Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.960 - 00:00:39.550

Hello and welcome to this BJGP podcast. I'm Nada Khan and I'm one of the Associate Editors of the Journal. Thanks for listening today.

In today's episode we're going to look back at the recent BJGP Research Conference which we held just last week on 20th March in Bristol. It was absolutely brilliant to welcome the BJGP team and people who attended to the Southwest.

And in today's episode I'm just going to talk about some the highlights and really focus on what the conference is about and maybe have a chat about how to get involved in the future. But first, here's a welcome to the conference from our Editor in Chief, Ewan Lawson.

Speaker B

00:00:40.270 - 00:01:16.520

My name's Ewan Lawson, I'm editor of the bjgp. So that means basically I'm the one person that the Journal would probably run without and everyone else does all the work.

But I do have to stand up here and say hello to you and I want to offer you the warmest of welcomes to the conference. Been running this for a few years and it's always really nice to get together and just try to help each other, you know, get involved.

It's not in a very scholarly way, you know, whether you're involved in research or whether you're interested in putting research into practice. We think we can offer you quite a lot more than just the fact that we publish research at BJGP and BJGP Open. So I hope you have a fantastic day.

Speaker A

00:01:17.320 - 00:03:26.850

So this was the seventh run of the BJGP Research Conference and this year we had a particular focus on a few different areas.

We took a bit of a deep dive into patient involvement, new and emerging research in general practice, general practice policy and how to get research into impact. And this year, as always, quite a bit around writing and also public speaking in academia.

The conference kicked off this year with an absolutely brilliant talk by Professor Martin Marshall, who some of you may know as the Chair of the Nuffield Trust. But he's also Emeritus professor of Healthcare Improvement at UCS and non Exec Director at the Royal Devon University Healthcare trust.

And until 2022, Martin was also the Chair of the Royal College of GPs and a GP in New East London. So definitely someone worth listening to about his experiences as well.

And Martin really focused in his talk on the relationship between general practice and policy and asked a really important question, which is how good are we as a profession at influencing decision decision makers?

And in his talk, Martin reflected on the fact that while the value of general practice is really well established for patients, communities and the wider nhs. It's often still misunderstood or undervalued at a policy level.

And in his talk he challenged whether that's purely down to policymakers or whether, as Julian Tudor Hart once put it, there's also an element of political literacy within the profession itself.

And what really followed was a thoughtful discussion about how both national leaders and individual clinicians can do more to shape policy, and whether that's through better communication, stronger advocacy, or even engaging more actively with the systems around us. It was a really thought provoking structure of the conference and linked closely to that broader theme of impact that ran throughout the day.

Here's just a short snippet of Martin speaking at the conference.

Speaker C

00:03:27.570 - 00:04:45.260

I wish I could have my career again and I'd be more influential than I was. I've learned a lot along the way, but this is what I've learned. First of all, as I've described, influencing is about far more than informy.

It's not about telling, it's about getting inside people's heads and understanding what's important to them. A lot of influencing is about timing. How do we decide when to influence? I think it's really important. Policy windows is an interesting concept.

So sometimes just a window opens that allows you to do something.

And a good example of this would be the evidence around Continuity of care, which is actually pretty strong in General practice was largely ignored by policymakers and politicians until the pandemic came along and they were looking for a way of delivering the vaccination program. And we made the case based on evidence that trust is really important to the success of uptake of vaccination programs.

And that's why government decided that general practice would deliver their program largely, rather than setting up a separate body to deliver it. So there's an example, another example of ways of change.

The NUFRE is doing some really important work around the distribution, the resource distribution formula for general practice, something which the Conservative governments of the past were not interested in, the Labour government is very interested in. So now is our time to push it while we can.

Speaker A

00:04:46.460 - 00:11:57.780

So it was a great start to the conference from Martin, which really focused down on how GPs and primary care researchers can get the most impact from their work to effect change. So in addition to the keynote sessions, we had a series of parallel sessions where people presented posters and talks about their work.

And what really struck me, listening to different talks and looking at the different posters that were on display, was just how strong the work was across the board, especially from medical students. And early career researchers.

There's clearly a lot of exciting work coming through and I wouldn't be surprised to see some of it published in the BJJP in the near future.

At the conference, we then had a series of workshops and these looked at patient and public involvement, writing for the BJGP and public speaking in academia. I attended Lucy Potter and the Bridging Gap team's excellent workshop on meaningful patient and public involvement in research.

Their team did an absolutely brilliant job at highlighting a familiar but important issue that those with the greatest health needs often face the biggest barriers to care and are probably the least likely to be involved meaningfully in research.

And what made this session stand out for me was that it was delivered alongside women with lived experience, which brought, I felt, a real deal, a real depth and authenticity to the discussion.

And the workshop was a absolutely powerful reminder of the importance of meaningful involvement and offered some really practical ideas for how we can better include marginalized patients in our work.

And going on to one of the regular features of the conference, which is the Right for Life workshop, led by our deputy editor at BJGP Life, Andrew Papaniktis and Tom Round. It's a really engaging session that encourages people to write and reflect on their experiences in general practice.

And I often describe JGP Life, the website, as sort of the coffee room of the journal. It's a space for more sort of reflective conversation and debate.

And here we're also always keen to receive some submissions from across the GP community, and it's probably worth pointing out that some of these pieces then go on to be published in the print journal too. And finally, the third workshop was led by Professor Graham Easton, who looked at public speaking for academics.

And I just want to touch on Graham's really interesting background that he was able to draw upon here. So, Graham was a senior producer for BBC Science Unit for many years and presented Case Notes, which is Radio 4's flagship medical program.

He's also a regular contributor to BBC Health Check and has quite a strong interest in the use of narratives and storytelling in medical education, which is a topic he looked at in depth in his doctoral work.

So, looking back to his workshop, it focused on something we've all experienced, which is sitting through a talk or presentation where the key message gets lost in really dense slides and you just lose the audience.

And Graham's session was all about how to communicate our work more clearly and make it engaging, using things like storytelling, simplifying your core message and using visuals that actually support you're saying, rather than Overwhelming it. It was a really practical session with lots of tips to take away and use straight away.

And I think that everyone who attended, who attended learned something new about how to present their research in an engaging and meaningful way. So that's a roundup of the workshops. And finally we had the last keynote speaker of the conference, Dr. Rebecca Payne.

And Rebecca really brought together one of the central themes of the conference, which was impact going back to Martin Marshall's talk as well. And Rebecca's talk focused on what happens after publication and challenged the idea that getting a paper accepted as the endpoint.

Instead, she kind of framed it as the beginning. So that's the point at which the real work of influencing practice...]]>Today, we’re going to back at the recent BJGP Research Conference, which was held just last week on the 20st of March 2025 in Bristol.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.960 - 00:00:39.550

Hello and welcome to this BJGP podcast. I'm Nada Khan and I'm one of the Associate Editors of the Journal. Thanks for listening today.

In today's episode we're going to look back at the recent BJGP Research Conference which we held just last week on 20th March in Bristol. It was absolutely brilliant to welcome the BJGP team and people who attended to the Southwest.

And in today's episode I'm just going to talk about some the highlights and really focus on what the conference is about and maybe have a chat about how to get involved in the future. But first, here's a welcome to the conference from our Editor in Chief, Ewan Lawson.

Speaker B

00:00:40.270 - 00:01:16.520

My name's Ewan Lawson, I'm editor of the bjgp. So that means basically I'm the one person that the Journal would probably run without and everyone else does all the work.

But I do have to stand up here and say hello to you and I want to offer you the warmest of welcomes to the conference. Been running this for a few years and it's always really nice to get together and just try to help each other, you know, get involved.

It's not in a very scholarly way, you know, whether you're involved in research or whether you're interested in putting research into practice. We think we can offer you quite a lot more than just the fact that we publish research at BJGP and BJGP Open. So I hope you have a fantastic day.

Speaker A

00:01:17.320 - 00:03:26.850

So this was the seventh run of the BJGP Research Conference and this year we had a particular focus on a few different areas.

We took a bit of a deep dive into patient involvement, new and emerging research in general practice, general practice policy and how to get research into impact. And this year, as always, quite a bit around writing and also public speaking in academia.

The conference kicked off this year with an absolutely brilliant talk by Professor Martin Marshall, who some of you may know as the Chair of the Nuffield Trust. But he's also Emeritus professor of Healthcare Improvement at UCS and non Exec Director at the Royal Devon University Healthcare trust.

And until 2022, Martin was also the Chair of the Royal College of GPs and a GP in New East London. So definitely someone worth listening to about his experiences as well.

And Martin really focused in his talk on the relationship between general practice and policy and asked a really important question, which is how good are we as a profession at influencing decision decision makers?

And in his talk, Martin reflected on the fact that while the value of general practice is really well established for patients, communities and the wider nhs. It's often still misunderstood or undervalued at a policy level.

And in his talk he challenged whether that's purely down to policymakers or whether, as Julian Tudor Hart once put it, there's also an element of political literacy within the profession itself.

And what really followed was a thoughtful discussion about how both national leaders and individual clinicians can do more to shape policy, and whether that's through better communication, stronger advocacy, or even engaging more actively with the systems around us. It was a really thought provoking structure of the conference and linked closely to that broader theme of impact that ran throughout the day.

Here's just a short snippet of Martin speaking at the conference.

Speaker C

00:03:27.570 - 00:04:45.260

I wish I could have my career again and I'd be more influential than I was. I've learned a lot along the way, but this is what I've learned. First of all, as I've described, influencing is about far more than informy.

It's not about telling, it's about getting inside people's heads and understanding what's important to them. A lot of influencing is about timing. How do we decide when to influence? I think it's really important. Policy windows is an interesting concept.

So sometimes just a window opens that allows you to do something.

And a good example of this would be the evidence around Continuity of care, which is actually pretty strong in General practice was largely ignored by policymakers and politicians until the pandemic came along and they were looking for a way of delivering the vaccination program. And we made the case based on evidence that trust is really important to the success of uptake of vaccination programs.

And that's why government decided that general practice would deliver their program largely, rather than setting up a separate body to deliver it. So there's an example, another example of ways of change.

The NUFRE is doing some really important work around the distribution, the resource distribution formula for general practice, something which the Conservative governments of the past were not interested in, the Labour government is very interested in. So now is our time to push it while we can.

Speaker A

00:04:46.460 - 00:11:57.780

So it was a great start to the conference from Martin, which really focused down on how GPs and primary care researchers can get the most impact from their work to effect change. So in addition to the keynote sessions, we had a series of parallel sessions where people presented posters and talks about their work.

And what really struck me, listening to different talks and looking at the different posters that were on display, was just how strong the work was across the board, especially from medical students. And early career researchers.

There's clearly a lot of exciting work coming through and I wouldn't be surprised to see some of it published in the BJJP in the near future.

At the conference, we then had a series of workshops and these looked at patient and public involvement, writing for the BJGP and public speaking in academia. I attended Lucy Potter and the Bridging Gap team's excellent workshop on meaningful patient and public involvement in research.

Their team did an absolutely brilliant job at highlighting a familiar but important issue that those with the greatest health needs often face the biggest barriers to care and are probably the least likely to be involved meaningfully in research.

And what made this session stand out for me was that it was delivered alongside women with lived experience, which brought, I felt, a real deal, a real depth and authenticity to the discussion.

And the workshop was a absolutely powerful reminder of the importance of meaningful involvement and offered some really practical ideas for how we can better include marginalized patients in our work.

And going on to one of the regular features of the conference, which is the Right for Life workshop, led by our deputy editor at BJGP Life, Andrew Papaniktis and Tom Round. It's a really engaging session that encourages people to write and reflect on their experiences in general practice.

And I often describe JGP Life, the website, as sort of the coffee room of the journal. It's a space for more sort of reflective conversation and debate.

And here we're also always keen to receive some submissions from across the GP community, and it's probably worth pointing out that some of these pieces then go on to be published in the print journal too. And finally, the third workshop was led by Professor Graham Easton, who looked at public speaking for academics.

And I just want to touch on Graham's really interesting background that he was able to draw upon here. So, Graham was a senior producer for BBC Science Unit for many years and presented Case Notes, which is Radio 4's flagship medical program.

He's also a regular contributor to BBC Health Check and has quite a strong interest in the use of narratives and storytelling in medical education, which is a topic he looked at in depth in his doctoral work.

So, looking back to his workshop, it focused on something we've all experienced, which is sitting through a talk or presentation where the key message gets lost in really dense slides and you just lose the audience.

And Graham's session was all about how to communicate our work more clearly and make it engaging, using things like storytelling, simplifying your core message and using visuals that actually support you're saying, rather than Overwhelming it. It was a really practical session with lots of tips to take away and use straight away.

And I think that everyone who attended, who attended learned something new about how to present their research in an engaging and meaningful way. So that's a roundup of the workshops. And finally we had the last keynote speaker of the conference, Dr. Rebecca Payne.

And Rebecca really brought together one of the central themes of the conference, which was impact going back to Martin Marshall's talk as well. And Rebecca's talk focused on what happens after publication and challenged the idea that getting a paper accepted as the endpoint.

Instead, she kind of framed it as the beginning. So that's the point at which the real work of influencing practice and policy starts.

Rebecca's got a lot of experience in research, but for this talk she drew specifically on examples from The Remote by Default 2 study, which explored how the shift towards remote consulting and general practice has played out in reality. And this includes some of the benefits, but also some of the unintended consequences for access, continuity and patient experience.

It was a really helpful example of how complex system changes can't be understood through simple metrics alone and how research, like the Remote to Default study, can help unpack those nuances.

I guess what Rebecca's trying to point out is that if we want research to make a difference, we need to think more deliberately, like much more deliberately, about how it's communicated, who it reaches, and how it feeds into decision making. And that could include things like engaging with policymakers, working with the media, or translating findings into more accessible formats.

And just going back to Martin Marshall's talk, he talked about how at the Nuffield Trust, they have a pretty strong allocation in their budgets towards dissemination. And I think that's a pointer to take away for researchers.

So when you're developing budgets or research programs, think really carefully at the outset about putting aside that funding and that money to get sort of your message across more widely.

So going back to Rebecca's talk, it felt like a really fitting way to close conference and a strong reminder that the value of research really lies in whether it leads to meaningful change in practice. So, yeah, just I just wanted to come back finally to that point.

About one of the things that we consistently hear about the BJGP research conference is how welcoming and approachable it is. It's a really easy space to strike up conversations with people at all stages of their careers.

So from students to early career researchers through to more senior academics and members of the BJJP editorial team who always attend.

And I think it's always just been a really great opportunity to have those informal conversations that sometimes often spark new ideas or collaborations.

So I guess what I'm trying to say is if you're interested in meeting like minded colleagues in general practice or primary care research or thinking about getting involved in research and publishing, it's definitely one to consider for next year. So a really big thank you to everyone who came along this year.

I hope you all found it as engaging and inspiring as I did and it was lovely to meet so many of you throughout the day as well.

And with that, that's the end of this season of the BJGP podcast, so we'll be taking a short break over Easter, but we'll be back soon with a new series where as always, we'll be discussing the latest research published in the BJGP and what it means for practice. We're planning to come back in early May, so do keep an eye out for that. But as always, thank you again for listening.

Title of paper: Implications of skill-mix change in general practice: secondary analysis of data from the GP Patient Survey

Available at: https://doi.org/10.3399/BJGP.2025.0360

To the authors’ knowledge, no previous studies have investigated the impact on patient trust or perception of needs met when patients are unsure what type of health professional they have seen. Using data from a large national survey, this study found that patients expressed lower confidence and trust, and were less likely to report their needs were met in general practice consultations when they were not sure who their appointment was with. The results are novel in demonstrating that the combination of not knowing who you saw and a remote appointment is particularly problematic for patient trust.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.600 - 00:00:58.530

Hello 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.

In today's episode, we're speaking to Dr. Charlotte Patterson, who is currently non Executive Director at Royal Papworth Hospital and formerly a Senior fellow and co lead for Primary Care at the Nuffield Trust.

We're here to discuss the paper she's recently published here in the BJGP titled Implications of Skill Mix Change in General Practice Secondary Analysis of Data from the GP Patient Survey.

So, hi, Charlotte, it's really lovely to meet you and to talk about your work and I just really wanted to start by exploring how we know that the composition of the general practice team is evolving with the increasing scope of multidisciplinary work. Really? And I wondered if you could just give us some of the context for this work and what you wanted to do here.

Speaker B

00:00:58.850 - 00:02:04.870

Absolutely. Nada.

So what we really wanted to understand was how two big shifts in policy are shaping the experience of patients care when they come to the GP practice. Why do we think that was interesting or potentially important?

Basically, we've seen two big changes happening at the same time in the last five years. So.

So we've seen the shift to multi professional team working with many more different types of health professionals working in general practice and at the same time, separately, we've seen a massive increase in the number of appointments delivered remotely. So what we wanted to know is what those changes really mean for patients.

We also know that some patients feel confused about who they're seeing and when they turn up to a GP appointment at the surgery, whether that's an appointment with a GP or a physician's associate or a social prescriber.

And this led on to another really important question for us in this study, which is what happens when patients are confused or uncertain about who they've seen and what does that mean for patient trust? Those are the kinds of questions we wanted to answer.

Speaker A

00:02:05.350 - 00:02:39.730

So this was an analysis of the 2023 GP Patient Survey, which is sent to patients registered in English general practices.

And I think the key thing for this work and what you've outlined just in terms of what you're saying right here, was that the survey asks people who their last general practice appointment was with and whether they had confidence and trust in that person and if their needs were met. And just given what you were describing, I wanted to move straight on to what you found.

What did the patient say about trust and how did it Vary by different patient characteristics.

Speaker B

00:02:40.050 - 00:03:27.890

Sure. So what we found in relation to trust. Nada.

Is that while every 2, 2 in every 3 patients reported they definitely had trust and confidence in the health professional they saw at their GP practice. And that's very positive.

We also found at the same time, there's a minority of patients, around 7%, who reported they did not at all have confidence and trust in their last GP practice appointment. And we found that trust is lower among patients who are younger, from minoritised ethnic backgrounds and living in more deprived areas.

So that's what we found in relation to trust. We also found that patients are confused about different roles of health professionals working in general practice.

And we've found this is likely to affect around one in every 20 patients.

Speaker A

00:03:28.370 - 00:03:30.290

That seems quite a lot, actually, doesn't it?

Speaker B

00:03:30.530 - 00:04:26.740

Yes.

And it's also we found, looking at the GP general practice patient survey, we found that the proportion of patients who feel confused about who they're seeing has gone up over time.

What I can tell you is that if we look backwards over time, the national survey data shows the percentage of patients who are unsure who their last appointment was with has more than doubled in six years. In 2018, it was around 1.9% of patients. In the 2024 survey, this had gone up to 5% of patients.

And at the same time, we've also seen a decline in confidence and trust. So what we can say there is that confidence has declined by around 5% over that same time period.

So 5 percentage points from 69% of patients saying, yes, definitely they had confidence and trust in the health professional they saw in 2018. But by 2025 that's dropped to 64%.

Speaker A

00:04:27.220 - 00:04:46.100

And I think that almost reflects what's happening in practice with the increasing number of other roles working in general practice as well. And I think one of the really striking findings here is that patients reported much lower trust when they weren't sure which professional they saw.

Do you want to talk us through that and why you think that is?

Speaker B

00:04:46.630 - 00:06:26.190

Absolutely. So what we've seen in terms of context here is that a lot of change happening in general practice, much of it taking place at the same time.

So we've seen in terms of multi professional team working, there are 40,000 additional non GP non nurse staff working in general practice, which is a whopping 387% per patient increase over a nine year period.

At the same time, we've also seen this huge policy focus on rapid access, delivering more remote appointments, working at scale and a shift to digital and online as well. So there's a lot going on in general practice all at the same time.

And we can also see alongside this changes in patients confidence and satisfaction with how general practice is working. So that's sort of a zoomed out, bigger picture lens.

We can see that in terms of the British Social attitude survey in 2024, almost half of all people said they were quite dissatisfied with how general practice was working. But looking back in time, if we look back to 1983, we see that only 13% of people were dissatisfied with how general practice was running.

And even looking back just 10 years ago, in 2016, that figure is 16% of the of people in the British Social Attitude Survey who were dissatisfied with general practice. So we're seeing massive shifts across multiple aspects of general practice.

At the same time, we're seeing a significant shift in the proportion of people who feel that they are satisfied with what's happening in terms of the care they're receiving from general practices.

Speaker A

00:06:27.070 - 00:06:35.070

And I guess that relates to some of the issues with trust and potentially not knowing who people are seeing in practice as well.

Speaker B

00:06:36.170 - 00:07:12.390

Absolutely.

So in our findings, what we found was that the combination of not knowing who you saw and a remote appointment is really problematic for patients in terms of trust and confidence.

So to give a flavour of this, when patients were not sure what health professional, what type of health professional they saw or spoke to, and this was a remote appointment, so an appointment by phone or video or message, the likelihood of reporting confidence and trust decreased by up to 80% when compared to patients who saw a GP in person at their practice.

Speaker A

00:07:12.470 - 00:07:48.910

And we did a podcast with Richard Baker talking about trust in healthcare professionals as well.

And one of the things he highlighted was that actually trust is really important in that patient clinician interaction, because, you know, that trust actually builds some foundation towards whether people might want to come back to the practice, they might want to take up that advice or management that's been suggested by the clinician they see.

So I think not only are you seeing these associations, but it's actually really drilling down to why trust is so important as well in these...]]>Today, we’re speaking to Dr Charlotte Paddison, who is currently non-executive director at Royal Papworth Hospital, and formerly a Senior Fellow and co-lead for Primary Care at the Nuffield Trust.

Title of paper: Implications of skill-mix change in general practice: secondary analysis of data from the GP Patient Survey

Available at: https://doi.org/10.3399/BJGP.2025.0360

To the authors’ knowledge, no previous studies have investigated the impact on patient trust or perception of needs met when patients are unsure what type of health professional they have seen. Using data from a large national survey, this study found that patients expressed lower confidence and trust, and were less likely to report their needs were met in general practice consultations when they were not sure who their appointment was with. The results are novel in demonstrating that the combination of not knowing who you saw and a remote appointment is particularly problematic for patient trust.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.600 - 00:00:58.530

Hello 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.

In today's episode, we're speaking to Dr. Charlotte Patterson, who is currently non Executive Director at Royal Papworth Hospital and formerly a Senior fellow and co lead for Primary Care at the Nuffield Trust.

We're here to discuss the paper she's recently published here in the BJGP titled Implications of Skill Mix Change in General Practice Secondary Analysis of Data from the GP Patient Survey.

So, hi, Charlotte, it's really lovely to meet you and to talk about your work and I just really wanted to start by exploring how we know that the composition of the general practice team is evolving with the increasing scope of multidisciplinary work. Really? And I wondered if you could just give us some of the context for this work and what you wanted to do here.

Speaker B

00:00:58.850 - 00:02:04.870

Absolutely. Nada.

So what we really wanted to understand was how two big shifts in policy are shaping the experience of patients care when they come to the GP practice. Why do we think that was interesting or potentially important?

Basically, we've seen two big changes happening at the same time in the last five years. So.

So we've seen the shift to multi professional team working with many more different types of health professionals working in general practice and at the same time, separately, we've seen a massive increase in the number of appointments delivered remotely. So what we wanted to know is what those changes really mean for patients.

We also know that some patients feel confused about who they're seeing and when they turn up to a GP appointment at the surgery, whether that's an appointment with a GP or a physician's associate or a social prescriber.

And this led on to another really important question for us in this study, which is what happens when patients are confused or uncertain about who they've seen and what does that mean for patient trust? Those are the kinds of questions we wanted to answer.

Speaker A

00:02:05.350 - 00:02:39.730

So this was an analysis of the 2023 GP Patient Survey, which is sent to patients registered in English general practices.

And I think the key thing for this work and what you've outlined just in terms of what you're saying right here, was that the survey asks people who their last general practice appointment was with and whether they had confidence and trust in that person and if their needs were met. And just given what you were describing, I wanted to move straight on to what you found.

What did the patient say about trust and how did it Vary by different patient characteristics.

Speaker B

00:02:40.050 - 00:03:27.890

Sure. So what we found in relation to trust. Nada.

Is that while every 2, 2 in every 3 patients reported they definitely had trust and confidence in the health professional they saw at their GP practice. And that's very positive.

We also found at the same time, there's a minority of patients, around 7%, who reported they did not at all have confidence and trust in their last GP practice appointment. And we found that trust is lower among patients who are younger, from minoritised ethnic backgrounds and living in more deprived areas.

So that's what we found in relation to trust. We also found that patients are confused about different roles of health professionals working in general practice.

And we've found this is likely to affect around one in every 20 patients.

Speaker A

00:03:28.370 - 00:03:30.290

That seems quite a lot, actually, doesn't it?

Speaker B

00:03:30.530 - 00:04:26.740

Yes.

And it's also we found, looking at the GP general practice patient survey, we found that the proportion of patients who feel confused about who they're seeing has gone up over time.

What I can tell you is that if we look backwards over time, the national survey data shows the percentage of patients who are unsure who their last appointment was with has more than doubled in six years. In 2018, it was around 1.9% of patients. In the 2024 survey, this had gone up to 5% of patients.

And at the same time, we've also seen a decline in confidence and trust. So what we can say there is that confidence has declined by around 5% over that same time period.

So 5 percentage points from 69% of patients saying, yes, definitely they had confidence and trust in the health professional they saw in 2018. But by 2025 that's dropped to 64%.

Speaker A

00:04:27.220 - 00:04:46.100

And I think that almost reflects what's happening in practice with the increasing number of other roles working in general practice as well. And I think one of the really striking findings here is that patients reported much lower trust when they weren't sure which professional they saw.

Do you want to talk us through that and why you think that is?

Speaker B

00:04:46.630 - 00:06:26.190

Absolutely. So what we've seen in terms of context here is that a lot of change happening in general practice, much of it taking place at the same time.

So we've seen in terms of multi professional team working, there are 40,000 additional non GP non nurse staff working in general practice, which is a whopping 387% per patient increase over a nine year period.

At the same time, we've also seen this huge policy focus on rapid access, delivering more remote appointments, working at scale and a shift to digital and online as well. So there's a lot going on in general practice all at the same time.

And we can also see alongside this changes in patients confidence and satisfaction with how general practice is working. So that's sort of a zoomed out, bigger picture lens.

We can see that in terms of the British Social attitude survey in 2024, almost half of all people said they were quite dissatisfied with how general practice was working. But looking back in time, if we look back to 1983, we see that only 13% of people were dissatisfied with how general practice was running.

And even looking back just 10 years ago, in 2016, that figure is 16% of the of people in the British Social Attitude Survey who were dissatisfied with general practice. So we're seeing massive shifts across multiple aspects of general practice.

At the same time, we're seeing a significant shift in the proportion of people who feel that they are satisfied with what's happening in terms of the care they're receiving from general practices.

Speaker A

00:06:27.070 - 00:06:35.070

And I guess that relates to some of the issues with trust and potentially not knowing who people are seeing in practice as well.

Speaker B

00:06:36.170 - 00:07:12.390

Absolutely.

So in our findings, what we found was that the combination of not knowing who you saw and a remote appointment is really problematic for patients in terms of trust and confidence.

So to give a flavour of this, when patients were not sure what health professional, what type of health professional they saw or spoke to, and this was a remote appointment, so an appointment by phone or video or message, the likelihood of reporting confidence and trust decreased by up to 80% when compared to patients who saw a GP in person at their practice.

Speaker A

00:07:12.470 - 00:07:48.910

And we did a podcast with Richard Baker talking about trust in healthcare professionals as well.

And one of the things he highlighted was that actually trust is really important in that patient clinician interaction, because, you know, that trust actually builds some foundation towards whether people might want to come back to the practice, they might want to take up that advice or management that's been suggested by the clinician they see.

So I think not only are you seeing these associations, but it's actually really drilling down to why trust is so important as well in these interactions.

Speaker B

00:07:49.710 - 00:09:55.280

Absolutely, you're 100% right. And I think we can see. And Richard Baker spoke to this.

So high trust means that people are less likely to overuse services, so they're less likely to repeatedly seek appointments from different health professionals for the same problem.

But importantly, they're also less likely to underuse services, because high trust means people are more likely to feel confident in presenting themselves as good candidates for care. For example, trust is Also important for other reasons in general practice.

So about a quarter of all appointments at GP practices are for medically unexplained symptoms. And that work of managing undifferentiated symptoms is hugely important.

And much of that rests on trust, the trust between a patient and health professional, when actually it's not the right thing to refer for further investigations or treatment. A lot of that rests on trusting relationships.

And we know that relationship based care, where the patient's more likely to see the same doctor over time, somebody they know, is hugely important. But at the same time, we've seen a massive drop off and continuity of care.

So if I can speak to the general practice patient survey, what we know is that in the last eight years, continuity of care as reported by patients in England has gone down by around 10 percentage points over the past seven years. So it was 50% of patients in 2018 who said they were able to see or speak to a preferred doctor.

They had a preferred doctor and they were able to see or speak to them either almost or all of the time. By 2055, that had reduced and dropped to just 39%. That's a really meaningful change for patients.

And I think if we look at our study and the results of our study, and we sit that alongside the work of a paper published by Carol Sinot and colleagues recently, we can see that there's real questions about whether the kind of model of care we have is delivering the types of appointments many patients want and need.

Speaker A

00:09:56.240 - 00:10:18.680

And I think Richard Baker talked about this in terms of two kind of different models of care almost.

So this sort of access, dependent, transactional kind of care model on one side, where there are lots of different people working in practice and access, quick access is prioritized, and then the more traditional sort of relationship based care that you're describing as well, that appears to be in decline.

Speaker B

00:10:18.680 - 00:10:52.380

Sadly, the evidence does show that we've seen a significant decline in continuity of care in general practice in the last five, six, seven years.

And that is really challenging for patients as well as for health professionals, because there's good evidence that relationship based care adds to meaning and work. Joy at work, satisfaction in your job.

It also makes it time efficient to be able to speak and meet with patients whom you already know, particularly if those patients with complex care.

Speaker A

00:10:52.700 - 00:10:57.020

Were there any results from your work here that surprised you when you looked at the data?

Speaker B

00:10:57.260 - 00:12:58.379

That's a really good question. Nada.

And I think while we understood that there had been so much change in general practice in recent years, trying to map out what that means for patients using evidence. If I'm honest, I don't think we expected to see the magnitude of the effects.

We saw the likelihood of reporting trust and confidence decreasing by 80%.

When you have an appointment where the patient's not sure who they've seen, they're confused about that and it's a remote appointment, that's a big effect size. And if I'm honest, that did surprise me.

I think there's things from here that I possibly worried were real and the results confirmed that, so they weren't so much surprising. But that doesn't take away at all from the level of concern about those.

So one of the things that has concerned me from here, from the results of our study, is that we know that almost 1 in 10 patients said their needs were not at all met in their last general practice appointment. That's really worrying.

And it's worrying mostly because, well, even more worrying because those living in deprived areas and those with a chronic illness were more likely to report that their needs weren't met. So that suggests that some of the shifts we've seen in the way that care is organised and delivered may be contributing to the inverse care law.

And that raises some really deep questions about what is the purpose of general practice and how do we ensure that we orientate service delivery models to provide care for patients not only who might prefer or need rapid access for a more transactional type of problem, at the same time as ensuring there's continuity of care and relationship based care for patients who need and will benefit from that model of care. So these are difficult but important questions for general practice.

Speaker A

00:12:58.860 - 00:13:06.620

And I wonder what your thoughts are about how much of this issue is about communication and expectations rather than the roles themselves.

Speaker B

00:13:07.020 - 00:15:03.940

I think there's a very important element that you're picking up on there. Nada. And I do think that communication is a hugely important part of embedding skill mix change successfully into general practice.

So I think it's a complex picture here.

What we can see is that it's really important that GP practices have good systems in place so that when a health professional introduces himself to a new patient, it's expected that they can say, you know, my name is X and I'm a physiotherapist working in this practice, or I'm a physician's associate working in this practice so patients can be clear.

We need clarity on that at both local practice level and also support for that at a national level in terms of successfully implementing some of these changes. I also think that it's not just about communicating roles.

Well, although that's a very important part of what needs to happen here, we also need to recognise that it's more difficult to establish trust and build rapport in situations where care is delivered remotely.

So thinking about practical strategies to support that sort of building of trust and confidence and knowing who it is that you're seeing when the appointment might be remote. I think we also need to recognise that the public really worry about not knowing who they're seeing.

And there's a element of social media in contributing to this.

We've seen some high profile cases leading up to a patient's death where the family and the patient have been confused about who it was the patient saw. And that's hugely upsetting. It's a significant issue of real public concern.

And I think we need to address those worries and communicate and provide assurance and reassurance for patients, both when they come into practice, but also thinking through how changes are implemented at a national level and whether there's things to learn from some of those experiences.

Speaker A

00:15:04.580 - 00:15:23.540

Yeah, and I just wanted to pick up on that, especially going back to your role and experiences working at the Nuffield Trust. And we know that national policy is strongly encouraging multi professional teams in general practice.

And do you have any thoughts about what your findings suggest policymakers should think about as these teams expand?

Speaker B

00:15:24.100 - 00:17:48.710

That's a great question, Nana.

I think what we can see is that multidisciplinary team working in primary care is not new, and we do know that it can offer a mix of potential benefits for staff and patients. But we also know that desired outcomes are not always delivered and we can see that implementation has been really challenging.

So I think there's important reflections there and lessons to be learned about, for example, the importance of building trust and clearly communicating new roles to patients, but also supporting staff and embedding new roles into practice and thinking about the cost of supervisory time to support new roles, to coordinate care, to ensure and avoid fragmenting care. When you have different members of a team working together to support an individual patient.

Title of paper: Pre-diagnostic primary care consultations and imaging in emergency-diagnosed vs referred lung cancer patients

Available at: https://doi.org/10.3399/BJGP.2025.0369

It has been postulated that emergency diagnoses of cancer (which occurs frequently and confers a poorer prognosis) may relate to suboptimal diagnostic management in primary care, but evidence to support or refute this hypothesis is sparse. We found that emergency-diagnosed patients with lung cancer were less likely to present with relevant respiratory symptoms and had fewer chest imaging investigations before diagnosis compared to patients diagnosed via referred routes, indicating an important role of disease factors in emergency diagnosis.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.200 - 00:01:06.690

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for listening to this podcast today.

In today's episode, we're speaking to Marta Bergland. Marta is a research assistant and PhD candidate at university College London.

She's recently published a paper here in the BJGP titled Pre Diagnostic Primary Care Consultations and Imaging in Emergency Diagnosed versus Referred Lung Cancer Patients.

So, hi, Marta, it's really lovely to meet you and it's great to talk to you about cancer diagnosis, which is a really important area for general practice and also a topic we publish on quite a lot here in the bjgp. It's been fascinating reading this paper and it tackles a cancer that we really don't do well with here in the UK in terms of early diagnosis.

But I wonder if you could just start off by telling us a little bit more about lung cancer and how it's actually often diagnosed, which can sometimes lead to some of those poor outcomes.

Speaker B

00:01:07.010 - 00:02:26.970

So, as you said, lung cancer is one of the cancer sites in the UK where the majority or a large proportion of patients are diagnosed through the emergency route, also known as emergency presentations, which is when a patient is diagnosed after they present through an urgent hospital admission or an A and E attendance in the 30 days before diagnosis.

And that could look like someone who has had a persistent cough for, say, two weeks, but didn't actually go to their gp, and then suddenly they have a more severe onset of symptoms like shortness of breath, and then they go to A and E and are referred to a chest X ray and then get diagnosed, which is a pathway that is associated with worse prognosis and worse outcomes after diagnosis. And the more preferred route, if you will, in England to diagnose patients is through primary care.

So through the GP routine referral or the urgent suspected referral route.

And that could look like someone who presents to primary care with cough or dyspneasia again, but then their GP refers them to a chest X ray and then they're diagnosed with lung cancer.

Speaker A

00:02:27.130 - 00:02:45.290

And I guess I wanted to just before we talk about what you found, I wanted to just cover here again, what you mean by this term, that's diagnostic window, because you mentioned that a few times in the paper. But what does this actually mean?

And it relates a bit back to some of what you're talking about, about people presenting with symptoms, isn't that right?

Speaker B

00:02:45.530 - 00:03:09.880

So, for us, it's a measure of healthcare use before diagnosis, and it could be any healthcare use Measure like consultations, symptoms, blood test use, anything like that.

And it's measuring when that changes compared to baseline before diagnosis, which can signal increased healthcare use associated with the subsequent diagnosis.

Speaker A

00:03:10.040 - 00:03:16.840

Okay, so it just, I guess it's what it says on the tin. It's just that window, isn't it, of potentially being able to pick up a change.

Speaker B

00:03:17.490 - 00:03:25.970

Exactly. So the idea is that if there is an increase long before diagnosis, then possibly there is an opportunity to diagnose these patients earlier.

Speaker A

00:03:26.450 - 00:04:09.190

So this was a really big study using the CPRD and this is a database that a lot of the listeners will be familiar with.

And you had a sample of a million patients registered with UK General Practice and then you looked at people diagnosed with cancer and their pre diagnosis rates of consultation like you were talking about, and also chest imaging by the different possible diagnosis routes. So either as an emergency, a routine or an urgent referral. But I really want to move straight to what you found here.

Can you give us just an overview of how the different people in this analysis were eventually diagnosed with lung cancer? So were there a lot of emergency diagnoses here?

Speaker B

00:04:09.350 - 00:05:46.240

Yes, I believe we had around 30% of patients who were diagnosed through the emergency route, compared to 20 something percent in the urgent referral route and the GP routine referral route. That aligns with the national data in NCRAS and also the Rapid Cancer Registry data. I guess that's what we expected to see.

We found that the majority of patients do present to primary care, which then disproves this hypothesis that has been presented in the literature that patients who are diagnosed through the emergency pathway don't present to primary care at all and therefore there wouldn't really be a chance to intervene and improve these patients diagnostic pathway. I think that is one of the key findings, although it is a simple finding.

Then we also found that there are short term similar diagnostic windows across these routes.

Patients who are diagnosed as emergencies had similar opportunity to intervene earlier as patients from the other routes, just because of the timing at which things changed.

However, we also looked at the rates and those were consistently lower for emergency diagnosed patients, even though the timing at which things change at the lower rates mean that these patients present less frequently. And so because they present less frequently, there are simpler, fewer chances in primary care to also like see warning signs earlier.

Speaker A

00:05:46.480 - 00:05:56.480

Yeah, so you looked at those consultations rates. So is that what you're describing here? So is that what those findings show in terms of potential opportunities for earlier diagnosis?

Speaker B

00:05:57.280 - 00:06:17.190

Yeah, so what I had in mind was mostly the consultations and the consultations with symptoms, but then acknowledging that we measured two different things.

So the timing at which things change, the diagnostic windows as well as the rates of these consultations, how frequently they were occurring for patients by route.

Speaker A

00:06:17.430 - 00:06:27.510

And what you're suggesting is that people who were diagnosed via emergency had lower rates. So that sort of is a bit counterintuitive. So can you talk us through that again a bit?

Speaker B

00:06:27.590 - 00:07:06.880

It's a bit contradicting.

Well, it would seem that it is because these patients do present to primary care and then when things start going wrong, let's say they happen around a similar time as for patients who are diagnosed through the other routes. But what sets the emergency diagnosed patients apart is that they present less frequently.

So they may still have cough and may still go to their gp, but they may not do so as often as someone who's referred on a two week wait, for example, or now urgent suspected referral, which then means that there are fewer chances for gps to pick up on persistent symptoms and then refer those patients.

Speaker A

00:07:07.200 - 00:07:19.780

And I guess just.

Were there any other main findings that you found in terms of sort of the diagnostic window or sort of consultations before diagnosis via the different routes?

Speaker B

00:07:19.940 - 00:09:14.860

Yeah, so I think one of the most interesting ones as well to the overall finding of patients presenting to primary care is that patients presented with non specific symptoms around 10 to five months before diagnosis across the routes, which is still quite a while before they're diagnosed.

So potentially this could mean that something could have been done differently to, for example, refer these patients earlier in like say month nine before diagnosis rather than nine months later. But again, as you said, this is also in lung cancer patients, which is a very difficult cancer site to diagnose early.

And part of that reason is because the symptoms that patients present with are non specific symptoms.

So it's also understandable that it is difficult to make that call based on someone presenting with cough in primary care, which is why there's more like work to be done and we need to better...]]>Today, we’re speaking to Marta Berglund, a Research Assistant and PhD candidate at University College London.

Title of paper: Pre-diagnostic primary care consultations and imaging in emergency-diagnosed vs referred lung cancer patients

Available at: https://doi.org/10.3399/BJGP.2025.0369

It has been postulated that emergency diagnoses of cancer (which occurs frequently and confers a poorer prognosis) may relate to suboptimal diagnostic management in primary care, but evidence to support or refute this hypothesis is sparse. We found that emergency-diagnosed patients with lung cancer were less likely to present with relevant respiratory symptoms and had fewer chest imaging investigations before diagnosis compared to patients diagnosed via referred routes, indicating an important role of disease factors in emergency diagnosis.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.200 - 00:01:06.690

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for listening to this podcast today.

In today's episode, we're speaking to Marta Bergland. Marta is a research assistant and PhD candidate at university College London.

She's recently published a paper here in the BJGP titled Pre Diagnostic Primary Care Consultations and Imaging in Emergency Diagnosed versus Referred Lung Cancer Patients.

So, hi, Marta, it's really lovely to meet you and it's great to talk to you about cancer diagnosis, which is a really important area for general practice and also a topic we publish on quite a lot here in the bjgp. It's been fascinating reading this paper and it tackles a cancer that we really don't do well with here in the UK in terms of early diagnosis.

But I wonder if you could just start off by telling us a little bit more about lung cancer and how it's actually often diagnosed, which can sometimes lead to some of those poor outcomes.

Speaker B

00:01:07.010 - 00:02:26.970

So, as you said, lung cancer is one of the cancer sites in the UK where the majority or a large proportion of patients are diagnosed through the emergency route, also known as emergency presentations, which is when a patient is diagnosed after they present through an urgent hospital admission or an A and E attendance in the 30 days before diagnosis.

And that could look like someone who has had a persistent cough for, say, two weeks, but didn't actually go to their gp, and then suddenly they have a more severe onset of symptoms like shortness of breath, and then they go to A and E and are referred to a chest X ray and then get diagnosed, which is a pathway that is associated with worse prognosis and worse outcomes after diagnosis. And the more preferred route, if you will, in England to diagnose patients is through primary care.

So through the GP routine referral or the urgent suspected referral route.

And that could look like someone who presents to primary care with cough or dyspneasia again, but then their GP refers them to a chest X ray and then they're diagnosed with lung cancer.

