Primary Care Knowledge Boost

Lisa and Sara are joined by Dr Amar Rughani and Dr Joanna Bircher to discuss team working in the context of leadership. We focus on specific examples of some potential conflicts within the primary care team such as when members of a team do not get on and how to manage interruptions of a surgery. ___ Amar Rughani and Joanna Bircher (2020): The Leadership Hike, Shaping Primary Care Together, First Edition, CRC Press: https://www.routledge.com/The-Leadership-Hike-Shaping-Primary-Care-Together/Rughani-Bircher/p/book/9780367236984 Hersey, P & Blanchard KH (2002). Management of Organizational Behaviour: Utilising Human Resources. Classiquese Hachette. https://www.goodreads.com/book/show/349881.Management_of_Organizational_Behavior Tuckman, B (1965). Team Building Theory, paraphrased here: https://www.teambuilding.co.uk/theory/Forming-Storming-Norming-Performing.html West, M A (2012). Effective Teamwork: Practical Lessons from Organizational Research. John Wiley & Sons and the British Psychological Society. https://www.wiley.com/en-gb/Effective+Teamwork%3A+Practical+Lessons+from+Organizational+Research%2C+3rd+Edition-p-9780470974988 Podcast: The Happiness Lab with Dr Laurie Santos https://www.happinesslab.fm/ ___ 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.

Lisa and Sara talk to practice managers Amanda Ormesher and Karen Bradshaw about the role of the practice manager in general practice. This is a great episode to find out more about the role and how varied it is. We go through what a practice manager is, the different remits of practice managers and some learning points about the role for new staff coming into primary care. Their passion and dedication are uplifting to hear. ___ Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester GP Excellence Resources: https://gpexcellencegm.org.uk/ Greater Manchester Training Hub: https://www.gmthub.co.uk ___ 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.

Lisa and Sara talk to Occupational Therapist and Advanced Clinical Practitioner Payal Wilson about the role of occupational therapists in primary care. She talks about how to become an occupational therapist, the training involved, and how occupational therapists might work in primary care (their remit and the roles they could take on). She also discusses her current career, the advantages of occupational therapists in advanced clinical practitioner roles, and considerations (including supervision) for occupational therapists when working in primary care as part of the additional roles reimbursement scheme (ARRS). ___ Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester GP Excellence Resources: https://gpexcellencegm.org.uk/ Greater Manchester Training Hub: https://www.gmthub.co.uk ___ 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.

Lisa and Sara talk to Geriatrician Dr Emma Vardy & GP Dr Helen Martin all about Delirium. If we pick delirium up early and treat the right cause it can make a world of difference to patients and families. They share some great tips on how to diagnose and remember the list of causes. We also discuss the Greater Manchester delirium toolkit which was developed for use in the community to act as a framework for assessment and management of delirium. ___ Greater Manchester Community Delirium Toolkit: https://dementia-united.org.uk/delirium-community-toolkit/ Dementia United (Greater Manchester based): https://dementia-united.org.uk/ Delirium NICE Clinical Knowledge Summaries: https://cks.nice.org.uk/topics/delirium/#!goals Scottish SIGN Guidelines, SIGN 157, Risk reduction and management of delirium: https://www.sign.ac.uk/media/1423/sign157.pdf ___ 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

In this episode Lisa and Sara discuss the topic of Primary Care Networks with Vicky Tolliday (Nurse, Director of the social enterprise “Better Health Manchester”, and Clinical Director of a Primary Care Network), and Dr Girish Patel (GP and Clinical Director of a Primary Care Network). They explain some of the basics about Primary Care Networks; what they are, their structure, leadership and their purpose. They also cover some aspects of funding including Directed Enhanced Services (DES), discuss how they both became clinical directors and what this role entails, as well as talking about some opportunities to get involved with Primary Care Networks. They finish by explaining what they see to be the pros and cons of Primary Care Networks. ___ Primary care networks explained, The King's Fund: https://www.kingsfund.org.uk/publications/primary-care-networks-explained?gclid=Cj0KCQjw9_mDBhCGARIsAN3PaFPmi-6hCpND-rBQKNAXuwpng0bFOYVs_BjlShvFWvhfltUoR-PICjAaApQLEALw_wcB Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ If you would like more information about the Additional Roles Reimbursement Scheme (ARRS), then check out some of our other episodes where we interview a representative from each of the new roles that can be employed by Primary Care Networks. ___ 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.

By popular demand we are delighted to share this talk about managing peri-menopausal symptoms in general practice! Dr Jacquelyn Gatenby joins us to discuss her approach; starting with common symptoms, alternatives to HRT, who she feels we should be offering HRT to, and the pros and cons of HRT. We talk about the contraindications, her process for deciding which type of HRT to give, and where testosterone and contraception fit in. ___ Discussion of the history of studies around the safety of hormone replacement therapy: https://www.womens-health-concern.org/help-and-advice/factsheets/hrt-the-history/ The British Menopause Society: https://thebms.org.uk/ The British Menopause Society Breast Cancer Risks factsheet, Nov 2020 (includes the 2019 Collaborative Group for Hormonal Risk Factors and 2020 long term follow-up of the placebo-controlled, randomised Women’s Health Initiative studies): https://thebms.org.uk/wp-content/uploads/2020/11/12-BMS-TfC-Fast-Facts-HRT-and-Breast-Cancer-Risk-01C.pdf My Menopause Doctor, resource by Dr Louise Newson (includes link to download the Balance app): https://www.menopausedoctor.co.uk/ NICE Guidelines: Menopause Diagnosis and Management: https://www.nice.org.uk/guidance/ng23 FSRH Clinical Guidelines: Contraception for Women Aged over 40 Years (Aug 2017, amended Sept 2019): https://www.fsrh.org/documents/fsrh-guidance-contraception-for-women-aged-over-40-years-2017/ ___ 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.

Dr Amar Rughani returns to the podcast today to share some great leadership and life skills. We spoke to him in a previous episode about the big picture of leadership skills and why they matter. In this episode we take a dive into the specifics around getting to know ourselves and how this can be useful both in leadership as well as our everyday lives. We discuss that what drives and inspires us will energise us, and why being our authentic selves can make for better leaders. He talks us through how playing to your strengths is the way forward in leadership, but that we need to know our limits and work with other types of key players to help achieve our goals. ___ Book: Amar Rughani and Joanna Bircher (2020): The Leadership Hike, Shaping Primary Care Together, First Edition, CRC Press: https://www.routledge.com/The-Leadership-Hike-Shaping-Primary-Care-Together/Rughani-Bircher/p/book/9780367236984 Book: Stephen R. Covey: The 7 habits of highly effective people: https://www.goodreads.com/book/show/36072.The_7_Habits_of_Highly_Effective_People Maslow’s Hierarchy of Needs: https://www.simplypsychology.org/maslow.html#gsc.tab=0 William Glasser’s Model of Need: https://wglasser.com/quickstart-guide-to-choice-theory/#basic-needs Primary colours of leadership: edgecumbe.co.uk/the-primary-colours-model/ ___ 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.

