BJGP Interviews

In this episode, we talk to Dr Jessica Watson, who is a GP and NIHR Academic Clinical Lecturer in general practice based at the Centre for Academic Primary Care at the University of Bristol.Paper: ‘Why test study: a UK-wide audit using the Primary Care Academic CollaboraTive to explore the reasons for primary care testing’.Available at: https://doi.org/10.3399/BJGP.2023.0191Previous research has shown a more than three-fold increase in the use of laboratory tests in UK primary care between 2000-2015, with significant variation in testing rates between GP practices. In this study around a quarter of tests were thought to be partially or fully unnecessary when reviewed retrospectively by another clinician. Around half of tests (48.8%) did not lead to any change in management or reassurance; 13.4% led to further blood tests or repeat blood tests, 2.7% led to further radiology tests. 6.2% of tests in primary care led to a new diagnosis or confirmation of diagnosis. This has important implications for how primary care clinicians talk to patients about blood tests, to ensure that patients have a better understanding and realistic expectations of the role of blood tests in their care.

In this episode, we talk to Dr Liz Sturgiss, who is an Associate Professor of Primary Care Research at the School of Primary and Allied Health Care at Monash University in Melbourne, Australia.Paper: Multifaceted intervention to increase the delivery of alcohol brief interventions in primary care: a mixed-methods process analysisAvailable at: https://doi.org/10.3399/BJGP.2022.0613Brief interventions can reduce alcohol- related harm when delivered in general practice, but there is an implementation gap in routine clinical practice. The REACH programme, which includes resources for patients, clinicians, and clinics, can improve alcohol recording in the general practice setting. Enhanced alignment between national policy and clinical need can support preventive health innovations through existing channels. When appropriately resourced and supported, general practice can deliver alcohol brief interventions in daily practice.

In this episode, we talk to Dr Victoria Welsh and Dr Claire Burton, who are both GPs and lecturers in primary care at the Centre for Musculoskeletal Health Research at Keele University. Title of paper: Trends in musculoskeletal consultations and prescribing: an electronic primary care records studyAvailable at: https://doi.org/10.3399/BJGP.2022.0648Rheumatic and musculoskeletal disorders (RMDs) are a common cause of pain and disability, with core non-pharmacological management supported by analgesic medications. To the author’s knowledge, no previous studies have observed the impact of the COVID-19 pandemic on the care of patients with rheumatic and musculoskeletal disorders (RMDs) in primary care, including consultation patterns and analgesic prescribing. This study demonstrates that fewer patients consulted with RMDs during lockdown, and a greater proportion were prescribed strong analgesia (including opioids) during pandemic-related restrictions. Clinicians appeared to respond to patient needs during the pandemic amidst restrictions placed upon non-pharmacological treatments, and commissioners must consider the impact of these behaviour changes during future pandemic planning.

In this episode, we talk to Margje van de Wiel from the Department of Work and Social Psychology, at Maastricht University in The Netherlands.Title of paper: ‘How do patients in general practice voice their gut feelings and value them?’Available at: https://doi.org/10.3399/BJGP.2022.0427We know that primary care professionals acknowledge the usefulness of patients’ gut feelings for their clinical reasoning. However, we do not precisely know the wordings and expressions patients use to voice their gut feelings and how they share them with professionals. The results we found may improve the professionals’ recognition of patients’ gut feelings and their insight into their background and enable further research into their validity.

We're taking a two week summer break, but why not hear more about the BJGP Research Conference which is being held on 22 March 2024. Learn more about the conference at https://bjgp.org/conference.

We're taking a two week summer break, but why not hear more about the BJGP Research Conference which is being held on 22 March 2024. Learn more about the conference at www.https://bjgp.org/conference.

In this episode, we talk to Line Pedersen and Anne Sophie Oxholm from the Research Unit for General Practice at the University of Southern Denmark.Title of paper: Mapping general practitioners’ motivation: It is not all about the money. A nation-wide cross-sectional survey study from DenmarkAvailable at: https://doi.org/10.3399/BJGP.2022.0563Understanding physicians’ motivation may be essential for designing policies and organisational structures that ensure the wellbeing and retention of GPs, and high-quality care. However, physicians’ motivation remains an understudied area. We find heterogeneity in GPs’ work motivation and identify five GP segments. The largest segment (53.2%) is characterised by being motivated ‘less by the money’.

In this episode, we talk to Charlie Coombs who is a medical student and School for Primary Care Research intern working at University College London. Title of paper: Opportunities, challenges and implications of primary care micro-teams for patients and healthcare professionals: an international systematic reviewAvailable at: https://doi.org/10.3399/BJGP.2022.0545The number of GP practices in the UK has overall reduced, whilst individual practice size lists have increased. This systematic review uses a framework analysis to synthesis the current literature available around micro-teams as a potential intervention to mitigate compromised care in larger practices. This review highlights micro-teams as a structure of general practice to promote accessible healthcare delivery and moderate losses to continuity. Further research in whether continuity can be offered by a team instead of an individual is warranted in the implementation of micro-teams.

