Download Primary Care Research Wales_Autumn2014

EDITION 01 • AUTUMN 2014
Primary Care
Research Wales
A magazine for primary care researchers in Wales
produced by the Wales School for Primary Care Research
In this addition:
WSPCR Director, Professor Chris Butler foreword
Primary health care initiatives: Community nursing
Research active GP practice profile: Ely Bridge Surgery
Primary Care Research Incentive Scheme (PiCRIS)
WSPCR flexible funding pilot projects & fellowship awards
Research studies spotlight: Cardiff University
Research studies spotlight: Bangor University
WSPCR leadership & support teams
Pg 2
Pg 3
Pg 4
Pg 5
Pg 6-7
Pg 8-9
Pg 9-10
Pg 11
Wales School for Primary Care Research (WSPCR)
Foreword from Professor Christopher
Butler, Director, WSPCR
Wales has always punched
above its weight in the field of
primary care research. Great
pioneers such as Tudor Hart and
Nigel Stott described the inverse
care law, unwarranted variation
in primary clinical care and
developed and evaluated whole
systems approaches to
enhancing primary care in
landmark studies that have
influenced the design and of
primary are services and
informed innumerable clinical
decisions worldwide over many
decades. For example, one of
the first randomized controlled
trials to show that antibiotics do
not provide meaningful benefit
to adults with acute cough was
done in Wales, and this evidence
is still being used to support
antimicrobial stewardship
strategies that are helping to
contain antibiotic resistance
worldwide.
More recently, primary care
researchers in Wales have led
flagship studies funded by the
Medical Research Council, the
EU funding Programs, the
Medical Research Council, The
Wellcome Trust, NISCHR and just
about all ‘blue chip’ funders that
have generated outputs that are
impacting and will impact on
care for generations, across
almost every domain of care.
Supported by NISCHR CRC,
Trials Units and enthusiastic
primary care clinicians and
patients, primary care studies
have often been the best
recruiting sites in multicenter
and international studies.
The message is out that Wales is
a world leader in identifying
important research questions, in
designing doable, imaginative
and robust studies, and in
implementing the studies to
generate outputs that make a
difference to peoples’ health
and quality of life.
NISCHR (and WORD before)
have been far-sighted in the
support given to primary care
research, and all will agree that
the returns on the investment
have been nothing short of
stellar. The ‘gearing of the
investment in primary care
research in Wales’ has been
considerable.
Despite this, primary care
research is underfunded, under
resourced and with a very small
critical mass when one
considers its importance: Within
the UK, over 95% of NHS clinical
contacts are made in general
practice and around 80% of
health problems are managed at
this level. Over 300 million
general practice consultations
take place in the UK each year;
these encompass health
promotion, prevention and
screening as well as acute and
chronic care. Governments
around the world all look to
increasing investment in primary
care to help make their health
systems sustainable by bringing
more care out of hospital back
into the community. Unless this
re-configuration is underpinned
by relevant and rigorous
research, it will fail to deliver
optimally.
This publication presents
evidence that Wales has a worldleading centre of excellence in
primary care research that is
making a difference to health
care and to people’s lives now.
There is a lot to be proud of that
should be even further
cherished and nurtured by
government, health boards,
higher education institutions
and the people of Wales.
Forthcoming event:
Healthy Ageing: The benefits of a healthy lifestyle
Let doctors leave the centre stage and usher in the prophylactic
age: A Conference and a Public Lecture
Thursday 30th October, 1.00pm to 5.30pm and 7.00pm to 8.30pm
All Nations Centre, Cardiff CF14 3NY
Registration: www.surveymonkey.com/s/HealthyAgeingConference
2 WSPCR NEWS • EDITION 1 • AUTUMN 2014
Primary health care initiatives: Community nursing research
In 2009, the Welsh Assembly
Government published ‘A
Community Nursing Strategy for
Wales’ which set out the vision
for the future services in Wales
that will ‘provide holistic,
seamless care with a nursing
workforce that is flexible,
adaptable and knowledgeable’.
