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<item rdf:about="http://bjgp.org/content/early/2022/12/22/BJGP.2022.0066.short?rss=1">
<title><![CDATA[The influence of health system change on treatment burden: a systematic review]]></title>
<link>http://bjgp.org/content/early/2022/12/22/BJGP.2022.0066.short?rss=1</link>
<description><![CDATA[Background: Treatment burden is a patient-centred concept describing the effort required of people to look after their health and the impact this has on their functioning and wellbeing. High treatment burden is more likely for people with multiple long-term conditions (LTCs). Validated treatment burden measures exist but have not been widely used in practice or as research outcomes. Aim: To establish whether changes in organisation and delivery of health systems and services improves aspects contributing to treatment burden for people with multiple LTCs. Design and setting: Systematic review of randomised controlled trials (RCTs) investigating the impact of systems-level interventions on at least one outcome relevant to previously-defined treatment burden domains among adults with two or more LTCs. Method: Electronic databases EMBASE, Medline (OVID) and Web of Science were searched from January 2010 to July 2021 for terms related to multimorbidity, system-level change and treatment burden. Treatment burden domains were derived from validated measures and qualitative literature. Synthesis without Meta-Analysis (SWiM) methodology was used to synthesise results and study quality assessed using the Cochrane Risk of Bias Tool. Results: Searches identified 1881 articles, with 18 meeting the inclusion criteria. Outcomes were grouped into seven domains. Studies exhibited substantial heterogeneity, limiting synthesis of results. Some concern over bias gave low confidence in results. Conclusion: There was some evidence for effect of systems-level interventions on some domains. Adoption of a standardised outcome set incorporating validated treatment burden measures and development of standard definitions for care processes in future research would aid study comparability.]]></description>
<dc:creator><![CDATA[Kate Siena Matthews, Susannah Christina Rennoldson, Simon D Fraser]]></dc:creator>
<dc:date>2022-12-23T00:24:38-08:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2022.0066</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2022.0066</dc:identifier>
<dc:title><![CDATA[The influence of health system change on treatment burden: a systematic review]]></dc:title>
<prism:publicationDate>2022-07-20</prism:publicationDate>
<prism:section>Systematic Review</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2022/12/22/BJGP.2022.0160.short?rss=1">
<title><![CDATA[Diagnosing hypertension in primary care: the importance of night-time blood pressure assessment]]></title>
<link>http://bjgp.org/content/early/2022/12/22/BJGP.2022.0160.short?rss=1</link>
<description><![CDATA[Background: Ambulatory blood pressure monitoring (ABPM) has become less frequent in primary care since the COVID-19 pandemic, with home blood pressure monitoring (HBPM) often the preferred alternative; however, HBPM cannot measure night-time blood pressure (BP) and patients whose night-time BP does not dip or rises (reverse-dipping) have poorer cardiovascular outcomes. Aim: To investigate the importance of measuring night-time BP when assessing individuals for hypertension. Design and Setting: Retrospective cohort study of two patient populations; the first being hospital patients admitted to four UK acute hospitals and the second being participants of the BP-Eth study recruited from 28 UK GP practices. Method: Using blood pressure data collected for the two cohorts, we studied three systolic blood pressure (SBP) phenotypes (dipper, non-dipper and reverse-dipper). Results: Among the hospital cohort (n=21,739) 48.9% patients were ‘reverse-dippers’, with an average day-night SBP difference of -8.0 mmHg. Among the community cohort (n=585) 10.8% patients were ‘reverse-dippers’ with an average day-night SBP difference of -8.5 mmHg. Non-dipper and reverse-dipper phenotypes both have lower day-time SBP and higher night-time SBP than the dipper phenotype. Average day-time SBP was lowest in the reverse-dipping phenotype (6.5 mmHg and 6.8 mmHg lower than for the dipper phenotype in the hospital and community cohorts, respectively), thus placing them at risk of undiagnosed, or masked hypertension. Conclusion: Not measuring night-time BP puts all groups other than dippers at risk of failure to identify hypertension. We recommend that GPs should offer ABPM to all patients aged ≥60 as a minimum, when assessing for hypertension.]]></description>
<dc:creator><![CDATA[Laura Catherine Armitage, Shaun Davidson, Adam Mahdi, Mirae Harford, Richard McManus, Andrew Farmer, Peter Watkinson, Lionel Tarassenko]]></dc:creator>
<dc:date>2022-12-23T00:24:38-08:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2022.0160</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2022.0160</dc:identifier>
<dc:title><![CDATA[Diagnosing hypertension in primary care: the importance of night-time blood pressure assessment]]></dc:title>
<prism:publicationDate>2022-08-30</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2022/12/22/BJGP.2022.0111.short?rss=1">
<title><![CDATA[Incidence of postural hypotension recorded in UK general practice: an electronic health records study]]></title>
<link>http://bjgp.org/content/early/2022/12/22/BJGP.2022.0111.short?rss=1</link>
<description><![CDATA[Background: Postural hypotension is a common condition associated with adverse outcomes in older adults. General practice plays an important role in identification. Aim: To examine i) the incidence of postural hypotension over the last decade in general practice and ii) how trends vary by age, sex, year, social deprivation. Design: Retrospective cohort study using electronic health records from IQVIA Medical Research Database (IMRD) between 2000 and 2018. Method: Patients from IMRD were included if they were aged at least 50 years. Incident postural hypotension was identified as a new (first) recording of a postural hypotension code. Recording of incident postural hypotension was estimated per 10,000 PYAR according to age, sex, year and social deprivation. Relative risk ratios were estimated by multivariable Poisson regression. A significant age/sex interaction was identified. Results: Of 2,911,260 patients, 24,973 had an electronic record indicating a new diagnosis of postural hypotension between 2008 and 2019. This was equivalent to 17.9 cases per 10,000 PYAR in men (95% CI 17.6-18.2) and 16.2 cases per 10,000 PYAR in women (95% CI 15.9-16.5). The rate of recorded postural hypotension increased with age, social deprivation and reduced between 2008 and 2018. The rate was higher in men compared with women, particularly in older age groups (>80 years). Conclusion: This is the first study to quantify incident recorded postural hypotension in general practice. The rate is lower than expected compared with studies in screened older populations. Future research should investigate benefits of routine screening of postural BP using standardised measures.]]></description>
<dc:creator><![CDATA[Cini Bhanu, Irene Petersen, Mine Orlu, Daniel Davis, Kate Walters]]></dc:creator>
<dc:date>2022-12-23T00:24:38-08:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2022.0111</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2022.0111</dc:identifier>
<dc:title><![CDATA[Incidence of postural hypotension recorded in UK general practice: an electronic health records study]]></dc:title>
<prism:publicationDate>2022-08-17</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2022/12/22/BJGP.2022.0088.short?rss=1">
<title><![CDATA[Should cancer history be a predictor in cardiovascular risk scores? Cohort study]]></title>
<link>http://bjgp.org/content/early/2022/12/22/BJGP.2022.0088.short?rss=1</link>
<description><![CDATA[Background: Cardiovascular risks are raised in cancer survivors but cancer history is not included in cardiovascular risk scores, which inform preventative decisions. Aim: We assessed whether cancer diagnosis should be included in cardiovascular risk scores. Design and Setting: Cohort study using data from English general practices linked to hospital, cancer registration and death registration data from 1990 to 2015. Methods: We identified adults alive one year after a first cancer diagnosis, and age, sex, general practice and calendar-time matched cancer-free individuals. We excluded individuals with less than two years follow-up before index, recent statin prescriptions, or pre-existing coronary heart or cerebrovascular disease. We replicated Cox proportional hazard models used to develop QRISK3 scores and added cancer history variables. We assessed whether adjusted hazard ratios for these variables met thresholds for inclusion in QRISK3 (>10% relative difference with p-value<0.01). Results: We followed 81,420 cancer survivors and 413,547 cancer-free individuals for a median (IQR) 5.2 years (IQR 2.8-9.1) and 6.3 years (IQR 3.5-10.2) years, respectively. Including a one-year cancer survivorship variable in a QRISK3-based model met the threshold for inclusion for males (adjusted Hazard Ratio 1.16, 95% CI 1.11-1.20, p-value<0.01) but not females (1.07, 1.01-1.14, 0.02). When including cancer type, the threshold was met for both sexes with history of haematological cancer (males 1.27, 1.16-1.40, 0.01; females 1.59, 1.32-1.91, 0.01) and for males but not females with history of solid cancers (males 1.13, 1.08-1.18, <0.01; females 1.04, 0.98-1.10, 0.19). Conclusions: Developers should consider including cancer history variables in future cardiovascular risk models.]]></description>
