BJGP Interviews

In this episode, we talk to Dr Holly Smith, Research Fellow in Perinatal Mental Health based at the Department of Primary Care and Population Health at University College London. Title of paper: The first 100 days after childbirth: cross-sectional study of maternal clinical events and health needs from primary careAvailable at: https://doi.org/10.3399/BJGP.2023.0634The first 100 days after childbirth are a crucial time for women as they recover mentally and physically from pregnancy and birth. Previous studies have sought to identify common postnatal conditions and symptoms women may experience after birth, but no studies, to the authors’ knowledge, have used electronic health records from primary care to examine women’s actual care use in this time. The current study found that women most commonly use primary care for: a post natal check or visit, monitoring (such as a blood pressure reading), and contraception. The study adds useful knowledge on women’s primary care use following childbirth.

In this episode, we talk to Dr Michelle Rickett, a Research Associate on the NIHR funded EXTEND study based at the School of Medicine at Keele University. Title of paper: Collaboration across the primary/specialist interface in early intervention in psychosis services: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2023.0558Early Intervention in Psychosis (EIP) service users may be referred from, and discharged back to, primary care. There is limited research on patient and carer experience of discharge to primary care from EIP services and little guidance around planning and implementation of discharge. This paper explores experiences of EIP care and discharge from the perspectives of service users, carers and healthcare professionals in EIP services and primary care. It explores the patient journey through EIP services, highlights the lost connection with primary care, and makes recommendations for more collaboration between primary and specialist care, particularly around physical health monitoring and management, which might improve patient experience and outcome.

In this episode, we talk again with Jen MacLellan, a qualitative researcher based within the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Title of paper: Unpacking complexity: GP perspectives on addressing the contribution of trauma to women’s ill healthAvailable at: https://doi.org/10.3399/BJGP.2024.0024Significant challenges and uncertainties reside in how best to manage the link between mind and body in communication with patients and in healthcare pathways. Lack of supportive resources to deliver holistic, trauma informed care risks practitioners (inadvertently) avoiding discussion of the contribution of distress in the illness presentation. A trauma informed systems level approach would support integration of psychological support within multiple care pathways and support wellbeing of practitioners providing care.This study was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (NIHR202450). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

We're taking a summer break but will be back with our BJGP interview podcast on Tuesday 3 September.

We're taking a summer break but will be back with our BJGP interview podcast on Tuesday 3 September.

In this episode, we talk to Professor Clare Turnbull, Professor in Cancer Genetics at the Institute for Cancer Research and Honorary Consultant based at the Marsden. Title of paper: Breast cancer risk assessment for prescription of menopausal hormone therapy in women with a family history of breast cancer: an epidemiological modelling studyAvailable at: https://doi.org/10.3399/BJGP.2023.0327Prospective longitudinal studies (such as the Collaborative Group on Hormonal Factors in Breast Cancer [CGHFBC]) have enabled the estimation of relative risks of breast cancer associated with different durations of exposure to and formulations of menopausal hormonal therapy (MHT). Risk models such as BOADICEA enable prediction of age-related breast cancer risk according to the extent and pattern of breast cancer family history. This study undertook integration of these two data sources (namely the CGHFBC datasets and the BOADICEA model) in order to model annual and 5-year risks for breast cancer incidence for the age window 50–80 years for hypothetical unaffected female consultands with different patterns of MHT exposure and different patterns of breast cancer family history, also generating predictions for breast cancer-specific death. This study modelled combined and oestrogen-only MHT but lacked data for analyses of newer types of MHT such as micronised progesterone or non-oral preparations.

In this episode, we talk to Dr Joe Hutchinson, who is a salaried GP and an academic GP working within the Centre for Primary Care and Health Services Research at the University of Manchester. Title of paper: Trends in full-time working in general practice: repeated cross-sectional studyAvailable at: https://doi.org/10.3399/BJGP.2023.0432General practice is under increasing pressure, in part due to a lack of GPs. There is contention as to the proportion of GPs working full-time. We find that average hours and sessions worked per week by GPs in England have declined, whilst average hours per session has increased. Over half (55%) of GPs work at least the NHS Digital standard full-time definition of 37.5 hours per week. Average hours worked per session in 2021 was 51% greater than the BMA standard definition of a session’s duration. We recommend removing sessions as a definition of full-time working. However, if full-time work commitment continues to be defined in terms of the number of sessions worked, alignment with the NHS definition of 37.5 hours per week could be achieved by recognising that 6.0 sessions per week of 6.2 hours constitutes full-time work.

