Tim is Senior Clinical Lecturer in Primary Care and a General Practitioner.
Tim has worked in public health, academia and at the National Institute for Health and Clinical Excellence (NICE) while relishing the challenge of being a part-time GP.
Tim has established through his work with NICE a national profile in health care quality improvement research and development with a focus on clinical practice guidelines, quality standards and performance measures. He has published over 50 research and quality improvement papers in peer reviewed journals. Tim has also developed and delivered international training courses on evidence based quality improvement.
Tim’s second research interest is practitioner-patient relations in primary care, including continuity of care, personal care and ‘difficult’ doctor-patient relationships. A key element of this work has been collaboration with social scientists and the conduct of theoretically informed qualitative research.
Fellow of the Royal College of Physicians, 2010
Fellow of the Royal College of General Practitioners, 2006
PhD in Health Services Research, University of Leicester, 2002
Fellow of the Higher Education Academy, 2000
MPH, University of Nottingham, 1997
MB ChB, University of Edinburgh, 1989
MPhil in History of Medicine, University of Cambridge, 1987
BA (Hons) in Physiological Sciences, University of Oxford, 1985
Tim grew up in Lancashire and studied medicine at the Universities of Oxford and Edinburgh, graduating in 1989. As an undergraduate he developed an interest in the history and social construction of medical knowledge and conducted research on the 1858 Medical Act for his Cambridge MPhil which was published in Medical History.
Tim undertook vocational training for general practice in West Yorkshire (Airedale scheme) 1990-1993. After a period as a GP locum and GP principal he undertook training in public health medicine in Leicestershire. Here he developed his interest in clinical practice guidelines: his MPH thesis developed a methodology for the local development of evidence based clinical guidelines (the management of genital chlamydial infection in primary care).
Tim took up a clinical lectureship in general practice at the University of Leicester in 1997 and undertook his doctoral research while working half time as a GP in inner city Leicester. His PhD was awarded in 2002 and was entitled ending the doctor-patient relationship: an investigation of the removal of patients from general practitioners' lists. The research was jointly supervised by a medical sociologist (Mary Dixon Woods) and a GP academic (Bob McKinley). His PhD output included publications in the British Medical Journal and Sociology of Health and Illness.
Tim was appointed to a NICE-funded part time clinical senior lectureship at the University of Leicester in 2002 to establish a clinical guidelines development centre for primary care (the National Collaborating Centre for Primary Care). Tim, as clinical director, led the development of the centre as a joint venture between Leicester and the Royal College of General Practitioners. Between 2002 and 2006 a series of national clinical guidelines funded by NICE were published, including the diagnosis and management of the epilepsies in adults and children in primary and secondary care and Obesity: the prevention, assessment, identification and management of overweight and obesity in primary and secondary care (joint with the Centre for Public Health Excellence, NICE - formerly Health Development Agency).
Between 2006 and 2013 Tim was directly employed by NICE as Consultant Clinical Adviser/Medical Associate Director and led on the development of several high impact national quality initiatives. He set up the NICE Short Clinical Guidelines programme which saw NICE develop clinical guidelines ‘in house’ for the first time and which included innovative guidelines for primary care (antibiotic prescribing for self limiting respiratory tract infections and controversial guidance on infective endocarditis prophylaxis. From 2009 he advised NICE on its management of the Quality and Outcomes Framework (QOF) for general practice and on the methodology for NICE’s quality standards programme. During this time Tim held an honorary university contract and continued to publish research from NICE’s work and collaborate on a number of National Institute for Health Research (NIHR) funded studies.
Tim took up his current position at the University of Birmingham in March 2013. He continues to work one day a week as a GP in Ashby de la Zouch, Leicestershire.
Medicine and Surgery MBChB
Tim has designed and run courses on evidence based quality improvement for a range of international audiences.
