The BJGP publishes videos and multimedia to highlight research findings, clinical impact, and top 10 articles. Here's a selection of BJGP videos. See BJGP YouTube playlist on RCGP's YouTube for more videos and updates. Also see BJGP's new YouTube channel. Accompanying podcasts are available at BJGP Audio. 

 

Preconception interventions

Primary care-based preconception care (PCC) is shown to be effective at reducing preconception risk factors and improving patients' health knowledge, according to a systematic review which found benefits with brief and intensive education, supplementary medication, and dietary modification. Findings also suggest that brief education improves health knowledge among males. Routinely providing PCC in primary care settings may assist in reducing maternal mortality and morbidity, and may also improve pregnancy outcomes.

 

Measuring continuity of care

Continuity of care is not part of health policy, but its benefits are well documented: reduced all-cause mortality, lower use of hospital care, increased adherence to drugs, decreased healthcare costs, and greater satisfaction for doctors and patients. This study used the Usual Provider of Care score, or UPC, to measure continuity. It found that patient age and practice size are the strongest predictors of continuity of care, and supports the use of the UPC as it is well correlated with patient views on continuity, and may be used as a new quality indicator for practice.

 

Unreliability of the NICE Traffic Light tool

The Traffic Light tool from NICE is designed to identify children at risk of serious illness, and it is widely used in general practice for the assessment of acutely unwell children. This new research shows that the Traffic Light tool is unreliable in detecting and excluding serious illness in children presenting to UK general practice with an acute illness. The authors state that this system is not suitable for use as a clinical tool in general practice. Further research is required to update or replace the Traffic Light system.

 

Burnout among GPs: systematic review and meta-analysis

A systematic review and meta-analysis on GP burnout found that there is considerable heterogeneity in the prevalence of GP burnout across studies, with burnout prevalence estimates ranging from 6% to 32%. Although moderate to high GP burnout exists worldwide, heterogeneity in prevalence estimates highlights the challenge of developing a uniform approach to characterise burnout. Findings suggest  burnout should be characterised, operationalised, and treated according to the workplace context.

 

Breast cancer is not associated with breast pain alone

This study of around 11,000 women found no relationship between breast cancer and breast pain only. This has significant implications for referrals, where the current rate of referral for women with breast pain alone is ~20%. The authors recommend that women with breast pain alone need an alternative form of care rather than referral to a cancer diagnostic clinic. Women and GPs should be reassured that breast pain alone is not a presenting symptom of breast cancer.

 

Physical activity for patients with multimorbidity

Group educational sessions to improve physical activity showed an unexpected result in this randomised controlled trial of patients with multimorbidity. It found a slight decrease in activity in the intervention group. This reduction in physical activity was statistically significant but possibly not clinically. The authors suggest that when devising strategies for increasing physical activity levels in those with multimorbidity, efforts should be made to stratify patients by baseline physical activity level and target those at greatest need of physical activity intervention. This study highlights some of the challenges of conducting physical activity research.

 

Long COVID coding: data from OpenSAFELY

Recording of long COVID in primary care is low and variable between practices, according to an analysis of 58 million patient records. This study of OpenSAFELY data found wide variation in the early use of these codes, by practice, geographic region, and practice electronic health record software. Long COVID coding was significantly higher among practices using EMIS compared with those using TPP. Increased awareness of diagnostic codes for long COVID is needed to facilitate research and planning of services. View an update on Long COVID Coding data at reports.opensafely.org.

 

Continuity predicts mortality, hospitalisation, and OOH care

Length of continuity with a GP is strongly associated with less need for acute hospitalisations and lower mortality, according to new research on GP continuity. This study included 4.5 million patients and their named GPs. It found a strong association between continuity and patient outcomes: mortality was 25% lower when the GP–patient relationship was greater than 15 years versus 1 year. Also, use of out-of-hours (OOH) services was lower, and acute hospitalisations were also lower. There was a dose-dependent relationship, in that increased continuity meant better outcomes. The authors conclude that this association of continuity and patient outcomes is probably causal, indicating the importance of continuity for patients' health.

