Carolyn Chew-Graham is Professor of General Practice Research at the School of Medicine, Keele University, and Chair of RCGP Research Paper of the Year.
Samina Begum is a Public Contributor with the People and Communities Group, Keele University.
The Research Paper of the Year (RPY), awarded by the Royal College of General Practitioners (RCGP), gives recognition to an individual or group of researchers who have undertaken and published an exceptional piece of research relating to general practice or primary care. The three categories are 1) Clinical Research; 2) Health Services Research (including Implementation and Public Health); and 3) Medical Education, with relevance to primary care. Papers are scored on the criteria of originality, impact, contribution to the reputation of general practice, scientific approach, and presentation.
The RPY 2024 winners
“The results of this trial, if implemented, could have immediate impact on the primary care management of people with self-limiting respiratory infections …”
For RPY 2024, we received 31 eligible submissions — papers reporting research across the whole range of primary care research and education.
The overall winner of RPY 2024 was Category 1 winner ‘Nasal sprays and behavioural interventions compared with usual care for acute respiratory illness in primary care: a randomised, controlled, open-label, parallel-group trial’, published in The Lancet Respiratory Medicine.1
Led by Paul Little, University of Southampton, the trial reported was deemed by the panel to represent primary care research ‘at it’s finest’. Trial participants were recruited from primary care (332 general practices). The key findings were that for people with viral respiratory infections, advice to use a nasal spray (either a saline or a gel-based nasal spray) reduced illness duration, and nasal spray plus a behavioural intervention (access to a website giving advice about physical activity and stress management) reduced antibiotic use. The results of this trial, if implemented, could have immediate impact on the primary care management of people with self-limiting respiratory infections, and has important implications for antibiotic stewardship.
Winner of Category 2 was a longitudinal ethnographic study that was, remarked members of the panel, ‘beautifully written’. This paper, published in the BJGP, and from Trish Greenhalgh’s team at the University of Oxford, describes the ‘Challenges to quality in contemporary, hybrid general practice: a multi-site longitudinal case study’.2 The authors highlight recent changes in the way primary care is delivered: digitalisation, physical distancing, extension of roles, and protocolisation, and suggest that there are unintended (but perhaps predictable?) consequences: fragmenting, compromising, and dehumanising care. The authors call for policymakers to urgently address these challenges to maintain the core values of general practice. The panel felt that this study, while reflecting many GPs’ perspectives on what’s happening in general practice, regretfully felt this paper would have little impact on their day-to-day work.
The winner of Category 3 was a secondary analysis of the data-set reported in the Payne et al paper that won Category 2. A mixed-methods study, this paper was published in the BJGP and describes the ‘Training needs of staff providing remote services in general practice’. The authors concluded that the knowledge needed to deliver high-quality remote encounters to diverse patient groups is complex, collective, and organisationally embedded. The vital role of non-didactic training, for example, joint clinical sessions, case-based discussions, and in-person, whole-team, on-the-job training, needs to be recognised. Protected learning time was highlighted by the panel as something that is vital for practices but often squashed out by competing priorities.
Samina reflects. All three papers highlight the pressures on primary care. The overall winning paper offers the chance to reduce consultations for people with self-limiting respiratory infections through education of patients and advice about use of nasal drops — fairly simple interventions. The opportunity to reduce anti-microbial resistance is important. The second paper describes what patients are seeing — poor access to general practice, perceived lack of good-quality care by patients, and pressure on clinicians. The third paper captures the need for training of primary care staff to operationalise remote working satisfactorily.
“This study suggests WPBA’s [workplace-based assessments] are considered fair and acceptable by GP trainees and trainers — a positive message for GP training.”
Highly commended papers
Each RPY category panel also suggested a ‘highly commended’ paper. The Category 1 panel recommended ‘The hidden work of general practitioners: an ethnography’, published in Social Science and Medicine.3 This paper describes how completing ‘hidden care work’ outside of expected working hours has been normalised, creating feelings of inefficiency and exacerbating workload pressure. Pushing tasks forward into an imagined future (when conditions might allow its completion) commonly led to overspill into GPs’ own time. GPs experienced tension between their desire to provide safe, continuous, ‘caring’ care and the desire to work a manageable day, in a context of increasing demand and burgeoning complexity. The panel reflected that, like the winning paper of Category 2, this study reflects the current stressors and stresses in UK general practice, is well worth a read and a reflection by GPs, but, more importantly, should be considered by policymakers.
