BJGP Interviews

In this episode we have a full version of the conversation we had with Professor Sir Michael Marmot. He scarcely needs introduction for his pioneering work on the social determinants of health. As many of you will know we have just passed the 50th anniversary of the publication of the article in which Julian Tudor Hart wrote about the inverse care law.

Sir Michael recorded this interview and we used a slightly shorter video version for the opening of our recent BJGP Webinar on health inequalities.

If you want to watch the webinar then visit www.bjgplife.com/webinar. The video version is, of course, included with that as well as all the other excellent speakers and panel discussion.

We talk to Dr Claire Friedemann Smith, a senior researcher at the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.

The paper is: GPs’ use of gut feelings when assessing c ancer risk in primary care: A qualitative study

Read the paper: https://doi.org/10.3399/bjgp21X714269

GP’s gut feelings have often been criticised because of their subjective nature. GP’s suggested that they did not rely on gut feelings in isolation but used them as prompts to gather additional clinical evidence to support their decisions and to reduce the potential criticism of being ‘unscientific’. They stated that gut feelings were integral to efficient and professional patient care, particularly when the presentation causing concern fell into a grey-area of clinical practice that guidelines do not adequately address. As gut feelings were described as most reliable when used by an experienced GP, grounded on years of observations and accumulated clinical knowledge, there may be a role for mentoring less experienced GPs to understand and respond appropriately to them.

In this episode we talk to Drs Laura Swaithes and Andrew Finney from the Impact Accelerator Unit, School of Medicine, Keele University in the UK.

Experience of implementing and delivering group consultations in UK general practice: a qualitative study

Read the paper: https://doi.org/10.3399/BJGP.2020.0856

Group consultations are a relatively new approach in UK general practice, with much of the literature examining the impact on clinical outcomes. This study explores the experiences of general practice staff implementing and delivering group consultations. Recommendations for clinicians focus on the need for an implementation strategy that considers local contextual circumstances, and, local and national evaluation data measuring process outcomes, to support the set-up and sustainability of the approach.

In this episode we talk to Dr Emily Donovan, a NIHR GP academic fellow from the School of Primary Care, Population Sciences and Medical Education at the University of Southampton.

Paper: Domestic abuse among female doctors: thematic analysis of qualitative interviews in the UK

Read the paper: https://doi.org/10.3399/BJGP.2020.0795

Previous qualitative research has focused on a doctor’s role in supporting victim-survivors of domestic abuse (DA) reinforcing the stereotype in which the doctor helps others experiencing DA rather than being a victim-survivor themselves. This study explored single doctor mothers’ lived experience of DA and identified several unique barriers to seeking help. Healthcare professionals need to be aware of these in order to better support patients who are medical doctors.

In this episode we talk to Clare MacRae, a GP at the Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics in Edinburgh.

Main paper: Comorbidity in chronic kidney disease:a large cross-sectional study of prevalence in Scottish primary care and this is at: https://doi.org/10.3399/bjgp20X714125

Additional paper discussed: Potentially inappropriate prescribing in people with chronic kidney disease: cross-sectional analysis of a large population cohort and this is at: https://doi.org/10.3399/BJGP.2020.0871

Chronic kidney disease (CKD) is common and results in significant mortality and morbidity, and is known to be commonly associated with hypertension, diabetes, and cardiovascular disease. Despite research indicating that people with CKD and comorbidity, of any type, are at increased risk of adverse clinical outcomes, little is known about the prevalence of discordant physical and mental health conditions in people with CKD. The present study found that almost all people with CKD have coexisting comorbidities, and that extreme comorbidity is >40 times more common in adults with CKD compared with age-, sex-, and deprivation-adjusted controls. The majority of discordant physical and mental health conditions were more common in people with CKD.

