Primary Care Epidemiology
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Julia Hippisley-Cox

Professor of Clinical Epidemiology & General Practice, Faculty of Medicine & Health Sciences

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Biography

Professor Julia Hippisley-Cox is Professor of Clinical Epidemiology and General Practice in the Division of Primary Care and a sessional GP at St Lukes Surgery in Nottingham.

She qualified with distinction from Sheffield University Medical School in 1989 where she was awarded the Prize Medal in Medicine and Surgery finals, the Dr Louis Debson Prize for General Practice; the Sigmund Shultz prize for Obstetrics and Gynaecology and the Bronze Medal for final MB parts 11a and 11b (awarded to the best student in the year).

In 1995 she was awarded a distinction in the MRCGP examination and awarded FRCGP in 2005.She was made a Member of the Royal College of Physicians in 1994, becoming a Fellow in 2013. Following training in both general medicine and general practice, she entered academic general practice as a lecturer at the University of Nottingham in 1995. She was awarded her doctoral thesis in 1998 and promoted to senior lecturer in 1999, reader in 2004 and chair in 2005. She has been a principal in general practice (1995-2002) and a sessional GP since then in an inner city practice in Nottingham.

She was awarded a Bronze Clinical Excellence Award in 2004 and a Sliver Clinical Excellence award in 2009 for an outstanding contribution to the NHS. In 2009 she was also awarded the John Fry Award by the Royal College of General Practitioners. In 2012 she was awarded RCGP paper of the year for the best paper published during 2011 in the cancer category.

Since 2012 she has been a trustee of the EMIS National User Group, an educational charity representing over half of all UK GP practices, whose aims are to improve patient care by the use of clinical computer systems. Her contribution involves organisation & delivery of educational content of national conferences with 500+ delegates; delivering lectures & training; co-producing online training materials on risk stratification, e.g.

Since 2013 she has been a founder member of the Cancer Decision Support Tools Clinical Expert Reference Group for Macmillan. In this role she has co-produced online education resources to support GPs using the Macmillan/QCancer tools.

In 2013 she was awarded the Dr John Perry Prize for an outstanding contribution to NHS IT. She also delivered the Dr Tony Mitchell memorial lecture on personalised medicine.

in 2014 she was member of international independent "statins panel" to advise the BMJ regarding retraction of two high profile papers. The panel did not find the papers needed retraction & gave public reassurance. She was also an expert witness to the Health Select Committee inquiry into handling of NHS patient data.

Between 2014 and 2016 she was Board member of the Health Technology Assessment Efficient Study Design Board - reviewing research grant applications & advising HTA on funding decision.

Since 2016 she has been a medical adviser for the cancer charity Pancreatic Cancer UK & member of its Research Board. She reviews & advise the charity on grant applications.She was an expert witness to the All Party Parliamentary Group on Pancreatic Cancer which led to recommendations on the use of risk assessment tools to improve early diagnosis of pancreatic cancer

She was co-founder of the QResearch database (www.qresearch.org) which is one of the largest clinical research databases worldwide. Since 2012 it has doubled in size to over 30 million patient records and is also linked to hospital, mortality & cancer data.

She also established QSurveillance (www.qsurveillance.org) , a national real time infectious diseases surveillance system used by Public Health England to alert government to epidemics. Since 2012 it has doubled in size to 30 million patients.

Her research interests are very broad and include the development of risk prediction algorithms using electronic databases from general practices. She has developed and validated risk prediction algorithms for a range of diseases including cardiovascular disease (www.qrisk.org). She is director of small medical software company (ClinRisk Ltd).

