BJGP Interviews

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• Quick wins or eat the frog? How GPs prioritise their day 30.06.2026 17Min.

  Today, we’re speaking to Andrew McClarey, who works as a GP and Education co-ordinator Lead for General Practice in the Scottish Centre for Simulation and Clinical Human Factors. Title of paper: “Quick wins” vs “eating the frog”: Exploring general practitioners’ prioritisation dilemmasAvailable at: https://doi.org/10.3399/BJGP.2025.0628Link to tactical decision making games: https://archive.johs.org.uk/article/doi/10.54531/svvw4195This is the first study to look at the factors which experienced GPs consider when prioritising their acute workload. Several themes have emerged which highlight the importance of prioritisation training in General Practice. These themes could be used to teach prioritisation decision making to GP registrars or in the creation of continuing professional development resources for experienced GPs.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.400 - 00:00:56.560Hi and welcome to BJ GP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for listening to this podcast today.In today's episode, we're speaking to Dr. Andrew McClary.Andrew is a GP partner and he also works as Education Coordinator, Lead for General Practice in the Scottish Centre for Simulation and Clinical Human Factors. We're here today to discuss the paper that he's recently published in the bjjp.And the paper is titled Quick Wins versus Eating the Frog, Exploring general practitioners Prioritization dilemmas. So, hi, Andrew, it's really nice to meet you.And this paper really stood out to us, I think, because prioritisation is something that gps do every day, but it's not really something that we discuss explicitly. I'm just interested in what made you do this work and made you interested in studying it.Speaker B00:00:57.200 - 00:02:00.600It's interesting, I think, that for me, I finished my GP training just after the pandemic and therefore I did a lot of my training during the COVID pandemic. And around then the face of general practice, like most things in life, changed completely overnight.We moved on to telephone consulting and being encouraged to have empty waiting rooms.And I think around the same time we realized that we probably couldn't continue doing what we had been doing, which was being everything to everyone, which brought us on to prioritizing our workload. We have to decide who needs seen, who does not, and when are they seen. And that was a real gap for me in the training that I was provided.And I found myself going into working as a fully qualified GP without really an awareness of how to prioritise in a, in a sensible way. And I think that's where this interest was born out of.Speaker A00:02:00.760 - 00:02:42.050And before we get into what you found, it's probably worth saying a little bit about how you approach the study. So this was a qualitative interview study involving gps from a range of practices and career stages.And what you did was you really explored how they prioritized work during the course of a typical surgery.And then I guess through those interviews you looked at sort of the strategies and influences and trade offs that shaped those decisions in everyday general practice. But one of the things I found really interesting was that prioritization wasn't just about clinical urgency.And I wonder if you could talk through some of the other factors that GPs are weighing up quickly, I suppose, when they're deciding what to tackle first.Speaker B00:02:42.690 - 00:06:17.800Absolutely.It was very interesting, the themes that emerged from the data and also actually how much agreement There was amongst the gps in the focus groups, as we're not traditionally a group of people who agree about very much. So one thing that GP is particularly interested in, there's five main themes. One is about the system awareness.So we're aware about our own surgeries and where the pressure points are.For example, we're low on particular acute slots today, or there's a certain type of patient that is coming in more frequently at the moment, so we're aware of that. But it's not just having that awareness, it's also being able to adjust how we consult based on the pressures that the system are under.For example, if there are a lot of children or fevers coming in, we want to see them all face to face. We ask the admin team, just bring them all in face to face and we'll see them that way, rather than setting everything up over the phone.So it's not just an awareness of the system, but actually adjusting ourselves to that demand. Another one is the time management. What's the most efficient use of my time?How am I going to get out on time this evening for nursery pickup or whatever else I have to do in the evening? But it's not just our time, it's also the system's time.So what I mean by that is, I know if I try and refer to a hospital service in the afternoon, they'll probably be at capacity. If I do that in the morning, I am much more or first thing, except an afternoon surgery.I'm much more likely to have my patient accepted and managed in a way that I think is most appropriate for them. Also, third theme, familiarity with our patients.We are more familiar with our patients and therefore we don't have to go trawl through their histories. We know, right? I know that patient, I know what that's about. I spoke to them about it last week. Let's just phone them first and move on.That's an easy thing for me to do. Then relationships.Fourth theme, relationships with patients, in that we develop a trusting relationship, particularly if you've been working in a practice for a long period of time.For example, we might be able to have a conversation on the phone saying, well, are you as bad as you were the last time, for example, when you went to hospital with your copd? Is it as bad as that? Well, no, no, Doctor, not as bad as that. And you know these patients and you trust them to tell you the story like it is.But we also not only prioritise relationships with our patients, but also with other staff members.For example, if you're interrupted during a duty doctor session and it's the practice nurse who is needing help with something, that person is there in front of you. They're a valued member of your team and you want to be able to provide input for them in a timely way.And I guess that takes us back to system awareness. We know that that nurse has also got lots of patients to see, and if there's a delay in that, then the whole system is suffering from it.And then lastly, fifth is this idea of personal preferences. Some of us like doing hard things first, so that's eating the frog.Some of us like the quick wins and the endorphin release, of actually seeing all of the columns or all of the slots in the IT system changing a different color, we get a bit of a rush from that. There's no right or wrong answer with this, but actually a lot of it does come down to that.But it's also about looking after ourselves, but also balancing that against good patient care and what needs to be done first from a clinical urgency perspective.Speaker A00:06:18.360 - 00:06:45.170And the title of the paper is Quick Wins versus Eating the Frog.And I find that really interesting because from my own clinical practice, sometimes I feel like I'm telling myself off if I'm only taking off the easy tasks, because I know then at the end of the day I'm going to have all the long referral letters, the things that I've really been putting off. And I think, gosh, why did I leave it to this point, really?But I wonder if you can explain what that means a bit more generally, and why it captured something important about GP decision making.Speaker B00:06:45.570 - 00:08:12.210I think ultimately, for me, it's about when we are at the trainee stage. We are actually honest about how we approach prioritizing our workload. And I think ultimately that comes down to personality.Some of us like doing the more difficult things first, and then we feel that we've got the wind at our back and we're able to go on about our afternoon knowing that the most difficult thing in that list is done. In fact, the quote goes, eat a live frog first thing in the morning and nothing worse will happen you for the rest of the day.And I think that's probably paraphrasing a little bit, but I think that's the thing. If the worst thing is out of the way, the afternoon suddenly seems much better versus actually some of us need that endorphin release.And the highs, I guess, of actually seeing, feeling that we're going through our afternoon at a Good rate. And we are managing things well and some of us like that.But I think ultimately, if we can have that conversation at the trainee stage to say, look, you're either a frog eater or you're a quick winner and you have to decide which you are. And maybe actually you're at the point in your career where you have the opportunity to actually try these out.Say, right, we'll do the hardest thing first, how does that feel? Versus, you know, take off a few easy things, how does...
• Parents as partners - Improving paediatric safety in general practice 23.06.2026 18Min.

  Today, we’re speaking to Dr Tom Purchase, a GP and Health and Care Research Wales NIHR doctoral fellow.Title of paper: Co-generating ideas for safer paediatric care in general practice with parents and stakeholdersAvailable at: https://doi.org/10.3399/BJGP.2025.0690Research has highlighted the important role parents play in in paediatric patient safety, for example, through mitigating safety incidents in general practice, yet their perspectives have rarely shaped system-level improvements. This study co-generated and prioritised ideas for change with parents and key stakeholders, identifying feasible and impactful strategies to improve paediatric safety in primary care. These strategies centred around practice communication, accessing care records and results, and fostering a culture of shared learning and development. Parents are willing and able to contribute meaningfully to safety improvement efforts, and their insights align with national patient safety priorities. Clinicians and policy makers can use these findings to strengthen collaboration with families, tailor safety interventions to local needs, and embed parent voices into the design of safer care systems.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.480 - 00:00:49.500Hello and welcome today to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for listening again to this podcast.In today's episode, we're talking to Dr. Tom Purchase. Tom is a GP and a health and Care Research Wales NIHR Doctoral Fellow.We're here today to talk about the paper he's just published in the bjgp and the paper is titled Co Generating Ideas for Safer Pediatric Care in General Practice with Parents and Stakeholders.So, hi, Tom, it's really great to meet you and to talk about your work, but before we talk about the study itself, I'm interested to know what first got you interested in pediatric patient safety in general practice.Speaker B00:00:50.060 - 00:02:26.850Thanks. It's born, I think, out of an extension of the work that we've been doing within the patient safety team within Cardiff University.So a lot of what we do is looking at incident reports, safety incident reports, and trying to pick out what are the, you know, high level key learning points and takeaway messages from those.And then within the team, we started to think about, as well as the types of incidents and the types of harms that are occurring within pediatric incidents. For example, how are parents involved?And it was a bit of a novel approach to what we normally do, trying to have that extra aspect within the incidents and figuring out how parents were either helping to contribute or to mitigate against the incidents, not just looking at the incidents themselves. So that was the starting point, really.And then once we'd started digging into that data and identifying that, actually the majority of the time, which is in one of the papers that was published last year in BJGP, 77% of the reports we were looking at specifically around general practice showed that parents were taking these mitigatory actions that, you know, positive actions that were able to prevent harm or further harm from occurring to their child, for example, chasing results or chasing referrals or importantly, being able to speak up. And then that highlighted, I think, the importance of parents being able to have a voice and advocating on behalf of their child.And that really sparked, I think, the interest, and therefore this part of the.Speaker A00:02:26.850 - 00:02:46.490Project, and I think that's a really interesting thing about this paper, is that it focuses on parents and parents not just as observers of care, but as active contributors to safety. And I wonder what your thoughts are about why that's an important shift in how we think about these things.I think you've touched on it a bit, but yeah, I'm interested to know a bit more about that.Speaker B00:02:46.810 - 00:03:55.980I think it is a really important aspect of care, but also particularly safety, which maybe is untapped in terms of parents as a resource as to how we can keep children safe.We know that children on the whole are more, maybe not more vulnerable, but certainly are a vulnerable group when it comes to patient care in general and patient safety.And that's because they're so heavily reliant on others to speak on their behalf, to make sure somebody else is looking out for their healthcare needs. And therefore they are probably playing a part within the world of patient safety.And there are good studies from hospital relating to incident reports that show that parents are capable of picking up issues early on. They're able to detect issues that maybe other parts or people within the system aren't detecting.And as I mentioned, our paper from last year specifically looking at general practice showed that parents are able to prevent harms from reaching their children. So they're playing a substantial part already.And from a systems perspective, that is mainly parents figuring out workarounds within a system that really isn't, I don't think, designed to support them as well as it could be.Speaker A00:03:56.460 - 00:04:33.810And I guess that's kind of the crux of what you were doing here.So I guess before we get into findings, just, you know, a quick word about the methods because you worked here with groups of parents to develop ideas for improving pediatric patient safety in, in general practice, in primary care, and then you explored those ideas with a wider group of stakeholders and that included clinicians, managers and policymakers, and then brought them all together to co generate ideas for safer care. And it was really interesting because the parents generated 16 different ideas for improving safety.And were there any that particularly surprised you and jumped out at you?Speaker B00:04:34.450 - 00:05:33.980I don't think necessarily any were too surprising on the basis that we. I don't think I really had any thoughts going into it as to what they might say.But I guess what did surprise me more was that some of the ideas that we then took forward to the stakeholder group kind of highlighted some disparities or some clear disagreements between the parents who were accessing our services and the people who work within the services. And how we viewed, I suppose, viewed what's actually happening, that kind of work is imagined and how we think things are going and the work is done.I guess what the parents were trying to do to come up with the idea is to bridge that gap unknowingly. I suppose maybe what's surprising is that none of them, I didn't think any of the ideas were necessarily too resource intensive.You know, I think what was quite reassuring is that lots of what the parents were saying were actually relatively simple things that we might be able to enact or at least adopt or adapt, you know, to our own environments.Speaker A00:05:34.540 - 00:05:47.730And a lot of the ideas seem to center, I think, around communication, access to records and test results, and actually just helping parents to speak up. And why do you think those themes emerge so strongly?Speaker B00:05:48.450 - 00:07:24.990I think that comes back to maybe that difference between how we like to think the system's functioning and how parents think the system's functioning as healthcare professionals and parents.Because we know from a thematic analysis we did, which is also going to be published in bjgp, from these discussions we've had with the parents, that a lot of them said they felt the need to fight in order to be heard.So although within, say, pediatrics and GP training programmes and CBDs and everything we have to do for revalidation, taking ideas, concerns, expectations, collateral histories, making sure we're really considering that the holistic approach is all considered clinically, what you're then getting, I suppose, from the parents is that maybe we're not doing it as well as we could be.And one parent within the workshop said, I know as a parent you are expected to advocate for your child, but what it surprises me is how regularly you have to do it and sometimes it feels like a full time job.And I think that one really struck a chord in terms of really emphasizing how much extra effort and how much work parents are feeling they need to put in. And I think that also implies that the system isn't making it as easy as possible for them to be able to do the right thing.So I can't necessarily explain unfortunately why they feel that those areas needed to be targeted.I guess it's because there are barriers that we are not tackling correctly in order to help parents to speak up more efficiently and certainly to be listened to.Speaker A00:07:26.840 - 00:07:35.160And one of the stakeholder priorities was this idea of a designated parent advocate. Can you tell us a bit more about that idea and why it resonated?Speaker B00:07:35.640 - 00:09:21.810Yeah, sure.I really liked that one and I thought it was an interesting one because again, it...
• From symptoms to signals: Using AI for early diagnosis of ovarian cancer 16.06.2026 15Min.

