Those living in socio-economic deprivation live sicker and shorter lives. General Practice in these high-need areas has more demand, less funding and fewer GPs (General Practitioners). The ‘Deep End’ is a network for GPs and other primary care staff who work in practices in the most socioeconomically deprived areas who are passionate about tackling health inequity.
This project explores the Northern Ireland context, identifying the key issues and workable solutions at the Deep End of Northern Ireland General Practice. Investigating the steps in establishing a Northern Ireland ‘Deep End’ initiative aiming to;
advocate for vulnerable patient groups and their healthcare providers
research and recording the experiences of Deep End GPs
research education and training opportunities in high need areas
Addressing the low uptake of pertussis and flu vaccine during pregnancy: what is happening and what can be done about it in primary care
Dr Stephanie McCarron
Academic Supervisors: Dr. Declan Bradley and Prof. Nigel Hart
Clinical Supervisor: Dr. Eddie Santin, Campbell Surgery Dungannon, Co. Tyrone
Summary of Project
GPARTS has provided me with an opportunity to pursue my research interests in womens health, particularly during pregnancy. My current research is addressing the significant morbidity and mortality that is caused by pertussis and influenza infections during pregnancy and in the neonatal period. Maternal vaccination in pregnancy would significantly reduce this but vaccine uptake rates have shown regional variation in NI, UK, and Ireland, with there being much scope for improvement. As yet, it is not clear what approaches are effective and used to promote uptake of pertussis and influenza vaccines in pregnant women in the UK and Ireland. I am anticipating that the results of a scoping review in this area of research will inform future research and methods of improving uptake of maternal vaccinations in the UK and Ireland.
Exploring GPs' Experiences of Assessing And Referring Young Adults With Lower GI Symptoms Suspicious For Cancer
Dr Orla O'Neill
Academic supervisors: Professor Helen Coleman, Dr Helen Reid
Clinical supervisor: Dr Darragh Lewis
Summary of project:
My research is looking into the increasing incidence of bowel cancer in young adults, those under the age of 50. Data from cancer research UK has shown that the incidence has increased by 41%(1993-2017) in this age group. This increasing trend has been replicated on a global scale, illustrating a shift in disease burden for future generations. These younger patients tend to present later with more aggressive disease, with 1 in 4 being diagnosed at the latest stage. Bowel cancer UK’s ‘Never too young report’ investigated the experiences of young bowel cancer patients. The report highlighted significant barriers for patients accessing timely care, including 43% visiting their GP at least 3 times prior to referral, with resultant delays in diagnosis. The report also highlighted the lack of awareness of early onset bowel cancer within the public and health professionals.
My qualitative study will take the form of semi-structured interviews with GPs' throughout Northern Ireland. By gaining a better understanding of the difficulties and barriers faced by GPs in assessing and referring this group of patients, I hope to identify ways to improve the diagnostic pathway and experience for young bowel cancer patients
Making the GP Contact Count
Dr Alex Huey
Academic Supervisors: Professor Nigel Hart and Dr Grainne Kearney
Clinical Supervisor: Dr James Crothers, Knock Medical Centre
Summary of Project:
Homelessness is experienced by individuals and families worldwide and we are not immune to its reach in the UK and Ireland. The statistics show that between January and March 2021 over 60,000 households in England and 2700 households in Northern Ireland received government support for housing issues.
Homelessness results in grave social and health costs, with the health outcomes of those experiencing homeless being significantly worse even in comparison to the most socially deprived housed groups.
Existing research shows that 50% of health outcomes are a result of social determinants of health and an individual’s physical environment, with the remainder attributable to health behaviours and the medical care received. This tells us that the health service is managing health outcomes where social issues are a significant causative factor. It is therefore in the best interests of clinicians and patients to play our part in prevention of these issues.
In North America there has been growth in the development of screening tools to screen for social determinants of health, including housing, in primary and secondary health care settings, with onward referral to available support services. Acceptability studies have shown that both patients and clinicians agree that screening is valuable for understanding patient context and enabling patient access to services. As a public facing service with high levels patient contact daily, we feel that GP is a great setting to opportunistically pick up housing concerns.
This research will trial housing screening questions from a pre-existing tool in a UK and Ireland GP setting for the first time. There is no gold standard screening tool, therefore the first step will be choosing a tool using a consensus method known as a Delphi process. Following that we will trial the tool in GP practices, and the final set will be an acceptability study with the GP participants
Domestic abuse in general practice: we could have done more?
Dr Claire McPeake
Academic Supervisors: Gerry Gormley, Helen Reid
Clinical Supervisor: Chris Murray
Summary of Project:
Rates of domestic violence and abuse (DVA) have soared during the covid-19 pandemic. The World Health Organization considers violence against women an “urgent public health priority.” GPs are often trusted by survivors; they are well placed to listen, and offer practical support. However, evidence would suggest that GPs, and staff in GP practices, could do more in helping victims of DVA to disclose about their violence. In partnership with Womens’ aid – we are developing an innovate intervention (in situ simulation by means of forum theatre) to help transform GP practices preparedness in recognising, and helping produce the conditions, for victims of DA to disclose and be offered appropriate care. Research would help shape this intervention.
Fibromyalgia in Primary Care
Dr Kerrie McConnell
Academic Supervisors: Dr Neil Heron & Prof Nigel Hart
Clinical Supervisor: Dr Paula Davidson, Glengormley Practice
Summary of Project
Chronic pain and fibromyalgia are extremely prevalent in General Practice, with a huge individual and societal impact. Indeed, Fibromyalgia has an estimated prevalence of 2.1% in the general population. Despite this, it remains difficult to diagnose and treat in Primary Care. As a General Practice trainee, I felt compelled to gain a better understanding of this condition, in order to improve my own knowledge and my ability to help my patients.
I started by completing a literature review on Fibromyalgia, focusing on the epidemiology, diagnostic criteria, current treatment guidance and patient and physicians' perspectives on the condition.
From my research, it became clear that Fibromyalgia remains a very frustrating condition for both patients and health-care professionals, with physicians uncertain regarding the diagnosis, feeling powerless to provide adequate treatment. Patients can become indignant that their symptoms are not getting better. In addition, patients can often struggle with the concept that there may not be a specific reversible cause for their pain, and that other factors, such as their lifestyle and psychology, may be having the greatest impact. This can result in difficult therapeutic relationships between patients and their healthcare providers.
Following on from my literature review, I am currently completing a scoping review, focusing on the question, “What does the literature tell us about providing an explanation of a fibromyalgia diagnosis in primary care?”. The overall aim is to identify areas of best practice regarding the communication of a fibromyalgia diagnosis, to provide better outcomes for both patients and clinicians. I hope to achieve this through further qualitative research with relevant stakeholder groups.