Primary care delivery
Primary Care Delivery is about how primary care systems are run, from national organisation and policy to the primary care workforce, and the systems put in place by individual practices and other providers to facilitate patient care. The Primary Care Delivery theme does not explicitly address the diagnosis and management of specific diseases and conditions, but often such intersections are present in the work that we do.
Our research reflects Berwick’s pursuit of the Triple Aim for health care, bringing this vision in line with the latest developments in digital technologies, evolving roles within the multidisciplinary workforce, training and education, and patient-centred care.
We are a multidisciplinary team, spanning all career stages, conducting research to inform, develop, and evaluate different ways of delivering primary care.
Through our research, we have a track record of influencing practice and policy both nationally and internationally.
The aims are:
- To conduct research that is driven by the priorities of patients, the public and practitioners as well as health and care providers, and reflects the needs of policy makers at local, national and international levels.
- To continue a legacy of work to improve patient experiences of care and access to primary care through research into continuity of care, shared decision-making and digital primary care services.
- To improve practitioner experiences of delivering primary care conducting research into recruitment and retention, diversity in primary care workforce, and developing research into training.
- To improve the health of populations by influencing the evidence-based delivery of high-quality, equitable and inclusive primary care, to address the diversity of needs amongst an increasingly complex patient population.
- To reduce per capita costs of primary care by influencing the evidence-based delivery of efficient, cost-effective care with a focus on workforce and service configuration and the digital delivery of care
Theme Leadership
| Professor Gary Abel - Co-Lead | Dr Jo Butterworth - Co-Lead |
Projects
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Title |
Funder |
Amount £ |
Project/ Programme/ Fellowship |
Exeter lead investigator |
Web link |
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IMPROVE - Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience |
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https://www.journalslibrary.nihr.ac.uk/pgfar/pgfar05090/#/abstract |
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ReGROUP - Policies and strategies to retain and support the return of experienced GPs in direct patient care: the ReGROUP mixed-methods study |
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ESTEEM - The effectiveness and cost effectiveness of telephone triage of patients requesting same day consultations in general practice: a cluster randomised controlled trial comparing nurse-led and GP-led management systems. |
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https://www.journalslibrary.nihr.ac.uk/hta/hta19130/#/abstract |
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Programme of work on group-based health interventions including Mechanisms of Action in Group Interventions (MAGI) study. |
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Other current active projects
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Title |
Funder |
Amount £ |
Project/ Programme/ Fellowship |
Exeter lead investigator |
Project web link (if none, please state) |
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Together 2: Evaluating video and hybrid group consultations in general practice |
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Wellbeing of the primary care workforce |
NIHR SPCR |
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Pitchforth E |
https://www.spcr.nihr.ac.uk/research/projects/well-being-of-the-primary-care-workforce |
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Primary Care Under Pressure: mapping the provision of staff wellbeing strategies and interventions for the primary care workforce in England |
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Assessing the contributions of additional role practitioners to general practice in England. |
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Extending pharmacists’ role in asthma care in the Gulf Countries |
University of Exeter MENA Development fund |
£10 K |
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Mahmoud A |
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Q-DaPS: Qualitative data preservation and sharing |
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Pitchforth E |
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Coproduction of a shared decision-making intervention and development of a new, relevant measure, for use during primary care training and practice |
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'Cross-NIHR Collaboration (CNC) - Models of Care for Multiple long-term conditions (MLTC)’. NIHR Team Science. Seeking to define the principles, values, roles, and practices that guide how care and support are provided throughout the stages of MLTC. |
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PACE GP/FP study: exploring GP’s attitudes towards person-centred care |
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IMPPP trial: Improving Medicines use in People with Polypharmacy in Primary Care |
NIHR HSDR |
£1.9 million |
Project |