Community nursing is one of the
WSPCR research themes, and is
led by Professor Joyce Kenkre,
WSPCR Executive Board
member, alongside Dr Carolyn
Wallace, WSPCR coordinator for
community nursing research.
Aware of the need to develop an
evidence base in order to
under-pin evidence based
practice in the community, a
strategy workshop was held in
December 2011. The workshop
was supported by the Chief
Nursing Officer, with
representation from
professionals from clinical
practice, higher educational
institutions, professional
representative bodies,
representatives from health
boards.
Using a consensus methodology
approach, the group identified
the key research priorities for
providing the evidence for the
future health and healthcare of
the people in Wales.
Since then, a Community
Nursing Research Strategy for
Wales Board has been
established, meeting quarterly,
and the team have been
delighted with the support
received and momentum gained
so far.
Full details about the CNR
strategy can be found at:
www.wspcr.ac.uk/crns-board
Research priorities and
themes identified by the
Community Nursing
Research Strategy Workshop
Research priorities
1. Barriers to translational
research in community nursing
2. Evaluating the impact and
value of community nurses
3. Role definition versus
flexibility
4. The system: making it work
5. Looking outwards not
inwards: person-centredness
The research themes
• Organisational change and
service redesign
• Nursing roles
• Skill mix
• Evidence and outcomes
• Education and development
• Long-term care
• Occupational health
• Patient safety
• Patient and user perspectives
Community nursing study profile: Medication monitoring for people
with dementia in care homes - A pre-pilot before and after study
Principal Investigator: Dr Sue Jordon, Swansea University
Aim: To explore the introduction of a structure nurse-led medication monitoring profile.
About the study: Pre-pilot work was conducted with 11 patients in 3 care homes. Nurses
administered the West Wales Adverse Drug Reaction Profile for Medicines in Mental Health to the
patients.
Researchers reviewed patients’ notes to record problems found and actioned before and after
administration of the profile. This nurse-led medication monitoring profile identified new
problems for all 11 patients. Some problems required actions on an individual level e.g. pain
management, while others required review of care planning e.g. oral health, postural
hypotension monitoring. Medication monitoring took 20-25 minutes per patient, and no
adverse effects were noted.
Conclusions: The profile improved the process of care, but longer-term follow up is needed to
demonstrate an effect on clinical outcomes. Patients are likely to benefit from structured nurseled medication monitoring, but without a full clinical trial, profiles are unlikely to be widely adopted
in routine care.
Funding: £6,995, WSPCR Flexible funding scheme / NISCHR
Update: A full pilot study is now underway, funded by WSPCR Flexible funding scheme / NISCHR
WSPCR NEWS • EDITION 1 • AUTUMN 2014 3
Research active GP surgery profile: Ely Bridge Surgery, Cardiff
10 questions with Research Manager, Mrs Melanie Davies
Q. What studies is the
Surgery currently involved in?
We have conducted studies
involving most therapeutic areas
and are currently participating in
studies focused on new
treatment or management
strategies for asthma, COPD,
diabetes, hyperlipidaemia, CHD,
UTI, heart failure, early lung
cancer detection, depression
and atrial fibrillation.
Q. What is your role at Ely Bridge
Surgery?
Full time Research Nurse /
Manager. I am also seconded by
the practice to the role of South
East Wales Regional Mentor for
practices participating in the
Primary Care Research Incentive
Scheme (PiCRIS).
Q. Can you describe Ely Bridge
Surgery?
This a large practice, located in
an area of social deprivation and
relatively high unemployment.
The practice list size is approx
13,250 patients, serviced by a
team of 4 full time and 6 part
time GPs and 1 GP trainee.
Q. How long has the Surgery
been involved in research?
Our research experience has
spanned approximately 18
years. We predominantly
perform research studies in
collaboration with academic
institutions and commercial
companies, however members
of the GP and Nursing team
have also conducted
independent research.
