case Studies

Dr Jim Cole (2020)

Improving the recognition of patients who have poorly controlled asthma, and providing local GP practices with tools to optimise their treatment.

Asthma is one of the most common long term conditions in the UK and we have particularly high numbers of people admitted to hospital with asthma exacerbations in East London. A severe asthma exacerbation can be fatal and our mortality rates are some of the highest in Europe. National audits have determined that many of these deaths could be prevented. Most care for patients with asthma takes place in GP practices – some of those who die from asthma will have had an annual asthma review, but many won’t.

As well as being a practising GP, I work part of the week with Queen Mary University of London as a Clinical Quality Improvement Fellow. We are seeking to improve the recognition of patients who have poorly controlled asthma and provide local GP practices with tools to optimise their treatment.

The Curriers' Company Millennium Healthcare Bursary has funded a two year project investigating this group of patients whose asthma could be better controlled, by virtue of the frequent use of particular inhalers. We are trying to understand who these people are, how they use appointments at their GP practice and how their health beliefs affect their behaviour when it comes to managing their asthma. We have used anonymised demographic, prescribing and appointment data from GP electronic health records across Tower Hamlets and interviews with 15 patients identified from my own practice in the borough.

Using these findings, we have developed a suite of tools which sit alongside the computer system used by the whole practice team – receptionists and administrators, as well as doctors and nurses. The tools alert staff to patients who may benefit from an asthma review soon and prompt the clinician carrying out the review to optimise the patient’s treatment.

Covid-19 has transformed life for all of us in so many ways, not least in how we offer primary care in GP practices. The arrival of the pandemic led to a brief pause in the asthma project, as we diverted our attention away from our academic interests towards clinical work and the development of resources to support East London practices identify and support symptomatic and shielding patients.

Coronavirus also gave this project a new perspective, as the traditional ‘one size fits all’ face-to-face 10 minute appointment for everyone became a thing of the past. Now practices have moved towards a model where all patient contacts are triaged on the telephone or via electronic messages which may result in a video consultation, rather than a physical visit to the surgery.

The data we collected, in particular about attendance, non-attendance and cancellation of appointments, related to a very different way of working in the pre-Covid world. The pandemic has, however, provided us with the opportunity to harness and evaluate these new approaches to providing asthma care and utilise some of the technological solutions we have at our disposal, particularly two way text messaging to mobile phones and online patient questionnaires.

We are now in the final months of the project and hope to publish our findings soon. We are grateful to the Curriers Company whose kind grant has enabled this novel work.

Rachel Cummings (2021)

Advanced Assessment course and independent non-medical prescribing qualification.

The grant from the Curriers’ Company has allowed me to do courses which are vital to my development as a nurse in primary care. The first of these is called ‘Advanced Assessment’ and as the name suggests teaches clinical assessments of each of the body’s systems. The course, which was all taught online due to the Covid pandemic, involved lectures, seminars and personal study alongside clinical observation. I spent 90 hours with my doctor colleagues observing assessments and practicing my own. Being able do a competent and comprehensive hands-on clinical exam is fundamental to working as an autonomous practitioner. Having written a reflective essay, completed 7 clinical assessments and participated in an online ‘viva’ about how I would respond to someone in respiratory distress, I am happy to report I passed the course and am already putting all the knowledge/skills I gained into my everyday clinical practice.

The Advanced Assessment course was a pre-requisite to the second (linked) module that the Curriers’ grant has very generously funded: the independent non-medical prescribing qualification. For the last 15 years, some non-medical professions such as nurses and pharmacists have been able to prescribe if they complete additional training. In primary care this is a really important skill as it enables clinicians to change medication during long-term condition reviews without taking additional time from the (always overworked) on-call doctor. I am currently completing this course, which again involves 90 hours of observation time with my prescribing colleagues, writing an essay and doing pharmacology and numeracy exams.

I have learnt huge amounts already, particularly about diabetes, chronic lung conditions, hypertension and raised cholesterol levels which will be my area of expertise. There is much scope for improvement in these conditions among our patients; making changes to someone’s management which could prevent a chest infection, heart attack or stroke down the line is very satisfying. I look forward to working autonomously when I have finished the prescribing qualification and remain extremely grateful to the Curriers’ bursary for giving me the opportunity to do so.

Dr Sara Calderón (2022)

The delivery of social prescribing and its role in the prevention of type 2 diabetes.

The grant received from The Currier’s Company has been key to successfully undertaking my PhD, which investigates the delivery of social prescribing and its role in the prevention of type 2 diabetes. Social prescribing involves linking patients in primary care with services and activities provided by the voluntary and community sector, such as, lifestyle programmes, welfare advice and/or community engagement initiatives. Social prescribing offers an opportunity to deliver accessible, community-embedded, and holistic type 2 diabetes prevention approaches. My research sought to investigate whether social prescribing could meet the complex health and social needs of people at high risk of diabetes, and if so, how.