Tim is interested in supervising doctoral research students in the following areas:
Health care improvement research in primary care, including the development and use of clinical guidelines and performance measures
Patient-Practitioner relations in primary care
If you are interesting in studying any of these subject areas please contact Tim on the contact details above, or for any general doctoral research enquiries, please email: firstname.lastname@example.org or call +44 (0)121 414 5005.
For a full list of available Doctoral Research opportunities, please visit our Doctoral Research programme listings.
Health care improvement research
This research theme is about how to get evidence into routine practice: specifically the development and use of clinical practice guidelines and performance measures. Tim’s interest is in understanding and promoting how research findings become embedded in routine health care in clinical, organisational and policy contexts.
Tim has conducted a number of systematic reviews in this area and is co-investigator on several ongoing NIHR funded studies that aim to promote the development of more rigorous NICE guidance and better implement clinical guideline recommendations in primary care:
• Are NICE clinical guidelines for primary care based on evidence from primary care? (PI: Nick Steele, University of East Anglia; NIHR Research for Patient Benefit Programme)
• Informing the development of NICE Quality Standards through secondary analysis of qualitative, narrative interviews on patient experiences (PI: Sue Ziebland, University of Oxford, NIHR Health Services and Delivery Research Programme)
• Targeted and sustainable implementation of high impact clinical practice recommendations in general practice (ASPIRE)” (PI: Robbie Foy, University of Leeds, NIHR Programme Grant for Applied Research)
Patient – practitioner relations research
A second research theme is practitioner-patient relations in primary care, including continuity of care, personal care and ‘difficult’ doctor-patient relationships. A key element of this work has been collaboration with social scientists and the conduct of theoretically informed qualitative research. His PhD research, funded by the Royal College of General Practitioners, argues that the removal of a patient from a GP’s list offers insight into the ending of the doctor-patient relationship both in terms of implications for GP practices and in advancing social theory in this area.
Postdoctoral research has addressed:
• the nature of professional-patient encounters in patients dying from malignant and non malignant (COPD/Heart Failure) disease in primary care
• patients’ expectations of care provided by nurse practitioners and general practitioners
• GPs’ views on continuity of care through an international survey
• the use of game theory to understand GP-patient encounters over time (PhD student supervision)
• Member, NICE Technology Appraisal Committee (2013- date)
• Member, Editorial Board, Quality in Primary Care (2011 – date)
• Professional development work in primary care for NICE International (2011 – date)
• Honorary Visiting Professorships at the Universities of Leicester (2010 – date) and Leeds (2012 - date).
Shaw EJ, Sutcliffe D, Lacey T, Stokes T. Assessing severity of depression in UK primary care using the QOF depression indicators – a systematic review of the evidence. British Journal of General Practice 2013 [in press].
Sutcliffe D, Lester H, Hutton J, Stokes T. NICE and the Quality and Outcomes Framework (QOF) 2009-2011. Quality in Primary Care 2012;20(1): 47-55.
Tarrant C, Dixon-Woods M, Colman AM, Stokes T. Continuity and trust in primary care: A qualitative study informed by game theory. Annals of Family Medicine 2010;8:440-446.
Tan T, Stokes T, Shaw EJ. Use of qualitative research as evidence in the clinical guideline program of the National Institute for Health and Clinical Excellence. International Journal of Evidence Based Healthcare 2009; 7: 169–172.
Richey R, Howdle P, Shaw EJ, Stokes T on behalf of the Guideline Development Group. NICE Guideline: Recognition and assessment of coeliac disease in children and adults. British Medical Journal 2009;338:1386-1387.
Adler AI, Shaw EJ, Stokes T, Ruiz R on behalf of the Guideline Development Group. NICE Guideline: Newer agents for blood glucose control in type 2 diabetes. British Medical Journal 2009;338:1328-1329.
Tan T, Brett S, Stokes T on behalf of guideline development group. NICE Guideline: Rehabilitation after critical illness. British Medical Journal 2009;338:767-769.
Tarrant C, Colman MA, Stokes T. Past experience, shadow of the future, and patient trust: a cross-sectional survey. British Journal of General Practice 2008;556:780-783.