Q. Who in your Surgery gets
involved with the research?
2 GPs have adopted the role of
Principal Investigators for all of
the research studies conducted
here, however all of the GPs
engage in discussions
concerning the feasibility and
desirability of engaging in
specific studies and participate
in the referral of suitable
patients within the practice.
The nursing team participate in
the identification of suitable
participants for inclusion in
research studies. This is
particularly successful in the
areas of chronic disease
management such as diabetes
and asthma etc.
Research has become an
integrated part of the practice
daily activity and involves in
some part all members of the
practice team, coordinated by
me as research manager.
4 WSPCR NEWS • EDITION 1 • AUTUMN 2014
Q. In your experience, what are
the benefits for a GP surgery to
be involved in research?
The practice can provide a
beneficial contribution to the
knowledge base required to
implement effective evidenced
based care within the primary
care population. Research
provides opportunities for GPs
and staff to gain and expand
their experience, knowledge and
training (often at no further
expense to the practice).
Patients can take advantage of
the opportunity to receive novel
therapies and management.
Research may provide an
additional income stream for the
practice.
Q. What are the challenges?
Lack of resource poses the
greatest challenge i.e. lack of
time and staff. Lack of
knowledge and perhaps
confidence in engaging in
research.
Q. Any tips for over-coming /
avoiding these challenges?
Find a member of your team
who is interested in finding out
more about research and is
happy to coordinate and take
accountability for the research
activity within your practice. Take
advantage of any funding
schemes (such as PiCRIS) that
can enable you to develop an
infrastructure within your practice conducive to research
activity, e.g. dedicated research
time for key members of your
team.
Access hands on support for
study recruitment from
personnel representing
organisations such as NISCHR
CRC.
Access free research training
which will assist you in learning
about and adhering to regulatory
guidelines and good clinical
practice eg from National
Institute of Health Research or
NISCHR CRC.
Q. What would you say to other
GP surgeries considering getting
involved in research?
Research activity can provide
many benefits to your practice.
My advice would be to “dip your
toe in the water” by starting with
simple observational studies. I
would also suggest that where
possible you take advantage of
external support. This may help
you to create a practice
infrastructure conducive to research and develop a research
strategy suited to your practice
dynamics.
Q. What are the plans for the
future research activities at the
Surgery?
Research has become
embedded within the culture of
this practice. With efficient
succession planning to cover
changes in staff etc, research
activity should continue
indefinitely and successfully at
Ely Bridge Surgery.
National Institute for Social Care and Health Research
(NISCHR) Academic Health Science Collaboration (AHSC)
Primary Care Research Incentive Scheme: PiCRIS
The purpose of the Primary
Care Research Incentive
Scheme (PiCRIS) is to increase
capacity and capability for
high quality NHS research in
primary care in Wales,
facilitating a strong primary
care research culture.
PiCRIS offers funding, support
and mentorship to general
practices across Wales to
provide them with an incentive
to become research active and
embed research activity in
daily practice. Practices
provided with a PiCRIS award
are assisted to develop the
necessary infrastructure,
capability and capacity to
effectively increase and
manage a portfolio of research
studies.
Support is also available from
NISCHR Clinical Research
Centre (CRC), which has
dedicated primary care teams,
who work with practices to
support the delivery of high
quality studies.
Potential benefits of
participation in the scheme
include:• A financial award
• Membership of the network
of NISCHR Research Practices
across Wales
• Ongoing mentorship from
one of 3 regional mentors
• Free training provided by
NISCHR Clinical Research
Centre
• Funding to gain RCGP
Research Ready accreditation
• Peer support from other
NISCHR Research Practices
• Opportunity to develop a
new revenue stream through
participating in commercial
research.
There are four level of PiCRIS
engagement available to
general practices (Affiliate,
Level 1, Level 2 and
Sessional). These offer
practices the opportunity to
choose a level of entry,
matched to their research
experience and capability.
