BJGP Interviews

Today, we're speaking to Dr Cini Bhanu, GP and Academic Clinical Lecturer in the Primary Care and Population Health Department at University College London. Title of paper: Antidepressants and risk of postural hypotension: a self-controlled case series study in UK primary careAvailable at: https://doi.org/10.3399/BJGP.2024.0429Antidepressants are associated with postural hypotension (PH). This is not widely recognised in general practice, where antihypertensives are considered the worst culprits. The present study examined >21 000 older adults and found a striking increased risk of PH with use of all antidepressants (over a four- fold risk with SSRIs) in the first 28 days of initiation. TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.480 - 00:00:56.990Hello and welcome to BJGP Interviews. My name is Nada Khan and I'm one of the associate editors of the bjgp. Thanks for listening to this podcast today.In today's episode, we're speaking to Dr. Cini Banu, who is a GP in an academic clinical lecturer based in the Department of Primary Care and Population Health at University College London.We're here to talk about her recent paper in the BJGP titled Antidepressants and Risk of Postural Hypertension, A Self Controlled Case Series Study in UK Primary Care. So, hi Cinny, it's really nice to meet you today.I guess this is an interesting area to cover, especially as the prescribing rates for some antidepressant medications are increasing.But I don't know what your feeling is, but I'm not sure if many GPs would actually know that antidepressants are associated with poison postural hypertension. So, yeah, talk us through that.Speaker B00:00:57.310 - 00:01:18.350Yeah, so I think that's one of the reasons this study is so important.So definitely from conversations that I've had with gps that I work with and it's not commonly recognized that postural hypotension is associated with antidepressants, though it is by geriatricians, for example, where it's very.Speaker A00:01:18.350 - 00:01:41.850Well recognized and in this study used a big database to look at the risk of new postural hypertension associated with the use of antidepressants in people aged over 60.I guess there's quite a lot of in depth stuff in the methods, but I guess just for a summary for people who are interested in what you did, do you mind just sort of going over it at sort of like a high level?Speaker B00:01:41.850 - 00:02:54.200Yeah, yeah. So we looked at a big database, what we call a routine primary care database called imrd.And essentially this captures data from software that gps use like EMIS and Vision System and captures a whole load of information like problems, symptoms and prescriptions. So we went into this database and identified everyone over the age of 60 that might be eligible during our study period.And for this we looked at people that were contributing at least one full year of data between 2010 and 2018. And then within that we identified people with a first diagnosis of postural hypotension.And then again we made subgroups according to people who had this diagnosis but also had a first prescription of a new antidepressant during that time.And what we were interested in, and the methodology is called a self controlled case series, we weren't interested in who got postural Hypotension, because everyone was a case, but rather...

Today, we're speaking to Dr Jamie Scuffell, GP and NIHR In Practice Fellow at King's College London.Title of paper: Patterns in GP Appointment Systems: a cluster analysis of 3480 English practicesAvailable at: https://doi.org/10.3399/BJGP.2024.0556GP practices in the UK are using a wide range of different appointment systems to meet patient demand and improve access. This cluster analysis of NHS appointment data from 56 million appointments and 3480 English practices demonstrates two predominant models of primary care delivery. ‘Same day' practices tend to fulfil appointments on the same day using GP telephone consultations. ‘Routine care' practices tend to employ non-GP staff members offering face-to-face appointments and longer appointment wait times. ‘Same day' care practices had younger and more urban populations. Episode transcriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.640 - 00:00:54.360Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the bjgp. Thanks for listening to this podcast today. In today's episode, we're speaking to Dr.Jamie Scuffle, who is a GP in South London and an NIHR In Practice Fellow at King's College London. We're here to talk about a really topical issue in his new paper here in the bjgp.The paper is called Paper Patterns in GP Appointment A cluster analysis of 3,480 English practices.So, hi, Jamie, it's really great to meet you and talk about this work, I guess, really just to start, as you point out in this paper, each practice has their own systems and strategies to manage appointment booking. But how do you think that this impacts on access and patient appointment booking in each practice?Speaker B00:00:55.000 - 00:02:17.300Yeah, it's interesting because I think, as you say, appointment systems have developed even further, really, since COVID and we've ended up with this a quite interesting diverse range of implementing appointments across the country, across England at least.And I suppose the things that have changed are, you know, if you phone up a practice now, actually, you might not even phone them up, you might submit an online consult, you might be triaged, you might see not a gp, but a range of other professionals as well. And also it might not be done face to face, it might be done by telephone or online.In fact, there's a new appointment system range of things that have happened across England, and actually there's some evidence that that might relate to access in some ways. So we know lots of people who don't speak English struggle to navigate that system of getting an appointment, for example.And we also know from the qualitative evidence that there's some digital exclusion as well with appointments. So, yeah, so I think there's lots of issues with access and how that relates to appointment systems.And so far what we've done is looked at components of the appointment system and how that then affects access. But what we haven't really done much of is looking at the appointment system as a whole and how that might affect access.Speaker A00:02:18.180 - 00:02:33.200Yeah.So in this study, you wanted to look at patterns of primary care delivery in English GP practices, and you used this Appointments in General Practice data set. Can you tell us just briefly what's available in this data and what you were looking at here?Speaker B00:02:33.360 - 00:03:20.700It's a tremendous data set and I think could be very useful. So...

