Croeso i Gaerdydd: better than Bali? by Rupert Payne

Posted by rap231

11 July 2025

I was recently moaning about the fact that a colleague of mine is presenting the economic evaluation of our recent IMPPP clinical trial at the International Health Economics Association congress later this month. In Bali. Meanwhile, yours truly had to make do with a trip to Cardiff for this year’s SAPC Annual Scientific Meeting. Clearly our Welsh colleagues can’t really compete with the blue seas (contrast the brown Severn estuary) or palm trees (Wales is obviously better known for leeks and daffodils, both currently out of season). But, staggeringly, the Met Office website tells me that Cardiff is actually much hotter than Bali at the moment. Perhaps I should shed a tear for my poor health economist pals after all?

It’s not just the South Wales sunshine that impressed – our Cardiff colleagues really shone in terms of delivering a fantastic conference, with some great science blended with the usual social opportunities which make the ASM such an enjoyable experience. I confess that I did not feel that the theme of “adaptable primary care” was particularly prominent, but that didn’t detract, and perhaps it’s because I may be taking the need for adaptability for granted, given the current upheaval and pressure on health services in this country. Furthermore, as noted by the closing keynote speaker Claire Goodman, perhaps it’s not our ability to adapt but rather our ability to change that is the issue.

This 53rd edition of the conference should be praised in particular for some outstanding keynote presentations. Martin Marshall (currently of the Nuffield Trust) started by reminiscing about general practice in the early 90s, working full-time in a relatively small practice with 1-in-6 on-calls, an average of two consultations annually per patient, and 90% of contacts with a doctor. Reactive care was typical of what he describes as the “John Wayne” contract – a GP’s got to do what a GP’s got to do. Fast forward to the present: huge GP corporates, mostly with part-time salaried doctors, a huge rise in technology and remote consultations, and nearly seven contacts per year for each patient. Martin reflected on the current crisis in general practice due to changes in the way care is delivered, a massive increase in workload, substantial stress, burnout and recruitment challenges, and a worrying rise in inequalities. The drop in satisfaction observed by the British Social Attitudes survey with GP services, from the highest within the NHS for many years to second bottom now, is unsurprising. But Martin also highlighted the opportunities this presents for us as primary care researchers, in particular to generate evidence to challenge key beliefs among policy-makers: that the partnership model is part of the problem; that “small scale” is inefficient and a barrier to change and innovation; that the doctor model is wasteful and most work can be done by “less expensive” professionals; that GPs do not focus enough on high-value consultations; and that general practice is too absorbed with individual patients rather than population health. Enough to keep us busy for a long time!

I also hugely enjoyed Margaret McCartney’s dossier of “stuff” that we are told to do but that lack an evidence base and are often pushed by industry or others with rather narrow perspectives. She discussed the promotion of a diverse range of activities, from AF screening, PSA testing or social prescribing, to the implementation of genetic testing or artificial intelligence. Many of these are not supported by evidence and indeed may be downright ethically wrong, yet policymakers are often keen to jump on such ideas. Margaret noted a glimmer of hope, with the BMA and RCGP standing together against the rollout of Inclisiran in general practice. But it also highlighted to me the critical roll that academic primary care has to play in ensuring that generalist practice is informed by high quality research.

Aside from the keynotes, I managed to attend a number of other sessions. The workshop we ran examining how to strengthen the broader clinical academic workforce was well attended; it was great to see a wide range of other professions represented, including paramedics, nursing pharmacy, psychology and physiotherapy. The challenges are clearly substantial and it was depressing to hear recurring stories of the lack of support for clinical colleagues wanting to pursue academic careers; hopefully SAPC can help advocate for change. I also made it to some interesting talks on prescribing, women’s health, workforce, and continuity of care. Hassan Awan (a clinical lecturer at Keele) and my own PhD student Polly Duncan (from Bristol) also presented excellent work in their respective fields of emotional distress amongst South Asian Men, and the unmet needs of housebound people. And there was a fantastic showing from many of my early career colleagues in Exeter. The future of academic primary care looks bright.

This was my final SAPC conference as Chair of the association, a position I’ve been privileged to hold (along with Dunx Shrewsbury) for the past three years. It’s been a challenging time, in particular recovering from the pandemic and developing a strong working relationship with a new secretariat. There is more I wish I could have done but, as is unfortunately too often the case, the realities of the day job too often get in the way. Nevertheless, I will continue to support SAPC from the sidelines, as well as helping with key aspects such as reapplication for charitable status and revitalising the rather tired website. I’m delighted that Gary Abel – also here in Exeter – is taking over the reins, and I’m sure he will do a fantastic job. In the meantime, I will take the opportunity to recuperate over what is expected to be a very hot weekend, and look forward with huge excitement to a trip to St Andrews in June 2026, even if my golf is non-existent and the North Sea is likely to be considerably cooler than the waters around a certain Indonesian island.

Rupert Payne (past Chair, SAPC)