Primary Care Knowledge Boost

We’ve got something a little bit different for you today, instead of our summer rewind. Some people may remember the wonderful episode about dealing with Uncertainty we did way back in 2020 with  GP, Primary Care Educator and Author Dr Avril Danczak. It was such an important episode in our careers and I know helped many others. We wanted to share the news that Avril is doing brilliant podcasting work with the ever pragmatic Professor James McCormack. Their podcast Contented clinician, people may have already found, but we thought it would be useful to post one here to signpost listeners to their good work. Welcome to Episode 6 of The Contented Clinician Podcast! Dr Avril Danczak and Professor James McCormack created The Contented Clinician Podcast to help clinicians find more joy and satisfaction in your practice by blending a collective of real-world experience, common sense, and the best available evidence. So, if you’re looking to make your clinical practice more fulfilling and sustainable, join us and our inspiring network of clinicians as we explore new perspectives and effective strategies to reshape the way you think about your work. The Case: Dr. Ashville is currently training to become a family physician. One day, they receive a phone call from a frustrated patient named Jane Brown. Jane had received a message stating: “As your cardiovascular risk is now 10%, it is recommended you take a statin medication.” She is upset because no one had a proper conversation with her about starting a new prescription. Her main concern is: “How likely am I to actually benefit from this treatment? Is it really worth it?” Dr. Ashville realizes they had simply been following a protocol and isn't entirely sure how to answer Jane's question. Wanting to better understand how to provide more balanced information, Dr. Ashville decides to discuss the issue with the clinician supervising their medical education. Resources: GP Evidence: https://gpevidence.org/   James McCormack: Doing statistics can be difficult but understanding them can be fairly simple: https://www.sensible-med.com/p/doing-statistics-can-be-difficult ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara are joined by Medical Microbiology and Infectious Diseases Consultant Dr Callum Mutch for an overview of Antibiotics and Microbiology in General Practice. Doctors Callum and Jame host a podcast in Infectious Diseases called ID:IOTS and we wanted to do a crossover episode exploring common themes in Microbiology that we encounter in General Practice. We talk about the case of a woman with recurrent UTIs and a man with epididymo-orchitis. This lends itself to a discussion on general approaches to cases, microbes and antibiotics. We cover a little bit about antimicrobial stewardship at the end.    You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Resources: Podcast: Infectious Diseases Insight of Two Specialists (ID:IOTS): https://www.britishinfection.org/education-events/idiots-podcast Antimicrobial Counselling Resources from Public Health Wales: https://phw.nhs.wales/services-and-teams/antibiotics-and-infections/harp-news/eaadwaaw-2021/resources/community-pharmacy-counselling-checklist/ Antimicrobial Counselling RCGP TARGET Resources: https://elearning.rcgp.org.uk/mod/book/view.php?id=12647 The Cynefin Framework for looking at decisions (Simple, complicated, Complex, Chaos): https://thecynefin.co/about-us/about-cynefin-framework/?srsltid=AfmBOopHNprchcOsISLVvXm2C5W-UU-oqHDkty_jo1IAAsupfoMu4_Cx Shared Decision Making Tool BRAN - Benefits, Risks, Alternatives, Nothing: https://www.england.nhs.uk/personalisedcare/shared-decision-making/decision-support-tools/how-to-use-a-decision-support-tool/#:~:text=Prepare%20patients%20to%20share%20decisions&text=In%20addition%20to%20the%20proactive,Nothing)%20or%20equivalent%20local%20initiatives World Health Organisation AWaRe Book: Access, Watch, Reserve Antimicrobial Book (can aid in decision making around which antibiotics to use. Accessed May 2025):  https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2022.02 UK Health Security Agency Adaptation of the Access, Watch, Reserve (AWaRe) Guidelines: https://www.gov.uk/government/publications/uk-aware-antibiotic-classification/uk-access-watch-reserve-and-other-classification-for-antibiotics-uk-aware-antibiotic-classification ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara take a deep dive into the recent combined asthma guidelines with Dr Murugesan Raja who is a GP and clinical lead for respiratory medicine for NHS Greater Manchester Strategic Clinical Network.  