What is the value of academic primary care?
As a General Practitioner (GP) in a busy practice, getting used to a new way of working, I became aware of people who reported having suffered from what sounded like COVID-19 infection in early Spring 2020 presenting with odd symptoms in late spring/summer: chest pain, shortness of breath, fatigue, headaches, skin rashes, indigestion and abdominal pains. I had no idea how to respond as this seemed to be a new phenomenon, and symptoms seemed to vary between the different patients who were contacting the practice. My GP and Nurse Practitioner colleagues discussed these presentations, and we all agreed this was puzzling and something new. So a research idea was born: what are the perspectives of people struggling with persistent symptoms following COVID-19 infection?
Working with colleagues, we developed a protocol and ethics application at speed, but were still able to work closely (although virtually) with a number of individual experts by experience, including a COVID support group run by Manchester Clinical Commissioning Group.
Recruitment to our study was using posts on social media which led to swift responses and demonstrated the power of these networks in reaching potential participants in research.
We had to learn how to do things differently – members of the research team had always believed that face to face interviews were the ‘gold standard’, but found remote interviewing supported the generation of very rich data in our study.
The research team worked remotely to analyse our growing body of data, in the face of changing evidence (and the naming of the condition we were investigating as ‘long-COVID’). We drafted our paper as we analysed the data, and linked in with experts by experience who fed back at all stages of the analysis.
We felt that it was important to publish in an open access journal - so thank you to BJGP Open for a speedy peer review. The paper was published on 14th October, and received an amazing amount of publicity nationally and internationally.
We have received tremendous feedback from study participants and other people struggling with persistent symptoms who feel we have represented the perspectives of people with long-COVID. The research team can reflect on a feeling of a job well done - we think our research will make a different to patient care (in the primary care consultation as well as commissioning of services), as well as being the foundation for further research into the management of people with long-COVID.
So, what are the lessons for academic primary care? We can be responsive to emerging clinical challenges - faced with a need to better understand what patients were going through prompts a research question. Access to a responsive ethical review system with the capacity to fast-track application was vital. Adapting to new ways of working - an allowance and acceptance of our clumsiness with the technology helped build rapport with study participants, and remind ourselves and participants that we were living through social restrictions and adapting together. Lastly, the sheer determination of our team cannot be under-estimated.
The Society for Academic Primary Care is supporting two initiatives to help novice researchers get started:
PACT (Primary care Academic Collaborative) is a UK-wide network of primary health care professionals, trainees and students that collectively design and take part in high impact research and there is a call for research ideas out now.
WISE GP is a joint initiative between the Society of Academic Primary Care, and the Royal College of General Practitioners. The work is led by Professor Joanne Reeve, in partnership with colleagues from across the academic and clinical communities.
Two WISE GP internships, supported by the NIHR School for Primary Care Research are now being advertised (closing date 2nd November 2020). Deatils of how to apply are here .
Do join us and become part of SAPC and the thriving academic primary care community.
Carolyn Chew-Graham
General Practitioner, Manchester
Professor of General Practice Research, Keele University
Tom Kingstone
Lecturer in Mental Health and Wellbeing, Keele University