Creating a data archive of GP consultations – the motivations and challenges

One in a million logoBy Dr Rebecca Barnes
Senior Research Fellow
Centre for Academic Primary Care

Nearly 14 years ago in summer school at University of California Santa Barbara, Professor Don Zimmerman provided my introduction to the analysis of institutional, in particular medical, interaction.

Those studies set the benchmark for my own research ambitions but the main obstacle I faced was getting access to data.

For all the right reasons, medical consultations data are challenging to collect. Where ethical approval is in place for reuse it is often restricted to the original research team. Sometimes retrospective approvals for reuse of existing data are possible but even then, consultations data that has been collected without reuse in mind is often of variable quality; the process of data collection and participant characteristics are not well-documented, recordings can be incomplete and they are often audio-only.

The idea for the Primary Care Consultations Archive was born with this … Read more

Listening to the child’s voice in research on domestic violence and abuse

LisaArai071015By Lisa Arai
Senior Research Associate
Centre for Academic Primary Care

Anybody who has worked on a systematic review will know you spend a lot of time thinking about the type of research papers to include in your review and those you will exclude. Tightly defined inclusion criteria, as well as critical appraisal, an explicit synthesis stage and measures to reduce reviewer bias (such as inter-rater checks), are what distinguish systematic from traditional reviews (a point usefully made by Mark Petticrew more than a decade ago, when he sought – among other things – to debunk the notion that systematic reviews are simply larger versions of traditional reviews).

Over many years teaching research methods, I’ve noticed students often regard this early stage of the review process as troublesome. It’s often approached with an uncertainty that, if not properly resolved, can render the review unwieldy. Or its significance might be underestimated; … Read more

Why GPs need training about domestic violence and children

Eszter Szilassy2by Eszter Szilassy
Senior Research Associate
Centre for Academic Primary Care

While violence against men continues to fall in the UK, women affected by violence and domestic abuse are bearing the brunt of a hidden rise in violent crime. This rise coincides with the austerity-led cutting of domestic violence services.

Domestic violence and abuse (DVA) damages physical and mental health resulting in increased use of health services by survivors of abuse. The prevalence of DVA among women attending general practice is higher than in the wider population. Women experiencing DVA are more likely to be in contact with GPs than with any other professionals. Reduced investment in specialist domestic violence services further increases the demand for direct general practice responses to DVA. Although victims tend not to disclose spontaneously to their GP, they have an expectation, often unfulfilled, that doctors can be trusted with disclosure, and can offer them … Read more

To test or not to test, that is the question

Jessica Watsonby Dr Jessica Watson
Research Fellow
Centre for Academic Primary Care

‘If you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health’
Mark Cuban, Twitter

With this one tweet Mark Cuban started a twitter storm. Advocates argued that the future of medicine lies with new technologies, with online companies and even future smartphone dongles allowing patients’ to test their own blood for everything from allergies to zinc.

This brave new world overlooks the responsibility of doctors to ‘first do no harm’. I have been qualified as a doctor for over 10 years but am still in training as a GP registrar and ‘junior doctor’. I have gradually learned that my well-meaning enthusiasm to do more and more tests to try to find out what is wrong with patients can quickly lead to … Read more

Who do GPs go to when they need help?

johanna-spiersBy Johanna Spiers
Research associate
Centre for Academic Primary Care

GPs often say they make the worst patients, but who do they turn to when they need help? That’s what I aim to find out on a new research project about GPs with mental health issues.

My new job is firmly at the centre of the zeitgeist. GPs are all over the news on a daily basis. Doctors are judged by journalists and picked apart by politicians for running unsafe surgeries, for closing their doors to new patients, and for long waiting lists. If you read (and believe) certain sectors of the UK press, you might be forgiven for thinking that GPs have a lot to answer for.

The reality is, of course, way more complex than the Daily Fail might have us believe. Yes, GPs are retiring early. Yes, many practices are unable to add new names … Read more

Domestic violence and abuse: how should doctors and nurses respond?

Gene FederBy Gene Feder
GP and Professor of Primary Care
Centre for Academic Primary Care

Domestic violence and abuse (DVA) is a violation of human rights with long-term health consequences, from chronic pain to mental ill-health. It is a global public health challenge, requiring political and educational intervention to drive prevention, as well as a robust criminal justice response. But what is required from front line doctors and nurses, beyond the requirement to respond with clinical competence and compassion to survivors of DVA presenting with, for example, acute injuries, pelvic pain or PTSD? What are the arguments and the evidence for an extended role for clinicians, as articulated in the NICE guidelines on DVA and the WHO guidelines on intimate partner and sexual violence, requiring specific training on DVA and the resources for referral of patients experiencing DVA to specialist DVA services?

A crucial argument and evidence source, as we … Read more

Bridging the gap between research and commissioning

Nadya+AnscombeBy Nadya Anscombe
Communications officer
Centre for Academic Primary Care

“Bridging the gap” – that was the name of the workshop I attended at a recent event organised by the Avon Primary Care Research Collaborative (APCRC).

The gap that apparently needed to be bridged is the gap between what someone called the “ivory towers of academia and the swampy lowlands of commissioning”.

I was sceptical – is there really a gap? Surely healthcare researchers and NHS commissioners are all working in the same sector; we all want to improve things; and we all want to make a difference to our population’s health and well-being. Surely the “gap” can’t be as big as some people make it out to be?

In theory, academia investigates the problems and issues of the sector, provides evidence for things that work and things that don’t; commissioners use this information to make decisions about what services … Read more

Investment in GP reception staff and simplified systems could bring down A&E attendance

profile-Emer-Brangan-900x900-c-defaultBy Emer Brangan
Research Associate
Centre for Academic Primary Care
and NIHR CLAHRC West

A&E departments in England have faced considerable pressure for several years, with high profile missed performance targets at several major A&E units last winter receiving widespread media coverage.

So how can GP practices help?

Our research suggests that investment in primary care reception staff, simplifying appointment systems and addressing patient perceptions of access could make a difference.

Our mixed methods study in England, funded by the NIHR School for Primary Care Research, is bringing together findings from a systematic review of the literature, multivariate analysis of routine data nationally, and six qualitative case studies in primary care practices.  Drawing on the qualitative case studies we produced an animation (see below) of three short stories about access to primary care, told from a patient, primary care receptionist, and GP perspective.

We found that practices responding to high … Read more

Dying in the UK? Lucky you.

Lesley Wye photoBy Lesley Wye
Senior Research Fellow
Centre for Academic Primary Care

My father is dying. This is pretty bad. What’s worse is that he’s dying in the US.

The Economist Intelligence Unit recently published a report that ranked the UK as the best place to die in the world, with the US ranking 9th, and I’m inclined to agree.

With advanced prostate cancer, a tumour in his liver 14 cm long, another pushing in his bladder and a recent bout of pneumonia, we’ve been told that my father has “weeks” to live.

He’s currently in a ‘skilled nursing facility’ on the premises of a retirement community. Medicare, a US federal government programme, is paying for his care, but only while he continues to have physiotherapy twice a day. It’s rather heart-breaking watching my father struggle to stand for more than 30 seconds and then collapse exhausted in his bed. But … Read more