We go through the new asthma recommendations for the different age groups, starting with a reminder of what symptoms make up a typical asthma history, moving on to the new pathway of investigations, and ending with a chat about management covering AIR and MART.  We also touch on green prescribing, steroid cards and other important areas of management such as adherence and inhaler technique.   You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Resources: Joint asthma guideline: https://www.nice.org.uk/guidance/ng244 GMMMG asthma guidelines: https://gmmmg.nhs.uk/guidance/clinical-guidance-and-pathways/gm-asthma-guideline-2024-for-web/ Asthma and Lung UK: https://www.asthmaandlung.org.uk/ Right Breathe: https://www.rightbreathe.com/ Asthma and Lung UK explainer videos: https://www.asthmaandlung.org.uk/living-with/inhaler-videos ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Episode four of four on Paediatric ENT. Doctors Lisa and Sara are back with Paediatric Ear Nose and Throat Consultant Dr Simone Schaefer for this episode on nasal obstruction in children. We use examples of typical cases to discuss an approach to assessing these patients, discussing who ENT might want to see urgently, and differentials for these presentations. We discuss options for management in Primary Care and what ENT can do.    You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Resources: Efficacy and Safety of Nasal Steroids reference: Li Y, Xiong J, Zhang Z, Liao K, Zho X, Li J, Xiang J, Xu L. Efficacy and safety of various corticosteroids in the treatment of children with allergic rhinitis: A systematic review and network meta-analysis. J Evid Based Med. 2024 Sep;17(3):626-642: https://pubmed.ncbi.nlm.nih.gov/39313999/ Safety of Intranasal Steroids link: McDonnell J, Weller K, Pien LC. Safety of Intranasal Steroids: an Updated Perspective. Curr Allergy Asthma Rep. 2020 Sep 7;20(11):69. https://pubmed.ncbi.nlm.nih.gov/32893309/ ENT UK Paediatric Snoring and Obstructive Sleep Apnoea in Children and Adolescents (accessed May 2025): https://www.entuk.org/_userfiles/pages/files/guidelines/global%20ent%20guidelines/global_health_guidelines_pediatric_snoring_obstructive_sleep_apnoea.pdf ENT UK Chronic Rhinosinusitis in Children: https://www.entuk.org/patients/conditions/64/chronic_rhinosinusitis_in_children/ NICE Clinical Knowledge Summaries Allergic Rhinitis (Jan 2024): https://cks.nice.org.uk/topics/allergic-rhinitis/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Episode three of four on Paediatric ENT. Doctors Lisa and Sara are back with Paediatric Ear Nose and Throat Consultant Dr Simone Schaefer for this episode on Recurrent Epistaxis in Children. We discuss important differentials, including a rare condition that can present in predominantly teenage boys not to be missed, before moving on to discuss options for management and why the vast majority of these patients can often be safely managed in the community. We discuss cases that would be useful to be seen by the ENT team. Short and sweet, full of useful resources.   You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Resources: Success Rates of Naseptin (Chlorhexidine dihydrochloride and neomycin sulfate) in reducing Epistaxis: Garry S, Wauchope J, Hintze J, Ryan E, O'Cathain E, Heffernan C. Factors affecting Naseptin treatment success – A prospective cohort study. International Journal of Pediatric Otorhinolaryngology. Volume 171. 2023: https://www.sciencedirect.com/science/article/abs/pii/S0165587623001878#:~:text=80.8%25%20(n%20%3D%20101),effects%20(skin%20irritation%20etc.) ENT UK: How to use a Nasal Spray: https://www.entuk.org/patients/conditions/79/how_to_use_nasal_sprays/ Asthma and Lung UK, How to use a Nasal Spray useful Video for patients: https://www.youtube.com/watch?v=S31maomo1xQ Alder Hey Children’s Hospital Patient leaflet: Nosebleeds: https://www.alderhey.nhs.uk/conditions/symptoms-checker/nosebleeds/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Episode two of four on Paediatric ENT conditions. Doctors Lisa and Sara are back with Paediatric Ear Nose and Throat Consultant Dr Simone Schaefer for this episode on Recurrent Tonsillitis in Children. We go through the definition of tonsillitis and what ENT class as recurrent Tonsillitis that would hit the criteria for Tonsillectomy in our region. We use a case and discuss why referral criteria are so strict, as well as some exceptions to the criteria.    