In this episode, we talk to Professor Katharine Wallis, Head of the General Practice Clinical Unit at the University of Queensland in Brisbane, Australia. We caught up with her whilst she was in the UK to discuss the paper that she and first author Suzanne McDonald have published here in the BJGP. Title of paper: Acceptability and optimisation of resources to support antidepressant cessation: A qualitative think-aloud study with patientsAvailable at: https://doi.org/10.3399/BJGP.2023.0269It is not known how best to support patients to safely stop long-term (>12 months) antidepressants when there is no clinical indication for continued use. The current study tested and optimised three patient resources designed to raise awareness and recognition of withdrawal symptoms and to provide step-by-step guidance for tapering drug dose to minimise withdrawal symptoms. Adults with lived experience of long-term antidepressant use reported that the resources were useful, acceptable, clear, comprehensible, and reassuring. The effectiveness of these consumer-informed resources in supporting safe cessation of long-term antidepressants is currently being tested in general practice.

In this episode, we talk to Dr Georgia Richards, who is a Research Fellow in the Centre for Evidence-Based Medicine at the University of Oxford. Paper: Private prescribing of controlled opioids in England, 2014-2021: a retrospective observational studyAvailable at: https://doi.org/10.3399/BJGP.2023.0146There are concerns over the long-term, high-dose use of opioids in people with chronic pain – trends for which have been described using NHS prescription data. However, opioids can also be acquired from outside of NHS services, including private prescribers, over-the-counter (e.g. CoCodamol), and through online healthcare services and pharmacies or the “dark web”. Without exploring non-NHS data, the full picture of opioid use in England cannot be understood. This is one of the first studies that sought to fill this important gap by investigating opioid prescribing in the private sector. We found that the number of controlled opioid items prescribed by private prescribers in England halved between January 2014 and November 2021, and that most prescribing occurred from prescribers in London. There were also controlled opioid items dispensed by “unidentified doctors”, which must be addressed to ensure patient safety. While there is the monitoring of controlled drug prescribing by NHS England Controlled Drug Accountable Officers, expanding access to such data to allow for a greater visibility and wider analysis of non-NHS data, including the private prescribing of controlled opioids, will help identify harms and policy gaps that can be addressed to improve patient safety.

In this episode, we talk to Dr Monica Molinaro, who is an Assistant Professor at the Institute of Health Sciences Education at McGill University in Canada. Title of paper: You’re doing everything you possibly could do, and you know it’s not enough”: Family physician narratives of moral distressAvailable: https://doi.org/10.3399/BJGP.2023.0193The moral distress of physicians who cannot provide adequate care due to systemic deficits is seldom heard in contemporary discussions about health care access and quality. Family physician stories of moral distress in relation to structural and systemic factors such as racism, colonialism, and drug, mental health, and housing policy, generate seemingly novel and vital understandings of the clinical work of primary care providers. The study findings are some of the first to illustrate family physicians’ experiences of moral distress, contributing to the limited body of literature on moral distress in primary care.

In this episode, we talk to Dr Sharon James, a Research Fellow and Project Manager based at the School of Public Health and Preventive Medicine at Monash University in Australia. Title of paper: lnterconception care in Australian general practice: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2022.0624Interconception care (ICC) provides an opportunity to address risk factors contributing to poor pregnancy outcomes. However, GP perceptions on providing ICC are not well established. ICC is not a familiar concept for GPs, it is delivered opportunistically and there is lack of clarity as to what ICC should consist of. GPs also feel there is lack of engagement and perceived value by women.

In this episode, we talk to Mr James Bailey, a Colorectal Research Fellow from the Nottingham Colorectal Service. Paper: Sociodemographic Variations in the Uptake of Faecal Immunochemical Tests in Primary CareAvailable at: https://doi.org/10.3399/BJGP.2023.0033FIT is increasingly used to triage patients with symptoms suggestive of colorectal cancer but variations in use by demographics, ethnicity and socioeconomic status are unknown. We show, in a large regional dataset, that male patients, patients under 65 years, the most deprived patients and ethnic minority groups are less likely to return a FIT sample. It is important that strategies are developed to ensure patients with these protected characteristics are not disadvantaged with the increasing usage of FIT to prioritise urgency of investigations.