Teaching Summary

As part of university role, I undertake a full load of undergraduate medical student teaching within the Division of Primary Care including seminar group teaching on history taking, communication… read more

Research Summary

Professor Julia Hippisley-Cox is a General Practitioner and researcher whose innovative methods have been recognised by her peers in the UK and internationally. She is in the top 10 academics… read more

Selected Publications

National Roles

  • 2017 - now member of GP Advisory Group for Care Quality Commission
  • 2016 - now member of roundtable discussion to advise deputy Chief Medical Officer on management of cholesterol
  • 2017 - now Expert witness All Party Parliamentary Enquiry into Pancreatic cancer
  • 2016 - now Medical Advisory Board Pancreatic Cancer UK
  • 2015 - now member of NHS England expert reference group generic cancer symptoms
  • 2015 - now member of expert panel for Pancreatic Cancer UK
  • 2015 - now member of the rebalancing foundation lung disease, Nottingham City Council
  • 2014 - 2015 expert witness House of Commons Health Selection Committee Enquiry into handling of NHS patient data.
  • 2014 - now member Pseudonymisation Steering Group for NHS Digital
  • 2013 - now Committee Member of Primary Health Care Specialist Group
  • 2013 - now Affiliate member of the British Computer Society
  • 2013 - 2016 Founder member of the Confidentiality Advisory Committee of the Health Research Authority
  • 2011 - 2013 Member of the Ethics and Confidentiality Committee of the National Information Governance Board for Health and Social Care
  • 2012 - now Committee Member of the EMIS National User Group
  • 2013 - now Member Clinical Reference Group Macmillan Decision Support tools
  • 2011 - now Member of the Expert Group to support the development of a public awareness campaign for the constellation of symptoms for Cancer, Cancer Policy Team, Department of Health
  • 2011 - 2012 RCGP Research and Surveillance Centre (RSC) Transitional Management Board
  • 2011 - 2012 Member of the Expert Reference Group for developing the NHS standard for "De-identification of information derived from confidential Care Records"
  • 2009 - 2010 Expert Reference Group to Support the National Diabetes Information Service (NDIS)
  • 2005 - 2008 Scientific Advisory Subgroup on Surveillance for Pandemic Influenza
  • 2005 - 2008 National Diabetes Public Health Intelligence Group
  • 2003 - 2006 Working party for the National Stroke Audit in Primary Care
  • 2002 - 2005 RCGP rep of the Diabetes Datasets Project Board, NHS Information Authority
  • 2002 - 2005 NHSIA Expert Reference Group for Practice-Based Disease Registers
  • 2002 - 2003 Department of Health Panel to undertake the 8-year Review of National Primary Care R&D Centre
  • 2000 - 2007 RCGP Representative on British Heart Foundation Primary Care Committee
  • 2000 - 2002 RCGP Representative for the Joint Hospital Recognition Committee
  • 1999 - 2001 Osteoporosis Working Party
  • 1997 - now Society for Academic Primary Care
  • 1996 ‑ 1998 European General Practice Research Workshop
  • 1996 - 1998 UK Collaborators Group for Trials in Dyspepsia in Primary Care
  • 2007 - now Fellow of the Royal College of General Practitioners, London.
  • 1995 - 2006 Member of the Royal College of General Practitioners, London.
  • 1995 - now Member of the Vale of Trent Faculty of the Royal College of General Practitioners
  • 1994 - now Member of the Royal College of Physicians, London

Local roles in NHS

  • 2014 - now member Nottingham City ACE Lung cancer screening group
  • 2013 - now Honorary Consultant Contract, NHS England
  • 2011 - 2013 Honorary Consultant Contract with NHS Nottingham City and NHS Notts County.
  • 2007 - 2010 Member Nottinghamshire CHD Network Clinical Standards Group2003 - 2009 Programme Lead for the Coronary Heart Disease & Diabetes Programme, Nottinghamshire County Council Teaching Primary Care Trust
  • 2002 - 2009 Member of the Nottinghamshire Primary Care Research Partnership
  • 2000 - 2003 GP NHS R&D adviser to the Trent Institute for Health Services Research
  • 2000 - 2005 Primary Care Representative on the Nottingham and Derby Research Alliance
  • 2000 - 2005 Member of the Trent Focus Collaborative Research Network Board
  • 2000 - 2002 Lead for Mansfield Designated Research Team