Payne RA |
https://www.bristol.ac.uk/primaryhealthcare/researchthemes/imppp/ |
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BRISMED: Improving the quality of medication reviews in general practice |
NIHR HSDR |
£0.9 million |
Project |
Payne RA |
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D-PiLL: Quantifying the risks of deprescribing |
NIHR SPCR |
£106 K |
Project |
Payne RA |
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PPhoCUs: Polypharmacy, Pharmacists and Clinical Uncertainty. Exploring the role of primary care pharmacists making person centred decisions in the thickets of polypharmacy and clinical uncertainty. |
NIHR SPCR |
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Fellowship |
Kallis T |
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ReGROUP ReLOADED |
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Early cancer diagnosis and community pharmacies in deprived areas |
NIHR SPCR |
£97 K |
Project |
Konya J |
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CORE group: Continuity of Care Research at Exeter |
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Khan N |
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Re-CONNECT, Realist evaluation of continuity of care in general practice |
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Khan N |
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Pharm-CONNECT, Continuity of care in general practice multi-disciplinary teams: Understanding the impact of pharmacy roles and measuring continuity across the wider team |
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Khan N |
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Accessibility, acceptability, and accuracy of peer online support groups for primary care conditions |
NIHR SPCR |
£148,000 |
Fellowship |
B Treadgold |
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Other recently completed projects
| Title | End date | Funder | Amount £ | Project/ Programme/ Fellowship | Exeter lead investigator | Project web link (if none, please state) |
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| Understanding experiences of virtual group interventions in primary care and community settings | NIHR SPCR | Reburn C | ||||
| Group interventions for hypertension | https://pubmed.ncbi.nlm.nih.gov/39117427/ | |||||
| National Clinical Excellence Awards - Reward, recognition and retention of highly-skilled doctors and dentists | NIHR PRP | £152 K | Project | Campbell J | https://www.fundingawards.nihr.ac.uk/award/NIHR202992 | |
| DiFacto - Facilitating access to online NHS primary care services – current experience and future potential | https://sites.exeter.ac.uk/difacto/ | |||||
| Development and feasibility testing of an intervention: To facilitate the inVolvement of OLder patients with muLtimorbidITy in decisION-making about their healthcare during general practice consultations (VOLITION) | NIHR DRF | £478 K | Fellowship | Butterworth J | https://fundingawards.nihr.ac.uk/award/DRF-2017-10-005 | |
| Implementing a training package for primary care clinicians to support women to do their Pelvic Floor Muscle Exercises for the prevention and management of incontinence: the Pflexi Study | SPCR | |||||
| Facilitating access to online NHS primary care services - current experience and future potential | NIHR SPCR | £1.0 million | Project | Campbell J | https://fundingawards.nihr.ac.uk/award/NIHR128268 | |
| A conceptual framework to improve understanding of AMR in livestock systems for translation into policy and practice | ||||||
| One Health Drivers of AMR in Thailand | MRC/DoH | https://www.bristol.ac.uk/amr/research/understanding-the-drivers-of-amr-in-a-one-health-context-/antibacterial-resistance-in-thailand/ |
Publications
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1 |
Wiering B, Lyratzopoulos G, Hamilton W, Campbell J, Abel G. Concordance with urgent referral guidelines in patients presenting with any of six 'alarm' features of possible cancer: a retrospective cohort study using linked primary care records. Bmj Quality & Safety. 2022;31(8):579-89. |
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Anderson M, Pitchforth E, Edwards N, Alderwick H, McGuire A, Mossialos E. United Kingdom: Health System Review. Health Syst Transit. 2022 May;24(1):1-194. |
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Brown EL, Poltawski L, Pitchforth E, Richards SH, Campbell JL, Butterworth JE (2022). Shared decision-making between older people with multimorbidity and GPs: focus group study. British Journal of General Practice, 72(721). |
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Anderson M, Pitchforth E, Asaria M, Brayne C, Casadei B, Charlesworth A, Coulter A, Franklin BD, Donaldson C, Drummond M, et al . LSE–Lancet Commission on the future of the NHS: re-laying the foundations for an equitable and efficient health and care service after COVID-19. The Lancet 2021; 397(10288), 1915-1978 [Joint lead author]. |
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Anderson M, O'Neill C, Macleod Clark J, Street A, Woods M, Johnston-Webber C, Charlesworth A, Whyte M, Foster M, Majeed A, et al (2021). Securing a sustainable and fit-for-purpose UK health and care workforce. The Lancet 2021; 397(10288), 1992-2011. |
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Abel G, Elliott MN. Identifying and quantifying variation between healthcare organisations and geographical regions: using mixed-effects models. Bmj Quality & Safety. 2019;28(12):1032-8. |
