Research

The Continuity Counts project, led by St Leonard's Practice, aims to improve continuity in five Devon general practices. This will be achieved by increasing the measurement of continuity, sharing research which shows its benefits and supporting staff in each practice throughout the project. For more information, please go to the project website https://www.continuitycounts.com/

St Leonard's Practice is proud to be a research practice. We believe that health care research is important because it helps to improve the quality of services available to patients.

Research studies help to answer specific questions about health and health care. The design of a study reflects the question(s) that it is seeking to answer. For example, studies can explore:

• whether new treatments or ways of organising services are effective (do they work?)
• whether those treatments or services are cost-effective (do they give value for money?)
• how different health problems develop and progress over time - to help gain a better understanding of that health problem
• the views of patients and health professionals about a particular treatment, intervention or service and how they might be improved

The results of research studies can be of interest to patients and useful to health professionals and managers in the NHS in helping to decide what treatments and services to provide.

Some studies may simply ask people to fill in questionnaires or take part in a short interview. Other studies may involve trying out non-drug interventions, testing out new drug treatments or perhaps a new combination of treatments.

All research projects must meet nationally-agreed standards to ensure that participants are protected and that high quality results are produced. Before we agree to run a study at this practice, we will always check that these standards have been met and that all necessary approvals have been obtained.

To find out more about the PCRN, you can access their website

If you meet the entry criteria for a particular research study that we are running at this practice, your doctor or nurse may discuss this with you. Alternatively, we may send you information through the post if we think you might be suitable for a new study.

If you are interested in finding out more about that study, we will ask for your permission to pass your name and contact details on to the relevant study team. For some studies, you might be asked to return a reply slip direct to the study team. The research team will then make contact with you directly to tell you more about the study and what it involves.

With regard to our research activity, please be assured that:

• Participation in research is entirely voluntary and you have the right to say 'No'. Nobody will put pressure on you to take part in research if you do not wish to. You do not have to give us a reason if you decide not to take part.
• Your care and your relationship with your doctor or nurse will not be affected in any way if you decide not to take part in a research study.
• You will always receive clear information about what taking part in a research study would involve. The practice will usually provide you with a patient information sheet; then, if you agree to take part, the study team will explain the study to you in more detail and you will have the opportunity to ask questions about it.
• Nobody from outside this practice will be given your contact details or have access to your medical records without your prior consent. If you do agree to take part in a study, you will be asked to sign a consent form - this will clearly state which parts of your notes (if any) may be looked at for the purposes of the research.
• You will not be asked to take part in a large number of studies. Most researchers are very specific about the criteria that people need to meet in order to enter their study. Usually this means that only a relatively small number of patients at the practice will be suitable for any one study.

What if I don't want to get involved in research?

We recognise that some people may not want to receive information about research studies by post. If you do not want to be contacted about research studies that we may run at the practice in the future, please let us know. If you change your mind at a later date, you can still opt back in at any time.

The St Leonard's Practice designs and runs some of its own research projects as well as supporting important national studies that are organised by other researchers.

Many of the studies simply ask patients to provide information about their health, lifestyle or health care - for example by completing a questionnaire or keeping a diary. Sometimes study participants may be asked to give their permission for relevant information to be obtained from their medical records.

Other studies might invite people to take part in a short interview or a group discussion to talk about their health care experiences or put across their views on a specific health-related issue.

Some of the studies may ask patients to try out a new treatment (or a new combination of treatments) for a specific health problem they have. This might involve taking tablets, or having a vaccination, or trying out a non-drug intervention - for example: a physical activity programme, a self-help course or a new 'talking therapy'. A few studies ask participants to have some simple tests - for example, provide a blood or urine sample, have a throat swab, or have their height and weight measured.

You can look at a list of the different research studies we are currently running and have supported in the past by clicking on this link - Current, future and past studies

We try to keep this list as up to date as possible. However, it is subject to change, as we receive many requests to support new studies, and some studies may only recruit participants for a limited period of time.

A current research priority is finding a treatment for COVID-19. A national trial on this is taking place, recruiting nationally. For details, you can read this poster or go to the trial website: www.principletrial.org

One study that we supported at the practice in 2009/2010 has now published some of its results - it looked at Swine 'Flu (H1N1) in Pregnancy. You can access the study team's report online (see pages 109-182) Yates L, Pierce M, Stephens S, Mill A, Spark P, Kurinczuk J, et al. Influenza A/H1N1v in pregnancy: an investigation of the characteristics and management of affected women and the relationship to pregnancy outcomes for mothers and infant. Health Technology Assessment, 2010; 14 (34): 109-182.

