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 … 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

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