In this episode, we talk to Dr Anna Wilding, a Research Fellow based at Health Organisation, Policy and Economics at the University of Manchester. Title of paper: Geographic inequalities in need and provision of social prescribing link workersAvailable at: https://doi.org/10.3399/BJGP.2023.0602Social prescribing link workers were proposed in the 2019 NHS Long Term Plan to address health inequalities. Using national administrative data, we find that the subsequent roll-out of link workers has not been sufficiently targeted at areas of highest need. Higher need areas require additional support for employing link workers to tackle health inequalities and better support population needs.

In this episode, we talk to Lisa Davies, a PhD candidate based at Utrecht University. Title of paper: Patients’ perspectives about the role of primary healthcare providers in long-term opioid therapy: a qualitative study in Dutch primary careAvailable at: https://doi.org/10.3399/BJGP.2023.0547Previous research has shown the pivotal role of primary healthcare providers in managing long-term opioid use for patients with chronic non-cancer pain. This study adds the patient’s perspective, underscoring the importance of improved communication, medication management, regular assessments, and a patient-centred approach, especially during opioid tapering. Clinicians should prioritise these aspects to enhance patient care and outcomes for patients in chronic non-cancer pain management.

In this episode, we talk to Juan Carlos Bazo-Alvarez, a Senior Research Fellow within the Department of Primary Care and Population Health at University College London. Title of paper: Risk of Parkinson’s disease in people with New Onset Anxiety over 50 years - Incidence and Associated FeaturesAvailable at: https://doi.org/10.3399/BJGP.2023.0423Presence of anxiety is known to be increased in the prodrome of Parkinson’s disease (PD). This study investigated the risk of developing PD in people with anxiety compared with those without anxiety, accounting for a number of confounding variables. The results suggest that there is a strong association between anxiety and later diagnosis of PD in patients aged ≥50 years who present with a new diagnosis of anxiety. This provides evidence for anxiety as a prodromal presentation of PD.

In this episode, we talk to Dr Meena Rafiq, Academic GP and Clinical Research Fellow within the Institute of Epidemiology and Health at University of Melbourne. Title of paper: Clinical activity in general practice before sarcoma diagnosis: an Australian cohort studyAvailable at: https://doi.org/10.3399/BJGP.2023.0610Sarcoma is challenging to diagnose with delays associated with poor patient outcomes and experiences. This study has shown that patients with sarcoma often have multiple GP visits and imaging requests in the year before their diagnosis. Clinical activity in general practice increases from 6 months before sarcoma diagnosis, primarily in the form of imaging requests, indicating that opportunities for a timelier diagnosis may exist in some patients. Primary care interventions to increase awareness of sarcoma symptoms and streamline diagnostic pathways, including promoting and clarifying guidelines to optimise the use of appropriate imaging and direct specialist centre referrals, could improve earlier diagnosis and patient outcomes.

In this episode, we talk to Dr Abi Eccles, Assistant Professor within Warwick Applied Health at Warwick Medical School. Title of paper: The GP’s role in supporting women with anal incontinence after childbirth injuryAvailable at: https://doi.org/10.3399/BJGP.2023.0356Anal incontinence after childbirth injury has profound impacts on women’s lives and many find they cannot access healthcare and support. GPs can play a crucial role, but we know that very few women speak to their GPs about their symptoms. In combining GPs’ and women’s views, we show how anal incontinence after childbirth injury is often missed in a primary care setting. Drawing on these findings, we highlight the key ways GPs can provide support for such womenClick here for the RCGP course on anal incontinence after childbirth.

In this episode, we talk to Dr Ed Tyrell, a GP and Clinical Assistant Professor within the Faculty of Medicine and Health Sciences at the University of Nottingham. Title of paper: Primary care consultation patterns before suicide: a nationally representative case–control studyAvailable at: https://doi.org/10.3399/BJGP.2023.0509Although increased primary care utilisation in the preceding year has been linked with death by suicide, longer-term consulting patterns and primary care-recorded reasons for consulting have not been previously examined. This large, nationally representative sample from England showed rates of consulting among patients who died by suicide continuously rose in the 5 years before suicide, especially in the last 3 months. Suicide risk was significantly increased among those who consulted more than once every month in the final year, irrespective of any sociodemographic characteristics and irrespective of the presence (or absence) of known psychiatric comorbidities. Common reasons why patients who died by suicide consulted before their death included medication review, depression, and pain.

In this episode, we talk to Carina Benthin, a psychologist and PhD student based at Helmut-Schmidt University. Title of paper: What helps and what hinders antidepressant discontinuation? Qualitative analysis of patients’ experiences and expectationsAvailable at: https://doi.org/10.3399/BJGP.2023.0020Long-term antidepressant use is increasing, including among those patients who may consider discontinuation. In this study, patients with remitted major depressive disorder and long-term antidepressant use reported negative expectations about discontinuation. These expectations were partly shaped by their previous negative experiences, which persisted despite a wish to stop antidepressants, and hindered discontinuation. The findings of this study highlight patients’ need for information about treatment discontinuation, and professional support and structure throughout discontinuation, while taking into account their individual expectations and previous experiences.