We are joined by Paediatric Consultant Dr Christos Zipitis to discuss a great overview of infant feeding issues. It was fabulous to go over definitions, presentations and management of colic, gastro oesophageal reflux and reflux disease, lactose intolerance and cow's milk protein allergy. We later touch on the resource ICON designed to help parents cope with crying babies. Thoroughly worthwhile learning for all the general practice team. ___ The GP Infant Feeding Network (UK): https://gpifn.org.uk/infant-feeding/ Milk Allergy in Primary Care (MAP) Guideline 2019: https://gpifn.org.uk/imap/ GP Online, Feeding Problems in infants (2015): https://www.gponline.com/feeding-problems-infants/paediatrics/paediatrics/article/1377305 Medicines for Children Leaflets: https://www.medicinesforchildren.org.uk NICE guidelines Food allergy in the under 19s: https://www.nice.org.uk/guidance/cg116 NICE Guidelines Gastro-oesophageal Reflux in children and young people, diagnosis and management: https://www.nice.org.uk/guidance/ng1/chapter/introduction Thickeners and bowel obstruction discussion reference: Parmar RS et al. Bezoar and bowel obstruction associated with the use of anti-gatro-oesophageal reflux medication in neonates. Infant. 2015; 11(3): 94-5. https://www.infantjournal.co.uk/pdf/inf_063_str.pdf Discussion on potential side effects of Proton Pump Inhibitors for babies: Cochrane review (2014): Pharmacological treatment of children with gastro‐oesophageal reflux (see PPI section re possible increased risk of respiratory infections) https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008550.pub2/full?highlightAbstract=inhibitors%7Cside%7Ceffects%7Cinhibitor%7Ceffect%7Cpump%7Cproton Long-term PPI use and association with gastric cancer: Ka Shing Cheung and Wei K Leung. Long-term use of PPIs and risk of gastric cancer: a review of the current evidence. Therapeutic Advances in Gastroenterology. 2019; 12: 1-11 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415482/ ICON: Resource for parents about how to cope with crying babies: https://iconcope.org/ ___ 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.

In this episode, we speak to safeguarding nurse lead Sarah Khalil, and adult safeguarding GP lead Dr Rebecca Marchmont about managing self-neglect in adult patients. We discuss the difference between neglect and self neglect, the importance of recognising both, the fundamentals of capacity, where other teams can fit in, and practical tips to help manage these patients. We hope you find the discussion as useful as we did. ___ Greater Manchester the Self-Neglect Assessment & Management flowchart: https://healthiermanchester.org/wp-content/uploads/2021/03/Self-Neglect-Assessment-and-Management-flow-chart.docx Self Neglect At a Glance Resource by Social Care Institute for Excellence: https://www.scie.org.uk/self-neglect/at-a-glance?gclid=CjwKCAjwu5CDBhB9EiwA0w6sLakH04adirdSw2566BTc4C2Wqv2AXpdTI84zMB117p8dgOJhBjVA9RoCADYQAvD_BwE ___ 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.

Lisa and Sara talk to senior physiotherapists Judith Dawson and Joanne Roberts about how they became involved in physiotherapy in primary care and the roles of physiotherapists in this setting, including First Contact Practitioners. Having been part of enhancing primary care access to physiotherapy throughout the years, it’s great to get their perspectives on the role now and what it might look like in the future. We take the opportunity to get their top tips for managing knee osteoarthritis and low risk back pain. ___ Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester GP Excellence Resources: https://gpexcellencegm.org.uk/ Greater Manchester Training Hub: https://www.gmthub.co.uk StartBack tool for low risk back pain: https://startback.hfac.keele.ac.uk/ North of England back pain pathway evaluation: https://www.necsu.nhs.uk/wp-content/uploads/2019/02/2018-05-NorthEnglandRegionalBackPainAndRadicularPainPathway.pdf Knee Osteoarthritis Guidelines (Dec 2020): https://www.guidelines.co.uk/musculoskeletal-and-joints-/nice-osteoarthritis-guideline/247991.article ___ 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.

The COVID pandemic caused an upheaval to the endoscopy services for suspected upper and lower gastrointestinal malignancies. To talk us through the changes in how referrals are managed and what that means for us in general practice and our patients, we’re joined by GPwSI in Gastroenterology Dr Sophie Nelson and Consultant Gastroenterologist Dr Alistair Makin. Our discussion includes using FIT tests to risk stratify patients with suspected lower GI malignancies, the use of the Edinburgh Dysphagia Scale for suspected upper GI malignancies, a reminder of 2 week wait criteria, and little on iron deficiency anaemia and Helicobacter Pylori. ___ Greater Manchester Gastroenterology Webinar 24th Sept 2020. Speakers: Dr Sophie Nelson, Dr Varinda Athwal (LFTs), Dr Sarah Taylor (FIT testing), Dr Alistair Makin (GI cancers), and Dr May Aldean (advice and guidance) The link includes links to endoscopy pathways. https://gpexcellencegm.org.uk/resources/gm-gastroenterology-gp-education-webinar/#.YEYVCWj7SUk 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 Gastrointestinal tract (lower) cancers - recognition and referral (Feb 2021): https://cks.nice.org.uk/topics/gastrointestinal-tract-lower-cancers-recognition-referral/ NICE Gastrointestinal tract (upper) cancers - recognition and referral (Feb 2021): https://cks.nice.org.uk/topics/gastrointestinal-tract-upper-cancers-recognition-referral/ Gateway C (an online cancer education platform for primary care): https://www.gatewayc.org.uk/ Greater Manchester Upper and Lower GI Cancer guidelines are available on TeamNet for Manchester clinicians North West Iron Deficiency Anaemia Guidelines and Coeliac Guidelines: Not yet published but watch out for these soon! ___ 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.

The next in our series talking about additional roles in primary care is all about paramedics in general practice. Lisa and Sara speak to Scott Murray, who has been working as a paramedic within primary care for some time now, having transitioned through acute care and urgent care. He talks us through his journey, why he chose to move to primary care and some tips for both paramedics and the general practice team about how to make that transition. ___ Health Education England: Paramedics in Primary Care: (Resource link for paramedics interested in General Practice and for General Practitioners and Practice Managers interested in taking on paramedics): https://www.hee.nhs.uk/our-work/primary-care/first-contact-practitioners-advanced-practitioners-paramedics Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Greater Manchester GP Excellence Resources: https://gpexcellencegm.org.uk/ Greater Manchester Training Hub: https://www.gmthub.co.uk ___ 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.

Lisa and Sara are joined by Dr Amar Rughani to discuss his approach to leadership. We talk about the importance of considering our influence, place in the world and how to achieve our goals. We consider our motivations for doing what we are doing in life; the importance of taking that step back to really consider why, how and what we are doing in the world and in general practice. From this we can then consider what we want the future to look like. Future episodes will then focus on how to get there. To get in touch with Amar: [email protected] ___ Book: Amar Rughani and Joanna Bircher (2020) The Leadership Hike, Shaping Primary Care Together, First Edition, CRC Press: https://www.routledge.com/The-Leadership-Hike-Shaping-Primary-Care-Together/Rughani-Bircher/p/book/9780367236984 Book: Erich Fromm (2003) Man for Himself First Edition Routledge Classics: https://www.bookdepository.com/Man-for-Himself-Erich-Fromm/9780805014037?ref=grid-view&qid=1612957185376&sr=1-2 Book: Roger Neighbour (2015) The Inner Consultation: How to Develop an Effective and Intuitive Consulting Style, Second Edition, CRC Press: https://blackwells.co.uk/bookshop/product/9781857756791?gC=5a105e8b&gclid=Cj0KCQiApY6BBhCsARIsAOI_GjZXqwnpj-8-NEg_nzo5sFRFej67mV70jhmMP5BQ9Ot-il7VJsyypp8aAuQOEALw_wcB ___ 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.

