The GM Care Record is part of something much bigger

The information in the GM Care Record helps us understand the answers to some of the most pressing health questions affecting our region, such as those related to COVID-19.

That’s because de-personalised data, i.e. health and care information whereby your name, NHS number and address has been removed, will be used for highly selective and world-leading research at Greater Manchester universities.

So far, the approved studies are limited to those that tackle specific topics related to how different groups within our regions’ 2.8 million citizens have been affected by COVID-19.

What are the benefits of facilitating vital research in Greater Manchester?

First and foremost, the GM Care Record has been established to ensure you and your family receive tailored, individual care and treatment.

However, this incredible resource is also an essential part of informing the future of our regions’ healthcare services. Helping to determine what support and funding is required, for which people and in what way.

All of the information that could identify a person, including name, NHS number or address, is removed before university researchers can use the data. This means that you can be confident that the health and care data provided will only reflect trends in people who have similar care needs, rather than identifying individuals.

By using de-personalised health data from the GM Care Record to study highly specific research questions, such as why those with type 2 diabetes are of increased risk of becoming seriously unwell from COVID-19, our regions’ frontline health and social care workers will be better prepared to make positive changes to health services in Greater Manchester.

Do you work with industry or other non-NHS partners?

We never sell or share any data from the GM Care Record to private industry for profit or their own private use.
 
There may be times in future when the NHS or care sector in Greater Manchester could form a partnership with an organisation outside the NHS such as a company that develops new technology or medicines to improve local services, or to better meet the health and care needs of local people.  An example of this might be working with a pharmaceutical company to understand how new types of drugs could support the better treatment of diseases. Looking at wider data from across Greater Manchester could also help us to get a better understanding of your future needs, and we may sometimes work with local universities to develop research studies around this.

Any use of the GM Care Record involving a non-NHS partner would be subject to full openness, transparency and scrutiny. The GM Care Record Expert Review Group, which is made up of people working for GPs, the NHS and Councils in Greater Manchester, would review every proposal to ensure that it was fair, suitable and feasible within the parameters agreed with the public and those who hold this data such as GP practices (the data controllers).

Proposals would also be further reviewed by our Oversight and Scrutiny Committee, which vitally includes members of the public, to ensure full transparency, and that we are acting in accordance with our legal requirements and the public interest.

What types of research studies are currently being approved to access the GM Care Record?

• Understanding COVID-19 trends and risks to public health
• Controlling and preventing the spread of COVID-19
• Identifying and understanding information about patients or potential patients with, or at risk of, COVID-19
• Research and planning in relation to COVID-19

Approved COVID-19 research studies

Research Focus

Examining health disparities in relation to COVID-19 for people with mental illness

Principal Investigator

Dr Joseph Firth, The University of Manchester

Summary

This research project will examine the differences in COVID-19 related outcomes between people with mental illness and the general population. COVID-19 related infections, vaccinations, hospitalisations and deaths will be investigated along with factors which may account for this. These may include demographic characteristics, prescribed medications, co-existing health conditions and vaccination access/uptake.

Number of researchers accessing the GM Care Record: 2

STATUS: CompletE

Results of Study

The research found that people with certain mental illnesses were significantly more likely to get vaccinated against COVID-19 than the general population.

Using the GM Care Record, a comparison was made in the vaccination rates of a sample of 1,152,831 adults with and without severe mental illness.

The proportion of people who received at least one dose of COVID-19 vaccine by 30^th June 2021, as recorded in their primary care records, was 77% for people with recurrent major depression, 76% for people with bipolar disorder, 75% for other depressive disorders, and 70% for psychotic disorders, compared to 68.4% for people not diagnosed with severe mental illness.

However, when we looked at records of who had refused a COVID-19 vaccine, people diagnosed with schizophrenia were more than twice as likely to refuse vaccination compared to people not diagnosed with severe mental illness (5% versus 2%). While the reasons for this are not clear, explanations could range from a heightened vaccine hesitancy among people with severe mental illness, to reflecting that health care professionals may have more actively offered, discussed and/or recorded attempts to promote vaccination with people with severe mental illness.

The study formed part of a broader programme of work looking at COVID-19 outcomes among people with mental illness. It has already been shown that people with schizophrenia are 5 times more likely to die due to COVID-19. By highlighting differences in vaccination uptake and refusal among people with different diagnoses, this latest paper takes another step towards showing where further work may need to be done to protect people with mental illness from COVID-19.

Click HERE for more information.

Research Focus

The equitability of the UK COVID-19 vaccination strategy

Principal Investigator

Dr Ruth Watkinson, The University of Manchester

Summary

To use electronic health data from across Greater Manchester to test whether the government vaccination plan meets the goal of giving equal priority to people with equal vulnerability to COVID.

