This blog was created to keep healthcare professionals, researchers, methodologists, and patients up to date with the latest primary care research. For more information about the Research Institute, visit our website;

Tuesday, 19 September 2017

A NIHR In-Practice Fellowship: Growing evidence-base for self-harm in primary care

Wtitten by Dr Faraz Mughal | | @PCSciences | @farazhmughal

As a GP and Royal College of General Practitioners (RCGP) Clinical Fellow for Children and Young People’s  Mental Health, I was delighted when I heard the news that my NIHR (National Institute for Health Research) In-Practice Fellowship application was successful. The fellowship will not only allow me to develop research skills and evolve as a clinical academic, but will also allow me to further understand self-harm within primary care, a subject which personally, really troubles me. 

But what is an In-Practice fellowship?

More often than not, General Practitioners will go through their training and have little to no involvement with research. This isn’t to say we have no interest in it, on the contrary, we often come across conditions that need further research to better inform practice, but we often don’t know how  to contribute.

In short, the fellowship offers an academic training opportunity to fully qualified General Practitioners who may have already spent  time in NHS practice or fresh from general practice training, but have had little formal academic training so far. Training opportunities are flexible, however provide structured supervision within a research setting to ensure attainment of academic goals and will often include the completion of a Master’s degree. 

What will I be doing?

My fellowship will lead to the completion of an MPhil, which will be supervised by Professor Carolyn Chew-Graham and Dr Lisa Dikomitis.  I will spend part of my time developing my research skills, completing two studies within the Mental Health Research Programme of  Keele University’s Research Institute for Primary Care and Health Sciences. I will spend the rest of my time continuing with my clinical commitments as a practising GP.

The first study is a systematic meta-synthesis of qualitative studies of primary care practitioner attitudes and knowledge of self-harm in young people. The second will be a qualitative study, where I will be interviewing young people between the ages of 16 and 25 about their experiences of self-harm, help seeking behaviour, and their access to care with a general practice focus. 

Why self-harm?

I developed an interest in self-harm in young people early in my career as a GP. Being a young person today, is very different to what it was like 20 or 30 years ago, and the accumulation of stressors on these young people may result to the feeling of wanting to self-harm, or indeed carry out the act of self-harm. However, even as a GP, I still find it difficult to fathom what inflicting (or wanting to inflict) pain onto one’s self could be like.

We are seeing more and more cases of self-harm within primary care, and I hope that the research conducted through this fellowship will be beneficial to the small but growing self-harm evidence-base in primary care, and form the basis for further research.  

Tips for a successful application

Because of the great opportunities that these fellowships offer, competition is often fierce where applicants must be able to demonstrate that they have an outstanding potential for development as a clinical academic in research, or research linked to medical education.

The selection process is intense, so if you’re considering applying for an In-Practice Fellowship my tips for writing a successful application would be; 

Gain some research skills

Even if it’s self-funded, gaining research skills will give you some extra weight in your application, and help you through the fellowship process. I’ve conducted some previous research during my training and in the early years of becoming a GP (unfunded), which resulted in a few research publications on tobacco and medical education  and non-research peer reviewed publications. I also had the opportunity to present at international and national conferences. 

Find a mentor

Finding a mentor to guide you through this process is invaluable. The RCGP and the Society for Academic Primary Care both offer mentorship opportunity that are definitely worth considering. 

Take your time

Take the time to focus on your research question, identify a suitable supervisory team, and plan your application. A mentor once advised me not to rush into applying and to ensure you apply at the right moment, and in hindsight, this was crucial advice for me. 

I am thoroughly looking forward to beginning my fellowship later this year, and starting my journey into clinical academia. It will give me the opportunity to learn from a team of experts from one of the top Primary Care Research Institutes in the UK and I know the experience will be invaluable as a practising GP. 

More information about these fellowships can be found on the NIHR website

Thursday, 14 September 2017

Incorporating a public's perspective into research: a research project on self-harm in older adults

Written by Isabela Troya | | @PCSciences | Published 15/09/2017

As an international PhD student studying in the UK, I am committed to developing research links between the UK and my home country, Ecuador. In particular, investigating the opportunities to translate my research into an Ecuadorian context. I was recently given the opportunity to travel back to Ecuador with the Santander travel bursary, where I was able to explore the transferability of my research around mental health and using patient and public involvement.

There are two core/influential elements that form part of my research: first, research that is meaningful in the real world, and the key to this is that it is informed by Patient and Public Involvement and Engagement (PPIE); and the second, increasing the understanding of mental health problems through research, specifically in vulnerable and under-served populations.

My PhD  will add to the understanding of self-harm in older adults. I am conducting a review of the published evidence and also interviewing older adults who self-harm or have done so in the past, as well as those working with this population, such as third sector (voluntary or chairity sector) workers.

The importance of self-harm research cannot be overstated: self-harm is a major risk factor for suicide and every 40 seconds a life lost due to suicide worldwide. The International Association for Suicide Prevention has designated 10th September as World Suicide Prevention Day. This day is not only meant for remembering the lives of those that have been lost because of suicide, but mostly it is about suicide awareness and prevention, through adequate support and early recognition.

In 2013 the theme for World Suicide Prevention Day was stigma as one of the main barriers to suicide prevention. This is true across all populations, but even more accentuated in those where suicide is even more stigmatized such as ethnic minorities and older adults. Being one of the age groups with highest suicide rates, older adults are particularly vulnerable towards suicidal behaviour and self-harm, because of varying factors such as physical illness, social isolation, bereavement and loss, mental illness. However, not all self-harm behaviour in older adults is due to suicidal intentions or wish to end one's life.

