BJGP Interviews

In this episode, we talk to Dr Adam Geraghty, Associate Professor of Psychology and Behavioural Medicine within the School of Primary Care, Population Sciences and Medical Education at the University of Southampton. 

Title of paper: Distinguishing emotional distress from mental disorder: A qualitative exploration of the Four-Dimensional Symptom Questionnaire (4DSQ)

Available at: https://doi.org/10.3399/BJGP.2023.0574

A range of different approaches have been suggested to support primary care clinicians in the identification and management of mental health problems, from brief depression questionnaires, to approaches focusing on shared understanding within consultations. The Four-Dimensional Symptom Questionnaire (4DSQ) is a questionnaire developed in primary care that can support this process by distinguishing general distress from depressive or anxiety disorder. In this study we show that people recruited from primary care and community settings find completing a multidimensional questionnaire acceptable and find the splitting of general (potentially severe) distress from depression and anxiety helpful. Use of the 4DSQ may support collaborative diagnostic conversations as part of primary care consultations.

In this episode, we’re going to recognise some exceptional researchers here in the UK. We talk to Dr Ben Bowers and Dr Steve Bradley, this year’s winners of the Royal College of GPs and Society for Academic Primary Care early career researcher award. 

For more information about the award, see below two interviews with Ben and Steve on the RCGP website:

Dr Ben Bowers: https://www.rcgp.org.uk/Blog/SAPC-OECR-Awards-2024-Ben-Bowers

Dr Steve Bradley: https://www.rcgp.org.uk/Blog/SAPC-OECR-Awards-2024-Stephen-Bradley

Congratulations to Ben and Steve!

In this episode, we talk to Dr Erin Oldenhof, Research Coordinator and a benzodiazepine withdrawal counsellor at Reconnexion, a non-profit organisation that offers teratmenta nd support for insomnia, depression and anxiety. We’re also joined by Dr Petra Staiger, Associate Professor within the School of Psychology at Deakin University in Melbourne. 

Title of paper: “Let’s talk about sleep health”: Patient perspectives on willingness to engage in psychological interventions for insomnia

Available at: https://doi.org/10.3399/BJGP.2023.0310

Psychological interventions for insomnia are recommended as the first-line treatment but remain underutilised in primary care settings relative to pharmacological treatments. Coupled with known harms regarding prolonged use of benzodiazepine receptor agonists (BZRAs) to manage insomnia, the need for increased uptake of psychological interventions is critical. This study explored the influence of key factors that motivate individuals’ intention to engage with psychological interventions, revealing the importance of active involvement of GPs in this process from the initial consultation through to supporting treatment adherence long-term. By understanding the consumer perspective in conjunction with the unique clinical expertise of GPs, we have offered guidance on how to enhance patient-practitioner collaboration across the entire treatment process and increase GP confidence to facilitate increased engagement with evidence-based psychological treatment modalities.

In this episode, we talk to Dr Erica di Martino, a Research Fellow based within the School of Medicine at the University of Leeds.

Title of paper: Understanding General Practitioners’ referral decisions for younger patients with symptoms of cancer: a qualitative interview study

Available at: https://doi.org/10.3399/BJGP.2023.0304

Some cancers are becoming more common in younger people, yet clinical guidelines often recommend urgent referral for suspected cancer only if patients are above a certain age. Findings from this study show that, whilst most GPs interpret age criteria in cancer guidelines flexibly, some perceive and apply them as firm directives. In addition, system constraints may create unwarranted rigidity and act as barriers to prompt investigation. More in-built and explicit flexibility in the referral system is required to facilitate timely diagnosis of younger patients perceived as at higher risk by their GP.

In this episode, we talk to Becky Gudka, a Graduate Research Assistant based at the University of Exeter, about a study she’s published here in the BJGP titled, ‘Primary care provision for young people with ADHD: A multi-perspective qualitative study’. We’re also joined by her study co-author, Dr Anna Price, a Senior Research Fellow also at the University of Exeter who is the study principle investigator and senior author who led this research. 

Title of paper: Primary care provision for young people with ADHD: A multi-perspective qualitative study

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

Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder, with negative consequences for individuals and their communities. Research indicates a current “failure of healthcare” for people with ADHD in England, but previous recommendations to improve support for ADHD in primary care lack feasible and practical recommendations for health professionals. This study highlights individual-, practice- and system-level barriers to accessing support for ADHD via primary care and provides suggestions for how to overcome these barriers from the perspectives of multiple stakeholders. Health professionals and people with lived experience provided data which points to the standardisation of ADHD provision, providing additional information and support for clinicians, and better utilisation of reasonable adjustments for patients with ADHD in general practice.

In this episode, we’re taking a slightly different slant to talk to Dr Mark Levy, a GP based in London who led the National Review of Asthma Deaths and is a member of the Dissemination Working Group of the Global Initiative for Asthma (GINA). We’re talking to Mark as part of acknowledging World Asthma Day, which this year falls on 7 of May. 

Title of paper: Asthma deaths in children in the UK: the last straw

Available at: https://doi.org/10.3399/bjgp24X738201

Mark's website is also available here: https://bigcatdoc.com/ with additional resources and links to his own podcast.

In this episode, we talk to Dr Lynsey Warwick-Giles, a Research Associate based within the Centre for Primary Care and Health Services Research at the University of Manchester. 

Title of paper: Can Primary Care Networks contribute to the national goal of reducing health inequalities? A mixed method study

Available at: https://doi.org/10.3399/BJGP.2023.0258

Primary Care Networks are an important policy development in English primary care, with an additional contract supporting practices to work collaboratively. Policy makers intend that they will tackle local health inequalities. Our research suggests that there is potential for them to achieve this, but it will require: continued weighting of funding formulas to account for deprivation; redistribution of funds and other resources internally to support the most deprived practices; managerial support, particularly for PCNs with deprived populations; and realistic and achievable targets for PCN action.

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.