Number of researchers accessing the GM Care Record: 4

STATUS: CompletE

Results of Study

Previous research has found wide inequalities in COVID-19 vaccine uptake between ethnic groups in many countries. In the UK, uptake of COVID-19 vaccination has been particularly low amongst people belonging to Black or Black British ethnic groups. However, previous studies tended to use broad ethnic groupings, and it was unclear how ethnic inequalities in COVID-19 vaccination compared to inequalities in uptake of previous vaccination programmes.

Using the GM Care Record, we estimated inequalities in COVID-19 and seasonal flu vaccine uptake between 17 ethnic groups within Greater Manchester. We found that ethnic inequalities in COVID-19 vaccine uptake are far wider than those seen previously for flu vaccine uptake, and exist even amongst people who recently had a flu vaccine. Of particular concern, ethnic inequalities in COVID-19 vaccine uptake are concentrated amongst the most vulnerable – people living in the most deprived neighbourhoods, and older and extremely clinically vulnerable adults.

Our findings suggest the COVID-19 vaccine rollout has widened pre-existing health inequalities in vaccine uptake. Themes raised in our public and community discussion groups suggest that lower trust in COVID-19 vaccines and practical barriers to vaccine access are both likely to contribute to lower COVID-19 vaccine uptake amongst minority ethnic groups. More research and community engagement is urgently needed to build trust and confidence amongst minority ethnic communities, and to better understand and remove barriers to vaccine access.

Click HERE for more information.

Research Focus

Frequency of recording of self-harm episodes in primary care records in GM: examining the impact of COVID-19

Principal Investigator

Dr. Sarah Steeg, The University of Manchester

Summary

To find out if the number of people seeking help following self-harm during Winter 2020, followed a similar
pattern to Spring 2020, to understand if health services are meeting people’s needs and if any groups need greater attention and enhanced support.

Number of researchers accessing the GM Care Record: 2

STATUS: CompletE

Results of Study

Self-harm is a common reason for people to seek help from health services and it is linked to suicide risk. Looking at trends over time in self-harm is an important part of understanding a population’s mental health. It is also essential in assessing the mental health impacts of COVID-19.

We used data from the GM Care Record to compare monthly numbers of self-harm episodes recorded in primary care. We studied 33,444 episodes of self-harm by 13,148 people recorded between 1 January 2019 and 31 May 2021. We explored findings by age groups, gender, level of social deprivation (a measure of poverty and access to services) and ethnic group. People with experience of self-harm, and carers, were involved in designing the study and making sense of and sharing the findings.

In April 2020 the number of self-harm episodes recorded in Greater Manchester primary care was around a third lower than in February 2020. We also found longer-term reductions, for example, between August 2020 and May 2021, the number of episodes was around a tenth lower than expected. These longer-term falls were largest for
men and people living in the most deprived neighbourhoods. There was also a small increase in self-harm episodes by young people aged 10 to 17 years.

People in Greater Manchester are now more likely to seek help for self-harm than during the first wave of COVID-19 in spring/summer 2020. However by May 2021, the number of people accessing healthcare for self-harm was still lower than before the pandemic. This could be because people aren’t seeking help from health services in the way they did before the pandemic. Some people could be accessing other types of support, while others may not be receiving any support. Access to care may be still be more unequal than before the pandemic, with men and people living in the poorest areas less likely to seek help.

This study is important for understanding the unmet need among patients who have self-harmed. It also helps understand the demand faced by health services. Future work includes looking at the types of treatment received by people who are in contact with primary care services after harming themselves.

Click HERE for more information.

Research Focus

Evaluation of why type 2 diabetes increases the risk of becoming seriously unwell or dying with COVID-19

Principal Investigator

Dr Adrian Heald, Salford Royal Hospital and The University of Manchester

Summary

To compare all people who have diabetes in Greater Manchester and were alive on 1 January 2020, who became seriously ill and/or died with COVID-19, with those with diabetes who were infected with COVID-19 and did not become seriously unwell.

This will determine what is different about the people with known diabetes who became seriously ill or die, versus those that had a mild infection or no symptoms at all.

Number of researchers accessing the GM Care Record: 3

STATUS: CompletE

Results of Study

Diabetes is a condition that affects around 4 million people in the UK. People with diabetes have high levels of blood glucose and if not managed, can lead to serious damage to the heart, feet, eyes and kidneys. Previous research has shown that people with diabetes are more likely to become seriously unwell, or die, after a COVID-19 infection. The exact reasons for this are still largely unknown.

This research looked at two areas: the risk of being admitted to hospital, and the risk of dying. Firstly, the study compared how likely patients with diabetes and patients without diabetes were of being admitted to hospital or dying after having a positive COVID-19 test. Then, using statistical models, the study investigated why might this risk be higher for diabetes patients: such as weight, BMI and blood pressure.

