BJGP Interviews

In this episode we talk to Dr Anita Lim who is a Senior Research Fellow, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King’s College London. Paper: Non-speculum clinician-taken samples for HPV testing: a cross sectional study in older women ( use is a significant barrier to cervical screening and can become particularly uncomfortable after the menopause. Self-sampling is an obvious solution but does not appeal to all women. Having a doctor or nurse take a sample without a speculum is another possibility but the test performance has not yet been examined. We found HPV testing on non-speculum clinician-taken samples to have comparable test performance to self-sampling, representing a promising new approach for cervical screening.

In this episode we talk to Dr Sarah Price who is a research fellow at the University of Exeter Medical School. Paper: Intra-abdominal cancer risk with abdominal pain: a prospective cohort primary care study ( pain is a non-specific symptom, which may portend serious disease, including intra-abdominal cancers. There is no unified pathway for investigation. This paper reports the 1-year cumulative incidence risk of intra-abdominal cancer with or without concurrent clinical features for men and women aged 40–59, 60–69 and ≥70 years. Results show that patient demographics and type of concurrent feature effects the cancer risk. These results will inform appropriate testing strategies and specialist referral.

In this episode we talk to Dr Yin Zhou who is a GP and Clinical Research Fellow at the Primary Care Unit, Department of Public Health and Primary Care, at the University of Cambridge. Paper: Pre-diagnostic clinical features and blood tests in patients with colorectal cancer: a retrospective linked data study ( pre-diagnostic patterns of relevant clinical features and abnormal blood test results in patients with colon and rectal cancer could elucidate windows of opportunity during which more timely investigations and referrals could be performed, and earlier diagnosis of cancer could be achieved. We found that consultation rates increased in the year leading up to diagnosis for relevant clinical features such as low haemoglobin, rectal bleeding and change in bowel habits, as well as non-specific blood tests, from as early as 9-10 months before diagnosis. Our findings suggest that potential opportunities for more timely use of cancer investigations or referral exist, and could improve diagnostic pathways, expediting diagnosis and treatment for some patients with colorectal cancer.

In this episode we talk to Dr Kimberley Foley who is a Research Associate at the Department of Primary Care and Public Health, Imperial College London. Paper: Impact of Covid-19 on primary care contacts with children and young people aged 0-24 years in England; longitudinal trends study 2015-2020 ( Covid-19 pandemic response led to health system reorganisation globally, but its impact on children and young people’s access to primary care is largely unknown. Children and young people’s health contacts with general practitioners (GPs) fell by 41%, equivalent to 2.8 million fewer contacts in England, during the first Covid-19 pandemic lockdown from March to June 2020 compared with the previous 5 years. Face-to-face contacts with GPs fell by 88% with a corresponding increase in remote contacts. The greatest falls in face-to-face contacts occurred among children aged 1-14 (> 90%). Remote contacts with infants and with young people aged 15-24 years more than doubled, mitigating some of the total falls in these age groups. GP contacts for respiratory illnesses fell 74% during lockdown compared with previous years, while contacts for common non-transmissible conditions (urinary tract infections, appendicitis, diabetes, and epilepsy) had a lesser fall at 31%.

In this episode we talk to Dr Rohini Mathur who is an associate professor of epidemiology at the London School of Hygiene and Tropical Medicine and Dr Sally Hull who is a GP and a member of the Clinical Effectiveness Group at QMUL. Paper: Characterisation of type 2 diabetes subgroups and their association with ethnicity and clinical outcomes: a UK real-world data study using the East London Database ( studies of predominantly White European populations have identified four type 2 diabetes subgroups. In the UK the clinical measures necessary to replicate these subgroups are only available in secondary care data, limiting their usefulness for diabetes management in primary care settings. The current study demonstrated how clinically meaningful type 2 diabetes subgroups can be pragmatically generated using real-world primary care data. Furthermore, it highlighted important differences between type 2 diabetes subgroups with respect to vascular outcomes, treatment initiation, and glycated haemoglobin control. Diabetes subgroups are a useful heuristic for assisting decision making by clinicians that, in turn, can lead to a more personalised design of diabetes care focused on more intensive management of subgroups most at risk of complications, such as those with severe hyperglycaemia at time of diagnosis.

In this episode we talk to Dr David Whiteley who is a lecturer at the Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University. Paper: Developing a primary care-initiated hepatitis C treatment pathway in Scotland: A qualitative study ( GPs were rarely involved in the treatment of HCV, their role more commonly restricted to viral testing and diagnosis. Contemporary drug therapy for HCV has allowed reconsideration of this status quo, and offers potential for GPs to initiate HCV treatment in primary care. This study provides a way forward, detailing a practicable theory-informed pathway and recommendations for primary care-initiated HCV treatment in the UK.

