Primary Care Knowledge Boost

Doctors Lisa and Sara talk to GP Dr Charlotte Bădescu about Ovarian Cancer. We focus on the important learning points about cardinal and other features of presentations to better understand this cancer as an abdominal cancer with symptoms that can and do often present much earlier than the diagnosis is often picked up. She talks us through the value of CA125 tests and the reasons not to be overly reliant on them, though they can be a useful tool in the tool box. The usefulness of ultrasound scans, both pelvic and transvaginal, as well as clinician continuity is discussed. We go through 2 hypothetical cases based on real examples as well as Charlotte’s own diagnosis. An excellent episode for picking up great learning points to avoid missing this diagnosis in your own patients. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: NICE Guidelines: Suspected Cancer, Recognition and Referral (Dec 2021): https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#gynaecological-cancers NICE guidelines on Ovarian Cancer (Published April 2011): https://www.nice.org.uk/guidance/cg122 GP network & resources: https://targetovariancancer.org.uk/health-professionals/GPs Nurses network & resources: https://targetovariancancer.org.uk/health-professionals/nurses Patient resources: https://targetovariancancer.org.uk/support-for-you Shine Cancer Support: https://shinecancersupport.org/ ForteenFish Free Ovarian Cancer Webinar (you will need to log-on and search Ovarian Cancer): https://www.fourteenfish.com/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara are joined by Community Pharmacist and Director of Pharmacy Transformation for Greater Manchester Luvjit Kandula. We learn all about the Essential Services and Enhanced Services Community Pharmacies are engaged in and get an understanding of the pressures Community Pharmacies are under. We discuss the plans for upcoming transformations and top tips to avoid errors in prescribing and to help take some of the pressure off Pharmacy teams. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: The Kings Fund, Community Pharmacies Explained: https://www.kingsfund.org.uk/publications/community-pharmacy-explained Primary Care Demand: Supporting General Practice and Community Pharmacy (Greater Manchester: https://greater-manchester.communitypharmacy.org.uk/wp-content/uploads/sites/118/2022/11/Primary-Care-Demand_Supporting-General-Practice-and-Community-Pharmacy_October-2022_Final.pdf Community Pharmacist Consultation Service (includes links to training Webinar, list of conditions, demos and case studies): https://gmpcb.org.uk/general-practice/gp-community-pharmacist-consultation-service/ Greater Manchester Primary Care Provider Board Community Pharmacy Hub: https://gmpcb.org.uk/community-pharmacy/ Save our pharmacies campaign: https://saveourpharmacies.co.uk/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara are joined this week by Dominic Anderson (Programme Director of the Health and Wellbeing Programme Greater Manchester), Lorna Laflin (Former Practice Manager who works with the GP Excellence team) and Joanna Bircher (GP and Programme Director for GP Excellence). We discuss the new QOF indicators around Workforce and Wellbeing in General Practice. We learn what the indicators are and get hints and tips about how to achieve them. We come at this slightly sceptical of the workload this might put on practices but are glad of the opportunity to talk thought the underlying principles of trying to support practices, what that support might look like and how to approach this in a quality improvement way that might help all staff, including those charged with collecting this data. This leads us to talk about Compassionate leadership. Please check out our episode resources for links and guides to these things. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: New wellbeing QOF indicator to reduce GP burnout risk, Pulse Article March 2023: https://www.pulsetoday.co.uk/news/clinical-areas/mental-health-and-addiction/new-wellbeing-qof-indicator-to-reduce-gp-burnout-risk/ Quality and Outcomes Framework guidance for 2023/24: https://www.england.nhs.uk/publication/quality-and-outcomes-framework-guidance-for-2023-24/ Greater Manchester Resilience Hub: https://www.penninecare.nhs.uk/gmrh Greater Manchester Health and Wellbeing Resources: https://gmprimarycare.org.uk/workforce/health-and-wellbeing/ King’s Fund Kind and Compassionate Leadership Online Learning Resource: https://www.kingsfund.org.uk/courses/introduction-kindness-compassion-health-and-social-care Kindness Leadership Network: https://carnegieuktrust.org.uk/publications/commitment-to-kindness/ Book: West M. Compassionate Leadership; sustaining wisdom, humanity and presence in health and social care. The Swirling Leaf Press. London, 2021: https://www.amazon.co.uk/gp/product/0995766975/ref=dbs_a_def_rwt_bibl_vppi_i1 Podcast: The Compassionate Leadership Interview with Chris Whitehead: https://www.podbean.com/podcast-detail/cdwzg-b7b51/The-Compassionate-Leadership-Interview-Podcast Book: The Leadership Hike: Shaping Primary Care Together. Rughani A, Bircher J. CRC Press 2020: https://www.waterstones.com/book/the-leadership-hike/amar-rughani/joanna-bircher/9780367236984 Staff Risk Assessments with Templates. Health and Safety Executive Website, Managing Risk and Risk Assessments at Work: https://www.hse.gov.uk/simple-health-safety/risk/index.htm Looking after you too Coaching Support from NHSE: https://www.england.nhs.uk/supporting-our-nhs-people/support-now/looking-after-you-confidential-coaching-and-support-for-the-primary-care-workforce/looking-after-you-too/ Dominic Anderson's email address for those with additional questions or wanting support in Greater Manchester: [email protected] ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara speak with Dr Uma Marthi who is a GP with a Specialist Interest in Gynaecology about red flags for gynaecological cancers. We discuss some cases based on real patients that involve cervical, vaginal and endometrial cancers. We’ll be recording a separate episode around the varied presentations of Ovarian cancer. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: NICE guidelines for Red Flags for Gynaecological Cancers (Updated Dec 2021): https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#gynaecological-cancers Cancer Research UK: https://www.cancerresearchuk.org/about-cancer/ Jo’s Trust for Cervical Cancer: https://www.jostrust.org.uk/ The Eve Appeal: UK Charity funding research and raising awareness of the five gynaecological cancers – womb, ovarian, cervical, vulval and vaginal: https://eveappeal.org.uk/ Go Girls: UK Charity Supporting Women with Gynaecological Cancers: https://www.gogirlssupport.org/ BMJ Research Article: Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12-13 in Scotland: retrospective population study (April 2019): https://www.bmj.com/content/365/bmj.l1161 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

**Summer Rewind: This episode was first released on Nov 30th 2022** Doctors Lisa and Sara talk to Consultant Otolaryngologist Ms Emma Stapleton and Clinical Scientist David Jay about Vertigo. We discuss the definition, differentials, and how to use information around timing and triggers to differentiate between the likely causes of vertigo. We get their take on the important details in the examination that can help identify the diagnosis, and talk options for managing the most common types of peripheral vertigo. The resources section of the episode description contains excellent resources to help, including examples of how to perform and interpret the Head Impulse test, as well as vestibular rehabilitation resources for patients. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE . Nov 2009, Stroke: https://pubmed.ncbi.nlm.nih.gov/19762709/ A summary of HINTS by David Jay: Developments in diagnostic approaches for acutely dizzy patients: (Feb 2020 ENT & Audiology News): https://www.entandaudiologynews.com/features/audiology-features/post/developments-in-diagnostic-approaches-for-acutely-dizzy-patients TiTrATE: A Novel Approach to Diagnosing Acute Dizziness and Vertigo. Newman-Toker and Edlow J A. Neurology Clinics (Aug 2015) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522574/ The Five Deadly D’s of Dizziness (red flags to remember): EM Resident, Unravelling the Mystery of Dizziness in the ED: A Guide for the Student Clerkship, Oct 2018 Wilcox K, Shafer K: https://www.emra.org/emresident/article/dizziness/ BMJ Vertigo: Dix-Hallpike Video: https://www.youtube.com/watch?v=8RYB2QlO1N4 BMJ Vertigo: Epley Manoeuvre Video: https://www.youtube.com/watch?v=jBzID5nVQjk&t=44s Examples of how to perform the Head Impulse Test for Peripheral Vestibular Dysfunction: https://www.youtube.com/watch?v=psyPED6anPo https://www.youtube.com/watch?v=XpghlvnrREI Professor Lucy Yardley: Retraining your Balance: https://www.menieres.org.uk/files/pdfs/balance-retraining-2012.pdf VeDA Vestibular Disorders Association USA Resources for Clinicians and Patients: Main Page: https://vestibular.org/ VeDA Vestibular Disorders Association USA Resources for Clinicians and Patients: Type of Vestibular Disorders Page: https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/ Meniere’s Society UK: https://www.menieres.org.uk/ The Migraine Trust: https://migrainetrust.org/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara speak with GP Dr Allison Rees for her advice on how to approach GP Appraisals and Revalidation. We heard her talk about this in a Health Education England First Five talk a few years ago and found it so helpful. We cover why they can be useful, the practicalities of what needs to be done and how to make them work for you. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: RCGP Guide to your Appraisal: https://www.rcgp.org.uk/your-career/revalidation/supporting-information-guidance Advice and Guidance for Locum Doctors and Doctors in Short Term Placements: https://www.england.nhs.uk/professional-standards/medical-revalidation/doctors/locum-ad/ RCGP Appraisal and Revalidation Mythbusters: https://www.rcgp.org.uk/your-career/revalidation/mythbusters NHS England Greater Manchester GP Fellowship scheme for GPs within 2 years of Qualifying: https://www.gmthub.co.uk/our-programmes/gp-fellowship New to Practice Health Education England Fellowship: https://madeinheene.hee.nhs.uk/general_practice/Primary-Care-Training-Hub/GP-GPN-Fellowship-Programme/New-to-Practice-Fellowships The Revalidation Management System (RMS): https://rms.england.nhs.uk/Account/Login?ReturnUrl=%2f Medical Appraisal Guide 2022: https://www.aomrc.org.uk/wp-content/uploads/2022/06/Medical_Appraisal_Guide_2022_0622.pdf National Association of Sessional GPs: https://www.nasgp.org.uk/ The General Medical Practice Framework for Appraisal and Revalidation: https://www.gmc-uk.org/-/media/documents/The_Good_medical_practice_framework_for_appraisal_and_revalidation___DC5707.pdf_56235089.