BJGP Interviews

In this episode we talk to Dr Felicity Knights who is a GP Academic Clinical Fellow at The Migrant Health Research Group, Institute for Infection and Immunity, St George’s, University of London.

Paper: Impact of COVID-19 on migrants’ access to primary care and implications for vaccine roll out: a national qualitative study

https://doi.org/10.3399/BJGP.2021.0028

The impact of pandemic-related shifts in primary care delivery on marginalised migrant groups, who may already face major disparities in accessing primary care, is poorly elucidated. We found that the rapid digitalisation of primary care services and physical closure of surgeries during the pandemic have amplified disparities in access to healthcare for specific migrant groups, with many lacking access to and capacity to use technology, compounded by language barriers. Migrants may be at increased risk of misinformation about COVID-19, and face barriers to vaccination, which merits further consideration as COVID-19 vaccine roll out begins. Improved outreach to local migrant community organisations and places of worship, alongside co-designing with migrants more inclusive delivery approaches and creative integration of migrant ambassadors into information- sharing campaigns are needed.

Primary care can maximise the opportunities of digitalisation for migrants through flexible engagement by multiple modalities (e.g. text, email, letter and YouTube videos) to provide targeted, translated advice and information, virtual group consultations for patients with a specific condition, and working with local leaders and NGOs to access and disseminate information through informal communication channels.

https://www.doctorsoftheworld.org.uk/what-we-stand-for/supporting-medics/safe-surgeries-initiative/safe-surgeries-toolkit/

In this episode we speak to Dr Fiona Cuthill who is a Senior Lecturer, School of Health in Social Science, University of Edinburgh.

Paper: An exploration of GP care in outreach settings for people experiencing homelessness: a qualitative study

https://doi.org/10.3399/BJGP.2020.0749

Although people experiencing homelessness (PEH) have the worst health outcomes in society, they have a low uptake of primary care services. GP outreach has developed as a way of increasing access into primary care but little is known about the experience of patients receiving care in this way. By exploring the experiences of PEH and staff/volunteers working within community outreach settings, this study uncovers the reasons why PEH engage with GPs in a community outreach setting but not a specialist or mainstream GP service. Clearly, physical space and organisational environment are important factors. These findings can help to inform GPs caring for PEH to build an environment which supports the development of stronger doctor-patient relationships within the confines of their current system.

In this episode we talk to Dr Elizabeth Cecil, Honorary Research Fellow, Department of Primary Care and Public Health, Imperial College London

Paper: Factors associated with potentially missed acute deterioration in primary care

https://doi.org/10.3399/BJGP.2020.0986

Failure to recognise serious illness (or patient deterioration) can contribute to avoidable harm to a patient. Little is known of determinants of missed deterioration in primary care. GP telephone and video consultations have increased substantially with the COVID-19 pandemic, but these forms of consultations have not been fully evaluated and may increase missed deterioration in primary care.

In this episode we are joined by Remco Tuijt who is a PhD candidate in the Research Department of Primary Care and Population Health, University College London

Paper: Remote primary care consultations for people living with dementia during the COVID-19 pandemic: experiences of people living with dementia and their carers

Available at: https://doi.org/10.3399/BJGP.2020.1094

Primary care consultations in the United Kingdom have shifted towards remote methods as a result of the COVID-19 pandemic. This qualitative study explores the experiences of and attitudes towards remote consultation through thematic analysis of interviews with people living with dementia and their carers. COVID-19 related check-up calls were found reassuring, albeit somewhat lacking in practical recommendations. Avoidance of healthcare services was reported for numerous reasons, including COVID-19 risk as well as relieving the strain on the NHS. However, when individuals did have remote consultations, these were mostly by telephone and commonly managed by the carer. Primary care professionals engaging with people living with dementia and their carers may need to make extra effort to ensure the efficacy of remote healthcare consultations with patients living with dementia and their carers.

In this episode we are joined by Dr Alison Berner, Clinical Research Fellow in Medical Oncology & Specialty Doctor in Gender Identity Medicine at Barts Cancer Institute, Queen Mary University of London and the Tavistock and Portman NHS Foundation Trust, London, UK.

Paper: Attitudes of trans men and non-binary people to UK cervical screening

https://doi.org/10.3399/BJGP.2020.0905

The UK’s National Health Service cervical screening program has contributed to a 70% reduction in the cervical cancer mortality since 1988. Trans men and non-binary people assigned female at birth (TMNB) experience barriers to accessing adequate cervical screening and are less likely to engage in screening than cisgender women but the attitudes, experiences and behaviours of TMNB as they relate to cervical screening remain unexplored in a UK context. This study indicates that TMNB lack sufficient information about cervical screening and experience barriers to accessing screening services at personal, interpersonal and institutional levels. Cervical screening uptake could be increased by adopting TMNB-appropriate screening invitations, providing options for self-sampling, improving cultural sensitivity in health literature, and improving access to trans-specific or trans-aware health services.

