BJGP Interviews

Today, we’re speaking to Catharina Savelkoul, a DPhil student in Health Economics based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford.Title of paper: Factors Influencing UK Medical Students’ Choice of General Practice: A Systematic ReviewAvailable at: https://doi.org/10.3399/BJGP.2025.0226The UK faces a projected shortage of approximately 15,000 GPs by 2036/37, with a declining proportion of UK medical graduates pursuing general practice. Previous research has identified various contributing factors but lacked a contemporary synthesis within a coherent theoretical framework. This systematic review examines factors influencing UK medical students' career decisions, finding three critical influences: curricula that inadequately represents general practice, a persistent negative hidden curriculum, and the impact of clinical placement quality. Our revised Bland-Meurer model incorporates these findings, providing a comprehensive framework to improve GP recruitment. This systematic review identifies the factors that shape UK medical students’ intentions toward general practice.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.120 - 00:00:59.530Hi and welcome to BJJP Interviews. I'm Nada Khan, one of the associate editors of the bjjp. Thanks for listening to this podcast today.In today's episode, we're speaking to Katharina Savalcool. Katharina is a DPHIL student in Health Economics based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford.We're here today to talk about the paper she's recently published in the BJJP titled Factors Influencing UK Medical Students Choice of General A Systematic Review. So, hi Katharine, it's lovely to meet you and to talk about your work.This is a super interesting area to study because we know that there is a push to increase the number of GPs in practice and I guess that does really start from medical school and people's intentions there. But just to start off, could you talk us through why you decided to do this work and what were you aiming to look at here?Speaker B00:01:00.050 - 00:03:17.090Yeah, of course.So the goal of this piece of research, of the systematic review was to synthesize the empirical evidence on the factors that influence medical students, GP, career intention. Because we know that the general practice is what makes the NHS functions.It handles over 300 million consultations annually, manages the long term, most long term conditions, issues over a billion prescriptions per year. And we also know that healthcare systems with a strong, with strong primary care achieve like, better population health in general.But at the same time, right now the projected shortages for the UK are approximately 15,000 GPs by 2036, which is of course a large number and shows like a workforce crisis. And then if we look at the policy response to this, they've been like quite ambitious but also largely unsuccessful.So for instance, Health Education England mandated that 50% of all new medical graduates should enter general practice. And this target has never been met. The same goes for the NHS long term workforce plan to increase GP training places by 50% to 6,000 places in 2031.And the interesting part about this is that the policy responses are all about setting this goal. Right?It's about, you know, we're shifting, we're shifting care to the community, we're expanding training places, more medical students should become a gp. But that's all. Yeah, setting like these, these, these strategies, but at the end it almost seems like the, we're achieving the reverse.So that, that kind of brought me to the question of if we want to, you know, make sure that we have a healthy primary care workforce, that the general practice avoids this large crisis in the future, then maybe Instead of setting these ambitious goals, we should look into the question of what draws medical students to the general practice and also what are some of the reasons why they might not become a gp?And I think if we zoom into those factors at medical school, during medical education, you get a lot more interesting insights that can actually inform more effective policy. I think that's the kind of. That was the reason I conducted this systematic review.Speaker A00:03:17.970 - 00:03:42.850That's a great summary of what's been going on with GP recruitment in the past little while in terms of policy and the push to increase the number of gps. And this was, as you mentioned, a systematic review that followed pretty conventional review processes.But I wonder if you could tell us a bit about this bland mirror model. It's a framework used in terms of organizing the results and how this informed how you structured the results.Speaker B00:03:43.990 - 00:04:47.410Yeah, I think it's for this specific research question, looking into factors that influence decision making.I decided to look up different theoretical frameworks in order to understand this, because decision making at the end of the days is, of course, something that's influenced by many things at the same time.This model specifically, which was, I think first published in 1995, helped a lot with like, systematically categorizing the findings because it identified three principal domains. One is the student characteristics, such as, like, personal values, maybe personality traits. The second one is the specialty characteristics.So what is the. What are the professional opportunities? And the third one is, like, the influences during medical school.And I think if those are the three kind of domains we saw in this across these, like, 30 years of research, and I think it was the most useful way to kind of theorize these factors.Speaker A00:04:48.210 - 00:05:01.970Great.So I guess just talk us through what you found, and I suppose it might be helpful to just talk through the different aspects of that model you've just described. So what were the sort of student characteristics that you found in the literature that influenced and informed specialty choice?Speaker B00:05:02.640 - 00:06:37.050Yeah, so I think the findings from this came from different types of studies.I think the largest ones were the ones that used a data set called UK met, which kind of has the data on all UK medical students in such demographic variables, but also more information about their educational performance in medical school.And I think these studies showed us like, the kind of the social, demographic, individual characteristics that are associated with a higher likelihood of pursuing a career in a general practice. And then there's these smaller studies which kind of like looked at personal preferences and personality traits.And I think that that's another really interesting question. Right. Because about this, like, specialty choice and Kind of individual preferences, personality traits.A lot of international research is talking about altruism or do people who enjoy social contact more, are they more likely to become gps?And I think this type of research is quite undeveloped in terms of the UK literature, but it was still interesting to look at it and compare it to different studies. And I think for the demographic factors we saw specifically that female students were more likely to choose gender practice graduates on entry.So age was another one we saw. Yeah, so there's like these different kind of demographic factors or personality traits that seem to predispose you to career in a general practice.Speaker A00:06:37.290 - 00:06:51.930And what about the characteristics of the specialty itself or working in general practice specifically that drew some medical students to think about it. So these are potentially medical students looking at gps and thinking, oh, I want that lifestyle or I don't or I want that work. Really? Yeah.Speaker B00:06:52.150 - 00:07:48.350On this question, first of all, a lot has changed recently.So I think work life balance was something that was mentioned in like the earlier studies, but right now it has changed so much that that's almost like not something we can, yeah, we can use anymore.But another interesting one, and I think one that we should really take seriously, is that a lot of one of the things that draws students to the general practice is the like, long term patient relationships. So continuity of care.And of course right now with the landscape changing and specifically like the prioritization of access over continuity of care, it might be important to kind of, you know, reconsider those changes in light of the fact that a lot of medical students decide on a career in a general practice because of this like continuity of care aspect that's so unique to primary care. So I think that's another really important one.Speaker A00:07:48.990 - 00:08:13.560Yeah, I can definitely relate to that.I think one of the reasons I figured out that general practice was for me was that when I was working in A E, I would flag all the patients I'd seen and clarked in and then wanted to know what happened in their...

Today, we’re going to back at the recent BJGP Research Conference, which was held just last week on the 20st of March 2025 in Bristol. TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.960 - 00:00:39.550Hello and welcome to this BJGP podcast. I'm Nada Khan and I'm one of the Associate Editors of the Journal. Thanks for listening today.In today's episode we're going to look back at the recent BJGP Research Conference which we held just last week on 20th March in Bristol. It was absolutely brilliant to welcome the BJGP team and people who attended to the Southwest.And in today's episode I'm just going to talk about some the highlights and really focus on what the conference is about and maybe have a chat about how to get involved in the future. But first, here's a welcome to the conference from our Editor in Chief, Ewan Lawson.Speaker B00:00:40.270 - 00:01:16.520My name's Ewan Lawson, I'm editor of the bjgp. So that means basically I'm the one person that the Journal would probably run without and everyone else does all the work.But I do have to stand up here and say hello to you and I want to offer you the warmest of welcomes to the conference. Been running this for a few years and it's always really nice to get together and just try to help each other, you know, get involved.It's not in a very scholarly way, you know, whether you're involved in research or whether you're interested in putting research into practice. We think we can offer you quite a lot more than just the fact that we publish research at BJGP and BJGP Open. So I hope you have a fantastic day.Speaker A00:01:17.320 - 00:03:26.850So this was the seventh run of the BJGP Research Conference and this year we had a particular focus on a few different areas.We took a bit of a deep dive into patient involvement, new and emerging research in general practice, general practice policy and how to get research into impact. And this year, as always, quite a bit around writing and also public speaking in academia.The conference kicked off this year with an absolutely brilliant talk by Professor Martin Marshall, who some of you may know as the Chair of the Nuffield Trust. But he's also Emeritus professor of Healthcare Improvement at UCS and non Exec Director at the Royal Devon University Healthcare trust.And until 2022, Martin was also the Chair of the Royal College of GPs and a GP in New East London. So definitely someone worth listening to about his experiences as well.And Martin really focused in his talk on the relationship between general practice and policy and asked a really important question, which is how good are we as a profession at influencing decision decision makers?And in his talk, Martin reflected on the fact that while the value of general practice is really well established for patients, communities and the wider nhs. It's often still misunderstood or undervalued at a policy level.And in his talk he challenged whether that's purely down to policymakers or whether, as Julian Tudor Hart once put it, there's also an element of political literacy within the profession itself.And what really followed was a thoughtful discussion about how both national leaders and individual clinicians can do more to shape policy, and whether that's through better communication, stronger advocacy, or even engaging more actively with the systems around us. It was a really thought provoking structure of the conference and linked closely to that broader theme of impact that ran throughout the day.Here's just a short snippet of Martin speaking at the conference.Speaker C00:03:27.570 - 00:04:45.260I wish I could have my career again and I'd be more influential than I was. I've learned a lot along the way, but this is what I've learned. First of all, as I've described, influencing is about far more than informy.It's not about telling, it's about getting inside people's heads and understanding what's important to them. A lot of influencing is about timing. How do we decide when to influence? I think it's really important. Policy windows is an interesting concept.So sometimes just a window opens that allows you to do something.And a good example of this would be the evidence around Continuity of care, which is actually pretty strong in General practice was largely ignored by policymakers and politicians until the pandemic came along and they were looking for a way of delivering the vaccination program. And we made the case based on evidence that trust is really important to the success of uptake of vaccination programs.And that's why government decided that general practice would deliver their program largely, rather than setting up a separate body to deliver it. So there's an example, another example of ways of change.The NUFRE is doing some really important work around the distribution, the resource distribution formula for general practice, something which the Conservative governments of the past were not interested in, the Labour government is very interested in. So now is our time to push it while we can.Speaker A00:04:46.460 - 00:11:57.780So it was a great start to the conference from Martin, which really focused down on how GPs and primary care researchers can get the most impact from their work to effect change. So in addition to the keynote sessions, we had a series of parallel sessions where people presented posters and talks about their work.And what really struck me, listening to different talks and looking at the different posters that were on display, was just how strong the work was across the board, especially from medical students. And early career researchers.There's clearly a lot of exciting work coming through and I wouldn't be surprised to see some of it published in the BJJP in the near future.At the conference, we then had a series of workshops and these looked at patient and public involvement, writing for the BJGP and public speaking in academia. I attended Lucy Potter and the Bridging Gap team's excellent workshop on meaningful patient and public involvement in research.Their team did an absolutely brilliant job at highlighting a familiar but important issue that those with the greatest health needs often face the biggest barriers to care and are probably the least likely to be involved meaningfully in research.And what made this session stand out for me was that it was delivered alongside women with lived experience, which brought, I felt, a real deal, a real depth and authenticity to the discussion.And the workshop was a absolutely powerful reminder of the importance of meaningful involvement and offered some really practical ideas for how we can better include marginalized patients in our work.And going on to one of the regular features of the conference, which is the Right for Life workshop, led by our deputy editor at BJGP Life, Andrew Papaniktis and Tom Round. It's a really engaging session that encourages people to write and reflect on their experiences in general practice.And I often describe JGP Life, the website, as sort of the coffee room of the journal. It's a space for more sort of reflective conversation and debate.And here we're also always keen to receive some submissions from across the GP community, and it's probably worth pointing out that some of these pieces then go on to be published in the print journal too. And finally, the third workshop was led by Professor Graham Easton, who looked at public speaking for academics.And I just want to touch on Graham's really interesting background that he was able to draw upon here. So, Graham was a senior producer for BBC Science Unit for many years and presented Case Notes, which is Radio 4's flagship medical program.He's also a regular contributor to BBC Health Check and has quite a strong interest in the use of narratives and storytelling in medical education, which is a topic he looked at in depth in his doctoral work.So, looking back to his workshop, it focused on something we've all experienced, which is sitting through a talk or presentation where the key message gets lost in really dense slides and you just lose the audience.And Graham's session was all about how to communicate our work more clearly and make it engaging, using things like storytelling, simplifying your core message and using visuals that actually support you're saying, rather than Overwhelming it. It was a really practical session with lots of tips to take away and use straight away.And I think that everyone who attended, who attended learned something new about how to present their research in an engaging and meaningful way. So that's a roundup of the workshops. And finally we had the last keynote speaker of the conference, Dr. Rebecca Payne.And Rebecca really brought together one of the central themes of the conference, which was impact going back to Martin Marshall's talk as well. And Rebecca's talk focused on what happens after publication and challenged the idea that getting a paper accepted as the endpoint.Instead, she kind of framed it as the beginning. So that's the point at which the real work of influencing practice...

Today, we’re speaking to Dr Charlotte Paddison, who is currently non-executive director at Royal Papworth Hospital, and formerly a Senior Fellow and co-lead for Primary Care at the Nuffield Trust.Title of paper: Implications of skill-mix change in general practice: secondary analysis of data from the GP Patient SurveyAvailable at: https://doi.org/10.3399/BJGP.2025.0360To the authors’ knowledge, no previous studies have investigated the impact on patient trust or perception of needs met when patients are unsure what type of health professional they have seen. Using data from a large national survey, this study found that patients expressed lower confidence and trust, and were less likely to report their needs were met in general practice consultations when they were not sure who their appointment was with. The results are novel in demonstrating that the combination of not knowing who you saw and a remote appointment is particularly problematic for patient trust.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.600 - 00:00:58.530Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for taking the time today to listen to this podcast.In today's episode, we're speaking to Dr. Charlotte Patterson, who is currently non Executive Director at Royal Papworth Hospital and formerly a Senior fellow and co lead for Primary Care at the Nuffield Trust.We're here to discuss the paper she's recently published here in the BJGP titled Implications of Skill Mix Change in General Practice Secondary Analysis of Data from the GP Patient Survey.So, hi, Charlotte, it's really lovely to meet you and to talk about your work and I just really wanted to start by exploring how we know that the composition of the general practice team is evolving with the increasing scope of multidisciplinary work. Really? And I wondered if you could just give us some of the context for this work and what you wanted to do here.Speaker B00:00:58.850 - 00:02:04.870Absolutely. Nada.So what we really wanted to understand was how two big shifts in policy are shaping the experience of patients care when they come to the GP practice. Why do we think that was interesting or potentially important?Basically, we've seen two big changes happening at the same time in the last five years. So.So we've seen the shift to multi professional team working with many more different types of health professionals working in general practice and at the same time, separately, we've seen a massive increase in the number of appointments delivered remotely. So what we wanted to know is what those changes really mean for patients.We also know that some patients feel confused about who they're seeing and when they turn up to a GP appointment at the surgery, whether that's an appointment with a GP or a physician's associate or a social prescriber.And this led on to another really important question for us in this study, which is what happens when patients are confused or uncertain about who they've seen and what does that mean for patient trust? Those are the kinds of questions we wanted to answer.Speaker A00:02:05.350 - 00:02:39.730So this was an analysis of the 2023 GP Patient Survey, which is sent to patients registered in English general practices.And I think the key thing for this work and what you've outlined just in terms of what you're saying right here, was that the survey asks people who their last general practice appointment was with and whether they had confidence and trust in that person and if their needs were met. And just given what you were describing, I wanted to move straight on to what you found.What did the patient say about trust and how did it Vary by different patient characteristics.Speaker B00:02:40.050 - 00:03:27.890Sure. So what we found in relation to trust. Nada.Is that while every 2, 2 in every 3 patients reported they definitely had trust and confidence in the health professional they saw at their GP practice. And that's very positive.We also found at the same time, there's a minority of patients, around 7%, who reported they did not at all have confidence and trust in their last GP practice appointment. And we found that trust is lower among patients who are younger, from minoritised ethnic backgrounds and living in more deprived areas.So that's what we found in relation to trust. We also found that patients are confused about different roles of health professionals working in general practice.And we've found this is likely to affect around one in every 20 patients.Speaker A00:03:28.370 - 00:03:30.290That seems quite a lot, actually, doesn't it?Speaker B00:03:30.530 - 00:04:26.740Yes.And it's also we found, looking at the GP general practice patient survey, we found that the proportion of patients who feel confused about who they're seeing has gone up over time.What I can tell you is that if we look backwards over time, the national survey data shows the percentage of patients who are unsure who their last appointment was with has more than doubled in six years. In 2018, it was around 1.9% of patients. In the 2024 survey, this had gone up to 5% of patients.And at the same time, we've also seen a decline in confidence and trust. So what we can say there is that confidence has declined by around 5% over that same time period.So 5 percentage points from 69% of patients saying, yes, definitely they had confidence and trust in the health professional they saw in 2018. But by 2025 that's dropped to 64%.Speaker A00:04:27.220 - 00:04:46.100And I think that almost reflects what's happening in practice with the increasing number of other roles working in general practice as well. And I think one of the really striking findings here is that patients reported much lower trust when they weren't sure which professional they saw.Do you want to talk us through that and why you think that is?Speaker B00:04:46.630 - 00:06:26.190Absolutely. So what we've seen in terms of context here is that a lot of change happening in general practice, much of it taking place at the same time.So we've seen in terms of multi professional team working, there are 40,000 additional non GP non nurse staff working in general practice, which is a whopping 387% per patient increase over a nine year period.At the same time, we've also seen this huge policy focus on rapid access, delivering more remote appointments, working at scale and a shift to digital and online as well. So there's a lot going on in general practice all at the same time.And we can also see alongside this changes in patients confidence and satisfaction with how general practice is working. So that's sort of a zoomed out, bigger picture lens.We can see that in terms of the British Social attitude survey in 2024, almost half of all people said they were quite dissatisfied with how general practice was working. But looking back in time, if we look back to 1983, we see that only 13% of people were dissatisfied with how general practice was running.And even looking back just 10 years ago, in 2016, that figure is 16% of the of people in the British Social Attitude Survey who were dissatisfied with general practice. So we're seeing massive shifts across multiple aspects of general practice.At the same time, we're seeing a significant shift in the proportion of people who feel that they are satisfied with what's happening in terms of the care they're receiving from general practices.Speaker A00:06:27.070 - 00:06:35.070And I guess that relates to some of the issues with trust and potentially not knowing who people are seeing in practice as well.Speaker B00:06:36.170 - 00:07:12.390Absolutely.So in our findings, what we found was that the combination of not knowing who you saw and a remote appointment is really problematic for patients in terms of trust and confidence.So to give a flavour of this, when patients were not sure what health professional, what type of health professional they saw or spoke to, and this was a remote appointment, so an appointment by phone or video or message, the likelihood of reporting confidence and trust decreased by up to 80% when compared to patients who saw a GP in person at their practice.Speaker A00:07:12.470 - 00:07:48.910And we did a podcast with Richard Baker talking about trust in healthcare professionals as well.And one of the things he highlighted was that actually trust is really important in that patient clinician interaction, because, you know, that trust actually builds some foundation towards whether people might want to come back to the practice, they might want to take up that advice or management that's been suggested by the clinician they see.So I think not only are you seeing these associations, but it's actually really drilling down to why trust is so important as well in these...

Today, we’re speaking to Marta Berglund, a Research Assistant and PhD candidate at University College London. Title of paper: Pre-diagnostic primary care consultations and imaging in emergency-diagnosed vs referred lung cancer patientsAvailable at: https://doi.org/10.3399/BJGP.2025.0369It has been postulated that emergency diagnoses of cancer (which occurs frequently and confers a poorer prognosis) may relate to suboptimal diagnostic management in primary care, but evidence to support or refute this hypothesis is sparse. We found that emergency-diagnosed patients with lung cancer were less likely to present with relevant respiratory symptoms and had fewer chest imaging investigations before diagnosis compared to patients diagnosed via referred routes, indicating an important role of disease factors in emergency diagnosis.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.200 - 00:01:06.690Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for listening to this podcast today.In today's episode, we're speaking to Marta Bergland. Marta is a research assistant and PhD candidate at university College London.She's recently published a paper here in the BJGP titled Pre Diagnostic Primary Care Consultations and Imaging in Emergency Diagnosed versus Referred Lung Cancer Patients.So, hi, Marta, it's really lovely to meet you and it's great to talk to you about cancer diagnosis, which is a really important area for general practice and also a topic we publish on quite a lot here in the bjgp. It's been fascinating reading this paper and it tackles a cancer that we really don't do well with here in the UK in terms of early diagnosis.But I wonder if you could just start off by telling us a little bit more about lung cancer and how it's actually often diagnosed, which can sometimes lead to some of those poor outcomes.Speaker B00:01:07.010 - 00:02:26.970So, as you said, lung cancer is one of the cancer sites in the UK where the majority or a large proportion of patients are diagnosed through the emergency route, also known as emergency presentations, which is when a patient is diagnosed after they present through an urgent hospital admission or an A and E attendance in the 30 days before diagnosis.And that could look like someone who has had a persistent cough for, say, two weeks, but didn't actually go to their gp, and then suddenly they have a more severe onset of symptoms like shortness of breath, and then they go to A and E and are referred to a chest X ray and then get diagnosed, which is a pathway that is associated with worse prognosis and worse outcomes after diagnosis. And the more preferred route, if you will, in England to diagnose patients is through primary care.So through the GP routine referral or the urgent suspected referral route.And that could look like someone who presents to primary care with cough or dyspneasia again, but then their GP refers them to a chest X ray and then they're diagnosed with lung cancer.Speaker A00:02:27.130 - 00:02:45.290And I guess I wanted to just before we talk about what you found, I wanted to just cover here again, what you mean by this term, that's diagnostic window, because you mentioned that a few times in the paper. But what does this actually mean?And it relates a bit back to some of what you're talking about, about people presenting with symptoms, isn't that right?Speaker B00:02:45.530 - 00:03:09.880So, for us, it's a measure of healthcare use before diagnosis, and it could be any healthcare use Measure like consultations, symptoms, blood test use, anything like that.And it's measuring when that changes compared to baseline before diagnosis, which can signal increased healthcare use associated with the subsequent diagnosis.Speaker A00:03:10.040 - 00:03:16.840Okay, so it just, I guess it's what it says on the tin. It's just that window, isn't it, of potentially being able to pick up a change.Speaker B00:03:17.490 - 00:03:25.970Exactly. So the idea is that if there is an increase long before diagnosis, then possibly there is an opportunity to diagnose these patients earlier.Speaker A00:03:26.450 - 00:04:09.190So this was a really big study using the CPRD and this is a database that a lot of the listeners will be familiar with.And you had a sample of a million patients registered with UK General Practice and then you looked at people diagnosed with cancer and their pre diagnosis rates of consultation like you were talking about, and also chest imaging by the different possible diagnosis routes. So either as an emergency, a routine or an urgent referral. But I really want to move straight to what you found here.Can you give us just an overview of how the different people in this analysis were eventually diagnosed with lung cancer? So were there a lot of emergency diagnoses here?Speaker B00:04:09.350 - 00:05:46.240Yes, I believe we had around 30% of patients who were diagnosed through the emergency route, compared to 20 something percent in the urgent referral route and the GP routine referral route. That aligns with the national data in NCRAS and also the Rapid Cancer Registry data. I guess that's what we expected to see.We found that the majority of patients do present to primary care, which then disproves this hypothesis that has been presented in the literature that patients who are diagnosed through the emergency pathway don't present to primary care at all and therefore there wouldn't really be a chance to intervene and improve these patients diagnostic pathway. I think that is one of the key findings, although it is a simple finding.Then we also found that there are short term similar diagnostic windows across these routes.Patients who are diagnosed as emergencies had similar opportunity to intervene earlier as patients from the other routes, just because of the timing at which things changed.However, we also looked at the rates and those were consistently lower for emergency diagnosed patients, even though the timing at which things change at the lower rates mean that these patients present less frequently. And so because they present less frequently, there are simpler, fewer chances in primary care to also like see warning signs earlier.Speaker A00:05:46.480 - 00:05:56.480Yeah, so you looked at those consultations rates. So is that what you're describing here? So is that what those findings show in terms of potential opportunities for earlier diagnosis?Speaker B00:05:57.280 - 00:06:17.190Yeah, so what I had in mind was mostly the consultations and the consultations with symptoms, but then acknowledging that we measured two different things.So the timing at which things change, the diagnostic windows as well as the rates of these consultations, how frequently they were occurring for patients by route.Speaker A00:06:17.430 - 00:06:27.510And what you're suggesting is that people who were diagnosed via emergency had lower rates. So that sort of is a bit counterintuitive. So can you talk us through that again a bit?Speaker B00:06:27.590 - 00:07:06.880It's a bit contradicting.Well, it would seem that it is because these patients do present to primary care and then when things start going wrong, let's say they happen around a similar time as for patients who are diagnosed through the other routes. But what sets the emergency diagnosed patients apart is that they present less frequently.So they may still have cough and may still go to their gp, but they may not do so as often as someone who's referred on a two week wait, for example, or now urgent suspected referral, which then means that there are fewer chances for gps to pick up on persistent symptoms and then refer those patients.Speaker A00:07:07.200 - 00:07:19.780And I guess just.Were there any other main findings that you found in terms of sort of the diagnostic window or sort of consultations before diagnosis via the different routes?Speaker B00:07:19.940 - 00:09:14.860Yeah, so I think one of the most interesting ones as well to the overall finding of patients presenting to primary care is that patients presented with non specific symptoms around 10 to five months before diagnosis across the routes, which is still quite a while before they're diagnosed.So potentially this could mean that something could have been done differently to, for example, refer these patients earlier in like say month nine before diagnosis rather than nine months later. But again, as you said, this is also in lung cancer patients, which is a very difficult cancer site to diagnose early.And part of that reason is because the symptoms that patients present with are non specific symptoms.So it's also understandable that it is difficult to make that call based on someone presenting with cough in primary care, which is why there's more like work to be done and we need to better...