Referees for funding bodies

  • 2016 - now Pancreatic Cancer UK research board.
  • 2016 -now member Wellcome Trust Committee Pool
  • 2014 - 2016 member of HTA Efficient Study Design Board
  • 2007 - 2014 Health Research Council of New Zealand
  • 2006 - 2014 Finnish Government Research Council
  • 2002 - now Research and Development Board (Northern Ireland)
  • 2002 - now Health Research Board (Ireland)
  • 2001 - 2009 British Lung Foundation
  • 2001 - now Wellcome Trust
  • 1999 - now Medical Research Council
  • 1998 - now NHS R&D Health Technology Assessment Programme
  • 2007 - 2014 Netherlands Organisation of Health, Research and Development
  • 2001 - 2002 Trent NHS Executive R&D
  • 1999 - 2012 NHS Executive Northern & Yorkshire Region

As part of university role, I undertake a full load of undergraduate medical student teaching within the Division of Primary Care including seminar group teaching on history taking, communication skills, data protection, ethical, legal & professional duties, doctor-patient relationship, management of chronic conditions. I have also examined BMed Sci degrees and undertake medical student admissions.

I am a trustee of the EMIS National User Group which is an educational Charity to improve IT systems to benefit patients and professionals representing GP practices using EMIS computer systems. This includes development of educational materials for website; design & organise annual conferences with 500+ delegates; delivery of lectures on clinical research and integration of resulting tools into NHS IT systems, for example, https://www.emisnug.org.uk/using-qcancer-emis-web

I deliver postgraduate educational and training sessions to CCGs interested in implementing risk prediction models into clinical practice

I am a founder member the Macmillan clinical reference group on clinical decision support tools which includes Macmillan, Cancer Research UK, academics & GP IT suppliers. This group helps focuses on methods for early diagnosis of cancer by developing and implementing QCancer & develop training and educational materials to support this across the NHS, http://www.macmillan.org.uk/aboutus/healthandsocialcareprofessionals/macmillansprogrammesandservices/earlydiagnosisprogramme/electroniccancerdecisionsupport(ecds)tool.aspx

-I have lead workshops to provide education and training on the use of the new openpseudonymiser software attended by range of organisations including academic, NHS, HSCIC, NHS England, Information Commissioners Officehttps://www.openpseudonymiser.org/Workshop.aspx

-I delivered the Tony Mitchell lecture on personalised medicine in 2013

Current Research

Professor Julia Hippisley-Cox is a General Practitioner and researcher whose innovative methods have been recognised by her peers in the UK and internationally. She is in the top 10 academics worldwide for her research using electronic health records.

She leads the Primary Care Clinical Epidemiology Group within the Division of Primary Care at the University of Nottingham. Th group studies the epidemiology of diseases (eg heart disease, diabetes, cancer, thrombosis, osteoporosis, depression and dementia) and drug safety of commonly prescribed drugs (including antidepressants, statins, novel anticoagulants, anticholinergics, NSAIDs, Cox-2 inhibitors and drugs used in the treatment of type 2 diabetes).

Whilst clinical trials are undertaken during the development and testing phases for new and commonly used drugs, this tends to be in small selected populations for limited periods of time. Once a drug is licensed, it tends to be used in large numbers of unselected individuals over long periods of time. It is therefore important to have independent systematic research into the effects of new and commonly used drugs to identify and quantify both intended and unintended effects on patients. We use the QResearch and other databases to undertake such studies which are of national and international importance.

