Are some patients more equal than others? Looking back at the Cancer Drugs Fund

Padraig Dixonby Dr Padraig Dixon
Senior Research Associate
Centre for Academic Primary Care

Imagine being given £400m of taxpayers’ money to spend on drugs for the benefit of NHS cancer patients. How would you decide which therapies to fund? Would you decide that all cancer patients should benefit equally, or would you decide to spend more on particular types of cancer, or on particular types of patient?

These issues were confronted by the Cancer Drugs Fund (CDF), the 2014/15 expenditures of which were £416m (against a budget of £280m). The CDF was created to make available to patients in England cancer drugs not recommended by the National Institute of Health and Care Excellence (NICE) on the basis of cost-effectiveness, not yet appraised by NICE or which were being used outside market authorisations.

The effects of the CDF on population health are controversial: one estimate is that the CDF has caused five … 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

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

Guidelines for children’s activity levels need to be presented more sensitively and positively

Georgina BentleyBy Georgina Bentley
PhD Student
Centre for Academic Primary Care

For many parents with young children (myself included), it may seem as if they never sit still, but surprisingly, research indicates that preschool children are not achieving the Government targets* for physical activity and are spending too much time in sedentary behaviours, such as watching TV.

As part of my PhD research on preschoolers’ physical activity and sedentary behaviour, I wanted to understand mothers’ reactions to these guidelines. Mothers are considered the gatekeepers of young children’s activity behaviours and so understanding how they perceive these guidelines seemed an obvious first step in determining how preschool children can be helped to meet the targets.

After interviewing mothers, the findings reveals that mothers don’t feel that the guidelines are relevant to their children, and some indicated that they wouldn’t take any notice of them. Their explanation for this is because they … 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

Research and activism – the challenge of remaining connected

Alison GregoryBy Dr Alison Gregory
Research Associate
Centre for Academic Primary Care

It’s easy to lose enthusiasm for your job if you’ve been doing it for many years, but when I attended the annual conference of the European Network on Gender and Violence last week, I was struck by the level of passion the delegates continue to have for their work, even after decades of working in their field.

The network was set up to support the exchange of ideas and to encourage collaboration among scholars and professionals who address violence, gender, violence prevention and related issues across Europe.

Nadia Khelaifat and I attended the meeting as young scholars from the Centre for Academic Primary Care (CAPC) at the University of Bristol to talk about our PhD work in the areas of domestic violence (DV) and migrant women, and the impacts on the friends and family members of DV survivors. In … Read more

GE2015: What are the main parties promising for primary health care, and what does it mean?

By Dr Alyson Huntley
Research Fellow
Centre for Academic Primary Care

Provision of primary health care is always in the headlines and is a priority for all the political parties. Of particular concern is the number of GPs and nurses in practice, and patients’ real and perceived access to them.  Expansion of primary and community health as an alternative to A&E is hotly debated as resources are carefully allocated.  An ageing population coupled with high expectations of the general public mean that timely and appropriate primary health care provision is a major issue for any potential government.

All the five main parties pledge improved NHS health care personnel provision in their manifestos. Whilst there is mixed evidence that the number of GPs in practice influences A&E attendance, we do know that care from the same GP (continuity of care) does help reduce it.  However, there is a very clear … Read more