The Currier’s generous funding has allowed me to complete relevant training in quantitative research methods at King’s College and London School of Hygiene and Tropical Medicine. Both courses gave me a thorough grounding in classical methods of analysis and more advanced techniques, as well as practical experience. As a result, I could use and analyse large anonymised primary care datasets to investigate the reach and equity of access to social prescribing across patients at high risk of type 2 diabetes. Interestingly, we found that social prescribing succeeded in reaching high type 2 diabetes risk individuals with greatest health and social vulnerability: people at high risk were four times more likely to be referred into social prescribing than the general population! The Currier’s funding also allowed me to cover fieldwork expenses (including, travel reimbursements, translation and transcription costs). I interviewed primary care clinicians, social prescribers, community organisations and social prescribing users at high risk of diabetes. I also undertook observations of community-based social prescribing activities. This rich data revealed the key ingredients (and the underlying approaches) that explain how and why social prescribing succeeded in reaching high risk people with greatest health and social vulnerability.

As a practicing GP, I have always been very mindful of the importance of making research findings available to end users so that they can contribute to improve daily practice. The Currier’s bursary has allowed me to collaborate with The Science Design Company to develop visually engaging lay summaries aimed at service providers, the voluntary and community sector, populations at high risk of type 2 diabetes and policymakers. I have also presented my work at conferences and published three scientific articles in peer-reviewed journals (a fourth one is under review at the moment!). Undertaking research into preventative approaches that address the social determinants of type 2 diabetes in populations at risk is highly relevant and satisfying. I look forward to advancing my research interest and career in this field after my PhD and remain very grateful to The Worshipful Company of Curriers for their invaluable support.

Esca van Blarikom (2023)

Using ethnographic and visual methods to explore the patient experience of physical and mental co-existing health conditions, or multimorbidity.

The grant received from The Curriers’ Company has been key to developing creative and co-productive outputs during my PhD. My project uses ethnographic and visual methods to explore the patient experience of physical and mental co-existing health conditions, or multimorbidity. Multimorbidity is commonly associated with ageing. But a recent study showed that in absolute numbers there are more people of working age living with multiple health conditions. These people are often living with a combination of physical and mental illnesses. This type of multimorbidity is highest in areas of social and economic disadvantage. My research focuses on the experiences of working-age adults living with multiple health conditions in a socially disadvantaged London borough. The aim of this study is to explore how care can be better organised according to the complex needs of patients with multiple health conditions.

The Curriers’ generous funding has allowed me to complete relevant training in creative methods. This included a workshop aimed at training researchers to use Photovoice. Photovoice is a community-based participatory research methodology where participants are invited to take photographs of their experiences with a certain phenomenon (in this case, the experience of multiple health conditions) and to bring those to a group discussion where they can discuss these images with their peers. Additionally, I engaged in a course aimed towards practical documentary filmmaking at University College London.

Both courses gave me a thorough grounding in creative methods, as well as practical experience. As a result, I have engaged study participants in a creative photography project, and I have produced a short, participatory research film with three study participants. The film is based on the photographs they themselves took. We titled this film "Harbouring Illness": it portrays an intimate portrait of three women living with long-term health conditions in an East London neighbourhood. Through their stories, the film offers a profound insight into the everyday challenges of living with multimorbidity.

We will organise a public screening of this short film and also exhibit the photographs participants made. The screening will be an opportunity to bring together local GPs, policymakers, community groups and patients to discuss the challenges involved in the everyday experience of long-term health conditions.

The Curriers’ funding additionally allowed me to cover fieldwork expenses (including costs for attending conferences and reimbursement for members of an expert advisory group). The Currier’s bursary, in summary, has allowed me to share my research findings with a wider audience, which is invaluable: especially as the lived experience of working-age adults with multimorbidity is an under-researched area of concern. I currently look forward to advancing my research interest and career in this field after my PhD and remain very grateful to The Worshipful Company of Curriers for their support.

Adenike Omotayo (2024)

Evaluating the circumstances that are essential for the Healthy Weight, Healthy Nutrition programme.

I was privileged to be granted one of the 2022 Millenium Currier’s Bursary which enabled me to continue my PhD study examining and evaluating the circumstances that are essential for the Healthy Weight, Healthy Nutrition programme and how it influences Health Visitor’s practice and what positive impacts it has on parents of overweight and obese children aged 0-5 years, at the University of Kent.

The bursary supported my research study when l was going through a very difficult period in my life and there was no means of funding whilst the research study was halfway through, and l was in a dilemma of whether to continue the study or to drop out of the study.

The bursary covered my tuition and other immediate research needs, such as the opportunity to work with parents in the early stage of the study to co-produce research interview question guide, participant’s information document and to draft the research ethics. The early parental participation supported the approval of the ethics application.

The funding afforded me the opportunity travel to clinic sites to recruit participants, conducted interviews and completed a national audit of Health Visiting Champions, and currently at the data analyses phase of the study hoping to complete in the next year.

I am indebted to the Millennium Currier’s Bursary that made it all happen.

Adenike Omotayo - RN (General), RM, SCPHN, MSc. MA. Currently Head of Quality at the Kent & Medway ICB.