PODCAST

BJGP Interviews

The British Journal of General Practice

Listen to BJGP Interviews for the latest updates on primary care and general practice research. Hear from researchers and clinicians who will update and guide you to the best practice. We all want to deliver better care to patients and improve health through better research and its translation into practice and policy. The BJGP is a leading international journal of primary care with the aim to serve the primary care community. Whether you are a general practitioner or a nurse, a researcher, we publish a full range of research studies from RCTs to the best qualitative literature on primary care. In addition, we publish editorials, articles on the clinical practice, and in-depth analysis of the topics that matter. We are inclusive and determined to serve the primary care community. BJGP Interviews brings all these articles to you through conversations with world-leading experts. The BJGP is the journal of the UK's Royal College of General Practitioners (RCGP). The RCGP grant full editorial independence to the BJGP and the views published in the BJGP do not necessarily represent those of the College. For all the latest research, editorials and clinical practice articles visit BJGP.org (https://www.bjgp.org). If you want all the podcast shownotes plus the latest comment and opinion on primary care and general practice then visit BJGP Life (https://www.bjgplife.com).
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The NICE traffic light system to assess sick children is not suitable for use as a clinical tool in general practice
The NICE traffic light system to assess sick children is not suitable for use as a clinical tool in general practice
2d ago
15 mins
The NICE traffic light system to assess sick children is not suitable for use as a clinical tool in general practice
The NICE traffic light system to assess sick children is not suitable for use as a clinical tool in general practice
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 https://doi.org/10.3399/BJGP.2021.0633 (https://doi.org/10.3399/BJGP.2021.0633) The 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.
2d ago
15 mins
The GP workforce crisis - how are outcomes associated with different professionals?
The GP workforce crisis - how are outcomes associated with different professionals?
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 https://doi.org/10.3399/BJGP.2021.0593 (https://doi.org/10.3399/BJGP.2021.0593) The 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.
03-05-2022
12 mins
PRINCIPLE trial findings on the use of colchicine for COVID-19 in the community
PRINCIPLE trial findings on the use of colchicine for COVID-19 in the community
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 https://doi.org/10.3399/BJGP.2022.0083 (https://doi.org/10.3399/BJGP.2022.0083) Colchicine 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.
26-04-2022
13 mins
The rise in prescribing for anxiety in primary care
The rise in prescribing for anxiety in primary care
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 https://doi.org/10.3399/BJGP.2021.0561 (https://doi.org/10.3399/BJGP.2021.0561) Previous 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.
12-04-2022
13 mins
GP wellbeing during the COVID-19 pandemic
GP wellbeing during the COVID-19 pandemic
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. https://doi.org/10.3399/BJGP.2021.0680 (https://doi.org/10.3399/BJGP.2021.0680) Many 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.
05-04-2022
15 mins
Austin O'Carroll talks about the Triple F**k Syndrome
Austin O'Carroll talks about the Triple F**k Syndrome
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: https://bjgplife.com/the-triple-fk-syndrome-how-medicine-contributes-to-the-systemic-oppression-of-people-born-into-poverty/ (https://bjgplife.com/the-triple-fk-syndrome-how-medicine-contributes-to-the-systemic-oppression-of-people-born-into-poverty/) Austin 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.
29-03-2022
18 mins
Do we need greater stratification of routine blood test monitoring in people on DMARDs?
Do we need greater stratification of routine blood test monitoring in people on DMARDs?
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 https://doi.org/10.3399/BJGP.2021.0595 (https://doi.org/10.3399/BJGP.2021.0595) Clinical 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: https://southampton.qualtrics.com/jfe/form/SV_bIRKhaA0CrmZJ3w (https://southampton.qualtrics.com/jfe/form/SV_bIRKhaA0CrmZJ3w)
22-03-2022
13 mins
Why do GPs rarely do video consultations?
Why do GPs rarely do video consultations?
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 https://doi.org/10.3399/BJGP.2021.0658 (https://doi.org/10.3399/BJGP.2021.0658) The 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.
15-03-2022
17 mins
Burnout among general practitioners across the world is often at high levels
Burnout among general practitioners across the world is often at high levels
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 https://doi.org/10.3399/BJGP.2021.0441 (https://doi.org/10.3399/BJGP.2021.0441) GP 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.
01-03-2022
14 mins
Large prospective cohort study shows no association between breast pain alone and breast cancer
Large prospective cohort study shows no association between breast pain alone and breast cancer
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 https://doi.org/10.3399/BJGP.2021.0475 (https://doi.org/10.3399/BJGP.2021.0475) zWomen 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.