In this episode, we talk to Professor Jonathan Mant who is Professor of Primary Care and Head of the Primary Care Unit within the Department of Public Health & Primary Care in the University of Cambridge. Title of paper: Progression of stroke risk in atrial fibrillation: Cohort study in general practiceAvailable at: https://doi.org/10.3399/BJGP.2022.0568New technologies are likely to result in younger people being diagnosed with atrial fibrillation who do not require anticoagulation treatment at diagnosis. There are few data to inform follow up of such people. Risk of development of hypertension and heart failure was found to be high in this group (indications for anticoagulation), suggesting

In this episode, we talk to Emma Whitfield, who is a PhD student in the Institute of Epidemiology and Health Care at University College London.Title of paper: Diagnostic windows in non-neoplastic diseases: a systematic reviewAvailable at: https://doi.org/10.3399/BJGP.2023.0044Improving timeliness of diagnosis is imperative across disease types. This review identified that for a range of nonneoplastic conditions healthcare use starts to increase in the time before diagnosis. For some conditions, this increase may first start to occur many years before diagnosis. Further research is needed to produce accurate estimates of how much earlier diagnosis may be possible.

In this episode, we’re going to do something a bit different and recognise some exceptional researchers here in the UK. We talk to Dr Sarah Bailey and Dr Ben Brown, this year’s winners of the Royal College of GPs and Society for Academic Primary Care early career researcher award. This award, which has a long history of recognising the up and coming superstars of primary care research, recognises the contribution of early career researchers to advancing primary care theory and practice.

In this episode, we talk to Dr Laura Jefferson, who is a Research Fellow within the Department of Health Sciences at the University of York. Title of paper: ‘Exploring gender differences in uptake of GP partnership roles: a qualitative mixed methods study’. Available at: https://doi.org/10.3399/BJGP.2022.0544An unadjusted gender pay gap of 33.5% exists in general practice, reflecting partly the differential uptake of partnerships amongst women GPs, but evidence exploring gender differences in GPs’ career progression is sparse. Our mixed methods approach used interview data, social media analysis and asynchronous online focus groups to explore factors affecting uptake of partnership roles, focusing particularly on gender differences. Factors at individual, organisational and national levels influence partnership uptake and career decisions of both men and women GPs, though gender differences were apparent with women reporting greater challenges balancing work/family, negative working conditions including maternity and sickness pay and discriminatory practices perceived to favour men and full time GPs. The relative attractiveness of salaried, locum or private roles in general practice appears to discourage both men and women from partnerships presently. Promoting positive workplace cultures through strong role models, improved flexibility in roles and skills training could potentially encourage greater uptake amongst both men and women.

In this episode, we talk to Ruth Swann who is a Senior Analyst for Cancer Research UK in partnership with NHS England, about the study she’s published alongside colleagues here in the BJGP. Title of paper: Comparison between the 2018 and 2014 National Cancer Diagnosis Audits for EnglandAvailable at: https://doi.org/10.3399/BJGP.2022.0268There is ongoing national monitoring of elements of the cancer referral process from primary care, including the proportion of urgent referrals (‘2-week waits’, TWW) and emergency presentations. The 2014 National Cancer Diagnosis Audit (NCDA) provided a richer picture of this process, as reported by GPs themselves. This research presents a direct comparison of that audit to the more recent one carried out on patients diagnosed in 2018, with revised NICE guidance on referral of suspected cancer having been published in 2015, showing the changes in practice and their direction.

In this episode, we talk to Dr Alex Hodkinson, who is an NIHR senior research fellow within the NIHR Patient Safety Translational Research Centre at the University of Manchester. Title of paper: Association of strong opioids and antibiotics prescribing with GP burnout: a retrospective cross-sectional study’. Available at: https://doi.org/10.3399/BJGP.2022.0394Prescribing has important implications for patient safety; this is particularly the case for high-risk medications such as strong opioids, and medications where there may be public health implications such as antibiotics. Physician wellness such as burnout can also have a significant impact on the productivity of healthcare organisations, intentions to leave medical practice, and both the quality and safety of patient care. At present, it is unclear if there is an association between the wellness of GPs within general practices and overprescribing of strong opioids and antibiotics in primary care in England. Over a 4-month period this study found higher prescribing of strong opioids and antibiotics among GPs with burnout symptoms, job dissatisfaction, and turnover intentions; working longer hours; and in practices based in the north of England serving more deprived populations.