Today, we’re speaking to Dr Mike Holmes, a GP in Yorkshire and Chair of Nimbuscare, a local GP-led multi-neighbourhood provider.Title of paper: Neighbourhood delivery of urgent care in North Yorkshire, UKAvailable at: https://bjgp.org/content/76/764/133Neighbourhood-based urgent care, led by GP Multineighbourhood providers, can reduce reliance on hospitals and NHS 111. Delivering urgent care in community settings is more cost effective than Urgent Treatment Centre and Emergency Departments attendances. Digital integration and shared clinical systems improve safety, responsiveness, and patient experience. Co-locating operational and clinical teams streamlines service delivery and enables operational and quality oversight. Sustained impact requires recurrent funding and performance measures that reflect system-wide improvement rather than single-provider metrics.

Today, we’re speaking to Dr Karol Basta, a Public Health Registrar based in London.Title of paper: Predictors of Childhood Vaccination Uptake and Timeliness in a Diverse Urban PopulationAvailable at: https://doi.org/10.3399/BJGP.2025.0319Childhood vaccination rates have declined in the UK, with inequalities in urban, deprived, and ethnically diverse populations. Previous studies have lacked individual-level clinical data or did not explore both uptake and timeliness. We analysed 13 years of routinely collected primary care data for over 37,000 children in a diverse London borough to identify predictors of uptake and timeliness. Distinct sociodemographic and clinical factors were associated with incomplete and delayed vaccination, offering timely insights as responsibility for vaccination services shifts closer to local systems and place-based commissioning.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.880 - 00:00:52.000Hi and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors of the Journal. Thanks for taking the time to listen to this podcast today.In today's episode, we're speaking to Dr. Carol Basta.Carol is a public health registrar based in London and we're here to talk about the paper she's recently published here in the bjgp, which is titled Predictors of Childhood Vaccination Uptake and Timeliness in a Diverse Urban Population. So, hi, Carol, it's really lovely to meet you and to talk about this work. And I guess just to start, I wanted to put this work into context.We know that in the uk, overall childhood vaccination rates have unfortunately been declining. Could you talk us through some of the current challenges around vaccination, especially in urban and diverse areas?Speaker B00:00:52.720 - 00:02:06.750Yep. So we know vaccinations are really powerful and cost effective tools we have in giving children the best start in life life.But unfortunately, in the UK, since 2012, the uptake has been declining and actually since 2021, none of the vaccines in England have reached the 95% target recommended by the WHO to stop communicable disease outbreaks. And the kind of negative consequences of this aren't just sort of future hypothetical risks.We've already been seeing vaccine preventable diseases such as measles and whooping cough resurgences, and this is especially in certain parts of the uk, such as London or the northwest of England. So no uptake of vaccines is decreasing and vaccine preventable diseases are increasing. But that's not the full picture.We also know, for example, following work done by, at the time, Public health England in 2017, there are avoidable inequalities across the childhood vaccination program nationally, for example, linked to deprivation, geography and ethnicity.However, what was missing was really kind of contemporary granular evidence on the social and clinical factors associated with unequal vaccine outcomes, especially in diverse urban environments.Speaker A00:02:06.990 - 00:02:16.670And I know this was highlighted as well during COVID but there is a mistrust of health services amongst some communities as well, which might be playing into this.Speaker B00:02:17.470 - 00:03:11.120Yeah, exactly.So at the time when I was working in Lamb of Council, we knew qualitatively from talking to our community and talking to our local GP partners, that there was kind of sense of rising mistrust in healthcare services, but also rising difficulties with actually access to services.And that doesn't just affect whether or not people can get the vaccine, for example, it also affects whether they can have conversations about vaccines and the kind of continuity of care and building up those relationships.And so this is what we had kind of on a local level, but we knew that there was also national feelings and sentiments around mistrust, not just national, but actually globally vaccination mistrust from the COVID 19 pandemic. And there were worries that this had run off into the childhood vaccination program as well, that it hadn't just confined itself to Covid vaccines.Speaker A00:03:11.440 - 00:03:41.490So this was a study looking at predictors of routine childhood vaccination from 40 general practices in Lambeth and London, which is a pretty ethnically and socioeconomic demographically diverse borough. And you looked here at the vaccination uptake and timeliness and some of the predictors for these. This was a really big sample.But just to underline the population here, tell us more about the demographics in Lambeth as a borough in terms of ethnicity, because that's where you were based when this work was done.Speaker B00:03:41.890 - 00:04:32.250Yeah, exactly.So Lambeth is an inner London borough and it is very ethnically diverse, it's very densely populated, but it also has some of the highest levels of deprivation in the country. And part of the strengths of this study is that we were able to use detailed ethnic subgroup breakdowns.So, for example, rather than using the broad category of South Asian, we were able to split this down into Pakistani, Bangladeshi, Indian, et cetera. And this was really important because this aligns with national health equity guidance.We know that health outcomes actually vary between the details, subgroups.There's some evidence to suggest that, but it was also important following local community engagement work, where people repeatedly told us these kind of big, broad groups don't reflect how we self identify.Speaker A00:04:32.490 - 00:04:39.530And I wanted to just move on to the results here, so can you start talking us through some of the associations based on deprivation to start with?Speaker B00:04:39.690 - 00:06:22.410Yeah, sure. So we looked at two main outcomes.We looked at vaccination uptake, so that's whether children had received their vaccines at any time point during the study. And we also looked at vaccination timeliness.And vaccination timeliness is important because although a child might eventually go on to receive their vaccine, it leaves them. They're late, it leaves them unprotected for at times when they're most potentially likely to get unwell.And what we found with deprivation in uptake, there was really clear patterns associated by deprivation.There was actually children living in more deprived areas were progressively less likely to be vaccinated compared with those living in the least deprived areas.So, for example, children living in the most deprived 20% of our population were about a third less likely to be fully vaccinated compared to those living in the least deprived areas. This kind of wasn't just a straight out deprivation.There was also lower uptake linked to other markers of social vulnerability, such as being born outside of eco, or such as children having safeguarding involvement. And so that was what we found for uptake. But what was interesting is the findings for timeliness didn't mirror this.So whilst those living deprivation were less likely to be vaccinated, if we zoom in on just the population that were vaccinated and think about were they vaccinated on time, we didn't find that children living in deprivation were less likely to be vaccinated on time. We found no difference. And there was a similar pattern for other markers of social vulnerability, such as safeguarding involvement.They have a lower uptake, but it wasn't associated with kind of untimely vaccination.Speaker A00:06:22.650 - 00:06:31.210And you've touched upon this, but there was a really striking result here in terms of children who were born outside of the uk. So can you talk us through this?Speaker B00:06:31.530 - 00:06:59.060Yeah. So we also found that children born outside of the UK were much less likely to be vaccinated compared to children born inside the uk.However, if again, we zoom in on just those vaccinated and look at timeliness, we actually find the opposite. So if you were born outside of the uk, you were more likely to have your vaccine delivered on time compared to those who were born in the uk?Speaker A00:06:59.380 - 00:07:03.380Sure, yeah. So talk us through some of the reasons that you think that this might be happening.Speaker B00:07:03.380 - 00:08:30.800Yeah, I think these findings, the difference between uptake and timeliness, not having the same predictors and in some case having the opposite patterns being shown are really quite interesting. And they're kind of a few possible explanations as to why this might be. One is perhaps potentially there's a form of selection going on.So when we look at only children who get vaccinated in groups with lower overall uptake, for example, children of non white British ethnicity, or as we've said, children not born in the uk, the children who do get vaccinated may represent more engaged, health literate or well supported families. And that same engagement may...

Today, we’re speaking to Prof Emma Crosbie, Professor of Gynaecological Oncology based at the University of Manchester.Title of paper: Urine human papillomavirus testing for cervical screening in a UK general screening population: a diagnostic test accuracy studyAvailable at: https://doi.org/10.3399/BJGP.2025.0105The switch from primary cytology to primary human papillomavirus testing has enabled innovations in self-sampling for cervical screening. This study shows that urine self-collected with a first-void urine collection device has similar diagnostic test accuracy and acceptability to cervical sampling in a general screening population. Urine self-sampling has real-world potential as an alternative cervical screening option.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.440 - 00:01:07.140Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the bjgp. Thanks for listening to this podcast today.In today's episode, we're speaking to Professor Emma Crosby, who is professor of Gynecological Oncology based at the University of Manchester. We're here to talk about her really exciting paper that's recently been published in the December 2025 issue of the BJGP.The paper is titled Urine Human Papillovirus Testing for Cervical Screening in UK General Screening Population A Diagnostic Test Accuracy Study. So, hi Emma, it's lovely to meet you and to talk about this paper.I really just wanted to start off talking a bit around cervical screening in the uk, and you mentioned this in the introduction to the paper as well, that cervical screening really does have variable uptake rates and we know that there are some, some barriers to access. But can you talk us through these and tell us a bit about why you decided to do this research?Speaker B00:01:07.940 - 00:03:41.440So, as you've just really nicely summarised, cervical screening is really important weapon against cervical cancer.So we know that it prevents cervical cancer and since the introduction of the NHS Cervical Screening program in the UK, we've seen deaths from cervical cancer drop by around 70%. So we know that it's very effective.But in the uk, the number of people attending is declining year on year and currently, currently only around 68% of those people who are eligible for cervical screening actually attend. There are a whole range of different reasons for non attendance.These include things to do with the speculum examination, so having to have an intimate examination to be examined. The anticipated embarrassment or fear of pain related to that procedure, I think are important barriers.But there are also barriers associated with access to reaching screening appointments, taking time off work, having childcare and so on and so forth. So we thought that there was some really important barriers there that could potentially be addressed by self sampling.Now, vaginal self sampling is actually been incorporated in many cervical screening programs around the world.Some cervical screening programs are using it just for people who are non attenders or underscreened by traditional screening routes and other countries are using it as a choice for everybody.Now, in the uk, we haven't yet taken up vaginal self sampling sampling, but it will be introduced this year in 2026, principally for under screened groups. And there is some work looking at whether or not it will be introduced as a choice for everyone in the future.But we know from research that's been done in the UK that only around 12 to 13% of people who are offered vaginal self sampling who are under screened actually return a sample. And therefore it clearly doesn't address all the barriers to cervical screening. And we wondered whether a urine test would have more app.It would have the same benefits of vaginal self sampling in that it can be collected at home and posted to the laboratory. So it removes that need for an intimate examination.It removes the need for, you know, making an appointment at a healthcare facility to have your screen taken, but it perhaps, you know, removes some of the barriers towards putting a swab inside the vagina that might be culturally or religiously unacceptable to some groups. And so we thought that a urine self sample could be another option for people who currently aren't screened.And so we wanted to see how accurate it was in this study.Speaker A00:03:42.320 - 00:04:03.760And those issues around access are really important, especially in this population of women who are juggling lots of caring responsibilities with young children or caring for older relatives as well.So sometimes it is just difficult to get to an appointment and, you know, juggling work hours and things which often then coincide with GP opening hours as well.Speaker B00:04:03.920 - 00:04:41.960Yeah, absolutely.And we, we have seen a drop in people, you know, in the youngest age group of people who are invited for screening, attending SCRE, their rates of attendance are even lower than the 68% that I quoted.And probably a lot of that is to do with having very busy lives, not seeing this as a priority, imagining that you're not at risk and seeing cervical cancer as something that affects older people, perhaps. So there are additional barriers related to certain age groups.But I definitely think that making time for a screening appointment, juggling all the different millions of things that we have to do every day, is a really important barrier that something like a urine based test could help to overcome.Speaker A00:04:42.120 - 00:05:10.680Yeah, fair enough. So this was quite a big prospective study of over 1500 women carried out across the northwest of England.So women provided both regular speculum based cervical samples alongside urine sample too. And the main thing you were looking at here was the accuracy of the urine based HPV testing for cervical cancer.But just in case people aren't completely aware of all this, can you talk us through first why we're now only looking at HPV in these samples?Speaker B00:05:11.060 - 00:06:30.230Yeah. So, I mean, in 2019 in the UK, we changed from primary cytology based cervical screening to primary HPV based cervical screening.So that means that the sample taken from your cervix is tested first for hpv and only if that is HPV positive is it then looked at under the microscope. To see if there are changes in the cells.And this was based on a very large study done in the UK that showed that HPV testing is a much more sensitive test than cytology as the primary scre.And by that what we mean is it's much more likely not to miss abnormal cells than cytology, which is very effective when there is a large lesion, if you will, that can be sampled with a cervical swab, but not so good at picking up smaller lesions. And so there is the chance that cytology might miss an abnormality. But HPV is really good at showing that somebody is at risk.So we now do all primary screening by HPV testing. And of course this is what has opened up the opportunity for us to do different sample types.So a vaginal swab tested for HPV or a urine sample tested for hpv, you know, could also be an effective way of screening people to see if they are at high risk of cervical pre cancers.Speaker A00:06:30.390 - 00:06:37.830So talk us through the results. So how well did the urine based testing perform? So both in terms of how sensitive and specific the results were?Speaker B00:06:38.130 - 00:09:24.670Well, first of all, it's really important to say that this piece of work followed on from another piece of work that looked at a high risk population. And in that other piece of work we were able to show that it's really important how the urine sample is collected.So absolutely must be collected with a colipy device or a similar device that collects the first fraction of urine sampled. And that's important because the HPV isn't in the urine itself.The urine is flushing cervical mucus that is accumulated around the urethra into the sample. And so if you don't collect that very first flush of urine, then you're likely to miss the hpv.So on that background, using the COLIP device in this study and collecting that urine sample prior to the routine clinician obtained cervical sample, we were able to obtain two samples from each person that we were then able to test with the same HPV test. And we were able to compare absolutely how accurate the urine was compared to the matched cervical sample.And because we were using a general population, so this is anybody that's due cervical screening rather than a high risk population, we knew that we weren't going to see very many people who had CIN2 plus, which is the cervical pre cancer that we want to identify and treat.And actually what we were looking for here was to see, you know, what prevalence of HPV infections do we pick up using the two tests, you know, the urine test and the Cervical test and how well matched are they at terms of, you know, telling somebody that they're HPV...

Today, we’re speaking to Professor Richard Baker, emeritus Professor at the University of Leicester. Title of paper: Factors influencing confidence and trust in health professionals: a cross-sectional study of English general practices.Available at: https://doi.org/10.3399/BJGP.2025.0154A transactional model of general practice is being introduced to improve access that involves triage and increasing percentages of appointments with professionals other than GPs or that are not face-to-face. Using summary data about almost all English general practices in 2023-24 with 750 or more patients, the patient-reported levels of confidence and trust from the General Practice Patient Survey were associated with increased percentages of appointments that were with GPs or were face-to-face, and with higher continuity, after adjusting for other practice and patient factors. Confidence and trust was lower in practices with fewer appointments per year per patient, fewer patients having their needs met, greater deprivation, fewer patients of White ethnicity, and in practices located in London, as compared to other regions of England. Access to general practice needs improving, but the findings of this cross-sectional study suggest that preserving features of relationship-based care is also needed to maintain patients’ trust and confidence in health professionals.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.200 - 00:00:46.980Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for joining us here to listen to this podcast today.In today's episode, we're speaking to Professor Richard Baker, Emeritus professor at the University of Leicester. We're here to talk about the paper that he and his colleagues have recently published here in the bjjp.The paper is titled Factors Influencing Confidence and Trust in Healthcare A Cross Sectional Study of English General Practices. So, hi, Richard, thanks for joining me here today and it's nice to see you again.Just before we talk about this paper, I wonder if you could just talk to me about trust and why you think it's important in general practice interactions.Speaker B00:00:47.780 - 00:01:32.060Well, it's difficult to have a consultation with a patient if they don't trust you. I mean, it's just very basic, a very basic level, very simple level. But there's lots of evidence as well that trust is important.People who trust you are more likely to follow your advice. They're more likely to take the medication.They're more likely therefore, to come back and see you again, more likely to use services appropriately in the future. And there's some evidence that the outcomes are better if there's trust there. Trust obviously should be earned.You can't take it for granted, you've got to be trustable. But it's obviously very important for clinical practice and essentially always has been, hasn't it, really? Going back to the.The Greek doctors, trust was important then, just as it is now.Speaker A00:01:32.460 - 00:01:38.540And you mentioned about different outcomes. So what sort of outcomes do we know could be associated with trust?Speaker B00:01:39.180 - 00:02:07.990Just use of services is one example.So you can get people who, if they don't trust who they see, they go and see someone else and again, and so they overuse services and that waste resources.On the other hand, you may get people who just won't come, so they'll delay presenting with the problems because they don't trust the provider to get it right. Then they risk of poor outcomes as a consequence of that. So it's a whole mixture of things.Speaker A00:02:09.030 - 00:02:21.190So what were you trying to do in the study?So you wanted to look at trust and how it impacted on patient outcomes, or was it more about sort of the predictors and associations with trust, isn't it?Speaker B00:02:21.800 - 00:04:33.330Yes, I think we were conscious that general practice has gone through a lot of change.The big changes came about during the pandemic as to how general practice is delivered, how people have their appointments and things have sort of Reverted a bit to how they were, but only partially in terms of who you get to see face to face, appointment and so on. And we were asking the question, well, what has been the consequence of this?Should we be thinking about confidence and trust in association with these changes?I mean, the changes may have been absolutely essential because we just don't have the capacity in general practice to do everything that we would like to do for an increasingly multi morbid population. But what are the consequences? How do we need to respond? How do we need to respond?Questions I guess for follow on from Is there a link between confidence and trust and these changes in general practice changes?I think when we looked at this, we've sort of grouped them, we sort of imagined that there are two models of general practice which the relationships based care and the transactional model. Of course there aren't two models, it's all mixed up. But to simplify it, you call it two different things.And we've tried to categorize or explain what relationship based care might be, which has typified by high context continuity, face to face appointments with someone, you know, usually a gp, to get generalist medical care.And then the transactional model where you, you have a problem, you, you phone up or email or whatever it might be online and you get allocated or triaged to a particular professional who deals with that particular problem and then off you go on to something else. And, and it could be face to face, it could be over the phone, it could be all sorts of different health professionals.So there's two different ways, it's all mixed up. And every practice offices offers these two approaches in different degrees. It's just.So this arbitrary division that we've described and we're sort of interested in how we look at that, how is competent trust linked to that?Speaker A00:04:34.769 - 00:04:56.790This was a study looking at the general practice patient survey, which includes a question about whether patients felt that they had confidence and trust in their healthcare professionals. And. And then as we were discussing, you looked at some of the factors that might influence this trust.But I wonder if you could talk us through the findings. So in this survey, how many respondents felt that they trusted their healthcare professionals?Speaker B00:04:57.590 - 00:06:12.790This was, we were interested and the question was, did you have complete confidence in trust in the professional scene at your last appointment? And around about the figure was 64, 65% on average across all the practices.So this was all general practices, but the vast majority of 99% or something of all general practices in England, 6200 practices were roughly in the study. And this was 20, 23, 24 year. It was a simple cross sectional study for reasons the data weren't available for a longitudinal study, unfortunately.But so there are inevitably limitations on that.But I suppose, yes, you would say two thirds had full confidence in trust and others had partial confidence trust and others had absolutely no competence and trust in the professional they had last seen.Now, this relates to all types of health professionals seen, so it would include gps, but it would include the nurse you saw, the physiotherapist or the pharmacist or whatever. It would be the general practice based pharmacist, the people in the primary care team who, who consult with them see patients.Speaker A00:06:12.870 - 00:06:38.150And you talked earlier about these two different models of care, the relationship based model and the transactional model.And you know, you described that some of this might be a bit more mixed in practice, but did you find any associations between those different ways of working and how trust was or how much patients trusted their interactions with their last healthcare professional?Speaker B00:06:39.610 - 00:07:53.140There's a tendency among the findings for relationship based care to be associated with higher levels of competence and trust, relationship based care being typified by higher levels of continuity, more face to face appointments, more appointments with gps. And of those three things, continuity is perhaps the most powerful association and then points with GPS the next most powerful.And face to face being the third or least powerful element of that three.When you put all three together, I think it becomes quite a powerful message really saying patients do by and large tend to be more trusting, have more confidence in relationship based care.But that doesn't mean to say there are patients who don't want transactional care and have trust and confidence in it, they get it and when they want it. So it's not a simple either...

