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Professor Richard Neal

Professor of Primary Care Medicine

Research Overview

Richard is Professor of Primary Care Medicine and is the Director of the North Wales Centre for Primary Care Research, Bangor University. Prior to this he was a Research Training Fellow, Lecturer and Senior Lecturer at the Centre for Research in Primary Care at the University of Leeds. Richard’s main research interests are in the diagnosis and management of cancers in general practice. He holds various administrative and representative roles including Chair of the (UK) National Cancer Research Institute (NCRI) Primary Care Clinical Studies Group. He is a founding member of Ca-PRI (the International Cancer and Primary Care Research Network). He has won over £5M in externally peer reviewed research and research infrastructure funding in the last five years, and has published 117 peer reviewed papers.

 

Biography

Current position held at Bangor University:

Professor of Primary Care Medicine & Director - North Wales Centre for Primary Care Research

 

Previous position held at Bangor University:

2011-2012: Clinical Senior Lecturer in General Practice – North Wales Centre for Primary Care Research

 

Other external positions currently held:

2016: Health and Care Research Wales Senior Research Leader

2013: Member of NISCHR Faculty

2012: NCRI Primary Care Clinical Studies Group – Chair of Early Diagnosis Sub-Group

2012: NCRI – Member of Screening Prevention and Early Diagnosis Group

2011: Associate GP, Betsi Cadwaladr University Health Board

2011: Cardiff University Honorary Senior Clinical Research Fellow

2010: Associate Editor BMC Health Services Research

2008: Cancer and Primary Care International Research Network – Founding Executive Member

 

Other external positions previously held:

2003-2011:  Clinical Senior Lecturer in General Practice – Cardiff University

2000–2002: Macmillan Senior Lecturer in Primary Care Oncology - University of Leeds

1996-1999: Lecturer in Primary Care Research - University of Leeds

1994-1996: Research Training Fellow - University of Leeds

 

Educational Background:

2009: FRCGP

2000: PhD, University of Leeds

1999: Postgraduate Certificate in Teaching and Learning in Higher Education, University of Leeds

1994: MRCGP

1988: MB ChB, University of Birmingham

Awards:

2013: NISCHR Faculty

2012: RCGP Research Paper of the Year Award – Children & Medicines Category

2012: RCGP Annual Conference - Best poster

2012: SAPC Annual Conference - Best poster

2008: SAPC/NAPCRG- Travel prize for best presentation

 

Research

Research Interests:

My main research interest is the interface of cancer with primary care, especially relating to early diagnosis and survivorship. This is driven by a desire to improve outcomes for patients with cancer, by understanding and changing the ways in which their diagnosis and survivorship experience is influenced by primary care. I have expertise in both quantitative and qualitative work, including evidence synthesis, observational studies, and randomised controlled trials.

 

Keywords to describe Research areas and interests:

Primary Care, Oncology, Randomised controlled trials, Evidence synthesis, Diagnosis, Health Services Research, General Practice

 

Impact of Research:

Significant policy relevance and impact in the field of primary care oncology since 2003. Impact has been made in two main areas:

  • The role of primary care in the earlier diagnosis of symptomatic cancer; for example by determining the predictive value of symptoms and translating this into Risk Assessment Tools for clinical practice

  • The contribution of primary care to cancer follow-up and the management of survivorship; for example by changing practice by illuminating poor care in prostate cancer

 

Impact of Current/Future Impact:

As PI / CI I currently lead:

  • ELCID – This is a pilot trial of earlier chest x-ray to diagnose lung cancer. If successful as a pilot this will lead to a further clinical trial (funded by Cancer Research UK)
  • ICBP 4 – This is the Welsh arm of an international comparative survey of cancer diagnosis and is likely to directly inform cancer policy and clinical practice (funded by Cancer Research Wales)
  • ABC-DEEP – This multi-centre study builds the evidence base for the early symptomatic diagnosis of cancer and will inform future policy (funded by Cancer Research UK)
  • Diagnostic journeys in myeloma – the first study of its kind in myeloma (funded by Tenovus)

I collaborate on grants led from elsewhere:

  • DISCOVERY – A research programme on optimising diagnosis in symptomatic cancer, already having significant policy and practice outcomes (funded by NIHR)
  • ACE – This is a trial of adolescent cancer awareness in schools, and is the first of its kind (funded by Scottish Government)
  • PROSPECTIV – This a trial of a psycho-educational intervention for men after prostate cancer treatment (funded by Prostate Cancer Charity)
  • ASTRID – This development and testing of a new tool to measure the diagnostic interval in cancer (funded by Cancer Research UK)
  • The Bangor / Cambridge / Durham collaboration – This is analysis of existing datasets including RCGP Cancer Diagnosis Audit (funded by NIHR)

 

Our main funders of Research:

In addition to the funding bodies above I receive funding from Public Health Wales and Betsi Cadwaladr University Health Board. Contributed to £4.4M in lifetime grant capture and £2.8M in past five years.

             

Research Environment:

Health is one of three strategic research priorities for Bangor University. Our research is focused and integrated through the methodological approaches of implementation research, knowledge synthesis, health economics and molecular laboratory studies, with key clinical foci on rehabilitation, dementia and cancer. We benefit from strong connections to related research in other units of the University, close collaboration with the local health board (which covers the whole of North Wales and is the third largest in Europe), as well as from participation in wider collaborative networks led by Cardiff and Liverpool, and in specific UK- and EU-wide projects. 

 

Key Publications

Nicholson BD, Mant D, Neal RD, Hart N, Hamilton W, Shinkins B, Rubin G, Rose PW. International variation in adherence to referral guidelines for suspected cancer: a secondary analysis of survey data. BJGP, Online First. 2016.

doi: 10.3399/bjgp16X683449

Shephard E, Neal RD, Rose PW, Walter FM, Hamilton W. The symptoms of adult chronic and acute Leukaemia before diagnosis: large primary care case-control studies using electronic records. BJGP. 2016; 66(64):e182-8. doi: 10.3399/bjgp16X683989

Rai N, Champaneria R, Snell K, Mallett S, Bayliss SE, Neal RD, Balogun M, Kehoe S, Deeks JJ, Sundar S, Davenport C. Symptoms, ultrasound imaging and biochemical markers alone or in combination for the diagnosis of ovarian cancer in women with symptoms suspicious of ovarian cancer (Protocol). Cochrane Library. 2015. doi: 10.1002/14651858.CD011964

Hughes DL, Neal RD, Lyratzopoulos G, Rubin GP. Profiling for primary care presentation, investigation and referral for liver cancers – evidence from a national audit. European Journal of Gastroenterology and Hepatology. (Accepted).

Hamilton W, Stapley S, Campbell C, Lyratzopolous G, Rubing G, Neal RD. For which cancers might patients benefit most from expedited symptomatic diagnosis? Construction of a ranking order by a modified Delphi technique. BMC Cancer. 2015; 15:820.doi: 10.1186/s12885-015-1865-x

Hamilton W, Astin M, Martins T, Neal RD, Rose PW. The diagnostic value of symptoms of oesophagogastric cancers in primary care: a systematic review and meta analysis. BJGP (Accepted)

Sundar S, Neal RD, Kehoe S. Diagnosis of Ovarian Cancer. BMJ. 2015;351:h444. doi: 10.1136/bmj.h4443

Rubin G, Berendsen A, Crawford M, Dommett R, Earle C, Emery J, Fahey T, Grassi L, Grunfeld E, Gupta S, Hamilton W, Hiom S, Hunter D, Lyratzopoulos G, Macleod U, Mason R, Mitchell G, Neal RD, Peake M, Roland M, Seifert B, Sisler J, Sussman J, Taplin S, Vedsted P, Voruganti T, Walter F, Wardle J, Watson E, Weller D, Wender R, Whelan J, Whitlock J, Wilkinson C The expanding role of primary care in cancer control.The Lancet Oncology Commission. 2015; 16(12):1231-72. doi: http://dx.doi.org/10.1016/S1470-2045(15)00205-3