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to Dr Wasim Javed, ST6 in Cardiology, about the diagnosis and management of Angina. Taking a theoretical case we talk through symptoms, differentials, diagnosis, including the guidelines and practicalities of different types of functional and non-functional tests, as well types of angina and their management. It was useful to understand the initial management once diagnosed, and where further investigations or referrals/discussions with cardiology come in. As well as the above, we discuss the difference between medical management and stenting and some of the third line anti-anginal medications. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: NICE guidelines on Stable Angina (updated July 2016): https://www.nice.org.uk/guidance/cg126 European Society of Cardiology 2019 Guideline on Chronic Coronary Syndromes: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Chronic-Coronary-Syndromes Life in the Fast Lane (ECG interpretations etc): https://litfl.com/library/ Traffic Light System for Primary Care Prescribing in Greater Manchester (contains information on what should be started by Specialists etc): https://gmmmg.nhs.uk/rag-category/adult/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to talk to Dr Mary Cheshire who is the GP lead on the NHS England Fellowships for Greater Manchester GPs. As she explains, this is a fairly informal fellowship done over 2 years offering different types of courses and support that essentially consists of a paid CPD session a week and a range of CPD events to facilitate this. The course runs a qualification in coaching people can sign up for and are offered Mentors. Completing a quality improvement project is encouraged, whether that is small or large and there are opportunities for support for this along the way. At the moment this is available for newly qualified GPs and those up to 2 years after CCT who are in Salaried or Partnership posts. There are other types of Fellowships - we mention the Health Education England GP Fellowships and GP Nurses Fellowships briefly, see details below. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: The Greater Manchester Training Hub GP Fellowship Information: https://www.gmthub.co.uk/our-programmes/gp-fellowship Links to information about the GP Fellowship, the GP Nurse Fellowship, Primary Care Mentoring and a course for clinicians New to Primary Care: https://www.gmthub.co.uk/our-programmes For Questions about the Fellowship and how it works that aren’t answered in the links above: [email protected] Health Education England GP Fellowships: https://www.nwpgmd.nhs.uk/post-cct-gp-fellowship-programme-hee-nw ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to talk to GP and Professor of General Practice Research Dr Carolyn Chew-Graham about the current landscape of Long COVID three years on. She spoke to us on the topic back in August 2021, but what we know and some of the treatments have moved on from then. In this talk we discuss why the patient-preferred term is Long COVID rather than Post COVID Syndrome, symptoms, how many people are living with the condition in the UK to date and some of the types of management and help that are available. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: Your COVID Recovery Website: https://www.yourcovidrecovery.nhs.uk/ Interviews with Patients with Long COVID: https://healthtalk.org/Long-Covid-In-Adults/overview Postural Orthostatic Tachycardia Syndrome: https://www.potsuk.org https://www.potsuk.org/gp_guide BMJ Article on Orthostatic Tachycardia with Infographic Mentioned (March 2023): https://www.bmj.com/content/378/bmj-2022-072117 Information on Mastocytosis and Mast Cell Activation Syndrome: https://ukmasto.org/#gsc.tab=0 https://www.potsuk.org/about-pots/associated-conditions/mcas/ Greater Manchester Long COVID Support Group: https://hsm.manchester.gov.uk/kb5/manchester/directory/service.page?id=Rn19N5XSimc UK Long COVID Support Group: https://www.longcovid.org/ Support Groups for Families with a Child with Long COVID: https://www.longcovidkids.org/ Advice for Supporting a Child with Long COVID: https://theconversation.com/supporting-a-child-with-long-covid-tips-from-parents-of-children-living-with-the-condition-195153 Research on Impact of Long COVID on Racially Minoritised Groups: https://blog.westminster.ac.uk/hicovestudy/ Research on whether existing Medications have any Impact on Long COVID ‘STIMULATE ICP’: https://www.stimulate-icp.org/ LOCOMOTION Study looking at Optimising Treatments in Long COVID: https://bmjopen.bmj.com/content/12/5/e063505 Be Part of Research: What Trials are available (here for people with Long COVID): https://bepartofresearch.nihr.ac.uk/results/search-results?query=long%20covid&location= National Institute for Health and Care Research: https://www.nihr.ac.uk/patients-carers-and-the-public/i-want-to-take-part-in-a-study.htm Resources around advice for Returning to Work: https://www.som.org.uk/take-planned-approach-managing-long-covid-workforce-new-som-guide https://www.fom.ac.uk/wp-content/uploads/longCOVID_guidance_04.pdf https://bjgp.org/content/71/712/508 NICE RCGP SIGN Guidance on Managing Patients with Long COVID (Last Updated Nov 2021): https://www.nice.org.uk/guidance/ng188 RCGP Online eLearning Module on Long COVID: https://elearning.rcgp.org.uk/course/view.php?id=492 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to GP Dr Adam Cliffe about how he and his practice went about changing the model by which patients access the practice. It is so far working very well for both staff and patients. It’s an interesting talk about change management and one example of how a difficult situation was changed for the better. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: House of Commons Committee Report: The Future of General Practice Oct 2022: https://publications.parliament.uk/pa/cm5803/cmselect/cmhealth/113/report.html#heading-0 The King’s Fund, Innovative Models for General Practice June 2018: https://www.kingsfund.org.uk/publications/innovative-models-general-practice ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to Dr Aseem Mishra, Academic GP trainee involved in helping produce the Guidelines for the Greater Manchester Lipid Pathway. Greater Manchester has very high levels of Major Adverse Cardiovascular Events (MACEs). The guidelines for how to treat hyperlipidaemia and what we’re aiming for have changed. Dr Mishra helps talk through these changes. Towards the end of the episode, we discuss injectable treatments for secondary prevention including Inclisiran. The resource links are extensive, we hope you find the discussion and the links as useful as we do. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: NICE Clinical Knowledge Summaries for Lipid Modification Jan 2023 (links to both Primary and Secondary Prevention): https://cks.nice.org.uk/topics/lipid-modification-cvd-prevention/ Familial Hypercholesterolaemia Assessment Guidelines (links to Simon Broome and the Dutch Lipid Clinic Criteria): https://cks.nice.org.uk/topics/hypercholesterolaemia-familial/diagnosis/assessment-diagnosis/ Statins Prescribing Information, with risks of serious side effects and interactions: https://cks.nice.org.uk/topics/lipid-modification-cvd-prevention/prescribing-information/statins/#adverse-effects National Statin Intolerance Pathway: https://www.england.nhs.uk/aac/publication/statin-intolerance-pathway/ Manchester Secondary Prevention Lipid Pathway: https://gmmmg.nhs.uk/wp-content/uploads/2023/02/Lipid-Management-Pathway-for-Secondary-Prevention-of-Cardiovascular-Disease-CVD-21.12.22.pdf GMMMG Prescribing Information for Inclisiran: https://gmmmg.nhs.uk/wp-content/uploads/2022/11/Inclisiran-prescribers-information-leaflet-13.10.22-for-web.pdf SPIRIT Trial on Inclisiran: https://clinicaltrials.gov/ct2/show/NCT04807400 NHS Accelerated Access Collaborative: https://www.england.nhs.uk/aac/what-we-do/innovation-for-healthcare-inequalities-programme/commercial-partnerships/ Health Innovation Manchester Lipid Webinar and Links to Prescribers and Patient Information for Inclisiran: https://healthinnovationmanchester.com/cvdprevention-lipidpathway-resources/ HeartUK resource on Statins: https://www.heartuk.org.uk/getting-treatment/statins Reference for the discussion on Plaque Regression: Kalanuria A, Nyquist P and Ling G. (2012) The prevention and regression of atherosclerotic plaques: Emerging Treatments Vascular Health Risk Management: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459726/ Tool to Calculate Lifetime Cardiovascular Disease risk: https://u-prevent.com/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to ENT Consultant Ms Sadie Khwaja about common throat symptoms we encounter in General Practice and get her take on how to assess and manage these. We cover Red Flag symptoms for the neck in detail as well as looking at three cases we commonly encounter; pain on swallowing, globus symptoms and hoarseness. We discuss a useful approach for assessing causes of throat problems, consider the triad of swallowing, breathing and voice difficulties and the importance of feeling for neck lumps amongst other interesting pearls of wisdom. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: NICE guidelines for Head and Neck Cancer Referrals: https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#head-and-neck-cancers Greater Manchester Cancer: Head and Neck Cancer: Homepage: https://gmcancer.org.uk/head-and-neck/ Greater Manchester Cancer: Head and Neck Cancer: 2 week wait Proforma: https://gmcancer.org.uk/wp-content/uploads/2021/10/head-and-neck-referral-form.pdf EAT-10 Swallowing Screening Tool Score: https://www.exservanhcp.com/assets/dist/pdfs/eat-10-screening-tool.pdf Use of proton pump inhibitors to treat persistent throat symptoms: multicentre, double blind, randomised, placebo controlled trial. BMJ Jan 2021: https://www.bmj.com/content/372/bmj.m4903 British Voice Association (BVA) resources: https://www.britishvoiceassociation.org.uk/free.htm British Voice Association (BVA) resources: General Voice Care Advice: https://www.britishvoiceassociation.org.uk/downloads/free-voice-care-literature/Take%20care%20of%20your%20voice.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to Dr Maiedha Raza to find out her take on issues of Equality and Diversity in General Practice. This is a gentle dive into the very complex world of diversity and inclusivity with messages of how we can improve our culture in the NHS. