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...
Today, we’re speaking to Claire Mann, a Research Fellow who is based at the University of Warwick, and Sarah Hillman, who is a GP and Clinical Associate Professor based at the University of Birmingham.Title of paper: Accessing Equitable Menopause Care in the Contemporary NHS – Women’s ExperiencesAvailable at: https://doi.org/10.3399/BJGP.2024.0781Menopause awareness has increased in recent years, as well as HRT use, however, this has not been experienced equally. Cultural influences such as stigma, preferences for non-medical approaches, perceptions of ailments appropriate for healthcare, lack of representation, work against women seeking help. GPs should not assume all women who would benefit from HRT will advocate for it. They ought to initiate discussions about potential HRT, as well as other approaches, with all presenting women who may benefit.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 - 00:01:12.020Hello 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.In today's episode, we're talking to Claire Mann, a research fellow who's based at the University of Warwick, and Sarah Hillman, who is a GP and Clinical Associate professor based at the University of Birmingham.We're here to discuss the recent paper published here in the BJGP titled Accessing Equitable Menopause Care in the Contemporary NHS Women's Experiences. Thanks, Claire and Sarah, for joining me here today to talk about this work.This study focuses particularly on the women's experience of menopause and accessing general practice and primary care. But I'll point out just before we begin that you've also published a linked paper looking at the clinician perspective.So anyone who's interested in that angle should look up your other paper. But back to this one. Sarah, I wonder if I could start with you first.I wonder if you could just talk us through the focus of the paper here and the kind of disparities that different women might face in accessing menopause care in the UK.Speaker B00:01:13.620 - 00:02:57.750Essentially, this work came about because in 2020, we published a piece of work in the BJGP that looked at prescribing a practice level of hrt.And what we found was that actually, if you were a patient at one of the most deprived practices in England, you were about a third less likely to be prescribed HRT than if you were in the most affluent. What we didn't have at that point in time was data at an individual level, just at a practice level.But it was important that work was done because that really pushed that forwards. But what we didn't understand was what was going on underneath that. So.So we asked the nihr, we wrote a grant for something called Research for Patient Benefit and said, look, we want to explore exactly why there is this disparity, because our feeling as researchers was that it wasn't straightforward and that there was a lot going on, both from the woman's perspective and the healthcare professional's perspective. And we really wanted to know exactly how that was all adding up to this gap in prescribing.What we did was we spoke to 40 women, but we were incredibly mindful that we wanted to speak to women that were less likely on paper to be prescribed hrt. So we tried to speak to women that were from more socially economically deprived areas and also black and South Asian women.So this project
Today, we’re speaking to Dr Luisa Pettigrew, a GP and Research Fellow at the London School of Hygiene and Tropical Medicine and Senior Policy Fellow at the Health Foundation.Title of paper: Counting GPs: A comparative repeat cross-sectional analysis of NHS general practitionersAvailable at: https://doi.org/10.3399/BJGP.2024.0833There have been successive Government promises to increase GP numbers. However, the numbers of GPs in NHS general practice depend upon how GPs are defined and how data are analysed. This paper provides a comprehensive picture of trends in GP capacity in English NHS general practice between 2015 and 2024. It shows that the number of fully qualified GPs working in NHS general practice is not keeping pace with population growth and there is increasing variation in the number of patients per GP between practices. We offer research and policy recommendations to improve the consistency and clarity of reporting GP workforce statistics.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.040 - 00:01:04.810Hello 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. Louisa Pettigrew, who is a GP and research fellow at the London School of Hygiene and Tropical Medicine.Louisa is also a Senior Policy Fellow at the Health foundation and we're here today to talk about the paper that she's recently published here in the bjgp. The paper is titled Counting A Comparative Repeat Cross Sectional analysis of NHS GPs.So, hi, Louisa, and thanks for joining me here today to talk about your work. And I guess just to set things out, it is really important to know how many gps there are working.But I wonder if you could just talk us through what we already know about this. We know that there have been successive government policies and promises to increase the number of gps.There are, as we know, different ways that gps could be counted.Speaker B00:01:05.530 - 00:02:37.470So, yeah, as you rightly point out, there's been recurrent governance promises to increase GP numbers.Not just our current Labour government, but the previous Conservative government too, and previous governments too, because they realize that, you know, having access to GP is important for the public and there's a shortage, a perceived shortage of them.So the issue that we notice that there's different ways to count GPs who are working NHS General practice, and therefore depending on how you choose to count them, then that affects the trends and it affects your numbers.So you can count a GP by headcount, whether they're working in NHS general practice or not, and you can count them by full time equivalent, so the actual reported numbers of working hours. You can also consider GPs to be fully qualified GPs alone, or you could include GPs who are fully qualified, plus what is categorized as GP trainees.Now, that category includes GP trainees, but it also includes foundation year one and two doctors and any other sort of junior doctor that might be in general practice. And the other dimension to how you count gps is whether you take population growth into population size.So in the UK, over the past, sort of between 2015 and 2024, which was a period of analysis of our study, there was about 12% increase in population size in England. So once you take population growth into...
