by Dr Jason Sarfo-Annin, Honorary Research Fellow, Centre for Academic Primary Care, University of Bristol
Debate surrounding the future of general practice is usually rooted in the context of the primary care workforce, the introduction of new roles and developing practitioners with a new skill-mix.
Such solutions are rooted in the medical model of health. I share the Marmotian view that health care is just one dimension of improving individual and population health.
As GPs, we often consult with patients who cannot be helped by our services. We are also often unable to effectively signpost patients or help navigate them to services that can support them. Consequently, I believe the future involves working as part of a collaboration of services – delivered optimally by co-location. Provision of these services would be based on the geographical location of patients and include amenities already provided by local authorities … Read more
by Dr Eszter Szilassy, Research Fellow, Centre for Academic Primary Care, University of Bristol
Men who experience domestic violence and abuse face significant barriers to getting help and access to specialist support services, our latest study shows.
Although the amount, severity and impact of domestic violence and abuse experienced by women is much higher than that experienced by men, men can also suffer significantly as a result of abuse from a partner, ex-partner or an adult family member.
An earlier study of 1,368 male patients in GP clinic waiting rooms in the UK found that more than one in four had experienced abusive behaviour from a partner or ex-partner. They were also between two and three times more likely to have symptoms of depression and anxiety.
The experiences of many men who are survivors of domestic violence and abuse are similar to those of women. Like … Read more
By Dr Lucy Pocock, GP Career Progression Fellow, Centre for Academic Primary Care, University of Bristol
Dealing with death is part of the job description for all doctors. For those working in general practice, this often means planning ahead, with GPs encouraged to keep a register of patients thought to be in the last year of their life.
One reason for this is to identify which patients might benefit from palliative and supportive care – the kind of care which focuses on symptom control, rather than cure. At the moment, these registers appear to consist mainly of patients with cancer. Yet most people (72%) in England don’t actually die of cancer. So why aren’t other dying patients being registered?
To answer this question, it is helpful to think about how we die. As a GP, I can often predict, to some degree, a decline … Read more
By Dr Natalia Lewis, Research Fellow, Centre for Academic Primary Care, University of Bristol
A new paper by researchers from the University of Bristol and NIHR CLAHRC North Thames highlights the post-trial journey of an evidence-based domestic violence and abuse (DVA) intervention to the NHS front-line, and the human and contextual factors that influence how its effect is sustained over time.
IRIS (Identification and Referral to Improve Safety) is a general-practice-based DVA training, support and referral programme. The programme develops DVA awareness and skills among general practice staff and provides a referral pathway to a named DVA advocate (IRIS advocate educator) based in a third sector agency. IRIS advocate educators provide IRIS training and ongoing support, consultancy to practice staff, and advocacy to referred patients.
Following a successful randomised controlled trial, IRIS has been implemented in over 30 local authorities in the UK. The trial … Read more
By Dr Jeremy Horwood, Senior Research Fellow, Centre for Academic Primary Care, University of Bristol and NIHR CLAHRC West, and Dr Andrew Turner, Senior Research Associate, NIHR CLAHRC West
Researchers from the DECODE study hosted a workshop late in 2018 to explore the unintended consequences of digital health tools used in primary care. The workshop was attended by members of the public, technology developers, GPs and key researchers in the field.
Digital health tools, such as health monitoring apps and online patient portals, are becoming commonplace, with NHS England supporting their use to improve patient access and care. But this increase in their use could lead to unintended consequences, both positive and negative. An understanding of these consequences is vital, so we can minimise the negative effects and harness the positive.
DECODE aims to improve how digital health tools are used in primary care by investigating … Read more
Guest blog by Dr James Dodd
Consultant Senior Lecturer
Academic Respiratory Unit, University of Bristol
and Southmead Hospital, Bristol
What is COPD?
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term which includes ‘chronic bronchitis’ and ‘emphysema’. It causes a progressive decline in lung function and health. It is common, affecting 2% of the adult population, and is projected to become the third leading cause of death in the UK. People with COPD experience breathlessness, cough and wheeze and often suffer with repeated chest infections. These ‘exacerbations’ are the second most common reason for emergency admissions to hospital.
Sadly, around two of the three million people with COPD in the UK remain undiagnosed, meaning that they live with debilitating symptoms for many years before receiving the support and advice they need. These ‘missing millions’ are the driving force behind COPD awareness month and World COPD Day.
It is … Read more
Guest blog by Medina Johnson (left), Chief Executive
and Lucy Downes (right), National Implementation Manager
As we gear up for events and conversations to mark the 16 Days of Activism against Gender-based Violence, it’s timely to reflect on the importance of the healthcare response to gender-based violence. IRISi’s vision is a world in which gender-based violence is consistently recognised and addressed as a health issue.
Violence against women is a global health problem of epidemic proportions. Dr Margaret Chan, World Health Organization Director-General
The IRIS programme is our flagship intervention working with primary care to change and improve clinical practice and to provide patients affected by domestic abuse with access to specialist advice and support. It provides training and support to GPs, practice nurses and other primary care clinicians to help them identify and refer women with experience of domestic violence and abuse (DVA) to … Read more
by Dr Rupert Payne
Consultant Senior Lecturer in Primary Health Care
Centre for Academic Primary Care
The seventieth anniversary of the NHS has made me reflect on how proud I am to have contributed to its work for over the past twenty-odd years. Founded on 5 July 1948, the service continues to this day to operate to the same three core principles – meeting the needs of everyone, free at the point of delivery, and based on clinical need.
Aside from providing comprehensive, high-quality healthcare services to virtually the entire UK population, the other thing that the NHS is known for is the constant political bickering that carries on in the background, with criticisms about chronic under-funding and stealth privatisation. However, these are not new issues, with medicines an important reason for the challenges the NHS now faces.
In a response to concerns about rising costs, perhaps the first … Read more
by Dr Sam Merriel
GP and Honorary Lecturer
Centre for Academic Primary Care
Dr Joanna Kesten
Senior Research Associate
NIHR Health Protection Research Unit in Evaluation of Interventions
Researchers from the Centre for Academic Primary Care and Population Health Sciences, Bristol Medical School, with colleagues from Queens University Belfast, Ulster University, and Southampton University, have published an editorial in the British Journal of General Practice (BJGP) in response to Public Health England’s (PHE) recommendation to roll out a targeted Human papillomavirus (HPV) vaccination programme for men who have sex with men (MSM) through genitourinary medicine (GUM) and HIV clinics across England.
The editorial argues that although this announcement is a positive step, it would be more effective to follow more recent recommendations to introduce gender neutral HPV vaccination to achieve total elimination of HPV, rather than a reduction. The PHE proposal means MSM who do … Read more
Unveiling the results of the 3D trial for patients with multimorbidity in general practice
by Chris Salibsury, Peter Bower, Stewart Mercer and Bruce Guthrie
There is good agreement about the sort of care that people with multimorbidity need. But can it be delivered in the busy setting of general practice, and does it improve outcomes? In this blog we discuss the results of the 3D trial, the largest study of an intervention for multimorbidity published to date.
Managing multimorbidity is a litmus test for modern health care systems. Patients with many long-term conditions face major challenges in managing their conditions and need significant support, which means that these patients are often associated with high costs.
Despite the complexity of caring for these patients, there is also significant agreement about what sort of care they need. Many authors have highlighted that patient-centred care is crucial, with a … Read more