Today, we’re speaking to Dr Laura Jefferson, Senior Research Fellow based at the University of Manchester. We’re here to discuss her paper recently published here in the BJGP titled, ‘Understanding persistent GP turnover using work and personal characteristics: a retrospective observational study’.Title of paper: Understanding persistent GP turnover using work and personal characteristics: a retrospective observational studyDOI: https://doi.org/10.3399/BJGP.2025.0260GP turnover rates from national administrative datasets have previously been used to explore practice-level factors associated with turnover and its relationship to patient. outcomes. The individual and work characteristics associated with turnover is less well understood, with much research focusing on intentions to leave or smaller samples of GPs leaving practice. This study sought to fill this research gap, through analysis of a large dataset of GPs working experiences linked to turnover, understanding potential predictors that may offer solutions to the workforce crisis being faced in general practice. We find that GPs’ sense of autonomy, belonging and competence are significantly lower in practices with problems with persistent turnover and demonstrate how satisfaction with work characteristics such as working hours and experiences of strained relationships differs in practices with persistent turnover. TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.880 - 00:00:53.050Hello and welcome to BJGP Interviews. My name is Nada Khan and I'm one of the Associate editors of the bjgp. Thanks for joining us here to listen to this podcast today.In today's episode, we're speaking to Dr. Laura Jefferson, who is a senior research fellow based at the University of Manchester.We're here to discuss her paper, recently published here in the journal, titled Understanding Persistent GP Turnover Using Work and Personal A Retrospective Observational Study.So, hi, Laura, it's really nice to see you again and to talk about this research and I suppose I really just wanted to frame our discussion here today by saying that there's been a lot of talk recently about the retention crisis in UK general practice, but I wonder, could you just talk us through how big is the scale of the problem that we're dealing with here?Speaker B00:00:53.370 - 00:02:12.110Yeah, thank you. Yeah, well, thank you for inviting me to talk to you today as well.I think it's interesting, we hear a lot of discussion in the media and in our research evidence as well, recently about an increase in GP turnover. In the past sort of decade, there's been a gradual increase, so that's in terms of GPs leaving medicine, but also moving across practices.And it's good to see a kind of change in policy focus from historically, a lot of policies focused on recruitment of GPS. So, you know, we've had like, pledges to have 6,000 GPS that have not been met and it's often kind of criticized as filling a leaky bucket.So if we try and obviously pay a lot. So I think it's approximately half a million pounds to train a gp, but actually to replace the GP is really expensive as well.So it's about £300,000 to replace the GP.And so, yeah, so there's a positive focus to thinking about retention, but actually it's about how can we do that effectively and understanding that the sort of one size fits all approach doesn't necessarily work and that there's different gps with different needs.Speaker A00:02:12.590 - 00:02:36.830And this was a study where you were looking at the association between high practice turnover of GPs and GP job satisfaction. And what you did was you linked data from different general practice practices and GP workforce surveys.But the first thing I wanted to really look into was that you identified these high turnover practices. What exactly did this mean?Speaker B00:02:37.070 - 00:04:33.190Yeah, so there's been previous research that's done this before, so it's using. We're really fortunate in the UK that we've got really good workforce data compared to a lot of other countries.So we have longitudinal data going back a long way that we can use for research purposes to try and understand more about these trends.So colleagues of mine at Manchester have previously used this data from NHS Digital, which is now NHS England, linking with data on gps by General Practice, which is has got data on their kind of start and leave dates in a practice. And that allows us to track where gps are moving out of a practice and how long they've stayed there for.So they've previously looked at sort of persistent turnover as being categorized as a practice where they have consistently, for three years running, had a 10% turnover of GPS. So this is where it seems to be a more worrying turnover figure.I think it's expected that there's going to be some level of turnover and some level of turnover that might be a useful thing. But those kind of practices where you think, oh, what's going on there?And particularly then within our research, looking at what are the striking differences in those practices, both in terms of the sort of workplace characteristics that GPs are experiencing? So can we use that data to explore strategies that could be used to actually support gps in those practices?So trying to understand, really, what does it feel like for a GP in these practices with persistent turnover, so that then, hopefully, through this sort of research, is kind of like the first step in a puzzle to try and determine strategies to support them.Speaker A00:04:33.750 - 00:04:50.310Yeah, fair enough. And then thinking a bit more about what you found here.So you looked, as you said, at some of the characteristics of the GPs who worked in these high turnover practices, and you found some really interesting differences that related to gender, age and experience. So can you talk us through that?Speaker B00:04:50.390 - 00:06:45.570Yeah.So this was the first time that these large data sets have been used to look at GP characteristics that might not necessarily predict turnover, but might be associated with turnover.So difficult to make predictions using the approaches that we've used, but we were able to, within our analysis, adjust for things like age, experience, gender, looking at GP partners and salaried GPs to try and draw out, are there any differences? And we did find a gender difference. So women were more likely to be in practices with persistent high turnover.But because of the analytical approach that we've used, it's really difficult for us to unpick. What does that actually mean? Does that mean that are they driving turnover or do they actually become stuck in these practices?So there's a lot of research literature that suggests that women may be less mobile in the workplace for a number of societal reasons. So it could be that that's a factor explaining the gender difference that we found.But this is a really important first step for us to then develop the strateg thinking about what different groups need. Only included a smaller proportion of salaried GPs, so we weren't able to look so well at partners versus salaried.And also looking at ethnic diversity and variations, particularly important given that there's a large proportion of international medical graduates now as GP registrars.So this is a kind of first step and there's going to be future research, which we've been commissioned now to do this research in a larger sample of gps, looking at a longer time frame as well, which will be really nice to be able to look after. Covid.Speaker A00:06:45.890 - 00:07:02.130Brilliant. That sounds really exciting. And I think what's really interesting here is how satisfied GPs were with different aspects of their work.What did the gps rate as low satisfaction in their job role and how did this impact on turnover?Speaker B00:07:02.550 - 00:09:38.570Yeah, so what we did is we used a theoretical framework to guide our analysis.So within the Work Life Survey, there's a number of different kind of components that gps can rate in terms of their satisfaction with their working lives. But that would be quite a messy analysis.So to try and break this down, we used the ABC of Doctors Needs, which is a framework which talks about the importance of autonomy, belonging and competence for doctors to feel that they're happy and well within their work and that impacts on retention. So, yeah, so we looked at those components and within each of those we used questions from the survey that spoke to those theoretical domains.So, for example, autonomy looked at sort of, there was an item around freedom to choose the methods that they're working with.Also items around paperwork, variety of work and hours of work, belonging looked at particularly around sort of relationships and feeling connected to and valued in the workplace.There's questions in the survey about strained relationships at work and also about recognition, so feeling like they're valued for delivering a good job. And then the third domain that we created around...

This episode, we have a round table discussion with the editorial team of Sam Merriel, Tom Round and Nada Khan. This collection of the BJGP’s top 10 research most read and published in 2025 brings together high-profile primary care research and clinical innovation.And here are the top 10 most read papers of 2025:10Adoption of clinical pharmacist roles in primary care: longitudinal evidence from English general practicehttps://doi.org/10.3399/BJGP.2024.03209Factors affecting prostate cancer detection through asymptomatic prostate-specific antigen testing in primary care in England: evidence from the 2018 National Cancer Diagnosis Audithttps://doi.org/10.3399/BJGP.2024.03768Paramedic or GP consultations in primary care: prospective study comparing costs and outcomeshttps://doi.org/10.3399/BJGP.2024.04697What patients want from access to UK general practice: systematic reviewhttps://doi.org/10.3399/BJGP.2024.05826Technostress, technosuffering, and relational strain: a multi-method qualitative study of how remote and digital work affects staff in UK general practicehttps://doi.org/10.3399/BJGP.2024.03225Antidepressants and risk of postural hypotension: a self-controlled case series study in UK primary carehttps://doi.org/10.3399/BJGP.2024.04294Challenges to quality in contemporary, hybrid general practice a multi-site longitudinal case studyhttps://doi.org/10.3399/BJGP.2024.01843Low-dose amitriptyline for irritable bowel syndrome: a qualitative study of patients’ and GPs’ views and experienceshttps://doi.org/10.3399/BJGP.2024.03032Artificial intelligence for early detection of lung cancer in GPs’ clinical notes: a retrospective observational cohort studyhttps://doi.org/10.3399/BJGP.2023.04891Effectiveness of low-dose amitriptyline and mirtazapine in patients with insomnia disorder and sleep maintenance problems: a randomised, double-blind, placebo-controlled trial in general practice (DREAMING)https://doi.org/10.3399/BJGP.2024.0173TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.480 - 00:01:27.500Hello and welcome to the BJGP Top 10 podcast.So this is where we take a closer look at the most read research papers in the BJGP in 2025 and just have a discussion about what they mean for day to day general practice. I'm Nada Khan, one of the associate editors of the Journal.And in today's episode we'll be exploring some of the themes that really captured attention with the readership, I suppose. And we'll be talking about things like consultation compl complexity and workload pressures.Some work around diagnostic uncertainty and how to look, look after people with multimorbidity.And I think we're going to have a discussion a bit more, not just about what these papers found, but maybe a bit about why they resonated and maybe give a bit of editorial feedback around that. And because it's a conversation here between three clinicians as well.And I'll go around and introduce everyone in a minute, maybe a bit about what they add to the conversations we're already already having in practice and where the gaps still are. And I guess with that we'll be keeping it grounded in the messy reality of today's general practice as well.So I've introduced myself and I'm joined here by Tom Round and Sam Merrill, who are both also associate editors of the bjgp. But I'll go to Tom first. So, yeah, tell us a bit about who you are and how is your day going?Speaker B00:01:27.720 - 00:01:59.550Great, Nada. Thanks for having me.So, Dr. Tom Rand, I'm a GP in northeast London and an academic clinical lecturer at King's College, interested in early disease and cancer detection and also health inequality. So, yeah, pretty good. Like everyone, I've got a mild cold at the moment.I think exactly the same last year when we did this podcast, winter cold season. So I think we're all sort of feeling that a little bit in primary care with flus and other things and staff, you know, so otherwise good.Looking forward to having really interesting discussion about these papers which are really fascinating and give a real broad breadth of what we do in general practice.Speaker A00:02:00.420 - 00:02:07.940Great. And Sam, we'll go to you and you have some really exciting news in the background as well.So, yeah, tell us about who you are and what you're up to today.Speaker C00:02:08.180 - 00:02:31.770Thanks, Nad.I think, yeah, you're alluding to the fact I'm on Puppy alert because our new addition to the family in the winter is keeping us busy and making remote working a challenge. But we're getting through. But yeah, lovely to be with you guys. And I catch up and BJGP and wider podcast audience.So, yes, I'm a GP working in the Northwest of England and a clinical senior lecture at the University of Manchester.Speaker A00:02:32.650 - 00:04:28.830Brilliant.Okay, so let's get into the top 10 most read research and published papers of 2025 and I'm going to kick off with number 10 and number 8, just because they're on a sort of related topic. So number 10 is by Michael Anderson and colleagues. Michael's based in Manchester and at lse.And this paper looks at prescribing, quality in practices and the role of clinical pharmacists as. And I'll just point out that I'll put links to all the papers in the show notes as well.So this paper looks at the adoption of clinical pharmacist roles in English general practice and asks that question of does bringing pharmacists into the primary care workforce actually lead to improvements? Michael looked at this through a longitudinal approach.They used national practice level data from 2015 to 2019 and just looked at practices that didn't, didn't have a clinical pharmacist role. And it's really interesting, the results actually.So, not surprisingly, the proportion of practices with a clinical pharmacist increased from about 3% to over 20% over the course of the study. And the, the team found some really significant improvements across several prescribing indicators.So things like reductions in total medication costs, better opioid prescribing and prescribing for anxiety meds after pharmacists were implemented in pract, I guess, really it would be interesting to hear your thoughts, Sam and Tom, about what do you think really are the outcomes we want most from clinical pharmacists? And how do you think we should interpret these modest changes at scale?Because there's a lot else going on in terms of workforce that we need to think about in general practice, like access and continuity and not just meds optimization.Speaker C00:04:29.310 - 00:05:41.170I can talk from practice experience because our clinical pharmacist just left for Canada just in the last month or so. But yeah, it was really interesting, like having him part of the team.I think in a lot of ways he took a lot of burden off the gps in terms of meds monitoring, meds management, medication reviews. He builds a lot of continuity with a lot of patients because he was doing a lot of checking in.So in a lot of ways he was quite invaluable member of the team and we have sought a replacement since.At the same time, you know, there was some, some extra challenges in terms of workload and stuff, because obviously pharmacists have different training and the role of a clinical pharmacist in general practice is relatively new.So, you know, their approaches to prescribing and, you know, how close you stick to guidelines and how much you adapt for individual patient situations is slightly different. So. Yeah, but I think that was part of sort of feeling a way out with the role.But it's really noticeable when he's not around because it does affect how the workload flows and how the practice runs and how the patients, you know, interact with the practice. So, yeah, it's been really interesting at the local level.But, yeah, Michael's study also...

Today, we’re speaking to Dr Joy McFadzean,a GP in Swansea and Clinical Lecturer of Patient Safety based at Cardiff University. We’re here to talk about the paper she’s recently published here in the BJGP alongside her colleagues titled, ‘Critical illness in prisons: a multi-method analysis of reported healthcare safety incidents in England’.Title of paper: Critical illness in prisons: a multi-method analysis of reported healthcare safety incidents in EnglandAvailable at: https://doi.org/10.3399/BJGP.2025.0239Using a mixed-methods descriptive and framework analysis, this paper provides new insights into the complexity of care delivery in prisons. Results resonate with and strengthen the recommendations from recent investigations into prison healthcare by further developing an understanding of the complex intersecting factors contributing to safety incidents and quality issues in care delivery. The fundamental importance of good quality and adequately resourced primary care delivery in prisons has been highlighted. It also identifies system-wide interventions that are needed to improve care delivery, and which are likely to interest policy-makers and scrutiny bodies, commissioners and teams working in prisons to inform developments in strategic health needs assessments, workforce profiling, and training requirements for healthcare and prison teams.FundingThis study/project is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (PR-R20-0318-21001). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the manuscript or the decision to submit.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.560 - 00:01:10.200Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjgp. Welcome back to the first season of the BJGP podcast here in 2026.And we're starting off this season of the podcast with a chat with Dr. Joy McFadyn. Joy is a GP based in Swansea and clinical lecturer of Patient safety based at Cardiff University.We're here to talk about the paper she's recently published here in the BJGP alongside her colleagues. The paper is titled Critical Illness in Prisons A Multi Method Analysis of Reported Healthcare Safety Incidents in England.So, hi, Joy, it's really lovely to meet you and to talk about this research, but yeah, just taking a step back, I think it's fair to say that the prison population is an underserved and probably fairly under researched population as well.But you point out here in the paper that it's not only this, but that the prison population is actually at a much higher risk of early mortality as well. So can you talk us through this at all?Speaker B00:01:10.680 - 00:02:31.010Yeah, that's a really good point. So we know that people who reside in prison, known as prisoners, will have very high rates of physical and mental health needs.And as you say, there are concerns that they have rates of premature mortality, so they may die up to 20 years earlier than the rest of the population. But they are a population which isn't necessarily the area of focus.So even though we know the importance of supporting their healthcare as a public health concern, they are often underserved, they're quite vulnerable, and yet there hasn't been enough research to support them to have what we call equivalent health outcomes. So there are lots of definitions of what is considered to be equivalence of care for people in prisons.So the Royal College of General Practitioners Secure Environments Group, they have defined what equivalence of care is for people in prisons, thinking that they should have the same quality of care, the same level of staffing, the same resources as anyone who is residing in the community in order to get the same health outcome. And currently that is not being realised.Speaker A00:02:31.330 - 00:02:38.210And just as a background to all this work, how many of these early deaths do you think are preventable?Speaker B00:02:38.930 - 00:03:39.270So we carried out a study which was called the Avoidable Harm in Prison Study. So it was focusing very much on healthcare events where people were harmed or could have been harmed whilst they reside in prisons.So our focus is very much on these patient safety incidents, reports and incidents themselves, and ultimately the findings of the other space of the study. We haven't released yet they're still embargoed.But we were seeing within our sample of patient safety incident reports, events where prisoners were undertaking significant harm. So within our paper, we haven't seen any evidence of the deaths which could be considered to be avoidable.But our focus was very much on events where without urgent treatment, there was a high risk of death. And we considered many of those events to be avoidable.Speaker A00:03:39.590 - 00:04:10.690And I guess all this is tied into what you're aiming to do here in this research, which was to look at and characterize patient safety incidents in the prison population and find opportunities to improve care.So you used a really detailed approach here and looked at patient safety incidents reported in England and carefully examined and coded all of the incidents here. But I really want us to talk through what you found, what were the main sorts of incident type.And what I'm trying to get at is what really happened in these reports.Speaker B00:04:11.410 - 00:07:08.750Yeah, thank you. So we reviewed Originally up to 4,000 of those patient safety incident reports.And then when we focused specifically on those events where someone was at very high risk of death if they hadn't received treatment, we were looking at conditions suggestive of heart attacks, strokes, status epilepticus, diabetic ketoacidosis, for example.And what we saw is that most of the reports that were included for analysis, so about 100 of those reports, people in prison were not being able to access healthcare professionals when they needed to. So in prisons, people will have an assessment when they arrive to the prison, which is an assessment of their healthcare needs.They should also have access to nursing staff, GPS and allied healthcare professionals, as well as referrals to secondary care as needed. And what we were seeing is that when there are events where someone was critically unwell, they couldn't access the staffing when they required.So it's very much a nurse led service in the prisons. And even when there were prisoners who had collapsed, nursing staff could not access the prisoners. And that was for lots of different reasons.Some of it was related to poor communication, that there's quite a reliance on the use of radios in our reports.And so if people were trying to radio from one area of the prison to the healthcare teams, then there was too much radio traffic that their messages weren't getting through or they were using the wrong emergency codes. So actually the nursing staff weren't aware of the urgency of when they needed to get there.So there were lots of delays in actually having the healthcare teams arrive and assess the patients themselves.But also when a decision was made that someone needed to be conveyed to an emergency department, for example, due to difficulties with staffing levels, there weren't sufficient prison officer numbers to escort them from the prison to hospital. So there was significant delays. So what we could see in some of the events is that someone had collapsed.There was concern that this was suggestive of a stroke, they were dysphasic, they had facial palsy, they had tinnitus, headaches, et cetera. And nursing staff had assessed, said, no, they're unwell.Gps had said they need to be conveyed to the hospital and they weren't transferred until the following day. So those types of delays were very evident as well.So difficulty accessing the healthcare professionals in the first place and then a delay getting the correct treatment or management, even with conditions which are time critical.Speaker A00:07:09.630 - 00:07:29.500That all sounds really shocking, actually. But I wonder if we could just take a step back and, and could you describe to us what healthcare provision is like generally in prisons?You mentioned about a nurse led care system, but how easy is it to access other healthcare professionals like GPs in prisons generally?Speaker B00:07:30.700 - 00:11:02.620So I think there are two very different opinions in this.So we have the access to the patient safety incident reports, which is telling us that it's very difficult for them to access healthcare professionals as needed within the prisons that we looked at for the avoidable harm in prison study, for example, we were only focusing on prisons where health care was delivered on site and the...

Today, we’re speaking to Dr Rob Perry, who is a Gastroenterology Clinical Research Fellow based at Imperial College London.Title of paper: Evaluating the Role of Faecal Calprotectin in Older AdultsAvailable at: https://doi.org/10.3399/BJGP.2025.0169There is considerable uncertainty surrounding the use of FC as a diagnostic test in older adults, with varying suggestions in guidelines and a lack of data in the wider literature. This study investigates the performance of FC in older adults (≥50 years), compared to a younger cohort, with a view to guide its correct use in a primary care setting. These data suggest that FC is a sensitive test for IBD and organic gastrointestinal pathology in both groups. However, concerns remain over its PPV and specificity, particularly in older adults, and it should not be used if colorectal cancer is suspected.Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.880 - 00:00:49.180Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the bjgp. Thanks for taking the time today to listen to this podcast. Today we're speaking to Dr.Rob Perry, who is a gastroenterology Clinical Research Fellow based at Imperial College London. We're here to talk about the paper he's recently published here in the BJGP titled Evaluating the Role of Fecal Calprotectin in Older Adults.So thanks, Rob, for joining me here to talk about your work.And I guess I just really want to preface this by saying that a lot has changed in the last few years just in terms of testing for inflammatory bowel disease and bowel cancer in general practice. But I wonder if you could just talk us through this, some of the different guidelines and why you wanted to do this study.Speaker B00:00:49.660 - 00:02:24.450Oh, yes, thank you for having me.Firstly, and the rationale for the study is that, you know, consultations for gastrointestinal symptoms make up a large number of consultations in primary care. I think the figures around 10%.And whilst fecal cow protection is an increasingly well established test for differentiating between inflammatory bowel disease and functional or other gastrointestinal or non inflammatory gastrointestinal diseases, its role in older adults is far less well established.With varying guidelines for clinicians in primary care, the NICE guidelines make no specific mention, for example, of age, other than that calprotectin should not be used where age is considered a risk factor in the context of certain symptoms. For suspicion of cancer, the BSG guidelines on IBD use a cutoff of 40, above which they suggest calprotectin is not used.The something called the NICE York Fecal cow protectant care pathway suggests an age cut above 60, which is a NICE endorsed pathway. So there's some uncertainty there in the literature about which cutoff should be used for fecal cow protectin.And the reason any cutoff is suggested is because data has previously shown that calprotectin lacks sensitivity for diagnosing colorectal cancer.And as age is considered a risk factor for colorectal cancer, guidelines normally mandate earlier endoscopic evaluation of patients with GI symptoms in older age groups.Speaker A00:02:24.530 - 00:02:39.170And can you just talk us through briefly what you did here? So you looked at patients referred for a colonoscopy at one single centre, so at Imperial College Healthcare Trust.But just talk us through briefly who was included in the study and what were you looking at specifically?Speaker B00:02:40.380 - 00:04:04.090So looking at patients where calprotectin was being used for diagnostic purposes, so calprotectin is also, as you probably know, well established for monitoring patients with existing ibd, monitoring response to treatment for flares, et cetera. We were just looking at patients where it was being used for diagnostic purposes. So any patients with existing IBD were excluded from the study.And then, yes, as you said, anyone who had a calprotectin within a six month period back in 2021, who then subsequently within a one year period had a colonoscopy performed at Imperial, which is the local referral centre, that were included in the study. And we only looked at adult patients. We had a cohort of older adults which we used to cut 50 and above, and a younger cohort below that.We didn't look at pediatric cases, that was how we selected patients.And then we reviewed available electronic documentation to ascertain the diagnosis of the patient, looking at clinic betters etc, as well as looking at other tests that patients may have had performed when their symptoms are being evaluated. Fit testing, for example. We also looked at CRP and haemoglobin.By collecting that data, we were able to ascertain the diagnostic performance of chiroprotectin in the two respective cohorts. And also in comparison with some of the other clinical tests that I mentioned.Speaker A00:04:04.710 - 00:04:21.670Yeah.And as you point out, because these tests might be used in quite a varied fashion depending on patient age or presentation, I suppose it's important to kind of work out what the diagnostic capabilities of them are. And I think that's what this study really aimed to achieve. Really.Speaker B00:04:22.630 - 00:05:04.510Yes, exactly.So we were trying to look at how calprotectin performed in the older age group compared to the younger age group, and also looking at how its performance relative to fit testing in those two cohorts. We looked at the performance of calprotectin, the differentiating between inflammatory bowel disease and non organic GI pathology.And we also looked at its ability to differentiate between organic GI pathology more generally. So inflammatory bowel disease, colorectal cancer and other significant GI diagnoses and non organic pathology.Those two questions, which I think are important questions when considering patients presenting with GI symptoms in primary care.Speaker A00:05:05.710 - 00:05:14.190And just talk us through what you found here. And I think the results were really striking in terms of things were different according to age and maybe not surprisingly. But talk us through that.Speaker B00:05:15.550 - 00:07:19.810I think the key findings are firstly that calprotectin remains a sensitive test in both groups.So sensitivity when using a cutoff of 50 micrograms per gram, which is the nice advised cutoff for considering a positive calprotectin Test suggested by nice.There are other, you know, there is other data in the literature about altering the cutoff which calprotectin is considered positive, but 50 is the cut, you know, is one of the cut offs we looked at and is what is suggested by, in the NICE guidelines using that cutoff, you get sensitivities of over 90% for diagnosing IBD from non organic GI pathology in both age groups. What you see in the older age group is a significantly lower positive predictive value. So positive predictive value of only about 12%.And using that cutoff in the patients who had, again using that cutoff of 50 in the small number of patients who did have colorectal cancer, if you then did try to push up the threshold at which calprotectin is considered positive, as many guidelines do suggest, you would then start to, to miss cases of colorectal cancer, which just highlights one of the important messages of the paper and that is clearly documented in the NICE guidelines that calprotectin shouldn't be used as a biomarker for cancer and if cancer is suspected, patients should be referred on the appropriate urgently suspected cancer pathway. We also found that calprotectin did perform better than fit tests for diagnosing ibd.But, but there's also potentially some future work to be done in patients who may have had FIT testing because of concern over potential colorectal cancer.But in patients where FIT is negative, calprotectin may then have a role as a good rule out test in that group where you've already ruled out suspected cancer.So that's maybe an area for future work and maybe it just helps to allow us to think about how we may have a more kind of joined up pathway for evaluating patients with lower GI symptoms in primary care.Speaker A00:07:20.930 - 00:07:30.290And I know some local guidelines might suggest faecal calprotectin alongside FIT in younger age groups. What are your thoughts about this based on the results of this work?Speaker B00:07:30.930 - 00:08:26.550I think it depends what symptoms the patient's presenting with.I think if patients present with symptoms that according to the NICE guideline that's potentially suggestive of colorectal cancer, then obviously they should be evaluated, you know, appropriately with FIT testing or, you know, onward referral. And I think, you know, I think calprotectin clearly has a role in younger patients for differentiating between non organic GI diseases and ibd.I think in older patients it's, you...