Speaker A

00:02:27.130 - 00:02:45.290

And I guess I wanted to just before we talk about what you found, I wanted to just cover here again, what you mean by this term, that's diagnostic window, because you mentioned that a few times in the paper. But what does this actually mean?

And it relates a bit back to some of what you're talking about, about people presenting with symptoms, isn't that right?

Speaker B

00:02:45.530 - 00:03:09.880

So, for us, it's a measure of healthcare use before diagnosis, and it could be any healthcare use Measure like consultations, symptoms, blood test use, anything like that.

And it's measuring when that changes compared to baseline before diagnosis, which can signal increased healthcare use associated with the subsequent diagnosis.

Speaker A

00:03:10.040 - 00:03:16.840

Okay, so it just, I guess it's what it says on the tin. It's just that window, isn't it, of potentially being able to pick up a change.

Speaker B

00:03:17.490 - 00:03:25.970

Exactly. So the idea is that if there is an increase long before diagnosis, then possibly there is an opportunity to diagnose these patients earlier.

Speaker A

00:03:26.450 - 00:04:09.190

So this was a really big study using the CPRD and this is a database that a lot of the listeners will be familiar with.

And you had a sample of a million patients registered with UK General Practice and then you looked at people diagnosed with cancer and their pre diagnosis rates of consultation like you were talking about, and also chest imaging by the different possible diagnosis routes. So either as an emergency, a routine or an urgent referral. But I really want to move straight to what you found here.

Can you give us just an overview of how the different people in this analysis were eventually diagnosed with lung cancer? So were there a lot of emergency diagnoses here?

Speaker B

00:04:09.350 - 00:05:46.240

Yes, I believe we had around 30% of patients who were diagnosed through the emergency route, compared to 20 something percent in the urgent referral route and the GP routine referral route. That aligns with the national data in NCRAS and also the Rapid Cancer Registry data. I guess that's what we expected to see.

We found that the majority of patients do present to primary care, which then disproves this hypothesis that has been presented in the literature that patients who are diagnosed through the emergency pathway don't present to primary care at all and therefore there wouldn't really be a chance to intervene and improve these patients diagnostic pathway. I think that is one of the key findings, although it is a simple finding.

Then we also found that there are short term similar diagnostic windows across these routes.

Patients who are diagnosed as emergencies had similar opportunity to intervene earlier as patients from the other routes, just because of the timing at which things changed.

However, we also looked at the rates and those were consistently lower for emergency diagnosed patients, even though the timing at which things change at the lower rates mean that these patients present less frequently. And so because they present less frequently, there are simpler, fewer chances in primary care to also like see warning signs earlier.

Speaker A

00:05:46.480 - 00:05:56.480

Yeah, so you looked at those consultations rates. So is that what you're describing here? So is that what those findings show in terms of potential opportunities for earlier diagnosis?

Speaker B

00:05:57.280 - 00:06:17.190

Yeah, so what I had in mind was mostly the consultations and the consultations with symptoms, but then acknowledging that we measured two different things.

So the timing at which things change, the diagnostic windows as well as the rates of these consultations, how frequently they were occurring for patients by route.

Speaker A

00:06:17.430 - 00:06:27.510

And what you're suggesting is that people who were diagnosed via emergency had lower rates. So that sort of is a bit counterintuitive. So can you talk us through that again a bit?

Speaker B

00:06:27.590 - 00:07:06.880

It's a bit contradicting.

Well, it would seem that it is because these patients do present to primary care and then when things start going wrong, let's say they happen around a similar time as for patients who are diagnosed through the other routes. But what sets the emergency diagnosed patients apart is that they present less frequently.

So they may still have cough and may still go to their gp, but they may not do so as often as someone who's referred on a two week wait, for example, or now urgent suspected referral, which then means that there are fewer chances for gps to pick up on persistent symptoms and then refer those patients.

Speaker A

00:07:07.200 - 00:07:19.780

And I guess just.

Were there any other main findings that you found in terms of sort of the diagnostic window or sort of consultations before diagnosis via the different routes?

Speaker B

00:07:19.940 - 00:09:14.860

Yeah, so I think one of the most interesting ones as well to the overall finding of patients presenting to primary care is that patients presented with non specific symptoms around 10 to five months before diagnosis across the routes, which is still quite a while before they're diagnosed.

So potentially this could mean that something could have been done differently to, for example, refer these patients earlier in like say month nine before diagnosis rather than nine months later. But again, as you said, this is also in lung cancer patients, which is a very difficult cancer site to diagnose early.

And part of that reason is because the symptoms that patients present with are non specific symptoms.

So it's also understandable that it is difficult to make that call based on someone presenting with cough in primary care, which is why there's more like work to be done and we need to better understand where the thresholds are for referral, like how many times someone comes in with the same symptoms, something like that.

But the work does show that that is like a common characteristic that is shared among, like across lung cancer patients, even diagnosed by the different routes.

And then another finding was also similar to the non specific symptoms, was that patients had chest imaging, so chest X rays around six to four months before diagnosis, which again is still a while before they're diagnosed.

And because these are chest X rays, then it could mean that they have negative chest X rays before diagnosis and then are again perhaps referred back to primary care with symptoms or they have an another chest X ray within those months where things are increasing, like month four to zero before diagnosis. Maybe there's a learning to be found from that.

Speaker A

00:09:15.100 - 00:09:32.620

Yeah, absolutely. And I wanted to just touch on those findings around imaging.

And I wonder what thoughts you had about the role of access to chest CTs for GPs, just given what you've described here about chest X rays and potential potentially negative chest X rays as well in this cohort.

Speaker B

00:09:33.180 - 00:10:02.380

Well, I do think that it's also pretty well documented in the literature that chest X rays aren't necessarily the best and most accurate diagnostic test for lung cancer and that improving access to low dose CT in England has helped diagnose lung cancer patients. So I think improving access to chest imaging and CT scans specifically could also present an opportunity to diagnose patients earlier.

Speaker A

00:10:02.830 - 00:10:16.990

And I wonder, just given all this information, what you found in this study, what do you think are the main implications for potentially opportunities to diagnose lung cancer earlier and not via emergency routes for these patients?

Speaker B

00:10:17.390 - 00:11:07.090

Again, I think the picture is complex because as you've also mentioned, the paper doesn't have kind of like a clear finding of something that was very different in the emergency diagnosed route. But actually patients who are diagnosed through the emergency route look quite similar to the, the primary care referred routes.

Then I think what we can do is focus on the things that were similar for all patients, meaning that there's also a similar opportunity to diagnose patients earlier across all routes.

Those things include being more vigilant about the non specific symptoms that patients present with and perhaps having a lower threshold for referral or more thorough follow up. And then I also think improving access to chest CTs could also help diagnose

Speaker A

00:11:07.090 - 00:11:22.290

patients earlier in the paper you touch very briefly on screening.

Is there anything that you want to mention here about sort of potentials for lung cancer screening or what might already be in play in terms of potential policy for screening for lung cancer?

Speaker B

00:11:22.850 - 00:12:16.370

Yeah, I mean, I think lung cancer screening is very important and it's definitely going to change the way things look in terms of how patients are diagnosed. And I think we're already seeing that since I think around like 2022 when the program started being rolled out.

There's around 7% of patients who are diagnosed through screening now, which we can see in the Rapid Cancer Registry data set that's actually publicly available as well.

So with that being said, it is still a bit difficult to know what that means because we need to let it play out for a few more years until we know what that means for diagnoses through the other routes. Hopefully it will mean that some patients who would be diagnosed through an emergency route won't be.

But of course we also don't know to what extent emergency diagnoses are completely avoidable.

Speaker A

00:12:16.610 - 00:12:23.280

And I think it's important to point out probably that the lung cancer screening programs are really targeted at the moment as well, aren't they?

Speaker B

00:12:23.360 - 00:12:50.190

Yeah, exactly. I believe there were patients who are eligible are those aged 55 to 74 and who have a history of smoking.

So for example, in our study that was 38% of patients who are diagnosed as emergency patients. So there's still 62% of emergency diagnosed patients who would not have been eligible for the screening pathway regardless.

Speaker A

00:12:50.910 - 00:13:11.950

And I think what you say here about actually not just focusing on what you found amongst the patients who were diagnosed with lung cancer via the emergency routes, but actually looking at everyone who's diagnosed with lung cancer and trying to improve care for all is really important in terms of extrapolating the findings here. It's been really great talking to you about this work. So thanks to again for joining me.

Speaker B

00:13:11.950 - 00:13:12.590

Thank you.

Speaker A

00:13:13.390 - 00:13:29.310

And thank you all very much for your time here and for listening to this BJGP podcast.

Marta's original research article can be found on bjgp.org and the show notes and podcast audio can be found@bjgplife.com thanks again for listening and bye.

Title of paper: Neighbourhood delivery of urgent care in North Yorkshire, UK

Available at: https://bjgp.org/content/76/764/133

Neighbourhood-based urgent care, led by GP Multineighbourhood providers, can reduce reliance on hospitals and NHS 111. Delivering urgent care in community settings is more cost effective than Urgent Treatment Centre and Emergency Departments attendances. Digital integration and shared clinical systems improve safety, responsiveness, and patient experience. Co-locating operational and clinical teams streamlines service delivery and enables operational and quality oversight. Sustained impact requires recurrent funding and performance measures that reflect system-wide improvement rather than single-provider metrics.

Title of paper: Predictors of Childhood Vaccination Uptake and Timeliness in a Diverse Urban Population

Available at: https://doi.org/10.3399/BJGP.2025.0319

Childhood vaccination rates have declined in the UK, with inequalities in urban, deprived, and ethnically diverse populations. Previous studies have lacked individual-level clinical data or did not explore both uptake and timeliness. We analysed 13 years of routinely collected primary care data for over 37,000 children in a diverse London borough to identify predictors of uptake and timeliness. Distinct sociodemographic and clinical factors were associated with incomplete and delayed vaccination, offering timely insights as responsibility for vaccination services shifts closer to local systems and place-based commissioning.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.880 - 00:00:52.000

Hi and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors of the Journal. Thanks for taking the time to listen to this podcast today.

In today's episode, we're speaking to Dr. Carol Basta.

Carol is a public health registrar based in London and we're here to talk about the paper she's recently published here in the bjgp, which is titled Predictors of Childhood Vaccination Uptake and Timeliness in a Diverse Urban Population. So, hi, Carol, it's really lovely to meet you and to talk about this work. And I guess just to start, I wanted to put this work into context.

We know that in the uk, overall childhood vaccination rates have unfortunately been declining. Could you talk us through some of the current challenges around vaccination, especially in urban and diverse areas?

Speaker B

00:00:52.720 - 00:02:06.750

Yep. So we know vaccinations are really powerful and cost effective tools we have in giving children the best start in life life.

But unfortunately, in the UK, since 2012, the uptake has been declining and actually since 2021, none of the vaccines in England have reached the 95% target recommended by the WHO to stop communicable disease outbreaks. And the kind of negative consequences of this aren't just sort of future hypothetical risks.

We've already been seeing vaccine preventable diseases such as measles and whooping cough resurgences, and this is especially in certain parts of the uk, such as London or the northwest of England. So no uptake of vaccines is decreasing and vaccine preventable diseases are increasing. But that's not the full picture.

We also know, for example, following work done by, at the time, Public health England in 2017, there are avoidable inequalities across the childhood vaccination program nationally, for example, linked to deprivation, geography and ethnicity.

However, what was missing was really kind of contemporary granular evidence on the social and clinical factors associated with unequal vaccine outcomes, especially in diverse urban environments.

Speaker A

00:02:06.990 - 00:02:16.670

And I know this was highlighted as well during COVID but there is a mistrust of health services amongst some communities as well, which might be playing into this.

Speaker B

00:02:17.470 - 00:03:11.120

Yeah, exactly.

So at the time when I was working in Lamb of Council, we knew qualitatively from talking to our community and talking to our local GP partners, that there was kind of sense of rising mistrust in healthcare services, but also rising difficulties with actually access to services.

And that doesn't just affect whether or not people can get the vaccine, for example, it also affects whether they can have conversations about vaccines and the kind of continuity of care and building up those relationships.

And so this is what we had kind of on a local level, but we knew that there was also national feelings and sentiments around mistrust, not just national, but actually globally vaccination mistrust from the COVID 19 pandemic. And there were worries that this had run off into the childhood vaccination program as well, that it hadn't just confined itself to Covid vaccines.

Speaker A

00:03:11.440 - 00:03:41.490

So this was a study looking at predictors of routine childhood vaccination from 40 general practices in Lambeth and London, which is a pretty ethnically and socioeconomic demographically diverse borough. And you looked here at the vaccination uptake and timeliness and some of the predictors for these. This was a really big sample.

But just to underline the population here, tell us more about the demographics in Lambeth as a borough in terms of ethnicity, because that's where you were based when this work was done.

Speaker B

00:03:41.890 - 00:04:32.250

Yeah, exactly.

So Lambeth is an inner London borough and it is very ethnically diverse, it's very densely populated, but it also has some of the highest levels of deprivation in the country. And part of the strengths of this study is that we were able to use detailed ethnic subgroup breakdowns.

So, for example, rather than using the broad category of South Asian, we were able to split this down into Pakistani, Bangladeshi, Indian, et cetera. And this was really important because this aligns with national health equity guidance.

We know that health outcomes actually vary between the details, subgroups.

There's some evidence to suggest that, but it was also important following local community engagement work, where people repeatedly told us these kind of big, broad groups don't reflect how we self identify.

Speaker A

00:04:32.490 - 00:04:39.530

And I wanted to just move on to the results here, so can you start talking us through some of the associations based on deprivation to start with?

Speaker B

00:04:39.690 - 00:06:22.410

Yeah, sure. So we looked at two main outcomes.

We looked at vaccination uptake, so that's whether children had received their vaccines at any time point during the study. And we also looked at vaccination timeliness.

And vaccination timeliness is important because although a child might eventually go on to receive their vaccine, it leaves them. They're late, it leaves them unprotected for at times when they're most potentially likely to get unwell.

And what we found with deprivation in uptake, there was really clear patterns associated by deprivation.

There was actually children living in more deprived areas were progressively less likely to be vaccinated compared with those living in the least deprived areas.

So, for example, children living in the most deprived 20% of our population were about a third less likely to be fully vaccinated compared to those living in the least deprived areas. This kind of wasn't just a straight out deprivation.

There was also lower uptake linked to other markers of social vulnerability, such as being born outside of eco, or such as children having safeguarding involvement. And so that was what we found for uptake. But what was interesting is the findings for timeliness didn't mirror this.

So whilst those living deprivation were less likely to be vaccinated, if we zoom in on just the population that were vaccinated and think about were they vaccinated on time, we didn't find that children living in deprivation were less likely to be vaccinated on time. We found no difference. And there was a similar pattern for other markers of social vulnerability, such as safeguarding involvement.

They have a lower uptake, but it wasn't associated with kind of untimely vaccination.

Speaker A

00:06:22.650 - 00:06:31.210

And you've touched upon this, but there was a really striking result here in terms of children who were born outside of the uk. So can you talk us through this?

Speaker B

00:06:31.530 - 00:06:59.060

Yeah. So we also found that children born outside of the UK were much less likely to be vaccinated compared to children born inside the uk.

However, if again, we zoom in on just those vaccinated and look at timeliness, we actually find the opposite. So if you were born outside of the uk, you were more likely to have your vaccine delivered on time compared to those who were born in the uk?

Speaker A

00:06:59.380 - 00:07:03.380

Sure, yeah. So talk us through some of the reasons that you think that this might be happening.

Speaker B

00:07:03.380 - 00:08:30.800

Yeah, I think these findings, the difference between uptake and timeliness, not having the same predictors and in some case having the opposite patterns being shown are really quite interesting. And they're kind of a few possible explanations as to why this might be. One is perhaps potentially there's a form of selection going on.

So when we look at only children who get vaccinated in groups with lower overall uptake, for example, children of non white British ethnicity, or as we've said, children not born in the uk, the children who do get vaccinated may represent more engaged, health literate or well supported families. And that same engagement may...]]>Today, we’re speaking to Dr Karol Basta, a Public Health Registrar based in London.

Title of paper: Predictors of Childhood Vaccination Uptake and Timeliness in a Diverse Urban Population

Available at: https://doi.org/10.3399/BJGP.2025.0319

Childhood vaccination rates have declined in the UK, with inequalities in urban, deprived, and ethnically diverse populations. Previous studies have lacked individual-level clinical data or did not explore both uptake and timeliness. We analysed 13 years of routinely collected primary care data for over 37,000 children in a diverse London borough to identify predictors of uptake and timeliness. Distinct sociodemographic and clinical factors were associated with incomplete and delayed vaccination, offering timely insights as responsibility for vaccination services shifts closer to local systems and place-based commissioning.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.880 - 00:00:52.000

Hi and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors of the Journal. Thanks for taking the time to listen to this podcast today.

In today's episode, we're speaking to Dr. Carol Basta.

Carol is a public health registrar based in London and we're here to talk about the paper she's recently published here in the bjgp, which is titled Predictors of Childhood Vaccination Uptake and Timeliness in a Diverse Urban Population. So, hi, Carol, it's really lovely to meet you and to talk about this work. And I guess just to start, I wanted to put this work into context.

We know that in the uk, overall childhood vaccination rates have unfortunately been declining. Could you talk us through some of the current challenges around vaccination, especially in urban and diverse areas?

Speaker B

00:00:52.720 - 00:02:06.750

Yep. So we know vaccinations are really powerful and cost effective tools we have in giving children the best start in life life.

But unfortunately, in the UK, since 2012, the uptake has been declining and actually since 2021, none of the vaccines in England have reached the 95% target recommended by the WHO to stop communicable disease outbreaks. And the kind of negative consequences of this aren't just sort of future hypothetical risks.

We've already been seeing vaccine preventable diseases such as measles and whooping cough resurgences, and this is especially in certain parts of the uk, such as London or the northwest of England. So no uptake of vaccines is decreasing and vaccine preventable diseases are increasing. But that's not the full picture.

We also know, for example, following work done by, at the time, Public health England in 2017, there are avoidable inequalities across the childhood vaccination program nationally, for example, linked to deprivation, geography and ethnicity.

However, what was missing was really kind of contemporary granular evidence on the social and clinical factors associated with unequal vaccine outcomes, especially in diverse urban environments.

Speaker A

00:02:06.990 - 00:02:16.670

And I know this was highlighted as well during COVID but there is a mistrust of health services amongst some communities as well, which might be playing into this.

Speaker B

00:02:17.470 - 00:03:11.120

Yeah, exactly.

So at the time when I was working in Lamb of Council, we knew qualitatively from talking to our community and talking to our local GP partners, that there was kind of sense of rising mistrust in healthcare services, but also rising difficulties with actually access to services.

And that doesn't just affect whether or not people can get the vaccine, for example, it also affects whether they can have conversations about vaccines and the kind of continuity of care and building up those relationships.

And so this is what we had kind of on a local level, but we knew that there was also national feelings and sentiments around mistrust, not just national, but actually globally vaccination mistrust from the COVID 19 pandemic. And there were worries that this had run off into the childhood vaccination program as well, that it hadn't just confined itself to Covid vaccines.

Speaker A

00:03:11.440 - 00:03:41.490

So this was a study looking at predictors of routine childhood vaccination from 40 general practices in Lambeth and London, which is a pretty ethnically and socioeconomic demographically diverse borough. And you looked here at the vaccination uptake and timeliness and some of the predictors for these. This was a really big sample.

But just to underline the population here, tell us more about the demographics in Lambeth as a borough in terms of ethnicity, because that's where you were based when this work was done.

Speaker B

00:03:41.890 - 00:04:32.250

Yeah, exactly.

So Lambeth is an inner London borough and it is very ethnically diverse, it's very densely populated, but it also has some of the highest levels of deprivation in the country. And part of the strengths of this study is that we were able to use detailed ethnic subgroup breakdowns.

So, for example, rather than using the broad category of South Asian, we were able to split this down into Pakistani, Bangladeshi, Indian, et cetera. And this was really important because this aligns with national health equity guidance.

We know that health outcomes actually vary between the details, subgroups.

There's some evidence to suggest that, but it was also important following local community engagement work, where people repeatedly told us these kind of big, broad groups don't reflect how we self identify.

Speaker A

00:04:32.490 - 00:04:39.530

And I wanted to just move on to the results here, so can you start talking us through some of the associations based on deprivation to start with?

Speaker B

00:04:39.690 - 00:06:22.410

Yeah, sure. So we looked at two main outcomes.

We looked at vaccination uptake, so that's whether children had received their vaccines at any time point during the study. And we also looked at vaccination timeliness.

And vaccination timeliness is important because although a child might eventually go on to receive their vaccine, it leaves them. They're late, it leaves them unprotected for at times when they're most potentially likely to get unwell.

And what we found with deprivation in uptake, there was really clear patterns associated by deprivation.

There was actually children living in more deprived areas were progressively less likely to be vaccinated compared with those living in the least deprived areas.

So, for example, children living in the most deprived 20% of our population were about a third less likely to be fully vaccinated compared to those living in the least deprived areas. This kind of wasn't just a straight out deprivation.

There was also lower uptake linked to other markers of social vulnerability, such as being born outside of eco, or such as children having safeguarding involvement. And so that was what we found for uptake. But what was interesting is the findings for timeliness didn't mirror this.

So whilst those living deprivation were less likely to be vaccinated, if we zoom in on just the population that were vaccinated and think about were they vaccinated on time, we didn't find that children living in deprivation were less likely to be vaccinated on time. We found no difference. And there was a similar pattern for other markers of social vulnerability, such as safeguarding involvement.

They have a lower uptake, but it wasn't associated with kind of untimely vaccination.

Speaker A

00:06:22.650 - 00:06:31.210

And you've touched upon this, but there was a really striking result here in terms of children who were born outside of the uk. So can you talk us through this?

Speaker B

00:06:31.530 - 00:06:59.060

Yeah. So we also found that children born outside of the UK were much less likely to be vaccinated compared to children born inside the uk.

However, if again, we zoom in on just those vaccinated and look at timeliness, we actually find the opposite. So if you were born outside of the uk, you were more likely to have your vaccine delivered on time compared to those who were born in the uk?

Speaker A

00:06:59.380 - 00:07:03.380

Sure, yeah. So talk us through some of the reasons that you think that this might be happening.

Speaker B

00:07:03.380 - 00:08:30.800

Yeah, I think these findings, the difference between uptake and timeliness, not having the same predictors and in some case having the opposite patterns being shown are really quite interesting. And they're kind of a few possible explanations as to why this might be. One is perhaps potentially there's a form of selection going on.

So when we look at only children who get vaccinated in groups with lower overall uptake, for example, children of non white British ethnicity, or as we've said, children not born in the uk, the children who do get vaccinated may represent more engaged, health literate or well supported families. And that same engagement may also support timely vaccination.

But in groups of higher overall uptake, for example, children of white British ethnicity or children born in the uk, the groups who do get vaccinated may include a kind of broader, more mixed group of families, including some who vaccinate later, which can then reduce their overall level of timeliness.

And this raises the possibility that our kind of existing recall and catch up systems may work better for some groups over others and in doing so may actually unintentionally reinforce inequalities rather than reduce them. But there are other alternative explanations and I think what's really key here is future research is really important.

Timeliness has generally been less well described and these findings potentially raise important questions. So it's definitely an area where both qualitative work and also future quantitative work I think would be helpful.

Speaker A

00:08:31.040 - 00:08:45.360

And you've touched a bit about the deprivation and children born outside of the uk and in this cohort, as you said, you were able to get quite detailed information about ethnicity rather than sort of the broad brush groups.

Speaker B

00:08:45.760 - 00:08:46.200

Yeah.

Speaker A

00:08:46.200 - 00:08:52.560

What did you find here in terms of ethnicity and uptake? So did it mirror some of the findings around children born outside the uk?

Speaker B

00:08:53.530 - 00:11:05.920

Yeah. So compared to children of white British ethnicity, lower uptake was observed with all other ethnic groups.

The largest gap was seen among children of black Caribbean ethnicity, whose odds of being fully vaccinated were around 70% lower than those of white British children.

But other groups such as Indian, Pakistani, Bangladeshi, Chinese, Arab and several other mixed ethnic groups also had lower uptakes, ranging between 30 to 50% lower than white British children.

And so all, although all groups had a lower uptake compared to white British, it suggests that the kind of barriers may not be experienced in the same way or to the same extent and could potentially reflect a combination of different structural, cultural and service related factors. I think with all of these findings, I think it's.

I think there's two important things to note, is one, we found all of the inequalities were present for both individual vaccines.

And then because we looked at overall patterns across the schedule, they weren't just kind of isolated to one vaccine, they were found for all the vaccines for all different sorts of combinations.

And this was important for us to find, as some of our work qualitatively, but also some findings nationally suggested perhaps some communities have lower uptake relating to just the MMR vaccine, for example, but we didn't find that.

So this suggests that kind of these inequalities are unlikely to be driven by really specific parental concerns about one vaccine, but it's kind of more wider barriers to accessing vaccination services. So I think that's one important thing to be aware of.

And then the second thing is that these inequalities are persisting after adjustment for a wide range of socio, demographic and clinical factors, as well as age as well as GP practice. So that kind of indicates a Certain level of robustness to measured confounding.

But however, as of any observational study, there are unmeasured factors that might be influencing things.

For example, in this case, things like parental education or family size, which we weren't able to explore but would be interesting to do in further studies.

Speaker A

00:11:06.080 - 00:11:25.620

It's interesting. You're talking about access as potentially quite a major contributing factor.

And one thing I was wondering was that, is it that there's more outreach needed to certain communities, or do you think it is sort of a matter of access to health care or an understanding about healthcare and what's being offered? Really?

Speaker B

00:11:26.500 - 00:12:25.010

Yeah. Research shows that it's often.

It's not necessarily just one thing, it's not necessarily just access, but it could be access combined with kind of vaccination misinformation or mistrust in the system. So there's often multiple things going on which can combine to cause vaccination inequalities.

I think, though, given the kind of strong findings across the vaccination pathways showing structural and social influences on vaccination inequalities, access is going to be definitely part of the story. And we also know this from qualitative research as well.

And so I think there are a number of things, not just general, general practices, but kind of different bodies that support general practice, such as national policy or integrated care boards. I think there are definitely things that can be done in this space.

Speaker A

00:12:25.250 - 00:12:45.120

And I think, as you're pointing out, this study has shown some of those persistent inequalities present with vaccination uptake. I think that actually your work as a public health doctor is really important to draw on here.

What do you think needs to be done at both the local or national level to start to tackle these inequalities?

Speaker B

00:12:46.160 - 00:13:02.720

Yeah, I think it's one of those things that requires a whole range of groups to play their part.

So I'd say there are kind of implications for GPs, implications for local teams, local integrated care boards, implications on a national level, and also implications for the research community.

Speaker A

00:13:03.040 - 00:13:14.150

It would be great to start with, what do you think that gps should be doing? Because these are people coming in to see us or families that we might know over time.

So it would be really interesting to hear your thoughts on that.

Speaker B

00:13:14.550 - 00:15:25.730

Yeah, yeah.

We've hopefully established that this study has shown a broad range of social and structural determinants of vaccination, and these are across the pathway. So I think practices are likely to have a greater impact by strengthening the overall vaccination pathway to work better for families.

Facing those barriers rather than focusing on individual vaccines or short term campaigns. There are a number of ways this can be done. Firstly, it's about making access easier, not more demanding.

So people who, families who are under vaccinated aren't necessarily even against vaccination, but they're juggling multiple competing pressures. Life is challenging.

So practical changes like flexible appointment times, opportunistic vaccination during other consultations, walk in clinics, simpler booking and recall systems could make a real difference. But it's not just the kind of process booking.

I think the experience of the appointment itself also matters, especially if it's kind of one of earlier on ones. Feeling welcome, not rushed and having questions taken seriously makes families more likely to return and stay engaged with a vaccination program.

But I think there's kind of secondly work that beyond the practice walls that gps can take.

So having stronger links with health visitors, children's centres and safeguarding teams can help reach families who are just going to find it really hard to consistently engage with general practices. And in some cases vaccination outside the surgery, for example, community settings or through health visitors, may be more effective.

And I think thirdly for practice, it's about building trust and continuity, which can sound kind of nebulous and difficult, but things like seeing a familiar clinician or having conversations in culturally sensitive ways can support engagement. And I think people who might have concerns about vaccines kind of not to expect that suddenly one consultation is going to solve all their problems.

But it's kind of about visit upon visit building that trust and engagement.

I've said all of that, but I'm very aware that this is very resource intensive and requires upfront investment, which I think it also needs to be supported by national policy and changing some of the funding mechanisms.

Speaker A

00:15:26.130 - 00:15:41.870

I think, I mean, that's really the main point that I wanted to highlight was, you know, you're talking about things like health visitors or children's centers and things like that, and we know that funding for those areas is tight and being cut and I think possibly that this is where the impact is being felt.

Speaker B

00:15:42.270 - 00:16:40.150

Yes, yes.

And I think even before we get to things like children's centers and health visitors, which definitely their funding is being cut and needs to be, we can talk a lot about vaccination as uptake. We need to use community centres, health visitors, but if the money's not there, it's not going to happen.

But I think even for general practice, funding for vaccination is linked to the number of vaccines given. But if you're in a Deprived practice, a very ethnically diverse urban with lots of challenges.

You're going to have a harder job trying to vaccinate your population and you're also going...]]>722dbed0-5f8e-405a-846a-1187cd8131a0Tue, 24 Feb 2026 08:00:00 +010019:53falsefull42252254From swabs to urine sampling: Rethinking cervical screening in general practiceToday, we’re speaking to Prof Emma Crosbie, Professor of Gynaecological Oncology based at the University of Manchester.

Title of paper: Urine human papillomavirus testing for cervical screening in a UK general screening population: a diagnostic test accuracy study

Available at: https://doi.org/10.3399/BJGP.2025.0105

The switch from primary cytology to primary human papillomavirus testing has enabled innovations in self-sampling for cervical screening. This study shows that urine self-collected with a first-void urine collection device has similar diagnostic test accuracy and acceptability to cervical sampling in a general screening population. Urine self-sampling has real-world potential as an alternative cervical screening option.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.440 - 00:01:07.140

Hello 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 Professor Emma Crosby, who is professor of Gynecological Oncology based at the University of Manchester. We're here to talk about her really exciting paper that's recently been published in the December 2025 issue of the BJGP.

The paper is titled Urine Human Papillovirus Testing for Cervical Screening in UK General Screening Population A Diagnostic Test Accuracy Study. So, hi Emma, it's lovely to meet you and to talk about this paper.

I really just wanted to start off talking a bit around cervical screening in the uk, and you mentioned this in the introduction to the paper as well, that cervical screening really does have variable uptake rates and we know that there are some, some barriers to access. But can you talk us through these and tell us a bit about why you decided to do this research?

Speaker B

00:01:07.940 - 00:03:41.440

So, as you've just really nicely summarised, cervical screening is really important weapon against cervical cancer.

So we know that it prevents cervical cancer and since the introduction of the NHS Cervical Screening program in the UK, we've seen deaths from cervical cancer drop by around 70%. So we know that it's very effective.

But in the uk, the number of people attending is declining year on year and currently, currently only around 68% of those people who are eligible for cervical screening actually attend. There are a whole range of different reasons for non attendance.

These include things to do with the speculum examination, so having to have an intimate examination to be examined. The anticipated embarrassment or fear of pain related to that procedure, I think are important barriers.

But there are also barriers associated with access to reaching screening appointments, taking time off work, having childcare and so on and so forth. So we thought that there was some really important barriers there that could potentially be addressed by self sampling.

Now, vaginal self sampling is actually been incorporated in many cervical screening programs around the world.

Some cervical screening programs are using it just for people who are non attenders or underscreened by traditional screening routes and other countries are using it as a choice for everybody.

Now, in the uk, we haven't yet taken up vaginal self sampling sampling, but it will be introduced this year in 2026, principally for under screened groups. And there is some work looking at whether or not it will be introduced as a choice for everyone in the future.

But we know from research that's been done in the UK that only around 12 to 13% of people who are offered vaginal self sampling who are under screened actually return a sample. And therefore it clearly doesn't address all the barriers to cervical screening. And we wondered whether a urine test would have more app.

It would have the same benefits of vaginal self sampling in that it can be collected at home and posted to the laboratory. So it removes that need for an intimate examination.

It removes the need for, you know, making an appointment at a healthcare facility to have your screen taken, but it perhaps, you know, removes some of the barriers towards putting a swab inside the vagina that might be culturally or religiously unacceptable to some groups. And so we thought that a urine self sample could be another option for people who currently aren't screened.

And so we wanted to see how accurate it was in this study.

Speaker A

00:03:42.320 - 00:04:03.760

And those issues around access are really important, especially in this population of women who are juggling lots of caring responsibilities with young children or caring for older relatives as well.

So sometimes it is just difficult to get to an appointment and, you know, juggling work hours and things which often then coincide with GP opening hours as well.

Speaker B

00:04:03.920 - 00:04:41.960

Yeah, absolutely.

And we, we have seen a drop in people, you know, in the youngest age group of people who are invited for screening, attending SCRE, their rates of attendance are even lower than the 68% that I quoted.

And probably a lot of that is to do with having very busy lives, not seeing this as a priority, imagining that you're not at risk and seeing cervical cancer as something that affects older people, perhaps. So there are additional barriers related to certain age groups.

But I definitely think that making time for a screening appointment, juggling all the different millions of things that we have to do every day, is a really important barrier that something like a urine based test could help to overcome.

Speaker A

00:04:42.120 - 00:05:10.680

Yeah, fair enough. So this was quite a big prospective study of over 1500 women carried out across the northwest of England.

So women provided both regular speculum based cervical samples alongside urine sample too. And the main thing you were looking at here was the accuracy of the urine based HPV testing for cervical cancer.

But just in case people aren't completely aware of all this, can you talk us through first why we're now only looking at HPV in these samples?

Speaker B

00:05:11.060 - 00:06:30.230

Yeah. So, I mean, in 2019 in the UK, we changed from primary cytology based cervical screening to primary HPV based cervical screening.

So that means that the sample taken from your cervix is tested first for hpv and only if that is HPV positive is it then looked at under the microscope. To see if there are changes in the cells.

And this was based on a very large study done in the UK that showed that HPV testing is a much more sensitive test than cytology as the primary scre.

And by that what we mean is it's much more likely not to miss abnormal cells than cytology, which is very effective when there is a large lesion, if you will, that can be sampled with a cervical swab, but not so good at picking up smaller lesions. And so there is the chance that cytology might miss an abnormality. But HPV is really good at showing that somebody is at risk.

So we now do all primary screening by HPV testing. And of course this is what has opened up the opportunity for us to do different sample types.

So a vaginal swab tested for HPV or a urine sample tested for hpv, you know, could also be an effective way of screening people to see if they are at high risk of cervical pre cancers.

Speaker A

00:06:30.390 - 00:06:37.830

So talk us through the results. So how well did the urine based testing perform? So both in terms of how sensitive and specific the results were?

Speaker B

00:06:38.130 - 00:09:24.670

Well, first of all, it's really important to say that this piece of work followed on from another piece of work that looked at a high risk population. And in that other piece of work we were able to show that it's really important how the urine sample is collected.

So absolutely must be collected with a colipy device or a similar device that collects the first fraction of urine sampled. And that's important because the HPV isn't in the urine itself.

The urine is flushing cervical mucus that is accumulated around the urethra into the sample. And so if you don't collect that very first flush of urine, then you're likely to miss the hpv.

So on that background, using the COLIP device in this study and collecting that urine sample prior to the routine clinician obtained cervical sample, we were able to obtain two samples from each person that we were then able to test with the same HPV test. And we were able to compare absolutely how accurate the urine was compared to the matched cervical sample.

And because we were using a general population, so this is anybody that's due cervical screening rather than a high risk population, we knew that we weren't going to see very many people who had CIN2 plus, which is the cervical pre cancer that we want to identify and treat.

And actually what we were looking for here was to see, you know, what prevalence of HPV infections do we pick up using the two tests, you know, the urine test and the Cervical test and how well matched are they at terms of, you know, telling somebody that they're HPV...]]>Today, we’re speaking to Prof Emma Crosbie, Professor of Gynaecological Oncology based at the University of Manchester.

Title of paper: Urine human papillomavirus testing for cervical screening in a UK general screening population: a diagnostic test accuracy study

Available at: https://doi.org/10.3399/BJGP.2025.0105

The switch from primary cytology to primary human papillomavirus testing has enabled innovations in self-sampling for cervical screening. This study shows that urine self-collected with a first-void urine collection device has similar diagnostic test accuracy and acceptability to cervical sampling in a general screening population. Urine self-sampling has real-world potential as an alternative cervical screening option.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.440 - 00:01:07.140

Hello 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 Professor Emma Crosby, who is professor of Gynecological Oncology based at the University of Manchester. We're here to talk about her really exciting paper that's recently been published in the December 2025 issue of the BJGP.

The paper is titled Urine Human Papillovirus Testing for Cervical Screening in UK General Screening Population A Diagnostic Test Accuracy Study. So, hi Emma, it's lovely to meet you and to talk about this paper.

I really just wanted to start off talking a bit around cervical screening in the uk, and you mentioned this in the introduction to the paper as well, that cervical screening really does have variable uptake rates and we know that there are some, some barriers to access. But can you talk us through these and tell us a bit about why you decided to do this research?

Speaker B

00:01:07.940 - 00:03:41.440

So, as you've just really nicely summarised, cervical screening is really important weapon against cervical cancer.

So we know that it prevents cervical cancer and since the introduction of the NHS Cervical Screening program in the UK, we've seen deaths from cervical cancer drop by around 70%. So we know that it's very effective.

But in the uk, the number of people attending is declining year on year and currently, currently only around 68% of those people who are eligible for cervical screening actually attend. There are a whole range of different reasons for non attendance.

These include things to do with the speculum examination, so having to have an intimate examination to be examined. The anticipated embarrassment or fear of pain related to that procedure, I think are important barriers.

But there are also barriers associated with access to reaching screening appointments, taking time off work, having childcare and so on and so forth. So we thought that there was some really important barriers there that could potentially be addressed by self sampling.

Now, vaginal self sampling is actually been incorporated in many cervical screening programs around the world.

Some cervical screening programs are using it just for people who are non attenders or underscreened by traditional screening routes and other countries are using it as a choice for everybody.

Now, in the uk, we haven't yet taken up vaginal self sampling sampling, but it will be introduced this year in 2026, principally for under screened groups. And there is some work looking at whether or not it will be introduced as a choice for everyone in the future.

But we know from research that's been done in the UK that only around 12 to 13% of people who are offered vaginal self sampling who are under screened actually return a sample. And therefore it clearly doesn't address all the barriers to cervical screening. And we wondered whether a urine test would have more app.

It would have the same benefits of vaginal self sampling in that it can be collected at home and posted to the laboratory. So it removes that need for an intimate examination.

It removes the need for, you know, making an appointment at a healthcare facility to have your screen taken, but it perhaps, you know, removes some of the barriers towards putting a swab inside the vagina that might be culturally or religiously unacceptable to some groups. And so we thought that a urine self sample could be another option for people who currently aren't screened.

And so we wanted to see how accurate it was in this study.

Speaker A

00:03:42.320 - 00:04:03.760

And those issues around access are really important, especially in this population of women who are juggling lots of caring responsibilities with young children or caring for older relatives as well.

So sometimes it is just difficult to get to an appointment and, you know, juggling work hours and things which often then coincide with GP opening hours as well.

Speaker B

00:04:03.920 - 00:04:41.960

Yeah, absolutely.

And we, we have seen a drop in people, you know, in the youngest age group of people who are invited for screening, attending SCRE, their rates of attendance are even lower than the 68% that I quoted.

And probably a lot of that is to do with having very busy lives, not seeing this as a priority, imagining that you're not at risk and seeing cervical cancer as something that affects older people, perhaps. So there are additional barriers related to certain age groups.

But I definitely think that making time for a screening appointment, juggling all the different millions of things that we have to do every day, is a really important barrier that something like a urine based test could help to overcome.

Speaker A

00:04:42.120 - 00:05:10.680

Yeah, fair enough. So this was quite a big prospective study of over 1500 women carried out across the northwest of England.

So women provided both regular speculum based cervical samples alongside urine sample too. And the main thing you were looking at here was the accuracy of the urine based HPV testing for cervical cancer.

But just in case people aren't completely aware of all this, can you talk us through first why we're now only looking at HPV in these samples?

Speaker B

00:05:11.060 - 00:06:30.230

Yeah. So, I mean, in 2019 in the UK, we changed from primary cytology based cervical screening to primary HPV based cervical screening.

So that means that the sample taken from your cervix is tested first for hpv and only if that is HPV positive is it then looked at under the microscope. To see if there are changes in the cells.

And this was based on a very large study done in the UK that showed that HPV testing is a much more sensitive test than cytology as the primary scre.

And by that what we mean is it's much more likely not to miss abnormal cells than cytology, which is very effective when there is a large lesion, if you will, that can be sampled with a cervical swab, but not so good at picking up smaller lesions. And so there is the chance that cytology might miss an abnormality. But HPV is really good at showing that somebody is at risk.

So we now do all primary screening by HPV testing. And of course this is what has opened up the opportunity for us to do different sample types.

So a vaginal swab tested for HPV or a urine sample tested for hpv, you know, could also be an effective way of screening people to see if they are at high risk of cervical pre cancers.

Speaker A

00:06:30.390 - 00:06:37.830

So talk us through the results. So how well did the urine based testing perform? So both in terms of how sensitive and specific the results were?

Speaker B

00:06:38.130 - 00:09:24.670

Well, first of all, it's really important to say that this piece of work followed on from another piece of work that looked at a high risk population. And in that other piece of work we were able to show that it's really important how the urine sample is collected.

So absolutely must be collected with a colipy device or a similar device that collects the first fraction of urine sampled. And that's important because the HPV isn't in the urine itself.

The urine is flushing cervical mucus that is accumulated around the urethra into the sample. And so if you don't collect that very first flush of urine, then you're likely to miss the hpv.

So on that background, using the COLIP device in this study and collecting that urine sample prior to the routine clinician obtained cervical sample, we were able to obtain two samples from each person that we were then able to test with the same HPV test. And we were able to compare absolutely how accurate the urine was compared to the matched cervical sample.

And because we were using a general population, so this is anybody that's due cervical screening rather than a high risk population, we knew that we weren't going to see very many people who had CIN2 plus, which is the cervical pre cancer that we want to identify and treat.

And actually what we were looking for here was to see, you know, what prevalence of HPV infections do we pick up using the two tests, you know, the urine test and the Cervical test and how well matched are they at terms of, you know, telling somebody that they're HPV negative and at low risk of cervical cancer and how well matched out they are picking up HPV positive people who also have cytological abnormalities that need to be referred to colposcopy.

