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

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

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

Get inspired – step out of your comfort zone

Medina Johnson_2By Medina Johnson

IRIS National Implementation Manager
Next Link Domestic Abuse Services
Research Collaborator, Centre for Academic Primary Care

Being neither an academic nor a general practitioner, I arrived feeling something like a fish out of water at the RCGP annual conference last month in Glasgow. My colleagues and I had won one of the categories of the RCGP’s Research Paper of the Year award with our paper about women’s experiences of referral to a domestic violence advocate and I was invited to give a short presentation in the wonderfully named “Winners’ Enclosure” section of the conference.

As I trotted, albeit nervously, up to the lectern (I’m going along with the “Winners’ Enclosure” analogy here!) I was reminded how easy it is for us to all stay within our own comfort zone whether that be professionally or personally. I had never presented on a paper before. I had never been … Read more

Greater GP access: a panacea for rising A&E use?

Fiona MacKichanBy Fiona MacKichan
Lecturer in Medical Sociology
Centre for Academic Primary Care

GP access has become a focus of governmental response to rising A&E attendance. Outlining a ‘new deal for general practice’ on 19th June Jeremy Hunt cited safeguarding hospital capacity as a key driver for seven-day primary care access.

The logic is that a significant proportion of A&E visits are for problems that could be managed in primary care and lack of available GP appointments drives people to A&E.

Can greater GP access reduce A&E use? The answer seems to be probably, some of the time and in certain contexts. A recent systematic review by our team found an association between better primary care access and reduced A&E attendance in US and Canadian studies, but no clear association in European studies.

Using patient-reported data from the GP Patient Survey, Tom Cowling and colleagues found that a significant … Read more

Why are so many children given antibiotics for a cough?

Christie CabralBy Dr Christie Cabral
Research Associate
Centre for Academic Primary Care

When I first started researching infectious cough in children, lots of clinicians told me they couldn’t understand why so many parents brought in children who were well enough to turn the consulting room upside down before they even started the examination. As a parent of two young children myself, I had some idea, but as a qualitative researcher, I was keen to get a balanced view.

In the TARGET Programme* we wanted to answer two questions. Given that most coughs will get better on their own:

1) Why do so many parents consult when their child has a cough?
2) Why do so many clinicians prescribe antibiotics for children with coughs?

We conducted five qualitative studies and began to notice common themes, not just across the studies but also shared by parents and clinicians. We found normative beliefs Read more

Why do some medical schools produce more General Practitioners than others?

Simon ThorntonBy Simon Thornton
GP registrar and academic clinical fellow
Centre for Academic Primary Care

As someone who has come into general practice via another specialty, I am particularly interested in what leads people to choose a career in primary care, and how we might be able to help improve recruitment.

There are lots of factors that influence people to choose a career in general practice. These include certain personality traits, such as scoring more highly on measures of empathy, being a graduate entry medic, exposure to general practice at an undergraduate level, and the attitudes of other healthcare professionals towards general practice. What I find most interesting is that there is a huge influence depending on which medical school you went to.

In 2012, of all doctors finishing their foundation programme training, only 11% of Cambridge graduates entered primary care training compared to 38.5% of Keele graduates.

Does this difference … Read more