Resources: ENT UK Recurrent Tonsillitis Decision Making Tool for Tonsillectomies (for parents): https://www.entuk.org/patients/conditions/63/helping_you_decide_about_tonsil_surgery_for_your_child NHS England ENT UK Recurrent Tonsillitis Decision Making Tool for Tonsillectomies (for adults and Children): https://www.england.nhs.uk/publication/decision-support-tool-making-a-decision-about-recurrent-tonsillitis-in-children-and-adults/   You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Episode one of four on Paediatric ENT conditions. Doctors Lisa and Sara are joined by Paediatric Ear Nose and Throat Consultant Dr Simone Schaefer for this episode on Recurrent Acute Otitis Media (AOM) in Children. A common problem, we take a classic presentation and work through getting the diagnosis right, red flags and differentials before discussing management and which children may need referrals. We then discuss the limited options of what might be done in an ENT clinic and helpful resources for families.   You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful Resources: NICE Clinical Knowledge Summaries on Acute Otitis Media (including initial presentation, persistent infections and recurrent infections (updated August 2024): https://cks.nice.org.uk/topics/otitis-media-acute/ Hoberman et al. 2021 NEJM Tympanostomy tube placement or medical management for recurrent acute otitis media: https://www.nejm.org/doi/full/10.1056/NEJMoa2027278 Resource for Patients: https://www.nhs.uk/conditions/ear-infections/ https://www.hopkinsmedicine.org/health/conditions-and-diseases/ear-infections-in-babies-and-toddlers ENT UK: Decision making aid for parents re Grommets: https://www.entuk.org/patients/conditions/5/grommets_a_decisionmaking_aid_for_parents ENT UK: Explainer leaflets, How to use ear drops or sprays: https://www.entuk.org/patients/conditions/74/how_to_use_ear_drops_or_sprays The Royal Children’s Hospital Melbourne. Clinical Paediatric Guideline (good algorithm, pictures of erythematous Tympanic Membranes versus Acute Otitis Media with bulging/effusion): https://www.rch.org.au/clinicalguide/guideline_index/acute_otitis_media/ ENT Guidelines for Derbyshire (includes details of Topical Drops in specific cases: https://www.derbyshiremedicinesmanagement.nhs.uk/assets/Clinical_Guidelines/Formulary_by_BNF_chapter_prescribing_guidelines/BNF_chapter_12/Chapter_12_Ear_nose_and_oropharynx.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara are joined by GP and Medical Educator Dr Alan Ng, working in Canada. We discuss what Balint groups are, starting from who Balint was. We go through the structure of a Balint session and why they exist in the form they do. We discuss the advantages to both Doctors and their patients of discussing cases within a Balint group and being part of a group. Discussions can help us gain a deeper understanding of the doctor-patient relationship and discover more about the dynamics and causes of our stresses in particular cases.    You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)   Useful resources:  UK Balint Society: https://balintsociety.org.uk/ American Balint Society: www.americanbalintsociety.org International Balint Federation: www.balintinternational.com Balint, Michael. The Doctor, His Patient and the Illness. Churchill Livingstone  1957, 1963, 2000: https://www.worldofbooks.com/en-gb/products/doctor-his-patient-and-the-illness-book-michael-balint-9780272792063 Salinsky, John and Sackin, Paul.  What Are You Feeling Doctor? Radcliffe 2000: https://www.worldofbooks.com/en-gb/products/what-are-you-feeling-doctor-book-john-salinsky-9781857754070 Joanne Reeve and the idea of ‘Knowledge Work’: https://bjgplife.com/reclaiming-general-practice-tackling-our-workforce-crisis-with-wisegp/ Stojanovic-Tasic M, Latas M, Milosevic N, Aritonovic Pribakovic J, Ljusic D, Sapic R, Vucurevic M, Trajkovic G, Grgurevic A. Is Balint training associated with the reduced burnout among primary health care doctors? Libyan J Med. 2018 Dec;13(1):1440123: https://pubmed.ncbi.nlm.nih.gov/29493438/ Van Roy K, Vanheule S, Inslegers R. Research on Balint groups: A literature review. Patient Educ Couns. 