Carolyn Chew-Graham is Professor of General Practice Research at Keele University, and Chair of the Royal College of General Practitioners Research Paper of the Year.
Sherene Howard-Walker is an ST1 GP Academic Clinical Fellowship registrar in Mental Health.
The Royal College of General Practitioners (RCGP) curriculum states: ‘Through confidential trusted partnerships with their patients (characterised by empathy and mutual trust, without bias or judgement), GPs provide evidence-informed personalised care in the community’. The curriculum also states that GPs should ‘striv[e] to provide comprehensive and equitable care for everyone, taking account their health care needs, stage of life and background.’1
How do GPs keep up-to-date with the latest evidence? We all know about National Institute for Health and Care Excellence (NICE) guidance and policy directives. The RCGP offers a multitude of courses and online training to support GPs and other primary care clinicians to expand their knowledge and apply to practice. We hope that the RCGP Research Paper of the Year (RPY) influences primary care practitioners directly and that the winning papers impact on policy and guideline development.
“RPY 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.”
RPY 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. Category panels judge and make decisions about submitted papers. All reviewers are primary care researchers and educators, and declare any conflicts of interest prior to decision-making meetings.
For RPY 2025, we received 61 eligible submissions — papers reporting research across the whole range of primary care research and education. We reflect on the implications of the winning papers for the RCGP curriculum and for the provision of equitable care.
The final judging panel could not decide between the winners of categories one and two, so agreed that there should be joint overall winners.
The category one winner was ‘Role of primary care in depression relapse: a qualitative study’, published in the BJGP.2
Andrew Moriarty and colleagues’ qualitative study of the perspectives of GPs and people with depression reported that social, personal, and environmental factors were described by all participants as associated with an unfavourable depression course and risk of relapse. A distinction was drawn between ‘external’ factors (social and environmental factors) outside the person’s control and ‘internal’ factors (personal factors). The authors implicitly suggest that socioeconomic deprivation influences risk of relapse.
The authors describe an evidence-informed framework to improve practice systems and GP consultations to enhance longer-term care and support for people with depression. Going forwards, the authors emphasise the need for management of people with depression to be optimised to include discussion of relapse risk and prevention early in the patient journey. Continuity of care is vital to achieve this — as emphasised by the RCGP curriculum across all topic areas, not just mental health.
“… weight gain is not matched with rates of referrals to services for weight management, thus widening health inequities in people with SMI [severe mental illness].”
The RCGP mental health curriculum recognises the impact of factors such as socioeconomic deprivation, ethnicity, and comorbid long-term physical conditions on risk of depression — factors that GPs need to take account of to enable the delivery of equitable care. The curriculum, however, focuses on identification and initial management of common mental health problems in primary care but doesn’t mention relapse prevention in depression and the role that primary care may play.
Sherene reflects: This study provides useful insight and important information for GPs as depression is a common mental health problem that is managed in primary care. The authors emphasise the need to discuss with a patient the risk of relapse and relapse prevention interventions. In doing so, patients could have fewer, or no longer have, depressive episodes from their initial diagnosis, which in turn will improve their overall health and wellbeing.
The category two, and joint overall, winner was ‘Weight trajectories and access to weight management services in individuals with severe mental illness in the UK: a population-based, matched cohort study’, published in The Lancet Psychiatry.3
We know that people with severe mental illness (SMI) are more likely to gain weight rapidly after diagnosis than the general population, with effects lasting up to 15 years.3 This contributes to the mortality gap that people with SMI experience — people with SMI dying 15 years before people without SMI — largely due to diabetes and cardiovascular disease.3 The need to monitor and intervene regarding the physical health of people with SMI is included in the RCGP mental health curriculum as well as NICE guidance (CG178).4 The role of primary care in supporting physical health monitoring is encouraged in the Quality and Outcomes Framework,5 with evidence-based guidance provided by the Lester resource.6
This study by Charlotte Lee and colleagues shows that weight gain is not matched with rates of referrals to services for weight management, thus widening health inequities in people with SMI. The RCGP curriculum does emphasise the need to take account of the social determinants of health and offer personalised care, but delivery of care is influenced by services commissioned in a practice’s locality. Commissioning guidance needs to take account of this demonstrated inequity and ensure weight management programmes are accessible to people with SMI.
Sherene reflects: This study highlighted the importance of utilising services within the community for individuals with SMI who have gained weight. The primary care team needs to manage not just a patient’s mental illness but also comorbid physical health conditions. Clinicians need to be mindful of the health inequities that people with SMI experience and try to address them.
In each category the panel can nominate a paper to be ‘highly commended’. The category one panel suggested a retrospective cohort study using the Clinical Practice Research Datalink, which found that patients with heart failure show early signs in primary care yet few receive timely assessment and diagnosis, be nominated: ‘Health inequalities and trends in heart failure diagnosis in primary care in England, 2000–21: a national retrospective cohort data-linkage study’, published in The Lancet Primary Care.7
“These results are helpful for people with eczema, giving them the freedom to choose what suits them best …”
This study by Claire Lawson and colleagues highlighted further evidence of health inequities in this clinical area: women, individuals living in deprived quintiles, and those with multiple long-term conditions had up to five times longer delays, lower investigation rates, and a higher likelihood of diagnosis when an inpatient. Delays, missed investigations, and inpatient diagnoses are associated with poor outcomes and care inequities.
The paper highly commended in category two provided evidence with practical implications: ‘Weekly versus daily bathing for people with eczema: results of the Eczema Bathing online randomized controlled trial’, published in the British Journal of Dermatology.8
This trial by Lucy Bradshaw and colleagues found no evidence of a difference in eczema symptoms between bathing or showering weekly versus daily. These results are helpful for people with eczema, giving them the freedom to choose what suits them best and helpful for clinicians to empower people to self-manage their condition. The panel were impressed by this innovative citizen science approach to delivering high-quality, co-produced trials, which has key messages for primary care researchers as well as for patients and clinicians.
