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Research Impact

Informing the quality of NHS Primary Care through measuring and monitoring patients’ experiences, 2002-present

The NHS needs clear, detailed feedback from patients to monitor the performance of primary care clinical teams. Research from the University of Exeter directly informed the creation and use of the national GP Patient Survey (GPPS) - one of the world’s largest annual patient surveys, covering all 6,900 practices, and over 14 million patients in England since 2014. 

The resulting impact has been:

(i) GPPS is routinely used to measure and monitor the quality of GP services

(ii) GPPS data has informed new national policies that have been introduced changing service provision

(iii) the public, regulators/inspection agencies, and service providers have been better informed about patient experience of general practice.


Professor John Campbell Professor of Primary Care 2002 to date
Dr Gary Abel Senior Lecturer in Primary Care (Medical Statistics) 2016 to date
Dr Ruben Mujica Mota Senior Lecturer in Health Economics 2003-2019


1. Campbell J, Smith P, Nissen S, Bower P, Elliott M, Roland M. The GP Patient Survey for use in primary care in the National Health Service in the UK–development and psychometric characteristics. BMC Family Practice. 2009 Dec;10(1):57.

2. Burt J, Campbell J, Abel G, et al. (+12 other University of Exeter co-authors). Improving patient experience in primary care: a multi-method programme of research on the measurement and improvement of patient experience. Programme Grants for Applied Research (NIHR Journals Library). 2017. No. 5(9).

3. Roberts MJ; Campbell JL; Abel GA; Davey AF; Elmore NL; Maramba I; Carter M; Elliott MN; Roland MO; Burt JA. Understanding high and low patient experience scores in primary care: Analysis of patients’ survey data for general practices and individual doctors. 2014. BMJ (Online) 349(nov11 3):g6034

4. Burt J; Newbould J; Abel G; Elliott MN; Beckwith J; LLanwarne N; Elmore N; Davey A; Gibbons C; Campbell J et al. Investigating the meaning of ‘good’ or ‘very good’ patient evaluations of care in English general practice: A mixed methods study. 2017. BMJ Open 7(3):e014718

5. Warren F, Abel G, Lyratzopoulos G, Richards S, Barry H, Elliott M, Roland M, Campbell J. Characteristics of service user and provider organisations associated with experience of out-of-hours general practitioner care in England: population based cross sectional postal questionnaire survey. BMJ 2015; 350: h2040.

6. Mujica-Mota RE; Roberts M; Abel G; Elliott M; Lyratzopoulos G; Roland M; Campbell J. Common patterns of morbidity and multi-morbidity and their impact on health-related quality of life: evidence from a national survey. 2015. Quality of Life Research 24(4):909-918.

Improved diagnosis of cancer through evidence-based risk assessment in primary care, 2010-2019

In the UK, cancer will affect 1 in 2 people during their life. Delays in diagnosis are common, and shorten lives. This large programme of research by Hamilton and the DISCO team has developed risk assessment tools for 13 more cancer sites. The resulting impact has been:

(i) These risk algorithms have been incorporated into the three main UK GP software systems. It is available for use by over 90% of general practices in the UK, covering more than 50 million registered patients.

(ii) This research also underpinned 89 of the 210 recommendations in the 2015 NICE guidelines for recognition of suspected cancer, governing ~£1bn of annual NHS spending.

(iii) Implementation of this guideline has speeded up cancer diagnosis by on average a week, with improved cancer survival.


Professor Willie Hamilton Professor of Primary Care Diagnostics 2010-date

Dr Elizabeth Shephard

Research Fellow 2010-date

Dr Sarah Price

Research Fellow 2013-date

Dr Sarah Walker

Research Fellow  2013-date
Dr Sarah Bailey Research Fellow  2013-date 
Prof Anne Spencer Professor  2012-date


1.     Shephard EA, Neal RD, Rose P, Walter FM, Litt EJ, Hamilton WT. Quantifying the risk of multiple myeloma from symptoms reported in primary care patients: a large case–control study using electronic records. Br J Gen Pract. 2015;65(631):e106-e13.

2.     Stapley S, Peters TJ, Neal RD, Rose PW, Walter FM, Hamilton W. The risk of pancreatic cancer in symptomatic patients in primary care: a large case-control study using electronic records. British Journal of Cancer. 2012;106(12):1940-4.