So if we take all of that information on board, then the bottom line figure is that urine picked up around 16% of people as having an HPV infection, while a cervical sample picked up around 13.5%. So you can see that we picked up slightly more HPV infections with urine than we did with the matched cervical sample.

But when we look at, you know, how many of those had CIN2 plus, it was just a very small number. So only 25 of our 15, 17 people actually had a CIN2 plus lesion, and urine picked up 24 of those.

So when we look at the relative specificity, if you like, of urine versus cervical sampling for HPV detection in this population, it was really good. It was 97% relative sensitivity specificity.

And when we look at sensitivity, you know, we're a little bit underpowered because, like I said, we only had 25 CIN2 plus lesions, but urine picked up 24 of those 25. So it had really excellent sensitivity as well, even bearing in mind small numbers.

Speaker A

00:09:24.830 - 00:09:43.940

And I think one of the main things to look at here and to point out was what the participants felt about the different forms of testing.

And you looked and asked them what they thought about the cervical screening using a urine sample instead of the more traditional based speculum based testing. And what did they feel about that in terms of sort of acceptability?

Speaker B

00:09:44.740 - 00:10:51.420

Well, I mean, as we might expect, most of them were quite happy with attending for routine cervical screening appointments. This probably is not the population for whom a urine based test is intended.

It's probably, at least in the first instance, intended for people that are under screened. But it's perhaps not surprising that people who do go for routine cervical screening are more than happy to continue doing so.

So we found that around 42% would prefer to continue to for their screening appointment and to have a sample taken by a healthcare professional. Interestingly, around 30% would prefer to switch to a urine based cervical screening test.

And another sort of 30% or so had no particular preference over screening method.

And this is quite interesting because it suggests that we probably need to have a menu of choices for people that, you know, one option for everybody is not going to answer the problems of reduced uptake of cervical screening and that if we had a menu of choices whereby people could choose the way that they would be screened in the future, that this might have the best way of increasing the number of people who are screened.

Speaker A

00:10:51.500 - 00:10:55.180

Any other key findings from the paper that you want to touch on at all?

Speaker B

00:10:55.420 - 00:11:42.680

Well, I think the main thing is that we were really impressed with the performance of urine. This is kind of.

We didn't directly compare it to a vaginal swab result, which, as I'd already mentioned, is going to be introduced by the NHS Cervical Screening Program from 2026 for under screened women.

But if we compare how urine has performed in study, especially if we look at it in combination with the study that was done in a high risk population, and then compare it with the recently published HP Validate study that compared different vaginal swabs with HPV testing results, we can see that urine performs at least as well as vaginal self sampling, if not slightly better.

So we were, we were a little bit surprised that it performs better than vaginal swab, but extremely excited that this paves the way for further research in this area.

Speaker A

00:11:43.190 - 00:12:02.710

And based on this study, and you've talked a bit about the introduction of vaginal self sampling this year as well, what do you think is the future for cervical cancer screening in the uk?

You've mentioned about having a menu of options, but you've also touched on the fact that there might be some groups for whom this is actually the preferred method of screening.

Speaker B

00:12:03.510 - 00:13:54.680

Yes, I mean, I think initially the cervical screening program's decision to offer vaginal self sampling to under screen populations is a really good one because it can't do any harm. These people are not being screened by definition and so offering them another option to help them to be screened is fantastic.

From previous research, we might expect only around 8 to 13% of those people to actually take up the offer of vaginal self sampling. So it might be that we actually need to introduce another option for under screened people, such as urine based sampling.

So I definitely see it as having a role for people who couldn't be screened in other ways.

And there are plenty of people that have been, for example, victims of sexual violence, people for whom putting a swab in the vagina is culturally or religiously taboo, people who have pelvic pain conditions, vaginismus, painful vulval conditions and so on. I can definitely see that urine based sampling, if we can show it's as accurate as vaginal based sampling, has a place.

But in terms of whether or not we're going to offer different ways of self sampling, for everybody in the cervical screening program, I think that needs a little bit of a more careful consideration.

And the reason that I say that is that if, for example, vaginal self sampling and urine self sampling are even a tiny bit less accurate than cervical self sampling, and what we find is that by introducing these self sampling methods to the general screening population doesn't really increase the number of people being screened, but does substantially influence people to switch from regular screening to urine or vaginal based cell sampling. We might actually see a deterioration in the cervical screening program. We might actually see more cervical cancers and deaths from cervical cancers.

So we really need to do more research in this area before we just introduce it as other countries have done.

Speaker A

00:13:54.920 - 00:14:05.240

And I guess that's the next thing I want to touch on is what's the next steps for you and your team in this area? Are you planning any further research and looking at urine based HPV testing?

Speaker B

00:14:05.560 - 00:15:06.700

Yes. So we have done two other large studies. One is looking at under screened women.

So we have randomized women to receive either a vaginal self sampling kit sent to their home address, a urine based self sampling kit sent to the home address, or an offer of the choice between a vaginal or a urine self sampling kit, or an offer of vagina self sampling kit or an offer of a urine self sampling kit.

So five different groups basically asking the question of whether we really need the option of vaginal versus urine self sampling or whether, you know, one type of option is going to be effective for everybody. And can urine based self sampling actually help people to to be able who are under screened to turn up for screening?

So that's the first study that we've done. And then another study that we have done is looking at the acceptability in a much larger population.

So several thousands of people who have tried urine based self sampling, what do they think about it? Compared to vaginal self sampling and compared to routine screening?

Speaker A

00:15:07.180 - 00:15:30.040

Brilliant.

That sounds like all really exciting work and as you say, it's tackling those challenges around the decrease in people taking up cervical cancer screening.

So I think this is really important work and it's been great to hear about it and look forward to hearing about the results from those other studies you're working on. But I just wanted to say that's I think a great place to wrap things up. So thanks very much for your time, Emma.

Speaker B

00:15:30.120 - 00:15:30.760

Thank you.

Speaker A

00:15:31.240 - 00:15:52.770

And thank you all very much for your time here and for listening to this BJ GP podcast.

Emma's original research article can be found on bjgp.org and the show notes and podcast audio are@bjgplife.com it's been great hearing about Emma's research in this area, and I hope you all enjoyed listening as well. Thanks again for your time and bye.

Title of paper: Factors influencing confidence and trust in health professionals: a cross-sectional study of English general practices.

Available at: https://doi.org/10.3399/BJGP.2025.0154

A transactional model of general practice is being introduced to improve access that involves triage and increasing percentages of appointments with professionals other than GPs or that are not face-to-face. Using summary data about almost all English general practices in 2023-24 with 750 or more patients, the patient-reported levels of confidence and trust from the General Practice Patient Survey were associated with increased percentages of appointments that were with GPs or were face-to-face, and with higher continuity, after adjusting for other practice and patient factors. Confidence and trust was lower in practices with fewer appointments per year per patient, fewer patients having their needs met, greater deprivation, fewer patients of White ethnicity, and in practices located in London, as compared to other regions of England. Access to general practice needs improving, but the findings of this cross-sectional study suggest that preserving features of relationship-based care is also needed to maintain patients’ trust and confidence in health professionals.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.200 - 00:00:46.980

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for joining us here to listen to this podcast today.

In today's episode, we're speaking to Professor Richard Baker, Emeritus professor at the University of Leicester. We're here to talk about the paper that he and his colleagues have recently published here in the bjjp.

The paper is titled Factors Influencing Confidence and Trust in Healthcare A Cross Sectional Study of English General Practices. So, hi, Richard, thanks for joining me here today and it's nice to see you again.

Just before we talk about this paper, I wonder if you could just talk to me about trust and why you think it's important in general practice interactions.

Speaker B

00:00:47.780 - 00:01:32.060

Well, it's difficult to have a consultation with a patient if they don't trust you. I mean, it's just very basic, a very basic level, very simple level. But there's lots of evidence as well that trust is important.

People who trust you are more likely to follow your advice. They're more likely to take the medication.

They're more likely therefore, to come back and see you again, more likely to use services appropriately in the future. And there's some evidence that the outcomes are better if there's trust there. Trust obviously should be earned.

You can't take it for granted, you've got to be trustable. But it's obviously very important for clinical practice and essentially always has been, hasn't it, really? Going back to the.

The Greek doctors, trust was important then, just as it is now.

Speaker A

00:01:32.460 - 00:01:38.540

And you mentioned about different outcomes. So what sort of outcomes do we know could be associated with trust?

Speaker B

00:01:39.180 - 00:02:07.990

Just use of services is one example.

So you can get people who, if they don't trust who they see, they go and see someone else and again, and so they overuse services and that waste resources.

On the other hand, you may get people who just won't come, so they'll delay presenting with the problems because they don't trust the provider to get it right. Then they risk of poor outcomes as a consequence of that. So it's a whole mixture of things.

Speaker A

00:02:09.030 - 00:02:21.190

So what were you trying to do in the study?

So you wanted to look at trust and how it impacted on patient outcomes, or was it more about sort of the predictors and associations with trust, isn't it?

Speaker B

00:02:21.800 - 00:04:33.330

Yes, I think we were conscious that general practice has gone through a lot of change.

The big changes came about during the pandemic as to how general practice is delivered, how people have their appointments and things have sort of Reverted a bit to how they were, but only partially in terms of who you get to see face to face, appointment and so on. And we were asking the question, well, what has been the consequence of this?

Should we be thinking about confidence and trust in association with these changes?

I mean, the changes may have been absolutely essential because we just don't have the capacity in general practice to do everything that we would like to do for an increasingly multi morbid population. But what are the consequences? How do we need to respond? How do we need to respond?

Questions I guess for follow on from Is there a link between confidence and trust and these changes in general practice changes?

I think when we looked at this, we've sort of grouped them, we sort of imagined that there are two models of general practice which the relationships based care and the transactional model. Of course there aren't two models, it's all mixed up. But to simplify it, you call it two different things.

And we've tried to categorize or explain what relationship based care might be, which has typified by high context continuity, face to face appointments with someone, you know, usually a gp, to get generalist medical care.

And then the transactional model where you, you have a problem, you, you phone up or email or whatever it might be online and you get allocated or triaged to a particular professional who deals with that particular problem and then off you go on to something else. And, and it could be face to face, it could be over the phone, it could be all sorts of different health professionals.

So there's two different ways, it's all mixed up. And every practice offices offers these two approaches in different degrees. It's just.

So this arbitrary division that we've described and we're sort of interested in how we look at that, how is competent trust linked to that?

Speaker A

00:04:34.769 - 00:04:56.790

This was a study looking at the general practice patient survey, which includes a question about whether patients felt that they had confidence and trust in their healthcare professionals. And. And then as we were discussing, you looked at some of the factors that might influence this trust.

But I wonder if you could talk us through the findings. So in this survey, how many respondents felt that they trusted their healthcare professionals?

Speaker B

00:04:57.590 - 00:06:12.790

This was, we were interested and the question was, did you have complete confidence in trust in the professional scene at your last appointment? And around about the figure was 64, 65% on average across all the practices.

So this was all general practices, but the vast majority of 99% or something of all general practices in England, 6200 practices were roughly in the study. And this was 20, 23, 24 year. It was a simple cross sectional study for reasons the data weren't available for a longitudinal study, unfortunately.

But so there are inevitably limitations on that.

But I suppose, yes, you would say two thirds had full confidence in trust and others had partial confidence trust and others had absolutely no competence and trust in the professional they had last seen.

Now, this relates to all types of health professionals seen, so it would include gps, but it would include the nurse you saw, the physiotherapist or the pharmacist or whatever. It would be the general practice based pharmacist, the people in the primary care team who, who consult with them see patients.

Speaker A

00:06:12.870 - 00:06:38.150

And you talked earlier about these two different models of care, the relationship based model and the transactional model.

And you know, you described that some of this might be a bit more mixed in practice, but did you find any associations between those different ways of working and how trust was or how much patients trusted their interactions with their last healthcare professional?

Speaker B

00:06:39.610 - 00:07:53.140

There's a tendency among the findings for relationship based care to be associated with higher levels of competence and trust, relationship based care being typified by higher levels of continuity, more face to face appointments, more appointments with gps. And of those three things, continuity is perhaps the most powerful association and then points with GPS the next most powerful.

And face to face being the third or least powerful element of that three.

When you put all three together, I think it becomes quite a powerful message really saying patients do by and large tend to be more trusting, have more confidence in relationship based care.

But that doesn't mean to say there are patients who don't want transactional care and have trust and confidence in it, they get it and when they want it. So it's not a simple either...]]>Today, we’re speaking to Professor Richard Baker, emeritus Professor at the University of Leicester.

Title of paper: Factors influencing confidence and trust in health professionals: a cross-sectional study of English general practices.

Available at: https://doi.org/10.3399/BJGP.2025.0154

A transactional model of general practice is being introduced to improve access that involves triage and increasing percentages of appointments with professionals other than GPs or that are not face-to-face. Using summary data about almost all English general practices in 2023-24 with 750 or more patients, the patient-reported levels of confidence and trust from the General Practice Patient Survey were associated with increased percentages of appointments that were with GPs or were face-to-face, and with higher continuity, after adjusting for other practice and patient factors. Confidence and trust was lower in practices with fewer appointments per year per patient, fewer patients having their needs met, greater deprivation, fewer patients of White ethnicity, and in practices located in London, as compared to other regions of England. Access to general practice needs improving, but the findings of this cross-sectional study suggest that preserving features of relationship-based care is also needed to maintain patients’ trust and confidence in health professionals.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.200 - 00:00:46.980

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for joining us here to listen to this podcast today.

In today's episode, we're speaking to Professor Richard Baker, Emeritus professor at the University of Leicester. We're here to talk about the paper that he and his colleagues have recently published here in the bjjp.

The paper is titled Factors Influencing Confidence and Trust in Healthcare A Cross Sectional Study of English General Practices. So, hi, Richard, thanks for joining me here today and it's nice to see you again.

Just before we talk about this paper, I wonder if you could just talk to me about trust and why you think it's important in general practice interactions.

Speaker B

00:00:47.780 - 00:01:32.060

Well, it's difficult to have a consultation with a patient if they don't trust you. I mean, it's just very basic, a very basic level, very simple level. But there's lots of evidence as well that trust is important.

People who trust you are more likely to follow your advice. They're more likely to take the medication.

They're more likely therefore, to come back and see you again, more likely to use services appropriately in the future. And there's some evidence that the outcomes are better if there's trust there. Trust obviously should be earned.

You can't take it for granted, you've got to be trustable. But it's obviously very important for clinical practice and essentially always has been, hasn't it, really? Going back to the.

The Greek doctors, trust was important then, just as it is now.

Speaker A

00:01:32.460 - 00:01:38.540

And you mentioned about different outcomes. So what sort of outcomes do we know could be associated with trust?

Speaker B

00:01:39.180 - 00:02:07.990

Just use of services is one example.

So you can get people who, if they don't trust who they see, they go and see someone else and again, and so they overuse services and that waste resources.

On the other hand, you may get people who just won't come, so they'll delay presenting with the problems because they don't trust the provider to get it right. Then they risk of poor outcomes as a consequence of that. So it's a whole mixture of things.

Speaker A

00:02:09.030 - 00:02:21.190

So what were you trying to do in the study?

So you wanted to look at trust and how it impacted on patient outcomes, or was it more about sort of the predictors and associations with trust, isn't it?

Speaker B

00:02:21.800 - 00:04:33.330

Yes, I think we were conscious that general practice has gone through a lot of change.

The big changes came about during the pandemic as to how general practice is delivered, how people have their appointments and things have sort of Reverted a bit to how they were, but only partially in terms of who you get to see face to face, appointment and so on. And we were asking the question, well, what has been the consequence of this?

Should we be thinking about confidence and trust in association with these changes?

I mean, the changes may have been absolutely essential because we just don't have the capacity in general practice to do everything that we would like to do for an increasingly multi morbid population. But what are the consequences? How do we need to respond? How do we need to respond?

Questions I guess for follow on from Is there a link between confidence and trust and these changes in general practice changes?

I think when we looked at this, we've sort of grouped them, we sort of imagined that there are two models of general practice which the relationships based care and the transactional model. Of course there aren't two models, it's all mixed up. But to simplify it, you call it two different things.

And we've tried to categorize or explain what relationship based care might be, which has typified by high context continuity, face to face appointments with someone, you know, usually a gp, to get generalist medical care.

And then the transactional model where you, you have a problem, you, you phone up or email or whatever it might be online and you get allocated or triaged to a particular professional who deals with that particular problem and then off you go on to something else. And, and it could be face to face, it could be over the phone, it could be all sorts of different health professionals.

So there's two different ways, it's all mixed up. And every practice offices offers these two approaches in different degrees. It's just.

So this arbitrary division that we've described and we're sort of interested in how we look at that, how is competent trust linked to that?

Speaker A

00:04:34.769 - 00:04:56.790

This was a study looking at the general practice patient survey, which includes a question about whether patients felt that they had confidence and trust in their healthcare professionals. And. And then as we were discussing, you looked at some of the factors that might influence this trust.

But I wonder if you could talk us through the findings. So in this survey, how many respondents felt that they trusted their healthcare professionals?

Speaker B

00:04:57.590 - 00:06:12.790

This was, we were interested and the question was, did you have complete confidence in trust in the professional scene at your last appointment? And around about the figure was 64, 65% on average across all the practices.

So this was all general practices, but the vast majority of 99% or something of all general practices in England, 6200 practices were roughly in the study. And this was 20, 23, 24 year. It was a simple cross sectional study for reasons the data weren't available for a longitudinal study, unfortunately.

But so there are inevitably limitations on that.

But I suppose, yes, you would say two thirds had full confidence in trust and others had partial confidence trust and others had absolutely no competence and trust in the professional they had last seen.

Now, this relates to all types of health professionals seen, so it would include gps, but it would include the nurse you saw, the physiotherapist or the pharmacist or whatever. It would be the general practice based pharmacist, the people in the primary care team who, who consult with them see patients.

Speaker A

00:06:12.870 - 00:06:38.150

And you talked earlier about these two different models of care, the relationship based model and the transactional model.

And you know, you described that some of this might be a bit more mixed in practice, but did you find any associations between those different ways of working and how trust was or how much patients trusted their interactions with their last healthcare professional?

Speaker B

00:06:39.610 - 00:07:53.140

There's a tendency among the findings for relationship based care to be associated with higher levels of competence and trust, relationship based care being typified by higher levels of continuity, more face to face appointments, more appointments with gps. And of those three things, continuity is perhaps the most powerful association and then points with GPS the next most powerful.

And face to face being the third or least powerful element of that three.

When you put all three together, I think it becomes quite a powerful message really saying patients do by and large tend to be more trusting, have more confidence in relationship based care.

But that doesn't mean to say there are patients who don't want transactional care and have trust and confidence in it, they get it and when they want it. So it's not a simple either or.

The picture at the moment appears to be there are probably more patients who want relationship based care than are able to get it.

Speaker A

00:07:53.940 - 00:08:14.000

And I wanted to touch here more on continuity of care and it's an area of research that you've worked in for a while and there have been previous studies. I know Chris Salisbury's team in Bristol did some work around healthcare professionals and trust and continuity.

What are your thoughts about this based the results that you've pulled out from this survey as well?

Speaker B

00:08:14.800 - 00:10:12.260

Well, it just reinforces my perception of continuity being preferred by patients.

Some of the first studies I did way back in the 1980s, 90s, I wasn't investigating continuity, but I was investigating what patients thought about their care and continuity just stood out. It just, it almost, almost slapped me around the face. Come on. Notice this.

And it was, it was as a became a to say, look, we need to take this seriously and try and provide what patients want.

They prefer, by and large, not all patients, but most patients, especially when they've got a more complex or worrying problem, want to see someone they developed a relationship with, a relationship of trust where they know, where they can understand what the person is telling them. Because if you've seen somebody once and they've got you right that time, then you're going to go back and see them again, aren't you?

It's just sort of obvious really, but the continuity has actually, since the 80s and 90s, it's really just steadily declined and that's a sort of frustration as to why that's happened.

And keep on providing more evidence about the value of continuity from the patient's perspective, from outcomes perspective, from health professionals perspective. This is just another example of one of those studies I'm totally expecting.

In this study we were to find that continuity was a predictor of confidence and trust. What we were looking at was a face to face appointments a predictor as well. And is seeing a GP a predictor as well? And yes, they were.

They're all linked parts of relationship based care. And yes, the story of the last two or three decades has been a gradual decline in relationship based care, which I think is a shame.

Speaker A

00:10:13.050 - 00:10:36.170

And there is this almost tension between this idea of relationship based care currently and quicker access, more transactional ways of working and fewer appointments between a patient and a GP in practice with an increasing multidisciplinary team. So in some ways it seems like a frustrating system, not just for patients, but for GPs as well. Really?

Speaker B

00:10:36.890 - 00:11:38.170

Yeah, absolutely, I'm sure it is. Yeah, absolutely. It must be.

Well, it's obvious we all know it's very, very difficult working in practice at the moment, juggling so many things at once. It's really difficult.

And the changes that have come about in terms of proportion of appointments with gps proportion that were face to face, it's almost, it's essential, it's necessary to enable the service to continue, isn't it? So it's not a deliberate policy of gps to reduce relationship based care. It's something that had to be done in the face of.

I don't know quite where the policies came from, but it feels to me as though there'd been a failure to respond to what we knew was going to happen. An aging population, greater demand for healthcare. We should have got our, rolled our sleeves up and planned to deal with that well in advance.

Maybe the NHS workforce plan will start to put right some of those things in the next few years. We'll have to see.

Speaker A

00:11:38.490 - 00:11:41.850

Any other key findings that you want to mention from this paper?

Speaker B

00:11:43.710 - 00:12:32.610

I think the other one that I picked up on is patients have greater confidence in trust when they report that their needs were met at their last consultation.

I think that was another finding using information from the general practice of patient survey data, and I think that was quite an interesting one in ways. It's sort of not unexpected.

People who write theories about trust, patient trust in the health professional talk about patients assessment of competence, and it seems to me that's perhaps linked to that. So I think that's another thing that it might be worthwhile just thinking about and knowing more about.

And I've sort of written that down as that'd be interesting to do a longitudinal study of that or something maybe in the future to try and get.

Speaker A

00:12:32.610 - 00:12:49.520

Further into that and just moving on to think about how we could apply the finding of the findings of this study more widely. Do you have any ideas about how practices could try to increase trust in their patient population?

Do you have any ideas for GPs or people working in general practice or policy?

Speaker B

00:12:51.040 - 00:15:22.040

I certainly, from a general practitioner's practice point of view, I would say look at the GPPS data and understand what's happening locally, what's happening for our practice, how are we doing? I think these are really goldmines of information and you follow it over a few years, years and you start to see trends and what have you.

I think that's really a starting point and every practice is going to be different. It's not. There's not a. I don't think there's a blanket thing general practice must do xyz, it's just not that simple.

But understanding your own situation and thinking about how we're doing, some practices will be doing fine and don't need to really worry too much. And some might feel, well, we could perhaps do a little bit better.

Maybe we need to when the opportunity presents, or we need to tweak things so we can bump up continuity a little bit. Or maybe we're in the situation of, you know, thinking about our staffing needs for the next year or two. How do we.

How do we make sure we've got the right staff in place that are going to help confidence and trust or those. Those sorts of questions, I think, are probably things that questions that practices can ask.

It's not going to produce an instant solution, but a little bit tweaking things a little bit each year. Moving in the right direction is better than either standing still or going backwards. And that's really what I would encourage.

But I mean, it's very difficult for practices, given this current resourcing situation, to dramatically change things. But over time, we hope the message gets through to policymakers that they do start to, I mean, I want to say invest in general practice, but.

And I think that's actually true. But I want to make it simpler for policy makers because things are not necessarily easy for them either, are they really?

They've got so many different demands and so we have to present solutions to the problems they're facing. And I think, yes, it is a little bit of resource improvement as well as everything else. And again, a tweaking a bit over time.

In a few years time we could make a difference. It's taken 20, 30 years to get to this low in terms of continuity and relationship based care.

Let's accept that it's going to take quite a few years to get back up to where we'd like to be. But it's making that the first step is always the important one. Keep making steps after that.

Speaker A

00:15:23.000 - 00:15:39.520

And as you mentioned, it's important to note that the general practice patient survey does have this longitudinal data over time, so it is a helpful tool for practices to go back and look at the data over time. And it's obviously publicly available as well for practices to go and look at.

Speaker B

00:15:40.160 - 00:16:09.820

Yeah, yes, I think, I think is a. We're very fortunate. We have public data.

We use the data from the NHS appointment, general practice appointments data sets as well in this study and that's got lots of material in as well. And there are other sources of data as well about general practice that we can draw on. We didn't look at.

Well, we didn't use any quaff variables in this particular project because they weren't helpful to us in this particular project. But there's lots of data and.

Speaker A

00:16:12.220 - 00:16:12.460

I.

Speaker B

00:16:12.460 - 00:16:22.860

Think that's really, really good that the NHS is collecting, using these data, making them publicly available. I think that's something to celebrate, I think.

Speaker A

00:16:23.740 - 00:16:37.180

Well, it's been great hearing about this research, Richard, and it sounds like it's given you lots of ideas for projects in the future as well. So we'll look forward to hearing about those as well. But I just wanted to say thanks very much for taking the time to talk about it today.

Speaker B

00:16:37.740 - 00:16:42.700

Okay. No, thank you very much. It's. It's great to talk to you and.

Speaker A

00:16:42.700 - 00:16:58.920

Thank you all very much for your time here and for listening to this BJGP podcast.

Richard's original research...]]>72032259-7947-4471-9313-781120b485e6Tue, 10 Feb 2026 08:00:00 +010017:07falsefull42232234Belonging, autonomy and burnout: Why GPs leaveToday, we’re speaking to Dr Laura Jefferson, Senior Research Fellow based at the University of Manchester. We’re here to discuss her paper recently published here in the BJGP titled, ‘Understanding persistent GP turnover using work and personal characteristics: a retrospective observational study’.

Title of paper: Understanding persistent GP turnover using work and personal characteristics: a retrospective observational study

DOI: https://doi.org/10.3399/BJGP.2025.0260

GP turnover rates from national administrative datasets have previously been used to explore practice-level factors associated with turnover and its relationship to patient. outcomes. The individual and work characteristics associated with turnover is less well understood, with much research focusing on intentions to leave or smaller samples of GPs leaving practice. This study sought to fill this research gap, through analysis of a large dataset of GPs working experiences linked to turnover, understanding potential predictors that may offer solutions to the workforce crisis being faced in general practice. We find that GPs’ sense of autonomy, belonging and competence are significantly lower in practices with problems with persistent turnover and demonstrate how satisfaction with work characteristics such as working hours and experiences of strained relationships differs in practices with persistent turnover.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.880 - 00:00:53.050

Hello and welcome to BJGP Interviews. My name is Nada Khan and I'm one of the Associate editors of the bjgp. Thanks for joining us here to listen to this podcast today.

In today's episode, we're speaking to Dr. Laura Jefferson, who is a senior research fellow based at the University of Manchester.

We're here to discuss her paper, recently published here in the journal, titled Understanding Persistent GP Turnover Using Work and Personal A Retrospective Observational Study.

So, hi, Laura, it's really nice to see you again and to talk about this research and I suppose I really just wanted to frame our discussion here today by saying that there's been a lot of talk recently about the retention crisis in UK general practice, but I wonder, could you just talk us through how big is the scale of the problem that we're dealing with here?

Speaker B

00:00:53.370 - 00:02:12.110

Yeah, thank you. Yeah, well, thank you for inviting me to talk to you today as well.

I think it's interesting, we hear a lot of discussion in the media and in our research evidence as well, recently about an increase in GP turnover. In the past sort of decade, there's been a gradual increase, so that's in terms of GPs leaving medicine, but also moving across practices.

And it's good to see a kind of change in policy focus from historically, a lot of policies focused on recruitment of GPS. So, you know, we've had like, pledges to have 6,000 GPS that have not been met and it's often kind of criticized as filling a leaky bucket.

So if we try and obviously pay a lot. So I think it's approximately half a million pounds to train a gp, but actually to replace the GP is really expensive as well.

So it's about £300,000 to replace the GP.

And so, yeah, so there's a positive focus to thinking about retention, but actually it's about how can we do that effectively and understanding that the sort of one size fits all approach doesn't necessarily work and that there's different gps with different needs.

Speaker A

00:02:12.590 - 00:02:36.830

And this was a study where you were looking at the association between high practice turnover of GPs and GP job satisfaction. And what you did was you linked data from different general practice practices and GP workforce surveys.

But the first thing I wanted to really look into was that you identified these high turnover practices. What exactly did this mean?

Speaker B

00:02:37.070 - 00:04:33.190

Yeah, so there's been previous research that's done this before, so it's using. We're really fortunate in the UK that we've got really good workforce data compared to a lot of other countries.

So we have longitudinal data going back a long way that we can use for research purposes to try and understand more about these trends.

So colleagues of mine at Manchester have previously used this data from NHS Digital, which is now NHS England, linking with data on gps by General Practice, which is has got data on their kind of start and leave dates in a practice. And that allows us to track where gps are moving out of a practice and how long they've stayed there for.

So they've previously looked at sort of persistent turnover as being categorized as a practice where they have consistently, for three years running, had a 10% turnover of GPS. So this is where it seems to be a more worrying turnover figure.

I think it's expected that there's going to be some level of turnover and some level of turnover that might be a useful thing. But those kind of practices where you think, oh, what's going on there?

And particularly then within our research, looking at what are the striking differences in those practices, both in terms of the sort of workplace characteristics that GPs are experiencing? So can we use that data to explore strategies that could be used to actually support gps in those practices?

So trying to understand, really, what does it feel like for a GP in these practices with persistent turnover, so that then, hopefully, through this sort of research, is kind of like the first step in a puzzle to try and determine strategies to support them.

Speaker A

00:04:33.750 - 00:04:50.310

Yeah, fair enough. And then thinking a bit more about what you found here.

So you looked, as you said, at some of the characteristics of the GPs who worked in these high turnover practices, and you found some really interesting differences that related to gender, age and experience. So can you talk us through that?

Speaker B

00:04:50.390 - 00:06:45.570

Yeah.

So this was the first time that these large data sets have been used to look at GP characteristics that might not necessarily predict turnover, but might be associated with turnover.

So difficult to make predictions using the approaches that we've used, but we were able to, within our analysis, adjust for things like age, experience, gender, looking at GP partners and salaried GPs to try and draw out, are there any differences? And we did find a gender difference. So women were more likely to be in practices with persistent high turnover.

But because of the analytical approach that we've used, it's really difficult for us to unpick. What does that actually mean? Does that mean that are they driving turnover or do they actually become stuck in these practices?

So there's a lot of research literature that suggests that women may be less mobile in the workplace for a number of societal reasons. So it could be that that's a factor explaining the gender difference that we found.

But this is a really important first step for us to then develop the strateg thinking about what different groups need. Only included a smaller proportion of salaried GPs, so we weren't able to look so well at partners versus salaried.

And also looking at ethnic diversity and variations, particularly important given that there's a large proportion of international medical graduates now as GP registrars.

So this is a kind of first step and there's going to be future research, which we've been commissioned now to do this research in a larger sample of gps, looking at a longer time frame as well, which will be really nice to be able to look after. Covid.

Speaker A

00:06:45.890 - 00:07:02.130

Brilliant. That sounds really exciting. And I think what's really interesting here is how satisfied GPs were with different aspects of their work.

What did the gps rate as low satisfaction in their job role and how did this impact on turnover?

Speaker B

00:07:02.550 - 00:09:38.570

Yeah, so what we did is we used a theoretical framework to guide our analysis.

So within the Work Life Survey, there's a number of different kind of components that gps can rate in terms of their satisfaction with their working lives. But that would be quite a messy analysis.

So to try and break this down, we used the ABC of Doctors Needs, which is a framework which talks about the importance of autonomy, belonging and competence for doctors to feel that they're happy and well within their work and that impacts on retention. So, yeah, so we looked at those components and within each of those we used questions from the survey that spoke to those theoretical domains.

So, for example, autonomy looked at sort of, there was an item around freedom to choose the methods that they're working with.

Also items around paperwork, variety of work and hours of work, belonging looked at particularly around sort of relationships and feeling connected to and valued in the workplace.

There's questions in the survey about strained relationships at work and also about recognition, so feeling like they're valued for delivering a good job. And then the third domain that we created around...]]>Today, we’re speaking to Dr Laura Jefferson, Senior Research Fellow based at the University of Manchester. We’re here to discuss her paper recently published here in the BJGP titled, ‘Understanding persistent GP turnover using work and personal characteristics: a retrospective observational study’.

Title of paper: Understanding persistent GP turnover using work and personal characteristics: a retrospective observational study

DOI: https://doi.org/10.3399/BJGP.2025.0260

GP turnover rates from national administrative datasets have previously been used to explore practice-level factors associated with turnover and its relationship to patient. outcomes. The individual and work characteristics associated with turnover is less well understood, with much research focusing on intentions to leave or smaller samples of GPs leaving practice. This study sought to fill this research gap, through analysis of a large dataset of GPs working experiences linked to turnover, understanding potential predictors that may offer solutions to the workforce crisis being faced in general practice. We find that GPs’ sense of autonomy, belonging and competence are significantly lower in practices with problems with persistent turnover and demonstrate how satisfaction with work characteristics such as working hours and experiences of strained relationships differs in practices with persistent turnover.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.880 - 00:00:53.050

Hello and welcome to BJGP Interviews. My name is Nada Khan and I'm one of the Associate editors of the bjgp. Thanks for joining us here to listen to this podcast today.

In today's episode, we're speaking to Dr. Laura Jefferson, who is a senior research fellow based at the University of Manchester.

We're here to discuss her paper, recently published here in the journal, titled Understanding Persistent GP Turnover Using Work and Personal A Retrospective Observational Study.

So, hi, Laura, it's really nice to see you again and to talk about this research and I suppose I really just wanted to frame our discussion here today by saying that there's been a lot of talk recently about the retention crisis in UK general practice, but I wonder, could you just talk us through how big is the scale of the problem that we're dealing with here?

Speaker B

00:00:53.370 - 00:02:12.110

Yeah, thank you. Yeah, well, thank you for inviting me to talk to you today as well.

I think it's interesting, we hear a lot of discussion in the media and in our research evidence as well, recently about an increase in GP turnover. In the past sort of decade, there's been a gradual increase, so that's in terms of GPs leaving medicine, but also moving across practices.

And it's good to see a kind of change in policy focus from historically, a lot of policies focused on recruitment of GPS. So, you know, we've had like, pledges to have 6,000 GPS that have not been met and it's often kind of criticized as filling a leaky bucket.

So if we try and obviously pay a lot. So I think it's approximately half a million pounds to train a gp, but actually to replace the GP is really expensive as well.

So it's about £300,000 to replace the GP.

And so, yeah, so there's a positive focus to thinking about retention, but actually it's about how can we do that effectively and understanding that the sort of one size fits all approach doesn't necessarily work and that there's different gps with different needs.

Speaker A

00:02:12.590 - 00:02:36.830

And this was a study where you were looking at the association between high practice turnover of GPs and GP job satisfaction. And what you did was you linked data from different general practice practices and GP workforce surveys.

But the first thing I wanted to really look into was that you identified these high turnover practices. What exactly did this mean?

Speaker B

00:02:37.070 - 00:04:33.190

Yeah, so there's been previous research that's done this before, so it's using. We're really fortunate in the UK that we've got really good workforce data compared to a lot of other countries.

So we have longitudinal data going back a long way that we can use for research purposes to try and understand more about these trends.

So colleagues of mine at Manchester have previously used this data from NHS Digital, which is now NHS England, linking with data on gps by General Practice, which is has got data on their kind of start and leave dates in a practice. And that allows us to track where gps are moving out of a practice and how long they've stayed there for.

So they've previously looked at sort of persistent turnover as being categorized as a practice where they have consistently, for three years running, had a 10% turnover of GPS. So this is where it seems to be a more worrying turnover figure.

I think it's expected that there's going to be some level of turnover and some level of turnover that might be a useful thing. But those kind of practices where you think, oh, what's going on there?

And particularly then within our research, looking at what are the striking differences in those practices, both in terms of the sort of workplace characteristics that GPs are experiencing? So can we use that data to explore strategies that could be used to actually support gps in those practices?

So trying to understand, really, what does it feel like for a GP in these practices with persistent turnover, so that then, hopefully, through this sort of research, is kind of like the first step in a puzzle to try and determine strategies to support them.

Speaker A

00:04:33.750 - 00:04:50.310

Yeah, fair enough. And then thinking a bit more about what you found here.

So you looked, as you said, at some of the characteristics of the GPs who worked in these high turnover practices, and you found some really interesting differences that related to gender, age and experience. So can you talk us through that?

Speaker B

00:04:50.390 - 00:06:45.570

Yeah.

So this was the first time that these large data sets have been used to look at GP characteristics that might not necessarily predict turnover, but might be associated with turnover.

So difficult to make predictions using the approaches that we've used, but we were able to, within our analysis, adjust for things like age, experience, gender, looking at GP partners and salaried GPs to try and draw out, are there any differences? And we did find a gender difference. So women were more likely to be in practices with persistent high turnover.

But because of the analytical approach that we've used, it's really difficult for us to unpick. What does that actually mean? Does that mean that are they driving turnover or do they actually become stuck in these practices?

So there's a lot of research literature that suggests that women may be less mobile in the workplace for a number of societal reasons. So it could be that that's a factor explaining the gender difference that we found.

But this is a really important first step for us to then develop the strateg thinking about what different groups need. Only included a smaller proportion of salaried GPs, so we weren't able to look so well at partners versus salaried.

And also looking at ethnic diversity and variations, particularly important given that there's a large proportion of international medical graduates now as GP registrars.

So this is a kind of first step and there's going to be future research, which we've been commissioned now to do this research in a larger sample of gps, looking at a longer time frame as well, which will be really nice to be able to look after. Covid.

Speaker A

00:06:45.890 - 00:07:02.130

Brilliant. That sounds really exciting. And I think what's really interesting here is how satisfied GPs were with different aspects of their work.

What did the gps rate as low satisfaction in their job role and how did this impact on turnover?

Speaker B

00:07:02.550 - 00:09:38.570

Yeah, so what we did is we used a theoretical framework to guide our analysis.

So within the Work Life Survey, there's a number of different kind of components that gps can rate in terms of their satisfaction with their working lives. But that would be quite a messy analysis.

So to try and break this down, we used the ABC of Doctors Needs, which is a framework which talks about the importance of autonomy, belonging and competence for doctors to feel that they're happy and well within their work and that impacts on retention. So, yeah, so we looked at those components and within each of those we used questions from the survey that spoke to those theoretical domains.

So, for example, autonomy looked at sort of, there was an item around freedom to choose the methods that they're working with.

Also items around paperwork, variety of work and hours of work, belonging looked at particularly around sort of relationships and feeling connected to and valued in the workplace.

There's questions in the survey about strained relationships at work and also about recognition, so feeling like they're valued for delivering a good job. And then the third domain that we created around competence, speaks to gps, sort of perceived ability within their role.

So I think gps know how to do their job well, but it's actually like their perception as to how well they're able to do that within the constraints of the working environment.

So that related to questions on the survey to do with complaints from patients feeling like they didn't have sufficient time to do a good job and also workload issues.

And when we came to do the analysis, we found that in those practices with persistent high turnover across three years, all of those domains were significantly related to turnover. So all of those factors are important and it is very Intuitive really, isn't it?

But this is the first kind of step in terms of research evidence in a decent sample to show us that these factors are what we should be prioritising for future intervention development.

Speaker A

00:09:39.450 - 00:09:50.490

Sure. And one thing that came out really clearly here was the association between that autonomy domain and turnover.

Can you talk us through this and why you think it's so important?

Speaker B

00:09:50.730 - 00:11:18.330

Yeah. So there's been previous work looking at retention in other fields where autonomy has been really valued. And so this is about.

About sort of having flexibility to work, how it's kind of suitable for them in their sort of work life and balancing work life, but also crafting the job to suit their own interests and needs.

And this is really interesting, I think, as well, in terms of thinking about the gender differences, I know you're familiar with the other research that I'm involved in about supporting women GPs to thrive in their roles, and that research has shown that there's differences in terms of how patients are allocated to gps according to gender. And so it's really about prioritising fair distribution of work, but also distribution according to doctors interests.

So that, that also then speaks to this feeling of competence and being valued.

But one of the areas actually that had the highest difference between persistent high turnover practices and the other practices was around competence.

And that was really striking, I thought, in terms of those issues around concerns about complaints not having sufficient time were some of the largest differences in practices with high turnover.

Speaker A

00:11:18.570 - 00:11:34.020

And I mean, this work is really important because it has shown that clear link between gps having, for instance, a sense of autonomy and belonging at work. But do you or your team have any ideas about how we could use these findings to improve GP retention and reduce turnover?

Speaker B

00:11:34.100 - 00:13:36.000

Yeah, I think, I mean, one of the key findings that would be easily implementable for practices would be about supporting team cultures. So there's been a lot of work that's looked at that, but it's.

And I know it's often challenging within the sort of workload environments that gps are working in, particularly across fast teams and other roles in general practice as well.

But having a sense of belonging within a team and trying to challenge where there are strained relationships would potentially be a kind of first step.

I think I've spoken to a number of GPs in my research and in planning future projects where there's just actually no kind of sense of like line management, particularly if you're a GP partner, the kind of.

Of getting on with things and not necessarily having that sort of strategic approach to workload management and allocation of work so perhaps a more supportive hierarchy in terms of line management.

I know that's, for example, part of the GP retainer scheme, but that's a end of the line approach, you know, and it's also quite short term, so it doesn't necessarily solve the problems that a number of GPs are experiencing. I think also in terms of potentially making the role more rewarding for gps.

So I think that they're feeling more distanced from patients, probably, particularly as there's been movements to online consultations and extensive roles in triaging and moving care to other parts of the team, perhaps not necessarily getting that feedback from patients that they're being valued, valued. And obviously there's quite a negative media narrative which drives that as well.

Speaker A

00:13:36.400 - 00:13:52.400

And that's a lot of clear messages for practice based working. So, you know, fostering a team environment and trying to think about how to maintain that doctor patient relationship.

But if you had a clear message to send to policymakers, what would that be?

Speaker B

00:13:52.400 - 00:14:44.400

I think it needs to be grounded in evidence. So we see a lot of policy changes, particularly, you know, in the past year where we don't have an evidence base to support these decisions.

And so the work that I'm doing with colleagues at Manchester is.

So we've got six years of funding to look at developing retention strategies for GPs that is going to be grounded within the evidence base and developed with gps so that they can be solutions that can be adapted to suit different workforce needs and not this one size fits all approach.

So strategies, women GPs, salary GPs, locum GPs and also different area needs so that hopefully then that can develop policy in future, guided by the evidence base.

Speaker A

00:14:44.640 - 00:14:57.280

That sounds really exciting, Laura. So, yeah, we'll look forward to hearing more about that big program of research in this area.

