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Today, we’re speaking to Dr Rebecca Payne and Professor Trish Greenhalgh. Rebecca is a GP and an NIHR In Practice Fellow, and works alongside Trish at the Nuffield Department of Primary Health Care Sciences at the University of Oxford.
Title of paper: What are the challenges to quality in modern, hybrid general practice? A multi-site longitudinal study
Available at: https://doi.org/10.3399/BJGP.2024.0184
Quality in primary care is a multidimensional construct embracing effectiveness, efficiency, safety, patient-centredness, equity, continuity, accessibility, and more. We report on how UK practices have striven to deliver on these aspects of quality as they move to a hybrid model that combines in-person with remote and digital care. The context for quality is currently very challenging, with resource constraints, staff shortages, and weak infrastructure. Digital systems intended to increase efficiency have produced some benefits for some people but have created new forms of inefficiency, increased fragmentation of care, contributed to staff stress, and widened inequities of access.
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Today, we’re speaking to Dr Dan Butler, a portfolio GP completing his PhD at Queen’s University Belfast.
Title of paper: “Challenging but ultimately rewarding”: A qualitative analysis of Deep End GPs’ experiences
Available at: https://doi.org/10.3399/BJGP.2024.0167
GPs working in the highest need, socioeconomically deprived areas, the “Deep End”, face additional challenges. This paper looks at the NI context and explores why, despite the challenges, GPs choose to work in these areas. The main issues relate to wider healthcare failings and the challenges of patient populations some of whom generally frequently use (‘medicalised’ group) and those who underuse (‘missingness’ group) health services. GPs tend to relate to ‘Deep End’ areas, either due to personal connections or feelings of duty and social responsibility. No amount of General Practice focused funding will ‘solve’ the issues, instead a far greater holistic approach improving the physical conditions people are born, live and work in, is needed.
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Fehlende Folgen?
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Today, we’re speaking to Dr Carol Sinnott, a GP and a Senior Clinical Research Associate based at The Healthcare Improvement Studies Institute.
Title of paper: Understanding access to general practice through the lens of candidacy: a critical review of the literature
Available at: https://doi.org/10.3399/BJGP.2024.0033
Dominant conceptualisations of access to health care are often framed in terms of speed and supply — these approaches risk obscuring important aspects of people’s experiences of access. The Candidacy Framework was developed to study access to health care by people in vulnerable groups. This study confirms the salience of the Candidacy Framework for understanding access in the setting of general practice, offering new insights for policy and practice.
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Today, we’re speaking to Dr Sarah Sullivan, a Senior Research Fellow based within the Centre for Academic Mental Health at the University of Bristol.
Title of paper: External validation of a prognostic model to improve prediction of psychosis in primary care
Available at: https://doi.org/10.3399/BJGP.2024.0017
This paper reports the external validation of the only psychosis risk prediction algorithm to be used in primary care. External validation of prediction algorithms is essential to provide evidence of transportability i.e. that the algorithm can be used outside its training environment. This vital step for prediction algorithms is often missed.
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Today, we’re speaking to Dr Sophie Ansems, a GP and PhD candidate, and Dr Lianne Mulder, both based at the Department of Primary and Long-term Care at the University of Groningen in the Netherlands.
Title of paper: General practitioners’ perspectives on diagnostic testing in children with persistent non-specific symptoms
Available at: https://doi.org/10.3399/BJGP.2023.0683
It is known that GPs employ diagnostic tests in adults with persistent non-specific symptoms for motives beyond strictly diagnostic purposes, but comparable research has not been conducted in children. This study adds that although GPs want to limit unnecessary invasive procedures in children, non-diagnostic motives to test are considered important, for example to provide reassurance or secure the GP-patient relationship. The decision to conduct diagnostic tests in children with persistent non-specific symptoms is based on a complex trade-off among medical considerations, psychosocial factors, consultation management, and efficient resource utilization. Awareness amongst GPs of the motives underlying their own testing behaviour in children with PNS could prompt changes in their testing practices.
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Today, we’re speaking to Dr Amy Clark and Dr Kathryn Hughes. Amy is a resident doctor in North West Anglia Foundation Trust, and Kathryn who is a GP and a Senior Clinical Lecturer based at PRIME Centre Wales within Cardiff University.
Title of paper: Assessing acutely ill children in general practice using the National PEWS and LqSOFA clinical scores: a retrospective cohort study
Available at: https://doi.org/10.3399/BJGP.2023.0638
The validity of the current NICE-recommended scoring system for identifying seriously ill children in general practice, the Traffic Light system, was recently investigated and shown to perform poorly. A new National PEWS (Paediatric Early Warning Score) has just been introduced in hospital settings with hopes for subsequent implementation in general practice, to improve the identification of seriously unwell children. To the authors’ knowledge, the score has not previously been validated in general practice. This study found that the National PEWS would not accurately identify children requiring hospital admission within two days of presenting to general practice with an acute illness and therefore should not be recommended for this purpose without adjustment. Another score, the Liverpool quick Sequential Organ Assessment (Lq-SOFA), was also investigated and found to perform poorly in general practice.