<dc:creator><![CDATA[Helen Strongman, Emily Herrett, Rod Jackson, Michael Sweeting, Alexander R Lyon, Susannah Stanway, Claire Lawson, Umesh Kadam, Liam Smeeth, Krishnan Bhaskaran]]></dc:creator>
<dc:date>2022-12-23T00:24:38-08:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2022.0088</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2022.0088</dc:identifier>
<dc:title><![CDATA[Should cancer history be a predictor in cardiovascular risk scores? Cohort study]]></dc:title>
<prism:publicationDate>2022-10-07</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2022/12/22/BJGP.2022.0118.short?rss=1">
<title><![CDATA[Any increment in physical activity reduces mortality of primary care inactive patients]]></title>
<link>http://bjgp.org/content/early/2022/12/22/BJGP.2022.0118.short?rss=1</link>
<description><![CDATA[Background: It is unclear how returning to physical activity (PA) after long periods of inactivity gives expected health benefits. Aim: To determine whether the inactive primary care population reduce their mortality by increasing PA, even in low doses. Design and setting: Prospective cohort of 3,357 inactive patients attending 11 Spanish public primary healthcare centers. Method: Change in PA was repeatedly measured during their participation in the ‘Experimental Program for Physical Activity Promotion’ clinical trial in 2003-2006, using the ‘7-day PA Recall’. Mortality until December 31, 2018, (312 deaths) has been recorded from national statistics and survival time from the end of the clinical trial analyzed using proportional hazard models. Results: After 46,191 person-years follow-up, compared with individuals that remained completely inactive, the mortality of those who achieved minimal recommendations of 150-300 minutes/week (M/W) of moderate or 75-150 M/W of vigorous intensity, was reduced by 45% (adjusted Hazard Ratio –aHR-= 0.55; 95% confidence interval -95%CI: 0.41 to 0.74); those who did not meet these recommendations but increased PA in low doses, i.e. 50 M/W of moderate PA, showed a 31% reduced mortality (aHR=0.69; 98%CI: 0.51 to 0.93); and those who surpassed the recommendation saw a 49% reduction in mortality (aHR= 0.51; 95%CI: 0.32 to 0.81). The inverse association between increased PA and mortality follows a continuous curvilinear dose-response relationship. Conclusion: Inactive primary care patients reduce mortality by increasing PA even in doses below the recommended. Greater reduction is achieved through meeting PA recommendations or adopting levels of PA higher than recommended.]]></description>
<dc:creator><![CDATA[Gonzalo Grandes, Arturo Garcia-Alvarez, Maider Ansorena, Ricardo Ortega Sanchez-Pinilla, Jesus Torcal, Maria Soledad Arietaleanizbeaskoa, Alvaro Sanchez]]></dc:creator>
<dc:date>2022-12-23T00:24:38-08:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2022.0118</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2022.0118</dc:identifier>
<dc:title><![CDATA[Any increment in physical activity reduces mortality of primary care inactive patients]]></dc:title>
<prism:publicationDate>2022-07-22</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2022/12/22/BJGP.2021.0720.short?rss=1">
<title><![CDATA[Unintended consequences of patient online access to health records: a qualitative study in UK primary care]]></title>
<link>http://bjgp.org/content/early/2022/12/22/BJGP.2021.0720.short?rss=1</link>
<description><![CDATA[Background: Health systems around the world are seeking to harness digital tools to promote patient autonomy and increase the efficiency of care. One example of this policy in England is online patient access to medical records in primary care (online access). Aim: To identify and understand the unintended consequences of online access. Design and Setting: Qualitative interview study in 10 general practices in South West and North West England. Method: Semi-structured individual interviews with 13 patients and 16 general practice staff with experience of online access. Results: Online access generated unintended consequences that negatively impacted patients’ understanding of their health care, for example patients discovering surprising information or information that was difficult to interpret. Online access impacted GPs’ documentation practices, such as when GPs pre-emptively attempted to minimise potential misunderstandings to aid patient understanding of their health care, in other cases, negatively impacting the quality of the records and patient safety when GPs avoided documenting their speculations or concerns. Contrary to assumptions that practice workload would be reduced, online access introduced extra work, such as managing and monitoring access and taking measures to prevent possible harm to patients. Conclusion: The unintended consequences described by staff and patients show that to achieve the intended consequences set out in NHS policy additional work is necessary to prepare records for sharing and prepare patients about what to expect. It is crucial that practices are adequately supported and resourced to manage the unintended consequences of online access now that it is the default position.]]></description>
<dc:creator><![CDATA[Andrew Turner, Rebecca Morris, Lorraine McDonagh, Fiona Hamilton, Sarah Blake, Michelle Farr, Fiona Stevenson, Jonathan Banks, Helen Atherton, Dylan Rakhra, Gemma Lasseter, Gene Feder, Sue Ziebland, Emma Hyde, John Powell, Jeremy Horwood]]></dc:creator>
<dc:date>2022-12-23T00:24:38-08:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2021.0720</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2021.0720</dc:identifier>
<dc:title><![CDATA[Unintended consequences of patient online access to health records: a qualitative study in UK primary care]]></dc:title>
<prism:publicationDate>2022-09-05</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2022/12/22/BJGP.2021.0726.short?rss=1">
<title><![CDATA[Performance of the SCORE and Globorisk cardiovascular risk prediction models among patients seen in Dutch general practice: a prospective cohort study]]></title>
<link>http://bjgp.org/content/early/2022/12/22/BJGP.2021.0726.short?rss=1</link>
<description><![CDATA[Background: General practitioners frequently use 10-year-risk estimations of cardiovascular disease (CVD) to identify high-risk patients. Aim: To assess the performance of four models for predicting the 10-year-risk of CVD in Dutch general practice. Design and setting: Prospective cohort study. We used routine data (2009-2019) from 46 Dutch general practices linked to cause-of-death statistics. Methods: The outcome measures were fatal-CVD for SCORE and first diagnosis of fatal- or non-fatal-CVD for SCORE fatal- and non-fatal (SCORE-FNF), Globorisk-laboratory, and Globorisk-office. Model performance was assessed by examining discrimination and calibration. Results: The final number of patients for risk prediction was 1,981 for SCORE and SCORE-FNF, 3,588 for Globorisk-laboratory, and 4,399 for Globorisk-office. The observed percentage of events was 18.6% for SCORE-FNF, 6.9% for Globorisk-laboratory, 7.9% for Globorisk-office, and 0,3% for SCORE. The models showed poor discrimination and calibration. The performance of SCORE could not be examined due to the limited number of fatal-CVD events. Conclusion: Wide eligibility criteria and a broad outcome measure contribute to the model applicability in daily practice. The restriction to fatal-CVD outcomes of SCORE renders it less usable in routine Dutch general practice. The models seriously underestimate the 10-year-risk of fatal- plus non-fatal-CVD in Dutch general practice. The poor model performance is possibly due to differences between patients that are eligible for risk prediction and the population that was used for model development. In addition, selection of higher risk patients for CVD risk assessment by GPs may also contribute to the poor model performance.]]></description>
<dc:creator><![CDATA[Merle CA Schoofs, Reinier Akkermans, Wim de Grauw, Bianca Schalk, Ineke van Dis, Judith Tjin-A-Ton, Erik Bischoff, Marion Biermans]]></dc:creator>
<dc:date>2022-12-23T00:24:38-08:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2021.0726</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2021.0726</dc:identifier>
<dc:title><![CDATA[Performance of the SCORE and Globorisk cardiovascular risk prediction models among patients seen in Dutch general practice: a prospective cohort study]]></dc:title>
<prism:publicationDate>2022-10-18</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2022/10/21/BJGP.2022.0260.short?rss=1">
<title><![CDATA[Medical treatment for heavy menstrual bleeding in primary care: ten-year data from the ECLIPSE trial]]></title>
<link>http://bjgp.org/content/early/2022/10/21/BJGP.2022.0260.short?rss=1</link>