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: Talks by Nancy Kline: Time to Think: https://www.youtube.com/channel/UCNF-NcrXmaOHp1KmLxIuNOw Pulse Article: Over one in five young GPs has experienced racism at work (Jan 2023): https://www.pulsetoday.co.uk/news/workforce/over-one-in-five-young-gps-has-experienced-racism-at-work/ Psychological Safety: https://psychsafety.co.uk/about-psychological-safety/ TED Talk by Amy Edmonson Building a Psychologically Safe Workplace (May 2014): https://www.youtube.com/watch?v=LhoLuui9gX8 British Medical Association Equality and Diversity Guidance: https://www.bma.org.uk/advice-and-support/equality-and-diversity-guidance British Medical Association Delivering Racial Equality in Medicine Report (2020): https://www.bma.org.uk/advice-and-support/equality-and-diversity-guidance/race-equality-in-medicine/delivering-racial-equality-in-medicine NHS leadership Academy Inclusion, Equality and Diversity Resources: https://www.leadershipacademy.nhs.uk/inclusion-equality-and-diversity/ NHS Leadership Inclusivity Course: https://www.leadershipacademy.nhs.uk/programme-course-1-inclusive-leadership-in-health-and-care/ Induction Resources for International Medical Graduates: https://www.e-lfh.org.uk/programmes/nhs-induction-programme-for-international-medical-graduates/#:~:text=The%20National%20Induction%20programme%20has,transition%20to%20UK%20clinical%20practice. TED Talk By Tiffany Alvoid: Eliminating Microaggressions: The Next Level of Inclusion: https://www.ted.com/talks/tiffany_alvoid_eliminating_microaggressions_the_next_level_of_inclusion Professor Camara Jones Talk on Anti-Racism and Health: Levels of Health Intervention (Nov 2022): https://www.youtube.com/watch?v=yEHXVUiUMtU Toolkit: Being an Ally: https://www.imperial.nhs.uk/-/media/website/about-us/how-we-work/equality-and-diversity/allyship-toolkit_14_03.pdf?rev=ff58666cce764881ac223312733c4abb&hash=93DED6E338883958AD0176E3FC130E86 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Dr Sarah Taylor about the changes being made to how Primary Care Clinicians refer patients for Suspected Lower Gastrointestinal Cancers. These changes are discussed in the context of referring in the Greater Manchester area, but you can view the joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology below. This will change the way we manage patients. To help, we go through some potential cases. Good tips for how to mitigate potential risks with the changes included. We hope you find this useful. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC): a joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG): https://www.bsg.org.uk/clinical-resource/faecal-immunochemical-testing-fit-in-patients-with-signs-or-symptoms-of-suspected-colorectal-cancer-crc-a-joint-guideline-from-the-acpgbi-and-the-bsg/ GatewayC FIT infographic: http://bit.ly/409mXUy GatewayC Lower GI infographic: http://bit.ly/3XJpIKN Raised Platelets and Cancer Risk: https://gpnotebook.com/en-au/simplepage.cfm?ID=x2019111783915921223 The Current NICE Guidelines last Updated December 2021: https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#lower-gastrointestinal-tract-cancers ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to GP Dr David Bartlett who works with the Neuroendocrine Cancer UK charity and GP Dr Will Evans who is a researcher specialising in rare diseases. We wanted to discuss how they approach finding rare diseases in General Practice whilst balancing this with the risk of over investigating. We start with definitions and classifications before discussing where neuroendocrine cancers fit into this landscape. Their pearls of wisdom could help us keep our antenae up, referrals helpful and resources for clinicians and patients well stocked. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: British Journal of General Practice Article: Rare diseases in General Practice: Recognising the Zebras among the Horses. Evans, W & Rafi I (Vol 66, 2016): https://bjgp.org/content/66/652/550 Rare Disease UK: https://www.raredisease.org.uk/ Neuroendocrine Cancer UK: https://www.neuroendocrinecancer.org.uk/ Royal College of GPs eLearning on Neuroendocrine Cancers (search here): https://www.rcgp.org.uk/learning-resources/courses-and-events/elearning-courses Medics for Rare Diseases: https://www.m4rd.org/ Information on Beckwith Wiedemann Syndrome: https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/beckwith-wiedemann-syndrome-bws/ Inattentional Bias Studies with Radiology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964612/ https://pubmed.ncbi.nlm.nih.gov/17412097/ Mnemonic Family GENES Reference: Genetic red flags: clues to thinking genetically in primary care practice. Whelan et al. Primary Care: Clinics in Office Practice (Sept 2006): https://pubmed.ncbi.nlm.nih.gov/15331244/ Resource with helpful leaflets for Chromosomal Diseases: https://rarechromo.org/ OMIM: An Online Catalogue of Human Genes and Genetic Disorders: https://www.omim.org/ Gene Reviews: https://www.ncbi.nlm.nih.gov/books/NBK1116/ Orphanet Rare Disease Platform with Search Engine: https://www.orpha.net Rare Disease Search Engine: https://www.findzebra.com/https://www.ndr-uk.org/browse ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa talk to Dietician Charlotte Cockman about managing weight for patients who are overweight or obese in General Practice. This includes a discussion around the definitions of overweight and obesity, risk factors, and what terms are less stigmatising when discussing weight with patients. Charlotte talks to us about her approach to weight, eating and health, and how this approach can encourage long term behavioural changes that focus on health and nutrition rather than weight. We discuss management options including what tier two and three NHS services do, as well as where some medications and surgery fit into this picture. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: NICE Clinical Knowledge Summaries Obesity (Sept 2022): https://cks.nice.org.uk/topics/obesity/ Waist to Height Ratio: https://www.nice.org.uk/guidance/cg189/chapter/Recommendations Greater Manchester Diabetes My Way: Healthy Living Support for People with Diabetes: https://diabetesmyway.nhs.uk/ The Association of UK Dieticians Resources: https://www.bda.uk.com/food-health/workplace-health-work-ready/what-we-do/resources.html Giles Yeo Webinar: https://mynutriweb.com/why-calories-dont-count/ Giles Yeo ‘Why Calories don’t count’ Book: https://www.betterworldbooks.com/search/results?q=Giles%20Yeo Giles Yeo: ‘Let’s consider the type of food we eat, not fixate on calories’ The Guardian. David Cox (Jun 2021): https://www.theguardian.com/science/2021/jun/20/giles-yeo-why-calories-dont-count-diet-interview British Dietetic Association Food Resources: https://www.bda.uk.com/food-health/food-facts.html Resources on Weight Stigma: https://www.bda.uk.com/news-campaigns/campaigns/managing-and-preventing-obesity/eliminating-weight-stigma-comms-guidelines.html https://www.worldobesity.org/what-we-do/our-policy-priorities/weight-stigma For Healthcare Professionals interested in more Nutritional Knowledge: https://mynutriweb.com/ Nutrition information leaflets: https://www.ndr-uk.org/browse ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa speak with Christopher Lewis, Operations Learning and Development Manager for Greater Manchester Training Hub. His non-pretentious, passionate approach to coaching and mentoring was infectious. We hope you get a flavour of how coaching and mentoring might help in General Practice. The episode was designed with GP fellows in mind but anyone working in Primary Care may benefit. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: Greater Manchester Training Hub with Links to the Fellowship Programme and the GP Supporting Mentors Scheme: https://www.gmthub.co.uk/our-programmes If you’re based in Greater Manchester and interested in signing up for coaching/mentoring, you can go to: https://www.gmthub.co.uk/our-programmes or email: [email protected] GROW model for Coaching: https://www.performanceconsultants.com/grow-model Videos of Sir John Whitmore Coaching in action: https://www.coachingcultureatwork.com/sir-john-whitmore/ The Golf coaching video we discussed: https://www.youtube.com/watch?v=Ncb1jjRZyNU Looking After You Too, NHS Wider Primary Care Workforce Coaching Offer: https://www.england.nhs.uk/supporting-our-nhs-people/support-now/looking-after-you-confidential-coaching-and-support-for-the-primary-care-workforce/looking-after-you-too/ How to use a Wheel of Life Coaching Tool: https://www.inside-out-coaching.com/how-to-use-the-wheel-of-life-coaching-tool-to-create-a-balanced-life/#:~:text=The%20Wheel%20of%20Life%20is,and%20I%20mean%20really%20know. Dr Rachel Morris Hosts the You are not a Frog Podcast for GPs and other professionals. The Episodes and her Shapes Toolkit and other resources Involve Coaching: https://youarenotafrog.com/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Consultant Otolaryngologist Ms Emma Stapleton and Clinical Scientist David Jay about Vertigo. We discuss the definition, differentials, and how to use information around timing and triggers to differentiate between the likely causes of vertigo. We get their take on the important details in the examination that can help identify the diagnosis, and talk options for managing the most common types of peripheral vertigo. The resources section of the episode description contains excellent resources to help, including examples of how to perform and interpret the Head Impulse test, as well as vestibular rehabilitation resources for patients. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE . Nov 2009, Stroke: https://pubmed.ncbi.nlm.nih.gov/19762709/ A summary of HINTS by David Jay: Developments in diagnostic approaches for acutely dizzy patients: (Feb 2020 ENT & Audiology News): https://www.entandaudiologynews.com/features/audiology-features/post/developments-in-diagnostic-approaches-for-acutely-dizzy-patients TiTrATE: A Novel Approach to Diagnosing Acute Dizziness and Vertigo. Newman-Toker and Edlow J A. Neurology Clinics (Aug 2015) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522574/ The Five Deadly D’s of Dizziness (red flags to remember): EM Resident, Unravelling the Mystery of Dizziness in the ED: A Guide for the Student Clerkship, Oct 2018 Wilcox K, Shafer K: https://www.emra.org/emresident/article/dizziness/ BMJ Vertigo: Dix-Hallpike Video: https://www.youtube.com/watch?v=8RYB2QlO1N4 BMJ Vertigo: Epley Manoeuvre Video: https://www.youtube.com/watch?v=jBzID5nVQjk&t=44s Examples of how to perform the Head Impulse Test for Peripheral Vestibular Dysfunction: https://www.youtube.com/watch?v=psyPED6anPo https://www.youtube.com/watch?v=XpghlvnrREI Professor Lucy Yardley: Retraining your Balance: https://www.menieres.org.uk/files/pdfs/balance-retraining-2012.pdf VeDA Vestibular Disorders Association USA Resources for Clinicians and Patients: Main Page: https://vestibular.org/ VeDA Vestibular Disorders Association USA Resources for Clinicians and Patients: Type of Vestibular Disorders Page: https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/ Meniere’s Society UK: https://www.menieres.org.uk/ The Migraine Trust: https://migrainetrust.org/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa speak with Dr John Patterson about Health Inequalities. This is the second of our two talks on Health Inequalities, please check out Dr Laura Neilson’s talk before this one. Dr John Patterson is a GP and Medical Director of Hope Citadel, as well as their Focused Care Lead and the Chief Clinical Officer for Oldham CCG. We discuss the social determinants of health and a working definition of health inequalities. He talks to us about his journey into tackling health inequalities, his projects, and others of interest. He makes a compelling case as to the importance of health inequalities, and how ‘the right thing is always the smart thing to do’. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: Book: Tackling Causes and Consequences of Health Inequalities: A Practical Guide (2020) Edited By James Matheson, John Patterson, Laura Neilson: https://www.routledge.com/Tackling-Causes-and-Consequences-of-Health-Inequalities-A-Practical-Guide/Matheson-Patterson-Neilson/p/book/9781138499867 Hope Citadel Resources: https://hopecitadel.org.uk/ Focused Care (service model to work with the most vulnerable families in communities): https://focusedcare.org.uk/ The Shared Health Foundation: https://sharedhealthfoundation.org.uk/ Greater Manchester Deprivation GP training programme: https://www.docsindepgpst.org.uk/ The Marmot Review 10 Years On: https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on?gclid=Cj0KCQjwkt6aBhDKARIsAAyeLJ28cEVgCnGVUAgk9SflEGZnM-Q0iZ76by6yxw7R-T0CktbmSGIqllkaAg9CEALw_wcB Doctors John Patterson and Laura Neilson both mention the Eden Project: https://joineden.org/ Maslow’s Hierarchy of Needs (discussed as an approach to Health): https://www.gp-training.net/communication-skills/communication-skills-theory/maslows-hierarchy-of-needs Professor Steve Fields (Previously NHS England’s Deputy National Medical Director, with the lead responsibility for addressing health inequalities): http://www.homelessnessandhealth.co.uk/events/2017/professor-steve-field/ Interesting Paper Mentioned: North and South: addressing the English health divide, Clare Bambra, Ben Barr, Eugene Milne (2014): https://academic.oup.com/jpubhealth/article/36/2/183/2901779 Related Blog: What can German reunification teach the UK about levelling up? UK policymakers can learn lessons from the German experience to help level up the UK economy Kathrin Enenkel (2021): https://www.centreforcities.org/blog/what-can-german-reunification-teach-the-uk-about-levelling-up/ Common-Wealth health Inequalities Global Research: https://www.common-wealth.co.uk/ David Buck Kings Fund Focused Secondary Prevention in Primary Care is the fastest way to close health inequalities: https://www.kingsfund.org.uk/blog/2011/04/incentivising-public-health-primary-care-learning-qof The Black Report on Health Inequalities in 1980: https://navigator.health.org.uk/theme/black-report-health-inequalities NHS Health Inequalities Oversight Group: https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/our-approach-to-reducing-healthcare-inequalities/strategic-drivers/ Core20PLUS5 A national approach to reducing health inequalities explained: https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5/ Bentley C and Leaman J Health Inequalities: National Support Team Priority actions based upon best practice that could impact inequalities in mortality and life expectancy in the short term (accessed Oct 2022): https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/215329/dh_130949.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of list

Doctors Sara and Lisa talk to Dr Laura Neilson the founder of Hope Citadel who is passionate about tackling Health Inequalities. She talks to us about the importance of addressing them, what the inverse care law is, and skills that people will find useful working in areas of deprivation. We ask her about her projects which include helping create Hope Citadel; a growing group of practices working in areas of deprivation in Manchester, Focused Care; a project that facilitates this, and the Shared Health Foundation. We ask what we in general practice can do to help, and talk about coping with the challenges. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: Book: Tackling Causes and Consequences of Health Inequalities: A Practical Guide (2020) Edited By James Matheson, John Patterson, Laura Neilson: https://www.routledge.com/Tackling-Causes-and-Consequences-of-Health-Inequalities-A-Practical-Guide/Matheson-Patterson-Neilson/p/book/9781138499867 Hope Citadel Resources: https://hopecitadel.org.uk/ Focused Care (service model to work with the most vulnerable families in communities): https://focusedcare.org.uk/ The Shared Health Foundation: https://sharedhealthfoundation.org.uk/ Policy and Advocacy advice from Shared Care Foundation; how to get involved with their projects: https://sharedhealthfoundation.org.uk/policy-and-advocacy/ Greater Manchester Deprivation GP training programme: https://www.docsindepgpst.org.uk/ The Marmot Review 10 Years On: https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on?gclid=Cj0KCQjwkt6aBhDKARIsAAyeLJ28cEVgCnGVUAgk9SflEGZnM-Q0iZ76by6yxw7R-T0CktbmSGIqllkaAg9CEALw_wcB The Inverse Care Law explained: https://www.kingsfund.org.uk/publications/articles/inverse-care-law Lives on the Line: Life Expectancy at Birth & Child Poverty as a Tube Map: https://life.mappinglondon.co.uk/ All Party Parliamentary Group for improving the lives of people in Temporary Accommodation across England: https://householdsintemporaryaccommodation.co.uk/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara speak with GP Dr Uma Marthi about Endometriosis; a topic she is passionate about due to the common delay in diagnosis, coupled with the impact this condition has on peoples’ lives. We talk through a hypothetical case and explore differential diagnoses for dysmenorrhoea, examination tips, investigations and management. We discuss the importance and impact of this condition, fertility and the need to think about and treat this as soon as we can. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: NICE Clinical Knowledge Summaries, Dysmenorrhoea: https://cks.nice.org.uk/topics/dysmenorrhoea/ NICE Clinical Knowledge Summaries, Endometriosis: https://cks.nice.org.uk/topics/endometriosis/ All Parliamentary Group on Endometriosis: https://www.endometriosis-uk.org/all-party-parliamentary-group-endometriosis Endometriosis UK: https://www.endometriosis-uk.org/ European Society of Human Reproduction and Embryology Endometriosis Guidelines: https://www.eshre.eu/Guideline/Endometriosis Guardian Article: Endometriosis took my fertility, and part of my self Hilary Mantel (Sept 2015): https://www.theguardian.com/commentisfree/2015/sep/28/endometriosis-fertility-hilary-mantel All Party Parliamentary Group (APPG) on Endometriosis Inquiry Report 2020: https://www.endometriosis-uk.org/sites/default/files/files/Endometriosis%20APPG%20Report%20Oct%202020.pdf British Society for Gynecological Endoscopy, includes links to Specialist Endometriosis Centres around the UK: https://www.bsge.org.uk/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara are joined by Dr Avil Danczak to talk about how we can use consultation skills to improve our time management in General Practice. She takes us through first principles and core skills before talking about common pitfalls and how to avoid them. The principles of all we discuss are elaborated on in the ‘Teaching and Learning Consultation Skills’ (TALC) resources that are available for all to access online in the link below. Useful resources: Teaching and Learning Communication Skills Resources: https://www.gmthub.co.uk/talc Mapping Uncertainty in Medicine: What to Do When You Don't Know What to Do? Book By Dr Avril Danczak: https://uk.bookshop.org/books/mapping-uncertainty-in-medicine-what-to-do-when-you-don-t-know-what-to-do/9780850844054?gclid=CjwKCAjwpqCZBhAbEiwAa7pXeVpSuq3GXdSwdGdHeebuLcrVd0WlMwnAV6qIgQPz9i7ZU2EhKmTk1hoCANIQAvD_BwE You are not a Frog Episode 74: Managing your Time in a System Which Sucks with Dr Ed Pooley: https://youarenotafrog.com/episode-74/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa speak with Consultant Psychiatrist Dr Raja Mukherjee about neurodevelopmental disorders in children. He has an interest in Foetal Alcohol Spectrum Disorder (FASD) and this is the focus of the talk. We cover what neurodevelopmental disorders are, discuss neurodiversity, common disorders such as Autism, ADHD, Dyspraxia aka Developmental Coordination Disorder and Foetal Alcohol Spectrum Disorder. Useful resources: NICE Foetal Alcohol Spectrum Disorders: https://www.nice.org.uk/guidance/qs204 My FASD and Me (Foetal Alcohol Spectrum Disorder resource): https://fasd.me/ Foetal Alcohol Syndrome Spectrum Disorder (FASD) Awareness Month Resources including information on the Campaign #Drymester: https://www.drymester.org.uk/resource/fasd-awareness-month-assets/ National FASD trust: https://nationalfasd.org.uk/about-us/who-we-are/ National FASD CPD accredited e-Learning and their website provides expert led advice for GPs and other health care professionals: https://nationalfasd.org.uk/learn-more/training/e-learning/ Greater Manchester based support group for FASD: https://fasdgreatermanchester.co.uk/ Prevention, Recognition and Management of Fetal Alcohol Spectrum Disorders Hardcover – 1 Aug. 2021 by Raja A. S. Mukherjee (Editor), Neil Aiton (Editor) https://searchworks.stanford.edu/view/13976811 The National Autistic Society: https://www.autism.org.uk/ FASD Book: Strategies not solutions: https://edmontonfetalalcoholnetwork.org/wp-content/uploads/2019/02/strategies_not_solutions_handbook.pdf The Time Is Now Book about Foetal Alcohol Spectrum Disorder: https://nationalfasd.org.uk/wp-content/uploads/2022/03/National-FASD-RT-Report-v004-INTERACTIVE-singles-2.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