For further information about
PiCRIS, please send an email
to [email protected]
or visit NISCHR AHSC’s
website:
www.wales.nhs.uk/sites3/pag
e.cfm?orgid=952&pid=51981
WSPCR NEWS • EDITION 1 • AUTUMN 2014 5
WSPCR Flexible funding scheme: supporting the development
of primary care researchers in Wales
Between 2011-2014, with the support of NISCHR, the Wales School for Primary Care Research was
delighted to be able to offer a flexible and responsive funding scheme. The focus of the funding was for
pilot projects and fellowships to develop high quality research proposals in primary care in Wales.
The scheme is now closed to applications with the total fund of £480,000 allocated. Pilot studies and
fellowships listed below are now well underway, and we look forward to soon sharing with you the
results of the studies, and news of how the awards have helped support developing primary care
researchers in Wales. Some of the supported pilot projects and fellowships are listed below:
A novel compound to aid infection control in primary care settings. (Pilot study). C Heard, Welsh
School of Pharmacy, Cardiff University.
A point of care test for lower respiratory tract bacterial infection in Primary Care: a proof of concept
study. I Matthews, C Gregory, Cardiff University.
Activity Increase Despite Arthritis (AIDA) Phase III / Development of a large scale trial evaluating
the 'Hip and Knee Book' for those diagnosed with osteoarthritis. (Grant writing fellowship). N
Williams, N Ud Din, Bangor University.
Adolescent mental health: Design of a web-based adolescent depression and prediction tool. (Pilot
study); A Thapar, Cardiff University.
Classification-Based Group Functional Therapy (CLASTER) in Subgroups of Chronic Low Back Pain.
(Pilot study). L Sheeran, V Sparkes, SOHSC, Cardiff University.
Clinical research post-doctoral fellowship in primary care dentistry. I Chestnutt, School of Dentistry,
Cardiff University.
Community-based mentoring for people living with chronic pain. (Pilot study). O Hughes, Powys
Teaching Health Board.
Determine the feasibility of a randomised controlled trial of evidence-based scripted consultations,
for HPV positive women with abnormal smear tests, designed to reduce anxiety, inform uptake,
and improve disease control (Grant writing fellowship). C Wilkinson, D Pasterfield, Bangor
University.
Developing Quality Care Metrics for Community Specialist Nurses in Rural Wales. (Pilot study) D
Roberts, Glyndŵr University.
‘Fit for List?’ Optimising Wellbeing, Fitness and Outcomes of Cancer Patients. (Pilot study). R
Barlow, Cardiff University.
Investigation into the factors affecting community pharmacists engagement with spontaneous
reporting of adverse drug reactions. (Pilot study). L Hughes, Welsh School of Pharmacy, Cardiff
University.
6 WSPCR NEWS • EDITION 1 • AUTUMN 2014
Management of dental pulpal and apical pathologies in primary care, use of antibiotics and
the influences of prescribing behaviours. (Pilot study). I Chestnutt, N Francis, A Cope, Cardiff
University.
Measuring activity recovery at home in the post-acute phase of stroke rehabilitation by means of a
novel computerised system. (Pilot study). R VanDeursen, Cardiff University.
Medication monitoring for people with dementia in care homes: A protocol for an outcomes study.
(Pilot study). S Jordan, Dept of Nursing, Swansea University.
Natural Salicylates and Cancer – Cancer RDG, Workshop and proposal development. (Fellowship).
P Elwood, R Davies, M Gal, M Mustafa, Cardiff University.
Nurse-led medication monitoring for patients with dementia in care homes in South West Wales: a
feasibility study for a stepped wedge trial. (Pilot study). S Jordan, Dept of Nursing, Swansea
University.
Prevalence of ocular pathologies in patients with diabetes mellitus and their impact upon vision.
(Pilot study). R North, Cardiff University.