In this episode we talk to Amy Clark who is a final year medical student at Cardiff and Dr Kathryn Hughes who is a GP and senior clinical lecturer at PRIME Centre Wales at the School of Medicine at Cardiff University. Paper: Accuracy of the NICE traffic light system in children presenting to general practice: a retrospective cohort study ( National Institute for Health and Care Excellence (NICE) traffic light system is widely used in general practice for the assessment of unwell children; however, the majority of previous studies validating this tool have been conducted in secondary care settings. To that authors’ knowledge, no studies have validated this tool within UK general practice. This study found that the traffic light system cannot accurately detect or exclude serious illness in children presenting to UK general practice with an acute illness. The conclusion reached was that it cannot be relied on by clinicians for the assessment of acutely unwell children and that it is unsuitable for use as a clinical decision tool.

In this episode we talk to Dr Jon Gibson who is a research fellow at the School of Health Sciences at the University of Manchester. Paper: Primary care workforce composition and population, professional, and system outcomes: a retrospective cross-sectional analysis ( increasing number of staff from diverse healthcare backgrounds is changing the general practice workforce in England. These changes provide a new opportunity to investigate whether, and how, workforce composition may be associated with outcomes. This analysis indicated that professional, population, and system outcomes show a variety of associations with primary care workforce composition. The findings demonstrated that different types of health professionals are not substitutes for each other, and the quantity and quality of primary care services delivered will depend on who is employed to work in this setting.

In this episode we speak to Professor Chris Butler who is a GP and professor of primary care at the Nuffield Department of Primary Care Health Science at the University of Oxford. He is also Co-Chief Investigator for the PRINCIPLE trial and the PANORAMIC trial. Paper: Colchicine for COVID-19 in the community (PRINCIPLE): a randomised, controlled, adaptive platform trial ( has been proposed as treatment for COVID-19 due to its anti-inflammatory properties, but evidence to support its use is inconclusive, and its effect on time to recovery in the community has not been evaluated. The RECOVERY trial found no benefit with colchicine use among people hospitalised with COVID-19, while the COLCORONA trial found some evidence of a 1.1% and 1.4% absolute reduction in hospitalisations/deaths among adults with suspected or confirmed COVID-19 in the community respectively. In this national, platform adaptive randomised controlled trial, we found evidence of no meaningful benefit with colchicine on time to recovery, and because the threshold for futility on time to recovery was met, randomisation to colchicine was stopped before collecting substantial data on hospitalisations and death, leading to imprecise estimates for that outcome. Our findings add to the evidence currently available and suggest that colchicine should not be recommended for treating symptoms of COVID-19.

In this episode we speak to Dr Charlotte Archer who is senior research associate in primary care mental health at Bristol Medical School at the University of Bristol. Paper: Rise in prescribing for anxiety in UK primary care between 2003 and 2018: a population-based cohort study using Clinical Practice Research Datalink ( studies have found substantial increases in the prescribing of antidepressants for any indication, and for depression, over the past two decades. The current study found increases in incident prescribing for anxiety in most anxiolytic drug classes, and an increase in the number of new patients starting treatment is more likely to explain the overall increase rather than increases in long-term use. Increases in prescribing were most notable in young adults, with a marked rise in benzodiazepine prescriptions for this group. Increases in incident prescribing may reflect better detection of anxiety or an earlier unmet need; however, some of this prescribing is not based on robust evidence of effectiveness, some may contradict guidelines, and there is limited evidence on the overall impact associated with taking antidepressants long term, and therefore, there may be unintended harm.

In this episode we talk to Dr Laura Jefferson who is a Research Fellow at the Department of Health Sciences at the University of York. Paper: General practitioner wellbeing during the COVID-19 pandemic: A systematic review. ( GPs have reported stress and burnout over recent years, which is potentially damaging not just to doctors themselves, but also to patients and healthcare systems. The coronavirus pandemic has presented new challenges and there is a need to evaluate the impact on GP wellbeing. This review synthesises the international evidence base exploring primary care doctors’ psychological wellbeing during the pandemic. Studies have highlighted multiple sources of stress during this time and reported experiences of stress, burnout, anxiety, depression, fear of COVID, reduced job satisfaction and physical symptoms. Gender and age differences may warrant further research to identify interventions targeted to the needs of specific groups.

In this episode we interview Dr Austin O'Carroll who is a GP based in Dublin and founder of Safetynet Ireland and North Dublin City GP Training, and co-founder GPCareForAll. Paper: The Triple F**k Syndrome: How medicine contributes to the systemic oppression of people born into poverty Link to article: ( argues that the label of personality disorder is inappropriate and harmful to patients who have suffered adverse social environments in childhood. By simultaneously ignoring social causation and denying the possibility of therapy the diagnosis perpetrates a systematic injustice against those who are labelled.