As part of their mini-series in Primary Care New Roles, Lisa and Sara spoke with Physician Associate Ricky Staniland to get an idea of how he became a Physician Associate in General Practice and what his role includes at present. Definite learning points were just how varied and useful Physician associates can be in practice. As part of her role as clinical director of Primary Care Workforce and Greater Manchester Training Hub, Dr Ali Lea joins the discussion. ___ Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Health Education England: Physician Associates in Primary Care: (Resource link for Physician Associates interesting in General Practice and for General Practitioners and Practice Managers interested in taking on Physician Associates): https://www.hee.nhs.uk/our-work/primary-care/physician-associates-primary-care North West Physician Associate Training Programmes: https://www.nwpgmd.nhs.uk/physician_associate Greater Manchester GP Excellence Resources: https://gpexcellencegm.org.uk/ Greater Manchester Training Hub: https://www.gmthub.co.uk ___ 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.

To teach us more about the New Roles in primary care, as well as the development of existing roles in general practice, Dr Ali Lea and Primary and Community Nurse Lead Lesley Royal-Price join us. The plans for Primary Care Work Transformation are described as ‘making sure we have the right team to deliver the best care looking after people the right way for them’. A great tagline that about sums it up. ___ Greater Manchester Primary Care Careers: https://gmprimarycarecareers.org.uk/jobs/ Nursing Leadership and Development Programme: https://www.rcn.org.uk/professional-development/professional-services/leadership-programmes Greater Manchester Primary Care Nurse Forum (including quarterly Webinars): https://gmprimarycarecareers.org.uk/gm-primary-care-and-community-nursing-forum-13-10-2020/ Leadership and Development Programme for Practice Nurses and other Primary Care Roles: https://gmprimarycarecareers.org.uk/generalpractice/careers/nursing/care-programme/ Greater Manchester GP Excellence Resources: https://gpexcellencegm.org.uk/ Greater Manchester Training Hub: https://www.gmthub.co.uk ___ 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.

Lisa and Sara talk to Dr Adam Abbs about remote consulting. Dr Abbs is a GP who has written a handbook about remote consulting which has been accredited by the RCGP. Remote consulting has been in our lives for quite some time now, and this doesn’t look likely to change anytime soon so we thought it was worth getting some more hints and tips to make us all the best remote consulters that we can be. We talk about common pitfalls, how to do some examinations remotely and a couple of special situations such as care homes and patients with visual or hearing impairments. **This is an amended episode from the one originally uploaded this morning as we realised that an older edit had been uploaded in error. Primary Care Pathways Website, Remote Consulting: https://primarycarepathways.co.uk/covid-19/clinical-assessment/resources-to-support-remote-working-for-doctors EGP Learning: https://egplearning.co.uk/ Remote Consultations Handbook: https://www.archealth.io/handbook GMC Remote Consultations: https://www.gmc-uk.org/ethical-guidance/ethical-hub/remote-consultations Healthier Together Website: https://what0-18.nhs.uk/professionals/gp-primary-care-staff/clinical-pathways-remote-assessment ___ 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 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.

Lisa and Sara are joined by Dr Uma Marthi (GP with a Special Interest in Gynaecology) to discuss some common gynaecological presentations in young girls up to teenage years. She takes us through her approach to vaginal bleeding in neonates, vaginal itch in toddlers, breast development and vaginal discharge in teenagers. The British Society for Paediatric and Adolescent Gynaecology (great patient leaflets): https://britspag.org/ Royal College of Obstetrics and Gynaecology guidelines: https://www.rcog.org.uk/en/guidelines-research-services/ NHS Resources example, Vaginal Discharge: https://www.nhs.uk/conditions/vaginal-discharge/ Primary Care Women’s Health Forum: https://pcwhf.co.uk/ eLearning for Health, Female Genital Mutilation Module: https://www.e-lfh.org.uk/programmes/female-genital-mutilation/ ___ 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 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.

Primary Care Knowledge Boost has teamed up with the Greater Manchester GP and GP Nurse Fellowship schemes as well as the Additional roles in General Practice scheme to incorporate episodes related to these topics into our schedule. Here to explain what fellowships are is GP and GM training hub Clinical Lead Dr Gill Tonge. It was really interesting to hear the thinking behind the fellowships and hear the aims of supporting doctors and nurses after the first year of qualifying. The content is free and relevant to all in primary care and will include episodes on remote working, practice management skills, leadership and quality improvement. Greater Manchester Training Hub (Application for Fellowships): https://www.gmthub.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://www.surveymonkey.co.uk/r/YLN6GKT ___ 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.

In this episode, Lisa and Sara speak to consultant neurologist, Dr Matt Jones about headaches. The discussion has a focus on the diagnosis and categorisation of common headaches with a touch of management at the end. We talk through where Dr Jones starts when taking a headache history and how he categorises them. We also discuss features that would be concerning to him, as well as thinking about who he would admit on the day. We then go through examination in the light of COVID-19 and helpful tips about headache management. North West Headache Management Guideline (2015): http://gmmmg.nhs.uk/docs/guidance/Headache-guidelines-algorithm-temporary-version-30-04-19.pdf The Migraine Trust: https://www.migrainetrust.org/ Headaches in over 12s: diagnosis and management (Nov 2015): https://www.nice.org.uk/guidance/cg150 National Migraine Centre: Heads Up Podcast all about Migraine: https://www.nationalmigrainecentre.org.uk/migraine-and-headaches/heads-up-podcast/ ___ 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 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.

Lisa and Sara are joined by GP and HIV lead for Greater Manchester Dr Marlon Morais and Yvonne Richards, an inspiring positive speaker from George House Trust to talk about HIV in Greater Manchester. We cover what it is, it’s prevalence and opportunities for testing. We then go on to speak about the importance of early diagnosis and effective treatment before hearing from Yvonne about her personal journey with HIV that led her to become a passionate advocate for women living with HIV. The resources are detailed below and we are grateful to Yvonne, Marlon, Victoria Morris and Paul Fairweather for helping to make this episode possible as well as helping to compile these. Latest Government Prevalence Data on HIV in the UK: https://www.gov.uk/guidance/hiv-overall-prevalence NICE HIV testing Guidelines: https://www.nice.org.uk/guidance/ng60/chapter/Recommendations#offering-and-recommending-hiv-testing-in-different-settings British HIV Association (BHIVA) HIV Testing Guidance: https://www.bhiva.org/HIV-testing-guidelines HIV Indicator Diseases, those in which an HIV test is recommended: http://www.eurotest.org/Portals/0/Indicator%20diseases/CHIP_Guidance%20in%20short_UK_updated%20JUN2016_mlj.pdf Manchester HIV Charity George House Trust: https://ght.org.uk/ Liverpool Interaction Checker for HIV Medications: https://www.hiv-druginteractions.org/checker iChart HIV Medication Interaction Checker for Phone: https://play.google.com/store/apps/details?id=com.liverpooluni.icharthiv&hl=en_GB Fingertips Public Health Profiles (can be used to find out the HIV prevalence in UK regions): https://fingertips.phe.org.uk/search/HIV UK Wide Charity Terrence Higgins Trust: https://www.tht.org.uk/ Terrence Higgins Trust on Facebook: https://www.facebook.com/6316017331/posts/10158506443587332/?sfnsn=scwspmo AIDS Maps (HIV and AIDS Charity): https://www.aidsmap.com/ Positively UK HIV Charity: https://positivelyuk.org/ Sophia Forum HIV Charity (focus on politics and women with HIV): https://sophiaforum.net/ National AIDS Trust: https://www.nat.org.uk/ CHIVA: Children’s HIV Association: https://www.chiva.org.uk/ HIV i-Base (HIV Charity focusing on HIV information and advocacy, pictorial approach to HIV): https://i-base.info/ HIV AIDS Foundation: https://www.eltonjohnaidsfoundation.org HIV: Let's sort this together: https://sorthiv.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://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.