Doctors and patients need both better information to inform decisions to investigate, refer and treat individuals. Both doctors and patients need better information to ensure patient are fully informed about the risks and benefits of clinical decisions and so can give consent. In response to nationally identified NHS needs, we have developed and updated a suite of risk prediction tools to identify patients at high risk of an adverse condition for intervention to improve outcomes. Many of these tools are recommended in policy, NICE guidelines & widely implemented in clinical practice. For example,

  • QRISK2,(available here) which continues to be developed and enhanced, has become the preferred cardiovascular risk assessment tool used across the NHS, recommended in the 2014 NICE guidelines & the NHS Health Check & GP Quality & Outcomes Framework (QOF). It is integrated in all major NHS GP IT systems; pharmacies & occupational health. The QRISK2 website has had 2.5 million hits since 2012, over and above the number already scored in GP systems. The impact study on QRISK2 cardiovascular risk assessment tool was rated as outstanding in the REF 2014. Use of QRISK2 forms the basis of the NHS Health check & has led to targeted interventions to reduce CVD risk as shown in NHS health check evaluation (2016).
  • In 2014, QRISK-lifetime, (available here) was implemented by Joint British Society third guideline (JBS3) as the engine beneath its own score. This was taken up by NHS Choices in 2015 as its "Heart Age" tool, which has had over 3 million hits since its launch. An evaluation of the initial implementation has been published here.
  • In 2012, the QFracture tool, (available here) which assesses fracture risk was recommended in 2012 NICE guidelines & is the preferred tool in the NICE quality standard (2016) & SIGN in Scotland. It was included 2013/4 QOF. It is integrated in over 4,300 GP practices.
  • QDiabetes (available here) is recommended by 2012 NICE guidance & used to identify patients for the PHE Diabetes Prevention Programme for interventions to reduce risk of type 2 diabetes
  • QAdmissions (available here) is recommended by 2016 NICE guidance on co-morbidity & used to delivery NHS England's unplanned admissions Designated Enhanced Service by identifying those at high risk of emergency admissions for targeted interventions
  • In 2013 the QCancer tool ([Available here]) was published which identifies patients at risk of cancer as yet undiagnosed to improve early diagnosis of cancer. Working with Macmillan 2014-2017, the QCancer decision support tool is now integrated in over 4300 GP practices. Her research into QCancer was awarded the 2012 RCGP paper of the year (cancer category).

Recent grants (since 2012)

  • Real-Time GP Data for Health Protection, Public Health England, 6 yrs (April 2013 to March 2019), £753,600
  • Unintended effects of novel oral anticoagulants, NIHR School of Primary Care Research(SPCR) 18 months (2016-17) £51,000.
  • Validation studies of QResearch & GPRD, NIHR SPCR, 3 years (2012-15) £209,500.
  • QSurveillance Uon/HPA collaborative research project. HPA. 1 year (April 2012-March2013) £160,180
  • NIHR Nottingham Biomedical Research Centre 5 yrs (2017-22), £23.5 million. Sub-theme lead on Mental Health Risk Assessment & Decision Aids £486,000.
  • SOS: Safety of Non-Steroidal Anti-inflammatory Drugs, European Union, 5 yrs (Feb 2009-July2014), €2,954,420
  • Evaluation of NHS Health Checks 4. Dept of Health Policy Research Programme 2 years, (Aug13-Sept15) £282,877 plus 2 yr extension 2017-19 for £313,85
  • Anticholinergic drugs & risk of dementia. NIHR SPCR, 1 year (Oct 2015-Sept 2016), £48,415
  • Diabetes treatments & risk of cancer. SPCR 3 years (2012-6), value: £49,761.
  • Safety of antidepressants in people aged less than 65: cohort study using a large primary care database, SPCR, value: £119,961 (2012-16).
  • Preparatory work for an application for a Phase IV trial using methods developed in the PINCER trial. Funder: SPCR. 4 years (2010-15). £119,909

Primary Care Epidemiology

The University of Nottingham
School of Medicine, Tower Building
Nottingham, NG7 2RD


telephone: +44 (0) 115 846 6915
email:julia.hippisley-cox@nottingham.ac.uk