BJGP Interviews

In this episode we speak to Dr Alex Walker who is an epidemiologist at the Nuffield Department of Primary Care Health Sciences, University of Oxford.Paper: Clinical coding of long COVID in English primary care: a federated analysis of 58 million patient records in situ using OpenSAFELYhttps://doi.org/10.3399/BJGP.2021.0301Early case definitions and clinical guidelines have been published to describe long COVID, and clinical codes based on these guidelines were published in late 2020. This study found wide variation in the early use of these codes, by practice, geographic region, and practice electronic health record software. Promotion of the clinical guidance and codes is important for future research and ongoing patient care.

In this episode we talk to Dr Hogne Sandvik who is a senior researcher at the National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen.Paper: Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norwayhttps://doi.org/10.3399/BJGP.2021.0340Continuity of care with a GP is generally regarded as an aspect of quality. It is usually measured by visit patterns with different providers over time and is associated with lower mortality rates, fewer hospital admissions, and less use of emergency departments. This nationwide study of the Norwegian population shows that longitudinal continuity with a named regular GP is significantly associated with the need for out-of-hours services, acute hospital admissions, and mortality in a dose-dependent way. When longitudinal continuity exceeds 15 years, the probability of these occurrences is reduced by 25–30%.

In this episode we talk to Professor Brendan C Delaney who is a GP partner and Chair in Medical Informatics and Decision Making at Imperial College London.Paper: Recommendations for the recognition, diagnosis, and management of long Covid: A Delphi studyhttps://doi.org/10.3399/BJGP.2021.0265There is an urgent need to devise clinical pathways and guidance for long Covid (thought to affect 10% of those diagnosed with Covid-19). In the absence of conclusive research to inform clinical practice, “expert physician-patients” (i.e., doctors with long Covid and those involved in nascent clinics) are a source of professional expertise. Using robust consensus methodology, we derived 35 clear and practical recommendations to assist in the organisation of clinics, and the diagnosis and management of patients with long Covid. Medically-led multidisciplinary clinics are required as serious cardiovascular, neurocognitive, respiratory and immune sequelae such as can present with only non-specific symptoms.

In this episode we speak to Dr Thomas Round who is a GP in East London and NIHR doctoral research fellow. Paper: Cancer detection via primary care urgent referral and association with practice characteristics: a retrospective cross-sectional study in England from 2009/2010 to 2018/2019https://doi.org/10.3399/BJGP.2020.1030There is considerable variation in the use of urgent suspected cancer referrals (2-week wait [2WW]) between general practices in England, with increased use associated with improved outcomes for patients with cancer. There has been limited research into the practice and population characteristics associated with cancer detection via 2WW referral pathways. Over the 10-year period up to 2018/2019, yearly 2WW referrals more than doubled to more than 2.24 million, leading to an increase in cancer detection and 66,172 additional cancers diagnosed via 2WW in 2018/2019 compared with 2009/2010. Higher cancer detection via 2WW referrals was associated with larger practices and those with younger GPs, although the relationship with GP age was attenuated in more recent years. Of concern are decreases in 2WW referrals during the COVID-19 pandemic and the appearance of potential disparity in cancer detection, with lower rates in practices that serve more deprived populations.

In this episode we talk to Professor Stewart Mercer who is a Professor of Primary Care and Multimorbidity at the Usher Institute, College of Medicine and Veterinary Medicine at the University of Edinburgh.Paper: Implementing social prescribing in primary care in areas of high socioeconomic deprivation: process evaluation of the ‘Deep End’ community links worker programmehttps://doi.org/10.3399/BJGP.2020.1153Social prescribing using primary care-based link workers is increasingly promoted across the four nations of the UK and elsewhere in the world, as a way of reducing health inequalities by better supporting people living in deprived areas. However, the evidence-base of effectiveness is limited, and there is very little information on how best to successfully implement a link worker approach in practice.This study reports on a process evaluation of the ‘Deep End’ Links Worker Programme (LWP) over a two-year period, in seven general practices in deprived areas of Glasgow. Despite the programme being well-funded and well supported, the majority of practices involved had not fully integrated the LWP within the first two years. Implementing social prescribing and link workers within primary care at scale is unlikely to be a ‘quick fix’ for mitigating health inequalities in deprived areas.

In this episode we talk to Dr Peter Edwards who is a GP and academic clinical fellow at the Centre for Academic Primary Care at the University of Bristol Medical School.Paper: Factors affecting the documentation of spoken safety-netting advice in routine GP consultationshttps://doi.org/10.3399/BJGP.2021.0195Previous research has provided qualitative insights into how GPs document safety-netting advice and there have been quantitative reports of the binary presence or absence of safety-netting in medical records. This is the first study to undertake a detailed analysis of the content of documented safety-netting advice and make objective comparisons to what was spoken in recorded consultations.GPs more frequently documented their safety-netting advice if it was specific (e.g. “I’d want you to come back if you start coughing up horrid coloured stuff, greeny-browny, or if you start coughing up any blood, or if you feel more short of breath.”) rather than generic advice (e.g. “any problems let me know”), for a new problem, and for problems that were the entire focus of a consultation.These trends in GP documentation practices highlight that certain consultations, such as those where multiple problems are assessed, may represent a higher medico-legal risk to GPs due to incomplete documentation, and these potential biases should be considered in medical-records based research.