Today, we’re speaking to Jadine Scragg, a researcher based at the University of Oxford, and Sabrina Keating about their recent paper published here in the BJGP.Title of paper: GPs’ perspectives on GLP-1RAs for obesity management: a qualitative study in EnglandAvailable at: https://doi.org/10.3399/BJGP.2025.0065General practitioners (GPs) play a central role in managing obesity yet face significant challenges due to limited treatment options and resource constraints. GLP-1RAs are emerging as a promising treatment for obesity but access in primary care is limited. This study provides new insights into GPs’ perspectives on the integration of GLP-1RAs into primary care, highlighting concerns around resource limitations, health equity, and misuse of the medications.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 - 00:01:00.730Hello 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 Judine Scragg, a researcher based at the University Oxford, and Sabrina Keating, a DPHIL student who's also based at the University of Oxford within the Nuffield Department of Primary Care Health Sciences.We're here to talk about their recent paper, published here in the BJJP, titled GP's Perspectives on GLP1 Receptor Agonists for Obesity Management A Qualitative Study in England. So, hi, Judine and Sabrina, it's great to meet you both for this chat.I guess the first thing to say is that this work is really topical at the moment, especially given current plans to increase the rollout of GLP1 receptor agonists into the community. But, Judine, I'll come to you first and I wonder if you could just tell us a bit more about what you wanted to do in this research and why.Speaker B00:01:01.510 - 00:02:25.330Yeah, absolutely. So, for a long time, as you've said, the GLP1s have been very topical, both in clinical groups and with patients as well.So I'm first and foremost, I'm a weight management researcher and I've done work in populations with people living with type 2 diabetes and polycystic ovary syndrome. And within those populations, one of the things they've constantly asked about is about GLP1s, when do I qualify? When do I get it around?And similarly with the gps GP groups as well, there's been a lot of questions, there's lots of media about, you know, both good and bad about GLPs and outlining different people's thought processes and are they good? Are they bad?So what we sought to do with this was to sort of more robustly work out what it is GPs actually feel about the perceived integration of the GLP1s into primary care to very kind of firmly focus on GP specifically.And this ended up coming at a really timely point, as midway through the study, the NICE guidance was brought out on outlining the plans for how tirepatide would be rolled out. So it was a really timely piece to find out exactly what they were thinking and feeling about how this may impact them and their patients.So that's really what we set out to do.Speaker A00:02:26.200 - 00:02:55.660Great.And this was a qualitative interview study of 25 GPs across England working across different roles, and they all had different experience in weight management services. But I really Just wanted to come on to what you found here.And let's start with an area that's quite a common issue right now, and I...
Today, we’re speaking to Dr Steph Stockwell, a senior analyst based at RAND Europe.Title of paper: Evolution of the general practice receptionist role and online services: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2024.0677The introduction of online systems and services into general practice and the impact on general practice staff has been considered from a clinician perspective, but comparatively little is known about how these introductions have affected the receptionist role. This study highlights that the use of online services is leading to an evolution of the general practice receptionist role. The role is becoming increasingly complex as practices use multiple online systems, which impacts demand management and navigation aspects of the role. Online systems have variable consequences on workload for receptionists, which has potential implications for workflow, consistency of task completion, job satisfaction, and retention and recruitment of these key staff members.This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.320 - 00:00:53.350Hello and welcome to BJJP 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 Dr. Steph Stockwell, a senior analyst based at RAND Europe.We're here to discuss the paper she's published here in the BJGP titled Evolution of the General Practice Receptionist Role and Online Services A Qualitative Study.So, hi, Steph, it's great to meet and talk about this work and one of the reasons I really wanted to talk about this is that I think it's timely work, given that we know there's an increasing emphasis just in general practice on triage and also the multidisciplinary team. You talk in the introduction of this paper just about the role of receptionists, which has been evolving and changing in recent years.So just talk us through that a bit.Speaker B00:00:53.720 - 00:02:09.550Yeah. So this work came about because we were doing some work for the wider de facto study, which was a.An observational, mixed methods study that involved delete reviews, some surveys, ethnographic case studies and some interviews.And it was whilst I was doing some of the ethnographic case study work that we spent a lot of time around reception staff because they were the ones who were doing most of the digital facilitation, which is the phenomena that we were. Were looking at. It was whilst doing these observations that the idea for this, this paper came to me, as, you know, often the.The first point of call for, for patients making contact with general practice and they're really crucial for helping to manage that demand and facilitating patient access to care.But during these observations, I noticed how the perception of what a receptionist did, particularly among patients and the public, was a little bit outdated and the array of technologies and platforms that they were having to manage and, and help patients use as well, was really sort of the stereotype of answering telephone calls.So, yeah, the rationale for this work sort of came about on the back of that and it made me want to look back at some of the work that we did for the De facto study and to see what sort of impact the online services had on the role of GP receptionists.Speaker A00:02:10.030 - 00:02:50.390Yeah. So you wanted to look, as you mentioned, just at the impact of online services on sort of the evolving role of...