So, great, great to hear about that, but I think that's probably a great place to wrap things up. But I just wanted to say thank you very much for your time here.

Speaker B

00:14:57.440 - 00:14:58.480

Thanks. Nada.

Speaker A

00:14:58.970 - 00:15:11.690

And thank you all very much for your time here and for listening to this BJGP podcast. Laura's original research article can be found on bjgp. Org and the show notes and podcast audio can be found at bjgplife.

Speaker B

00:15:11.690 - 00:15:12.090

Com.

Speaker A

00:15:12.330 - 00:15:14.090

Thanks again for listening and bye.

And here are the top 10 most read papers of 2025:

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https://doi.org/10.3399/BJGP.2024.0303

2

Artificial intelligence for early detection of lung cancer in GPs’ clinical notes: a retrospective observational cohort study

https://doi.org/10.3399/BJGP.2023.0489

1

Effectiveness of low-dose amitriptyline and mirtazapine in patients with insomnia disorder and sleep maintenance problems: a randomised, double-blind, placebo-controlled trial in general practice (DREAMING)

https://doi.org/10.3399/BJGP.2024.0173

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.480 - 00:01:27.500

Hello and welcome to the BJGP Top 10 podcast.

So this is where we take a closer look at the most read research papers in the BJGP in 2025 and just have a discussion about what they mean for day to day general practice. I'm Nada Khan, one of the associate editors of the Journal.

And in today's episode we'll be exploring some of the themes that really captured attention with the readership, I suppose. And we'll be talking about things like consultation compl complexity and workload pressures.

Some work around diagnostic uncertainty and how to look, look after people with multimorbidity.

And I think we're going to have a discussion a bit more, not just about what these papers found, but maybe a bit about why they resonated and maybe give a bit of editorial feedback around that. And because it's a conversation here between three clinicians as well.

And I'll go around and introduce everyone in a minute, maybe a bit about what they add to the conversations we're already already having in practice and where the gaps still are. And I guess with that we'll be keeping it grounded in the messy reality of today's general practice as well.

So I've introduced myself and I'm joined here by Tom Round and Sam Merrill, who are both also associate editors of the bjgp. But I'll go to Tom first. So, yeah, tell us a bit about who you are and how is your day going?

Speaker B

00:01:27.720 - 00:01:59.550

Great, Nada. Thanks for having me.

So, Dr. Tom Rand, I'm a GP in northeast London and an academic clinical lecturer at King's College, interested in early disease and cancer detection and also health inequality. So, yeah, pretty good. Like everyone, I've got a mild cold at the moment.

I think exactly the same last year when we did this podcast, winter cold season. So I think we're all sort of feeling that a little bit in primary care with flus and other things and staff, you know, so otherwise good.

Looking forward to having really interesting discussion about these papers which are really fascinating and give a real broad breadth of what we do in general practice.

Speaker A

00:02:00.420 - 00:02:07.940

Great. And Sam, we'll go to you and you have some really exciting news in the background as well.

So, yeah, tell us about who you are and what you're up to today.

Speaker C

00:02:08.180 - 00:02:31.770

Thanks, Nad.

I think, yeah, you're alluding to the fact I'm on Puppy alert because our new addition to the family in the winter is keeping us busy and making remote working a challenge. But we're getting through. But yeah, lovely to be with you guys. And I catch up and BJGP and wider podcast audience.

So, yes, I'm a GP working in the Northwest of England and a clinical senior lecture at the University of Manchester.

Speaker A

00:02:32.650 - 00:04:28.830

Brilliant.

Okay, so let's get into the top 10 most read research and published papers of 2025 and I'm going to kick off with number 10 and number 8, just because they're on a sort of related topic. So number 10 is by Michael Anderson and colleagues. Michael's based in Manchester and at lse.

And this paper looks at prescribing, quality in practices and the role of clinical pharmacists as. And I'll just point out that I'll put links to all the papers in the show notes as well.

So this paper looks at the adoption of clinical pharmacist roles in English general practice and asks that question of does bringing pharmacists into the primary care workforce actually lead to improvements? Michael looked at this through a longitudinal approach.

They used national practice level data from 2015 to 2019 and just looked at practices that didn't, didn't have a clinical pharmacist role. And it's really interesting, the results actually.

So, not surprisingly, the proportion of practices with a clinical pharmacist increased from about 3% to over 20% over the course of the study. And the, the team found some really significant improvements across several prescribing indicators.

So things like reductions in total medication costs, better opioid prescribing and prescribing for anxiety meds after pharmacists were implemented in pract, I guess, really it would be interesting to hear your thoughts, Sam and Tom, about what do you think really are the outcomes we want most from clinical pharmacists? And how do you think we should interpret these modest changes at scale?

Because there's a lot else going on in terms of workforce that we need to think about in general practice, like access and continuity and not just meds optimization.

Speaker C

00:04:29.310 - 00:05:41.170

I can talk from practice experience because our clinical pharmacist just left for Canada just in the last month or so. But yeah, it was really interesting, like having him part of the team.

I think in a lot of ways he took a lot of burden off the gps in terms of meds monitoring, meds management, medication reviews. He builds a lot of continuity with a lot of patients because he was doing a lot of checking in.

So in a lot of ways he was quite invaluable member of the team and we have sought a replacement since.

At the same time, you know, there was some, some extra challenges in terms of workload and stuff, because obviously pharmacists have different training and the role of a clinical pharmacist in general practice is relatively new.

So, you know, their approaches to prescribing and, you know, how close you stick to guidelines and how much you adapt for individual patient situations is slightly different. So. Yeah, but I think that was part of sort of feeling a way out with the role.

But it's really noticeable when he's not around because it does affect how the workload flows and how the practice runs and how the patients, you know, interact with the practice. So, yeah, it's been really interesting at the local level.

But, yeah, Michael's study also...]]>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 2025 brings together high-profile primary care research and clinical innovation.

And here are the top 10 most read papers of 2025:

10

Adoption of clinical pharmacist roles in primary care: longitudinal evidence from English general practice

https://doi.org/10.3399/BJGP.2024.0320

9

Factors affecting prostate cancer detection through asymptomatic prostate-specific antigen testing in primary care in England: evidence from the 2018 National Cancer Diagnosis Audit

https://doi.org/10.3399/BJGP.2024.0376

8

Paramedic or GP consultations in primary care: prospective study comparing costs and outcomes

https://doi.org/10.3399/BJGP.2024.0469

7

What patients want from access to UK general practice: systematic review

https://doi.org/10.3399/BJGP.2024.0582

6

Technostress, technosuffering, and relational strain: a multi-method qualitative study of how remote and digital work affects staff in UK general practice

https://doi.org/10.3399/BJGP.2024.0322

5

Antidepressants and risk of postural hypotension: a self-controlled case series study in UK primary care

https://doi.org/10.3399/BJGP.2024.0429

4

Challenges to quality in contemporary, hybrid general practice a multi-site longitudinal case study

https://doi.org/10.3399/BJGP.2024.0184

3

Low-dose amitriptyline for irritable bowel syndrome: a qualitative study of patients’ and GPs’ views and experiences

https://doi.org/10.3399/BJGP.2024.0303

2

Artificial intelligence for early detection of lung cancer in GPs’ clinical notes: a retrospective observational cohort study

https://doi.org/10.3399/BJGP.2023.0489

1

Effectiveness of low-dose amitriptyline and mirtazapine in patients with insomnia disorder and sleep maintenance problems: a randomised, double-blind, placebo-controlled trial in general practice (DREAMING)

https://doi.org/10.3399/BJGP.2024.0173

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.480 - 00:01:27.500

Hello and welcome to the BJGP Top 10 podcast.

So this is where we take a closer look at the most read research papers in the BJGP in 2025 and just have a discussion about what they mean for day to day general practice. I'm Nada Khan, one of the associate editors of the Journal.

And in today's episode we'll be exploring some of the themes that really captured attention with the readership, I suppose. And we'll be talking about things like consultation compl complexity and workload pressures.

Some work around diagnostic uncertainty and how to look, look after people with multimorbidity.

And I think we're going to have a discussion a bit more, not just about what these papers found, but maybe a bit about why they resonated and maybe give a bit of editorial feedback around that. And because it's a conversation here between three clinicians as well.

And I'll go around and introduce everyone in a minute, maybe a bit about what they add to the conversations we're already already having in practice and where the gaps still are. And I guess with that we'll be keeping it grounded in the messy reality of today's general practice as well.

So I've introduced myself and I'm joined here by Tom Round and Sam Merrill, who are both also associate editors of the bjgp. But I'll go to Tom first. So, yeah, tell us a bit about who you are and how is your day going?

Speaker B

00:01:27.720 - 00:01:59.550

Great, Nada. Thanks for having me.

So, Dr. Tom Rand, I'm a GP in northeast London and an academic clinical lecturer at King's College, interested in early disease and cancer detection and also health inequality. So, yeah, pretty good. Like everyone, I've got a mild cold at the moment.

I think exactly the same last year when we did this podcast, winter cold season. So I think we're all sort of feeling that a little bit in primary care with flus and other things and staff, you know, so otherwise good.

Looking forward to having really interesting discussion about these papers which are really fascinating and give a real broad breadth of what we do in general practice.

Speaker A

00:02:00.420 - 00:02:07.940

Great. And Sam, we'll go to you and you have some really exciting news in the background as well.

So, yeah, tell us about who you are and what you're up to today.

Speaker C

00:02:08.180 - 00:02:31.770

Thanks, Nad.

I think, yeah, you're alluding to the fact I'm on Puppy alert because our new addition to the family in the winter is keeping us busy and making remote working a challenge. But we're getting through. But yeah, lovely to be with you guys. And I catch up and BJGP and wider podcast audience.

So, yes, I'm a GP working in the Northwest of England and a clinical senior lecture at the University of Manchester.

Speaker A

00:02:32.650 - 00:04:28.830

Brilliant.

Okay, so let's get into the top 10 most read research and published papers of 2025 and I'm going to kick off with number 10 and number 8, just because they're on a sort of related topic. So number 10 is by Michael Anderson and colleagues. Michael's based in Manchester and at lse.

And this paper looks at prescribing, quality in practices and the role of clinical pharmacists as. And I'll just point out that I'll put links to all the papers in the show notes as well.

So this paper looks at the adoption of clinical pharmacist roles in English general practice and asks that question of does bringing pharmacists into the primary care workforce actually lead to improvements? Michael looked at this through a longitudinal approach.

They used national practice level data from 2015 to 2019 and just looked at practices that didn't, didn't have a clinical pharmacist role. And it's really interesting, the results actually.

So, not surprisingly, the proportion of practices with a clinical pharmacist increased from about 3% to over 20% over the course of the study. And the, the team found some really significant improvements across several prescribing indicators.

So things like reductions in total medication costs, better opioid prescribing and prescribing for anxiety meds after pharmacists were implemented in pract, I guess, really it would be interesting to hear your thoughts, Sam and Tom, about what do you think really are the outcomes we want most from clinical pharmacists? And how do you think we should interpret these modest changes at scale?

Because there's a lot else going on in terms of workforce that we need to think about in general practice, like access and continuity and not just meds optimization.

Speaker C

00:04:29.310 - 00:05:41.170

I can talk from practice experience because our clinical pharmacist just left for Canada just in the last month or so. But yeah, it was really interesting, like having him part of the team.

I think in a lot of ways he took a lot of burden off the gps in terms of meds monitoring, meds management, medication reviews. He builds a lot of continuity with a lot of patients because he was doing a lot of checking in.

So in a lot of ways he was quite invaluable member of the team and we have sought a replacement since.

At the same time, you know, there was some, some extra challenges in terms of workload and stuff, because obviously pharmacists have different training and the role of a clinical pharmacist in general practice is relatively new.

So, you know, their approaches to prescribing and, you know, how close you stick to guidelines and how much you adapt for individual patient situations is slightly different. So. Yeah, but I think that was part of sort of feeling a way out with the role.

But it's really noticeable when he's not around because it does affect how the workload flows and how the practice runs and how the patients, you know, interact with the practice. So, yeah, it's been really interesting at the local level.

But, yeah, Michael's study also very interesting to look at the wider picture about how it's affecting quality of care.

Speaker A

00:05:41.730 - 00:05:45.970

And I'll just jump now to number eight, unless, Tom, you want to add.

Speaker B

00:05:45.970 - 00:06:10.770

No, just to say, obviously this, this paper is looking at the macro level up to 2019, so it'd be really interesting what happened since, because we only started having a pharmacist after that point with the induction of ARS roles.

So I think, yeah, further, you know, this is giving a signal, we think that some indices are improving, but also I think it's important to be aligned with our own subjective experience, maybe qualitative and other implementation type research. But overall, I think this trend is a good thing, I think, from my own experience.

Speaker A

00:06:11.570 - 00:07:55.630

Yeah, absolutely.

And then I guess jumping to paper number eight, which was written by William Hollingsworth and his team from Bristol, and this is looking at comparing paramedics in general practice with gps.

And the paper is asking a really practical workforce question, which is, is what happens to patient experience, safety and NHS costs when patients are seen by a paramedic in general practice rather than a gp.

And this team looked at this, they used a prospective cohort study across sites in England and they looked at patients who had an urgent or same day consultation with either a paramedic or a GP and then looked at their outcomes over the next 30 days.

And I guess the headline finding is that really there wasn't a clear difference in patient reported health and well being over 30 days, but there were some differences in that experience right after the consultation. So patients who saw a paramedic said that they were.

Well, they reported lower confidence in their health provision, they felt there are more communication problems and maybe a lower perception of how the practice promotes safety.

And there were fewer subsequent GP appointments in the paramedic group, but there weren't really any GP savings as such that were offset by higher use of other health care professionals. So I guess that you could sort of summarize that by seeing.

Seeing a paramedic might lower GP pressure, but it doesn't necessarily reduce overall NHS costs. So I wonder, yeah, Tom, coming to you, what do you think should really matter when we diversify the workforce?

Do you think it should be workload, cost? Yeah.

Speaker B

00:07:55.710 - 00:09:28.360

Really interesting discussion, isn't it? And we talk about testification, isn't it? Sort of, you know, how do we, you know, how do we help GPs with workload? Workload, sorry.

Fundamentally we need more GPs, don't we? We need to have, you know, we've got high 2,300 to 2,500 patients, sometimes even higher deprived areas.

So fundamentally, I think the workforce, we do need more gps. This also debate, also, you know, obviously there's a slightly toxic now debate about physicians, associates.

You know, from my own viewpoint, you know, undifferentiated initial consultations in primary care are high risk. We know that from all the evidence and the research. So you've got to be very careful about patient select selection and triage for this.

And you can see, I think also this links to. We've got this big increase in the ARS roles, but then we haven't seen that increase in primary care satisfaction.

So I think this comes down to people probably still want to see a GP for certain conditions. How do we get to that right model of MDT working? And I think we do need robust safety evidence.

So this obviously is, you know, it's good study, but it's fairly small scale, probably need larger scale and systematic review evidence about this replacement. You know, what's the safe role? What are the guidelines?

What sort of cases should these people, should other allied healthcare professionals be seeing, particularly for undifferentiated illness?

And going back to the, obviously, the PA debate, we've obviously got the college position that probably PAs should not be seeing undifferentiated illness in primary care. So I think it's a nuanced discussion, but we need better, we need further studies like this to help us decide what we're doing.

Speaker A

00:09:28.760 - 00:09:54.380

Absolutely.

And I think that's really important as the workforce in general practice increases to diversify and policy shifts towards an increasing multidisciplinary team as well. So, yeah, be interesting to see what happens in the future. Really great.

So I'm going to go over to Sam and Sam, you're talking about paper number nine, but, yeah, talk us through this. This is a bit a paper that, you know well, so tell us a.

Speaker B

00:09:54.380 - 00:09:55.820

Bit more about it and your involvement.

Speaker C

00:09:55.820 - 00:09:59.700

In it, first author on a BJGP top 10 paper. I'm very honored.

Speaker B

00:09:59.700 - 00:10:00.460

Congratulations.

Speaker C

00:10:01.020 - 00:13:14.370

Humble to all the readers out there who had looked at it. So this was a study of asymptomatic prostate cancer detection using PSA in primary care in England.

And we used data from what's called the National Cancer Diagnosis Audit. This was the 2018 version.

So we had about a quarter of practices in England participate in the ncda and data was gathered using a sort of standardized template on all the new cancer diagnoses in a practice in 2018. So practices participate were given that list and a template to complete and looking at the record in detail.

So what happened to these patients in the lead up to their diagnosis? Were they seen in general practice? What happened? Were they investigated? Were they referred to?

And it was not screen detected cases for any of these were specifically cases coming through primary care. And the strength of this data set is that we have access to both coded and free text data in the record.

So a lot of large primary care research data sets like CPRD don't have free text data. So it's relying on GP coding, which we know varies between practices. So the big things that this study found we looked at.

So There were nearly 10,000 prostate cancer cases in the entity.

Overall, when we filtered out all the patients who had symptoms recorded at the time of presentation of primary care and the time of diagnosis, we were only left with about 1900.

So the vast majority of men with prostate cancer symptoms were present at the time of diagnosis, which conflicts somewhat with existing literature out there, the quality of which is pretty variable and often not great. So that was one interesting finding.

In terms of the differences between practices for asymptomatic prostate cancer detection and PSA testing, there's huge variation, something like 14 fold difference between the practices picking up the most men through asymptomatic PSA testing and the practice picking up the least.

And we didn't see any obvious GP practice level factors, so it didn't matter about geography, list size, number of GPs, cough outcomes, none of that seemed to make any difference.

There were patient level factors, so older men less likely picked up through that route, which kind of makes sense because symptoms are much more common in men as they get older. And PSA testing, the benefit is less generally depending on their general health, so it might be done less often. So that makes sense.

Men from deprived areas were less likely to be diagnosed through this route, which we know there are significant inequalities for men deprived regions in terms of prostate cancer outcomes. Not Just PSA testing, but stage of diagnosis, treatment outcomes, we need to do better with that group.

And interestingly, white men were less likely to be diagnosed through this route. Even though the sort of stereotypical person being, coming in, asking for a PSA test when there are no symptoms and maybe a low risk is a.

Is an older, wealthy white male, they were less likely to diagnose through this route, which. That was an interesting finding. Yeah. So really interesting study.

Obviously grabbed some interest and is a very, very, very topical issue at the moment with the NSCS recommendation that's out for consultation. And I think, you know, we still got to watch this space because I think there's going to be more coming in the year's ed.

Speaker A

00:13:15.170 - 00:13:42.330

Yeah, really super topical, Sam. And just to point out, we did record a podcast talking about this paper in more detail, if anyone wants to listen to that.

Tom, you work a lot in cancer diagnosis in that sort of world. I mean, obviously brilliant work from Sam and his colleagues, but I just wanted to know what your thoughts were.

Just reflecting on this paper in terms of sort of the wider policy discussions and discussions around the future of prostate cancer screening.

Speaker B

00:13:42.330 - 00:14:36.520

Yeah, yeah. So I think it's very topical, isn't it? There's lots of. In the press around, you know, should we be doing PSA testing?

So we currently got a slightly...]]>3548773a-12bd-4172-8d5a-2275c73ab96bTue, 27 Jan 2026 08:00:00 +010040:18falsefull42212214Safety incidents in prison healthcare: Lessons from critical illnessToday, we’re speaking to Dr Joy McFadzean,a GP in Swansea and Clinical Lecturer of Patient Safety based at Cardiff University. We’re here to talk about the paper she’s recently published here in the BJGP alongside her colleagues titled, ‘Critical illness in prisons: a multi-method analysis of reported healthcare safety incidents in England’.

Title of paper: Critical illness in prisons: a multi-method analysis of reported healthcare safety incidents in England

Available at: https://doi.org/10.3399/BJGP.2025.0239

Using a mixed-methods descriptive and framework analysis, this paper provides new insights into the complexity of care delivery in prisons. Results resonate with and strengthen the recommendations from recent investigations into prison healthcare by further developing an understanding of the complex intersecting factors contributing to safety incidents and quality issues in care delivery. The fundamental importance of good quality and adequately resourced primary care delivery in prisons has been highlighted. It also identifies system-wide interventions that are needed to improve care delivery, and which are likely to interest policy-makers and scrutiny bodies, commissioners and teams working in prisons to inform developments in strategic health needs assessments, workforce profiling, and training requirements for healthcare and prison teams.

Funding

This study/project is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (PR-R20-0318-21001). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the manuscript or the decision to submit.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.560 - 00:01:10.200

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjgp. Welcome back to the first season of the BJGP podcast here in 2026.

And we're starting off this season of the podcast with a chat with Dr. Joy McFadyn. Joy is a GP based in Swansea and clinical lecturer of Patient safety based at Cardiff University.

We're here to talk about the paper she's recently published here in the BJGP alongside her colleagues. The paper is titled Critical Illness in Prisons A Multi Method Analysis of Reported Healthcare Safety Incidents in England.

So, hi, Joy, it's really lovely to meet you and to talk about this research, but yeah, just taking a step back, I think it's fair to say that the prison population is an underserved and probably fairly under researched population as well.

But you point out here in the paper that it's not only this, but that the prison population is actually at a much higher risk of early mortality as well. So can you talk us through this at all?

Speaker B

00:01:10.680 - 00:02:31.010

Yeah, that's a really good point. So we know that people who reside in prison, known as prisoners, will have very high rates of physical and mental health needs.

And as you say, there are concerns that they have rates of premature mortality, so they may die up to 20 years earlier than the rest of the population. But they are a population which isn't necessarily the area of focus.

So even though we know the importance of supporting their healthcare as a public health concern, they are often underserved, they're quite vulnerable, and yet there hasn't been enough research to support them to have what we call equivalent health outcomes. So there are lots of definitions of what is considered to be equivalence of care for people in prisons.

So the Royal College of General Practitioners Secure Environments Group, they have defined what equivalence of care is for people in prisons, thinking that they should have the same quality of care, the same level of staffing, the same resources as anyone who is residing in the community in order to get the same health outcome. And currently that is not being realised.

Speaker A

00:02:31.330 - 00:02:38.210

And just as a background to all this work, how many of these early deaths do you think are preventable?

Speaker B

00:02:38.930 - 00:03:39.270

So we carried out a study which was called the Avoidable Harm in Prison Study. So it was focusing very much on healthcare events where people were harmed or could have been harmed whilst they reside in prisons.

So our focus is very much on these patient safety incidents, reports and incidents themselves, and ultimately the findings of the other space of the study. We haven't released yet they're still embargoed.

But we were seeing within our sample of patient safety incident reports, events where prisoners were undertaking significant harm. So within our paper, we haven't seen any evidence of the deaths which could be considered to be avoidable.

But our focus was very much on events where without urgent treatment, there was a high risk of death. And we considered many of those events to be avoidable.

Speaker A

00:03:39.590 - 00:04:10.690

And I guess all this is tied into what you're aiming to do here in this research, which was to look at and characterize patient safety incidents in the prison population and find opportunities to improve care.

So you used a really detailed approach here and looked at patient safety incidents reported in England and carefully examined and coded all of the incidents here. But I really want us to talk through what you found, what were the main sorts of incident type.

And what I'm trying to get at is what really happened in these reports.

Speaker B

00:04:11.410 - 00:07:08.750

Yeah, thank you. So we reviewed Originally up to 4,000 of those patient safety incident reports.

And then when we focused specifically on those events where someone was at very high risk of death if they hadn't received treatment, we were looking at conditions suggestive of heart attacks, strokes, status epilepticus, diabetic ketoacidosis, for example.

And what we saw is that most of the reports that were included for analysis, so about 100 of those reports, people in prison were not being able to access healthcare professionals when they needed to. So in prisons, people will have an assessment when they arrive to the prison, which is an assessment of their healthcare needs.

They should also have access to nursing staff, GPS and allied healthcare professionals, as well as referrals to secondary care as needed. And what we were seeing is that when there are events where someone was critically unwell, they couldn't access the staffing when they required.

So it's very much a nurse led service in the prisons. And even when there were prisoners who had collapsed, nursing staff could not access the prisoners. And that was for lots of different reasons.

Some of it was related to poor communication, that there's quite a reliance on the use of radios in our reports.

And so if people were trying to radio from one area of the prison to the healthcare teams, then there was too much radio traffic that their messages weren't getting through or they were using the wrong emergency codes. So actually the nursing staff weren't aware of the urgency of when they needed to get there.

So there were lots of delays in actually having the healthcare teams arrive and assess the patients themselves.

But also when a decision was made that someone needed to be conveyed to an emergency department, for example, due to difficulties with staffing levels, there weren't sufficient prison officer numbers to escort them from the prison to hospital. So there was significant delays. So what we could see in some of the events is that someone had collapsed.

There was concern that this was suggestive of a stroke, they were dysphasic, they had facial palsy, they had tinnitus, headaches, et cetera. And nursing staff had assessed, said, no, they're unwell.

Gps had said they need to be conveyed to the hospital and they weren't transferred until the following day. So those types of delays were very evident as well.

So difficulty accessing the healthcare professionals in the first place and then a delay getting the correct treatment or management, even with conditions which are time critical.

Speaker A

00:07:09.630 - 00:07:29.500

That all sounds really shocking, actually. But I wonder if we could just take a step back and, and could you describe to us what healthcare provision is like generally in prisons?

You mentioned about a nurse led care system, but how easy is it to access other healthcare professionals like GPs in prisons generally?

Speaker B

00:07:30.700 - 00:11:02.620

So I think there are two very different opinions in this.

So we have the access to the patient safety incident reports, which is telling us that it's very difficult for them to access healthcare professionals as needed within the prisons that we looked at for the avoidable harm in prison study, for example, we were only focusing on prisons where health care was delivered on site and the...]]>Today, we’re speaking to Dr Joy McFadzean,a GP in Swansea and Clinical Lecturer of Patient Safety based at Cardiff University. We’re here to talk about the paper she’s recently published here in the BJGP alongside her colleagues titled, ‘Critical illness in prisons: a multi-method analysis of reported healthcare safety incidents in England’.

Title of paper: Critical illness in prisons: a multi-method analysis of reported healthcare safety incidents in England

Available at: https://doi.org/10.3399/BJGP.2025.0239

Using a mixed-methods descriptive and framework analysis, this paper provides new insights into the complexity of care delivery in prisons. Results resonate with and strengthen the recommendations from recent investigations into prison healthcare by further developing an understanding of the complex intersecting factors contributing to safety incidents and quality issues in care delivery. The fundamental importance of good quality and adequately resourced primary care delivery in prisons has been highlighted. It also identifies system-wide interventions that are needed to improve care delivery, and which are likely to interest policy-makers and scrutiny bodies, commissioners and teams working in prisons to inform developments in strategic health needs assessments, workforce profiling, and training requirements for healthcare and prison teams.

Funding

This study/project is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (PR-R20-0318-21001). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the manuscript or the decision to submit.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.560 - 00:01:10.200

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjgp. Welcome back to the first season of the BJGP podcast here in 2026.

And we're starting off this season of the podcast with a chat with Dr. Joy McFadyn. Joy is a GP based in Swansea and clinical lecturer of Patient safety based at Cardiff University.

We're here to talk about the paper she's recently published here in the BJGP alongside her colleagues. The paper is titled Critical Illness in Prisons A Multi Method Analysis of Reported Healthcare Safety Incidents in England.

So, hi, Joy, it's really lovely to meet you and to talk about this research, but yeah, just taking a step back, I think it's fair to say that the prison population is an underserved and probably fairly under researched population as well.

But you point out here in the paper that it's not only this, but that the prison population is actually at a much higher risk of early mortality as well. So can you talk us through this at all?

Speaker B

00:01:10.680 - 00:02:31.010

Yeah, that's a really good point. So we know that people who reside in prison, known as prisoners, will have very high rates of physical and mental health needs.

And as you say, there are concerns that they have rates of premature mortality, so they may die up to 20 years earlier than the rest of the population. But they are a population which isn't necessarily the area of focus.

So even though we know the importance of supporting their healthcare as a public health concern, they are often underserved, they're quite vulnerable, and yet there hasn't been enough research to support them to have what we call equivalent health outcomes. So there are lots of definitions of what is considered to be equivalence of care for people in prisons.

So the Royal College of General Practitioners Secure Environments Group, they have defined what equivalence of care is for people in prisons, thinking that they should have the same quality of care, the same level of staffing, the same resources as anyone who is residing in the community in order to get the same health outcome. And currently that is not being realised.

Speaker A

00:02:31.330 - 00:02:38.210

And just as a background to all this work, how many of these early deaths do you think are preventable?

Speaker B

00:02:38.930 - 00:03:39.270

So we carried out a study which was called the Avoidable Harm in Prison Study. So it was focusing very much on healthcare events where people were harmed or could have been harmed whilst they reside in prisons.

So our focus is very much on these patient safety incidents, reports and incidents themselves, and ultimately the findings of the other space of the study. We haven't released yet they're still embargoed.

But we were seeing within our sample of patient safety incident reports, events where prisoners were undertaking significant harm. So within our paper, we haven't seen any evidence of the deaths which could be considered to be avoidable.

But our focus was very much on events where without urgent treatment, there was a high risk of death. And we considered many of those events to be avoidable.

Speaker A

00:03:39.590 - 00:04:10.690

And I guess all this is tied into what you're aiming to do here in this research, which was to look at and characterize patient safety incidents in the prison population and find opportunities to improve care.

So you used a really detailed approach here and looked at patient safety incidents reported in England and carefully examined and coded all of the incidents here. But I really want us to talk through what you found, what were the main sorts of incident type.

And what I'm trying to get at is what really happened in these reports.

Speaker B

00:04:11.410 - 00:07:08.750

Yeah, thank you. So we reviewed Originally up to 4,000 of those patient safety incident reports.

And then when we focused specifically on those events where someone was at very high risk of death if they hadn't received treatment, we were looking at conditions suggestive of heart attacks, strokes, status epilepticus, diabetic ketoacidosis, for example.

And what we saw is that most of the reports that were included for analysis, so about 100 of those reports, people in prison were not being able to access healthcare professionals when they needed to. So in prisons, people will have an assessment when they arrive to the prison, which is an assessment of their healthcare needs.

They should also have access to nursing staff, GPS and allied healthcare professionals, as well as referrals to secondary care as needed. And what we were seeing is that when there are events where someone was critically unwell, they couldn't access the staffing when they required.

So it's very much a nurse led service in the prisons. And even when there were prisoners who had collapsed, nursing staff could not access the prisoners. And that was for lots of different reasons.

Some of it was related to poor communication, that there's quite a reliance on the use of radios in our reports.

And so if people were trying to radio from one area of the prison to the healthcare teams, then there was too much radio traffic that their messages weren't getting through or they were using the wrong emergency codes. So actually the nursing staff weren't aware of the urgency of when they needed to get there.

So there were lots of delays in actually having the healthcare teams arrive and assess the patients themselves.

But also when a decision was made that someone needed to be conveyed to an emergency department, for example, due to difficulties with staffing levels, there weren't sufficient prison officer numbers to escort them from the prison to hospital. So there was significant delays. So what we could see in some of the events is that someone had collapsed.

There was concern that this was suggestive of a stroke, they were dysphasic, they had facial palsy, they had tinnitus, headaches, et cetera. And nursing staff had assessed, said, no, they're unwell.

Gps had said they need to be conveyed to the hospital and they weren't transferred until the following day. So those types of delays were very evident as well.

So difficulty accessing the healthcare professionals in the first place and then a delay getting the correct treatment or management, even with conditions which are time critical.

Speaker A

00:07:09.630 - 00:07:29.500

That all sounds really shocking, actually. But I wonder if we could just take a step back and, and could you describe to us what healthcare provision is like generally in prisons?

You mentioned about a nurse led care system, but how easy is it to access other healthcare professionals like GPs in prisons generally?

Speaker B

00:07:30.700 - 00:11:02.620

So I think there are two very different opinions in this.

So we have the access to the patient safety incident reports, which is telling us that it's very difficult for them to access healthcare professionals as needed within the prisons that we looked at for the avoidable harm in prison study, for example, we were only focusing on prisons where health care was delivered on site and the provision is very variable. So different prisons may have NHS provision, but the majority is probably private provision as well.

So it's a commission service, there's a lot of competitive tendering and there are concerns by some that a focus may be more on cost saving than it is on quality provision. So what we saw within our patient safety incident reports was evidence that it was very difficult to access the healthcare teams.

So even though healthcare provision should be delivered and there are nurses, you know, round the clock, they were having lots of difficulties accessing any types of healthcare provision out of hours. Our instant reports was an overreliance often on some of the electronic E consulting systems.

So the use of System 1, for example, in prisons in England, and what we could see is that people were presenting with quite significant symptoms and instead of what we would have thought would happen is someone was picking up the phone and referring them in.

Lots of electronic tasks were being sent around teams without necessarily an overview as to who was completing those tasks or an overview of what that meant. So our focus is very much on these critical conditions, but some of it was related to the management of long term conditions.

In the first place that if someone's diabetes was being managed appropriately, that they were having annual blood tests or having their blood pressure checked, they were making sure that they had sufficient insulin, for example, then there shouldn't have been an occasion where they were experiencing diabetic ketoacidosis and needed to be admitted. Making sure that there's appropriate management of care, but also then that organisational factors.

Are there sufficient staffing numbers or are there not?

And part of the concern that we could see in our incident reports was the role of locums and agency staff who perhaps were not as familiar with prisons and prison health care systems. And they would often forget their passes to even log into the system, so they couldn't see a patient's medical records.

They were not familiar with the need to actually call for help, how they called for help.

They didn't know that if an emergency code is coming through the radio, that meant they needed to grab the healthcare bag with all the emergency equipment and run towards a specific wing or whatever is needed.

But focusing very much on these emergency conditions, there was a concern that the locum staff were not familiar with the protocols, the policies of the prison.

They were not carrying out observations, they were not documenting efficiently what they had actually carried out with the person residing in the prisons and that was delaying care that was stopping them from being transferred to emergency departments when they needed to be. Yeah.

Speaker A

00:11:02.620 - 00:11:15.860

And what's interesting here is that in this paper you looked at some major themes here around these different incidents. Can you talk us through this and what were the main findings here?

Speaker B

00:11:16.740 - 00:17:45.240

So we were thinking about the different aspects and cogs within the healthcare system in the prison and how they all interact with each other.

And we use the CEAPS model, which is the systems engineering initiative for patient safety, and it has six main domains that we were trying to understand if thinking about our patient safety incident reports and the themes within it, as well as the contributory factors, so why these events were taking place. We tried to then map them to the domains of the Systems engineering and initiatives patient safety model, which is ceps.

And what we could see were the different domains were prevalent throughout the reports. So there is a concern about tools and technology. For example, so I've mentioned about the emergency radios, but also the lack of certain tools.

So there wasn't a provision of life saving equipment in prisons.

So there were often reports from paramedics as well as people who reside in prison to advise that when there were events where a patient may have harmed themselves or there'd been an assault and an injury. There wasn't life saving equipment within the prison, so no cannulas, no IV fluids. Obviously there was going to be no consideration.

There would be blood products or anything of the like, but there was nothing that they thought would, would support major blood loss and hemorrhage. There were also, in many of the prisons, no AEDs.

So if someone had collapsed, potentially having a heart attack, for example, and their heart had stopped, we know the evidence that they need to get the paddles on their chest, we need to restart their heart if it's in an appropriate rhythm. But there was nothing of that, like in many of these prisons, to actually support that.

So if there is any type of delay in calling for an ambulance, an ambulance should be adhering to the same national guidance of the emerg response times. That should still be actualized within a prison too. But what was happening is that an ambulance was being called.

There was some confusion as to where in the prison the prisoner actually was, which wing of the prison, which area of the prison.

Once the ambulance was arriving at a gate, they couldn't actually come straight through because of security concerns that the ambulance might need to be stopped and searched to ensure that nothing was entering the prison that shouldn't be. And that was, you know, causing significant delays.

And then when they were getting to patients who'd collapsed, for example, there were delays for them even conveying them out of the prison.

So there was a concern that the healthcare professionals were not saying to them, you just need to convey them now they need to go to an emergency department. We do not have sufficient care for them here.

So that was the concerns about tools and technology, for example, and then thinking about the organisational aspects. So that would be within a healthcare system, things like staff rotors.

You know, I've mentioned already that there were some concerns with sufficient staffing levels. So there are concerns by people who work in prison. There can be quite a high turnover, perhaps an over reliance on locum and agency staff.

People may become quite burnt out in the system and therefore they may leave the prison. And for some GPs who work in prisons, it may not be there full time physician.

They may work elsewhere and then they may do a couple of shifts in the prison. So there isn't necessarily that continuity of care and how that might impact on prisoner healthcare.

Then within the CEIBS model there's concerns about personal factors or person factors. So these are the people working in the system as well as the patients themselves.

So one of our recommendations after reading all of the reports, is that perhaps they require more focused training for how to deal with emergency conditions and the response.

So what we saw is that people weren't prepared to have multiple emergencies happening at the same time, which unfortunately does happen in the prison. So there were lots of reports in which there were concerns with substance use in parts of the wing, perhaps using the substance spice, for example.

And then there was a report that three, four, five prisoners were all unconscious at the same time.

They therefore all required set of observations, need to check their oxygen levels, probably be placed in the recovery position and observed carefully until they came round, or if they weren't coming round, they need to be conveyed to an emergency department. And then thinking about the context of the prison, we think about the internal environment.

So knowing that within the prison, security constraints will often outweigh concerns with healthcare.

And that is an important balance that both the prison teams, the prison officers, the governors, need to balance alongside the healthcare professionals. And so what we were seeing, for example, is that during any type of lockdown in the prison, so security concern, a wing needs to be locked down.

That means the prisoners need to return to their cells. They cannot le.

If something happens where someone is considered to be critically unwell, they collapse, they are complaining of chest pain, they have symptoms suggestive of a stroke, for example, they haven't got access to their insulin, so their sugars are rising, they become unwell, etc. What we could see is that the healthcare teams could not access the prisoners, they couldn't get to them.

So that's the constraints of the internal environment. And then the external environment is like I was mentioning, about those commissioning gaps.

So concerns where care is not being funded appropriately, if that emphasis is on the cost of a service rather than the quality and the outcomes for patients, then perhaps they're not getting appropriate care when they should be.

Speaker A

00:17:45.480 - 00:18:04.580

And I think I'd suggest to anyone listening who's interested in this area, I'd suggest they go back to the paper and take a close look at box two, where you talk about the main recommendations for prisoner health as a result of this work. But what do you think are the most important...]]>6d134f6b-8380-4b26-926b-7e73ebfe655dTue, 20 Jan 2026 08:00:00 +010021:00falsefull42202204Faecal calprotectin in the over-50s: Rule-out test or red flag?Today, we’re speaking to Dr Rob Perry, who is a Gastroenterology Clinical Research Fellow based at Imperial College London.

Title of paper: Evaluating the Role of Faecal Calprotectin in Older Adults

Available at: https://doi.org/10.3399/BJGP.2025.0169

There is considerable uncertainty surrounding the use of FC as a diagnostic test in older adults, with varying suggestions in guidelines and a lack of data in the wider literature. This study investigates the performance of FC in older adults (≥50 years), compared to a younger cohort, with a view to guide its correct use in a primary care setting. These data suggest that FC is a sensitive test for IBD and organic gastrointestinal pathology in both groups. However, concerns remain over its PPV and specificity, particularly in older adults, and it should not be used if colorectal cancer is suspected.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.880 - 00:00:49.180

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the bjgp. Thanks for taking the time today to listen to this podcast. Today we're speaking to Dr.

Rob Perry, who is a gastroenterology Clinical Research Fellow based at Imperial College London. We're here to talk about the paper he's recently published here in the BJGP titled Evaluating the Role of Fecal Calprotectin in Older Adults.

So thanks, Rob, for joining me here to talk about your work.

And I guess I just really want to preface this by saying that a lot has changed in the last few years just in terms of testing for inflammatory bowel disease and bowel cancer in general practice. But I wonder if you could just talk us through this, some of the different guidelines and why you wanted to do this study.

Speaker B

00:00:49.660 - 00:02:24.450

Oh, yes, thank you for having me.

Firstly, and the rationale for the study is that, you know, consultations for gastrointestinal symptoms make up a large number of consultations in primary care. I think the figures around 10%.

And whilst fecal cow protection is an increasingly well established test for differentiating between inflammatory bowel disease and functional or other gastrointestinal or non inflammatory gastrointestinal diseases, its role in older adults is far less well established.

With varying guidelines for clinicians in primary care, the NICE guidelines make no specific mention, for example, of age, other than that calprotectin should not be used where age is considered a risk factor in the context of certain symptoms. For suspicion of cancer, the BSG guidelines on IBD use a cutoff of 40, above which they suggest calprotectin is not used.

The something called the NICE York Fecal cow protectant care pathway suggests an age cut above 60, which is a NICE endorsed pathway. So there's some uncertainty there in the literature about which cutoff should be used for fecal cow protectin.

And the reason any cutoff is suggested is because data has previously shown that calprotectin lacks sensitivity for diagnosing colorectal cancer.

And as age is considered a risk factor for colorectal cancer, guidelines normally mandate earlier endoscopic evaluation of patients with GI symptoms in older age groups.

Speaker A

00:02:24.530 - 00:02:39.170

And can you just talk us through briefly what you did here? So you looked at patients referred for a colonoscopy at one single centre, so at Imperial College Healthcare Trust.

But just talk us through briefly who was included in the study and what were you looking at specifically?

Speaker B

00:02:40.380 - 00:04:04.090

So looking at patients where calprotectin was being used for diagnostic purposes, so calprotectin is also, as you probably know, well established for monitoring patients with existing ibd, monitoring response to treatment for flares, et cetera. We were just looking at patients where it was being used for diagnostic purposes. So any patients with existing IBD were excluded from the study.

And then, yes, as you said, anyone who had a calprotectin within a six month period back in 2021, who then subsequently within a one year period had a colonoscopy performed at Imperial, which is the local referral centre, that were included in the study. And we only looked at adult patients. We had a cohort of older adults which we used to cut 50 and above, and a younger cohort below that.

We didn't look at pediatric cases, that was how we selected patients.

And then we reviewed available electronic documentation to ascertain the diagnosis of the patient, looking at clinic betters etc, as well as looking at other tests that patients may have had performed when their symptoms are being evaluated. Fit testing, for example. We also looked at CRP and haemoglobin.

By collecting that data, we were able to ascertain the diagnostic performance of chiroprotectin in the two respective cohorts. And also in comparison with some of the other clinical tests that I mentioned.

Speaker A

00:04:04.710 - 00:04:21.670

Yeah.

And as you point out, because these tests might be used in quite a varied fashion depending on patient age or presentation, I suppose it's important to kind of work out what the diagnostic capabilities of them are. And I think that's what this study really aimed to achieve. Really.