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 podcast episode is all about Polycystic Ovarian Syndrome with Tameside Consultant Obstetrician & Gynaecologist Dr Mahshid Nickkho-Amiry. It’s a detailed look at the subject using an example case, following this from diagnosis to management. Useful resources: Royal College of Obstetricians and Gynaecologists - Patient Leaflet on Polycystic Ovarian Syndrome (2015): https://www.rcog.org.uk/en/patients/patient-leaflets/polycystic-ovary-syndrome-pcos-what-it-means-for-your-long-term-health/ Verity - Self Help Charity with excellent online resources for patients: https://www.verity-pcos.org.uk/ NICE - Clinical Knowledge Summaries: https://cks.nice.org.uk/topics/polycystic-ovary-syndrome/ RCOG - Green Top guidelines - Long terms consequences of PCOS (Nov 2014): https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_33.pdf International evidence-based guideline for the assessment and management of polycystic ovary syndrome (2018): https://pcwhf.co.uk/wp-content/uploads/2018/12/PCOS_Evidence-Based-Guidelines_20181009.pdf Guidelines - Diagnosis and Management of Polycystic Ovarian Syndrome (Jun 2020): https://www.guidelines.co.uk/womens-health/pcos-uk-guideline/236071.article ___ 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.

Managing the common palliative symptoms of nausea, vomiting and constipation can make a world of difference to the quality of life of our patients. This week, Lisa and Sara are joined again by Drs Liam Hosie and Anna Murray to continue their discussion about managing palliative patients in general practice. We cover important features in a history that point to the cause of symptoms for nausea/vomiting and constipation. The causes of nausea and vomiting are then broken down to four categories and we consider what medications might work best for these. We go on to discuss managing constipation and point to a helpful guide for further reference. Useful resources: Greater Manchester Medicines Management Group, Palliative Care Pain and Symptom Control for Adults (Fifth Edition, Nov 2019): http://gmmmg.nhs.uk/docs/guidance/GMMMG-Palliative-Care-Pain-and-Symptom-Control-Guidelines-for-Adults-v1-1.pdf#search=%22nausea%22 NICE Clinical Knowledge Summaries, Palliative Care - Nausea and Vomiting: https://cks.nice.org.uk/topics/palliative-care-nausea-vomiting/ NICE Clinical Knowledge Summaries, Palliative Care - Constipation: https://cks.nice.org.uk/topics/palliative-care-constipation/ Wigan & Leigh Hospice Symptom Management Guidelines for the Care of Adults in the Last Hours or Days of Life (Community Version 3): https://d2abk28tx5gxte.cloudfront.net/app/uploads/2018/11/26165005/symptom_management_guidance_end_of_life_adults_community_v3.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://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.

To help us brush up on managing palliative patients with pain, Lisa and Sara speak to Dr Anna Murray (Palliative Care Specialist, WWL) and GP Lead Dr Liam Hosie (Palliative Care and GP, WWL). We start with a general approach to pain and then move on to consider the causes, discuss opioid titrations as well as adjuvant therapies. We also touch on agitation and breathlessness and when to consider changing the routes of medication. Useful resources: GMMMG Palliative Care Pain and Symptom Control Guidelines for Adults: http://gmmmg.nhs.uk/docs/guidance/GMMMG-Palliative-Care-Pain-and-Symptom-Control-Guidelines-for-Adults-v1-1.pdf Wigan & Leigh Hospice Symptom Management Guidelines for the Care of Adults in the Last Hours or Days of Life (Community Version 3): https://d2abk28tx5gxte.cloudfront.net/app/uploads/2018/11/26165005/symptom_management_guidance_end_of_life_adults_community_v3.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://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.

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.

Good consultation skills can hone diagnosis, management plans, safety-netting and safety thereby really affecting patient outcomes. GP and Primary Care Educator Dr Avril Danczak shares her insights into teaching GP trainees and trainers about consultation skills with Lisa and Sara. Useful resources: Health Education North West Advanced Communication Skills Resources https://www.nwpgmd.nhs.uk/resources/advanced-communication-skills-reading-list Article: Kaiser Permanente: Enhancing Clinician Communication Skills in a Large Healthcare Organization: A longitudinal Case Study https://www.sciencedirect.com/science/article/abs/pii/S0738399105000133 Book: Silverman, Kurtz and Draper: Skills for Communicating with Patients https://www.amazon.co.uk/Skills-Communicating-Patients-Jonathan-Silverman/dp/1846193656/ref=pd_rhf_se_p_img_2?_encoding=UTF8&psc=1&refRID=T0WVKH6Y145JAJ1VDHCJ Book: Platt and Gordon: Field Guide to the Difficult Patient Interview https://www.amazon.co.uk/Field-Guide-Difficult-Patient-Interview/dp/0781747740 Book: Barry Bub MD: Communication Skills That Heal https://www.amazon.co.uk/Communication-Skills-That-Heal-Professionalism/dp/1857756649 ___ 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 episode has been made with the support of Health Education North West. Given that they are 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.

As part of her role as Associate Dean in Health Education North West, Dr Alison Caldwell looks after GP trainees who sit the AKT and those that may fail. In this episode she shares her pearls of wisdom for preparing and sitting the AKT. It has lots of useful information for trainees and trainers including how to break down the curriculum and where to best focus learning as well as how to actually do that learning effectively. We also cover how to improve exam technique as well as useful resources and specific advice for those who have tried and failed the exam. ____ Useful resources: Fourteen Fish for GP Trainees: https://www.fourteenfish.com/audience/gptrainee RCGP - MRCGP Applied Knowledge Test (AKT): https://www.rcgp.org.uk/training-exams/mrcgp-exam-overview/mrcgp-applied-knowledge-test-akt.aspx RCGP- GP Curriculum Overview: https://www.rcgp.org.uk/training-exams/training/gp-curriculum-overview.aspx BNF Online: https://bnf.nice.org.uk/ RCGP - Clinical evidence and data interpretation: https://www.rcgp.org.uk/training-exams/mrcgp-exam-overview/-/media/B4406D5D2E9A492B86AD74BC3FEFD08B.ashx Bolton GP scheme - Medical statistics: https://gp-training.hee.nhs.uk/bolton/mrcgp-examinations/ General Practice Education in Health Education England working across the North West: https://www.nwpgmd.nhs.uk/general-practice-education-north-western-deanery ____ 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 episode has been made with the support of Health Education North West. Given that they are 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 bring back Dr Joanna Bircher and Dr Viren Mehta for this last episode in the COVID-19 series to reflect on all of the positives that have come from the outbreak in general practice, the personal and professional learning that they have had and some focus on staff wellbeing with a few simple ideas on how to support each other. Thank you to Practice Managers Sara Mayer at Archwood Medical Practice and Michelle Davenport at Heaton Mersey Medical Practice for sharing their insights too. ____ Useful resources: Headspace - information about free NHS access: https://help.headspace.com/hc/en-us/articles/360044971154-Headspace-for-the-NHS Looking After You Too coaching: https://people.nhs.uk/lookingafteryoutoo/ NHS Practitioner Health programme: https://www.practitionerhealth.nhs.uk/accessing-the-service RCGP Wellbeing Resources: https://www.rcgp.org.uk/training-exams/practice/gp-wellbeing.aspx ____ 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/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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.