Today, we're speaking to Dr Steve Bradley, GP and Senior Clinical Lecturer based within the School of Medicine and Population Health at the University of Sheffield.Title of paper: General practice chest X-ray rate is associated with earlier lung cancer diagnosis and reduced all-cause mortality: a retrospective observational studyAvailable at: https://doi.org/10.3399/BJGP.2024.0466It is known that there is wide variation in the use of chest X-ray (CXR) by general practices, but previous studies have provided conflicting evidence as to whether greater utilisation of them leads to lung cancer being diagnosed at an earlier stage and improves survival. This observational study analysed data from the English national cancer registry on CXR rates for individual general practices, along with stage and survival outcomes; it found earlier stage at diagnosis and improved survival for patients diagnosed with cancer at practices that used the test more frequently. Increasing use of CXR by GPs for symptomatic patients, particularly by focusing on practices that use the test infrequently, could improve lung cancer outcomes.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.640 - 00:01:06.820Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors at the Journal. Thanks for taking the time today to listen to this podcast.In today's episode, we're talking to Dr. Steve Bradley. Steve is a GP and senior clinical Lecturer based within the School of Medicine and Population Health at the University of Sheffield.Early diagnosis of cancer has been an area of research that is Steve's real strength. And we're here to discuss his recent paper here in the BJJP titled General Practice.Chest X Ray Rate is Associated with Earlier Lung Cancer Diagnosis and Reduced All Cause Mortality A Retrospective Observational Study. Hi, Steve, Great to speak again and to talk through this paper.I suppose I want to start by saying that, yes, we know that earlier diagnosis of cancer is a good thing because it can lead to earlier stages of diagnosis and treatment. And you start the paper with a short discussion about screening for lung cancer.But talk us through why this, this alone won't solve delays in lung cancer diagnosis and what else we need to be doing.Speaker B00:01:07.540 - 00:02:14.620So, yeah, this context is really important because screening is a hugely important development and the UK has led in many ways on lung cancer screening using low dose ct. And this, we hope is going to be very, very beneficial for patients.But it would be a mistake to think that this is going to solve the problem of lung cancer. And there's a few reasons for that.One is that only about half of people who get lung cancer would have been eligible for screening because screening concentrates on the highest risk population. And also we know that only about half of people who are invited for screening actually choose to participate in screening.So the upshot for general practice really is that most patients are still going to be coming through by symptoms and in the same way.So screening is good news in terms of lung cancer detection, but we still need to do as well as we can in terms of picking these patients up through symptomatic pathways. And actually, this is something we touched on in an editorial for BJGP about a year or 18 months ago, I think.Speaker A00:02:15.020 -...

Today, we're speaking to Professor Martijn Schut, Professor of Translational AI in Laboratory Medicine and Professor Henk CPM van Weert, GP and Emeritus Professor of General Practice, both based at Amsterdam University Medical Center.Title of paper: Artificial intelligence for early detection of lung cancer in GPs' clinical notes: a retrospective observational cohort studyAvailable at: https://doi.org/10.3399/BJGP.2023.0489In most cancers, the prognosis depends substantially on the stage at the start of therapy. Therefore, many methods have been developed to enhance earlier diagnosis, for example, logistic regression models, biomarkers, and electronic-nose technology (exhaled volatile organic compounds). However, as most patients are referred by their GP, who keeps life-long histories of enlisted patients, general practice files might contain hidden information that could be used for earlier case finding. An algorithm was developed to identify patients with lung cancer 4 months earlier, just by analysing their files. Contrary to other methods, all medical information available in general practice was used.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.600 - 00:00:55.370Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the journal. Thanks for taking the time today to listen to this podcast.Today we're speaking to Professor Martin Schutt, who is a professor in translational AI and Laboratory medicine, and Professor Hank Vanwort, GP and Emeritus professor in General Practice, who are both based at Amsterdam University Medical Center. We're here to discuss their paper, which is titled Artificial Intelligence for Early Detection of lung cancer in GP's clinical notes.So, yeah, it's great to see you both here today. And Martin, I'll come to you first.I suppose we know that it's important to try and diagnose cancer early, but could you talk us through what's the potential for artificial intelligence here in terms of identifying cancer earlier based on patient records?Speaker B00:00:55.810 - 00:01:52.220Yeah, that's a very interesting question because the potential kind of like goes hand in hand with the huge amount of interest in AI. And I think there are great opportunities. There are also great challenges.But talking about the opportunities, especially in the context of the article that we wrote, is on the data side. So on the data side, the digitalization of electronic health records gives great opportunities.A lot more is digitalized, and that means that we also, in our case, have access to free text, and that we, with the advent of the large language models, with also new developments in AI, we also have better ways of making use of those data. So those two combined creates a really interesting formula for big opportunities for AI in the general practice and healthcare in general.Speaker A00:01:52.300 - 00:02:05.960And you mentioned access to free text records. So what GPs are typing into the record records?But before we get into the study, can you just briefly describe what is natural language processing and how that can be used in free text records?Speaker B00:02:06.760 - 00:03:10.100So we know that a lot of clinical risk scores, they work with features of patients, so their age and their gender or sex. And. But of course, a lot of information is also written up in unstructured way. And in our case that is...