In this episode, we talk to Dr Adam Geraghty, Associate Professor of Psychology and Behavioural Medicine within the School of Primary Care, Population Sciences and Medical Education at the University of Southampton. Title of paper: Distinguishing emotional distress from mental disorder: A qualitative exploration of the Four-Dimensional Symptom Questionnaire (4DSQ)Available at: https://doi.org/10.3399/BJGP.2023.0574A range of different approaches have been suggested to support primary care clinicians in the identification and management of mental health problems, from brief depression questionnaires, to approaches focusing on shared understanding within consultations. The Four-Dimensional Symptom Questionnaire (4DSQ) is a questionnaire developed in primary care that can support this process by distinguishing general distress from depressive or anxiety disorder. In this study we show that people recruited from primary care and community settings find completing a multidimensional questionnaire acceptable and find the splitting of general (potentially severe) distress from depression and anxiety helpful. Use of the 4DSQ may support collaborative diagnostic conversations as part of primary care consultations.

In this episode, we’re going to recognise some exceptional researchers here in the UK. We talk to Dr Ben Bowers and Dr Steve Bradley, this year’s winners of the Royal College of GPs and Society for Academic Primary Care early career researcher award. For more information about the award, see below two interviews with Ben and Steve on the RCGP website:Dr Ben Bowers: https://www.rcgp.org.uk/Blog/SAPC-OECR-Awards-2024-Ben-BowersDr Steve Bradley: https://www.rcgp.org.uk/Blog/SAPC-OECR-Awards-2024-Stephen-BradleyCongratulations to Ben and Steve!

In this episode, we talk to Dr Erin Oldenhof, Research Coordinator and a benzodiazepine withdrawal counsellor at Reconnexion, a non-profit organisation that offers teratmenta nd support for insomnia, depression and anxiety. We’re also joined by Dr Petra Staiger, Associate Professor within the School of Psychology at Deakin University in Melbourne. Title of paper: “Let’s talk about sleep health”: Patient perspectives on willingness to engage in psychological interventions for insomniaAvailable at: https://doi.org/10.3399/BJGP.2023.0310Psychological interventions for insomnia are recommended as the first-line treatment but remain underutilised in primary care settings relative to pharmacological treatments. Coupled with known harms regarding prolonged use of benzodiazepine receptor agonists (BZRAs) to manage insomnia, the need for increased uptake of psychological interventions is critical. This study explored the influence of key factors that motivate individuals’ intention to engage with psychological interventions, revealing the importance of active involvement of GPs in this process from the initial consultation through to supporting treatment adherence long-term. By understanding the consumer perspective in conjunction with the unique clinical expertise of GPs, we have offered guidance on how to enhance patient-practitioner collaboration across the entire treatment process and increase GP confidence to facilitate increased engagement with evidence-based psychological treatment modalities.

In this episode, we talk to Dr Erica di Martino, a Research Fellow based within the School of Medicine at the University of Leeds.Title of paper: Understanding General Practitioners’ referral decisions for younger patients with symptoms of cancer: a qualitative interview studyAvailable at: https://doi.org/10.3399/BJGP.2023.0304Some cancers are becoming more common in younger people, yet clinical guidelines often recommend urgent referral for suspected cancer only if patients are above a certain age. Findings from this study show that, whilst most GPs interpret age criteria in cancer guidelines flexibly, some perceive and apply them as firm directives. In addition, system constraints may create unwarranted rigidity and act as barriers to prompt investigation. More in-built and explicit flexibility in the referral system is required to facilitate timely diagnosis of younger patients perceived as at higher risk by their GP.

In this episode, we talk to Becky Gudka, a Graduate Research Assistant based at the University of Exeter, about a study she’s published here in the BJGP titled, ‘Primary care provision for young people with ADHD: A multi-perspective qualitative study’. We’re also joined by her study co-author, Dr Anna Price, a Senior Research Fellow also at the University of Exeter who is the study principle investigator and senior author who led this research. Title of paper: Primary care provision for young people with ADHD: A multi-perspective qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2023.0626Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder, with negative consequences for individuals and their communities. Research indicates a current “failure of healthcare” for people with ADHD in England, but previous recommendations to improve support for ADHD in primary care lack feasible and practical recommendations for health professionals. This study highlights individual-, practice- and system-level barriers to accessing support for ADHD via primary care and provides suggestions for how to overcome these barriers from the perspectives of multiple stakeholders. Health professionals and people with lived experience provided data which points to the standardisation of ADHD provision, providing additional information and support for clinicians, and better utilisation of reasonable adjustments for patients with ADHD in general practice.

