INTRODUCTION
The Research Paper of the Year (RPY), awarded by the Royal College of General Practitioners (RCGP), gives recognition to an individual or group of researchers who have undertaken and published an exceptional piece of research relating to general practice or primary care. The three categories are Clinical Research, Health Services Research (including Implementation and Public Health), and Medical Education with Relevance to Primary Care. Papers are scored on the criteria of originality, impact, contribution to the reputation of general practice, scientific approach, and presentation.
General practices are changing — the Additional Roles Reimbursement Scheme (ARRS) can be viewed as an opportunity to offer patients a choice of clinicians, or as a system to ensure that the patient is seen by the correct clinician at the appropriate time (often as judged by systems and protocols within practices), or as an effort to plug the gap that exists because there are insufficient GPs.1 NHS England outlines a supervision framework for these additional roles.2 A report by the King’s Fund highlighted numerous concerns about the roll-out of the ARRS roles, including lack of estate to accommodate extra practitioners, and the need for clinical supervision and managerial and peer support.3 The latter are critical to the effective integration of ARRS roles within general practice, but adequate additional funding is required to provide this support. The new roles are here to stay, and it is vital that our College embraces the practitioners delivering care and ensures that we all understand the evolving evidence base, and deliver consistent advice and care to our patients.
So, how relevant are the RPY-winning papers to the broader primary care team?
For RPY 2022, we received 59 eligible submissions; these were all really excellent papers.
CLINICAL RESEARCH
The overall winner of the RPY award 2022 was from category 1 (Clinical Research): ‘Effectiveness and safety of lotion, cream, gel, and ointment emollients for childhood eczema: a pragmatic, randomised, phase 4, superiority trial’.4 This study was led by Professor Matthew Ridd, University of Bristol, and found no difference in effectiveness between the four main types of emollients for childhood eczema. The authors state the need for parents to be able to choose from a range of emollients to find one that they are more likely to use effectively. This new evidence is important for primary care clinicians, including pharmacists and those writing prescribing guidelines, to ensure that parents are offered choice when managing their child’s eczema. A discussion about emollient choices may well be conducted by a member of the pharmacy team to support parents’ shared decision making.
Two papers were highly commended by the panel judging category 1 papers: ‘Higher arm versus lower arm systolic blood pressure and cardiovascular outcomes: a meta-analysis of individual participant data from the INTERPRESS-IPD collaboration’5 and ‘Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial’.6 Clark and colleagues conclude that using BP (blood pressure) from higher instead of lower reading arms reclassified 12% of people over thresholds used to diagnose hypertension.
All prediction models performed better when using the higher arm BP. Both arms should be measured for accurate diagnosis and management of hypertension.5 With patients increasingly being asked to monitor their own BP, all primary care clinicians need to bear this new evidence in mind.
Butler and colleagues conclude that the antiviral drug molnupiravir did not reduce the frequency of COVID-19-associated admissions to hospital or death among high-risk vaccinated adults in the community and that, in a highly vaccinated population at high risk (but not the highest risk) of complications from COVID-19, the avoidance of admissions to hospital and death is primarily achieved via extensive vaccination.6 All practice team members have a role in advising about vaccination programmes, and staying up to date with current guidance.
HEALTH SERVICES RESEARCH
The winner of category 2 (Health Services Research) was another trial: ‘Effectiveness and cost-effectiveness of referral to a commercial open group behavioural weight management programme in adults with overweight and obesity: 5-year follow-up of the WRAP randomised controlled trial’.7 The RPY panel concluded that this study may affect the strength of the current process of first prescribing behavioural/psychological treatments before approving bariatric surgery; however, it will depend on the view commissioners take of the small overall impact of the intervention on long- term weight loss. All primary care clinicians should signpost patients who are overweight or obese to weight management programmes — either directly commissioned or commercial groups.
The panel commended the following paper in category 2: ‘The effect of devolution on health: a generalised synthetic control analysis of Greater Manchester, England’.8 The authors suggest modest improvements in life expectancy were observed in Greater Manchester compared with the rest of the country after the introduction of devolution until the start of the COVID-19 pandemic, with the benefits of devolution apparent in the areas with the highest income deprivation and lowest life expectancy, suggesting a narrowing of inequalities. The authors, working in Central Manchester, see the impact of deprivation on registered patients in their everyday work. Improvements were likely to be due to a coordinated devolution across sectors, affecting wider determinants of health and the organisation of care services. The RPY panel accepted that, although the relevance of this paper is less easy to see for individual clinicians, the message for policymakers is clear — the findings provide early evidence on the potential success or failure of Integrated Care Systems in England, suggesting that the response to local challenges will be key.
MEDICAL EDUCATION WITH RELEVANCE TO PRIMARY CARE
The winner of category 3 (Medical Education with Relevance to Primary Care) was a ‘realist review’ that attempts to produce one or more theories to explain particular phenomena. The paper, ‘Optimising planned medical education strategies to develop learners’ person-centredness: a realist review’,9 offers possible explanations as to why communication skills-based interventions alone may be insufficient to develop learners’ person-centredness. The findings offer educationalists and policymakers testable theories to inform education strategies to support development of person-centredness across all primary care clinicians. The RPY panel for category 3 commended the paper: ‘The effect of specific learning difficulties on general practice written and clinical assessments’.10 The finding that adjustments need to be made for candidates with specific learning difficulties (neurological conditions including dyslexia and dyspraxia that affect the way information is learned and processed, and which can have a significant impact on learning and education) during training and assessment holds across all clinicians.
CONTINUING THE WORK OF THE RESEARCH PAPER OF THE YEAR
We hope that you will (re-)read the winning papers and reflect on how research carried out in general practice informs the clinical decision making in primary care, enabling us to deliver evidence-based care to our patients. In addition, we encourage all primary care practitioners to look at WiseGP (https://www.wisegp.co.uk), an initiative supported by the RCGP, the Society for Academic Primary Care (SAPC), and the NIHR School for Primary Care Research (NIHR SPCR). Winners of the RPY award are encouraged to submit General practice Evidence for Modern day practice (GEMS) to the WiseGP website.
The call for RPY 2023 is out in December 2023 — do submit a paper you feel has impacted on your clinical practice, training, or policy. Further details are online: https://www.rcgp.org.uk/about/awards#research.
Acknowledgments
The review panels are well supported by RCGP staff in Policy, Research and Campaigns. Thank you to everyone involved in the RPY award panels for the giving of their time to read and judge submitted papers.
Notes
Funding
There was no external funding.
Provenance
Freely submitted; not externally peer reviewed.
Competing interests
Carolyn Chew-Graham is Chair, RCGP Research Paper of the Year.
- © British Journal of General Practice 2023