Today, we're speaking to Dr Afrodita Marcu, a Research Fellow in Cancer Care at the University of Surrey.Title of paper: Symptom appraisal and help- seeking before a cancer diagnosis during pregnancy: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2024.0208There is a gap in current understanding about the experiences of women diagnosed with cancer during or around pregnancy including how they appraise and seek help for cancer-related symptoms. This qualitative study found that women and healthcare professionals often interpreted symptoms through the lens of pregnancy, particularly when symptoms were vague. Health professionals need to ensure full assessment of symptoms, timely referral, and effective safety-netting for these women.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.040 - 00:01:04.650Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjgp. Thanks for listening to this podcast today. In today's episode, we're speaking to Dr.Aphrodite Marcoux, a research fellow in Cancer care at the University of Surrey.We're here to talk about a paper she's recently published here in the bjgp, which is titled Symptom Appraisal and Help Seeking Before a Cancer Diagnosis during Pregnancy, A Qualitative Study. So it's really lovely to meet you, Aphrodita, to talk about your research.And I think this is a really important area and I wanted to get your thoughts on just why this area is so important to research.But I think that most people will probably appreciate that during pregnancy, women's bodies are going through lots of changes, so it can sometimes be difficult to know what's normal and what's not. But talk us through why you wanted to do this study.What are the challenges faced by patients and by doctors around cancer diagnosis in women who are pregnant?Speaker B00:01:05.050 - 00:02:32.190It's an important area to research because the symptoms of pregnancy, the bodily changes that naturally occur during pregnancy, can mask the symptoms of cancer, both for the women experiencing them, but also for the healthcare professionals with whom they come into contact and with whom they share the symptoms.So it's an important area to research from that point of view in terms of understanding the potential causes for delay in receiving a cancer diagnosis.And one of the areas which we discovered was less researched was early diagnosis or timeliness of diagnosis of cancer diagnosis in the context of pregnancy.So we conducted this research because there was a lack of research, especially in the uk, on women's pathway or other pathways to a cancer diagnosis and pregnancy.And we wanted to get a more detailed understanding knowledge of how women make sense of their symptoms during pregnancy, how they seek help and why to whom they present, midwife, gp, other healthcare professionals and how they receive a diagnosis. What is the pathway to a cancer diagnosis and pregnancy?We wanted to get more clarity about that, more detail, and we were also interested to find out whether delays characterize this pathway to a cancer diagnosis in pregnancy, be they patient related delays or healthcare system related delays.Speaker A00:02:32.830 - 00:02:44.750And I guess you've touched on this. So does do we know if there are delays in cancer diagnosis amongst women who are pregnant?So do they tend to have a...