In this episode, we talk to Ameerah Ibrahim and Carmel Hughes about the paper they’ve recently published in the BJGP titled, ‘GPs’ and pharmacists’ views of integrating pharmacists into general practices: a qualitative study’Title of paper: GPs’ and pharmacists’ views of integrating pharmacists into general practices: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2022.0518Little is known about primary healthcare professionals’ views on the impact of practice-based pharmacists (PBPs) in general practice. Participants interviewed in this study reported that PBPs had integrated well and perceived a positive impact on primary healthcare delivery. The findings indicated that continued integration would need PBPs, all members of the practice team, and community pharmacists (CPs) to understand each other's roles well and to communicate clearly to ensure the delivery of efficient PBP-led patient care. A number of areas for development were identified such as patient awareness of the role and communication pathways between PBPs and CPs.

Today we are talking to Dr Nick Thomas, who is clinical lead for research at the Royal College of General Practice here in the UK.Read more about research here at the RCGP: https://www.rcgp.org.uk/representing-you/research-at-rcgpAnd for more information about the Research and Surveillance Centre, look here: https://www.rcgp.org.uk/representing-you/research-at-rcgp/research-surveillance-centreIf you are looking for research funding opportunities through the RCGP, read more here: https://www.rcgp.org.uk/representing-you/research-at-rcgp/how-rcgp-support-your-research#grants

In this episode, we talk to Dr Joe Hutchinson, an academic clinical fellow at the Centre for Primary Care and Health Services Research at the University of Manchester. Title of paper: Consequences of the closure of General Practices: a retrospective cross-sectional studyDOI: https://doi.org/10.3399/BJGP.2022.0501Closures of UK general practices are increasingly common, yet little is known about the consequences. This cross-sectional study of English general practices finds practice closures increase list size in exposed practices, with changes in workforce composition and reductions in patient satisfaction.

In this episode, we talk to Dr Faraz Mughal, who is a practising NHS General Practitioner and NIHR Doctoral Fellow at the School of Medicine at Keele University. Title of paper: Recent GP consultation before death by suicide in middle-aged males: a national consecutive case series studyAvailable at: https://doi.org/10.3399/BJGP.2022.0589Preventing suicide in middle-aged males is a global priority. This national case series study found that 43% of middle-aged males who died by suicide had a final GP consultation in the preceding 3 months, and of these males, over half presented with a mental health problem. Males who had recent GP contact before suicide were more likely to have self-harmed in the 3 months before compared with males who had no recent GP contact. Males who had a current physical illness, recent history of self-harm, attended for a mental health problem, and experienced recent work-related problems were more likely to consult with their GP shortly before dying by suicide. GPs and primary care clinicians should be alert to these clinical factors that may be proximal to suicide, and in turn, offer personalised holistic care.

In this episode, we talk to Dr James Sheppard, who is an Associate Professor at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Title of paper: Predicting the risk of acute kidney injury: Derivation and validation of STRATIFY-AKIAvailable at: https://doi.org/10.3399/BJGP.2022.0389Acute kidney injury (AKI) is one of the more serious adverse events associated with antihypertensive treatment, reducing an individual’s health-related quality of life and increasing the risk of admission to hospital. Clinical guidelines recommend that when prescribing antihypertensives GPs should take into account the likelihood of both the benefits and harms from treatment, but few data exist in regard to the risk of AKI. A clinical prediction model was developed and externally validated for the risk of AKI up to 10 years in the future in patients eligible for antihypertensive medication, incorporating commonly recorded patient characteristics, comorbidities, and prescribed medications. The model showed good discrimination and good calibration for probabilities up to 20%, enabling GPs to accurately identify patients at higher risk of AKI. This could be useful to reassure the majority of patients starting or continuing treatment that their risk of AKI is very low.

In this episode, we talk to Gillian Doe and Rachael Evans, both based at the University of Leicester. Title of paper: Diagnostic delays for breathlessness in primary care: a qualitative study to investigate current care and inform future pathwaysAvailable at: https://doi.org/10.3399/BJGP.2022.0475Delays to diagnosis for patients presenting with chronic breathlessness are well described. This study set out to investigate current care for patients awaiting a diagnosis to inform future diagnostic pathways. The data highlight the challenges of symptom recognition, timely investigations, making a positive diagnosis, and difficult consultations. To achieve earlier diagnosis and better outcomes for patients with breathlessness, clinicians need to Ask, Act, and Advise: Ask to understand and validate symptoms, Act to initiate timely investigations, and Advise a positive diagnosis while offering breathlessness relief strategies.