Today, we’re speaking to Dr Sophie McGrath, Consultant Medical Oncologist based at the Royal Marsden NHS Foundation Trust and at Kingston Hospital in London.Title of paper: Management of menopausal symptoms following treatment for hormone receptor positive breast cancerAvailable at: https://doi.org/10.3399/BJGP.2025.0264This 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 - 00:01:11.660Hello and welcome to BJJP Interviews. My name is Nada Khan and I'm one of the associate editors of the bjgp. Thanks for joining us today to listen to this podcast.In today's episode, we're speaking to Dr. Sophie McGrath, who is a consultant medical oncologist based at the Royal Morrison NHS Trust and at Kingston Hospital in London.We're here to talk about the recent analysis article that she and her colleagues have published here in the BJDP titled Management of Menopausal Symptoms Following Treatment for Hormone Receptor Positive Breast Cancer.And just to point out that these colleagues included not just medical oncologists, but also GPs and patients, which I think has really shaped this article and is one of the reasons why we wanted to highlight it here in the podcast. So, hi Sophie, thanks for meeting me to talk about this article, which I think touches on a really important topic in practice.But talk us through some of the initial side effects that you discuss in the introduction here. Just in terms of hormone positive breast cancer, what kind of symptoms do women experience generally as a result of endocrine therapy?Speaker B00:01:12.220 - 00:02:32.900So, yeah, thanks very much for asking. And it's a bit of a broad answer that I would give.I mean, I've focused on, or we have focused on three main symptoms within the article which relate to hot flushes or vasomotor symptoms, also to joint stiffness and pain and swelling, arthralgia, and also to vulvovaginal symptoms, otherwise known as genitourinary syndrome of menopause.But I think what we've tried to include within the article as well is a table that certainly acknowledges that there are unfortunately many other symptoms that women can get as a result of these medications, essentially mimicking menopausal side effects.And of course, you know, these might be symptoms that women having already gone through the menopause may have suffered or experienced at some point already.But actually for a population of premenopausal women, these will be symptoms that they haven't had any experience of yet and can often be quite intense and develop quite suddenly. Whereas often our post menopausal women have had some sort of lead up to this, they've had some experience.Speaker A00:02:34.710 - 00:02:44.710And you work as a medical oncologist. But just talk me through your own experience of working with women who are going through the sort of sudden menopause as you describe as well.Speaker B00:02:45.350 - 00:05:50.240So obviously the focus of the article here is on menopausal side effects in general from the treatments that we use. And we've talked a lot about using our endocrine treatments such as tamoxifen, letrozole.But actually many of our women also experience menopausal type side effect secondary to the chemotherapies we give them. So I think, you know, there's sort of two groups you often have, particularly premenopausal women who stop their periods whilst on chemotherapy.That may happen several weeks into their chemotherapy treatment and it can be quite sudden.You know, they're already dealing with the numerous side...
Today, we’re speaking to Euan Lawson, the Editor in Chief of the BJGP, about a number of issues around editing, the future of the journal and how you can get involved with the BJGP.Here's a link to the BJGP Research and Publishing Conference: https://bjgp.org/conferenceThis 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 - 00:00:55.980Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjjp. Thanks for taking the time today to listen to this podcast.In today's episode, we're speaking to Euan Lawson, who is the editor in chief of the bjjp.We're going to have a chat about a number of issues around the future of the Journal, around editorial issues and how you can get involved with the BJJP as well. So, hi, Ewan. Yeah, nice to see you. And just wanted to really start by saying thanks for joining me here today for this podcast.But yeah, thanks for joining me here today, Ewan, just to have a general chat about things going on with BJGP and your role as editor.And yeah, just a chance to catch up about some of your thoughts about issues around academic publishing and then just have a chat generally about other things that you've been thinking about as editor. So how's your week been?Speaker B00:00:57.420 - 00:02:13.730We've already had that conversation before we got here. Now we won't go there again. As you know, it's not been perhaps my ideal week.But as I'm delighted to be here and talking a little bit about what's going on with the Journal and just give a little bit of insight into how things are going, perhaps the biggest thing that we're I've recently written about the impact factor at the Journal, and perhaps the most important thing I need to say is that we don't worry too much about the impact factor.I know we do quite well on the impact factor, but I wrote an editorial which really pointed out that we are much more interested in the real world influence of the journal rather than what is quite a narrow metric about citations. We're more interested in how it affects clinical, how the journal articles affect clinical practice, how they affect policy.And we're really pushing, trying to push in that direction.And once we get into worrying about the impact factor and there are a lot of perverse kind of incentives in academia and it can sometimes result in what's known as questionable research practices and things can just slide away from the ideal a little bit.So that's perhaps one of the things that we're trying to concentrate on most in this coming months and years is just making sure that we keep our impact all about real world rather than anything else.Speaker A00:02:14.130 - 00:02:26.230Yeah, you mentioned questionable research practices and you did talk about this in your editorial or your editor's briefing, but how do you think the Journal can tackle that head on?Speaker B00:02:27.750 - 00:04:23.309I mean, it is challenging because it's.The thing about QRP questionable research practices is that there's like they're a spectrum and they go from really very minor stuff, which is like, you know, giving you, a professor in your department authorship on a paper where they really didn't do anything, to a kind of a. The far end of the spectrum where you start to creep into outright research fraud.And most researchers, and I think particularly in the primary care field though, you know, we'd always got to be. You always. One has to be careful about making assumptions,
Today, we’re speaking to Dr Jo Burgin, a GP and a researcher based at the University of Bristol.Title of paper: Mental health consultations during the perimenopausal age range – Are GPs and patients on the same page?: A qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2025.0069Mood changes are a recognised symptom of perimenopause, for which Hormone Replacement Therapy is considered a first line treatment. Recent studies have found mental health symptoms are overlooked in menopause care, which is mostly delivered in primary care. This study identifies some key barriers to identifying perimenopause in women presenting with mental health symptoms and suggests important changes clinicians could make to their consultations to address this.