<description><![CDATA[BACKGROUND: Heavy menstrual bleeding (HMB) is a common problem that can significantly affect women’s lives. There is a lack of evidence on long-term outcomes after seeking treatment. AIM: To assess continuation rates of medical treatments, and rates of surgery, in women 10 years after initial management for HMB in primary care. DESIGN: Prospective observational cohort study. METHODS: Women with HMB who participated in the ECLIPSE primary care trial (ISRCTN86566246) completed questionnaires 10 years after randomisation to levonorgestrel-releasing intra-uterine system (LNG-IUS) or to other usual medical treatments (oral tranexamic acid, mefenamic acid, combined oestrogen–progestogen; or progesterone alone). Outcomes were rates of surgery, medical treatments and quality of life using SF-36 and EQ-5D. RESULTS: The responding cohort of 206 women was demographically and clinically representative of the original trial population. Mean age at baseline was 41.9 (SD 4.9) and 53.7 years (SD 5.1) at follow up. Over the 10-year follow-up, 60 of 206 (29%) women had surgery (hysterectomy 34 [17%], endometrial ablation 26 [13%]). Between 5 and 10 years, 89 women (43%) ceased all medical treatments and 88 (43%) used LNG-IUS alone or in combination with other treatments. Fifty-six women (28%) were using LNG-IUS at 10 years. There were improvements over time in quality of life scores, with no evidence of differences in these or other outcomes between the two groups. CONCLUSIONS: Medical treatments for women with HMB can be successfully initiated in primary care, with low rates of surgery and improvement in quality of life observed a decade later.]]></description>
<dc:creator><![CDATA[Joe Kai, Brittany Dutton, Yana Vinogradova, Nicholas Hilken, Janesh Gupta, Jane Daniels]]></dc:creator>
<dc:date>2022-10-31T07:45:07-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2022.0260</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2022.0260</dc:identifier>
<dc:title><![CDATA[Medical treatment for heavy menstrual bleeding in primary care: ten-year data from the ECLIPSE trial]]></dc:title>
<prism:publicationDate>2022-10-31</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2024/09/10/BJGP.2024.0179.short?rss=1">
<title><![CDATA[A Thematic Synthesis of the Experiences of Social Prescribing Among Patients in the UK]]></title>
<link>http://bjgp.org/content/early/2024/09/10/BJGP.2024.0179.short?rss=1</link>
<description><![CDATA[Background: Social prescribing connects patients to resources or activities to meet their non-medical needs. In the UK, it is often implemented in primary care. In the social prescribing pathway, patients are directed to link workers to identify suitable solutions for their needs such as art workshops or welfare benefit guidance. Social prescribing marks a notable transition from traditional medical treatments to more comprehensive strategies focusing on holistic health and wellbeing strategies. Insights from patient experiences can improve the development of social prescribing to better meet their needs. This understanding can aid in improving the delivery and outcomes of social prescribing. Aim: To synthesise qualitative research on the experiences of social prescribing among patients in the UK. Design and Setting: A qualitative systematic review – using thematic synthesis for peer-reviewed papers focused on experiences of social prescribing users in the UK. Method: An exhaustive search was performed in six databases: ASSIA, CINAHL, EMBASE, MEDLINE, PSYCINFO, and SOCIAL SCIENCE CITATION INDEX via Web of Science. The CASP tool for qualitative research was used for quality assessment and PRISMA 2020 Checklist was used to ensure the report transparency. Result: Titles and abstracts of 1,269 papers were screened. In total, 85 papers were full text-screened, and 19 studies were included in the review. Five analytical themes were developed from these papers: (a) Searching for hope in times of adversity; (b) Variability in temporal responsiveness; (c) Feeling supported and empowered by the social prescribing pathway; (d) Sustained change from a positive response; (e) Misalignment producing no response. Conclusion: Patients might experience lasting advantages from social prescribing if it aligns with their needs and expectations. Results highlighted the importance of matching social prescribing referral with patients’ readiness to engage. Therefore, it is recommended that healthcare professionals evaluate patient suitability prior to beginning a social prescribing referral.]]></description>
<dc:creator><![CDATA[Nur Hidayati Handayani, Marta Wanat, Stephanie Tierney]]></dc:creator>
<dc:date>2024-09-12T02:50:22-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2024.0179</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2024.0179</dc:identifier>
<dc:title><![CDATA[A Thematic Synthesis of the Experiences of Social Prescribing Among Patients in the UK]]></dc:title>
<prism:publicationDate>2024-09-12</prism:publicationDate>
<prism:section>Systematic Review</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2024/09/19/BJGP.2024.0099.short?rss=1">
<title><![CDATA[Improving personal continuity in general practice: a focus group study]]></title>
<link>http://bjgp.org/content/early/2024/09/19/BJGP.2024.0099.short?rss=1</link>
<description><![CDATA[<b>Background</b> Personal continuity is an important dimension of continuity of care in general practice and is associated with many benefits including a higher quality of GP care and lower mortality rate. Over time, changes in society and healthcare have challenged the provision of personal continuity. Especially older patients experience more negative consequences from receiving discontinuous care. <b>Aim</b> To explore perspectives of general practitioners (GPs), older patients, practice nurses, and assistants on improving personal continuity in general practice, and to identify barriers and facilitators that affect this improvement process. <b>Design and setting</b> A Qualitative study using focus groups was conducted from May to August 2019. <b>Method</b> We organised four focus groups: two with GPs (n=17), one with patients (n=7), and one with practice assistants (n=4) and nurses (n=2). Focus groups were analysed using reflexive thematic analysis. <b>Results</b> Personal continuity was viewed as being provided by the entire general practice team and not just by the own GP. To improve personal continuity, it was suggested to invest in team communication and stability (e.g., by efficient use of the EHR) and retaining availability and accessibility of the own GP (e.g., by delegating tasks). Barriers and facilitators were perceived on individual (e.g., GPs’ involvement in tasks), organisation (e.g., staff shortages) and societal level (e.g., payment system). <b>Conclusion</b> As general practice moves towards a more team-based approach to ensure personal continuity, efforts to improve personal continuity should focus on supporting team-based provision of continuous care.]]></description>
<dc:creator><![CDATA[Lex Jozef Johannes Groot, Esther Janssen, Mar&#x0237;an Westerman, Henk Schers, Jako S. Burgers, Martin Smalbrugge, Annemarie A. Ui&#x0237;en, Henriette van der Horst, Otto R Maarsingh]]></dc:creator>
<dc:date>2024-09-20T06:55:47-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2024.0099</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2024.0099</dc:identifier>
<dc:title><![CDATA[Improving personal continuity in general practice: a focus group study]]></dc:title>
<prism:publicationDate>2024-09-20</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/05/27/BJGP.2025.0748.short?rss=1">
<title><![CDATA[Equity and impact of social prescribing in type 2 diabetes prevention: cross-sectional and cohort study using national primary care data]]></title>
<link>http://bjgp.org/content/early/2026/05/27/BJGP.2025.0748.short?rss=1</link>
<description><![CDATA[Background.Social prescribing(SP) has expanded rapidly in English primary care since 2019 to support the prevention and management of long-term conditions. However,evidence on its equity of access and effectiveness for type 2 diabetes(T2D) prevention is limited. Aim.To examine the reach,equity of access,and potential impact of SP on T2D prevention among adults at high risk. Design&Setting.Observational study using routinely collected data from the Royal College of General Practitioners Research and Surveillance Centre, including 1,790 general practices in England(January 2019–November 2023). Method.Cross-sectional analyses using multivariable logistic regression examined factors associated with SP referral amongst adults at high risk of T2D.Cohort analyses estimated the association between SP referral and incident T2D, adjusting for baseline covariates. We used calendar-period–stratified Cox models to capture programme roll-out and COVID-19 changes.Exploratory time-since-index analyses tested whether effects varied over time. Results.Among 2,326,400 adults at high-risk of T2D, 271,582(11.7%)developed T2D over a median 3.7 years.Referrals to SP increased 27-fold from 0.3% to 7.1% and were more common among women(aOR 1.42 [95%CI1.40–1.43]),individuals living in more deprived areas(aOR:1.89 [95%CI:1.86–1.93]), current smokers(1.71 [1.68–1.73]),people with obesity(1.19 [1.17–1.21]), depression/anxiety(2.52 [2.49–2.54]),and multimorbidity(1.45 [1.43–1.47]).By calendar year,SP was associated with increased risk in 2019(aHR 1.67 [1.20–2.32]) but became protective by 2023 (aHR 0.84 [0.79–0.89]).By follow-up,SP increased risk within 0–2 years post-referral(aHR 1.09 [1.04–1.15])but was protective after ≥3 years (aHR 0.88 [0.80–0.97]). Conclusion.SP reached those with greater health and social need. The protective association against T2D emerged as services matured post-COVID and with longer follow-up, potentially reflecting cumulative engagement, though activity data were unavailable.]]></description>