2015 Jun;98(6):685-94: https://pubmed.ncbi.nlm.nih.gov/25681874/ Player M, Freedy JR, Diaz V, Brock C, Chessman A, Thiedke C, Johnson A. The role of Balint group training in the professional and personal development of family medicine residents. Int J Psychiatry Med. 2018 Jan-Mar;53(1-2):24-38. doi: 10.1177/0091217417745289. Epub 2017 Dec 13: https://pubmed.ncbi.nlm.nih.gov/29235909/ Kjeldmand D, Holmström I. Balint groups as a means to increase job satisfaction and prevent burnout among general practitioners. Ann Fam Med. 2008 Mar-Apr;6(2):138-45. doi: 10.1370/afm.813: https://pubmed.ncbi.nlm.nih.gov/18332406/ Mathers and Rowland (1997). General practice-a post-modern speciality? British Journal of General Practice, 47, 177-179: https://bjgp.org/content/47/416/177 ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara were delighted to interview Dr Sylvia Kama-Kieghe, a GP based in Sheffield with an interest in Women’s Health. She is the Chair of the Royal College of General Practice North of England International Medical Graduates Group. We start with what the group does, why it was set up and look at issues International Medical Graduates might face when working and training in the UK. We consider what practices, staff and supervisors can do to help make International Medical Graduates feel welcome and supported so that the experiences for all can be positive.    A useful listen for all working in Primary Care and specifically those new to Practice in the UK and to Educational and Clinical GP Supervisors.   You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Dr Sylvia Kama-Kieghe’s YouTube Channel for Women’s Health: https://www.youtube.com/c/AskAwayHealth GMC Welcome to the UK pack for International Medical Graduates and Supervisors: https://www.gmc-uk.org/about/what-we-do-and-why/learning-and-support/workshops-for-doctors/welcome-to-uk-practice Royal College of General Practitioners Resources for International Medical Graduates: https://www.rcgp.org.uk/blog/international-medical-graduates-support Royal College of General Practitioners Guide for Overseas Doctors: https://www.rcgp.org.uk/your-career/overseas-doctors-guide Royal College of General Practitioners International Medical Graduates Forum: https://forum.rcgp.org.uk/login Guide on How the NHS works (2021): https://www.nhsemployers.org/system/files/media/Working-and-training-in-NHS-2021_0.pdf International Medical Graduates Podcasts with Raykal Simm: https://open.spotify.com/episode/5ZB88fc9X1tKftnYLhRytb?si=7c906c86bee34fbf Our Episode on How General Practice is Funded (2024): https://www.podbean.com/ew/pb-84rq4-15bc17f ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

For the podcast this week we spoke to Dr Abid Ali Khan, a GP trainee in East London currently on a Clinical Fellowship in Leadership (National Medical Directors Clinical Fellow). We focused on his experiences as an International Medical Graduate to gain an understanding of the challenges he faced coming to the UK. We got his advice for other International Medical Graduates and those supporting IMGs. We have a second episode out next month focusing more on what practices and staff can do to help support International Medical Graduates.   A useful listen for all working in Primary Care and specifically those new to Practice in the UK and to Educational and Clinical GP Supervisors.   You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  GMC Welcome to the UK pack for International Medical Graduates and Supervisors: https://www.gmc-uk.org/about/what-we-do-and-why/learning-and-support/workshops-for-doctors/welcome-to-uk-practice Royal College of General Practitioners Resources for International Medical Graduates: https://www.rcgp.org.uk/blog/international-medical-graduates-support Royal College of General Practitioners Guide for Overseas Doctors: https://www.rcgp.org.uk/your-career/overseas-doctors-guide Royal College of General Practitioners International Medical Graduates Forum: https://forum.rcgp.org.uk/login Guide on How the NHS works (2021): https://www.nhsemployers.org/system/files/media/Working-and-training-in-NHS-2021_0.pdf International Medical Graduates Podcasts with Dr Raykal Sim: https://open.spotify.com/episode/5ZB88fc9X1tKftnYLhRytb?si=7c906c86bee34fbf Our Episode on How General Practice is Funded (2024): https://www.podbean.com/ew/pb-84rq4-15bc17f ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Hepatitis C GP Champion Dr Lindsey Kent and Greater Manchester Peer Programme Manager Tony Horrocks for an overview of Hepatitis C. We cover the basics around the virus and prevalence, potential symptoms and at risk groups to consider when offering testing. We discuss the great work being done to eradicate Hepatitis C in Manchester (and around the UK) including Tony’s personal story as well as his work as a Peer Programme Manager. Wonderful to hear the success rate for cure with medications and how the team ‘leave no one behind’.  