In this episode, we speak to Dr Diarmuid Quinlan, a GP and MD candidate based at the Department of General Practice at University College Cork.Title of paper: Competencies and clinical guidelines for managing acne with isotretinoin in general practice: a scoping reviewAvailable at: https://doi.org/10.3399/BJGP.2025.0135There is evidence of inequitable access to the most effective treatment for severe acne, isotretinoin. This scoping review identified the clinical competencies to safely manage acne using isotretinoin. No global consensus exists among clinical practice guidelines (CGPs) on whether GPs are appropriate prescribers of isotretinoin. Appropriately resourced and CPG-guided patient access to isotretinoin in primary care may promote safe, timely, and equitable acne management for patients and improve antimicrobial stewardship.Transcript:This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.440 - 00:01:07.850Hello and welcome to BJGP Interviews. My name is Nada Khan and I'm one of the associate editors of the bjgp. And welcome to our autumn edition of the BJGP podcast.We're kicking off with a new set of interviews for the next few months. So thanks again for joining us.Today we're speaking to Dr. Dermod Quinlan, who is a practicing GP in Cork and is also an MD candidate at University College Cork in Ireland.We're here today to discuss his paper, recently published in the BJGP titled Competency and Clinical Guidelines for Managing Acne with Isotretinoin in General Practice. A Scoping Review. So thanks very much, Dermid, for joining me here today to talk about this paper.But yeah, I guess I just wanted to start by saying that this is a really interesting paper and I think it covers a very common condition that we see in general practice and covers treatment, which can be quite difficult as well for acne.But I wonder if you could just start by telling us a little bit about why you wanted to do this research and just a bit about the treatment of it and why you focused down on this topic, really.Speaker B00:01:09.610 - 00:02:59.510So lovely to meet you, Nada. I'm first and foremost a GP and I see patients three days a week, 20 hours a week.And I did a diploma in dermatology over a decade ago and I still do some online tutoring. So I have a long standing interest in dermatology and have an extended role in dermatology.I work in an urban practice with lots of young teenagers and young people in it.Acne is a common chronic disorder and I would see a lot of young people with acne of all grades of severity, mild, moderate and severe, and very severe. And as a clinician, very clearly recognize that behind acne is a patient very commonly suffering profound distress.And we know that the morbidity associated with acne and particularly severe acne, is very extensive.There's the emotional morbidity, there's psychological morbidity, it impacts people's employment opportunities, their education achievements, and then more widely, because treating acne is resource intensive, it has an impact on the healthcare workforce. And then there are concerns about the very prolonged use of antibiotics in acne, raising real antimicrobial stewardship concerns.So I have an interest in this. And then we decided that we would do research into it because we don't know the clinical competencies for safe use of isotretinoin.So I was particularly interested in severe acne and the management of severe acne, and also it didn't clearly...
Today, we’re speaking to Professor Helen Atherton. Helen is Professor of Primary Care Research based at the University of Southampton.Title of paper: What do patients want from access to UK general practice?Available at: https://doi.org/10.3399/BJGP.2024.0582Widely accepted as perpetuated by the media is that patients are unhappy with access to general practice and desire faster access to a general practitioner. This review sought to summarise the research evidence about reported patient wants from access to general practice. Patients wanted to easily make an appointment in a timely fashion, to have a positive relationship with the practice, to see a specific clinician and choose consultation modality according to individual circumstance. Communication and being kept informed about access throughout the process of making and having an appointment, was something patients wanted, and this could be addressed by general practice.Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.480 - 00:01:00.150Hello 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 Helen Atherton.Helen is professor of Primary Care Research based at the University of Southampton, and we've only just speaking to her recently on this podcast about the increasing digitalization of general practice. This time we're speaking to her about her recent paper here in the BJDP titled what Do Patients Want from Access to UK General Practice?So, hi, Helen.It's really nice to speak again about this area of research and I guess I just wanted to start by saying that access is such a loaded word and really, when it comes to general practice, it's part of a fairly negative media campaign against general practice. But it seems that this negative narrative just keeps getting pushed, despite lots of attempts to fix it.So I just wonder if you could reflect on that.Speaker B00:01:00.470 - 00:01:51.950Yeah, absolutely. So that the negative media coverage was one of the reasons that I wanted to do this review.So this review was a bit of a labour of love because I had a feeling from the work that I was doing on digital access and other research that actually the reality was probably quite different, what we were seeing in the headlines and having looked into it, although there's lots of research out there on patient experience and satisfaction, we have a national survey that looks at that. There wasn't anything about what patients actually want. And so that kind of.I thought, actually, wouldn't it be really interesting to find out from the evidence what they actually want and see if it does fit with the narrative we see in the papers and on social media. So, yes. So completely agree. And that was kind of where the idea came from, really.Speaker A00:01:52.420 - 00:02:08.180Yeah.And I just want to unpick what you really mean by access in this paper, because I think for some people it means, you know, just getting an appointment to see their GP within a day, but it can mean lots of different things to other people. So what did you conceptualize that as?Speaker B00:02:08.740 - 00:02:49.840Well, it was difficult.And you're right, there are lots of different definitions of access, and particularly in the research context, for us, we were...