<dc:creator><![CDATA[Sara Calderon&ndash;Larranaga, Bernardo Meza&ndash;Torres, Simon de Lusignan, Rohini Mathur, Sarah Finer, Daniel Stow]]></dc:creator>
<dc:date>2026-06-01T08:40:31-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2025.0748</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2025.0748</dc:identifier>
<dc:title><![CDATA[Equity and impact of social prescribing in type 2 diabetes prevention: cross-sectional and cohort study using national primary care data]]></dc:title>
<prism:publicationDate>2026-06-01</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/05/27/BJGP.2026.0055.short?rss=1">
<title><![CDATA[Non-antibiotic interventions to prevent recurrent urinary tract infections in women: overview of systematic reviews of randomised controlled trials]]></title>
<link>http://bjgp.org/content/early/2026/05/27/BJGP.2026.0055.short?rss=1</link>
<description><![CDATA[Background Recurrent urinary tract infections (rUTI), i.e. 2 or more UTIs in last 6 months or 3 or more in last 12 months, are common, have substantial impact on quality of life and cause major antibiotic use. Design Overview of systematic reviews of randomised controlled trials (RCTs) of non-pharmaceutical and pharmaceutical (non-antibiotic) interventions for preventing rUTI in women. Methods We searched MEDLINE, EMBASE, CINAHL, Google Scholar and Cochrane from January 2014 to May 2025 for systematic reviews of RCTs assessing effectiveness of community-based non-antibiotic interventions for preventing UTI in women aged 16 or over with rUTI. We excluded studies in intensive care units, people with indwelling catheters or comparing different oral antibiotic regimens. There were no limitations regarding outcome measures or language. Findings 27 systematic reviews met inclusion criteria evaluating probiotics (9), D-mannose (7), vaginal oestrogen (7), cranberry (6), methenamine hippurate (3), herbal medicine (3), increased fluid intake (2), systemic oestrogen (4), acupuncture (2), vaccines (2). Eight examined combination strategies. Cranberry and methenamine hippurate use are supported by systematic reviews, as is vaginal oestrogen amongst postmenopausal women, although questions remain around dose, duration and treatment adherence. Reviews of probiotics, D-mannose, herbal medicine, acupuncture and vaccines concluded that stronger evidence is needed. Increased fluid intake benefits women with low intake, but further research is needed on optimal intake. There was little information on treatment adherence or acceptability for many interventions. Conclusions For effective interventions, questions remain about optimal use and for many stronger evidence is needed.]]></description>
<dc:creator><![CDATA[Miriam Santer, Sascha Miller, Susannah Fraser, Nick Francis, Mark Lown, Taeko Becque, Fiona Tenters, Luke Hanna, Ingrid Muller]]></dc:creator>
<dc:date>2026-06-01T08:40:31-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0055</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0055</dc:identifier>
<dc:title><![CDATA[Non-antibiotic interventions to prevent recurrent urinary tract infections in women: overview of systematic reviews of randomised controlled trials]]></dc:title>
<prism:publicationDate>2026-06-01</prism:publicationDate>
<prism:section>Systematic Review</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/05/27/BJGP.2025.0525.short?rss=1">
<title><![CDATA[Who are we listening to? A Systematic Scoping Review of Surveys Exploring Patient Satisfaction, Care Experience, And Access to Primary Care Services]]></title>
<link>http://bjgp.org/content/early/2026/05/27/BJGP.2025.0525.short?rss=1</link>
<description><![CDATA[Background: Globally, patient surveys are used to improve quality of primary care services. Survey items lacking an equity focus may limit the applicability of findings, leading to changes in services that are not tailored to the needs of underserved populations (e.g., socially disadvantaged populations and those with greater needs). Aim: To review the global literature to 1) identify validated surveys used to evaluate quality in primary care and 2) assess if these surveys were designed for underserved populations (using the Candidacy Framework: a tool designed to examine equity in primary care). Design and setting: The Arksey and O’Malley framework for systematic scoping reviews guided the study. All findings were reported according to the PRISMA-Equity 2012 guidelines. Method: Five datasets Medline, CINHAL, PsycINFO, Embase, and Web of Science and reference lists of relevant published literature were systematically searched to identify studies that reported validated quantitative survey to assess access of primary care services, and/or care experience and patient satisfaction. Results: From 5,404 records, 69 articles were included, and 46 unique surveys identified. Twenty-one articles (30%) reported a survey tailored to underserved populations or contexts. Most survey items mapped to permeability of services, with few focused on adjudication by healthcare professionals or digital care experience. Tools assessing dimensions of quality in primary care often overlook the potentially nuanced experience of underserved populations (e.g., ableism, racism). Conclusions: Our findings revealed a significant gap in efforts to understand the factors that privilege some populations and disadvantage others, potentially widening the primary care divide.]]></description>
<dc:creator><![CDATA[Mar Estupinan Fernandez de Mesa, Esra Hassan, Arsene Hobabagabo, Claire Friedemann Smith, Christian von Wagner, Anna Cox, Robert S. Kerrison, Katriina Whitaker]]></dc:creator>
<dc:date>2026-06-01T08:40:31-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2025.0525</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2025.0525</dc:identifier>
<dc:title><![CDATA[Who are we listening to? A Systematic Scoping Review of Surveys Exploring Patient Satisfaction, Care Experience, And Access to Primary Care Services]]></dc:title>
<prism:publicationDate>2026-06-01</prism:publicationDate>
<prism:section>Systematic Review</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/06/30/BJGP.2025.0688.short?rss=1">
<title><![CDATA['One of the hardest things in medicine is challenging an initial diagnosis&#x2019;: interim diagnoses and missed opportunities for diagnosing cancer in primary care, a qualitative study]]></title>
<link>http://bjgp.org/content/early/2026/06/30/BJGP.2025.0688.short?rss=1</link>
<description><![CDATA[BackgroundPatients later diagnosed with cancer may first be diagnosed with another ‘interim’ diagnosis based on their clinical presentation. In some cases, interim diagnoses may be missed opportunities to diagnose cancer.AimTo explore healthcare professionals’ perspectives of when interim non-cancer diagnoses occur how they have an impact on a cancer diagnosis and what could trigger their prompt review.Design and settingInterviews were conducted between March and November 2024 with 35 GPs, three other clinicians, and three practice administrators from 31 general practices in southern England, UK.MethodThe semi-structured interviews were undertaken via videocall and were analysed using framework analysis.ResultsParticipants reported that interim diagnoses occurred in cases of diagnostic uncertainty, especially when non-specific symptoms were attributed to common differential diagnoses. Remote consultations were thought to increase the likelihood of interim diagnosis by limiting information gathering. Interim diagnoses were suggested to delay cancer diagnoses, although this was not always seen as avoidable. Clinicians hoped to facilitate opportunities to make a cancer diagnosis by using safety-netting to encourage reattendance, and an informal rule of ‘three strikes and you’re in’. Colleagues providing a ‘fresh pair of eyes’, discussing diagnostic uncertainty in the clinical team, and using past cases as learning opportunities were suggested approaches to facilitate prompt review of interim diagnoses.ConclusionConsistent safety-netting is required to ensure timely review of non-cancer ‘interim’ diagnoses when there is a possible underlying cancer diagnosis. The range of interim diagnoses and their impact on cancer diagnosis requires further quantification to inform interventions to mitigate their effect.]]></description>
<dc:creator><![CDATA[Luke A Robles, Gary A Abel, Georgia B Black, Willie Hamilton, Angela King, Luke Mounce, Richard D Neal, Brian D Nicholson, Sarah Price, Mel Ramasawmy, Suzanne E Scott, Anne Spencer, Fiona M Walter, Bianca Wiering, Claire Friedemann Smith]]></dc:creator>
<dc:date>2026-06-30T04:29:33-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2025.0688</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2025.0688</dc:identifier>
<dc:title><![CDATA['One of the hardest things in medicine is challenging an initial diagnosis&#x2019;: interim diagnoses and missed opportunities for diagnosing cancer in primary care, a qualitative study]]></dc:title>
<prism:publicationDate>2026-04-16</prism:publicationDate>
<prism:section>Research</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/07/01/BJGP.2024.0253.short?rss=1">
<title><![CDATA[Enriching New-onset Diabetes for Pancreatic Cancer (ENDPAC): External validation using English sentinel network]]></title>
<link>http://bjgp.org/content/early/2026/07/01/BJGP.2024.0253.short?rss=1</link>
