Sparkle and joy: a totally one-sided round up of the 46th SAPC ASM (12-14 July 2017, Warwick)

There are times in conferences when you suddenly get struck by a real surge of energy and excitement; something really hits a nerve or a new area of possibility opens up which you hadn’t considered before. I believe this happened for many of the Warwick organising team when, at the conference dinner, they enthusiastically embraced the call of The Diabolus Waits (“one of England’s finest Elizabethan Town Bands”) to perform as horses in a complex Tudor dance. Sadly I seem to have been outside enjoying some fresh air at Wroxall Abbey at the time of this particular event, so my inspiration came at a different point in the conference. Helen Stokes-Lampard, Chair of Council of the Royal College of General Practitioners (RCGP), took to the stage on the second day to call for “Sparkle and Joy” in general practice. An unusual approach, but her advice to talk to your peers or senior colleagues if you are having a bad day, and to junior colleagues if you are having a good day, seemed to me very apposite, both for clinicians and non-clinicians. There are, I am well aware, many dark mutterings in general practice about the dire straits the profession finds itself in, and accusations that organisations such as the RCGP (and clinical academic GPs too) have no idea what it is like “at the coal face”. Yet at SAPC, as well as Prof Stokes-Lampard’s call for trying to run with a bit of optimism for a change, there were many earnest discussions going on at coffee about what it really means to be a GP within the current context of primary care, and how education and research can contribute to our understanding of this. No magic bullet yet, I am afraid.

So – research highlights. I think Julia Bailey summed things up brilliantly when she pointed out via twitter that there was “…increasing recognition of theory and social science at SAPC”. As those who know me will testify, my ongoing methodological whining usually targets the plethora of poor quality descriptive qualitative research which takes place in primary care. Many studies lack depth, driven in part by a lack of robust methodological training and consequent misunderstandings which, unfortunately, have become embedded in the field (I’m looking at you, grounded theory). There was, inevitably, still much of this in evidence. Cheeky discussion around a potential new strapline to help people understand what the SAPC PHoCuS (non-clinical Primary Health Care Scientists) group does brought the suggestion (which will remain anonymous) “helping doctors actually do good research”. Unfortunately, decent methodologists are still too few, and clinical academics still forget to use them. At this point, I’d better swiftly point out that you can of course be clinical and an awesome methodologist, although most of these still lean towards the quantitative side. Not all, though: I can’t wait for the findings from Deborah Swinglehurst’s Apollo-MM programme looking at patients’ and healthcare professionals’ experiences and practices of polypharmacy. This will be using longitudinal observation of older patients experiencing polypharmacy, observations of practices (shadowing, interviewing, video-recording consultations) and video-reflexive ethnography to elicit professional concerns. It was telling that Deborah explained how 40 practices initially volunteered to be involved, when they only needed two, highlighting the major concerns practice staff have about polypharmacy, and also their receptiveness to in-depth methods with a focus on understanding their real needs and challenges. The early career researcher award went to another GP – Matthew Booker – also using varied ethnographic approaches to develop a typology outlining the contexts and “triggers” that tip primary care patients into the receipt of ambulance care.  Personally, I would like to see such approaches extended to understand in much more detail simply what is happening in primary care and general practice (here, we’re back to the point about what GPs are ‘for’). These kinds of studies are really difficult to do in a funding climate which wants instant patient benefit. But, I wondered as I listened to many presentations about intervention development for a whole host of clinical conditions – how are these going to be implemented in practice? What is going to be taken out so we can put something new in? A bit of going back to basics to understand the work which is currently done may give us a stronger foundation to understand the way new or different work may be done.

A few last points. It was great to see a stronger than ever presence for patient engagement and involvement. Clare McDermott’s work with people with severe chronic fatigue syndrome/ME was super here, with a full two and a half years of collaborative development work prior to shaping an intervention: an impressive feat. Sessions showed that we’re all very worried about appropriate prescribing, and the needs of older people, and whether GPs should be doing telephone or email consultations, and a demoralised and dwindling workforce, and how to best encourage medical students to become GPs, and whether the apples have run out at break (they went before the biscuits – unheard of). We need more people to come and have fun with tweeting – the best and silliest conversations always happen in a darkened lecture theatre as you find out you are actually sitting next to the person you are having a furious Twitter exchange with (the amazing Kerry Boardman was my Twitter hero of the conference, as ever). And finally, we need to talk to each other as much as possible, to break down the silos that mean methodological expertise is not shared, and smaller local studies are duplicated, and people feel isolated and demoralised. Look forward to seeing you next year.

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