Great listening for all of us working in General Practice. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)   Useful resources:  NICE Clinical Knowledge Summaries Hepatitis C (last revised Sept 2022): https://cks.nice.org.uk/topics/hepatitis-c/ The Hepatitis C Trust UK Online Risk Checker: https://www.hepctrust.org.uk/hepatitis-c-risk-checker/ Order free Hepatitis C test UK: https://hepctest.nhs.uk/ Liverpool Hepatitis Interaction Checker: https://hep-druginteractions.org/checker Greater Manchester and East Cheshire Hepatitis C Operational Delivery Network: https://research.cmft.nhs.uk/innovation-at-mft/hepatitis-c-operational-delivery-network-for-greater-manchester-and-east-cheshire Aneesha Noonan’s podcast on Expanding hepatitis C elimination into Primary Care settings: https://youtu.be/U5TdLJdAGrI?si=Woy1nkVxfCztXaJY Hep C U Later Primary Care Toolkit: https://www.hepculater.com/wp-content/uploads/2024/05/Primary-Care-Toolkit-Final-with-links-v2-with-updated-date.pdf Hep C U Later’s ‘Hep C Elimination Successes’: https://www.hepculater.com/hepatitis-c-elimination-successes/ Hep C U Later: GP practices can run a case finding tools (these are already installed on systems within general practice). If you’re interested in running these tools with support from other organisations email connect.HepCULater@mpft.nhs.uk so we can link you to the right people.  NHS England » NHS set to eliminate Hepatitis C ahead of rest of the world: https://www.england.nhs.uk/2022/12/nhs-set-to-eliminate-hepatitis-c/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Sara and Lisa discuss the podcast episodes over the year. We talk about our longer term learning points, how the year has gone and what's to come. ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Locum Consultant Dr Caitriona MacDermott about assessing and managing constipation in Palliative Patients. A common symptom with a significant impact on people’s quality of life, the episode aims to get across the importance of the topic, the often multifactorial nature of clinical scenarios, the red flags not to miss and arm you with a logical and holistic approach to management. We discuss how management might differ for patients with certain conditions such as partial bowel obstruction, neurological causes, or liver disease. An important listen for those of us in the community looking after palliative patients.    You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)   Useful resources:  Greater Manchester Palliative Care Symptom Control Guidelines for Adults (2019): https://www.england.nhs.uk/north-west/wp-content/uploads/sites/48/2020/01/Palliative-Care-Pain-and-Symptom-Control-Guidelines.pdf Clinical Knowledge Summaries from NICE: Palliative Care - Constipation (Updated Feb 2024): https://cks.nice.org.uk/topics/palliative-care-constipation/ NICE CKS Table of Doses of Laxatives that can be used for Palliative Patients: https://cks.nice.org.uk/topics/palliative-care-constipation/prescribing-information/doses-of-laxatives/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

As requested by GP Trainees, this week's episode is on tips to pass the Simulated Consultation Assessment exam; the final exam for GP trainees in the UK. We spoke to Dr Anne Hawkridge who was a GP trainer in Bolton for over 20 years and has been a MRCGP examiner since 2007 when the CSA (Clinical Skills Assessment) started, the predecessor to the pandemic RCA and now the SCA. She is also the co-founder of the successful exam support programme here in the North West; the SOX programme (Support on Exams) and co-author of the North West England Consultation Toolkit which is published in full on the MRCGP SCA preparation website. Questions we had were; what is the exam, what does it look like, how much does it cost, when to consider sitting in, how to approach revising for it and what pitfalls to avoid. The top tips fit into 4 themes; GP consulting skills, ensuring knowledge, good exam technique and timing. Anne covers the changes in the exam through the recent years and there’s plenty in there to give people a flavour of how they can approach the exam in a way that will maximise their chance of success, as well as gaining skills for being a good GP.    