*Recorded in June 2020 - Summer Replay* In this episode Lisa and Sara talk to Dr Avril Danczak, a GP with an interest in managing uncertainty in medicine which led to her co-authoring the RCGP published book called Mapping Uncertainty in Medicine. We cover what uncertainty is, and why it is important to address this within medicine and general practice. We talk about ‘what to do when you don’t know what to do’, how to classify and identify different forms of uncertainty and then think about how you can go about addressing and managing this uncertainty in a structured way. Useful resources: Book: Mapping uncertainty in medicine, what to do when you don’t know what to do; Avril Danczak, Alison Lea and Geraldine Murphy (2016): https://www.amazon.co.uk/Mapping-Uncertainty-Medicine-What-When/dp/0850844053 Paper: Varieties of uncertainty in medicine; Paul Han, William Klein and Neeraj Arora (2011): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146626/ Paper: Dealing with uncertainty in general practice: an essential skill for the general practitioner; Margaret O’Riordan et al: https://pubmed.ncbi.nlm.nih.gov/21781433/ Bradford VTS Resources on decisions, diagnoses and uncertainty: https://www.bradfordvts.co.uk/clinical-skills/decisions-diagnoses-uncertainty/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This week’s episode is designed for primary care clinicians wanting an overview of current diabetes management. Doctors Lisa and Sara are joined by Dr Marlon Morais and Nicola Milne to talk first about Type 1 diabetes briefly (from the GP point of view) before going on to discuss the recent changes to the NICE guidelines for management of Type 2 Diabetes Mellitus. We cover useful ways of sifting through the options for medicines and the importance of a holistic approach and the NHS low calorie programmes. The resource list is incredibly useful. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: Visual Summary of NICE Guidelines (Feb 2022): https://www.nice.org.uk/guidance/ng28/resources/visual-summary-full-version-choosing-medicines-for-firstline-and-further-treatment-pdf-10956472093#page=2 Diabetes UK Emotional Wellbeing Module CPD: https://www.diabetes.org.uk/professionals/training--competencies/courses/emotional-wellbeing-module Diabetes on the Net Six Steps to Insulin Safety Module for Healthcare Professionals (based on key recommendations by NICE in 2017): https://diabetesonthenet.com/diabetes-news/six-steps-to-insulin-safety-e-learning-module/ Trend Diabetes Injection Technique Matters: https://trenddiabetes.online/injection-technique-matters/ NICE Clinical Knowledge Summaries: Type 2 Diabetes Mellitus Management for Adults: https://cks.nice.org.uk/topics/diabetes-type-2/management/management-adults/ Diabetes in Control, When and When Not to use an SGLT2 Inhibitor (traffic light system): http://www.northoftyneapc.nhs.uk/wp-content/uploads/sites/6/2021/12/SGLT-2-Top-Tips-V7.pdf SGLT2 inhibitors: Indications, doses and licences from Diabetes & Primary Care: https://diabetesonthenet.com/wp-content/uploads/Brown_Need-to-know-SGLT2is.pdf Diabetes drugs and renal impairment: Updated GPnotebook Shortcuts (Nov 2021): https://diabetesonthenet.com/journal-diabetes-nursing/diabetes-drugs-and-renal-impairment-updated-gpnotebook-shortcuts/ Diabetes on the Net At a Glance Factsheets: https://diabetesonthenet.com/tag/at-a-glance-factsheet/ Diabetes UK: What is a Healthy, Balanced Diet for Diabetes: https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/what-is-a-healthy-balanced-diet The DiRECT Trial: Weight Management Interventions in Type 2 Diabetes Mellitus (informing the Low Calorie Diet Pilots): https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30068-3/fulltext Sick Day Rules for Type 1 Diabetes Mellitus Leicester: https://static1.squarespace.com/static/5c2ccb867c93271f5edc9718/t/5ed7a143ee2bfa731b017aac/1591189828264/Sick_Day_Rules_T1_Infographic_V4%5B1438%5D.pdf Sick Day Rules for Type 2 Diabetes Mellitus Leicester: https://static1.squarespace.com/static/5a6439bab7411c94f2ebe216/t/6000117d2a88fe77419f655a/1610617215447/Sick_Day_Rules_T2DM.pdf NHS Very Low Calorie Diets: https://www.england.nhs.uk/diabetes/treatment-care/low-calorie-diets/https://preventing-diabetes.co.uk/know-your-risk-dtc/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based

Doctors Lisa and Sara are joined by Diabetes Lead for Manchester CCG GP Dr Marlon Morais and Diabetes Support Lead and Diabetes Specialist Nurse Nicola Milne to discuss diagnosis of Diabetes Mellitus. We go through the types of Diabetes Mellitus, touching on MODY and LADA and get advice on avoiding common pitfalls in making a new diagnosis of Diabetes in General Practice. We talk about the prevalence and importance of this diagnosis, both for patients and the NHS and red flags to look out for. We then cover impaired fasting glucose and the current management options for this including the NHS Diabetes Prevention Programme. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: Diabetes UK: types of Diabetes Mellitus explained: https://www.diabetes.org.uk/diabetes-the-basics/types-of-diabetes WHO Classification of Diabetes Mellitus (2019): https://www.who.int/publications/i/item/classification-of-diabetes-mellitus GP Notebook Clinical Classification of Diabetes Mellitus (2021): https://gpnotebook.com/en-gb/simplepage.cfm?ID=-26542064 What is MODY Maturity-Onset Diabetes of the Young?: https://www.diabetesgenes.org/what-is-mody/ NICE guidelines: When to suspect Type 2 Diabetes Mellitus (April 2022): https://cks.nice.org.uk/topics/diabetes-type-2/diagnosis/diagnosis-in-adults/ NICE CKS Guidelines Type 1 Diabetes Mellitus (Nov 2020): https://cks.nice.org.uk/topics/diabetes-type-1/ Language Matters in Diabetes: https://www.england.nhs.uk/publication/language-matters-language-and-diabetes/ Diabetes UK Information Prescriptions: https://www.diabetes.org.uk/professionals/resources/resources-to-improve-your-clinical-practice/information-prescriptions-qa Finish Diabetes Prevention Study (2003): https://diabetesjournals.org/care/article/26/12/3230/21849/The-Finnish-Diabetes-Prevention-Study-DPS National Diabetes Prevention Programme: https://www.england.nhs.uk/diabetes/diabetes-prevention/ Flatbush Diabetes information on GP Notebook: https://gpnotebook.com/en-gb/simplepage.cfm?ID=x20160928141517439169 Effects of Diet and Exercise in Preventing NIDDM in People With Impaired Glucose Tolerance: The Da Qing IGT and Diabetes Study (Apr 1997): https://diabetesjournals.org/care/article/20/4/537/22408/Effects-of-Diet-and-Exercise-in-Preventing-NIDDM The Da Qing IGT and Diabetes Study 30 year follow up: Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study. Lancet Diabetes Endocrinol. Jun 2019: https://pubmed.ncbi.nlm.nih.gov/31036503/ NHS Diabetes Prevention Programme: Know Your Risk Patient Calculator: https://preventing-diabetes.co.uk/know-your-risk-dtc/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara welcome Consultant Haematologist Dr Chris Gregory back to the podcast to discuss bruising and bleeding issues. We go through history, examination and differentials including patterns of bleeding more associated with different causes. We cover what constitutes excessive/concerning bleeding and blood test values that would lead to on the day/urgent referrals. At the end of the episode, you will hear our learning points. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources: Clinical Knowledge Summaries: Bruising (March 2021) https://cks.nice.org.uk/topics/bruising/ BMJ article Survey, Vitamin C deficiency as a cause of bruising: https://www.bmj.com/content/375/bmj.n2511.full NICE Suspected Cancer Referrals for Haematological Malignancies (as of Dec 2021): https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#haematological-cancers Greater Manchester Safeguarding Guidelines for Bruising in Non-mobile Children: https://greatermanchesterscb.proceduresonline.com/chapters/pr_bruising_babies_child.html British Society for Haematology Guidelines: https://b-s-h.org.uk/guidelines/ Non UK based Information: American Family Physician Feb 2016 ‘Clinical evaluation of bleeding and bruising in primary care’. Includes a helpful breakdown of normal vs excessive bleeding etc: https://www.aafp.org/afp/2016/0215/p279.html ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Drs Lisa and Sara were thrilled to welcome Professor Dame Helen Stokes-Lampard onto the podcast to talk about one of her passions within medicine - social prescribing. They discuss what social prescribing is and why it matters. They talk about the National Academy of Social Prescribing, and its current roles and remit. There are some great examples shared about social prescribing in action, and resources highlighted where people can find out more information about getting involved and having social prescribing link workers in practice. Useful resources: Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester Training Hub: https://www.gmthub.co.uk NHS England - Social Prescribing: https://www.england.nhs.uk/personalisedcare/social-prescribing/ Academy of Medical Royal Colleges: https://www.aomrc.org.uk/ National Academy for Social Prescribing: https://socialprescribingacademy.org.uk/ National Academy for Social Prescribing Twitter: https://twitter.com/NASPTweets Global Social Prescribing Alliance: https://www.gspalliance.com/ Men’s Sheds: https://menssheds.org.uk/ The Money and Pensions Service: https://moneyandpensionsservice.org.uk/ Park Run: https://www.parkrun.org.uk/ English National Opera - Breathe: https://www.eno.org/eno-breathe-3/ Campaign to End Loneliness: https://www.campaigntoendloneliness.org/ Football Association - Walking Football: https://thewfa.co.uk/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Today Lisa and Sara welcome Dr Rachel Morris back onto the podcast. Rachel is a former GP who has previously worked in GP education. She is now an executive coach and host of the wonderful podcast You Are Not a Frog. The discussion in this episode is all about assertiveness - we chat about what assertiveness is, general tips, frameworks and models for how to approach assertiveness, as well as showcasing how these can work with a few examples. Useful resources: Looking after Yourself in General Practice (previous Primary Care Knowledge Boost episode): https://www.pckb.org/e/looking-after-yourself-in-general-practice/ To Sign Up to the Shapes Toolkit mailing list and get a free Zone of Power handout as well as being notified when their brand new mini video series is released in a couple of weeks: https://www.shapestoolkit.com/zone-of-power Check out the You Are Not A Frog podcast: www.youarenotafrog.com Find out more about