In this episode, we talk to Emma Whitfield, who is a PhD student in the Institute of Epidemiology and Health Care at University College London.Title of paper: Diagnostic windows in non-neoplastic diseases: a systematic reviewAvailable at: https://doi.org/10.3399/BJGP.2023.0044Improving timeliness of diagnosis is imperative across disease types. This review identified that for a range of nonneoplastic conditions healthcare use starts to increase in the time before diagnosis. For some conditions, this increase may first start to occur many years before diagnosis. Further research is needed to produce accurate estimates of how much earlier diagnosis may be possible.

In this episode, we’re going to do something a bit different and recognise some exceptional researchers here in the UK. We talk to Dr Sarah Bailey and Dr Ben Brown, this year’s winners of the Royal College of GPs and Society for Academic Primary Care early career researcher award. This award, which has a long history of recognising the up and coming superstars of primary care research, recognises the contribution of early career researchers to advancing primary care theory and practice.

In this episode, we talk to Dr Laura Jefferson, who is a Research Fellow within the Department of Health Sciences at the University of York. Title of paper: ‘Exploring gender differences in uptake of GP partnership roles: a qualitative mixed methods study’. Available at: https://doi.org/10.3399/BJGP.2022.0544An unadjusted gender pay gap of 33.5% exists in general practice, reflecting partly the differential uptake of partnerships amongst women GPs, but evidence exploring gender differences in GPs’ career progression is sparse. Our mixed methods approach used interview data, social media analysis and asynchronous online focus groups to explore factors affecting uptake of partnership roles, focusing particularly on gender differences. Factors at individual, organisational and national levels influence partnership uptake and career decisions of both men and women GPs, though gender differences were apparent with women reporting greater challenges balancing work/family, negative working conditions including maternity and sickness pay and discriminatory practices perceived to favour men and full time GPs. The relative attractiveness of salaried, locum or private roles in general practice appears to discourage both men and women from partnerships presently. Promoting positive workplace cultures through strong role models, improved flexibility in roles and skills training could potentially encourage greater uptake amongst both men and women.

In this episode, we talk to Ruth Swann who is a Senior Analyst for Cancer Research UK in partnership with NHS England, about the study she’s published alongside colleagues here in the BJGP. Title of paper: Comparison between the 2018 and 2014 National Cancer Diagnosis Audits for EnglandAvailable at: https://doi.org/10.3399/BJGP.2022.0268There is ongoing national monitoring of elements of the cancer referral process from primary care, including the proportion of urgent referrals (‘2-week waits’, TWW) and emergency presentations. The 2014 National Cancer Diagnosis Audit (NCDA) provided a richer picture of this process, as reported by GPs themselves. This research presents a direct comparison of that audit to the more recent one carried out on patients diagnosed in 2018, with revised NICE guidance on referral of suspected cancer having been published in 2015, showing the changes in practice and their direction.

In this episode, we talk to Dr Alex Hodkinson, who is an NIHR senior research fellow within the NIHR Patient Safety Translational Research Centre at the University of Manchester. Title of paper: Association of strong opioids and antibiotics prescribing with GP burnout: a retrospective cross-sectional study’. Available at: https://doi.org/10.3399/BJGP.2022.0394Prescribing has important implications for patient safety; this is particularly the case for high-risk medications such as strong opioids, and medications where there may be public health implications such as antibiotics. Physician wellness such as burnout can also have a significant impact on the productivity of healthcare organisations, intentions to leave medical practice, and both the quality and safety of patient care. At present, it is unclear if there is an association between the wellness of GPs within general practices and overprescribing of strong opioids and antibiotics in primary care in England. Over a 4-month period this study found higher prescribing of strong opioids and antibiotics among GPs with burnout symptoms, job dissatisfaction, and turnover intentions; working longer hours; and in practices based in the north of England serving more deprived populations.

In this episode, we talk to Ameerah Ibrahim and Carmel Hughes about the paper they’ve recently published in the BJGP titled, ‘GPs’ and pharmacists’ views of integrating pharmacists into general practices: a qualitative study’Title of paper: GPs’ and pharmacists’ views of integrating pharmacists into general practices: a qualitative studyAvailable at: https://doi.org/10.3399/BJGP.2022.0518Little is known about primary healthcare professionals’ views on the impact of practice-based pharmacists (PBPs) in general practice. Participants interviewed in this study reported that PBPs had integrated well and perceived a positive impact on primary healthcare delivery. The findings indicated that continued integration would need PBPs, all members of the practice team, and community pharmacists (CPs) to understand each other's roles well and to communicate clearly to ensure the delivery of efficient PBP-led patient care. A number of areas for development were identified such as patient awareness of the role and communication pathways between PBPs and CPs.

Today we are talking to Dr Nick Thomas, who is clinical lead for research at the Royal College of General Practice here in the UK.Read more about research here at the RCGP: https://www.rcgp.org.uk/representing-you/research-at-rcgpAnd for more information about the Research and Surveillance Centre, look here: https://www.rcgp.org.uk/representing-you/research-at-rcgp/research-surveillance-centreIf you are looking for research funding opportunities through the RCGP, read more here: https://www.rcgp.org.uk/representing-you/research-at-rcgp/how-rcgp-support-your-research#grants

In this episode, we talk to Dr Joe Hutchinson, an academic clinical fellow at the Centre for Primary Care and Health Services Research at the University of Manchester. Title of paper: Consequences of the closure of General Practices: a retrospective cross-sectional studyDOI: https://doi.org/10.3399/BJGP.2022.0501Closures of UK general practices are increasingly common, yet little is known about the consequences. This cross-sectional study of English general practices finds practice closures increase list size in exposed practices, with changes in workforce composition and reductions in patient satisfaction.

In this episode, we talk to Dr Faraz Mughal, who is a practising NHS General Practitioner and NIHR Doctoral Fellow at the School of Medicine at Keele University. Title of paper: Recent GP consultation before death by suicide in middle-aged males: a national consecutive case series studyAvailable at: https://doi.org/10.3399/BJGP.2022.0589Preventing suicide in middle-aged males is a global priority. This national case series study found that 43% of middle-aged males who died by suicide had a final GP consultation in the preceding 3 months, and of these males, over half presented with a mental health problem. Males who had recent GP contact before suicide were more likely to have self-harmed in the 3 months before compared with males who had no recent GP contact. Males who had a current physical illness, recent history of self-harm, attended for a mental health problem, and experienced recent work-related problems were more likely to consult with their GP shortly before dying by suicide. GPs and primary care clinicians should be alert to these clinical factors that may be proximal to suicide, and in turn, offer personalised holistic care.

In this episode, we talk to Dr James Sheppard, who is an Associate Professor at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Title of paper: Predicting the risk of acute kidney injury: Derivation and validation of STRATIFY-AKIAvailable at: https://doi.org/10.3399/BJGP.2022.0389Acute kidney injury (AKI) is one of the more serious adverse events associated with antihypertensive treatment, reducing an individual’s health-related quality of life and increasing the risk of admission to hospital. Clinical guidelines recommend that when prescribing antihypertensives GPs should take into account the likelihood of both the benefits and harms from treatment, but few data exist in regard to the risk of AKI. A clinical prediction model was developed and externally validated for the risk of AKI up to 10 years in the future in patients eligible for antihypertensive medication, incorporating commonly recorded patient characteristics, comorbidities, and prescribed medications. The model showed good discrimination and good calibration for probabilities up to 20%, enabling GPs to accurately identify patients at higher risk of AKI. This could be useful to reassure the majority of patients starting or continuing treatment that their risk of AKI is very low.