Now that the Greater Manchester Enabling Safe Certification of Death in the Community service is being stood down, we take the opportunity to talk through the new legislation (from the Coronavirus Act 2020) and how this applies in practice. Dr Aamna Khan (GP and Clinical Lead for the Enabling Safe Certification of Death in the community service) and Dr Viren Mehta (GP partner, clinical director of his PCN and clinical director for Stockport CCG) take us through this important subject. They discuss: Expected and unexpected deaths and how these should be approached Who should be referred to the coroner and when to write COVID-19 on the death certificate Verification of death and who can do this Who can complete paperwork such as the death certificate and cremation forms and the criteria that now needs to be satisfied to enable this to be done Tips on how to complete this paperwork at the moment The ways in which the registration process has changed Thoughts on how practices and PCNs can think about their systems to make death in the community safer and smoother for everyone involved ____ Useful resources: Information and contact details for Greater Manchester Enabling Safe Certification of Deaths in the Community Service: https://gmprimarycare.org.uk/coronavirus/ Coronavirus Act 2020: http://www.legislation.gov.uk/ukpga/2020/7/contents/enacted Red Whale - COVID-19: Death in the community: https://www.gp-update.co.uk/SM4/Mutable/Uploads/pdf_file/28_GP_COVID-19_The-Coronovirus-Act-2020-Death-certification,-cremation-and-burial.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://www.surveymonkey.co.uk/r/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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.

At the moment with increased isolation, anxiety and loneliness, social prescribing has become more important than ever. Sara and Lisa speak to GP Dr Jaweeda Idoo (clinical champion for personalised care in Greater Manchester) and Sophie Glinka (social prescribing lead for people and communities in Greater Manchester) about the role of social prescribing during COVID-19 and indeed in general. They talk about some case studies where social prescribing has been invaluable to the care and support of patients, and showcase the importance of this facet of community care. ____ Useful resources: The Health Foundation - What makes us healthy? An introduction to the social determinants of health (2018): https://www.health.org.uk/sites/default/files/What-makes-us-healthy-quick-guide.pdf International Journal of Epidemiology - Sick individuals and sick populations (2001): https://academic.oup.com/ije/article/30/3/427/736897 Proceedings of the National Academy of Sciences of the United States of America - Social isolation, loneliness, and all-cause mortality in older men and women (2013): https://www.pnas.org/content/110/15/5797.short ____ 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/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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.

Staff risk assessments in primary care during COVID-19 are generating many questions such as; Which tool? How should they be carried out? What are the advantages and disadvantages of doing them? How does Vitamin D fit in? What does this mean for practice? GPs Sara and Lisa talk to Greater Manchester based GP Dr Jaweeda Idoo and Practice manager Gina Bird about their experiences of staff risk assessments in general practice at the moment. ____ Useful resources: BMJ Covid-19: Known risk factors fail to explain the increased risk of death among people from ethnic minorities May 2020: https://www.bmj.com/content/369/bmj.m1873 NHS Staff Risk Assessments: https://www.nhsemployers.org/covid19/health-safety-and-wellbeing/risk-assessments-for-staff SAAD Risk Assessment: https://abmacademy.com/saad-risk-scoring-for-bame/ Welsh Risk Assessment Tool COVID-19 (WRATC): https://www.bapio.co.uk/wp-content/uploads/2020/05/Risk-Assessment-Tool.pdf RCOG Covid-19 Advice in Pregnancy: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/ ____ 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/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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 January 2020, this is the long awaited second part of Lisa and Sara’s conversation with Professor Anthony Jones and Consultant Physiotherapist William Gregory from Salford Royal Foundation Trust. In Part 1 we covered diagnosis and in Part 2 we look at management of fibromyalgia including: The role of targeted CBT and physiotherapy Groups for patient education and support The role of medications Where secondary care fits in Research in the area The place alternative therapies occupy for some with this condition Natural progression and associated conditions Helpful resources for patients and practitioners ____ Useful resources: Fibromyalgia Action (FMA) UK website (for patient info and list of local support groups): http://www.fmauk.org/ Versus Arthritis booklet: https://www.versusarthritis.org/about-arthritis/conditions/fibromyalgia/ Pain toolkit: https://www.paintoolkit.org/ Living well with pain: https://livewellwithpain.co.uk/ Moving Medicine: https://movingmedicine.ac.uk/ Theatre Performance for all interested in learning about how the brain works in chronic pain: Pain, the Brain and a little bit of Magic: http://research.bmh.manchester.ac.uk/pain//events/PainTheBrainandabitofMagic Currently available checklist for Fibromyalgia diagnosis on ACR website: https://www.rheumatology.org/Practice-Quality/Clinical-Support/Criteria/ACR-Endorsed-Criteria A version of the 2016 ACR checklist (amended from the 2010 version): https://people.clarkson.edu/~lrussek/2016FMS.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 make our day and fill out our really quick anonymous survey here: https://www.surveymonkey.co.uk/r/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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.

With so much changing in how we work in general practice at the moment, assessing and investigating patients for suspected cancer symptoms can be a challenge. To help talk us through the current situation, Lisa and Sara speak to: Dr Sarah Taylor: GP in Fallowfield and Cancer Research UK Cancer Diagnosis Lead for Greater Manchester Dr Viren Mehta: GP in Cheadle, Clinical Director at Stockport CCG and Clinical Director at his PCN We discuss: Thoughts around how to assess patients with suspected cancer at the moment, including discussion around the remote nature of working currently and the challenges that come with this How to approach ‘cough’ presentations, remembering to continue to consider lung cancer Advice around how to decide who to see face to face The advice around suspected cancer referrals to secondary care at the moment What patients can now expect following a referral to secondary care for suspected cancer ____ Useful resources: Greater Manchester Cancer Lung Pathway Board - Coronavirus (COVID-19) Resource Centre: https://gmcancer.org.uk/coronavirus/ NICE - Suspected Cancer: Recognition and Referral: https://www.nice.org.uk/guidance/ng12 BMA - Taking and Using Pictures and Recordings of Patients: https://www.bma.org.uk/advice-and-support/ethics/confidentiality-and-health-records/taking-and-using-pictures-and-recordings-of-patients ____ 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/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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.