Today, we’re speaking to Dr Sara Noden, a GP with an extended role in ADHD, and Dr Nishi Yarger, Consultant Psychiatrist in adult ADHD services.Title of paper: A guide for primary care clinicians managing ADHD medication side effectsAvailable at: https://doi.org/10.3399/bjgp25X742653TranscriptThis 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 - 00:00:55.720Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors at the bjgp. Thanks for listening to this podcast today. In today's episode, we're speaking to Dr.Sara Noden, a GP with an extended role in ADHD, and Dr. Nishi Yarger, consultant psychiatrist in Adult ADHD Services.We're talking about the recent Clinical Practice article here in the BJGP titled A Guide for Primary Care Clinicians Managing ADHD Medication Side Effects. So, thanks. It's great to meet you both Sara and Nishi.This is a really topical area to highlight in the journal, and not least because it seems that every week there seems to be a new article in the media about the increasing diagnosis of adhd. So it's a really topical area to look at, but I guess, Sar, I just really wanted to start with what prompted you to write this article and why now?Speaker B00:00:56.620 - 00:01:39.320Yeah, so I think coming from a GP perspective, before I specialized in adhd, I think these medications did create a bit of anxiety, especially as they're controlled drugs, their stimulants, their specialist medications, and there was a lot that I didn't know about them as I since developed a special interest and it sort of demystified some of these medications. And I just.I think we wanted to pass on to primary care clinicians some of that knowledge that we've learned, some really basic things that they can look out for that may or may not be related to medications and some common things that they can advise and to know when to escalate secondary care and how to manage these patients, essentially.Speaker A00:01:39.560 - 00:01:54.040Yeah. And Saura, I wonder if you could just tell us a bit more about your role as a GP with an extended role in adhd.So you must be very much in demand at the moment, but talk us through what led you to sort of take that role and what your typical week is like.Speaker B00:01:54.320 - 00:02:58.810Yeah, So I think my interest in ADHD stemmed during my training years and I currently am working as a salary GP, but also working at CNWL under Dr. Jaga. I'm doing diagnosis and medication titrations. And I think my interest stemmed because of how prevalent ADHD is becoming.I was seeing such an increase in patients presenting to gp, suspecting they have ADHD and requesting referral, and reading about this treatment and what we can offer, I was really taken aback by not only how ADHD can impact a patient in terms of their symptoms and concentration of focus, but also the lifelong issues that can arise sometimes with adhd, like all the Research showing that it increases rates of depression, underachievement at school, even early death and accidental injuries. So I feel it's a really important, important condition for us to be able to pick up, to be able to refer promptly and start treatment.And that's where the interest started.Speaker A00:02:59.050 - 00:03:14.570And, Nishi, from your perspective, what's it like having a GP working with your team?And from a secondary care perspective, I wonder if you...
Today, we’re speaking to Dr Cini Bhanu, GP and Academic Clinical Lecturer in the Primary Care and Population Health Department at University College London. Title of paper: Antidepressants and risk of postural hypotension: a self-controlled case series study in UK primary careAvailable at: https://doi.org/10.3399/BJGP.2024.0429Antidepressants are associated with postural hypotension (PH). This is not widely recognised in general practice, where antihypertensives are considered the worst culprits. The present study examined >21 000 older adults and found a striking increased risk of PH with use of all antidepressants (over a four- fold risk with SSRIs) in the first 28 days of initiation. 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 - 00:00:56.990Hello and welcome to BJGP Interviews. My name is 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 Dr. Cini Banu, who is a GP in an academic clinical lecturer based in the Department of Primary Care and Population Health at University College London.We're here to talk about her recent paper in the BJGP titled Antidepressants and Risk of Postural Hypertension, A Self Controlled Case Series Study in UK Primary Care. So, hi Cinny, it's really nice to meet you today.I guess this is an interesting area to cover, especially as the prescribing rates for some antidepressant medications are increasing.But I don't know what your feeling is, but I'm not sure if many GPs would actually know that antidepressants are associated with poison postural hypertension. So, yeah, talk us through that.Speaker B00:00:57.310 - 00:01:18.350Yeah, so I think that's one of the reasons this study is so important.So definitely from conversations that I've had with gps that I work with and it's not commonly recognized that postural hypotension is associated with antidepressants, though it is by geriatricians, for example, where it's very.Speaker A00:01:18.350 - 00:01:41.850Well recognized and in this study used a big database to look at the risk of new postural hypertension associated with the use of antidepressants in people aged over 60.I guess there's quite a lot of in depth stuff in the methods, but I guess just for a summary for people who are interested in what you did, do you mind just sort of going over it at sort of like a high level?Speaker B00:01:41.850 - 00:02:54.200Yeah, yeah. So we looked at a big database, what we call a routine primary care database called imrd.And essentially this captures data from software that gps use like EMIS and Vision System and captures a whole load of information like problems, symptoms and prescriptions. So we went into this database and identified everyone over the age of 60 that might be eligible during our study period.And for this we looked at people that were contributing at least one full year of data between 2010 and 2018. And then within that we identified people with a first diagnosis of postural hypotension.And then again we made subgroups according to people who had this diagnosis but also had a first prescription of a new antidepressant during that time.And what we were interested in, and the methodology is called a self controlled case series, we weren't interested in who got postural Hypotension, because everyone was a case, but rather...
