BJGP Interviews

In this episode we talk to Mr Ashu Gandhi who is a consultant surgeon from Wythenshawe Hospital in Manchester and an honorary senior lecturer at the Manchester Breast Centre at the University of Manchester.

Paper: No association between breast pain and breast cancer: A prospective cohort study of 10,830 symptomatic women presenting to a breast cancer diagnostic clinic

https://doi.org/10.3399/BJGP.2021.0475

zWomen with breast pain are often anxious that this symptom may represent an underlying breast malignancy and are consequently referred to secondary care to exclude this diagnosis. This study shows that the incidence of breast cancer in women with breast pain alone (no associated symptoms such as breast lumps or nipple discharge) is 0.4%, a figure similar to that seen in asymptomatic women invited for breast screening. Economic analysis confirms that referral of women with breast pain alone to secondary care diagnostic clinics is associated with increased cost but no additional health benefits. Women with breast pain should be reassured that they are at no greater risk of breast cancer than asymptomatic women.

In this episode we talk to Dr Hassan Awan who is a GP and Wellcome Doctoral Fellow at the School of Medicine, Keele University.

Paper: Emotional distress, anxiety and depression in South Asians with long-term conditions: a qualitative systematic review

https://doi.org/10.3399/BJGP.2021.0345

Mental health is reported to be poorer among people with long-term conditions (LTCs) and people of South Asian origin, but little is known about their experiences. This research adds that people of South Asian origin with long-term conditions describe emotional distress using non-medical terminology, even when describing suicidality. This may be related to their cultural understanding of the world. We highlight the importance of cultural competence to prevent clinicians from being viewed as not understanding the patient, and irrelevant as a means of support.

In this episode we talk to Dr Joāo Delgado who is a lecturer in Epidemiology and Public Health, College of Medicine and Health at the University of Exeter.

Paper: Continuity of general practitioner care for patients with dementia: impact on prescribing and the health of patients

https://doi.org/10.3399/BJGP.2021.0413

Evidence is limited about the potential positive effects of higher continuity of general practice care (CGPC) in patients with dementia. There is no cure for dementia, so finding elements of care that make a difference to patients remains a priority. Patients with dementia in the highest CGPC quartile were 34.8% less likely to develop delirium, 57.9% less likely to develop incontinence, and 9.7% less likely to have an emergency admission to hospital, compared with the lowest quartile. Higher continuity of care was also associated with lower medication burden and fewer potential inappropriate prescriptions.

In this episode we talk to Professor Jeremy Horwood who is a professor of social sciences and applied health research at NIHR ARC West, and the Centre for Academic Primary Care, at the University of Bristol.

Paper: Unintended consequences of online consultations: a qualitative study in UK primary care

https://doi.org/10.3399/BJGP.2021.0426

Previous studies have shown that online consultations may be best for straightforward transactions such as simple and administrative queries, but do not necessarily deliver improvements in access to care or practice efficiency. This qualitative study identified unintended consequences of a range of online consultation tools that negatively impacted patients’ ability to communicate effectively with a GP, access to care, practice workload, and staff satisfaction. These consequences were often operational challenges that could be foreseen and prevented; however, the tools also had consequences that favoured simple, remote transactions and a shift away from holistic face-to-face care.

In this episode we talk to Dr Gail Hayward who is a GP and Associate Professor of Primary Care at the Nuffield Department of Primary Care Health Sciences, University of Oxford.

Paper: Urine collection devices to reduce contamination in urine samples for diagnosis of uncomplicated UTI: a single-blind randomised controlled trial in primary care

https://doi.org/10.3399/BJGP.2021.0359

This trial is the first to evaluate the effectiveness of urine collection devices in the population of most relevance: women with symptoms of UTI presenting to primary care. Neither device tested reduced sample contamination when used by women presenting to primary care with symptoms attributable to uncomplicated UTI. Since there are no other studies in this population, their use cannot be recommended for this purpose in this setting.

In this episode we talk to Dr Stephen Bradley who is a GP and clinical research fellow at the University of Leeds.

Paper: Associations between general practice characteristics and chest X-ray rate: an observational study

https://doi.org/10.3399/BJGP.2021.0232

Abnormal findings on chest X-rays that have been requested by GPs because of symptoms are an important route to lung cancer diagnosis. Previous research has suggested that increased rates of chest X-ray and urgent referral for suspected cancer may be associated with earlier stage at diagnosis for lung cancer. This study demonstrates that there is substantial variation in rates of investigation between practices, and that only a small proportion of that variation is owing to examined population and practice characteristics. Encouraging practices that have low chest X-ray rates to lower their thresholds for investigation could prove to be an effective strategy to detect lung cancer earlier and improve outcomes.