Today, we’re speaking to Flo Martin, an honorary research associate at the University of Bristol.Title of paper: First trimester antidepressant use and miscarriage: a comprehensive analysis in the Clinical Practice Research Datalink GOLDAvailable at: https://doi.org/10.3399/BJGP.2025.0092Antidepressant use during pregnancy is rising, with concerns from pregnant women that these medications may increase the risk of miscarriage if taken prenatally. Evidence is conflicting so we used the Clinical Practice Research Datalink, a large repository of UK-based primary care data, and a range of methods to investigate antidepressant use during trimester one and risk of miscarriage.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.240 - 00:00:52.800Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors at the bjgp. Thanks for taking the time today to listen to this podcast.In today's episode, we're speaking to Dr. Flo Martin, an honorary research associate at the University of Bristol.We're here to look at the paper she's recently published here in the BJGP titled First Trimester Antidepressant Use and Miscarriage A Comprehensive Analysis in the Clinical Practice Research Data Link. Gold. So, hi, Flo, it's great to meet you and talk about this research.And I think this paper touches on an area that clinicians and women often approach with a bit of uncertainty, just in terms of prescribing safety, really, in pregnancy in general. But can you talk us through what we know already about prescribing for antidepressants and risk in pregnancy, just to frame what you've done here?Speaker B00:00:53.280 - 00:02:22.860Yeah, absolutely.So we actually did some work a couple of years ago doing a systematic review of the literature in this space, so looking at antidepressant use during pregnancy and the risk of miscarriage. And the work spanned the last kind of 30 years.And what we found was a 30% increase in risk of miscarriage following antidepressant use during pregnancy. And this was obviously kind of alarming to see this increase in risk. But the kind of key takeaway from the paper was not actually this finding.It was mostly the kind of variation in the literature that we observed when answering this question.We kind of were very cautious about interpreting this 30% increase in risk as a kind of true causal effect because we had observed these other things that might be driving the estimate kind of upwards and might not necessarily show the true effect that was happening in this population. So that was kind of the environment that we were existing in before we started the study.And it really informed the way that we wanted to do this study.So we thought it was really important to try and understand that baseline risk in both unexposed and exposed pregnancies, so that whatever we observed was contextualized against what the underlying risk was among those who hadn't been prescribed antidepressants.Speaker A00:02:23.500 - 00:02:58.120Yeah, fair enough.So this is a large analysis of the clinical practice research data link, and you looked at pregnancies between 1996 and 2016 and then followed up women who had been prescribed or not antidepressants and risk of miscarriage.And I think if people are specifically interested in how you did this, they can go back to the paper and look at some of the different methods you used. But I wanted to focus really on what you found here.And I think the first thing to point out is that it wasn't uncommon for women to have a prescription for an antidepressant in that first trimester of pregnancy. So talk us through that.Speaker B00:02:58.440 - 00:03:43.270Yeah, exactly. So I think we. We kind of report about 7% of the pregnancies in our study that had been prescribed antidepressants.And I think, as you say, this is, you know, potentially higher than what you would expect. I think there are kind of multiple things driving this.If we look outside of pregnancy and kind of zoom out and look at the prescribing rates of antidepressants in both men and women, we can see it's going up, you know, between the 1990s and the late sort of 20 teens. And.And I think, yeah, people will be maybe surprised to see, but it's very, you know, on trend with what we're seeing outside of pregnancy and then looking.Speaker A00:03:43.270 - 00:03:45.950Specifically at the risk of miscarriage here. What did you find?Speaker B00:03:47.150 - 00:04:59.060Yeah, so when we applied our kind of primary analysis where we were looking at pregnancies who had been prescribed antidepressants in trimester one, and comparing them to pregnancies who were not prescribed antidepressants in trimester one, we found a very, very small increase in relative risk. So I think we found about 4% increase in risk of miscarriage among the prescribed group than. Than the non prescribed.And what this translated to in terms of that baseline risk, we observed 13.1% of those not prescribed antidepressants, they experienced a miscarriage, and this increased to 13.6% among those who were prescribed. So I think that really puts into perspective when we talk about increases in risk, this is an incredibly modest one, an increase all the same.And it's important to not kind of trivialize that increase in risk.But I think it's also incredibly reassuring that when we kind of really place it within what the underlying risk is had someone not taken antidepressants, it's very, very small.Speaker A00:04:59.620 - 00:05:00.100Yeah.Speaker B00:05:00.180 - 00:06:32.630Yeah. I think this is a really important piece of the puzzle for risk communication.Being able to show relative increases in risk, which are incredibly useful alongside what that actually means in terms of the percentage, the proportion of people that experience an outcome, because it just reminds people that, you know, clinicians and patients alike, that this isn't something that you have complete control over. This isn't purely your behavior driven. It's not.So I think that can be really kind of reassuring for Individuals who feel that kind of burden of risk mitigation.We see it in Heather James's paper in BJDP last year, a beautiful qualitative study speaking to women who had experienced antidepressant use during pregnancy and talking through their decision making process and their fears and concerns.And a couple of the participants who were involved in that study cited miscarriage as one of a specific, one of their specific concerns when taking antidepressants during pregnancy and actually discontinued their antidepressants because they were worried about miscarriage.So these concerns are having direct impacts on individuals and their behaviour and, you know, their potential management of their depression and anxiety.Speaker A00:06:33.190 - 00:06:44.230So, yeah, I think it's important to balance these risks against the mental health risks for the woman who's taking or needing antidepressants. And I think, as you point out, that was demonstrated beautifully in that qualitative research as well.Speaker B00:06:44.310 - 00:06:45.030Definitely.Speaker A00:06:45.670 - 00:06:59.990I wanted to sort of just draw back to how we can use these results in practice, really.And I wonder what your thoughts are about how clinicians and women should use these findings to inform their decisions around using antidepressants in pregnancy.Speaker B00:07:00.950 - 00:08:34.090Absolutely, yeah. So while I'm hoping that these results, as a non clinician myself, I'm hoping that these results can be informative for decision making.This isn't the only piece of evidence out there and it shouldn't be considered as the kind of gold standard, because it isn't.We utilize a lot of methods and comparators, we use large data, we've thought carefully about all of the things that might be driving these effects and discuss them at length. But it's not the only piece of the puzzle.I'm hoping that these results can help to kind of illuminate what the truth might be and the factors that might be influencing our perception of the results.So understanding data, understanding methods that will make us kind of rightly critical and cautious and understanding of what these types of studies in general mean, and also the fact that we've tried to kind of get at this baseline risk where we can report these proportions in both prescribed and non prescribed pregnancies should really allow for easy access to what these results mean. Rather than kind of speaking generally about relative increases, we can speak objectively about proportions in these data in these patients.Speaker A00:08:35.130 - 00:09:09.040Yeah, and absolutely, as you mentioned, it's part of the picture in terms of the decision making process that doctors and women...

Today, we’re speaking to Claire Mann, a Research Fellow who is based at the University of Warwick, and Sarah Hillman, who is a GP and Clinical Associate Professor based at the University of Birmingham.Title of paper: Accessing Equitable Menopause Care in the Contemporary NHS – Women’s ExperiencesAvailable at: https://doi.org/10.3399/BJGP.2024.0781Menopause awareness has increased in recent years, as well as HRT use, however, this has not been experienced equally. Cultural influences such as stigma, preferences for non-medical approaches, perceptions of ailments appropriate for healthcare, lack of representation, work against women seeking help. GPs should not assume all women who would benefit from HRT will advocate for it. They ought to initiate discussions about potential HRT, as well as other approaches, with all presenting women who may benefit.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.240 - 00:01:12.020Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the bjgp. Thanks for taking the time today to listen to this podcast.In today's episode, we're talking to Claire Mann, a research fellow who's based at the University of Warwick, and Sarah Hillman, who is a GP and Clinical Associate professor based at the University of Birmingham.We're here to discuss the recent paper published here in the BJGP titled Accessing Equitable Menopause Care in the Contemporary NHS Women's Experiences. Thanks, Claire and Sarah, for joining me here today to talk about this work.This study focuses particularly on the women's experience of menopause and accessing general practice and primary care. But I'll point out just before we begin that you've also published a linked paper looking at the clinician perspective.So anyone who's interested in that angle should look up your other paper. But back to this one. Sarah, I wonder if I could start with you first.I wonder if you could just talk us through the focus of the paper here and the kind of disparities that different women might face in accessing menopause care in the UK.Speaker B00:01:13.620 - 00:02:57.750Essentially, this work came about because in 2020, we published a piece of work in the BJGP that looked at prescribing a practice level of hrt.And what we found was that actually, if you were a patient at one of the most deprived practices in England, you were about a third less likely to be prescribed HRT than if you were in the most affluent. What we didn't have at that point in time was data at an individual level, just at a practice level.But it was important that work was done because that really pushed that forwards. But what we didn't understand was what was going on underneath that. So.So we asked the nihr, we wrote a grant for something called Research for Patient Benefit and said, look, we want to explore exactly why there is this disparity, because our feeling as researchers was that it wasn't straightforward and that there was a lot going on, both from the woman's perspective and the healthcare professional's perspective. And we really wanted to know exactly how that was all adding up to this gap in prescribing.What we did was we spoke to 40 women, but we were incredibly mindful that we wanted to speak to women that were less likely on paper to be prescribed hrt. So we tried to speak to women that were from more socially economically deprived areas and also black and South Asian women.So this project really was. Was underlying that. That gap.Speaker A00:02:57.910 - 00:03:31.880Yeah.And I guess, as you said, based on that previous research, you really wanted to get this deeper understanding of what was shaping menopause and HRT management and prescribing patterns.And I think just to sort of move on to what you found, really, I thought that one of the initial things that really stood out to me was the women that you spoke to talked about the menopause and how menopause care has changed over generations and how that impacts how women seek help. And I wonder if you could just start by talking us through this and what the women you spoke to told you.Speaker C00:03:31.880 - 00:05:16.160It's a really interesting study because obviously the time is right to be talking about menopause. It's going through this phenomenal change.And a lot of the women that we spoke to reflected on how that change had impacted their lives and how different their experiences might have been from the. The previous generation. A lot of women talked about when it came to menopause, they wanted to know about their mum and their mum's experiences.That's often a first port of call.But actually what a lot, particularly of the black and Asian women were telling us was that they were experiencing a different life to their own mum, that there were different pressures now, particularly in terms of being career driven, juggling intergenerational family and feeling the pressure of modern life, whilst also trying to manage their own experiences.So the current generation really are quite unique in as far as they've got a whole load of challenges and a whole load of stress that perhaps generations before them haven't had.So when they're having conversations in the family, it's a little bit mismatched because Mum might be saying, well, that's not what my experience was like.But the younger generation is perhaps thinking, well, yeah, because mom didn't, perhaps didn't work full time or, you know, didn't exist in the Western world in the same way as we do now.So it, I think that comes to play for a lot of women, particularly around career development and the fact that so many women in their middle lives now are still working full time and juggling family responsibilities, and that presents an additional stress to then also prioritizing your own health. And that's something that women found difficult to do amongst all those pressures as well, I think, was something they told us.Speaker A00:05:16.810 - 00:05:25.210Yeah. And in some communities it seemed as though there's still quite a lot of stigma around discussing the menopause openly. What did they talk about here?Speaker C00:05:25.610 - 00:06:46.450Yeah, I think obviously menopause is a hot topic and it's being spoken about in lots of ways, but that doesn't mean it's not still taboo for lots of women.Many of the women that we spoke to still hadn't had those conversations within their families because it was still something that was considered perhaps shameful and that they were expected to just deal with. Some of the black women spoke about the stoicism and being expected to be brave and have a high pain threshold.And some of the Asian women spoke about families and fertility and the patriarchy and the way that things are perceived and said that for them, actually having those menopause conversations within their homes was not as easy as it might be perceived. And so having that peer support from within the family, within the communities hasn't developed as strongly yet.It is starting to come through so that women are enabling each other with their own experiences. And where that does happen, it's really powerful.I think the women told us that, you know, peer support is really valuable, family support is really valuable, but it is still a topic that women feel stigmatized and embarrassed sometimes to talk about, particularly if it's not something that they've been open to discussing as they've been brought up through their, through their families.Speaker A00:06:47.180 - 00:07:11.340Yeah, it's really interesting because when we think about maybe the kind of information sources that women might have, so family or community or peer support would really play into that.And I wonder if they talked about that tension from how menopause or seeking help for the menopause might be perceived in the community and how that affected their help seeking behavior to their gps at all.Speaker B00:07:11.900 - 00:09:02.730So I think, I think that's exactly right.Women spoke about how not only how menopause was, as Claire said, talked about or not talked about in their own communities, but actually how any information around menopause in this country, how often they felt they didn't feel represented.And actually if they didn't feel represented, that might be through what was said or an image of what a woman going through menopause might look like or on an advertisement, actually. They just didn't feel a connection there. And therefore they felt, well, this isn't about me.And that was a barrier really for them not going forward to get help.But really interestingly, lots of women spoke about the fact that actually when they'd got to a stage when they felt that they did need help, some of them considered how they might be in sometimes racially stereotyped during that consultation.That was something that for me as a researcher, I thought, crikey, the fact that women had actually...

Today, we’re speaking to Dr Luisa Pettigrew, a GP and Research Fellow at the London School of Hygiene and Tropical Medicine and Senior Policy Fellow at the Health Foundation.Title of paper: Counting GPs: A comparative repeat cross-sectional analysis of NHS general practitionersAvailable at: https://doi.org/10.3399/BJGP.2024.0833There have been successive Government promises to increase GP numbers. However, the numbers of GPs in NHS general practice depend upon how GPs are defined and how data are analysed. This paper provides a comprehensive picture of trends in GP capacity in English NHS general practice between 2015 and 2024. It shows that the number of fully qualified GPs working in NHS general practice is not keeping pace with population growth and there is increasing variation in the number of patients per GP between practices. We offer research and policy recommendations to improve the consistency and clarity of reporting GP workforce statistics.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.040 - 00:01:04.810Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the Journal. Thanks for taking the time today to listen to this podcast.In today's episode, we're speaking to Dr. Louisa Pettigrew, who is a GP and research fellow at the London School of Hygiene and Tropical Medicine.Louisa is also a Senior Policy Fellow at the Health foundation and we're here today to talk about the paper that she's recently published here in the bjgp. The paper is titled Counting A Comparative Repeat Cross Sectional analysis of NHS GPs.So, hi, Louisa, and thanks for joining me here today to talk about your work. And I guess just to set things out, it is really important to know how many gps there are working.But I wonder if you could just talk us through what we already know about this. We know that there have been successive government policies and promises to increase the number of gps.There are, as we know, different ways that gps could be counted.Speaker B00:01:05.530 - 00:02:37.470So, yeah, as you rightly point out, there's been recurrent governance promises to increase GP numbers.Not just our current Labour government, but the previous Conservative government too, and previous governments too, because they realize that, you know, having access to GP is important for the public and there's a shortage, a perceived shortage of them.So the issue that we notice that there's different ways to count GPs who are working NHS General practice, and therefore depending on how you choose to count them, then that affects the trends and it affects your numbers.So you can count a GP by headcount, whether they're working in NHS general practice or not, and you can count them by full time equivalent, so the actual reported numbers of working hours. You can also consider GPs to be fully qualified GPs alone, or you could include GPs who are fully qualified, plus what is categorized as GP trainees.Now, that category includes GP trainees, but it also includes foundation year one and two doctors and any other sort of junior doctor that might be in general practice. And the other dimension to how you count gps is whether you take population growth into population size.So in the UK, over the past, sort of between 2015 and 2024, which was a period of analysis of our study, there was about 12% increase in population size in England. So once you take population growth into account, that again, changes your trends and your current figures.Speaker A00:02:38.510 - 00:02:46.830And in this paper you used a few different ways to calculate the number of gps. But just talk us through briefly the data sets that you used here to look at that.Speaker B00:02:46.990 - 00:03:45.590So we use the nhs, England's GP workforce data set that provides both national figures and practice level figures.So we use the national figures to look at the overall trends and then we looked at practice level figures to disaggregate and look at sort of the range, the median and the 95th and 5th percentile of patients per GP across practices in England. We also used the number of patients registered at jail practice to get our total number of patients, your denominator from the nhs.But we also compared this to Office of National Statistics, Office for national statistics ONS figures of mid year population estimates between 2017 and 2023 to again compare how you know what your population is changes the number of patients per GP or gps per capita. You can calculate it both ways and.Speaker A00:03:45.590 - 00:03:57.920I think just setting that out shows us why this is actually a really complicated area.So there's lots of different ways to define a GP and how they're working, but there's also lots of different sources you can look to to count a GP as well.Speaker B00:03:58.880 - 00:04:21.140Correct. And, you know, there's, there's nuance to this.And the risk is that if we don't consistently count them and report them in the same way, then you end up having different figures and people end up speaking at cross purposes and people can pick and choose which figures to use depending on what's more convenient in terms of the story that one wants to tell.Speaker A00:04:21.940 - 00:04:27.980Fair enough. Okay, so let's move on to what you found. So what were the numbers of total GPS if we were just doing a.Speaker B00:04:27.980 - 00:06:05.730Headcount between 2015 and 2024? So we took quarterly data over that period and we saw that there was.If you take headcount, so this is the absolute best case scenario, you take headcount and you include trainees, there was an 18% increase, so it rose from 41,193 to 48,758. That's raw number of GPs in NHS general practice. A separate question is GP's not in NHS general practice? But that's a different study, not this one.But then if you consider working hours so full time equivalent and you exclude GP trainees on the basis that they are not equivalent to a GP because they might not be delivering the same amount of care, foundation union doctors may not choose to specialise in general practice. So therefore, arguably shouldn't be included in the overall numbers. So full time equivalent and no trainee, what we found is actually a 5% reduction.So from 29,364 down to 27,966 between September 2015 and September 2024.If then you take into account population growth and using NHS registered patients rather than ONS figures, what we actually see is only a 6% rise in the headcount plus trainees. So that's 6% rise versus an 18% rise. That's once you've taken population growth into account.And when you actually take in population growth into account and consider true sort of working figures, which are full time equivalents without trainees, there's actually a 5% reduction in the number of GPS per capita. Yeah.Speaker A00:06:05.730 - 00:06:16.030And I also wanted to touch about the range of patient to GP ratios across the country, because what you found here suggested that there's actually a big range between these ratios across England as well.Speaker B00:06:16.510 - 00:06:55.010Yeah, that's right. So that was the next part of the analysis where we looked at practice level data.So what we saw is that between the period of September 15 and September 2024, the gap, or the difference between, say, the 5% practice of the least number of patients per GP and the 95th percentile, practices with the greatest number of patients per GP, that increased. So there's a big difference.So, and that's principally driven because the gap has increased, because those at higher end, those with more patients per capita, has increased that faster rate than those with less patients per capita.Speaker A00:06:55.490 - 00:07:01.250And what does that mean on the ground for these practices in terms of the ratio of patients to GPs?Speaker B00:07:01.970 - 00:07:49.290Well, the thing is, I guess we don't. We don't know the reason for this. So our study didn't examine the reasons for this. You might speculate there might be a variety of reasons.So practices may have employment shortages, they might be in areas that are struggling to recruit, they may have made active decisions not to recruit for financial reasons, they may have less gps, but actually may have many other additional roles.So other direct patient care roles, pharmacists, social prescribers, physios and so on, and therefore compensating their GP shortage, the relative GP shortage with other roles. But again, that was beyond the study and that's only, you know, what we can infer based on what's going on in just now.Speaker A00:07:49.930 - 00:08:10.920Yeah, and I think this study is really interesting because it's kind of based around how all these things are defined. And you point out in the paper that depending on how you define a GP, there could have been a rise of 18% of GP

Today, we’re speaking to Jadine Scragg, a researcher based at the University of Oxford, and Sabrina Keating about their recent paper published here in the BJGP.Title of paper: GPs’ perspectives on GLP-1RAs for obesity management: a qualitative study in EnglandAvailable at: https://doi.org/10.3399/BJGP.2025.0065General practitioners (GPs) play a central role in managing obesity yet face significant challenges due to limited treatment options and resource constraints. GLP-1RAs are emerging as a promising treatment for obesity but access in primary care is limited. This study provides new insights into GPs’ perspectives on the integration of GLP-1RAs into primary care, highlighting concerns around resource limitations, health equity, and misuse of the medications.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.200 - 00:01:00.730Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjgp. Thanks for taking the time today to listen to this podcast.Today we're speaking to Judine Scragg, a researcher based at the University Oxford, and Sabrina Keating, a DPHIL student who's also based at the University of Oxford within the Nuffield Department of Primary Care Health Sciences.We're here to talk about their recent paper, published here in the BJJP, titled GP's Perspectives on GLP1 Receptor Agonists for Obesity Management A Qualitative Study in England. So, hi, Judine and Sabrina, it's great to meet you both for this chat.I guess the first thing to say is that this work is really topical at the moment, especially given current plans to increase the rollout of GLP1 receptor agonists into the community. But, Judine, I'll come to you first and I wonder if you could just tell us a bit more about what you wanted to do in this research and why.Speaker B00:01:01.510 - 00:02:25.330Yeah, absolutely. So, for a long time, as you've said, the GLP1s have been very topical, both in clinical groups and with patients as well.So I'm first and foremost, I'm a weight management researcher and I've done work in populations with people living with type 2 diabetes and polycystic ovary syndrome. And within those populations, one of the things they've constantly asked about is about GLP1s, when do I qualify? When do I get it around?And similarly with the gps GP groups as well, there's been a lot of questions, there's lots of media about, you know, both good and bad about GLPs and outlining different people's thought processes and are they good? Are they bad?So what we sought to do with this was to sort of more robustly work out what it is GPs actually feel about the perceived integration of the GLP1s into primary care to very kind of firmly focus on GP specifically.And this ended up coming at a really timely point, as midway through the study, the NICE guidance was brought out on outlining the plans for how tirepatide would be rolled out. So it was a really timely piece to find out exactly what they were thinking and feeling about how this may impact them and their patients.So that's really what we set out to do.Speaker A00:02:26.200 - 00:02:55.660Great.And this was a qualitative interview study of 25 GPs across England working across different roles, and they all had different experience in weight management services. But I really Just wanted to come on to what you found here.And let's start with an area that's quite a common issue right now, and I certainly don't seem to go a day without a patient asking me about whether they can get a weight loss injection. But what did gps think about navigating these patient requests when they. When they get them?Speaker C00:02:56.140 - 00:03:56.260Yeah. So at kind of the moment we were conducting interviews, that was definitely a real source of sort of frustration and difficulty.There were quite a few patients presenting, asking for GLP1s, the majority of whom were ineligible often, or would only be eligible through kind of this longer, more drawn out process of accessing specialist care, which in many of the regions just did not exist or was going to take kind of years and years. So it was not necessarily an amazing option.This kind of left the gps we spoke to in quite an uncomfortable position where they kind of had to play the role of gatekeeper, really manage those expectations and potentially kind of have that compromising sort of interaction with their patients. So certainly the gps that we spoke to had some frustrations associated with that.Speaker A00:03:56.820 - 00:04:03.620Yeah, absolutely. And I suppose it's a little bit about how to manage those requests. So did the gps talk about that at all?Speaker C00:04:04.100 - 00:04:31.440Yeah, there were some different strategies that we heard about. I would say the primary one was just around identifying other options that would be available.That was more difficult in some cases where patients had already exhausted those options and were feeling quite frustrated.One of the other strategies that we heard about was testing patients for type 2 diabetes to try to identify whether maybe there was another avenue that they could kind of come in through.Speaker A00:04:31.840 - 00:04:47.040And did they talk at all about private prescribing or. We might come on to this a bit later. But did any of the gps talk about suggesting or dealing with patient requests for private prescriptions?Because I think that's quite a big industry and a growing industry at the moment as well.Speaker C00:04:47.360 - 00:05:42.850Yes, certainly our sample were very much aware of this going on and it had been kind of entering the remit of their practice, specifically kind of asking for prescriptions to be carried over into NHS care, which most of the time the answer was a pretty concrete and clear no on.So that could also be quite disappointing, particularly for patients who had come in through other international health systems who are then like, oh, I thought I would surely be able to get this on the nhs. And, yeah, a lot of the services didn't have, like, a great answer or kind of protocol to responding to those requests for private prescription.So there was also kind of the frustration of okay.This is taking up quite a lot of our time, quite a lot of our effort that could be put towards other things, especially at a time when we're so overstretched.Speaker A00:05:43.810 - 00:06:08.040And I think that leads on to the next thing I wanted to talk about.And I think that, as you say, one of the big concerns for GPs, especially given the increasing effort to provide GLP1 agonists to a wider community population, is how we're going to fit this in alongside all the other things that we're doing. So what else did the GP say about this and about the different resource limitations in general practice?Speaker B00:06:08.760 - 00:06:09.320Yeah.Speaker C00:06:09.400 - 00:07:15.450So I think many had an awareness that in kind of an ideal world, this made a lot of sense to be carrying out in primary care.A GP has that kind of connection, ideally to their patients, and is able to see kind of the broader context of where and how they live, who they are as an individual. But within that, there was an awareness that that was going to be exceedingly difficult given the resource limitations of the time.So a few of the gps we spoke to were essentially just like, we don't know how this is going to happen. This needs to stay in secondary care. It's just not kind of a viable model.Others were really worried that some of the components that should be integral to GLP1 delivery, like wraparound care, behavioral and psychological support, were certainly not going to be easy to provide within primary care. And there was a real discomfort of this is just simply not how the medications are or should be used.Speaker A00:07:16.570 - 00:07:48.870Yeah, I guess that goes back to How Current Tier 3 weight management services are provided or were provided, perhaps, in the nhs.And the fact that you're right, there's a bit of a wraparound system around it, and certainly GLP1 agonists would only have typically been prescribed in those services alongside, as you say, all of the different weight management services. So that's quite a hefty burden for a GP or practice to pick up.Judine, I don't know if you wanted to comment on that, given your background in weight management research as well.Speaker B00:07:49.590 - 00:09:14.320Yeah, I mean, I think, as Sabrina said, there's definitely concerns, but I think as well, there's definitely some very strong themes of these GLP1 drugs coming in as a very helpful tool as well, in a few different ways.So, for example, I think one of the gps that we spoke to voiced concerns about how sometimes it's quite tricky for people to navigate the best way to support themselves, to lose weight and to navigate