  Today, we’re speaking to Dr Garth Funston, a GP and Clinical Senior Lecturer in Primary Care Cancer Research at Queen Mary University of London. Title of paper: Using large language models to identify pre-diagnostic clinical features of ovarian cancer from healthcare records: a population-based case-control studyAvailable at: https://doi.org/10.3399/BJGP.2025.0366Most women with ovarian cancer present with symptoms, but many symptoms are recorded only in free text healthcare records and missed by studies and clinical decision support tools that rely on coded data. We found that using large language models (LLMs) to extract symptoms from free text records substantially increased symptom detection and strengthened associations with ovarian cancer. Incorporating LLM-extracted symptom information into research and clinical decision tools may support identification of women at higher risk of cancer and aid appropriate investigation.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.800 - 00:00:50.940Hi and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for listening to this podcast today.In today's episode, we're talking to Dr. Garth Funston, who is an academic GP and clinical senior Lecturer in Primary Care Research at Queen Mary University of London.We're here to talk about his recent paper in the BJDP which is titled Using Large Language Models to Identify Pre Diagnostic Clinical Features of Ovarian and Cancer from Healthcare Records.So, Garth, thanks so much for talking to us again today, but I wonder, just before we get into the AI side of this paper, can you briefly explain the clinical problem you're trying to address here with ovarian cancer diagnosis in general practice?Speaker B00:00:51.500 - 00:01:55.010So most women with ovarian cancer are diagnosed after they develop symptoms and see their doctor. The challenge is that most symptoms are really non specific. There's no real red flag symptoms for ovarian cancer.That makes it a real clinical challenge for the GP to kind of recognize it and perform tests.So the symptoms are things like abdominal and pelvic pain, persistent bloating, urinary urgency and frequency, things that we see really frequently in gp. So knowing when to consider ovarian cancer is the big challenge.And we know that certainly a proportion of women see their GP multiple times before the diagnosis. Now we're lucky for ovarian cancer in that we have reasonably good triage tests and CA125 and transvaginal ultrasound.So the challenge really is to identify women with these non specific symptoms early so as we can work out who to test and hopefully improve early diagnosis and on outcomes in that way.Speaker A00:01:55.250 - 00:02:14.530Yeah, and I'm sure you're well aware of sort of the body work around this area and people like Willie Hamilton, who's done work around early diagnosis of ovarian cancer, along with Claire Bankhead, and they did some really interesting work around things like bloating, didn't they? But that was slightly different, I think, and a little bit that's some time ago now, isn't it?Speaker B00:02:14.930 - 00:02:39.230Yeah, it was some time ago. I think all of that is, you know, fundamental and still holds true.And they did a lot of work around things like IBS and in women over, over 50 and things like that that are kind of these subtle signs that we need to be aware of with ovarian cancer.So, yeah, we know there's lots of features that are associated with ovarian cancer, but it's recognizing when to invest to get those features because they're so common.Speaker A00:02:39.630 - 00:02:49.310Yeah. And do you think that's why it's described as difficult to diagnose early in general practice? Is it because the symptoms are so common?What are your thoughts on that?Speaker B00:02:49.390 - 00:03:48.750I think there's a few reasons.I think ovarian cancer used to be called, certainly in the media, the kind of the silent killer and terminology, which I really, really frustrates me, because we know it's not. We know that most women of symptoms for diagnosis. We actually know that from this paper and other papers that are symptoms in early stage cancer.But that kind of thought around ovarian cancer still holds. Secondly, the symptoms are nonspecific, they're reasonably common. I mean, you know, I probably see a.A patient with abdominal pain most days and it's kind of working out which ones to investigate for ovarian cancer. Yeah. And so I think those are the main things. And thirdly, it's, you know, it's not the most common common cancer.GP will see people probably only encounter a case of ovarian cancer every three to five years, a new case. And that's the extra challenge. It's kind of suspecting it when it's a rare thing in primary care.Speaker A00:03:49.100 - 00:04:03.500Yeah. And one thing I found really interesting about this work is that you're using free text clinical records rather than just coded data.So can you tell us a little bit about the data you accessed here and why it was so important to use this free text data?Speaker B00:04:04.220 - 00:05:09.600So a lot of the work that we do with primary care data focuses on coded data and certainly within the uk, because that's really the data we can actually access within UK for research purposes. But up to 80% of clinical information is not in that coded format, it's in the free text.And work from people like Sarah Price in the past have shown that often subtle things that we need to pick up are in the free text and GPS don't code that.So it's something I've been really keen to use in research for many years now to try and look at what extra information is there in the free text that could help us in both research and clinical practice and kind of picking up these cancers. And the data we accessed was from the United States, it was from healthcare clinics associated with the University of Washington.And that included kind of coded data, but also the free text medical records of patients which had been anonymized and were accessed in a kind of a safe and appropriate way.Speaker A00:05:10.000 - 00:05:40.140Yeah.And I think a lot of clinical staff listening to this will certainly, certainly appreciate that a Lot goes into the notes that we just type in that doesn't really get coded. So it's phenomenal that you're able to access that data.And this paper uses large language models or LLMs, which some people might associate, associate with tools like ChatGPT, but just at a very basic level. Can you just talk us through what actually is a large language model and what sort of it was used for in this, in this study?Speaker B00:05:40.950 - 00:06:49.130Large language models, lots of people use them on a daily basis. Absolutely right.Things like ChatGPT, they're essentially a tool for our purposes which we use to extract information from the free text medical records. Now natural language processing approaches have been used actually for many years, kind of rule based approaches.Other models, these require lots of training. You need to lots of highly annotated records and notes to train the models.Advantage of large language models, things like GPT, is they need less annotated notes and we did still do some of that, but they require less and that makes them much easier to apply and use in practice. We use them in this setting to effectively pull out key information on symptoms.We predefined a list of 17 symptoms from the literature which were associated with ovarian cancer and we used the large language models to go through the notes, pull out information on those symptoms that we could use in the study alongside the coded data.Speaker A00:06:50.090 - 00:07:03.350And I think that as we've been discussing, these large language models are probably really useful for this kind of data. I think especially because a lot of general practice is narrative and contextual as we've been discussing as well.Speaker B00:07:03.350 - 00:07:38.940Yeah, I think, I mean there's two challenges with using free text data. One is access requirements because there's lots of concerns around confidentiality. The other is just the volume of it.You've got these massive records that you know, contain lots of information, lots of writing, go back years. How do you actually process that to find the key information that you need?I think large language models are a really useful tool here because with a bit of training you can use them to actually extract the information that's pertinent to your kind of question.Speaker A00:07:39.340 - 00:07:48.620So let's go into what you found and I'm really interested to know about what kind of patterns or features was this model able to identify before an ovarian cancer diagnosis.Speaker B00:07:49.180 - 00:09:06.690So we looked at 17, 17 features. We find actually that 14 of the features were more frequently recorded within the free text and coded...
• When mothers need more: Postnatal care and complex social needs 09.06.2026 21Min.

  Today, we’re speaking to Dr Clare Macdonald, an Academic Clinical Lecturer in General Practice based at the University of Birmingham.Title of paper: Complex social needs and maternal postnatal care: what can primary care do?Available at: https://doi.org/10.3399/BJGP.2026.0069Throughout the discussion we use the terms ‘woman’ and ‘women’, but we know that not all those who give birth will identify as women and intend this to mean all those who give birth.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.480 - 00:00:51.740Hello and welcome to BJ GP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the Journal. Thanks for listening to this podcast today.In today's episode, we're speaking to Dr. Claire MacDonald. Claire is an academic clinical lecturer in general practice, and she's based at the University of Birmingham.We're here today to talk about the editorial she's just published in the May issue of the bjgp, and it's titled Complex Social Needs and Maternal Postnatal Care. What Can Primary Care Do?So, hi, Clare, it's lovely to meet you and to talk about this brilliant editorial, but before we get into the editorial itself, I wonder if you can just talk us through what you actually mean by complex social needs in the context of postnatal care.Speaker B00:00:51.980 - 00:02:21.290Yeah.So I think when we talk about social complexity in the postnatal population, we're talking about women who have multiple factors that might be influencing how they can access care or influencing the clinical and social risks that they have. So for most people, the time after they've had a baby results in some social change.Even in the most straightforward, most brilliantly supported, most physically well person, there are big social changes. And that is a period of a complex time to navigate and finding your way and your identity as a family with a new baby and so on.When we talk about complex social needs, we're talking about women who face other aspects of adversity.So it might be that they have housing instability, it might be that they have experienced domestic abuse or they continue to experience domestic abuse, that they have a history of safeguarding issues, safeguarding for themselves or safeguarding concern, concerns about other children or other family members.And when we see women who have overlapping social risk factors that produces this kind of network of complexity that puts them at compounded additional risk and they need additional help in navigating their health needs in that time.Speaker A00:02:21.450 - 00:02:47.310And I wonder why you felt that this was an important issue to highlight right now. So is there anything in particular that makes you think that this is the right time to sort of look into this?I know that there's a complex picture in terms of sort of maternal care, and if we look at things like the cost of living crisis, which is compounding a lot of the pressures that people are facing. But talk me through what your impetus was in thinking about this as a now issue.Speaker B00:02:48.110 - 00:05:26.470Yeah, that's right.So maternity services are really high profile in the news a lot at the moment, but from a secondary care perspective, and quite rightly, there's a spotlight on the poor care that some women and their families and their babies receive from secondary care. And there are, you know, huge pieces of work being done to improve that, to improve outcomes and to improve people's experiences.But that focus tends to be on intrapartum care.So the care that people receive in hospital around the time of birth, sometimes there's a little bit of focus on antenatal care as well and reducing risk during pregnancy, there's a lot less focus on what looks like the less exciting time of preconception care and then postnatal care. So after women get discharged from maternity services, we know that they're often left feeling a little bit isolated in the healthcare context.Some qualitative research that we've done in the past, looking at women's experiences of postnatal care, women told us that they were surprised about they'd had so many appointments during pregnancy and then so much healthcare retention in the first few days after birth, and then they were just surprised. No, you know, they had a baby and no one was really interested in their health anymore. And that genuinely came as a surprise to them.We know that maternal mortality in the uk, which, thankfully, in absolute numbers, is. Is quite small, but it's certainly higher than it could be and maybe should be, particularly compared to other kind of similar European countries.And there are actually more maternal deaths postnatally, so in the sort of later postnatal period, six weeks to a year after birth, than there are in that sort of antenatal, intrapartum and early postnatal period. And all of the political drive tends to be about reducing maternal mortality in its traditional definition of being up to six weeks after birth.But as GPs, where we can really have an impact is in those late maternal deaths.And of course, very few of us, thankfully, will be involved in the care of a woman who dies in that period, because they are small in absolute numbers. But there are all the women who do not die, but have those risk factors and have that complexity.And the longer they live with those sort of adverse health conditions and adverse social conditions, that is dramatically reducing their quality life course health. And we can really step in, in that postnatal period to look at how we can influence that.Speaker A00:05:26.870 - 00:05:49.080Yeah, and you've mentioned about the kind of care that women get in during their pregnancy. And sometimes, I'm sure for some women, the postnatal period can feel already pretty fragmented for those reasons.But how do you think that that fragmentation can become amplified for women with complex social needs? Do you have any thoughts about that?Speaker B00:05:50.280 - 00:08:25.320Absolutely. So a Lot of people will know how to contact their gp, right?I think if you ask people, most people have probably got that number saved in their phone or they know where their GP practice is.But after you have a baby, women are then given all these kind of new healthcare professionals who are interested and involved and it's impossible to know how that all fits together.So the midwife will typically follow women up for that kind of, you know, 10 to 14 days postnatally, usually just at the time the midwife is giving you the final sign off appointment. Within a day or two, you have an appointment with the health visitor, which again is somebody new, and then you might have a follow up.For example, if a woman's had a third degree tear or is having some additional hospital follow up because of hypertension or gestational diabetes, then the hospital are involved and then they come back to the GP.And I often feel like, for us as GPs, women, as soon as they're pregnant, they can generally self refer to the midwife and they get kind of lifted out of the primary care system to an extent.We might not see them through their whole pregnancy, then they have a baby, we might or might not get a discharge summary that gives us some details about the birth and then we invite them for their postnatal consultation and in that time, you know, they've had an entire pregnancy, a huge life changing event, and then we get to see them for this one appointment. And it's so complicated.Often for women who are not sure where they're going to get their next meal from, how can they be giving any kind of cognitive time to figuring out if the midwife told the health visitor and if the health visitor told the GP and if they're worried that their bleeding's gone on for a bit too long, do they try and phone the woman who came on Thursday or the woman who came on Monday, or do they come back to their gp?We're asking a lot and we also place a lot of burden on women to retell their story because information transfer is not always timely, it's not always sufficiently detailed.And again, for women who are living in more precarious social situations, that burden then of having to, you know, they're juggling and the, you know, the mental load of everything they're trying to figure out. And then we're asking them, can you remember if your blood pressure was high during your pregnancy?Whereas we should know that we should have that information from those other services. So that fragmentation in services really means that the burden is unduly placed on women to kind of patch that up.And we need to find a better way of dealing with that.Speaker A00:08:25.640 - 00:08:38.260One of the things I think that comes through really strongly is that some of the women with the greatest needs often face the biggest barriers, care. And what kind of barriers are we talking about here that these women are facing?Speaker B00:08:38.980 - 00:10:06.270The Embrace report, which is well, well worth a look at at least their infographics, I think for every gp, it's just a...
• Seeing skin differently: Eczema, acne and psoriasis in skin of colour 02.06.2026 15Min.

  Today, we’re speaking to Dr Eliza Hutchinson, a dermatology registrar and academic clinical fellow based at the Centre for Applied Excellence in Skin and Allergy Research at the University of Bristol.Title of paper: Eczema, acne, and psoriasis in people with skin of colour: a qualitative UK-based studyAvailable at: https://doi.org/10.3399/BJGP.2025.0720This study is the first, to the authors’ knowledge, to explore the experiences of living with an inflammatory dermatosis specifically in people with skin of colour. We generated eight themes important to participants: delayed or missed diagnosis; preferences regarding healthcare professionals; lack of online information and social media use; misunderstandings in cultural communities; concerns about treatment and lack of research; complementary medicine use; experiences and impact of dyspigmentation; and challenges with structural racism. These findings offer insight into the complex experiences and challenges faced by UK adults with skin of colour living with eczema, acne, and psoriasis. Our practical points for primary care clinicians are a step towards facilitating mutual understanding and improving care for people with skin of colour.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.560 - 00:00:53.150Hi and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the BJGP. In today's episode, we're speaking to Dr. Eliza Hutchinson.Eliza is a dermatology registrar and an academic clinical fellow and she's based at the Centre for Applied Excellence in Skin and Skin Allergy Research at the University of Bristol. We're here to talk about the paper she's just published in the bjgp and the paper is titled Eczema Acne and Psoriasis in People with Skin of Color.A Qualitative UK based Study. So, Eliza, it's lovely to meet you and thanks again for joining us to talk about this paper.But before we talk about the paper itself, I'm just wondering what made you specifically interested in researching skin conditions in skin of color?Speaker B00:00:53.550 - 00:01:34.700Yeah, thank you so much for having me.So I think people with skin of color have been and still are massively underrepresented in kind of medical curricula, learning resources, clinical trials. And I certainly remember when I was at medical school, I don't think I had any teaching on diverse skin tones at all.And so it was as I sort of learned more dermatology, I just became very aware that they are so underrepresented. And I think earlier work in this area, I really tried to improve education for medical students and healthcare professionals around skin of color.That was kind of my starting point.And then I realised actually there's very little, if anything actually on the experiences of people with skin of colour, which is kind of what led me to this project.Speaker A00:01:35.820 - 00:01:38.380And you work in dermatology, is that right?Speaker B00:01:38.460 - 00:01:42.300Yes, yes, I'm a dermatology registrar based in the Bristol Bath area.Speaker A00:01:42.540 - 00:02:06.890Great. So it's wonderful to have your expertise in this especially.And we may get into this sort of about sort of your perspective from secondary care as well, looking back into general practice as well. But this paper focuses on eczema, acne and psoriasis and these are conditions that we see a lot as gps.So why did you feel that this was an important area to look at for people with skin of colour?Speaker B00:02:07.290 - 00:02:41.470Yes, I mean, as you said, we know that skin conditions are super common.They make up over 14% of GP consultations and eczema, acne and psoriasis are some of the most common inflammatory skin conditions we see and we know that they have a significant burden on everyone that experiences them.But I think particularly in people with skin of colour, we already know that these people experience kind of increasing things like Dispigmentation, so skin tone getting lighter or darker from their skin condition. And yeah, I think I just wanted to focus on some of the more common conditions that are seen kind of day to day in primary care.Speaker A00:02:42.110 - 00:02:54.890And this was a qualitative study and you emphasized that you really wanted to understand the experiences of people here. So talk us through a bit what you did. You spoke to people who had these conditions and had skin of colour?Speaker B00:02:55.050 - 00:03:26.060Yes. So we recruited using online methods for a couple of reasons, but really wanted to get kind of diverse range of experiences from across the uk.So we started off with an online survey and that was open to people of all skin tones. And we have written this up as a separate paper which should be out hopefully in the next few months.But based on these responses, we then kind of purposefully recruited people with skin of color to take part in an online one to one interview. And so we spoke to 20 different people with skin of colour as part of this.Speaker A00:03:26.460 - 00:03:40.300And I think one of the really interesting things that came out and is running as a strong theme through the paper is that skin conditions can present really differently in skin of colour. Can you explain a bit about what that means in practice as well?Speaker B00:03:40.700 - 00:04:49.210Yeah. So we know that skin conditions can look and behave very differently in people with skin of colour compared to white skin.So for example, eczema is typically in a kind of flexural distribution in people with white skin, so like in the elbow creases behind the knees.But in people with skin of colour it might be more likely to be on the extensor surfaces, it might be in a sort of discoid type pattern, so kind of well defined round patches or sort of a follicular pattern is another one we see. So if you look at medical textbooks and what we're taught at medical school, we just don't see pictures of these presentations.And I think another big thing is obviously redness is much less obvious in skin of colour. So that's typically what we would associate with skin inflammation is redness and it is much less obvious.And instead in darker skin tones it might look kind of purpley. Brownie might not be as obvious. And certainly in the interviews we found that patients were aware of this as well.So they were looking at their own skin and not picking up that it was kind of actively inflamed. They didn't know what it was and they'd go and see a GP or another healthcare professional in primary care and they also wouldn't know.And then it's just kind of leading to Delayed diagnosis, misdiagnoses.Speaker A00:04:50.140 - 00:05:16.780Yeah, And I think that's certainly something. So the people you spoke to described these delays in diagnosis and also this uncertainty from clinicians.And I do wonder if that is reflected in what we learn and what the wider public understand is what inflammation might look like as well. So I wonder what really stood out to you from these experiences.So how did people and clinicians sort of navigate those delays and uncertainty as well?Speaker B00:05:17.320 - 00:05:44.760What was quite shocking was in terms of the misdiagnosis a lot of the time, infection and infestation.So, for example, scabies was a big one that people were misdiagnosed with, and that in some circumstances did lead to kind of stigmatisation, psychological distress, embarrassment, and then people were more afraid to seek help. Further delays in diagnosis. Yeah, I think that was the thing that struck me the most in terms of this problem.Speaker A00:05:45.240 - 00:06:00.040And you've mentioned this, you talked about dyspigmentation, and that came through as well very strongly in the interviews. And I think that's probably a problem that's specific to skin of color as well.And can you talk through why that came up as such an important issue for patients in this study?Speaker B00:06:00.760 - 00:06:46.890Yeah, of course. So I think we already know that dyspigmentation.So skin tone usually getting darker, but sometimes lighter as a result of skin inflammation, we know that it is more common in darker skin tones just because they've got more melanin there to start with. But the thing that struck me in these interviews was just the profound impact that this can have on patients.So embarrassment, isolation, body dysmorphia. There's a lot of misunderstanding as well, kind of within certain communities about what causes it.And some people experience negative comments from within their own community, from friends and family, which really exacerbated that kind of psychosocial impact even more. And obviously, skin tone is massively tied into kind of identity, and the impact on people's wellbeing was just. Yeah, it was huge.Speaker A00:06:47.690 - 00:06:58.490And coming from a general practice perspective, it sometimes feels like the treatment options for dyspigmentation are really...
• ‘It’s not just thrush’: Navigating recurrent vulvovaginal thrush in primary care 26.05.2026 17Min.

  Today, we’re speaking to Dr Tori Ford, a qualitative researcher based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford.Title of papers: ‘Accumulative Experiences: Navigating Healthcare for Recurrent Vulvovaginal Thrush from Patient and Clinician Perspectives’ and ‘It’s not just thrush, it’s recurrent thrush’: Patient and Clinician Perspectives on Diagnosing Recurrent Vulvovaginal Candidiasis’.Available at: https://doi.org/10.3399/BJGP.2025.0437 and https://doi.org/10.3399/BJGP.2025.0531TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.280 - 00:01:15.200Hi, and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the journal. Thanks again for listening to this podcast today.In today's episode, we're speaking to Dr. Tori Ford, who is a qualitative researcher based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. We're going to talk today about two linked papers that she and her team have published here in the bjgp.The first one is titled Accumulative Navigating Healthcare for Recurrent Vulvovaginal Thrush from Patient and Clinician Perspectives. And the second paper is it's not just thrush, it's recurrent thrush.Patient and Clinician Perspectives on Diagnosing Recurrent Vulva Vaginal Candidiasis. So, Tori, thanks very much for joining us here today.And this might come from a slightly unscientific perspective, but my feeling is that I'm seeing a lot more recurrent thrush in practice. And we know that it's incredibly common. I think, despite that, it's not something we hear discussed very often in primary care research.So my first question is, what made you want to study it?Speaker B00:01:15.520 - 00:01:54.060So, like you say, recurrent thrush is an increasingly common condition. We know that 1.2 million women in the UK live with it, 6% of people globally, and I just happen to have been one of them.So my paper came out of lived experience of living with recurrent thrush over many years and having a diagnostic journey of, you know, seeing different healthcare professionals looking for answers. And like you say, those feelings of shame and stigma that keep you feeling alone were all too familiar for me.So that's what actually led me into starting my PhD, looking at recurrent thrush and then wanting to hear other patient experiences as well.Speaker A00:01:54.460 - 00:02:22.220And we're looking at two of your papers here that were published in the bjgp, and they're both looking at the patient and the clinician perspective.And one thing that comes through really strongly in both papers is that recurrent thrush is often treated as if it's just repeated acute episodes rather than a condition in its own right. Why do you think that that distinction matters to patients and probably to clinicians as well, or should do?Speaker B00:02:22.380 - 00:03:55.420I think when we hear about thrush, it's often something that's seen as trivial or mundane, and that's often because it's through this lens of acute, transient, episodic, episod, and most of the time it is right. 75% Of people with Vaginas will have thrush at some point in their life.It's usually self managed over the counter with pharmacy care and symptoms resolved within a few days.But where recurrent thrush differs is when those symptoms keep coming back so that itching, burning pain and irritation becomes sometimes cyclical, sometimes repetitive. And I spoke to three or two patients who all had different durations of heat know, happening every two weeks, every month.And what they often found was because they were accessing fragmented care.So, you know, going to the pharmacy, sometimes going to the gp, sometimes maybe seeing sexual health, it was often seen as again, that mundane, one off, trivial case. And it was really hard to trace those patterns across care, especially due to a lack of continuity. Right.If you're trying to track a pattern but nobody is following you up, it's really difficult to, to capture those. So I think it's a few layers of one.I explore how these sort of social dimensions keep it seen as something maybe less long term, but then also in the ways that sort of care was fragmented made it harder for those patterns to be picked up and then to transition the care moving away from, you know, acute one off prescriptions of an antifungal medication to something that required repeat, repetitive, enduring, you know, testing, treatment, retesting of treatments.Speaker A00:03:56.060 - 00:04:09.970Absolutely. And I think what's interesting is that your papers describe recurrent thrush as something that's accumulative and cyclical over time.And you mentioned that it's not just these sort of one off episodes. Can you explain what patients meant by that?Speaker B00:04:10.210 - 00:05:13.850Yeah.So often, I think when we talk about healthcare, journeys are presented in a way that's quite linear and straightforward that, you know, you see a healthcare professional, you get treatment, you go home, you start to feel better. But with recurrence, something interesting happens where people aren't, you know, returning to the start.It's not that you go back to a blank page and then restart your healthcare journey every time you're carrying with you everything, everything that's amassed through healthcare encounters, what you've seen online, what you discuss with friends, and that is all carrying through to those consultations.And I think what was really important there was acknowledging that for many people there was a lot to unpack there and often they felt that it wasn't being acknowledged in those clinical spaces. It was seen as, oh, it's just thrush. And that's why in one of the papers the title is, it's not just thrush, it's recurrent thrush.And that's a quote from One of the participants who was speaking about the importance of labeling and distinguishing this condition, especially in terms of the impacts it had on people's lives and also the approaches and pathways that would be needed to properly treat it.Speaker A00:05:14.330 - 00:05:32.570And this is an issue that we see across clinical care and women's healthcare. But a lot of participants described feeling dismissed or not listened to.And I wanted to just get your perspective from your wider sort of work in this area is how much of that reflected wider issues in women's health care, do you think?Speaker B00:05:33.170 - 00:06:46.980Yeah, I mean, we know there's increasing conversations, right, with the women's health strategy, with the Cumberlage report, about how people's pain is often dismissed based on their gender. And that definitely came across in the studies. But I think what was interesting was that both patients and clinicians were aware of this.And something that is quite interesting was in the diagnostic paper, we look at sort of those moments where there were sort of miscommunication or differing expectations between patients and clinicians, clinicians, where clinicians were, you know, operating on a standard guideline that requires two swabs, two positive swabs for a thrush within a year to diagnose recurrent thrush.But when that wasn't communicated to the patient, of being told we need to accumulate these number of swabs, what the patients thought was happening was, oh, they're swabbing me again, they're not listening to me, they don't believe me.So it was interesting where the dismissal was often in those moments of, you know, it wasn't healthcare professionals saying, this isn't important, or please don't come see me about this. It was really in those sort of small details where patients were operating on one framework and clinicians on another.And there were these gaps in communication. And that's why our papers seek to address some of those gaps with some recommendations as well.Speaker A00:06:47.620 - 00:07:04.640Yeah, and as you mentioned, one of the papers is called it's not just thrush, it's recurrent thrush.And I wonder what you felt were the key challenges around actually recognizing recurrence in primary care, as opposed to it just being a, a one off episode.Speaker B00:07:04.720 - 00:09:30.220There's multiple layers to this, I think, in terms of the. The papers are sort of split in terms of the diagnostic journey and then the healthcare journey.But that's sort of an artificial split in some ways, because what we saw a lot was, you know, patients trying to seek out continuity of care to get someone to notice the pattern that they were starting to see and assign a label to it and we saw some hesitancy with this in clinicians who said, you know, I'm not going to use the term recurrence because that sounds like it's something serious or sounds like it's chronic. And they saw that being helpful.But then for patients they found that really challenging because they said, you know, they just see it as thrush, they just see it as a one off case, they're not recognizing it when often...
• ‘They knew me’: Relationships, continuity and dementia care 19.05.2026 13Min.

  Today, we’re speaking to Dr Charlotte Morris, a GP and academic based at the University of Manchester.Title of paper: Experiences of primary care for people with dementia from socioeconomically disadvantaged areas: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2025.0407Existing national guidance recommends primary care-led dementia health care, but little is known about the experience of this for people living in socioeconomically deprived areas. This study highlights that people with dementia, and their carers, in socioeconomically disadvantaged areas want to maintain identity and understand their decline. Support from healthcare services often diminishes over time, with difficulties accessing and navigating healthcare systems when needed. There was uncertainty about primary care’s role in dementia health care. Clearer communication and proactive support from primary care may improve experiences for these patients.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.320 - 00:00:32.850Hello and welcome to BJ GP Interviews. I'm Ewan Lawson and I'm the editor of the BJ gp. Thanks for listening to the podcast today. In this episode, we are speaking to Charlotte Morris.Charlotte is a GP and doctoral research fellow at the University of Manchester and we have recently published her paper, Experiences of Primary Care for People with Dementia from Socioeconomically Disadvantaged Areas A Qualitative Study.So, Charlotte, first of all, what I'd like to ask you is how did you come to focus on people with dementia in deprived areas specifically, and what surprised you most in the interviews?Speaker B00:00:33.170 - 00:02:03.470Thanks, Ewan. Thanks so much to you and the BJGP for inviting me to do the podcast and publishing the paper.So, I guess my interest in people with dementia started when I finished my foundation training and I did a clinical fellowship year in London where I worked on a ward with people with dementia specifically. And at that time I wanted to be a care of the elderly doctor.But I was struck by how many people kept coming in and out of hospital with dementia regularly. We'd spend ages trying to get them home. They go home for maybe one or two days and then sadly come back on this cycle.And I think in reality, a lot of those people would probably have been better at home, even if that shortened their lives very sadly.And it made me realise I wanted to work in the community with people with dementia, trying to improve healthcare in terms of advanced care planning and kind of planning for progression. So that's where my interest in dementia came in.And I work in a practice in a relatively deprived area of Greater Manchester, and I always had an interest in health equity for kind of various reasons and health equity in terms of various lenses as well.So when I was designing my PhD project, I decided to kind of focus on both aspects, so health inequalities in terms of deprivation and primary care for people with dementia.Speaker A00:02:03.870 - 00:02:08.270I mean, I know we're going to touch another on some other stuff, but. Yeah. What surprised you most in the interviews?Speaker B00:02:09.390 - 00:02:47.530I think in terms of what surprised me most in the interviews, I think I was actually struck by how much people wanted more health care from their primary care teams. It's not like they felt they were getting the best care or they were really kind of thrilled with what they were getting in lot of times.But they were actually very trusting of their primary care teams and they really, really wanted more of that health care, which kind of struck me, really.And I actually found it kind of quite touching and humbling, as a practicing GP myself, to know that we were really valued and that the care that we provide, people tend to want more of it rather than less.Speaker A00:02:47.610 - 00:03:21.390Yeah, so that leads in nicely, because I wanted to ask you about one of the themes in your paper, which was the kind of proactive continuity.And several of your participants described your wanting their GP to take the initiative, you know, to call them, to know them, so just to anchor their sense of self while the dementia progresses. There was a one man who had Alzheimer's who named it Ali. Was a kind of a. Was a striking example. You know, what, what kind of sense?What does that tell us about what primary care needs to be doing? I mean, you mentioned there about how much it was appreciated, but what kind of. What do you think they can do more of?Speaker B00:03:22.000 - 00:04:42.080Yeah, I think that kind of theme of proactive continuity splits into two, really. So I think the idea of being proactive is really important and people wanted their GPs not only to know them, but to actively contact them.Sorry, I mean, not just their gps, actually their whole primary care team recognising that we all work together in our practices as well as that proactivity.They wanted somebody who knew them, knew their family, knew their kind of history, knew the kind of outside of their life, rather than just their medical condition or their dementia. And that was really striking and came through kind of very strongly from most people who were interviewed, really.And I interviewed people with dementia and carers and from both sides. That idea of being known by their primary care team did come through very strongly.And I think for me as the interviewer and for me as a practicing gp, I also really like that side.You know, knowing our patients, knowing that person, and being there for the kind of entire journey of a diagnosis to dementia all the way through to that progressing. It's a real privilege and I think it's something really precious for us as, as primary care teams, that continuity.Speaker A00:04:42.240 - 00:05:02.930There was a bit of a gap. There wasn't. There's this kind of, oh, you know, there's potential gap in that.And you mentioned this in the paper about the falling away support, that sometimes participants went to the memory clinic, then they were discharged, and then they felt a little bit like they, you know, they weren't picked up necessarily. I wondered if you could tell us a little bit more how that showed up in your interviews.Speaker B00:05:03.570 - 00:06:27.830Yeah, yeah, for sure. So I guess everybody, everyone did describe a kind of different journey.And I don't want to just generalize, but the sentiment or the feeling I got from most people was that there was concern around a possible diagnosis, a kind of flurry of activity around when the diagnosis was made, referral to memory clinic, lots of calls.Somebody described a mind boggling array of things being offered around that time of diagnosis and then after that things seeming to kind of fall away. So somebody described the specialist dropped them and they were seen by memory clinic, started on medication and then just left back to the gp.So that idea of kind of there being a flurry of activity and then things gradually dropping away and that being a paradox because actually people felt that their needs generally increased as time went on. So that was very interesting really. And I've also done.It's kind of not a published paper yet and it's still being worked up, but I've done some interviews with primary care providers as well and that seemed to kind of come through as well from them and that there is a flurry of activity around one point around diagnosis. But then as time goes on do things do seem to kind of drop off and change. So it's perhaps felt from both sides as well.Speaker A00:06:27.830 - 00:07:03.200Yeah. Let's talk a little bit about when sometimes it doesn't happen so much or people who knew the system.And there was definitely an interesting rather novel finding that came out and I guess it's something we might be aware of, but I haven't seen too many papers that have highlighted it, that if there was someone in the family who knew the system, that was often perceived as crucial and it sort of implies a system rewards social capital or maybe it's just very specific to medical systems. But I wondered if you could, you know, how worried should we be about that? What can primary care do to address it or to flatten those kind of.Those kind of flatten it out. If there is a. If it is an inequality.Speaker B00:07:04.000 - 00:08:54.200Yeah, I think a great question and I also thought this was one of the most interesting themes to come out of the paper actually.So just to kind of describe it, a lot of people described how if they had a family member or a friend who knew a little bit about the healthcare system, so if they'd worked in research or if they'd worked in social care, they would be called upon to kind of navigate this complexity of the system and it kind of came through that they would know who to contact, know how much to push, know what strings to pull to get somebody seen. And that insider knowledge, how we termed it, seemed crucial in kind of getting things done.And, and that was described in detail by one...
• Choosing general practice: What shapes medical student decisions? 12.05.2026 15Min.

  Today, we’re speaking to Catharina Savelkoul, a DPhil student in Health Economics based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford.Title of paper: Factors Influencing UK Medical Students’ Choice of General Practice: A Systematic ReviewAvailable at: https://doi.org/10.3399/BJGP.2025.0226The UK faces a projected shortage of approximately 15,000 GPs by 2036/37, with a declining proportion of UK medical graduates pursuing general practice. Previous research has identified various contributing factors but lacked a contemporary synthesis within a coherent theoretical framework. This systematic review examines factors influencing UK medical students' career decisions, finding three critical influences: curricula that inadequately represents general practice, a persistent negative hidden curriculum, and the impact of clinical placement quality. Our revised Bland-Meurer model incorporates these findings, providing a comprehensive framework to improve GP recruitment. This systematic review identifies the factors that shape UK medical students’ intentions toward general practice.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.120 - 00:00:59.530Hi and welcome to BJJP Interviews. I'm Nada Khan, one of the associate editors of the bjjp. Thanks for listening to this podcast today.In today's episode, we're speaking to Katharina Savalcool. Katharina is a DPHIL student in Health Economics based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford.We're here today to talk about the paper she's recently published in the BJJP titled Factors Influencing UK Medical Students Choice of General A Systematic Review. So, hi Katharine, it's lovely to meet you and to talk about your work.This is a super interesting area to study because we know that there is a push to increase the number of GPs in practice and I guess that does really start from medical school and people's intentions there. But just to start off, could you talk us through why you decided to do this work and what were you aiming to look at here?Speaker B00:01:00.050 - 00:03:17.090Yeah, of course.So the goal of this piece of research, of the systematic review was to synthesize the empirical evidence on the factors that influence medical students, GP, career intention. Because we know that the general practice is what makes the NHS functions.It handles over 300 million consultations annually, manages the long term, most long term conditions, issues over a billion prescriptions per year. And we also know that healthcare systems with a strong, with strong primary care achieve like, better population health in general.But at the same time, right now the projected shortages for the UK are approximately 15,000 GPs by 2036, which is of course a large number and shows like a workforce crisis. And then if we look at the policy response to this, they've been like quite ambitious but also largely unsuccessful.So for instance, Health Education England mandated that 50% of all new medical graduates should enter general practice. And this target has never been met. The same goes for the NHS long term workforce plan to increase GP training places by 50% to 6,000 places in 2031.And the interesting part about this is that the policy responses are all about setting this goal. Right?It's about, you know, we're shifting, we're shifting care to the community, we're expanding training places, more medical students should become a gp. But that's all. Yeah, setting like these, these, these strategies, but at the end it almost seems like the, we're achieving the reverse.So that, that kind of brought me to the question of if we want to, you know, make sure that we have a healthy primary care workforce, that the general practice avoids this large crisis in the future, then maybe Instead of setting these ambitious goals, we should look into the question of what draws medical students to the general practice and also what are some of the reasons why they might not become a gp?And I think if we zoom into those factors at medical school, during medical education, you get a lot more interesting insights that can actually inform more effective policy. I think that's the kind of. That was the reason I conducted this systematic review.Speaker A00:03:17.970 - 00:03:42.850That's a great summary of what's been going on with GP recruitment in the past little while in terms of policy and the push to increase the number of gps. And this was, as you mentioned, a systematic review that followed pretty conventional review processes.But I wonder if you could tell us a bit about this bland mirror model. It's a framework used in terms of organizing the results and how this informed how you structured the results.Speaker B00:03:43.990 - 00:04:47.410Yeah, I think it's for this specific research question, looking into factors that influence decision making.I decided to look up different theoretical frameworks in order to understand this, because decision making at the end of the days is, of course, something that's influenced by many things at the same time.This model specifically, which was, I think first published in 1995, helped a lot with like, systematically categorizing the findings because it identified three principal domains. One is the student characteristics, such as, like, personal values, maybe personality traits. The second one is the specialty characteristics.So what is the. What are the professional opportunities? And the third one is, like, the influences during medical school.And I think if those are the three kind of domains we saw in this across these, like, 30 years of research, and I think it was the most useful way to kind of theorize these factors.Speaker A00:04:48.210 - 00:05:01.970Great.So I guess just talk us through what you found, and I suppose it might be helpful to just talk through the different aspects of that model you've just described. So what were the sort of student characteristics that you found in the literature that influenced and informed specialty choice?Speaker B00:05:02.640 - 00:06:37.050Yeah, so I think the findings from this came from different types of studies.I think the largest ones were the ones that used a data set called UK met, which kind of has the data on all UK medical students in such demographic variables, but also more information about their educational performance in medical school.And I think these studies showed us like, the kind of the social, demographic, individual characteristics that are associated with a higher likelihood of pursuing a career in a general practice. And then there's these smaller studies which kind of like looked at personal preferences and personality traits.And I think that that's another really interesting question. Right. Because about this, like, specialty choice and Kind of individual preferences, personality traits.A lot of international research is talking about altruism or do people who enjoy social contact more, are they more likely to become gps?And I think this type of research is quite undeveloped in terms of the UK literature, but it was still interesting to look at it and compare it to different studies. And I think for the demographic factors we saw specifically that female students were more likely to choose gender practice graduates on entry.So age was another one we saw. Yeah, so there's like these different kind of demographic factors or personality traits that seem to predispose you to career in a general practice.Speaker A00:06:37.290 - 00:06:51.930And what about the characteristics of the specialty itself or working in general practice specifically that drew some medical students to think about it. So these are potentially medical students looking at gps and thinking, oh, I want that lifestyle or I don't or I want that work. Really? Yeah.Speaker B00:06:52.150 - 00:07:48.350On this question, first of all, a lot has changed recently.So I think work life balance was something that was mentioned in like the earlier studies, but right now it has changed so much that that's almost like not something we can, yeah, we can use anymore.But another interesting one, and I think one that we should really take seriously, is that a lot of one of the things that draws students to the general practice is the like, long term patient relationships. So continuity of care.And of course right now with the landscape changing and specifically like the prioritization of access over continuity of care, it might be important to kind of, you know, reconsider those changes in light of the fact that a lot of medical students decide on a career in a general practice because of this like continuity of care aspect that's so unique to primary care. So I think that's another really important one.Speaker A00:07:48.990 - 00:08:13.560Yeah, I can definitely relate to that.I think one of the reasons I figured out that general practice was for me was that when I was working in A E, I would flag all the patients I'd seen and clarked in and then wanted to know what happened in their...
• Looking back at the BJGP Research Conference 2026 24.03.2026 12Min.

  Today, we’re going to back at the recent BJGP Research Conference, which was held just last week on the 20st of March 2025 in Bristol. TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.960 - 00:00:39.550Hello and welcome to this BJGP podcast. I'm Nada Khan and I'm one of the Associate Editors of the Journal. Thanks for listening today.In today's episode we're going to look back at the recent BJGP Research Conference which we held just last week on 20th March in Bristol. It was absolutely brilliant to welcome the BJGP team and people who attended to the Southwest.And in today's episode I'm just going to talk about some the highlights and really focus on what the conference is about and maybe have a chat about how to get involved in the future. But first, here's a welcome to the conference from our Editor in Chief, Ewan Lawson.Speaker B00:00:40.270 - 00:01:16.520My name's Ewan Lawson, I'm editor of the bjgp. So that means basically I'm the one person that the Journal would probably run without and everyone else does all the work.But I do have to stand up here and say hello to you and I want to offer you the warmest of welcomes to the conference. Been running this for a few years and it's always really nice to get together and just try to help each other, you know, get involved.It's not in a very scholarly way, you know, whether you're involved in research or whether you're interested in putting research into practice. We think we can offer you quite a lot more than just the fact that we publish research at BJGP and BJGP Open. So I hope you have a fantastic day.Speaker A00:01:17.320 - 00:03:26.850So this was the seventh run of the BJGP Research Conference and this year we had a particular focus on a few different areas.We took a bit of a deep dive into patient involvement, new and emerging research in general practice, general practice policy and how to get research into impact. And this year, as always, quite a bit around writing and also public speaking in academia.The conference kicked off this year with an absolutely brilliant talk by Professor Martin Marshall, who some of you may know as the Chair of the Nuffield Trust. But he's also Emeritus professor of Healthcare Improvement at UCS and non Exec Director at the Royal Devon University Healthcare trust.And until 2022, Martin was also the Chair of the Royal College of GPs and a GP in New East London. So definitely someone worth listening to about his experiences as well.And Martin really focused in his talk on the relationship between general practice and policy and asked a really important question, which is how good are we as a profession at influencing decision decision makers?And in his talk, Martin reflected on the fact that while the value of general practice is really well established for patients, communities and the wider nhs. It's often still misunderstood or undervalued at a policy level.And in his talk he challenged whether that's purely down to policymakers or whether, as Julian Tudor Hart once put it, there's also an element of political literacy within the profession itself.And what really followed was a thoughtful discussion about how both national leaders and individual clinicians can do more to shape policy, and whether that's through better communication, stronger advocacy, or even engaging more actively with the systems around us. It was a really thought provoking structure of the conference and linked closely to that broader theme of impact that ran throughout the day.Here's just a short snippet of Martin speaking at the conference.Speaker C00:03:27.570 - 00:04:45.260I wish I could have my career again and I'd be more influential than I was. I've learned a lot along the way, but this is what I've learned. First of all, as I've described, influencing is about far more than informy.It's not about telling, it's about getting inside people's heads and understanding what's important to them. A lot of influencing is about timing. How do we decide when to influence? I think it's really important. Policy windows is an interesting concept.So sometimes just a window opens that allows you to do something.And a good example of this would be the evidence around Continuity of care, which is actually pretty strong in General practice was largely ignored by policymakers and politicians until the pandemic came along and they were looking for a way of delivering the vaccination program. And we made the case based on evidence that trust is really important to the success of uptake of vaccination programs.And that's why government decided that general practice would deliver their program largely, rather than setting up a separate body to deliver it. So there's an example, another example of ways of change.The NUFRE is doing some really important work around the distribution, the resource distribution formula for general practice, something which the Conservative governments of the past were not interested in, the Labour government is very interested in. So now is our time to push it while we can.Speaker A00:04:46.460 - 00:11:57.780So it was a great start to the conference from Martin, which really focused down on how GPs and primary care researchers can get the most impact from their work to effect change. So in addition to the keynote sessions, we had a series of parallel sessions where people presented posters and talks about their work.And what really struck me, listening to different talks and looking at the different posters that were on display, was just how strong the work was across the board, especially from medical students. And early career researchers.There's clearly a lot of exciting work coming through and I wouldn't be surprised to see some of it published in the BJJP in the near future.At the conference, we then had a series of workshops and these looked at patient and public involvement, writing for the BJGP and public speaking in academia. I attended Lucy Potter and the Bridging Gap team's excellent workshop on meaningful patient and public involvement in research.Their team did an absolutely brilliant job at highlighting a familiar but important issue that those with the greatest health needs often face the biggest barriers to care and are probably the least likely to be involved meaningfully in research.And what made this session stand out for me was that it was delivered alongside women with lived experience, which brought, I felt, a real deal, a real depth and authenticity to the discussion.And the workshop was a absolutely powerful reminder of the importance of meaningful involvement and offered some really practical ideas for how we can better include marginalized patients in our work.And going on to one of the regular features of the conference, which is the Right for Life workshop, led by our deputy editor at BJGP Life, Andrew Papaniktis and Tom Round. It's a really engaging session that encourages people to write and reflect on their experiences in general practice.And I often describe JGP Life, the website, as sort of the coffee room of the journal. It's a space for more sort of reflective conversation and debate.And here we're also always keen to receive some submissions from across the GP community, and it's probably worth pointing out that some of these pieces then go on to be published in the print journal too. And finally, the third workshop was led by Professor Graham Easton, who looked at public speaking for academics.And I just want to touch on Graham's really interesting background that he was able to draw upon here. So, Graham was a senior producer for BBC Science Unit for many years and presented Case Notes, which is Radio 4's flagship medical program.He's also a regular contributor to BBC Health Check and has quite a strong interest in the use of narratives and storytelling in medical education, which is a topic he looked at in depth in his doctoral work.So, looking back to his workshop, it focused on something we've all experienced, which is sitting through a talk or presentation where the key message gets lost in really dense slides and you just lose the audience.And Graham's session was all about how to communicate our work more clearly and make it engaging, using things like storytelling, simplifying your core message and using visuals that actually support you're saying, rather than Overwhelming it. It was a really practical session with lots of tips to take away and use straight away.And I think that everyone who attended, who attended learned something new about how to present their research in an engaging and meaningful way. So that's a roundup of the workshops. And finally we had the last keynote speaker of the conference, Dr. Rebecca Payne.And Rebecca really brought together one of the central themes of the conference, which was impact going back to Martin Marshall's talk as well. And Rebecca's talk focused on what happens after publication and challenged the idea that getting a paper accepted as the endpoint.Instead, she kind of framed it as the beginning. So that's the point at which the real work of influencing practice...
• Skill mix and patient trust in general practice 17.03.2026 18Min.

  Today, we’re speaking to Dr Charlotte Paddison, who is currently non-executive director at Royal Papworth Hospital, and formerly a Senior Fellow and co-lead for Primary Care at the Nuffield Trust.Title of paper: Implications of skill-mix change in general practice: secondary analysis of data from the GP Patient SurveyAvailable at: https://doi.org/10.3399/BJGP.2025.0360To the authors’ knowledge, no previous studies have investigated the impact on patient trust or perception of needs met when patients are unsure what type of health professional they have seen. Using data from a large national survey, this study found that patients expressed lower confidence and trust, and were less likely to report their needs were met in general practice consultations when they were not sure who their appointment was with. The results are novel in demonstrating that the combination of not knowing who you saw and a remote appointment is particularly problematic for patient trust.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.600 - 00:00:58.530Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for taking the time today to listen to this podcast.In today's episode, we're speaking to Dr. Charlotte Patterson, who is currently non Executive Director at Royal Papworth Hospital and formerly a Senior fellow and co lead for Primary Care at the Nuffield Trust.We're here to discuss the paper she's recently published here in the BJGP titled Implications of Skill Mix Change in General Practice Secondary Analysis of Data from the GP Patient Survey.So, hi, Charlotte, it's really lovely to meet you and to talk about your work and I just really wanted to start by exploring how we know that the composition of the general practice team is evolving with the increasing scope of multidisciplinary work. Really? And I wondered if you could just give us some of the context for this work and what you wanted to do here.Speaker B00:00:58.850 - 00:02:04.870Absolutely. Nada.So what we really wanted to understand was how two big shifts in policy are shaping the experience of patients care when they come to the GP practice. Why do we think that was interesting or potentially important?Basically, we've seen two big changes happening at the same time in the last five years. So.So we've seen the shift to multi professional team working with many more different types of health professionals working in general practice and at the same time, separately, we've seen a massive increase in the number of appointments delivered remotely. So what we wanted to know is what those changes really mean for patients.We also know that some patients feel confused about who they're seeing and when they turn up to a GP appointment at the surgery, whether that's an appointment with a GP or a physician's associate or a social prescriber.And this led on to another really important question for us in this study, which is what happens when patients are confused or uncertain about who they've seen and what does that mean for patient trust? Those are the kinds of questions we wanted to answer.Speaker A00:02:05.350 - 00:02:39.730So this was an analysis of the 2023 GP Patient Survey, which is sent to patients registered in English general practices.And I think the key thing for this work and what you've outlined just in terms of what you're saying right here, was that the survey asks people who their last general practice appointment was with and whether they had confidence and trust in that person and if their needs were met. And just given what you were describing, I wanted to move straight on to what you found.What did the patient say about trust and how did it Vary by different patient characteristics.Speaker B00:02:40.050 - 00:03:27.890Sure. So what we found in relation to trust. Nada.Is that while every 2, 2 in every 3 patients reported they definitely had trust and confidence in the health professional they saw at their GP practice. And that's very positive.We also found at the same time, there's a minority of patients, around 7%, who reported they did not at all have confidence and trust in their last GP practice appointment. And we found that trust is lower among patients who are younger, from minoritised ethnic backgrounds and living in more deprived areas.So that's what we found in relation to trust. We also found that patients are confused about different roles of health professionals working in general practice.And we've found this is likely to affect around one in every 20 patients.Speaker A00:03:28.370 - 00:03:30.290That seems quite a lot, actually, doesn't it?Speaker B00:03:30.530 - 00:04:26.740Yes.And it's also we found, looking at the GP general practice patient survey, we found that the proportion of patients who feel confused about who they're seeing has gone up over time.What I can tell you is that if we look backwards over time, the national survey data shows the percentage of patients who are unsure who their last appointment was with has more than doubled in six years. In 2018, it was around 1.9% of patients. In the 2024 survey, this had gone up to 5% of patients.And at the same time, we've also seen a decline in confidence and trust. So what we can say there is that confidence has declined by around 5% over that same time period.So 5 percentage points from 69% of patients saying, yes, definitely they had confidence and trust in the health professional they saw in 2018. But by 2025 that's dropped to 64%.Speaker A00:04:27.220 - 00:04:46.100And I think that almost reflects what's happening in practice with the increasing number of other roles working in general practice as well. And I think one of the really striking findings here is that patients reported much lower trust when they weren't sure which professional they saw.Do you want to talk us through that and why you think that is?Speaker B00:04:46.630 - 00:06:26.190Absolutely. So what we've seen in terms of context here is that a lot of change happening in general practice, much of it taking place at the same time.So we've seen in terms of multi professional team working, there are 40,000 additional non GP non nurse staff working in general practice, which is a whopping 387% per patient increase over a nine year period.At the same time, we've also seen this huge policy focus on rapid access, delivering more remote appointments, working at scale and a shift to digital and online as well. So there's a lot going on in general practice all at the same time.And we can also see alongside this changes in patients confidence and satisfaction with how general practice is working. So that's sort of a zoomed out, bigger picture lens.We can see that in terms of the British Social attitude survey in 2024, almost half of all people said they were quite dissatisfied with how general practice was working. But looking back in time, if we look back to 1983, we see that only 13% of people were dissatisfied with how general practice was running.And even looking back just 10 years ago, in 2016, that figure is 16% of the of people in the British Social Attitude Survey who were dissatisfied with general practice. So we're seeing massive shifts across multiple aspects of general practice.At the same time, we're seeing a significant shift in the proportion of people who feel that they are satisfied with what's happening in terms of the care they're receiving from general practices.Speaker A00:06:27.070 - 00:06:35.070And I guess that relates to some of the issues with trust and potentially not knowing who people are seeing in practice as well.Speaker B00:06:36.170 - 00:07:12.390Absolutely.So in our findings, what we found was that the combination of not knowing who you saw and a remote appointment is really problematic for patients in terms of trust and confidence.So to give a flavour of this, when patients were not sure what health professional, what type of health professional they saw or spoke to, and this was a remote appointment, so an appointment by phone or video or message, the likelihood of reporting confidence and trust decreased by up to 80% when compared to patients who saw a GP in person at their practice.Speaker A00:07:12.470 - 00:07:48.910And we did a podcast with Richard Baker talking about trust in healthcare professionals as well.And one of the things he highlighted was that actually trust is really important in that patient clinician interaction, because, you know, that trust actually builds some foundation towards whether people might want to come back to the practice, they might want to take up that advice or management that's been suggested by the clinician they see.So I think not only are you seeing these associations, but it's actually really drilling down to why trust is so important as well in these...
• What happens in general practice before an emergency lung cancer diagnosis? 10.03.2026 13Min.

  Today, we’re speaking to Marta Berglund, a Research Assistant and PhD candidate at University College London. Title of paper: Pre-diagnostic primary care consultations and imaging in emergency-diagnosed vs referred lung cancer patientsAvailable at: https://doi.org/10.3399/BJGP.2025.0369It has been postulated that emergency diagnoses of cancer (which occurs frequently and confers a poorer prognosis) may relate to suboptimal diagnostic management in primary care, but evidence to support or refute this hypothesis is sparse. We found that emergency-diagnosed patients with lung cancer were less likely to present with relevant respiratory symptoms and had fewer chest imaging investigations before diagnosis compared to patients diagnosed via referred routes, indicating an important role of disease factors in emergency diagnosis.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.200 - 00:01:06.690Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for listening to this podcast today.In today's episode, we're speaking to Marta Bergland. Marta is a research assistant and PhD candidate at university College London.She's recently published a paper here in the BJGP titled Pre Diagnostic Primary Care Consultations and Imaging in Emergency Diagnosed versus Referred Lung Cancer Patients.So, hi, Marta, it's really lovely to meet you and it's great to talk to you about cancer diagnosis, which is a really important area for general practice and also a topic we publish on quite a lot here in the bjgp. It's been fascinating reading this paper and it tackles a cancer that we really don't do well with here in the UK in terms of early diagnosis.But I wonder if you could just start off by telling us a little bit more about lung cancer and how it's actually often diagnosed, which can sometimes lead to some of those poor outcomes.Speaker B00:01:07.010 - 00:02:26.970So, as you said, lung cancer is one of the cancer sites in the UK where the majority or a large proportion of patients are diagnosed through the emergency route, also known as emergency presentations, which is when a patient is diagnosed after they present through an urgent hospital admission or an A and E attendance in the 30 days before diagnosis.And that could look like someone who has had a persistent cough for, say, two weeks, but didn't actually go to their gp, and then suddenly they have a more severe onset of symptoms like shortness of breath, and then they go to A and E and are referred to a chest X ray and then get diagnosed, which is a pathway that is associated with worse prognosis and worse outcomes after diagnosis. And the more preferred route, if you will, in England to diagnose patients is through primary care.So through the GP routine referral or the urgent suspected referral route.And that could look like someone who presents to primary care with cough or dyspneasia again, but then their GP refers them to a chest X ray and then they're diagnosed with lung cancer.Speaker A00:02:27.130 - 00:02:45.290And I guess I wanted to just before we talk about what you found, I wanted to just cover here again, what you mean by this term, that's diagnostic window, because you mentioned that a few times in the paper. But what does this actually mean?And it relates a bit back to some of what you're talking about, about people presenting with symptoms, isn't that right?Speaker B00:02:45.530 - 00:03:09.880So, for us, it's a measure of healthcare use before diagnosis, and it could be any healthcare use Measure like consultations, symptoms, blood test use, anything like that.And it's measuring when that changes compared to baseline before diagnosis, which can signal increased healthcare use associated with the subsequent diagnosis.Speaker A00:03:10.040 - 00:03:16.840Okay, so it just, I guess it's what it says on the tin. It's just that window, isn't it, of potentially being able to pick up a change.Speaker B00:03:17.490 - 00:03:25.970Exactly. So the idea is that if there is an increase long before diagnosis, then possibly there is an opportunity to diagnose these patients earlier.Speaker A00:03:26.450 - 00:04:09.190So this was a really big study using the CPRD and this is a database that a lot of the listeners will be familiar with.And you had a sample of a million patients registered with UK General Practice and then you looked at people diagnosed with cancer and their pre diagnosis rates of consultation like you were talking about, and also chest imaging by the different possible diagnosis routes. So either as an emergency, a routine or an urgent referral. But I really want to move straight to what you found here.Can you give us just an overview of how the different people in this analysis were eventually diagnosed with lung cancer? So were there a lot of emergency diagnoses here?Speaker B00:04:09.350 - 00:05:46.240Yes, I believe we had around 30% of patients who were diagnosed through the emergency route, compared to 20 something percent in the urgent referral route and the GP routine referral route. That aligns with the national data in NCRAS and also the Rapid Cancer Registry data. I guess that's what we expected to see.We found that the majority of patients do present to primary care, which then disproves this hypothesis that has been presented in the literature that patients who are diagnosed through the emergency pathway don't present to primary care at all and therefore there wouldn't really be a chance to intervene and improve these patients diagnostic pathway. I think that is one of the key findings, although it is a simple finding.Then we also found that there are short term similar diagnostic windows across these routes.Patients who are diagnosed as emergencies had similar opportunity to intervene earlier as patients from the other routes, just because of the timing at which things changed.However, we also looked at the rates and those were consistently lower for emergency diagnosed patients, even though the timing at which things change at the lower rates mean that these patients present less frequently. And so because they present less frequently, there are simpler, fewer chances in primary care to also like see warning signs earlier.Speaker A00:05:46.480 - 00:05:56.480Yeah, so you looked at those consultations rates. So is that what you're describing here? So is that what those findings show in terms of potential opportunities for earlier diagnosis?Speaker B00:05:57.280 - 00:06:17.190Yeah, so what I had in mind was mostly the consultations and the consultations with symptoms, but then acknowledging that we measured two different things.So the timing at which things change, the diagnostic windows as well as the rates of these consultations, how frequently they were occurring for patients by route.Speaker A00:06:17.430 - 00:06:27.510And what you're suggesting is that people who were diagnosed via emergency had lower rates. So that sort of is a bit counterintuitive. So can you talk us through that again a bit?Speaker B00:06:27.590 - 00:07:06.880It's a bit contradicting.Well, it would seem that it is because these patients do present to primary care and then when things start going wrong, let's say they happen around a similar time as for patients who are diagnosed through the other routes. But what sets the emergency diagnosed patients apart is that they present less frequently.So they may still have cough and may still go to their gp, but they may not do so as often as someone who's referred on a two week wait, for example, or now urgent suspected referral, which then means that there are fewer chances for gps to pick up on persistent symptoms and then refer those patients.Speaker A00:07:07.200 - 00:07:19.780And I guess just.Were there any other main findings that you found in terms of sort of the diagnostic window or sort of consultations before diagnosis via the different routes?Speaker B00:07:19.940 - 00:09:14.860Yeah, so I think one of the most interesting ones as well to the overall finding of patients presenting to primary care is that patients presented with non specific symptoms around 10 to five months before diagnosis across the routes, which is still quite a while before they're diagnosed.So potentially this could mean that something could have been done differently to, for example, refer these patients earlier in like say month nine before diagnosis rather than nine months later. But again, as you said, this is also in lung cancer patients, which is a very difficult cancer site to diagnose early.And part of that reason is because the symptoms that patients present with are non specific symptoms.So it's also understandable that it is difficult to make that call based on someone presenting with cough in primary care, which is why there's more like work to be done and we need to better...
• Designing neighbourhood urgent care: A general practice perspective 03.03.2026 24Min.

  Today, we’re speaking to Dr Mike Holmes, a GP in Yorkshire and Chair of Nimbuscare, a local GP-led multi-neighbourhood provider.Title of paper: Neighbourhood delivery of urgent care in North Yorkshire, UKAvailable at: https://bjgp.org/content/76/764/133Neighbourhood-based urgent care, led by GP Multineighbourhood providers, can reduce reliance on hospitals and NHS 111. Delivering urgent care in community settings is more cost effective than Urgent Treatment Centre and Emergency Departments attendances. Digital integration and shared clinical systems improve safety, responsiveness, and patient experience. Co-locating operational and clinical teams streamlines service delivery and enables operational and quality oversight. Sustained impact requires recurrent funding and performance measures that reflect system-wide improvement rather than single-provider metrics.
• Delayed, declined, or disengaged? Understanding childhood vaccination patterns 24.02.2026 19Min.

  Today, we’re speaking to Dr Karol Basta, a Public Health Registrar based in London.Title of paper: Predictors of Childhood Vaccination Uptake and Timeliness in a Diverse Urban PopulationAvailable at: https://doi.org/10.3399/BJGP.2025.0319Childhood vaccination rates have declined in the UK, with inequalities in urban, deprived, and ethnically diverse populations. Previous studies have lacked individual-level clinical data or did not explore both uptake and timeliness. We analysed 13 years of routinely collected primary care data for over 37,000 children in a diverse London borough to identify predictors of uptake and timeliness. Distinct sociodemographic and clinical factors were associated with incomplete and delayed vaccination, offering timely insights as responsibility for vaccination services shifts closer to local systems and place-based commissioning.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.880 - 00:00:52.000Hi and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors of the Journal. Thanks for taking the time to listen to this podcast today.In today's episode, we're speaking to Dr. Carol Basta.Carol is a public health registrar based in London and we're here to talk about the paper she's recently published here in the bjgp, which is titled Predictors of Childhood Vaccination Uptake and Timeliness in a Diverse Urban Population. So, hi, Carol, it's really lovely to meet you and to talk about this work. And I guess just to start, I wanted to put this work into context.We know that in the uk, overall childhood vaccination rates have unfortunately been declining. Could you talk us through some of the current challenges around vaccination, especially in urban and diverse areas?Speaker B00:00:52.720 - 00:02:06.750Yep. So we know vaccinations are really powerful and cost effective tools we have in giving children the best start in life life.But unfortunately, in the UK, since 2012, the uptake has been declining and actually since 2021, none of the vaccines in England have reached the 95% target recommended by the WHO to stop communicable disease outbreaks. And the kind of negative consequences of this aren't just sort of future hypothetical risks.We've already been seeing vaccine preventable diseases such as measles and whooping cough resurgences, and this is especially in certain parts of the uk, such as London or the northwest of England. So no uptake of vaccines is decreasing and vaccine preventable diseases are increasing. But that's not the full picture.We also know, for example, following work done by, at the time, Public health England in 2017, there are avoidable inequalities across the childhood vaccination program nationally, for example, linked to deprivation, geography and ethnicity.However, what was missing was really kind of contemporary granular evidence on the social and clinical factors associated with unequal vaccine outcomes, especially in diverse urban environments.Speaker A00:02:06.990 - 00:02:16.670And I know this was highlighted as well during COVID but there is a mistrust of health services amongst some communities as well, which might be playing into this.Speaker B00:02:17.470 - 00:03:11.120Yeah, exactly.So at the time when I was working in Lamb of Council, we knew qualitatively from talking to our community and talking to our local GP partners, that there was kind of sense of rising mistrust in healthcare services, but also rising difficulties with actually access to services.And that doesn't just affect whether or not people can get the vaccine, for example, it also affects whether they can have conversations about vaccines and the kind of continuity of care and building up those relationships.And so this is what we had kind of on a local level, but we knew that there was also national feelings and sentiments around mistrust, not just national, but actually globally vaccination mistrust from the COVID 19 pandemic. And there were worries that this had run off into the childhood vaccination program as well, that it hadn't just confined itself to Covid vaccines.Speaker A00:03:11.440 - 00:03:41.490So this was a study looking at predictors of routine childhood vaccination from 40 general practices in Lambeth and London, which is a pretty ethnically and socioeconomic demographically diverse borough. And you looked here at the vaccination uptake and timeliness and some of the predictors for these. This was a really big sample.But just to underline the population here, tell us more about the demographics in Lambeth as a borough in terms of ethnicity, because that's where you were based when this work was done.Speaker B00:03:41.890 - 00:04:32.250Yeah, exactly.So Lambeth is an inner London borough and it is very ethnically diverse, it's very densely populated, but it also has some of the highest levels of deprivation in the country. And part of the strengths of this study is that we were able to use detailed ethnic subgroup breakdowns.So, for example, rather than using the broad category of South Asian, we were able to split this down into Pakistani, Bangladeshi, Indian, et cetera. And this was really important because this aligns with national health equity guidance.We know that health outcomes actually vary between the details, subgroups.There's some evidence to suggest that, but it was also important following local community engagement work, where people repeatedly told us these kind of big, broad groups don't reflect how we self identify.Speaker A00:04:32.490 - 00:04:39.530And I wanted to just move on to the results here, so can you start talking us through some of the associations based on deprivation to start with?Speaker B00:04:39.690 - 00:06:22.410Yeah, sure. So we looked at two main outcomes.We looked at vaccination uptake, so that's whether children had received their vaccines at any time point during the study. And we also looked at vaccination timeliness.And vaccination timeliness is important because although a child might eventually go on to receive their vaccine, it leaves them. They're late, it leaves them unprotected for at times when they're most potentially likely to get unwell.And what we found with deprivation in uptake, there was really clear patterns associated by deprivation.There was actually children living in more deprived areas were progressively less likely to be vaccinated compared with those living in the least deprived areas.So, for example, children living in the most deprived 20% of our population were about a third less likely to be fully vaccinated compared to those living in the least deprived areas. This kind of wasn't just a straight out deprivation.There was also lower uptake linked to other markers of social vulnerability, such as being born outside of eco, or such as children having safeguarding involvement. And so that was what we found for uptake. But what was interesting is the findings for timeliness didn't mirror this.So whilst those living deprivation were less likely to be vaccinated, if we zoom in on just the population that were vaccinated and think about were they vaccinated on time, we didn't find that children living in deprivation were less likely to be vaccinated on time. We found no difference. And there was a similar pattern for other markers of social vulnerability, such as safeguarding involvement.They have a lower uptake, but it wasn't associated with kind of untimely vaccination.Speaker A00:06:22.650 - 00:06:31.210And you've touched upon this, but there was a really striking result here in terms of children who were born outside of the uk. So can you talk us through this?Speaker B00:06:31.530 - 00:06:59.060Yeah. So we also found that children born outside of the UK were much less likely to be vaccinated compared to children born inside the uk.However, if again, we zoom in on just those vaccinated and look at timeliness, we actually find the opposite. So if you were born outside of the uk, you were more likely to have your vaccine delivered on time compared to those who were born in the uk?Speaker A00:06:59.380 - 00:07:03.380Sure, yeah. So talk us through some of the reasons that you think that this might be happening.Speaker B00:07:03.380 - 00:08:30.800Yeah, I think these findings, the difference between uptake and timeliness, not having the same predictors and in some case having the opposite patterns being shown are really quite interesting. And they're kind of a few possible explanations as to why this might be. One is perhaps potentially there's a form of selection going on.So when we look at only children who get vaccinated in groups with lower overall uptake, for example, children of non white British ethnicity, or as we've said, children not born in the uk, the children who do get vaccinated may represent more engaged, health literate or well supported families. And that same engagement may...
• From swabs to urine sampling: Rethinking cervical screening in general practice 17.02.2026 15Min.

  Today, we’re speaking to Prof Emma Crosbie, Professor of Gynaecological Oncology based at the University of Manchester.Title of paper: Urine human papillomavirus testing for cervical screening in a UK general screening population: a diagnostic test accuracy studyAvailable at: https://doi.org/10.3399/BJGP.2025.0105The switch from primary cytology to primary human papillomavirus testing has enabled innovations in self-sampling for cervical screening. This study shows that urine self-collected with a first-void urine collection device has similar diagnostic test accuracy and acceptability to cervical sampling in a general screening population. Urine self-sampling has real-world potential as an alternative cervical screening option.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.440 - 00:01:07.140Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the bjgp. Thanks for listening to this podcast today.In today's episode, we're speaking to Professor Emma Crosby, who is professor of Gynecological Oncology based at the University of Manchester. We're here to talk about her really exciting paper that's recently been published in the December 2025 issue of the BJGP.The paper is titled Urine Human Papillovirus Testing for Cervical Screening in UK General Screening Population A Diagnostic Test Accuracy Study. So, hi Emma, it's lovely to meet you and to talk about this paper.I really just wanted to start off talking a bit around cervical screening in the uk, and you mentioned this in the introduction to the paper as well, that cervical screening really does have variable uptake rates and we know that there are some, some barriers to access. But can you talk us through these and tell us a bit about why you decided to do this research?Speaker B00:01:07.940 - 00:03:41.440So, as you've just really nicely summarised, cervical screening is really important weapon against cervical cancer.So we know that it prevents cervical cancer and since the introduction of the NHS Cervical Screening program in the UK, we've seen deaths from cervical cancer drop by around 70%. So we know that it's very effective.But in the uk, the number of people attending is declining year on year and currently, currently only around 68% of those people who are eligible for cervical screening actually attend. There are a whole range of different reasons for non attendance.These include things to do with the speculum examination, so having to have an intimate examination to be examined. The anticipated embarrassment or fear of pain related to that procedure, I think are important barriers.But there are also barriers associated with access to reaching screening appointments, taking time off work, having childcare and so on and so forth. So we thought that there was some really important barriers there that could potentially be addressed by self sampling.Now, vaginal self sampling is actually been incorporated in many cervical screening programs around the world.Some cervical screening programs are using it just for people who are non attenders or underscreened by traditional screening routes and other countries are using it as a choice for everybody.Now, in the uk, we haven't yet taken up vaginal self sampling sampling, but it will be introduced this year in 2026, principally for under screened groups. And there is some work looking at whether or not it will be introduced as a choice for everyone in the future.But we know from research that's been done in the UK that only around 12 to 13% of people who are offered vaginal self sampling who are under screened actually return a sample. And therefore it clearly doesn't address all the barriers to cervical screening. And we wondered whether a urine test would have more app.It would have the same benefits of vaginal self sampling in that it can be collected at home and posted to the laboratory. So it removes that need for an intimate examination.It removes the need for, you know, making an appointment at a healthcare facility to have your screen taken, but it perhaps, you know, removes some of the barriers towards putting a swab inside the vagina that might be culturally or religiously unacceptable to some groups. And so we thought that a urine self sample could be another option for people who currently aren't screened.And so we wanted to see how accurate it was in this study.Speaker A00:03:42.320 - 00:04:03.760And those issues around access are really important, especially in this population of women who are juggling lots of caring responsibilities with young children or caring for older relatives as well.So sometimes it is just difficult to get to an appointment and, you know, juggling work hours and things which often then coincide with GP opening hours as well.Speaker B00:04:03.920 - 00:04:41.960Yeah, absolutely.And we, we have seen a drop in people, you know, in the youngest age group of people who are invited for screening, attending SCRE, their rates of attendance are even lower than the 68% that I quoted.And probably a lot of that is to do with having very busy lives, not seeing this as a priority, imagining that you're not at risk and seeing cervical cancer as something that affects older people, perhaps. So there are additional barriers related to certain age groups.But I definitely think that making time for a screening appointment, juggling all the different millions of things that we have to do every day, is a really important barrier that something like a urine based test could help to overcome.Speaker A00:04:42.120 - 00:05:10.680Yeah, fair enough. So this was quite a big prospective study of over 1500 women carried out across the northwest of England.So women provided both regular speculum based cervical samples alongside urine sample too. And the main thing you were looking at here was the accuracy of the urine based HPV testing for cervical cancer.But just in case people aren't completely aware of all this, can you talk us through first why we're now only looking at HPV in these samples?Speaker B00:05:11.060 - 00:06:30.230Yeah. So, I mean, in 2019 in the UK, we changed from primary cytology based cervical screening to primary HPV based cervical screening.So that means that the sample taken from your cervix is tested first for hpv and only if that is HPV positive is it then looked at under the microscope. To see if there are changes in the cells.And this was based on a very large study done in the UK that showed that HPV testing is a much more sensitive test than cytology as the primary scre.And by that what we mean is it's much more likely not to miss abnormal cells than cytology, which is very effective when there is a large lesion, if you will, that can be sampled with a cervical swab, but not so good at picking up smaller lesions. And so there is the chance that cytology might miss an abnormality. But HPV is really good at showing that somebody is at risk.So we now do all primary screening by HPV testing. And of course this is what has opened up the opportunity for us to do different sample types.So a vaginal swab tested for HPV or a urine sample tested for hpv, you know, could also be an effective way of screening people to see if they are at high risk of cervical pre cancers.Speaker A00:06:30.390 - 00:06:37.830So talk us through the results. So how well did the urine based testing perform? So both in terms of how sensitive and specific the results were?Speaker B00:06:38.130 - 00:09:24.670Well, first of all, it's really important to say that this piece of work followed on from another piece of work that looked at a high risk population. And in that other piece of work we were able to show that it's really important how the urine sample is collected.So absolutely must be collected with a colipy device or a similar device that collects the first fraction of urine sampled. And that's important because the HPV isn't in the urine itself.The urine is flushing cervical mucus that is accumulated around the urethra into the sample. And so if you don't collect that very first flush of urine, then you're likely to miss the hpv.So on that background, using the COLIP device in this study and collecting that urine sample prior to the routine clinician obtained cervical sample, we were able to obtain two samples from each person that we were then able to test with the same HPV test. And we were able to compare absolutely how accurate the urine was compared to the matched cervical sample.And because we were using a general population, so this is anybody that's due cervical screening rather than a high risk population, we knew that we weren't going to see very many people who had CIN2 plus, which is the cervical pre cancer that we want to identify and treat.And actually what we were looking for here was to see, you know, what prevalence of HPV infections do we pick up using the two tests, you know, the urine test and the Cervical test and how well matched are they at terms of, you know, telling somebody that they're HPV...
• Trust matters: A practice-level look at patient confidence in health professionals 10.02.2026 17Min.

  Today, we’re speaking to Professor Richard Baker, emeritus Professor at the University of Leicester. Title of paper: Factors influencing confidence and trust in health professionals: a cross-sectional study of English general practices.Available at: https://doi.org/10.3399/BJGP.2025.0154A transactional model of general practice is being introduced to improve access that involves triage and increasing percentages of appointments with professionals other than GPs or that are not face-to-face. Using summary data about almost all English general practices in 2023-24 with 750 or more patients, the patient-reported levels of confidence and trust from the General Practice Patient Survey were associated with increased percentages of appointments that were with GPs or were face-to-face, and with higher continuity, after adjusting for other practice and patient factors. Confidence and trust was lower in practices with fewer appointments per year per patient, fewer patients having their needs met, greater deprivation, fewer patients of White ethnicity, and in practices located in London, as compared to other regions of England. Access to general practice needs improving, but the findings of this cross-sectional study suggest that preserving features of relationship-based care is also needed to maintain patients’ trust and confidence in health professionals.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.200 - 00:00:46.980Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for joining us here to listen to this podcast today.In today's episode, we're speaking to Professor Richard Baker, Emeritus professor at the University of Leicester. We're here to talk about the paper that he and his colleagues have recently published here in the bjjp.The paper is titled Factors Influencing Confidence and Trust in Healthcare A Cross Sectional Study of English General Practices. So, hi, Richard, thanks for joining me here today and it's nice to see you again.Just before we talk about this paper, I wonder if you could just talk to me about trust and why you think it's important in general practice interactions.Speaker B00:00:47.780 - 00:01:32.060Well, it's difficult to have a consultation with a patient if they don't trust you. I mean, it's just very basic, a very basic level, very simple level. But there's lots of evidence as well that trust is important.People who trust you are more likely to follow your advice. They're more likely to take the medication.They're more likely therefore, to come back and see you again, more likely to use services appropriately in the future. And there's some evidence that the outcomes are better if there's trust there. Trust obviously should be earned.You can't take it for granted, you've got to be trustable. But it's obviously very important for clinical practice and essentially always has been, hasn't it, really? Going back to the.The Greek doctors, trust was important then, just as it is now.Speaker A00:01:32.460 - 00:01:38.540And you mentioned about different outcomes. So what sort of outcomes do we know could be associated with trust?Speaker B00:01:39.180 - 00:02:07.990Just use of services is one example.So you can get people who, if they don't trust who they see, they go and see someone else and again, and so they overuse services and that waste resources.On the other hand, you may get people who just won't come, so they'll delay presenting with the problems because they don't trust the provider to get it right. Then they risk of poor outcomes as a consequence of that. So it's a whole mixture of things.Speaker A00:02:09.030 - 00:02:21.190So what were you trying to do in the study?So you wanted to look at trust and how it impacted on patient outcomes, or was it more about sort of the predictors and associations with trust, isn't it?Speaker B00:02:21.800 - 00:04:33.330Yes, I think we were conscious that general practice has gone through a lot of change.The big changes came about during the pandemic as to how general practice is delivered, how people have their appointments and things have sort of Reverted a bit to how they were, but only partially in terms of who you get to see face to face, appointment and so on. And we were asking the question, well, what has been the consequence of this?Should we be thinking about confidence and trust in association with these changes?I mean, the changes may have been absolutely essential because we just don't have the capacity in general practice to do everything that we would like to do for an increasingly multi morbid population. But what are the consequences? How do we need to respond? How do we need to respond?Questions I guess for follow on from Is there a link between confidence and trust and these changes in general practice changes?I think when we looked at this, we've sort of grouped them, we sort of imagined that there are two models of general practice which the relationships based care and the transactional model. Of course there aren't two models, it's all mixed up. But to simplify it, you call it two different things.And we've tried to categorize or explain what relationship based care might be, which has typified by high context continuity, face to face appointments with someone, you know, usually a gp, to get generalist medical care.And then the transactional model where you, you have a problem, you, you phone up or email or whatever it might be online and you get allocated or triaged to a particular professional who deals with that particular problem and then off you go on to something else. And, and it could be face to face, it could be over the phone, it could be all sorts of different health professionals.So there's two different ways, it's all mixed up. And every practice offices offers these two approaches in different degrees. It's just.So this arbitrary division that we've described and we're sort of interested in how we look at that, how is competent trust linked to that?Speaker A00:04:34.769 - 00:04:56.790This was a study looking at the general practice patient survey, which includes a question about whether patients felt that they had confidence and trust in their healthcare professionals. And. And then as we were discussing, you looked at some of the factors that might influence this trust.But I wonder if you could talk us through the findings. So in this survey, how many respondents felt that they trusted their healthcare professionals?Speaker B00:04:57.590 - 00:06:12.790This was, we were interested and the question was, did you have complete confidence in trust in the professional scene at your last appointment? And around about the figure was 64, 65% on average across all the practices.So this was all general practices, but the vast majority of 99% or something of all general practices in England, 6200 practices were roughly in the study. And this was 20, 23, 24 year. It was a simple cross sectional study for reasons the data weren't available for a longitudinal study, unfortunately.But so there are inevitably limitations on that.But I suppose, yes, you would say two thirds had full confidence in trust and others had partial confidence trust and others had absolutely no competence and trust in the professional they had last seen.Now, this relates to all types of health professionals seen, so it would include gps, but it would include the nurse you saw, the physiotherapist or the pharmacist or whatever. It would be the general practice based pharmacist, the people in the primary care team who, who consult with them see patients.Speaker A00:06:12.870 - 00:06:38.150And you talked earlier about these two different models of care, the relationship based model and the transactional model.And you know, you described that some of this might be a bit more mixed in practice, but did you find any associations between those different ways of working and how trust was or how much patients trusted their interactions with their last healthcare professional?Speaker B00:06:39.610 - 00:07:53.140There's a tendency among the findings for relationship based care to be associated with higher levels of competence and trust, relationship based care being typified by higher levels of continuity, more face to face appointments, more appointments with gps. And of those three things, continuity is perhaps the most powerful association and then points with GPS the next most powerful.And face to face being the third or least powerful element of that three.When you put all three together, I think it becomes quite a powerful message really saying patients do by and large tend to be more trusting, have more confidence in relationship based care.But that doesn't mean to say there are patients who don't want transactional care and have trust and confidence in it, they get it and when they want it. So it's not a simple either...
• Belonging, autonomy and burnout: Why GPs leave 03.02.2026 15Min.

  Today, we’re speaking to Dr Laura Jefferson, Senior Research Fellow based at the University of Manchester. We’re here to discuss her paper recently published here in the BJGP titled, ‘Understanding persistent GP turnover using work and personal characteristics: a retrospective observational study’.Title of paper: Understanding persistent GP turnover using work and personal characteristics: a retrospective observational studyDOI: https://doi.org/10.3399/BJGP.2025.0260GP turnover rates from national administrative datasets have previously been used to explore practice-level factors associated with turnover and its relationship to patient. outcomes. The individual and work characteristics associated with turnover is less well understood, with much research focusing on intentions to leave or smaller samples of GPs leaving practice. This study sought to fill this research gap, through analysis of a large dataset of GPs working experiences linked to turnover, understanding potential predictors that may offer solutions to the workforce crisis being faced in general practice. We find that GPs’ sense of autonomy, belonging and competence are significantly lower in practices with problems with persistent turnover and demonstrate how satisfaction with work characteristics such as working hours and experiences of strained relationships differs in practices with persistent turnover. TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.880 - 00:00:53.050Hello and welcome to BJGP Interviews. My name is Nada Khan and I'm one of the Associate editors of the bjgp. Thanks for joining us here to listen to this podcast today.In today's episode, we're speaking to Dr. Laura Jefferson, who is a senior research fellow based at the University of Manchester.We're here to discuss her paper, recently published here in the journal, titled Understanding Persistent GP Turnover Using Work and Personal A Retrospective Observational Study.So, hi, Laura, it's really nice to see you again and to talk about this research and I suppose I really just wanted to frame our discussion here today by saying that there's been a lot of talk recently about the retention crisis in UK general practice, but I wonder, could you just talk us through how big is the scale of the problem that we're dealing with here?Speaker B00:00:53.370 - 00:02:12.110Yeah, thank you. Yeah, well, thank you for inviting me to talk to you today as well.I think it's interesting, we hear a lot of discussion in the media and in our research evidence as well, recently about an increase in GP turnover. In the past sort of decade, there's been a gradual increase, so that's in terms of GPs leaving medicine, but also moving across practices.And it's good to see a kind of change in policy focus from historically, a lot of policies focused on recruitment of GPS. So, you know, we've had like, pledges to have 6,000 GPS that have not been met and it's often kind of criticized as filling a leaky bucket.So if we try and obviously pay a lot. So I think it's approximately half a million pounds to train a gp, but actually to replace the GP is really expensive as well.So it's about £300,000 to replace the GP.And so, yeah, so there's a positive focus to thinking about retention, but actually it's about how can we do that effectively and understanding that the sort of one size fits all approach doesn't necessarily work and that there's different gps with different needs.Speaker A00:02:12.590 - 00:02:36.830And this was a study where you were looking at the association between high practice turnover of GPs and GP job satisfaction. And what you did was you linked data from different general practice practices and GP workforce surveys.But the first thing I wanted to really look into was that you identified these high turnover practices. What exactly did this mean?Speaker B00:02:37.070 - 00:04:33.190Yeah, so there's been previous research that's done this before, so it's using. We're really fortunate in the UK that we've got really good workforce data compared to a lot of other countries.So we have longitudinal data going back a long way that we can use for research purposes to try and understand more about these trends.So colleagues of mine at Manchester have previously used this data from NHS Digital, which is now NHS England, linking with data on gps by General Practice, which is has got data on their kind of start and leave dates in a practice. And that allows us to track where gps are moving out of a practice and how long they've stayed there for.So they've previously looked at sort of persistent turnover as being categorized as a practice where they have consistently, for three years running, had a 10% turnover of GPS. So this is where it seems to be a more worrying turnover figure.I think it's expected that there's going to be some level of turnover and some level of turnover that might be a useful thing. But those kind of practices where you think, oh, what's going on there?And particularly then within our research, looking at what are the striking differences in those practices, both in terms of the sort of workplace characteristics that GPs are experiencing? So can we use that data to explore strategies that could be used to actually support gps in those practices?So trying to understand, really, what does it feel like for a GP in these practices with persistent turnover, so that then, hopefully, through this sort of research, is kind of like the first step in a puzzle to try and determine strategies to support them.Speaker A00:04:33.750 - 00:04:50.310Yeah, fair enough. And then thinking a bit more about what you found here.So you looked, as you said, at some of the characteristics of the GPs who worked in these high turnover practices, and you found some really interesting differences that related to gender, age and experience. So can you talk us through that?Speaker B00:04:50.390 - 00:06:45.570Yeah.So this was the first time that these large data sets have been used to look at GP characteristics that might not necessarily predict turnover, but might be associated with turnover.So difficult to make predictions using the approaches that we've used, but we were able to, within our analysis, adjust for things like age, experience, gender, looking at GP partners and salaried GPs to try and draw out, are there any differences? And we did find a gender difference. So women were more likely to be in practices with persistent high turnover.But because of the analytical approach that we've used, it's really difficult for us to unpick. What does that actually mean? Does that mean that are they driving turnover or do they actually become stuck in these practices?So there's a lot of research literature that suggests that women may be less mobile in the workplace for a number of societal reasons. So it could be that that's a factor explaining the gender difference that we found.But this is a really important first step for us to then develop the strateg thinking about what different groups need. Only included a smaller proportion of salaried GPs, so we weren't able to look so well at partners versus salaried.And also looking at ethnic diversity and variations, particularly important given that there's a large proportion of international medical graduates now as GP registrars.So this is a kind of first step and there's going to be future research, which we've been commissioned now to do this research in a larger sample of gps, looking at a longer time frame as well, which will be really nice to be able to look after. Covid.Speaker A00:06:45.890 - 00:07:02.130Brilliant. That sounds really exciting. And I think what's really interesting here is how satisfied GPs were with different aspects of their work.What did the gps rate as low satisfaction in their job role and how did this impact on turnover?Speaker B00:07:02.550 - 00:09:38.570Yeah, so what we did is we used a theoretical framework to guide our analysis.So within the Work Life Survey, there's a number of different kind of components that gps can rate in terms of their satisfaction with their working lives. But that would be quite a messy analysis.So to try and break this down, we used the ABC of Doctors Needs, which is a framework which talks about the importance of autonomy, belonging and competence for doctors to feel that they're happy and well within their work and that impacts on retention. So, yeah, so we looked at those components and within each of those we used questions from the survey that spoke to those theoretical domains.So, for example, autonomy looked at sort of, there was an item around freedom to choose the methods that they're working with.Also items around paperwork, variety of work and hours of work, belonging looked at particularly around sort of relationships and feeling connected to and valued in the workplace.There's questions in the survey about strained relationships at work and also about recognition, so feeling like they're valued for delivering a good job. And then the third domain that we created around...
• BJGP Top 10 research most read and published in 2025 27.01.2026 40Min.

  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 2025 brings together high-profile primary care research and clinical innovation.And here are the top 10 most read papers of 2025:10Adoption of clinical pharmacist roles in primary care: longitudinal evidence from English general practicehttps://doi.org/10.3399/BJGP.2024.03209Factors affecting prostate cancer detection through asymptomatic prostate-specific antigen testing in primary care in England: evidence from the 2018 National Cancer Diagnosis Audithttps://doi.org/10.3399/BJGP.2024.03768Paramedic or GP consultations in primary care: prospective study comparing costs and outcomeshttps://doi.org/10.3399/BJGP.2024.04697What patients want from access to UK general practice: systematic reviewhttps://doi.org/10.3399/BJGP.2024.05826Technostress, technosuffering, and relational strain: a multi-method qualitative study of how remote and digital work affects staff in UK general practicehttps://doi.org/10.3399/BJGP.2024.03225Antidepressants and risk of postural hypotension: a self-controlled case series study in UK primary carehttps://doi.org/10.3399/BJGP.2024.04294Challenges to quality in contemporary, hybrid general practice a multi-site longitudinal case studyhttps://doi.org/10.3399/BJGP.2024.01843Low-dose amitriptyline for irritable bowel syndrome: a qualitative study of patients’ and GPs’ views and experienceshttps://doi.org/10.3399/BJGP.2024.03032Artificial intelligence for early detection of lung cancer in GPs’ clinical notes: a retrospective observational cohort studyhttps://doi.org/10.3399/BJGP.2023.04891Effectiveness of low-dose amitriptyline and mirtazapine in patients with insomnia disorder and sleep maintenance problems: a randomised, double-blind, placebo-controlled trial in general practice (DREAMING)https://doi.org/10.3399/BJGP.2024.0173TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.480 - 00:01:27.500Hello and welcome to the BJGP Top 10 podcast.So this is where we take a closer look at the most read research papers in the BJGP in 2025 and just have a discussion about what they mean for day to day general practice. I'm Nada Khan, one of the associate editors of the Journal.And in today's episode we'll be exploring some of the themes that really captured attention with the readership, I suppose. And we'll be talking about things like consultation compl complexity and workload pressures.Some work around diagnostic uncertainty and how to look, look after people with multimorbidity.And I think we're going to have a discussion a bit more, not just about what these papers found, but maybe a bit about why they resonated and maybe give a bit of editorial feedback around that. And because it's a conversation here between three clinicians as well.And I'll go around and introduce everyone in a minute, maybe a bit about what they add to the conversations we're already already having in practice and where the gaps still are. And I guess with that we'll be keeping it grounded in the messy reality of today's general practice as well.So I've introduced myself and I'm joined here by Tom Round and Sam Merrill, who are both also associate editors of the bjgp. But I'll go to Tom first. So, yeah, tell us a bit about who you are and how is your day going?Speaker B00:01:27.720 - 00:01:59.550Great, Nada. Thanks for having me.So, Dr. Tom Rand, I'm a GP in northeast London and an academic clinical lecturer at King's College, interested in early disease and cancer detection and also health inequality. So, yeah, pretty good. Like everyone, I've got a mild cold at the moment.I think exactly the same last year when we did this podcast, winter cold season. So I think we're all sort of feeling that a little bit in primary care with flus and other things and staff, you know, so otherwise good.Looking forward to having really interesting discussion about these papers which are really fascinating and give a real broad breadth of what we do in general practice.Speaker A00:02:00.420 - 00:02:07.940Great. And Sam, we'll go to you and you have some really exciting news in the background as well.So, yeah, tell us about who you are and what you're up to today.Speaker C00:02:08.180 - 00:02:31.770Thanks, Nad.I think, yeah, you're alluding to the fact I'm on Puppy alert because our new addition to the family in the winter is keeping us busy and making remote working a challenge. But we're getting through. But yeah, lovely to be with you guys. And I catch up and BJGP and wider podcast audience.So, yes, I'm a GP working in the Northwest of England and a clinical senior lecture at the University of Manchester.Speaker A00:02:32.650 - 00:04:28.830Brilliant.Okay, so let's get into the top 10 most read research and published papers of 2025 and I'm going to kick off with number 10 and number 8, just because they're on a sort of related topic. So number 10 is by Michael Anderson and colleagues. Michael's based in Manchester and at lse.And this paper looks at prescribing, quality in practices and the role of clinical pharmacists as. And I'll just point out that I'll put links to all the papers in the show notes as well.So this paper looks at the adoption of clinical pharmacist roles in English general practice and asks that question of does bringing pharmacists into the primary care workforce actually lead to improvements? Michael looked at this through a longitudinal approach.They used national practice level data from 2015 to 2019 and just looked at practices that didn't, didn't have a clinical pharmacist role. And it's really interesting, the results actually.So, not surprisingly, the proportion of practices with a clinical pharmacist increased from about 3% to over 20% over the course of the study. And the, the team found some really significant improvements across several prescribing indicators.So things like reductions in total medication costs, better opioid prescribing and prescribing for anxiety meds after pharmacists were implemented in pract, I guess, really it would be interesting to hear your thoughts, Sam and Tom, about what do you think really are the outcomes we want most from clinical pharmacists? And how do you think we should interpret these modest changes at scale?Because there's a lot else going on in terms of workforce that we need to think about in general practice, like access and continuity and not just meds optimization.Speaker C00:04:29.310 - 00:05:41.170I can talk from practice experience because our clinical pharmacist just left for Canada just in the last month or so. But yeah, it was really interesting, like having him part of the team.I think in a lot of ways he took a lot of burden off the gps in terms of meds monitoring, meds management, medication reviews. He builds a lot of continuity with a lot of patients because he was doing a lot of checking in.So in a lot of ways he was quite invaluable member of the team and we have sought a replacement since.At the same time, you know, there was some, some extra challenges in terms of workload and stuff, because obviously pharmacists have different training and the role of a clinical pharmacist in general practice is relatively new.So, you know, their approaches to prescribing and, you know, how close you stick to guidelines and how much you adapt for individual patient situations is slightly different. So. Yeah, but I think that was part of sort of feeling a way out with the role.But it's really noticeable when he's not around because it does affect how the workload flows and how the practice runs and how the patients, you know, interact with the practice. So, yeah, it's been really interesting at the local level.But, yeah, Michael's study also...
• Safety incidents in prison healthcare: Lessons from critical illness 20.01.2026 21Min.

  Today, we’re speaking to Dr Joy McFadzean,a GP in Swansea and Clinical Lecturer of Patient Safety based at Cardiff University. We’re here to talk about the paper she’s recently published here in the BJGP alongside her colleagues titled, ‘Critical illness in prisons: a multi-method analysis of reported healthcare safety incidents in England’.Title of paper: Critical illness in prisons: a multi-method analysis of reported healthcare safety incidents in EnglandAvailable at: https://doi.org/10.3399/BJGP.2025.0239Using a mixed-methods descriptive and framework analysis, this paper provides new insights into the complexity of care delivery in prisons. Results resonate with and strengthen the recommendations from recent investigations into prison healthcare by further developing an understanding of the complex intersecting factors contributing to safety incidents and quality issues in care delivery. The fundamental importance of good quality and adequately resourced primary care delivery in prisons has been highlighted. It also identifies system-wide interventions that are needed to improve care delivery, and which are likely to interest policy-makers and scrutiny bodies, commissioners and teams working in prisons to inform developments in strategic health needs assessments, workforce profiling, and training requirements for healthcare and prison teams.FundingThis study/project is funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (PR-R20-0318-21001). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the manuscript or the decision to submit.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.560 - 00:01:10.200Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjgp. Welcome back to the first season of the BJGP podcast here in 2026.And we're starting off this season of the podcast with a chat with Dr. Joy McFadyn. Joy is a GP based in Swansea and clinical lecturer of Patient safety based at Cardiff University.We're here to talk about the paper she's recently published here in the BJGP alongside her colleagues. The paper is titled Critical Illness in Prisons A Multi Method Analysis of Reported Healthcare Safety Incidents in England.So, hi, Joy, it's really lovely to meet you and to talk about this research, but yeah, just taking a step back, I think it's fair to say that the prison population is an underserved and probably fairly under researched population as well.But you point out here in the paper that it's not only this, but that the prison population is actually at a much higher risk of early mortality as well. So can you talk us through this at all?Speaker B00:01:10.680 - 00:02:31.010Yeah, that's a really good point. So we know that people who reside in prison, known as prisoners, will have very high rates of physical and mental health needs.And as you say, there are concerns that they have rates of premature mortality, so they may die up to 20 years earlier than the rest of the population. But they are a population which isn't necessarily the area of focus.So even though we know the importance of supporting their healthcare as a public health concern, they are often underserved, they're quite vulnerable, and yet there hasn't been enough research to support them to have what we call equivalent health outcomes. So there are lots of definitions of what is considered to be equivalence of care for people in prisons.So the Royal College of General Practitioners Secure Environments Group, they have defined what equivalence of care is for people in prisons, thinking that they should have the same quality of care, the same level of staffing, the same resources as anyone who is residing in the community in order to get the same health outcome. And currently that is not being realised.Speaker A00:02:31.330 - 00:02:38.210And just as a background to all this work, how many of these early deaths do you think are preventable?Speaker B00:02:38.930 - 00:03:39.270So we carried out a study which was called the Avoidable Harm in Prison Study. So it was focusing very much on healthcare events where people were harmed or could have been harmed whilst they reside in prisons.So our focus is very much on these patient safety incidents, reports and incidents themselves, and ultimately the findings of the other space of the study. We haven't released yet they're still embargoed.But we were seeing within our sample of patient safety incident reports, events where prisoners were undertaking significant harm. So within our paper, we haven't seen any evidence of the deaths which could be considered to be avoidable.But our focus was very much on events where without urgent treatment, there was a high risk of death. And we considered many of those events to be avoidable.Speaker A00:03:39.590 - 00:04:10.690And I guess all this is tied into what you're aiming to do here in this research, which was to look at and characterize patient safety incidents in the prison population and find opportunities to improve care.So you used a really detailed approach here and looked at patient safety incidents reported in England and carefully examined and coded all of the incidents here. But I really want us to talk through what you found, what were the main sorts of incident type.And what I'm trying to get at is what really happened in these reports.Speaker B00:04:11.410 - 00:07:08.750Yeah, thank you. So we reviewed Originally up to 4,000 of those patient safety incident reports.And then when we focused specifically on those events where someone was at very high risk of death if they hadn't received treatment, we were looking at conditions suggestive of heart attacks, strokes, status epilepticus, diabetic ketoacidosis, for example.And what we saw is that most of the reports that were included for analysis, so about 100 of those reports, people in prison were not being able to access healthcare professionals when they needed to. So in prisons, people will have an assessment when they arrive to the prison, which is an assessment of their healthcare needs.They should also have access to nursing staff, GPS and allied healthcare professionals, as well as referrals to secondary care as needed. And what we were seeing is that when there are events where someone was critically unwell, they couldn't access the staffing when they required.So it's very much a nurse led service in the prisons. And even when there were prisoners who had collapsed, nursing staff could not access the prisoners. And that was for lots of different reasons.Some of it was related to poor communication, that there's quite a reliance on the use of radios in our reports.And so if people were trying to radio from one area of the prison to the healthcare teams, then there was too much radio traffic that their messages weren't getting through or they were using the wrong emergency codes. So actually the nursing staff weren't aware of the urgency of when they needed to get there.So there were lots of delays in actually having the healthcare teams arrive and assess the patients themselves.But also when a decision was made that someone needed to be conveyed to an emergency department, for example, due to difficulties with staffing levels, there weren't sufficient prison officer numbers to escort them from the prison to hospital. So there was significant delays. So what we could see in some of the events is that someone had collapsed.There was concern that this was suggestive of a stroke, they were dysphasic, they had facial palsy, they had tinnitus, headaches, et cetera. And nursing staff had assessed, said, no, they're unwell.Gps had said they need to be conveyed to the hospital and they weren't transferred until the following day. So those types of delays were very evident as well.So difficulty accessing the healthcare professionals in the first place and then a delay getting the correct treatment or management, even with conditions which are time critical.Speaker A00:07:09.630 - 00:07:29.500That all sounds really shocking, actually. But I wonder if we could just take a step back and, and could you describe to us what healthcare provision is like generally in prisons?You mentioned about a nurse led care system, but how easy is it to access other healthcare professionals like GPs in prisons generally?Speaker B00:07:30.700 - 00:11:02.620So I think there are two very different opinions in this.So we have the access to the patient safety incident reports, which is telling us that it's very difficult for them to access healthcare professionals as needed within the prisons that we looked at for the avoidable harm in prison study, for example, we were only focusing on prisons where health care was delivered on site and the...
• Faecal calprotectin in the over-50s: Rule-out test or red flag? 11.11.2025 14Min.