It was found that that patients with diabetes (type 1 and type 2) were at a much higher risk of being admitted to hospital or dying than other patients. The factors that added to the risk of dying included: age, being male, social deprivation, kidney problems, a history of high blood pressure and having certain medical conditions such as Chronic Obstructive Pulmonary Disease (COPD), but not asthma. It was also found that patients prescribed certain diabetes medications (metformin and gliflozins) had a lower risk of dying. Smoking significantly increased the chance of dying.

The factors that added to the increase in the risk of people with diabetes being admitted to hospital included age, social disadvantage, being of African ethnicity, being overweight, high blood pressure, having COPD and kidney problems. Again, patients on the drug metformin had a lower risk.

The findings of this study will be used in decisions made in the UK to help reduce the risk of people with diabetes of all types becoming seriously ill or dying after having COVID-19.

Research Focus

Healthcare utilisation across Greater Manchester during the COVID-19 Pandemic

Principal Investigator

Dr. Stuart Grant, The University of Manchester

Summary

The GM Care Record will be used to study how the healthcare system in Greater Manchester has been utilised by our regions’ citizens throughout the pandemic.

For example, how busy GP surgeries are, how many routine operations are conducted, and how full the hospitals are. This will lead to important insights into any bottlenecks in the system and help with planning for subsequent waves and future pandemics.

Number of researchers accessing the GM Care Record: 2

STATUS: UNDERWAY

Research Focus

COVID-19 incidence, hospital admission and death in cancer patients in Greater Manchester.

Principal Investigator

Professor Corinne Faivre-Finn, The University of Manchester

Summary

The GM Care Record will be used to determine the risks and factors associated with a COVID-19 diagnosis, hospital admission and death in cancer patients.

This work will provide an overall picture of the COVID-19 risk in all GM patients with cancer and help inform care decisions for cancer patients regarding treatment and need for shielding.

Number of researchers accessing the GM Care Record: 3

Status: UNDERWAY

Research Focus

Opportunities to improve practice and reduce harm in patients with rheumatoid arthritis taking methotrexate

Principal Investigator

Jenny Humphreys, The University of Manchester

Summary

Rheumatoid arthritis (RA) is a long-term inflammatory disease that requires treatment with medications to suppress the immune system, such as Methotrexate. Patients with
RA taking these medications need to have monitoring blood tests, but how often this should take place is not yet known.

During the COVID-19 pandemic, routine blood tests were impacted for RA patients and the National Institute for Health and Care Excellence (NICE) issued urgent guidelines which said that the gap between monitoring blood tests could be increased in patients who are on stable treatment.

NICE would now like to improve the research evidence supporting these guidelines using data from the GM Care Record.

Number of researchers accessing the GM Care Record: 2

Status: Underway

Research Focus

The indirect impact of COVID-19 on the diagnosis of physical and mental health conditions

Principal Investigator

Professor Niels Peek, The University of Manchester

Summary

To investigate changes in diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic and how these indirect impacts differ across GM and the three waves of COVID-19.

Number of researchers accessing the GM Care Record: 2

STATUS: UNDERWAY

Research Focus

DiabetesMyWay: Whether digital interventions improved diabetes self-management during the pandemic

Principal Investigator

Professor Martin K. Rutter, The University of Manchester

Summary

Restricted access to primary care services due to the COVID-19 pandemic has had negative effects on diabetes management.

This study aims to assess whether digital interventions improved type-2 diabetes management during the pandemic.

Number of researchers accessing the GM Care Record: 2

Status: Underway

Research Focus

Study into post-COVID interstitial lung disease

Principal Investigator

Dr. John Blaikley, The University of Manchester

Summary

This study will try to understand what proportion of COVID-19 patients report persistent respiratory symptoms and how these reports were actioned by primary care services (e.g. GP practices).

It will also investigate the proportion of patients who, after suffering from COVID-19, were diagnosed with a new respiratory disease, or referred for further respiratory consultations or tests.

The study will will also look at the impact of socioeconomic and demographic differences in the level of care provided.

Number of researchers accessing the GM Care Record: 2

Status: Underway

The Future of Research

The future of healthcare is more connected, more data driven and more evidence-based.

Currently, the GM Care Record data is being used for COVID-19 related research only.

Yet despite being a relatively new resource, the immeasurable benefits of the GM Care Record are clear. It has already helped to better plan our services and guide funding and support within our region in the response to the COVID-19 crisis.

We’ve only scratched the surface, but this success gives us assurance that in the future, we will be able use the health and care information in the GM Care Record to answer other health questions, creating better health policies and services for the Greater Manchester population.