22-02-2022
13 mins
Managing emotional distress in people of South Asian origin with long-term conditions
Managing emotional distress in people of South Asian origin with long-term conditions
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 https://doi.org/10.3399/BJGP.2021.0345 (https://doi.org/10.3399/BJGP.2021.0345) Mental 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.
15-02-2022
15 mins
Continuity of care for people with dementia is linked to significant clinical benefits
Continuity of care for people with dementia is linked to significant clinical benefits
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 https://doi.org/10.3399/BJGP.2021.0413 (https://doi.org/10.3399/BJGP.2021.0413) Evidence 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.
08-02-2022
12 mins
The unintended consequences of online consultations
The unintended consequences of online consultations
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 https://doi.org/10.3399/BJGP.2021.0426 (https://doi.org/10.3399/BJGP.2021.0426) Previous 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.
01-02-2022
10 mins
Using urine collection devices to reduce urine sample contamination - results from a single-blind randomised controlled trial
Using urine collection devices to reduce urine sample contamination - results from a single-blind randomised controlled trial
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 https://doi.org/10.3399/BJGP.2021.0359 (https://doi.org/10.3399/BJGP.2021.0359) This 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.
25-01-2022
11 mins
The use of CXRs varies significantly between practices and addressing this could help with early detection of lung cancer
The use of CXRs varies significantly between practices and addressing this could help with early detection of lung cancer
In this episode we talk to Dr Stephen Bradley who is a GP and clinical research fellow at the University of Leeds. Paper: Associations between general practice characteristics and chest X-ray rate: an observational study https://doi.org/10.3399/BJGP.2021.0232 (https://doi.org/10.3399/BJGP.2021.0232) Abnormal findings on chest X-rays that have been requested by GPs because of symptoms are an important route to lung cancer diagnosis. Previous research has suggested that increased rates of chest X-ray and urgent referral for suspected cancer may be associated with earlier stage at diagnosis for lung cancer. This study demonstrates that there is substantial variation in rates of investigation between practices, and that only a small proportion of that variation is owing to examined population and practice characteristics. Encouraging practices that have low chest X-ray rates to lower their thresholds for investigation could prove to be an effective strategy to detect lung cancer earlier and improve outcomes. Relevant referencesStudies by CanTest Leeds team on CXR discussed in the podcastSystematic Review on sensitivity CXR: https://bjgp.org/content/69/689/e827 (https://bjgp.org/content/69/689/e827) Observational study on sensitivity of CXR: https://bjgp.org/content/71/712/e862 (https://bjgp.org/content/71/712/e862) Estimating risk of lung cancer following negative CXR: https://bjgp.org/content/71/705/e280 (https://bjgp.org/content/71/705/e280) Observational study on frequency of CXR use and practice/population characteristics: https://bjgp.org/content/72/714/e34 (https://bjgp.org/content/72/714/e34) Remaining uncertainty regarding whether increasing GP CXR rates leads to improved outcomesLung cancer stage shift following a symptom awareness campaign (Kennedy) https://thorax.bmj.com/content/73/12/1128 (https://thorax.bmj.com/content/73/12/1128) What characteristics of primary care and patients are associated with early death in patients with lung cancer in the UK? (O'Dowd )https://thorax.bmj.com/content/70/2/161 (https://thorax.bmj.com/content/70/2/161) Lung cancer screening and the place for ongoing sympatomatic detection alongside asymptomatic screeningThe proportion of lung cancer patients attending UK lung cancer clinics who would have been eligible for low-dose CT screening (Gracie) https://erj.ersjournals.com/content/54/2/1802221 (https://erj.ersjournals.com/content/54/2/1802221) What is the balance of benefits and harms for lung cancer screening with low-dose computed tomography?  (Bradley) https://journals.sagepub.com/doi/full/10.1177/0141076821991108 (https://journals.sagepub.com/doi/full/10.1177/0141076821991108) Views expressed on the future of lung cancer imaging policy and research in the UKEvidence submitted to health & social care parliamentary select committee inquiry on cancer services (Bradley) https://committees.parliament.uk/writtenevidence/38850/pdf/ (https://committees.parliament.uk/writtenevidence/38850/pdf/)
18-01-2022
14 mins
Locum use in England has remained stable in recent years
Locum use in England has remained stable in recent years
In this episode we talk to Dr Christos Grigoroglou and Professor Kieran Walshe. Christos is a Research Fellow in Health Services Research, Manchester Centre for Health Economics and Kieran is a Professor of Health Policy and Management both at the University of Manchester. Paper: The scale and scope of locum doctor use in general practice in England: Analysis of routinely collected workforce data in 2017-2020 https://doi.org/10.3399/BJGP.2021.0311 (https://doi.org/10.3399/BJGP.2021.0311) Prior research on the extent of GP locum use in general practice and the composition of the GP locum workforce is sparse, and the availability of new data from general practice allows for a real opportunity to generate new knowledge and to add to the understanding of the current GP workforce composition. Results of the study suggest that GP locum use has remained stable over time and our comparisons of GP locums with other types of GPs show that locums are mostly younger male doctors of whom a large proportion have qualified elsewhere than the UK and who work in underperforming practices. Substantial regional variation in GP locum use across England indicate differences in workforce planning, recruitment and retention. This work provides a useful approach to measure the extent of locum use in primary care and can aid workforce planning by identifying areas of increased recruitment, areas with high GP turnover and also the drivers behind variation in locum use in primary care in England.
