BJGP Interviews

Today, we’re speaking to Dr Pete Edwards, a GP and NIHR Research Fellow based at the University of Bristol. Pete has published a research article in the February issue of the BJGP titled,’ Safety-netting advice documentation in out-of-hours primary care: a retrospective cohort from 2013 to 2020’ along with an editorial about safety netting that we’re going to discuss today.

Title of paper: Safety-netting advice documentation in out-of-hours primary care: a retrospective cohort from 2013 to 2020

Available at: https://doi.org/10.3399/BJGP.2024.0057

Title of editorial: Safety netting in primary care : managing the low incidence, high uncertainty of severe illness

Available at: https://doi.org/10.3399/bjgp25X740529

Previous research has reported on safety-netting advice (SNA) documented in patient records during in-hours practice but this, to the authors’ knowledge, is the first large-scale (>1000 consultations) longitudinal analysis of the type of safety-netting documented advice during out-of-hours (OOH) primary care. This study demonstrated an increasing frequency of documented SNA in OOH records and increasing utility of specific advice over time. In contrast to previous reports of verbalised safety-netting during in-hours practice, this study found a higher frequency of SNA in records from face-to-face compared with telephone encounters. This study also showed safety-netting advice was more likely to be documented for patients with possible infections, but less frequently for mental health consultations. That is a possible area for improvement, in line with current UK policy for ‘parity of esteem’ between physical and mental health conditions.

Today, we’re speaking to Professor Anne Slowther, Emeritus Professor of Clinical Ethics based at the University of Warwick.

Title of paper: Experiences of using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in English general practice: a qualitative study among key primary health and social care professionals, patients, and their relatives

Available at: https://doi.org/10.3399/BJGP.2024.0248

The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a specific model of emergency care treatment planning now used in primary care and hospitals, and in many areas of the UK. It has been evaluated in hospital settings, but little is known about how it is understood and operationalised in general practice. Our research found a consensus that ReSPECT could facilitate a person-centred approach to future treatment decision making, but there are specific challenges in implementing ReSPECT in a community setting. A revised approach needs to consider uncertainty of illness trajectories over time and to emphasise patient values to facilitate decision making in an emergency.

In this episode, we talk to Professor Paul Little, Professor in Primary Care Research at the University of Southampton.

Title of paper: A randomised controlled trial of a digital intervention (Renewed) to support symptom management, wellbeing and quality of life in cancer survivors

Available at: https://doi.org/10.3399/BJGP.2023.0262

There are increasing numbers of cancer survivors who have finished their primary treatment whose quality of life remains consistently poor over years. There is limited robust evidence for pragmatic, brief interventions to support cancer survivors in primary care - which is where most participants are managed, and where resources are increasingly stretched. Cancer survivors quality of life improved with detailed generic online support. Robustly developed bespoke digital support provided limited additional benefit for cancer survivors in the short term, but modest additional longer term benefit in enabling symptom management and self-rated health, and with significantly reduced costs to the health service.

It’s that time of the year again! This episode, we have a round table discussion with the editorial team of Sam Merriel, Tom Round and Nada Khan. This collection of the BJGP’s top 10 research most read and published in 2024 brings together high-profile primary care research and clinical innovation.

And here are the top 10 most read papers of 2024:

10. Patient experiences of an online consultation system: a qualitative study in English primary care post-COVID-19

Available at: https://doi.org/10.3399/BJGP.2023.0076

9. Does shortage of GPs matter? A cross-sectional study of practice population life expectancy

Available at: https://doi.org/10.3399/BJGP.2023.0195

8. Primary care provision for young people with ADHD: a multi-perspective qualitative study

Available at: https://doi.org/10.3399/BJGP.2023.0626

7. Breast cancer risk assessment for prescription of Menopausal Hormone Therapy in women who have a family history of breast cancer

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

6. Training needs for staff providing remote services in general practice: a mixed-methods study

Available at: https://doi.org/10.3399/BJGP.2023.0251

5. Long-term cardiovascular risks and the impact of statin treatment on socioeconomic inequalities: a microsimulation model

