Clinical Effectiveness Group

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CEG

The Clinical Effectiveness Group works to support clinical improvement in primary care


CEG supports practices in delivering high quality primary care in a challenging inner city environment. This innovative unit, based in the Centre for Primary Care and Public Health at the Blizard Institute, Queen Mary University of London, has been supporting primary care for over 20 years.

Our multidisciplinary team includes GP clinical leads, clinical facilitators, data analysts, and researchers. CEG covers the three PCTs of Newham, Tower Hamlets and City and Hackney, which together have a population of 800,000 served by 150 general practices and about 500 GPs.CEGwebsite

CEG aims to promote equality of access to effective primary care by translating new initiatives and research on quality and clinical excellence into inner city areas through evidence-based guidelines. We support implementation in practices through the development of software tools, provision of practice-based facilitation services and the analysis of data in order to monitor progress.

The group received the John Perry Award of the Primary Care Group of the British Computer Society in 2010 and was a finalist in the 2011 NICE awards for improvement and shared learning in promoting statins for people with heart disease and strokes in east London.

Research

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The CEG team leads research in the effective delivery of primary care in an ethnically diverse, inner city environment. The findings of this research are directly translated back into health practice through the development of clinical guidelines, risk scores and software tools.

There are three key strands to CEG research:

1. Health inequalities

Health Equity Project

The Tower Hamlets Health Equity Project, 2007-11, targeted three long-term conditions (coronary heart disease, diabetes and COPD) over three years in order to assess the impact of gender, age and ethnicity on service provision and disease outcomes in Tower Hamlets. It also considered the provision and effectiveness of self-management programmes for chronic disease.

Ethnicity Recording in East London

Developing reliable methods of recording ethnicity at general practice level is an essential first stage in identifying disparities in service provision and developing local health policy for ethnically diverse populations. In April 2005 CEG extended data-entry templates for routine recording of self-reported ethnicity to the entire general practice population of three east London PCTs – Tower Hamlets, Newham, and City & Hackney.

Between the 2005 and 2010, total ethnicity recording in east London has increased from 38% to 80%. Recording levels on chronic disease registered have reached a plateau at values of 98%. The scheme now covers almost 150 practices and over 800,000 patients, and forms the basis of much of CEG’s research and guidelines.

Chronic Kidney Disease in East London Populations

CEG has worked with partners at Barts and the London Renal Centre to identify differences by ethnicity in prevalence, progression and management of Chronic Kidney Disease in hypertensive and diabetic populations in east London.

2. Chronic disease management in Primary Care

Atrial fibrillation Programme East London; improving anticoagulation

Atrial fibrillation (AF) is a major cause of stroke. It affects 1 in 20 people over 65 and around 1 in 5 people over 80. Warfarin is the anticoagulant of first choice for AF: it is three times more effective than aspirin. However, in Newham, Tower Hamlets and Hackney & City in 2011, just 50% of people were on warfarin, whilst 40% were on aspirin and 1 in 7 on no antithrombotic at all.

CEG has devised a computer tool – the Anticoagulant Programme East London (APEL) – to assist all east London practices in optimising anticoagulation for patients with AF. This tool is supported by clinical guidelines, baseline and ongoing practice audits, and in-practice facilitation. It is currently being rolled out to all practices in Newham, City & Hackney, and Tower Hamlets.

Atrial fibrillation: ethnicity, stroke risk and anticoagulation

CEG are collaborating with King’s College London to identify people with atrial fibrillation in four London PCTs – Newham, City and Hackney, Tower Hamlets and Lambeth – with a total population of around 1 million patients. This is one of the few studies to report atrial fibrillation and its management by ethnic group.

QDScore: risk of developing diabetes

CEG staff have been involved in the development of the QDScore, a validated diabetes risk score which predicts the risk of developing diabetes in the next 5 - 10 years on the basis of a prospective cohort study, including both social deprivation and ethnicity. In east London, inclusion of QDScore into NHS Checks is now under consideration and the score is already included as part of the local Joint Strategic Needs Assessment in Tower Hamlets.

QRisk

CEG staff worked with the University of Nottingham to develop the QRisk score identifying the risk of cardiovascular events. The score is the first to take account of ethnic and socioeconomic diversity in England. QRisk is now integrated into all major GP computer systems and is used throughout England and Wales as part of the NHS Health Checks programme aiming to cover 20 million people.

Chronic Obstructive Pulmonary Disease: ethnicity, severity and management

CEG has undertaken a cross-sectional study using data from general practice in three east London PCTs to identify the prevalence, severity and management of local people with Chronic Obstructive Pulmonary Disease (COPD). In collaboration with south London (Guy’s, King’s and Thomas’s), CEG now plans to examine differences in management by ethnicity across east and south London.

3. Improvement in Primary Care

Integrated Care evaluation

CEG is working with Tower Hamlets PCT and the new clinical commissioning group (CCG) to evaluate the Integrated Care programme which has been in place for the past 3 years. We plan a separate quantitative evaluation of each of the four care packages: Childhood immunisations, COPD, Diabetes and Cardiovascular disease.

Clinical guidelines

CEG guidelines aim to support improvement in primary care by providing recommendations on the diagnosis and management of patients, combining up-to-date national guidance and an understanding of local needs through CEG research.

Teaching

Facilitation-brightCEG clinical leads teach on the medical student undergraduate course, supporting Community Health Sciences BMedSci modules in Clinical Effectiveness, as well as Practice Based Learning modules.

The clinical leads and CEG staff also teach extensively in post-graduate community settings to general practitioners and primary care staff.

We present 20 sessions annually in GP Fora, practice Protected Learning Time and other settings on clinical topics to support clinical guidelines, continuing professional development and improvement programmes. CEG facilititators make 200 visits to GP practices each year to support improvement programmes. Clinical leads regularly present at national academic meetings and conferences, national general practitioner courses and policy fora.

 

Staff

Clinical leads

KambizBoomla

 

Dr Kambiz Boomla

Clinical Lead

 

 

SallyHull

 

Dr Sally Hull

Clinical Lead

 

 

JohnRobson

 

Dr John Robson

Clinical Lead

 


Researchers

Philippa Cockman

Post-graduate education

Isabel Dostal

Research Assistant

RohiniMathur

 

Rohini Mathur

Research Fellow

 

 

Kate Homer

 

Kate Homer

Research Assistant

 

 


Data Analysts

MartinSharp

 

Martin Sharp

Data Analyst

 

Kelvin Smith

Data Analyst

Jack Dunne

Data Analysis Assistant

Rachael South

Data Analysis Assistant

 


Facilitators

Jo Tissier

Clinical facilitator

Jayne Callaghan

Primary Care Facilitator

AnaGutierrez

 

Ana Gutierrez

Primary Care Facilitator

 

 

LuisRivas

Luis Rivas

Primary Care Facilitator 

 

 


Manager

Keith Prescott

Manager


Administrator

Shirley Dryden

Administrator

Contact

ContactCEG

Clinical Effectiveness Group
Centre for Primary Care & Public Health
Yvonne Carter Building
58 Turner Street
London
E1 2AB

Tel: 020 7882 2553
Fax: 020 7882 2552
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