Today, we’re speaking to Dr Steph Stockwell, a senior analyst based at RAND Europe.Title of paper: Evolution of the general practice receptionist role and online services: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2024.0677The introduction of online systems and services into general practice and the impact on general practice staff has been considered from a clinician perspective, but comparatively little is known about how these introductions have affected the receptionist role. This study highlights that the use of online services is leading to an evolution of the general practice receptionist role. The role is becoming increasingly complex as practices use multiple online systems, which impacts demand management and navigation aspects of the role. Online systems have variable consequences on workload for receptionists, which has potential implications for workflow, consistency of task completion, job satisfaction, and retention and recruitment of these key staff members.This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.320 - 00:00:53.350Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the bjgp. Thanks for listening to this podcast today.In today's episode, we're speaking to Dr. Steph Stockwell, a senior analyst based at RAND Europe.We're here to discuss the paper she's published here in the BJGP titled Evolution of the General Practice Receptionist Role and Online Services A Qualitative Study.So, hi, Steph, it's great to meet and talk about this work and one of the reasons I really wanted to talk about this is that I think it's timely work, given that we know there's an increasing emphasis just in general practice on triage and also the multidisciplinary team. You talk in the introduction of this paper just about the role of receptionists, which has been evolving and changing in recent years.So just talk us through that a bit.Speaker B00:00:53.720 - 00:02:09.550Yeah. So this work came about because we were doing some work for the wider de facto study, which was a.An observational, mixed methods study that involved delete reviews, some surveys, ethnographic case studies and some interviews.And it was whilst I was doing some of the ethnographic case study work that we spent a lot of time around reception staff because they were the ones who were doing most of the digital facilitation, which is the phenomena that we were. Were looking at. It was whilst doing these observations that the idea for this, this paper came to me, as, you know, often the.The first point of call for, for patients making contact with general practice and they're really crucial for helping to manage that demand and facilitating patient access to care.But during these observations, I noticed how the perception of what a receptionist did, particularly among patients and the public, was a little bit outdated and the array of technologies and platforms that they were having to manage and, and help patients use as well, was really sort of the stereotype of answering telephone calls.So, yeah, the rationale for this work sort of came about on the back of that and it made me want to look back at some of the work that we did for the De facto study and to see what sort of impact the online services had on the role of GP receptionists.Speaker A00:02:10.030 - 00:02:50.390Yeah. So you wanted to look, as you mentioned, just at the impact of online services on sort of the evolving role of receptionists.And as you mentioned, you took quite an interesting and varied approach here.So you did the ethnographic work that you mentioned, but you also did interviews with patients and staff and practices and the ethnographic work was really interesting. So you were actually sitting in eight different practices and observing what receptionists were doing.But I want to really focus on what you found here and I think the first thing to talk about is that the receptionists had a really different and varied role between those different practices and even within the practice itself. So talk us through that.Speaker B00:02:51.170 - 00:03:43.630Yeah.So speaking to a couple of receptionists who'd been in the role sort of a longer time, they were reflecting in their interviews about how the role itself, from their point of view, having been in it for such a long period of time, has changed. Previously they would do sort of fewer and more repetitive type jobs, but now it's just so much more varied.That's just one person within their role over a period of time.But then we were noticing that receptionists within one practice and between the different practices, we went into what was conceptualised as a receptionist.What the receptionist role looks like was very different and it was impacted by whether the practices had specific administrators, so people like reception clerks or IT officers, the number of different receptionists that were available and working on. On shift, and also the confidence and competence of each specific receptionist themselves.Speaker A00:03:43.950 - 00:04:02.830Yeah, it's interesting you talk about experience and I think that probably a lot of people who work in general practice might reflect on that.But talk us through what you found in terms of the differing experience that receptionists had, just in terms of how comfortable they felt with the varied role or changing role. Really.Speaker B00:04:03.310 - 00:04:55.060Yeah. So some staff who were sort of newer to the role, it's all. They're sort of known. We had some cases of.Because there was sort of a lack of training and support around some of these newer bits of the role in a formal sense. There was a lot of support happening from receptionist to receptionists and sort of learning on the job types of things.But it would mean that for newer members of staff who are learning on the job, they might be shown something by one person and then shown how to do the same task, but in a slightly different way by another person.And then for that new member of staff, that could be quite disorientating, quite nerve wracking, because then they didn't really know which was the right way to do it and which way they should be doing it. So, yeah, because of that lack of more formalized training there for newer members of staff, that was. That was quite tricky.Speaker A00:04:55.300 - 00:05:24.370Yeah, fair enough. So maybe a nod there to the need for more formal training rather than the ad hoc kind of training that people get on the job, potentially.Yeah, fair enough.And I think that one thing that a lot of people working in general practice and probably patients really can empathize with is how people get through to practices, you know, by phone or by E consults. It's quite complicated, actually, at the moment. And you talk about this in terms of demand management in this work.How did this impact on the receptionists?Speaker B00:05:24.850 - 00:06:20.400Yeah, so it's, as you say, it's not just them seeing people as they walk in face to face and letters and telephones, which was, you know, how things happen traditionally, but all of these different online ways to access practice, which is great for patients, but, you know, can be a bit of a nightmare to manage. So you've got things like email, you've got online triage tools, you've got practice websites, you've got different apps.And then, you know, during the pandemic, the NHS app came in, so sometimes practices were running, you know, a more local app with the NHS app with the practice website and all of these things. So there were lots of modalities for patients to contact the practice via, which in. In some ways can be a good thing. You know, it's.It's just the reception staff were saying, it's.It's not actually reducing demand, it's just the same level split across multiple different things, which adds complexity to what they're having to manage through those different channels.Speaker A00:06:20.640 - 00:06:25.120And did they have clear pathways on how to manage that? How did they deal with that?Speaker B00:06:25.360 - 00:07:06.750Yeah, so, I mean, every practice was kind of worked it through differently.So they might have some members of staff who would monitor emails, they might have some members of staff who would look at econsults or something like that. So they split it up that way. And other people might say they split it up by the individual person was responsible for the different way in.Others split it up by a bit more of a rota to try and make it a bit more varied for staff so they didn't get bored doing the same thing every day.So they might have a morning being responsible for whatever E consults were coming in, and then the afternoon they might be doing something else and someone else would take over that role. So, yeah, each practice was sort of.Speaker A00:07:06.750 -...

Today, we’re speaking to Dr Sophie McGrath, Consultant Medical Oncologist based at the Royal Marsden NHS Foundation Trust and at Kingston Hospital in London.Title of paper: Management of menopausal symptoms following treatment for hormone receptor positive breast cancerAvailable at: https://doi.org/10.3399/BJGP.2025.0264This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.800 - 00:01:11.660Hello and welcome to BJJP Interviews. My name is Nada Khan and I'm one of the associate editors of the bjgp. Thanks for joining us today to listen to this podcast.In today's episode, we're speaking to Dr. Sophie McGrath, who is a consultant medical oncologist based at the Royal Morrison NHS Trust and at Kingston Hospital in London.We're here to talk about the recent analysis article that she and her colleagues have published here in the BJDP titled Management of Menopausal Symptoms Following Treatment for Hormone Receptor Positive Breast Cancer.And just to point out that these colleagues included not just medical oncologists, but also GPs and patients, which I think has really shaped this article and is one of the reasons why we wanted to highlight it here in the podcast. So, hi Sophie, thanks for meeting me to talk about this article, which I think touches on a really important topic in practice.But talk us through some of the initial side effects that you discuss in the introduction here. Just in terms of hormone positive breast cancer, what kind of symptoms do women experience generally as a result of endocrine therapy?Speaker B00:01:12.220 - 00:02:32.900So, yeah, thanks very much for asking. And it's a bit of a broad answer that I would give.I mean, I've focused on, or we have focused on three main symptoms within the article which relate to hot flushes or vasomotor symptoms, also to joint stiffness and pain and swelling, arthralgia, and also to vulvovaginal symptoms, otherwise known as genitourinary syndrome of menopause.But I think what we've tried to include within the article as well is a table that certainly acknowledges that there are unfortunately many other symptoms that women can get as a result of these medications, essentially mimicking menopausal side effects.And of course, you know, these might be symptoms that women having already gone through the menopause may have suffered or experienced at some point already.But actually for a population of premenopausal women, these will be symptoms that they haven't had any experience of yet and can often be quite intense and develop quite suddenly. Whereas often our post menopausal women have had some sort of lead up to this, they've had some experience.Speaker A00:02:34.710 - 00:02:44.710And you work as a medical oncologist. But just talk me through your own experience of working with women who are going through the sort of sudden menopause as you describe as well.Speaker B00:02:45.350 - 00:05:50.240So obviously the focus of the article here is on menopausal side effects in general from the treatments that we use. And we've talked a lot about using our endocrine treatments such as tamoxifen, letrozole.But actually many of our women also experience menopausal type side effect secondary to the chemotherapies we give them. So I think, you know, there's sort of two groups you often have, particularly premenopausal women who stop their periods whilst on chemotherapy.That may happen several weeks into their chemotherapy treatment and it can be quite sudden.You know, they're already dealing with the numerous side effects attributed to the chemotherapy itself, but then they're also having to tackle these hot flushes, insomnia, potentially arthralgia. Obviously the vaginal symptoms may be more medium to longer term impact.So you've got that group of women who are sort of thrust into menopausal symptoms very quickly and then you have the other group who perhaps have already gone through their menopause.So they're not necessarily getting those symptoms alongside chemotherapy, but, but then after that we are introducing letrozole, which by removing even that last little bit of oestrogen production in the system is giving them enhanced menopausal side effects yet again. So I think that's sort of psychologically a big thing for the patients to deal with as well.Whether they're sort of having all of that thrust upon them in one go or whether it's more gradual and they're almost waiting for it to occur. So I think for us, us there's a lot we've got to get through in our consultations.Obviously if it happens alongside chemotherapy, then we're seeing them regularly anyway. We've got our nurses to support them in the clinics too.But I think the challenge arises more when our ladies are moving on to their endocrine therapy and moving away from regular consultations in our clinics and having more contact again with primary care. They're wanting to get on with their lives. They're wanting to not be coming up to the hospital quite so often.And so that was a real focus of this article, wanting to reach out to primary care, but also perhaps non oncology based secondary or tertiary care practitioners.So maybe gynecologists or people that work very closely within menopausal clinics, not necessarily just within primary care and try and work out how can we support these ladies with symptoms that may take several months to declare themselves and may even be once they've been discharged to our stratified follow up programs, but not necessarily seeing us regularly in, in the clinic.Speaker A00:05:51.120 - 00:06:13.110And I think one thing that I'm always struck by, especially with Women going through the perimenopause and the menopause is that this is a busy time in women's lives. So they might be juggling younger children, a career, caring for, you know, older parents.So there's a lot going on in these women's lives that things like arthralgia, vasomotor symptoms are going to have a big impact on. Really?Speaker B00:06:13.910 - 00:07:33.180Absolutely. And I think it's really important that we let these ladies know that we're there to try and help and support them.We're not going to have a one size fits all approach for everybody. But also we do try and not paint a doom and gloom picture from the outset.Not all women suffer these symptoms to the same degree, of course, so it's sort of in making them aware that they could happen, but then arming all of those medical professionals that they may come into contact with, with the tools to work through and try and help and support. I think, you know, one, one thing that often vasomotor symptoms really impact, for instance, is sleep.And so, you know, insomnia can be a really big problem for our ladies.But actually, if you dig into it, you often find that it's because they're having their mainstay of their vasomotor symptoms in the night and they're being woken up by them and then they're struggling to get back to sleep.So, you know, yes, I agree it's a really challenging time, both in terms of what we might be contributing to in terms of their symptoms, but also them wanting to get on with their lives after this diagnosis.Speaker A00:07:33.820 - 00:07:52.690Yeah, fair enough. And you touch on the fact that systemic hormone replacement therapy is avoided in people with a history of breast cancer due to the increase in risk.But I wonder if you could talk us through some of the alternative options here that you mentioned in the paper. And let's start with the vasomotor symptoms because you just touched on that as well.Speaker B00:07:53.170 - 00:12:56.770So I suppose just to clarify, obviously the focus of this paper is in hormone receptor positive breast cancer because it is the majority subtype that we see in our women.It's not a blanket rule, but we are less concerned usually about the use of hormone replacement therapy in our ladies with the hormone negative subtypes. Of course, the primary care practitioners always very happy for you to contact us oncologists if you want to clarify anything there.But, you know, the focus of this article is about the hormone positive space.And so certainly within those early years after a diagnosis, our mainstay is trying to minimize that Circulating level of oestrogen as much as possible.Obviously that may be suppressing ovarian function with GnRH analogues but even on top of that, you know, if that were all that were required, then why do women, postmenopausal women develop hormone sensitive breast cancer? We know it's because of these, this production of estrogen elsewhere in the system.So then you've got your aromatase inhibitor medications, they're trying to eradicate even those small amounts.So it, it does, it's very counterintuitive for us to be able to support the use of even topical estrogen based treatments when we're in this sort of early stage after a diagnosis.That said, of course, and it's sort of outside the scope of this discussion, but of course, you know, we will consider the particular risk of that individual patient. We'll have...

Today, we’re speaking to Euan Lawson, the Editor in Chief of the BJGP, about a number of issues around editing, the future of the journal and how you can get involved with the BJGP.Here's a link to the BJGP Research and Publishing Conference: https://bjgp.org/conferenceThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.400 - 00:00:55.980Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjjp. Thanks for taking the time today to listen to this podcast.In today's episode, we're speaking to Euan Lawson, who is the editor in chief of the bjjp.We're going to have a chat about a number of issues around the future of the Journal, around editorial issues and how you can get involved with the BJJP as well. So, hi, Ewan. Yeah, nice to see you. And just wanted to really start by saying thanks for joining me here today for this podcast.But yeah, thanks for joining me here today, Ewan, just to have a general chat about things going on with BJGP and your role as editor.And yeah, just a chance to catch up about some of your thoughts about issues around academic publishing and then just have a chat generally about other things that you've been thinking about as editor. So how's your week been?Speaker B00:00:57.420 - 00:02:13.730We've already had that conversation before we got here. Now we won't go there again. As you know, it's not been perhaps my ideal week.But as I'm delighted to be here and talking a little bit about what's going on with the Journal and just give a little bit of insight into how things are going, perhaps the biggest thing that we're I've recently written about the impact factor at the Journal, and perhaps the most important thing I need to say is that we don't worry too much about the impact factor.I know we do quite well on the impact factor, but I wrote an editorial which really pointed out that we are much more interested in the real world influence of the journal rather than what is quite a narrow metric about citations. We're more interested in how it affects clinical, how the journal articles affect clinical practice, how they affect policy.And we're really pushing, trying to push in that direction.And once we get into worrying about the impact factor and there are a lot of perverse kind of incentives in academia and it can sometimes result in what's known as questionable research practices and things can just slide away from the ideal a little bit.So that's perhaps one of the things that we're trying to concentrate on most in this coming months and years is just making sure that we keep our impact all about real world rather than anything else.Speaker A00:02:14.130 - 00:02:26.230Yeah, you mentioned questionable research practices and you did talk about this in your editorial or your editor's briefing, but how do you think the Journal can tackle that head on?Speaker B00:02:27.750 - 00:04:23.309I mean, it is challenging because it's.The thing about QRP questionable research practices is that there's like they're a spectrum and they go from really very minor stuff, which is like, you know, giving you, a professor in your department authorship on a paper where they really didn't do anything, to a kind of a. The far end of the spectrum where you start to creep into outright research fraud.And most researchers, and I think particularly in the primary care field though, you know, we'd always got to be. You always. One has to be careful about making assumptions, you know, are.Have bags of integrity and do the best they can, but they're working in pressurized systems. And sometimes the QRPs are just things like that can be about the authorship or it can be about declarations of conflicts of interest.It's how we go about doing our work in terms of how we quote other papers. Or sometimes it can be a little bit about how we tweak results to try to get positive results out because they're more likely to be published.And those are perhaps the areas where as a journal we can be a little bit more helpful in that, you know, making sure we are quite happy to publish negative findings. We don't overstate results.It's very easy as a journal to take a paper and there's a, you know, you want a brief summary of it to explain it to people. But it's important that we don't overstate and overinflate results that result in inaccurate messages going out about those papers.So they're the kind of areas we can help. But let's not be under any illusions. It's a systems kind of problem.Academic departments and the culture they have and the whole system of getting grants, publishing how those then get disseminated in the media as well. So it's a big old complex beast. And I think we just try and look at the areas journals may have the.May have an impact, and we're trying to push things in the right direction.Speaker A00:04:23.789 - 00:04:40.109Fair enough. And you mentioned impact and I just wanted to touch here on the BJJP research conference next year, which is going to have a focus on impact.So talk us through what we're doing there and sort of what your aim is really to get that focus for the conference next year.Speaker B00:04:40.269 - 00:06:24.960Yeah, I think one of the things I've always been keen on, the BJJP Research and Publishing Conference is that it's very much just, you know, it's a little bit something that we want to offer more for the Community, particularly early career researchers and academics.But any GP that's got a scholar or primary care person, clinician, that's got an interest in sort of the scholarly aspects of work and understanding a little bit more about that. So we're a small, friendly conference. I certainly had some feedback recently that they were.Someone was happy that they had had a really great experience and found it very welcoming. And I was really. I mean, that was that. I felt really pleased about that because that's certainly what we're aiming at.And this year the theme is a little bit around impact and influence. We're very lucky to have a couple of speakers who really know about that.We're going to have Rebecca Payne, who's the gp, former chair of RCGP Wales, and also we're going to have Prof. Martin Marshall, who was former chair of the college, of course, during COVID and is now over at the Nuffield Trust.And I think that's a really interesting perspective because the think tanks like the Nuffield or the King's or, you know, Health foundation, others that are around, have an enormous understanding of how to influence policy through research and we're hoping that'll be really useful for people and give them an understanding. What we see a lot of is that people are.People do the research, but often everybody knows you have to do something to try to make your research get your. Everyone wants to get the research out in the world, but far too often, and again, this is part of the way the system is set up.People just stop at that point and nothing further happens beyond that. And there's so many opportunities in so many ways that you can actually develop that. So we want to try and help people a little bit with that.Speaker A00:06:25.200 - 00:06:38.160Yeah, and we've talked a bit about that just in terms of actually the impact of research and disseminating the results, that actually makes an impact. And I think that's going to be an interesting angle to get from Martin, especially from his perspective as well.Speaker B00:06:38.240 - 00:07:46.020Yeah, it'd be good to see. I want to. We should point out the last few years, all of the research in the journal is open access, so it's not paywalled at all.And we're having conversations about reducing paywalls across the journal as well. So there. That's in development, but, you know, yeah, we're. We're keen to make sure that we can do. We're trying to do our bit.It's important that stuff just doesn't disappear into the journal. There's a slight risk of that.Perhaps some of my favorite moments as editor in the past couple of year, few years have been when I've heard about papers that have changed practice and policy. The very obvious one being the Sandvik paper about continuity, which has been really picked up in government level particularly.I know in Scotland they're pushing hard on that.But also when we hear from people like NB Medical or Red Whale or the other RCGP Essential Updates, when they take our papers and they're part of the look obviously across all journals, but when I hear about our papers that are then really being translated into actionable clinical findings, they're perhaps some of my best. That's why I really love seeing that. That's. I think that's really where we want to be and what we want to be doing.Speaker A00:07:46.580 - 00:08:02.740Yeah.And we've been talking about the clinical practice and analysis papers in the BJGP and we've often reflected on the fact that some of those papers are some of the most read papers across the journal...

Today, we’re speaking to Dr Jo Burgin, a GP and a researcher based at the University of Bristol.Title of paper: Mental health consultations during the perimenopausal age range – Are GPs and patients on the same page?: A qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2025.0069Mood changes are a recognised symptom of perimenopause, for which Hormone Replacement Therapy is considered a first line treatment. Recent studies have found mental health symptoms are overlooked in menopause care, which is mostly delivered in primary care. This study identifies some key barriers to identifying perimenopause in women presenting with mental health symptoms and suggests important changes clinicians could make to their consultations to address this.