Rachel’s CPD community for doctors: www.permissiontothrive.org Find out more about the Resilient Team Academy online membership for busy leaders in healthcare: https://www.shapestoolkit.com/resilient-team-academy Get in touch with Rachel: [email protected] Find out more about her training: www.shapestoolkit.com Sign up for your FREE mini video series training from Rachel, all about setting boundaries and saying no https://www.shapestoolkit.com/boundaries Thomas–Kilmann Conflict Mode Instrument: https://kilmanndiagnostics.com/overview-thomas-kilmann-conflict-mode-instrument-tki/ NonViolent Communication Model by by Marshall B. Rosenberg: https://www.nonviolentcommunication.com/learn-nonviolent-communication/4-part-nvc/ Dr. Rangan Chatterjee Podcast, Feel Better Live More: How to Build Exceptional Relationships and Why You Should with David Bradford and Carole Robin: https://drchatterjee.com/how-to-build-exceptional-relationships-and-why-you-should-with-david-bradford-and-carole-robin/ Connect: Building Exceptional Relationships with Family, Friends and Colleagues by David L. Bradford and Carole Robin: https://www.penguin.co.uk/books/314/314545/connect/9780241986868.html ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This is another episode with a focus on Urology. Doctors Lisa and Sara invited Professor Ian Pearce back to speak about overactive bladder and urinary incontinence in women. They discuss the types of lower urinary tract symptoms in women (drilling down into the definitions of commonly used terms), before looking at the red flags to consider. They then use fictional cases to illustrate how to approach overactive bladder and incontinence in terms of assessment, investigation and management options. Useful resources: NICE CKS: Urinary incontinence in women: https://cks.nice.org.uk/topics/incontinence-urinary-in-women/ GMMMG Guidelines for assessment and treatment of overactive bladder in adults: https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Management-of-OAB-in-adults-v3-0-approved-Aug-2019.pdf Conservative management tips: Bladder and Bowel Community UK: https://www.bladderandbowel.org/bladder/bladder-treatments/urinary-tract-infection-treatments/ Guidelines in Practice: Top tips: urinary incontinence in women: https://www.guidelinesinpractice.co.uk/urology/top-tips-urinary-incontinence-in-women/455577.article Anticholinergic Burden resource 2: Anticholinergic Burden Calculator: http://www.acbcalc.com/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara speak to Judith Dawson to learn all about the ins and outs of supervising the Additional Roles Reimbursement Scheme members as the landscape stands at the moment. They discuss who can be a supervisor, the training involved and what that might mean for the day job. Useful resources: Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester Training Hub: https://www.gmthub.co.uk A Roadmap to Practice: https://www.hee.nhs.uk/sites/default/files/documents/A%20Roadmap%20to%20Practice.pdf GP mythbuster 106: Primary care first contact practitioners (FCPs), Care Quality Commission: https://www.cqc.org.uk/guidance-providers/gps/gp-mythbuster-106-primary-care-first-contact-practitioners-fcps Integrating additional roles into primary care networks, The King's Fund: https://www.kingsfund.org.uk/publications/integrating-additional-roles-into-primary-care-networks ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This is another episode in the series looking at all of the different roles that exist within primary care. Doctors Lisa and Sara speak to Charlotte Cockman who is a Dietician working in Primary Care in South Manchester. They discuss what a Dietician is and what the role can look like in Primary Care. It’s a new role and can be tailored to best suit the community. They also cover what the training consists of, what the day job looks like and advice for clinicians in Primary care around brief discussions with patients on nutrition. The discussion ends with some quick fire questions around supervision, opportunities for further professional development and registration requirements Useful resources: Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester Training Hub: https://www.gmthub.co.uk A Roadmap to Practice: https://www.hee.nhs.uk/sites/default/files/documents/A%20Roadmap%20to%20Practice.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Drs Sara and Lisa tackle another urology topic today - recurrent urinary tract infections (UTIs) in non-pregnant women. They speak to Ian Pearce who is a consultant urologist at Manchester Royal Infirmary. They discuss what UTIs are, and what makes them recurrent vs relapsing. They also chat through how to assess someone with recurrent UTIs and highlight some of the risk factors, before talking about the red flags for more sinister causes. The management options for recurrent UTIs are also covered, from conservative options to medications, including a detailed dive into antibiotic prophylaxis. They also get Ian’s opinions on who to refer to urology. Useful resources: Conservative management tips: Bladder and Bowel Community UK: https://www.bladderandbowel.org/bladder/bladder-treatments/urinary-tract-infection-treatments/ NICE Recurrent UTI Guidelines (Published Oct 2018): https://www.nice.org.uk/guidance/ng112 Guidelines in Practice: The diagnosis and management of uncomplicated recurrent urinary tract infection (March 2019): https://www.guidelines.co.uk/urology/uncomplicated-recurrent-uti-guideline/454623.article GMMMG Antibiotic Prescribing Guidelines (last updated Oct 2021): https://gmmmg.nhs.uk/wp-content/uploads/2021/10/GM-Antimicrobial-guidelines-OCT-2021-v10.0.pdf BMJ article: Methenamine hippurate for recurrent urinary tract infections, published on 9/3/22 (after episode was recorded): https://www.bmj.com/content/376/bmj.o533 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

****DISCLAIMER - CONTAINS STRONG LANGUAGE**** Doctors Lisa and Sara talk with GP Dr Austin O'Carroll. Austin works in Inner-City Dublin with marginalised and homeless/rough sleeping communities. He is co-founder of Safetynet Ireland, North Dublin City GP Training, and GPCareForAll. He talks to us about his take on how unhelpful the label of personality disorder is for patients in his care, about his take on the situation: the Triple F**k syndrome, and how medicine contributes to the systemic oppression of people born into poverty. We talk about trauma informed care and examples of outcomes for patients in his care. Useful resources: Dr Austin O'Carroll's TED talk about developing health services for homeless people (July 2017): https://www.youtube.com/watch?v=GiwRSPY_JqI Safetynet Ireland Charity: https://www.primarycaresafetynet.ie/ GPCareForAll: https://www.gpcareforall.org/our-story BJGP Article: The Triple F**k Syndrome: How medicine contributes to the systemic oppression of people born into poverty (Jan 2022): https://bjgplife.com/the-triple-fk-syndrome-how-medicine-contributes-to-the-systemic-oppression-of-people-born-into-poverty/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk with Consultant Urologist Dan Burke about Lower Urinary Tract Symptoms in Men. We start with how to divide symptoms into voiding and storage. Red flags to consider are discussed, before tackling cases that lead us to talk about bladder diaries, tips for assessing the prostate and how PSA discussions have changed since the introduction of MRI scans and transperineal prostate biopsies. In discussing the thorny subject of prostate cancer and best treatment choices for individuals, we talk about radical treatment, advanced disease and the difference between watchful waiting and active surveillance. Though we talk about men, it is well worth mentioning these symptoms will apply to all people with a prostate including trans women and some non-binary people. Useful resources: NICE Clinical Knowledge Summaries (Updated March 2019): https://cks.nice.org.uk/topics/luts-in-men/ Guidelines in Practice (2014): Full assessment is key for men with lower urinary tract symptoms: https://www.guidelinesinpractice.co.uk/mens-health/full-assessment-is-key-for-men-with-lower-urinary-tract-symptoms/341437.article Urinary Frequency Charts to assess bladder volume, polyuria and nocturia: https://bladdermatters.co.uk/downloads/85923fchart.pdf LUTS in Men Tower Hamlets NHS guidelines (2012) includes patient information sheets: https://www.qmul.ac.uk/blizard/ceg/media/blizard/images/documents/Lower-Urinary-Tract-Symptoms-in-Men,-Care-Pathway,-January-2012.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This episode is part 2 of our focus on Quality Improvement. This time Drs Lisa and Sara are joined by Dr Varshini Rajakulendran alongside Dr Joanna Bircher. Varshini is a GP who is on the NHS England fellowship, and she talks to us about a quality improvement example that she is currently working on around weight management. Joanna (our resident QI expert) has a passion for the subject and has been involved in writing guidelines and teaching for QI. We hear why Varshini chose this particular project, and the context to it including enablers and barriers. Joanna then helps us break it down further, thinking about the tool used, considering the aim of the project, what was and could be measured and what ideas were implemented and tested during the project. If you haven’t already, we recommend listening to “An Introduction to Quality Improvement” which provides some great initial theoretical knowledge about QI. Useful resources: Quality Improvement Resources by the Royal College of General Practitioners: https://www.rcgp.org.uk/clinical-and-research/our-programmes/quality-improvement/quality-improvement-guide-for-general-practice.aspx RCGP QI Ready: https://qiready.rcgp.org.uk/ Domains of Healthcare Quality: http://www.ihi.org/education/IHIOpenSchool/resources/Pages/Activities/DefiningQualityAimingforaBetterHealthCareSystem.aspx Public Health England National General Practice Profiles: https://fingertips.phe.org.uk/profile/general-practice/data#page/8/gid/2000005/pat/166/par/E38000220/ati/7/are/M85736/yrr/1/cid/4/tbm/1 GP Patient Survey data: https://www.gp-patient.co.uk/ Prescribing data: https://openprescribing.net/ Institute for Healthcare Improvement (IHI) Model for Improvement: http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx The Health Foundation booklet: Quality Improvement made simple, written by Bryan Jones, Esther Kwong and Will Warburton: https://www.health.org.uk/sites/default/files/QualityImprovementMadeSimple.pdf RCGP Quality Improvement Webcast with Dr Joanna Bircher Aug 2019: https://youtu.be/BJSbvu3j0cE The Q Community Webcast: ‘Can QI help us to match capacity and demand in General Practice with Dr Joanna Bircher’: https://www.youtube.com/watch?v=RS-GMMZgbfw Run Chart Tool: https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/A-guide-to-creating-and-interpreting-run-and-control-charts.