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

Conference reflections from a basement

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by Dr Rupert Payne, Consultant Senior Lecturer in Primary Health Care, Centre for Academic Primary Care, University of Bristol

Dr Rupert Payne reflects on the highlights of the two-day Society for Academic Primary Care (SAPC) Annual Scientific Meeting, which was held virtually this year from 30 June to 1 July. This blog was first published on the SAPC website.

Another year, another conference! The last time I attended a SAPC conference was the regional South-West one that we hosted in Bristol – about a week before the first lockdown kicked in, and normality abruptly ended. Indeed, I suspect it was actually the last big face-to-face meeting many of us attended. This time, Leeds beckoned. But rather than jumping on the train to the “grim north”, I descended the stairs to my rather grimmer basement (yes, my wife has kicked me out the dining room), for … Read more

Is there value in GPs diagnosing an anxiety disorder?

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by Charlotte Archer, Senior Research Associate in Primary Care Mental Health, and Katrina Turner, Professor of Primary Care Research, Centre for Academic Primary Care, University of Bristol

Research has shown that fewer people in primary care are now being diagnosed with anxiety than in the past, despite reports that rates of anxiety have increased in the general population. Individuals with anxiety may be reluctant to seek help for their symptoms. They may also find it difficult to talk to their GP about their mental health or may normalise their symptoms.

Although most anxiety is managed in primary care by GPs, we know very little about whether GPs and patients think it is important to diagnose and manage anxiety disorders. Knowing this might help us identify possible reasons for the decline in their recording, and the potential impact of this on patient care and … Read more

How UK newspapers made sense of COVID-19 related death and bereavement

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Headshot photos of Dr Ryann Sowden and Dr Lucy Selman

 

 

 

 

by Dr Ryann Sowden, Research Assistant, Population Health Sciences, Bristol Medical School and Dr Lucy Selman Senior Research Fellow, Centre for Academic Primary Care, University of Bristol

In a paper published recently in PLOS One, we explore the coverage of COVID-19 in British newspapers with a focus on key media narratives about the virus.

COVID-19 and media narratives

COVID-19 has caused over 120,000 deaths in the UK, leaving over a million people bereaved. Although death is often described as a societal taboo in British culture, it remains ever-present in the public realm of news and media which COVID-19 has dominated for the past 12 months.

In the spring of 2020, as the COVID-19 pandemic began to claim a large number of lives in the UK, newspapers reported on the threat, damage and bereavement caused by the virus, as well as providing a … Read more

International Women’s Day 2021 – Q&A with Dr Alison Gregory

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As a research centre, we are proud to host a fantastic team specialising in sexual and domestic violence and abuse and their impacts on health. What better way to mark this year’s International Women’s Day than to focus on the work of an outstanding member of the team, Dr Alison Gregory, whose recent investigations have focused on the role of friends, family, neighbours and colleagues (informal supporters) in the lives of domestic abuse survivors.

In this Q&A, Alison reflects on the challenges of working on a sensitive topic with a vulnerable population group, made all the more critical during this time of pandemic and the ‘shadow’ pandemic, which has seen rates of domestic abuse soar globally.

Your research activities have focused on Covid-19 recently. Could you tell us a little more? 
I’ve been researching the role of friends, family members, neighbours, and colleagues (informal supporters) in the lives of … 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

Primary care and the maintenance of abstinence in alcohol dependence: what might work?

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by Dr Vincent Cheng, Senior Research Associate in Research Synthesis, Bristol Medical School and Professor David Kessler, Professor of Primary Care, Centre for Academic Primary Care and Centre for Academic Mental Health,  University of Bristol

The problem

Specialist alcohol treatment services cannot cope with the growing problem of alcohol use disorder. Even before the recent COVID-19 lockdown, it was estimated that more than 80% of those in need of treatment were not receiving it. The predicted economic downturn is not likely to improve this figure. Given that primary care is universally accessible in the UK, we were interested in bringing together the evidence on what interventions could be delivered in primary care.

We conducted a systematic review and network meta-analysis of treatments (psychological, pharmacological, or both) for maintaining abstinence in recently detoxified, alcohol dependent adults that could be delivered in a community setting. … Read more

Tech-enhanced academic writing

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by Dr Yvette Pyne, GP and Academic Clinical Fellow, Centre for Academic Primary Care, University of Bristol

Coronavirus has completely changed how we work across most professions including in academic research. While those impromptu conversations around the coffee machine at work, or over drinks at academic conferences seem both a distant memory and a far-flung future dream, there have been some wins for collaborative working as well. Lockdown has brought both technological improvements and culture-change around the use of video conferencing and collaboration tools. A colleague – Dr Stuart Stewart based at the University of Manchester and I (based at the University of Bristol) have been “meeting” once a week to discuss the creation of a concept paper covering ideas that have been percolating for years after a fortuitous meeting at a conference in 2018. Both of us are tech-adept and we often discuss ways … 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