You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)   Useful resources:  Interviews from successful North West Deanery Trainees: https://www.nwpgmd.nhs.uk/sca-resources We highly recommends listening to the interviews in full on the North West Deanery SCA resources site here https://www.nwpgmd.nhs.uk/sca-resources Royal College of General Practitioners Simulated Consultation Assessments Introduced and Explained with the Toolkit: https://www.rcgp.org.uk/mrcgp-exams/simulated-consultation-assessment/introduction We recommend that you watch the short How to use the toolkit video: https://www.youtube.com/watch?v=AMHfHJVENfk Royal College of General Practitioners Red Amber Green (RAG) Rating Tool: https://www.rcgp.org.uk/getmedia/95fa6d76-b02d-41c8-873d-f1ccf576dd4b/sca-consultation-toolkit-rag.pdf North West England Deanery Website with information and tips on Passing the SCA: https://www.nwpgmd.nhs.uk/sca-resources The SCA-SOX Programme: https://heeoe.hee.nhs.uk/general_practice/sca-sox-programme ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Respiratory Physiotherapist Thomas James about COPD. We start with what COPD is, when to suspect it, a standard work up, pitfalls and points of consideration about spirometry, before moving on to an overview of management. We then cover some changes in the way COPD exacerbations are managed in South Manchester and the role of Eosinophils in both acute and chronic management. Understanding the role of Pulmonary rehabilitation, prednisolone and exercise in management are particular highlights. We cover our learning points from the episode at the end.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  NICE COPD in adults (last updated Sept 2023): https://www.nice.org.uk/guidance/QS10 The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Spirometry Guide: https://goldcopd.org/gold-spirometry-guide/ Association for Respiratory Technology and Physiology (ARTP) advice on Spirometry Interpretation: https://www.artp.org.uk/en/spirometry Greater Manchester Medicines Management Group (GMMMG) COPD Management Plan Guideline (2021): https://gmmmg.nhs.uk/wp-content/uploads/2021/11/COPD-Treatment-Guideline-Nov-2021-V7.1.pdf Greater Manchester Medicines Management Group (GMMMG) COPD Inhaler Guide (2021): https://gmmmg.nhs.uk/wp-content/uploads/2023/05/GMMMG-COPD-Inhaler-Guide-update-Mar-2023.pdf Greater Manchester CURE Project for Smoking Cessation: https://gmcancer.org.uk/programmes-of-work/treatment/the-cure-project/ Greater Manchester Change, Grow, Live Services including Smoking Cessation: https://www.changegrowlive.org/ Primary Care Respiratory Society MRC Breathlessness scale: https://www.pcrs-uk.org/mrc-dyspnoea-scale Our podcast with Dr Lesley Henson and Dr Caitriona MacDermott on Breathlessness in Palliative Care (May 2024): https://pckb.org/e/breathlessness-in-palliative-care/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Dr Joanna Bircher, Dr Nikesh Vallabh, Shelley Ryder (SWAN PCN Manager and Transformation Lead) and Dr Fran Fitton. We find out what proactive care is all about and then launch into example projects around dementia care that Shelley and Fran are involved in. We hope this gives people a flavour of what proactive care projects could entail in General Practice in terms of design and implementation.  Later in the year, we hope to bring more examples of projects and how they managed to get them off the ground.  You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  NHS Long Term Plan, Overview and Summary: https://www.longtermplan.nhs.uk/online-version/overview-and-summary/ Proactive care: New GM support offer for 20 PCNs: https://gmpcb.org.uk/proactive-care-new-gm-support-offer-for-20-pcns/ An Introduction to Quality Improvement: https://www.podbean.com/ew/pb-ubnht-114762e ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

***SUMMER REWIND  - INITIALLY RELEASED ON 31ST JAN 2024*** To get in touch: primarycarepodcasts@gmail.com Doctors Lisa and Sara talk to Senior Pharmacist Sarah Hafeez about Polypharmacy. She explains the difference between inappropriate and appropriate polypharmacy before talking through some typical cases that illustrate several examples of common scenarios.  