Innovation in front line general practice

Clare Taylor, winner of this years Yvonne Carter Award for outstanding new researcher, impressed the award panel with her determination, commitment and achievements at this early stage in her academic career. Clare’s work tackles a core challenge for today’s primary care: how to address the personal needs of people living with cardiovascular problems. She has already contributed to some key publications in the field, secured grant income to support her work, and is an experienced speaker. All before she has even completed her PhD. The panel were unanimous in recommending Clare for the award.

The award panel, consisting of members of the RCGP Scientific Foundation Board and members of the Society for Academic Primary Care (SAPC), were pleased to see that applicants represented a wide range of disciplines that will impact and ultimately improve general practice, primary care and patient outcomes.

Dr Joanne Reeve, Chair of the SAPC said, “Clare has already demonstrated her capacity to lead and make a difference during her time as Chair of the Associates in Training Committee. We look forward to continuing to watch her bring this same energy, enthusiasm and success into her academic work.”

Clare Taylor is an academic GP combining clinical practice with teaching and research into cardiovascular disease. Alongside research publications on heart failure and atrial fibrillation, she was also an editor of Cardiovascular Disease in Primary Care: A guide for GPs. An active RCGP Council member, who was instrumental in the establishment of the First5 initiative, Clare has proven herself as a leader in general practice early in her career. In the interview below Clare discusses advice and support for patients with heart failure and the value of research in supporting her as a GP.

What advice do you have for GPs managing patients with heart failure – any top tips?
Patients with heart failure rarely have just one thing wrong with them. Heart failure usually coexists with multiple other diseases such as chronic kidney disease or chronic obstructive pulmonary disease. These patients need generalists to manage them well and GPs are ideally placed to do this. It’s not just about increasing the dose of an angiotensin converting enzyme inhibitor in patients with heart failure due to reduced ejection fraction, although there is strong evidence that this improves outcome, so it is an important aspect of treatment. No, it’s about taking a patient centred approach and optimally managing multimorbidity and dealing with the polypharmacy which goes with it to provide the best care for that particular patient.

In my qualitative research study looking at patient experiences of heart failure, no two patients with heart failure are the same. It is difficult to give ‘top tips’ but here are a few suggestions:

  • Consider heart failure in anyone presenting with breathlessness or ankle swelling, particularly if they have a history of ischaemic heart disease.
  • Patients with COPD not getting better despite inhalers – consider heart failure.
  • Know who your patients with heart failure are – check they are on the right treatment.
  • Ask the patient if they know what heart failure is – a better understanding of their condition can help them to manage their own illness.

What triggered your interest in the field of heart failure?
I did a cardiology job during my general medical training before I became a GP, and I found the subject fascinating and very logical. Cardiology can be broken up into three keys areas – vessels, electrics and structure (valve and muscle). Problems with any of these things, and other factors outside the heart itself, can lead to heart failure. In primary care we see the end result of what is often a gradual deterioration in cardiac health. When I moved to Birmingham to take up an academic GP training post, the team here had a real interest in cardiovascular disease and that fitted with my past experience in general medicine and cardiology. I have been a researcher in the field of heart failure for nearly 8 years now and I, sadly, never get bored of the subject.

What does your research involve?
Since I started as an academic GP trainee I have been involved with lots of different projects about heart failure. The first involved data collection for a large heart failure screening study called ECHOES-X. I was out in the field filling in case record forms and taking blood from patients. Research is by its very nature protocol driven and the uniformity of each research clinic was entirely different to the undifferentiated world of real life general practice I see as a practising GP. I also used data from a previous heart failure screening study (ECHOES) to find out how long patients survived following a diagnosis of heart failure. From the ECHOES cohort of patients over the age of 45 years, only 30% were still alive ten years after their diagnosis at screening. The survival rates in heart failure are poor and much still needs to be done to improve outcomes for patients.

How will you be using the award?
The Yvonne Carter Award funds an overseas research trip and I am planning to travel to Australia to work with a team at the University of Sydney. The UK and Australian healthcare systems are similar in many ways, both having a strong primary care base, and I am keen to explore the similarities and differences in the way patients with heart failure are managed and their outcomes. In research I think it’s important to look beyond your immediate environment to find out if things are done better or differently elsewhere.

What’s it like to be an academic GP?
I love being an academic GP and there are increasingly more of us although it remains a bit of a ‘minority sport’. I really believe we need a stronger evidence base for general practice and the only way to achieve that is by clinicians leading the way. As GPs we know what the important research questions are and we can work with multidisciplinary research teams, which include statisticians, research nurses, project managers, health economists, qualitative researchers and others, to provide answers which ultimately improve the care we provide to our patients.

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