West Midlands Specialty Registrars in Public Health An insight into the training and experience of Specialty Registrars in Public Health in the West Midlands region
Contents Overview of the programme 3 > > Education > > Examinations > > Placements > > Competencies > > On call Registrar case studies 4 Five Registrars discuss their training in the West Midlands region. > > Nicola talks about her time in a Primary Care Trust > > Nicholas examines the benefits of a health protection specialisation > > Mariana describes academic public health > > Paul outlines the balance of experience gained from his placements > > Tom illustrates the benefit of training in national treasures Training locations 9 Editor: Paul Fisher For more information, visit the NHS West Midlands Deanery website at http://www.westmidlandsdeanery.nhs.uk/specialtyschools/publichealth.aspx 2
Overview The training scheme is designed to produce leaders in public health for organisations such as local authorities, Public Health England and academic departments. These positions will play significant roles in improving the health and wellbeing of the population. Therefore, to prepare for these key responsibilities, Specialty Registrars (StRs) in Public Health need to become expert at both the science (e.g. epidemiology and surveillance) and the art (e.g. management and leadership) of public health. A rigorous multi-stage selection process identifies promising individuals from both medical and non-medical backgrounds for the programme. Successful candidates then undertake an intensive, full-time training programme over, typically, a five year period. The training can cover general public health but also offers the option of specialist training in academic public health through the Walport scheme or specialist training in health protection. However, regardless of choices taken throughout their training, all StRs will be capable of working at a strategic level across the breadth of public health functions. Approximately ten StRs will complete the scheme each year in the West Midlands. Education Registrars study for a Masters in Public Health (MPH) during their first year, unless they already hold an equivalent qualification. The course includes modules on epidemiology, statistics, health protection and promotion, aspects of social services and the principles of administration and management. Examinations As well as the MPH, StRs are required to pass the Part A and Part B examinations after which they become Members of the Faculty of Public Health. Placements Registrars undertake a number of placements during their training ranging from a couple of months to a couple of years in duration. Competencies In addition to qualifications and examinations, to complete each of the three phases of training evidence needs to be provided that demonstrates a series of competencies. These competencies are reviewed formally on an annual basis. On call Depending on local clinical governance arrangements StRs participate in the public health on-call out of hours rota for communicable disease and environmental health. 3
Public Health Departments Much public health work is project based, with long term horizons. In Primary Care Trusts (PCTs), public health departments assess the needs of the population for health care, helping to change clinical services and other agencies to provide that care, and contribute to protecting the health of the population through the control of communicable disease and environmental hazards. Nicola Wright StR at NHS Warwickshire My role over the last three years has been to lead the PCT s programme of NHS Health Checks which were introduced by the Department of Health in 2008/9, with the need for the programme to be fully rolled out across the country by March 2013. To achieve this locally I identified the best method for delivering Health Checks, via the local GPs, and developed a Locally Enhanced Service (LES) between the PCT and the GPs. I was also responsible for negotiating the LES with the Local Medical Committee (LMC) and have undertaken annual reviews and enhancements of the LES. I created monitoring and reporting systems, and developed resource tools to support Practices in delivering Health Checks. I regularly visited Practices to support GPs, Practice Managers and Nursing Staff in delivery of the Health Checks, and I attended and presented at GP and CCG learning events. I reviewed the data from the first locality offering Health Checks, and shared the learning with the second and third localities that came on board. I managed the development of training and monitored the uptake of the in-house testing and procured point of care equipment so that patients have to attend fewer visits to complete a Health Check. Other tasks completed during my time on the scheme include: > > Adult mental health needs assessment author of majority of chapters and over 30 1:1 interviews carried out > > CAMHS needs assessment overview of the Registrars that were authors of 5 chapters and coordination with the local authority > > Disabled Go a review of the accessibility of the Primary Care Providers in the county > > Review of the communication and language challenges for antenatal hepatitis B services > > Review of the BCG vaccination systems and report back to Directors of Public Health > > Member of the University of Warwick team s systematic review of Polypills and Cardiovascular Disease > > Member of the University of Warwick team reviewing and validating different scoring tools for health and wellbeing Throughout I have been responsible for reporting to the PCT executive and the SHA Performance Teams regarding our local performance. 4