Hubbard G, Stoddart I, Forbat L, Neal RD, O'Carroll RE, Haw S, Rauchhaus P, and Kyle R.G. School-based brief psycho-educational intervention to raise adolescent cancer awareness and address barriers to medical help-seeking about cancer: a cluster randomised controlled trial. Psycho-Onchology. 2015. doi: 10.1002/pon.4001

Stanciu MA, Morris C, Makin M, Watson E, Bulger J, Evans R, Hiscock J, Hoare Z, Tudor Edwards R, Neal RD, Wilkinson C. A pilot randomised controlled trial of personalised care after treatment for prostate cancer (TOPCAT-P): nurse-led holistic-needs assessment and individualised psychoeducational intervention: study protocol. BMJ Open. 2015; 5:e008470. doi:10.1136/bmjopen-2015-008470

Din NU, Ukoumunne OC, Rubin G, Hamilton W, Carter B, Stapley S, et al. Age and Gender Variations in Cancer Diagnostic Intervals in 15 Cancers: Analysis of Data from the UK Clinical Practice Research Datalink. PLoS ONE. 2015; 10(5):e0127717. doi:10.1371/journal.pone.0127717

Rose PW, Rubin G, Perrera-Salazar R, Almberg SS, Barisic A, Dawes M, Grunfeld E, Hart N, Neal RD, Pirotta M, Sisler J, Toftegaard BS, Thulesius H, Vedsted P, Young J, Hamilton W. Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey. BMJ Open. 2015; 5(5):e007212. doi: 10.1136/bmjopen-2014-007212

Watson E, Shinkins B, Frith E, Neal D, Hamdy F, Walter F, Weller D, Wilkinson C, Faithfull S. Wolstenholme J. Sooriakumaran P, Kastner C, Campbell C, Neal RD, Butcher H, Matthews M, Perera R, Russell S, Rose P. Symptoms, unmet needs, psychological well-being and health status in prostate cancer survivors: implications for redesigning follow-up. BJU International. 2015. doi: 10.1111/bju.13122

Shephard E, Neal RD, Rose P, Walter F, Hamilton W. Quantifying the risk of Hodgkin lymphoma in symptomatic primary care patients aged ≥40 years : a case-control study using electronic records. BJGP. 2015; 65(634):e289-94. doi: 10.3399/bjgp15X684805

Shephard E, Neal RD, Rose P, Walter F, Hamilton W. Quantifying the risk of Non-Hodgkin lymphoma from symptoms reported by primary care patients aged ≥40 years: a large case-control study using electronic records. BJGP. 2015; 65(634):e281-8. doi: 10.3399/bjgp15X684793

Rubin GP, Saunders CL, Abel GA, MacPhail S, Lyratzopoulos G, Neal RD. Impact of investigations in general practice on timeliness of referral for patients subsequently diagnosed with cancer: evidence from a National Audit of Cancer Diagnosis in Primary Care. BJC. 2015; 112(4):676-687. doi 10.1038/bjc.2014.634

Lyratzopoulos G, Saunders CL, Abel GA, MacPhail S, Neal RD, Wardle J, Rubin GP. The relative length of the patient and the primary care interval in 28 common and rarer cancers. BJC. 2015; 112:S35-S40. doi: 10.1038/bjc.2015.40

Neal RD, Tharmanathan P, France B, Din NU, Cotton S, Fallon-Ferguson J, Hamilton W, Hendry A, Hendry M, Lewis R, Macleod U, Mitchell ED, Pickett M, Rai T, Shaw K, Stuart N, Tørring ML, Wilkinson C, Williams B, Williams N, Emery J. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. BJC. 2015; S92-S107. doi: 10.1038/bjc.2015.48

Neal RD, Robbé IJ, Lewis M, Williamson I, Hanson J. The complexity and difficulty of diagnosing lung cancer: findings from a national primary care study in Wales. Primary Health Care Research & Development. 2015; 16(5):436-49. doi:10.1017/S1463423614000516.   [Epub 2014 Dec 8.]