<description><![CDATA[Pancreatic cancer has very low survival due to late diagnosis. Symptoms are often non-specific, complicating early detection in primary care. The Enriching New-Onset Diabetes for Pancreatic Cancer (ENDPAC) algorithm uses weight change, glycaemic control, and age at diabetes onset to identify new-onset diabetes (NOD) patients at increased pancreatic cancer risk. It was developed in the USA and has not been validated in the UK. Aim To validate ENDPAC in a UK primary care population and assess its predictive utility. Design and setting Retrospective cohort study using ORCHID, a national primary care sentinel network. Method Adults aged ≥50 with NOD and requisite glycated haemoglobin (HbA1c) and weight data were included. ENDPAC scores were calculated. Model performance was evaluated via discrimination, calibration, sensitivity, specificity, PPV and NPV. The Youden index identified optimal cutoffs. Sensitivity analyses assessed measurement timing, repeat HbA1c testing and multiple values. Results Among 70,050 individuals, 185 (0.26%) developed pancreatic cancer. Cases were older with higher HbA1c and greater weight loss at diagnosis. ENDPAC achieved an area under the curve (AUC) of 0.733. An optimal cutoff of ≥3 classified 27.6% of individuals as high-risk, with 62.6% sensitivity, 72.3% specificity, 0.6% PPV and 99.9% NPV. Sensitivity analyses showed similar performance across measurement windows and handling of multiple values. ENDPAC shows moderate discrimination in UK primary care. Although it has a relatively low PPV (0.6%), integration into routine systems could provide scalable, low-cost automated risk stratification, identifying people with NOD at higher pancreatic cancer risk as part of a sequential diagnostic pathway]]></description>
<dc:creator><![CDATA[Claire A Price, Hugh Claridge, Simon de Lusignan, Natalia Khalaf, Freda Mold, Nadia A. S. Smith, Martyn Winn, Agnieszka Lemanska]]></dc:creator>
<dc:date>2026-07-02T08:56:11-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2024.0253</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2024.0253</dc:identifier>
<dc:title><![CDATA[Enriching New-onset Diabetes for Pancreatic Cancer (ENDPAC): External validation using English sentinel network]]></dc:title>
<prism:publicationDate>2026-07-02</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/07/01/BJGP.2025.0678.short?rss=1">
<title><![CDATA[Recording of Pharmacy First consultations in general practice records in England: an observational study of the service's first year using OpenSAFELY]]></title>
<link>http://bjgp.org/content/early/2026/07/01/BJGP.2025.0678.short?rss=1</link>
<description><![CDATA[Background: Pharmacy First, a national community pharmacy service, launched in January 2024 to improve access to primary care for patients with minor conditions facing backlogs caused by the COVID-19 pandemic. Pharmacies are required to share details about their consultations with general practices. Aim: To describe how and what clinical activity was recorded in general practice during the first year of the Pharmacy First service. Design and Setting: With the approval of NHS England, we conducted a retrospective cohort study between 31 January 2024 and 30 January 2025 using OpenSAFELY-TPP, a secure platform for analysing pseudonymised GP records from practices using TPP software. Method: We described patient demographics, Pharmacy First consultation trends, and the clinical conditions and medications coded with the consultations. Results: A total of 402,165 Pharmacy First consultations were recorded for 340,710 patients from a general population of 26,142,380 registered patients in OpenSAFELY-TPP. Acute pharyngitis (28.9%) and uncomplicated urinary tract infection (28%) were the most frequently recorded conditions. By January 2025, 36.3% of recorded Pharmacy First consultations had a clinical condition, medication, or both. Females, younger adults and those living in more deprived areas were observed more often in Pharmacy First records compared to the general population. Conclusion: Increasing recording of the Pharmacy First community pharmacy service was observed in general practice records during its first year, particularly among younger and more deprived populations. However, variation in structured recording of consultation details may limit evaluation.]]></description>
<dc:creator><![CDATA[Viveck J Kingsley, Milan Wiedemann, Christopher Wood, Helen J Curtis, Amelia Green, Louis Fisher, Colm D Andrews, David Evans, Amir Mehrkar, Sebastian CJ. Bacon, Ben Goldacre, Amelia C Taylor, Diane Ashiru-Oredope, Kimberley Sonnex, Thomas Allen, Hannah Higgins, Tracey Thornley, Nicholas Mays, Rebecca E Glover, Rachel Elliott, Anthony J. Avery, Brian MacKenna]]></dc:creator>
<dc:date>2026-07-02T08:56:11-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2025.0678</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2025.0678</dc:identifier>
<dc:title><![CDATA[Recording of Pharmacy First consultations in general practice records in England: an observational study of the service's first year using OpenSAFELY]]></dc:title>
<prism:publicationDate>2026-07-02</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/07/06/BJGP.2026.0067.short?rss=1">
<title><![CDATA[Evaluating Additional Roles in Primary Care: Expanding Capacity and Transforming Care Delivery]]></title>
<link>http://bjgp.org/content/early/2026/07/06/BJGP.2026.0067.short?rss=1</link>
<description><![CDATA[Background: The Additional Roles Reimbursement Scheme (ARRS), introduced by NHS England in 2019, aimed to expand the workforce, promote multidisciplinary team-based care, and improve patient outcomes. Aim: To examine changes in consultation rates and outcomes in relation to ARRS implementation, and compare outcomes across primary care roles. Design and Setting: Longitudinal cohort study using the Clinical Practice Research Datalink (CPRD) AURUM, analysing 12,170,079 consultations (2015-21) from 600,000 randomly sampled patients at 400 English practices. Methods: Joinpoint regression modelled trends in age- and sex-standardised consultation rates, further consultations within 1-14 days, prescribing, and referrals. Multilevel regression compared outcomes between diagnostic-capable roles and general practitioners (GPs). Results: Most consultations remained GP- or nurse-led, but rates with direct patient care (DPC)-ARRS-eligible roles increased, particularly for pharmacists, physiotherapists, and nursing associates. For paramedics and mental health practitioners, growth preceded formal ARRS inclusion, suggesting the scheme accelerated rather than initiated expansion. Most DPC-ARRS-eligible roles were consulted more frequently in less deprived areas, except physiotherapists. Compared to GPs, most DPC-ARRS-eligible roles delivered more consultations face-to-face (except pharmacists), had lower prescribing (except advanced nurse practitioners) and referral rates, and higher further consultation rates with a diagnostic-capable clinician within 1-14 days. However, all DPC-ARRS-eligible roles had lower odds of a further consultation specifically with a GP. Conclusion: ARRS has supported and accelerated the diversification of the primary care skill-mix. Patterns of consultation activity suggest an expansion of overall primary care capacity with some redistribution of workload across the multidisciplinary team, rather than a direct reduction in GP workload.]]></description>
<dc:creator><![CDATA[Jialan Hong, Christopher Penfold, Peter Jonathan Edwards, Mavin Nathan Kashyap, Hugh Mcleod, Chris Salisbury, Nicola Walsh, Ben Bennett, John Macleod, Maria T Redaniel]]></dc:creator>
<dc:date>2026-07-07T08:28:03-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0067</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0067</dc:identifier>
<dc:title><![CDATA[Evaluating Additional Roles in Primary Care: Expanding Capacity and Transforming Care Delivery]]></dc:title>
<prism:publicationDate>2026-07-07</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/07/30/BJGP.2025.0710.short?rss=1">
<title><![CDATA[Patient perspectives on the impact of an initial non-cancer diagnosis prior to a subsequent cancer diagnosis: a secondary qualitative analysis]]></title>
<link>http://bjgp.org/content/early/2026/07/30/BJGP.2025.0710.short?rss=1</link>
<description><![CDATA[Background Timely diagnosis of cancer can be challenging as most present with non-specific symptoms in primary care. A third of those diagnosed with cancer report receiving a non-cancer diagnosis, before being referred for cancer investigations (‘interim’ diagnosis), presenting a potential missed diagnostic opportunity. Aim This study explored patients’ experiences of receiving a non-cancer diagnosis prior to referral for investigation for suspected cancer. Design and Setting Secondary qualitative analysis of seven interview datasets collected in primary care in the UK since 2015. Method Patient journeys were summarised, charted and analysed using framework analysis. Patient Public Involvement and Engagement collaborators were involved throughout. Results 58 transcripts were included in which the patient presented to primary care with symptoms and received an interim non-cancer diagnosis. We identified eight common scenarios involving an initial non-cancer diagnosis followed by referral for suspected cancer. For example, individuals considered at low risk of cancer reported symptoms being linked to lifestyle factors, requiring multiple contacts over time before further investigation was considered. Patients queried interim diagnoses when they felt their symptoms and interpretations had been poorly understood, or they had been given inappropriate investigations or ineffective treatment. While patients recognised the difficulty of deciding when common symptoms required onward referral, they trusted clinicians who were responsive to their concerns, regardless of outcome. Conclusion Interim diagnoses arise as part of the normal diagnostic process in patients presenting with non-specific symptoms. Challenging these diagnoses in the face of new evidence could mitigate potential delays in diagnosis and improve patient outcomes.]]></description>
