In this episode, we talk to Dr Michelle Rickett, a Research Associate on the NIHR funded EXTEND study based at the School of Medicine at Keele University. 

Title of paper: Collaboration across the primary/specialist interface in early intervention in psychosis services: a qualitative study

Available at: https://doi.org/10.3399/BJGP.2023.0558

Early Intervention in Psychosis (EIP) service users may be referred from, and discharged back to, primary care. There is limited research on patient and carer experience of discharge to primary care from EIP services and little guidance around planning and implementation of discharge. This paper explores experiences of EIP care and discharge from the perspectives of service users, carers and healthcare professionals in EIP services and primary care. It explores the patient journey through EIP services, highlights the lost connection with primary care, and makes recommendations for more collaboration between primary and specialist care, particularly around physical health monitoring and management, which might improve patient experience and outcome.

In this episode, we talk again with Jen MacLellan, a qualitative researcher based within the Nuffield Department of Primary Care Health Sciences at the University of Oxford. 

Title of paper: Unpacking complexity: GP perspectives on addressing the contribution of trauma to women’s ill health

Available at: https://doi.org/10.3399/BJGP.2024.0024

Significant challenges and uncertainties reside in how best to manage the link between mind and body in communication with patients and in healthcare pathways. Lack of supportive resources to deliver holistic, trauma informed care risks practitioners (inadvertently) avoiding discussion of the contribution of distress in the illness presentation. A trauma informed systems level approach would support integration of psychological support within multiple care pathways and support wellbeing of practitioners providing care.

This study was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (NIHR202450). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

We're taking a summer break but will be back with our BJGP interview podcast on Tuesday 3 September.

We're taking a summer break but will be back with our BJGP interview podcast on Tuesday 3 September.

In this episode, we talk to Professor Clare Turnbull, Professor in Cancer Genetics at the Institute for Cancer Research and Honorary Consultant based at the Marsden. 

Title of paper: Breast cancer risk assessment for prescription of menopausal hormone therapy in women with a family history of breast cancer: an epidemiological modelling study

Available at: https://doi.org/10.3399/BJGP.2023.0327

Prospective longitudinal studies (such as the Collaborative Group on Hormonal Factors in Breast Cancer [CGHFBC]) have enabled the estimation of relative risks of breast cancer associated with different durations of exposure to and formulations of menopausal hormonal therapy (MHT). Risk models such as BOADICEA enable prediction of age-related breast cancer risk according to the extent and pattern of breast cancer family history. This study undertook integration of these two data sources (namely the CGHFBC datasets and the BOADICEA model) in order to model annual and 5-year risks for breast cancer incidence for the age window 50–80 years for hypothetical unaffected female consultands with different patterns of MHT exposure and different patterns of breast cancer family history, also generating predictions for breast cancer-specific death. This study modelled combined and oestrogen-only MHT but lacked data for analyses of newer types of MHT such as micronised progesterone or non-oral preparations.

In this episode, we talk to Dr Joe Hutchinson, who is a salaried GP and an academic GP working within the Centre for Primary Care and Health Services Research at the University of Manchester. 

Title of paper: Trends in full-time working in general practice: repeated cross-sectional study

Available at: https://doi.org/10.3399/BJGP.2023.0432

General practice is under increasing pressure, in part due to a lack of GPs. There is contention as to the proportion of GPs working full-time. We find that average hours and sessions worked per week by GPs in England have declined, whilst average hours per session has increased. Over half (55%) of GPs work at least the NHS Digital standard full-time definition of 37.5 hours per week. Average hours worked per session in 2021 was 51% greater than the BMA standard definition of a session’s duration. We recommend removing sessions as a definition of full-time working. However, if full-time work commitment continues to be defined in terms of the number of sessions worked, alignment with the NHS definition of 37.5 hours per week could be achieved by recognising that 6.0 sessions per week of 6.2 hours constitutes full-time work.

In this episode, we talk to Dr Anna Wilding, a Research Fellow based at Health Organisation, Policy and Economics at the University of Manchester. 

Title of paper: Geographic inequalities in need and provision of social prescribing link workers

Available at: https://doi.org/10.3399/BJGP.2023.0602

Social prescribing link workers were proposed in the 2019 NHS Long Term Plan to address health inequalities. Using national administrative data, we find that the subsequent roll-out of link workers has not been sufficiently targeted at areas of highest need. Higher need areas require additional support for employing link workers to tackle health inequalities and better support population needs.

In this episode, we talk to Lisa Davies, a PhD candidate based at Utrecht University. 

Title of paper: Patients’ perspectives about the role of primary healthcare providers in long-term opioid therapy: a qualitative study in Dutch primary care

Available at: https://doi.org/10.3399/BJGP.2023.0547

Previous research has shown the pivotal role of primary healthcare providers in managing long-term opioid use for patients with chronic non-cancer pain. This study adds the patient’s perspective, underscoring the importance of improved communication, medication management, regular assessments, and a patient-centred approach, especially during opioid tapering. Clinicians should prioritise these aspects to enhance patient care and outcomes for patients in chronic non-cancer pain management.

In this episode, we talk to Juan Carlos Bazo-Alvarez, a Senior Research Fellow within the Department of Primary Care and Population Health at University College London. 

Title of paper: Risk of Parkinson’s disease in people with New Onset Anxiety over 50 years - Incidence and Associated Features

Available at: https://doi.org/10.3399/BJGP.2023.0423

Presence of anxiety is known to be increased in the prodrome of Parkinson’s disease (PD). This study investigated the risk of developing PD in people with anxiety compared with those without anxiety, accounting for a number of confounding variables. The results suggest that there is a strong association between anxiety and later diagnosis of PD in patients aged ≥50 years who present with a new diagnosis of anxiety. This provides evidence for anxiety as a prodromal presentation of PD.

In this episode, we talk to Dr Meena Rafiq, Academic GP and Clinical Research Fellow within the Institute of Epidemiology and Health at University of Melbourne. 

Title of paper: Clinical activity in general practice before sarcoma diagnosis: an Australian cohort study

Available at: https://doi.org/10.3399/BJGP.2023.0610

Sarcoma is challenging to diagnose with delays associated with poor patient outcomes and experiences. This study has shown that patients with sarcoma often have multiple GP visits and imaging requests in the year before their diagnosis. Clinical activity in general practice increases from 6 months before sarcoma diagnosis, primarily in the form of imaging requests, indicating that opportunities for a timelier diagnosis may exist in some patients. Primary care interventions to increase awareness of sarcoma symptoms and streamline diagnostic pathways, including promoting and clarifying guidelines to optimise the use of appropriate imaging and direct specialist centre referrals, could improve earlier diagnosis and patient outcomes.