 

Long COVID: recognition, diagnosis, and management

Recommendations for the investigation and management of long COVID are that specific alternative diagnoses and underlying conditions should be sought. Important alternative diagnoses include pulmonary embolism, diabetes and thyroid disorder (all of which may be triggered by COVID-19). Many patients with long-COVID symptoms have features of autonomic system dysfunction (such as Postural Orthostatic Tachycardia Syndrome or ‘disordered’ breathing patterns), allergic type responses (termed ‘mast-cell disorder’), or inflammation of the heart or nervous system. Recognising and treating these conditions can greatly assist patients in recovery. Exclusion of heart inflammation is important prior to increasing physical activity in patients with chest pain or lowered blood oxygen saturation. Careful pacing of activity is needed to avoid relapse.

 

Cancer detection via primary care urgent referral

Primary care urgent referrals for suspected cancer have more than doubled in the last decade to over 2 million per year. This increase has had significant impacts on cancer detection and improved patient outcomes. Higher cancer detection via 2-week wait (2WW) referrals was associated with larger practices and those with younger GPs, though the relationship with GP age was attenuated. Of concern are decreases in 2WW referrals during the COVID-19 pandemic and potential disparity in cancer detection, with lower rates in more deprived populations. This study of urgent referral for cancer detection included all general practices in England (>7000) over 10 years from 2008/9 to 2018/19.

 

Link workers for social prescribing

Integration of health and social care is a challenge, and link workers are being employed to address one aspect of this. New research examines the role of link workers who assist with social prescribing in primary care within the Links Worker Programme (LWP). Results showed that, even in a well-resourced government-funded social prescribing programme, the majority of general practices involved had not fully integrated LWP within the first 2 years. Although social prescribing within primary care can help patients, at scale it is unlikely to be a ‘quick fix’ for mitigating health inequalities. Successful implementation was associated with GP buy-in, collaborative leadership, good team dynamics, link worker support, and the absence of competing innovations.

 

Safety-netting advice 

GPs frequently do not document safety-netting advice they have discussed with patients which may have medico-legal implications. This is the first study to undertake a detailed analysis of documented safety-netting advice and make comparisons with what was spoken in recorded consultations. Two-thirds of routine GP consultations contained spoken safety-netting advice which was only documented in one-third. GPs were less likely to discuss or document safety-netting advice for problems raised in consultations where multiple problems were assessed. Although there are pressures on both patients and GPs to discuss multiple problems in a single visit, sharing these risks with patients may help to manage expectations of what can be safely achieved in a GP consultation.

 

Ondansetron for paediatric gastroenteritis

Ondansetron is found to be effective in reducing vomiting in secondary care, but this effect had not previously been evaluated in primary care. This study examined ondansetron for gastroenteritis in children and found that it is effective in reducing vomiting, seems safe, and is positively evaluated by parents. An additional cost-effectiveness evaluation showed that a single dose of oral ondansetron at out-of-hours primary care services also decreases the social and medical costs of managing acute gastroenteritis in these children. These studies show that ondansetron could be considered by GPs as an additional treatment in the management of dehydration due to acute gastroenteritis, when the child predominantly experiences vomiting.

 

Managing lower urinary tract symptoms 

Lower urinary tract symptoms (LUTS) in men can usually be treated effectively in primary care; however, referrals to urology services are increasing. This study explores the experiences of GPs and patients, including the key challenges of difficulty establishing causes and differentiating symptoms. Treatment for LUTS by GPs is often a process of trial and error, due to challenges such as symptoms having multiple causes and patients presenting with mixed symptoms. A diagnostic tool for use by GPs, together with greater exploration of non-pharmacological treatment approaches, could help to support effective management of LUTS in primary care settings.

 

Endometriosis in primary care

Diagnostic delays are common for endometriosis, as patients present to primary care with undifferentiated concerns and the symptoms suggestive of endometriosis are non-specific, making endometriosis one possible consideration of many. Therefore, GPs move through a diagnostic hierarchy to exclude other possible causes – which takes time. In this interview, Dr Sharon Dixon explains that in consulting with patients, acknowledging the length of time living with symptoms was important. Also important were recognising that symptoms might be non-cyclical and non-gynaecological; and symptom diaries could be helpful for GPs and patients. The research suggests proactively asking patients to try this and book a follow-up, and to avoid assumptions; for example, about sexuality and reproductive intentions. It was very important to note that while distress can drive pain, difficult, prolonged pain causes distress.