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Butterworth JE, Hays R, Richards SH, Bower P, Campbell J (2018). Interventions for involving older patients with multimorbidity in decision-making during primary care consultations. Cochrane Database of Systematic Reviews, 2018(9). Art. No.: CD013124. |
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Newbould J, Abel G, Ball S, Corbett J, Elliott M, Exley J, et al. Evaluation of telephone first approach to demand management in English general practice: observational study. Bmj-British Medical Journal. 2017;358. |
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Roberts MJ, Campbell JL, Abel GA, Davey AF, Elmore NL, Maramba I, et al. Understanding high and low patient experience scores in primary care: analysis of patients' survey data for general practices and individual doctors. Bmj-British Medical Journal. 2014;349. |
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10 |
Wiering B, Lyratzopoulos G, Hamilton W, Campbell J, Abel G. Concordance with urgent referral guidelines in patients presenting with any of six 'alarm' features of possible cancer: a retrospective cohort study using linked primary care records. Bmj Quality & Safety. 2022;31(8):579-89. |
Recent publications
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Stoffel ST, Spencer R, Konya J, Vlaev I, Schwenkglenks M. Herding-like behaviour in medical decision making: An experimental study investigating general practitioners' prescription behaviour. PLoS One. 2024 Jul 8;19(7):e0297019. doi: 10.1371/journal.pone.0297019. PMID: 38976681; PMCID: PMC11230524. |
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Edwards PJ, Finnikin SJ, Wilson F, Bennett-Britton I, Carson-Stevens A, Barnes R, Payne RA. Safety-netting advice documentation out-of-hours: a retrospective cohort from 2013 to 2020. Br J Gen Pract. 2024 Jul 1:BJGP.2024.0057. doi: 10.3399/BJGP.2024.0057. Epub ahead of print. PMID: 38950945. |
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Butterworth J, Richards SH (2024). ‘Establishing Equality Diversity and Equality in Patient and Public Involvement and Engagement’ (conference abstract), in press BMJ Evidence Based Medicine. |
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Parslow R, Duncan LJ, Caddick B, Chew-Graham CA, Turner K, Payne RA, Mann C, Guthrie B, Blair P, McCahon D. Collaborative discussions between pharmacists and general practitioners to optimise patient medication: a qualitative study within a clinical trial. Br J Gen Pract. 2024 Jul 1:BJGP.2024.0190. doi: 10.3399/BJGP.2024.0190. Epub ahead of print. PMID: 38950941. |
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Butterworth J, Abel G, Payne, R (2024) ‘D-PiLL: Quantifying the risks of deprescribing of long-term cardiovascular medicines in people with limited life expectancy: a review of systematic reviews’. Protocol. Prospero CRD42024499615. |
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Bickerstaff K, Abram S, Christie I, Devine-Wright P, Guilbert S, Hinchliffe S, Moseley A, Pitchforth E, Walker G and Whitmarsh L. (2024) Making a Net Zero Society: Follow the Social Science – Full Report. ACCESS Project, University of Exeter, UK. |
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Allel K, Fernandez-Miyakawa M, Gaze W, Petroni A, Corso A, Barcelona L, Boden L, AMR Policy Research Group, Pitchforth E Opportunities and challenges in antimicrobial resistance policy including animal production systems and humans across stakeholders in Argentina: a context and qualitative analysis.BMJ Open 2024;14:e082156. doi: 10.1136/bmjopen-2023-082156 |
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Parsons J, Abel G, Bryce C, Campbell J, Newbould J, Pitchforth E, Stockwell S, Treadgold B, Winder R, Atherton H. Supporting patients with a mental health diagnosis to use online services in primary care: a qualitative interview study. Digital Health 2024; (In Press). |
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Allel K, Peters A, Furuya-Kanamori L, Spencer-Sandino M, Pitchforth E, Yakob L, Munita JM, Undurraga E. Impact of Inappropriate Empirical Antibiotic Therapy on Mortality: A Retrospective Multicentre Cohort Study of Patients with Bloodstream Infections in Chile, 2018-2022. Pre- print available at SSRN: https://ssrn.com/abstract=4677015 or http://dx.doi.org/10.2139/ssrn.4677015 |
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Abel G, Froud R, Pitchforth E, Treadgold B, Hocking L, Sussex J, Elliott M, Campbell J. Informing the development of a scoring system for National Health Service Clinical Impact Awards; a Delphi process and simulated scoring exercise. JRSM Open. 2024;15(1). doi:10.1177/20542704231217887 |
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Khan N, Pitchforth E, Winder R, Abel G, Clark CE, Cockcroft E, Campbell J. What helps patients access web-based services in primary care? Free-text analysis of patient responses to the Di-Facto questionnaire. BMC Prim. Care 25, 20 (2024). https://doi.org/10.1186/s12875-023-02257-5 |
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Papoutsi C, Abel G, Iglesias C et al. Evaluating video and hybrid group consultations in general practice: mixed-methods, participatory study protocol (TOGETHER 2) [version 2; peer review: 1 approved, 1 approved with reservations]. NIHR Open Res 2024, 4:30 (https://doi.org/10.3310/nihropenres.13584.2) |