Health Protection Training Placements exist for general Health Protection training in each of the three Health Protection Agency Units in the region. StRs may also take up placements out of the region (post part B), for example with the Communicable Disease Surveillance Centre (CDSC) in London and four, three-month, specialised health protection placements within the West Midlands. Nicholas Aigbogun Locum Consultant in Health Protection, West Midlands North HPU I joined the West Midlands Public Health training scheme as a second year registrar following completion of the MPH at the University of Birmingham. I spent a total of 30 months in two PCTs where my projects included an Adult Mental Health Needs Assessment, the development of evidence for and participation in appraisal of a number of Individual Funding Requests (IFRs), a Gambling Needs Assessment, and the development of a service specification for weight management services in Solihull. During this period, I also worked part-time at the West Midlands SHA, where I conducted a Health/Equality Impact Assessment of the West Midlands Quality, Innovation, Productivity and Prevention (QIPP) Programme. Between my two PCT placements, I joined the West Midlands East HPU for three months, where I participated actively in the management of the swine flu (Influenza A H1N1) pandemic, including carrying out risk assessments, contact tracing and providing advice to clinicians and members of the public. I was also a member of the West Midlands Flu Response Centre, which managed the largest outbreak of swine flu in a single setting in England (a primary school in Birmingham). I then undertook specialist training in Health Protection, and joined the West Midlands Regional Epidemiology Unit (REU) for 5 months. My responsibilities included provision of epidemiological support during outbreak investigations, risk assessment of key communicable disease incidents/ events in the West Midlands region and presenting findings at a weekly national infection teleconference. I was a member of a team that investigated a national outbreak of Salmonella enteritidis PT14b (caused by eggs imported from Spain), and my role included questionnaire interviews of cases, epidemiological analysis, writing daily situation reports and contributing to the final press statement. I spent the next three months at the Chemical and Environmental Hazards Unit in Birmingham, where I was involved in the risk assessment of acute and chronic chemical and environmental incidents. I played a lead role in investigating an odour complaint by a family living near a chemical factory in Stoke-on-Trent, and provided a report to a multi-agency team that mediated the complaint resolution. My next placement was at the HPA Centre for Infections (CfI) in Colindale, London. Here, I had duty doctor responsibilities, dealing with queries from all parts of England on all kinds of infectious diseases, including vaccine preventable diseases and prophylaxis following rabies exposure. I also joined a team to write an update paper on recent cases/incidents of Botulism in the UK. Presently, I work as a locum consultant in health protection, which gives me ample opportunity to put all my specialist health protection training into practice every day. My HPU recently led a complex investigation of a large outbreak of Legionnaires disease in Stoke-on-Trent, during which a probable source of the outbreak was found in near record time (next time you see a hot tub on display in a store, watch out!). 5
Academic Public Health Academic public health (APH) covers two broad areas: teaching and research. Most academic public health departments are based in Universities, most often but not always, attached to medical schools. Understanding how research is undertaken and what it does and doesn t mean, are skills which are integral to the practice of every-day practical public health Mariana Dyakova NIHR Clinical Lecturer in Public Health at Warwick Medical School / StR at NHS Coventry Originally from Bulgaria, I applied for the National Institute for Health Research (NIHR) post at the University of Warwick and started my appointment in 2011. My responsibilities are research and teaching in Warwick and public health clinical (NHS) work in Coventry. Arriving at Warwick, I had the chance to meet with a number of prominent academics in different research fields, including chronic disease (CVD & diabetes) epidemiology; mental health and wellbeing; child