Today, we're speaking to Dr Stephen Gibbons, Consultant Clinical Biochemist at Leeds Teaching Hospitals NHS Trust, and Dr Clare Spencer, GP Partner and Menopause Specialist at the Meanwood Group Practice in Leeds.Title of paper: Optimising testosterone therapy in patients with hypoactive sexual desire disorderAvailable at: https://doi.org/10.3399/bjgp25X741321TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.400 - 00:01:08.824Hello and welcome to BJJP interviews and welcome to our new season of the podcast. Hope you all had a great break over Easter and thanks again for listening to this podcast today.My name is Nada Khan and I'm one of the associate editors of the BJTP. In today's episode, we're speaking to Dr. Stephen Gibbons, consultant clinical biochemist at Leeds Teaching Hospital NHS Trust, and Dr.Claire Spencer, a GP partner and menopause specialist at the Meanwood Group Practice in Leeds. We're here to talk about the recent clinical practice paper published here in the bjgp.The paper is titled Optimizing Testosterone Therapy in Patients with Hypoactive Sexual Desire Disorder. So thanks, Stephen and Claire, for joining me here today.It's great to talk to you about this paper, especially because it's in an area of a lot of interest to patients and clinicians in general practice wondering what to do about testosterone prescribing.I guess I wanted to kick things off, Stephen, really, by asking, what made you start investigating testosterone replacement in patients with hypoactive sexual desire disorder?Speaker B00:01:08.952 - 00:03:09.662So it was actually a conversation with a colleague at work over coffee and she mentioned to me that she'd noted quite a lot of high testosterone in females of a particular age and she was asking why that might be. So I explained it's probably because of TRT in this condition called hsdd, but that was kind of quite anecdotal at that point.So we thought we'd do a clinical audit. So myself and two colleagues, Kia and eloise, we audited 100 patients from Leeds.So we looked at a sample of 100 patients on TRT for HSDD and we audited them against the British Menopause Society guidance, which state that you should do a pre testosterone measurement and then you should check at at six to eight weeks, I believe. And what we found is that actually there was quite poor compliance with the BMS guidance. And at this point we felt a little bit out of our depth.But we thought, well, this is quite alarming. Probably the most alarming thing was the number of patients with a really high testosterone that weren't adequately followed up.So we thought, right, let's bring some clinical experts in at this point. So that's when we got in touch with Dr. Spencer and Dr. Jasim and Dr. Wal Ford, who's also on the paper.She's a consultant endocrinologist at Leeds, and we kind of had a look at the data and we all agreed that, you know, there were significant findings. And the question was why?Because there are quite comprehensive guidance out there from the bms, but I think we all felt that potentially they lacked some of the finer detail. Potentially in some areas they were a little vague. So that's when we came up with these additional recommendations.And they're certainly not supposed to replace the BMS guidance, but it's a supplementary kind of recommendations to support the BMS guidance. So that's where we started, really.Speaker...

Today, we're going to do something a bit different and take a look back at the recent BJGP Research Conference, which was held on the 21st of March 2025 in Manchester. I'm going to discuss some of the highlights and really focus on what the conference is about and how to get involved in the future.Here are some of the links I discussed in the podcast:Linkshttps://journals.sagepub.com/doi/full/10.1177/1609406918797475https://bjgplife.com/write-for-bjgp-life/

Today, we're speaking to Dr Louise Clarke, a GP and researcher based at the University of Nottingham.Title of paper: Barriers to diagnosing and treating vulval lichen sclerosus: a survey studyAvailable at: https://doi.org/10.3399/BJGP.2024.0360Previous research has identified a significant diagnostic delay and misdiagnosis of vulval lichen sclerosus (VLS), a condition most commonly presenting to primary care. Health care professionals (HCPs) in primary care share the concerns of women with VLS citing frequent misdiagnosis, embarrassment and lack of knowledge as barriers to diagnosis. In this survey, 92.6% of HCPs felt further education would be useful with 37.7% never having participated in learning on vulval skin disease, self-directed or otherwise. Key enablers identified to facilitate timely VLS diagnosis and treatment include: a comprehensive education programme for HCPs, implementation of standardised pathways of care and development of a VLS diagnostic criteria to be implemented in primary care workflow.

Today, we're speaking to Dr Victoria Tzortziou Brown, a GP and Reader in Primary Healthcare and Health Policy at Queen Mary University of London, and Vice Chair for External Affairs at the Royal College of General Practitioners.Title of paper: Language of primary medical qualification and differential MRCGP exam attainment: an observational studyAvailable at: https://doi.org/10.3399/BJGP.2024.0296To the authors' knowledge, this is the first study on the association between the language of the primary medical qualification and attainment in the Membership of the Royal College of General Practitioners (MRCGP) examination. It shows that undertaking undergraduate clinical training in a country where the native language is not English can statistically significantly and negatively affect examination performance in MRCGP exams. The study also shows statistically significant positive correlations between Multi- Specialty Recruitment Assessment, International English Language Testing System, and Professional and Linguistic Assessments Board scores and the MRCGP exam scores; this suggests that past performance in these assessments can help with the identification of those international medical graduate registrars who may find tailored support beneficial.

Today, we're speaking to Professor Helen Atherton, Professor of Primary Care Research at the University of Southampton. Title of paper: Supporting patients to use online services in general practice: focused ethnographic case studyAvailable at: https://doi.org/10.3399/BJGP.2024.0137Use of, and access to, online services are increasing within general practice in England. Current approaches to digital facilitation as observed in this study, appeared to be ad hoc and fitted around multiple services. Reception staff were key to supporting patients to use these platforms, but training, resources and support for such staff were not readily available. Enabling patients to have the best chance of using online services requires vision, strategy and investment of time and money. As practices and patients increasingly use online approaches to healthcare provision, practices should be mindful of patient groups who may find accessing services online to be a challenge and who thus require targeted help and support.