 

Self-harm: general practice care

This study found that young people who have self-harmed described mixed experiences of consulting GPs which can influence help-seeking from general practice. In this 2-minute video, Dr Faraz Mughal explains that 1 in 4 people up to the age of 25 years has harmed themselves previously; that self-harm presenting in primary care is increasing in females; and peak age for overdosing in young people is 16-24 years. Findings showed that young patients in distress did not want to wait weeks to see their GP, and that requests to see a GP on that day should be taken seriously. A relationship with one GP who listens and offers proactive follow-up is an important facilitator to help reduce self-harm behaviour in young people.

 

Continuous, risk-based, consultation peer-review

This study demonstrates the potential of using a continuous, risk-based, consultation peer-review system to improve safety and efficiency in general practice. Continuous, risk-based, consultation peer-review uses consultation sampling based on clinical-risk status. The sample is randomly screened by a clinical peer-review team, and any learning or safety issues are escalated to a consensus peer-review panel, and clinicians are given feedback on learning and safety. The benefits identified were supporting learning and quality assurance, and this peer-review system showed that learning and safety were valued. This provides  a potential mechanism to detect and minimise unwarranted variation in clinician practice, and support an increasingly multidisciplinary workforce to practise to its full potential.

 

Benefits and harms of treatments for long-term conditions

New research examines long-term conditions and GPs' use of quantitative data in decision making around benefits and harms of treatments. Research has shown that doctors, including GPs, often have poor knowledge of the quantitative benefits and harms of treatments (such as absolute risk reduction and numbers needed to treat). Yet this kind of information is considered key to shared decision making and optimal management of polypharmacy. This study found that GPs would like better access to this kind of numerical information about the pros and cons of treatments. In the 2-minute video Dr Julian Treadwell explains that GPs use quantitative information usually around statin prescribing; and that QRISK was used to determine baseline risk and frame conversations or make treatment threshold decisions.

 

Primary care transformation in Europe during COVID-19

This is the first pan-European study to explore experiences of primary-care professionals in the first COVID-19 peak by conducting interviews across England, Belgium, the Netherlands, Ireland, Germany, Poland, Greece, and Sweden. Dr Marta Wanat discusses the findings in a podcast interview and video highlights in which she explains face-to-face consultations were arranged differently across countries; remote consultations were new for many professionals; peer-to-peer information sharing was common; and there was huge variation in how much support practices received. Read the full research on how primary care rapidly transformed services in relation to COVID-19 as well as non-COVID-19 care.

 

Benzodiazepine discontinuation

The dilemma of long-term benzodiazepine use has plagued GPs for decades. New research can help GPs to tackle this longstanding issue with confidence. Results showed that barriers and facilitators to ceasing benzodiazepine use varied according to their stage of change. This indicates that GPs need to modify their intervention based on the patients’ 'readiness' to change.

In this 2-minute video Erin Oldenhof explains that original problems tend to persist after taking benzodiazepines; beyond discontinuing medication it is useful to ask 'What can we explore to help?'; underlying issues are talking points for GPs with patients; knowing the harms of benzodiazepines was a motivator for patients; and 'Is this working for you?' is a better approach than discouraging use.

 

Impact of COVID-19 on migrants’ access to primary care

Migrants are already known to face barriers in accessing primary care, such as confusion about the NHS, language difficulties, and discrimination. This new research examined the impact on migrants of pandemic-related changes in primary care delivery, such as the increased use of technology, and physical closure of some GP practices.  In this 1.5-minute video and full-length podcast, Dr Felicity Knights outlines research findings and opportunities for improving migrant health, including support with forms and signposting; videos and translations; virtual group consultations; and the Safe Surgeries initiative by Doctors of the World. 