Research in self-harm has shown the complexity behind self-harm behaviour and there not being one single contributing factor or motivation behind the act. This has been explored through published qualitative research which has attempted to understand self-harm in other populations such as adolescents, those with a specific condition such as Borderline Personality Disorder, or imprisoned adults, and which has helped to increase the understanding and service provision given to these populations. Still to be explored are the perspectives of self-harm in older adults: a PPIE group identified the need of exploring self-harm in older adults three years ago, which led to the Keele Univeristy ACORN funding of my PhD.

During my visit to Ecuador, made possible by a successful application for the Santander travel bursary, I was invited to at the Quito Brain and Behaviour Lab based at University San Francisco de Quito, my former university. Here, I presented an outline of my doctoral thesis with a particular emphasis on PPIE, to staff and students. I was received with an attentive, open and curious audience, where challenging questions were posed, which resulted in me expanding of views and broader conceptualisation of my research project.

Additionally, since there are Ecuadorian public policies and laws that support the involvement of the public in health research, I explored the ongoing research at the Quito Brain and Behaviour Lab, in order to see whether PPIE would be opportune within the context. Doing so allowed me to learn how context specific and resource dependent health research can be. Specifically within Ecuador and the Quito Brain and Behaviour Lab, despite there existing supporting policies from the state in order to incorporate PPIE in health research, this is something which is not a priority, as other fundamental structures are needed prior adding any other elements to research such as PPIE. Additionally, adequate structure, leadership, and support from authorities as well as research staff is needed in order to evaluate whether PPIE would be opportune and/or successful in the South American country. But for this, a strong research culture needs to exist, something which is still in its early stages from what I gathered from my trip to Ecuador.

The reception and openess to involving the public in research from staff and students conducting research must not be understated as well, as this is crucial within any research context that wishes to incorporate PPIE. This is something that cannot be forced upon with national policies, but an educational shift that needs to be incorporated amongst research staff early on so acceptance and reception towards PPIE can be succesful.

After my visit to Ecuador, I returned with a further understanding of what core elements are needed in order to even start thinking of incorporating the public’s perspective in research. So instead, I came back learning what structure and support is needed in order to successfully incorporate PPIE in research.

As a PhD student with PPIE very present in my study this is very valuable, as PPIE has received much criticism due to claims of superficial involvement and the limited impact the public still has in health research. Being able to partially understand what is needed before incorporating PPIE, and identifying some of the key elements to avoid falling into superficial involvement have been some of the valuable lessons I take back after my visit to Ecuador, as well as an added perspective to my research project.

Acknowledgment: Funding provided by Keele University and Santander Bank.

Allied Health Professionals working hard to keep Clinical Practice Evidence Based

Written by  Treena Larkin  | @PCSciences | | Published Thursday 14th September 2017

"Linking research to clinical practice"

Every four months, a group of Allied Health Professionals get together to form the NHS Staffordshire and Stoke-on-Trent Partnership Trust (SSOTP) 'Evidence-Based Practice' (EBP) group. The group is made up of clinicians working within musculoskeletal healthcare, such as physiotherapists, occupational therapists and extended-scope podiatrists who have joined forces with musculoskeletal researchers and health librarians to answer clinically generated questions and get research implemented into practice.

The group has been meeting for the past two years, and is led by Treena Larkin (Physiotherapy Research Facilitator) and Kay Stevenson (Consultant Physiotherapist). Here the team assess literature, providing knowledge and skills to interpret the applicability of research papers to clinical practice within the specific area. 

The group are actually a 'hub and spoke' model of the larger 'CAT' group, based at the Research Institute for Primary Care and Health Sciences at Keele University, which has been running for 14 years. 

Members of the SSOTP Musculoskeletal Evidence Based Practice Group  

Over the years, the team has had a great impact on providing commissioners, GPs, clinicians with evidence based practice, and the need for this support is ever increasing. With the support of Primary Care managers, the group is able to evaluate and adapt when the possibility of change within clinical practice is indicated. 

The group is supported by managers within a primary care setting, which means that when the possibility of change within clinical practice is indicated, the team can evaluate and adapt where necessary. 

The need for this knowledge is growing more than ever, as commissioners, GPs and clinicians work hard to provide the patient with evidenced based practice. 

The work that the group does is having a big impact on health care professionals on a number of levels for example; 

Physiotherapist feedback

"My participation in our CAT group has developed my research appraising skills and given me more confidence to draw more accurate decisions from research articles. The group gives me the time to consider questions that develop clinically and help me justify treatment options."

Pain Management Team feedback 

Our involvement has enabled us to formulate relevant questions which inform best practice for our patients. The group is motivational and reflective with members who have a variety of clinical backgrounds thus contributing to lively discussions. 

EBP Podiatrist 

Being part of this local group helps me to think outside the box. Being in front of patients all the time, making diagnoses, working out the best treatment pathway, only comes from research like this and experience. I am able to liaise and with colleagues and share best practice. This has really developed my skills and made me more confident in critical appraisal, to keep up-to-date in research and to not be afraid to question. 

The group were awarded the British Society of Rheumatology Award for Outstanding Clinical Practice in 2016, and have also had their work presented at the World Congress of Physical Therapy (July 2017) and Physiotherapy UK later this year. 

If you would like to find out more about the group, or would like to take part, then please contact Treena Larkin by email; More information about forming evidence-based practice groups can also be found on our website;