In this episode we speak to Anouk Weghorst who is a doctoral candidate in the Department of General Practice and Elderly Care Medicine, University of Groningen, Netherlands.Paper: Oral ondansetron for paediatric gastroenteritis in primary care: a randomised controlled trialhttps://doi.org/10.3399/BJGP.2021.0211Ondansetron was found to be effective in reducing vomiting in secondary care, but this effect has never been evaluated in primary care. Based on the findings of this study, ondansetron use is effective in reducing vomiting from 42.9% to 19.5%, seems safe and is positively evaluated by parents. Therefore, ondansetron could be considered by general practitioners as an additional treatment in the management of dehydration due to acute gastroenteritis, when the child predominantly vomits. Future research should disentangle the key factors leading to hospital referrals and consider ways to administer ORT more effectively in primary care or at home.

In this episode we speak to Professor Adrian Edwards who is Professor of General Practice and Director of PRIME Centre Wales and Director of Wales Covid-19 Evidence Centre at Cardiff University.Paper: Managing lower urinary tract symptoms in primary care: qualitative study of GPs’ and patients’ experienceshttps://doi.org/10.3399/BJGP.2020.1043Lower urinary tract symptoms (LUTS) in males can usually be treated effectively in primary care; however, referrals to urology services are increasing. This study explores in detail the experiences of GPs and patients in relation to the management of LUTS in primary care. Difficulty establishing causes and differentiating symptoms were identified as key challenges; therefore, treatment was often a process of trial and error, and no patient’s symptoms were completely resolved. A diagnostic tool for use by GPs, together with greater exploration of non-pharmacological treatment approaches, could support effective management of LUTS in primary care settings.This study aimed to explore GPs’ experiences of diagnosing and managing LUTS, together with patients’ experiences of and preferences for treatment of LUTS in primary care. Tell us a little more about the background to theTelephone interviews were conducted with GPs and patients from GP practices involved in the PriMUS (Primary care Management of lower Urinary tract Symptoms in men: development and validation of a diagnostic and clinical decision support tool) study16 across three UK regions: Newcastle upon Tyne, Bristol, and South Wales. PriMUS is a prospective diagnostic accuracy study aimed at developing a decision tool to help GPs more accurately diagnose and manage LUTS in males.

In this episode we talk to Dr Sharon Dixon, GP and researcher, at the Nuffield Department of Primary Care Health Sciences, University of Oxford. The research was funded by the NIHR School of Primary Care Research.Paper: Navigating possible endometriosis in primary care: a qualitative study of GP perspectiveshttps://doi.org/10.3399/BJGP.2021.0030There are documented time lags between women presenting to primary care with symptoms suggesting endometriosis and receiving a diagnosis. It has been suggested that increasing GPs awareness will improve this situation. As GPs perspectives on these care journeys are not known, how best to educate health professionals to reduce delays in diagnosis is unclear. Even with awareness of the possibility of endometriosis, GP accounts suggest that journeys are complex and can involve navigating significant uncertainties, including when managing women whose symptoms are well controlled with primary care treatment or who do not want to have referral or operative investigation.

In this episode we speak to Dr Faraz Mughal who is a National Institute for Health Research (NIHR) doctoral fellow at Keele University.Paper: Experiences of general practice care for self-harm: a qualitative study of young people’s perspectiveshttps://doi.org/10.3399/BJGP.2021.0091Young people who self-harm present to GPs in the NHS, but their perceptions of care remain largely unexplored. This qualitative study indicated that young people sought help from a variety of services, including non-statutory services and NHS services. Young people described mixed experiences of consulting GPs, which can influence help-seeking from general practice. A relationship with one GP who listens, appears to understand, and offers proactive follow-up is an important facilitator for young people who access general practice for self-harm.

In this episode we speak to Dr Ian Bennett-Briton who is a Clinical Research Fellow in Primary Health Care at the Centre for Academic Primary Care at the University of Bristol.Paper: Understanding the benefits and limitations of continuous, risk-based, consultation peer-review in out-of-hours general practice: A qualitative interview studyhttps://doi.org/10.3399/BJGP.2021.0076Unwarranted variation in clinical practice is an area of increasing interest due to the costs and harms of too much or too little healthcare. Effective systems to detect and minimise unwarranted variation in clinician practice are crucial to ensure clinicians in increasingly multidisciplinary healthcare workforces are supported to practise to their full potential. Such systems are limited in English general practice settings, with implications for the efficiency and safety of care. Continuous, risk-based, consultation peer-review provides a mechanism to detect and minimise unwarranted variation in clinician practice, and a potential methodology to support clinicians in an increasingly multidisciplinary general practice workforce to efficiently and safely practise to their full potential.

This episode is a quick update from BJGP Editor, Euan Lawson, as we are taking a break for a couple of weeks and we will back in August with more interviews. We would love you to get involved. Why not write us an article for BJGP Life? Check out the links for more details.BJGP Life Call for Summer articles: https://bjgplife.com/2021/07/26/bjgp-life-call-for-summer-articles/BJGP.org eLetters: https://bjgp.org/lettersSign up for the print BJGP: https://www.bjgplife.com/print

In this episode we talk to Dr Julian Treadwell who is a GP and doctoral research fellow at the Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford.Paper: GPs’ use and understanding of the benefits and harms of treatments for long-term conditions: a qualitative interview studyhttps://doi.org/10.3399/BJGP.2020.1027Research has shown that doctors, including GPs, often have poor knowledge of quantitative benefits and harms of treatments, such as absolute risk reduction and numbers needed to treat. Yet this kind of information is considered key to shared decision making and optimal management of polypharmacy. This qualitative study explored the attitudes and understanding of GPs in the UK with regard to this issue, and reveals a complex set of behaviours and feelings. These findings will be of interest to doctors wishing to reflect on their own practice, and to authors of guidelines and information resources.Linkshttps://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/shared-decision-making