Reasons for placement and replacement of crowns in primary dental care in Wales. (Pilot study). C
Lynch, School of Dentistry, Cardiff University.
Scoping study to inform future research to develop and implement a generic patient reported
outcome measure of patient empowerment in primary care. (Pilot study). M McAllister, Institute of
Genetics, Cardiff University.
The GROMIT study (GROup Motivational InTerviewing): intervention development of group
motivational interviewing to promote emotional and physical health in school pupils. (Pilot study).
S Murphy, Cardiff University.
The MOSAIC study. Molluscum Contagiosum in the Community: A description of the Epidemiology
of the disease in the community. (Pilot study). N Francis, J Olsen, Cardiff University.
Trial TORRENT software (recruitment aid) for the ADVICE (Acute Diahorrea and vomiting in
children) study. (Pilot study). F Lugg, N Francis, Cardiff University.
Understanding primary care perspectives on treatment options for skin and soft tissue infections
(Pilot study). C O'Neill, SEWTU, Cardiff University.
Vision screening for stroke. (Pilot study). R North, School of Optometry and Vision Sciences,
Cardiff University.
WSPCR NEWS • EDITION 1 • AUTUMN 2014 7
Research studies spotlight: South Wales WSPCR team
The Wales School for Primary Care Research is currently leading 17 active research projects, and
supporting a further 17, valued at a combined total of over £68M. The studies are based across
the settings of primary care, community nursing and midwifery, dentistry, optometry and vision
sciences, pharmacy and physiotherapy.
The full research WSPCR portfolio is available to view online at: www.wspcr.ac.uk/research-portfolio
If you are interested in getting involved in research, sign up to the WSPCR researcher network at:
www.wspcr.ac.uk/join-researcher-network
Here we profile a selection of active projects led by WSPCR researchers based in South Wales.
Seal or Varnish
Principal Investigator: Professor Ivor
Chestnutt, Cardiff University
Aim: To compare the proportion of children
who receive the alternative treatments
who are caries-free in their first molar
Ivor Chestnutt
teeth after three years.
About the study: Dental caries (tooth decay) remains a significant source of morbidity in children,
particularly those from deprived backgrounds where levels of decay are three times higher than in
better off areas. In the worst affected areas 69% of 12 year olds have decay in their permanent
teeth.
The majority of this (84%) is located on the biting surface of the first molars which erupt at age
six. We know that the application of pit and fissure sealants to the biting surface is effective in
preventing tooth decay. This treatment consists of a plastic coating that occludes the rough biting
surface which harbour decay-causing bacteria. The application at six-monthly intervals of fluoride
varnish, containing high levels of fluoride is also known to prevent decay. This works by
strengthening the tooth enamel making in more decay resistant.
What is not know is which of these two modes of treatment works best and which is the most
cost-effective. It is also not know which of these treatments are most acceptable from the
perspective of children and their parents. Fissure sealant application requires an involved dental
intervention (use of rotary brush, tooth surface preparation to make the sealant stick, use of a
sucker to keep the tooth dry). Varnish application simply involves painting the tooth surface. This
study will examine the relative clinical and cost effectiveness of these treatments and investigate
their acceptability to children and their parents.
Type of study: Randomised controlled trial
Funding: £1.3M, NIHR Health Technology Assessment Programme
8 WSPCR NEWS • EDITION 1 • AUTUMN 2014
ChildRen with Eczema Antibiotic Management Study (CREAM)
Nick Francis
Principal Investigator: Dr Nick Francis, Cardiff University
Aim: To determine whether oral or topical antibiotics, in addition to corticosteroid cream, are
effective at reducing subjective eczema severity at two weeks in children with suspected infected
eczema in primary care.
About the study: Eczema is a debilitating skin condition that is especially common in young
children. People with eczema frequently have a bacterium called Staphylococcus aureus (S. aureus)
on their eczematous skin. Many doctors believe that infection with this bacterium can make
eczema worse.