Today, we're speaking to Dr Sam Merriel, a GP, and NIHR Academic Clinical Lecturer in General Practice based at the University of Manchester.Title of paper: Factors affecting prostate cancer detection through asymptomatic PSA testing in primary care in England: Evidence from the 2018 National Cancer Diagnosis AuditAvailable at: https://doi.org/10.3399/BJGP.2024.0376Asymptomatic, informed choice prostate specific antigen (PSA) testing occurs in primary care in the UK in the absence of a national prostate cancer screening programme. This study shows that four fifths of prostate cancers are diagnosed following symptomatic presentation rather than from asymptomatic PSA testing. There is a 13-fold variation in asymptomatic PSA test detected prostate cancer between English GP practices, without clear explanatory practice-level factors. Patient factors amongst men diagnosed with prostate cancer, including ethnicity, age, deprivation, and multi-morbidity, have a significant impact on the likelihood of being diagnosed following asymptomatic PSA testing.

Today, we're speaking to Dr Pete Edwards, a GP and NIHR Research Fellow based at the University of Bristol. Pete has published a research article in the February issue of the BJGP titled,' Safety-netting advice documentation in out-of-hours primary care: a retrospective cohort from 2013 to 2020' along with an editorial about safety netting that we're going to discuss today.Title of paper: Safety-netting advice documentation in out-of-hours primary care: a retrospective cohort from 2013 to 2020Available at: https://doi.org/10.3399/BJGP.2024.0057Title of editorial: Safety netting in primary care : managing the low incidence, high uncertainty of severe illnessAvailable at: https://doi.org/10.3399/bjgp25X740529Previous research has reported on safety-netting advice (SNA) documented in patient records during in-hours practice but this, to the authors' knowledge, is the first large-scale (>1000 consultations) longitudinal analysis of the type of safety-netting documented advice during out-of-hours (OOH) primary care. This study demonstrated an increasing frequency of documented SNA in OOH records and increasing utility of specific advice over time. In contrast to previous reports of verbalised safety-netting during in-hours practice, this study found a higher frequency of SNA in records from face-to-face compared with telephone encounters. This study also showed safety-netting advice was more likely to be documented for patients with possible infections, but less frequently for mental health consultations. That is a possible area for improvement, in line with current UK policy for ‘parity of esteem' between physical and mental health conditions.

Today, we're speaking to Professor Anne Slowther, Emeritus Professor of Clinical Ethics based at the University of Warwick.Title of paper: Experiences of using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in English general practice: a qualitative study among key primary health and social care professionals, patients, and their relativesAvailable at: https://doi.org/10.3399/BJGP.2024.0248The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a specific model of emergency care treatment planning now used in primary care and hospitals, and in many areas of the UK. It has been evaluated in hospital settings, but little is known about how it is understood and operationalised in general practice. Our research found a consensus that ReSPECT could facilitate a person-centred approach to future treatment decision making, but there are specific challenges in implementing ReSPECT in a community setting. A revised approach needs to consider uncertainty of illness trajectories over time and to emphasise patient values to facilitate decision making in an emergency.

In this episode, we talk to Professor Paul Little, Professor in Primary Care Research at the University of Southampton.Title of paper: A randomised controlled trial of a digital intervention (Renewed) to support symptom management, wellbeing and quality of life in cancer survivorsAvailable at: https://doi.org/10.3399/BJGP.2023.0262There are increasing numbers of cancer survivors who have finished their primary treatment whose quality of life remains consistently poor over years. There is limited robust evidence for pragmatic, brief interventions to support cancer survivors in primary care - which is where most participants are managed, and where resources are increasingly stretched. Cancer survivors quality of life improved with detailed generic online support. Robustly developed bespoke digital support provided limited additional benefit for cancer survivors in the short term, but modest additional longer term benefit in enabling symptom management and self-rated health, and with significantly reduced costs to the health service.

It's that time of the year again! This episode, we have a round table discussion with the editorial team of Sam Merriel, Tom Round and Nada Khan. This collection of the BJGP's top 10 research most read and published in 2024 brings together high-profile primary care research and clinical innovation.And here are the top 10 most read papers of 2024:10. Patient experiences of an online consultation system: a qualitative study in English primary care post-COVID-19Available at: https://doi.org/10.3399/BJGP.2023.00769. Does shortage of GPs matter? A cross-sectional study of practice population life expectancyAvailable at: https://doi.org/10.3399/BJGP.2023.01958. Primary care provision for young people with ADHD: a multi-perspective qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2023.06267. Breast cancer risk assessment for prescription of Menopausal Hormone Therapy in women who have a family history of breast cancerAvailable at: https://doi.org/10.3399/BJGP.2023.03276. Training needs for staff providing remote services in general practice: a mixed-methods studyAvailable at: https://doi.org/10.3399/BJGP.2023.02515. Long-term cardiovascular risks and the impact of statin treatment on socioeconomic inequalities: a microsimulation modelAvailable at: https://doi.org/10.3399/BJGP.2023.01984. Exploring GPs views on beta-blocker prescribing for people with anxiety disorders: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2024.00913. Optimising the use of the prostate- specific antigen blood test in asymptomatic men for early prostate cancer detection in primary care: report from a UK clinical consensusAvailable at: https://doi.org/10.3399/BJGP.2023.05862. First Contact Physiotherapy: An evaluation of clinical effectiveness and costsAvailable at: https://doi.org/10.3399/BJGP.2023.05601. Risk of Parkinsons disease in people with New Onset Anxiety over 50 years - Incidence and Associated FeaturesAvailable at: https://doi.org/10.3399/BJGP.2023.0423