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Today, we’re speaking to Professor Carolyn Chew-Graham, Professor of General Practice Research at Keele University.
Title of paper: People from ethnic minorities seeking help for Long Covid: a qualitative study.
Available at: https://doi.org/10.3399/BJGP.2023.0631
People from ethnic minority groups are less likely to present to primary healthcare for Long Covid. This study explored the lived experiences of Long Covid amongst people from ethnic minority groups. Participants were often previously unaware of Long Covid or available support and some described not feeling worthy of receiving care. Experiences of stigma and discrimination contribute to a lack of trust in healthcare professionals and services, and are common in previous negative healthcare encounters. Receiving empathy, validation, and fairness in recognition of symptoms, and support is needed to enhance trust and safety in healthcare.
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Today, we’re speaking to Marije Splinter, an epidemiologist and sociologist based at the Department of Epidemiology at Erasmus University Medical Centre in the Netherlands.
Title of paper: Healthcare avoidance during the early stages of the COVID-19 pandemic and all-cause mortality: a longitudinal community-based study
Available at: https://doi.org/10.3399/BJGP.2023.0637
During the COVID-19 pandemic, trends of reduced healthcare-seeking behaviour were observed alongside global patterns of excess mortality, raising concerns about the consequences of healthcare avoidance for population health. This study found that individuals who avoided healthcare during COVID-19 were at an increased risk of all-cause mortality. Importantly, these individuals were characterised by underlying symptoms of depression and anxiety, as well as poor self-appreciated health. The findings of this study emphasise the need for targeted interventions to safeguard access to primary and specialist care for these vulnerable individuals, during and beyond healthcare crises.
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Today, we’re speaking to Dr Charlotte Archer, Research fellow in primary care mental health based at the University of Bristol.
Title of paper: GPs’ views of prescribing beta- blockers for people with anxiety disorders: a qualitative study
Available at: https://doi.org/10.3399/BJGP.2024.0091
Beta-blockers are licensed for managing the symptoms of anxiety, and new prescriptions for patients with anxiety have increased substantially in recent years. However, National Institute for Health and Care Excellence guidance for anxiety does not recommend beta-blockers as a treatment for anxiety, and recent reports have highlighted risks associated with the beta-blocker propranolol. Our research found that GPs prescribe beta-blockers for anxiety because they consider them to be low risk, a quicker solution than other treatments, and useful for managing associated physical symptoms.
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Today, we speak to Dr Jet Klunder, a GP trainee and a PhD candidate based at the Department of General Practice at Amsterdam University Medical Centre in the Netherlands.
Title of paper: Predicting unplanned admissions to hospital in older adults using routinely recorded general practice data: development and validation of a prediction model
Available at: https://doi.org/10.3399/BJGP.2023.0350
Unplanned hospital admissions in older adults are a critical concern for patients, family caregivers, healthcare professionals, and service planners. In this study a robust and easy-to-use prediction model has been developed and validated using routinely recorded data from general practices to predict the risk of unplanned hospital admissions in community-dwelling older adults. Identifying older adults at high risk can facilitate targeted preventive interventions, such as case management, telemedicine, or anticipatory care planning. Moreover, the model could also be utilised by policymakers for capacity planning of hospital beds.
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In this episode, we talk to Dr Holly Smith, Research Fellow in Perinatal Mental Health based at the Department of Primary Care and Population Health at University College London.
Title of paper: The first 100 days after childbirth: cross-sectional study of maternal clinical events and health needs from primary care
Available at: https://doi.org/10.3399/BJGP.2023.0634
The first 100 days after childbirth are a crucial time for women as they recover mentally and physically from pregnancy and birth. Previous studies have sought to identify common postnatal conditions and symptoms women may experience after birth, but no studies, to the authors’ knowledge, have used electronic health records from primary care to examine women’s actual care use in this time. The current study found that women most commonly use primary care for: a post natal check or visit, monitoring (such as a blood pressure reading), and contraception. The study adds useful knowledge on women’s primary care use following childbirth.
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In this episode, we talk to Dr Michelle Rickett, a Research Associate on the NIHR funded EXTEND study based at the School of Medicine at Keele University.
Title of paper: Collaboration across the primary/specialist interface in early intervention in psychosis services: a qualitative study
Available at: https://doi.org/10.3399/BJGP.2023.0558
Early Intervention in Psychosis (EIP) service users may be referred from, and discharged back to, primary care. There is limited research on patient and carer experience of discharge to primary care from EIP services and little guidance around planning and implementation of discharge. This paper explores experiences of EIP care and discharge from the perspectives of service users, carers and healthcare professionals in EIP services and primary care. It explores the patient journey through EIP services, highlights the lost connection with primary care, and makes recommendations for more collaboration between primary and specialist care, particularly around physical health monitoring and management, which might improve patient experience and outcome.