In this episode, we talk to Jennifer MacLellan and Sultana Bi about the paper they have recently published here in the BJGP. Title of paper: Primary care practitioners’ experiences of peri/menopause help-seeking among ethnic minority womenAvailable at: https://doi.org/10.3399/BJGP.2022.0569Ethnic minority women may have different experiences of the peri/menopause from their white peers. Ethnic minority women may face language, inhibition and health literacy barriers to primary care. There is a need for increased awareness and trustworthy information resources to help ethnic minority women prepare for the menopause and advocate for their health. Resources, training and quality interpreter support are needed to help clinicians recognise ethnic minority women’s experiences and offer support, improving quality of life and potentially reducing future disease risk.

In this episode, we talk to Dr Gail Davidge and Dr Brian McMillan, who are both based at the Centre for Primary Care and Health Services Research at the University of Manchester.Title of paper: Putting principles into practice: A qualitative exploration of the views and experiences of primary care staff regarding patients having online access to their electronic health recordAvailable at: https://doi.org/10.3399/BJGP.2022.0436Previous research has noted primary care staff concerns about patients having online access to their health record, relating to issues such as: workload, safeguarding, patient confusion or distress, and health inequities. This study provides additional insights in the aftermath of the Covid-19 pandemic and in the light of NHS England’s plans to enable full prospective records access for patients by default. Findings highlight that most primary care staff agree with patient records access in principle, and can see its potential benefits, but remain concerned about the impact on patient centred care, safeguarding, and how to navigate this change. This study underlines the need for additional training and support for primary care staff to adapt their practice so they can address the needs of patients and protect patient safety and well-being whilst maintaining the clinical integrity of health records.

In this episode, we talk to Professor Jon Emery, who is the Herman Chair of Primary Care Cancer Research at the University of Melbourne. Title of paper: The CRISP Trial: RCT of a decision support tool for risk-stratified colorectal cancer screeningAvailable at: https://doi.org/10.3399/BJGP.2022.0480Using risk models that account for family history, lifestyle and medical history could tailor CRC screening and determine starting age and screening test. This could be more cost-effective than population screening. In this RCT, we showed that using the CRISP risk tool in general practice can increase risk-appropriate CRC screening in those due screening. Its effect is more uncertain in patients who are up-to-date with screening. The CRISP intervention could be used in people in their fifth decade to ensure people start CRC screening at the optimal age with the most cost-effective screening test.

In this episode, we talk to Dr Emma Ladds, who is a Primary Care In-Practice Fellow and GP based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford.Title of paper: ‘How have remote care approaches impacted continuity? A mixed-studies systematic review’Available at: https://doi.org/10.3399/BJGP.2022.0398The value of continuity in primary care has been repeatedly demonstrated for multiple outcomes. However little is known about how the expansion of remote and digital care models have impacted continuity. Here we demonstrate a disturbing lack of systematic research in this area and emphasize the need for real world explorations of the links between the shift to remote care, continuity and equity to ascertain when and for whom continuity adds most value and how this can be enabled or maintained.

In this episode, we talk to Maria Mathews, who is a Professor in the Department of Family Medicine at Western University in Canada. Title of paper: Strengthening the integration of primary care in pandemic response plans: A qualitative interview study of Canadian family physiciansAvailable at: https://doi.org/10.3399/BJGP.2022.0350Previous pandemic plans have largely overlooked the important role of primary care in a pandemic response. The COVID-19 pandemic presents a novel opportunity to examine the key roles family physicians play during a pandemic, and sheds light on existing barriers and supports. Findings from this study highlight the need for greater incorporation of primary care in the development of strengthened pandemic plans.

In this episode, we talk to Professor Lucy Ziegler, Professor of Palliative Care and head of the St Gemma’s Academic Unit of Palliative Care at the University of Leeds.Title of paper: What characterises good home-based end-of-life care: Analysis of 5-year data from a nationwide mortality follow-back survey in EnglandAvailable at: https://doi.org/10.3399/BJGP.2022.0315Determinants of high quality care for patients living at home during their last three months of life are not well understood. We analysed 5-year data from a large, nationally representative bereavement survey collecting information on experiences and quality of end-of-life care for adults with advanced disease, in England. The importance of good continuity of care from general practitioners on positive outcomes is identified as a potentially modifiable factor. Inequity in access to good end-of-life care is highlighted, with patients from lower socio-economic and minority ethnic groups less likely to receive good end-of-life care.

In this episode, we talk to Dr Simon Beerten, who is a GP and a research fellow from the Department of Public Health and Primary Care at KU Leuven in Belgium. Title of paper: Trends in the registration of anxiety in Belgian primary care from 2000 to 2021: A registry-based studyAvailable at: https://doi.org/10.3399/BJGP.2022.0196Figures on anxiety in general practice are scarce. This study shows increasing incidence and prevalence of physician-registered anxiety. Patients with anxiety had an increasing number of comorbidities over time. Treatment of anxiety in this setting seems very dependent on medication, particularly SSRIs and anxiolytics.