Missed appointments in health care have been an area of concern for policy, practice, and research, and the concept of ‘missingness’ is important for primary care. GPs tend to reflect that the ‘DNA’ (did not attend) gives them a welcome break, whereas we should be concerned what this means for the patient — why did they not attend?
The paper that was highly commended by the Category 2 panel was ‘Understanding the causes of missingness in primary care: a realist review’, published in BMC Medicine.4 The authors conclude that practices should respond to a DNA by identifying needs of patients who were unable to attend an appointment, and address barriers to those people seeking but not managing to avail themselves of care. The panel recognised that such proactive work was needed but could not always be accommodated in a busy general practice.
Highly commended in Category 3 was ‘Perceptions and experiences of trainers and trainees of UK workplace-based assessment for general practice licensing: a mixed methods survey’, published in Education for Primary Care.5 The study shows that trainers and trainees were positive towards most aspects of workplace-based assessment (WPBA), and contrary to concerns of bias, there were no differences by sex or ethnicity, and International Medical Graduates were significantly more positive towards WPBA. This study suggests WPBA’s are considered fair and acceptable by GP trainees and trainers — a positive message for GP training.
Samina reflects. The importance of a work–life balance is vital, but the pressure on working outside of the 9–5 hours, including weekends, for GPs has become the norm. Patients perceive that it is difficult to get a GP appointment and want better access. At the same time, some people do not attend their appointments. The concept of ‘missingness’ is an important one and ideally practices should be following up people who do not attend appointments — more potential work. How to balance demands must be difficult for practices and GPs — I hope this is covered in GP training.
“Policymakers need to look at the pressures that primary care is under and ensure that these challenges do not further exacerbate health inequalities.”
Fit for the future
The Ten Year Health Plan emphasises the shift to primary and community care and focuses on prevention.6 To achieve these aims, we need strong and effective primary care. The RPY 2024 winning paper offers messages for supporting self-management of people with common respiratory infections. The qualitative study reported in RPY Category winners 2 and 3 and published in the BJGP, however, emphasises the pressure that primary care is under and the barriers that exist that prevent the delivery of optimum care.
Samina reflects. Some vulnerable groups have more difficulty accessing care than others, and these people may be overrepresented in those who miss appointments. Policymakers need to look at the pressures that primary care is under and ensure that these challenges do not further exacerbate health inequalities. Education and communication about anti-microbial resistance is required to enable people to self-manage respiratory infections.
As Chair of the RPY panel, I would ask all readers to reflect on papers they have read this year and nominate the best papers for RPY 2025 — those that have impacted on the care of an individual patient, on systems and processes within their practice, or a paper they feel will (or should) influence policy. Applications will open for the 2025 award early on in 2026. Keep an eye on the RCGP website for updates: https://www.rcgp.org.uk/about/awards#research.
References
1. Little P, Vennik J, Rumsby K, et al. Nasal sprays and behavioural interventions compared with usual care for acute respiratory illness in primary care: a randomised, controlled, open-label, parallelgroup trial. Lancet Respir Med 2024; 12(8): 619–632.
2. Payne R, Dakin F, MacIver E, et al. Challenges to quality in contemporary, hybrid general practice a multi-site longitudinal case study. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/BJGP.2024.0184.
3. Barnard R, Spooner S, Hubmann M, et al. The hidden work of general practitioners: an ethnography. Soc Sci Med 2024; 350: 116922.
4. Lindsay C, Baruffati D, Mackenzie M, et al. Understanding the causes of missingness in primary care: a realist review. BMC Med 2024; 22(1): 235.
5. Siriwardena AN, Phung V-H, Emerson K, Anstey T. Perceptions and experiences of trainers and trainees of UK workplace-based assessment for general practice licensing: a mixed methods survey. Educ Prim Care 2024; 35(5): 147–159.
6. Department of Health and Social Care. Fit for the Future: The 10 Year Health Plan for England. 2025. https://assets.publishing.service.gov.uk/media/6888a0b1a11f859994409147/fit-for-the-future-10-year-health-plan-for-england.pdf (accessed 7 Oct 2025).
Featured photo by Brands&People on Unsplash.
