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Prof Nick Francis

PhD, MD, BA, PGD (Epidemiology), MRCGP

Professor of Primary Care Research; Deputy Head of School (Research), School of Primary Care, Population Sciences and Medical Education; Divisional Clinical Lead (division 5), CRN Wessex

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Professor Francis' research focuses on helping patients and healthcare professionals prevent and manage infections to improve outcomes and reduce antimicrobial resistance.

He leads research that focuses on the management of respiratory, urinary, and skin problems in a primary care setting, with a particular focus on the prevention, diagnosis and management of infections and antimicrobial stewardship.

He has extensive experience and expertise in leading clinical research including randomised controlled trials, observational studies, developing complex interventions, and epidemiological studies using large routine healthcare datasets.

Landmark publications:

1. Butler CC, Gillespie D, White P, Bates J, Lowe R, Thomas-Jones E, Wootton M, Hood K, Phillips R, Melbye H, Llor C, Cals JWL, Naik G, Kirby N, Gal M, Riga E, Francis NA. C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. New England Journal of Medicine. 2019 Jul 11;381(2):111–20.

2. Francis NA, Cannings-John R, Waldron CA, Thomas-Jones E, Winfield T, Shepherd V, Harris D, Hood K, Fitzsimmons D, Roberts A, Powell C, Gal M, Butler CC. Oral steroids for resolution of otitis media with effusion in children (OSTRICH): a double-blinded, placebo-controlled randomised trial. The Lancet. 2018 Jan 1;392(10147):557–68.

3. Little P, Stuart B, Francis NA, Douglas E, Tonkin-Crine SKG, Anthierens S, Cals JWL, Melbye H, Santer M, Moore M, Coenen S, Butler CC, Hood K, Kelly M, Godycki-Cwirko M, Mierzecki A, Torres A, Llor C, Davies M, Mullee M, O’Reilly G, van der Velden A, Geraghty AW, Goossens H, Verheij TJM, Yardley L, on behalf of the GRACE consortium. Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. Lancet. 2013 Jul 31;382(9899):1175–82.

4. Francis NA, Butler CC, Hood K, Simpson S, Wood F, Nuttall J. Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomised controlled trial. BMJ. 2009 Jan 1;339(jul29 2):b2885–b2885.

5. Francis NA, Ridd MJ, Thomas-Jones E, Butler CC, Hood K, Shepherd V, Marwick CA, Huang C, Longo M, Wootton M, Sullivan F, CREAM Trial Management Group. Oral and Topical Antibiotics for Clinically Infected Eczema in Children: A Pragmatic Randomized Controlled Trial in Ambulatory Care. Annals of family medicine. 2017 Mar 1;15(2):124–30.

6. Butler CC, van der Velden AW, Bongard E, Saville BR, Holmes J, Coenen S, Cook J, Francis NA, Lewis RJ, Godycki-Cwirko M, Llor C, Chlabicz S, Lionis C, Seifert B, Sundvall PD, Colliers A, Aabenhus R, Bjerrum L, Jonassen Harbin N, Lindbæk M, Glinz D, Bucher HC, Kovács B, Radzeviciene Jurgute R, Touboul Lundgren P, Little P, Murphy AW, De Sutter A, Openshaw P, de Jong MD, Connor JT, Matheeussen V, Ieven M, Goossens H, Verheij TJ. Oseltamivir plus usual care versus usual care for influenza-like illness in primary care: an open-label, pragmatic, randomised controlled trial. The Lancet. 2020 Jan 4;395(10217):42–52.

Major grants:

  • Feasibility cohort study on predictors of diagnosis and prognosis of urine infection in care home residents: DIagnoSing Care hOme UTI Study. NIHR School for Primary Care Research. 2022-24. £109K (Chief Investigator)

  • Cellulitis Optimal Antibiotic Treatment. NIHR HTA. 2022-26. £1.5M (Chief Investigator)

  • Acne Care Online. NIHR PGfAR. 2022-27. £1.7M (Co-Investigator)

  • LOngitudinal study of behaviours, risk factors, and effects of COVID-19 in the Community (LOCC): a large, rapid online observational study. NIHR School for Primary Care Research. 2020-21. £100K (Chief Investigator)

  • Spironolactone for Adult Female Acne (SAFA): pragmatic multicentre double-blind randomised superiority trial to investigate the clinical and cost-effectiveness of spironolactone for moderate or severe persistent acne in women. NIHR HTA. 2018-21. £1.7M

  • Antibiotics for lower Respiratory Tract Infection in Children in Primary Care (ARTIC-PC). NIHR HTA. 2016-19. £1.6M

Impact example:

Improving the management of respiratory tract infections in children in primary care

My research has focused on reducing unnecessary antibiotic use while at the same time improving diagnosis and enhancing communication between clinicians and patients. An example of this is the research I conducted to understand the concerns that parents have when their child has a respiratory tract infection, and develop an interactive booklet to improve communication with GPs and safety-netting ( I then demonstrated that use of this intervention in general practice led to a safe two-thirds reduction in antibiotic prescribing ( and that it was highly valued by parents, increasing their confidence in managing respiratory infections in children ( More than 300,000 printed copies of the booklet I developed have been distributed by NHS organisations, and it is freely available to parents online ( and regularly used (over 40,000 users in last full year of data). It is also promoted by the Royal College of General Practitioners (, resulted in a research impact award from Health and Care Research Wales, and is regularly requested by clinicians. It has been the focus of specific antimicrobial stewardship campaigns by health authorities in Wales and Scotland, and was used (with my permission) to develop the cough and cold section on the Healthier Together website (, which is used extensively by parents. It has also been translated into more than 12 languages and used around the world (confirmed use in USA, Germany, Poland, Spain). Furthermore, this concept was used by myself and others to develop similar tools which have demonstrated similar benefits for children in the out of hours setting ( and adults with chesty coughs (

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