The importance of providing support for victims and survivors of domestic abuse has long been established and a considerable body of research shows what effective support should look like. How to engage with perpetrators of domestic abuse is less well understood. There are a range of interventions of different lengths and purposes such as shorter ones to assess risk, and containment and disruption approaches for the highest risk perpetrators to try to manage that risk.
For lower risk perpetrators, longer (e.g. six month) group programmes aiming to reduce abusive behaviour and offering support to the partners and ex-partners alongside are recommended by Respect, a UK membership organisation that sets standards and accredits perpetrator programmes. However, the evidence for these group programmes is uncertain and there are extensive methodological challenges to … Read more
CAPC researchers, Dr Alex Burrell, Dr Grace Scrimgeour and Dr Matthew Booker have conducted a systematic review and narrative synthesis to assess the evidence on how GPs are used in emergency medical services.
Emergency medical services in the UK are under significant pressure. A considerable proportion of their workload relates to problems that could be dealt with by a GP. Using GPs in emergency medical services, such as the ambulance service, might reduce the number of people being taken to Accident and Emergency (A&E) and may more appropriately meet these patients’ needs. This could also free up ambulances and paramedics to respond to life-threatening emergency calls.
GPs have been used in emergency medical services in a number of countries. In some countries, … Read more
The prevalence of antibiotic use in modern society is well established. Antibiotics have revolutionised medicine and how society sees – and deals with – disease. Along with concerns regarding the rise of antibiotic resistant bacteria, thought to be exacerbated by their over-use in many areas, there is a need to understand the history of their adoption and use, especially in primary care. Comprehending the many-tendrilled circumstances and behaviours that led to this point might help to inform future choices, and give some insight into future best practice.
Over a third of all pregnancies in women over 40 result in therapeutic abortion. This is one of the highest rates of abortion compared to live births in any age group. This suggests an unmet need for contraception. I interviewed women over 40 about their views and experience with contraception to find out more.
“I couldn’t do another child”
Previous studies have attributed the relatively low use of reliable contraception in women over 40 to women’s perceptions of themselves as low risk of pregnancy. However, participants in this study felt pregnancy was a real possibility and that an unplanned pregnancy would have a significant negative impact on their lives. Some had completed their families or had other caring responsibilities. While others knew they did not want any children and did not want to … Read more
“I think everyone’s been in the situation where they go to a doctor to talk about something that they find hard to talk about or they might find it difficult to voice their concerns.”
“I just couldn’t get a word in edgewise, sometimes you find you’ve just arrived and the GP is writing the prescription you know?”
These are some of the things patients said to us when we interviewed them for the Consultation Open and Close (COAC) study. Patients felt that, in the 10-minute consultation, particularly when it was by telephone, the GP did not always have time to get to the root of their problems.
“You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.” Dame Cicely Saunders
Many people express a wish to die at home. The proportion of deaths that occurred in the community (including private homes and care homes) rose significantly during the pandemic and has been sustained. As a consequence, the need to fund and improve our community palliative care services has never been more important. Earlier this year, this was recognised by a change in the Health and Social Care Bill to fund palliative care services in all areas. This will hopefully remove the postcode lottery that currently exists in the UK for … Read more
How did England’s National Health Service (NHS) change at the start of the COVID-19 pandemic?
Dr Lorna Duncan and Kelly Cheng wrote two companion pieces for F1000Research, exploring how the NHS modified general practice (GP) consultations to minimize the spread of COVID-19 and what the public thought about those changes. F1000Research spoke to Dr. Duncan about what they discovered and the potential implications for primary care. You can read the full blog on their website.… Read more
Have you ever found yourself looking at blood test results and wondered why the test was done in the first place?
Why Test? – It seems like a simple question. Yet despite increasing access to research databases such as Clinical Practice Research Datalink (CPRD), which contain millions of test results, there is no easy way to find out why these tests are being performed in the first place. How many are for monitoring, screening or diagnosis? Which symptoms trigger testing? To explore this, we are launching the Why Test study using the Primary Care Academic CollaboraTive (PACT).
Currently, only a tiny proportion of primary care clinicians have a formal academic contract with a University. PACT aims to open up opportunities for non-academic primary care clinicians to get … Read more
As a teacher and researcher, I have learned that, unless my aim is clear, I will confuse myself, my students, my clinical colleagues, and my co-investigators. And yet, as a GP I often wonder, ‘Can I summarise my objective?’
The June edition of the UK’s British Journal of General Practice included articles describing an existential crisis in primary care (asking ‘What is the essence of general practice?’), a novel study describing some of the most complex work undertaken by GPs (largely invisible to most people most of the time), and other articles asking how we should deliver care post-COVID. However, the common thread for me was: ‘What is our aim?’
And why is it important to be able to explain our … Read more
Primary care plays a key role in responding to patients experiencing or perpetrating domestic violence and abuse regardless of their gender, age, sexuality, or experience. There is, however, uncertainty about the value and effectiveness of integrated training and support programmes addressing the needs of all patients affected by domestic abuse.
IRIS (Identification and Referral to Improve Safety) is a broadly commissioned, evidence-based primary care training and support programme designed to reach female survivors of domestic violence and abuse through general practice. The IRIS+ (Enhanced Identification and Referral to Improve Safety) study tested the feasibility of an adaptation of IRIS for all patients affected by domestic abuse, including men and children.
Reaching everyone in general practice?
Challenges to applying the IRIS domestic violence model to other patient groups have been highlighted by the … Read more