BJGP Interviews

In this episode, we talk to Dr Jennifer Voorhees, who is a GP in Tameside and an NIHR Academic Clinical Lecturer based at the University of Manchester. 

Title of paper: A paradox of access problems in general practice: a qualitative participatory case study

Available at: https://doi.org/10.3399/BJGP.2023.0276

Access to general practice is an important topic, yet research and policies addressing access often take a simplistic definition, resulting in a lack of understanding of the complexities of longstanding interrelated problems. This research explains a paradox of access problems, in which the focus and attention on the increasing demand on general practice both creates and obscures another problem of unmet need. This is done through reactive rules and policies to manage demand, which largely undermine continuity in favour of speed of access, and generate work that takes up capacity of staff and patients. Clinicians can look at their current ways of working and identify ways to reverse the paradox in order to address hidden unmet needs and the resulting health inequalities in the population.

In this episode, we talk to Isabel Leach, who is a final year medical student at the University of Sheffield. 

Title of paper: Understanding patient views and experiences of the IDENTIfication of PALLiative care needs (IDENTI-Pall): a qualitative interview study

Available at: https://doi.org/10.3399/BJGP.2023.0071

Understanding into patient views and experiences of identification of palliative care needs is lacking. This study suggests an individualised and compassionate approach is required, with key components including open conversations about palliative care and the sharing of prognostic uncertainty. Proactive palliative care intervention by primary healthcare professionals following identification of need is valued by patients and requires further attention in research, policy, and practice.

In this episode, we talk to Dr Alice Harper, an NIHR Academic Clinical Fellow based at the Centre for Academic Primary Care at the University of Bristol. 

Title of paper: Understanding the patient experience of coeliac disease diagnosis: a qualitative interview study

Available at: https://doi.org/10.3399/BJGP.2023.0299

Previous qualitative studies on coeliac disease (CD) focus on patient experience after diagnosis. This study found patients experience uncertainty during the pathway to CD diagnosis, particularly pre-diagnosis and during investigations. Endoscopy was thought to be necessary for diagnostic confidence and conviction in a lifelong gluten free diet. As the diagnostic pathway evolves, consideration must be given to reducing patient uncertainty.

In this Christmas edition of the BJGP podcast we discuss Christmas stocking filler books. We're joined by Ben Hoban, Nada Khan, Euan Lawson and Andrew Papanikitas and talk through four books for the holiday season.

A quick note to say we're taking a break over Christmas but we'll be back with another BJGP Interview on 9 January 2024.

In this episode, we talk to Dr Garth Funston, who is a Clinical Senior Lecturer in Primary Care Cancer Research within the Wolfson Institute of Population Health at Queen Mary University of London.

Title of paper: Pre-diagnostic prescription patterns in bladder and renal cancer: a longitudinal linked data study

Available at: https://doi.org/10.3399/BJGP.2023.0122

Previous studies have demonstrated that prescription rates for certain medications increase many months before the diagnosis of some cancers. Determining whether prescribing for common urological clinical features increases in patients with renal and bladder cancer could help us identify opportunities for more timely diagnosis. We found that prescription rates for UTI medications increased 9 months before bladder and renal cancer diagnosis, with an even earlier increase occurring before bladder cancer diagnosis in women (11 months). This indicates that there is a window of opportunity in which investigation and referral could lead to earlier cancer detection in some patients presenting to their GP with features of UTI.

In this episode, we talk to Professor Stephane Jouneau, Professor in Pulmonology and Dr Anthony Chapron, a GP and Associate Professor from the University of Rennes in France. 

Title of paper: Early detection of chronic obstructive pulmonary disease in primary care: a randomised controlled trial

Available at: https://doi.org/10.3399/BJGP.2022.0565

 In primary care, the use of questions adapted from symptoms and risk factors identified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and chronic obstructive pulmonary disease (COPD) coordination to facilitate spirometry access, either alone or

combined, facilitates COPD detection. These interventions are relatively easy to implement in everyday clinical practice and can be adapted for countries in which most GPs are not trained to perform spirometry.

In this episode, we talk to Professor Katharine Wallis, Head of the General Practice Clinical Unit at the University of Queensland in Brisbane, Australia. We caught up with her whilst she was in the UK to discuss the paper that she and first author Suzanne McDonald have published here in the BJGP.

Title of paper: Acceptability and optimisation of resources to support antidepressant cessation: A qualitative think-aloud study with patients

Available at: https://doi.org/10.3399/BJGP.2023.0269

It is not known how best to support patients to safely stop long-term (>12 months) antidepressants when there is no clinical indication for continued use. The current study tested and optimised three patient resources designed to raise awareness and recognition of withdrawal symptoms and to provide step-by-step guidance for tapering drug dose to minimise withdrawal symptoms. Adults with lived experience of long-term antidepressant use reported that the resources were useful, acceptable, clear, comprehensible, and reassuring. The effectiveness of these consumer-informed resources in supporting safe cessation of long-term antidepressants is currently being tested in general practice.

In this episode, we talk to Dr Georgia Richards, who is a Research Fellow in the Centre for Evidence-Based Medicine at the University of Oxford. 

Paper: Private prescribing of controlled opioids in England, 2014-2021: a retrospective observational study

Available at: https://doi.org/10.3399/BJGP.2023.0146

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

In this episode, we talk to Dr Monica Molinaro, who is an Assistant Professor at the Institute of Health Sciences Education at McGill University in Canada. 

Title of paper: You’re doing everything you possibly could do, and you know it’s not enough”: Family physician narratives of moral distress

Available: https://doi.org/10.3399/BJGP.2023.0193

The moral distress of physicians who cannot provide adequate care due to systemic deficits is seldom heard in contemporary discussions about health care access and quality. Family physician stories of moral distress in relation to structural and systemic factors such as racism, colonialism, and drug, mental health, and housing policy, generate seemingly novel and vital understandings of the clinical work of primary care providers. The study findings are some of the first to illustrate family physicians’ experiences of moral distress, contributing to the limited body of literature on moral distress in primary care.