<dc:creator><![CDATA[Mel Ramasawmy, Gary A. Abel, Georgia Black, Claire Friedemann Smith, William Hamilton, Angela King, Richard Neal, Brian D Nicholson, Sarah Price, Luke Robles, Fiona M. Walter, Bianca Wiering, Suzanne Scott]]></dc:creator>
<dc:date>2026-07-31T10:58:23-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2025.0710</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2025.0710</dc:identifier>
<dc:title><![CDATA[Patient perspectives on the impact of an initial non-cancer diagnosis prior to a subsequent cancer diagnosis: a secondary qualitative analysis]]></dc:title>
<prism:publicationDate>2026-07-31</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/07/30/BJGP.2025.0685.short?rss=1">
<title><![CDATA[Experience and impacts of violence and abuse by patients towards general practice staff]]></title>
<link>http://bjgp.org/content/early/2026/07/30/BJGP.2025.0685.short?rss=1</link>
<description><![CDATA[Background: General practice (family medicine) experiences more violence and abuse by patients and the public than general hospital settings. Qualitative accounts on how violence and abuse are experienced and perceived remain limited in both breadth and depth. Aims: To explore 1. direct and indirect experiences of violence and abuse that general practice staff have encountered from patients and the public, and 2. its perceived impacts on staff well-being and their practice. Design and Setting: This qualitative study was the second part of a mixed methods project, following an online nationwide survey. Participants were invited to an interview at the end of the survey. Method: Data were collected via semi-structured interviews conducted between August and December 2023. Quantitative survey responses were extracted to describe the characteristics of participants, their experience of violence and abuse and feelings of safety and support at work. Interviews were transcribed and thematically analysed following the framework approach. Results: Twenty-three general practice staff members participated, including 17 women and six men. Fifteen participants were in non-clinical roles and eight were clinicians. Six themes were identified: violence and abuse through direct interactions, violence and abuse beyond direct interactions, increased risk, individual impacts, occupational impacts, and impacts on care and services. Conclusion: Violence and abuse by patients and the public includes a wide range of behaviours. It has profound, and in some instances longstanding, impacts on staff, including constantly feeling unsafe and affected personal or social life, but also on clinical services, including staff turnover, and reduced service capacity.]]></description>
<dc:creator><![CDATA[Shihning Chou, Edward Tyrrell, Emma Rowe, Julie Bryant]]></dc:creator>
<dc:date>2026-07-31T10:58:23-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2025.0685</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2025.0685</dc:identifier>
<dc:title><![CDATA[Experience and impacts of violence and abuse by patients towards general practice staff]]></dc:title>
<prism:publicationDate>2026-07-31</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/07/30/BJGP.2026.0105.short?rss=1">
<title><![CDATA[GP roles in emergency ambulance services in the United Kingdom: a qualitative realist study]]></title>
<link>http://bjgp.org/content/early/2026/07/30/BJGP.2026.0105.short?rss=1</link>
<description><![CDATA[Background Demand on emergency healthcare services is increasing. Utilising GPs in emergency ambulance services (EAS) may be effective in reducing avoidable conveyances to emergency departments and releasing emergency ambulances for higher-acuity cases. There is limited evidence on models of GP EAS roles in the UK. Aims To describe current provision of GP EAS roles and to develop a provisional explanatory programme theory. Design  those involving non-conveyance, alternatives to conveyance, or lower-acuity responses. GPs do this effectively due to their seniority, broad clinical knowledge and experience, approach to risk and uncertainty, ability to practice outside guidelines, consultation and communication skills, and system awareness. Conclusion GPs in EAS serve both individual patients and the system by individualising organisational approaches to risk and resource management.]]></description>
<dc:creator><![CDATA[Alex Burrell, Matthew Booker]]></dc:creator>
<dc:date>2026-07-31T10:58:23-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0105</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0105</dc:identifier>
<dc:title><![CDATA[GP roles in emergency ambulance services in the United Kingdom: a qualitative realist study]]></dc:title>
<prism:publicationDate>2026-07-31</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/08/06/BJGP.2026.0217.short?rss=1">
<title><![CDATA[Why Primary Care Clinicians use Advice and Guidance: A qualitative study]]></title>
<link>http://bjgp.org/content/early/2026/08/06/BJGP.2026.0217.short?rss=1</link>
<description><![CDATA[Background Where available, Advice and Guidance (A&G) can enable primary care clinicians to seek specialist input, supporting decision making and avoiding unnecessary referrals. The use of A&G has significantly expanded, accelerated by COVID19 and contractual changes. While A&G is intended to streamline elective care, concerns persist regarding workload shift, variable responsiveness, and system usability. Despite growing policy emphasis, little is known about why clinicians choose to use A&G. Aim Explore the current use of A&G within primary care, focusing on decision making processes which underpin PCCs’ (primary care clinicians’) decision to use A&G. Design and Setting Qualitative study set in English Primary Care Method Twenty semi structured video interviews were conducted with primary care clinicians purposively sampled for maximum variation. Data were analysed using reflexive thematic analysis within an interpretive description framework, with themes developed collaboratively and refined through discussion with researchers and PPIE contributors. Ethical approval was obtained (REC 333799). Results Four overarching themes encapsulate clinicians’ decisions to use A&G: clinical presentation (acuity and complexity), navigating healthcare pathways, previous experiences of A&G, and using A&G to validate clinical decision making. Barriers included delayed responses and uncertainty about inequitable workload distribution. These factors shape how effectively A&G could be integrated into routine practice. Conclusion Primary care clinicians use A&G to support patient care and aid decision-making, but its effectiveness depends on timely, clinically helpful responses. Ensuring responses remain appropriate to primary care remit and capacity will be essential if A&G becomes the main route into elective care.]]></description>
<dc:creator><![CDATA[Alice Faux-Nightingale, Rosie Harrison, Claire Burton, Ram Bajpai, Lorna Clarson, Tina Hadley-Barrows, John Haines, Toby Helliwell, Samantha Hider, Clare Jinks, Kelvin Jordan, Natalie Knight, Christian D. Mallen, Kayleigh J Mason, Victoria K Welsh]]></dc:creator>
<dc:date>2026-08-07T07:55:04-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0217</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0217</dc:identifier>
<dc:title><![CDATA[Why Primary Care Clinicians use Advice and Guidance: A qualitative study]]></dc:title>
<prism:publicationDate>2026-08-07</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/08/06/BJGP.2026.0076.short?rss=1">
<title><![CDATA[Talking about online activity and mental health with young people in primary care: A qualitative interview study]]></title>
<link>http://bjgp.org/content/early/2026/08/06/BJGP.2026.0076.short?rss=1</link>
<description><![CDATA[Background: Young people – aged 16-24 – are high users of digital technology. Online activity can be both beneficial for mental health and harmful. Appointments in general practice (GP) or primary care talking therapy provide opportunities to discuss online activity and its impact on mental health with young people. Such conversations could have preventive value by increasing awareness of problematic behaviours, identifying risk and suggest safer use strategies. However, little is known about whether such conversations are currently delivered in primary care. Aim: To explore practitioners views on discussing online activity and its role in the mental health of young people in primary care. Design and setting: Qualitative study with practitioners in GP and Talking Therapy Method: Semi-structured interviews with 24 practitioners, analysed using reflexive thematic analysis. Results: Practitioners recognise helpful and harmful aspects to online activity, but there is variation in whether practitioners currently ask about online activity and whether they consider conversations appropriate for primary care. Several factors may shape confidence and decision making: practitioners own understanding of the online world; unable to change the impact on mental health or signpost to services; limitations in time, confidence or topic awareness. Practitioners identified a need for guidance and training to inform conversations about online activity. Conclusion: There is variation in whether conversations about online activity with young people are happening in primary care. The development of best-practice resources is required to ensure conversations are acceptable to young people and effective at changing problematic online activity to improve mental health.]]></description>