11-01-2022
12 mins
Non-speculum sampling with a clinician boosts cervical screening uptake in older women
Non-speculum sampling with a clinician boosts cervical screening uptake in older women
In this episode we speak to Dr Anita Lim who is a Senior Research Fellow, School of Cancer and Pharmaceutical Sciences at King’s College London. Paper: Non-speculum sampling approaches for cervical screening in older women: randomised controlled trial https://doi.org/10.3399/BJGP.2021.0350 (https://doi.org/10.3399/BJGP.2021.0350) Inadequately screened women aged 50 and older are at a disproportionately higher risk of cervical cancer and dying from it. Speculum use is a major barrier to cervical screening and can become more uncomfortable with ageing and the menopause. Although self-sampling has been hailed as a game-changer for cervical screening, it does not appeal to all women. This study showed that offering a choice of non-speculum clinician sampling or self-sampling substantially increased cervical screening uptake in older lapsed attendees across all ethnicities, an approach which could be easily implemented into existing practice in primary care.
04-01-2022
13 mins
Iona Heath on rewilding general practice
Iona Heath on rewilding general practice
In this episode we talk to Dr Iona Heath, a retired GP from Kentish Town and former President of the RCGP. She talked to us after writing an editorial for the BJGP. She discusses the current crisis in UK general practice and offers an approach that can tackle some of the deep-rooted problems we face.  The editorial: Rewilding general practice. Paper: https://doi.org/10.3399/bjgp21X717689 (https://doi.org/10.3399/bjgp21X717689)
14-12-2021
19 mins
Identifying how GPs spend their time and the everyday obstacles they face
Identifying how GPs spend their time and the everyday obstacles they face
In this episode we talk to Dr Jordan Moxey and Dr Carol Sinnott who are both at the Department of Public Health and Primary Care, The Healthcare Improvement Studies Institute in Cambridge. Jordan is a medical doctor and programme coordinator. Carol is a Senior Clinical Research Associate and GP. Paper: Identifying how GPs spend their time and the obstacles they face: a mixed-methods study https://doi.org/10.3399/BJGP.2021.0357 (https://doi.org/10.3399/BJGP.2021.0357) Direct observations of what consumes GPs’ time and what might disrupt their ability to complete tasks have remained remarkably rare. Operational failures are common in general practice and highly consequential. Frequent operational failures include interruptions interfering with task completion, problems relating to equipment and supplies, problems arising from GPs’ coordination role, and defects in organisational processes within practices. The impact of operational failures in general practice goes well beyond diversion of time and interference with task completion: they are very adverse for GPs’ experiences of work.
07-12-2021
19 mins
How patients feel about GPs using gut feelings
How patients feel about GPs using gut feelings
PLAYER In this episode we speak to Dr Claire Friedemann Smith who is a senior researcher at the Nuffield Department of Primary Care, University of Oxford Paper: Building the case for the use of gut-feelings in cancer referrals: perspectives of patients referred to a non-specific symptoms pathway https://doi.org/10.3399/BJGP.2021.0275 (https://doi.org/10.3399/BJGP.2021.0275) Despite the reported diagnostic utility for cancer of GPs’ gut feelings and the role they may play in facilitating diagnosis through prompting investigation, research has not explored the use of gut-feelings in clinical decision making with patients. Our study found that patients were supportive of the use of gut-feelings if they facilitated investigations but cautioned against their use if it meant that investigations would be deferred or denied. Patients discussed the difficulty facing GPs of having to fit individuals to referral ‘tick boxes’ in order to make a referral, were aware of the time pressured and resource limited conditions of primary care practice, and raised these as reasons for why GPs’ use of gut-feelings is justified. Patients share GPs’ concerns around gut-feelings overburdening NHS resources and increasing the risk of negligence and litigation and these should be investigated.
30-11-2021
13 mins