Yesterday was international nurses day and so we wanted to highlight the great work that is being done by our community nurses during COVID-19. Our guests are: Lesley Royle-Pryor: Primary and Community Nurse Lead for Greater Manchester Health and Social Care Partnership Moira Ogunsakin: Greater Manchester Training Hub Lead Nurse, Lead Nurse for Practice Renewal for Salford Primary Care Together and Practice Nurse in Salford Dr Joanna Bircher: GP Partner in Tameside and Glossop and Clinical Director of the GP Excellence programme We discuss: What life is like for practice nurses and district nurses at the moment and what has changed since COVID-19 The challenges that community nurses face at the moment How practices can continue to adapt their nursing work going forward Places to look for support as a community nurse Thoughts on how other members of the practice team can support nursing colleagues at the minute and going forward ____ Useful resources: Asthma UK - How to use your inhaler: https://www.asthma.org.uk/advice/inhaler-videos/ Royal College of Nursing - COVID-19: https://www.rcn.org.uk/covid-19 Nursing and Midwifery Council - COVID-19: https://www.nmc.org.uk/news/coronavirus/ Wound Care at Home: https://www.scribd.com/document/461038756/Wound-Care-at-Home?secret_password=3bSG1Z3zL26wPiiZFRDp ____ 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/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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 doctors involved in primary care research to give an overview of what developments are happening in COVID-19 research in the community at the moment. Our guests are: Professor Philip Evans - GP, Associate Professor of General Practice at The University of Exeter, National Speciality Lead for Primary Care at NIHR, Cluster Lead at Clinical Research Network National Speciality Hub Dr Sheila McCorkindale - GP, Local Clinical Research Speciality Lead at NIHR Clinical Research Network, Greater Manchester Dr Nick Thomas - GP, Clinical Research Speciality Lead with NIHR, Clinical Research Lead at the Clinical Innovation and Research Centre at RCGP We discuss: The ‘PRINCIPLE’ study, the first clinical trial in COVID-19 patients consulting in primary care The RCGP Research and Surveillance programmes The National Institute for Health Research programmes We reflect on the joined up nature of research efforts between branches and within Primary and Secondary care, contributing to all teams working towards the common goal to help patients nationally at this unprecedented time. Note: We have taken down episode 4 (managing death in the community) in our COVID-19 series as the Enabling Safe Certification of Death Service has been updated, making parts of the episode no longer relevant. You can check our their FAQ in the resources below for the most up to date information about the service. ____ Useful resources: Enabling Safe Certification of Death Service FAQ: https://gmprimarycare.org.uk/coronavirus/ The National Institute for Health Research (NIHR) Clinical Research Network (CRN) website: https://www.nihr.ac.uk/explore-nihr/support/clinical-research-network.htm The Urgent Public Health (UPH) studies: https://www.nihr.ac.uk/covid-19/ The ‘PRINCIPLE’ (Platform Randomised trial of INterventions against COVID-19 In older peoPLE) study: https://www.phctrials.ox.ac.uk/principle-trial NIHR: Be Part of Research: https://bepartofresearch.nihr.ac.uk/ RCGP: Research and Surveillance Centre programmes: https://www.rcgp.org.uk/clinical-and-research/our-programmes/research-and-surveillance-centre.aspx COVID-19 Symptom Tracker App: https://covid.joinzoe.com/​ Moodbuster: https://www.mentalhealth.org.uk/research/moodbuster​ Clinical Practice Research Datalink (CPRD): https://www.cprd.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://www.surveymonkey.co.uk/r/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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 take a short break from full recording this week. They give an update on what to hopefully expect from episodes over the next few weeks as well as sharing a couple of useful links and information from listeners. Useful resources: Bereavement helpline number: 0800 2600 400 Centre for Evidence Based Medicine, Oxford: https://www.cebm.net/ NHS England Time for Care: https://www.england.nhs.uk/gp/gpfv/redesign/gpdp/releasing-time/ ____ 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/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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.

There have been a lot of questions within primary care regarding shielding and vulnerable patients. Sara and Lisa speak to Dr Joanna Bircher and Dr Viren Mehta about the confusion and get their thoughts on the subject. In the episode we cover: Demystifying all of the terminology and putting it into simpler terms. What has been asked of primary care with regards to these lists of patients, tips on how to complete these tasks and where to look for help. How to support extremely vulnerable/shielded and vulnerable patients as a practice, and how to safely manage clinical issues that arise for these people during COVID-19. Other groups of patients that might need extra support but don’t fall into the shielded (extremely vulnerable, high risk) category. Patient employment issues in primary care with relation to shielding. ____ Useful resources: Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19 (17th April 2020): https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19 NHS Guidance and updates for GPs - Highest clinical risk patients: https://www.england.nhs.uk/coronavirus/publication/guidance-and-updates-for-gps-at-risk-patients/ RCGP - Shielding vulnerable patients from Covid-19 (April 2020): https://elearning.rcgp.org.uk/course/view.php?id=377 NHS Digital - Coronavirus (COVID-19): Shielded patients list: https://digital.nhs.uk/coronavirus/shielded-patient-list NHS Standard operating procedures: https://www.england.nhs.uk/coronavirus/primary-care/general-practice/standard-operating-procedures/ COVID-19: guidance for employees, employers and businesses: https://www.gov.uk/government/publications/guidance-to-employers-and-businesses-about-covid-19 Identifying and helping to protect patients most at risk from COVID-19: https://www.rcplondon.ac.uk/news/identifying-and-helping-protect-patients-most-risk-covid-19 BMA - Identifying patients at highest risk from COVID-19: advice for GPs (16th April 2020): https://www.bma.org.uk/news-and-opinion/identifying-patients-at-highest-risk-from-covid-19-advice-for-gps Lymphoma Action - Guidance on shielding for people who have lymphoma: https://lymphoma-action.org.uk/about-lymphoma-covid-19-and-lymphoma/guidance-shielding-people-who-have-lymphoma Myeloma UK - COVID-19: What measures should I be following?: https://www.myeloma.org.uk/news-and-stories/covid-19-information-hub/covid-19-what-measures-should-i-be-following/ Blood Cancer UK - Coronavirus and blood cancer: https://bloodcancer.org.uk/support-for-you/coronavirus-covid-19/coronavirus-blood-cancer/ MPN Voice - COVID-19 Outbreak: Advice for Patients with Myeloproliferative Neoplasms (MPNs) (30th March 2020): https://www.mpnvoice.org.uk/coronavirus-covid-19-advice-and-information/coronavirus_covid_19_advice_for_people_with_mpns.aspx CLL Support - Latest advice on COVID-19 (15th April 2020): https://www.cllsupport.org.uk/latest-advice-on-covid-19/ Clinical guide for the management of Rheumatology patients during the coronavirus pandemic (8th April 2020): https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/clinical-guide-rheumatology-patients-v2-08-april-2020.pdf British Society for Gastroenterology expanded consensus advice for the management of IBD during the COVID-19 pandemic (6th April 2020): https://www.bsg.org.uk/covid-19-advice/bsg-advice-for-management-of-inflammatory-bowel-diseases-during-the-covid-19-pandemic/ NICE - COVID-19 rapid guideline: severe asthma (3rd April 2020): https://www.nice.org.uk/guidance/ng166 British Thoracic Society - COVID-19: identifying patients for shielding: https://www.brit-thoracic.org.uk/about-us/covid-19-identifying-patients-for-shielding/ Good SAM Volunteer app: Patient referral form: https://www.goodsamapp.org/NHSreferral ____ 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/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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

A current concern for primary care clinicians is how to manage end of life care in the context of the COVID-19 pandemic. Lisa and Sara are joined by Dr Liam Hosie, Dr Adam Firth and Dr Viren Mehta who have sifted through the key information and guidelines that are available on this topic. We talk about: Advanced care planning Common symptoms for patients with COVID-19 at the end of life Discuss 5 guidelines (including NICE, RCGP, Hospice UK) relevant to this topic and some take home messages Anticipatory medication and stock issues Post death support for families and for clinicians ____ Useful resources: Dr Adam Firth Stockport Grand Round: Making sense of symptom control guidance in suspected COVID - a GPs perspective: https://app.box.com/s/in48s14ee7r1c0pzk2i63m914gr1p0um NG31 NICE Guidelines: Care of dying adults in the last days of life (Dec 2015): https://www.nice.org.uk/guidance/ng31 GMMMG Guidelines: Palliative care pain and symptom control: http://gmmmg.nhs.uk/docs/guidance/GMMMG-Palliative-Care-Pain-and-Symptom-Control-Guidelines-for-Adults-v1-1.pdf#search=%22end%20of%20life%22 RCGP: Community palliative, end of life and bereavement care in the COVID-19 pandemic (March 2020): https://elearning.rcgp.org.uk/pluginfile.php/149342/mod_resource/content/1/COVID%20Community%20symptom%20control%20and%20end%20of%20life%20care%20for%20General%20Practice%20FINAL.PDF NICE COVID-19 rapid guideline: Managing symptoms (including at the end of life) in the community (Apr 2020): https://www.nice.org.uk/guidance/ng163 Hospice UK guidance including advice for carers and health care professionals: https://www.hospiceuk.org/what-we-offer/clinical-and-care-support/coronavirus-guidance Harvard Business Review: That Discomfort You’re Feeling Is Grief: https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief Funerals and Dying in Absentia: Inspiration and tips during COVID-19: http://www.orderofthegooddeath.com/funerals-dying-in-absentia-inspiration-tips-during-covid-19 RCGP: End of Life Care Quality Improvement Resources: https://www.rcgp.org.uk/clinical-and-research/resources/a-to-z-clinical-resources/daffodil-standards/end-of-life-care-quality-improvement-resources.aspx ____ 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/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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 by GPs Dr Viren Mehta and Dr Joanna Bircher who summarise new guidelines and evidence relevant in primary care this week. Covered this episode: Clinically recognised natural courses of COVID-19 infection Remotely assessing and risk stratifying COVID-19 patients Learning points from the updated standard operating procedures from NHS England Salient points from the new NICE guidelines on managing pneumonia in adults in the community Briefly touch on the updated PHE guidance on PPE ____ Useful resources: NICE COVID-19 rapid guideline managing suspected or confirmed pneumonia in adults in the community: https://www.nice.org.uk/guidance/ng165/resources/covid19-rapid-guideline-managing-suspected-or-confirmed-pneumonia-in-adults-in-the-community-pdf-66141902429125 Primary care pathways website: https://primarycarepathways.co.uk/ Centre for evidence based medicine: https://www.cebm.net/covid-19/ PHE what level of PPE, recommended PPE for primary, OP and community care: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877599/T2_Recommended_PPE_for_primary_outpatient_and_community_care_by_setting_poster.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://www.surveymonkey.co.uk/r/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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.