Today, we’re speaking to Dr Jamie Scuffell, GP and NIHR In Practice Fellow at King’s College London.Title of paper: Patterns in GP Appointment Systems: a cluster analysis of 3480 English practicesAvailable at: https://doi.org/10.3399/BJGP.2024.0556GP practices in the UK are using a wide range of different appointment systems to meet patient demand and improve access. This cluster analysis of NHS appointment data from 56 million appointments and 3480 English practices demonstrates two predominant models of primary care delivery. ‘Same day’ practices tend to fulfil appointments on the same day using GP telephone consultations. ‘Routine care’ practices tend to employ non-GP staff members offering face-to-face appointments and longer appointment wait times. ‘Same day’ care practices had younger and more urban populations. Episode transcriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.640 - 00:00:54.360Hello 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 Dr.Jamie Scuffle, who is a GP in South London and an NIHR In Practice Fellow at King's College London. We're here to talk about a really topical issue in his new paper here in the bjgp.The paper is called Paper Patterns in GP Appointment A cluster analysis of 3,480 English practices.So, hi, Jamie, it's really great to meet you and talk about this work, I guess, really just to start, as you point out in this paper, each practice has their own systems and strategies to manage appointment booking. But how do you think that this impacts on access and patient appointment booking in each practice?Speaker B00:00:55.000 - 00:02:17.300Yeah, it's interesting because I think, as you say, appointment systems have developed even further, really, since COVID and we've ended up with this a quite interesting diverse range of implementing appointments across the country, across England at least.And I suppose the things that have changed are, you know, if you phone up a practice now, actually, you might not even phone them up, you might submit an online consult, you might be triaged, you might see not a gp, but a range of other professionals as well. And also it might not be done face to face, it might be done by telephone or online.In fact, there's a new appointment system range of things that have happened across England, and actually there's some evidence that that might relate to access in some ways. So we know lots of people who don't speak English struggle to navigate that system of getting an appointment, for example.And we also know from the qualitative evidence that there's some digital exclusion as well with appointments. So, yeah, so I think there's lots of issues with access and how that relates to appointment systems.And so far what we've done is looked at components of the appointment system and how that then affects access. But what we haven't really done much of is looking at the appointment system as a whole and how that might affect access.Speaker A00:02:18.180 - 00:02:33.200Yeah.So in this study, you wanted to look at patterns of primary care delivery in English GP practices, and you used this Appointments in General Practice data set. Can you tell us just briefly what's available in this data and what you were looking at here?Speaker B00:02:33.360 - 00:03:20.700It's a tremendous data set and I think could be very useful. So...
Today, we’re speaking to Dr Steve Bradley, GP and Senior Clinical Lecturer based within the School of Medicine and Population Health at the University of Sheffield.Title of paper: General practice chest X-ray rate is associated with earlier lung cancer diagnosis and reduced all-cause mortality: a retrospective observational studyAvailable at: https://doi.org/10.3399/BJGP.2024.0466It is known that there is wide variation in the use of chest X-ray (CXR) by general practices, but previous studies have provided conflicting evidence as to whether greater utilisation of them leads to lung cancer being diagnosed at an earlier stage and improves survival. This observational study analysed data from the English national cancer registry on CXR rates for individual general practices, along with stage and survival outcomes; it found earlier stage at diagnosis and improved survival for patients diagnosed with cancer at practices that used the test more frequently. Increasing use of CXR by GPs for symptomatic patients, particularly by focusing on practices that use the test infrequently, could improve lung cancer outcomes.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.640 - 00:01:06.820Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors at the Journal. Thanks for taking the time today to listen to this podcast.In today's episode, we're talking to Dr. Steve Bradley. Steve is a GP and senior clinical Lecturer based within the School of Medicine and Population Health at the University of Sheffield.Early diagnosis of cancer has been an area of research that is Steve's real strength. And we're here to discuss his recent paper here in the BJJP titled General Practice.Chest X Ray Rate is Associated with Earlier Lung Cancer Diagnosis and Reduced All Cause Mortality A Retrospective Observational Study. Hi, Steve, Great to speak again and to talk through this paper.I suppose I want to start by saying that, yes, we know that earlier diagnosis of cancer is a good thing because it can lead to earlier stages of diagnosis and treatment. And you start the paper with a short discussion about screening for lung cancer.But talk us through why this, this alone won't solve delays in lung cancer diagnosis and what else we need to be doing.Speaker B00:01:07.540 - 00:02:14.620So, yeah, this context is really important because screening is a hugely important development and the UK has led in many ways on lung cancer screening using low dose ct. And this, we hope is going to be very, very beneficial for patients.But it would be a mistake to think that this is going to solve the problem of lung cancer. And there's a few reasons for that.One is that only about half of people who get lung cancer would have been eligible for screening because screening concentrates on the highest risk population. And also we know that only about half of people who are invited for screening actually choose to participate in screening.So the upshot for general practice really is that most patients are still going to be coming through by symptoms and in the same way.So screening is good news in terms of lung cancer detection, but we still need to do as well as we can in terms of picking these patients up through symptomatic pathways. And actually, this is something we touched on in an editorial for BJGP about a year or 18 months ago, I think.Speaker A00:02:15.020 -...