Speaker B

00:04:22.630 - 00:05:04.510

Yes, exactly.

So we were trying to look at how calprotectin performed in the older age group compared to the younger age group, and also looking at how its performance relative to fit testing in those two cohorts. We looked at the performance of calprotectin, the differentiating between inflammatory bowel disease and non organic GI pathology.

And we also looked at its ability to differentiate between organic GI pathology more generally. So inflammatory bowel disease, colorectal cancer and other significant GI diagnoses and non organic pathology.

Those two questions, which I think are important questions when considering patients presenting with GI symptoms in primary care.

Speaker A

00:05:05.710 - 00:05:14.190

And just talk us through what you found here. And I think the results were really striking in terms of things were different according to age and maybe not surprisingly. But talk us through that.

Speaker B

00:05:15.550 - 00:07:19.810

I think the key findings are firstly that calprotectin remains a sensitive test in both groups.

So sensitivity when using a cutoff of 50 micrograms per gram, which is the nice advised cutoff for considering a positive calprotectin Test suggested by nice.

There are other, you know, there is other data in the literature about altering the cutoff which calprotectin is considered positive, but 50 is the cut, you know, is one of the cut offs we looked at and is what is suggested by, in the NICE guidelines using that cutoff, you get sensitivities of over 90% for diagnosing IBD from non organic GI pathology in both age groups. What you see in the older age group is a significantly lower positive predictive value. So positive predictive value of only about 12%.

And using that cutoff in the patients who had, again using that cutoff of 50 in the small number of patients who did have colorectal cancer, if you then did try to push up the threshold at which calprotectin is considered positive, as many guidelines do suggest, you would then start to, to miss cases of colorectal cancer, which just highlights one of the important messages of the paper and that is clearly documented in the NICE guidelines that calprotectin shouldn't be used as a biomarker for cancer and if cancer is suspected, patients should be referred on the appropriate urgently suspected cancer pathway. We also found that calprotectin did perform better than fit tests for diagnosing ibd.

But, but there's also potentially some future work to be done in patients who may have had FIT testing because of concern over potential colorectal cancer.

But in patients where FIT is negative, calprotectin may then have a role as a good rule out test in that group where you've already ruled out suspected cancer.

So that's maybe an area for future work and maybe it just helps to allow us to think about how we may have a more kind of joined up pathway for evaluating patients with lower GI symptoms in primary care.

Speaker A

00:07:20.930 - 00:07:30.290

And I know some local guidelines might suggest faecal calprotectin alongside FIT in younger age groups. What are your thoughts about this based on the results of this work?

Speaker B

00:07:30.930 - 00:08:26.550

I think it depends what symptoms the patient's presenting with.

I think if patients present with symptoms that according to the NICE guideline that's potentially suggestive of colorectal cancer, then obviously they should be evaluated, you know, appropriately with FIT testing or, you know, onward referral. And I think, you know, I think calprotectin clearly has a role in younger patients for differentiating between non organic GI diseases and ibd.

I think in older patients it's, you...]]>Today, we’re speaking to Dr Rob Perry, who is a Gastroenterology Clinical Research Fellow based at Imperial College London.

Title of paper: Evaluating the Role of Faecal Calprotectin in Older Adults

Available at: https://doi.org/10.3399/BJGP.2025.0169

There is considerable uncertainty surrounding the use of FC as a diagnostic test in older adults, with varying suggestions in guidelines and a lack of data in the wider literature. This study investigates the performance of FC in older adults (≥50 years), compared to a younger cohort, with a view to guide its correct use in a primary care setting. These data suggest that FC is a sensitive test for IBD and organic gastrointestinal pathology in both groups. However, concerns remain over its PPV and specificity, particularly in older adults, and it should not be used if colorectal cancer is suspected.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.880 - 00:00:49.180

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the bjgp. Thanks for taking the time today to listen to this podcast. Today we're speaking to Dr.

Rob Perry, who is a gastroenterology Clinical Research Fellow based at Imperial College London. We're here to talk about the paper he's recently published here in the BJGP titled Evaluating the Role of Fecal Calprotectin in Older Adults.

So thanks, Rob, for joining me here to talk about your work.

And I guess I just really want to preface this by saying that a lot has changed in the last few years just in terms of testing for inflammatory bowel disease and bowel cancer in general practice. But I wonder if you could just talk us through this, some of the different guidelines and why you wanted to do this study.

Speaker B

00:00:49.660 - 00:02:24.450

Oh, yes, thank you for having me.

Firstly, and the rationale for the study is that, you know, consultations for gastrointestinal symptoms make up a large number of consultations in primary care. I think the figures around 10%.

And whilst fecal cow protection is an increasingly well established test for differentiating between inflammatory bowel disease and functional or other gastrointestinal or non inflammatory gastrointestinal diseases, its role in older adults is far less well established.

With varying guidelines for clinicians in primary care, the NICE guidelines make no specific mention, for example, of age, other than that calprotectin should not be used where age is considered a risk factor in the context of certain symptoms. For suspicion of cancer, the BSG guidelines on IBD use a cutoff of 40, above which they suggest calprotectin is not used.

The something called the NICE York Fecal cow protectant care pathway suggests an age cut above 60, which is a NICE endorsed pathway. So there's some uncertainty there in the literature about which cutoff should be used for fecal cow protectin.

And the reason any cutoff is suggested is because data has previously shown that calprotectin lacks sensitivity for diagnosing colorectal cancer.

And as age is considered a risk factor for colorectal cancer, guidelines normally mandate earlier endoscopic evaluation of patients with GI symptoms in older age groups.

Speaker A

00:02:24.530 - 00:02:39.170

And can you just talk us through briefly what you did here? So you looked at patients referred for a colonoscopy at one single centre, so at Imperial College Healthcare Trust.

But just talk us through briefly who was included in the study and what were you looking at specifically?

Speaker B

00:02:40.380 - 00:04:04.090

So looking at patients where calprotectin was being used for diagnostic purposes, so calprotectin is also, as you probably know, well established for monitoring patients with existing ibd, monitoring response to treatment for flares, et cetera. We were just looking at patients where it was being used for diagnostic purposes. So any patients with existing IBD were excluded from the study.

And then, yes, as you said, anyone who had a calprotectin within a six month period back in 2021, who then subsequently within a one year period had a colonoscopy performed at Imperial, which is the local referral centre, that were included in the study. And we only looked at adult patients. We had a cohort of older adults which we used to cut 50 and above, and a younger cohort below that.

We didn't look at pediatric cases, that was how we selected patients.

And then we reviewed available electronic documentation to ascertain the diagnosis of the patient, looking at clinic betters etc, as well as looking at other tests that patients may have had performed when their symptoms are being evaluated. Fit testing, for example. We also looked at CRP and haemoglobin.

By collecting that data, we were able to ascertain the diagnostic performance of chiroprotectin in the two respective cohorts. And also in comparison with some of the other clinical tests that I mentioned.

Speaker A

00:04:04.710 - 00:04:21.670

Yeah.

And as you point out, because these tests might be used in quite a varied fashion depending on patient age or presentation, I suppose it's important to kind of work out what the diagnostic capabilities of them are. And I think that's what this study really aimed to achieve. Really.

Speaker B

00:04:22.630 - 00:05:04.510

Yes, exactly.

So we were trying to look at how calprotectin performed in the older age group compared to the younger age group, and also looking at how its performance relative to fit testing in those two cohorts. We looked at the performance of calprotectin, the differentiating between inflammatory bowel disease and non organic GI pathology.

And we also looked at its ability to differentiate between organic GI pathology more generally. So inflammatory bowel disease, colorectal cancer and other significant GI diagnoses and non organic pathology.

Those two questions, which I think are important questions when considering patients presenting with GI symptoms in primary care.

Speaker A

00:05:05.710 - 00:05:14.190

And just talk us through what you found here. And I think the results were really striking in terms of things were different according to age and maybe not surprisingly. But talk us through that.

Speaker B

00:05:15.550 - 00:07:19.810

I think the key findings are firstly that calprotectin remains a sensitive test in both groups.

So sensitivity when using a cutoff of 50 micrograms per gram, which is the nice advised cutoff for considering a positive calprotectin Test suggested by nice.

There are other, you know, there is other data in the literature about altering the cutoff which calprotectin is considered positive, but 50 is the cut, you know, is one of the cut offs we looked at and is what is suggested by, in the NICE guidelines using that cutoff, you get sensitivities of over 90% for diagnosing IBD from non organic GI pathology in both age groups. What you see in the older age group is a significantly lower positive predictive value. So positive predictive value of only about 12%.

And using that cutoff in the patients who had, again using that cutoff of 50 in the small number of patients who did have colorectal cancer, if you then did try to push up the threshold at which calprotectin is considered positive, as many guidelines do suggest, you would then start to, to miss cases of colorectal cancer, which just highlights one of the important messages of the paper and that is clearly documented in the NICE guidelines that calprotectin shouldn't be used as a biomarker for cancer and if cancer is suspected, patients should be referred on the appropriate urgently suspected cancer pathway. We also found that calprotectin did perform better than fit tests for diagnosing ibd.

But, but there's also potentially some future work to be done in patients who may have had FIT testing because of concern over potential colorectal cancer.

But in patients where FIT is negative, calprotectin may then have a role as a good rule out test in that group where you've already ruled out suspected cancer.

So that's maybe an area for future work and maybe it just helps to allow us to think about how we may have a more kind of joined up pathway for evaluating patients with lower GI symptoms in primary care.

Speaker A

00:07:20.930 - 00:07:30.290

And I know some local guidelines might suggest faecal calprotectin alongside FIT in younger age groups. What are your thoughts about this based on the results of this work?

Speaker B

00:07:30.930 - 00:08:26.550

I think it depends what symptoms the patient's presenting with.

I think if patients present with symptoms that according to the NICE guideline that's potentially suggestive of colorectal cancer, then obviously they should be evaluated, you know, appropriately with FIT testing or, you know, onward referral. And I think, you know, I think calprotectin clearly has a role in younger patients for differentiating between non organic GI diseases and ibd.

I think in older patients it's, you know, clearly for a much, if a tool is for a much narrower group and you know, shouldn't be used where cancer is suspected, which for A large number of patients presenting with GI symptoms. In this group it will be.

Although there may be this subgroup of older patients where because calprotectin maintains a high sensitivity, it does still have a role potentially that fit negative group that we were talking about. Though I think further research is needed to find exactly what that group is.

Speaker A

00:08:27.030 - 00:08:44.150

And I think just generally from my discussions with other GPs there is sometimes a bit of uncertainty about which tests should be used in patients presenting with lower GI symptoms. And I wonder what you want to tell GPs based on the results of this study and your background about the use of faecal calprotectin in fit.

Speaker B

00:08:45.430 - 00:09:35.060

Yes, I think that the study highlights and what is already in the guidelines that calprotectin shouldn't be used if colorectal cancer is suspected. So that's the first thing to say.

I think there is a role for calprotectin clearly in patients under the age of 50, younger adults representing the GI symptoms without, you know, without, without obviously alarm symptoms. But I think you should calculating should be used cautiously in the over 50s.

Whilst it remains a, you know, a sensitive test, it clearly lacks in specificity the poor positive predictor value.

And as we said, it is not a test for cancer which is most or a large, a large proportion of patients in that age group who have lower GI symptoms will meet criteria for referral on a cancer pathway. I think that's the key message for the study really.

Speaker A

00:09:35.700 - 00:09:44.340

So stay aligned to the current two week wait guidelines clearly. But just think carefully about calprotectin testing in those older patients.

Speaker B

00:09:44.340 - 00:10:03.970

I think the study confirms it's a sensitive test, but that again should not be used as a test for colorectal cancer.

And so maybe in a proportion of patients where who don't make referral for referral on a cancer pathway, it may have a role due to its high sensitivity. But with those caveats, fair enough.

Speaker A

00:10:03.970 - 00:10:07.570

Okay. Any other main findings you want to highlight from this paper?

Speaker B

00:10:08.210 - 00:11:06.010

So I think, yeah, I think those, the points we've discussed are the main points.

I think it is interesting to note that for the diagnosis of ibd, calprotectin did outperform FIT testing, which I think suggests there is still a role for calprotectin in the diagnosis of ibd.

Some studies suggested that FIT tests may well be positive in the context of ibd, particularly where there's obviously bleeding present, which often may be with more severe inflammation.

I think it highlights that somewhere in the pathway for evaluating patients in primary care with GI symptoms, particularly in younger patients, there is likely still to be a role for calprotectin. So I think that's an interesting additional finding. Confirms, you know, confirms what most GPs are already doing.

I think beyond that, I think that the key points, as we said, are whilst calprotectin maintains its sensitivity in older adults, caution should be used on exactly which patients it's used in, in that group.

Speaker A

00:11:06.650 - 00:11:19.930

And as you said, it's important to look at the wider clinical picture and there will be a cohort of patients with potentially a strong family history or symptoms strongly suggestive of inflammatory bowel disease, where you might want to think carefully about what you're testing.

Speaker B

00:11:20.170 - 00:12:18.160

I think you also, I mean, you do also have to ask with those patients whether actually ultimately those patients need referral for endoscopy, irrespective of what their calprotectin shows.

You know, even if cancer is not suspected, if there's a very high suspicion of IBD and, you know, you still might consider onward referral even in the context of a negative calprotectin, if you have a very high index of suspicion, they may be patients where is still appropriate, maybe through advice and guidance or discussions with colleagues. You may not want just to draw the line at a negative calprotectin.

But yes, those are the kind of patients where you aren't being referred on a cancer pathway, where a calprotectin is of potential benefit. But like any test, it's important to interpret it in the clinical context.

And if it's not, if there are other things you're concerned about, you know, it's only one test and needs to be interpreted in the context of the patient's symptoms and their individual risk factors.

Speaker A

00:12:19.440 - 00:12:40.480

I think this is really interesting work.

Again, looking at that sort of primary secondary care interface and how tests are being conducted, how referral pathways are being designed or co designed.

From your perspective as a secondary care colleague, where do you think the next steps are from this work and where do you want to see this research going next?

Speaker B

00:12:41.060 - 00:14:01.000

We always say that we want more data and want to be able to look at things in more depth. I think that's true, particularly for trying to work out where calprotectin and fit testing fit in more widely.

With patients presenting with GI symptoms across all age ranges, I think it can be difficult for gps to know exactly which set of guidelines they're going to. I think trying to join all these things up to work out exactly which pathway which patient should be on is important.

That's why I mentioned that in older adults there may be potentially a role for calprotect in the context of a negative fit.

So in that lower risk subgroup of older adults and I think some more work looking at that would be interesting and I think also for adults more generally, including younger adults with need to work out how to use calprotectin in the most effective way possible, are there certain symptom groups that should be targeted with calprotectin?

Some of the data out there suggests that, as we talked about earlier, that calprotectin can often result in a low diagnostic yield of subsequent investigations, that is lots of false positives.

And I think trying to make sure we're using calprotectin as effectively as possible and not exposing patients to unnecessary investigation is also important. And I think more looking into that would be interesting.

Speaker A

00:14:01.680 - 00:14:08.880

Great. Some great pointers for future research, but I think that's probably a great place to wrap things up.

So I just wanted to say thanks very much for joining me.

Speaker B

00:14:09.280 - 00:14:10.080

Thank you very much.

Speaker A

00:14:10.560 - 00:14:40.480

And thank you all very much for your time here and for listening to this BJGP podcast.

Rob's original research article can be found on bjgp.org and the show notes and podcast audio can be found@bjgplife.com and that's the last podcast for this season of BJGP Podcast. We'll be back again towards the end of January 2026 for more interviews showcasing current research and clinical practice articles from the Journal.

Thanks again for your time and bye.

Title of paper: First trimester antidepressant use and miscarriage: a comprehensive analysis in the Clinical Practice Research Datalink GOLD

Available at: https://doi.org/10.3399/BJGP.2025.0092

Antidepressant use during pregnancy is rising, with concerns from pregnant women that these medications may increase the risk of miscarriage if taken prenatally. Evidence is conflicting so we used the Clinical Practice Research Datalink, a large repository of UK-based primary care data, and a range of methods to investigate antidepressant use during trimester one and risk of miscarriage.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.240 - 00:00:52.800

Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors at the bjgp. Thanks for taking the time today to listen to this podcast.

In today's episode, we're speaking to Dr. Flo Martin, an honorary research associate at the University of Bristol.

We're here to look at the paper she's recently published here in the BJGP titled First Trimester Antidepressant Use and Miscarriage A Comprehensive Analysis in the Clinical Practice Research Data Link. Gold. So, hi, Flo, it's great to meet you and talk about this research.

And I think this paper touches on an area that clinicians and women often approach with a bit of uncertainty, just in terms of prescribing safety, really, in pregnancy in general. But can you talk us through what we know already about prescribing for antidepressants and risk in pregnancy, just to frame what you've done here?

Speaker B

00:00:53.280 - 00:02:22.860

Yeah, absolutely.

So we actually did some work a couple of years ago doing a systematic review of the literature in this space, so looking at antidepressant use during pregnancy and the risk of miscarriage. And the work spanned the last kind of 30 years.

And what we found was a 30% increase in risk of miscarriage following antidepressant use during pregnancy. And this was obviously kind of alarming to see this increase in risk. But the kind of key takeaway from the paper was not actually this finding.

It was mostly the kind of variation in the literature that we observed when answering this question.

We kind of were very cautious about interpreting this 30% increase in risk as a kind of true causal effect because we had observed these other things that might be driving the estimate kind of upwards and might not necessarily show the true effect that was happening in this population. So that was kind of the environment that we were existing in before we started the study.

And it really informed the way that we wanted to do this study.

So we thought it was really important to try and understand that baseline risk in both unexposed and exposed pregnancies, so that whatever we observed was contextualized against what the underlying risk was among those who hadn't been prescribed antidepressants.

Speaker A

00:02:23.500 - 00:02:58.120

Yeah, fair enough.

So this is a large analysis of the clinical practice research data link, and you looked at pregnancies between 1996 and 2016 and then followed up women who had been prescribed or not antidepressants and risk of miscarriage.

And I think if people are specifically interested in how you did this, they can go back to the paper and look at some of the different methods you used. But I wanted to focus really on what you found here.

And I think the first thing to point out is that it wasn't uncommon for women to have a prescription for an antidepressant in that first trimester of pregnancy. So talk us through that.

Speaker B

00:02:58.440 - 00:03:43.270

Yeah, exactly. So I think we. We kind of report about 7% of the pregnancies in our study that had been prescribed antidepressants.

And I think, as you say, this is, you know, potentially higher than what you would expect. I think there are kind of multiple things driving this.

If we look outside of pregnancy and kind of zoom out and look at the prescribing rates of antidepressants in both men and women, we can see it's going up, you know, between the 1990s and the late sort of 20 teens. And.

And I think, yeah, people will be maybe surprised to see, but it's very, you know, on trend with what we're seeing outside of pregnancy and then looking.

Speaker A

00:03:43.270 - 00:03:45.950

Specifically at the risk of miscarriage here. What did you find?

Speaker B

00:03:47.150 - 00:04:59.060

Yeah, so when we applied our kind of primary analysis where we were looking at pregnancies who had been prescribed antidepressants in trimester one, and comparing them to pregnancies who were not prescribed antidepressants in trimester one, we found a very, very small increase in relative risk. So I think we found about 4% increase in risk of miscarriage among the prescribed group than. Than the non prescribed.

And what this translated to in terms of that baseline risk, we observed 13.1% of those not prescribed antidepressants, they experienced a miscarriage, and this increased to 13.6% among those who were prescribed. So I think that really puts into perspective when we talk about increases in risk, this is an incredibly modest one, an increase all the same.

And it's important to not kind of trivialize that increase in risk.

But I think it's also incredibly reassuring that when we kind of really place it within what the underlying risk is had someone not taken antidepressants, it's very, very small.

Speaker A

00:04:59.620 - 00:05:00.100

Yeah.

Speaker B

00:05:00.180 - 00:06:32.630

Yeah. I think this is a really important piece of the puzzle for risk communication.

Being able to show relative increases in risk, which are incredibly useful alongside what that actually means in terms of the percentage, the proportion of people that experience an outcome, because it just reminds people that, you know, clinicians and patients alike, that this isn't something that you have complete control over. This isn't purely your behavior driven. It's not.

So I think that can be really kind of reassuring for Individuals who feel that kind of burden of risk mitigation.

We see it in Heather James's paper in BJDP last year, a beautiful qualitative study speaking to women who had experienced antidepressant use during pregnancy and talking through their decision making process and their fears and concerns.

And a couple of the participants who were involved in that study cited miscarriage as one of a specific, one of their specific concerns when taking antidepressants during pregnancy and actually discontinued their antidepressants because they were worried about miscarriage.

So these concerns are having direct impacts on individuals and their behaviour and, you know, their potential management of their depression and anxiety.

Speaker A

00:06:33.190 - 00:06:44.230

So, yeah, I think it's important to balance these risks against the mental health risks for the woman who's taking or needing antidepressants. And I think, as you point out, that was demonstrated beautifully in that qualitative research as well.

Speaker B

00:06:44.310 - 00:06:45.030

Definitely.

Speaker A

00:06:45.670 - 00:06:59.990

I wanted to sort of just draw back to how we can use these results in practice, really.

And I wonder what your thoughts are about how clinicians and women should use these findings to inform their decisions around using antidepressants in pregnancy.

Speaker B

00:07:00.950 - 00:08:34.090

Absolutely, yeah. So while I'm hoping that these results, as a non clinician myself, I'm hoping that these results can be informative for decision making.

This isn't the only piece of evidence out there and it shouldn't be considered as the kind of gold standard, because it isn't.

We utilize a lot of methods and comparators, we use large data, we've thought carefully about all of the things that might be driving these effects and discuss them at length. But it's not the only piece of the puzzle.

I'm hoping that these results can help to kind of illuminate what the truth might be and the factors that might be influencing our perception of the results.

So understanding data, understanding methods that will make us kind of rightly critical and cautious and understanding of what these types of studies in general mean, and also the fact that we've tried to kind of get at this baseline risk where we can report these proportions in both prescribed and non prescribed pregnancies should really allow for easy access to what these results mean. Rather than kind of speaking generally about relative increases, we can speak objectively about proportions in these data in these patients.

Speaker A

00:08:35.130 - 00:09:09.040

Yeah, and absolutely, as you mentioned, it's part of the picture in terms of the decision making process that doctors and women...]]>Today, we’re speaking to Flo Martin, an honorary research associate at the University of Bristol.

Title of paper: First trimester antidepressant use and miscarriage: a comprehensive analysis in the Clinical Practice Research Datalink GOLD

Available at: https://doi.org/10.3399/BJGP.2025.0092

Antidepressant use during pregnancy is rising, with concerns from pregnant women that these medications may increase the risk of miscarriage if taken prenatally. Evidence is conflicting so we used the Clinical Practice Research Datalink, a large repository of UK-based primary care data, and a range of methods to investigate antidepressant use during trimester one and risk of miscarriage.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.240 - 00:00:52.800

Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors at the bjgp. Thanks for taking the time today to listen to this podcast.

In today's episode, we're speaking to Dr. Flo Martin, an honorary research associate at the University of Bristol.

We're here to look at the paper she's recently published here in the BJGP titled First Trimester Antidepressant Use and Miscarriage A Comprehensive Analysis in the Clinical Practice Research Data Link. Gold. So, hi, Flo, it's great to meet you and talk about this research.

And I think this paper touches on an area that clinicians and women often approach with a bit of uncertainty, just in terms of prescribing safety, really, in pregnancy in general. But can you talk us through what we know already about prescribing for antidepressants and risk in pregnancy, just to frame what you've done here?

Speaker B

00:00:53.280 - 00:02:22.860

Yeah, absolutely.

So we actually did some work a couple of years ago doing a systematic review of the literature in this space, so looking at antidepressant use during pregnancy and the risk of miscarriage. And the work spanned the last kind of 30 years.

And what we found was a 30% increase in risk of miscarriage following antidepressant use during pregnancy. And this was obviously kind of alarming to see this increase in risk. But the kind of key takeaway from the paper was not actually this finding.

It was mostly the kind of variation in the literature that we observed when answering this question.

We kind of were very cautious about interpreting this 30% increase in risk as a kind of true causal effect because we had observed these other things that might be driving the estimate kind of upwards and might not necessarily show the true effect that was happening in this population. So that was kind of the environment that we were existing in before we started the study.

And it really informed the way that we wanted to do this study.

So we thought it was really important to try and understand that baseline risk in both unexposed and exposed pregnancies, so that whatever we observed was contextualized against what the underlying risk was among those who hadn't been prescribed antidepressants.

Speaker A

00:02:23.500 - 00:02:58.120

Yeah, fair enough.

So this is a large analysis of the clinical practice research data link, and you looked at pregnancies between 1996 and 2016 and then followed up women who had been prescribed or not antidepressants and risk of miscarriage.

And I think if people are specifically interested in how you did this, they can go back to the paper and look at some of the different methods you used. But I wanted to focus really on what you found here.

And I think the first thing to point out is that it wasn't uncommon for women to have a prescription for an antidepressant in that first trimester of pregnancy. So talk us through that.

Speaker B

00:02:58.440 - 00:03:43.270

Yeah, exactly. So I think we. We kind of report about 7% of the pregnancies in our study that had been prescribed antidepressants.

And I think, as you say, this is, you know, potentially higher than what you would expect. I think there are kind of multiple things driving this.

If we look outside of pregnancy and kind of zoom out and look at the prescribing rates of antidepressants in both men and women, we can see it's going up, you know, between the 1990s and the late sort of 20 teens. And.

And I think, yeah, people will be maybe surprised to see, but it's very, you know, on trend with what we're seeing outside of pregnancy and then looking.

Speaker A

00:03:43.270 - 00:03:45.950

Specifically at the risk of miscarriage here. What did you find?

Speaker B

00:03:47.150 - 00:04:59.060

Yeah, so when we applied our kind of primary analysis where we were looking at pregnancies who had been prescribed antidepressants in trimester one, and comparing them to pregnancies who were not prescribed antidepressants in trimester one, we found a very, very small increase in relative risk. So I think we found about 4% increase in risk of miscarriage among the prescribed group than. Than the non prescribed.

And what this translated to in terms of that baseline risk, we observed 13.1% of those not prescribed antidepressants, they experienced a miscarriage, and this increased to 13.6% among those who were prescribed. So I think that really puts into perspective when we talk about increases in risk, this is an incredibly modest one, an increase all the same.

And it's important to not kind of trivialize that increase in risk.

But I think it's also incredibly reassuring that when we kind of really place it within what the underlying risk is had someone not taken antidepressants, it's very, very small.

Speaker A

00:04:59.620 - 00:05:00.100

Yeah.

Speaker B

00:05:00.180 - 00:06:32.630

Yeah. I think this is a really important piece of the puzzle for risk communication.

Being able to show relative increases in risk, which are incredibly useful alongside what that actually means in terms of the percentage, the proportion of people that experience an outcome, because it just reminds people that, you know, clinicians and patients alike, that this isn't something that you have complete control over. This isn't purely your behavior driven. It's not.

So I think that can be really kind of reassuring for Individuals who feel that kind of burden of risk mitigation.

We see it in Heather James's paper in BJDP last year, a beautiful qualitative study speaking to women who had experienced antidepressant use during pregnancy and talking through their decision making process and their fears and concerns.

And a couple of the participants who were involved in that study cited miscarriage as one of a specific, one of their specific concerns when taking antidepressants during pregnancy and actually discontinued their antidepressants because they were worried about miscarriage.

So these concerns are having direct impacts on individuals and their behaviour and, you know, their potential management of their depression and anxiety.

Speaker A

00:06:33.190 - 00:06:44.230

So, yeah, I think it's important to balance these risks against the mental health risks for the woman who's taking or needing antidepressants. And I think, as you point out, that was demonstrated beautifully in that qualitative research as well.

Speaker B

00:06:44.310 - 00:06:45.030

Definitely.

Speaker A

00:06:45.670 - 00:06:59.990

I wanted to sort of just draw back to how we can use these results in practice, really.

And I wonder what your thoughts are about how clinicians and women should use these findings to inform their decisions around using antidepressants in pregnancy.

Speaker B

00:07:00.950 - 00:08:34.090

Absolutely, yeah. So while I'm hoping that these results, as a non clinician myself, I'm hoping that these results can be informative for decision making.

This isn't the only piece of evidence out there and it shouldn't be considered as the kind of gold standard, because it isn't.

We utilize a lot of methods and comparators, we use large data, we've thought carefully about all of the things that might be driving these effects and discuss them at length. But it's not the only piece of the puzzle.

I'm hoping that these results can help to kind of illuminate what the truth might be and the factors that might be influencing our perception of the results.

So understanding data, understanding methods that will make us kind of rightly critical and cautious and understanding of what these types of studies in general mean, and also the fact that we've tried to kind of get at this baseline risk where we can report these proportions in both prescribed and non prescribed pregnancies should really allow for easy access to what these results mean. Rather than kind of speaking generally about relative increases, we can speak objectively about proportions in these data in these patients.

Speaker A

00:08:35.130 - 00:09:09.040

Yeah, and absolutely, as you mentioned, it's part of the picture in terms of the decision making process that doctors and women might want to take on in terms of information when informing their decisions. So I think this is really important work, as you say, looking at those absolute risks to help guide those conversations as well.

But I think that's probably a great place to wrap things up.

And I think it's been great to hear more about the research, and hopefully, as you mentioned, it's building up the evidence in this area and helping women and clinicians make those decisions together.

Speaker B

00:09:10.410 - 00:09:10.890

Thank you.

Speaker A

00:09:11.290 - 00:09:26.730

And thank you all very much for your time here and listening to this BJTP podcast.

Flo's original research article can be found on bjgp.org and the show notes and podcast audio can be found@bjgplife.com thanks again for listening and bye.

Title of paper: Accessing Equitable Menopause Care in the Contemporary NHS – Women’s Experiences

Available at: https://doi.org/10.3399/BJGP.2024.0781

Menopause awareness has increased in recent years, as well as HRT use, however, this has not been experienced equally. Cultural influences such as stigma, preferences for non-medical approaches, perceptions of ailments appropriate for healthcare, lack of representation, work against women seeking help. GPs should not assume all women who would benefit from HRT will advocate for it. They ought to initiate discussions about potential HRT, as well as other approaches, with all presenting women who may benefit.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.240 - 00:01:12.020

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the bjgp. Thanks for taking the time today to listen to this podcast.

In today's episode, we're talking to Claire Mann, a research fellow who's based at the University of Warwick, and Sarah Hillman, who is a GP and Clinical Associate professor based at the University of Birmingham.

We're here to discuss the recent paper published here in the BJGP titled Accessing Equitable Menopause Care in the Contemporary NHS Women's Experiences. Thanks, Claire and Sarah, for joining me here today to talk about this work.

This study focuses particularly on the women's experience of menopause and accessing general practice and primary care. But I'll point out just before we begin that you've also published a linked paper looking at the clinician perspective.

So anyone who's interested in that angle should look up your other paper. But back to this one. Sarah, I wonder if I could start with you first.

I wonder if you could just talk us through the focus of the paper here and the kind of disparities that different women might face in accessing menopause care in the UK.

Speaker B

00:01:13.620 - 00:02:57.750

Essentially, this work came about because in 2020, we published a piece of work in the BJGP that looked at prescribing a practice level of hrt.

And what we found was that actually, if you were a patient at one of the most deprived practices in England, you were about a third less likely to be prescribed HRT than if you were in the most affluent. What we didn't have at that point in time was data at an individual level, just at a practice level.

But it was important that work was done because that really pushed that forwards. But what we didn't understand was what was going on underneath that. So.

So we asked the nihr, we wrote a grant for something called Research for Patient Benefit and said, look, we want to explore exactly why there is this disparity, because our feeling as researchers was that it wasn't straightforward and that there was a lot going on, both from the woman's perspective and the healthcare professional's perspective. And we really wanted to know exactly how that was all adding up to this gap in prescribing.

What we did was we spoke to 40 women, but we were incredibly mindful that we wanted to speak to women that were less likely on paper to be prescribed hrt. So we tried to speak to women that were from more socially economically deprived areas and also black and South Asian women.

So this project really was. Was underlying that. That gap.

Speaker A

00:02:57.910 - 00:03:31.880

Yeah.

And I guess, as you said, based on that previous research, you really wanted to get this deeper understanding of what was shaping menopause and HRT management and prescribing patterns.

And I think just to sort of move on to what you found, really, I thought that one of the initial things that really stood out to me was the women that you spoke to talked about the menopause and how menopause care has changed over generations and how that impacts how women seek help. And I wonder if you could just start by talking us through this and what the women you spoke to told you.

Speaker C

00:03:31.880 - 00:05:16.160

It's a really interesting study because obviously the time is right to be talking about menopause. It's going through this phenomenal change.

And a lot of the women that we spoke to reflected on how that change had impacted their lives and how different their experiences might have been from the. The previous generation. A lot of women talked about when it came to menopause, they wanted to know about their mum and their mum's experiences.

That's often a first port of call.

But actually what a lot, particularly of the black and Asian women were telling us was that they were experiencing a different life to their own mum, that there were different pressures now, particularly in terms of being career driven, juggling intergenerational family and feeling the pressure of modern life, whilst also trying to manage their own experiences.

So the current generation really are quite unique in as far as they've got a whole load of challenges and a whole load of stress that perhaps generations before them haven't had.

So when they're having conversations in the family, it's a little bit mismatched because Mum might be saying, well, that's not what my experience was like.

But the younger generation is perhaps thinking, well, yeah, because mom didn't, perhaps didn't work full time or, you know, didn't exist in the Western world in the same way as we do now.

So it, I think that comes to play for a lot of women, particularly around career development and the fact that so many women in their middle lives now are still working full time and juggling family responsibilities, and that presents an additional stress to then also prioritizing your own health. And that's something that women found difficult to do amongst all those pressures as well, I think, was something they told us.

Speaker A

00:05:16.810 - 00:05:25.210

Yeah. And in some communities it seemed as though there's still quite a lot of stigma around discussing the menopause openly. What did they talk about here?

Speaker C

00:05:25.610 - 00:06:46.450

Yeah, I think obviously menopause is a hot topic and it's being spoken about in lots of ways, but that doesn't mean it's not still taboo for lots of women.

Many of the women that we spoke to still hadn't had those conversations within their families because it was still something that was considered perhaps shameful and that they were expected to just deal with. Some of the black women spoke about the stoicism and being expected to be brave and have a high pain threshold.

And some of the Asian women spoke about families and fertility and the patriarchy and the way that things are perceived and said that for them, actually having those menopause conversations within their homes was not as easy as it might be perceived. And so having that peer support from within the family, within the communities hasn't developed as strongly yet.

It is starting to come through so that women are enabling each other with their own experiences. And where that does happen, it's really powerful.

I think the women told us that, you know, peer support is really valuable, family support is really valuable, but it is still a topic that women feel stigmatized and embarrassed sometimes to talk about, particularly if it's not something that they've been open to discussing as they've been brought up through their, through their families.

Speaker A

00:06:47.180 - 00:07:11.340

Yeah, it's really interesting because when we think about maybe the kind of information sources that women might have, so family or community or peer support would really play into that.

And I wonder if they talked about that tension from how menopause or seeking help for the menopause might be perceived in the community and how that affected their help seeking behavior to their gps at all.

Speaker B

00:07:11.900 - 00:09:02.730

So I think, I think that's exactly right.

Women spoke about how not only how menopause was, as Claire said, talked about or not talked about in their own communities, but actually how any information around menopause in this country, how often they felt they didn't feel represented.

And actually if they didn't feel represented, that might be through what was said or an image of what a woman going through menopause might look like or on an advertisement, actually. They just didn't feel a connection there. And therefore they felt, well, this isn't about me.

And that was a barrier really for them not going forward to get help.

But really interestingly, lots of women spoke about the fact that actually when they'd got to a stage when they felt that they did need help, some of them considered how they might be in sometimes racially stereotyped during that consultation.

That was something that for me as a researcher, I thought, crikey, the fact that women had actually...]]>Today, we’re speaking to Claire Mann, a Research Fellow who is based at the University of Warwick, and Sarah Hillman, who is a GP and Clinical Associate Professor based at the University of Birmingham.

Title of paper: Accessing Equitable Menopause Care in the Contemporary NHS – Women’s Experiences

Available at: https://doi.org/10.3399/BJGP.2024.0781

Menopause awareness has increased in recent years, as well as HRT use, however, this has not been experienced equally. Cultural influences such as stigma, preferences for non-medical approaches, perceptions of ailments appropriate for healthcare, lack of representation, work against women seeking help. GPs should not assume all women who would benefit from HRT will advocate for it. They ought to initiate discussions about potential HRT, as well as other approaches, with all presenting women who may benefit.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.240 - 00:01:12.020

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the bjgp. Thanks for taking the time today to listen to this podcast.

In today's episode, we're talking to Claire Mann, a research fellow who's based at the University of Warwick, and Sarah Hillman, who is a GP and Clinical Associate professor based at the University of Birmingham.

We're here to discuss the recent paper published here in the BJGP titled Accessing Equitable Menopause Care in the Contemporary NHS Women's Experiences. Thanks, Claire and Sarah, for joining me here today to talk about this work.

This study focuses particularly on the women's experience of menopause and accessing general practice and primary care. But I'll point out just before we begin that you've also published a linked paper looking at the clinician perspective.

So anyone who's interested in that angle should look up your other paper. But back to this one. Sarah, I wonder if I could start with you first.

I wonder if you could just talk us through the focus of the paper here and the kind of disparities that different women might face in accessing menopause care in the UK.

Speaker B

00:01:13.620 - 00:02:57.750

Essentially, this work came about because in 2020, we published a piece of work in the BJGP that looked at prescribing a practice level of hrt.

And what we found was that actually, if you were a patient at one of the most deprived practices in England, you were about a third less likely to be prescribed HRT than if you were in the most affluent. What we didn't have at that point in time was data at an individual level, just at a practice level.

But it was important that work was done because that really pushed that forwards. But what we didn't understand was what was going on underneath that. So.

So we asked the nihr, we wrote a grant for something called Research for Patient Benefit and said, look, we want to explore exactly why there is this disparity, because our feeling as researchers was that it wasn't straightforward and that there was a lot going on, both from the woman's perspective and the healthcare professional's perspective. And we really wanted to know exactly how that was all adding up to this gap in prescribing.

What we did was we spoke to 40 women, but we were incredibly mindful that we wanted to speak to women that were less likely on paper to be prescribed hrt. So we tried to speak to women that were from more socially economically deprived areas and also black and South Asian women.

So this project really was. Was underlying that. That gap.

Speaker A

00:02:57.910 - 00:03:31.880

Yeah.

And I guess, as you said, based on that previous research, you really wanted to get this deeper understanding of what was shaping menopause and HRT management and prescribing patterns.

And I think just to sort of move on to what you found, really, I thought that one of the initial things that really stood out to me was the women that you spoke to talked about the menopause and how menopause care has changed over generations and how that impacts how women seek help. And I wonder if you could just start by talking us through this and what the women you spoke to told you.

Speaker C

00:03:31.880 - 00:05:16.160

It's a really interesting study because obviously the time is right to be talking about menopause. It's going through this phenomenal change.

And a lot of the women that we spoke to reflected on how that change had impacted their lives and how different their experiences might have been from the. The previous generation. A lot of women talked about when it came to menopause, they wanted to know about their mum and their mum's experiences.

That's often a first port of call.

But actually what a lot, particularly of the black and Asian women were telling us was that they were experiencing a different life to their own mum, that there were different pressures now, particularly in terms of being career driven, juggling intergenerational family and feeling the pressure of modern life, whilst also trying to manage their own experiences.

So the current generation really are quite unique in as far as they've got a whole load of challenges and a whole load of stress that perhaps generations before them haven't had.

So when they're having conversations in the family, it's a little bit mismatched because Mum might be saying, well, that's not what my experience was like.

But the younger generation is perhaps thinking, well, yeah, because mom didn't, perhaps didn't work full time or, you know, didn't exist in the Western world in the same way as we do now.

So it, I think that comes to play for a lot of women, particularly around career development and the fact that so many women in their middle lives now are still working full time and juggling family responsibilities, and that presents an additional stress to then also prioritizing your own health. And that's something that women found difficult to do amongst all those pressures as well, I think, was something they told us.

Speaker A

00:05:16.810 - 00:05:25.210

Yeah. And in some communities it seemed as though there's still quite a lot of stigma around discussing the menopause openly. What did they talk about here?

Speaker C

00:05:25.610 - 00:06:46.450

Yeah, I think obviously menopause is a hot topic and it's being spoken about in lots of ways, but that doesn't mean it's not still taboo for lots of women.

Many of the women that we spoke to still hadn't had those conversations within their families because it was still something that was considered perhaps shameful and that they were expected to just deal with. Some of the black women spoke about the stoicism and being expected to be brave and have a high pain threshold.

And some of the Asian women spoke about families and fertility and the patriarchy and the way that things are perceived and said that for them, actually having those menopause conversations within their homes was not as easy as it might be perceived. And so having that peer support from within the family, within the communities hasn't developed as strongly yet.

It is starting to come through so that women are enabling each other with their own experiences. And where that does happen, it's really powerful.

I think the women told us that, you know, peer support is really valuable, family support is really valuable, but it is still a topic that women feel stigmatized and embarrassed sometimes to talk about, particularly if it's not something that they've been open to discussing as they've been brought up through their, through their families.

Speaker A

00:06:47.180 - 00:07:11.340

Yeah, it's really interesting because when we think about maybe the kind of information sources that women might have, so family or community or peer support would really play into that.

And I wonder if they talked about that tension from how menopause or seeking help for the menopause might be perceived in the community and how that affected their help seeking behavior to their gps at all.

Speaker B

00:07:11.900 - 00:09:02.730

So I think, I think that's exactly right.

Women spoke about how not only how menopause was, as Claire said, talked about or not talked about in their own communities, but actually how any information around menopause in this country, how often they felt they didn't feel represented.

And actually if they didn't feel represented, that might be through what was said or an image of what a woman going through menopause might look like or on an advertisement, actually. They just didn't feel a connection there. And therefore they felt, well, this isn't about me.

And that was a barrier really for them not going forward to get help.

But really interestingly, lots of women spoke about the fact that actually when they'd got to a stage when they felt that they did need help, some of them considered how they might be in sometimes racially stereotyped during that consultation.

That was something that for me as a researcher, I thought, crikey, the fact that women had actually had to go away and think, how am I going to approach this consultation?

Because I don't want to be stereotyped as having a higher pain threshold or being angry or all these other things, which meant that actually they thought the whole thing out before they even got through the door.

And women also spoke about the fact that they felt sometimes that healthcare professionals didn't appreciate the fact that by the time they'd got in front of them, they hadn't been experiencing symptoms for a little bit of time. They'd been experiencing symptoms for a long time.