However, studies so far of treating patients with eczema to eliminate or reduce S. aureus have been
inconclusive and mostly of poor quality. So we do not know whether patients with eczema, which a
GP or nurse suspects is infected, will benefit from treatment with antibiotics.
Furthermore, we do not know whether taking an antibiotic by mouth (oral) or using an antibiotic
cream on the skin (topical) is more effective and/or causes least harm.
Type of study: Randomised controlled trial
Funding: £1.3M, NIHR Health Technology Assessment Programme
Oral Steroids for Resolution of Otitis Media with Effusion (OME) In CHildren: the OSTRICH study
Principal Investigators: Dr NIck Francis &
Professor Chris Butler, Cardiff University
Aim: To determine if a short course of oral
steroids improves the hearing of children
with OME in the short and long term.
About the study: Otitis media with effusion
Chris Butler
(OME, also known as glue ear) is an
accumulation of fluid in the middle ear. About 80% of children have had OME by age 4. OME often
gets better by itself, but for thousands of children every year it can result in deafness, which can
affect speech and social development and result in depression and attention disorders. If
deafness lasts longer than 3 months, children are usually offered hearing aids or a grommet
operation. Both these procedures have associated risks and side effects, are costly, and require
repeated visits to hospital clinics. Many oral medications do not work for OME. However, there is
evidence from pooling findings from small trials that a short course of oral steroids may work. But
these studies were either too small or of poor quality, so there is uncertainty about meaningful,
longer term benefit.
Type of study: RCT
Funding: £1.58M, NIHR Health Technology Assessment Programme
WSPCR NEWS • EDITION 1 • AUTUMN 2014 9
Research studies spotlight: North Wales Centre for Primary Care
Research (NWCPCR), Bangor University
International Cancer Benchmarking Partnership: Module 4 For Wales
(ICBP)
Principal Investigator:
Professor Richard Neal,
Bangor University
Aim: What are the root causes
of diagnostic delay for lung, ovarian, breast and colorectal cancers in Wales?
About the study: There are important differences in cancer survival across the world and the
reason for this has not been fully explored. The International Cancer Benchmarking Partnership is
a unique and innovative international partnership of clinicians, academics and policy makers. It is
the first of its kind and involves 12 jurisdictions in 6 countries. Module 4 is about understanding
the journey a patient makes from first realising something is wrong and approaching a doctor,
through to specialist referral, diagnosis and treatment. It is imperative to find out where the key
areas of delay exist, what may be causing them and how this varies between jurisdictions.
The International Cancer Benchmarking Partnership (ICBP) is a unique and innovative global
partnership of clinicians, academics and policymakers. It is the first of its kind, seeking to
understand how and why cancer survival varies between countries/jurisdictions. The partnership
aims to generate insight and understanding that will help all partners improve cancer survival
outcomes by optimising cancer policies and services.
Type of study: Patient, primary care and specialist care surveys
Funding: £114,000, Cancer Research Wales
Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)
Principal Investigator: Dr Nefyn Williams
Aim: FEMuR proposes to assess the feasibility of delivery an
enhanced rehabilitation package to hip fracture patients aged 65 and over
and receiving care in North Wales. This will enable an assessment to be
made on the clinical and cost-effectiveness of such rehabilitation programme.
About the study: Proximal hip fracture is a major health problem and the
incidence increases in old age. Many living independently pre-fracture lose
Nefyn Williams
their independence afterwards, so it imposes a large cost burden on society,
amounting to about £2 billion a year.
Systematic reviews of rehabilitation programmes have concluded that there is insufficient evidence
to demonstrate overall clinical or cost-effectiveness of such programme. Individual components of
such a package show promise, but further investigation into their efficacy in specific patients
groups is required.