In this episode I am joined by all three of our Associate Editors, Sam Merriel, Tom Round and Nada Khan, for some conversation. The May issue has been published and we talk over some of the highlights in this month's issue.

MAY ISSUE: https://bjgp.org/content/71/706

In this episode we speak to Dr Jo Parsons, Research Fellow at Warwick Medical School, University of Warwick.

Paper: Which patients miss appointments with general practice and why? A systematic review

https://doi.org/10.3399/BJGP.2020.1017

Missed GP appointments have considerable time and cost implications on healthcare services. This review reveals how many booked primary care appointments are missed, reasons given for this, and what characteristics are commonly associated with missed appointments. This has implications for general practices and clinicians aiming to reduce rates of missed appointments, and implementing strategies for this.

In this episode we are joined by Dr Jean-Pierre Laake who was an epidemiologist at Centre for Cancer Prevention at Queen Mary University of London when this research was undertaken but who has now taken up medical training. We are also joined by Professor Willie Hamilton who is Professor of Primary Care Diagnostics at the University of Exeter and also a GP although he has recently dropped his clinical practice.

Paper: Targeted encouragement of GP consultations for possible cancer symptoms: a randomised controlled trial

https://doi.org/10.3399/bjgp20x713489

Later stage of cancer diagnosis is associated with poorer survival, and may arise from low symptom awareness and delays in presenting to primary care. Population-wide campaigns to increase awareness and encourage help seeking have shown mixed results in terms of stage at diagnosis and numbers of primary care consultations. This randomised controlled trial was targeted at a population whose circumstances suggested that, should they develop cancer, they would be at increased risk of being diagnosed with later-stage disease. This study demonstrates that targeted interventions of this nature, promoting both awareness of cancer symptoms and earlier health seeking, can change consultation behaviour of those who are likely to benefit most from earlier symptomatic presentation. However, in his study the intervention increased the frequency of consultation but not the number of persons consulting.

In this episode we are joined by Dr Riitta Partanen who is a GP and Associate Professor at the Rural Clinical School, Faculty of Medicine, The University of Queensland in Australia.

Paper: GPs’ insights about discontinuing long-term antidepressant use: a qualitative study

https://doi.org/10.3399/BJGP.2020.0913

Most antidepressant prescriptions are generated in general practice and discontinuation is challenging. Understanding GPs’ insights into decision-making around discontinuing long-term antidepressant use is needed to underpin change. This study points to discontinuation as a journey for the GP-patient dyad that is not a simple deprescribing decision but is built on relationship and grounded in enabling social context.

In this episode I am joined by two of our Associate Editors, Sam Merriel and Tom Round, for some conversation. The April issue has been published and we talk over some of the highlights in this month's issue.

APRIL ISSUE

https://bjgp.org/content/71/705

EDITORIAL: Remote by default general practice: must we, should we, dare we? https://doi.org/10.3399/bjgp21X715313

EDITORIAL: Helping GPs to diagnose children’s cancer https://doi.org/10.3399/bjgp20X715241

LETTER: Prostate-specific antigen testing and opportunistic prostate cancer screening — CAP intervention https://doi.org/10.3399/bjgp20X715361

RESEARCH: Diagnosing community-acquired pneumonia via a smartphone-based algorithm: a prospective cohort study in primary and acute-care consultations https://doi.org/10.3399/bjgp.2020.0750

RESEARCH: Estimating lung cancer risk from chest X-ray and symptoms: a prospective cohort study https://doi.org/10.3399/bjgp20X713993

LIFE & TIMES: Drugs for chronic pain: we still need them https://doi.org/10.3399/bjgp21X715457

Visit BJGP Life: www.bjgplife.com/contribute

Book mentioned: In Control by Jane Monckton-Smith

PSA links mentioned by Sam:

https://phescreening.blog.gov.uk/2020/01/20/psa-testing-guidance/

https://www.gov.uk/government/publications/prostate-specific-antigen-testing-explanation-and-implementation/advising-well-men-about-the-psa-test-for-prostate-cancer-information-for-gps

https://www.cancerresearchuk.org/about-cancer/prostate-cancer/getting-diagnosed/screening