In this episode, we speak to Dr Diarmuid Quinlan, a GP and MD candidate based at the Department of General Practice at University College Cork.Title of paper: Competencies and clinical guidelines for managing acne with isotretinoin in general practice: a scoping reviewAvailable at: https://doi.org/10.3399/BJGP.2025.0135There is evidence of inequitable access to the most effective treatment for severe acne, isotretinoin. This scoping review identified the clinical competencies to safely manage acne using isotretinoin. No global consensus exists among clinical practice guidelines (CGPs) on whether GPs are appropriate prescribers of isotretinoin. Appropriately resourced and CPG-guided patient access to isotretinoin in primary care may promote safe, timely, and equitable acne management for patients and improve antimicrobial stewardship.Transcript:This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.440 - 00:01:07.850Hello and welcome to BJGP Interviews. My name is Nada Khan and I'm one of the associate editors of the bjgp. And welcome to our autumn edition of the BJGP podcast.We're kicking off with a new set of interviews for the next few months. So thanks again for joining us.Today we're speaking to Dr. Dermod Quinlan, who is a practicing GP in Cork and is also an MD candidate at University College Cork in Ireland.We're here today to discuss his paper, recently published in the BJGP titled Competency and Clinical Guidelines for Managing Acne with Isotretinoin in General Practice. A Scoping Review. So thanks very much, Dermid, for joining me here today to talk about this paper.But yeah, I guess I just wanted to start by saying that this is a really interesting paper and I think it covers a very common condition that we see in general practice and covers treatment, which can be quite difficult as well for acne.But I wonder if you could just start by telling us a little bit about why you wanted to do this research and just a bit about the treatment of it and why you focused down on this topic, really.Speaker B00:01:09.610 - 00:02:59.510So lovely to meet you, Nada. I'm first and foremost a GP and I see patients three days a week, 20 hours a week.And I did a diploma in dermatology over a decade ago and I still do some online tutoring. So I have a long standing interest in dermatology and have an extended role in dermatology.I work in an urban practice with lots of young teenagers and young people in it.Acne is a common chronic disorder and I would see a lot of young people with acne of all grades of severity, mild, moderate and severe, and very severe. And as a clinician, very clearly recognize that behind acne is a patient very commonly suffering profound distress.And we know that the morbidity associated with acne and particularly severe acne, is very extensive.There's the emotional morbidity, there's psychological morbidity, it impacts people's employment opportunities, their education achievements, and then more widely, because treating acne is resource intensive, it has an impact on the healthcare workforce. And then there are concerns about the very prolonged use of antibiotics in acne, raising real antimicrobial stewardship concerns.So I have an interest in this. And then we decided that we would do research into it because we don't know the clinical competencies for safe use of isotretinoin.So I was particularly interested in severe acne and the management of severe acne, and also it didn't clearly identify which were the clinicians that could be safely tasked with managing acne using isotretinoin. So they were the two research questions that we set out to look at.Speaker A00:02:59.750 - 00:03:27.250The first thing is I just wonder if you could talk us through, because typically in general practice, at least in the places where I've practiced, we wouldn't, as gps typically, be expected to start isotretinoids in practice. And I wonder if that was part of your reasoning for doing this research.So did you go into it trying to establish whether GPs could be clinically competent to prescribe these medications?Speaker B00:03:27.650 - 00:04:48.480For many years, I transcribed prescriptions initiated by dermatologists and then increasingly found that patients faced challenges in access to dermatologists and waiting to see a dermatologist. The research clearly shows there are issues with timely and equitable access to isotretinoin.And in terms of equity, the inequity particularly affects ethnic minorities, people from lower social classes and women. So there are very real issues for patients accessing isotretinoin.One of the concerns about isotretinoin is that it is a very potent teratogen, causing severe fetal abnormalities. GPs are competent in managing many other teratogenic medicines, lithium, methotrexate, sodium valproate, ACEs and ARBs, to name a few.And GPS can are good at providing contraceptive advice and pregnancy prevention. So I felt that as a gp, that I had a lot of the skill set but didn't know what the guidelines say.So that that was what led us and led me like it was the equity piece, it was a timely access and also it was the skill set required with clinical competencies to safely manage acne using isotretinoin hadn't been defined in.Speaker A00:04:48.480 - 00:05:34.780The literature, so all really topical issues in terms of access and equity.And as you say, this research aimed to look at clinical practice guidelines and consensus statement recommendations to look to see what should be the clinical competencies for prescribing oral isotretinoids in practice. And you did a scoping review? And we won't go too much into the methods because it followed sort of established methods for doing a scoping review.And I really just wanted to focus on the results, really. So what did you find? So you found eight clinical practice guidelines, is that right?And talk us through those and just how you looked at those and what you found really, in terms of what should be the clinical competencies and how you think that applies to general practice.Speaker B00:05:35.180 - 00:08:18.270So we identified eight clinical practice guidelines, five of which originated from Europe, one each, then from America, Canada, and Malaysia. The Clinical Practice guidelines identified four clinical competencies for doctors to safely manage isotretinoin.And these are dermatology, blood testing, mental health, and a pregnancy prevention program. And to take these one by one, the dermatology piece.Obviously, doctors, GPs need to be able to diagnose acne and more especially need to be able to identify those patients with acne which should perhaps be treated with isotretinoin.And they are, you know, people with severe acne, acne resistant to treatment, acne causing scarring, or acne which is having a severe psychological impact on patients.The blood testing has reduced very substantially in recent years because the evidence for undertaking blood tests in otherwise fit largely young people indicates that the benefit is relatively modest. There is some heterogeneity among the guidelines as to what tests should be done and when they should be done and how often they should be done.But largely there is an agreement that some blood tests are prudent, but not excessive blood testing. The two big pieces really are around mental health and pregnancy prevention.Mental health is a concern with isotretinoin, and isotretinoin has been on the mark now since licensed in 1982 by the FDA. So it's around a very long time. And there have been concerns expressed continually about mental health and isotretinoin.It's very reassuring that the evidence also identifies that at a population level, there isn't an increase in suicide. But case reports continue about raising concerns about mental health.So the guidelines all recommend that people should have regular mental health assessments.And while we can look at the potential adverse side effects of using isotretinoin to treat acne, we must also be very cognizant of the other side of the equation, where young people and people in general with severe acne can suffer very substantial emotional and psychological harms and burdens by virtue of their severe acne. And parents and doctors will be very familiar with the adverse psychological, emotional, social issues that arise with severe acne.So, as in everything else in medicine, it's balancing the risks and the harms.Speaker A00:08:19.230 - 00:08:26.350And then the final thing was around contraception, is that right? But again, here the guidelines diverged in some areas, didn't they, on their recommendations?Speaker B00:08:26.830 - 00:09:34.750Absolutely, yeah.So again, and pregnancy prevention and isotretinoin and all teratogenic medicines like, it's a really important piece that we can safely manage acne using isotretinoin. And pregnancy prevention is more than simply contraception. It is contraception, it's emergency...

Today, we’re speaking to Professor Helen Atherton. Helen is Professor of Primary Care Research based at the University of Southampton.Title of paper: What do patients want from access to UK general practice?Available at: https://doi.org/10.3399/BJGP.2024.0582Widely accepted as perpetuated by the media is that patients are unhappy with access to general practice and desire faster access to a general practitioner. This review sought to summarise the research evidence about reported patient wants from access to general practice. Patients wanted to easily make an appointment in a timely fashion, to have a positive relationship with the practice, to see a specific clinician and choose consultation modality according to individual circumstance. Communication and being kept informed about access throughout the process of making and having an appointment, was something patients wanted, and this could be addressed by general practice.Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.480 - 00:01:00.150Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the bjgp. Thanks for listening to this podcast today.In today's episode, we're speaking to Professor Helen Atherton.Helen is professor of Primary Care Research based at the University of Southampton, and we've only just speaking to her recently on this podcast about the increasing digitalization of general practice. This time we're speaking to her about her recent paper here in the BJDP titled what Do Patients Want from Access to UK General Practice?So, hi, Helen.It's really nice to speak again about this area of research and I guess I just wanted to start by saying that access is such a loaded word and really, when it comes to general practice, it's part of a fairly negative media campaign against general practice. But it seems that this negative narrative just keeps getting pushed, despite lots of attempts to fix it.So I just wonder if you could reflect on that.Speaker B00:01:00.470 - 00:01:51.950Yeah, absolutely. So that the negative media coverage was one of the reasons that I wanted to do this review.So this review was a bit of a labour of love because I had a feeling from the work that I was doing on digital access and other research that actually the reality was probably quite different, what we were seeing in the headlines and having looked into it, although there's lots of research out there on patient experience and satisfaction, we have a national survey that looks at that. There wasn't anything about what patients actually want. And so that kind of.I thought, actually, wouldn't it be really interesting to find out from the evidence what they actually want and see if it does fit with the narrative we see in the papers and on social media. So, yes. So completely agree. And that was kind of where the idea came from, really.Speaker A00:01:52.420 - 00:02:08.180Yeah.And I just want to unpick what you really mean by access in this paper, because I think for some people it means, you know, just getting an appointment to see their GP within a day, but it can mean lots of different things to other people. So what did you conceptualize that as?Speaker B00:02:08.740 - 00:02:49.840Well, it was difficult.And you're right, there are lots of different definitions of access, and particularly in the research context, for us, we were interested in access to an appointment, so we were very focused on the processes that patient would go through in order to get the appointment, go to the appointment.And we did go back and forth several times with this review because it was so difficult to define and there will be other researchers who use different definition, but because we were so interested in a lot of the kind of media narrative. It just felt like the best fit to look at access to an appointment with a gp.Speaker A00:02:50.000 - 00:03:04.540So this paper was a systematic review and you looked at papers which explored different aspects of access. And I guess the big question here is, what did patients want in terms of access?I wonder if you could just give sort of a headline summary and then we can talk a bit more in depth about it.Speaker B00:03:04.780 - 00:03:56.070Sure. So what was interesting is I don't think their wants were particularly surprising or out of line with what general practice wants to deliver.That's the first thing to say. And it was things like wanting to choose a clinician that they've seen before, if they.If they've seen a clinician before, wanting to have choice around the skill mix. So which healthcare professional. They saw the consultation modality wanting to have a good relationship with the practice.They wanted ease of booking and relatively speedy access. But not. There wasn't any evidence that people all wanted to be seen on the same day, which is maybe how the media narrative goes.And there were also some things around wanting it to be easy to get to and having a nice waiting room. So really quite simple things as well.Speaker A00:03:56.230 - 00:04:19.350I think choice is a really interesting area to explore.So some people might not feel they have the right access if they get booked in, like you say with the gp, they don't know, or if they get booked in to see someone working in another clinical role in the practice.But I wonder what you thought about the implications, given the increasing lack of continuity of care and this widening multidisciplinary team in practice.Speaker B00:04:19.870 - 00:05:16.510Yeah. So it didn't escape our notice that a lot of what we were seeing was probably at odds with current policy around general practice.The fact that patients fully understand that continuity of care is important at times, and there's lots of evidence that that is the case. And general practice, as a rule, tends to encourage that, I would say. And then also with the skill mix at odds with the idea that you.You can kind of sub in other healthcare professionals as a way to tackle lack of capacity. Whereas I think patients are smarter than that and realise that sometimes it's appropriate, but other times it's not. Yeah.And then also with the digital as well.So, again, people wanting the choice, understanding that sometimes it's better to do things that way or more convenient, but not wanting to be forced down that route, which is kind of the way that we're going, really, in terms of policy for digital access.Speaker A00:05:16.990 - 00:05:24.830And. Yeah, talk us through that.What people thought about access in terms of the kind of consultation they got like a telephone or a face to face appointment.Speaker B00:05:24.830 - 00:06:12.650Yeah. So patients were happy to have those types of consultation.So when it came to use of remote consultations, patients were happy to do that where it met a need. So if they didn't want to come to the practice, they weren't able to.Perhaps if they had a sensory disability, lots of reasons why they wanted to do it, but wanting to have the choice about how that happened, which was interesting. So people would say they didn't want to have to travel to the practice because it wasn't convenient.This could be around work or childcare, or it might be that they had mobility issues, but there was generally a reason why they didn't want to be in the proximity of the general practice. And that's when remote consultations were what patients wanted.Speaker A00:06:13.450 - 00:06:35.840Yeah, fair enough.So it seems a lot of the time people just want a choice and I think it's interesting, particularly given the increase in a triage first approach in many practices.But there was something you mentioned in the article that I thought was quite interesting, which was about co production with patients to solve access problems. Just tell us what you think this should look like.Speaker B00:06:36.160 - 00:08:01.890So as well as doing this review, I'm involved in other research around access to general practice. And a big thing that we see happening is almost like a. Not a lack of communication, but a miscommunication between patients and practices.You know, not intentional, nobody's trying to confuse the other, but patients perhaps not really understanding the access systems in place, not understanding what is available to them. If they don't have a choice, why they don't have a choice.And so I think there's a lot of room for more kind of working together in terms of what that looks like. I think we have to be brave and ask patients what they want.This is a systematic review, so it looks at existing evidence and most of those studies were not focused on looking at just what patients wanted, they were looking at other things as well. I think if we were to ask...

Today, we’re speaking to Dr Sara Noden, a GP with an extended role in ADHD, and Dr Nishi Yarger, Consultant Psychiatrist in adult ADHD services.Title of paper: A guide for primary care clinicians managing ADHD medication side effectsAvailable at: https://doi.org/10.3399/bjgp25X742653TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.320 - 00:00:55.720Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors at the bjgp. Thanks for listening to this podcast today. In today's episode, we're speaking to Dr.Sara Noden, a GP with an extended role in ADHD, and Dr. Nishi Yarger, consultant psychiatrist in Adult ADHD Services.We're talking about the recent Clinical Practice article here in the BJGP titled A Guide for Primary Care Clinicians Managing ADHD Medication Side Effects. So, thanks. It's great to meet you both Sara and Nishi.This is a really topical area to highlight in the journal, and not least because it seems that every week there seems to be a new article in the media about the increasing diagnosis of adhd. So it's a really topical area to look at, but I guess, Sar, I just really wanted to start with what prompted you to write this article and why now?Speaker B00:00:56.620 - 00:01:39.320Yeah, so I think coming from a GP perspective, before I specialized in adhd, I think these medications did create a bit of anxiety, especially as they're controlled drugs, their stimulants, their specialist medications, and there was a lot that I didn't know about them as I since developed a special interest and it sort of demystified some of these medications. And I just.I think we wanted to pass on to primary care clinicians some of that knowledge that we've learned, some really basic things that they can look out for that may or may not be related to medications and some common things that they can advise and to know when to escalate secondary care and how to manage these patients, essentially.Speaker A00:01:39.560 - 00:01:54.040Yeah. And Saura, I wonder if you could just tell us a bit more about your role as a GP with an extended role in adhd.So you must be very much in demand at the moment, but talk us through what led you to sort of take that role and what your typical week is like.Speaker B00:01:54.320 - 00:02:58.810Yeah, So I think my interest in ADHD stemmed during my training years and I currently am working as a salary GP, but also working at CNWL under Dr. Jaga. I'm doing diagnosis and medication titrations. And I think my interest stemmed because of how prevalent ADHD is becoming.I was seeing such an increase in patients presenting to gp, suspecting they have ADHD and requesting referral, and reading about this treatment and what we can offer, I was really taken aback by not only how ADHD can impact a patient in terms of their symptoms and concentration of focus, but also the lifelong issues that can arise sometimes with adhd, like all the Research showing that it increases rates of depression, underachievement at school, even early death and accidental injuries. So I feel it's a really important, important condition for us to be able to pick up, to be able to refer promptly and start treatment.And that's where the interest started.Speaker A00:02:59.050 - 00:03:14.570And, Nishi, from your perspective, what's it like having a GP working with your team?And from a secondary care perspective, I wonder if you could just tell us a bit more about your impression on how secondary care and general practice communicate around ADHD and people living with it.Speaker C00:03:14.650 - 00:04:27.649It's been great having Sara in the team for many reasons. So I guess primarily we're very aware that we need to work more closely with primary care.There's so much back and forth with emails and us trying to be helpful to primary care primary care, having concerns and needing our input, that the idea of actually training primary care keeps coming up for us as a service, like, how much can we involve them, how much can we train them? It's such a huge area of work. We know more and more patients are coming forward and we know very much that it can't just stay a specialist service.So as a service, we're very keen to have involvement from primary care. So we have Sara and we also have a GP trainee, which is great from more selfish point of view.It's been great to have a GP in the team because ADHD patients often have a lot of medical comorbidity and it's been great for us to be able to discuss that with a GP instead of needing to contact a cardiologist or go to another specialist. We know that probably this is, you know, within the remit of a gp, so it works well both ways.Speaker A00:04:27.969 - 00:05:05.980Great.And I think, as you mentioned, you know, I don't think any specialty or general practice practitioner would feel that less collaboration is a good thing. So I think the more the better. And I guess I'd recommend people listening to go and read the full article here and take a close look at it.But I wanted to specifically focus on Table 1, which lists some common ADHD medication and then some key practical advice around prescribing it.But I wonder if you could just summarize some of the common areas we should be considering in general practice amongst patients who are being prescribed ADHD medication. What are your top tips?Speaker B00:05:06.300 - 00:06:14.360I think some of the most common symptoms and side effects that we see with patients taking medications are things like appetite suppression and weight loss.And there are some basic advice that can be offered to a patient who might be Experiencing these, such as having a big breakfast, taking the medication with or just before. Sorry, just after food. And if this is still a persistent issue, then we would encourage the GP to refer back to secondary care.Another common issue is sleep disturbance. And again, some advice the GP can give can be taking medication. Medication at different times of the day, such as taking it earlier.Often a lot of these things would have been worked out with the specialist when they're being titrated, and often by the time the patient gets to the gp, these symptoms would be stabilised and the patient would be stable.However, things can change and I think what the GP needs to look out for is any new symptoms or any new side effects that weren't present before and be able to identify what's normal, what's acceptable, what would be sufficient for simple advice and what needs to be flagged back up to the psychiatrist.Speaker A00:06:14.840 - 00:06:26.840And I guess that touches on the next thing, which is shared care agreements in ADHD prescribing. And I guess, where do you think the GP role lies here in terms of monitoring and assessing side effects of treatment for adhd?Speaker B00:06:27.880 - 00:07:16.120I think it's a really complex question, actually, and quite controversial because the NICE guidelines do say that the annual review should be done by someone with expertise in adhd, but often we know that that can fall on the gp.And I know there are lots of discussions in various areas across the country of how to best manage this and create a more uniform shared care agreement, which is really clear on who's doing the reviews.And I think essentially, if the GP is feeling confident and competent to do the reviews and they have a good pathway back to secondary care and a good support system to raise any red flags to, then that could be something that gps might be comfortable and can consider. But there are funding implications for that and I think that it's probably a wider issue that needs to be addressed. Absolutely.Speaker A00:07:16.280 - 00:07:18.520Nishi, do you have any thoughts about that at all?Speaker C00:07:18.680 - 00:09:38.930It's a very hot topic, really, because of the number of patients that are being diagnosed and that are taking treatment. For any service to manage annual reviews for thousands of people is not feasible.So I think, and I agree with Sara, that you know, where there is a level of confidence, and I think our hope with this article was to give gps confidence and to enable them to almost realize that they probably are able to do this. They. They manage such severe illness, they manage all kinds of medications, they. They do have the knowledge.So I guess we wanted to share that it's not that specialist an area for most patients can be managed. But we do appreciate that there are the more complex patients, there are the ones that do need to be seen in secondary care.And we would just really like a much smoother collaborative working where it's easy for the GP to ask and it's easy for us to see the person that would be the ideal.With shared care, the GP always knows I have someone I can speak to, I can send a quick email, I can get a response without the really hard kind of boundary of you have to do this

Today, we’re speaking to Dr Cini Bhanu, GP and Academic Clinical Lecturer in the Primary Care and Population Health Department at University College London. Title of paper: Antidepressants and risk of postural hypotension: a self-controlled case series study in UK primary careAvailable at: https://doi.org/10.3399/BJGP.2024.0429Antidepressants are associated with postural hypotension (PH). This is not widely recognised in general practice, where antihypertensives are considered the worst culprits. The present study examined >21 000 older adults and found a striking increased risk of PH with use of all antidepressants (over a four- fold risk with SSRIs) in the first 28 days of initiation. TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.480 - 00:00:56.990Hello and welcome to BJGP Interviews. My name is Nada Khan and I'm one of the associate editors of the bjgp. Thanks for listening to this podcast today.In today's episode, we're speaking to Dr. Cini Banu, who is a GP in an academic clinical lecturer based in the Department of Primary Care and Population Health at University College London.We're here to talk about her recent paper in the BJGP titled Antidepressants and Risk of Postural Hypertension, A Self Controlled Case Series Study in UK Primary Care. So, hi Cinny, it's really nice to meet you today.I guess this is an interesting area to cover, especially as the prescribing rates for some antidepressant medications are increasing.But I don't know what your feeling is, but I'm not sure if many GPs would actually know that antidepressants are associated with poison postural hypertension. So, yeah, talk us through that.Speaker B00:00:57.310 - 00:01:18.350Yeah, so I think that's one of the reasons this study is so important.So definitely from conversations that I've had with gps that I work with and it's not commonly recognized that postural hypotension is associated with antidepressants, though it is by geriatricians, for example, where it's very.Speaker A00:01:18.350 - 00:01:41.850Well recognized and in this study used a big database to look at the risk of new postural hypertension associated with the use of antidepressants in people aged over 60.I guess there's quite a lot of in depth stuff in the methods, but I guess just for a summary for people who are interested in what you did, do you mind just sort of going over it at sort of like a high level?Speaker B00:01:41.850 - 00:02:54.200Yeah, yeah. So we looked at a big database, what we call a routine primary care database called imrd.And essentially this captures data from software that gps use like EMIS and Vision System and captures a whole load of information like problems, symptoms and prescriptions. So we went into this database and identified everyone over the age of 60 that might be eligible during our study period.And for this we looked at people that were contributing at least one full year of data between 2010 and 2018. And then within that we identified people with a first diagnosis of postural hypotension.And then again we made subgroups according to people who had this diagnosis but also had a first prescription of a new antidepressant during that time.And what we were interested in, and the methodology is called a self controlled case series, we weren't interested in who got postural Hypotension, because everyone was a case, but rather when that diagnosis happened in relation to antidepressant exposure.Speaker A00:02:55.230 - 00:03:07.310And we'll talk about those different time points in a bit, but I wonder if you could just talk us through why that focus on people aged over 60 and why this is so important, especially in that age group.Speaker B00:03:07.710 - 00:04:22.710Yes, so two big reasons.So, postural hypotension is very, very common in people aged over 60 and we know that it affects around a third of people living out in the community. It's largely under recognized and under detected by gps and in prim care.And postural hypotension in older adults has significant risk of adverse complications and long term effects, including risk of being admitted to hospital, falls, fractures, but also later down the line it increases your risk of stroke and cognitive decline. So it's a really important common diagnosis. We're probably not managing as well as we can in primary care.Second is that antidepressants are actually used quite commonly in this group of patients.So we know that for people with late life depression, they're more likely to be given an antidepressant treatment for their depression rather than another therapy. So over 80% of people with depression in this age group are given an anti, are prescribed an antidepressant.So there's very high risk with both the exposure and the outcome.Speaker A00:04:23.510 - 00:04:50.610And I guess this comes back to the fact that, yes, a lot of GPs might not know about this as a risk. So it's really important that you've done this research.And so you looked at these different time points of people after starting their antidepressants and risk of postural hypertension. But talk us through what you found here.So in people who were taking one of the most commonly prescribed antidepressant classes, SSRIs, what did you find here about the risks?Speaker B00:04:50.770 - 00:06:05.480Yeah, so we actually found some really interesting time variable trends with the risk of postural hypotension associated with ssri. So we looked at two specific time periods.And that was initiating the drug, which was between a short period, days 1 to 28, and then days 29 to 56, which we treated as initiation, and then a continuation period, day 57 onwards.And what we've seen in SSRIs, but also all of the antidepressant drugs, is this peak in your risk of developing a new diagnosis of postural hypotension within that acute day 1 to 28 period.And so that was mimicked across SSRIs, tricyclic antidepressants and the other antidepressant group for SSRIs in particular, we noticed a fourfold increase in that day 1 to 28 peak that gradually declined as time went on.And tricyclic antidepressants and other antidepressants had a similarly increased peak, not to the same extent, but about twofold that declined with time.Speaker A00:06:05.960 - 00:06:17.240And we know that tricyclic drugs are often prescribed for other things as well, like pain. So do we need to be careful when prescribing it at lower doses for things like neuropathic pain?Speaker B00:06:17.240 - 00:06:51.460We didn't look into dosing, but it's certainly likely that the majority of these prescriptions were prescribed in low doses for other indications, like neuropathic pain, as you. You've said, and insomnia. And we've already seen a twofold increased risk in that acute initiation period, likely for low doses.So there is certainly a risk to be aware of in older patients that we're prescribing tricyclic antidepressants to. And it's likely that as the dose increases, that this risk increases.Speaker A00:06:51.620 - 00:07:04.400And I think one thing that's really important here is that the effect sizes are actually pretty significant. So this could represent a fairly significant risk for patients, especially in that initial peak time that you mentioned.Speaker B00:07:04.960 - 00:07:38.380Absolutely, yes.And I think there's certainly a striking risk associated with SSRIs in this group, and a lot of it depends on the context of the person you're prescribing this medication to.So whilst we know there's a fourfold increased risk in this study, you may be more cautious with someone who is at greater risk of postural hypotension at their baseline anyway, either related to advancing age or other chronic conditions like diabetes or Parkinson's, for example.Speaker A00:07:38.700 - 00:07:53.740And I think what's really interesting is you point out in the paper that actually postural hypertension isn't highlighted as a common side effect in the BNF for these drugs. So it seems with such a significant effect that probably that's something that should be highlighted.Speaker B00:07:54.300 - 00:08:19.640Yes, that's something I think is really, really important.So you'll often see hypotension cited as a side, but they are quite different and the assessment is different and how you might manage it would be different too. So I think it's definitely really important that that increased risk of postural changes in blood pressure is documented for these medications.Speaker A00:08:20.760 - 00:08:46.019I think it's interesting because often when people start these medications, they might have an early review with a GP about how they're getting on with it. And often that that initial review really focuses on mood and how they're coping and may touch on side...