Neal RD, Rogers T, Hamilton W. Easily Missed? Lung Cancer. BMJ. 2014; 349:g6560. doi: http://dx.doi.org/10.1136/bmj.g6560

Walter FM, Mwaka A, Neal RD. Achieving earlier diagnosis of symptomatic cervical cancer. BJGP. 2014; 64(627):495-6. doi: 10.3399/bjgp14X681649

Bulger JK, Hiscock J, Neal RD, Stanciu A, Makin M, Wilkinson C. ‘Carrying on the way we are, is becoming shambolic’ An interview study with prostate cancer specialists about their usual practice of follow-up. Journal of Clinical Urology. 2015; 8(4);240-245. doi: 10.1177/2051415814545804

Rubin G, Walter F, Emery J, Neal RD, Hamilton W, Wardle J. Research into practice: earlier diagnosis of symptomatic cancer. BJGP. 2014; 64(625):428-430. doi:  10.3399/bjgp14X681205

Hubbard G, Macmillan I, Canny A, Forbat L, Neal RD, O’Carroll RE, Haw S, Kyle RG. Cancer symptom awareness and barriers to medical help-seeking in Scottish adolescents: a cross-sectional study. BMC Public Health. 2014; 14:1117. doi: 10.1186/1471-2458-14-1117


Walter FM, Mwaka A, Neal RD. Achieving earlier diagnosis of symptomatic cervical cancer. BJGP. 2014; 64:495-6. doi: 10.3399/bjgp14X681649

Rose PW, Hamilton W, Aldersey K, Barisic A, Dawes M, Foot C, Grunfeld E, Hart N, Neal RD, Pirotta M, Sisler J, Thulesius H, Vedsted P, Young J. Rubin G, Development of a survey instrument to investigate the primary care factors related to differences in cancer diagnosis between international jurisdictions. BMC Family Practice. 2014; 15:122. doi: 10.1186/1471-2296-15-122.

Keeble S, Abel GA, Saunders CL McPhail S, Walters FM, Neal RD, Rubin GP, Lyratzopoulos G.  Variation in promptness of presentation among 10,297 patients subsequently diagnosed with one of 18 cancers: Evidence from a national audit of cancer diagnosis in primary care. International Journal of Cancer. 2014; 135(5):1220–8. doi: 10.1002/ijc.28763. [Epub 2014 Feb 25.]

Neal RD, Nafees S, Pasterfield D, Hood K, Hendry M, Gollins S, Makin M, Stuart N, Turner J, Carter B, Wilkinson C, Williams N, Robling M. Patient-reported measurement of time to diagnosis in cancer: development of the Cancer Symptom Interval Measure (C-SIM) and randomised controlled trial of method of delivery. BMC Health Services Research. 2014; 14:3.  doi: 10.1186/1472-6963-14-3

Rubin G, Walter F, Emery J, Neal RD, Hamilton W, Wardle J. Research into practice: earlier diagnosis of symptomatic cancer. BJGP. 2014; 64(625):428-430. doi: 10.3399/bjgp14X681205

Watson E, Rose P, Frith E, Hamdy F, Neal D, Kastner C, Russell S, Walter FM, Faithfull S, Wolstenholme J, Pereira R, Weller D, Campbell C, Wilkinson C, Neal RD, Sooriakumaran P, Butcher H, Matthews M. PROSPECTIV – A pilot trial of a nurse-led psycho-educational intervention delivered in primary care to prostate cancer survivors: study protocol for a randomised controlled trial. BMJ Open. 2014; 4:e005186. doi:10.1136/bmjopen-2014-005186

Kyle RG, MacMillan I, Forbat L, Neal RD, O’Carroll RE, Haw S, Hubbard G. Scottish adolescents’ sun-related behaviours, tanning attitudes and associations with skin cancer awareness: a cross-sectional study. BMJ Open. 2014; 4:e005137. doi:10.1136/bmjopen-2014-005137

Brain K, Smits S, Simon A, Forbes L, Roberts C, Robbe I, Steward J, White C, Neal RD, Hanson J. Ovarian cancer awareness and anticipated delayed presentation in a population sample. BMC Cancer. 2014; 14:171. doi:10.1186/1471-2407-14-171

