BJGP Interviews

In this episode we talk to Dr David Whiteley who is a lecturer at the Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University.

Paper: Developing a primary care-initiated hepatitis C treatment pathway in Scotland: A qualitative study

https://doi.org/10.3399/BJGP.2022.0044

Historically, GPs were rarely involved in the treatment of HCV, their role more commonly restricted to viral testing and diagnosis. Contemporary drug therapy for HCV has allowed reconsideration of this status quo, and offers potential for GPs to initiate HCV treatment in primary care. This study provides a way forward, detailing a practicable theory-informed pathway and recommendations for primary care-initiated HCV treatment in the UK.

In this episode we talk to Amy Clark who is a final year medical student at Cardiff and Dr Kathryn Hughes who is a GP and senior clinical lecturer at PRIME Centre Wales at the School of Medicine at Cardiff University.

Paper: Accuracy of the NICE traffic light system in children presenting to general practice: a retrospective cohort study

https://doi.org/10.3399/BJGP.2021.0633

The National Institute for Health and Care Excellence (NICE) traffic light system is widely used in general practice for the assessment of unwell children; however, the majority of previous studies validating this tool have been conducted in secondary care settings. To that authors’ knowledge, no studies have validated this tool within UK general practice. This study found that the traffic light system cannot accurately detect or exclude serious illness in children presenting to UK general practice with an acute illness. The conclusion reached was that it cannot be relied on by clinicians for the assessment of acutely unwell children and that it is unsuitable for use as a clinical decision tool.

In this episode we talk to Dr Jon Gibson who is a research fellow at the School of Health Sciences at the University of Manchester.

Paper: Primary care workforce composition and population, professional, and system outcomes: a retrospective cross-sectional analysis

https://doi.org/10.3399/BJGP.2021.0593

The increasing number of staff from diverse healthcare backgrounds is changing the general practice workforce in England. These changes provide a new opportunity to investigate whether, and how, workforce composition may be associated with outcomes. This analysis indicated that professional, population, and system outcomes show a variety of associations with primary care workforce composition. The findings demonstrated that different types of health professionals are not substitutes for each other, and the quantity and quality of primary care services delivered will depend on who is employed to work in this setting.

In this episode we speak to Professor Chris Butler who is a GP and professor of primary care at the Nuffield Department of Primary Care Health Science at the University of Oxford. He is also Co-Chief Investigator for the PRINCIPLE trial and the PANORAMIC trial.

Paper: Colchicine for COVID-19 in the community (PRINCIPLE): a randomised, controlled, adaptive platform trial

https://doi.org/10.3399/BJGP.2022.0083

Colchicine has been proposed as treatment for COVID-19 due to its anti-inflammatory properties, but evidence to support its use is inconclusive, and its effect on time to recovery in the community has not been evaluated. The RECOVERY trial found no benefit with colchicine use among people hospitalised with COVID-19, while the COLCORONA trial found some evidence of a 1.1% and 1.4% absolute reduction in hospitalisations/deaths among adults with suspected or confirmed COVID-19 in the community respectively. In this national, platform adaptive randomised controlled trial, we found evidence of no meaningful benefit with colchicine on time to recovery, and because the threshold for futility on time to recovery was met, randomisation to colchicine was stopped before collecting substantial data on hospitalisations and death, leading to imprecise estimates for that outcome. Our findings add to the evidence currently available and suggest that colchicine should not be recommended for treating symptoms of COVID-19.

In this episode we speak to Dr Charlotte Archer who is senior research associate in primary care mental health at Bristol Medical School at the University of Bristol.

Paper: Rise in prescribing for anxiety in UK primary care between 2003 and 2018: a population-based cohort study using Clinical Practice Research Datalink

https://doi.org/10.3399/BJGP.2021.0561

Previous studies have found substantial increases in the prescribing of antidepressants for any indication, and for depression, over the past two decades.

The current study found increases in incident prescribing for anxiety in most anxiolytic drug classes, and an increase in the number of new patients starting treatment is more likely to explain the overall increase rather than increases in long-term use. Increases in prescribing were most notable in young adults, with a marked rise in benzodiazepine prescriptions for this group. Increases in incident prescribing may reflect better detection of anxiety or an earlier unmet need; however, some of this prescribing is not based on robust evidence of effectiveness, some may contradict guidelines, and there is limited evidence on the overall impact associated with taking antidepressants long term, and therefore, there may be unintended harm.