This leads to discussions on prioritising concerns, weaning/stopping medications, counselling patients on the effects of Opioids and Gabapentinoids and involving community teams aiming for successful reductions of addiction forming medications. Other gems include a discussion of the potential long term risks of Proton Pump Inhibitors and advice on weaning, remembering to consider anticholinergic burdens as well as handy resources for tackling Polypharmacy, Structured Medications Reviews and medication reductions. You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful resources:  Greater Manchester Medicines Management Group: Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack (from Dec 2022, accessed Dec 2023): https://gmmmg.nhs.uk/wp-content/uploads/2023/02/GMMMG-Polypharmacy-resource-pack-v3.0.pdf Scotland Polypharmacy Resources for Professionals and for Patients: https://www.polypharmacy.scot.nhs.uk/for-patients-and-carers/ Scottish Polypharmacy Guidance 2018: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf Lewis T. Using the NO TEARS tool for medication review. BMJ. 2004 Aug 21;329(7463):434. doi: 10.1136/bmj.329.7463.434. PMID: 15321901; PMCID: PMC514207 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC514207/ Toolkit for General Practice in Supporting Older People Living with Frailty (includes a great Appendix of the STOPP/START criteria (2017): https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf An example of an Anticholinergic Burdon Resource from West Essex CCG 2020: https://westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/clinical-guidelines-and-prescribing-formularies/04-central-nervous-system/61-anticholinergic-side-effects-and-prescribing-guidance/file Canadian Resource for Deprescribing including reducing medications and some patient information leaflets: https://deprescribing.org/ Resource for help reducing and stopping medications: https://medstopper.com/ Me and My Medicines Resource for Patients to look through their medications before reviews or for information: https://meandmymedicines.org.uk/ Anticholinergic Medications and Risks of Dementia Cochrane Editorial with Reports in Link (Sept 2021): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000154/full Anticholinergic drugs and risk of dementia: Time for action? British Pharmacological Society. Bell B et al Jun 2021 (9:3). Accessed 15/1/2024:  https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.793 Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder. Clin Interv Aging. 2020; 15: 1493–1503: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457731/ Greater Manchester Medicines Management Group: Management of Overactive Bladder Including a simple Bladder Diary before and after stopping Medications (Jun 2019): https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Management-of-OAB-in-adults-v3-0-approved-Aug-2019.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Palliative Care Consultant Lesley Henson and Specialty Doctor Caitriona MacDermott for a discussion on common issues Primary Care Clinicians face when dealing with patients at the end of life and their families. We discuss Hospice admission criteria and the role of the hospice. We then look at how they approach questions around palliative symptoms like breathlessness, reduced oral intake and this leads on to a conversation about assessing and discussing options around hydration. We get their approach to answering questions around prognosis and navigating the scenario where relatives/carers might see the set of symptoms differently to other carers.  Useful resources:  Hospice UK: What is Hospice Care: https://www.hospiceuk.org/information-and-support/your-guide-hospice-and-end-life-care/im-looking-hospice-care/what-hospice Greater Manchester Palliative Care Symptom Control Guidelines for Adults (2019): https://www.england.nhs.uk/north-west/wp-content/uploads/sites/48/2020/01/Palliative-Care-Pain-and-Symptom-Control-Guidelines.pdf Clinical Knowledge Summaries: Palliative Care General Issues: https://cks.nice.org.uk/topics/palliative-care-general-issues/ Pain Assessment Tool for People with Dementia or Communication Difficulties from Doncaster and Bassetlaw NHS Hospitals (2015): https://www.dbth.nhs.uk/wp-content/uploads/2018/10/DBH-Pain-Tool.pdf MacMillan Resources: Managing Breathlessness, advice for Patients: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/breathlessness/managing-everyday-life-with-breathlessness?gad_source=1&gclid=cjwkcajwrckxbhbmeiwaivf8rhfcgjkvqpsq-is9gahloaxjoyq9tsfxwykwym08ewcsyoluupn-1xocq1sqavd_bwe&gclsrc=aw.ds Cancer Research UK Resource for Patients and relatives around Breathing Problems for Patients with Cancer: https://www.cancerresearchuk.org/about-cancer/coping/physically/breathing-problems _____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com _____ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Palliative Care Consultant Lesley Henson and Specialty Doctor Dr Caitriona MacDermott about Breathlessness as a symptom in Palliative Patients. We start with a case to look at an approach to a patient with deteriorating breathlessness, before discussing a diagnosis of refractory breathlessness. We explore the importance of understanding the subjective nature of this experience before moving on to non-pharmacological and pharmacological options to help manage this often distressing symptom. We talk about managing anxiety around breathlessness and get their advice on discussions about death and managing these symptoms well.  