<dc:creator><![CDATA[Charlotte Archer, Myles-Jay Linton, David Kessler, Nicola Wiles, Lucy Biddle]]></dc:creator>
<dc:date>2026-08-07T07:55:04-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0076</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0076</dc:identifier>
<dc:title><![CDATA[Talking about online activity and mental health with young people in primary care: A qualitative interview study]]></dc:title>
<prism:publicationDate>2026-08-07</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/08/11/BJGP.2026.0057.short?rss=1">
<title><![CDATA[Understanding chronic pelvic pain in women survivors of sexual violence: a qualitative study]]></title>
<link>http://bjgp.org/content/early/2026/08/11/BJGP.2026.0057.short?rss=1</link>
<description><![CDATA[Background: Chronic pelvic pain (CPP) affects an estimated 14.8% of UK women. Survivors of sexual violence are more likely to experience CPP, but the relationship is complex and underexplored. Shame and stigma from both experiences may interact and influence help-seeking. Aims: To broaden understanding of how women survivors of sexual violence make personal meaning of CPP, and to consider clinical implications of findings. Design  (2) Treating the whole woman, describing the need for integrated, biopsychosocial approaches; and (3) A woman’s place is in the resistance, highlighting women’s active efforts to reclaim their narratives and pursue care. Shame was compounded across experiences, and women expressed frustration with fragmented care and assumptions about the psychological origins of pain. Conclusions: These results give insights into the complex meanings women survivors of sexual violence hold about their CPP, and how healthcare systems could better support them to explore and respond to those meanings. The aim should be compassionate care that recognises the complex biopsychosocial impact of sexual violence and CPP, while keeping women in control of their own care.]]></description>
<dc:creator><![CDATA[Catherine Mccarter, Amanda C de C Williams]]></dc:creator>
<dc:date>2026-08-11T03:46:45-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0057</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0057</dc:identifier>
<dc:title><![CDATA[Understanding chronic pelvic pain in women survivors of sexual violence: a qualitative study]]></dc:title>
<prism:publicationDate>2026-08-11</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/08/11/BJGP.2026.0007.short?rss=1">
<title><![CDATA[Diagnostic and prognostic outcomes for men with prostate cancer detected through opportunistic, asymptomatic PSA testing or symptomatic presentation to primary care: The PC3 cohort study]]></title>
<link>http://bjgp.org/content/early/2026/08/11/BJGP.2026.0007.short?rss=1</link>
<description><![CDATA[Background Primary care is the main route to diagnosis for patients with prostate cancer, either following asymptomatic Prostate Specific Antigen (PSA) testing or investigating prostate-related symptoms. Whilst previous primary care studies suggest an association between symptoms and prostate cancer diagnosis, it remains unknown whether outcomes differ based on the presence or absence of symptoms. Aim To compare prostate cancer stage, grade, and mortality amongst symptomatic patients presenting to primary care with asymptomatic patients. Design and setting Retrospective cohort study using Clinical Practice Research Datalink (CPRD) Aurum. Included adult males aged 50 years and above with first presentation to primary care for coded lower urinary tract symptoms (LUTS), haematuria, or erectile dysfunction between 01/01/2011 and 31/12/2016 with up to two asymptomatic males matched by age, ethnicity, and GP practice. Method Main outcomes: Clinically significant prostate cancer (Gleason Grade Group ≥ 3); Early-stage prostate cancer; Cambridge Prognostic Group; prostate cancer mortality; all-cause mortality. Mixed effect logistic regression modelling was performed. Results 722,597 males were included (262,178 [36.3%] had coded symptoms). Mean age was 64.4 years (SD 9.76). 90.68% identified as White ethnicity. 12,297 new prostate cancer diagnoses within 24 months of index consultation (8,101 [65.88%] in symptomatic group). Clinically significant prostate cancer (Adjusted OR 1.14 95% CI 1.07, 1.23) was more likely in the symptomatic group. No difference was found in stage at diagnosis (aOR 1.02 95% CI 0.95,1.09). Conclusion Investigating symptomatic patients in primary care is more likely to detect clinically significant prostate cancer with no difference in stage at diagnosis.]]></description>
<dc:creator><![CDATA[Samuel Merriel, Peter Nickol, Gary A. Abel, William Hamilton]]></dc:creator>
<dc:date>2026-08-11T03:46:45-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0007</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0007</dc:identifier>
<dc:title><![CDATA[Diagnostic and prognostic outcomes for men with prostate cancer detected through opportunistic, asymptomatic PSA testing or symptomatic presentation to primary care: The PC3 cohort study]]></dc:title>
<prism:publicationDate>2026-08-11</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/08/23/BJGP.2025.0735.short?rss=1">
<title><![CDATA[Online triage and cancer diagnostic activity in general practice: a cross-sectional study]]></title>
<link>http://bjgp.org/content/early/2026/08/23/BJGP.2025.0735.short?rss=1</link>
<description><![CDATA[BackgroundPatient-facing online triage tools potentially offer GPs a way to recognise cancer-related symptoms and features to facilitate appropriate suspected cancer referrals. Little is known about their impact on cancer diagnostic process and outcomes.AimTo describe patterns of cancer outcome and process indicators associated with the use of online triage tools in primary care.Design and settingThis cross-sectional study examined the association between publicly reported practice-level data on 3053 English general practices. An online triage tool was used that linked to practice-level data and 31 233 594 triage forms completed using an online triage tool in 2022–2023.MethodA cross-sectional analysis (mixed-effects regression) was conducted to evaluate the association between the annual rate of eConsult forms received (weighted to practice registrations) and various cancer diagnosis process and outcome measures.ResultsIncreased use of online triage forms was associated with higher rates of urgent suspected cancer (USC) referrals and investigations; for example, there was a 7.75% difference in colonoscopy rate (95% confidence interval [CI] = 3.83% to 8.98%) across the 90% mid-range of practices. Despite this, there was no evidence of an association with USC referrals resulting in diagnosis or emergency presentations.ConclusionGreater use of online triage forms is associated with more investigations and referrals for suspected cancer, but not associated with better diagnostic outcomes. This may indicate that any additional referrals are of lower quality and overall there is an increase in inappropriate use of USC referrals. Research is needed to understand how this impacts investigations and referrals for individual patients.]]></description>
<dc:creator><![CDATA[Armina Paule, Helen Atherton, Joanne Parsons, Louise Hiller, Gary Abel]]></dc:creator>
<dc:date>2026-08-24T16:30:14-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2025.0735</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2025.0735</dc:identifier>
<dc:title><![CDATA[Online triage and cancer diagnostic activity in general practice: a cross-sectional study]]></dc:title>
<prism:publicationDate>2026-06-01</prism:publicationDate>
<prism:section>Research</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/08/23/BJGP.2025.0802.short?rss=1">
<title><![CDATA[Understanding risk stratification of chronic kidney disease: a qualitative study in primary care]]></title>
<link>http://bjgp.org/content/early/2026/08/23/BJGP.2025.0802.short?rss=1</link>