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This is another episode in the series looking at all of the different roles that exist within primary care. Lisa and Sara speak to Heidi West who is a nursing associate as well as an apprenticeship facilitator for nursing associates, and Marina Khan who is a trainee nursing associate. They discuss what a nursing associate is and how they differ from health care assistants and nurses. They also cover what the training consists of, and the day job and remit of a nursing associate. The discussion ends with some quick fire questions around supervision, opportunities for further professional development and registration requirements. Useful resources: Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester Training Hub: https://www.gmthub.co.uk University of Salford Nursing Associate Programme: https://www.salford.ac.uk/courses/degree-apprenticeship/nursing-associate-nursing-associate-higher-apprenticeship A Roadmap to Practice: https://www.hee.nhs.uk/sites/default/files/documents/A%20Roadmap%20to%20Practice.pdf Nursing and Midwifery Council: Nursing Associates Information: https://www.nmc.org.uk/about-us/our-role/who-we-regulate/nursing-associates/ Information on Career Development for Nursing Associates: https://www.healthcareers.nhs.uk/explore-roles/nursing/roles-nursing/nursing-associate ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Joining doctors Lisa and Sara on today’s episode are GP and Perinatal Mental Health Champion Dr Carrie Ladd and Perinatal Psychiatrist Dr Sarah Jones. We discuss types of mental illness that can be experienced in the perinatal period and the challenges in primary care when helping patients and families. We cover tips for addressing these challenges, focusing on communication, resources and managing medications. We also talk about the impact of the pandemic and the Spotlight programme for disseminating perinatal mental health teaching and training trainers. Useful resources: RCGP Perinatal Mental Health toolkit: https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/perinatal-mental-health-toolkit.aspx Best Use of Medicines in Pregnancy ‘Bumps’ website: https://www.medicinesinpregnancy.org/ The Lancet Series on Perinatal Mental Health (2014): https://www.thelancet.com/series/perinatal-mental-health NICE Guidance on antenatal and postnatal mental health: clinical management and service guidance: https://www.nice.org.uk/guidance/cg192 Proud 2 b Parents Organisation: https://www.proud2bparents.co.uk/ Dad Matters Organisation: https://dadmatters.org.uk/ The Dad Pad, advice for new fathers: https://thedadpad.co.uk/ First 1001 days movement: https://parentinfantfoundation.org.uk/1001-days/ Action on Postpartum Psychosis Charity: https://www.app-network.org/ Maternal Mental Health Alliance Charity: https://maternalmentalhealthalliance.org/ Tommy's Trust: https://www.tommys.org/ Maternal OCD Organisation: https://maternalocd.org/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Drs Lisa and Sara are joined by GP Dr Nikesh Vallabh, Consultant Cardiologist Dr Karthikeyan and Consultant Gastroenterologist Dr Bliss to discuss advice and guidance. For those unfamiliar, the advice and guidance system came about to try to ease pressure on the long outpatient waiting lists, providing a different way of managing some cases. It is in place for a number of specialties for primary care clinicians to ask questions to consultants, getting an answer that will help guide patient care within a matter of short weeks at most. We talk about the system and where it can fit in to make a difference to patient care. We take the opportunity to go through some common themes and glean learning points from these to help our own practice. Useful resources: Wigan, Wrightington and Leigh have their own LFTs guideline that should be available on the intranet or contact the local CCG BMJ LFTs Algorithm 2017: https://www.bsg.org.uk/wp-content/uploads/2019/12/Guidelines-on-the-management-of-abnormal-liver-blood-tests.pdf Greater Manchester Guidelines for managing patients with dyspepsia in primary care: https://gpexcellencegm.org.uk/resources/guidelines-for-managing-patients-with-dyspepsia-in-primary-care/#.YFEP4C2l23U NICE guidelines Chronic Heart Failure in Adults: Diagnosis and Management (2018) https://www.nice.org.uk/guidance/ng106 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Drs Lisa and Sara welcome Dr Joanna Bircher back to the podcast to speak about an area which she is very passionate about - Quality Improvement. We talk about what quality improvement is, how it differs from audits and why it’s so important within general practice. We also learn about the processes that can be followed when approaching quality improvement, and some helpful tools and tips to think about before you start. We hope it’s accessible for all within general practice, and think it provides a great starting point for those considering quality improvement within their setting. Useful resources: Quality Improvement Resources by the Royal College of General Practitioners: https://www.rcgp.org.uk/clinical-and-research/our-programmes/quality-improvement/quality-improvement-guide-for-general-practice.aspx RCGP QI Ready: https://qiready.rcgp.org.uk/ Domains of Healthcare Quality: http://www.ihi.org/education/IHIOpenSchool/resources/Pages/Activities/DefiningQualityAimingforaBetterHealthCareSystem.aspx Public Health England National General Practice Profiles: https://fingertips.phe.org.uk/profile/general-practice/data#page/8/gid/2000005/pat/166/par/E38000220/ati/7/are/M85736/yrr/1/cid/4/tbm/1 GP Patient Survey data: https://www.gp-patient.co.uk/ Prescribing data: https://openprescribing.net/ Institute for Healthcare Improvement (IHI) Model for Improvement: http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx The Health Foundation booklet: Quality Improvement made simple, written by Bryan Jones, Esther Kwong and Will Warburton: https://www.health.org.uk/sites/default/files/QualityImprovementMadeSimple.pdf RCGP Quality Improvement Webcast with Dr Joanna Bircher Aug 2019: https://youtu.be/BJSbvu3j0cE The Q Community Webcast: ‘Can QI help us to match capacity and demand in General Practice with Dr Joanna Bircher’: https://www.youtube.com/watch?v=RS-GMMZgbfw Run Chart Tool: https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/A-guide-to-creating-and-interpreting-run-and-control-charts.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Drs Lisa and Sara talk to Dr Luke Wookey, Dr Joanna Bircher and Ava Bircher for an introduction to Trans and Non-Binary Health in General Practice. We start with all important definitions, which leads us to talking about coding, healthcare records and a discussion about screening and health inequalities. We talk about how our practices and consultations can be welcoming, before considering Hormone Replacement Therapy and NHS funded surgical options which are potential options for people accessing Gender Clinics. We move onto health issues that disproportionately affect Trans and Non-Binary people, and discuss important resources for clinicians and patients. A lot more could be said but we hope you will find this a useful resource for the whole Primary Care Team to access. Useful resources: LGBT Foundation including links to Pride in Practice: https://lgbt.foundation/ GMC ethical guidelines: Your rights as lesbian, gay, bi and trans patients: https://www.gmc-uk.org/Ethical-guidance/Patient-guides-and-materials/LGBT-patient-guide?utm_source=press&utm_medium=press%20release&utm_campaign=LGBT Royal College of General Practitioners Transgender Care: https://www.rcgp.org.uk/policy/rcgp-policy-areas/transgender-care.aspx TransActual UK: Supporting trans patients: A brief guide for GP surgery staff (excellent resource and links): https://www.transactual.org.uk/gp-surgery-trans Information for trans and non-binary patients seeking fertility treatment: https://www.hfea.gov.uk/treatments/fertility-preservation/information-for-trans-and-non-binary-people-seeking-fertility-treatment/ Changing Name Greater Manchester LMC Guidance: https://manchesterlmc.co.uk/wp-content/uploads/2016/06/LGBT-Foundation-changing-a-trans-persons-name.pdf Changing Name and Gender, Primary Care Support England Flow Diagram: https://pcse.england.nhs.uk/media/1291/process-for-registering-a-patient-gender-re-assignment.pdf Greater Manchester Indigo Gender Service: https://indigogenderservice.uk/ Gender Identity Research and Education Society (includes eLearning packages): https://www.gires.org.uk/ The World Professional Association of Transgender Health: https://www.wpath.org/ The Royal College of General Practitioners Gender Variance eLearning module: https://elearning.rcgp.org.uk/course/search.php?search=transgender Mutual Aid Resource for trans and non binary people in Greater Manchester: https://www.consortium.lgbt/member-directory/trans-mutual-aid-manchester/ Information about Hate Crimes, reporting them and third party Hate Crime centres: https://www.report-it.org.uk/home ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara speak to Sam Howard, who is an advanced clinical practitioner in primary care. She talks us through her career journey to date and what her job looks like now, as well as highlighting the varied role of an advanced clinical practitioner. She also explains details about supervision, registration and training requirements. This episode was supported by Greater Manchester Training Hub. Useful resources: Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester Training Hub: https://www.gmthub.co.uk A Roadmap to Practice: https://www.hee.nhs.uk/sites/default/files/documents/A%20Roadmap%20to%20Practice.