Today, we’re speaking to Dr Jamie Scuffell, GP and NIHR In Practice Fellow at King’s College London.Title of paper: Patterns in GP Appointment Systems: a cluster analysis of 3480 English practicesAvailable at: https://doi.org/10.3399/BJGP.2024.0556GP practices in the UK are using a wide range of different appointment systems to meet patient demand and improve access. This cluster analysis of NHS appointment data from 56 million appointments and 3480 English practices demonstrates two predominant models of primary care delivery. ‘Same day’ practices tend to fulfil appointments on the same day using GP telephone consultations. ‘Routine care’ practices tend to employ non-GP staff members offering face-to-face appointments and longer appointment wait times. ‘Same day’ care practices had younger and more urban populations. Episode transcriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.640 - 00:00:54.360Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the bjgp. Thanks for listening to this podcast today. In today's episode, we're speaking to Dr.Jamie Scuffle, who is a GP in South London and an NIHR In Practice Fellow at King's College London. We're here to talk about a really topical issue in his new paper here in the bjgp.The paper is called Paper Patterns in GP Appointment A cluster analysis of 3,480 English practices.So, hi, Jamie, it's really great to meet you and talk about this work, I guess, really just to start, as you point out in this paper, each practice has their own systems and strategies to manage appointment booking. But how do you think that this impacts on access and patient appointment booking in each practice?Speaker B00:00:55.000 - 00:02:17.300Yeah, it's interesting because I think, as you say, appointment systems have developed even further, really, since COVID and we've ended up with this a quite interesting diverse range of implementing appointments across the country, across England at least.And I suppose the things that have changed are, you know, if you phone up a practice now, actually, you might not even phone them up, you might submit an online consult, you might be triaged, you might see not a gp, but a range of other professionals as well. And also it might not be done face to face, it might be done by telephone or online.In fact, there's a new appointment system range of things that have happened across England, and actually there's some evidence that that might relate to access in some ways. So we know lots of people who don't speak English struggle to navigate that system of getting an appointment, for example.And we also know from the qualitative evidence that there's some digital exclusion as well with appointments. So, yeah, so I think there's lots of issues with access and how that relates to appointment systems.And so far what we've done is looked at components of the appointment system and how that then affects access. But what we haven't really done much of is looking at the appointment system as a whole and how that might affect access.Speaker A00:02:18.180 - 00:02:33.200Yeah.So in this study, you wanted to look at patterns of primary care delivery in English GP practices, and you used this Appointments in General Practice data set. Can you tell us just briefly what's available in this data and what you were looking at here?Speaker B00:02:33.360 - 00:03:20.700It's a tremendous data set and I think could be very useful. So every English GP practice for every day of the week publishes up to NHS England.The appointments that have Happened for the day across lots of different categories, actually, so across whether they've been attended or not, or not attended, whether they're face to face or telephone or home visits or online also if they're GP or non GP appointments. And the sort of. The real clincher that is brand new is looking at appointment lead times as well.Whether these appointments were booked same day or whether they were booked more in advance when the data is good enough, which is an. If it's a very, very useful data set.Speaker A00:03:20.780 - 00:03:43.720Yeah, so you looked at data from about three and a half thousand practices this year. So as you mentioned, you weren't able to look at all practices due to quality issues.But just talk us through what you were looking at here and I guess, yeah, just start us off with telling us what you found and perhaps we'll get into how you group the practices as well into clusters. But yeah, tell us a bit more about what you found here.Speaker B00:03:43.720 - 00:05:23.440What we wanted to do was take a set of measures, I suppose, of an appointment book.So for every practice we said, well, actually we might define their appointment book by the proportion of people who see a GP or the proportion of people who have a telephone consult, or the proportion of people who are booked same day and seen same day. And we kind of came up with actually about 12, in the end, 12 measures of an appointment book.What we then wanted to do was kind of group together practices with similar characteristics and we picked two different types. I suppose these were the two poles at either end of the spectrum.And the two poles are that there's a more traditional, what we've called a routine care group of practices, and this is about two thirds of the English practices that we included.And the appointment characteristics they had were they are more likely to book in advance appointments rather than booked on the same day, more likely to be face to face appointments, interestingly, more likely to use not just GPs but also non GP appointments for delivering care. So they're the big categorization of the routine ones.So longer wait times, more likely to use non gps and more likely to have face to face appointments.And then I suppose there's the sort of the more the newer style of appointment system, which we've called the same day appointment system, and that's more likely to be led by GP telephone consults that happen and are booked on the same day. And in this case, same day appointment availability is quite substantially higher than the routine care practices.Speaker A00:05:23.600 - 00:05:34.560And you found that actually there was quite a lot of difference within the practice population and where the practice was based on these two sort of clusters. So the routine and the same day practices as well.Speaker B00:05:34.960 - 00:06:59.980Yeah.It's absolutely fascinating that it's not just differences in the appointment systems, but actually there are underlying differences, not just in the practice populations, but also in the workforce associated with each of those practices. So the practices that were same day, much more likely to be in urban serving urban populations rather than rural populations.Also, this might just be an account of. Because they're more likely to serve urban populations, they also serve more ethnically diverse populations.Interestingly, no big differences between deprivation. And then also the same day practices have a very slightly younger population overall than the routine care practices.List size is also slightly bigger with those same day practices compared to those that have a more routine approach. Also, differences in workforce.The number of direct patient care staff, full time equivalents per 10,000 people on the practice books is a bit higher in the routine care cluster than the ones who are delivering same day care.And the differences are that actually GP levels are pretty much the same, but the routine care cluster employs more nurses and more nurse practitioners and also employs slightly more administrative staff.Speaker A00:07:00.540 - 00:07:19.490Yeah.So you work as a GP and I just wonder from your own experiences whether what you found in this data reflects what you know or understand sort of on the ground and whether you had any insights from your own work, which might sort of explain why there are these differences, or if you had any thoughts about that.Speaker B00:07:19.650 - 00:08:44.140I did a whole load of locoming when I finished training, actually. It was fascinating to go to a dozen practices over a period of time and look at how the appointment system was set up.And I think when you're an individual GP behind a door, seeing patients, it's sometimes quite hard to anchor yourself in the wider picture of what's happening at other practices, even the one just down the road.So I think it's quite interesting to think about how especially the slightly more bigger practices where I work in South London do tend to have had a more of a same day approach to delivering appointments and have also been a little bit more telephone, triage, telephone first in their approach for a longer period of time.So I think the, I mean, one of the challenges of when you cluster these data is you can cluster into lots and lots of different...

Today, we’re speaking to Dr Steve Bradley, GP and Senior Clinical Lecturer based within the School of Medicine and Population Health at the University of Sheffield.Title of paper: General practice chest X-ray rate is associated with earlier lung cancer diagnosis and reduced all-cause mortality: a retrospective observational studyAvailable at: https://doi.org/10.3399/BJGP.2024.0466It is known that there is wide variation in the use of chest X-ray (CXR) by general practices, but previous studies have provided conflicting evidence as to whether greater utilisation of them leads to lung cancer being diagnosed at an earlier stage and improves survival. This observational study analysed data from the English national cancer registry on CXR rates for individual general practices, along with stage and survival outcomes; it found earlier stage at diagnosis and improved survival for patients diagnosed with cancer at practices that used the test more frequently. Increasing use of CXR by GPs for symptomatic patients, particularly by focusing on practices that use the test infrequently, could improve lung cancer outcomes.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.640 - 00:01:06.820Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors at the Journal. Thanks for taking the time today to listen to this podcast.In today's episode, we're talking to Dr. Steve Bradley. Steve is a GP and senior clinical Lecturer based within the School of Medicine and Population Health at the University of Sheffield.Early diagnosis of cancer has been an area of research that is Steve's real strength. And we're here to discuss his recent paper here in the BJJP titled General Practice.Chest X Ray Rate is Associated with Earlier Lung Cancer Diagnosis and Reduced All Cause Mortality A Retrospective Observational Study. Hi, Steve, Great to speak again and to talk through this paper.I suppose I want to start by saying that, yes, we know that earlier diagnosis of cancer is a good thing because it can lead to earlier stages of diagnosis and treatment. And you start the paper with a short discussion about screening for lung cancer.But talk us through why this, this alone won't solve delays in lung cancer diagnosis and what else we need to be doing.Speaker B00:01:07.540 - 00:02:14.620So, yeah, this context is really important because screening is a hugely important development and the UK has led in many ways on lung cancer screening using low dose ct. And this, we hope is going to be very, very beneficial for patients.But it would be a mistake to think that this is going to solve the problem of lung cancer. And there's a few reasons for that.One is that only about half of people who get lung cancer would have been eligible for screening because screening concentrates on the highest risk population. And also we know that only about half of people who are invited for screening actually choose to participate in screening.So the upshot for general practice really is that most patients are still going to be coming through by symptoms and in the same way.So screening is good news in terms of lung cancer detection, but we still need to do as well as we can in terms of picking these patients up through symptomatic pathways. And actually, this is something we touched on in an editorial for BJGP about a year or 18 months ago, I think.Speaker A00:02:15.020 - 00:02:20.300Yeah. So talk us through that. What was that editorial focusing on? Just for people who may not have had a chance to read it.Speaker B00:02:20.620 - 00:03:10.660So it really was really discussing the situation where we are now in terms of awaiting for a national screening program for lung cancer screening and also considering the role of general practice.So we set out that, just as I've said, that the role of gps is still going to be very important for lung cancer detection, but also that there are certain considerations that are important for GPs in terms of understanding what the program is, because a lot of patients might come to us to talk about lung cancer screening.So it's good for us to have a basic understanding of what's involved and also some issues around the data that lung cancer screening uses, particularly smoking status.So it becomes particularly important for our smoking records to be as accurate as possible because a lot of decisions around eligibility for lung cancer screening may. May hinge on that.Speaker A00:03:10.740 - 00:03:20.340And just talk us through. So what were you trying to do in this paper?So in this paper you were looking at people sent for chest X rays in different practices, but talk us through why you wanted to look at this.Speaker B00:03:20.980 - 00:04:06.250Yeah, so this, this study was really inspired by earlier work which looked at rates of endoscopy requested from general practices and how that might affect outcomes for upper gastrointestinal cancers in terms of. Of when they are detected, what stage they are detected at.So One of my PhD supervisors, Matt Callister, had had this idea for this project, I think, going back around 15 years or longer, as to whether we could look at practices in terms of how much they use chest X ray, and then look at what happens to patients who are diagnosed with lung cancer, in terms of what stage of lung cancer they are diagnosed with, when they are diagnosed, and also with their survival as well. So that's really what we aim to do in this paper.Speaker A00:04:06.490 - 00:04:17.050Talk us through just briefly what you did and just. Yeah, it was quite a big study. But yeah, just briefly, how did you go about doing this?Because you looked at quite a lot of data, didn't you, to try to look at these different associations?Speaker B00:04:17.849 - 00:05:13.860So we took data on general practices from 2013 to 2017. So this is general practices in England. And we used the kinds of data that's available on general practice profiles.That website is also known as fingertips. And we got information on how often different general practices were requesting chest X ray in a year from the Diagnostic Imaging Data set.And then we also got data on lung cancer outcomes from the National Cancer Registry from the year after. So 2014 to 2018.So we put those together and we had Data on around 160,000 patients diagnosed with lung cancer in that period and information on general practices. Around 7,000 general practices.Speaker A00:05:14.500 - 00:05:23.780Let's go to what you found here. So what was that association between the rate of practice chest X rays and stage of cancer diagnosis? What did you find here?Speaker B00:05:24.520 - 00:07:23.330So what we did was we broke up practices in terms of how often they were requesting chest X rays, and we did that in two ways. One was in five groups into quintiles and that was adjusted based on factors like demography of the practice, smoking status, et cetera.And then we had another set of categories which was just based on what we call natural frequency. So just numbers that weren't into three categories that weren't adjusted.And the purpose for that was we wanted to be able to have a way that people in practices or who are working in the health system could just eyeball figures and get a sense of where practices were and how this might affect outcomes. So we had those different categories.And for the quintiles we found that practices in the top quintile of chest X ray requesting had both improved stage of diagnosis. So we find an odds ratio of 0.87 favoring early stage diagnosis. So that's stage one or two compared to late stage, stage three or four.So an odds ratio of 0.87. So that's, that's a really quite substantial improvement. And also improvements in survival.So hazards ratio of 0.92 favoring one year survival for that top quintile, 0.95 for five year survival as well. And that five year survival that's using only patients who survived to at least one year.So that's, that improvement isn't just a reflection of the improved one year survival. So we feel this is really quite important.The other categories with the three different groups that what we call the natural frequencies, we didn't see the quite the same scale effect in the top grip, the top third group, but that's, that's really probably a dilutional effect because they're broader categories. So the top group isn't showing us the same scale of effect.Speaker A00:07:23.650 - 00:07:39.410And you've sort of alluded to this, but you know, each practice will have its own specific population and demographics. Was there anything at a practice level that influenced the rate of chest X ray requests or stage of cancer diagnosis or survival?Speaker B00:07:40.740 - 00:08:39.100So in terms of how often practices request chest X rays. So we've looked at this previously in a paper...

Today, we’re speaking to Professor Martijn Schut, Professor of Translational AI in Laboratory Medicine and Professor Henk CPM van Weert, GP and Emeritus Professor of General Practice, both based at Amsterdam University Medical Center.Title of paper: Artificial intelligence for early detection of lung cancer in GPs’ clinical notes: a retrospective observational cohort studyAvailable at: https://doi.org/10.3399/BJGP.2023.0489In most cancers, the prognosis depends substantially on the stage at the start of therapy. Therefore, many methods have been developed to enhance earlier diagnosis, for example, logistic regression models, biomarkers, and electronic-nose technology (exhaled volatile organic compounds). However, as most patients are referred by their GP, who keeps life-long histories of enlisted patients, general practice files might contain hidden information that could be used for earlier case finding. An algorithm was developed to identify patients with lung cancer 4 months earlier, just by analysing their files. Contrary to other methods, all medical information available in general practice was used.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.600 - 00:00:55.370Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the journal. Thanks for taking the time today to listen to this podcast.Today we're speaking to Professor Martin Schutt, who is a professor in translational AI and Laboratory medicine, and Professor Hank Vanwort, GP and Emeritus professor in General Practice, who are both based at Amsterdam University Medical Center. We're here to discuss their paper, which is titled Artificial Intelligence for Early Detection of lung cancer in GP's clinical notes.So, yeah, it's great to see you both here today. And Martin, I'll come to you first.I suppose we know that it's important to try and diagnose cancer early, but could you talk us through what's the potential for artificial intelligence here in terms of identifying cancer earlier based on patient records?Speaker B00:00:55.810 - 00:01:52.220Yeah, that's a very interesting question because the potential kind of like goes hand in hand with the huge amount of interest in AI. And I think there are great opportunities. There are also great challenges.But talking about the opportunities, especially in the context of the article that we wrote, is on the data side. So on the data side, the digitalization of electronic health records gives great opportunities.A lot more is digitalized, and that means that we also, in our case, have access to free text, and that we, with the advent of the large language models, with also new developments in AI, we also have better ways of making use of those data. So those two combined creates a really interesting formula for big opportunities for AI in the general practice and healthcare in general.Speaker A00:01:52.300 - 00:02:05.960And you mentioned access to free text records. So what GPs are typing into the record records?But before we get into the study, can you just briefly describe what is natural language processing and how that can be used in free text records?Speaker B00:02:06.760 - 00:03:10.100So we know that a lot of clinical risk scores, they work with features of patients, so their age and their gender or sex. And. But of course, a lot of information is also written up in unstructured way. And in our case that is text.But we can also think of images and audio, and in that sense we have access to that data by different ways, which natural language processing is one of them. And it means that we give AI access to this text through, for example, advanced models like we now have, like ChatGPT users.But that's only one extreme of the spectrum that we can talk about, because you could also imagine that we just simply look with keywords through the text, and then if certain keywords were mentioned, that you include that in the information that is available to your Docu to your, to your model.Speaker A00:03:10.260 - 00:03:18.820And Hank, I don't know if you want to comment on just what we know already about clinical scoring systems for early diagnosis of cancer.Speaker C00:03:19.140 - 00:04:21.310The problem with what we already know is that we know things because they have been coded in the past. If, if you look at the ways to access data, the only way to access data was by using codes.And the big jump forward is made by using not only codes, but also text, because codes will always be replicating themselves.By which I mean that a GP who likes to, to have to make notes of what he has been speaking about with patients, he cannot code all the things that he will write down.So codes will always form a very exquisite extraction of the content of a consultation and will never present us with new information because codes only exist when the information was already there. Otherwise there will be no codes. Just so implicitly there is be a replication of what we know when we have to code our things.Speaker A00:04:21.899 - 00:04:49.139Yeah, absolutely.And I work with a colleague called Sarah Price who's done some research around coding and she's shown in her research that clinical coding can be biased depending on the outcome. So people who have bladder cancer, they're more likely to have codes for hematuria or blood in the urine.So, yeah, there could be a discrepancy in how clinicians code things rather than write it in the free text.Speaker C00:04:49.139 - 00:05:09.160Yeah, because in the past there has been done some marvelous research by Willie Hamilton, Hamilton and for example, and Judy Hippisley Cox is well known, but they had to use codes. So there was never a jump forward. And I think that now with the aid of natural language, we can make a jump forward.Speaker A00:05:09.559 - 00:05:36.620And the methods that you use here are quite complex, but I'll try to summarize it briefly.So essentially you analyze the electronic health records of over half a million Dutch patients and used these natural language processing techniques and machine learning to look back in the records of people diagnosed with cancer. And then you look to see what data in those records could be used to predict lung cancer.But is there anything you want to add to that, just for a lay audience? Martin?Speaker B00:05:36.700 - 00:06:20.170Yeah, one nuance, a small correction on that is that we don't only look at the patient with cancer, but we look at the cases and controls. So we both look at that because the AI needs to be able to distinguish the case from the controls.I think that's one important distinction because in healthcare, fortunately, we always have to do with low prevalences. We don't have too many patients compared to the healthy patients. That is Something of what the complexity of these kinds of models is.I think that is also important to realize when you develop these kinds of models.Speaker C00:06:20.810 - 00:06:22.250May I add something because.Speaker A00:06:22.250 - 00:06:22.730Yes, please.Speaker C00:06:22.730 - 00:07:09.230Because if you look at the, the scientific side of it, then if you develop a prediction model for, for a cancer, for example, then you have to do that with a logistic regression method. And logistic regressions can, can contain many variables, but not as many as you can use when you, when you can use new large language models.So you can also analyze many more variables. But you can. That's one point. And the second point is that you can analyze those variables in connection to each other.Great advantage compared to the past. So if you look at the model that we are, we used for this research, I think we use two layers of 100 variables in different relations to each other.So that gives you 100 times, hundred possibilities.Speaker A00:07:09.470 - 00:07:14.630Talk us through what you did develop here. So what? Talk us through that. Maybe Martin, you can try to explain.Speaker B00:07:14.630 - 00:08:21.700Yeah, Can I start with. So we picked up a signal.So we develop prediction models taking into all of these, what you said, over half a million patients, all the clinical notes, the consultations that they had, put it in a prediction model. We pick up a signal, we can make a prediction model that can. That performs well. So that's one.But the second step is that ideally we would also like to get some information from that model. It's like, what do you use to predict what does contribute to a prediction for lung cancer?And then we come to the nature of the complex methods that we use is that they are black box. We are not able to open them up and see what is in them.And that is actually, I say, planning forward that we would like to peek into those boxes to see...

Today, we’re speaking to Dr Afrodita Marcu, a Research Fellow in Cancer Care at the University of Surrey.Title of paper: Symptom appraisal and help- seeking before a cancer diagnosis during pregnancy: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2024.0208There is a gap in current understanding about the experiences of women diagnosed with cancer during or around pregnancy including how they appraise and seek help for cancer-related symptoms. This qualitative study found that women and healthcare professionals often interpreted symptoms through the lens of pregnancy, particularly when symptoms were vague. Health professionals need to ensure full assessment of symptoms, timely referral, and effective safety-netting for these women.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.040 - 00:01:04.650Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjgp. Thanks for listening to this podcast today. In today's episode, we're speaking to Dr.Aphrodite Marcoux, a research fellow in Cancer care at the University of Surrey.We're here to talk about a paper she's recently published here in the bjgp, which is titled Symptom Appraisal and Help Seeking Before a Cancer Diagnosis during Pregnancy, A Qualitative Study. So it's really lovely to meet you, Aphrodita, to talk about your research.And I think this is a really important area and I wanted to get your thoughts on just why this area is so important to research.But I think that most people will probably appreciate that during pregnancy, women's bodies are going through lots of changes, so it can sometimes be difficult to know what's normal and what's not. But talk us through why you wanted to do this study.What are the challenges faced by patients and by doctors around cancer diagnosis in women who are pregnant?Speaker B00:01:05.050 - 00:02:32.190It's an important area to research because the symptoms of pregnancy, the bodily changes that naturally occur during pregnancy, can mask the symptoms of cancer, both for the women experiencing them, but also for the healthcare professionals with whom they come into contact and with whom they share the symptoms.So it's an important area to research from that point of view in terms of understanding the potential causes for delay in receiving a cancer diagnosis.And one of the areas which we discovered was less researched was early diagnosis or timeliness of diagnosis of cancer diagnosis in the context of pregnancy.So we conducted this research because there was a lack of research, especially in the uk, on women's pathway or other pathways to a cancer diagnosis and pregnancy.And we wanted to get a more detailed understanding knowledge of how women make sense of their symptoms during pregnancy, how they seek help and why to whom they present, midwife, gp, other healthcare professionals and how they receive a diagnosis. What is the pathway to a cancer diagnosis and pregnancy?We wanted to get more clarity about that, more detail, and we were also interested to find out whether delays characterize this pathway to a cancer diagnosis in pregnancy, be they patient related delays or healthcare system related delays.Speaker A00:02:32.830 - 00:02:44.750And I guess you've touched on this. So does do we know if there are delays in cancer diagnosis amongst women who are pregnant?So do they tend to have a later diagnosis than women who aren't pregnant?Speaker B00:02:45.540 - 00:03:15.770International research suggests so. For example, in relation to breast cancer, which is the most frequent cancer diagnosed during pregnancy?Women are typically diagnosed later or later stage breast cancer than women who are not pregnant of similar age groups.So there is some indication that in the body of literature around cancer in pregnancy that women might receive a later diagnosis compared to women who are not pregnant.Speaker A00:03:16.570 - 00:03:56.710And this was a qualitative research study. So your team talked to women diagnosed with cancer during or soon after pregnancy and you talked to 20 women.And I really wanted to focus on what you found here. And you used an interesting model here.So you map the findings of your research onto a commonly used framework in cancer diagnosis, the models of pathway to treatment. So you've talked about sort of these pathways that women experience during their cancer diagnosis journey during pregnant.And I wanted to just talk through some of the findings. So when women were pregnant, how did they interpret their symptoms that may or may not have been related to cancer?Speaker B00:03:58.390 - 00:06:22.420Well, they interpreted these symptoms in various ways and that depended on the type of cancer they had, but also the type of symptom or symptoms that they experienced.So, for example, we had a couple of women with colon cancer, bowel cancer, one of them had abdominal pain and bloatedness, bloating, whilst the other one had blood in the stool. So obviously the symptoms were interpreted differently by the two women.The one with blood in the stool saw this as incongruent with pregnancy because it's very unusual to have blood in stool during pregnancy, and looked up her symptoms online, did some reading and decided that these symptoms warrant medical attention. So she contacted her GP fairly promptly.The other lady with more diffuse symptoms with abdominal pain and bloating repeatedly mentioned these symptoms to her midwife, but these were put down to pregnancy. And she always, when she actually engaged in information seeking online, she always added in pregnancy.So she saw these symptoms as being part of the pregnancy, was her first child, and thought it's normal to have abdominal pain or to feel bloated during pregnancy. So she was actually diagnosed quite late with stage 4 colon cancer.Of course, we are not drawing cause effect conclusions because this was a qualitative study, but we do find that the symptoms, which are vague, are more likely to be interpreted as being signs or symptoms of pregnancy, as being pregnancy related bodily changes.So it depends on the type of symptom that people symptoms that people experience, but also depends on the type of cancer they have, because some cancers, such as breast cancer, are more people are more familiar with breast cancer, let's say, than with lymphoma or other types of cancer, and they're more likely to see breast lumps which are typical symptom of breast cancer as being indicative or being suggestive of breast cancer, and it makes them more worried and more inclined, speak to a healthcare professional to see their GP promptly. So for women who experience breast lumps, the pathway was in a sense clearer.They knew who to contact and also the healthcare professional in question, the GP was more likely to make referrals to tests and secondary care, refer them to the breast clinic.Speaker A00:06:22.980 - 00:06:30.180I think it was interesting in the paper you described this as people viewing their symptoms through the lens of pregnancy.Speaker B00:06:30.620 - 00:07:20.420Yes.So the pregnancy offered for the women sort of heuristic and also in competitive lens, they understood their symptoms in the context of the pregnancy.Of course, people, women expected their bodies to change during pregnancy, such as breasts becoming larger or various lumps appearing, perhaps being related to milk ducts and things like that. So they always thought of pregnancy as being the reason for their bodily changes rather than cancer.So again, we have different patient histories, different types of symptoms, and this leads to different ways or different pathways to cancer.Diagnosis in pregnancy for some people can be a very straightforward pathway, for others, it's more prolonged, one more complicated one because of the types of symptoms they experience.Speaker A00:07:21.380 - 00:07:36.880And I guess the flip side to this is what the healthcare professionals did with women coming to them with symptoms during their pregnancy.And this is all from the perspective of the women you talked to in the study, but what did they feel that the healthcare professionals thought of their symptoms when they presented to them?Speaker B00:07:37.120 - 00:09:06.970Well, I suppose it varied from individual to individual.In some cases, the healthcare professionals thought that the symptoms were due to pregnancy, saying it's hormonal, just hormonal changes, nothing to worry about.In some cases they thought that the baby was lying on a nerve, which explained why people had symptoms such as back pain or breathlessness or other symptoms, in some cases, the gps thought it is hormonal change, it's probably due to pregnancy, but I will refer the patient to a breast clinic because the system is there in place, it's better