Today, we’re speaking to Professor Martijn Schut, Professor of Translational AI in Laboratory Medicine and Professor Henk CPM van Weert, GP and Emeritus Professor of General Practice, both based at Amsterdam University Medical Center.Title of paper: Artificial intelligence for early detection of lung cancer in GPs’ clinical notes: a retrospective observational cohort studyAvailable at: https://doi.org/10.3399/BJGP.2023.0489In most cancers, the prognosis depends substantially on the stage at the start of therapy. Therefore, many methods have been developed to enhance earlier diagnosis, for example, logistic regression models, biomarkers, and electronic-nose technology (exhaled volatile organic compounds). However, as most patients are referred by their GP, who keeps life-long histories of enlisted patients, general practice files might contain hidden information that could be used for earlier case finding. An algorithm was developed to identify patients with lung cancer 4 months earlier, just by analysing their files. Contrary to other methods, all medical information available in general practice was used.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 - 00:00:55.370Hello 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.Today we're speaking to Professor Martin Schutt, who is a professor in translational AI and Laboratory medicine, and Professor Hank Vanwort, GP and Emeritus professor in General Practice, who are both based at Amsterdam University Medical Center. We're here to discuss their paper, which is titled Artificial Intelligence for Early Detection of lung cancer in GP's clinical notes.So, yeah, it's great to see you both here today. And Martin, I'll come to you first.I suppose we know that it's important to try and diagnose cancer early, but could you talk us through what's the potential for artificial intelligence here in terms of identifying cancer earlier based on patient records?Speaker B00:00:55.810 - 00:01:52.220Yeah, that's a very interesting question because the potential kind of like goes hand in hand with the huge amount of interest in AI. And I think there are great opportunities. There are also great challenges.But talking about the opportunities, especially in the context of the article that we wrote, is on the data side. So on the data side, the digitalization of electronic health records gives great opportunities.A lot more is digitalized, and that means that we also, in our case, have access to free text, and that we, with the advent of the large language models, with also new developments in AI, we also have better ways of making use of those data. So those two combined creates a really interesting formula for big opportunities for AI in the general practice and healthcare in general.Speaker A00:01:52.300 - 00:02:05.960And you mentioned access to free text records. So what GPs are typing into the record records?But before we get into the study, can you just briefly describe what is natural language processing and how that can be used in free text records?Speaker B00:02:06.760 - 00:03:10.100So we know that a lot of clinical risk scores, they work with features of patients, so their age and their gender or sex. And. But of course, a lot of information is also written up in unstructured way. And in our case that is...
Today, we’re speaking to Dr Afrodita Marcu, a Research Fellow in Cancer Care at the University of Surrey.Title of paper: Symptom appraisal and help- seeking before a cancer diagnosis during pregnancy: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2024.0208There is a gap in current understanding about the experiences of women diagnosed with cancer during or around pregnancy including how they appraise and seek help for cancer-related symptoms. This qualitative study found that women and healthcare professionals often interpreted symptoms through the lens of pregnancy, particularly when symptoms were vague. Health professionals need to ensure full assessment of symptoms, timely referral, and effective safety-netting for these women.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.040 - 00:01:04.650Hello and welcome to BJJP 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 Dr.Aphrodite Marcoux, a research fellow in Cancer care at the University of Surrey.We're here to talk about a paper she's recently published here in the bjgp, which is titled Symptom Appraisal and Help Seeking Before a Cancer Diagnosis during Pregnancy, A Qualitative Study. So it's really lovely to meet you, Aphrodita, to talk about your research.And I think this is a really important area and I wanted to get your thoughts on just why this area is so important to research.But I think that most people will probably appreciate that during pregnancy, women's bodies are going through lots of changes, so it can sometimes be difficult to know what's normal and what's not. But talk us through why you wanted to do this study.What are the challenges faced by patients and by doctors around cancer diagnosis in women who are pregnant?Speaker B00:01:05.050 - 00:02:32.190It's an important area to research because the symptoms of pregnancy, the bodily changes that naturally occur during pregnancy, can mask the symptoms of cancer, both for the women experiencing them, but also for the healthcare professionals with whom they come into contact and with whom they share the symptoms.So it's an important area to research from that point of view in terms of understanding the potential causes for delay in receiving a cancer diagnosis.And one of the areas which we discovered was less researched was early diagnosis or timeliness of diagnosis of cancer diagnosis in the context of pregnancy.So we conducted this research because there was a lack of research, especially in the uk, on women's pathway or other pathways to a cancer diagnosis and pregnancy.And we wanted to get a more detailed understanding knowledge of how women make sense of their symptoms during pregnancy, how they seek help and why to whom they present, midwife, gp, other healthcare professionals and how they receive a diagnosis. What is the pathway to a cancer diagnosis and pregnancy?We wanted to get more clarity about that, more detail, and we were also interested to find out whether delays characterize this pathway to a cancer diagnosis in pregnancy, be they patient related delays or healthcare system related delays.Speaker A00:02:32.830 - 00:02:44.750And I guess you've touched on this. So does do we know if there are delays in cancer diagnosis amongst women who are pregnant?So do they tend to have a...
