Atrial fibrillation (AF) is a heart condition that causes irregular heartbeat. It affects up to 1 in 10 people over the age of 65. AF greatly increases risk of stroke, but treatment with blood thinning (“anticoagulant”) medication can stop this happening. About 10% of strokes happen in people unaware they have AF. Detecting AF can be difficult because it often comes and goes, and may not cause symptoms.

Many clinicians think the NHS should promote AF screening. The UK National Screening Committee has highlighted a lack of evidence that detecting AF in people by screening would benefit them.

We are therefore undertaking a large 8-year programme of work to find out if screening for AF in people aged 65 and over does prevent stroke and other problems like heart attacks, does not cause significant harm, and represents good value-for-money for the NHS. The SAFER Trial is a cluster randomised trial that will address these questions.

The SAFER Trial takes place in 360 UK GP practices and include about 126,000 people. Practices will be randomised to control or screening (2:1). Consented participants in screening practices will be invited to be screened for AF. Participants will use a handheld single-lead ECG recorder to record ECGs at home over a period of 3 weeks. The ECGs will be read by a validated computer algorithm, with diagnoses confirmed by a cardiologist. Participants diagnosed with AF will be invited to a GP appointment to discuss treatment with blood thinning (anticoagulant) medication.

General practice is under pressure due to increasing workload and a shortage of GPs and other primary care staff. New forms of practice are also emerging.  Our aim is to explore how the composition of GP teams, and the relationships among team members (called team climate) affects the quality of care and health outcomes for patients, and the costs for the practice. 

A range of viruses circulate each winter and cause respiratory infections (RTIs) (the viruses that causes colds, sore throats, sinus, chest or ear infections, flu). These can lead to people being off work, to seeking help from the NHS, and to be admitted to hospital in winter months. The combined effect of both the normal winter viruses (and also the COVID virus in the current pandemic) are likely to cause major problem for the NHS not only during the coming 2020-21 winter season but in subsequent years. There is promising evidence that using nasal sprays, or alternatively reducing stress and increasing exercise, could help people’s immune defences, reduce the number of people getting infections, reduce how severe illnesses are and how long they last.

This study will involve approximately 200 GP practices and up to 15000 patients who are at risk from respiratory infections. Patients will be invited to take part in the study through invitation letters from their GP surgery. Those who are interested in taking part will be asked to register online and to answer some questions to ensure the study is right for them. Eligible patients will be randomised to one of the following groups for 12 months: i) A microgel nasal spray ii) Saline nasal spray, iii) Getting Active and Reducing Stress or iv) Usual Care. Participants will be asked to complete monthly questionnaires for 6 months, and more detailed questionnaires at 3, 6 and 12 months about any infections and about their general health. Patients happy to do so will complete a daily diary of symptoms if they do become unwell to give a more detailed understanding of the course of each illness. A sample of patients and healthcare practitioners will be asked to take part in a telephone interview about their experiences of taking part in the trial.

Due to growing pressure on health services in recent years, there has been an increase in the use of internet-based services in general practice (GP) surgeries. This includes the ability to book appointments, order repeat prescriptions, as well as offering an alternative to face-to-face consultations via email and video. With a drive towards an increased provision of these services, it is important to understand any ‘barriers to use’ and how they might be overcome, particularly in order to ensure fairness in the provision of healthcare to different groups of people. One way to ensure this is with digital facilitation; supporting NHS patients and carers in their use of online services.    The study aims to understand:  • How the use of internet-based services are advertised and supported in GP surgeries.  • The benefits and challenges of different approaches used to support internet-based services for patients and staff.  • How different approaches work in practice.  

Qualitative study exploring how older people with memory problems and other stakeholders consider an active dementia prevention intervention should be designed and delivered: Stream one of APPLE-Tree (Active Prevention in People at risk of dementia: Lifestyle, bEhaviour change and Technology to REducE cognitive and functional decline) programme.

This application is for part one of a larger programme, in which we will co-produce an intervention to try to reduce older people’s chances of getting dementia. The intervention will support older people who are experiencing memory problems to make lifestyle changes that are likely to improve their wellbeing and may reduce their dementia risk. These are:  1. Being more socially, physically and mentally active   2. Eating more healthily   3. Looking after their mental and physical health   4. Reducing alcohol.    

The aim is to help prevent problems with things like remembering, concentrating or reasoning (known as cognitive decline). The website will help older adults to make simple changes such as getting more active, playing brain training games and finding ways to eat more healthily.  This research will test how well the website works.