BJGP Interviews

PLAYER

In this episode we speak to Dr Claire Friedemann Smith who is a senior researcher at the Nuffield Department of Primary Care, University of Oxford

Paper: Building the case for the use of gut-feelings in cancer referrals: perspectives of patients referred to a non-specific symptoms pathway

https://doi.org/10.3399/BJGP.2021.0275

Despite the reported diagnostic utility for cancer of GPs’ gut feelings and the role they may play in facilitating diagnosis through prompting investigation, research has not explored the use of gut-feelings in clinical decision making with patients. Our study found that patients were supportive of the use of gut-feelings if they facilitated investigations but cautioned against their use if it meant that investigations would be deferred or denied. Patients discussed the difficulty facing GPs of having to fit individuals to referral ‘tick boxes’ in order to make a referral, were aware of the time pressured and resource limited conditions of primary care practice, and raised these as reasons for why GPs’ use of gut-feelings is justified. Patients share GPs’ concerns around gut-feelings overburdening NHS resources and increasing the risk of negligence and litigation and these should be investigated.

In this episode we speak to Professor Helen Snooks who is Professor of Health Services Research in the Medical School at Swansea University in Wales.

Paper: Implementing emergency admission risk prediction in general practice: a qualitative study

https://doi.org/10.3399/BJGP.2021.0146

UK policy has incentivised use of risk prediction stratification in primary care to reduce emergency hospital admissions, despite lack of evidence about process or effect. In a trial evaluating a risk prediction tool (PRISM) in general practice, our team reported increased emergency and hospital admissions. To understand implementation, we interviewed GPs and Practice Managers who reported using PRISM on a small group of high-risk patients. Although they doubted any impact on care, they said PRISM raised their awareness of highest-risk patient groups, which potentially may affect unplanned hospital attendance and admissions.

In this episode we speak to Dr Lucy Martin who is a GP at Eve Hill Medical Practice in Dudley in the West Midlands.

Paper: The professional resilience of mid-career GPs in the UK: a qualitative study

https://doi.org/10.3399/BJGP.2021.0230

In this study, GPs identify ‘good’ mid-career resilience and protective factors such as social support, which concurs with existing research. The novel contribution is the identification of clear factors that reduce the professional resilience of GPs in the UK. A GP with strong resilience may exhibit obstructive work behaviours and surface acting to demonstrate resilience. Resilience has become another work task for GPs. Social media, despite being intended to be supportive, can act as a drain on resilience.

In this episode we speak to Dr Patrick Highton who is a Research Associate at the Diabetes Research Centre at the University of Leicester and also part of the NIHR Applied Research Collaboration East Midlands.

Paper: Promoting physical activity through group self-management support for those with multimorbidity: a randomised controlled trial

https://doi.org/10.3399/BJGP.2021.0172

People with multimorbidity typically display increased morbidity and mortality risk, driven in part by reduced levels of habitual physical activity. Disease self-management empowers patients to take more of an active role in their own healthcare and has shown promise in individual conditions, though this is under-researched in multimorbidity. This study investigated the impact of a targeted group-based disease self-management programme on habitual physical activity levels in people with multimorbidity. However, a slight decrease in physical activity levels was observed, suggesting that the intervention was ineffective, and that future research should target those at greatest need for physical activity intervention.

In this episode we speak to Dr Alex Walker who is an epidemiologist at the Nuffield Department of Primary Care Health Sciences, University of Oxford.

Paper: Clinical coding of long COVID in English primary care: a federated analysis of 58 million patient records in situ using OpenSAFELY

https://doi.org/10.3399/BJGP.2021.0301

Early case definitions and clinical guidelines have been published to describe long COVID, and clinical codes based on these guidelines were published in late 2020. This study found wide variation in the early use of these codes, by practice, geographic region, and practice electronic health record software. Promotion of the clinical guidance and codes is important for future research and ongoing patient care.

In this episode we talk to Dr Hogne Sandvik who is a senior researcher at the National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen.

Paper: Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway

https://doi.org/10.3399/BJGP.2021.0340

Continuity of care with a GP is generally regarded as an aspect of quality. It is usually measured by visit patterns with different providers over time and is associated with lower mortality rates, fewer hospital admissions, and less use of emergency departments. This nationwide study of the Norwegian population shows that longitudinal continuity with a named regular GP is significantly associated with the need for out-of-hours services, acute hospital admissions, and mortality in a dose-dependent way. When longitudinal continuity exceeds 15 years, the probability of these occurrences is reduced by 25–30%.