In this episode, we talk to Professor Niro Siriwardena, Professor of Primary and Pre-hospital Health care at the School of Health and Social Care at the University of Lincoln. Title of paper: Academic performance of ethnic minority versus White doctors in the MRCGP assessment 2016-2021: cross sectional studyAvailable at: https://doi.org/10.3399/BJGP.2022.0474Differential attainment is widely found in undergraduate and postgraduate medical examinations. It has been suggested that subjective bias due to racial in discrimination clinical skills assessments may be a cause of examination failure for UK trained ethnic minority candidates and international medical graduates. No previous study has examined differential attainment in all components of GP licensing assessments including workplace-based assessment, taking into account scores at selection in GP specialty training. Ethnicity did not reduce the chance of passing GP licensing tests once Sex, place of primary medical qualification, declared disability and selection (multispecialty recruitment assessment) scores were taken into account. Doctors admitted to GP speciality training who are in the lowest MSRA score bands may need additional support during training to maximise their chances of achieving licensing regardless of their ethnicity or other demographic characteristics.

In this episode, we talk to Professor Joe Kai, who is a GP and Clinical Professor in the Centre for Academic Primary Care at the University of Nottingham. Title of paper: Women’s experiences of heavy menstrual bleeding and medical treatment: Qualitative studyPaper available at: https://doi.org/10.3399/BJGP.2022.0460Heavy menstrual bleeding (HMB) is known to significantly affect women’s health and quality of life, with pressure to conceal symptoms. Recent evidence on women’s experiences of HMB and its treatment after seeking primary care is lacking. This research shows the debilitating impacts of HMB on women, and the challenges they can still face, including overcoming taboo and low general awareness that treatment can help. Women had widely differing experiences of current medical treatments for HMB in general practice, and emphasised how they valued patient-centred communication and involvement in decisions in helping them.

In this episode, we talk to Kelly Lloyd, who is a research fellow within the Leeds Institute of Health Sciences at the University of Leeds.Title of paper: A factorial randomised trial investigating factors influencing general practitioners’ willingness to prescribe aspirin for cancer preventive therapy in Lynch syndrome: a registered reportAvailable at: https://doi.org/10.3399/BJGP.2021.0610National Institute for Health and Care Excellence (NICE) guidance for England and Wales recommends daily aspirin for colorectal cancer prevention in people with Lynch syndrome, and it is likely that prescribing will occur in primary care. GPs may be reluctant to prescribe due to concerns about the side-effects, supporting evidence and lack of awareness of the NICE guidance. In a randomised factorial trial, providing GPs with information on these factors did not increase willingness to prescribe, or comfort discussing harms and benefits. Alternative strategies targeting multiple levels of prescribing behaviour among unwilling GPs may support prescribing.

In this episode, we talk to Dr Sarah Tonkin-Crine, an Associate Professor and Health Psychologist based within the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Title of paper: Implementing antibiotic stewardship in high prescribing English general practices: a mixed-methods studyAvailable at: https://doi.org/10.3399/BJGP.2022.0298An intervention to support the implementation of three evidence-based antimicrobial stewardship (AMS) strategies was evaluated in nine high antibiotic prescribing general practices in England. General practice teams received intervention materials and chose to use them in substantially different ways in real-life settings, outside of trial conditions. AMS strategies are complex interventions that require sufficient understanding and engagement by clinicians for successful adoption and use, to obtain the full benefit in reducing antibiotic prescribing. This study highlights that remote, one-sided delivery of AMS strategies should be done cautiously to avoid misunderstanding and sub-optimal use.

In this episode, we talk to Dr Bianca Perera, a GP in Tasmania who is undertaking a PhD at Monash University.Title of paper: General practice management of COPD patients following acute exacerbations: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2022.0342The period immediately following an acute exacerbation of COPD is a high-risk period for recurrence and a critical time to intervene. Hospital-initiated, guideline-based care bundles have been previously proposed to optimise post-exacerbation care and reduce readmission, however convincing evidence of effectiveness has been lacking. As post-exacerbation care is mainly delivered by GPs in Australia, this study describes detailed insights from their perspectives regarding factors affecting the provision of evidence-based care in the period following hospital discharge. The findings highlight factors that should be addressed to enhance care of COPD patients to prevent future exacerbations and hospital readmissions.

