Alumni Profile: Dr Nicholas Hicks

Dr Nicholas Hicks FRCP FRCGP FFPH (Clinical Medicine, 1979)  remains closely integrated with college as an Associate Fellow and Chair of the Management in Medicine Steering Committee.

Nicholas writes

If you had asked me at graduation in 1982 what I was going to do with my medical degree, I would have been very wrong. I was sure I would be a clinician – cardiologist, GP, paediatrician or similar. In practice, I trained in public health and primary care and spent most of my career trying to understand how a health and care system can be as powerful a determinant of health as possible.

After training in general practice in Bath and public health in Bristol, I spent an exciting year as a Harkness Fellow based at the RAND Corporation – a US policy think tank – in Santa Monica, California before returning to Oxford as Consultant in Public Health. There I focussed on coronary heart disease – a major public health issue in its own right whose toll was influenced by everything from the environment and individual behaviours through to primary, secondary and tertiary health care. There was also much valid, relevance evidence imperfectly reflected in practice – offering the opportunity to contribute to significant practical improvement. In the quality and outcomes of care.

I was fortunate to be able work with giants like Sir Iain Chalmers as he set up the Cochrane Collaboration, Professor David Sackett as he set up the Centre for Evidence Based Medicine, and Professor Colin Baigent at the Clinical Trials Unit trying to turn the implications of their work into practice. In 1998, a year after the Blair government was elected, I got a call from a senior civil servant asking me to help draft the National Service Framework for Coronary Heart Disease. I became its lead author. I was then invited to become the doctor in a newly established ministerial strategy unit working to Health Secretary Alan Milburn.

Working with the Chief Medical Officer, Liam Donaldson and the Minister of Public Health, Yvette Cooper, my main achievement there was to develop and implement the policies and for tackling health inequalities in the NHS Plan. I was proud of that work and pleased to see that a recently published systematic review in the BMJ has shown that it contributed to a measurable reduction in the period from 2003 to 2010 in inequalities between rich and poor in infant mortality and expectation of life. This was the first reduction in mortality inequalities in a century. Sadly, much of those gains have been reversed since 2010.

I enjoyed Whitehall but missed working with local communities, so, after four years I asked to go back to the NHS to implement some of the policies I had a hand in writing. I was appointed Director of Public Health in Milton Keynes and soon after was asked to combine that with the role of Chief Executive of the Primary Care Trust (PCT). I thus, somewhat by accident, found myself responsible locally for the unpopular commissioning system. I quickly became frustrated with the so called ‘payment by results’ and became more interested in how better to focus care on achieving the outcomes that mattered most to the public which led me to develop an interest outcome measurement, integrated care and population health management.

The Lansley reforms of 2012 abolished primary care trusts and moved the Director of Public Health role from the NHS to local government, I set up a small consultancy through which to pursue my interests in outcome measurement, population health management and health policy. In 2020, when the pandemic reached the UK, I was asked to join Public Health England and then the UK HeaIth Security Agency where I worked as the Public Health Strategy Advisor to the Chief Medical Advisor (Susan Hopkins) until 2023.

As Chair of Steering Committee I oversee the Management in Medicine Programme at college. The Management in Medicine Programme is accredited by the Faculty of Medical Leadership and Management and supports clinicians-in-training and others who work in and around health services to develop healthcare management and leadership skills. I am also an Honorary Senior Research Fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford.