The next few months might be an inflection point for GPs in England and Wales 

Our strong primary care system is often credited in the success of the NHS - But changes to how that system works are currently underway. Legislation is quietly proceeding through parliament that will reorganise the way in which local care is structured, and those changes are raising concerns for GPs.

To talk about how we build a stronger primary care system, and stronger NHS we're joined by:

We also take the opportunity to hear about where social prescribing fits into this new picture, and why our panel think it's important in changing the UK's health.

Reading list

Building a stronger NHS: an open letter from past and present presidents and chairs of the Royal College of General Practitioners

In this week’s podcast we’ll be hearing a lot about exams - the bane of many doctor’s training lives, exams that determine your future are scattered through medicine and can cause a huge amount of anxiety and stress…

John McLachlan, professor of medical education at the University of Lancashire, has carried out four reviews of medical exams. He explains what happens to the people who have been marked wrongly, why he thinks re-sits should be done differently, and why multiple choice questions are still in use.

Over the Summer there have been extensive protests from the young people of India, the “Cockroach Janta Party” has led demonstrations across the country, sparked by allegations of cheating in India’s “NEET” exams - the federal tests taken by applicants to India's medical training.

Rohan Krishnan, orthopaedic surgeon in Delhi, and chief of the Federation of All India Medical Association, and Kathir Karuppiah, a house surgeon in Tamil Nadu, join us to explain where India's medical admissions tests are failing students.

We’ll also hear about new research into Chronic Traumatic Encephalopathy in NFL players.  Daniel Daneshvar is associate professor at Harvard Medical School, and he and his co-authors have examined the brains of 338 former players, with the goal of determining how many of them died with CTE neurodegeneration. He joins us to explain his findings, and what it means for competitive sports players and others who play contact sports.

Reading list:

“Cockroach” victory: India’s education minister resigns over medical exam scandal linked to 12 suicides

Prevalence of chronic traumatic encephalopathy at death in National Football League players: retrospective population based cohort study, 2008-21

This week we’re focusing on how healthcare is using AI systems. The NHS is firmly set on a course of AI integration, with NHS England committing £10 billion of taxpayer funds to the cause over the next three years. The pressure to implement AI in our hospitals is intense. But, how can healthcare leaders know what makes for a good AI adoption strategy? Victor Montori and Jon Tilburt are physicians from the US’ Mayo Clinic. They join us to lay out what they are calling the ‘five red flags’ that any organisation needs to consider in its AI rollout.

The UK is already having this conversation. The National Commission into the Regulation of AI in Healthcare released its initial report in June of this year. Among its findings was a call for a ‘lifecycle-based approach’ to regulation. To explain what this means, as well as how doctors can be equipped to ‘surveil’ AI systems as conditions evolve, we’re joined by the co-authors of a new BMJ editorial - Mark Ball from the University of Derby, and Elvira Perez Vallejos from the University of Nottingham.

And lastly, we talk about a research paper from last week that sparked off some concern. Researchers at Stanford University in California have used generative AI to design novel bacteriophage viruses. But, what have these scientists actually accomplished, and how can we put the right safeguards around the technology? Simon Clarke, associate professor in cellular microbiology at the University of Reading, explains the breakthrough and lays out its real implications.

References:

We can, but should we? Red flags for hasty, low integrity AI integration into healthcare

Regulating AI in healthcare: a moving target

Developments in AI designed viruses demonstrate why such research must be done in the open

Bipolar disorder affects almost 40 million people worldwide, but finding the right treatment is complex, and nearly half of patients struggle to follow their prescribed treatment plans.

In the first part of this episode, we discuss new research which aims to help patients and their doctors identify the right treatment. Michele De Prisco, psychiatrist and researcher at the Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques, joins us to discuss his team's comprehensive umbrella analysis of bipolar disorder treatment options.

Also this week, with the malaria vaccines RTS,S and R21 passing regulatory hurdles, and becoming available for populations around the world, the fight against malaria is shifting. Gillian Turner, Principal Research Associate at the Liverpool School of Tropical Medicine, explains the logistical challenges of the malaria vaccine rollout and what steps are needed next to control the disease.

Evidence based interventions for bipolar disorder across phases and age groups

Scaling up Malaria Vaccines in Africa

This week we focus on the external forces that shape medicine and healthcare. 

Global health is changing, after the reduction in financing from wealthy nations, the global community are beginning to implement reforms to improve the situation. However, any change will be unsuccessful until we tackle the fundamental structures that govern outcomes, argue Daniel Bernal-Serrano and Omar Gabriel Torres Valencia from the London School of Hygiene and Tropical Medicine. They join us to explain how economic forces, wealth distribution, and market dynamics undermine health outcomes.

We also learn about the rapid rise in private equity financing of healthcare in the UK, and the dangers that poses to healthcare quality. Bernd Rechel is a researcher at the European Observatory on Health Systems and Policies, and explains how different countries are handling this drive for healthcare profit extraction.

Reading list:

In this week's podcast - the Sensitivity of Patient Questionnaires: If you've ever asked a patient to fill out a Patient Health Questionnaire (like the PHQ-9) to assess their mental health and wondered exactly how much of a change it can actually detect, new research just published on bmj.com sets out to answer that question. We're joined by Brett Thombs, Professor in the department of Psychiatry at McGill University

Also this week, Are Doctors Scared of Death? BMJ Careers Editor Abi Rimmer sits down in the studio with Richard Coker, Emeritus Professor of Public Health at LSHTM. Drawing from his early days as an HIV doctor during the onset of the AIDS epidemic, and later with infectious disease outbreaks in South East Asia. Professor Coker discusses the profound experiences of the end of his patients lives that shaped his new book, Timor Mortis: How We Live with Death.

Reading list:

Minimal detectable change of the Patient Health Questionnaire-9, Patient Health Questionnaire-8, and Patient Health Questionnaire-2`

Known for his use of devolved powers, during his tenure as Mayor of Greater Manchester, Andy Burnham now has the opportunity to bring his local blueprint to the national stage. But what does this mean for the future of health and social care?

Our panel explore the deeply rooted health inequalities tied to the social determinants of health, the disconnect between local decision-making and national infrastructure, and the urgent need to extend the ability to access social care to more of England's population.

We're joined by

Michael Marmot: Professor of Epidemiology and Public Health at University College London (UCL) and author of the landmark Marmot Review.

Sarah Woolnough: Chief Executive of the health think tank, The King's Fund.

Matt Sutton: Professor of Health Economics at the University of Manchester.

Devolution can create new opportunities for better health

Will devolving powers to mayors close England’s health gap?

Andy Burnham’s goal of good growth could be a health-creating mission that supports environmental action

Discrimination in NHS Hiring: We examine the troubling success rates of Black and Asian doctors when applying for NHS jobs. Deputy news editor, Gareth Iacobucci speaks to Anthony Emmanushares his analysis on why discrimination persists in the medical workforce and what recent reports reveal.

The Ethnicity Data Gap in Research: While sex and gender are reported in 99% of trials, ethnicity is reported in only 48%. Bianca Brijnath, Professor of Health Communication in Society at La Trobe University, joins us to discuss a newly published framework aimed at standardizing the capture and reporting of ethnicity data in clinical trials.

The Evidence Revolution: We celebrate how evidence-based medicine (EBM) has set the gold standard for other areas of science. Mun-Keat Looi, The BMJ’s International News and Features Editor, speaks with Nature editor and science journalist Helen Pearson about her new book, Beyond Belief: How Evidence Shows What Really Works.

Black and Asian doctors are up to 30 times less likely to be offered medical training posts in some specialties, data show 

Measurement of ethnicity in clinical trials: Delphi survey and consensus statement 

Beyond Belief: How Evidence Shows What Really Works by Helen Pearson

Two NHS maternity reviews have been published over the past few weeks. The biggest ever conducted, involving nearly 2500 families, investigated services at Nottingham university hospitals NHS trust. It was led by senior midwife, Donna Ockenden, and its findings on poor and avoidable harm to babies and mothers have reverberated throughout UK healthcare.

This was followed immediately by publication of an independent investigation into maternity and neonatal services in England, conducted by Valerie Amos, which states that the UK's poor maternity care is "on a scale that shames our society".

We speak to  Kate Duhig, clinical senior lecturer at  Kings College London, and Marian Knight, professor of of maternal and child population health at the University of Oxford, about why we keep having reports saying the same thing, but little action to solve the problem.

As many wealthy nations have stepped back from previous aid promises, a new force has emerged to fill the gaps: private finance. David McCoy is professor of global public health at the United Nations University, and explains why turning to investment banks, wealth funds, and private equity in the pursuit of universal health coverage might cause more problems than it solves.

Reading list:

Dangers of finance capital in healthcare

Amos maternity review: Doctors must work differently as units “no longer fit for purpose,” but report is dogged by controversy

Nottingham maternity review: 520 mothers and babies were seriously harmed on “toxic” ward, damning inquiry finds