Greater GP access: a panacea for rising A&E use?

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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?

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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

Why do some medical schools produce more General Practitioners than others?

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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

Do we really need primary care academics?

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Gene FederBy Gene Feder
GP and Professor of Primary Care
Centre for Academic Primary Care

I recently took part in a debate hosted by the Centre for Primary Care and Public Health (QMUL) where I argued that the future quality of the NHS depends on academic primary care.

The vote at the start of the debate: in favour 16, against 11, abstaining 2.

My pitch was based on the challenges of developing integrated health (and social care) for our aging population, a patient-centred shared decision-making model of medical practice, and turning back  the commercially (and specialist) driven tide of over-diagnosis and over-treatment. The future quality of the NHS requires those challenges to be met and will depend on a vigorous primary care-based system. And that will (in part) depend on the work of primary care academics.  I reminded the audience that I was using the term “academic” to mean having to … Read more

Research and activism – the challenge of remaining connected

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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?

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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