The dermatology curriculum could include basic, simple advice to patients and parents about bathing frequency, as well as use of topical emollients.
It is worth reflecting on other evidence around management of eczema, such as the lack of evidence for bath additives that should impact on prescribing guidelines and costs,9 and the trial by Matthew Ridd and colleagues, which found no difference in effectiveness between the four main types of emollients for childhood eczema.10 People need to be able to choose from a range of emollients to find one that they are more likely to use effectively.
Sherene reflects: Eczema is a common dermatological condition seen by GPs so being mindful of simple, effective, self-management treatment plans for a patient is important. Bringing evidence together is so important, I realise that one study does not, and should not, change practice.
“We would ask all readers, GP registrars, primary care clinicians, GP academics, and health service researchers to reflect on the papers they have read in 2026 …”
Category three of RPY focuses on medical education relevant to primary care, so how the GP curriculum is delivered. The winning paper was: ‘A question of risk: how do undergraduate GP teachers experience entrustment decision-making in primary care?’, by Jayne Victoria Cullen and Hugh Alberti, published in Medical Education Online.11
The panel highly commended ‘Exploring the perceptions of doctors with specific learning differences undertaking assessments for UK general practice licencing: a qualitative study’, by Julie Pattinson and colleagues, published in Education for Primary Care.12
Sherene reflects: The paper by Cullen and Alberti focused on entrustment decision making in primary care made me reflect on how registrars are likely to encounter situations where they feel unsure about how to manage patients independently. This could feel quite daunting for a supervisor, as maintaining the patients’ health and safety remains the highest priority. It could therefore be useful for a trainer to have to have ‘entrustable professional activities’ for their registrars so that they can feel better prepared for situations of uncertainty and unpreparedness. This could reduce a supervisor’s apprehension and potentially provide a smoother clinical training pathway for the registrar, which is beneficial for both individuals. The paper by Pattinson et al reporting work on doctors with specific learning differences undertaking assessments, demonstrates the importance of having flexible, adaptable, and tailored working environments so that clinicians are able to successfully learn and train in a safe and supportive space. We all learn and take in information differently. So, it’s not only important for the clinician to make their team, department, and/or supervisors aware of their needs, but also for those who know this information about them to be versatile, mindful, and understanding.
We would ask all readers, GP registrars, primary care clinicians, GP academics, and health service researchers to reflect on the papers they have read in 2026 and the implications for their work, and how they might impact on the care of an individual patient, systems, and processes within general practices, and how the paper will influence health policy. The call for nominations for RPY 2026 will be out soon.
References
1. Royal College of General Practitioners. The RCGP curriculum: being a general practitioner. 2025.
https://www.rcgp.org.uk/mrcgp-exams/gp-curriculum/rcgp-curriculum-being-gp (accessed 20 Oct 2026).
2. Moriarty AS, Williams E, McMillan D, et al. Role of primary care in depression relapse: a qualitative study. Br J Gen Pract 2025; DOI: https://doi.org/10.3399/BJGP.2024.0384.
3. Lee CL, Gao M, Smith MC, et al. Weight trajectories and access to weight management services in individuals with severe mental illness in the UK: a population-based, matched cohort study. The Lancet Psychiatry 2025; 12(10): 736–745.
4. National Institute for Health and Care Excellence (NICE). Psychosis and schizophrenia in adults: prevention and management. CG178. London: NICE, 2026. https://www.nice.org.uk/guidance/cg178 (accessed 20 Oct 2026).
5. NHS England. Quality and Outcomes Framework guidance for 2026/27. 2026. https://www.england.nhs.uk/gp/investment/gp-contract/quality-on-outcomes-framework-qof-changes (accessed 20 Oct 2026).
6. Perry BI, Holt RIG, Chew-Graham CA, et al. Positive cardiometabolic health resource: an intervention framework for people experiencing psychosis and schizophrenia. 2023. https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/national-clinical-audits/ncap-library/eip-2024/ncap-lester-tool-intervention-framework.pdf (accessed 20 Oct 2026).
7. Lawson CA, Ali MR, McCann GP, et al. Health inequalities and trends in heart failure diagnosis in primary care in England, 2000–21: a national retrospective cohort data-linkage study. Lancet Prim Care 2025; DOI: 10.1016/j.lanprc.2025.100060.
8. Bradshaw L, Howells LM, Muller I, et al. Weekly versus daily bathing for people with eczema: results of the Eczema Bathing online randomized controlled trial. Br J Dermatol 2026; 194(3): 450–460.
9. Santer M, Ridd MJ, Francis NA, et al. Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness. BMJ 2018; 361: k1332.
10. Ridd MJ, Santer M, MacNeill SJ, et al. Effectiveness and safety of lotion, cream, gel, and ointment emollients for childhood eczema: a pragmatic, randomised, phase 4, superiority trial. Lancet Child Adolesc Health 2022; 6(8): 522–532.
11. Cullen JV, Alberti H. A question of risk: how do undergraduate GP teachers experience entrustment decision-making in primary care? Med Educ Online 2025; 30(1): 2479755.
12. Pattinson J, Akanuwe JNA, Emerson K, Siriwardena AN. Exploring the perceptions of doctors with specific learning differences undertaking assessments for UK general practice licencing: a qualitative study. Educ Prim Care 2025; 36(3): 94–105.
Featured photo by Kingsley Mkpandiok on Unsplash.