 

GP outreach for people experiencing homelessness

New research shows GP outreach services for homeless people were found to be more comfortable and safe, and promoted belonging. They provide a one-stop shop with facilities, and outreach settings were more relaxed and informal, for GPs too. In this 2-minute video and full-length podcast, Dr Fiona Cuthill explains that interviews were at food & clothing banks and a dedicated day centre; outreach was more comfortable and safe, and promoted belonging; outreach provided a one-stop shop with facilities including medical services; outreach settings were more relaxed and informal; and outreach helps to reduce the stigma people experiencing homelessness report in formal settings. 

 

Missed acute deterioration in primary care

New research investigates the circumstances around patients who had seen a GP before hospitalisation. It found that patients were less likely to self-refer to hospital (potentially an indication of missed deterioration) after longer face-to-face consultations. GP telephone and video consultations have increased substantially with the COVID-19 pandemic, but these forms of consultations have not been fully evaluated and may increase missed deterioration in primary care. Findings discussed in the interview with Dr Elizabeth Cecil are the strong association between time spent with GP and self-referral; GPs are more likely to miss deterioration with phone consultations; patients are less likely to self-refer when face-to-face is followed by phone consultations; and this research supports the lengthening of consultation times.  

 

Webinar: Cancer and primary care

The second BJGP Webinar took place on 26 May, focusing on Cancer and primary care. The webinar was introduced by Prof. Fiona Walter, from Queen Mary University of London & University of Cambridge. There were presentations, a panel discussion, and time for attendees' questions. Jump to a 2-minute summary of the clinical messages from each speaker. For more jump links, watch on YouTube and 'show more' to navigate to sections of interest. Keep up-to-date, follow #BJGPWebinar on Twitter, and BJGP Webinar on BJGP Life. 

 

Remote consultations and dementia during COVID-19

New research from University College London shows that remote healthcare consultations with patients with dementia are easier for issues like medicines, but new issues and physical signs are more difficult when remote. Remote consultations that were described as feasible were mostly by telephone and managed by the carer. Practitioners engaging with people living with dementia and their carers should make extra effort to ensure the efficacy of remote healthcare consultations, addressing difficulties by encouraging use of prompts to remember problems, assessing new emerging issues, rescheduling/missed calls, and inclusion of the person with dementia’s voice. Listen to the podcast interview with Remco Tuijt.

 

Trans men and non-binary UK cervical screening

Dr Alison May Berner discusses new research on cervical screening for trans men and non-binary people. She explains that trans men and non-binary people assigned female at birth (TMNB) experience barriers to accessing adequate cervical screening at personal, interpersonal, and institutional levels, and are less likely to engage in screening than cisgender women. Findings show that many trans men and non-binary people don’t have hysterectomies, 10% clearly do not want a hysterectomy, and 35% are not sure. Unfortunately, current NHS recording of sex/gender as only male or female misses trans men from the screening register. Cervical screening uptake could be increased with improved training for providers, more inclusive clinical environments, and by embracing new testing methods such as self-taken swabs. More information is available from Jo's Cervical Cancer Trust.

 

Which patients miss appointments?  

New research reveals how many primary care appointments are missed, reasons given for this, and what characteristics are commonly associated with missed appointments. Main points discussed in the video:
– In this systematic review 3–48% of appointments were missed 
– Family and work commitments were common reasons 
– Weather, transport, and feeling better were other reasons 
– Doctor–patient relationship and miscommunication were relevant 
– Monday appointments were likely to be missed  

Those from minority ethnicity, low socio-demographic status, and younger patients were more likely to miss appointments. This research is important in addressing the estimated 15 million missed appointments annually in England, costing NHS England £216 million per year. 

 

CKD: inappropriate prescribing 

Potentially inappropriate prescribing in primary care is common in chronic kidney disease and existing prescribing recommendations are often non-specific and relatively unhelpful to clinicians. In this video, Dr Clare MacRae explains that: BNF renal impairment warnings are heterogeneous in terminology; almost 4% of patients were prescribed a drug with a clear ‘contraindicated’ warning; and ‘potentially high risk’ drugs were prescribed in almost 1/4 of patients. High risk prescribing in CKD contributes to adverse drug reactions, unintended harmful events attributed to the use of medicines, and drug-related acute kidney injury (AKI). People with CKD have poorest health outcomes after drug-related AKI, specifically being most likely to have additional loss of kidney function, require dialysis, and die. Adjustment of medications according to kidney function, and avoiding medications that increase the risk of kidney damage, can slow progression of kidney disease and reduce rates of illness.

