Category: Organisation and delivery of care

Improving consultations for patients and GPs: The Consultation Open and Close Study

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Dr Mairead Murphy

 

 

 

by Dr Mairead Murphy, Honorary Research Fellow, Centre for Academic Primary Care, University of Bristol and Evaluation Lead, South West Academic Health Science Network

“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.

This is not new or surprising. The 10-minute GP consultation is the shortest in Europe… Read more

How do we provide high quality palliative care in the community?

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By Dr Tanuka Palit, NIHR Academic Clinical Fellow in Primary Care, Centre for Academic Primary Care, University of Bristol

“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

Lessons from lockdown: NHS general practice changes and public perceptions

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by Dr Lorna Duncan, Centre for Academic Primary Care, University of Bristol

 

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

Opening opportunities for GP trainees and allied health professionals to get into research: the PACT ‘Why test?’ study

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by Dr Jessica Watson, NIHR Clinical Lecturer in General Practice, Centre for Academic Primary Care, University of Bristol

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

The aim of general practice: can it be explained in one sentence?

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by Professor Alastair Hay, Centre for Academic Primary Care, University of Bristol

This article was first published in the British Journal of General Practice.

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

Extending the IRIS domestic violence model to other patient groups

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by Dr Eszter Szilassy, Research Fellow, Centre for Academic Primary Care, University of Bristol

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

Should we be concerned about declining continuity of primary care?

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by Peter Tammes, Mairead Murphy and Chris Salisbury, Centre for Academic Primary Care, University of Bristol

Decreasing trend of continuity of care

Seeing the same GP over time is highly valued by most patients and GPs in the UK. This is known as ‘continuity of care’ and it is linked with lower healthcare costs, more satisfied patients, fewer emergency hospital admissions and even with reduced mortality.

Given these multiple benefits, one would expect it to be highly prioritised. However, our recently published study in the British Journal of General Practice shows that continuity of care declined steadily between 2012 and 2017. On average, the percentage of patients who reported to have a preferred GP declined by nine percentage points and the percentage who can usually see their preferred GP declined by 10 percentage points.

Is decreasing continuity of care a concern?

Decreasing continuity is … Read more

Destabilising primary health care: digitalised remote consulting and post-COVID-19 patient care

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by Sophie Park, Professor of Primary Care and Medical Education, Research Department of Primary Care and Population Health, University College London, Yathavan Premadasan, BSc Medical Student, University College London and Chris Salisbury, Professor of Primary Health Care, Centre for Academic Primary Care, University of Bristol

The COVID-19 pandemic has changed primary care dramatically, with most consultations conducted remotely by telephone, video or online messaging. But is this a short-term adjustment or the future norm? In general practice, clinical care has been based on long term face-to-face contact, establishing trusting relationships through continuity of care, and using knowledge of patients’ personal circumstances and social context to provide holistic support. Now, these fundamental principles are challenged.

Matt Hancock (UK Health Secretary) has welcomed rapid changes towards digitalised clinical practice as an overdue development, stating that wherever possible, all future consultations should be conducted remotely. But is the … Read more

Conducting research during COVID-19: a medical student’s perspective

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by Kelly Cheng, Medical Student, University of Bristol

 

“Cancelled due to COVID-19” – a rare opportunity to practise lifesaving pre-hospital emergency medicine skills in the French Alps was abruptly transformed into another cancellation email, as with many other glorious plans for 2020. Before I knew it, hospital placements had also been suspended until further notice. Instead, I found myself back home, huddled before my laptop, about to embark on a 6-week long student choice project working with highly-experienced academics for the first time – over Zoom, of course.

In this post, I share my experience as a third year medical student undertaking a research project alongside Dr Lorna Duncan from the Centre of Academic Primary Care (CAPC), and explore the methods we used to successfully gather primary data from all regions of England amid a national lockdown. Ironically, the chance to carry out a project focused on … Read more

Funerals in the COVID-19 pandemic – how restrictions might affect the bereaved

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by Dr Alex Burrell, Foundation Year 2 doctor, North Bristol NHS Trust and Dr Lucy Selman, Senior Research Fellow, Centre for Academic Primary Care, University of Bristol

Restrictions on funeral attendance have been put in place to try to prevent the spread of COVID-19. We conducted a rapid systematic review to try to understand what impact these restrictions might have on the bereaved. We found that the impact of funeral practices was not clear-cut: observational studies assessed different outcomes and their results varied. However, there were important lessons from qualitative research. What seems to be most important is helping people create a meaningful personal ritual which provides a sense of social support however they mourn, whether together in person or virtually.

COVID-19 has caused hundreds of thousands of deaths around the world, with over 45,000 confirmed deaths in the UK as of 23 July … Read more