The BJGP podcast is back for a new season! Today, we're speaking to Professor Joanne Reeve, who is a GP and Professor of Primary Care Research at Hull York Medical School. Joanne has published an editorial in the recent January edition of the BJGP titled, ‘Standing up for general practice', and today we're going to speak about this article and what it means to be a GP. Title of paper: Standing up for general practiceAvailable at: https://doi.org/10.3399/bjgp25X740373

We're taking a break over Christmas and new year, but we'll be back at the end of January 2025 with a new BJGP podcast. Look forward to seeing you then!

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 studyAvailable at: https://doi.org/10.3399/BJGP.2024.0184Quality 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.

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' experiencesAvailable at: https://doi.org/10.3399/BJGP.2024.0167GPs 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.

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 literatureAvailable at: https://doi.org/10.3399/BJGP.2024.0033Dominant 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.

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 careAvailable at: https://doi.org/10.3399/BJGP.2024.0017This 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.

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 symptomsAvailable at: https://doi.org/10.3399/BJGP.2023.0683It 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.

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 studyAvailable at: https://doi.org/10.3399/BJGP.2023.0638The 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.

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.2023.0631People 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.

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 studyAvailable at: https://doi.org/10.3399/BJGP.2023.0637During 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.

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 studyAvailable at: https://doi.org/10.3399/BJGP.2024.0091Beta-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.

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 modelAvailable at: https://doi.org/10.3399/BJGP.2023.0350Unplanned 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.

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 careAvailable at: https://doi.org/10.3399/BJGP.2023.0634The 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.

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 studyAvailable at: https://doi.org/10.3399/BJGP.2023.0558Early 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.

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 healthAvailable at: https://doi.org/10.3399/BJGP.2024.0024Significant 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.

We're taking a summer break but will be back with our BJGP interview podcast on Tuesday 3 September.

We're taking a summer break but will be back with our BJGP interview podcast on Tuesday 3 September.

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 studyAvailable at: https://doi.org/10.3399/BJGP.2023.0327Prospective 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.

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 studyAvailable at: https://doi.org/10.3399/BJGP.2023.0432General 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.

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 workersAvailable at: https://doi.org/10.3399/BJGP.2023.0602Social 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.

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 careAvailable at: https://doi.org/10.3399/BJGP.2023.0547Previous 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.

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 FeaturesAvailable at: https://doi.org/10.3399/BJGP.2023.0423Presence 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.

In this episode, we talk to Dr Meena Rafiq, Academic GP and Clinical Research Fellow within the Institute of Epidemiology and Health at University of Melbourne. Title of paper: Clinical activity in general practice before sarcoma diagnosis: an Australian cohort studyAvailable at: https://doi.org/10.3399/BJGP.2023.0610Sarcoma is challenging to diagnose with delays associated with poor patient outcomes and experiences. This study has shown that patients with sarcoma often have multiple GP visits and imaging requests in the year before their diagnosis. Clinical activity in general practice increases from 6 months before sarcoma diagnosis, primarily in the form of imaging requests, indicating that opportunities for a timelier diagnosis may exist in some patients. Primary care interventions to increase awareness of sarcoma symptoms and streamline diagnostic pathways, including promoting and clarifying guidelines to optimise the use of appropriate imaging and direct specialist centre referrals, could improve earlier diagnosis and patient outcomes.

In this episode, we talk to Dr Abi Eccles, Assistant Professor within Warwick Applied Health at Warwick Medical School. Title of paper: The GP's role in supporting women with anal incontinence after childbirth injuryAvailable at: https://doi.org/10.3399/BJGP.2023.0356Anal incontinence after childbirth injury has profound impacts on women's lives and many find they cannot access healthcare and support. GPs can play a crucial role, but we know that very few women speak to their GPs about their symptoms. In combining GPs' and women's views, we show how anal incontinence after childbirth injury is often missed in a primary care setting. Drawing on these findings, we highlight the key ways GPs can provide support for such womenClick here for the RCGP course on anal incontinence after childbirth.

In this episode, we talk to Dr Ed Tyrell, a GP and Clinical Assistant Professor within the Faculty of Medicine and Health Sciences at the University of Nottingham. Title of paper: Primary care consultation patterns before suicide: a nationally representative case–control studyAvailable at: https://doi.org/10.3399/BJGP.2023.0509Although increased primary care utilisation in the preceding year has been linked with death by suicide, longer-term consulting patterns and primary care-recorded reasons for consulting have not been previously examined. This large, nationally representative sample from England showed rates of consulting among patients who died by suicide continuously rose in the 5 years before suicide, especially in the last 3 months. Suicide risk was significantly increased among those who consulted more than once every month in the final year, irrespective of any sociodemographic characteristics and irrespective of the presence (or absence) of known psychiatric comorbidities. Common reasons why patients who died by suicide consulted before their death included medication review, depression, and pain.