In this episode, we talk to Dr Karin Smit, who is a GP trainee and PhD student at the Department of General Practice at Utrecht University in The Netherlands. Title of paper: Home monitoring by pulse oximetry of primary care patients with COVID-19 - a pilot randomised controlled trialAvailable at: https://doi.org/10.3399/BJGP.2022.0224During the course of the pandemic, home or remote monitoring of COVID-19 patients by pulse oximetry took off. However, studies on its use are scarce. Our pilot randomised controlled trial showed that home monitoring of moderate-severe COVID-19 patients with a validated pulse oximeter is feasible; adherence was high, patients reported a high feeling of safety, while the number of primary care consultations remained similar to usual care. We believe these pragmatic findings form an important building block for safe implementation of pulse oximetry as a home monitoring tool in primary care.

In this episode, we talk to Dr Sarah Sowden, an Advanced Academic Clinical Fellow and honorary consultant in Public Health at Newcastle University. Title of paper: Which non-pharmaceutical primary care interventions improve mental health amongst socioeconomically disadvantaged populations? Systematic reviewAvailable at: https://doi.org/10.3399/BJGP.2022.0343New models of healthcare and clinical practice, such as social prescribing and collaborative care, are increasingly used as non-pharmaceutical alternatives for treating common mental disorders (CMDs) in primary care. However, there is a lack of evidence available to GPs about the effectiveness of these types of interventions for socioeconomically disadvantaged patients, among whom CMDs are most prevalent. This systematic review synthesised the international evidence exploring the impact on CMD outcomes for socioeconomically disadvantaged patients. Although the evidence base was weak, there was evidence for an overall positive effect on anxiety, depression, self-reported mental health and wellbeing.

In this episode, we talk to Professor Emma Wallace, who is a GP and Professor of General Practice at University College Cork about the incidence and severity of adverse drug reactions in older adults in the community. Title of paper: Cumulative incidence and severity of adverse drug reactions and associated patient characteristics in older community-dwelling adults attending general practice – a six year prospective cohort studyAvailable at: https://doi.org/10.3399/BJGP.2022.0181No prospective studies have examined adverse drug reaction (ADR) occurrence among older adults attending general practice. ADRs were found to occur for approximately 1 in 4 older adults over a six-year period. Cardiovascular, nervous system and anti-infective drugs for systemic use were the most commonly implicated drug classes. Approximately 1 in 4 ADRs rated as moderate result in additional healthcare utilisation. Female sex, polypharmacy (5-9 drug classes) and major polypharmacy (≥10 drug classes) increased the likelihood for ADRs.

Today, we talk to Becky White, who is a Research Fellow at the Epidemiology of Cancer Healthcare and Outcomes Research Group at UCL. Paper: Underlying cancer risk among patients with fatigue and other vague symptoms in primary care: a population-based cohort studyAvailable at: https://doi.org/10.3399/BJGP.2022.0371When patients present to GPs with new-onset fatigue and no alarm symptoms for cancer, optimal management is often unclear, as it is not known which of these patients may be at risk of having present but currently undetected cancer. We found that among fatigue presenters without alarm symptoms, the chance of underlying cancer exceeded risk referral thresholds of 3% in older men with fatigue combined with any of another 19 vague symptoms for cancer, and in older women with fatigue-weight loss, fatigue-abdominal pain, or fatigue-abdominal bloating. These findings can support diagnostic management and referral decisions for patients presenting with fatigue in the absence of alarm symptoms for cancer.

Today, we talk to Dr Claire Taylor, a GP and NIHR Clinical Lecturer at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Paper: Natriuretic peptide testing and heart failure diagnosis in primary care: diagnostic accuracy studyAvailable at : https://doi.org/10.3399/BJGP.2022.0278International guidelines recommend natriuretic peptide (NP) testing to prioritise referral for heart failure (HF) diagnostic assessment in primary care. European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) guidelines differ significantly in their recommended NP referral threshold. Our study found at the lower ESC threshold fewer HF diagnoses were missed but more referrals from primary care would be required. Healthcare systems need to balance the risk of a missed or delayed diagnosis for individual patients with capacity in diagnostic services. An NP level below both the ESC and NICE thresholds was reliable in ruling out HF.

This episode (our 100th podcast!), we have a round table discussion with our Editor-in-Chief, Euan Lawson, alongside the editorial team of Sam Merriel, Tom Round and Nada Khan. We take a look at the top 10 most read papers on the BJGP website from 2022

In this episode, we talk to Dr Kitty Worthing, a GP registrar working for the Sheffield Teaching Hospitals Trust about work she did whilst working as an academic clinical foundation doctor and then clinical fellow at Queen Mary University. Title of paper: Reluctance to register: an exploration of the experiences and perceptions of general practice staff in North East LondonAvailable at: https://doi.org/10.3399/BJGP.2022.0336Previous research shows that people are often refused GP registration if they do not have access to documentation, highlighting a discrepancy between guidance and practice that has not been previously explored. Current third sector initiatives to improve inclusive registration have largely focused on reiterating guidance and explaining to staff why people may not have access to documentation. This study found that reluctance to register this group was common, and reluctance was generally fuelled not by lack of knowledge of the guidance, but by workplace and resourcing pressures, and moral judgements concerning who should be entitled to NHS services based on immigration status. The perceived practical and financial burdens relate to overall increases in workload and the current funding model utilised in general practice. Initiatives to improve access must acknowledge such concerns, alongside addressing the wider malign impact of the ‘hostile environment’ policies on individual staff decision making.