Neal RD, Din NU, Hamilton W, Ukoumunne O, Carter BR, Stapley S, Rubin GP. Comparison of cancer diagnostic intervals before and after implementation of NICE guidelines: analysis of data from the UK General Practice Research Database. British Journal of Cancer. 2014; 110:584-92. doi:10.1038/bjc.2013.791

Neal RD, Nafees S, Pasterfield D, Hood K, Hendry M, Gollins S, Makin M, Stuart N, Turner J, Carter B, Wilkinson C, Williams N, Robling M. Patient-reported measurement of time to diagnosis in cancer: development of the Cancer Symptom Interval Measure (C-SIM) and randomised controlled trial of method of delivery. BMC Health Services Research. 2014; 14:3.  doi: 10.1186/1472-6963-14-3

Hurt CN, Roberts K, Rogers TK, Girffiths OG, Hood K, Prout H, Nelson A, Fitzgibbon J, Barham A, Thomas-Jones E, Tudor Edwards R, Yeo ST, Hamilton W, Tod A, Neal RD. A feasibility study examining the effect on lung cancer diagnosis of offering a chest X-ray to higher-risk patients with chest symptoms: protocol for a randomized control trial. Biomed Central. 2013; 14:405. doi: 10.1186/1745-6215-14-405

Fern LA, Birch R, Whelan J, Cooke M, Sutton S, Neal RD, Gerrand C, Hubbard G, Smith S, Lethaby C, Dommett R, Gibson F. Why can’t we improve the timeliness of cancer diagnosis in children, teenagers, and young adults? BMJ. 2013; 347:f6493 doi:10.1136/bmj.f6493

Hendry M, Lewis R, Clements A, Damery S, Wilkinson C (on behalf of the HPV Core Messages team - including Neal RD). ‘HPV? Never heard of it!’ A systematic review of girls’ and parents’ information needs, views and preferences about human papillomavirus vaccination. Vaccine. 2013; 31:5152-5167. doi: 10.1016/j.vaccine.2013.08.091

Kyle RG, Macmillan I, Rauchhaus P, O’Carroll R, Neal RD, Forbat L, Haw S, Hubbard G. Adolescent Cancer Education (ACE): study protocol for a cluster randomised controlled trial of a school-based educational intervention to increase adolescent and parent cancer awareness and communication. Trials. 2013; 14:286. doi:10.1186/1745-6215-14-286

Lyratzopoulos G, Abel GA, McPhail S, Neal RD, Rubin GP. Gender inequalities in the promptness of diagnosis of bladder and renal cancer after symptomatic presentation: evidence from secondary analysis of primary care audit survey. BMJ Open. 2013; 3:e002861.  doi:10.1136/bmjopen-2013-002861

Cotton S, Belcher J, Rose P, Jagadeesan SK, Neal RD. The risk of a subsequent cancer diagnosis after herpes zoster infection: primary care database study. Br J Cancer. 2013; 108(3):721-726. doi:10.1038/bjc.2013.13 [Epub 2013 Jan 29.]

Lyratzopoulos G, Abel GA, McPhail S, Neal RD, Rubin GP. Measures of promptness of cancer diagnosis in primary care: Secondary analysis of national audit data on patients with 18 common and rarer cancers. Br J Cancer. 2013; 108(3):686-690. doi 10.1038/bjc.2013.1 [Epub 2013 Feb 7]

Stapley S, Peters TJ, Neal RD, Rose PW, Walter FM, Hamilton W. The risk of oesophago-gastric cancer in symptomatic patients in primary care: a large case-control study using electronic records. Br J Cancer. 2013; 108(1):25-31. doi: 10.1038/bjc.2012.551 [Epub 2012 Dec 20.]

Shephard EA, Neal RD, Rose P, Walter FM, Hamilton WT. Clinical features of kidney cancer in primary care. BJGP. 2013; 62(602):e598-604. doi: 10.3399/bjgp12X654560.