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In this episode, we talk again with Jen MacLellan, a qualitative researcher based within the Nuffield Department of Primary Care Health Sciences at the University of Oxford.
Title of paper: Unpacking complexity: GP perspectives on addressing the contribution of trauma to women’s ill health
Available at: https://doi.org/10.3399/BJGP.2024.0024
Significant challenges and uncertainties reside in how best to manage the link between mind and body in communication with patients and in healthcare pathways. Lack of supportive resources to deliver holistic, trauma informed care risks practitioners (inadvertently) avoiding discussion of the contribution of distress in the illness presentation. A trauma informed systems level approach would support integration of psychological support within multiple care pathways and support wellbeing of practitioners providing care.
This study was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (NIHR202450). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
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We're taking a summer break but will be back with our BJGP interview podcast on Tuesday 3 September.
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We're taking a summer break but will be back with our BJGP interview podcast on Tuesday 3 September.
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In this episode, we talk to Professor Clare Turnbull, Professor in Cancer Genetics at the Institute for Cancer Research and Honorary Consultant based at the Marsden.
Title of paper: Breast cancer risk assessment for prescription of menopausal hormone therapy in women with a family history of breast cancer: an epidemiological modelling study
Available at: https://doi.org/10.3399/BJGP.2023.0327
Prospective longitudinal studies (such as the Collaborative Group on Hormonal Factors in Breast Cancer [CGHFBC]) have enabled the estimation of relative risks of breast cancer associated with different durations of exposure to and formulations of menopausal hormonal therapy (MHT). Risk models such as BOADICEA enable prediction of age-related breast cancer risk according to the extent and pattern of breast cancer family history. This study undertook integration of these two data sources (namely the CGHFBC datasets and the BOADICEA model) in order to model annual and 5-year risks for breast cancer incidence for the age window 50–80 years for hypothetical unaffected female consultands with different patterns of MHT exposure and different patterns of breast cancer family history, also generating predictions for breast cancer-specific death. This study modelled combined and oestrogen-only MHT but lacked data for analyses of newer types of MHT such as micronised progesterone or non-oral preparations.
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In this episode, we talk to Dr Joe Hutchinson, who is a salaried GP and an academic GP working within the Centre for Primary Care and Health Services Research at the University of Manchester.
Title of paper: Trends in full-time working in general practice: repeated cross-sectional study
Available at: https://doi.org/10.3399/BJGP.2023.0432
General practice is under increasing pressure, in part due to a lack of GPs. There is contention as to the proportion of GPs working full-time. We find that average hours and sessions worked per week by GPs in England have declined, whilst average hours per session has increased. Over half (55%) of GPs work at least the NHS Digital standard full-time definition of 37.5 hours per week. Average hours worked per session in 2021 was 51% greater than the BMA standard definition of a session’s duration. We recommend removing sessions as a definition of full-time working. However, if full-time work commitment continues to be defined in terms of the number of sessions worked, alignment with the NHS definition of 37.5 hours per week could be achieved by recognising that 6.0 sessions per week of 6.2 hours constitutes full-time work.
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In this episode, we talk to Dr Anna Wilding, a Research Fellow based at Health Organisation, Policy and Economics at the University of Manchester.
Title of paper: Geographic inequalities in need and provision of social prescribing link workers
Available at: https://doi.org/10.3399/BJGP.2023.0602
Social prescribing link workers were proposed in the 2019 NHS Long Term Plan to address health inequalities. Using national administrative data, we find that the subsequent roll-out of link workers has not been sufficiently targeted at areas of highest need. Higher need areas require additional support for employing link workers to tackle health inequalities and better support population needs.
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In this episode, we talk to Lisa Davies, a PhD candidate based at Utrecht University.
Title of paper: Patients’ perspectives about the role of primary healthcare providers in long-term opioid therapy: a qualitative study in Dutch primary care
Available at: https://doi.org/10.3399/BJGP.2023.0547
Previous research has shown the pivotal role of primary healthcare providers in managing long-term opioid use for patients with chronic non-cancer pain. This study adds the patient’s perspective, underscoring the importance of improved communication, medication management, regular assessments, and a patient-centred approach, especially during opioid tapering. Clinicians should prioritise these aspects to enhance patient care and outcomes for patients in chronic non-cancer pain management.
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In this episode, we talk to Juan Carlos Bazo-Alvarez, a Senior Research Fellow within the Department of Primary Care and Population Health at University College London.
Title of paper: Risk of Parkinson’s disease in people with New Onset Anxiety over 50 years - Incidence and Associated Features
Available at: https://doi.org/10.3399/BJGP.2023.0423
Presence of anxiety is known to be increased in the prodrome of Parkinson’s disease (PD). This study investigated the risk of developing PD in people with anxiety compared with those without anxiety, accounting for a number of confounding variables. The results suggest that there is a strong association between anxiety and later diagnosis of PD in patients aged ≥50 years who present with a new diagnosis of anxiety. This provides evidence for anxiety as a prodromal presentation of PD.
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