And so actually, at that point in time, they really needed the GP to pay attention and listen to them.

Speaker A

00:09:03.210 - 00:09:27.670

Yeah.

And I think that really came out in the paper where, as you say, some of the women described how, by the point, they got to see their gp, they were at that stage where things had been difficult. And you described this almost emotionally charged consultation where they knew what they wanted from the interaction as well.

And could you talk us through a little bit more about how women experienced this and how it impacted how things were managed in the end?

Speaker B

00:09:27.910 - 00:10:29.550

So, interestingly, one of the things that they felt was going to happen was that they were going to have to advocate for what they wanted, particularly hrt.

Now, actually, that didn't always come to pass, and I think that some women were in front of the GP and the consultation didn't go as they thought it would, but it was this.

Whether it's been fueled by things they've seen in the media, women felt that they were going to have to sit there and advocate for their HRT and that it was likely it was going to be refused, but that actually, sometimes that was a problem and sometimes they felt fobbed off and sometimes they felt that they'd been offered alternatives that they didn't want, but actually, sometimes they were given the prescription that they wanted. But it was just really interesting that women felt before they even walked through the door that they were going to have a fight on their hands.

And I think that was, again, as a clinician, that was a really important learning point for me.

Speaker A

00:10:30.050 - 00:10:40.850

And I think, in general, what you found here is that women's cultural backgrounds had a really big impact on their approaches to accessing care. And I wonder if you wanted to just unpick this a bit further at all.

Speaker B

00:10:41.250 - 00:11:43.200

So I think one of the things that was interesting was that actually it was around what care they were expecting, actually, when they presented with menopausal symptoms, and that some women wanted hrt, which was incredibly important. But many women found or felt that actually what they wanted was a much more holistic approach.

They felt like they wanted advice about lifestyle and other aspects of menopause. They also felt that they wanted often to talk about complementary therapies.

And that's because for some women in the communities that they live in, complementary therapies are incredibly important. But actually, as gps, we're often not trained in that area.

So that was a slight area in which women felt that their options weren't being addressed because it was a sort of HRT or nothing situation and they felt they needed more than that.

Speaker A

00:11:43.760 - 00:11:57.280

Yeah.

And just following on from that, I wonder what either of you thought really about what you would want to tell gps about how they approach women from different cultural backgrounds around the time of the menopause. Based on the results of this study.

Speaker B

00:11:58.160 - 00:13:29.430

I think what I would want to say to gps is that there are certain groups of women that are not going to sit in front of you and tell you that they've got perimenopausal, menopausal symptoms.

It's going to take more than one consultation and sometimes there are going to be some stigmas and taboos that you might have to break down a little bit. And to keep the consultation holistic, make sure you're talking about hrt, but also about other options and to make sure that you keep the door open.

I think that's incredibly important. I think a lot of women felt that the consultations were one off.

And actually what they were saying was, I want somebody who is going to help me throughout this period of my life. And as we know, you know, average length of sort of vasomotor symptoms, things could be eight years.

We don't want women to think that this is a one time offer.

And I also think that it's incredibly important to recognise as a gp, that when the person sits in front of you, I know you've done 10, 15 consultations already that morning, but for them, they may well have been experiencing those symptoms for a long time. And that consultation might have taken a lot of preparation.

And I think it's really identifying that and acknowledging that, and I think that's important.

Speaker A

00:13:30.149 - 00:13:31.990

Sorry, Claire, go ahead. Do you wanted to add something?

Speaker C

00:13:32.390 - 00:14:27.960

Yeah, no, I was just going to fully support that and say, actually opening the door to the conversation is one thing, and then ending the conversation with that door open. A woman will come back if you tell her, I want you to come back.

And there was some really great examples of women and GPs that we spoke to where they'd had an initial appointment and been given some time to go away and consider things and read things and learn more and then come back and have another conversation. Somebody who is reluctant to HRT initially may well change their mind over the course of conversations. But I think Sarah's absolutely right.

Sometimes it takes a lot for a woman to get through the door on that first occasion and it's unlikely that everything might be resolved. So they need that door open and that encouragement for that continuity of care.

Because this is a journey, as you say, it's gonna, it's gonna last several years and women need to be encouraged to engage with us throughout that journey whenever they need us. I think.

Speaker A

00:14:28.360 - 00:15:00.030

Yeah, well, I think you took the words straight out of my mouth, Claire, about continuity of care.

And I think that especially with menopause and discussions around prescribing or not prescribing or alternative options, these kind of conversations can't happen in 10 or 15 minutes. And it is something that needs to be a much longer term solution and discussion as you, as you both identify.

But I think that's a great place to wrap things up. But I just wanted to say thank you very much both for your time here and for joining me to talk about this work.

Speaker B

00:15:00.590 - 00:15:04.430

Oh, thank you for asking us. And Claire, thanks for joining as well.

Speaker C

00:15:04.750 - 00:15:08.270

Thanks for having me. Yeah, real privilege to be involved. Really appreciate it. Thank you.

Speaker A

00:15:09.490 - 00:15:37.110

And thank you all very much for your time here and for listening to this BJGP podcast.

The original research article can be found on bjgp.org and the show notes and podcast audio can be found@bjgplife.com and again, it's great to see research that's involved so much of women's experiences and patient engagement. So well done to Claire and Sarah for involving that in this, in this research as well. Thanks again for listening and bye.

Title of paper: Counting GPs: A comparative repeat cross-sectional analysis of NHS general practitioners

Available at: https://doi.org/10.3399/BJGP.2024.0833

There have been successive Government promises to increase GP numbers. However, the numbers of GPs in NHS general practice depend upon how GPs are defined and how data are analysed. This paper provides a comprehensive picture of trends in GP capacity in English NHS general practice between 2015 and 2024. It shows that the number of fully qualified GPs working in NHS general practice is not keeping pace with population growth and there is increasing variation in the number of patients per GP between practices. We offer research and policy recommendations to improve the consistency and clarity of reporting GP workforce statistics.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.040 - 00:01:04.810

Hello 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.

In today's episode, we're speaking to Dr. Louisa Pettigrew, who is a GP and research fellow at the London School of Hygiene and Tropical Medicine.

Louisa is also a Senior Policy Fellow at the Health foundation and we're here today to talk about the paper that she's recently published here in the bjgp. The paper is titled Counting A Comparative Repeat Cross Sectional analysis of NHS GPs.

So, hi, Louisa, and thanks for joining me here today to talk about your work. And I guess just to set things out, it is really important to know how many gps there are working.

But I wonder if you could just talk us through what we already know about this. We know that there have been successive government policies and promises to increase the number of gps.

There are, as we know, different ways that gps could be counted.

Speaker B

00:01:05.530 - 00:02:37.470

So, yeah, as you rightly point out, there's been recurrent governance promises to increase GP numbers.

Not just our current Labour government, but the previous Conservative government too, and previous governments too, because they realize that, you know, having access to GP is important for the public and there's a shortage, a perceived shortage of them.

So the issue that we notice that there's different ways to count GPs who are working NHS General practice, and therefore depending on how you choose to count them, then that affects the trends and it affects your numbers.

So you can count a GP by headcount, whether they're working in NHS general practice or not, and you can count them by full time equivalent, so the actual reported numbers of working hours. You can also consider GPs to be fully qualified GPs alone, or you could include GPs who are fully qualified, plus what is categorized as GP trainees.

Now, that category includes GP trainees, but it also includes foundation year one and two doctors and any other sort of junior doctor that might be in general practice. And the other dimension to how you count gps is whether you take population growth into population size.

So in the UK, over the past, sort of between 2015 and 2024, which was a period of analysis of our study, there was about 12% increase in population size in England. So once you take population growth into account, that again, changes your trends and your current figures.

Speaker A

00:02:38.510 - 00:02:46.830

And in this paper you used a few different ways to calculate the number of gps. But just talk us through briefly the data sets that you used here to look at that.

Speaker B

00:02:46.990 - 00:03:45.590

So we use the nhs, England's GP workforce data set that provides both national figures and practice level figures.

So we use the national figures to look at the overall trends and then we looked at practice level figures to disaggregate and look at sort of the range, the median and the 95th and 5th percentile of patients per GP across practices in England. We also used the number of patients registered at jail practice to get our total number of patients, your denominator from the nhs.

But we also compared this to Office of National Statistics, Office for national statistics ONS figures of mid year population estimates between 2017 and 2023 to again compare how you know what your population is changes the number of patients per GP or gps per capita. You can calculate it both ways and.

Speaker A

00:03:45.590 - 00:03:57.920

I think just setting that out shows us why this is actually a really complicated area.

So there's lots of different ways to define a GP and how they're working, but there's also lots of different sources you can look to to count a GP as well.

Speaker B

00:03:58.880 - 00:04:21.140

Correct. And, you know, there's, there's nuance to this.

And the risk is that if we don't consistently count them and report them in the same way, then you end up having different figures and people end up speaking at cross purposes and people can pick and choose which figures to use depending on what's more convenient in terms of the story that one wants to tell.

Speaker A

00:04:21.940 - 00:04:27.980

Fair enough. Okay, so let's move on to what you found. So what were the numbers of total GPS if we were just doing a.

Speaker B

00:04:27.980 - 00:06:05.730

Headcount between 2015 and 2024? So we took quarterly data over that period and we saw that there was.

If you take headcount, so this is the absolute best case scenario, you take headcount and you include trainees, there was an 18% increase, so it rose from 41,193 to 48,758. That's raw number of GPs in NHS general practice. A separate question is GP's not in NHS general practice? But that's a different study, not this one.

But then if you consider working hours so full time equivalent and you exclude GP trainees on the basis that they are not equivalent to a GP because they might not be delivering the same amount of care, foundation union doctors may not choose to specialise in general practice. So therefore, arguably shouldn't be included in the overall numbers. So full time equivalent and no trainee, what we found is actually a 5% reduction.

So from 29,364 down to 27,966 between September 2015 and September 2024.

If then you take into account population growth and using NHS registered patients rather than ONS figures, what we actually see is only a 6% rise in the headcount plus trainees. So that's 6% rise versus an 18% rise. That's once you've taken population growth into account.

And when you actually take in population growth into account and consider true sort of working figures, which are full time equivalents without trainees, there's actually a 5% reduction in the number of GPS per capita. Yeah.

Speaker A

00:06:05.730 - 00:06:16.030

And I also wanted to touch about the range of patient to GP ratios across the country, because what you found here suggested that there's actually a big range between these ratios across England as well.

Speaker B

00:06:16.510 - 00:06:55.010

Yeah, that's right. So that was the next part of the analysis where we looked at practice level data.

So what we saw is that between the period of September 15 and September 2024, the gap, or the difference between, say, the 5% practice of the least number of patients per GP and the 95th percentile, practices with the greatest number of patients per GP, that increased. So there's a big difference.

So, and that's principally driven because the gap has increased, because those at higher end, those with more patients per capita, has increased that faster rate than those with less patients per capita.

Speaker A

00:06:55.490 - 00:07:01.250

And what does that mean on the ground for these practices in terms of the ratio of patients to GPs?

Speaker B

00:07:01.970 - 00:07:49.290

Well, the thing is, I guess we don't. We don't know the reason for this. So our study didn't examine the reasons for this. You might speculate there might be a variety of reasons.

So practices may have employment shortages, they might be in areas that are struggling to recruit, they may have made active decisions not to recruit for financial reasons, they may have less gps, but actually may have many other additional roles.

So other direct patient care roles, pharmacists, social prescribers, physios and so on, and therefore compensating their GP shortage, the relative GP shortage with other roles. But again, that was beyond the study and that's only, you know, what we can infer based on what's going on in just now.

Speaker A

00:07:49.930 - 00:08:10.920

Yeah, and I think this study is really interesting because it's kind of based around how all these things are defined. And you point out in the paper that depending on how you define a GP, there could have been a rise of 18% of GP]]>Today, we’re speaking to Dr Luisa Pettigrew, a GP and Research Fellow at the London School of Hygiene and Tropical Medicine and Senior Policy Fellow at the Health Foundation.

Title of paper: Counting GPs: A comparative repeat cross-sectional analysis of NHS general practitioners

Available at: https://doi.org/10.3399/BJGP.2024.0833

There have been successive Government promises to increase GP numbers. However, the numbers of GPs in NHS general practice depend upon how GPs are defined and how data are analysed. This paper provides a comprehensive picture of trends in GP capacity in English NHS general practice between 2015 and 2024. It shows that the number of fully qualified GPs working in NHS general practice is not keeping pace with population growth and there is increasing variation in the number of patients per GP between practices. We offer research and policy recommendations to improve the consistency and clarity of reporting GP workforce statistics.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.040 - 00:01:04.810

Hello 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.

In today's episode, we're speaking to Dr. Louisa Pettigrew, who is a GP and research fellow at the London School of Hygiene and Tropical Medicine.

Louisa is also a Senior Policy Fellow at the Health foundation and we're here today to talk about the paper that she's recently published here in the bjgp. The paper is titled Counting A Comparative Repeat Cross Sectional analysis of NHS GPs.

So, hi, Louisa, and thanks for joining me here today to talk about your work. And I guess just to set things out, it is really important to know how many gps there are working.

But I wonder if you could just talk us through what we already know about this. We know that there have been successive government policies and promises to increase the number of gps.

There are, as we know, different ways that gps could be counted.

Speaker B

00:01:05.530 - 00:02:37.470

So, yeah, as you rightly point out, there's been recurrent governance promises to increase GP numbers.

Not just our current Labour government, but the previous Conservative government too, and previous governments too, because they realize that, you know, having access to GP is important for the public and there's a shortage, a perceived shortage of them.

So the issue that we notice that there's different ways to count GPs who are working NHS General practice, and therefore depending on how you choose to count them, then that affects the trends and it affects your numbers.

So you can count a GP by headcount, whether they're working in NHS general practice or not, and you can count them by full time equivalent, so the actual reported numbers of working hours. You can also consider GPs to be fully qualified GPs alone, or you could include GPs who are fully qualified, plus what is categorized as GP trainees.

Now, that category includes GP trainees, but it also includes foundation year one and two doctors and any other sort of junior doctor that might be in general practice. And the other dimension to how you count gps is whether you take population growth into population size.

So in the UK, over the past, sort of between 2015 and 2024, which was a period of analysis of our study, there was about 12% increase in population size in England. So once you take population growth into account, that again, changes your trends and your current figures.

Speaker A

00:02:38.510 - 00:02:46.830

And in this paper you used a few different ways to calculate the number of gps. But just talk us through briefly the data sets that you used here to look at that.

Speaker B

00:02:46.990 - 00:03:45.590

So we use the nhs, England's GP workforce data set that provides both national figures and practice level figures.

So we use the national figures to look at the overall trends and then we looked at practice level figures to disaggregate and look at sort of the range, the median and the 95th and 5th percentile of patients per GP across practices in England. We also used the number of patients registered at jail practice to get our total number of patients, your denominator from the nhs.

But we also compared this to Office of National Statistics, Office for national statistics ONS figures of mid year population estimates between 2017 and 2023 to again compare how you know what your population is changes the number of patients per GP or gps per capita. You can calculate it both ways and.

Speaker A

00:03:45.590 - 00:03:57.920

I think just setting that out shows us why this is actually a really complicated area.

So there's lots of different ways to define a GP and how they're working, but there's also lots of different sources you can look to to count a GP as well.

Speaker B

00:03:58.880 - 00:04:21.140

Correct. And, you know, there's, there's nuance to this.

And the risk is that if we don't consistently count them and report them in the same way, then you end up having different figures and people end up speaking at cross purposes and people can pick and choose which figures to use depending on what's more convenient in terms of the story that one wants to tell.

Speaker A

00:04:21.940 - 00:04:27.980

Fair enough. Okay, so let's move on to what you found. So what were the numbers of total GPS if we were just doing a.

Speaker B

00:04:27.980 - 00:06:05.730

Headcount between 2015 and 2024? So we took quarterly data over that period and we saw that there was.

If you take headcount, so this is the absolute best case scenario, you take headcount and you include trainees, there was an 18% increase, so it rose from 41,193 to 48,758. That's raw number of GPs in NHS general practice. A separate question is GP's not in NHS general practice? But that's a different study, not this one.

But then if you consider working hours so full time equivalent and you exclude GP trainees on the basis that they are not equivalent to a GP because they might not be delivering the same amount of care, foundation union doctors may not choose to specialise in general practice. So therefore, arguably shouldn't be included in the overall numbers. So full time equivalent and no trainee, what we found is actually a 5% reduction.

So from 29,364 down to 27,966 between September 2015 and September 2024.

If then you take into account population growth and using NHS registered patients rather than ONS figures, what we actually see is only a 6% rise in the headcount plus trainees. So that's 6% rise versus an 18% rise. That's once you've taken population growth into account.

And when you actually take in population growth into account and consider true sort of working figures, which are full time equivalents without trainees, there's actually a 5% reduction in the number of GPS per capita. Yeah.

Speaker A

00:06:05.730 - 00:06:16.030

And I also wanted to touch about the range of patient to GP ratios across the country, because what you found here suggested that there's actually a big range between these ratios across England as well.

Speaker B

00:06:16.510 - 00:06:55.010

Yeah, that's right. So that was the next part of the analysis where we looked at practice level data.

So what we saw is that between the period of September 15 and September 2024, the gap, or the difference between, say, the 5% practice of the least number of patients per GP and the 95th percentile, practices with the greatest number of patients per GP, that increased. So there's a big difference.

So, and that's principally driven because the gap has increased, because those at higher end, those with more patients per capita, has increased that faster rate than those with less patients per capita.

Speaker A

00:06:55.490 - 00:07:01.250

And what does that mean on the ground for these practices in terms of the ratio of patients to GPs?

Speaker B

00:07:01.970 - 00:07:49.290

Well, the thing is, I guess we don't. We don't know the reason for this. So our study didn't examine the reasons for this. You might speculate there might be a variety of reasons.

So practices may have employment shortages, they might be in areas that are struggling to recruit, they may have made active decisions not to recruit for financial reasons, they may have less gps, but actually may have many other additional roles.

So other direct patient care roles, pharmacists, social prescribers, physios and so on, and therefore compensating their GP shortage, the relative GP shortage with other roles. But again, that was beyond the study and that's only, you know, what we can infer based on what's going on in just now.

Speaker A

00:07:49.930 - 00:08:10.920

Yeah, and I think this study is really interesting because it's kind of based around how all these things are defined. And you point out in the paper that depending on how you define a GP, there could have been a rise of 18% of GP numbers or a 5% reduction.

And what do you think this means about how we look at the data or talk about the number of gps in practice?

Speaker B

00:08:11.960 - 00:09:43.860

Yeah, I think.

And what we recommend in the paper is that we ought to, we ought to report both headcount and full time equivalent because it's important for policy decisions to understand whether it's a complete headcount shortage or whether it's about people reducing their work hours. And obviously it's important to know the number of retainees and report them as well. So it's important to understand with and without trainees.

But when you're looking at capacity, I think it's important to report full time equivalent and it's important to capture the figures or report the figures without trainees to actually try and capture what actual GP capacity there is in general practice at that moment in time. There's some other nuances. So for example, ad hoc locums are not captured in the same place in the workforce statistics.

And also the new ARS funded GP roles are also captured in a slightly different place in the data sets. So bringing them all in to the data set is important because then once you bring them in, you can see the overall net increase or decrease.

Because for example, the government has been reporting the rises in additional roles reimbursement employed GPs because the practices get funded to employ these roles, but they're presenting them in a way that doesn't let you capture either the full time clue figures or the net overall increase or decrease in gps, because obviously at the same time as they're joining the workforce, other GPs are leaving or reducing their hours.

Speaker A

00:09:45.060 - 00:10:01.840

This all sounds quite complex in some way, even discussing it on a methodological level, but I guess getting this message out to the public is another thing because you kind of have to explain around how things have been counted to make the data meaningful. Really?

Speaker B

00:10:02.080 - 00:11:09.970

Absolutely.

And I think one of the things that's probably important to highlight as well, around the full time equivalent hours, there are limitations to the study and the statum, and I think probably one of the more important limitations is that there is evidence from elsewhere, colleagues in Manchester have looked at this, that actually full time equivalent reported hours are likely to be underestimating the actual hours worked by GPs. They estimate that GPs are working around 50% extra than their full time equivalent reported hours.

So that is an important limitation in this, in this process. But it doesn't mean that we shouldn't do it. It means that we need to work better at capturing those full time equivalent hours.

So currently it's subject to a practice manager submitting the hours on an online portal. So, you know, you need to be checked whether they've submitted it, submitted it correctly.

The GPs whose hours are reporting are usually not involved in that process. So you could for example, ask the gps to sign off or cross check whether those hours correct.

And once those systems were in place, then you probably improve the collection collection of this data.

Speaker A

00:11:10.130 - 00:11:22.930

And another interesting point you touch upon in the paper is that we kind of need to know what GPs are really doing in that time as well. So whether it is direct patient contact, whether it's supervision or other activities as well. So talk us through that.

Speaker B

00:11:24.050 - 00:12:31.010

Yes, I guess these figures only give us the number of hours worked or the headcounts in practice.

It doesn't tell us whether they're seeing patients face to face or what the other responsibilities that might be involved with being a GP might be, which are very broad and may be different, for example for a partner than a salaried doctor.

So for a partner it might be interesting to understand how much of their time is spent on practice management and things related to the running of the practice.

And for a salary gp, it might be interesting to understand actually how much back office work they're doing with admin and so on, which also applies for partners. But actually understanding these issues are important because I think in general there is a retention issue in general practice.

So it's not just about the overall figures, it's understanding the pressures of what GPs are doing with their time.

So therefore we can design policies and understand how to improve or make it a more attractive job and address some of the challenges that the workforce currently facing that leads to. To attrition.

Speaker A

00:12:32.210 - 00:12:58.270

Yeah, and I think there's a couple of ongoing projects. The RCGP is doing one and where the projects are essentially counting what gps are doing in their time.

So asking gps to time code each activity to find out actually what's happening in that time and maybe that might capture some of that so called hidden work or that extra work that gps are doing on top of their full time hours. Really. So that's interesting to think about as well.

Speaker B

00:12:58.670 - 00:13:17.710

Yeah.

And knowing that would be helpful as well because then you can understand for example better what activities might could be automated or technology could help with or which activities need additional or could be done by additional different roles to make the job more effective and more attractive for the gps that we do have.

Speaker A

00:13:17.710 - 00:13:20.430

Any other findings that you wanted to pull out from this paper?

Speaker B

00:13:20.830 - 00:14:12.270

I think if you look at the overall difference difference. So to sort of to present to you, the difference in this is like if you count by headcount and trainees.

So again, the best case scenario per thousand patients versus full time equivalent without trainees, it's 40% higher in 2015 and then in 2024 it's 74% higher. Now, there's two things that have been driving that. One, there's more trainees, which is a great thing, but we also need to think about retention.

And two, GPs are being reported to working at less full time equivalent hours in NHS general practice.

So the importance of measuring the gps in a consistent way is getting even more important because the gap is widening because of other things that are going on, which are more trainees and more full time equivalent hours. So less full time equivalent hours, more part time working.

Speaker A

00:14:12.430 - 00:14:29.260

And often I ask people coming on the podcast what they'd want to sort of tell gps working in practice, but I think for this paper it's more important to ask, what would you tell people wanting to use figures about gps, or how is this important for policy? And where do you want this work to go next, really?

Speaker B

00:14:29.580 - 00:15:13.600

So I think there's multiple ways to report NHS general practice workforce statistics. This can end up with contradictory discussions about trends and current figures.

So what we'd suggest is you report headcounts, including Trinis, and ignoring population growth will overestimate GP capacity and will harm the interpretation of workforce trends. So using fully qualified full time equivalent gps per capita will capture the current downwards trend in GP capacity.

But there are limitations to current NHS data, so that needs to be worked on.

And reporting the extent of variation across practices in England is necessary to capture widening variation and differences in GP provision within practices in England.

Speaker A

00:15:13.760 - 00:15:21.360

And I think that's probably a great place to wrap things up. But yeah, I just wanted to say congratulations that you're on the paper and thanks for talking to me today.

Speaker B

00:15:22.000 - 00:15:24.200

Thanks very much for the opportunity and.

Speaker A

00:15:24.200 - 00:15:39.770

Thank you all very much for your time here and for listening to this BJGP podcast.

Louisa's original research article can be found@bjgp.org and the show notes and podcast audio can be found@bg bjjp life.com thanks again for your time here, and by.

Title of paper: GPs’ perspectives on GLP-1RAs for obesity management: a qualitative study in England

Available at: https://doi.org/10.3399/BJGP.2025.0065

General practitioners (GPs) play a central role in managing obesity yet face significant challenges due to limited treatment options and resource constraints. GLP-1RAs are emerging as a promising treatment for obesity but access in primary care is limited. This study provides new insights into GPs’ perspectives on the integration of GLP-1RAs into primary care, highlighting concerns around resource limitations, health equity, and misuse of the medications.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.200 - 00:01:00.730

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjgp. Thanks for taking the time today to listen to this podcast.

Today we're speaking to Judine Scragg, a researcher based at the University Oxford, and Sabrina Keating, a DPHIL student who's also based at the University of Oxford within the Nuffield Department of Primary Care Health Sciences.

We're here to talk about their recent paper, published here in the BJJP, titled GP's Perspectives on GLP1 Receptor Agonists for Obesity Management A Qualitative Study in England. So, hi, Judine and Sabrina, it's great to meet you both for this chat.

I guess the first thing to say is that this work is really topical at the moment, especially given current plans to increase the rollout of GLP1 receptor agonists into the community. But, Judine, I'll come to you first and I wonder if you could just tell us a bit more about what you wanted to do in this research and why.

Speaker B

00:01:01.510 - 00:02:25.330

Yeah, absolutely. So, for a long time, as you've said, the GLP1s have been very topical, both in clinical groups and with patients as well.

So I'm first and foremost, I'm a weight management researcher and I've done work in populations with people living with type 2 diabetes and polycystic ovary syndrome. And within those populations, one of the things they've constantly asked about is about GLP1s, when do I qualify? When do I get it around?

And similarly with the gps GP groups as well, there's been a lot of questions, there's lots of media about, you know, both good and bad about GLPs and outlining different people's thought processes and are they good? Are they bad?

So what we sought to do with this was to sort of more robustly work out what it is GPs actually feel about the perceived integration of the GLP1s into primary care to very kind of firmly focus on GP specifically.

And this ended up coming at a really timely point, as midway through the study, the NICE guidance was brought out on outlining the plans for how tirepatide would be rolled out. So it was a really timely piece to find out exactly what they were thinking and feeling about how this may impact them and their patients.

So that's really what we set out to do.

Speaker A

00:02:26.200 - 00:02:55.660

Great.

And this was a qualitative interview study of 25 GPs across England working across different roles, and they all had different experience in weight management services. But I really Just wanted to come on to what you found here.

And let's start with an area that's quite a common issue right now, and I certainly don't seem to go a day without a patient asking me about whether they can get a weight loss injection. But what did gps think about navigating these patient requests when they. When they get them?

Speaker C

00:02:56.140 - 00:03:56.260

Yeah. So at kind of the moment we were conducting interviews, that was definitely a real source of sort of frustration and difficulty.

There were quite a few patients presenting, asking for GLP1s, the majority of whom were ineligible often, or would only be eligible through kind of this longer, more drawn out process of accessing specialist care, which in many of the regions just did not exist or was going to take kind of years and years. So it was not necessarily an amazing option.

This kind of left the gps we spoke to in quite an uncomfortable position where they kind of had to play the role of gatekeeper, really manage those expectations and potentially kind of have that compromising sort of interaction with their patients. So certainly the gps that we spoke to had some frustrations associated with that.

Speaker A

00:03:56.820 - 00:04:03.620

Yeah, absolutely. And I suppose it's a little bit about how to manage those requests. So did the gps talk about that at all?

Speaker C

00:04:04.100 - 00:04:31.440

Yeah, there were some different strategies that we heard about. I would say the primary one was just around identifying other options that would be available.

That was more difficult in some cases where patients had already exhausted those options and were feeling quite frustrated.

One of the other strategies that we heard about was testing patients for type 2 diabetes to try to identify whether maybe there was another avenue that they could kind of come in through.

Speaker A

00:04:31.840 - 00:04:47.040

And did they talk at all about private prescribing or. We might come on to this a bit later. But did any of the gps talk about suggesting or dealing with patient requests for private prescriptions?

Because I think that's quite a big industry and a growing industry at the moment as well.

Speaker C

00:04:47.360 - 00:05:42.850

Yes, certainly our sample were very much aware of this going on and it had been kind of entering the remit of their practice, specifically kind of asking for prescriptions to be carried over into NHS care, which most of the time the answer was a pretty concrete and clear no on.

So that could also be quite disappointing, particularly for patients who had come in through other international health systems who are then like, oh, I thought I would surely be able to get this on the nhs. And, yeah, a lot of the services didn't have, like, a great answer or kind of protocol to responding to those requests for private prescription.

So there was also kind of the frustration of okay.

This is taking up quite a lot of our time, quite a lot of our effort that could be put towards other things, especially at a time when we're so overstretched.

Speaker A

00:05:43.810 - 00:06:08.040

And I think that leads on to the next thing I wanted to talk about.

And I think that, as you say, one of the big concerns for GPs, especially given the increasing effort to provide GLP1 agonists to a wider community population, is how we're going to fit this in alongside all the other things that we're doing. So what else did the GP say about this and about the different resource limitations in general practice?

Speaker B

00:06:08.760 - 00:06:09.320

Yeah.

Speaker C

00:06:09.400 - 00:07:15.450

So I think many had an awareness that in kind of an ideal world, this made a lot of sense to be carrying out in primary care.

A GP has that kind of connection, ideally to their patients, and is able to see kind of the broader context of where and how they live, who they are as an individual. But within that, there was an awareness that that was going to be exceedingly difficult given the resource limitations of the time.

So a few of the gps we spoke to were essentially just like, we don't know how this is going to happen. This needs to stay in secondary care. It's just not kind of a viable model.

Others were really worried that some of the components that should be integral to GLP1 delivery, like wraparound care, behavioral and psychological support, were certainly not going to be easy to provide within primary care. And there was a real discomfort of this is just simply not how the medications are or should be used.

Speaker A

00:07:16.570 - 00:07:48.870

Yeah, I guess that goes back to How Current Tier 3 weight management services are provided or were provided, perhaps, in the nhs.

And the fact that you're right, there's a bit of a wraparound system around it, and certainly GLP1 agonists would only have typically been prescribed in those services alongside, as you say, all of the different weight management services. So that's quite a hefty burden for a GP or practice to pick up.

Judine, I don't know if you wanted to comment on that, given your background in weight management research as well.

Speaker B

00:07:49.590 - 00:09:14.320

Yeah, I mean, I think, as Sabrina said, there's definitely concerns, but I think as well, there's definitely some very strong themes of these GLP1 drugs coming in as a very helpful tool as well, in a few different ways.

So, for example, I think one of the gps that we spoke to voiced concerns about how sometimes it's quite tricky for people to navigate the best way to support themselves, to lose weight and to navigate]]>Today, we’re speaking to Jadine Scragg, a researcher based at the University of Oxford, and Sabrina Keating about their recent paper published here in the BJGP.

Title of paper: GPs’ perspectives on GLP-1RAs for obesity management: a qualitative study in England

Available at: https://doi.org/10.3399/BJGP.2025.0065

General practitioners (GPs) play a central role in managing obesity yet face significant challenges due to limited treatment options and resource constraints. GLP-1RAs are emerging as a promising treatment for obesity but access in primary care is limited. This study provides new insights into GPs’ perspectives on the integration of GLP-1RAs into primary care, highlighting concerns around resource limitations, health equity, and misuse of the medications.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.200 - 00:01:00.730

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjgp. Thanks for taking the time today to listen to this podcast.

Today we're speaking to Judine Scragg, a researcher based at the University Oxford, and Sabrina Keating, a DPHIL student who's also based at the University of Oxford within the Nuffield Department of Primary Care Health Sciences.

We're here to talk about their recent paper, published here in the BJJP, titled GP's Perspectives on GLP1 Receptor Agonists for Obesity Management A Qualitative Study in England. So, hi, Judine and Sabrina, it's great to meet you both for this chat.

I guess the first thing to say is that this work is really topical at the moment, especially given current plans to increase the rollout of GLP1 receptor agonists into the community. But, Judine, I'll come to you first and I wonder if you could just tell us a bit more about what you wanted to do in this research and why.

Speaker B

00:01:01.510 - 00:02:25.330

Yeah, absolutely. So, for a long time, as you've said, the GLP1s have been very topical, both in clinical groups and with patients as well.

So I'm first and foremost, I'm a weight management researcher and I've done work in populations with people living with type 2 diabetes and polycystic ovary syndrome. And within those populations, one of the things they've constantly asked about is about GLP1s, when do I qualify? When do I get it around?

And similarly with the gps GP groups as well, there's been a lot of questions, there's lots of media about, you know, both good and bad about GLPs and outlining different people's thought processes and are they good? Are they bad?

So what we sought to do with this was to sort of more robustly work out what it is GPs actually feel about the perceived integration of the GLP1s into primary care to very kind of firmly focus on GP specifically.

And this ended up coming at a really timely point, as midway through the study, the NICE guidance was brought out on outlining the plans for how tirepatide would be rolled out. So it was a really timely piece to find out exactly what they were thinking and feeling about how this may impact them and their patients.

So that's really what we set out to do.

Speaker A

00:02:26.200 - 00:02:55.660

Great.

And this was a qualitative interview study of 25 GPs across England working across different roles, and they all had different experience in weight management services. But I really Just wanted to come on to what you found here.

And let's start with an area that's quite a common issue right now, and I certainly don't seem to go a day without a patient asking me about whether they can get a weight loss injection. But what did gps think about navigating these patient requests when they. When they get them?

Speaker C

00:02:56.140 - 00:03:56.260

Yeah. So at kind of the moment we were conducting interviews, that was definitely a real source of sort of frustration and difficulty.

There were quite a few patients presenting, asking for GLP1s, the majority of whom were ineligible often, or would only be eligible through kind of this longer, more drawn out process of accessing specialist care, which in many of the regions just did not exist or was going to take kind of years and years. So it was not necessarily an amazing option.

This kind of left the gps we spoke to in quite an uncomfortable position where they kind of had to play the role of gatekeeper, really manage those expectations and potentially kind of have that compromising sort of interaction with their patients. So certainly the gps that we spoke to had some frustrations associated with that.

Speaker A

00:03:56.820 - 00:04:03.620

Yeah, absolutely. And I suppose it's a little bit about how to manage those requests. So did the gps talk about that at all?

Speaker C

00:04:04.100 - 00:04:31.440

Yeah, there were some different strategies that we heard about. I would say the primary one was just around identifying other options that would be available.

That was more difficult in some cases where patients had already exhausted those options and were feeling quite frustrated.

One of the other strategies that we heard about was testing patients for type 2 diabetes to try to identify whether maybe there was another avenue that they could kind of come in through.

Speaker A

00:04:31.840 - 00:04:47.040

And did they talk at all about private prescribing or. We might come on to this a bit later. But did any of the gps talk about suggesting or dealing with patient requests for private prescriptions?

Because I think that's quite a big industry and a growing industry at the moment as well.

Speaker C

00:04:47.360 - 00:05:42.850

Yes, certainly our sample were very much aware of this going on and it had been kind of entering the remit of their practice, specifically kind of asking for prescriptions to be carried over into NHS care, which most of the time the answer was a pretty concrete and clear no on.

So that could also be quite disappointing, particularly for patients who had come in through other international health systems who are then like, oh, I thought I would surely be able to get this on the nhs. And, yeah, a lot of the services didn't have, like, a great answer or kind of protocol to responding to those requests for private prescription.

So there was also kind of the frustration of okay.

This is taking up quite a lot of our time, quite a lot of our effort that could be put towards other things, especially at a time when we're so overstretched.

Speaker A

00:05:43.810 - 00:06:08.040

And I think that leads on to the next thing I wanted to talk about.

And I think that, as you say, one of the big concerns for GPs, especially given the increasing effort to provide GLP1 agonists to a wider community population, is how we're going to fit this in alongside all the other things that we're doing. So what else did the GP say about this and about the different resource limitations in general practice?

Speaker B

00:06:08.760 - 00:06:09.320

Yeah.

Speaker C

00:06:09.400 - 00:07:15.450

So I think many had an awareness that in kind of an ideal world, this made a lot of sense to be carrying out in primary care.

A GP has that kind of connection, ideally to their patients, and is able to see kind of the broader context of where and how they live, who they are as an individual. But within that, there was an awareness that that was going to be exceedingly difficult given the resource limitations of the time.

So a few of the gps we spoke to were essentially just like, we don't know how this is going to happen. This needs to stay in secondary care. It's just not kind of a viable model.

Others were really worried that some of the components that should be integral to GLP1 delivery, like wraparound care, behavioral and psychological support, were certainly not going to be easy to provide within primary care. And there was a real discomfort of this is just simply not how the medications are or should be used.

Speaker A

00:07:16.570 - 00:07:48.870

Yeah, I guess that goes back to How Current Tier 3 weight management services are provided or were provided, perhaps, in the nhs.

And the fact that you're right, there's a bit of a wraparound system around it, and certainly GLP1 agonists would only have typically been prescribed in those services alongside, as you say, all of the different weight management services. So that's quite a hefty burden for a GP or practice to pick up.

Judine, I don't know if you wanted to comment on that, given your background in weight management research as well.

Speaker B

00:07:49.590 - 00:09:14.320

Yeah, I mean, I think, as Sabrina said, there's definitely concerns, but I think as well, there's definitely some very strong themes of these GLP1 drugs coming in as a very helpful tool as well, in a few different ways.

So, for example, I think one of the gps that we spoke to voiced concerns about how sometimes it's quite tricky for people to navigate the best way to support themselves, to lose weight and to navigate that wraparound care, and they perceived that GLP1 is a really helpful tool to help, particularly some people will find it a bit more tricky to navigate.

You know, all the different referral systems that exist within wraparound care, such as try this dietary program, you might be eligible for this program. And they saw that as a helpful tool to do that. Yeah.

Thinking about some of the other patient groups that we've spoken with, so particularly I'm thinking patients here with type 2 diabetes or with polycystic ovary syndrome. They have often told us when they've tried to access care and they ended up managing to get in through Tier 3 services.

And I used the word managing because obviously that is quite tricky to access. And there are, as we know, very long wait lists across huge areas of the country.

They felt like they really had to advocate for themselves to get to those and have not necessarily found it the easiest setting to navigate from a patient perspective.

Speaker A

00:09:14.800 - 00:09:39.260

Another aspect your participants talked about was health equity, and this is certainly an area we've covered elsewhere in BJJP life. I wrote an about this titled how to drug your way out of an obesity crisis.

And we know that there are other environmental and social determinants of obesity that really need to be a focus here. And Sabrina, I'll come back to you. What did the GP say here about that?

Speaker C

00:09:39.579 - 00:10:32.900

Yeah, I would say that was definitely front and center in many of the conversations that we had. We did also kind of actively sample for general practices and general practitioners within kind of more deprived settings.

There certainly a discomfort of, okay, if these medications are becoming our first line treatment for obesity at kind of like an individual level, a political level, a medical level, does this become our sole solution to obesity and, you know, a real awareness of the consequences that that could have when obesity is a much more embedded issue and the kind of social factors that contributed to people being in these situations in the first place were not going to go. And in that case, some of the momentum to actually addressing them may just be sort of smoothed over.

Speaker A

00:10:34.580 - 00:10:37.940

I guess those things don't really have an easy fix, do they really?

Speaker C

00:10:39.540 - 00:10:54.180

Yeah, which is why there was also that counterbalance. Awareness of these things take time. There might not be that political motivation to solve them in the short term. We do need something immediate.

We just can't let that be everything.

Speaker A

00:10:55.470 - 00:11:02.430

Fair enough. And I think finally some GPs were concerned about the misuse of these injections. So can you talk us through that as well?

Speaker C

00:11:02.750 - 00:12:14.870

Yes. Some of that concern about misuse, was it becoming this overriding treatment for everyone?

I think especially with everything going on in media and patient demand, it's easy to have kind of that kickback response of, oh, gosh, everyone wants these, everyone wants to be slimmer. So that was a source of kind of discomfort, especially when social inequality might be taking the backseat.

There was also just awareness that these medications could cause some really uncomfortable dynamics in consultation, be that around requests or prescribing or discontinuation of the medications. So there was kind of a view that in the future there might be problems to do with the appropriateness of prescribing.

And since patients are coming in and applying potentially actually significant pressure for the medications to be prescribed, GPs are in quite a difficult position to say no to that. One of our participants referred to it as being called in as the policeman to kind of keep an eye on patients and be the one making those calls.

Speaker B

00:12:15.350 - 00:13:03.340

I think one thing that cropped up was sort of that concern there, that if they said no, that ultimately patients would seek to obtain these medications through other avenues, be it private use.

And then there was obviously that very real concern about how do GPs within an NHS setting look after patients who are obtaining these medicines through private resources?

I think some of the participants mentioned that sort of factoring into those dynamics where they couldn't provide the patients with what the patients were explicitly asking for, that there's this sort of sense that the patient will, you know, if they are able to financially, they'll. They'll just simply try get it elsewhere.

And I think that was a source of anxiety for some of our participants about how do they best make sure that these patients are being looked after appropriately.

Speaker A

00:13:03.820 - 00:13:27.600

Yeah, and there's certainly no shortage of different quality of clinics that are providing these different injections as well.

And I guess this is sort of happening now and many local ICBs and PCNs are trying to figure out how to roll out GLP1 agonists and who should be eligible. I just wonder, after doing this research, what you would say to them about the GP perspective here, given your research.

Speaker B

00:13:28.240 - 00:16:02.500

One thing that we are very looking forward to is getting the data on how many patients actually end up taking these, particularly in the first phase of the rollout, because it is quite a small group of people in primary care who are in the first phase. So I think that's going to be really interesting to see, actually. How many people are we talking in primary care? How many people choose to do it?

We talk a lot about how patients really want this, but there are definitely groups of patients that don't want this. We know, for example, when we think about diabetes One of the key drivers of often weight loss and remission is to take themselves off medicines.

So this might not be a thing that's of interest to everybody.

So in terms of advice, I think maybe it's not so much advice as in we are going to be learning a lot over the next few years about how patients actually feel about these. Now they're on offer potentially to them.

And in terms of advice to gps, I think a lot of that is just keeping themselves as, I guess, kind of up to date with other things that they can offer patients in the meantime. As Sabrina said, there's always going to be an influx of patients wanting these and they might not be eligible just yet.

So being able to offer patients something in the meantime is probably something that certainly patients have said to us in the past about. The main thing they feel downhearted with is when they feel like they get nothing at all. So, you know, something is better than nothing.

I mean, a lot of ICBs as well, I think are doing a really good job of putting on their social media or their websites kind of about some information. So I've seen quite a lot of different ICPs put together.