In this episode, we talk to Carina Benthin, a psychologist and PhD student based at Helmut-Schmidt University. Title of paper: What helps and what hinders antidepressant discontinuation? Qualitative analysis of patients' experiences and expectationsAvailable at: https://doi.org/10.3399/BJGP.2023.0020Long-term antidepressant use is increasing, including among those patients who may consider discontinuation. In this study, patients with remitted major depressive disorder and long-term antidepressant use reported negative expectations about discontinuation. These expectations were partly shaped by their previous negative experiences, which persisted despite a wish to stop antidepressants, and hindered discontinuation. The findings of this study highlight patients' need for information about treatment discontinuation, and professional support and structure throughout discontinuation, while taking into account their individual expectations and previous experiences.

In this episode, we talk to Dr Adam Geraghty, Associate Professor of Psychology and Behavioural Medicine within the School of Primary Care, Population Sciences and Medical Education at the University of Southampton. Title of paper: Distinguishing emotional distress from mental disorder: A qualitative exploration of the Four-Dimensional Symptom Questionnaire (4DSQ)Available at: https://doi.org/10.3399/BJGP.2023.0574A range of different approaches have been suggested to support primary care clinicians in the identification and management of mental health problems, from brief depression questionnaires, to approaches focusing on shared understanding within consultations. The Four-Dimensional Symptom Questionnaire (4DSQ) is a questionnaire developed in primary care that can support this process by distinguishing general distress from depressive or anxiety disorder. In this study we show that people recruited from primary care and community settings find completing a multidimensional questionnaire acceptable and find the splitting of general (potentially severe) distress from depression and anxiety helpful. Use of the 4DSQ may support collaborative diagnostic conversations as part of primary care consultations.

In this episode, we're going to recognise some exceptional researchers here in the UK. We talk to Dr Ben Bowers and Dr Steve Bradley, this year's winners of the Royal College of GPs and Society for Academic Primary Care early career researcher award. For more information about the award, see below two interviews with Ben and Steve on the RCGP website:Dr Ben Bowers: https://www.rcgp.org.uk/Blog/SAPC-OECR-Awards-2024-Ben-BowersDr Steve Bradley: https://www.rcgp.org.uk/Blog/SAPC-OECR-Awards-2024-Stephen-BradleyCongratulations to Ben and Steve!

In this episode, we talk to Dr Erin Oldenhof, Research Coordinator and a benzodiazepine withdrawal counsellor at Reconnexion, a non-profit organisation that offers teratmenta nd support for insomnia, depression and anxiety. We're also joined by Dr Petra Staiger, Associate Professor within the School of Psychology at Deakin University in Melbourne. Title of paper: “Let's talk about sleep health”: Patient perspectives on willingness to engage in psychological interventions for insomniaAvailable at: https://doi.org/10.3399/BJGP.2023.0310Psychological interventions for insomnia are recommended as the first-line treatment but remain underutilised in primary care settings relative to pharmacological treatments. Coupled with known harms regarding prolonged use of benzodiazepine receptor agonists (BZRAs) to manage insomnia, the need for increased uptake of psychological interventions is critical. This study explored the influence of key factors that motivate individuals' intention to engage with psychological interventions, revealing the importance of active involvement of GPs in this process from the initial consultation through to supporting treatment adherence long-term. By understanding the consumer perspective in conjunction with the unique clinical expertise of GPs, we have offered guidance on how to enhance patient-practitioner collaboration across the entire treatment process and increase GP confidence to facilitate increased engagement with evidence-based psychological treatment modalities.

In this episode, we talk to Dr Erica di Martino, a Research Fellow based within the School of Medicine at the University of Leeds.Title of paper: Understanding General Practitioners' referral decisions for younger patients with symptoms of cancer: a qualitative interview studyAvailable at: https://doi.org/10.3399/BJGP.2023.0304Some cancers are becoming more common in younger people, yet clinical guidelines often recommend urgent referral for suspected cancer only if patients are above a certain age. Findings from this study show that, whilst most GPs interpret age criteria in cancer guidelines flexibly, some perceive and apply them as firm directives. In addition, system constraints may create unwarranted rigidity and act as barriers to prompt investigation. More in-built and explicit flexibility in the referral system is required to facilitate timely diagnosis of younger patients perceived as at higher risk by their GP.