early development and parenting; evidence synthesis. Despite my previous work (PhD thesis) in cardiovascular epidemiology and management, I decided to shift to more applied research, e.g. evidence synthesis and public health knowledge translation and communication into policy and practice. I joined a large Cochrane Collaboration project at Warwick, carrying out systematic reviews for primary prevention of CVDs. I also convened a new research group Public Health Communication and Media under the Institute of Health. In my NHS work I was involved in two small (Coventry City Council public health policies summary and analysis; Vaccination cold chain breach) and one bigger piece of work (Dementia Needs Assessment). However, I plan to extend my field/practical public health work, both in the NHS Coventry and also working for the HPU next year. Thus, I m developing both my academic and my applied (clinical) public health competencies. Getting the Certificate of Completion of Training (CCT) in public health will open a number of doors for jobs and career development in either field, both in the UK and abroad. Thanks to my academic supervisor, I joined a running European project PHIRE (Public Health Innovation and Research in Europe) phase II project, representing the FPH & the SSM. I also became the PI for Warwick in the European project ICARE4EU (Innovating care for people with multiple chronic conditions in Europe). Apart from research, I was seriously involved in teaching both underand postgraduate students (medical and MPH). Being interested in improving medical and public health education, I have recently joined PHEMS (Public Health Educators in Medical Schools) and also took the PG Certificate in Medical Education. 6
Broad spectrum Trainees will generally spend most of their training up to CCT or equivalent level in PCTs, but there are also a variety of more specialised attachments within the West Midlands and elsewhere which can be considered usually after passing Part A and B examinations. To prepare for strategic roles across the breadth of public health functions StRs are encouraged to get involved in a wide range of placements and projects. Paul Fisher StR at Health Protection Agency Having worked in Eastern Europe for a decade followed by six years at the Health Protection Agency (HPA), I joined the second year of the public health training scheme as I had already completed the Masters in Public Health whilst at the HPA. My first role was 13 months as part of the senior management team at Solihull Primary Care Trust. My key responsibilities included: seasonal flu coordinator (increased uptake of vaccines in public and healthcare workers); healthy start lead (persuaded pharmacies to stock and significantly increased awareness and uptake); facilitator of the public health transition with Solihull Metropolitan Borough Council; Director of Public Health annual report editor (introduced innovative web-based document with video clips from key internal/external stakeholders). I also authored a mental health needs assessment and a maternity services needs assessment that informed the redesign of services at Solihull Hospital. In my third year I refined my health protection skills, dealing with over a hundred cases of communicable disease at the Health Protection Unit based in Birmingham where I also worked on prison health and the health benefits of street trees (with colleagues at Birmingham City Council). My next post was Honorary Researcher at the University of Birmingham working on the impact of climate change on human health. This post gave me the opportunity to work with a number of researchers on joint projects as well as to develop EU funding bids, PhD applications and research proposals. Now in my fourth year, I have taken on a management role at the national Real-time Syndromic Surveillance Team at the Health Protection Agency where I am risk assessing the daily alarms/alerts, appraising the potential for new systems to be added to the syndromic surveillance service and evaluating the expanded service provided over the London 2012 Olympics and Paralympic Games. This placement will hopefully lead to the publication of a number of academic papers that I have authored. Next, I will work with West Midlands Specialised Commissioning to help ensure patients across the region receive fair and equitable access to all specialised services with improved health outcomes. I will finish my fourth year at Public Health England (PHE) aiding the development of the expanded role of the new PHE centres. My final year will be spent at the public health department within Birmingham City Council, where I hope to help ensure that the opportunities created by moving public health back to local authorities are successfully realised. 7