In this episode, we’re taking a slightly different slant to talk to Dr Mark Levy, a GP based in London who led the National Review of Asthma Deaths and is a member of the Dissemination Working Group of the Global Initiative for Asthma (GINA). We’re talking to Mark as part of acknowledging World Asthma Day, which this year falls on 7 of May. Title of paper: Asthma deaths in children in the UK: the last strawAvailable at: https://doi.org/10.3399/bjgp24X738201Mark's website is also available here: https://bigcatdoc.com/ with additional resources and links to his own podcast.

In this episode, we talk to Dr Lynsey Warwick-Giles, a Research Associate based within the Centre for Primary Care and Health Services Research at the University of Manchester. Title of paper: Can Primary Care Networks contribute to the national goal of reducing health inequalities? A mixed method studyAvailable at: https://doi.org/10.3399/BJGP.2023.0258Primary Care Networks are an important policy development in English primary care, with an additional contract supporting practices to work collaboratively. Policy makers intend that they will tackle local health inequalities. Our research suggests that there is potential for them to achieve this, but it will require: continued weighting of funding formulas to account for deprivation; redistribution of funds and other resources internally to support the most deprived practices; managerial support, particularly for PCNs with deprived populations; and realistic and achievable targets for PCN action.

In this episode, we talk to Dr Sahar Pahlavanyali, a doctor and PhD candidate based at the Department of Global Public Health and Primary Care at the University of Bergen in Norway. Title of paper: Continuity and breaches in GP care and their associations with mortality for patients with chronic disease: an observational study using Norwegian registry dataAvailable at: https://doi.org/10.3399/BJGP.2023.0211There is a growing body of evidence on advantages of continuity, and a GP personal list is believed to be one of the positive measures to improve continuity, though not much researched. In a Norwegian setting with GP personal lists, we investigated the associations between GP continuity and mortality for patients with different chronic diseases. Our results showed that lower GP continuity was associated with increased risk of death, but the association was not significantly different for patients with the same RGP compared with those with different RGPs. This study suggests that high informational and management continuity provided by a GP personal list might lower and compensate for the adverse effects when changing GP.

In this episode, we talk to Dr Zoe Anchors, a Research Fellow based at the Centre for Health and Clinical Research at the University of the West of England. Title of paper: A qualitative investigation of the Additional Roles Reimbursement Scheme in primary care’Available at: https://doi.org/10.3399/BJGP.2023.0433The government has delivered on its commitment of recruiting 26,000 more primary care professionals through the ARRS in order to reduce patient waiting lists, widen the range of healthcare services and meet the needs of local populations. This qualitative analysis supports the positive impact of these additional roles in broadening the healthcare available to patients, and finds similar challenges (i.e., lack of career progression and supervision; lack of understanding of role descriptions and scope creep; problematic roadmaps; and poor integration) to implementation previously identified. However, our data reveals the scheme’s inflexibility and lack of available workforce particularly impacted Primary Care Networks in deprived areas resulting in the potential exacerbation of health inequalities, with the needs of populations not necessarily being met. More flexibility needs to be provided about who and what is funded under the scheme, with particular focus in areas of higher deprivation.

In this episode, we talk to Dr Lucy Potter, a GP and a doctoral research fellow based at the Centre for Academic Primary Care at the University of Bristol.Title of paper: Improving access to general practice for and with people with severe and multiple disadvantageAvailable at: https://doi.org/10.3399/BJGP.2023.0244This study builds on previous work showing that continuity of care, being able to develop a trusting relationship and being proactive are of particular importance in providing care to highly people with SMD(3-7). This work describes co-designed strategies including prioritising patients on an inclusion patient list with more flexible access, continuity from a care coordinator and micro-team, and an information sharing tool, in addition to rich contextual information on how to shift ways of working to achieve this. These co-designed strategies are practical examples of proportionate universalism in general practice, where resources are prioritised to those most in need. They could be adapted and piloted in other practices and areas and may also offer promise in improving inclusion of other marginalised groups. Investing in this focused way of working may improve healthcare accessibility, health equity and staff wellbeing.

We are taking a break from the BJGP podcast this week for Easter, but we’ll be back on 9 April 2024. 

In this episode, we talk to Professor Miranda Pallan, a public health doctor who is Professor of Child and Adolescent Public Health at the University of Birmingham.Title of paper: Supporting healthcare professionals to address child weight with parents: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2023.0238Healthcare professionals (HCPs) working in primary care and community settings are known to experience barriers in discussing child excess weight with parents. We conducted a qualitative study with General Practitioners, Primary Care Nurses and School Nurses to further explore these barriers and identify facilitating factors to inform recommendations for actions to support HCPs in addressing child weight with parents. Structural changes within primary/community care, joined up systems and data sharing across agencies, and development of HCP knowledge and skills through core training and continuing professional development will enable HCPs to discuss child weight and provide advice to parents.