 

Discontinuing long-term antidepressant use

Discontinuation of long-term antidepressants is more than a simple deprescribing decision. New research shows a repeat prescription should not be considered as ‘just a script’ consultation. Deprescribing begins with considering a patient's social and relational context, and is a journey involving careful preparation, tailored care and regular review. This study suggests GPs need clinical time to do the complex contextual and relational decision-making around diagnosis, prescribing and discontinuing antidepressants. A request for a repeat prescription should always come with a review of whether this medication is still required. Deprescribing is an important consideration, particularly as long-term antidepressant use is on the rise, most antidepressant prescribing takes place in general practice, and about one-third of long-term users have no clear reason for continued use. Listen to the podcast with Associate Prof. Riitta Partanen.

 

GPs’ gut feelings for assessing cancer risk

The use of gut feelings has often been described in primary care, and bodies like NICE are beginning to recognise clinicians' judgement in their guidance. This study shows how, rather than being used in isolation, gut feelings prompt evidence gathering and discussion with colleagues that can benefit patients with symptoms that don't easily fit with clinical guidelines. GPs use their gut feelings to prompt building a case for accessing further investigations, by re-examining the reasons why the patient came to them, how their presentation fits with clinical guidance, and seeking second opinions from their colleagues. Experience was seen as important to the development of reliable gut feelings, but so too was empathy and the GPs' relationships with their patients which allowed them to notice the subtle changes that could make them think: 'Something is not right here and I need to find out what it is'. Read the new qualitative research and the associated quantitative article. 

 

BJGP Webinar on Health Inequalities​ ​

It is 50 years since the ‘Inverse Care Law’ was introduced by Dr Julian Tudor Hart. In recognition of the totemic article, the BJGP hosted a free 1.5-hour webinar on health inequalities, with a video introduction from Prof. Sir Michael Marmot. The webinar focused on recent research and analysis from leading primary care researchers, in the form of short presentations. Visit BJGP Webinars for upcoming events and join the Twitter discussion at: #BJGPwebinar.

Jump to various sections in the video by following the links: 00:00 BJGP Editor, Dr Euan Lawson, opens the webinar. 01:07 Webinar chaired by Dr Carey Lunan, GP, Chair of the Deep End Project, and former Chair of RCGP Scotland; Dr Lunan introduces Prof. Sir Michael Marmot. 03:59 Prof. Sir Michael Marmot speaks on 50 years of the Inverse Care Law. 16:42 Prof. Simon de Lusignan, Professor of Primary Care and Clinical Informatics, University of Oxford: Excess mortality in the first COVID-19 wave. 29:54 Dr Sarah Hillman, GP and Clinical Lecturer in Primary Care, University of Warwick: Socioeconomic status and HRT. 43:55 Prof Paramjit Gill, Professor of Primary Care, University of Warwick; Trustee, South Asian Health Foundation: BME minorities and COVID-19. 01:02:22 Q&A Panel Attendees’ questions. 01:26:11 Close and final comments by Chair: sum up of '3 things we can take back to our practice'.

 

Group consultations in UK general practice ​

New research by Dr Laura Swaithes and colleagues at Keele University suggests group consultations provide an enjoyable interaction between general practice staff and patients. Seeking interviews with general practice staff from a range of disciplines, the research revealed that group consultations may enhance multidisciplinary working, provide the opportunity for more patient-centred care, and reduce workload. With GPs and nurses reporting high levels of stress and burnout, primary care needs to adapt and deliver new models of care to ease workload pressures. Could group consultations be the future?

