The Cambridge Primary Care Unit (PCU) works to reduce the
burden of ill health:
––by identifying and targeting the behaviours that lead to chronic disease;
––by improving early detection of illness;
––by improving the delivery of health services in community settings;
––and by teaching medical students, clinicians, researchers and educators.
We aim to deliver research and education at the highest international standards
of excellence. Read more about the Primary Care Unit’s research.
NIHR School for Primary Care Research
The Primary Care Unit re-joined the NIHR School for Primary Care Research in October 2015, which aims to increase the evidence base for primary care practice and train future leaders by providing multi-disciplinary training and career
We are contributing to research in prevention and diagnosis, including for example, early detection of type 2 diabetes and novel and scalable interventions for smoking cessation using very brief face-to-face interventions and mobile technology.
We will explore the effectiveness of approaches to improving the delivery of end of life care in the community – the NIHR School is well placed to access the data needed to make an important international contribution. We will also be able to develop and evaluate interventions to enhance the interaction between patients and practitioners and look at how that can improve the quality of care offered
– Professor Jonathan Mant
- Stroke research
- Brief interventions for physical activity
- Clinical nursing
- Medical student education in Palliative and End of Life Care
- Decisions about nutrition and hydration towards the end of life
- Cancer research at the Primary Care Unit
- Breathlessness – developing interventions
A new £2 million NIHR funded research programme at the Primary Care Unit, in collaboration with the University of Leicester, aims to address two of the key issues that stroke survivors identify: a feeling of abandonment after discharge and a lack of information and knowledge about many aspects of stroke and stroke care. The team, led by Professor Jonathan Mant, is developing a new way for primary care services to work to enable them to meet the needs of stroke survivors after they have been discharged from specialist rehabilitation. This
will include: improving communication between primary care and specialist services; structured review of patient needs; re-referral to specialist care where indicated; and a novel “Managing Life After Stroke” programme for stroke survivors and their carers.
Brief interventions for physical activity
Professor Stephen Sutton leads the Behavioural Science Group at the Unit, which published a comprehensive systematic review of brief interventions to increase physical activity, showing that they are cost effective (British Journal of Sports Medicine, 2015). The use of pedometers and motivational interviews were the most cost-effective approaches. However, more research on the longer term costs and benefits of such interventions is needed.
The developing research at Professor Christi Deaton’s Clinical Nursing Research Group focuses on improving the provision of, and access to, rehabilitation for patients with heart failure and COPD, and supporting carers of patients with heart failure. Ongoing research focuses on variation in care and the role of specialist nurses for patients with non ST elevation myocardial infarction, and outcomes after stroke. The Clinical Nursing Research Group (CNRG) has obtained funding from the Cambridge Biomedical Research Centre and Addenbrooke’s Charitable Trust to support internal research fellowships for nurses, midwives and allied health professionals to develop doctoral and
post-doctoral research fellowships. Four fellows have been funded for 2015-16.
Medical student education – Palliative and End of Life Care
The teaching of Palliative Care in the Clinical School is led by Dr Stephen’s Barclay’s team within the Primary Care Unit, who have ensured considerable expansion of curricular time over recent years, and led the revision of a national curriculum document. Research has highlighted the positive changes in student attitudes during the clinical course and highlighted factors associated with the formation of anxiety and avoidance of dying patients amongst students (Barclay S, Journal of Pain and Symptom Management, 2014; Thiemann P, Journal of Pain and Symptom Management 2015).
Decisions about nutrition and hydration towards the end of life
Poor clinical decision-making concerning hydration towards the end of life was a major concern contributing to the withdrawal of the Liverpool Care Pathway for the Dying in 2013. The Palliative and End of Life Care Group have an established programme of work in this difficult area, led by Dr Stephen Barclay and Dr Gemma Clarke, with recent publications highlighting the challenges involved in decision-making in a local hospital (Knights D, British Journal of General Practice 2015; Clarke G, PLOS ONE 2013; Clarke G, Clinical Medicine 2014; Clarke G, BMC Medical Ethics 2015).
Cancer research at the Primary Care Unit
The cancer group led by Dr Fiona Walter at the Unit has contributed to revised NICE guidelines for suspected cancer (2015) and delivered key findings on early diagnosis and patient preferences. As government in the UK increasingly turns to primary care to play a larger role in healthcare, the group is focused on how to equip doctors to tackle cancer effectively. We contributed to the Lancet Oncology Commission led by Greg Rubin, Professor of General Practice and Primary Care at Durham University. Looking ahead, new grants from the NIHR and charities (The Brain Tumour Charity, Macmillan Cancer Support) will support research including: a trial of a clinical decision support tool for oesophago-gastric cancer; exploration of barriers to early diagnosis of brain, upper gastrointestinal and prostate cancer; and to develop new models of care for cancer survivors.
Breathlessness – developing interventions
A Breathlessness Intervention Service for patients with advanced disease which was co-developed and evaluated in a collaboration between Dr Morag Farquhar’s group at the Primary Care Unit and clinicians at Addenbrooke’s Hospital was shown to be both clinically and cost-effective for patients with advanced cancer in a randomised controlled trial (Farquhar M, BMC Medicine 2014). Other services modelled on the intervention are now being established both within UK and internationally (Canada, Germany and Australia). The Living with Breathlessness study is identifying unmet support needs in patients with advanced COPD and their informal carers (family and friends who support them). The study team are working with national stakeholders to develop actionable responses to these findings. The Learning about Breathlessness study is developing an evidence-based educational intervention on breathlessness for informal carers of patients with breathlessness due to advanced COPD or cancer.