In this episode, we talk to Dr Susan Moschogianis, a Research Associate based at the Health Services Research and Primary Care team at the University of Manchester.Title of paper: Patient experiences of an online consultation system: qualitative study in primary care post-COVID-19Available at: https://doi.org/10.3399/BJGP.2023.0076Online consultation systems (OCSs) have been rolled out rapidly, but little is known about patients’ experiences using them. We undertook the largest ever reported qualitative study of patient experiences using an OCS. Our findings provide insight into why some patients prefer in-person consultations, and why others prefer to use OCSs. Patients’ experiences of using OCSs can be influenced by how they are designed, how GP practices use them, and characteristics of the patient and request they use them for.

In this episode, we talk to Laiba Hussain, a THIS Institute Research Fellow and PhD Candidate at the Nuffield Department of Primary Care Health Sciences at the University of Oxford.Title of paper: Developing user personas to capture intersecting dimensions of disadvantage in marginalised older patients: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2023.0412Equity is an important core value in primary care, but meeting the needs of patients who are multiply disadvantaged is increasingly difficult as services become more digitised. User personas (fictional cases based on empirical data which draw together and illustrate the multiple intersecting elements of disadvantage) could help practices better plan for the needs of disadvantaged groups.

In this episode, we talk to Dr Shamil Haroon, Associate Clinical Professor and Honorary Consultant in Public Health Medicine at the University of Birmingham, and Dr Prasad Nagakumar, a Paediatric Respiratory Consultant. Title of paper: Post-hospitalisation asthma management in primary care: a retrospective cohort studyAvailable at: https://doi.org/10.3399/BJGP.2023.0214Asthma is a common cause of hospital admissions and clinical guidelines recommend that hospitalised patients are followed up in primary care. Little research has been done on 3 evaluating post-hospitalisation asthma management in primary care. We found that 40% of hospitalised patients did not receive asthma management in primary care following hospital discharge, particularly among patients from black ethnic minority groups. Primary and secondary care services should develop systems for ensuring the timely follow-up of asthma patients after hospital discharge and address the observed health inequities.

In this episode, we talk to Patrick Burch, a GP and a THIS Institute PhD fellow at the Centre for Primary Care and Health Services Research at the University of Manchester.Title of paper: An observational study of how clinicians, patients and the health care system create the experience of joined up, continuous primary care in the absence of relational continuityDOI: https://doi.org/10.3399/BJGP.2023.0208The way that many modern healthcare systems are designed increasingly relies on the assumption that, in the absence of relational continuity, any competent clinician can deliver joined up, continuous care if they have access to clinical notes. This study of a primary care environment, where patients are usually seen by a clinician they have not seen before, demonstrates multiple connected patient, clinician, and system factors that appear important for a patient to experience joined up, continuous care. Considering these factors in the design of primary care systems may have the potential to improve experience for patients.

In this episode, we talk to Dr Shoba Dawson, a Senior Research Fellow within the School of Medicine and Population Health at the University of Sheffield .Title of paper: Understanding non-recreational prescription medication sharing behaviours: A systematic reviewAvailable at: https://doi.org/10.3399/BJGP.2023.0189Sharing of prescription medicines for non-recreational purposes is a form of inappropriate medication use and such practices can cause delays in seeking medical care, masking the symptoms and severity of disease and could potentially result in the progression of the health condition. The reasons why people engage in medication sharing, how they assess the potential risks and benefits of these practices, and the factors which influence these behaviours are poorly understood. This systematic review shows that prescription medication sharing for non-recreational purposes is common with analgesics and antibiotics being the most commonly shared medications. Data on the prevalence and predictors of these behaviours are however limited. This review highlights that prescription medication sharing for non-recreational purposes is a potentially important medicines safety issue and significant public health concern which merits healthcare provider intervention, public awareness efforts and further research.

In this episode, we talk to Dr Cathy Morgan, a Research Fellow within the NIHR Greater Manchester Patient Safety Research Collaboration at the University of Manchester, and Professor Carolyn Chew-Graham, GP and Professor of General Practice Research at Keele University. Title of paper: Identifying prior signals of bipolar disorder using primary care electronic health recordsAvailable at: https://doi.org/10.3399/BJGP.2022.0286Delayed diagnosis and treatment of BD of between 6-10 years leads to adverse patient outcomes. No published studies examine the timings of early signals of BD in a primary care setting and/or use electronic health records. Routinely collected data identified early signals of undiagnosed BD: previous depressive episodes, sleep disturbance, substance misuse, those receiving 3 or more different psychotropic medication classes in a year, escalating self-harm, twice as many face-to face consultations and missing scheduled appointments. Awareness of collective early signals can be used to prompt consideration of BD and offer timelier referral for specialist assessment of a BD diagnosis and initiation of appropriate treatment.