In this episode, we’re doing something a bit different. Last week, the BJGP team attended the annual Royal College of GPs conference up in Glasgow, and presented a workshop looking at continuity of care. In this podcast, we’re going to pull together some of what we spoke about at that workshop, which highlighted some of the exceptional research that has been published in the BJGP on continuity, and also present a piece by Sir Denis Pereria Gray who also contributed to the workshop and spoke about how to put continuity into practice. Links to the research papers mentioned in this podcast:Relational continuity and patients’ perception of GP trust and respect: a qualitative studyhttps://doi.org/10.3399/bjgp20X712349Modernising continuity: a new conceptual frameworkhttps://doi.org/10.3399/bjgp23X732897Is continuity of primary care declining in England? Practice-level longitudinal study from 2012 to 2017https://doi.org/10.3399/BJGP.2020.0935Continuity of GP care for patients with dementia: impact on prescribing and the health of patientshttps://doi.org/10.3399/BJGP.2021.0413Team-based continuity of care for patients with hypertension: a retrospective primary care cohort study in Hong Konghttps://doi.org/10.3399/BJGP.2023.0150

In this episode, we talk to Dr Nish Jayasooriya, Research Fellow and specialist registrar in gastroenterology and hepatology. Paper: Adherence to 5-aminosalicylic acid maintenance treatment in young people with ulcerative colitis: a retrospective cohort study in primary careAvailable at: https://doi.org/10.3399/BJGP.2023.0006Adolescents and young adults diagnosed with ulcerative colitis (UC) are recommended long- term maintenance treatment for disease control, but adherence rates in primary care are unknown. This observational cohort study using real-world data from primary care found one-quarter of newly diagnosed adolescents and young adults, aged 10–24 years, discontinued oral 5-aminosalicylic acid (5-ASA) maintenance treatment within 1 month of starting and two-thirds within 1year. Young adults aged 18–24years and those living in a deprived area were most likely to discontinue and have poor adherence to treatment. Having an acute flare-up of UC was linked to better adherence to oral 5-ASA maintenance treatment. The first year of starting lifelong therapies among individuals diagnosed with UC is a critical window to improve adherence for adolescents transitioning to young adulthood and those from deprived postcodes.

In this episode, we talk to Dr Lizzie Emsley and Dr Eszter Szilassy from the University of Bristol. Paper: General practice as a place to receive help for domestic abuse during the COVID-19 pandemic: a qualitative interview study in England and WalesAvailable at: https://doi.org/10.3399/BJGP.2022.0528General practice is an important place for patients experiencing or perpetrating domestic violence and abuse (DVA) and for their children to seek and receive help. While the incidence of DVA may have increased during the COVID-19 pandemic, there has been a substantial reduction in DVA identifications and referrals to specialist services from general practice. At the same time, there has been the imposition of stringent lockdown measures and a rapid shift to remote care in general practice. This study explored patient experiences of seeking help for DVA in general practice during the COVID-19 pandemic, with additional insight from healthcare professionals. This study also included a focus on children affected by DVA. The authors found that patients affected by DVA had a strong preference for face-to-face consultation models in general practice for the opportunity of non- verbal communication. Children affected by DVA are a vulnerable group and this study reported concerns regarding their visibility to healthcare professionals in general practice during the pandemic.

In this episode, we talk to Dr Francine Toye and Dr Sharon Dixon, both working at Oxford on this project. Title of paper: Understanding primary care perspectives on supporting women’s health needs: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2023.0141The Women’s Health Strategy for England highlighted a need to understand and develop how general practice can support women’s health needs. This study’s aim was to hear the voices of primary care practitioners with experience of delivering services, and to further understand what works well to provide quality care. Relationships and advocacy are at the core of general practice and women’s health, and this study highlights threats to these core values and skills. Care is needed when evolving services to ensure that relationship-based longitudinal knowledge of individuals, families, and communities is not devalued, as this is integral to high- quality health and social care.Here's the link to the previous podcast I mention here by the same team:https://bjgplife.com/episode-117-how-can-we-improve-our-care-for-ethnic-minority-women-through-the-menopause/

In this episode, we talk to Dr Jessica Watson, who is a GP and NIHR Academic Clinical Lecturer in general practice based at the Centre for Academic Primary Care at the University of Bristol.Paper: ‘Why test study: a UK-wide audit using the Primary Care Academic CollaboraTive to explore the reasons for primary care testing’.Available at: https://doi.org/10.3399/BJGP.2023.0191Previous research has shown a more than three-fold increase in the use of laboratory tests in UK primary care between 2000-2015, with significant variation in testing rates between GP practices. In this study around a quarter of tests were thought to be partially or fully unnecessary when reviewed retrospectively by another clinician. Around half of tests (48.8%) did not lead to any change in management or reassurance; 13.4% led to further blood tests or repeat blood tests, 2.7% led to further radiology tests. 6.2% of tests in primary care led to a new diagnosis or confirmation of diagnosis. This has important implications for how primary care clinicians talk to patients about blood tests, to ensure that patients have a better understanding and realistic expectations of the role of blood tests in their care.

In this episode, we talk to Dr Liz Sturgiss, who is an Associate Professor of Primary Care Research at the School of Primary and Allied Health Care at Monash University in Melbourne, Australia.Paper: Multifaceted intervention to increase the delivery of alcohol brief interventions in primary care: a mixed-methods process analysisAvailable at: https://doi.org/10.3399/BJGP.2022.0613Brief interventions can reduce alcohol- related harm when delivered in general practice, but there is an implementation gap in routine clinical practice. The REACH programme, which includes resources for patients, clinicians, and clinics, can improve alcohol recording in the general practice setting. Enhanced alignment between national policy and clinical need can support preventive health innovations through existing channels. When appropriately resourced and supported, general practice can deliver alcohol brief interventions in daily practice.