Today, we talk to Professor Paul Little, who is Professor of Primary Care Research within Medicine at the University of Southampton. Paul and his team conducted a study looking at the effectiveness of antibiotics for chest infections in children. Title of paper: Antibiotic effectiveness for children with lower respiratory infections: prospective cohort and trialAvailable at: https://doi.org/10.3399/BJGP.2022.0239Antibiotics are commonly prescribed for children with chest infections, but prescribing antibiotics fuels antibiotic resistance which is one of the major global public health threats. There is little randomised evidence, and trials commonly recruit selected populations which undermines their applicability. In a cohort of unwell children antibiotics for chest infections were not effective in significantly shortening the illness, and increased side effects. GP’s should support parents to self-manage at home and communicate clearly on when and how to seek medical help if they continue to be concerned.

In this episode, we talk to Nishadi Withanage, a doctoral student in the Department of General Practice at Monash University in Australia. Title of paper: Effectiveness of preconception interventions in primary care: a systematic reviewAvailable at: https://doi.org/10.3399/BJGP.2022.0040Preconception care (PCC) delivered in community and hospital settings are effective in improving pregnancy outcomes and health knowledge, and reducing preconception risk factors; however, the effectiveness of primary care-based PCC has been unclear. This systematic review demonstrates that primary care-based PCC including brief and intensive education, supplementary medication, and dietary modification are effective in improving health knowledge and reducing preconception risk factors among females, even when delivered by trained non-healthcare professionals. Non-healthcare professionals could help improve access to PCC in systems that are already struggling to provide care. As there is a limited number of studies reporting on pregnancy outcomes, further research is required to determine whether primary care-based PCC can improve pregnancy outcomes.

Today, we talk to Mai Stafford, who is a senior analytical manager at the Health Foundation. Title of paper: Continuity of care in diverse ethnic groups: a general practice record study in EnglandAvailable at: https://doi.org/10.3399/BJGP.2022.0271Nationally representative survey data show lower continuity of care for most ethnic minority groups. To the authors’ knowledge, this is the first national study to examine ethnic inequalities in continuity of care using GP records. The study found that relational continuity of care was lower for people from Black African, Black Caribbean, any other Black background, Bangladeshi, and Pakistani ethnic groups. These ethnic inequalities are not accounted for by socioeconomic deprivation and are seen for people with and without multiple long-term conditions.

In this episode, we talk to Dr Laura Armitage, a GP and Doctoral Research Fellow at the Nuffield Department of Primary Health Care Sciences at the University of Oxford. Laura and her team conducted a study looking at a common issue in primary care: hypertension, and how to measure it in practice.Title of paper: Diagnosing hypertension in primary care: the importance of night-time blood pressure assessment. Available at: https://doi.org/10.3399/BJGP.2022.0160Since the 1990s, the phenotypic classification of 24-hour blood pressure has divided the population into ‘dippers’, ‘non-dippers’ (minimal night-time BP decrease compared to daytime BP) and ‘reverse dippers’ (night-time BP increases compared to day-time BP). There is an established body of research demonstrating that reverse dippers are at higher risk of death and that the night-day systolic blood pressure ratio is an independent predictor of all cause mortality and cardiovascular events. Presently, UK guidelines suggest clinicians should diagnose hypertension based solely on daytime BP measurements. This study reveals a marked proportion of our population are reverse dippers; together with the established clinical research that has demonstrated worse cardiovascular outcomes for such patients, this highlights the need for 24-hour ambulatory blood pressure assessments to detect and diagnose those with nocturnal hypertension, non-dipping or reverse-dipping blood pressure phenotypes. 

In this episode, we talk to Dr Pauline Williams, a GP and an NRS Career Research Fellow. She’s based at the Institute of Applied Health Sciences at the University of Aberdeen.Title of paper: Help seeking behaviour in women diagnosed with gynaecological cancer: a systematic review. Available at: https://doi.org/10.3399/BJGP.2022.0071Reducing diagnostic delay, by improving patients’ help seeking behaviour, may reduce the UK’s excess gynaecological cancer mortality. This review identifies that symptom knowledge is not enough to initiate help seeking; patients must also have the time or means to attend health care and be motivated enough, by previous experience, to overcome any fear or embarrassment they may have.