Joining me today are the Editor in Chief of the BJGP and my two fellow associate editors, Sam Merriel and Tom Round. This week we’re taking the time to reflect back on some of the most read research here at the BJGP, looking at the top 10 papers of 2023.  BJGP Top 10 research This collection of Top 10 research most read and published in 2023 brings together high-profile primary care research and clinical innovation. Listen to the accompanying podcast in which BJGP Editors discuss the Top 10: 10. Cancer risk and fatigueRead the research here: https://doi.org/10.3399/BJGP.2022.0371 9. Antibiotics for LRTIsRead the research here: https://doi.org/10.3399/BJGP.2022.0239 8. Why do GPs do blood tests?Read the research here: https://doi.org/10.3399/BJGP.2023.0191 7. What motivates GPs' work?  Read the research here:https://doi.org/10.3399/BJGP.2022.0563 6. Opioids, antibiotics, and GP burnout Read the research here:https://doi.org/10.3399/BJGP.2022.0394 5. Non-drug interventions in mental health Read the research here: https://doi.org/10.3399/BJGP.2022.0343 4. Nitrofurantoin failure for UTIsRead the research here: https://doi.org/10.3399/BJGP.2022.0354 3. Perimenopause in ethnic minorities Read the research here:https://doi.org/10.3399/BJGP.2022.0569 2.  Suicide risk in middle-aged men Read the research here:https://doi.org/10.3399/BJGP.2022.0589 1. Adverse drug reactions (ADRs)Read the research here: https://doi.org/10.3399/BJGP.2022.0181  

In this episode, we talk to Professor Kate Brain, who is a Professor of Health Psychology, within the School of Medicine at Cardiff University.Title of paper: Satisfaction with remote consultations in primary care during COVID-19: a population survey of UK adultsAvailable at: https://doi.org/10.3399/BJGP.2023.0092Remote consultations became more widespread during the COVID-19 pandemic and continue to date. However, patterns of association between demographic characteristics and satisfaction with GP remote consultations during the pandemic were unclear. People with higher levels of educational qualification were found to have greater levels of satisfaction with remote GP consultations. Those with lower educational levels may benefit from further support with remote consultations.

In this episode, we talk to Dr Jennifer Voorhees, who is a GP in Tameside and an NIHR Academic Clinical Lecturer based at the University of Manchester. Title of paper: A paradox of access problems in general practice: a qualitative participatory case studyAvailable at: https://doi.org/10.3399/BJGP.2023.0276Access to general practice is an important topic, yet research and policies addressing access often take a simplistic definition, resulting in a lack of understanding of the complexities of longstanding interrelated problems. This research explains a paradox of access problems, in which the focus and attention on the increasing demand on general practice both creates and obscures another problem of unmet need. This is done through reactive rules and policies to manage demand, which largely undermine continuity in favour of speed of access, and generate work that takes up capacity of staff and patients. Clinicians can look at their current ways of working and identify ways to reverse the paradox in order to address hidden unmet needs and the resulting health inequalities in the population.

In this episode, we talk to Isabel Leach, who is a final year medical student at the University of Sheffield. Title of paper: Understanding patient views and experiences of the IDENTIfication of PALLiative care needs (IDENTI-Pall): a qualitative interview studyAvailable at: https://doi.org/10.3399/BJGP.2023.0071Understanding into patient views and experiences of identification of palliative care needs is lacking. This study suggests an individualised and compassionate approach is required, with key components including open conversations about palliative care and the sharing of prognostic uncertainty. Proactive palliative care intervention by primary healthcare professionals following identification of need is valued by patients and requires further attention in research, policy, and practice.

In this episode, we talk to Dr Alice Harper, an NIHR Academic Clinical Fellow based at the Centre for Academic Primary Care at the University of Bristol. Title of paper: Understanding the patient experience of coeliac disease diagnosis: a qualitative interview studyAvailable at: https://doi.org/10.3399/BJGP.2023.0299Previous qualitative studies on coeliac disease (CD) focus on patient experience after diagnosis. This study found patients experience uncertainty during the pathway to CD diagnosis, particularly pre-diagnosis and during investigations. Endoscopy was thought to be necessary for diagnostic confidence and conviction in a lifelong gluten free diet. As the diagnostic pathway evolves, consideration must be given to reducing patient uncertainty.

In this Christmas edition of the BJGP podcast we discuss Christmas stocking filler books. We're joined by Ben Hoban, Nada Khan, Euan Lawson and Andrew Papanikitas and talk through four books for the holiday season.

A quick note to say we're taking a break over Christmas but we'll be back with another BJGP Interview on 9 January 2024.