  Today, we’re speaking to Dr Rob Perry, who is a Gastroenterology Clinical Research Fellow based at Imperial College London.Title of paper: Evaluating the Role of Faecal Calprotectin in Older AdultsAvailable at: https://doi.org/10.3399/BJGP.2025.0169There is considerable uncertainty surrounding the use of FC as a diagnostic test in older adults, with varying suggestions in guidelines and a lack of data in the wider literature. This study investigates the performance of FC in older adults (≥50 years), compared to a younger cohort, with a view to guide its correct use in a primary care setting. These data suggest that FC is a sensitive test for IBD and organic gastrointestinal pathology in both groups. However, concerns remain over its PPV and specificity, particularly in older adults, and it should not be used if colorectal cancer is suspected.Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.880 - 00:00:49.180Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the bjgp. Thanks for taking the time today to listen to this podcast. Today we're speaking to Dr.Rob Perry, who is a gastroenterology Clinical Research Fellow based at Imperial College London. We're here to talk about the paper he's recently published here in the BJGP titled Evaluating the Role of Fecal Calprotectin in Older Adults.So thanks, Rob, for joining me here to talk about your work.And I guess I just really want to preface this by saying that a lot has changed in the last few years just in terms of testing for inflammatory bowel disease and bowel cancer in general practice. But I wonder if you could just talk us through this, some of the different guidelines and why you wanted to do this study.Speaker B00:00:49.660 - 00:02:24.450Oh, yes, thank you for having me.Firstly, and the rationale for the study is that, you know, consultations for gastrointestinal symptoms make up a large number of consultations in primary care. I think the figures around 10%.And whilst fecal cow protection is an increasingly well established test for differentiating between inflammatory bowel disease and functional or other gastrointestinal or non inflammatory gastrointestinal diseases, its role in older adults is far less well established.With varying guidelines for clinicians in primary care, the NICE guidelines make no specific mention, for example, of age, other than that calprotectin should not be used where age is considered a risk factor in the context of certain symptoms. For suspicion of cancer, the BSG guidelines on IBD use a cutoff of 40, above which they suggest calprotectin is not used.The something called the NICE York Fecal cow protectant care pathway suggests an age cut above 60, which is a NICE endorsed pathway. So there's some uncertainty there in the literature about which cutoff should be used for fecal cow protectin.And the reason any cutoff is suggested is because data has previously shown that calprotectin lacks sensitivity for diagnosing colorectal cancer.And as age is considered a risk factor for colorectal cancer, guidelines normally mandate earlier endoscopic evaluation of patients with GI symptoms in older age groups.Speaker A00:02:24.530 - 00:02:39.170And can you just talk us through briefly what you did here? So you looked at patients referred for a colonoscopy at one single centre, so at Imperial College Healthcare Trust.But just talk us through briefly who was included in the study and what were you looking at specifically?Speaker B00:02:40.380 - 00:04:04.090So looking at patients where calprotectin was being used for diagnostic purposes, so calprotectin is also, as you probably know, well established for monitoring patients with existing ibd, monitoring response to treatment for flares, et cetera. We were just looking at patients where it was being used for diagnostic purposes. So any patients with existing IBD were excluded from the study.And then, yes, as you said, anyone who had a calprotectin within a six month period back in 2021, who then subsequently within a one year period had a colonoscopy performed at Imperial, which is the local referral centre, that were included in the study. And we only looked at adult patients. We had a cohort of older adults which we used to cut 50 and above, and a younger cohort below that.We didn't look at pediatric cases, that was how we selected patients.And then we reviewed available electronic documentation to ascertain the diagnosis of the patient, looking at clinic betters etc, as well as looking at other tests that patients may have had performed when their symptoms are being evaluated. Fit testing, for example. We also looked at CRP and haemoglobin.By collecting that data, we were able to ascertain the diagnostic performance of chiroprotectin in the two respective cohorts. And also in comparison with some of the other clinical tests that I mentioned.Speaker A00:04:04.710 - 00:04:21.670Yeah.And as you point out, because these tests might be used in quite a varied fashion depending on patient age or presentation, I suppose it's important to kind of work out what the diagnostic capabilities of them are. And I think that's what this study really aimed to achieve. Really.Speaker B00:04:22.630 - 00:05:04.510Yes, exactly.So we were trying to look at how calprotectin performed in the older age group compared to the younger age group, and also looking at how its performance relative to fit testing in those two cohorts. We looked at the performance of calprotectin, the differentiating between inflammatory bowel disease and non organic GI pathology.And we also looked at its ability to differentiate between organic GI pathology more generally. So inflammatory bowel disease, colorectal cancer and other significant GI diagnoses and non organic pathology.Those two questions, which I think are important questions when considering patients presenting with GI symptoms in primary care.Speaker A00:05:05.710 - 00:05:14.190And just talk us through what you found here. And I think the results were really striking in terms of things were different according to age and maybe not surprisingly. But talk us through that.Speaker B00:05:15.550 - 00:07:19.810I think the key findings are firstly that calprotectin remains a sensitive test in both groups.So sensitivity when using a cutoff of 50 micrograms per gram, which is the nice advised cutoff for considering a positive calprotectin Test suggested by nice.There are other, you know, there is other data in the literature about altering the cutoff which calprotectin is considered positive, but 50 is the cut, you know, is one of the cut offs we looked at and is what is suggested by, in the NICE guidelines using that cutoff, you get sensitivities of over 90% for diagnosing IBD from non organic GI pathology in both age groups. What you see in the older age group is a significantly lower positive predictive value. So positive predictive value of only about 12%.And using that cutoff in the patients who had, again using that cutoff of 50 in the small number of patients who did have colorectal cancer, if you then did try to push up the threshold at which calprotectin is considered positive, as many guidelines do suggest, you would then start to, to miss cases of colorectal cancer, which just highlights one of the important messages of the paper and that is clearly documented in the NICE guidelines that calprotectin shouldn't be used as a biomarker for cancer and if cancer is suspected, patients should be referred on the appropriate urgently suspected cancer pathway. We also found that calprotectin did perform better than fit tests for diagnosing ibd.But, but there's also potentially some future work to be done in patients who may have had FIT testing because of concern over potential colorectal cancer.But in patients where FIT is negative, calprotectin may then have a role as a good rule out test in that group where you've already ruled out suspected cancer.So that's maybe an area for future work and maybe it just helps to allow us to think about how we may have a more kind of joined up pathway for evaluating patients with lower GI symptoms in primary care.Speaker A00:07:20.930 - 00:07:30.290And I know some local guidelines might suggest faecal calprotectin alongside FIT in younger age groups. What are your thoughts about this based on the results of this work?Speaker B00:07:30.930 - 00:08:26.550I think it depends what symptoms the patient's presenting with.I think if patients present with symptoms that according to the NICE guideline that's potentially suggestive of colorectal cancer, then obviously they should be evaluated, you know, appropriately with FIT testing or, you know, onward referral. And I think, you know, I think calprotectin clearly has a role in younger patients for differentiating between non organic GI diseases and ibd.I think in older patients it's, you...
• Antidepressants in pregnancy: A closer look at miscarriage risk 04.11.2025 9Min.

  Today, we’re speaking to Flo Martin, an honorary research associate at the University of Bristol.Title of paper: First trimester antidepressant use and miscarriage: a comprehensive analysis in the Clinical Practice Research Datalink GOLDAvailable at: https://doi.org/10.3399/BJGP.2025.0092Antidepressant use during pregnancy is rising, with concerns from pregnant women that these medications may increase the risk of miscarriage if taken prenatally. Evidence is conflicting so we used the Clinical Practice Research Datalink, a large repository of UK-based primary care data, and a range of methods to investigate antidepressant use during trimester one and risk of miscarriage.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.240 - 00:00:52.800Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors at the bjgp. Thanks for taking the time today to listen to this podcast.In today's episode, we're speaking to Dr. Flo Martin, an honorary research associate at the University of Bristol.We're here to look at the paper she's recently published here in the BJGP titled First Trimester Antidepressant Use and Miscarriage A Comprehensive Analysis in the Clinical Practice Research Data Link. Gold. So, hi, Flo, it's great to meet you and talk about this research.And I think this paper touches on an area that clinicians and women often approach with a bit of uncertainty, just in terms of prescribing safety, really, in pregnancy in general. But can you talk us through what we know already about prescribing for antidepressants and risk in pregnancy, just to frame what you've done here?Speaker B00:00:53.280 - 00:02:22.860Yeah, absolutely.So we actually did some work a couple of years ago doing a systematic review of the literature in this space, so looking at antidepressant use during pregnancy and the risk of miscarriage. And the work spanned the last kind of 30 years.And what we found was a 30% increase in risk of miscarriage following antidepressant use during pregnancy. And this was obviously kind of alarming to see this increase in risk. But the kind of key takeaway from the paper was not actually this finding.It was mostly the kind of variation in the literature that we observed when answering this question.We kind of were very cautious about interpreting this 30% increase in risk as a kind of true causal effect because we had observed these other things that might be driving the estimate kind of upwards and might not necessarily show the true effect that was happening in this population. So that was kind of the environment that we were existing in before we started the study.And it really informed the way that we wanted to do this study.So we thought it was really important to try and understand that baseline risk in both unexposed and exposed pregnancies, so that whatever we observed was contextualized against what the underlying risk was among those who hadn't been prescribed antidepressants.Speaker A00:02:23.500 - 00:02:58.120Yeah, fair enough.So this is a large analysis of the clinical practice research data link, and you looked at pregnancies between 1996 and 2016 and then followed up women who had been prescribed or not antidepressants and risk of miscarriage.And I think if people are specifically interested in how you did this, they can go back to the paper and look at some of the different methods you used. But I wanted to focus really on what you found here.And I think the first thing to point out is that it wasn't uncommon for women to have a prescription for an antidepressant in that first trimester of pregnancy. So talk us through that.Speaker B00:02:58.440 - 00:03:43.270Yeah, exactly. So I think we. We kind of report about 7% of the pregnancies in our study that had been prescribed antidepressants.And I think, as you say, this is, you know, potentially higher than what you would expect. I think there are kind of multiple things driving this.If we look outside of pregnancy and kind of zoom out and look at the prescribing rates of antidepressants in both men and women, we can see it's going up, you know, between the 1990s and the late sort of 20 teens. And.And I think, yeah, people will be maybe surprised to see, but it's very, you know, on trend with what we're seeing outside of pregnancy and then looking.Speaker A00:03:43.270 - 00:03:45.950Specifically at the risk of miscarriage here. What did you find?Speaker B00:03:47.150 - 00:04:59.060Yeah, so when we applied our kind of primary analysis where we were looking at pregnancies who had been prescribed antidepressants in trimester one, and comparing them to pregnancies who were not prescribed antidepressants in trimester one, we found a very, very small increase in relative risk. So I think we found about 4% increase in risk of miscarriage among the prescribed group than. Than the non prescribed.And what this translated to in terms of that baseline risk, we observed 13.1% of those not prescribed antidepressants, they experienced a miscarriage, and this increased to 13.6% among those who were prescribed. So I think that really puts into perspective when we talk about increases in risk, this is an incredibly modest one, an increase all the same.And it's important to not kind of trivialize that increase in risk.But I think it's also incredibly reassuring that when we kind of really place it within what the underlying risk is had someone not taken antidepressants, it's very, very small.Speaker A00:04:59.620 - 00:05:00.100Yeah.Speaker B00:05:00.180 - 00:06:32.630Yeah. I think this is a really important piece of the puzzle for risk communication.Being able to show relative increases in risk, which are incredibly useful alongside what that actually means in terms of the percentage, the proportion of people that experience an outcome, because it just reminds people that, you know, clinicians and patients alike, that this isn't something that you have complete control over. This isn't purely your behavior driven. It's not.So I think that can be really kind of reassuring for Individuals who feel that kind of burden of risk mitigation.We see it in Heather James's paper in BJDP last year, a beautiful qualitative study speaking to women who had experienced antidepressant use during pregnancy and talking through their decision making process and their fears and concerns.And a couple of the participants who were involved in that study cited miscarriage as one of a specific, one of their specific concerns when taking antidepressants during pregnancy and actually discontinued their antidepressants because they were worried about miscarriage.So these concerns are having direct impacts on individuals and their behaviour and, you know, their potential management of their depression and anxiety.Speaker A00:06:33.190 - 00:06:44.230So, yeah, I think it's important to balance these risks against the mental health risks for the woman who's taking or needing antidepressants. And I think, as you point out, that was demonstrated beautifully in that qualitative research as well.Speaker B00:06:44.310 - 00:06:45.030Definitely.Speaker A00:06:45.670 - 00:06:59.990I wanted to sort of just draw back to how we can use these results in practice, really.And I wonder what your thoughts are about how clinicians and women should use these findings to inform their decisions around using antidepressants in pregnancy.Speaker B00:07:00.950 - 00:08:34.090Absolutely, yeah. So while I'm hoping that these results, as a non clinician myself, I'm hoping that these results can be informative for decision making.This isn't the only piece of evidence out there and it shouldn't be considered as the kind of gold standard, because it isn't.We utilize a lot of methods and comparators, we use large data, we've thought carefully about all of the things that might be driving these effects and discuss them at length. But it's not the only piece of the puzzle.I'm hoping that these results can help to kind of illuminate what the truth might be and the factors that might be influencing our perception of the results.So understanding data, understanding methods that will make us kind of rightly critical and cautious and understanding of what these types of studies in general mean, and also the fact that we've tried to kind of get at this baseline risk where we can report these proportions in both prescribed and non prescribed pregnancies should really allow for easy access to what these results mean. Rather than kind of speaking generally about relative increases, we can speak objectively about proportions in these data in these patients.Speaker A00:08:35.130 - 00:09:09.040Yeah, and absolutely, as you mentioned, it's part of the picture in terms of the decision making process that doctors and women...