3.    Walker S, Hyde C, Hamilton W. Risk of breast cancer in symptomatic women in primary care: a case-control study uing electronic records. Br J Gen Pract. 2014;64(629):e788-e93.

4.    Hamilton W, Hajioff S, Graham J, Schmidt-Hansen M. Suspected cancer (part 2 – adults): reference tables from updated NICE guidance. Brit Med J. 2015;350:h3044.

5.    Banks J, Hollinghurst S, Bigwood L, Peters TJ, Walter FM, Hamilton W. Preferences for cancer investigation: a vignette based study of primary care attendees. The Lancet Oncology. 2014;15:232-40.

6.    Bailey SE, Ukoumunne OC, Shephard EA, Hamilton W. Clinical relevance of thromocytosis in primary care: a prospective cohort study of cancer incidence using English electronic medical records and cancer registry data. Br J Gen Pract. 2017;67:405-13

7.    Price S, Spencer A, Medina-Lara A, Hamilton W. Availability and use of cancer decision-support tools: a cross-sectional survey of UK primary care. British Journal of General Practice. 2019;69(684):e437

Informing the creation, content and ongoing development of the NHS Diabetes Prevention Programme, 2003-2020

Type 2 diabetes affects around 4 million people in England, with around 200,000 new diagnoses every year. However, the disease can be prevented by identifying early signs of its development (so-called ‘pre-diabetes’) and supporting people to improve their diet, increase physical activity and reduce weight. Behaviour change research at Exeter since 2003 has directly informed the creation in 2015 and subsequent development of the NHS Diabetes Prevention Programme (NHS DPP) in England. Over 400,000 people have been referred to NHS DPP and in 2018 -19. It exceeded its policy goal of 100,000 people on the programme each year. Based on similar numbers, NHS England’s own impact analysis of the NHS DPP estimated net economic benefits of £1.2bn for 5 years’ of the programme from 2016 to 2021.

(i) Evidence from University of Exeter research led to the 2012 change in the recommendations of the NICE public health guidance PH38 on diabetes prevention

(ii) The NHS DPP has been a joint programme of NHS England, Public Health England and Diabetes UK, delivering at scale, evidence-based behavioural interventions for individuals identified as being at high risk of developing Type 2 diabetes

(iii) Based on similar participation assumptions, NHS England’s own impact analysis (in 2016) of the NHS DPP estimated that by the end of the fifth year of the programme (i.e. 2020) 18,000 cases of diabetes would have been prevented or delayed among 390,000 programme participants


Dr Jane Smith

Senior Lecturer in Primary Care


Professor Colin Greaves

Associate Professor of Psychology Applied to Health


Dr Phil Evans

Associate Professor of General Practice and Primary Care 2012-date


1. Greaves CJ, Sheppard KE, Abraham C, et al. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health 2011;11(119):1-12. doi: 10.1186/1471-2458-11-119

2. Greaves CJ, Stead J, Hattersley A, et al. A simple pragmatic system for detecting new cases of type 2 diabetes in primary care. Family Practice 2004;21(1):57-62. doi: 10.1093/fampra/cmh113

3. Dunkley AJ, Bodicoat DH, Greaves CJ, et al. Diabetes Prevention in the Real World: Effectiveness of Pragmatic Lifestyle Interventions for the Prevention of Type 2 Diabetes and of the Impact of Adherence to Guideline Recommendations: A Systematic Review and Meta-analysis. Diabetes Care 2014;37(4):922-33. doi: 10.2337/dc13-2195

4. Evans PH, Greaves C, Winder R, et al. Development of an educational "toolkit" for health professionals and their patients with prediabetes: The WAKEUP study (Ways of Addressing Knowledge Education and Understanding in Pre-diabetes). Diabetic Medicine 2007;24(7):770-77. doi: 10.1111/j.1464-5491.2007.02130.x

5. Evans P, Greaves CJ. Helping people at high risk of type 2 diabetes: Using the WAKEUP materials. Diabetes and Primary Care 2015;17(4):175–79.

6.  Smith JR, Greaves CJ, Thompson JL, et al. The community-based prevention of diabetes (ComPoD) study: a randomised, waiting list controlled trial of a voluntary sector-led diabetes prevention programme. Int J Behav Nutr Phys Act. 2019;16(1):112. doi:10.1186/s12966-019-0877-3