 

Doctors experiencing domestic abuse

Female doctors face unique barriers to help-seeking and reporting domestic abuse. The work environment is often experienced as unsupportive, victim–survivors often do not feel able to talk about the abuse confidentially, and they fear consequences of reporting. Domestic abuse among doctors needs to be acknowledged by NHS workplaces to ensure suitable policies are in place. Dr Emily Donovan discusses the impact of domestic abuse on doctors experiencing partner violence. Listen to the podcast interview. If you have been affected by the issues raised here, visit Refuge or Women's Aid.

 

Comorbidity in chronic kidney disease

New research has found that almost all people with CKD have coexisting comorbidities, and that extreme comorbidity is over 40 times more common in adults with CKD compared with controls. As increases in medications with more long-term conditions may harm the kidneys, the authors call for guidance to assist clinicians in treating CKD that takes into account other illnesses. This study compared over 1 million people in Scotland, and found that almost all physical and mental health conditions are more common in people with CKD. Investigating this complexity will help identify new ways of treating people while reducing the risks of simultaneous treatments. Dr Clare MacRae discusses this in a podcast.

 

BJGP Top 10 research – articles most read and published in 2020

This collection of Top 10 research most read and published in 2020 brings together high-profile primary care research and clinical innovation. Congratulations to Top 10 authors and all BJGP contributors in 2020!

BJGP Top 10 research: 1. Gut feelings,  2. Chronic kidney disease, 3. Paramedics in primary care, 4. COVID-19 and older adults, 5. GP burnout, 6. Methotrexate safety, 7. Oseltamivir for coronavirus, 8. COVID-19 and ethnicity,  9. Cancer risk, 10. Sepsis referral with NEWS.

 

Targeting treatment for depression with Target-D​

New research examines a self-administered tool for depression. This RCT shows that 'Target-D', a person-centred clinical prediction tool and e-health platform matching management options to prognosis, results in greater improvement in depressive symptoms at 3 months than usual care. Target-D is administered via a set of questions on a tablet in the waiting room. Within minutes patients receive feedback and a suggestion of next steps for treatment. This approach could feasibly be implemented in routine practice to support more efficient and effective depression care without adding to GPs’ workload. Listen to the podcast interview with Prof. Jane Gunn.

 

Psychosis risk

GPs rarely encounter patients with psychosis, but more commonly see patients with psychotic symptoms that do not meet diagnostic criteria for psychotic disorder, such as hearing voices or having paranoid beliefs. One-third of these patients at risk will go on to develop psychosis within 3 years. Findings in this new study show that some GPs were not familiar with the concept of being at-risk of developing psychosis. Also, when patients met criteria for a more common mental health condition, such as depression or anxiety, GPs would not always screen for psychotic symptoms. In the podcast and video, Prof. Stanley Zammit and Daniela Strelchuk explain ways that GPs can screen for psychotic symptoms.

 

Media depictions of remote consulting throughout COVID-19

This new study by Oxford academics, led by Professor Trisha Greenhalgh, looked at newspaper coverage of the shift to remote consultations. It found that media depictions of remote GP consultations in the early months of the pandemic linked GPs with progress, efficiency, and safety; whereas media reports in more recent months have emphasised missed diagnoses, challenges to the therapeutic relationship, and digital inequalities. Perhaps rightly, the press have questioned why a policy originally introduced for infection control was then made permanent. Listen to the podcast interview with Dr Gilly Mroz and Professor Trisha Greenhalgh.

 

Reducing missed appointments

Missed appointments, or DNAs ('did not attends'), come at a great cost to general practice. While most view DNAs as a patient problem, this study, supported by the Health Foundation, highlights the appointment system itself as an integral cause of DNAs. This study shows the impact of quality improvement coaching, including sharing appointment system data, among practices. The findings illustrate how structural change to the appointment system can produce sustained reductions in DNA rates. Listen to the full podcast interview with Dr Tom Margham.

 

Association of non-malignant diseases with thrombocytosis

Previous research shows 11% of people with high platelet count in primary care are diagnosed with cancer in the following year. But what about diagnosing the 89%? A new study from the same team at University of Exeter flags up likely conditions. They found that inflammatory bowel disease, iron-deficiency anaemia, rheumatoid arthritis, COPD, and giant cell arteritis were more likely in patients with thrombocytosis than in those with a normal platelet count.