Type of study: Randomised feasibility study
Funding: £533,000, NIHR Health Technology Assessment Programme
10 WSPCR NEWS • EDITION 1 • AUTUMN 2014
A feasibility randomised control trial looking at the effect on lung cancer
diagnosis of giving a Chest X-Ray to smokers aged over 60 with new chest
symptoms (ELCID)
Principal Investigator: Professor Richard Neal
Aim: Is it feasible to design and run an RCT to determine the effect on lung cancer diagnosis of giving a
Chest X-Ray to smokers aged over 60 with new chest
symptoms?
Richard Neal
About the study: In 2010, lung cancer killed over
34,000 people in the UK. Compared with other
countries, patients in the UK have more advanced
stage at presentation and a lower rate of resections. Most commonly, lung cancer is diagnosed
following symptomatic presentation at primary care. No screening programmes or biomarkers
currently exist. Our hypothesis is that one option for achieving earlier stage diagnosis (and more
curative resections) is for earlier investigation of symptoms. For lung cancer there is a simple,
cheap and readily available diagnostic investigation - the Chest X-ray (CXR). NICE guidelines
currently identify the qualifying symptoms that should trigger referral for a CXR. In this trial we test
the effect of referral for CXR with a lower threshold for symptoms ('extra-NICE').
Type of study: Feasibility randomised controlled trial
Funding: £380,000, Cancer Research UK
Talking about HPV-related cancer: Developing and testing scripted
consultations after HPV-related cancer diagnosis
Principal Investigator: Professor Clare Wilkinson, Bangor University
Aim: To develop and field test evidence-based, cancer site-specific versions
of a scripted HPV consultation, back up by take-home messages on brief
information sheets, for patients diagnosed with HPV-related cancer.
About the study: HPV is complex and difficult to explain to patients. A rapid
Clare Wilkinson
increase in HPV-related cancers has led to an urgent need for an intervention
to help clinicians communicate with patients about HPV-related cancer.
The study builds on the HPV core messages developed through our previous research. It uses a
qualitative approach to obtain the views of patients diagnosed with HPV-related cancer about the
content, phrasing and contextualisation of draft scripts. This will lead to the development of
evidence based cancer site specific versions of a scripted HPV consultation, backed up by
take-home messages on paper for patients diagnosed with HPV-related cancer.
Type of study: Qualitative design using interviews and cognitive debrief interviews
Funding: £228,000, NISCHR-RfPPB
WSPCR NEWS • EDITION 1 • AUTUMN 2014 11
WSPCR Board of Directors
Chris Butler
Professor of
Primary Care
Medicine, Cardiff
University
Ivor Chestnutt
Professor and
Honorary Consultant
in Dental Public
Health, Cardiff
University
Stephen Denyer
Professor of
Pharmacy, Cardiff
University
Joyce Kenkre
Professor of
Primary Care,
University of South
Wales
Rachel North
Professor of
Optometry and
Vision Sciences,
Cardiff University
Robert van
Deursen
Professor of
Physiotherapy,
Cardiff University
WSPCR Research Team
Harry Ahmed
GP Research
Fellow
Robyn Davies
Manager
Julia Hiscock
Research Fellow
Micaela Gal
Portfolio
Development
Research Fellow
Nina Gobat
Research Fellow
Guru Naik
GP Research
Fellow
Mohammed
Mustafa
GP Research
Fellow
Carolyn Wallace
Clinical Research
Fellow, Community
Nursing
Rhiannon Phillips
Research Fellow
Angela Watkins
Senior
Communications
Officer
Wales School for Primary Care Research (WSPCR):
Developing Excellence
www.wspcr.ac.uk
Editor: Mrs Angela Watkins, WSPCR, School of Medicine, Health Park, Cardiff CF14 4YS.
The Editor wishes to thank all contributors to this edition of ‘Primary Care Research Wales.
The Editor reserves the right to edit contributions received.
Whilst care is taken to ensure the accuracy of information, this cannot be guaranteed.
Views expressed in ‘Primary Care Research Wales’ do not necessarily reflect those of WSPCR.
Feedback and items of interest relating to WSPCR are welcome and should be sent to [email protected]