By Dr Tanuka Palit, NIHR Academic Clinical Fellow in Primary Care, Centre for Academic Primary Care, University of Bristol
“You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.” Dame Cicely Saunders
Many people express a wish to die at home. The proportion of deaths that occurred in the community (including private homes and care homes) rose significantly during the pandemic and has been sustained. As a consequence, the need to fund and improve our community palliative care services has never been more important. Earlier this year, this was recognised by a change in the Health and Social Care Bill to fund palliative care services in all areas. This will hopefully remove the postcode lottery that currently exists in the UK for … Read more
by Dr Simon Thornton, GP and GP Engagement Lead, Centre for Academic Primary Care, University of Bristol and Professor Trevor Thompson, GP and Head of Primary Care Teaching, Centre for Academic Primary Care, University of Bristol
The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care teaching and research based in Bristol Medical School. In April 2022, we held an inaugural Festival of Teaching at Bristol Zoo, to celebrate the skill and commitment of GP teachers, who are helping develop the primary care workforce of the future.
The day started with an introduction to teaching for the coming (2022/23) academic year from the teaching team. If you’re interested in teaching medical students and haven’t seen it already, do take a look at our Teaching Brochure that gives you all the information you need about teaching … Read more
by Dr Jessica Watson, NIHR Clinical Lecturer in General Practice, Centre for Academic Primary Care, University of Bristol
Have you ever found yourself looking at blood test results and wondered why the test was done in the first place?
Why Test? – It seems like a simple question. Yet despite increasing access to research databases such as Clinical Practice Research Datalink (CPRD), which contain millions of test results, there is no easy way to find out why these tests are being performed in the first place. How many are for monitoring, screening or diagnosis? Which symptoms trigger testing? To explore this, we are launching the Why Test study using the Primary Care Academic CollaboraTive (PACT).
Currently, only a tiny proportion of primary care clinicians have a formal academic contract with a University. PACT aims to open up opportunities for non-academic primary care clinicians to get … Read more
by Alastair Hay, Professor of Primary Care, Centre for Academic Primary Care, University of Bristol
I became a GP in 1997 and was appointed professor of primary care at the University of Bristol in 2013.
As a child, I was an avid Lego® player and reader of ‘how things work’ books. I was state-educated and did not enjoy school until my ‘A’ levels. I enjoyed the conceptual challenge of mathematics and, in 1985, was offered a place at Birmingham University to study maths and psychology. My results were better than I expected, so I withdrew and applied for medicine, securing a place at Sheffield.
I was initially disappointed by the course because of the lack of conceptual challenges. I was expected just to absorb lots of knowledge. Later, as I took responsibility for patient care, the application of knowledge became the interest. I did not intercalate … Read more
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
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
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
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
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
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
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