In this, our second of the COVID-19 specific episodes, GPs Lisa and Sara are joined electronically by Dr Dan Bunstone (GP and Clinical Director of Warrington CCG and Chief Medical Officer at Push Doctor) and Dr Joanna Bircher (GP partner, clinical director for GPExcellence and Pandemic Lead for her PCN). We discuss: Advantages of telephone and video consultations including how to use the golden minute, picking up cues on video consults and when they might be most useful. Safety points around confirming patient identity and others that may be in the room. The need for excellent documentation for non face to face consultations. Tips for good safety netting. Logistics of picking up prescriptions and how to protect shielded groups. ____ Useful resources Faculty of Sexual and Reproductive Health Covid-19 specific guidelines: https://www.fsrh.org/fsrh-and-covid-19-resources-and-information-for-srh/ Trisha Greenhalgh's excellent BMJ article: Covid-19: a remote assessment in primary care:https://www.bmj.com/content/368/bmj.m1182 eGP learning great telephone consultations tips https://egplearning.co.uk/quick-telephone-consultation-tips-for-primary-care/ Red Whale Emotional and Psychological Survival Guide: https://www.gp-update.co.uk/SM4/Mutable/Uploads/pdf_file/PEARL-Emotional-and-Psychological-wellbeing%5B2%5D-EDITED.pdf Website collating useful COVID-19 links: https://primarycarepathways.co.uk/covid19 ____ 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/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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.

We have decided to take a break from our normal release schedule to do a special, weekly series about the COVID-19 situation which is unfolding. Our hope is that we can provide some useful and practical information for everyone within primary care during this difficult time. In this first episode we talk to Dr Joanna Bircher (GP partner, clinical director for GPExcellence and Pandemic Lead for her PCN) and Dr Viren Mehta (GP partner, clinical director of his PCN and clinical director for Stockport CCG). We summarise some of the Standard Operating Procedure from 19th March with practical tips on how to implement this. We think about ways that surgeries can reduce their footfall and protect staff and patients from exposure. We also touch on which normal general practice services should continue during this time and where to look for guidance. We talk about some ways to look after your staff, and speak specifically about home visits. ____ Useful resources: NHS England Standard Operating Procedure for General Practice (19th March 2020): https://www.england.nhs.uk/coronavirus/primary-care/general-practice/standard-operating-procedures/ RCGP Guidance on workload prioritisation during COVID-19 (23rd March 2020): https://www.rcgp.org.uk/-/media/Files/Policy/A-Z-policy/2020/covid19/RCGP%20guidance/202003233RCGPGuidanceprioritisationroutineworkduringCovidFINAL PPE video for UK primary care: https://www.youtube.com/watch?v=Zpg64grevO0 Website collating useful COVID-19 links: https://primarycarepathways.co.uk/covid19 ____ 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/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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.

In this week’s episode Lisa and Sara speak to Professor Anthony Jones and Consultant Physiotherapist William Gregory from Salford Royal Foundation Trust to learn more about Fibromyalgia. In part 1 we cover what the condition involves, the central sensitisation theory, useful examination tips and differentials to consider. We also talk about simple ways of explaining a diagnosis of Fibromyalgia to your patients. In part 2 (which will be released in 2 weeks), we break down management options as well as hearing about research and resources helpful to patients and practitioners. ____ Useful resources: Fibromyalgia prevalence at 1 in 10: Mansfield et al (2016) A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population. Pain 157:1 https://www.ncbi.nlm.nih.gov/pubmed/26270591 American College of Rheumatology (ACR) 2016 fibromyalgia diagnostic criteria: Wolfe F, Clauw DJ, FitzCharles M, Goldenberg D, Hauser W, Katz RS, Russell IJ, Mease PJ, Russell A, Walitt B. 2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria. Arthritis Rheumatol. 2016;68 (suppl 10) https://www.ncbi.nlm.nih.gov/pubmed/27916278 Currently available checklist for Fibromyalgia diagnosis on ACR website: https://www.rheumatology.org/Practice-Quality/Clinical-Support/Criteria/ACR-Endorsed-Criteria A version of the 2016 ACR checklist (amended from the 2010 version): https://people.clarkson.edu/~lrussek/2016FMS.pdf National Rheumatoid Arthritis Society - Have you got the S factor?: https://www.nras.org.uk/have-you-got-the-s-factor- FMA UK website (for patient info and list of local support groups): http://www.fmauk.org/ Changes in healthcare utilisation pre- versus post- diagnosis; Hughes et al (2006) The impact of a diagnosis of fibromyalgia on healthcare resource use by primary care patients in the UK. Arthritis and Rheumatism (54, 1, p177-183) https://www.ncbi.nlm.nih.gov/pubmed/16385513 ____ Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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.

Bronchiectasis can sometimes be overlooked amongst the other, more common lung conditions such as COPD. Because of this, it can be difficult for primary care clinicians to be fully aware of how to comprehensively diagnose and manage patients who have this condition. Lisa and Sara talk to respiratory consultant Dr Ashish about bronchiectasis. We learn exactly what this condition is, what the risk factors are for developing it, and when we should be suspicious of it as a cause. We also talk through important differentials to think about, what to look for on examination and which investigations to do (and the reliability of these). We finish by hearing about the role of sputum samples and what we can be doing in Primary Care to manage patients with bronchiectasis alongside Secondary Care. ____ Useful resources: Table showing targeted antibiotic choices in bronchiectasis on NICE CKS: https://cks.nice.org.uk/bronchiectasis#!scenario:1 ____ Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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.

Interstitial lung disease (ILD) can be difficult to identify in primary care and unfortunately for some patients, currently carries a poor prognosis; the median survival for those with idiopathic pulmonary fibrosis is only 3–3.5 years (https://www.england.nhs.uk/wp-content/uploads/2018/08/Interstitial-lung-disease-service-adult.pdf). Lisa and Sara talk to respiratory consultant Dr Ashish about this condition. We learn about when to be suspicious about a diagnosis of ILD, who is at risk and the symptoms and signs. We also hear about the reliability of the different investigations that are recommended in primary care and what happens after we have referred someone to outpatient respiratory clinic. We end with talking through how to manage exacerbations in these patients, prognosis and a little bit about fitness to fly. ____ Useful resources: IPF Lung Sounds: https://www.insightsinipf.com/clinical-resources/auscultation/gallery/ GMMMG Shared Care Guidelines: http://gmmmg.nhs.uk/html/gmmmg_app_scgs.php Fitness to Fly article from British Thoracic Society Standards of Care Committee: 'Managing passengers with respiratory disease planning air travel': https://thorax.bmj.com/content/57/4/289 ____ Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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.