In this episode, we talk to Dr Garth Funston, who is a Clinical Senior Lecturer in Primary Care Cancer Research within the Wolfson Institute of Population Health at Queen Mary University of London.Title of paper: Pre-diagnostic prescription patterns in bladder and renal cancer: a longitudinal linked data studyAvailable at: https://doi.org/10.3399/BJGP.2023.0122Previous studies have demonstrated that prescription rates for certain medications increase many months before the diagnosis of some cancers. Determining whether prescribing for common urological clinical features increases in patients with renal and bladder cancer could help us identify opportunities for more timely diagnosis. We found that prescription rates for UTI medications increased 9 months before bladder and renal cancer diagnosis, with an even earlier increase occurring before bladder cancer diagnosis in women (11 months). This indicates that there is a window of opportunity in which investigation and referral could lead to earlier cancer detection in some patients presenting to their GP with features of UTI.

In this episode, we talk to Professor Stephane Jouneau, Professor in Pulmonology and Dr Anthony Chapron, a GP and Associate Professor from the University of Rennes in France. Title of paper: Early detection of chronic obstructive pulmonary disease in primary care: a randomised controlled trialAvailable at: https://doi.org/10.3399/BJGP.2022.0565 In primary care, the use of questions adapted from symptoms and risk factors identified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and chronic obstructive pulmonary disease (COPD) coordination to facilitate spirometry access, either alone orcombined, facilitates COPD detection. These interventions are relatively easy to implement in everyday clinical practice and can be adapted for countries in which most GPs are not trained to perform spirometry.

In this episode, we talk to Professor Katharine Wallis, Head of the General Practice Clinical Unit at the University of Queensland in Brisbane, Australia. We caught up with her whilst she was in the UK to discuss the paper that she and first author Suzanne McDonald have published here in the BJGP. Title of paper: Acceptability and optimisation of resources to support antidepressant cessation: A qualitative think-aloud study with patientsAvailable at: https://doi.org/10.3399/BJGP.2023.0269It is not known how best to support patients to safely stop long-term (>12 months) antidepressants when there is no clinical indication for continued use. The current study tested and optimised three patient resources designed to raise awareness and recognition of withdrawal symptoms and to provide step-by-step guidance for tapering drug dose to minimise withdrawal symptoms. Adults with lived experience of long-term antidepressant use reported that the resources were useful, acceptable, clear, comprehensible, and reassuring. The effectiveness of these consumer-informed resources in supporting safe cessation of long-term antidepressants is currently being tested in general practice.

In this episode, we talk to Dr Georgia Richards, who is a Research Fellow in the Centre for Evidence-Based Medicine at the University of Oxford. Paper: Private prescribing of controlled opioids in England, 2014-2021: a retrospective observational studyAvailable at: https://doi.org/10.3399/BJGP.2023.0146There are concerns over the long-term, high-dose use of opioids in people with chronic pain – trends for which have been described using NHS prescription data. However, opioids can also be acquired from outside of NHS services, including private prescribers, over-the-counter (e.g. CoCodamol), and through online healthcare services and pharmacies or the “dark web”. Without exploring non-NHS data, the full picture of opioid use in England cannot be understood. This is one of the first studies that sought to fill this important gap by investigating opioid prescribing in the private sector. We found that the number of controlled opioid items prescribed by private prescribers in England halved between January 2014 and November 2021, and that most prescribing occurred from prescribers in London. There were also controlled opioid items dispensed by “unidentified doctors”, which must be addressed to ensure patient safety. While there is the monitoring of controlled drug prescribing by NHS England Controlled Drug Accountable Officers, expanding access to such data to allow for a greater visibility and wider analysis of non-NHS data, including the private prescribing of controlled opioids, will help identify harms and policy gaps that can be addressed to improve patient safety.

In this episode, we talk to Dr Monica Molinaro, who is an Assistant Professor at the Institute of Health Sciences Education at McGill University in Canada. Title of paper: You’re doing everything you possibly could do, and you know it’s not enough”: Family physician narratives of moral distressAvailable: https://doi.org/10.3399/BJGP.2023.0193The moral distress of physicians who cannot provide adequate care due to systemic deficits is seldom heard in contemporary discussions about health care access and quality. Family physician stories of moral distress in relation to structural and systemic factors such as racism, colonialism, and drug, mental health, and housing policy, generate seemingly novel and vital understandings of the clinical work of primary care providers. The study findings are some of the first to illustrate family physicians’ experiences of moral distress, contributing to the limited body of literature on moral distress in primary care.

In this episode, we talk to Dr Sharon James, a Research Fellow and Project Manager based at the School of Public Health and Preventive Medicine at Monash University in Australia. Title of paper: lnterconception care in Australian general practice: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2022.0624Interconception care (ICC) provides an opportunity to address risk factors contributing to poor pregnancy outcomes. However, GP perceptions on providing ICC are not well established. ICC is not a familiar concept for GPs, it is delivered opportunistically and there is lack of clarity as to what ICC should consist of. GPs also feel there is lack of engagement and perceived value by women.