Today, we’re speaking to Dr Stephen Gibbons, Consultant Clinical Biochemist at Leeds Teaching Hospitals NHS Trust, and Dr Clare Spencer, GP Partner and Menopause Specialist at the Meanwood Group Practice in Leeds.Title of paper: Optimising testosterone therapy in patients with hypoactive sexual desire disorderAvailable at: https://doi.org/10.3399/bjgp25X741321TranscriptThis 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 - 00:01:08.824Hello and welcome to BJJP interviews and welcome to our new season of the podcast. Hope you all had a great break over Easter and thanks again for listening to this podcast today.My name is Nada Khan and I'm one of the associate editors of the BJTP. In today's episode, we're speaking to Dr. Stephen Gibbons, consultant clinical biochemist at Leeds Teaching Hospital NHS Trust, and Dr.Claire Spencer, a GP partner and menopause specialist at the Meanwood Group Practice in Leeds. We're here to talk about the recent clinical practice paper published here in the bjgp.The paper is titled Optimizing Testosterone Therapy in Patients with Hypoactive Sexual Desire Disorder. So thanks, Stephen and Claire, for joining me here today.It's great to talk to you about this paper, especially because it's in an area of a lot of interest to patients and clinicians in general practice wondering what to do about testosterone prescribing.I guess I wanted to kick things off, Stephen, really, by asking, what made you start investigating testosterone replacement in patients with hypoactive sexual desire disorder?Speaker B00:01:08.952 - 00:03:09.662So it was actually a conversation with a colleague at work over coffee and she mentioned to me that she'd noted quite a lot of high testosterone in females of a particular age and she was asking why that might be. So I explained it's probably because of TRT in this condition called hsdd, but that was kind of quite anecdotal at that point.So we thought we'd do a clinical audit. So myself and two colleagues, Kia and eloise, we audited 100 patients from Leeds.So we looked at a sample of 100 patients on TRT for HSDD and we audited them against the British Menopause Society guidance, which state that you should do a pre testosterone measurement and then you should check at at six to eight weeks, I believe. And what we found is that actually there was quite poor compliance with the BMS guidance. And at this point we felt a little bit out of our depth.But we thought, well, this is quite alarming. Probably the most alarming thing was the number of patients with a really high testosterone that weren't adequately followed up.So we thought, right, let's bring some clinical experts in at this point. So that's when we got in touch with Dr. Spencer and Dr. Jasim and Dr. Wal Ford, who's also on the paper.She's a consultant endocrinologist at Leeds, and we kind of had a look at the data and we all agreed that, you know, there were significant findings. And the question was why?Because there are quite comprehensive guidance out there from the bms, but I think we all felt that potentially they lacked some of the finer detail. Potentially in some areas they were a little vague. So that's when we came up with these additional recommendations.And they're certainly not supposed to replace the BMS guidance, but it's a supplementary kind of recommendations to support the BMS guidance. So that's where we started, really.Speaker...
Today, we’re going to do something a bit different and take a look back at the recent BJGP Research Conference, which was held on the 21st of March 2025 in Manchester. I’m going to discuss some of the highlights and really focus on what the conference is about and how to get involved in the future.Here are some of the links I discussed in the podcast:Linkshttps://journals.sagepub.com/doi/full/10.1177/1609406918797475https://bjgplife.com/write-for-bjgp-life/
Today, we’re speaking to Dr Louise Clarke, a GP and researcher based at the University of Nottingham.Title of paper: Barriers to diagnosing and treating vulval lichen sclerosus: a survey studyAvailable at: https://doi.org/10.3399/BJGP.2024.0360Previous research has identified a significant diagnostic delay and misdiagnosis of vulval lichen sclerosus (VLS), a condition most commonly presenting to primary care. Health care professionals (HCPs) in primary care share the concerns of women with VLS citing frequent misdiagnosis, embarrassment and lack of knowledge as barriers to diagnosis. In this survey, 92.6% of HCPs felt further education would be useful with 37.7% never having participated in learning on vulval skin disease, self-directed or otherwise. Key enablers identified to facilitate timely VLS diagnosis and treatment include: a comprehensive education programme for HCPs, implementation of standardised pathways of care and development of a VLS diagnostic criteria to be implemented in primary care workflow.
Today, we’re speaking to Dr Victoria Tzortziou Brown, a GP and Reader in Primary Healthcare and Health Policy at Queen Mary University of London, and Vice Chair for External Affairs at the Royal College of General Practitioners.Title of paper: Language of primary medical qualification and differential MRCGP exam attainment: an observational studyAvailable at: https://doi.org/10.3399/BJGP.2024.0296To the authors’ knowledge, this is the first study on the association between the language of the primary medical qualification and attainment in the Membership of the Royal College of General Practitioners (MRCGP) examination. It shows that undertaking undergraduate clinical training in a country where the native language is not English can statistically significantly and negatively affect examination performance in MRCGP exams. The study also shows statistically significant positive correlations between Multi- Specialty Recruitment Assessment, International English Language Testing System, and Professional and Linguistic Assessments Board scores and the MRCGP exam scores; this suggests that past performance in these assessments can help with the identification of those international medical graduate registrars who may find tailored support beneficial.