Worldwide, sepsis kills more people than cancer (https://www.bbc.co.uk/news/health-51138859). In 2050 it is predicted antibiotic resistance will kill more than cancer (http://bsac.org.uk/securing-new-drugs-for-future-generations/). What a difficult balance! Lisa and Sara opportunistically talk to Trafford GP Dr Anya Leaver about antibiotic prescribing in Greater Manchester. We discuss the issues, recent changes in local guidelines, helpful tips to improve prescribing practice, great resources and ideas for practice audits. ____ Useful resources: Trafford’s two page CCG Antibiotic guidelines. Not online but may be available on request from: [email protected] Other Greater Manchester CCG Medicine Management Teams available from link: http://psnc.org.uk/greater-manchester-lpc/service-information/medicines-management-and-guidance/ GMMMG Antimicrobial Guidelines: http://gmmmg.nhs.uk/html/cgp.php TARGET leaflets for patients from RCGP (including 'Treating your infection UTI'): https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/amr/target-antibiotics-toolkit.aspx 'When should I worry?' leaflets and online resources including e-learning: http://www.whenshouldiworry.com/ Fever Pain score for sore throats: https://ctu1.phc.ox.ac.uk/feverpain/index.php Why the guidelines were changed for treating Chlamydia: https://www.bashhguidelines.org/current-guidelines/urethritis-and-cervicitis/chlamydia-2015/ ESPAUR report (national data on antibiotic prescribing and resistance): https://www.gov.uk/government/publications/english-surveillance-programme-antimicrobial-utilisation-and-resistance-espaur-report ____ Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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 several different primary care professionals about portfolio working. Dr Anya Leaver, Dr Hussain Gandhi, Practice Nurse Alyson Rimmer, Dr Nikesh Vallabh, and Dr Saira Zaman share with us their journey into Primary Care, how they got involved in their different roles outside of clinical work, what it means to them and advice for those out there wanting to explore adding variety to their working week. ____ Useful resources: eGP Learning (made by Dr Gandhi): https://egplearning.co.uk/ PED Course with Health Education North West: https://www.nwpgmd.nhs.uk/ped-2019-study-day-one Post-CCT Fellowships with Health Education North West: https://www.nwpgmd.nhs.uk/post-cct-gp-fellowship-programme-hee-nw-20192020 ____ Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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 GPwSI, Dr Rachel Hilton about Urticaria (aka hives/wheals). She talks us through the pathophysiology, causes, potential triggers, history, examination and management of this sometimes difficult area. ____ Useful resources: Skin Support Website (urticaria page): http://skinsupport.org.uk/conditions-details/urticaria-and-angioedema British Association of Dermatologists (urticaria leaflet): http://www.bad.org.uk/for-the-public/patient-information-leaflets/urticaria-and-angioedema NICE CKS urticaria: https://cks.nice.org.uk/urticaria#!diagnosis ____ Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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 GPwSI, Dr Rachel Hilton about Generalised Itching. She talks us through how to approach a patient presenting with generalised itching, the common and important causes, useful investigations and the management that we can try in primary care for these patients. ____ Useful resources: BATHE Study, BMJ 2018: https://www.bmj.com/content/361/bmj.k1332 Skin Support Website (pruritus page): http://skinsupport.org.uk/conditions-details/pruritus British Association of Dermatologists (pruritus leaflet): http://www.bad.org.uk/for-the-public/patient-information-leaflets/pruritus NICE CKS Widespread Itching Causes: https://cks.nice.org.uk/itch-widespread#!backgroundSub:1 ____ Have feedback or suggestions? You can help us know how we are doing with our 3 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C ____ This podcast has been made with the support of Wigan CCG and GP Excellence in Greater Manchester. Given that they are 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 Dr Rebecca Baron from Health Education England about Resilience. This is part two of a two-part series about Resilience. In this episode we continue the theme of exploring resources available to healthcare professionals around resilience; books and research that have advanced the field. Rebecca gives us her learning points from these. ____ Resources mentioned in the episode: • When “resilience” becomes a dirty word - BMJ article by David Oliver July 2017 https://www.bmj.com/content/358/bmj.j3604 • 'eGPLearning PodBlast' podcast - episode about Wellbeing with Dr Helen Garr: https://www.podbean.com/eu/pb-w2jut-c480f4 • 'You are not a frog' podcast by Dr Rachel Morris all about Resilience: https://shapesfordoctors.com/podcasts/ • NHS Practitioner Health Programme https://php.nhs.uk/ or call 020 3049 4505 • Positivity book by Barbara Fredrickson https://amzn.to/2OFrOcw • Rainy Brain, Sunny Brain book by Elaine Fox https://amzn.to/2DfE6D2 • Building Physician Resilience Canadian Family Physician May 2008 https://www.nwpgmd.nhs.uk/resources/building-physician-resilience • Foundation for Positive Mental Health http://www.foundationforpositivementalhealth.com/ • Thinking, Fast and Slow book by Daniel Kahneman https://amzn.to/2XO3Pfo • The New Leaders book by Daniel Goleman https://amzn.to/2KP8Miy • The 7 Habits of Highly Effective People book by Stephen R. Covey https://amzn.to/34jcOHM • Health Education North West Resilience resources: https://www.nwpgmd.nhs.uk/taxonomy/term/6 • Why We Sleep book by Matthew Walker https://amzn.to/35ugNkW • The Business of Sleep book by Vicki Culpin https://amzn.to/37AINoV • The Body Keeps a Score book by Bessel van der Kolk https://amzn.to/2XIuVEw • Eat that Frog book by Brian Tracy https://amzn.to/33jNaBc ____ We would love your feedback & suggestions…Let us know how we are doing with our 5 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C ____ This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan 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 Dr Rebecca Baron from Health Education England about Resilience. This is part one of a two part series about Resilience. In this episode we talk about what Resilience is and how it started as a concept in general and in healthcare. We also hear about the neuroscience behind Resilience and Rebecca goes through some resources that she has found particularly helpful herself. ____ Resources mentioned in the episode: BMJ article by David Oliver - When “resilience” becomes a dirty word: https://www.bmj.com/content/358/bmj.j3604 'eGPLearning PodBlast' podcast - episode about Wellbeing with Dr Helen Garr: https://www.podbean.com/eu/pb-w2jut-c480f4 'You are not a frog' podcast by Dr Rachel Morris all about Resilience: https://shapesfordoctors.com/podcasts/ NHS Practitioner Health Programme https://php.nhs.uk/ or call 020 3049 4505 The Body Keeps the Score book by Bessel van der Kolk: https://amzn.to/34wKpxp The Chimp Paradox book by Professor Steve Peters: https://amzn.to/2JKIlKm Blink: The Power of Thinking Without Thinking book by Malcolm Gladwell: https://amzn.to/2C7Dizl Flourish book by Martin Seligman: https://amzn.to/2NGJvrH Health Education North West Resilience resources: https://www.nwpgmd.nhs.uk/taxonomy/term/6 ____ Have feedback or suggestions? You can help us know how we are doing with our 5 minute survey: https://www.surveymonkey.co.uk/r/YYQ763C ____ This podcast has been made with the support of Wigan CCG. Given that they are recorded with Wigan 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.