In this episode, we talk to Dr Sahar Pahlavanyali, a doctor and PhD candidate based at the Department of Global Public Health and Primary Care at the University of Bergen in Norway. 

Title of paper: Continuity and breaches in GP care and their associations with mortality for patients with chronic disease: an observational study using Norwegian registry data

Available at: https://doi.org/10.3399/BJGP.2023.0211

There is a growing body of evidence on advantages of continuity, and a GP personal list is believed to be one of the positive measures to improve continuity, though not much researched. In a Norwegian setting with GP personal lists, we investigated the associations between GP continuity and mortality for patients with different chronic diseases. Our results showed that lower GP continuity was associated with increased risk of death, but the association was not significantly different for patients with the same RGP compared with those with different RGPs. This study suggests that high informational and management continuity provided by a GP personal list might lower and compensate for the adverse effects when changing GP.

In this episode, we talk to Dr Zoe Anchors, a Research Fellow based at the Centre for Health and Clinical Research at the University of the West of England. 

Title of paper: A qualitative investigation of the Additional Roles Reimbursement Scheme in primary care’

Available at: https://doi.org/10.3399/BJGP.2023.0433

The government has delivered on its commitment of recruiting 26,000 more primary care professionals through the ARRS in order to reduce patient waiting lists, widen the range of healthcare services and meet the needs of local populations. This qualitative analysis supports the positive impact of these additional roles in broadening the healthcare available to patients, and finds similar challenges (i.e., lack of career progression and supervision; lack of understanding of role descriptions and scope creep; problematic roadmaps; and poor integration) to implementation previously identified. However, our data reveals the scheme’s inflexibility and lack of available workforce particularly impacted Primary Care Networks in deprived areas resulting in the potential exacerbation of health inequalities, with the needs of populations not necessarily being met. More flexibility needs to be provided about who and what is funded under the scheme, with particular focus in areas of higher deprivation.

In this episode, we talk to Dr Lucy Potter, a GP and a doctoral research fellow based at the Centre for Academic Primary Care at the University of Bristol.

Title of paper: Improving access to general practice for and with people with severe and multiple disadvantage

Available at: https://doi.org/10.3399/BJGP.2023.0244

This study builds on previous work showing that continuity of care, being able to develop a trusting relationship and being proactive are of particular importance in providing care to highly people with SMD(3-7). This work describes co-designed strategies including prioritising patients on an inclusion patient list with more flexible access, continuity from a care coordinator and micro-team, and an information sharing tool, in addition to rich contextual information on how to shift ways of working to achieve this. These co-designed strategies are practical examples of proportionate universalism in general practice, where resources are prioritised to those most in need. They could be adapted and piloted in other practices and areas and may also offer promise in improving inclusion of other marginalised groups. Investing in this focused way of working may improve healthcare accessibility, health equity and staff wellbeing.

We are taking a break from the BJGP podcast this week for Easter, but we’ll be back on 9 April 2024. 

In this episode, we talk to Professor Miranda Pallan, a public health doctor who is Professor of Child and Adolescent Public Health at the University of Birmingham.

Title of paper: Supporting healthcare professionals to address child weight with parents: a qualitative study

Available at: https://doi.org/10.3399/BJGP.2023.0238

Healthcare professionals (HCPs) working in primary care and community settings are known to experience barriers in discussing child excess weight with parents. We conducted a qualitative study with General Practitioners, Primary Care Nurses and School Nurses to further explore these barriers and identify facilitating factors to inform recommendations for actions to support HCPs in addressing child weight with parents. Structural changes within primary/community care, joined up systems and data sharing across agencies, and development of HCP knowledge and skills through core training and continuing professional development will enable HCPs to discuss child weight and provide advice to parents.

In this episode, we talk to Dr Susan Moschogianis, a Research Associate based at the Health Services Research and Primary Care team at the University of Manchester.

Title of paper: Patient experiences of an online consultation system: qualitative study in primary care post-COVID-19

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

Online consultation systems (OCSs) have been rolled out rapidly, but little is known about patients’ experiences using them. We undertook the largest ever reported qualitative study of patient experiences using an OCS. Our findings provide insight into why some patients prefer in-person consultations, and why others prefer to use OCSs. Patients’ experiences of using OCSs can be influenced by how they are designed, how GP practices use them, and characteristics of the patient and request they use them for.

In this episode, we talk to Laiba Hussain, a THIS Institute Research Fellow and PhD Candidate at the Nuffield Department of Primary Care Health Sciences at the University of Oxford.

Title of paper: Developing user personas to capture intersecting dimensions of disadvantage in marginalised older patients: a qualitative study

Available at: https://doi.org/10.3399/BJGP.2023.0412

Equity is an important core value in primary care, but meeting the needs of patients who are multiply disadvantaged is increasingly difficult as services become more digitised. User personas (fictional cases based on empirical data which draw together and illustrate the multiple intersecting elements of disadvantage) could help practices better plan for the needs of disadvantaged groups.

In this episode, we talk to Dr Shamil Haroon, Associate Clinical Professor and Honorary Consultant in Public Health Medicine at the University of Birmingham, and Dr Prasad Nagakumar, a Paediatric Respiratory Consultant. 

Title of paper: Post-hospitalisation asthma management in primary care: a retrospective cohort study

Available at: https://doi.org/10.3399/BJGP.2023.0214

Asthma is a common cause of hospital admissions and clinical guidelines recommend that hospitalised patients are followed up in primary care. Little research has been done on 3 evaluating post-hospitalisation asthma management in primary care. We found that 40% of hospitalised patients did not receive asthma management in primary care following hospital discharge, particularly among patients from black ethnic minority groups. Primary and secondary care services should develop systems for ensuring the timely follow-up of asthma patients after hospital discharge and address the observed health inequities.

In this episode, we talk to Patrick Burch, a GP and a THIS Institute PhD fellow at the Centre for Primary Care and Health Services Research at the University of Manchester.

Title of paper: An observational study of how clinicians, patients and the health care system create the experience of joined up, continuous primary care in the absence of relational continuity

DOI: https://doi.org/10.3399/BJGP.2023.0208

The way that many modern healthcare systems are designed increasingly relies on the assumption that, in the absence of relational continuity, any competent clinician can deliver joined up, continuous care if they have access to clinical notes. This study of a primary care environment, where patients are usually seen by a clinician they have not seen before, demonstrates multiple connected patient, clinician, and system factors that appear important for a patient to experience joined up, continuous care. Considering these factors in the design of primary care systems may have the potential to improve experience for patients.

In this episode, we talk to Dr Shoba Dawson, a Senior Research Fellow within the School of Medicine and Population Health at the University of Sheffield .

Title of paper: Understanding non-recreational prescription medication sharing behaviours: A systematic review

Available at: https://doi.org/10.3399/BJGP.2023.0189

Sharing of prescription medicines for non-recreational purposes is a form of inappropriate medication use and such practices can cause delays in seeking medical care, masking the symptoms and severity of disease and could potentially result in the progression of the health condition. The reasons why people engage in medication sharing, how they assess the potential risks and benefits of these practices, and the factors which influence these behaviours are poorly understood. This systematic review shows that prescription medication sharing for non-recreational purposes is common with analgesics and antibiotics being the most commonly shared medications. Data on the prevalence and predictors of these behaviours are however limited. This review highlights that prescription medication sharing for non-recreational purposes is a potentially important medicines safety issue and significant public health concern which merits healthcare provider intervention, public awareness efforts and further research.