NHS at 75: Highlighting the Pivotal Role of Primary Care in Tackling Health Challenges

As we commemorate the 75th anniversary of the National Health Service (NHS), the Nuffield Department of Primary Care Health Sciences at the University of Oxford is proud to spotlight the indispensable role of primary care in our healthcare system and in addressing healthcare inequalities. From the pioneering use of penicillin to the current battle against antimicrobial resistance (AMR), primary care remains at the forefront of healthcare innovation and delivery.

Primary care plays a pivotal role in the NHS. In 2021, there were over 300 million patient consultations in general practice in England^[1]. General practice accounts for around 90% of all NHS contacts, with an average of 1.34 million standard (non-Covid) appointments delivered per working day in April 2023 alone^[2]. Importantly, it’s not just physical health – 90% of people with mental health problems receive their care entirely within the primary care setting^[3].

In this milestone year we recall that the building that now houses our department was once the Radcliffe Infirmary, the site where penicillin, the world's first antibiotic, was first tested on patients. This revolutionary discovery, and its subsequent purification for human use here at Oxford, changed the face of medicine and has saved countless lives across the globe.

Fast forward to the present, and we are grappling with a new challenge – antimicrobial resistance, where microbes like bacteria, viruses or fungi evolve to resist the effects of the antimicrobial drugs that were previously effective in treating infections. AMR threatens to reverse the strides made since the introduction of penicillin. Antimicrobial resistance could cause more deaths than cancer by 2050 if not promptly addressed^[4]. It is worth noting that around 80-90% of antibiotic prescribing occurs in primary care^[5], placing us at the heart of this critical battle.

AMR isn’t a future problem, it’s happening now, as research from our own department has shown, even for common infections seen daily by GPs. Our department is rising to this challenge. Not only have our colleagues helped inform government and recently won awards in recognition of their antimicrobial resistance work, they are also actively working on a wide range of projects aimed at understanding, preventing, and combatting AMR through a wide range of approaches.

This isn’t just about finding new medications – though that is hugely important – but finding ways to make better, safer, and more appropriate use of the antibiotics we do have now.

For example, through the work of the NIHR Community Healthcare MIC, based within the department, we are testing new diagnostic devices that can be used to diagnose and therefore treat infections more appropriately and faster, without having to send blood samples off to hospital labs.

Ongoing AMR related clinical trials currently include:

• The ALABAMA trial (working with the University of Leeds). This project is looking at people’s penicillin allergy status and its effect on antimicrobial prescribing, patient outcomes, and antimicrobial resistance. Around 1 in 10 people think they are allergic to penicillin, yet when tested usually only about 1% of people truly have such an allergy. Incorrect penicillin allergy records are associated with AMR and worse patient outcomes, as it may mean the most appropriate antimicrobial is not prescribed for fear of causing an allergic reaction.
• The PRUDENCE Trial, part of the larger VALUE-Dx project, is investigating the use of point of care diagnostic tests in making antibiotic prescribing decisions for community-acquired acute respiratory tract infections. The trial aims to assess if immediate diagnostic results lead to more judicious antibiotic use, thereby combating antibiotic resistance. Roughly 2,500 participants will be enrolled in various European primary care centres for this research. Additionally, this project had an embedded process evaluation which aims to understand patient and clinician views on how we can implement these tests beyond the trial.
• The DURATION study aims to identify the shortest effective antibiotic treatment duration for urinary tract infections (UTIs) in women, enrolling 2,248 participants across UK GP practices. It seeks to shape prescribing guidelines and reduce antibiotic resistance.
• The TOUCAN study is testing new rapid diagnostic tests for UTIs in women. Comparing these point of care tests with established lab tests, the study aims to guide immediate, appropriate antibiotic prescribing, thereby combating antibiotic resistance.

This is just a sample of the AMR related work currently happening at the Nuffield Department of Primary Care Health Sciences. Our other key research areas in primary care and community settings also align with NHS priorities, benefiting patients and populations alike. These include Health Behaviours, Cancer, Cardiovascular and Metabolic Health, Infections and Acute Care, Evidence-Based Medicine, Digital Healthcare, Health Policy, and Big Data.

As we celebrate 75 years of the NHS, we underscore the central role that primary care plays in our healthcare system. From spearheading the antibiotic revolution to the fight against antimicrobial resistance, we remain committed to improving healthcare delivery and patient outcomes. Here's to the next 75 years of research, innovation, and excellence in primary care.