Lyratzopoulos G, Greenberg DC, Rubin GP, Abel GA, Walter FM, Neal RD. Advanced stage diagnosis of cancer – who is at greater risk? Expert Review of Anticancer Therapy. 2012; 12(8): 993–996. doi: 10.1586/era.12.77

Hulbert-Williams NJ, Morrison V, Wilkinson C, Neal RD. Investigating the cognitive precursors of emotional response to cancer stress:  Re-testing Lazarus’s Transactional Model. British Journal of Health Psychology. 2013; 18(1):97-121. doi: 10.1111/j.2044-8287.2012.02082

Williams NH, Amoakwa E, Belcher J, Burton K, Hendry M, Lewis R, Hood K, Bennett P, Neal RD, Wilkinson C. Measuring illness and exercise beliefs in osteoarthritis of the hip or knee: psychometric properties of the ‘Hip and Knee Beliefs Questionnaire’ and the ‘Exercise Attitude Questionnaire’. International Muskuloskeletal Medicine. 2012; 34(1):13-20. doi: 10.1179/1753615411Y.0000000014

Hendry M, Pasterfield D, Lewis L, Clements A, Damery S, Neal RD, Adke R, Weller D, Campbell C, Patnick J, Sasieni P,  Hurt C, Wilson S, Wilkinson C. Are women ready for the new cervical screening protocol in England? A systematic review and qualitative synthesis of views about human papillomavirus testing.  Br J Cancer. 2012; 107:243-254. doi: 10.1038/bjc.2012.256

Stapley S, Peters TJ, Neal RD, Rose P, Walter F, Hamilton W. The risk of pancreatic cancer in symptomatic patients in primary care: a large case-control study using electronic records. Br J Cancer. 2012; 106:1940-4. doi:10.1038/bjc.2012.190

Shephard E, Stapley S, Neal RD, Rose P, Walter F, Hamilton WT. Clinical features of bladder cancer in primary care. BJGP. 2012; 62(602):e598-604. doi: 10.3399/bjgp12X654560

Lyratzopoulos G, Neal RD, Barbiere JM, Rubin G, Abel G. Variation in the number of general practitioner consultations before hospital referral for cancer: findings from a national patient experience survey. The Lancet Oncology. 2012; 13(4):353-65.             doi.org/10.1016/S1470-2045(12)70041-4 [Epub 2012 Feb 24.]

Weller D, Vedsted P, Rubin G, Walter F, Emery J, Scott S, Campbell C, Andersen RS, Hamilton W, Olesen F, Rose P, Nafees S, van Rijswijk E, Muth C, Beyer M, Neal RD. The Aarhus Statement: Improving design and reporting of studies on early cancer diagnosis. Br J Cancer. 2012; 106(7):1262-1267. doi: 10.1038/bjc.2012.68 [Epub 2012 Mar 13.]

Hulbert-Williams NJ, Neal RD, Morrison V, Hood K, Wilkinson C. Anxiety, depression and quality of life after cancer diagnosis: What psychosocial variables best predict how patients adjust? Psycho-Oncology. 2012; 21(8):857–867. doi: 10.1002/pon.1980

Hulbert-Williams NJ, Hulbert-Williams SL, Morrison V, Neal RD, Wilkinson C. The Mini-Mental Adjustment to Cancer Scale: re-analysis of its psychometric properties in a sample of 160 mixed cancer patients. Psycho-Oncology. 2012; 21(7):792-797. doi: 10.1002/pon.1994

 

Teaching:

PhD Supervision, PGT & UG teaching:

I teach individual medical students and have had a variety of strategic roles. For example I have contributed to the recruitment of teaching practices, marking and final examinations (MBBCH) for Cardiff University. I have contributed in to post-graduate education of doctors and other health care professionals. Some examples include supporting post-graduate education schemes, and our clinical academic fellows programme in collaboration with the Health Board.   We currently host a novel F1 rotation involving our academic unit. I am now involved with the teaching of the new BMedSci course at Bangor University. The aim of the Medical Sciences BMedSci degree is to provide a science programme related to medicine with strong professional skills/ethics and research elements. My role is to supervise 2nd and 3rd year students with their research project proposals. I have supervised PhD students. I have acted as an external examiner for 5 PhDs.