In this episode, we talk to Dr Victoria Welsh and Dr Claire Burton, who are both GPs and lecturers in primary care at the Centre for Musculoskeletal Health Research at Keele University. Title of paper: Trends in musculoskeletal consultations and prescribing: an electronic primary care records studyAvailable at: https://doi.org/10.3399/BJGP.2022.0648Rheumatic and musculoskeletal disorders (RMDs) are a common cause of pain and disability, with core non-pharmacological management supported by analgesic medications. To the author’s knowledge, no previous studies have observed the impact of the COVID-19 pandemic on the care of patients with rheumatic and musculoskeletal disorders (RMDs) in primary care, including consultation patterns and analgesic prescribing. This study demonstrates that fewer patients consulted with RMDs during lockdown, and a greater proportion were prescribed strong analgesia (including opioids) during pandemic-related restrictions. Clinicians appeared to respond to patient needs during the pandemic amidst restrictions placed upon non-pharmacological treatments, and commissioners must consider the impact of these behaviour changes during future pandemic planning.

In this episode, we talk to Margje van de Wiel from the Department of Work and Social Psychology, at Maastricht University in The Netherlands.Title of paper: ‘How do patients in general practice voice their gut feelings and value them?’Available at: https://doi.org/10.3399/BJGP.2022.0427We know that primary care professionals acknowledge the usefulness of patients’ gut feelings for their clinical reasoning. However, we do not precisely know the wordings and expressions patients use to voice their gut feelings and how they share them with professionals. The results we found may improve the professionals’ recognition of patients’ gut feelings and their insight into their background and enable further research into their validity.

We're taking a two week summer break, but why not hear more about the BJGP Research Conference which is being held on 22 March 2024. Learn more about the conference at https://bjgp.org/conference.

We're taking a two week summer break, but why not hear more about the BJGP Research Conference which is being held on 22 March 2024. Learn more about the conference at www.https://bjgp.org/conference.

In this episode, we talk to Line Pedersen and Anne Sophie Oxholm from the Research Unit for General Practice at the University of Southern Denmark.Title of paper: Mapping general practitioners’ motivation: It is not all about the money. A nation-wide cross-sectional survey study from DenmarkAvailable at: https://doi.org/10.3399/BJGP.2022.0563Understanding physicians’ motivation may be essential for designing policies and organisational structures that ensure the wellbeing and retention of GPs, and high-quality care. However, physicians’ motivation remains an understudied area. We find heterogeneity in GPs’ work motivation and identify five GP segments. The largest segment (53.2%) is characterised by being motivated ‘less by the money’.

In this episode, we talk to Charlie Coombs who is a medical student and School for Primary Care Research intern working at University College London. Title of paper: Opportunities, challenges and implications of primary care micro-teams for patients and healthcare professionals: an international systematic reviewAvailable at: https://doi.org/10.3399/BJGP.2022.0545The number of GP practices in the UK has overall reduced, whilst individual practice size lists have increased. This systematic review uses a framework analysis to synthesis the current literature available around micro-teams as a potential intervention to mitigate compromised care in larger practices. This review highlights micro-teams as a structure of general practice to promote accessible healthcare delivery and moderate losses to continuity. Further research in whether continuity can be offered by a team instead of an individual is warranted in the implementation of micro-teams.

In this episode, we talk to Professor Jonathan Mant who is Professor of Primary Care and Head of the Primary Care Unit within the Department of Public Health & Primary Care in the University of Cambridge. Title of paper: Progression of stroke risk in atrial fibrillation: Cohort study in general practiceAvailable at: https://doi.org/10.3399/BJGP.2022.0568New technologies are likely to result in younger people being diagnosed with atrial fibrillation who do not require anticoagulation treatment at diagnosis. There are few data to inform follow up of such people. Risk of development of hypertension and heart failure was found to be high in this group (indications for anticoagulation), suggesting

In this episode, we talk to Emma Whitfield, who is a PhD student in the Institute of Epidemiology and Health Care at University College London.Title of paper: Diagnostic windows in non-neoplastic diseases: a systematic reviewAvailable at: https://doi.org/10.3399/BJGP.2023.0044Improving timeliness of diagnosis is imperative across disease types. This review identified that for a range of nonneoplastic conditions healthcare use starts to increase in the time before diagnosis. For some conditions, this increase may first start to occur many years before diagnosis. Further research is needed to produce accurate estimates of how much earlier diagnosis may be possible.

In this episode, we’re going to do something a bit different and recognise some exceptional researchers here in the UK. We talk to Dr Sarah Bailey and Dr Ben Brown, this year’s winners of the Royal College of GPs and Society for Academic Primary Care early career researcher award. This award, which has a long history of recognising the up and coming superstars of primary care research, recognises the contribution of early career researchers to advancing primary care theory and practice.