An interview with Anna Moore

Anna Moore is an HEE Population Health Fellow for Lewisham, an Education Fellow at the Royal London Hospital in Simulation and a Respiratory specialist registrar, North East Thames.

Tell us a bit about yourself and what attracted you to the fellowship.

I started my training as a respiratory registrar in 2010 – a really long time ago! Since then, I’ve worked part time and had some periods of maternity leave, then, in the middle of a bit of a career crisis, I took some time out to work as an education fellow and found I absolutely loved it.

I’ve also always been really concerned about the climate crisis and my education job gave me an opportunity to ‘zoom out’ and do some thinking around this. I have also completed two years of a master’s in medical education which I found fascinating and eye opening.

Bringing all of this together I now help to run a staff sustainability group at my trust called ‘Green at Barts Health’ which was set up by a colleague who has a master’s in public health. We started doing lots of teaching on climate, health and sustainable healthcare together and I began to understand how important prevention is and to get a handle on some of the social and commercial determinants of health. I had really never learned about all this before – it’s just not really there in our clinical training, especially in secondary care unless you go looking for it. When I saw the Population Health Fellowship I thought it not only looked really interesting but also that it could help me to start linking up everything I was doing, both clinically and educationally. So, I applied.

What do you hope to achieve in joining the fellowship?

I hope to achieve a grounding in public health knowledge and skills, and to find opportunities as a clinician and educationalist to bring a population health approach into my work.

Tell us a little about your project.

My project is around Chronic Obstructive Pulmonary Disease (COPD), as a respiratory registrar it’s one of the most common conditions we see. In the UK, it is estimated that 3 million people have COPD, of whom 2 million are undiagnosed - so only a third of the people living with COPD are actually being treated, and even when a diagnosis has been made, it tends to be quite late. My project aims to find those missing people in Lewisham. If we can find them then we have an opportunity to improve their health at a much earlier stage.

So far, I have worked with other members of the population health team to get our COPD registry picking up the data correctly so that we can use it to track known COPD. As part of this process, we have identified that there are more than 500 people with a diagnosis of COPD in Lewisham which is only recorded in secondary care, and not on their primary care record. We are in the process of validating this number currently but already there is an opportunity to improve outcomes for these people. We are now developing a strategy for finding people without a diagnosis recorded anywhere in the system by searching for risk factors for, and symptoms of, COPD.  Our population health management system “HealtheIntent” which pulls data from primary and secondary care enables us to do this.

I’ve also just got some funding for a project from a CCG which will provide a bike, equipment and free cycle lessons to people who are seen in the smoking cessation service. There is evidence that says if you take up exercise at the same time as quitting smoking you are more likely to be successful with your quit attempt – so if we can get this project off the ground we could reduce smoking, increase physical activity and reduce car dependence – which is one of the greatest threats to health out there – all at the same time: a triple win!

How is this project going to help the population in your community?

I hope to find people with COPD earlier, then we can get them treated sooner. It’s also about prevention, so making sure they have had their flu and pneumonia jabs but also doing pulmonary rehabilitation and referring for smoking cessation which are the best treatments we have for COPD. Putting those things in place as well as the inhaled therapy as they need it to try to keep them healthier, for longer.

Also, seeing both projects for what they are, which is sustainable healthcare, is really important. If we can stop people smoking its good for their health, but also that’s a massive carbon saving as the carbon impacts of cigarettes and tobacco production is huge. Not just the shipping of tobacco products around the world, but also the huge amount of water needed to produce a cigarette – it’s 3.7 litres per stick! Not forgetting when someone has established COPD then they are likely to be prescribed inhalers to treat their symptoms – those little blue MDI inhalers have a carbon footprint equivalent of driving 175 miles in a petrol car. So, if we can reduce smoking, and help people get out of their cars and become more physically active it could massively improve our sustainability as a health service.

This is so important because we now know that the climate crisis is a health crisis. If we make climate change worse, then we make people sicker and the people who are the most sick are the ones that are most likely to suffer. If you have COPD and you’re living through a heat wave or in an area of high pollution, it’s much more likely you’re going to get an exacerbation of your COPD. It is all a big vicious cycle. But it can be changed into a virtuous cycle and population health has a huge role to play in turning all of this around.

How is the fellowship going so far?

Finding the 500 people who have a diagnosis of COPD without it being documented in the GP record is a real eye-opening number and having the time to go through the data and work with analysts has been a highlight so far. I’ve also really enjoyed the study days, which are definitely more than meeting my hopes about getting some education and training in public and population health.

Have you connected with other people on the fellowship?

We have biweekly teaching sessions, and we have a buddy group, which is great, so I have met people working all around the country. We’re all working on different projects and in different specialties, so it has been amazing to see the breadth of projects going on. I have learnt lots from those interactions.

Have you learnt anything about yourself, or the area you are doing your project in, so far?

One of the early sessions we had was around, ‘how do we learn’ and what type of person we are. I learnt that I’m an action person – I like to do things! I found that I tend to not be data driven. The fellowship has allowed me to spend a bit of time looking at some of the data we have about health in this country and has certainly prompted me to think a bit more critically about our current systems, which is a really good thing.

I have also learnt about place-based approaches to health, which were not part of my thinking before. I’ve learned how vital it is to know where somebody lives, both in terms of the impact on their health and to what you can do to improve things. As Michael Marmot says (I’m paraphrasing), what’s the good of making someone better then sending them back to the place that made them ill in the first place? This has really changed my clinical practice – I now ask many more questions about people’s lives and try to support them much more. Even if I can’t change it, it’s really important to document the reasons for their ill health, the “causes of the causes”.

I now see things in a very different way from when I started this fellowship – I’m already taking lots of this learning back to my clinical practice and trying to spread the word!

For more information on the fellowship, or to find relevant contact details, see our Population Health Fellowship webpage.