Really lovely patient facing documents to advise them that, you know, when these drugs might make their way to the patients and to sort of help their patients advocate the system a little bit. For example, you know, helpful tips and tricks.

If they're already in specialist weight management, they'll probably contact us about it very shortly and try.

I can see that ICPs are already making really, really helpful patient facing documentation, which I think is a really, of course, really useful trick to manage that patient demand. I can see why that, you know, doing that potentially to stop, you know, dozens and dozens and dozens of patients coming to their doors every day.

But I think there's definitely something to be said for kind of reassuring the patients about when they may be eligible, what they can do in the meantime and that, you know, not to worry, you've not been forgotten. We can't give it just yet, but no, it's happening soon.

Speaker A

00:16:04.250 - 00:16:54.390

And as you say, it's very interesting times around this and things are a bit in flux as different ICBs work out the best way to provide these services to the right patients. So as I said before, I think this is really timely research.

So great to chat to you about it, but I think that's a great place to just wrap things up. So I just really wanted to say thank you both for your time here.

Thanks so much and thank you all very much for your time here and for listening to this BJGP podcast.

Sabrina and Judine's original research article can be found on bjgp.org and the show notes and podcast audio can be found@bjgplife.com and I just wanted to say a special thanks to Sabrina who is on the west coast of the US and had to wake up at 5am for this podcast. So thanks again for joining us here today and thanks to you all again. Bye.

Title of paper: Evolution of the general practice receptionist role and online services: a qualitative study

Available at: https://doi.org/10.3399/BJGP.2024.0677

The introduction of online systems and services into general practice and the impact on general practice staff has been considered from a clinician perspective, but comparatively little is known about how these introductions have affected the receptionist role. This study highlights that the use of online services is leading to an evolution of the general practice receptionist role. The role is becoming increasingly complex as practices use multiple online systems, which impacts demand management and navigation aspects of the role. Online systems have variable consequences on workload for receptionists, which has potential implications for workflow, consistency of task completion, job satisfaction, and retention and recruitment of these key staff members.

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.320 - 00:00:53.350

Hello 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. Steph Stockwell, a senior analyst based at RAND Europe.

We're here to discuss the paper she's published here in the BJGP titled Evolution of the General Practice Receptionist Role and Online Services A Qualitative Study.

So, hi, Steph, it's great to meet and talk about this work and one of the reasons I really wanted to talk about this is that I think it's timely work, given that we know there's an increasing emphasis just in general practice on triage and also the multidisciplinary team. You talk in the introduction of this paper just about the role of receptionists, which has been evolving and changing in recent years.

So just talk us through that a bit.

Speaker B

00:00:53.720 - 00:02:09.550

Yeah. So this work came about because we were doing some work for the wider de facto study, which was a.

An observational, mixed methods study that involved delete reviews, some surveys, ethnographic case studies and some interviews.

And it was whilst I was doing some of the ethnographic case study work that we spent a lot of time around reception staff because they were the ones who were doing most of the digital facilitation, which is the phenomena that we were. Were looking at. It was whilst doing these observations that the idea for this, this paper came to me, as, you know, often the.

The first point of call for, for patients making contact with general practice and they're really crucial for helping to manage that demand and facilitating patient access to care.

But during these observations, I noticed how the perception of what a receptionist did, particularly among patients and the public, was a little bit outdated and the array of technologies and platforms that they were having to manage and, and help patients use as well, was really sort of the stereotype of answering telephone calls.

So, yeah, the rationale for this work sort of came about on the back of that and it made me want to look back at some of the work that we did for the De facto study and to see what sort of impact the online services had on the role of GP receptionists.

Speaker A

00:02:10.030 - 00:02:50.390

Yeah. So you wanted to look, as you mentioned, just at the impact of online services on sort of the evolving role of receptionists.

And as you mentioned, you took quite an interesting and varied approach here.

So you did the ethnographic work that you mentioned, but you also did interviews with patients and staff and practices and the ethnographic work was really interesting. So you were actually sitting in eight different practices and observing what receptionists were doing.

But I want to really focus on what you found here and I think the first thing to talk about is that the receptionists had a really different and varied role between those different practices and even within the practice itself. So talk us through that.

Speaker B

00:02:51.170 - 00:03:43.630

Yeah.

So speaking to a couple of receptionists who'd been in the role sort of a longer time, they were reflecting in their interviews about how the role itself, from their point of view, having been in it for such a long period of time, has changed. Previously they would do sort of fewer and more repetitive type jobs, but now it's just so much more varied.

That's just one person within their role over a period of time.

But then we were noticing that receptionists within one practice and between the different practices, we went into what was conceptualised as a receptionist.

What the receptionist role looks like was very different and it was impacted by whether the practices had specific administrators, so people like reception clerks or IT officers, the number of different receptionists that were available and working on. On shift, and also the confidence and competence of each specific receptionist themselves.

Speaker A

00:03:43.950 - 00:04:02.830

Yeah, it's interesting you talk about experience and I think that probably a lot of people who work in general practice might reflect on that.

But talk us through what you found in terms of the differing experience that receptionists had, just in terms of how comfortable they felt with the varied role or changing role. Really.

Speaker B

00:04:03.310 - 00:04:55.060

Yeah. So some staff who were sort of newer to the role, it's all. They're sort of known. We had some cases of.

Because there was sort of a lack of training and support around some of these newer bits of the role in a formal sense. There was a lot of support happening from receptionist to receptionists and sort of learning on the job types of things.

But it would mean that for newer members of staff who are learning on the job, they might be shown something by one person and then shown how to do the same task, but in a slightly different way by another person.

And then for that new member of staff, that could be quite disorientating, quite nerve wracking, because then they didn't really know which was the right way to do it and which way they should be doing it. So, yeah, because of that lack of more formalized training there for newer members of staff, that was. That was quite tricky.

Speaker A

00:04:55.300 - 00:05:24.370

Yeah, fair enough. So maybe a nod there to the need for more formal training rather than the ad hoc kind of training that people get on the job, potentially.

Yeah, fair enough.

And I think that one thing that a lot of people working in general practice and probably patients really can empathize with is how people get through to practices, you know, by phone or by E consults. It's quite complicated, actually, at the moment. And you talk about this in terms of demand management in this work.

How did this impact on the receptionists?

Speaker B

00:05:24.850 - 00:06:20.400

Yeah, so it's, as you say, it's not just them seeing people as they walk in face to face and letters and telephones, which was, you know, how things happen traditionally, but all of these different online ways to access practice, which is great for patients, but, you know, can be a bit of a nightmare to manage. So you've got things like email, you've got online triage tools, you've got practice websites, you've got different apps.

And then, you know, during the pandemic, the NHS app came in, so sometimes practices were running, you know, a more local app with the NHS app with the practice website and all of these things. So there were lots of modalities for patients to contact the practice via, which in. In some ways can be a good thing. You know, it's.

It's just the reception staff were saying, it's.

It's not actually reducing demand, it's just the same level split across multiple different things, which adds complexity to what they're having to manage through those different channels.

Speaker A

00:06:20.640 - 00:06:25.120

And did they have clear pathways on how to manage that? How did they deal with that?

Speaker B

00:06:25.360 - 00:07:06.750

Yeah, so, I mean, every practice was kind of worked it through differently.

So they might have some members of staff who would monitor emails, they might have some members of staff who would look at econsults or something like that. So they split it up that way. And other people might say they split it up by the individual person was responsible for the different way in.

Others split it up by a bit more of a rota to try and make it a bit more varied for staff so they didn't get bored doing the same thing every day.

So they might have a morning being responsible for whatever E consults were coming in, and then the afternoon they might be doing something else and someone else would take over that role. So, yeah, each practice was sort of.

Speaker A

00:07:06.750 -...]]>Today, we’re speaking to Dr Steph Stockwell, a senior analyst based at RAND Europe.

Title of paper: Evolution of the general practice receptionist role and online services: a qualitative study

Available at: https://doi.org/10.3399/BJGP.2024.0677

The introduction of online systems and services into general practice and the impact on general practice staff has been considered from a clinician perspective, but comparatively little is known about how these introductions have affected the receptionist role. This study highlights that the use of online services is leading to an evolution of the general practice receptionist role. The role is becoming increasingly complex as practices use multiple online systems, which impacts demand management and navigation aspects of the role. Online systems have variable consequences on workload for receptionists, which has potential implications for workflow, consistency of task completion, job satisfaction, and retention and recruitment of these key staff members.

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.320 - 00:00:53.350

Hello 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. Steph Stockwell, a senior analyst based at RAND Europe.

We're here to discuss the paper she's published here in the BJGP titled Evolution of the General Practice Receptionist Role and Online Services A Qualitative Study.

So, hi, Steph, it's great to meet and talk about this work and one of the reasons I really wanted to talk about this is that I think it's timely work, given that we know there's an increasing emphasis just in general practice on triage and also the multidisciplinary team. You talk in the introduction of this paper just about the role of receptionists, which has been evolving and changing in recent years.

So just talk us through that a bit.

Speaker B

00:00:53.720 - 00:02:09.550

Yeah. So this work came about because we were doing some work for the wider de facto study, which was a.

An observational, mixed methods study that involved delete reviews, some surveys, ethnographic case studies and some interviews.

And it was whilst I was doing some of the ethnographic case study work that we spent a lot of time around reception staff because they were the ones who were doing most of the digital facilitation, which is the phenomena that we were. Were looking at. It was whilst doing these observations that the idea for this, this paper came to me, as, you know, often the.

The first point of call for, for patients making contact with general practice and they're really crucial for helping to manage that demand and facilitating patient access to care.

But during these observations, I noticed how the perception of what a receptionist did, particularly among patients and the public, was a little bit outdated and the array of technologies and platforms that they were having to manage and, and help patients use as well, was really sort of the stereotype of answering telephone calls.

So, yeah, the rationale for this work sort of came about on the back of that and it made me want to look back at some of the work that we did for the De facto study and to see what sort of impact the online services had on the role of GP receptionists.

Speaker A

00:02:10.030 - 00:02:50.390

Yeah. So you wanted to look, as you mentioned, just at the impact of online services on sort of the evolving role of receptionists.

And as you mentioned, you took quite an interesting and varied approach here.

So you did the ethnographic work that you mentioned, but you also did interviews with patients and staff and practices and the ethnographic work was really interesting. So you were actually sitting in eight different practices and observing what receptionists were doing.

But I want to really focus on what you found here and I think the first thing to talk about is that the receptionists had a really different and varied role between those different practices and even within the practice itself. So talk us through that.

Speaker B

00:02:51.170 - 00:03:43.630

Yeah.

So speaking to a couple of receptionists who'd been in the role sort of a longer time, they were reflecting in their interviews about how the role itself, from their point of view, having been in it for such a long period of time, has changed. Previously they would do sort of fewer and more repetitive type jobs, but now it's just so much more varied.

That's just one person within their role over a period of time.

But then we were noticing that receptionists within one practice and between the different practices, we went into what was conceptualised as a receptionist.

What the receptionist role looks like was very different and it was impacted by whether the practices had specific administrators, so people like reception clerks or IT officers, the number of different receptionists that were available and working on. On shift, and also the confidence and competence of each specific receptionist themselves.

Speaker A

00:03:43.950 - 00:04:02.830

Yeah, it's interesting you talk about experience and I think that probably a lot of people who work in general practice might reflect on that.

But talk us through what you found in terms of the differing experience that receptionists had, just in terms of how comfortable they felt with the varied role or changing role. Really.

Speaker B

00:04:03.310 - 00:04:55.060

Yeah. So some staff who were sort of newer to the role, it's all. They're sort of known. We had some cases of.

Because there was sort of a lack of training and support around some of these newer bits of the role in a formal sense. There was a lot of support happening from receptionist to receptionists and sort of learning on the job types of things.

But it would mean that for newer members of staff who are learning on the job, they might be shown something by one person and then shown how to do the same task, but in a slightly different way by another person.

And then for that new member of staff, that could be quite disorientating, quite nerve wracking, because then they didn't really know which was the right way to do it and which way they should be doing it. So, yeah, because of that lack of more formalized training there for newer members of staff, that was. That was quite tricky.

Speaker A

00:04:55.300 - 00:05:24.370

Yeah, fair enough. So maybe a nod there to the need for more formal training rather than the ad hoc kind of training that people get on the job, potentially.

Yeah, fair enough.

And I think that one thing that a lot of people working in general practice and probably patients really can empathize with is how people get through to practices, you know, by phone or by E consults. It's quite complicated, actually, at the moment. And you talk about this in terms of demand management in this work.

How did this impact on the receptionists?

Speaker B

00:05:24.850 - 00:06:20.400

Yeah, so it's, as you say, it's not just them seeing people as they walk in face to face and letters and telephones, which was, you know, how things happen traditionally, but all of these different online ways to access practice, which is great for patients, but, you know, can be a bit of a nightmare to manage. So you've got things like email, you've got online triage tools, you've got practice websites, you've got different apps.

And then, you know, during the pandemic, the NHS app came in, so sometimes practices were running, you know, a more local app with the NHS app with the practice website and all of these things. So there were lots of modalities for patients to contact the practice via, which in. In some ways can be a good thing. You know, it's.

It's just the reception staff were saying, it's.

It's not actually reducing demand, it's just the same level split across multiple different things, which adds complexity to what they're having to manage through those different channels.

Speaker A

00:06:20.640 - 00:06:25.120

And did they have clear pathways on how to manage that? How did they deal with that?

Speaker B

00:06:25.360 - 00:07:06.750

Yeah, so, I mean, every practice was kind of worked it through differently.

So they might have some members of staff who would monitor emails, they might have some members of staff who would look at econsults or something like that. So they split it up that way. And other people might say they split it up by the individual person was responsible for the different way in.

Others split it up by a bit more of a rota to try and make it a bit more varied for staff so they didn't get bored doing the same thing every day.

So they might have a morning being responsible for whatever E consults were coming in, and then the afternoon they might be doing something else and someone else would take over that role. So, yeah, each practice was sort of.

Speaker A

00:07:06.750 - 00:07:18.320

Different, increasingly, and sometimes referring to receptionists more as care navigators. How did reception staff that you talked to or observed look at this? And what was their perception about that?

Speaker B

00:07:18.800 - 00:08:20.840

Yeah, so the navigation of patients has always been sort of a key part of the receptionist role. But, you know, with the increasing skill mix within general practice, where they route people to is is changing and become more Complex.

But the addition of the online services adds another level of complexity because.

So, for instance, when patients were phoning up and there were no appointments left, receptionists were sort of navigating patients through the find routes, because that way they could offer people an appointment because there had been slots saved for econsult appointments or something like that. So there was just an extra level of something that they could help patients navigate to try and get access to an appointment.

And receptionist themselves said, you know what, that is actually quite helpful, implicating some patients. You've got someone on the phone who is looking for some help, there are no appointments left.

And so actually being able to say, well, if you go through this route, actually I can. Can offer you something. And that made things a little bit less stressful for the receptionists.

Speaker A

00:08:21.080 - 00:08:45.000

I think that really speaks to the perception of receptionists being seen in the public as these sort of dragons at the front door of general practice, where actually we all know that they're really just trying to help the patients rather than block patient access. And it's a shame that that perception is still really persisting because they are kind of that front door to overstretched services. Really.

Speaker B

00:08:45.380 - 00:09:00.180

Yeah, no, absolutely. And there were.

There were lots of cases that we saw where receptionists were really trying to help patients through that digital facilitation, you know, helping them to use the online services to try and help them get the. The care that they. That they needed.

Speaker A

00:09:00.420 - 00:09:10.420

You were embedded in these practices. Did you get a sense from sitting and observing what was going on, what worked and what didn't work in terms of the reception role?

Speaker B

00:09:11.070 - 00:10:04.210

Yeah, I think when receptionists were tasked with something quite specific for a short period of time, that they could then dedicate their focus and their attention to that thing. And they did it really, really well.

Other instances where maybe there weren't as many receptionists to kind of balance that demand coming in, it felt a little bit more. From my perspective, it may not have been the experience of.

But from my perspective, it looked a little bit more chaotic because there was a lot of task switching and trying to balance things.

Whereas where you had, this receptionist is going to be on telephone calls, this receptionist is going to be on E consults, this one is going to be doing X, Y, Z.

That seemed to really use the skills of the people and keep them focused on a task, which meant that things were, I don't know, a little bit more calm, potentially from the outside looking in, at least.

Speaker A

00:10:05.010 - 00:10:17.790

Yeah.

And I think we all know that things can sometimes get a little Bit chaotic in general practice or anything to sort of ease that sounds like a good shout. Wonder if there's any other key findings that you want to pull out from the paper at all.

Speaker B

00:10:18.030 - 00:12:20.790

One thing that was really interesting was that a lot of the online services are sort of badged as a great way to kind of reduce workload and, you know, help staff and help patients and all that kind of thing.

And in some ways they do because, you know, if patients can self serve via online routes, that can kind of sometimes help reduce some of the workload for reception staff because of the links that are available to people they can book into appointment slots and things. But that requires the patients to actually be able to do it themselves.

And you know, when patients aren't able to do that themselves, it's often the receptionist that they call upon to help them. So that doesn't actually reduce any, anything for the receptionist themselves.

There are also cases where patients were using the online systems incorrectly.

So either because they didn't really have a, an understanding of how to use them properly or how they were intended to be used, or actually where patients were trying to work around the system to try and get what they really wanted. And that involved the reception staff having to kind of reconcile things behind the scenes.

For instance, people might be booking into inappropriate appointment slots because they don't understand that actually you don't need a 20 minute appointment with this particular practitioner for a blood test or something. And so that would require the receptionist to go in and rebook it and move things around.

Or they might fill in a form, an inquiry form online, but it's the wrong form because those forms go to this particular team and those forms go to that particular team, but the patient doesn't really know that. They just see, you know, it's on the website, so it just goes to the, the practice. And.

But if they, if those forms do go to the different teams, then it's normally the receptionist or the administration team, depending on which practice, that has to do all of that work behind the scenes to then redirect it to the right people, the right teams.

So that was, that was quite an interesting thing that I hadn't really thought about in terms of that sort of hidden work that the receptionists are doing behind the scenes.

Speaker A

00:12:21.430 - 00:12:42.940

It sort of sounds like, you know, that kind of calm duck above the water and then the sort of legs are really going underneath. Just a lot of work going on really to help manage that.

And I think it's an important point to make, especially with an increasing emphasis on Online services in policy, really in terms of how people want general practice to work?

Speaker B

00:12:43.340 - 00:12:44.380

Yeah, absolutely.

Speaker A

00:12:44.540 - 00:12:56.540

I wonder, just given the findings from this work, what do you think it's important for practices to know here to help support their reception staff during this period of flux and change? Any tips for practices?

Speaker B

00:12:56.940 - 00:14:37.070

Yeah, I mean, for me this work really is important for the consideration.

When you're thinking about recruitment and retention of GP receptionists, we can see that the role has definitely evolved and become more complex since the introduction of these online services services and that should really be reflected in job descriptions and skills requirements.

Maybe having that digital element in there, the digital competencies in there for those who are newly recruited or already in post, maybe some more formal training or support for those reception staff might be helpful.

As I said earlier, even if it's just here's how we're going to do it in this practice to standardise the messaging and practices within a single surgery, that could be potentially helpful. But I also think it's not just on the GP practice to make changes.

I think a lot of these online systems are developed by tech companies and if for instance, the systems were really simple and really easy for patients to use and to use them correctly as they're intended, then that would actually reduce the workload for the receptionist trying to rectify things behind the scenes.

So it's also on the developers of these technologies to co design those from the patient facing side of things so that patients can understand and easily use them and to make them very intuitive.

Then also the behind the scenes version that you see, that the receptionist staff see and other members of staff see it in the practice, they're also co designed so that they are useful to those people in those roles and they can be used in a way that, you know, isn't going to overburden them, it isn't going to create more workload and actually makes things easier for them.

Speaker A

00:14:38.200 - 00:14:59.880

Brilliant. Yeah, really helpful advice, I think, for practices and as you say, also for people designing these different systems too.

You know, we do it in research to co design systems with patients and with the people who are going to be using it. Wise words, great. But yeah, I think that's probably a great place to wrap up. But I just want to say thanks very much for speaking about it.

Speaker B

00:15:00.200 - 00:15:02.920

Thank you so much and thank you.

Speaker A

00:15:02.920 - 00:15:06.455

All very much for your time here and for listening to this BJGP podcast.

Speaker B

00:15:06.455 - 00:15:06.550

Thank you.

Speaker A

00:15:07.500 - 00:15:32.220

Steph's original research article can be found on bjgp.org and the show notes and podcast audio can...]]>53fb48bc-d7fb-410a-b4c2-8364890c2edeTue, 07 Oct 2025 08:00:00 +010015:38falsefull32142143Menopausal symptoms from hormone receptor positive breast cancer treatmentToday, we’re speaking to Dr Sophie McGrath, Consultant Medical Oncologist based at the Royal Marsden NHS Foundation Trust and at Kingston Hospital in London.

Title of paper: Management of menopausal symptoms following treatment for hormone receptor positive breast cancer

Available at: https://doi.org/10.3399/BJGP.2025.0264

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.800 - 00:01:11.660

Hello and welcome to BJJP Interviews. My name is Nada Khan and I'm one of the associate editors of the bjgp. Thanks for joining us today to listen to this podcast.

In today's episode, we're speaking to Dr. Sophie McGrath, who is a consultant medical oncologist based at the Royal Morrison NHS Trust and at Kingston Hospital in London.

We're here to talk about the recent analysis article that she and her colleagues have published here in the BJDP titled Management of Menopausal Symptoms Following Treatment for Hormone Receptor Positive Breast Cancer.

And just to point out that these colleagues included not just medical oncologists, but also GPs and patients, which I think has really shaped this article and is one of the reasons why we wanted to highlight it here in the podcast. So, hi Sophie, thanks for meeting me to talk about this article, which I think touches on a really important topic in practice.

But talk us through some of the initial side effects that you discuss in the introduction here. Just in terms of hormone positive breast cancer, what kind of symptoms do women experience generally as a result of endocrine therapy?

Speaker B

00:01:12.220 - 00:02:32.900

So, yeah, thanks very much for asking. And it's a bit of a broad answer that I would give.

I mean, I've focused on, or we have focused on three main symptoms within the article which relate to hot flushes or vasomotor symptoms, also to joint stiffness and pain and swelling, arthralgia, and also to vulvovaginal symptoms, otherwise known as genitourinary syndrome of menopause.

But I think what we've tried to include within the article as well is a table that certainly acknowledges that there are unfortunately many other symptoms that women can get as a result of these medications, essentially mimicking menopausal side effects.

And of course, you know, these might be symptoms that women having already gone through the menopause may have suffered or experienced at some point already.

But actually for a population of premenopausal women, these will be symptoms that they haven't had any experience of yet and can often be quite intense and develop quite suddenly. Whereas often our post menopausal women have had some sort of lead up to this, they've had some experience.

Speaker A

00:02:34.710 - 00:02:44.710

And you work as a medical oncologist. But just talk me through your own experience of working with women who are going through the sort of sudden menopause as you describe as well.

Speaker B

00:02:45.350 - 00:05:50.240

So obviously the focus of the article here is on menopausal side effects in general from the treatments that we use. And we've talked a lot about using our endocrine treatments such as tamoxifen, letrozole.

But actually many of our women also experience menopausal type side effect secondary to the chemotherapies we give them. So I think, you know, there's sort of two groups you often have, particularly premenopausal women who stop their periods whilst on chemotherapy.

That may happen several weeks into their chemotherapy treatment and it can be quite sudden.

You know, they're already dealing with the numerous side effects attributed to the chemotherapy itself, but then they're also having to tackle these hot flushes, insomnia, potentially arthralgia. Obviously the vaginal symptoms may be more medium to longer term impact.

So you've got that group of women who are sort of thrust into menopausal symptoms very quickly and then you have the other group who perhaps have already gone through their menopause.

So they're not necessarily getting those symptoms alongside chemotherapy, but, but then after that we are introducing letrozole, which by removing even that last little bit of oestrogen production in the system is giving them enhanced menopausal side effects yet again. So I think that's sort of psychologically a big thing for the patients to deal with as well.

Whether they're sort of having all of that thrust upon them in one go or whether it's more gradual and they're almost waiting for it to occur. So I think for us, us there's a lot we've got to get through in our consultations.

Obviously if it happens alongside chemotherapy, then we're seeing them regularly anyway. We've got our nurses to support them in the clinics too.

But I think the challenge arises more when our ladies are moving on to their endocrine therapy and moving away from regular consultations in our clinics and having more contact again with primary care. They're wanting to get on with their lives. They're wanting to not be coming up to the hospital quite so often.

And so that was a real focus of this article, wanting to reach out to primary care, but also perhaps non oncology based secondary or tertiary care practitioners.

So maybe gynecologists or people that work very closely within menopausal clinics, not necessarily just within primary care and try and work out how can we support these ladies with symptoms that may take several months to declare themselves and may even be once they've been discharged to our stratified follow up programs, but not necessarily seeing us regularly in, in the clinic.

Speaker A

00:05:51.120 - 00:06:13.110

And I think one thing that I'm always struck by, especially with Women going through the perimenopause and the menopause is that this is a busy time in women's lives. So they might be juggling younger children, a career, caring for, you know, older parents.

So there's a lot going on in these women's lives that things like arthralgia, vasomotor symptoms are going to have a big impact on. Really?

Speaker B

00:06:13.910 - 00:07:33.180

Absolutely. And I think it's really important that we let these ladies know that we're there to try and help and support them.

We're not going to have a one size fits all approach for everybody. But also we do try and not paint a doom and gloom picture from the outset.

Not all women suffer these symptoms to the same degree, of course, so it's sort of in making them aware that they could happen, but then arming all of those medical professionals that they may come into contact with, with the tools to work through and try and help and support. I think, you know, one, one thing that often vasomotor symptoms really impact, for instance, is sleep.

And so, you know, insomnia can be a really big problem for our ladies.

But actually, if you dig into it, you often find that it's because they're having their mainstay of their vasomotor symptoms in the night and they're being woken up by them and then they're struggling to get back to sleep.

So, you know, yes, I agree it's a really challenging time, both in terms of what we might be contributing to in terms of their symptoms, but also them wanting to get on with their lives after this diagnosis.

Speaker A

00:07:33.820 - 00:07:52.690

Yeah, fair enough. And you touch on the fact that systemic hormone replacement therapy is avoided in people with a history of breast cancer due to the increase in risk.

But I wonder if you could talk us through some of the alternative options here that you mentioned in the paper. And let's start with the vasomotor symptoms because you just touched on that as well.

Speaker B

00:07:53.170 - 00:12:56.770

So I suppose just to clarify, obviously the focus of this paper is in hormone receptor positive breast cancer because it is the majority subtype that we see in our women.

It's not a blanket rule, but we are less concerned usually about the use of hormone replacement therapy in our ladies with the hormone negative subtypes. Of course, the primary care practitioners always very happy for you to contact us oncologists if you want to clarify anything there.

But, you know, the focus of this article is about the hormone positive space.

And so certainly within those early years after a diagnosis, our mainstay is trying to minimize that Circulating level of oestrogen as much as possible.

Obviously that may be suppressing ovarian function with GnRH analogues but even on top of that, you know, if that were all that were required, then why do women, postmenopausal women develop hormone sensitive breast cancer? We know it's because of these, this production of estrogen elsewhere in the system.

So then you've got your aromatase inhibitor medications, they're trying to eradicate even those small amounts.

So it, it does, it's very counterintuitive for us to be able to support the use of even topical estrogen based treatments when we're in this sort of early stage after a diagnosis.

That said, of course, and it's sort of outside the scope of this discussion, but of course, you know, we will consider the particular risk of that individual patient. We'll have...]]>Today, we’re speaking to Dr Sophie McGrath, Consultant Medical Oncologist based at the Royal Marsden NHS Foundation Trust and at Kingston Hospital in London.

Title of paper: Management of menopausal symptoms following treatment for hormone receptor positive breast cancer

Available at: https://doi.org/10.3399/BJGP.2025.0264

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.800 - 00:01:11.660

Hello and welcome to BJJP Interviews. My name is Nada Khan and I'm one of the associate editors of the bjgp. Thanks for joining us today to listen to this podcast.

In today's episode, we're speaking to Dr. Sophie McGrath, who is a consultant medical oncologist based at the Royal Morrison NHS Trust and at Kingston Hospital in London.

We're here to talk about the recent analysis article that she and her colleagues have published here in the BJDP titled Management of Menopausal Symptoms Following Treatment for Hormone Receptor Positive Breast Cancer.

And just to point out that these colleagues included not just medical oncologists, but also GPs and patients, which I think has really shaped this article and is one of the reasons why we wanted to highlight it here in the podcast. So, hi Sophie, thanks for meeting me to talk about this article, which I think touches on a really important topic in practice.

But talk us through some of the initial side effects that you discuss in the introduction here. Just in terms of hormone positive breast cancer, what kind of symptoms do women experience generally as a result of endocrine therapy?

Speaker B

00:01:12.220 - 00:02:32.900

So, yeah, thanks very much for asking. And it's a bit of a broad answer that I would give.

I mean, I've focused on, or we have focused on three main symptoms within the article which relate to hot flushes or vasomotor symptoms, also to joint stiffness and pain and swelling, arthralgia, and also to vulvovaginal symptoms, otherwise known as genitourinary syndrome of menopause.

But I think what we've tried to include within the article as well is a table that certainly acknowledges that there are unfortunately many other symptoms that women can get as a result of these medications, essentially mimicking menopausal side effects.

And of course, you know, these might be symptoms that women having already gone through the menopause may have suffered or experienced at some point already.

But actually for a population of premenopausal women, these will be symptoms that they haven't had any experience of yet and can often be quite intense and develop quite suddenly. Whereas often our post menopausal women have had some sort of lead up to this, they've had some experience.

Speaker A

00:02:34.710 - 00:02:44.710

And you work as a medical oncologist. But just talk me through your own experience of working with women who are going through the sort of sudden menopause as you describe as well.

Speaker B

00:02:45.350 - 00:05:50.240

So obviously the focus of the article here is on menopausal side effects in general from the treatments that we use. And we've talked a lot about using our endocrine treatments such as tamoxifen, letrozole.

But actually many of our women also experience menopausal type side effect secondary to the chemotherapies we give them. So I think, you know, there's sort of two groups you often have, particularly premenopausal women who stop their periods whilst on chemotherapy.

That may happen several weeks into their chemotherapy treatment and it can be quite sudden.

You know, they're already dealing with the numerous side effects attributed to the chemotherapy itself, but then they're also having to tackle these hot flushes, insomnia, potentially arthralgia. Obviously the vaginal symptoms may be more medium to longer term impact.

So you've got that group of women who are sort of thrust into menopausal symptoms very quickly and then you have the other group who perhaps have already gone through their menopause.

So they're not necessarily getting those symptoms alongside chemotherapy, but, but then after that we are introducing letrozole, which by removing even that last little bit of oestrogen production in the system is giving them enhanced menopausal side effects yet again. So I think that's sort of psychologically a big thing for the patients to deal with as well.

Whether they're sort of having all of that thrust upon them in one go or whether it's more gradual and they're almost waiting for it to occur. So I think for us, us there's a lot we've got to get through in our consultations.

Obviously if it happens alongside chemotherapy, then we're seeing them regularly anyway. We've got our nurses to support them in the clinics too.

But I think the challenge arises more when our ladies are moving on to their endocrine therapy and moving away from regular consultations in our clinics and having more contact again with primary care. They're wanting to get on with their lives. They're wanting to not be coming up to the hospital quite so often.

And so that was a real focus of this article, wanting to reach out to primary care, but also perhaps non oncology based secondary or tertiary care practitioners.

So maybe gynecologists or people that work very closely within menopausal clinics, not necessarily just within primary care and try and work out how can we support these ladies with symptoms that may take several months to declare themselves and may even be once they've been discharged to our stratified follow up programs, but not necessarily seeing us regularly in, in the clinic.

Speaker A

00:05:51.120 - 00:06:13.110

And I think one thing that I'm always struck by, especially with Women going through the perimenopause and the menopause is that this is a busy time in women's lives. So they might be juggling younger children, a career, caring for, you know, older parents.

So there's a lot going on in these women's lives that things like arthralgia, vasomotor symptoms are going to have a big impact on. Really?

Speaker B

00:06:13.910 - 00:07:33.180

Absolutely. And I think it's really important that we let these ladies know that we're there to try and help and support them.

We're not going to have a one size fits all approach for everybody. But also we do try and not paint a doom and gloom picture from the outset.

Not all women suffer these symptoms to the same degree, of course, so it's sort of in making them aware that they could happen, but then arming all of those medical professionals that they may come into contact with, with the tools to work through and try and help and support. I think, you know, one, one thing that often vasomotor symptoms really impact, for instance, is sleep.

And so, you know, insomnia can be a really big problem for our ladies.

But actually, if you dig into it, you often find that it's because they're having their mainstay of their vasomotor symptoms in the night and they're being woken up by them and then they're struggling to get back to sleep.

So, you know, yes, I agree it's a really challenging time, both in terms of what we might be contributing to in terms of their symptoms, but also them wanting to get on with their lives after this diagnosis.

Speaker A

00:07:33.820 - 00:07:52.690

Yeah, fair enough. And you touch on the fact that systemic hormone replacement therapy is avoided in people with a history of breast cancer due to the increase in risk.

But I wonder if you could talk us through some of the alternative options here that you mentioned in the paper. And let's start with the vasomotor symptoms because you just touched on that as well.

Speaker B

00:07:53.170 - 00:12:56.770

So I suppose just to clarify, obviously the focus of this paper is in hormone receptor positive breast cancer because it is the majority subtype that we see in our women.

It's not a blanket rule, but we are less concerned usually about the use of hormone replacement therapy in our ladies with the hormone negative subtypes. Of course, the primary care practitioners always very happy for you to contact us oncologists if you want to clarify anything there.

But, you know, the focus of this article is about the hormone positive space.

And so certainly within those early years after a diagnosis, our mainstay is trying to minimize that Circulating level of oestrogen as much as possible.

Obviously that may be suppressing ovarian function with GnRH analogues but even on top of that, you know, if that were all that were required, then why do women, postmenopausal women develop hormone sensitive breast cancer? We know it's because of these, this production of estrogen elsewhere in the system.

So then you've got your aromatase inhibitor medications, they're trying to eradicate even those small amounts.

So it, it does, it's very counterintuitive for us to be able to support the use of even topical estrogen based treatments when we're in this sort of early stage after a diagnosis.

That said, of course, and it's sort of outside the scope of this discussion, but of course, you know, we will consider the particular risk of that individual patient. We'll have to consider, you know, their age, the quality of life etc.

So by no means is it a blanket rule but I think, you know, what we're hoping to gain from this article is to highlight what other possibilities are out there that we could look to try.

First of all, so in terms of the vasomotor symptoms, as you say, there are some of the sort of lifestyle changes which to be perfectly honest, I imagine most of our patients are well read.

You know, they will have already looked to methods that they can help themselves with such as portable fans, layered clothing, but it is important to bear those things in mind trying to use lighter fabrics where possible. There is some data to suggest that reducing or removing alcohol and caffeine can help with such symptoms.

And then there is, you know, the exercise in its own right, we know that's very helpful for the arthralgia but actually there is suggestion that that can help with the individual vasomotor symptoms as well.

But what we'll often then talk about with our ladies is say, right, well the next sort of group of potential strategies is around non pharmacological interventions but things that do have now a good database behind them. So actually there's qu a lot of growing evidence for cognitive behavioral therapy which I'm quite excited about.

You know we've had various trials including a major UK led trial, Menos 4 which really did show significant benefit for management of the vasomotor symptoms and many of the patients that I speak to are really open to this concept. The British Menopausal Society has great links.

Our local Maggie Centre, and I'm sure this is the case elsewhere around the country, is starting to offer on site or online CBT as well to try and help with such symptoms. But certainly there are self directed programs as well, which I would highly recommend patients to explore.

But the other thing from a non pharmacological perspective is acupuncture. And again we're fortunate where I work that we do have on site acupuncture services.

The wait is fairly long unfortunately, but at least we can offer that.

And many of our women have really noticed a significant improvement in the intensity and the frequency of their hot flushes from, from a course of acupuncture.

And sometimes ladies can be taught to self needle as well, which can be quite useful if they do find months down the line that they get a slight flare in the symptoms and then they can get that control back using the technique themselves. And then I suppose the final group is the pharmacological interventions.

Speaker A

00:12:57.250 - 00:13:00.690

And you mentioned tibalone in the paper as well, don't you? As well?

Speaker B

00:13:00.690 - 00:14:46.130

Yeah.

So in terms of data support supporting tibalone, I mean at the moment, just to clarify, I'm not recommending that within the paper as a well researched safe intervention within these patient group.

Unfortunately, you know, we know that it's got oestrogenic progestogenic properties, but unfortunately the main trial looking at this was actually stopped prematurely because there was a suggestion of increased recurrence rates of breast cancer. So at the moment that's certainly not something that we would advocate.

We weren't able to go into great amount of detail in the article, but I think a really interesting watch this space area is going to be these novel neurokinin 3 receptor antagonists.

So fezzalinitant is the one that probably most people will have heard of, but there are others and certainly in the non breast cancer space, I know that many women have gained significant improvement in menopausal symptoms from these medications, but we're just a little nervous reticent at the moment in the hormone positive breast cancer population, mainly because we just don't have the data in that group specifically.

But the trials are running at the moment and hopefully we'll have that data soon and have such medication available to our ladies if those other non pharmacological methods aren't working well for them.

Speaker A

00:14:46.210 - 00:15:02.050

And in terms of joint issues in arthralgia, you point out the lifestyle modifications that people can make, many of them quite similar to what you've described for the vasomotor symptoms alongside acupuncture as well, which you've mentioned. But you also touch on the use of duloxetine as well.

Speaker B

00:15:03.170 - 00:15:19.080

Yes. So it's there as an option. It has been looked at in trials.

There was some benefit noted, but I think it's a really tricky drug from a toxicity profile.

Speaker A

00:15:19.160 - 00:15:19.720

Yeah.

Speaker B

00:15:20.440 - 00:17:05.040

And also I think it's the same for the vasomotor symptoms.

When you start mentioning to patients about taking another medication to solve the side effects of the medication you're giving them, people do start getting a little bit nervous about that, that prospect. And duloxetine is one of those personally that I haven't seen a great deal of good benefit from in my own patient cohort.

That's not to say, of course, that it doesn't work for ladies out there.

Again, I was interested in producing this article that there was very little objective evidence supporting things like the omega 3 fish oils, glucosamine. Actually, in practice, many of my ladies are taking that not just for their joints, but for cardiovascular and brain health.

And they will say, look, actually when I'm not on it, I notice the difference. So I do find that generally in my ladies to be helpful and trying where possible, to keep regular movement and exercise. But it is a challenge.

And that is where, you know, by all means, sometimes we do end up having to change the endocrine therapy. It's much less prevalent, of course, with tamoxifen versus the aromatase inhibitors.

In practice, it can be less with exomestane versus some of the other aromatase inhibitors.

So I think it's really important that we try and work with our ladies as closely as possible and get these symptoms ironed out as much as we can in those early months.

Speaker A

00:17:05.840 - 00:17:40.750

Yeah, fair enough. And I think a common thing that we see a lot in practice and deal with as gps are the genitourinary symptoms of the menopause.

And I think there is some confusion about what kind of topical treatments we can use safely for this and whether oestrogen containing pessaries are safe in women with a history of a hormone receptor positive breast cancer. And I think I've even had, had, you know, conflicting advice given to me from colleagues or from hospital specialists as well.

Do you think gps are safe to start this in practice in this group of women?

Speaker B

00:17:41.790 - 00:22:01.630

So I suppose if we go to the guidelines now, whether that's UK based or American guidelines, they will mostly still say in the case of a hormone sensitive breast cancer patient that it is advisable to avoid even topical containing oestrogen containing products. There is a mixed data set from the trials as to whether there really is an increased rate of recurrence with the use of such medications.

But we do know that you definitely can detect increased rates of circulating oestrogen or estradiol in ladies that use such products. Whether that of course results in a recurrence is, you know, yet to be fully elucidated.

So I suppose, you know that judging by the guidelines that we have available to us, what we tend to say in the first instance is let's try and see if all non hormonal containing products have been utilized to the fore in the first instance. And I think what's often missed is the importance of saying with these non hormonal containing products.

So actually, you know, the lubricants are very useful around the time of intercourse, but it's actually the moisturizers that are going to provide the longer term benefit. And actually they need to be used regularly.

So the suggestion is at least two to three times per week applied and that on average, you know, it may take 30 plus days for a lady using that regular regime to really notice a significant difference. So I sort of say to my women, right, this becomes part of your skincare routine, okay?

It, you know, might not be what you would normally associate with your skincare routine, but you, you add this into, you know, your, your regular routine.

And by all means, if you have young sexually active ladies who are religiously applying these products, they've, they've done everything you've said and they are still really, really struggling. Even those women who, it may not be around intercourse, it may be recurrent urinary tract or just symptoms of itch or pain in the vaginal area.

If these methods have been tried and are not alleviating the symptoms, then I think we have to be open to the fact of looking at potentially short courses of using things like, I suppose, low dose estriol in the vaginal area.

What the article does talk about though is that it's thought that it's probably safer if you're going to use such products to combine those with tamoxifen based endocrine treatment rather than continuing with an aromatase inhibitor.

So I suppose what my quick answer]]>2784b6f6-29da-4c26-8286-12fdaa28b0b3Tue, 30 Sep 2025 08:00:00 +010024:17falsefull32132133Inside the BJGP and editorial insights: Euan Lawson on the future of publishing and how to get publishedToday, we’re speaking to Euan Lawson, the Editor in Chief of the BJGP, about a number of issues around editing, the future of the journal and how you can get involved with the BJGP.

Here's a link to the BJGP Research and Publishing Conference: https://bjgp.org/conference

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.400 - 00:00:55.980

Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjjp. Thanks for taking the time today to listen to this podcast.

In today's episode, we're speaking to Euan Lawson, who is the editor in chief of the bjjp.

We're going to have a chat about a number of issues around the future of the Journal, around editorial issues and how you can get involved with the BJJP as well. So, hi, Ewan. Yeah, nice to see you. And just wanted to really start by saying thanks for joining me here today for this podcast.

But yeah, thanks for joining me here today, Ewan, just to have a general chat about things going on with BJGP and your role as editor.

And yeah, just a chance to catch up about some of your thoughts about issues around academic publishing and then just have a chat generally about other things that you've been thinking about as editor. So how's your week been?

Speaker B

00:00:57.420 - 00:02:13.730

We've already had that conversation before we got here. Now we won't go there again. As you know, it's not been perhaps my ideal week.