 

Recognising end of life in older people

Identification of end of life can be challenging for clinicians, particularly in older people living with frailty. In this study, fewer than half of people aged ≥75 years who died had a code in their electronic health record (EHR) to suggest that their death was anticipated by their GP. End-of-life codes in EHRs were entered near to death (median 4 months prior). In the minority of older decedents (aged ≥75 years) for whom end of life was recognised, only a small proportion were on the palliative care register or had their preferences for place of care or death recorded.

 

Mortality in the first COVID-19 pandemic peak

The COVID-19 pandemic has passed its first peak in many countries in Europe. A study from the University of Oxford examined the characteristics associated with excess deaths in the first COVID-19 pandemic peak. Findings were that male sex, population density, black ethnicity, and people with long-term conditions, including learning disability, had higher odds of mortality. Planning for subsequent peaks should take account of these findings. Listen to the podcast interview with Professor Simon de Lusignan.

 

Pregnancy abnormalities from ACE inhibitors and ARBs 

The adverse effects of ACE inhibitors and ARBs for pregnant women and their babies are known, but the recording of pre-pregnancy advice when prescribing these drugs is suboptimal, according to a new study from Queen Mary University of London. The study was conducted across 140 general practices in East London in women aged 15-45 years who were issued a prescription for an ACE inhibitor or ARB. Of over 300,000 women, 2651 were prescribed an ACE inhibitor or an ARB; and of these, 81.4% had no record of contraception prescription. Dr Elizabeth Lovegrove discusses the findings and their clinical relevance in a podcast interview.

 

COVID-19: twice the risk for ethnic minorities

Research by Hull et al. shows patients with south Asian and black ethnicity are at increased risk of suspected COVID-19, even when we take into account multimorbidity, obesity and social deprivation. This study of GP records also shows that GPs were adept at distinguishing symptoms of COVID-19 from common respiratory infections and saw large numbers of suspected cases. Daily counts of suspected cases recorded by GPs can act as an early warning system to detect new outbreaks of disease in the future. Watch the interview with Dr Sally Hull, who emphasises the importance of GPs recording and managing cases in their community.

 

Legacy of grief and COVID-19

Iona Heath, Former President of the RCGP, writes of the many unexpected kinds of grief from COVID-19. She states: ‘It will be very important to resist the temptation to pathologise, label, or precipitately refer on the sequelae of grief’. She emphasises we must acknowledge that some communities, particularly those subject to the structural violence of poverty and racism, have been significantly more exposed to loss of parents, life partners, children, and dear friends. She describes the power of relationship-building as an investment that has the potential to make future care easier for both patient and GP.

 

GPs' gut feelings in cancer diagnosis

A systematic review suggests GPs' gut feelings may have a role in cancer diagnosis. The studies, which used varied conceptualisations of 'gut feelings', showed associations with patients initially being unwell rather than with a suspicion of cancer. Pooled odds of a cancer diagnosis were four times higher when gut feelings were recorded, and became more predictive of cancer as clinical experience and familiarity with the patient increased. This may encourage GPs to acknowledge the diagnostic value of gut feelings and have more confidence in including them in their clinical assessment. Claire Friedemann Smith explains the findings in a video interview.

 

Racism and health​​

Dr Carter Singh is a full time GP partner at Willowbrook Medical Practice, Nottinghamshire. An 'expert-by-lived-experience' in racial inequality, it is this passion that motivates him to challenge discrimination, inequality, and marginalisation in the NHS. The August issue of the BJGP publishes Dr Singh’s letter on Asking questions along with an Editorial on Racism and Health by Paramjit Gill and Virinder Kalra, and an Editor’s briefing on Prejudice Plus Power = Racism. Life & Times looks at BAME excess deaths and chronic stress by Sarah Evans, Conversations about race and abuse in the NHS by Tariq Hussain, COVID-19 and equity by Gemma Ashwell et al, and indigenous health in the COVID-19 torch by Tim Senior. View the full contents of the August BJGP.