• Systematic Review on sensitivity CXR: https://bjgp.org/content/69/689/e827
• Observational study on sensitivity of CXR: https://bjgp.org/content/71/712/e862
• Estimating risk of lung cancer following negative CXR: https://bjgp.org/content/71/705/e280
• Observational study on frequency of CXR use and practice/population characteristics: https://bjgp.org/content/72/714/e34

1. Lung cancer stage shift following a symptom awareness campaign (Kennedy) https://thorax.bmj.com/content/73/12/1128
2. What characteristics of primary care and patients are associated with early death in patients with lung cancer in the UK? (O'Dowd )https://thorax.bmj.com/content/70/2/161

• The proportion of lung cancer patients attending UK lung cancer clinics who would have been eligible for low-dose CT screening (Gracie) https://erj.ersjournals.com/content/54/2/1802221
• What is the balance of benefits and harms for lung cancer screening with low-dose computed tomography?  (Bradley) https://journals.sagepub.com/doi/full/10.1177/0141076821991108

• Evidence submitted to health & social care parliamentary select committee inquiry on cancer services (Bradley) https://committees.parliament.uk/writtenevidence/38850/pdf/

In this episode we talk to Dr Christos Grigoroglou and Professor Kieran Walshe. Christos is a Research Fellow in Health Services Research, Manchester Centre for Health Economics and Kieran is a Professor of Health Policy and Management both at the University of Manchester.

Paper: The scale and scope of locum doctor use in general practice in England: Analysis of routinely collected workforce data in 2017-2020

https://doi.org/10.3399/BJGP.2021.0311

Prior research on the extent of GP locum use in general practice and the composition of the GP locum workforce is sparse, and the availability of new data from general practice allows for a real opportunity to generate new knowledge and to add to the understanding of the current GP workforce composition. Results of the study suggest that GP locum use has remained stable over time and our comparisons of GP locums with other types of GPs show that locums are mostly younger male doctors of whom a large proportion have qualified elsewhere than the UK and who work in underperforming practices. Substantial regional variation in GP locum use across England indicate differences in workforce planning, recruitment and retention. This work provides a useful approach to measure the extent of locum use in primary care and can aid workforce planning by identifying areas of increased recruitment, areas with high GP turnover and also the drivers behind variation in locum use in primary care in England.

In this episode we speak to Dr Anita Lim who is a Senior Research Fellow, School of Cancer and Pharmaceutical Sciences at King’s College London.

Paper: Non-speculum sampling approaches for cervical screening in older women: randomised controlled trial

https://doi.org/10.3399/BJGP.2021.0350

Inadequately screened women aged 50 and older are at a disproportionately higher risk of cervical cancer and dying from it. Speculum use is a major barrier to cervical screening and can become more uncomfortable with ageing and the menopause. Although self-sampling has been hailed as a game-changer for cervical screening, it does not appeal to all women. This study showed that offering a choice of non-speculum clinician sampling or self-sampling substantially increased cervical screening uptake in older lapsed attendees across all ethnicities, an approach which could be easily implemented into existing practice in primary care.

In this episode we talk to Dr Iona Heath, a retired GP from Kentish Town and former President of the RCGP. She talked to us after writing an editorial for the BJGP. She discusses the current crisis in UK general practice and offers an approach that can tackle some of the deep-rooted problems we face. 

The editorial: Rewilding general practice.

Paper: https://doi.org/10.3399/bjgp21X717689

In this episode we talk to Dr Jordan Moxey and Dr Carol Sinnott who are both at the Department of Public Health and Primary Care, The Healthcare Improvement Studies Institute in Cambridge. Jordan is a medical doctor and programme coordinator. Carol is a Senior Clinical Research Associate and GP.

Paper: Identifying how GPs spend their time and the obstacles they face: a mixed-methods study

https://doi.org/10.3399/BJGP.2021.0357

Direct observations of what consumes GPs’ time and what might disrupt their ability to complete tasks have remained remarkably rare. Operational failures are common in general practice and highly consequential. Frequent operational failures include interruptions interfering with task completion, problems relating to equipment and supplies, problems arising from GPs’ coordination role, and defects in organisational processes within practices. The impact of operational failures in general practice goes well beyond diversion of time and interference with task completion: they are very adverse for GPs’ experiences of work.