Primary care has a key role in ensuring that disease is diagnosed at an early and treatable stage. This is particularly important for cancer, where the chances of survival, and the costs of NHS care, are determined more by diagnostic delay than any other health service factor. Dr Willie Hamilton leads the cancer theme. Early diagnosis is also important for other diseases with major economic implications for the NHS such as stroke. For example, failure to diagnose and treat a transient ischaemic attack in primary care increases the risk of major stroke causing death or serious disability.
As the diagnostic value of symptoms and signs and investigation depends on the prevalence of the disease and so on the care setting, and since the evolution of disease is often poorly understood, research on diagnosis in primary care must take place in primary care rather than hospital settings. Likewise, research on behavioural change is essential in order to understand how potentially effective interventions can most efficiently produce change at individual and population level.
Despite its clinical and economic importance to the NHS, research on prevention and diagnosis receives a very small proportion of health research funding in the UK (prevention 2.5%; screening and diagnosis 5.2%) and the evidence base for many areas of prevention and diagnosis still needs strengthening. Our key research questions are:
How can we diagnose cancer at the earliest opportunity?
How can we avoid missing life-threatening infection in young children?
How can we improve the diagnosis of heart failure, thyroid disease, stroke, and MRSA infection?
How can we increase and sustain physical activity in patients at high risk of developing diabetes?
Dr Alastair Hay leads the theme on infection within the programme.