In this episode, we talk to Mr James Bailey, a Colorectal Research Fellow from the Nottingham Colorectal Service. Paper: Sociodemographic Variations in the Uptake of Faecal Immunochemical Tests in Primary CareAvailable at: https://doi.org/10.3399/BJGP.2023.0033FIT is increasingly used to triage patients with symptoms suggestive of colorectal cancer but variations in use by demographics, ethnicity and socioeconomic status are unknown. We show, in a large regional dataset, that male patients, patients under 65 years, the most deprived patients and ethnic minority groups are less likely to return a FIT sample. It is important that strategies are developed to ensure patients with these protected characteristics are not disadvantaged with the increasing usage of FIT to prioritise urgency of investigations.

In this episode, we’re doing something a bit different. Last week, the BJGP team attended the annual Royal College of GPs conference up in Glasgow, and presented a workshop looking at continuity of care. In this podcast, we’re going to pull together some of what we spoke about at that workshop, which highlighted some of the exceptional research that has been published in the BJGP on continuity, and also present a piece by Sir Denis Pereria Gray who also contributed to the workshop and spoke about how to put continuity into practice. Links to the research papers mentioned in this podcast:Relational continuity and patients’ perception of GP trust and respect: a qualitative studyhttps://doi.org/10.3399/bjgp20X712349Modernising continuity: a new conceptual frameworkhttps://doi.org/10.3399/bjgp23X732897Is continuity of primary care declining in England? Practice-level longitudinal study from 2012 to 2017https://doi.org/10.3399/BJGP.2020.0935Continuity of GP care for patients with dementia: impact on prescribing and the health of patientshttps://doi.org/10.3399/BJGP.2021.0413Team-based continuity of care for patients with hypertension: a retrospective primary care cohort study in Hong Konghttps://doi.org/10.3399/BJGP.2023.0150

In this episode, we talk to Dr Nish Jayasooriya, Research Fellow and specialist registrar in gastroenterology and hepatology. Paper: Adherence to 5-aminosalicylic acid maintenance treatment in young people with ulcerative colitis: a retrospective cohort study in primary careAvailable at: https://doi.org/10.3399/BJGP.2023.0006Adolescents and young adults diagnosed with ulcerative colitis (UC) are recommended long- term maintenance treatment for disease control, but adherence rates in primary care are unknown. This observational cohort study using real-world data from primary care found one-quarter of newly diagnosed adolescents and young adults, aged 10–24 years, discontinued oral 5-aminosalicylic acid (5-ASA) maintenance treatment within 1 month of starting and two-thirds within 1year. Young adults aged 18–24years and those living in a deprived area were most likely to discontinue and have poor adherence to treatment. Having an acute flare-up of UC was linked to better adherence to oral 5-ASA maintenance treatment. The first year of starting lifelong therapies among individuals diagnosed with UC is a critical window to improve adherence for adolescents transitioning to young adulthood and those from deprived postcodes.

In this episode, we talk to Dr Lizzie Emsley and Dr Eszter Szilassy from the University of Bristol. Paper: General practice as a place to receive help for domestic abuse during the COVID-19 pandemic: a qualitative interview study in England and WalesAvailable at: https://doi.org/10.3399/BJGP.2022.0528General practice is an important place for patients experiencing or perpetrating domestic violence and abuse (DVA) and for their children to seek and receive help. While the incidence of DVA may have increased during the COVID-19 pandemic, there has been a substantial reduction in DVA identifications and referrals to specialist services from general practice. At the same time, there has been the imposition of stringent lockdown measures and a rapid shift to remote care in general practice. This study explored patient experiences of seeking help for DVA in general practice during the COVID-19 pandemic, with additional insight from healthcare professionals. This study also included a focus on children affected by DVA. The authors found that patients affected by DVA had a strong preference for face-to-face consultation models in general practice for the opportunity of non- verbal communication. Children affected by DVA are a vulnerable group and this study reported concerns regarding their visibility to healthcare professionals in general practice during the pandemic.

In this episode, we talk to Dr Francine Toye and Dr Sharon Dixon, both working at Oxford on this project. Title of paper: Understanding primary care perspectives on supporting women’s health needs: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2023.0141The Women’s Health Strategy for England highlighted a need to understand and develop how general practice can support women’s health needs. This study’s aim was to hear the voices of primary care practitioners with experience of delivering services, and to further understand what works well to provide quality care. Relationships and advocacy are at the core of general practice and women’s health, and this study highlights threats to these core values and skills. Care is needed when evolving services to ensure that relationship-based longitudinal knowledge of individuals, families, and communities is not devalued, as this is integral to high- quality health and social care.Here's the link to the previous podcast I mention here by the same team:https://bjgplife.com/episode-117-how-can-we-improve-our-care-for-ethnic-minority-women-through-the-menopause/