Available at: https://doi.org/10.3399/BJGP.2023.0198

4. Exploring GPs views on beta-blocker prescribing for people with anxiety disorders: a qualitative study

Available at: https://doi.org/10.3399/BJGP.2024.0091

3. Optimising the use of the prostate- specific antigen blood test in asymptomatic men for early prostate cancer detection in primary care: report from a UK clinical consensus

Available at: https://doi.org/10.3399/BJGP.2023.0586

2. First Contact Physiotherapy: An evaluation of clinical effectiveness and costs

Available at: https://doi.org/10.3399/BJGP.2023.0560

1. Risk of Parkinsons disease in people with New Onset Anxiety over 50 years - Incidence and Associated Features

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

The BJGP podcast is back for a new season! Today, we’re speaking to Professor Joanne Reeve, who is a GP and Professor of Primary Care Research at Hull York Medical School. Joanne has published an editorial in the recent January edition of the BJGP titled, ‘Standing up for general practice’, and today we’re going to speak about this article and what it means to be a GP. 

Title of paper: Standing up for general practice

Available at: https://doi.org/10.3399/bjgp25X740373

We’re taking a break over Christmas and new year, but we’ll be back at the end of January 2025 with a new BJGP podcast. Look forward to seeing you then!

Today, we’re speaking to Dr Rebecca Payne and Professor Trish Greenhalgh. Rebecca is a GP and an NIHR In Practice Fellow, and works alongside Trish at the Nuffield Department of Primary Health Care Sciences at the University of Oxford. 

Title of paper: What are the challenges to quality in modern, hybrid general practice? A multi-site longitudinal study

Available at: https://doi.org/10.3399/BJGP.2024.0184

Quality in primary care is a multidimensional construct embracing effectiveness, efficiency, safety, patient-centredness, equity, continuity, accessibility, and more. We report on how UK practices have striven to deliver on these aspects of quality as they move to a hybrid model that combines in-person with remote and digital care. The context for quality is currently very challenging, with resource constraints, staff shortages, and weak infrastructure. Digital systems intended to increase efficiency have produced some benefits for some people but have created new forms of inefficiency, increased fragmentation of care, contributed to staff stress, and widened inequities of access.

Today, we’re speaking to Dr Dan Butler, a portfolio GP completing his PhD at Queen’s University Belfast. 

Title of paper: “Challenging but ultimately rewarding”: A qualitative analysis of Deep End GPs’ experiences

Available at: https://doi.org/10.3399/BJGP.2024.0167

GPs working in the highest need, socioeconomically deprived areas, the “Deep End”, face additional challenges. This paper looks at the NI context and explores why, despite the challenges, GPs choose to work in these areas. The main issues relate to wider healthcare failings and the challenges of patient populations some of whom generally frequently use (‘medicalised’ group) and those who underuse (‘missingness’ group) health services. GPs tend to relate to ‘Deep End’ areas, either due to personal connections or feelings of duty and social responsibility. No amount of General Practice focused funding will ‘solve’ the issues, instead a far greater holistic approach improving the physical conditions people are born, live and work in, is needed.

Today, we’re speaking to Dr Carol Sinnott, a GP and a Senior Clinical Research Associate based at The Healthcare Improvement Studies Institute. 

Title of paper: Understanding access to general practice through the lens of candidacy: a critical review of the literature

Available at: https://doi.org/10.3399/BJGP.2024.0033

Dominant conceptualisations of access to health care are often framed in terms of speed and supply — these approaches risk obscuring important aspects of people’s experiences of access. The Candidacy Framework was developed to study access to health care by people in vulnerable groups. This study confirms the salience of the Candidacy Framework for understanding access in the setting of general practice, offering new insights for policy and practice.

Today, we’re speaking to Dr Sarah Sullivan, a Senior Research Fellow based within the Centre for Academic Mental Health at the University of Bristol. 

Title of paper: External validation of a prognostic model to improve prediction of psychosis in primary care

Available at: https://doi.org/10.3399/BJGP.2024.0017

This paper reports the external validation of the only psychosis risk prediction algorithm to be used in primary care. External validation of prediction algorithms is essential to provide evidence of transportability i.e. that the algorithm can be used outside its training environment. This vital step for prediction algorithms is often missed.