Arriving or departing: Primary Care Annual Scientific Meeting

Rising to the challenge

The opening plenary by Dr Jennifer Dixon, Chief Executive of the Health Foundation, set the scene. She reminded us of the many challenges that primary care has faced over the last decade. However, also emphasising that patient satisfaction remains high and opportunities continue to arise to change the way we work to meet these challenges. She highlighted a need for organisational change, in particular the need for increased diversity of the primary care workforce to include more allied health professionals, such as physician associates, pharmacists and physiotherapists. Furthermore, primary care has seen an increase in alternative forms of patient contact, including e-mail and e-consulting. If these are routes to be pursued, then their use requires a strong evidence-base.

The digital technologies workshop highlighted the NHS’s long-term plan, which includes a digital strategy aiming for the first point of access into primary care to become digital. ASM attendees presented a wide range of digital solutions to improve primary care efficacy and patient self-management, exploring how digital interventions could work for people with learning difficulties, remote consulting, decision support software, and text messaging in diabetes. Further research to build the evidence-base in this area is important, as service delivery interventions which allow GPs to spend longer with the patients that need them the most has the potential to improve GP retention and improve patient health.

Academic primary care provides the foundations for good clinical practice

Dr Shannon Barkley, from the World Health Organisation (WHO), reminded us of our responsibility as primary care academics to push forward the priorities outlined in the Declaration of Astana 2018 (WHO, 2018); the human right to health, the right and duty of people to participate in planning and implementation of their healthcare and to address the unacceptable injustice of inequalities between and within countries. These commitments are as relevant to primary health care today as they were when outlined in the original 1978 Declaration of Alma-Ata (WHO, 1978).

Healthcare systems with good primary care lead to increased life expectancy in the populations served, lower infant mortality, better cancer detection, lower cardiovascular disease burden, less adverse events, and fewer negative effects of social inequality, all at a lower cost. In order to strengthen primary care, the WHO are looking to academic primary care to develop the evidence-base on what constitutes good primary care practice and clinical training, so as to support the successful implementation of this vision.

Encouragingly, the diversity and depth of the ASM programme reflected the healthy state of UK academic primary care. The workshop on advocacy and social accountability reinforced the message that academic primary care should research the evidence needed to action change. Medical students need to understand equity and social justice to produce doctors empowered to advocate for their patients and tackle social determinants of ill health. The medical education research work-stream reflected the need for funding, training and research to move into the community to produce a workforce fit for the future, with the focus firmly on primary care.

Research in action

The Helen Lester Memorial Lecture presented by Professor Gene Feder OBE, University of Bristol, brought home the importance of the impact of research beyond academia, and the role of GPs as advocates at the micro and macro level. The WHO describes intimate partner violence (IPV) as a ‘healthcare emergency’ with this being the biggest cause of disease burden in women under the age of 44 years. Professor Feder’s research, understanding what victims of IPV want and need from primary care, provided a clear example of how primary care research is informing clinical decision-making and policy, and making a real difference to people’s lives.

In Professor Andrew Hattersley’s plenary, we learnt about advances in precision medicine. His research has led to young patients, previously misdiagnosed with type 1 diabetes, being correctly diagnosed with Mature Onset Diabetes of the Young, enabling them to stop insulin while achieving better control, literally transforming lives.

Highlights for Associates-in-Training

There was a dedicated stream of events for Associates-in-Training and early career researchers. An interactive workshop introduced a new research collaborative for GP trainees, the Primary Care Academic Collaborative for Trainees. Their vision is to establish a network of GP trainees and First5® doctors working together to collaborate on large-scale high-impact meaningful research projects, with an emphasis on engaging trainees with no previous research experience.

Furthermore, the early careers workshop was delivered in a ‘solution room’ style with an expert panel of researchers addressing our most pressing career-related questions. The panel had incredibly varied careers and career paths, highlighting the vast opportunities offered by a career in academic primary care.

Olivia’s highlights

This was my first SAPC and my impressions were that it was a very relaxed and welcoming meeting. The networking events were a great opportunity to meet people, with everyone being very approachable and keen to support trainees. I was struck by the wide range of research being presented; there really was something for everyone, including a Lego® serious play workshop! My main take-away was gaining a new level of understanding about the power of academic primary care, not only to change clinical practice through evidence-based medicine, but also to widely influence primary care funding, healthcare delivery, policy, political agendas and education. I came away feeling inspired to be part of the solution to the challenges facing primary care and empowered to influence change through evidence generated through high-quality research.

Emily’s highlights

I particularly enjoyed the creative enquiry stream (a new theme for SAPC) that breaks with scientific tradition. Presenters used art to empathetically engage with difficult scenarios from their personal or professional life, for example, one GP used poetry to express what she had learned from ‘the darkest time’ in her life. In one workshop we had to reflect ourselves using art. I found it a cathartic process and this way of reflection facilitated a different kind of conversation. We discussed how important it is for clinicians to understand themselves and we were introduced to a quote from McWhinney: ‘We can only attend to a patient’s feelings and emotions if we know our own, but self-knowledge is neglected in medical education, perhaps because the path to this knowledge is so long and hard.’ (McWhinney, 1996) We each wrote a Haiku (a short Japanese poem used to evoke images) and this way of reflection felt very different to the tick-box reflections I feel required to write for my ePortfolio. If medical students and doctors were equipped with tools to help them understand themselves, surely it would help with burnout and retention, and enable a better relationship with and understanding of their patients, for ‘we do not see things as they are, we see things as we are’ (Nin, 1993).

Social schedule

There were many opportunities for networking and a range of evening social events including swimming in the outdoor pool, a tour of the botanical gardens and a football tournament. The drinks reception and conference dinner, accompanied by a jazz band and late-night dancing, were impressive.

Why should you attend SAPC ASM 2020?

Attending SAPC is an opportunity to learn about opportunities in academic primary care, to get inspired, get involved, meet interesting people and present your work. SAPC is for anyone working in primary care, from established academic GPs and primary care scientists, to those starting out on academic clinical fellowships like us, GPs wanting to find out more about how to implement their research and quality improvement ideas, foundation doctors considering an academic career and importantly representatives from the widening primary care team, including nurses and physiotherapists. No previous research experience is required and we highly recommend getting involved.

For details on becoming a SAPC member or attending next year’s ASM visit: https://sapc.ac.uk.