National Treasures National Treasures are training placements which offer opportunities to acquire specific additional or contextual experience which may not be available in all regional programmes. National Treasure placements are intended to be undertaken by trainees in the final phase of training, allowing them to consolidate core skills in the practice of public health and/or to develop their specific interests. Tom Fowler StR at Department of Health Before starting the training scheme I was working in a university, doing research into child and adolescent mental health. The work included adolescent alcohol and tobacco initiation and progression to heavier use. This got me really interested in applying research in an evidence-based way to address health problems in the general population. Since starting the scheme I have been involved in a wide range of projects. In collaboration with another trainee I undertook a suicide audit for Birmingham and Solihull which was one of the first in the country. This was published in the Journal of Public Health, and now forms the basis of Birmingham s suicide reduction strategy. I was also heavily involved in a local sexual health needs assessment. This work identified gaps in our provision and was also used to lobby for changes to national policy on the way outcomes are measured in the Chlamydia screening programme. I achieved notable success working on genetic services in Birmingham this project showed increased levels of genetic risk for recessive disorders in some of Birmingham s communities. As a result of this work I was able to secure extra resources and commission a large initiative (over one million pounds) to extend the current services. Since then I have undertaken several placements at national treasures in Department of Health (DH). Currently I am based with the Chief Medical Officer for England (Dame Sally C Davies) and am editor in chief of her annual report on the state of the public s health. This has allowed me to see at the national level how the political world interacts with the health world. Understanding the civil service code and the ethical position the civil service comes from, I am in a much better position to influence and advocate for public health. I now understand the thinking behind many different DH initiatives and, if necessary, where and how to challenge them. I have also had a chance to observe at first hand the different leadership styles and thinking of the leaders of our profession. Other placements have included time with the immunisation branch, public health workforce and intelligence branch in DH and the Behavioural Insight (nudge) team in Cabinet Office. Much of the work completed as part of the programme has made a real difference on a number of issues. I have helped to write keynote lectures for the Chief Medical Officer (CMO); I have commented on policy initiatives, including the forthcoming antimicrobial resistance strategy; I have been involved in the public health workforce strategy; I have also been involved in identifying the recommendations and priorities in the CMO s Annual report; I helped to update the storage chapter of the Green Book and was lead author for the DH guidance on Hepatitis B antenatal screening and newborn immunisation programme: Best practice guidance. There are many national treasures placements available for people with different interests that can provide invaluable insight into work within, or interaction between centres of excellence. 8
Training locations The Postgraduate School of Public Health oversees the placement of trainees, and providing they feel that the quality of the experience is good, trainees can arrange to be appropriately seconded to other locations. The Faculty of Public Health also approves some posts outside the United Kingdom for training purposes. It is possible for StRs to apply to rotate from the West Midlands Training Scheme to a national or overseas post once they have passed their Part B examination. A range of placements attended by West Midlands Registrars is given below. Recent West Midlands Public Health Training Scheme Placements PCTs HPA Solihull Sandwell Warwcickshire Shropshire Wolverhampton Herefordshire Walsall Staffordshire Telford and Wrekin Worcestershire Stoke on Trent Dudley Coventry Universities Birmingham Public Health Commissioning support team Joint transition team CRCE Centre for Infection, Colindale Real time syndromic surveillance West Midlands Specialised Commissioning Birmingham Children s Hospital NHS West Midlands Strategic Health Authority West Midlands Public Health Observatory Health Impact Assessment Department of Health CMO s private office Immunisation branch Health protection units (HPUs) West East North Birmingham Warwick Staffordshire Health inequalities unit MPH MPH MPH Public health workforce and intelligence NHR Horizon Scanning Centre Health Services Management Centre Public Health Communication and Media Research Group Keele International WHO Polio eradication in Nigeria University Hospital Birmingham Commissioning Support Unit Health & Climate Change FPH National Perinatal Epidemiology Unit, Oxford Others Regional laboratory/ University of Oxford/ Birmingham Chest Clinic For more information, visit the NHS West Midlands Deanery website at http://www.westmidlandsdeanery.nhs.uk/specialtyschools/publichealth.aspx 9