But as I'm delighted to be here and talking a little bit about what's going on with the Journal and just give a little bit of insight into how things are going, perhaps the biggest thing that we're I've recently written about the impact factor at the Journal, and perhaps the most important thing I need to say is that we don't worry too much about the impact factor.

I know we do quite well on the impact factor, but I wrote an editorial which really pointed out that we are much more interested in the real world influence of the journal rather than what is quite a narrow metric about citations. We're more interested in how it affects clinical, how the journal articles affect clinical practice, how they affect policy.

And we're really pushing, trying to push in that direction.

And once we get into worrying about the impact factor and there are a lot of perverse kind of incentives in academia and it can sometimes result in what's known as questionable research practices and things can just slide away from the ideal a little bit.

So that's perhaps one of the things that we're trying to concentrate on most in this coming months and years is just making sure that we keep our impact all about real world rather than anything else.

Speaker A

00:02:14.130 - 00:02:26.230

Yeah, you mentioned questionable research practices and you did talk about this in your editorial or your editor's briefing, but how do you think the Journal can tackle that head on?

Speaker B

00:02:27.750 - 00:04:23.309

I mean, it is challenging because it's.

The thing about QRP questionable research practices is that there's like they're a spectrum and they go from really very minor stuff, which is like, you know, giving you, a professor in your department authorship on a paper where they really didn't do anything, to a kind of a. The far end of the spectrum where you start to creep into outright research fraud.

And most researchers, and I think particularly in the primary care field though, you know, we'd always got to be. You always. One has to be careful about making assumptions, you know, are.

Have bags of integrity and do the best they can, but they're working in pressurized systems. And sometimes the QRPs are just things like that can be about the authorship or it can be about declarations of conflicts of interest.

It's how we go about doing our work in terms of how we quote other papers. Or sometimes it can be a little bit about how we tweak results to try to get positive results out because they're more likely to be published.

And those are perhaps the areas where as a journal we can be a little bit more helpful in that, you know, making sure we are quite happy to publish negative findings. We don't overstate results.

It's very easy as a journal to take a paper and there's a, you know, you want a brief summary of it to explain it to people. But it's important that we don't overstate and overinflate results that result in inaccurate messages going out about those papers.

So they're the kind of areas we can help. But let's not be under any illusions. It's a systems kind of problem.

Academic departments and the culture they have and the whole system of getting grants, publishing how those then get disseminated in the media as well. So it's a big old complex beast. And I think we just try and look at the areas journals may have the.

May have an impact, and we're trying to push things in the right direction.

Speaker A

00:04:23.789 - 00:04:40.109

Fair enough. And you mentioned impact and I just wanted to touch here on the BJJP research conference next year, which is going to have a focus on impact.

So talk us through what we're doing there and sort of what your aim is really to get that focus for the conference next year.

Speaker B

00:04:40.269 - 00:06:24.960

Yeah, I think one of the things I've always been keen on, the BJJP Research and Publishing Conference is that it's very much just, you know, it's a little bit something that we want to offer more for the Community, particularly early career researchers and academics.

But any GP that's got a scholar or primary care person, clinician, that's got an interest in sort of the scholarly aspects of work and understanding a little bit more about that. So we're a small, friendly conference. I certainly had some feedback recently that they were.

Someone was happy that they had had a really great experience and found it very welcoming. And I was really. I mean, that was that. I felt really pleased about that because that's certainly what we're aiming at.

And this year the theme is a little bit around impact and influence. We're very lucky to have a couple of speakers who really know about that.

We're going to have Rebecca Payne, who's the gp, former chair of RCGP Wales, and also we're going to have Prof. Martin Marshall, who was former chair of the college, of course, during COVID and is now over at the Nuffield Trust.

And I think that's a really interesting perspective because the think tanks like the Nuffield or the King's or, you know, Health foundation, others that are around, have an enormous understanding of how to influence policy through research and we're hoping that'll be really useful for people and give them an understanding. What we see a lot of is that people are.

People do the research, but often everybody knows you have to do something to try to make your research get your. Everyone wants to get the research out in the world, but far too often, and again, this is part of the way the system is set up.

People just stop at that point and nothing further happens beyond that. And there's so many opportunities in so many ways that you can actually develop that. So we want to try and help people a little bit with that.

Speaker A

00:06:25.200 - 00:06:38.160

Yeah, and we've talked a bit about that just in terms of actually the impact of research and disseminating the results, that actually makes an impact. And I think that's going to be an interesting angle to get from Martin, especially from his perspective as well.

Speaker B

00:06:38.240 - 00:07:46.020

Yeah, it'd be good to see. I want to. We should point out the last few years, all of the research in the journal is open access, so it's not paywalled at all.

And we're having conversations about reducing paywalls across the journal as well. So there. That's in development, but, you know, yeah, we're. We're keen to make sure that we can do. We're trying to do our bit.

It's important that stuff just doesn't disappear into the journal. There's a slight risk of that.

Perhaps some of my favorite moments as editor in the past couple of year, few years have been when I've heard about papers that have changed practice and policy. The very obvious one being the Sandvik paper about continuity, which has been really picked up in government level particularly.

I know in Scotland they're pushing hard on that.

But also when we hear from people like NB Medical or Red Whale or the other RCGP Essential Updates, when they take our papers and they're part of the look obviously across all journals, but when I hear about our papers that are then really being translated into actionable clinical findings, they're perhaps some of my best. That's why I really love seeing that. That's. I think that's really where we want to be and what we want to be doing.

Speaker A

00:07:46.580 - 00:08:02.740

Yeah.

And we've been talking about the clinical practice and analysis papers in the BJGP and we've often reflected on the fact that some of those papers are some of the most read papers across the journal...]]>Today, we’re speaking to Euan Lawson, the Editor in Chief of the BJGP, about a number of issues around editing, the future of the journal and how you can get involved with the BJGP.

Here's a link to the BJGP Research and Publishing Conference: https://bjgp.org/conference

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.400 - 00:00:55.980

Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjjp. Thanks for taking the time today to listen to this podcast.

In today's episode, we're speaking to Euan Lawson, who is the editor in chief of the bjjp.

We're going to have a chat about a number of issues around the future of the Journal, around editorial issues and how you can get involved with the BJJP as well. So, hi, Ewan. Yeah, nice to see you. And just wanted to really start by saying thanks for joining me here today for this podcast.

But yeah, thanks for joining me here today, Ewan, just to have a general chat about things going on with BJGP and your role as editor.

And yeah, just a chance to catch up about some of your thoughts about issues around academic publishing and then just have a chat generally about other things that you've been thinking about as editor. So how's your week been?

Speaker B

00:00:57.420 - 00:02:13.730

We've already had that conversation before we got here. Now we won't go there again. As you know, it's not been perhaps my ideal week.

But as I'm delighted to be here and talking a little bit about what's going on with the Journal and just give a little bit of insight into how things are going, perhaps the biggest thing that we're I've recently written about the impact factor at the Journal, and perhaps the most important thing I need to say is that we don't worry too much about the impact factor.

I know we do quite well on the impact factor, but I wrote an editorial which really pointed out that we are much more interested in the real world influence of the journal rather than what is quite a narrow metric about citations. We're more interested in how it affects clinical, how the journal articles affect clinical practice, how they affect policy.

And we're really pushing, trying to push in that direction.

And once we get into worrying about the impact factor and there are a lot of perverse kind of incentives in academia and it can sometimes result in what's known as questionable research practices and things can just slide away from the ideal a little bit.

So that's perhaps one of the things that we're trying to concentrate on most in this coming months and years is just making sure that we keep our impact all about real world rather than anything else.

Speaker A

00:02:14.130 - 00:02:26.230

Yeah, you mentioned questionable research practices and you did talk about this in your editorial or your editor's briefing, but how do you think the Journal can tackle that head on?

Speaker B

00:02:27.750 - 00:04:23.309

I mean, it is challenging because it's.

The thing about QRP questionable research practices is that there's like they're a spectrum and they go from really very minor stuff, which is like, you know, giving you, a professor in your department authorship on a paper where they really didn't do anything, to a kind of a. The far end of the spectrum where you start to creep into outright research fraud.

And most researchers, and I think particularly in the primary care field though, you know, we'd always got to be. You always. One has to be careful about making assumptions, you know, are.

Have bags of integrity and do the best they can, but they're working in pressurized systems. And sometimes the QRPs are just things like that can be about the authorship or it can be about declarations of conflicts of interest.

It's how we go about doing our work in terms of how we quote other papers. Or sometimes it can be a little bit about how we tweak results to try to get positive results out because they're more likely to be published.

And those are perhaps the areas where as a journal we can be a little bit more helpful in that, you know, making sure we are quite happy to publish negative findings. We don't overstate results.

It's very easy as a journal to take a paper and there's a, you know, you want a brief summary of it to explain it to people. But it's important that we don't overstate and overinflate results that result in inaccurate messages going out about those papers.

So they're the kind of areas we can help. But let's not be under any illusions. It's a systems kind of problem.

Academic departments and the culture they have and the whole system of getting grants, publishing how those then get disseminated in the media as well. So it's a big old complex beast. And I think we just try and look at the areas journals may have the.

May have an impact, and we're trying to push things in the right direction.

Speaker A

00:04:23.789 - 00:04:40.109

Fair enough. And you mentioned impact and I just wanted to touch here on the BJJP research conference next year, which is going to have a focus on impact.

So talk us through what we're doing there and sort of what your aim is really to get that focus for the conference next year.

Speaker B

00:04:40.269 - 00:06:24.960

Yeah, I think one of the things I've always been keen on, the BJJP Research and Publishing Conference is that it's very much just, you know, it's a little bit something that we want to offer more for the Community, particularly early career researchers and academics.

But any GP that's got a scholar or primary care person, clinician, that's got an interest in sort of the scholarly aspects of work and understanding a little bit more about that. So we're a small, friendly conference. I certainly had some feedback recently that they were.

Someone was happy that they had had a really great experience and found it very welcoming. And I was really. I mean, that was that. I felt really pleased about that because that's certainly what we're aiming at.

And this year the theme is a little bit around impact and influence. We're very lucky to have a couple of speakers who really know about that.

We're going to have Rebecca Payne, who's the gp, former chair of RCGP Wales, and also we're going to have Prof. Martin Marshall, who was former chair of the college, of course, during COVID and is now over at the Nuffield Trust.

And I think that's a really interesting perspective because the think tanks like the Nuffield or the King's or, you know, Health foundation, others that are around, have an enormous understanding of how to influence policy through research and we're hoping that'll be really useful for people and give them an understanding. What we see a lot of is that people are.

People do the research, but often everybody knows you have to do something to try to make your research get your. Everyone wants to get the research out in the world, but far too often, and again, this is part of the way the system is set up.

People just stop at that point and nothing further happens beyond that. And there's so many opportunities in so many ways that you can actually develop that. So we want to try and help people a little bit with that.

Speaker A

00:06:25.200 - 00:06:38.160

Yeah, and we've talked a bit about that just in terms of actually the impact of research and disseminating the results, that actually makes an impact. And I think that's going to be an interesting angle to get from Martin, especially from his perspective as well.

Speaker B

00:06:38.240 - 00:07:46.020

Yeah, it'd be good to see. I want to. We should point out the last few years, all of the research in the journal is open access, so it's not paywalled at all.

And we're having conversations about reducing paywalls across the journal as well. So there. That's in development, but, you know, yeah, we're. We're keen to make sure that we can do. We're trying to do our bit.

It's important that stuff just doesn't disappear into the journal. There's a slight risk of that.

Perhaps some of my favorite moments as editor in the past couple of year, few years have been when I've heard about papers that have changed practice and policy. The very obvious one being the Sandvik paper about continuity, which has been really picked up in government level particularly.

I know in Scotland they're pushing hard on that.

But also when we hear from people like NB Medical or Red Whale or the other RCGP Essential Updates, when they take our papers and they're part of the look obviously across all journals, but when I hear about our papers that are then really being translated into actionable clinical findings, they're perhaps some of my best. That's why I really love seeing that. That's. I think that's really where we want to be and what we want to be doing.

Speaker A

00:07:46.580 - 00:08:02.740

Yeah.

And we've been talking about the clinical practice and analysis papers in the BJGP and we've often reflected on the fact that some of those papers are some of the most read papers across the journal as well. I'm remembering the one about Earwax from a couple of years ago.

Speaker B

00:08:03.860 - 00:08:05.540

I was thinking earwax as you were speaking.

Speaker A

00:08:05.540 - 00:08:22.290

Yeah, fair enough. But I think it's important to think about how we can promote other writers and clinicians, primary care academics to submit those articles to us.

And I don't know if you just want to give a plug for those articles and how we use them.

Speaker B

00:08:22.450 - 00:09:57.910

Yeah, so absolutely. I'd be delighted to receive many more submissions around clinical practice. I think the key thing about this is you don't.

You know, almost all the academics who do anything related to clinical could write a clinical practice article almost next week because they're, they're subject area experts. But There are many GPs out there who've got a special interest.

Well, not just GPs, but any clinicians who've got a special interest in an area could write a really could write incredibly valuable articles that would change people's practice. I think the thing about clinical practice is they're relatively short, sharp articles.

But what we're really what think the ones that have worked really well are, you know the earwax one. Yeah, we saw incredible number of downloads for that.

I mean, I think there are some niche areas where people just don't get their education anywhere else. So they're incredibly useful.

We tend to try to tilt clinical practice and I'm not sure this is written down in the author guidance, but it's worth flagging it towards kind of when we have the ideal reader in mind, we perhaps think of the more experienced GP mid career Onwards, who knows their way.

It doesn't need the basics explaining to them, but has got some quite deep, challenging questions when you get the more complex patients or you've got a little niche area and that's like the perfect zone for us. And the perfect zone is not a great big topic like all of you know how to manage, you know, menopause.

It has to be a niche within that and then those kind of those because mostly because of the allowances of space, but like a niche in that targeted, that kind of gp, that kind of clinician who's got that level of knowledge. Where would. I would love to hear from you, you know, people who've got those, they should get in touch.

Speaker A

00:09:58.150 - 00:09:59.270

Yeah, send us an email.

Speaker B

00:09:59.270 - 00:10:00.230

We're happy to guide.

Speaker A

00:10:00.470 - 00:10:14.060

Fair enough. And what about the analysis papers?

Because often they're quite interesting in terms of critical look at a specific aspect of general practice policy or research and I know that you're interested to get more submissions on, on that angle as well.

Speaker B

00:10:14.060 - 00:12:01.900

Yeah, Again, my personal view is, again, if you're involved in any kind of research or writing articles or you're working in these areas, you could almost, you should almost always be able to write an analysis article that we could publish and I hope you will, people will consider doing it because, you know, whether it's two page version or a four page version, the. You've got that, people have got that expertise, they've got that understanding and they could, they should be able to really. We, we.

I know we've got some academics who are very good at it and understand that process and we often get submissions from them and. But I think so many more people could be doing it to improve their impact and influence of the work they do.

One thing I should mention about analysis, and this is kind of like a heads up, it's in the pipeline and one of the things that we've struggled with over the years with the BJGP is to publish service evaluations and sometimes Innovations in Practice.

We're working quite hard at the moment to create a new section which will be very analysis like and it's probably going to be called something like Innovations in Practice and it's going to be an opportunity to publish things that do that. People that.

Some of the radical, not necessarily radical, but some of the innovations that are going on, developments in general practice, particularly when we consider the ten Year Plan at the moment, it's an opportunity to publish those.

There might be some audit data, some service evaluation data as part of that and share good practice, good policy and so we're creating a section of the journal where those can go in. We've got a little bit of work, so we're not quite there yet.

But if you're doing something novel, important, you think valuable in your area of primary care, we will very soon be.

We're hoping to get that launched early part of next year, to give people an opportunity to bring forward again very much about influence, so that we can actually do a real world influence rather than just. It's not about pushing our impact factor up.

Speaker A

00:12:02.220 - 00:12:16.080

Yeah, fair enough.

And I think that kind of section would really support gps who might not be linked to an academic department, but, as you say, are doing something innovative in practice. Might not have a lot of experience of publishing research, but, yeah, we're certainly.

Speaker B

00:12:16.080 - 00:12:42.530

Going to create it so that it's relatively templated up so you don't have to just know, you don't have to understand all the kind of the nuances and wrinkles of how to write an academic paper. We're going to try and make that as straightforward as possible. And I think that's right.

It's examined exactly that kind of scholarly gp, doing good work, who thinks what they're doing could be valuable to let other GPs and other primary care systems so people know about. And that's probably been a slight gap in our offering over in past years and we're trying to fix it.

Speaker A

00:12:42.770 - 00:13:03.490

Yeah, fair enough.

So I wanted to take a bit more of a philosophical slant here and just get some of your reflections on general practice and primary care research as a whole. And how do you think this role that you've taken on as BJGP editor has shaped your view of research or your clinical practice?

How is it making an impact in other areas?

Speaker B

00:13:06.330 - 00:15:13.420

I think it's. It's hard to say. My reflections on general practice in general are kind of.

I mean, I come from a particular perspective, I guess, and it's hard not to have it in mind when I'm working clinically.

One of the things that's probably my about myself is I've never been a GP partner and that's probably an important declaration because I do have some comments about GP partnership at times that I can, you know, I'm broadly a supporter, but I can see some serious flaws in the model at points that worry me that we are kind of wedded to it in a way that is a barrier to future change.

And I think there was an article, in fact, from the RCGP saying, you know, recently from Camilla Hawthorne, the chair, saying that how important the partnership model is, but we've got to be able to develop it for the future.

I've never been a partner and I've tended to work on the fringes a little bit, you know, out of Arrows Care, drug and alcohol services, prison medicine. I was in the army in the past, so I've worked in a lot of kind of more fringy areas rather than.

Of course I've done mainstream general practice as a salary GP as well. And so I'm not sure I can. That perhaps has been.

That's perhaps more important in terms of what I have brought as BJ GP editor rather than the other way around.

And so it's influenced me in terms of trying to work hard as an editor to cover bits of general practice that don't otherwise get seen and particularly related to inequalities as well. But it's just trying to find the bits of general practice that don't get good coverage. And sometimes, you know, I.

And I can think of numerous examples over the past few years where we've just not had a single article about sex. There was a.

There was one, I think we had an editorial on sex work like a year or two ago and I looked back and really couldn't find an article on that at all in the journals archives going back what, 60, 70 years, whatever it's been. So I really think that's kind of. In terms of my role as editor, I'm really very keen not to kind of ensure we cover those.

So I guess that's a plea as well if you're working in an area of general practice and you think it's had very poor coverage, it's not visible. Get in touch again. I'm really. I love having these conversations and hearing about them.

Speaker A

00:15:13.740 - 00:15:28.630

Yeah. And we often have issues focusing on inclusion, health and we had that focus on missingness from Andrew Williamson's team up in Scotland as well.

So I think that's been really great to highlight and I know that's influenced a lot of people who are thinking about that space as well.

Speaker B

00:15:28.630 - 00:15:51.930

Yeah, that's exactly a good example. And I think we cover tons of the mainstream stuff as well. Of course, all the regular practice.

Yeah, I'm keen to shine a light, try to...]]>bb14f56c-e790-471f-80f9-c56ab6681d45Tue, 23 Sep 2025 08:00:00 +010020:46falsefull32122123Bridging the gap: GPs, patients, and mental health in perimenopauseToday, we’re speaking to Dr Jo Burgin, a GP and a researcher based at the University of Bristol.

Title of paper: Mental health consultations during the perimenopausal age range – Are GPs and patients on the same page?: A qualitative study

Available at: https://doi.org/10.3399/BJGP.2025.0069

Mood changes are a recognised symptom of perimenopause, for which Hormone Replacement Therapy is considered a first line treatment. Recent studies have found mental health symptoms are overlooked in menopause care, which is mostly delivered in primary care. This study identifies some key barriers to identifying perimenopause in women presenting with mental health symptoms and suggests important changes clinicians could make to their consultations to address this.

Title of paper: Competencies and clinical guidelines for managing acne with isotretinoin in general practice: a scoping review

Available at: https://doi.org/10.3399/BJGP.2025.0135

There is evidence of inequitable access to the most effective treatment for severe acne, isotretinoin. This scoping review identified the clinical competencies to safely manage acne using isotretinoin. No global consensus exists among clinical practice guidelines (CGPs) on whether GPs are appropriate prescribers of isotretinoin. Appropriately resourced and CPG-guided patient access to isotretinoin in primary care may promote safe, timely, and equitable acne management for patients and improve antimicrobial stewardship.

Transcript:

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.440 - 00:01:07.850

Hello and welcome to BJGP Interviews. My name is Nada Khan and I'm one of the associate editors of the bjgp. And welcome to our autumn edition of the BJGP podcast.

We're kicking off with a new set of interviews for the next few months. So thanks again for joining us.

Today we're speaking to Dr. Dermod Quinlan, who is a practicing GP in Cork and is also an MD candidate at University College Cork in Ireland.

We're here today to discuss his paper, recently published in the BJGP titled Competency and Clinical Guidelines for Managing Acne with Isotretinoin in General Practice. A Scoping Review. So thanks very much, Dermid, for joining me here today to talk about this paper.

But yeah, I guess I just wanted to start by saying that this is a really interesting paper and I think it covers a very common condition that we see in general practice and covers treatment, which can be quite difficult as well for acne.

But I wonder if you could just start by telling us a little bit about why you wanted to do this research and just a bit about the treatment of it and why you focused down on this topic, really.

Speaker B

00:01:09.610 - 00:02:59.510

So lovely to meet you, Nada. I'm first and foremost a GP and I see patients three days a week, 20 hours a week.

And I did a diploma in dermatology over a decade ago and I still do some online tutoring. So I have a long standing interest in dermatology and have an extended role in dermatology.

I work in an urban practice with lots of young teenagers and young people in it.

Acne is a common chronic disorder and I would see a lot of young people with acne of all grades of severity, mild, moderate and severe, and very severe. And as a clinician, very clearly recognize that behind acne is a patient very commonly suffering profound distress.

And we know that the morbidity associated with acne and particularly severe acne, is very extensive.

There's the emotional morbidity, there's psychological morbidity, it impacts people's employment opportunities, their education achievements, and then more widely, because treating acne is resource intensive, it has an impact on the healthcare workforce. And then there are concerns about the very prolonged use of antibiotics in acne, raising real antimicrobial stewardship concerns.

So I have an interest in this. And then we decided that we would do research into it because we don't know the clinical competencies for safe use of isotretinoin.

So I was particularly interested in severe acne and the management of severe acne, and also it didn't clearly identify which were the clinicians that could be safely tasked with managing acne using isotretinoin. So they were the two research questions that we set out to look at.

Speaker A

00:02:59.750 - 00:03:27.250

The first thing is I just wonder if you could talk us through, because typically in general practice, at least in the places where I've practiced, we wouldn't, as gps typically, be expected to start isotretinoids in practice. And I wonder if that was part of your reasoning for doing this research.

So did you go into it trying to establish whether GPs could be clinically competent to prescribe these medications?

Speaker B

00:03:27.650 - 00:04:48.480

For many years, I transcribed prescriptions initiated by dermatologists and then increasingly found that patients faced challenges in access to dermatologists and waiting to see a dermatologist. The research clearly shows there are issues with timely and equitable access to isotretinoin.

And in terms of equity, the inequity particularly affects ethnic minorities, people from lower social classes and women. So there are very real issues for patients accessing isotretinoin.

One of the concerns about isotretinoin is that it is a very potent teratogen, causing severe fetal abnormalities. GPs are competent in managing many other teratogenic medicines, lithium, methotrexate, sodium valproate, ACEs and ARBs, to name a few.

And GPS can are good at providing contraceptive advice and pregnancy prevention. So I felt that as a gp, that I had a lot of the skill set but didn't know what the guidelines say.

So that that was what led us and led me like it was the equity piece, it was a timely access and also it was the skill set required with clinical competencies to safely manage acne using isotretinoin hadn't been defined in.

Speaker A

00:04:48.480 - 00:05:34.780

The literature, so all really topical issues in terms of access and equity.

And as you say, this research aimed to look at clinical practice guidelines and consensus statement recommendations to look to see what should be the clinical competencies for prescribing oral isotretinoids in practice. And you did a scoping review? And we won't go too much into the methods because it followed sort of established methods for doing a scoping review.

And I really just wanted to focus on the results, really. So what did you find? So you found eight clinical practice guidelines, is that right?

And talk us through those and just how you looked at those and what you found really, in terms of what should be the clinical competencies and how you think that applies to general practice.

Speaker B

00:05:35.180 - 00:08:18.270

So we identified eight clinical practice guidelines, five of which originated from Europe, one each, then from America, Canada, and Malaysia. The Clinical Practice guidelines identified four clinical competencies for doctors to safely manage isotretinoin.

And these are dermatology, blood testing, mental health, and a pregnancy prevention program. And to take these one by one, the dermatology piece.

Obviously, doctors, GPs need to be able to diagnose acne and more especially need to be able to identify those patients with acne which should perhaps be treated with isotretinoin.

And they are, you know, people with severe acne, acne resistant to treatment, acne causing scarring, or acne which is having a severe psychological impact on patients.

The blood testing has reduced very substantially in recent years because the evidence for undertaking blood tests in otherwise fit largely young people indicates that the benefit is relatively modest. There is some heterogeneity among the guidelines as to what tests should be done and when they should be done and how often they should be done.

But largely there is an agreement that some blood tests are prudent, but not excessive blood testing. The two big pieces really are around mental health and pregnancy prevention.

Mental health is a concern with isotretinoin, and isotretinoin has been on the mark now since licensed in 1982 by the FDA. So it's around a very long time. And there have been concerns expressed continually about mental health and isotretinoin.

It's very reassuring that the evidence also identifies that at a population level, there isn't an increase in suicide. But case reports continue about raising concerns about mental health.

So the guidelines all recommend that people should have regular mental health assessments.

And while we can look at the potential adverse side effects of using isotretinoin to treat acne, we must also be very cognizant of the other side of the equation, where young people and people in general with severe acne can suffer very substantial emotional and psychological harms and burdens by virtue of their severe acne. And parents and doctors will be very familiar with the adverse psychological, emotional, social issues that arise with severe acne.

So, as in everything else in medicine, it's balancing the risks and the harms.

Speaker A

00:08:19.230 - 00:08:26.350

And then the final thing was around contraception, is that right? But again, here the guidelines diverged in some areas, didn't they, on their recommendations?

Speaker B

00:08:26.830 - 00:09:34.750

Absolutely, yeah.

So again, and pregnancy prevention and isotretinoin and all teratogenic medicines like, it's a really important piece that we can safely manage acne using isotretinoin. And pregnancy prevention is more than simply contraception. It is contraception, it's emergency...]]>In this episode, we speak to Dr Diarmuid Quinlan, a GP and MD candidate based at the Department of General Practice at University College Cork.

Title of paper: Competencies and clinical guidelines for managing acne with isotretinoin in general practice: a scoping review

Available at: https://doi.org/10.3399/BJGP.2025.0135

There is evidence of inequitable access to the most effective treatment for severe acne, isotretinoin. This scoping review identified the clinical competencies to safely manage acne using isotretinoin. No global consensus exists among clinical practice guidelines (CGPs) on whether GPs are appropriate prescribers of isotretinoin. Appropriately resourced and CPG-guided patient access to isotretinoin in primary care may promote safe, timely, and equitable acne management for patients and improve antimicrobial stewardship.

Transcript:

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01.440 - 00:01:07.850

Hello and welcome to BJGP Interviews. My name is Nada Khan and I'm one of the associate editors of the bjgp. And welcome to our autumn edition of the BJGP podcast.

We're kicking off with a new set of interviews for the next few months. So thanks again for joining us.

Today we're speaking to Dr. Dermod Quinlan, who is a practicing GP in Cork and is also an MD candidate at University College Cork in Ireland.

We're here today to discuss his paper, recently published in the BJGP titled Competency and Clinical Guidelines for Managing Acne with Isotretinoin in General Practice. A Scoping Review. So thanks very much, Dermid, for joining me here today to talk about this paper.

But yeah, I guess I just wanted to start by saying that this is a really interesting paper and I think it covers a very common condition that we see in general practice and covers treatment, which can be quite difficult as well for acne.

But I wonder if you could just start by telling us a little bit about why you wanted to do this research and just a bit about the treatment of it and why you focused down on this topic, really.

Speaker B

00:01:09.610 - 00:02:59.510

So lovely to meet you, Nada. I'm first and foremost a GP and I see patients three days a week, 20 hours a week.

And I did a diploma in dermatology over a decade ago and I still do some online tutoring. So I have a long standing interest in dermatology and have an extended role in dermatology.

I work in an urban practice with lots of young teenagers and young people in it.

Acne is a common chronic disorder and I would see a lot of young people with acne of all grades of severity, mild, moderate and severe, and very severe. And as a clinician, very clearly recognize that behind acne is a patient very commonly suffering profound distress.

And we know that the morbidity associated with acne and particularly severe acne, is very extensive.

There's the emotional morbidity, there's psychological morbidity, it impacts people's employment opportunities, their education achievements, and then more widely, because treating acne is resource intensive, it has an impact on the healthcare workforce. And then there are concerns about the very prolonged use of antibiotics in acne, raising real antimicrobial stewardship concerns.

So I have an interest in this. And then we decided that we would do research into it because we don't know the clinical competencies for safe use of isotretinoin.

So I was particularly interested in severe acne and the management of severe acne, and also it didn't clearly identify which were the clinicians that could be safely tasked with managing acne using isotretinoin. So they were the two research questions that we set out to look at.

Speaker A

00:02:59.750 - 00:03:27.250

The first thing is I just wonder if you could talk us through, because typically in general practice, at least in the places where I've practiced, we wouldn't, as gps typically, be expected to start isotretinoids in practice. And I wonder if that was part of your reasoning for doing this research.

So did you go into it trying to establish whether GPs could be clinically competent to prescribe these medications?

Speaker B

00:03:27.650 - 00:04:48.480

For many years, I transcribed prescriptions initiated by dermatologists and then increasingly found that patients faced challenges in access to dermatologists and waiting to see a dermatologist. The research clearly shows there are issues with timely and equitable access to isotretinoin.

And in terms of equity, the inequity particularly affects ethnic minorities, people from lower social classes and women. So there are very real issues for patients accessing isotretinoin.

One of the concerns about isotretinoin is that it is a very potent teratogen, causing severe fetal abnormalities. GPs are competent in managing many other teratogenic medicines, lithium, methotrexate, sodium valproate, ACEs and ARBs, to name a few.

And GPS can are good at providing contraceptive advice and pregnancy prevention. So I felt that as a gp, that I had a lot of the skill set but didn't know what the guidelines say.

So that that was what led us and led me like it was the equity piece, it was a timely access and also it was the skill set required with clinical competencies to safely manage acne using isotretinoin hadn't been defined in.

Speaker A

00:04:48.480 - 00:05:34.780

The literature, so all really topical issues in terms of access and equity.

And as you say, this research aimed to look at clinical practice guidelines and consensus statement recommendations to look to see what should be the clinical competencies for prescribing oral isotretinoids in practice. And you did a scoping review? And we won't go too much into the methods because it followed sort of established methods for doing a scoping review.

And I really just wanted to focus on the results, really. So what did you find? So you found eight clinical practice guidelines, is that right?

And talk us through those and just how you looked at those and what you found really, in terms of what should be the clinical competencies and how you think that applies to general practice.

Speaker B

00:05:35.180 - 00:08:18.270

So we identified eight clinical practice guidelines, five of which originated from Europe, one each, then from America, Canada, and Malaysia. The Clinical Practice guidelines identified four clinical competencies for doctors to safely manage isotretinoin.

And these are dermatology, blood testing, mental health, and a pregnancy prevention program. And to take these one by one, the dermatology piece.

Obviously, doctors, GPs need to be able to diagnose acne and more especially need to be able to identify those patients with acne which should perhaps be treated with isotretinoin.

And they are, you know, people with severe acne, acne resistant to treatment, acne causing scarring, or acne which is having a severe psychological impact on patients.

The blood testing has reduced very substantially in recent years because the evidence for undertaking blood tests in otherwise fit largely young people indicates that the benefit is relatively modest. There is some heterogeneity among the guidelines as to what tests should be done and when they should be done and how often they should be done.

But largely there is an agreement that some blood tests are prudent, but not excessive blood testing. The two big pieces really are around mental health and pregnancy prevention.

Mental health is a concern with isotretinoin, and isotretinoin has been on the mark now since licensed in 1982 by the FDA. So it's around a very long time. And there have been concerns expressed continually about mental health and isotretinoin.

It's very reassuring that the evidence also identifies that at a population level, there isn't an increase in suicide. But case reports continue about raising concerns about mental health.

So the guidelines all recommend that people should have regular mental health assessments.

And while we can look at the potential adverse side effects of using isotretinoin to treat acne, we must also be very cognizant of the other side of the equation, where young people and people in general with severe acne can suffer very substantial emotional and psychological harms and burdens by virtue of their severe acne. And parents and doctors will be very familiar with the adverse psychological, emotional, social issues that arise with severe acne.

So, as in everything else in medicine, it's balancing the risks and the harms.

Speaker A

00:08:19.230 - 00:08:26.350

And then the final thing was around contraception, is that right? But again, here the guidelines diverged in some areas, didn't they, on their recommendations?

Speaker B

00:08:26.830 - 00:09:34.750

Absolutely, yeah.

So again, and pregnancy prevention and isotretinoin and all teratogenic medicines like, it's a really important piece that we can safely manage acne using isotretinoin. And pregnancy prevention is more than simply contraception. It is contraception, it's emergency contraception and it's termination of pregnancy.

And that really speaks to the complexity of sexual health medicine in the current world. The guidelines are on contraception. There is some divergence, but most guidelines recommend dual contraception.

The key piece from it, from a clinician's perspective, is about how to manage pregnancy prevention in women who are not sexually active. And most of the current guidelines recommend that women who are not sexually active, that the use of hormonal contraception is not mandatory.

And that's an important clinical piece because often young women in the our women are not sexually active. And there is an ethical issue of coercing women to take hormonal contraception, which brings its own litany of side effects.

Speaker A

00:09:35.230 - 00:10:00.330

So I guess one of my questions to you is what do you think about the divergence in the different guidelines?

Do you think that these are divergent enough that we might not be able to find a consensus about what we should be doing, for instance, in general practice around blood tests?

Or do you think that we should be developing new guidelines in terms of potentially how general practice could take prescribing of isotretinoids forward?

Speaker B

00:10:00.730 - 00:12:16.270

I was involved in a paper published with the BMJ in January of 2025 which looked at the New Zealand experience of GPS prescribing isotretinoid from 2008 onwards.

And a single policy change in New Zealand to enable GPs to issue isotretinoin had a seismic effect on the subsequent access to isotretinoin since 2008. Back in 2008, almost all isotretinoin in New Zealand was prescribed by dermatologists.

In 2023, 80% of isotretinoin is prescribed by GPs in New Zealand and there's a very substantial enhanced access to ethnic minorities, particularly Maoris, Asians and Pacific people, less so with socially deprived people, but certainly an increased access.

So enabling, Supporting and resourcing GPs in New Zealand to take on this work has certainly helped overcome the access barriers that people have described and the inequity I think we can learn from the New Zealand experience. And the two big pieces that they found with gps in New Zealand required were education supports and resources.

And we are, the research team are currently looking at the education resources that are required for GPs to safely prescribe isotretinoin. And then the final piece is the resourcing, because prescribing isotretinoin is resource intensive.

Patients are seen usually once a month, possibly for six months or so. So it is resource intensive. There is a global shortage of GPs. There is a shortage of GPs in most Western countries.

The UK, Ireland, Canada all describe severe GP workforce shortages. So GPs, if they are to take on this work and the clinical competencies, suggest that we may be able to.

But there is a resourcing issue which needs to be addressed at policy level, at national level, so that gps can incrementally take on this work and support our patients with safe, timely, equitable access to isotretinoin.

Speaker A

00:12:17.060 - 00:12:34.580

And that touches on a point that I wanted to pick up on, really was about the perspective of GPs and dermatologists and patients. And I think you touch on this in the discussion. And do we know from the New Zealand model what is coming out from those perspectives?

And could that help inform what happens in the future?

Speaker B

00:12:34.900 - 00:13:18.010

Elsewhere, the New Zealand model has found that the GPs have embraced access to isotretinoin. And incrementally, the number of patients prescribed isotretinoin has grown year on year.

In 2008, it was just under 8000 patients a year in New Zealand, and in 2023 it was almost 24,000.

So the number of patients accessing isotretinoin in New Zealand has almost trebled in that time, showing that there is a very significant unmet need and also that the gps, with appropriate resources and education supports, can incrementally deliver that service in a safe, timely and equitable fashion for patients.

Speaker A

00:13:18.090 - 00:13:54.100

And I suppose one thing really to touch upon is that, as you say, this would be an equitable way of accessing these treatments for a range of patients that may not necessarily get to have these due to long wait times from dermatology or a fear of coming in to speak to a dermatologist or a specialist.

And I just wonder if from your own practice you have any thoughts about how potentially being able to prescribe these medications might impact on patients and their use of these medications and their perspectives as well.

Speaker B

00:13:54.420 - 00:14:39.090

Certainly I have found it very positive in my practice. I've been prescribing isotretinoin for in excess of a decade at this stage. I take referrals from other GPs in the area.

The patient experience is very positive. I have young people coming in and initially, often when they come in, they're very downcast, they're.

Their mood is quite low, they avoid eye contact, and then they're back a month later and they're feeling much better. So the psychological impact of acne on our young people is enormous. We have described the clinical competencies that are required.

GPs meet these clinical competencies, but we do require education and resources to incrementally adopt this work.

Speaker A

00:14:39.970 - 00:14:53.790

And I think one word that you're using repeatedly is incrementally and I think that's a really important word to keep in mind as well as we try to learn more about what's actually needed in terms of resourcing and workload implications as well?

Speaker B

00:14:54.110 - 00:15:30.099

So there are very significant workload and resourcing implications.

It is a resource intensive piece and we know that young people like the New Zealand experience shows that there is an incremental expansion in people using isotretinoin. So there is definitely an unmet need, there is an equity barrier.

Working with our patients and our dermatology colleagues, we can safely and equitably address this education gap, this resource gap, this service provision gap, and improve the, you know, the well being of our patients with acne.

Speaker A

00:15:30.099 - 00:15:54.270

I think a lot of the findings from your paper have implications at a policy level, at a broader system level. But do you have any thing that you want to say to gps practicing who are managing patients with acne?

Do you have any take home messages for them in terms of what they can be doing now in terms of the results of this scoping review?

Speaker B

00:15:54.750 - 00:16:48.140

I think that gps are already managing this very well. Many of them are already managing the mental health assessments, they're managing the ongoing pregnancy prevention contraception piece of it.

Many of them are doing the blood testing. They're also looking after the mild and moderate acne. It's a small additional increment of clinical expertise required.

We know that in the UK, many GPs already working within dermatology departments are actually doing this work under dermatologist governance. So there is very substantial expertise already within the UK GP community.

And we would encourage GPs to consider, albeit the workforce challenges and workload challenges that we all are very familiar with, whether this is a role that might, in time, migrate increasingly into general practice and into our surgeries.

Speaker A

00:16:49.100 - 00:17:03.000

Thank you for that.

It's very thoughtful words and I think it's very wise of you to think about the clinical benefits, but also consider very carefully the system changes that may need to be be allowed to support this as well in the future.

Speaker B

00:17:04.040 - 00:17:30.729

And we know that if GPs take this work, you know, there are opportunity costs that if GPs are seeing patients with acne, then they may not be available to see other patients.

So we need to consider the implications of any evolution of access to isotretinoin and balance that against the current inequitable access which adversely affects women, ethnic minorities and people from socioeconomic economically deprived Macrons.

Speaker A

00:17:31.209 - 00:17:38.729

Great. Thank you, Dermod. That's been a really great chat around this paper and I just wanted to say thank you again for joining us to talk about it today.

Speaker B

00:17:39.449 - 00:17:40.649

My pleasure, Nada.

Speaker A

00:17:41.289 - 00:18:03.530

And thank you all very much for your time here and for listening to this BJGP podcast.

Dermid's original research article can be found on bjgp.org and the show notes and podcast audio can be found@bjgplife.com it's been great to chat to Dermot about a very clinically relevant topic, and I hope you all have a chance to go back and read the paper. Thanks again for listening. Bye.

Title of paper: What do patients want from access to UK general practice?

Available at: https://doi.org/10.3399/BJGP.2024.0582

Widely accepted as perpetuated by the media is that patients are unhappy with access to general practice and desire faster access to a general practitioner. This review sought to summarise the research evidence about reported patient wants from access to general practice. Patients wanted to easily make an appointment in a timely fashion, to have a positive relationship with the practice, to see a specific clinician and choose consultation modality according to individual circumstance. Communication and being kept informed about access throughout the process of making and having an appointment, was something patients wanted, and this could be addressed by general practice.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.480 - 00:01:00.150

Hello 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 Professor Helen Atherton.

Helen is professor of Primary Care Research based at the University of Southampton, and we've only just speaking to her recently on this podcast about the increasing digitalization of general practice. This time we're speaking to her about her recent paper here in the BJDP titled what Do Patients Want from Access to UK General Practice?

So, hi, Helen.

It's really nice to speak again about this area of research and I guess I just wanted to start by saying that access is such a loaded word and really, when it comes to general practice, it's part of a fairly negative media campaign against general practice. But it seems that this negative narrative just keeps getting pushed, despite lots of attempts to fix it.

So I just wonder if you could reflect on that.

Speaker B

00:01:00.470 - 00:01:51.950

Yeah, absolutely. So that the negative media coverage was one of the reasons that I wanted to do this review.

So this review was a bit of a labour of love because I had a feeling from the work that I was doing on digital access and other research that actually the reality was probably quite different, what we were seeing in the headlines and having looked into it, although there's lots of research out there on patient experience and satisfaction, we have a national survey that looks at that. There wasn't anything about what patients actually want. And so that kind of.

I thought, actually, wouldn't it be really interesting to find out from the evidence what they actually want and see if it does fit with the narrative we see in the papers and on social media. So, yes. So completely agree. And that was kind of where the idea came from, really.

Speaker A

00:01:52.420 - 00:02:08.180

Yeah.

And I just want to unpick what you really mean by access in this paper, because I think for some people it means, you know, just getting an appointment to see their GP within a day, but it can mean lots of different things to other people. So what did you conceptualize that as?

Speaker B

00:02:08.740 - 00:02:49.840

Well, it was difficult.

And you're right, there are lots of different definitions of access, and particularly in the research context, for us, we were interested in access to an appointment, so we were very focused on the processes that patient would go through in order to get the appointment, go to the appointment.

And we did go back and forth several times with this review because it was so difficult to define and there will be other researchers who use different definition, but because we were so interested in a lot of the kind of media narrative. It just felt like the best fit to look at access to an appointment with a gp.