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

FEBRUARY ISSUE: https://bjgp.org/content/71/703

EDITORIAL: COVID-19 vaccination programme: a central role for primary care https://doi.org/10.3399/bjgp21X714929

EDITORIAL: Long COVID and the importance of the doctor–patient relationship https://doi.org/10.3399/bjgp21X714641

EDITORIAL: Integrating primary care across the prison and community interface https://doi.org/10.3399/bjgp21X714653

RESEARCH: Identifying patients at risk of psychosis: a qualitative study of GP views in South West England https://doi.org/10.3399/bjgp20X713969

LIFE & TIMES: The MRCGP Recorded Consultation Assessment: time to drop 10 minutes as standard? https://doi.org/10.3399/bjgp21X714725

LIFE & TIMES: The trolley problem, 2021 style https://doi.org/10.3399/bjgp21X714773

Visit BJGP Life: www.bjgplife.com/contribute

Book mentioned: On Immunity by Eula Bliss

In this episode we talk to Professor Jane Gunn, chair of primary care research, Department of General Practice, Melbourne Medical School, University of Melbourne, Australia.

The paper is: Matching depression management to severity prognosis in primary care: results of the Target-D randomised controlled trial

Read the paper: https://doi.org/10.3399/BJGP.2020.0783

Depression is a leading contributor to the global burden of disease and a significant problem in primary care, where it is typically identified and managed. Stepped care approaches are recommended but difficult to implement in routine care, due in part to a lack of effective tools to guide GPs in matching intervention intensity to patient need. Therefore, a clinical prediction tool was developed, which was embedded into a person-centred e-health platform, that matches depression management options to symptom severity prognosis. This randomised controlled trial showed using this platform results in greater improvement in depressive symptoms at 3 months compared to usual care. This approach could be implemented in routine care to support more efficient and effective depression care without adding to GPs’ workload.

In this episode we talk to Dr Garth Funston, a Clinical Research Fellow, from the Primary Care Unit, Department of Public Health and Primary Care at the University of Cambridge.

The paper is: Time from presentation to pre-diagnostic chest X-ray in patients with symptomatic lung cancer: a cohort study using electronic patient records from English primary care.

Read the paper: https://doi.org/10.3399/bjgp20X714077

England’s national cancer referral guidelines recommend that patients attending general practice with unexplained symptoms possibly caused by lung cancer, such as persistent cough, shortness of breath, and weight loss, have a chest X-ray promptly (within 14 days) to aid timely diagnosis. Only 35% of patients with lung cancer in this study had a chest X-ray within the recommended 14 days; and time between attending general practice with symptoms and having an X-ray was longer among people who smoke, females, and older patients. This research highlights a potential source of delayed lung cancer diagnosis and could inform initiatives aiming to achieve earlier diagnosis and improve outcomes.

In this episode we talk to Daniela Strelchuk from Population Health Sciences at the University of Bristol and Professor Stan Zammit from the Centre for Academic Mental Health, also at Bristol.

The paper is: Identifying patients at risk of psychosis: a qualitative study of GP views in South West England

Read the paper: https://doi.org/10.3399/bjgp20X713969

Previous research has shown that GPs have limited knowledge about the insidious symptoms of psychosis but little is known about the difficulties that GPs face in identifying patients at risk of psychosis. This study used semi-structured interviews to explore GPs’ experiences of this patient group, and found that some GPs were not familiar with the concept of being at risk of developing psychosis.

Whereas this could, in itself, be a barrier to identifying these patients, other barriers were present that related to patients not consulting or disclosing psychotic symptoms, lack of continuity of care, and high thresholds for accessing secondary care services.

In this episode we talk to Dr Gilly Mroz who is a postdoctoral researcher at the University of Oxford and Professor Trish Greenhalgh from the Nuffield Department of Primary Care Health Sciences at Oxford as well.

The title of the paper is: Changing media depictions of remote consulting in COVID-19: analysis of UK newspapers

Read the paper: https://doi.org/10.3399/BJGP.2020.0967

Remote consulting changed UK general practice overnight, resulting in new barriers to access and levels of care. This study explored how this change was portrayed in national newspapers over time. Early newspaper coverage of this change was largely positive and emphasised its necessity for safety reasons during the pandemic. Later coverage was more negative, raising concerns about quality and safety of care and digital inequalities.