In this episode we talk to Dr Simon Fraser who is an associate professor of public health at the School of Primary Care at the University of Southampton. Paper: Persistently normal blood tests in patients taking methotrexate for RA or azathioprine for IBD: a retrospective cohort study ( guidance from the National Institute for Health and Care Excellence recommends 3-monthly blood-tests for the ongoing safety monitoring of conventional synthetic disease-modifying anti-rheumatic drugs, but questions have been raised about the need for this testing frequency. Using 2 years’ data from a large primary care database, this study found that persistent normality of blood-test results was common and abnormalities were dominated by reduced renal function among older people, with relatively few hepatic or haematological abnormalities. Greater stratification of monitoring may reduce workload and costs for patients and health services, but more evidence is required on the long-term safety, acceptability, and cost-effectiveness of changing current practice. BJGP research on optimising primary care research dissemination: an online surveyERGO number: 70228.A1 We would like to find out how often practising GPs and GP trainees access primary care research (in any form), and how we could improve its dissemination. We are very much interested in the views of those who don't access research regularly, as well as those who do. We would therefore be very grateful if you could consider completing a short online survey which will take less than 5 minutes to complete. If you are willing to participate, please access the survey via this link: (

In this episode we talk to Professor Trisha Greenhalgh from the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Paper: Why do GPs rarely do video consultations? A qualitative study in UK general practice ( pandemic provided strong impetus to extend remote consultation services in general practice, but video remains infrequently used. This study used in-depth case study methods to explore the multiple interacting influences on the non-adoption and abandonment of video consulting in general practice. Telephone was considered adequate for most remote consultations; the need for a hands-on physical examination explained why video rarely replaced in-person assessment in the remainder.

In this episode we talk to Dr Christo Karuna who is a Senior Lecturer at Monash University, Australia. Paper: Prevalence of burnout among general practitioners: a systematic review & meta-analysis ( burnout is widely recognised as a problem in health care. However, no study has been conducted on the global burden of this condition. The systematic review and meta-analysis conducted in this study show that moderate to high levels of burnout exist worldwide. However, a challenge to policy makers is the wide variation in burnout estimates across studies and countries documented in this review. The findings from this review highlight that the context within which GPs work should be considered in better understanding GP burnout.

In this episode we talk to Mr Ashu Gandhi who is a consultant surgeon from Wythenshawe Hospital in Manchester and an honorary senior lecturer at the Manchester Breast Centre at the University of Manchester. Paper: No association between breast pain and breast cancer: A prospective cohort study of 10,830 symptomatic women presenting to a breast cancer diagnostic clinic ( with breast pain are often anxious that this symptom may represent an underlying breast malignancy and are consequently referred to secondary care to exclude this diagnosis. This study shows that the incidence of breast cancer in women with breast pain alone (no associated symptoms such as breast lumps or nipple discharge) is 0.4%, a figure similar to that seen in asymptomatic women invited for breast screening. Economic analysis confirms that referral of women with breast pain alone to secondary care diagnostic clinics is associated with increased cost but no additional health benefits. Women with breast pain should be reassured that they are at no greater risk of breast cancer than asymptomatic women.

In this episode we talk to Dr Hassan Awan who is a GP and Wellcome Doctoral Fellow at the School of Medicine, Keele University. Paper: Emotional distress, anxiety and depression in South Asians with long-term conditions: a qualitative systematic review ( health is reported to be poorer among people with long-term conditions (LTCs) and people of South Asian origin, but little is known about their experiences. This research adds that people of South Asian origin with long-term conditions describe emotional distress using non-medical terminology, even when describing suicidality. This may be related to their cultural understanding of the world. We highlight the importance of cultural competence to prevent clinicians from being viewed as not understanding the patient, and irrelevant as a means of support.

In this episode we talk to Dr Joāo Delgado who is a lecturer in Epidemiology and Public Health, College of Medicine and Health at the University of Exeter. Paper: Continuity of general practitioner care for patients with dementia: impact on prescribing and the health of patients ( is limited about the potential positive effects of higher continuity of general practice care (CGPC) in patients with dementia. There is no cure for dementia, so finding elements of care that make a difference to patients remains a priority. Patients with dementia in the highest CGPC quartile were 34.8% less likely to develop delirium, 57.9% less likely to develop incontinence, and 9.7% less likely to have an emergency admission to hospital, compared with the lowest quartile. Higher continuity of care was also associated with lower medication burden and fewer potential inappropriate prescriptions.

In this episode we talk to Professor Jeremy Horwood who is a professor of social sciences and applied health research at NIHR ARC West, and the Centre for Academic Primary Care, at the University of Bristol. Paper: Unintended consequences of online consultations: a qualitative study in UK primary care ( studies have shown that online consultations may be best for straightforward transactions such as simple and administrative queries, but do not necessarily deliver improvements in access to care or practice efficiency. This qualitative study identified unintended consequences of a range of online consultation tools that negatively impacted patients’ ability to communicate effectively with a GP, access to care, practice workload, and staff satisfaction. These consequences were often operational challenges that could be foreseen and prevented; however, the tools also had consequences that favoured simple, remote transactions and a shift away from holistic face-to-face care.

In this episode we talk to Dr Gail Hayward who is a GP and Associate Professor of Primary Care at the Nuffield Department of Primary Care Health Sciences, University of Oxford. Paper: Urine collection devices to reduce contamination in urine samples for diagnosis of uncomplicated UTI: a single-blind randomised controlled trial in primary care ( trial is the first to evaluate the effectiveness of urine collection devices in the population of most relevance: women with symptoms of UTI presenting to primary care. Neither device tested reduced sample contamination when used by women presenting to primary care with symptoms attributable to uncomplicated UTI. Since there are no other studies in this population, their use cannot be recommended for this purpose in this setting.