In this episode we talk to Professor Brendan C Delaney who is a GP partner and Chair in Medical Informatics and Decision Making at Imperial College London.

Paper: Recommendations for the recognition, diagnosis, and management of long Covid: A Delphi study

https://doi.org/10.3399/BJGP.2021.0265

There is an urgent need to devise clinical pathways and guidance for long Covid (thought to affect 10% of those diagnosed with Covid-19). In the absence of conclusive research to inform clinical practice, “expert physician-patients” (i.e., doctors with long Covid and those involved in nascent clinics) are a source of professional expertise. Using robust consensus methodology, we derived 35 clear and practical recommendations to assist in the organisation of clinics, and the diagnosis and management of patients with long Covid. Medically-led multidisciplinary clinics are required as serious cardiovascular, neurocognitive, respiratory and immune sequelae such as can present with only non-specific symptoms.

In this episode we speak to Dr Thomas Round who is a GP in East London and NIHR doctoral research fellow.

Paper: Cancer detection via primary care urgent referral and association with practice characteristics: a retrospective cross-sectional study in England from 2009/2010 to 2018/2019

https://doi.org/10.3399/BJGP.2020.1030

There is considerable variation in the use of urgent suspected cancer referrals (2-week wait [2WW]) between general practices in England, with increased use associated with improved outcomes for patients with cancer. There has been limited research into the practice and population characteristics associated with cancer detection via 2WW referral pathways. Over the 10-year period up to 2018/2019, yearly 2WW referrals more than doubled to more than 2.24 million, leading to an increase in cancer detection and 66,172 additional cancers diagnosed via 2WW in 2018/2019 compared with 2009/2010.

Higher cancer detection via 2WW referrals was associated with larger practices and those with younger GPs, although the relationship with GP age was attenuated in more recent years. Of concern are decreases in 2WW referrals during the COVID-19 pandemic and the appearance of potential disparity in cancer detection, with lower rates in practices that serve more deprived populations.

In this episode we talk to Professor Stewart Mercer who is a Professor of Primary Care and Multimorbidity at the Usher Institute, College of Medicine and Veterinary Medicine at the University of Edinburgh.

Paper: Implementing social prescribing in primary care in areas of high socioeconomic deprivation: process evaluation of the ‘Deep End’ community links worker programme

https://doi.org/10.3399/BJGP.2020.1153

Social prescribing using primary care-based link workers is increasingly promoted across the four nations of the UK and elsewhere in the world, as a way of reducing health inequalities by better supporting people living in deprived areas. However, the evidence-base of effectiveness is limited, and there is very little information on how best to successfully implement a link worker approach in practice.

This study reports on a process evaluation of the ‘Deep End’ Links Worker Programme (LWP) over a two-year period, in seven general practices in deprived areas of Glasgow. Despite the programme being well-funded and well supported, the majority of practices involved had not fully integrated the LWP within the first two years. Implementing social prescribing and link workers within primary care at scale is unlikely to be a ‘quick fix’ for mitigating health inequalities in deprived areas.

In this episode we talk to Dr Peter Edwards who is a GP and academic clinical fellow at the Centre for Academic Primary Care at the University of Bristol Medical School.

Paper: Factors affecting the documentation of spoken safety-netting advice in routine GP consultations

https://doi.org/10.3399/BJGP.2021.0195

Previous research has provided qualitative insights into how GPs document safety-netting advice and there have been quantitative reports of the binary presence or absence of safety-netting in medical records. This is the first study to undertake a detailed analysis of the content of documented safety-netting advice and make objective comparisons to what was spoken in recorded consultations.

GPs more frequently documented their safety-netting advice if it was specific (e.g. “I’d want you to come back if you start coughing up horrid coloured stuff, greeny-browny, or if you start coughing up any blood, or if you feel more short of breath.”) rather than generic advice (e.g. “any problems let me know”), for a new problem, and for problems that were the entire focus of a consultation.

These trends in GP documentation practices highlight that certain consultations, such as those where multiple problems are assessed, may represent a higher medico-legal risk to GPs due to incomplete documentation, and these potential biases should be considered in medical-records based research.