In this episode, we talk to Becky Gudka, a Graduate Research Assistant based at the University of Exeter, about a study she's published here in the BJGP titled, ‘Primary care provision for young people with ADHD: A multi-perspective qualitative study'. We're also joined by her study co-author, Dr Anna Price, a Senior Research Fellow also at the University of Exeter who is the study principle investigator and senior author who led this research. Title of paper: Primary care provision for young people with ADHD: A multi-perspective qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2023.0626Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder, with negative consequences for individuals and their communities. Research indicates a current “failure of healthcare” for people with ADHD in England, but previous recommendations to improve support for ADHD in primary care lack feasible and practical recommendations for health professionals. This study highlights individual-, practice- and system-level barriers to accessing support for ADHD via primary care and provides suggestions for how to overcome these barriers from the perspectives of multiple stakeholders. Health professionals and people with lived experience provided data which points to the standardisation of ADHD provision, providing additional information and support for clinicians, and better utilisation of reasonable adjustments for patients with ADHD in general practice.

In this episode, we're taking a slightly different slant to talk to Dr Mark Levy, a GP based in London who led the National Review of Asthma Deaths and is a member of the Dissemination Working Group of the Global Initiative for Asthma (GINA). We're talking to Mark as part of acknowledging World Asthma Day, which this year falls on 7 of May. Title of paper: Asthma deaths in children in the UK: the last strawAvailable at: https://doi.org/10.3399/bjgp24X738201Mark's website is also available here: https://bigcatdoc.com/ with additional resources and links to his own podcast.

In this episode, we talk to Dr Lynsey Warwick-Giles, a Research Associate based within the Centre for Primary Care and Health Services Research at the University of Manchester. Title of paper: Can Primary Care Networks contribute to the national goal of reducing health inequalities? A mixed method studyAvailable at: https://doi.org/10.3399/BJGP.2023.0258Primary Care Networks are an important policy development in English primary care, with an additional contract supporting practices to work collaboratively. Policy makers intend that they will tackle local health inequalities. Our research suggests that there is potential for them to achieve this, but it will require: continued weighting of funding formulas to account for deprivation; redistribution of funds and other resources internally to support the most deprived practices; managerial support, particularly for PCNs with deprived populations; and realistic and achievable targets for PCN action.

In this episode, we talk to Dr Sahar Pahlavanyali, a doctor and PhD candidate based at the Department of Global Public Health and Primary Care at the University of Bergen in Norway. Title of paper: Continuity and breaches in GP care and their associations with mortality for patients with chronic disease: an observational study using Norwegian registry dataAvailable at: https://doi.org/10.3399/BJGP.2023.0211There is a growing body of evidence on advantages of continuity, and a GP personal list is believed to be one of the positive measures to improve continuity, though not much researched. In a Norwegian setting with GP personal lists, we investigated the associations between GP continuity and mortality for patients with different chronic diseases. Our results showed that lower GP continuity was associated with increased risk of death, but the association was not significantly different for patients with the same RGP compared with those with different RGPs. This study suggests that high informational and management continuity provided by a GP personal list might lower and compensate for the adverse effects when changing GP.

In this episode, we talk to Dr Zoe Anchors, a Research Fellow based at the Centre for Health and Clinical Research at the University of the West of England. Title of paper: A qualitative investigation of the Additional Roles Reimbursement Scheme in primary care'Available at: https://doi.org/10.3399/BJGP.2023.0433The government has delivered on its commitment of recruiting 26,000 more primary care professionals through the ARRS in order to reduce patient waiting lists, widen the range of healthcare services and meet the needs of local populations. This qualitative analysis supports the positive impact of these additional roles in broadening the healthcare available to patients, and finds similar challenges (i.e., lack of career progression and supervision; lack of understanding of role descriptions and scope creep; problematic roadmaps; and poor integration) to implementation previously identified. However, our data reveals the scheme's inflexibility and lack of available workforce particularly impacted Primary Care Networks in deprived areas resulting in the potential exacerbation of health inequalities, with the needs of populations not necessarily being met. More flexibility needs to be provided about who and what is funded under the scheme, with particular focus in areas of higher deprivation.

In this episode, we talk to Dr Lucy Potter, a GP and a doctoral research fellow based at the Centre for Academic Primary Care at the University of Bristol.Title of paper: Improving access to general practice for and with people with severe and multiple disadvantageAvailable at: https://doi.org/10.3399/BJGP.2023.0244This study builds on previous work showing that continuity of care, being able to develop a trusting relationship and being proactive are of particular importance in providing care to highly people with SMD(3-7). This work describes co-designed strategies including prioritising patients on an inclusion patient list with more flexible access, continuity from a care coordinator and micro-team, and an information sharing tool, in addition to rich contextual information on how to shift ways of working to achieve this. These co-designed strategies are practical examples of proportionate universalism in general practice, where resources are prioritised to those most in need. They could be adapted and piloted in other practices and areas and may also offer promise in improving inclusion of other marginalised groups. Investing in this focused way of working may improve healthcare accessibility, health equity and staff wellbeing.