Useful resources:  Greater Manchester Palliative Care Symptom Control Guidelines for Adults (2019 (p46, section on breathlessness): https://www.england.nhs.uk/north-west/wp-content/uploads/sites/48/2020/01/Palliative-Care-Pain-and-Symptom-Control-Guidelines.pdf Clinical Knowledge Summaries: Palliative Care - Dyspnoea (Updated Feb 2024): https://cks.nice.org.uk/topics/palliative-care-dyspnoea/#:~:text=Managing%20dyspnoea%20in%20palliative%20care,window%2C%20relaxation%20and%20breathing%20techniques. MacMillan Resources: Managing Breathlessness, advice for Patients: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/breathlessness/managing-everyday-life-with-breathlessness?gad_source=1&gclid=cjwkcajwrckxbhbmeiwaivf8rhfcgjkvqpsq-is9gahloaxjoyq9tsfxwykwym08ewcsyoluupn-1xocq1sqavd_bwe&gclsrc=aw.ds Cancer Research UK Resource for Patients and relatives around Breathing Problems for Patients with Cancer: https://www.cancerresearchuk.org/about-cancer/coping/physically/breathing-problems _____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com _____ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Dr Saadat Ahmed, ST5 in Geriatrics for a deep dive into Osteoporosis. We cover what it is, why it matters, what the risks factors are, who and how to assess for it, and what to do with results from FRAX and DXA scans. After a discussion on lifestyle options to help improve bone health, we ask advice on counselling patients around the pros and cons of taking Bisphosphonates including his advice on talking about the rarer side effects. We talk through a case and ask advice on how to reassess bone health after these initial conversations, and medications might have been started, including when to consider drug holidays.   Lots of excellent CPD here we feel. Enjoy and please share with any interested clinicians/trainees as you see fit.   Useful resources:  Osteoporosis - Prevention of Fragility Fractures NICE CKS Guidelines (updated Apr 2023): https://cks.nice.org.uk/topics/osteoporosis-prevention-of-fragility-fractures/ FRAX Calculator UK (Link from National Osteoporosis Guideline Group UK: https://frax.shef.ac.uk/FRAX/tool.aspx?country=1 WHO Falls Management: https://www.who.int/news-room/fact-sheets/detail/falls National Osteoporosis Guideline Group UK: https://www.nogg.org.uk/full-guideline/section-4-intervention-thresholds-and-strategy https://www.nogg.org.uk/full-guideline/section-7-strategies-management-osteoporosis-and-fracture-risk SIGN Scottish Osteoporosis Guidelines (discussion of evidence for links between PPIs and Osteoporosis on page 27): https://www.sign.ac.uk/media/1812/sign-142-osteoporosis-v3.pdf Osteonecrosis of the Jaw relative risk discussed on page 37 of National Osteoporosis Guideline Group UK: https://www.nogg.org.uk/sites/nogg/download/NOGG-Guideline-2021-g.pdf Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus, Journal of Bone and Mineral Research. Khan A et al 2015: https://pubmed.ncbi.nlm.nih.gov/25414052/ Flow Chart for Oral Bisphosphonates long term treatment and monitoring NOGG Guidelines: Page 35: https://www.nogg.org.uk/sites/nogg/download/NOGG-Guideline-2021-g.pdf Rubin KH, Rothmann MJ, Holmberg T, et al. Effectiveness of a two-step population-based osteoporosis screening program using FRAX: the randomized Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study. Osteoporosis Int 2018; 29(3): 567-78. https://pubmed.ncbi.nlm.nih.gov/29218381/ Merlijn T, Swart KM, van Schoor NM, et al. The Effect of a Screening and Treatment Program for the Prevention of Fractures in Older Women: A Randomized Pragmatic Trial. J Bone Miner Res 2019; 34(11): 1993-2000. https://pubmed.ncbi.nlm.nih.gov/31220365/ Merlijn T, Swart KMA, van der Horst HE, Netelenbos JC, Elders PJM. Fracture prevention by screening for high fracture risk: a systematic review and meta-analysis. Osteoporosis Int 2020; 31(2): 251-7. https://pubmed.ncbi.nlm.nih.gov/31838551/ _____ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com _____ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.