In this episode, we talk to Julien Vos, who is a doctoral student and clinician based at the Department of General Practice at the University of Amsterdam. We’re going to discuss his paper about survivorship care for colorectal cancer and patients experiences of GP-led care in the Netherlands.  Paper: Patients’ experiences with general practitioner-led colon cancer survivorship care; a mixed-methods evaluation at various time pointsAvailable at: https://doi.org/10.3399/BJGP.2022.0104Cancer survivorship care is often complex and requires a multi-dimensional approach. Patients receiving colon cancer survivorship care from either the GP or surgeon rate the received care as of high quality. Roles and responsibilities of patients and physicians need to be clear in order to help organize survivorship care. GPs can take on a more prominent role in cancer survivorship care, but other outcomes, including patients’ and physicians’ preferences, will also be important.

In this episode, we talk to Professor Jeremy Horwood, Professor of Social Science and Health at the Centre for Academic Primary Care at the University of Bristol. Paper: Unintended consequences of patient online access to health records: a qualitative study in UK primary careAvailable at: https://doi.org/10.3399/BJGP.2021.0720Previous studies of patient online access to their medical records have noted a range of concerns about potential unintended consequences. This study reports real-world experiences of the consequences of online access. We identified unintended consequences that impacted patient autonomy and GP documentation practices, and also increased workload through providing access while avoiding harm to patients. It is crucial that practices are adequately supported and resourced to manage the unintended consequences of online access now that it is the default position.

In this episode, we talk to Ben Cranfield, who is undertaking a PhD In the Department of Behavioural Science and Health at UCL. Paper: Primary care blood tests before cancer diagnosis: National Cancer Diagnosis audit dataAvailable at: https://doi.org/10.3399/BJGP.2022.0265Evidence relating to the predictive value of blood tests for cancer diagnosis is growing, yet how often they are used by GPs in pre-diagnosed cancer patients is unclear. In England, two-fifths of patients subsequently diagnosed with cancer in 2018 had at least one full blood count, urea & electrolyte or liver function test. Blood test use was less likely in women, non-white and younger patients and more likely in those presenting with non-specific symptoms, with longer intervals to referral and diagnosis being associated with tested patients. This research highlights potential unmet need for interventions to reduce the risk of overuse (in populations presenting with more-specific symptoms) and underuse (in patients presenting with less-specific symptoms) of blood tests in cancer populations.

In this episode, we talk to Maha Abo-Tabik, a doctoral research student at the Global Psoriasis Atlas who is based at the University of Manchester.Paper: Mapping opportunities for the earlier diagnosis of psoriasis in primary care settings in the UKAvailable at: https://doi.org/10.3399/BJGP.2022.0137Many people suffer needlessly from psoriasis due to missed or delayed diagnosis. Primary care professionals are most often the first point of contact for people with psoriasis. The diagnosis of psoriasis can be a challenging task for non-dermatologists. Examining electronic health records from general practices showed that the diagnosis of psoriasis may be missed or delayed. People with undiagnosed psoriasis (missed or delayed diagnosis) have an increased frequency of GP consultations from five years before their diagnosis of psoriasis is confirmed. Individuals with psoriasis are often prescribed topical corticosteroids and/or topical antifungal medications before being diagnosed with psoriasis. These medications may mask the signs of psoriasis.

In this episode, we talk to Professor Trish Greenhalgh, Professor of Primary Care Health Sciences at the University of Oxford. Paper: UK newspapers “on the warpath”: media analysis of remote consulting in 2021Available at: https://doi.org/10.3399/BJGP.2022.0258How this fits inIn 2020, the shift from in-person to remote consulting in general practice was depicted positively by the media as part of the “war” on COVID-19. In 2021, remote consulting was depicted negatively by the media, and linked in press articles to difficulties accessing primary care and compromises in patient safety.  Newspapers led campaigns which successfully put pressure on government to require a return to in-person consultations. 

In this episode, we talk to Dr Natasha Tyler and Dr Maria Panagioti who both work in the Centre for Primary Care and Health Services Research at the University of Manchester.Paper:  Patient Safety, Self-injection and B12 deficiency: A UK Cross sectional studyhttps://doi.org/10.3399/BJGP.2021.0711It is known that individuals with vitamin B12 deficiency (including pernicious anaemia) describe their primary care consultations as ‘battles’ and feel stigmatised. However, the extent of this dissatisfaction with primary care and the effect this might have on patient safety and unsafe health behaviours is unknown. This is the first study to assess the association between patient reported safety and self-medication via injection and to consider the contributory factors to patient safety that affect this patient group. Understanding any negative effects of current practice and how general practitioners and primary care clinicians can better meet the needs of this marginalised group is key, to improving safety and care.