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.