At this practice, we also carry out regular clinical audits to monitor (and where necessary improve) the quality of services that we provide for a number of different health problems. These audits are carried out by staff who are employed at the practice. They involve the extraction of relevant information from the computerised medical records of patients with the health problem that is being audited (e.g. patients with diabetes). This information is usually extracted in anonymised form and all staff at the practice have a duty to maintain patient confidentiality.

If you would like to opt out of anonymised data collection, please let the practice know in writing to the Data Quality Department and no data from your records will be collected or used in research. This will not affect your care in any way.

Lead Researcher: Dr Philip Evans MPhil FRCGP DRCOG
Research Assistant: Dr Kate Sidaway-Lee PhD
Research Consultant : Sir Denis Pereira Gray OBE FRCP FRCGP FMedSci
Patient Representative : Mr Geoff Barr MPhil
Practice Research Nurse : Mrs Dawn Broadhurst RN MSc
Practice Manager : Helen Kingdon

There is a research department within the St Leonard's Practice, where the researchers meet regularly and there is a wider research group that includes patients, medical and nursing colleagues and other members of the practice administration team.

Dr Philip Evans is the lead research GP. The research office is supported by Dr Kate Sidaway-Lee (Research Assistant) who is an experienced researcher with a PhD.

We also have an active patient representative, Mr Geoff Barr, and a consultant who also provides research support to the team, Professor Sir Denis Pereira Gray, who is a former GP partner of the Practice.

Our Nurse Practioner, Dawn Broadhurst, is actively involved in research. Our Practice Manager, Lucille Hudson, also belongs to the research group.

The research team has special interests in areas of primary care research. These include:

• Diabetes;
• heart disease;
• whole person medicine;
• the doctor-patient relationship;
• continuity of care;
• common disorders and genetics.

We have established strategic links with the University of Exeter Medical School (UEMS) / Peninsula College of Medicine and Dentistry (PCMD), and the South West Peninsula Primary Care Research Network (PCRN SW - West Hub), of which Dr Evans is the Director.

The Practice was accredited in December 2006 for its R&D activities through the Primary Care Research Team Assessment exercise of the Royal College of General Practitioners (RCGP). The RCGP accreditation process changed last year to a scheme known as 'Research Ready'. The Practice has successfully applied to be included in this scheme and has been accredited for research up to the end of December 2014.

The research practice receives funding to support its research activity from a number of different sources. Currently, this is provided by the National Institute for Health Research (NIHR) and the Primary Care Incentive Scheme (PCIS) run by the Comprehensive Local Research Networks (CLRN)

The research team also applies for money from organisations that fund medical research so that it can continue to run its own studies at the practice.

In 2010 we were awarded a small grant by a local charitable organisation called DIRECT (administered via the Pensinsula Foundation). We have used this money to run the CLOUDS study, which involved people who were diagnosed with type 2 diabetes through screening at this Practice. We are currently analysing the data we have collected and hope to discover what types of health problems these patients experience and when these occur.

You can view a list of articles written by members of the St Leonard's research team by clicking on this link - St Leonard's Staff Publications

Our systematic review of the link between increased continuity of care and decreased mortality can be found here. This article was featured on the front pages of the Times and the Guardian newspapers.

An article describing our method for measuring continuity of care in general practice can be found here

A copy of an article about diagnosing Type 2 diabetes by screening (before patients complain of diabetic symptons) can be found here

A summary of another article about the cost of detecting Type 2 diabetes by screening can be found here

Our Patient Representative, Mr Geoff Barr, has produced short summaries of some of our recent articles - you can read these by clicking on the links below:
Medicalisation in the UK: changing dynamics, but still on-going
Diagnosis and Prevention of Type 2 Diabetes
Screen Test Testing for Type 2 Diabetes
Research into Lyme Disease
Diet and physical activity interventions to help prevent Type 2 Diabetes
The effectiveness of various models of primary care-based follow-up after stroke: a systemic review
Detecting diabetes early at St Leonard's Practice - how much does it cost?
Can exercise help to treat depression (the TREAD study)?

We also have an information folder in the waiting area for paitents to browse through if they wish to find out more about research at the practice. This includes examples of other articles that we have published, and copies of the article summaries written by Geoff Barr.

We also aim to present the results of our research at conferences - both in this country and abroad.

In June 2010, Dr Philip Evans and Sir Denis Pereira Gray presented the findings of one of our research projects at an international conference (organised by the American Diabetes Association) in Florida, USA. They reported on the cost of detecting Type 2 Diabetes via GP-initiated screening before patients complained of any symptoms of diabetes.