In this episode we talk to Dr Laura Jefferson who is a Research Fellow at the Department of Health Sciences at the University of York.

Paper: General practitioner wellbeing during the COVID-19 pandemic: A systematic review.

https://doi.org/10.3399/BJGP.2021.0680

Many GPs have reported stress and burnout over recent years, which is potentially damaging not just to doctors themselves, but also to patients and healthcare systems. The coronavirus pandemic has presented new challenges and there is a need to evaluate the impact on GP wellbeing. This review synthesises the international evidence base exploring primary care doctors’ psychological wellbeing during the pandemic. Studies have highlighted multiple sources of stress during this time and reported experiences of stress, burnout, anxiety, depression, fear of COVID, reduced job satisfaction and physical symptoms. Gender and age differences may warrant further research to identify interventions targeted to the needs of specific groups.

In this episode we interview Dr Austin O'Carroll who is a GP based in Dublin and founder of Safetynet Ireland and North Dublin City GP Training, and co-founder GPCareForAll.

Paper: The Triple F**k Syndrome: How medicine contributes to the systemic oppression of people born into poverty

Link to article: https://bjgplife.com/the-triple-fk-syndrome-how-medicine-contributes-to-the-systemic-oppression-of-people-born-into-poverty/

Austin argues that the label of personality disorder is inappropriate and harmful to patients who have suffered adverse social environments in childhood. By simultaneously ignoring social causation and denying the possibility of therapy the diagnosis perpetrates a systematic injustice against those who are labelled.

In this episode we talk to Dr Simon Fraser who is an associate professor of public health at the School of Primary Care at the University of Southampton.

Paper: Persistently normal blood tests in patients taking methotrexate for RA or azathioprine for IBD: a retrospective cohort study

https://doi.org/10.3399/BJGP.2021.0595

Clinical guidance from the National Institute for Health and Care Excellence recommends 3-monthly blood-tests for the ongoing safety monitoring of conventional synthetic disease-modifying anti-rheumatic drugs, but questions have been raised about the need for this testing frequency. Using 2 years’ data from a large primary care database, this study found that persistent normality of blood-test results was common and abnormalities were dominated by reduced renal function among older people, with relatively few hepatic or haematological abnormalities. Greater stratification of monitoring may reduce workload and costs for patients and health services, but more evidence is required on the long-term safety, acceptability, and cost-effectiveness of changing current practice.

ERGO number: 70228.A1

We would like to find out how often practising GPs and GP trainees access primary care research (in any form), and how we could improve its dissemination.

We are very much interested in the views of those who don't access research regularly, as well as those who do.

We would therefore be very grateful if you could consider completing a short online survey which will take less than 5 minutes to complete.

If you are willing to participate, please access the survey via this link: https://southampton.qualtrics.com/jfe/form/SV_bIRKhaA0CrmZJ3w

In this episode we talk to Professor Trisha Greenhalgh from the Nuffield Department of Primary Care Health Sciences at the University of Oxford.

Paper: Why do GPs rarely do video consultations? A qualitative study in UK general practice

https://doi.org/10.3399/BJGP.2021.0658

The pandemic provided strong impetus to extend remote consultation services in general practice, but video remains infrequently used. This study used in-depth case study methods to explore the multiple interacting influences on the non-adoption and abandonment of video consulting in general practice. Telephone was considered adequate for most remote consultations; the need for a hands-on physical examination explained why video rarely replaced in-person assessment in the remainder.

In this episode we talk to Dr Christo Karuna who is a Senior Lecturer at Monash University, Australia.

Paper: Prevalence of burnout among general practitioners: a systematic review & meta-analysis

https://doi.org/10.3399/BJGP.2021.0441

GP burnout is widely recognised as a problem in health care. However, no study has been conducted on the global burden of this condition. The systematic review and meta-analysis conducted in this study show that moderate to high levels of burnout exist worldwide. However, a challenge to policy makers is the wide variation in burnout estimates across studies and countries documented in this review. The findings from this review highlight that the context within which GPs work should be considered in better understanding GP burnout.