Today, we’re speaking to Dr Stephen Gibbons, Consultant Clinical Biochemist at Leeds Teaching Hospitals NHS Trust, and Dr Clare Spencer, GP Partner and Menopause Specialist at the Meanwood Group Practice in Leeds.Title of paper: Optimising testosterone therapy in patients with hypoactive sexual desire disorderAvailable at: https://doi.org/10.3399/bjgp25X741321TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.400 - 00:01:08.824Hello and welcome to BJJP interviews and welcome to our new season of the podcast. Hope you all had a great break over Easter and thanks again for listening to this podcast today.My name is Nada Khan and I'm one of the associate editors of the BJTP. In today's episode, we're speaking to Dr. Stephen Gibbons, consultant clinical biochemist at Leeds Teaching Hospital NHS Trust, and Dr.Claire Spencer, a GP partner and menopause specialist at the Meanwood Group Practice in Leeds. We're here to talk about the recent clinical practice paper published here in the bjgp.The paper is titled Optimizing Testosterone Therapy in Patients with Hypoactive Sexual Desire Disorder. So thanks, Stephen and Claire, for joining me here today.It's great to talk to you about this paper, especially because it's in an area of a lot of interest to patients and clinicians in general practice wondering what to do about testosterone prescribing.I guess I wanted to kick things off, Stephen, really, by asking, what made you start investigating testosterone replacement in patients with hypoactive sexual desire disorder?Speaker B00:01:08.952 - 00:03:09.662So it was actually a conversation with a colleague at work over coffee and she mentioned to me that she'd noted quite a lot of high testosterone in females of a particular age and she was asking why that might be. So I explained it's probably because of TRT in this condition called hsdd, but that was kind of quite anecdotal at that point.So we thought we'd do a clinical audit. So myself and two colleagues, Kia and eloise, we audited 100 patients from Leeds.So we looked at a sample of 100 patients on TRT for HSDD and we audited them against the British Menopause Society guidance, which state that you should do a pre testosterone measurement and then you should check at at six to eight weeks, I believe. And what we found is that actually there was quite poor compliance with the BMS guidance. And at this point we felt a little bit out of our depth.But we thought, well, this is quite alarming. Probably the most alarming thing was the number of patients with a really high testosterone that weren't adequately followed up.So we thought, right, let's bring some clinical experts in at this point. So that's when we got in touch with Dr. Spencer and Dr. Jasim and Dr. Wal Ford, who's also on the paper.She's a consultant endocrinologist at Leeds, and we kind of had a look at the data and we all agreed that, you know, there were significant findings. And the question was why?Because there are quite comprehensive guidance out there from the bms, but I think we all felt that potentially they lacked some of the finer detail. Potentially in some areas they were a little vague. So that's when we came up with these additional recommendations.And they're certainly not supposed to replace the BMS guidance, but it's a supplementary kind of recommendations to support the BMS guidance. So that's where we started, really.Speaker A00:03:09.766 - 00:03:18.014And I guess if we just dial this back a bit. Can you or Claire talk us through what is hypoactive sexual desire disorder and how common is it?Speaker B00:03:18.102 - 00:04:38.868So hsdd, essentially, it's a condition where they get persistent absence of sexual dis. Desires or fantasies. So you might.Some people might term it low libido, I suppose, but the difference between low libido and HSDD is that in HSDD there's an emotional component, so emotional distress. And it doesn't just affect women, of course. This affects both males and females. But the prevalence seems to be much higher in females between.Between about 15 and 20% of females will experience HSDD. In males, it's probably slightly lower, around 5%. And I mean, Claire may expand on this, but we don't actually fully understand the causes, really.Probably multifactorial. There's certainly associations with physical conditions, things like diabetes and thyroid disorders.There is an association with hormonal imbalances, estradiol and testosterone, although the evidence is not as strong as one might think for testosterone. Certain medications can be associated with hsdd, things like antidepressants and then psychological issues.So anxiety, depression and current or previous relationship problems.Speaker A00:04:38.964 - 00:04:51.368And Claire, you are a menopause specialist, and I think the question that lots of people are probably wondering about is, is this an issue amongst women who are going through perimenopause or menopause as well?Speaker C00:04:51.564 - 00:06:31.562Yes, it's an incredibly common condition or symptom of the perimenopause and menopause. And as Stephen said so brilliantly, there are so many reasons behind that. So HSDD is obviously the far more severe end of the spectrum.But depending on which study you read, anywhere between 40 and 60% will complain of.Women will complain of low libido in the menopause, and obviously that then needs unpicking as to whether that's the more severe end of the spectrum or incredibly common. And this does happen to men as well as women, I think it's worth calling out. But in the menopause, a very common cause would be final symptoms.So in the menopause, with the loss of estrogen. Up to two thirds of women will develop vaginal dryness, soreness, irritation, lack of lubrication, painful or discomfort during intercourse.And that can have a really significant impact then on libido. And so there are some very specific causes related to the menopause.Also, if we think about all of the myriad of symptoms of the menopause, so including hot flushes, night sweats, lower mood, low motivation, many women gain weight in the menopause. Again, you can see how that then impacts and add to that anxiety, loss of resilience, you know, and the sort of more psychosocial factors.Plus layer on top of that, often women have been in a relationship for many, many years. You can see that there are additional challenges also. So it's a really common and distressing issue.Speaker A00:06:31.746 - 00:06:46.874And I think the question that maybe lots of gps will have, I think, is what are the current guidelines around using testosterone? And Stephen, you mentioned the BMS guidelines, the British Menopause Society. So what are the current guidelines telling us about using testosterone?Speaker C00:06:47.002 - 00:08:47.795So if we think about the NICE guidance for menopause first, that's NG23 and that has been recently updated, the new Update published in November 2024. And so nice say that testosterone can be used for low libido in the menopause in adequately estrogenized women.So basically women on hrt, because actually HRT containing estrogen plus or minus progesterogen can be helpful in managing libido. Libido and estrogen definitely has a really important part to play.But NICE say that testosterone can be added if you've managed the vaginal symptoms, if you've managed menopause symptoms. If women are taking hrt, then you can add testosterone.On top of that, the British Menopause Society have really helpfully published guidance also, which goes into a little more detail on the practicalities of prescribing and monitoring.And so the British Menopause Society would recommend that total testosterone is checked as a baseline and then pragmatically at around three months and then six to 12 months after that, again highlighting that this is predominantly prescribed for women on HRT and highlighting the importance of managing as much as you can the other symptoms that might be having an impact on libido.Also, it can be really difficult because, as we both said, there are so many factors that can impact and sometimes you do have to take more of a pragmatic approach and manage symptoms as best you can. Plus there may be a psychological aspect that needs to be approached through talking therapies plus testosterone on top of it.So complex issues, complex answers, often multifactorial approach is needed.Speaker A00:08:47.907 - 00:09:11.660And I guess what you've done here, as you mentioned, Stephen, was to develop local guidelines to help clinicians to guide testosterone testing.And I'd recommend to people listening to take a look at the full paper, which will be linked in the show notes that give the specific guidelines that you've described and developed. But can you give us a bit of a summary of what GP should be thinking about in terms of testosterone...

Today, we’re going to do something a bit different and take a look back at the recent BJGP Research Conference, which was held on the 21st of March 2025 in Manchester. I’m going to discuss some of the highlights and really focus on what the conference is about and how to get involved in the future.Here are some of the links I discussed in the podcast:Linkshttps://journals.sagepub.com/doi/full/10.1177/1609406918797475https://bjgplife.com/write-for-bjgp-life/

Today, we’re speaking to Dr Louise Clarke, a GP and researcher based at the University of Nottingham.Title of paper: Barriers to diagnosing and treating vulval lichen sclerosus: a survey studyAvailable at: https://doi.org/10.3399/BJGP.2024.0360Previous research has identified a significant diagnostic delay and misdiagnosis of vulval lichen sclerosus (VLS), a condition most commonly presenting to primary care. Health care professionals (HCPs) in primary care share the concerns of women with VLS citing frequent misdiagnosis, embarrassment and lack of knowledge as barriers to diagnosis. In this survey, 92.6% of HCPs felt further education would be useful with 37.7% never having participated in learning on vulval skin disease, self-directed or otherwise. Key enablers identified to facilitate timely VLS diagnosis and treatment include: a comprehensive education programme for HCPs, implementation of standardised pathways of care and development of a VLS diagnostic criteria to be implemented in primary care workflow.

Today, we’re speaking to Dr Victoria Tzortziou Brown, a GP and Reader in Primary Healthcare and Health Policy at Queen Mary University of London, and Vice Chair for External Affairs at the Royal College of General Practitioners.Title of paper: Language of primary medical qualification and differential MRCGP exam attainment: an observational studyAvailable at: https://doi.org/10.3399/BJGP.2024.0296To the authors’ knowledge, this is the first study on the association between the language of the primary medical qualification and attainment in the Membership of the Royal College of General Practitioners (MRCGP) examination. It shows that undertaking undergraduate clinical training in a country where the native language is not English can statistically significantly and negatively affect examination performance in MRCGP exams. The study also shows statistically significant positive correlations between Multi- Specialty Recruitment Assessment, International English Language Testing System, and Professional and Linguistic Assessments Board scores and the MRCGP exam scores; this suggests that past performance in these assessments can help with the identification of those international medical graduate registrars who may find tailored support beneficial. 

Today, we’re speaking to Professor Helen Atherton, Professor of Primary Care Research at the University of Southampton. Title of paper: Supporting patients to use online services in general practice: focused ethnographic case studyAvailable at: https://doi.org/10.3399/BJGP.2024.0137Use of, and access to, online services are increasing within general practice in England. Current approaches to digital facilitation as observed in this study, appeared to be ad hoc and fitted around multiple services. Reception staff were key to supporting patients to use these platforms, but training, resources and support for such staff were not readily available. Enabling patients to have the best chance of using online services requires vision, strategy and investment of time and money. As practices and patients increasingly use online approaches to healthcare provision, practices should be mindful of patient groups who may find accessing services online to be a challenge and who thus require targeted help and support.

Today, we’re speaking to Dr Sam Merriel, a GP, and NIHR Academic Clinical Lecturer in General Practice based at the University of Manchester.Title of paper: Factors affecting prostate cancer detection through asymptomatic PSA testing in primary care in England: Evidence from the 2018 National Cancer Diagnosis AuditAvailable at: https://doi.org/10.3399/BJGP.2024.0376Asymptomatic, informed choice prostate specific antigen (PSA) testing occurs in primary care in the UK in the absence of a national prostate cancer screening programme. This study shows that four fifths of prostate cancers are diagnosed following symptomatic presentation rather than from asymptomatic PSA testing. There is a 13-fold variation in asymptomatic PSA test detected prostate cancer between English GP practices, without clear explanatory practice-level factors. Patient factors amongst men diagnosed with prostate cancer, including ethnicity, age, deprivation, and multi-morbidity, have a significant impact on the likelihood of being diagnosed following asymptomatic PSA testing.

Today, we’re speaking to Dr Pete Edwards, a GP and NIHR Research Fellow based at the University of Bristol. Pete has published a research article in the February issue of the BJGP titled,’ Safety-netting advice documentation in out-of-hours primary care: a retrospective cohort from 2013 to 2020’ along with an editorial about safety netting that we’re going to discuss today.Title of paper: Safety-netting advice documentation in out-of-hours primary care: a retrospective cohort from 2013 to 2020Available at: https://doi.org/10.3399/BJGP.2024.0057Title of editorial: Safety netting in primary care : managing the low incidence, high uncertainty of severe illnessAvailable at: https://doi.org/10.3399/bjgp25X740529Previous research has reported on safety-netting advice (SNA) documented in patient records during in-hours practice but this, to the authors’ knowledge, is the first large-scale (>1000 consultations) longitudinal analysis of the type of safety-netting documented advice during out-of-hours (OOH) primary care. This study demonstrated an increasing frequency of documented SNA in OOH records and increasing utility of specific advice over time. In contrast to previous reports of verbalised safety-netting during in-hours practice, this study found a higher frequency of SNA in records from face-to-face compared with telephone encounters. This study also showed safety-netting advice was more likely to be documented for patients with possible infections, but less frequently for mental health consultations. That is a possible area for improvement, in line with current UK policy for ‘parity of esteem’ between physical and mental health conditions.

Today, we’re speaking to Professor Anne Slowther, Emeritus Professor of Clinical Ethics based at the University of Warwick.Title of paper: Experiences of using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in English general practice: a qualitative study among key primary health and social care professionals, patients, and their relativesAvailable at: https://doi.org/10.3399/BJGP.2024.0248The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a specific model of emergency care treatment planning now used in primary care and hospitals, and in many areas of the UK. It has been evaluated in hospital settings, but little is known about how it is understood and operationalised in general practice. Our research found a consensus that ReSPECT could facilitate a person-centred approach to future treatment decision making, but there are specific challenges in implementing ReSPECT in a community setting. A revised approach needs to consider uncertainty of illness trajectories over time and to emphasise patient values to facilitate decision making in an emergency.

In this episode, we talk to Professor Paul Little, Professor in Primary Care Research at the University of Southampton.Title of paper: A randomised controlled trial of a digital intervention (Renewed) to support symptom management, wellbeing and quality of life in cancer survivorsAvailable at: https://doi.org/10.3399/BJGP.2023.0262There are increasing numbers of cancer survivors who have finished their primary treatment whose quality of life remains consistently poor over years. There is limited robust evidence for pragmatic, brief interventions to support cancer survivors in primary care - which is where most participants are managed, and where resources are increasingly stretched. Cancer survivors quality of life improved with detailed generic online support. Robustly developed bespoke digital support provided limited additional benefit for cancer survivors in the short term, but modest additional longer term benefit in enabling symptom management and self-rated health, and with significantly reduced costs to the health service.

It’s that time of the year again! This episode, we have a round table discussion with the editorial team of Sam Merriel, Tom Round and Nada Khan. This collection of the BJGP’s top 10 research most read and published in 2024 brings together high-profile primary care research and clinical innovation.And here are the top 10 most read papers of 2024:10. Patient experiences of an online consultation system: a qualitative study in English primary care post-COVID-19Available at: https://doi.org/10.3399/BJGP.2023.00769. Does shortage of GPs matter? A cross-sectional study of practice population life expectancyAvailable at: https://doi.org/10.3399/BJGP.2023.01958. Primary care provision for young people with ADHD: a multi-perspective qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2023.06267. Breast cancer risk assessment for prescription of Menopausal Hormone Therapy in women who have a family history of breast cancerAvailable at: https://doi.org/10.3399/BJGP.2023.03276. Training needs for staff providing remote services in general practice: a mixed-methods studyAvailable at: https://doi.org/10.3399/BJGP.2023.02515. Long-term cardiovascular risks and the impact of statin treatment on socioeconomic inequalities: a microsimulation modelAvailable at: https://doi.org/10.3399/BJGP.2023.01984. Exploring GPs views on beta-blocker prescribing for people with anxiety disorders: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2024.00913. Optimising the use of the prostate- specific antigen blood test in asymptomatic men for early prostate cancer detection in primary care: report from a UK clinical consensusAvailable at: https://doi.org/10.3399/BJGP.2023.05862. First Contact Physiotherapy: An evaluation of clinical effectiveness and costsAvailable at: https://doi.org/10.3399/BJGP.2023.05601. Risk of Parkinsons disease in people with New Onset Anxiety over 50 years - Incidence and Associated FeaturesAvailable at: https://doi.org/10.3399/BJGP.2023.0423

The BJGP podcast is back for a new season! Today, we’re speaking to Professor Joanne Reeve, who is a GP and Professor of Primary Care Research at Hull York Medical School. Joanne has published an editorial in the recent January edition of the BJGP titled, ‘Standing up for general practice’, and today we’re going to speak about this article and what it means to be a GP. Title of paper: Standing up for general practiceAvailable at: https://doi.org/10.3399/bjgp25X740373

We’re taking a break over Christmas and new year, but we’ll be back at the end of January 2025 with a new BJGP podcast. Look forward to seeing you then!

Today, we’re speaking to Dr Rebecca Payne and Professor Trish Greenhalgh. Rebecca is a GP and an NIHR In Practice Fellow, and works alongside Trish at the Nuffield Department of Primary Health Care Sciences at the University of Oxford. Title of paper: What are the challenges to quality in modern, hybrid general practice? A multi-site longitudinal studyAvailable at: https://doi.org/10.3399/BJGP.2024.0184Quality in primary care is a multidimensional construct embracing effectiveness, efficiency, safety, patient-centredness, equity, continuity, accessibility, and more. We report on how UK practices have striven to deliver on these aspects of quality as they move to a hybrid model that combines in-person with remote and digital care. The context for quality is currently very challenging, with resource constraints, staff shortages, and weak infrastructure. Digital systems intended to increase efficiency have produced some benefits for some people but have created new forms of inefficiency, increased fragmentation of care, contributed to staff stress, and widened inequities of access.

Today, we’re speaking to Dr Dan Butler, a portfolio GP completing his PhD at Queen’s University Belfast. Title of paper: “Challenging but ultimately rewarding”: A qualitative analysis of Deep End GPs’ experiencesAvailable at: https://doi.org/10.3399/BJGP.2024.0167GPs working in the highest need, socioeconomically deprived areas, the “Deep End”, face additional challenges. This paper looks at the NI context and explores why, despite the challenges, GPs choose to work in these areas. The main issues relate to wider healthcare failings and the challenges of patient populations some of whom generally frequently use (‘medicalised’ group) and those who underuse (‘missingness’ group) health services. GPs tend to relate to ‘Deep End’ areas, either due to personal connections or feelings of duty and social responsibility. No amount of General Practice focused funding will ‘solve’ the issues, instead a far greater holistic approach improving the physical conditions people are born, live and work in, is needed.

Today, we’re speaking to Dr Carol Sinnott, a GP and a Senior Clinical Research Associate based at The Healthcare Improvement Studies Institute. Title of paper: Understanding access to general practice through the lens of candidacy: a critical review of the literatureAvailable at: https://doi.org/10.3399/BJGP.2024.0033Dominant conceptualisations of access to health care are often framed in terms of speed and supply — these approaches risk obscuring important aspects of people’s experiences of access. The Candidacy Framework was developed to study access to health care by people in vulnerable groups. This study confirms the salience of the Candidacy Framework for understanding access in the setting of general practice, offering new insights for policy and practice.

Today, we’re speaking to Dr Sarah Sullivan, a Senior Research Fellow based within the Centre for Academic Mental Health at the University of Bristol. Title of paper: External validation of a prognostic model to improve prediction of psychosis in primary careAvailable at: https://doi.org/10.3399/BJGP.2024.0017This paper reports the external validation of the only psychosis risk prediction algorithm to be used in primary care. External validation of prediction algorithms is essential to provide evidence of transportability i.e. that the algorithm can be used outside its training environment. This vital step for prediction algorithms is often missed.

Today, we’re speaking to Dr Sophie Ansems, a GP and PhD candidate, and Dr Lianne Mulder, both based at the Department of Primary and Long-term Care at the University of Groningen in the Netherlands. Title of paper: General practitioners’ perspectives on diagnostic testing in children with persistent non-specific symptomsAvailable at: https://doi.org/10.3399/BJGP.2023.0683It is known that GPs employ diagnostic tests in adults with persistent non-specific symptoms for motives beyond strictly diagnostic purposes, but comparable research has not been conducted in children. This study adds that although GPs want to limit unnecessary invasive procedures in children, non-diagnostic motives to test are considered important, for example to provide reassurance or secure the GP-patient relationship. The decision to conduct diagnostic tests in children with persistent non-specific symptoms is based on a complex trade-off among medical considerations, psychosocial factors, consultation management, and efficient resource utilization. Awareness amongst GPs of the motives underlying their own testing behaviour in children with PNS could prompt changes in their testing practices.

Today, we’re speaking to Dr Amy Clark and Dr Kathryn Hughes. Amy is a resident doctor in North West Anglia Foundation Trust, and Kathryn who is a GP and a Senior Clinical Lecturer based at PRIME Centre Wales within Cardiff University. Title of paper: Assessing acutely ill children in general practice using the National PEWS and LqSOFA clinical scores: a retrospective cohort studyAvailable at: https://doi.org/10.3399/BJGP.2023.0638The validity of the current NICE-recommended scoring system for identifying seriously ill children in general practice, the Traffic Light system, was recently investigated and shown to perform poorly. A new National PEWS (Paediatric Early Warning Score) has just been introduced in hospital settings with hopes for subsequent implementation in general practice, to improve the identification of seriously unwell children. To the authors’ knowledge, the score has not previously been validated in general practice. This study found that the National PEWS would not accurately identify children requiring hospital admission within two days of presenting to general practice with an acute illness and therefore should not be recommended for this purpose without adjustment. Another score, the Liverpool quick Sequential Organ Assessment (Lq-SOFA), was also investigated and found to perform poorly in general practice.

Today, we’re speaking to Professor Carolyn Chew-Graham, Professor of General Practice Research at Keele University. Title of paper: People from ethnic minorities seeking help for Long Covid: a qualitative study.Available at: https://doi.org/10.3399/BJGP.2023.0631People from ethnic minority groups are less likely to present to primary healthcare for Long Covid. This study explored the lived experiences of Long Covid amongst people from ethnic minority groups. Participants were often previously unaware of Long Covid or available support and some described not feeling worthy of receiving care. Experiences of stigma and discrimination contribute to a lack of trust in healthcare professionals and services, and are common in previous negative healthcare encounters. Receiving empathy, validation, and fairness in recognition of symptoms, and support is needed to enhance trust and safety in healthcare.

Today, we’re speaking to Marije Splinter, an epidemiologist and sociologist based at the Department of Epidemiology at Erasmus University Medical Centre in the Netherlands. Title of paper: Healthcare avoidance during the early stages of the COVID-19 pandemic and all-cause mortality: a longitudinal community-based studyAvailable at: https://doi.org/10.3399/BJGP.2023.0637During the COVID-19 pandemic, trends of reduced healthcare-seeking behaviour were observed alongside global patterns of excess mortality, raising concerns about the consequences of healthcare avoidance for population health. This study found that individuals who avoided healthcare during COVID-19 were at an increased risk of all-cause mortality. Importantly, these individuals were characterised by underlying symptoms of depression and anxiety, as well as poor self-appreciated health. The findings of this study emphasise the need for targeted interventions to safeguard access to primary and specialist care for these vulnerable individuals, during and beyond healthcare crises.

Today, we’re speaking to Dr Charlotte Archer, Research fellow in primary care mental health based at the University of Bristol.Title of paper: GPs’ views of prescribing beta- blockers for people with anxiety disorders: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2024.0091Beta-blockers are licensed for managing the symptoms of anxiety, and new prescriptions for patients with anxiety have increased substantially in recent years. However, National Institute for Health and Care Excellence guidance for anxiety does not recommend beta-blockers as a treatment for anxiety, and recent reports have highlighted risks associated with the beta-blocker propranolol. Our research found that GPs prescribe beta-blockers for anxiety because they consider them to be low risk, a quicker solution than other treatments, and useful for managing associated physical symptoms.

Today, we speak to Dr Jet Klunder, a GP trainee and a PhD candidate based at the Department of General Practice at Amsterdam University Medical Centre in the Netherlands. Title of paper: Predicting unplanned admissions to hospital in older adults using routinely recorded general practice data: development and validation of a prediction modelAvailable at: https://doi.org/10.3399/BJGP.2023.0350Unplanned hospital admissions in older adults are a critical concern for patients, family caregivers, healthcare professionals, and service planners. In this study a robust and easy-to-use prediction model has been developed and validated using routinely recorded data from general practices to predict the risk of unplanned hospital admissions in community-dwelling older adults. Identifying older adults at high risk can facilitate targeted preventive interventions, such as case management, telemedicine, or anticipatory care planning. Moreover, the model could also be utilised by policymakers for capacity planning of hospital beds.