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This episode is another of our lovely chats with wider members of the primary care team. Today Lisa and Sara speak to Vishika Rabadia, a senior pharmacist who is working in primary care in a PCN and CCG pharmacist role. She gives insights into the varied roles of a pharmacist within primary care, the training, and what the supervision and registration side entails. She also provides great examples of some of the work that she has been involved with in her PCN. This episode was supported by Greater Manchester Training Hub. Useful resources: The National Pharmacy Association (NPA): https://www.npa.co.uk/ Primary Care Pharmacy Education Pathway: https://www.cppe.ac.uk/career/pcpep/pcpep-training-pathway General Pharmaceutical Council: https://www.pharmacyregulation.org/ Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester Training Hub: https://www.gmthub.co.uk Community Pharmacist Consultation Service (CPCS): https://www.england.nhs.uk/primary-care/pharmacy/community-pharmacist-consultation-service/ Royal Pharmaceutical Society: https://www.rpharms.com/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence, Greater Manchester Training Hub and the GP Fellowship Programme, as well as Wigan Borough CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Working in General Practice can be challenging at the best of times, but needless to say has been more challenging of late. Lisa and Sara are joined by Dr Rachel Morris; GP, coach and host of You are not a Frog Podcast. She talks us through her top tips for looking after yourself in general practice. These include: the importance of framing this discussion with the caveat of not teaching ourselves how to put up with toxic work environments, but to consider how we can take control over things that we do have some control over. We discuss the importance of prioritising, planning your week, doing your best work at the best time and consider the importance of ‘catching the story that you’re telling yourself’. We then consider coping with the negativity in the media about general practice at the moment, assertiveness and the difference between stress and burnout. This episode was supported by Greater Manchester Training Hub NHSE GP Fellowship programme. Useful resources: Greater Manchester Training Hub NHSE GP Fellowship information: https://www.gmthub.co.uk/offers/gp-fellowship Dr Rachel Morris’s Podcast and Wellbeing/Resilience resources: https://youarenotafrog.com/ NHS Practitioner Help: https://www.practitionerhealth.nhs.uk/ Book recommendation: ‘Essentialism: The Disciplined Pursuit of Less’ by Greg McKeown https://uk.bookshop.org/books/essentialism-the-disciplined-pursuit-of-less/9780753558690 Book Recommendation: ‘The 7 Habits of Highly Effective People’ By Stephen Covey https://uk.bookshop.org/books/the-7-habits-of-highly-effective-people/9780762408337 Permission to Thrive monthly Webinars for doctors: https://www.shapestoolkit.com/permission-to-thrive Resilient Team Academy - membership for leaders in Healthcare to help team to beat burnout and work happier: https://www.shapestoolkit.com/resilient-team-academy-2021 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of Greater Manchester training hub, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Back by popular demand, Consultant Neurologist Dr Matt Jones joins us to share his approach to assessing patients with peripheral paraesthesia. Patients don’t present with textbook terms. Dr Matt Jones takes us through how to de-code tingling, numbness and burning, and take a structured approach to these often difficult presentations. We cover the high value examination findings that could help us clinch the diagnosis and put his approach to the test with some theoretical cases. Useful resources: A resource for clinicians and patients around Functional Neurological Disorder: https://www.neurosymptoms.org/en_GB/ An example of a link to buy a 128 Hertz Tuning fork: https://www.amazon.co.uk/Gardiner-Brown-128Hz-Vibration-Tuning/dp/B005GZ1RG0/ref=dp_prsubs_2?pd_rd_i=B005GZ1RG0&psc=1 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara are joined again by the lovely Dr Rachel Hilton, who is a speciality doctor in Dermatology. In this episode she takes us through psoriasis - what it is, differentials to consider and associated triggers and comorbidities. She then systematically talks about the management of psoriasis, how this might need to be amended for pregnant patients, and her thoughts about referral indications. Useful resources: British Association of Dermatologists: https://www.bad.org.uk/ Primary Care Dermatology Society: www.pcds.org.uk Derm Net NZ: www.dermnetnz.org Psoriasis Association: www.psoriasis-association.org.uk Psoriasis and Psoriatic Arthritis Alliance, PAPAA: www.papaa.org IMPACT study information: https://www.researchgate.net/publication/288833029_The_IMPACT_Programme_in_Psoriasis_Phase_I_-_where_we_are_now_and_future_directions ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://pckb.org/feedback ____ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Speciality Doctor Rachel Hilton joins us on the podcast to talk about eczema. You’ll hear from the episode that she is passionate about getting the basics right as a way of providing vastly better care to our patients. In the episode we cover: what eczema is, types of eczema and some important differentials, before focusing on the management of atopic eczema. This includes navigating emollients, steroids and calcineurin inhibitors with advice on how to use these effectively. Useful resources: Primary Care Dermatology Society: www.pcds.org.uk DermNet New Zealand: www.dermnetnz.org GMMMG Emollient Guidelines: www.gmmmg.nhs.uk/docs/guidance/GM-Emollient-Ladder.pdf GMMMG Steroid Ladder: www.gmmmg.nhs.uk/docs/guidance/GM-Steroid-Ladder.pdf BATHE Study: https://www.rcgp.org.uk/clinical-and-research/about/clinical-news/2019/november/rcgp-research-paper-of-the-year-2018-the-bathe-study.aspx BATHE study BMJ resources: https://www.bmj.com/content/361/bmj.k1332 Recommended resource for patients or parents: National Eczema Society: www.eczema.org ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Originally recorded in January 2020 and released in August 2020... Early diagnosis of cancer is a huge priority in order to try to improve our cancer survival rates in the UK. Lisa and Sara took the opportunity to speak to Dr Sarah Taylor, GP in Fallowfield and Cancer Research UK Cancer Diagnosis Lead for Greater Manchester about this important subject. It was recorded pre-Covid-19 and so some of the information given about services might have changed in your local area. We thought the general tips about picking up cancer as early as possible were incredibly useful however which is why we decided to release the episode. We cover why early diagnosis of cancer is a priority for the UK, learning points/common themes picked up from significant events in delayed cancer diagnosis, tools that we can use in primary care to help our pick up rate and useful resources for primary care. Useful resources: Gateway C: https://www.gatewayc.org.uk/ Cancer Research UK Health Professional Section: https://www.cancerresearchuk.org/health-professional Macmillan Health Professional Resources: https://www.macmillan.org.uk/about-us/health-professionals/resources QCancer Score: https://www.qcancer.org/ Cancer Research UK Facilitator Programme: https://www.cancerresearchuk.org/health-professional/learning-and-support/about-our-partnerships/what-is-the-facilitator-programme NICE Suspected cancer - recognition and referral: https://www.nice.org.uk/guidance/ng12 BJGP - Improving early diagnosis of cancer in UK general practice: https://bjgp.org/content/67/659/276 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YLN6GKT ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Lisa and Sara talk to GP and Professor of General Practice Research Carolyn Chew Graham about Long COVID. We discuss what Long COVID is, its prevalence, and how to assess and manage those presenting with symptoms of possible Long COVID in primary care. We also talk about the condition in children, Long COVID clinics, and how to support patients on this still very new journey. Hopefully this episode will help support learning for the new Long-COVID enhanced service that has recently been launched by NHS England. ___ NICE COVID-19 rapid guideline: managing the long-term effects of COVID-19 [NG188] Published: 18 December 2020: https://www.nice.org.uk/guidance/ng188 The Post-hospitalisation COVID-19 study (PHOSP-COVID): https://www.phosp.org/ British Thoracic Society Resources for the respiratory Community about COVID-19 (includes advice on chest x-rays and COVID): https://www.brit-thoracic.org.uk/covid-19/covid-19-information-for-the-respiratory-community/ Your COVID recovery resource: https://www.yourcovidrecovery.nhs.uk/app/ Long COVID SOS support group for patients: https://www.blf.org.uk/support-for-you/long-covid UK Doctors with Long COVID Facebook Group: https://www.facebook.com/groups/479687042869493/ BJGP Open Article: Finding the 'right' GP: a qualitative study of the experiences of people with long-COVID 2020: 4(5) Kingstone T, Taylor AK, O'Donnell CA, Atherton H, Blane DN and Chew-Graham CA: https://bjgpopen.org/content/4/5/bjgpopen20X101143 Health Expectations Article: 'Reluctant pioneer': A qualitative study of doctors' experiences as patients with long COVID (Mar 2021) Taylor AK, Kingstone T, Briggs TA, O'Donnell CA, Atherton H, Blane DN, Chew-Graham CA: https://onlinelibrary.wiley.com/doi/10.1111/hex.13223 The Royal College of General Practitioners online learning module on Long COVID: https://elearning.rcgp.org.uk/course/view.php?id=492 Article, The Conversation: Aiyegbus OL, Haroon S, (July 2021) Long COVID: symptoms experienced during infection may predict lasting illness: https://theconversation.com/long-covid-symptoms-experienced-during-infection-may-predict-lasting-illness-164649?utm_source=twitter&utm_medium=bylinetwitterbutton ___ We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

This episode is another of our lovely chats with wider members of the primary care team. Today Lisa and Sara speak to Laura Butroid, a pharmacy technician who is working in primary care. She gives insights into the varied roles of a pharmacy technician within primary care, and how this differs from a pharmacist. She also discusses what the training looks like and what the supervision and registration side entails. ___ The National Pharmacy Association (NPA): https://www.npa.co.uk/ Buttercups Integrated Level 3 Cross Sector Programme: https://www.buttercupstraining.co.uk/news/buttercups-launches-new-level-3-pharmacy-technician-integrated-programme Primary Care Pharmacy Education Pathway: https://www.cppe.ac.uk/career/pcpep/pcpep-training-pathway General Pharmaceutical Council: https://www.pharmacyregulation.org/ Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester Training Hub: https://www.gmthub.co.uk HEE Medicines optimisation: https://hee.nhs.uk/our-work/medicines-optimisation ___ We welcome any feedback you might have, our survey takes 1-2 minutes: pckb.org/feedback or contact us on Twitter @PCKBpodcast ___ This podcast has been made with the support of Greater Manchester Health and Social Care Partnership, GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.