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Pitchforth E, Gemma-Clare A, Smith E, Taylor J, Rayner T, Lichten C, d'Angelo C, Gradmann C, Berridge V, Bertscher A, Allel K. What and how can we learn from complex global problems for antimicrobial resistance policy? A comparative study combining historical and foresight approaches. J Glob Antimicrob Resist. 2023 Sep 14;35:110-121. doi: 10.1016/j.jgar.2023.08.019. Epub ahead of print. PMID: 37714379. |
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Konya J, McDonagh STJ, Hayes P, Debus S, Aboyans V, Clark CE, for the EuroPAD investigators (2024). Peripheral artery disease recognition, diagnosis, and management in general practice in the Republic of Ireland and England: an online survey. BJGP Open; 8 (2): BJGPO.2023.0150. DOI: 10.3399/BJGPO.2023.0150 |
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Winn E, Kissane M, Merriel SW, Brain T, Silverwood VA, Whitehead IO, Howe LD, Payne RA, Duncan P; Primary Care Academic Collaborative (PACT). Using the Primary care Academic CollaboraTive to explore the characteristics and healthcare use of older housebound patients in England: protocol for a retrospective observational study and clinician survey (the CHiP study). BJGP Open. 2023 Dec 19;7(4):BJGPO.2023.0114. doi: 10.3399/BJGPO.2023.0114. PMID: 37402549; PMCID: PMC11176688. |
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Edwards PJ, Sellers GM, Leach I, Holt L, Ridd MJ, Payne RA, Barnes RK. Ideas, concerns, expectations, and effects on life (ICEE) in GP consultations: an observational study using video-recorded UK consultations. BJGP Open. 2023 Dec 19;7(4):BJGPO.2023.0008. doi: 10.3399/BJGPO.2023.0008. PMID: 37277172; PMCID: PMC11176686. |
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Miani C, Batram-Zantvoort S, Pitchforth E, Treadgold B, Johnston K. Out-of-hospital births: a small but growing phenomenon in high income countries: a viewpoint. Journal of Asian Midwives 2023;10(2):77-78. |
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Nyamapfene T, Butterworth J, Merchant H, Eaton M (2023). GPs’ perceptions of teaching methods in shared decision-making training: a qualitative study. British Journal of General Practice, 73 (729): e310-e317. DOI: https://doi.org/10.3399/BJGP.2022.0194. |
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Ghiga, I., Pitchforth, E., Stålsby Lundborg, C. et al. Family doctors’ roles and perceptions on antibiotic consumption and antibiotic resistance in Romania: a qualitative study. BMC Prim. Care 2023; 24, 93. https://doi.org/10.1186/s12875-023-02047-z |
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Hodkinson A, Zghebi SS, Kontopantelis E, Grigoroglou C, Ashcroft DM, Hann M, Chew-Graham CA, Payne RA, Little P, de Lusignan S, Zhou A, Esmail A, Panagioti M. Association of strong opioids and antibiotics prescribing with GP burnout: a retrospective cross-sectional study. Br J Gen Pract. 2023 Jul 27;73(733):e634-e643. doi: 10.3399/BJGP.2022.0394. PMID: 37500457; PMCID: PMC10227993. |
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Pitchforth E, Chapman P, Keogh S, Ravindran TKS. Thirty years and beyond…celebrating and supporting our authors. Sexual and Reproductive Health Matters; 2023:31(1). https://doi.org/10.1080/26410397.2024.2346412 |
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Ghiga I, Sidorchuk A, Pitchforth E, Stalsby Lundborg C, Machowska A. ‘If you want to go far, go together’ – community-based behaviour change interventions to improve antibiotic use: a systematic review of quantitative and qualitative evidence. Journal of Antimicrobial Chemotherapy 2023; 78(6): 1344-1353. |
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Ongenda IO-N, Mengistu Z, Tincello D, Williams C and Pitchforth E Opinion: pelvic floor disorders: learning from chronicity & chronic care models. Front. Glob. Womens Health 2023;4:1006693. doi: 10.3389/fgwh.2023.1006693 |
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Naughton M, Payne RA. The fight against climate change in primary care: a prescription for change. Fam Pract. 2023 May 31;40(3):508-510. doi: 10.1093/fampra/cmac119. PMID: 36821486. |
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Treadgold BM, Campbell JL, Abel GA, Sussex J, Froud R, Hocking L, Pitchforth E Investigating Clinical Excellence and Impact Awards (INCEA): a qualitative study into how current assessors and other key stakeholders define and score excellence. BMJ Open 2023; 13:e068602. doi: 10.1136/bmjopen-2022-068602 |
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Sexton V, Atherton H, Dale J, Abel G. Clinician-led secondary triage in England's urgent care delivery: a cross-sectional study. Br J Gen Pract. 2023;73(731):e427-e34. |
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Fletcher E, Burns A, Wiering B, Lavu D, Shephard E, Hamilton W, et al. Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review. BMC Prim Care. 2023;24(1):23. |
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Edwards L, Pickett J, Ashcroft DM, Dambha-Miller H, Majeed A, Mallen C, et al. UK research data resources based on primary care electronic health records: review and summary for potential users. BJGP Open. 2023;7(3). |
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Konya J, Neal RD, Clark C, Bearman D, Campbell J. Can early cancer detection be improved in deprived areas by involving community pharmacists? British Journal of General Practice 2022; 72 (717): 153-154. DOI: 10.3399/bjgp22X718865 |
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