 

Unsafe prescribing of methotrexate

GPs in England continue to breach national guidelines on tablet strength designed to avoid accidental methotrexate overdose, according to research on trends in prescribing of methotrexate. High doses of methotrexate increase the risk of toxicity and 21 deaths have been attributed to methotrexate from 1993 to 2017. Doctors are advised to avoid 10mg tablets and prescribe only 2.5mg tablets. Here, Brian MacKenna, Pharmacist Researcher – University of Oxford, from the Evidence-based DataLab discusses the findings. Also watch videos on Practice and OpenPrescribing at BJGP Life.

 

Avoid the term ‘morning sickness’

According to new research, ‘morning sickness’ is a misnomer. It can happen at any time in a 24-hour period. In a video interview, author Professor Roger Gadsby explains why GPs should drop the unhelpful name ‘morning sickness’. He states that many pregnant women feel that it trivialises the problem. In an accompanying video interview Caitlin Dean, researcher, nurse specialist, and mother, states: 'Telling her she's got a bit of morning sickness is the most invalidating and upsetting thing you can do’. She asks that GPs talk about it in terms of ‘nausea and vomiting’. Article and videos are all available via ArticlePLUS. 

 

Hospitalisation and homelessness

Homeless people registered at a specialist surgery who had a combination of chronic physical illness, mental illness, plus alcohol and/or drug dependence – known as ‘trimorbidity’ – were four times more likely to have an unplanned hospital admission. The study, conducted in a specialist homeless practice in Brighton, showed that the three significant risk factors were enduring mental health problems and/or personality disorder, gastrointestinal disease and alcohol dependence. Catherine Himsworth discusses the findings in this short video.

 

Paramedics in primary care

The role of paramedics is expanding beyond the ambulance service into general practice. Georgette Eaton, herself a paramedic, and colleagues from Nuffield Department of Primary Care Health Sciences, University of Oxford, explored the role of paramedics in primary care.

 

Professor Martin Marshall at the BJGP Research Conference

BJGP Research Conference Plenary 1: The importance of research in taking the NHS into the next decade. Professor Martin Marshall, 12 March 2020, RCGP London. https://bjgp.org/conference | #BJGPRC

 

Dr Richard Vautrey at the BJGP Research Conference

BJGP Research Conference Plenary 2: The NHS and the current political climate. Dr Richard Vautrey, 12 March 2020, RCGP London. https://bjgp.org/conference | #BJGPRC 

 

Early GP referrals lead to longer surviving cancer patients​

A study analysed data of 1.4 million patients with cancer in England, and found that cancer patients from the highest referring GP practices had a lower mortality rate. The research highlights increases in primary care referrals and access to diagnostic tests which allows more cancers to be diagnosed. This has also led to the number of people diagnosed with cancer following an A&E presentation to drop from 1 in 4 to fewer than 1 in 5. 

 

BJGP Top 10 research

Countdown of top 10 research articles most read and published in 2019 – 10. End-of-life admissions, 9. Online triage, 8. Video consultations, 7. UK newspaper coverage of GPs, 6. Brain tumour diagnosis, 5. Inflammatory marker testing: sensitivity, 4. Hospital admissions of frail older people, 3. Multiple inflammatory marker testing, 2. Medication reviews, 1. Asylum seeker health. 

 

BJGP's impact, readership, and peer review

Find out in 90 seconds why authors publish with us. The BJGP publishes high-quality research and has the highest impact factor of all primary care journals worldwide, reaching 4.43 for 2018; additional journal metrics are the 5-year impact factor 4.187, Immediacy Index 1.380, Eigenfactor 0.00937, and Article Influence Score 1.370. View download statistics and top Altmetric scores, plus time from submission to first and final decisions.

 

BJGP's clinical research impact

The BJGP publishes high-quality research with clinical impact. This video shows the impact of research on: 1. Detecting multiple myeloma, 2. Avoiding unnecessary thyroid tests, 3. Recognising testicular cancer, 4. Detecting atrial fibrillation, 5. Cancer safety netting, 6. Extending prescription length, 7. Investigating weight loss, 8. Responding to maternal non-attendance, 9. Shortening antibiotic treatment for sore throat, 10. Prescribing exercise for postnatal depression, 11. C-reactive protein and acute cough.