<description><![CDATA[BackgroundChronic kidney disease (CKD) affects approximately 10% of adults in England. Of these adults, approximately 1% progress to kidney failure with a significant impact on health-related quality of life and high healthcare costs. CKD is associated with increased cardiovascular disease risk. New therapies to improve outcomes highlight the need for effective risk stratification.AimTo explore primary care teams’ views and experiences of CKD risk stratification.Design and settingQualitative interview and focus group study with GP practices in South England, South London, and Yorkshire.MethodTwenty-six semi-structured interviews with GPs, pharmacists, and practice nurses, and four focus groups (31 participants) with practice teams including clinical, administration, and management staff were undertaken between January 2024 and January 2025 across 20 practices, informed by normalisation process theory, using thematic analysis.ResultsWe identified four key themes: 1) awareness of diagnostic criteria and risk- stratification tools, 2) value of coding CKD and discussion of risk, 3) barriers to CKD risk stratification, 4) improving CKD risk stratification. Despite universal awareness of diagnostic criteria, there was low awareness of risk-stratification tools. Coding was perceived as valuable for health professionals but not for patients. Concerns included increasing patient anxiety and overmedicalisation. Time pressures and lack of incentivisation were perceived as key barriers. Improved healthcare professional education, guidelines, pathways, and technology/automation were highlighted as areas of potential improvement.ConclusionPrimary care awareness of CKD is high, but workload, time pressures, and concerns regarding patient anxiety/overmedicalisation may contribute to incomplete risk stratification. Refining processes and effective patient communication could improve care.]]></description>
<dc:creator><![CDATA[Kristin Veighey, Emma Teasdale, Michelle Myall, Kate Henaghan-Sykes, Thomas Blakeman, Kinda Ibrahim, Bhargav Raut, Hazel Everitt, Simon DS Fraser]]></dc:creator>
<dc:date>2026-08-24T16:30:14-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2025.0802</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2025.0802</dc:identifier>
<dc:title><![CDATA[Understanding risk stratification of chronic kidney disease: a qualitative study in primary care]]></dc:title>
<prism:publicationDate>2026-04-16</prism:publicationDate>
<prism:section>Research</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/08/25/BJGP.2025.0768.short?rss=1">
<title><![CDATA[Patients' perceptions of hand osteoarthritis care in Dutch general practice]]></title>
<link>http://bjgp.org/content/early/2026/08/25/BJGP.2025.0768.short?rss=1</link>
<description><![CDATA[Background Hand osteoarthritis (OA) is the second most prevalent form of OA, often associated with pain, reduced function, and diminished quality of life. Despite its prevalence, patients frequently report unmet needs in primary care, where the condition is typically managed.AimTo explore patient perspectives on the management of hand OA in primary care, and identify key barriers and facilitators to care.Design and Setting A qualitative study based on semi-structured interviews with hand OA patients in the Netherlands.Method Semi-structured interviews were conducted with 16 patients using a framework-based interview guide. Patients were recruited through purposive sampling. Thematic analysis identified key themes. Respondent validation was performed via a follow-up questionnaire completed by 51 patients.ResultsSeven barriers and three facilitators were found. The quality of guidance provided by the GP, the availability of information and explanation about hand OA, and the perceived effectiveness of treatment were described as barriers when insufficient and facilitators when adequate. Other barriers included a demotivating attitude toward hand OA, poor collaboration between healthcare providers, perceived limited treatment options, and patient reluctance to pursue certain treatments.ConclusionHand OA patients face several barriers in primary care, many related to GP communication, support, and coordination. Patients desire an engaged GP who offers practical tools and guidance for managing their condition in daily life. To support GPs in this role, improved training, clearer clinical guidelines, and accessible patient education resources are needed. These measures can enable proactive, patient-centred care and improve outcomes for people with hand OA.]]></description>
<dc:creator><![CDATA[Onur Kaya, Emma van Baalen, Rob Strijkers, Margreet Kloppenburg, Ruud Selles, Sita Bierma-Zeinstra, Dieuwke Schiphof]]></dc:creator>
<dc:date>2026-08-25T06:53:00-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2025.0768</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2025.0768</dc:identifier>
<dc:title><![CDATA[Patients' perceptions of hand osteoarthritis care in Dutch general practice]]></dc:title>
<prism:publicationDate>2026-08-25</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/08/26/BJGP.2026.0126.short?rss=1">
<title><![CDATA[General practice closures or mergers: a survival analysis of contributing practice factors]]></title>
<link>http://bjgp.org/content/early/2026/08/26/BJGP.2026.0126.short?rss=1</link>
<description><![CDATA[Background 20% of general practices in the England have closed or merged since 2013. Little is known about factors that are associated with these closures, despite evidence on their negative impacts. Understanding these risks is important for recovering general practice. Aim Describe how differences in the patient mix, practice location, workforce, funding and quality are associated with the future risk of closure Design and Setting Multilevel survival analysis of all general practices in England. Method All practices open on 1st April 2019 were followed until 1st April 2025 or closure. We gathered data on practice population characteristics, workforce, funding and quality. Cox proportional hazards models were used to analyse how these measures were associated with time to closure. Results Practice contract type and geographic location (region and rurality) were key factors associated with closures or mergers. For example, rates ranged from 3.7% to 19.7% by geographic region. Greater risk was associated with smaller practices, with a practice at the 10th percentile (3,032 patients) having 253% (95% CrI: 200%, 312%) higher risk of closure or merger than the median (7,256 patients). Greater risk of closure or merger was associated with losing or failing to gain patients (hazard ratio v medium increase 1.68 (95%CrI: 1.44, 1.96), lower baseline funding, poorer clinical quality, higher socioeconomic deprivation and certain contract types, but not the supply of general practitioners or nurses. Conclusion The practice contract, relevant region, practice list size, funding and quality are key hazards for the subsequent closure or merger of general practices.]]></description>
<dc:creator><![CDATA[Joseph Hutchinson, Michael Anderson, Rita Santos, Evangelos Kontopantelis, Matt Sutton]]></dc:creator>
<dc:date>2026-08-26T05:20:27-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0126</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0126</dc:identifier>
<dc:title><![CDATA[General practice closures or mergers: a survival analysis of contributing practice factors]]></dc:title>
<prism:publicationDate>2026-08-07</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/08/31/BJGP.2026.0207.short?rss=1">
<title><![CDATA[Understanding Suicide through Coroners&#x2019; Narratives: implications for primary care from a mixed-methods study of 157 Coroners&#x2019; reports]]></title>
<link>http://bjgp.org/content/early/2026/08/31/BJGP.2026.0207.short?rss=1</link>
<description><![CDATA[Suicide is a major public health concern, and general practice is often a recent point of contact before death. While mental illness is well recognised, the broader social and contextual factors influencing suicide risk remain under-reported in primary care and epidemiological research Aim To describe the demographic, clinical, and psychosocial characteristics of individuals who died by suicide, integrating coronial quantitative data with qualitative narrative accounts to identify implications for primary/ secondary care and public health. Design and setting Explanatory sequential mixed‑methods study of 157 consecutive deaths by suicide recorded by coroners (2018-19) across five English local authorities. Method Demographic, clinical, and social data were extracted from coroners’ records and summarised descriptively. Narrative case summaries were coded and analysed thematically to identify contextual, relational, and service factors preceding death. Results Of 157 individuals: 79% were male; 65% lived in the most deprived IMD quintile; 85% had a diagnosed mental health condition; 62% had a long‑term physical illness; 41% had a previous suicide attempt. About half consulted a GP in the preceding three months; mental health featured in about half of those consultations. Common stressors were relationship breakdown (37.2%), housing instability (22.1%), and work pressures (18.2%). Seven interlinked themes were identified: Mental health; Alcohol/Substance use, Physical health; Social connectedness; Life course trauma, Socioeconomic and Structural Vulnerability; Healthcare access. Service transitions were key vulnerability points Conclusion Coroners’ records offer important insights into the complex circumstances preceding suicide and highlight opportunities for GPs to recognise intersectional complexity and support integrated, cross-sector suicide prevention approaches.]]></description>
<dc:creator><![CDATA[Phillip Oliver, Emily Reed, Joe Hulin, Brigitte Delaney, Jack Marshall, Caroline Mitchell]]></dc:creator>
<dc:date>2026-09-01T03:26:14-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0207</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0207</dc:identifier>
<dc:title><![CDATA[Understanding Suicide through Coroners&#x2019; Narratives: implications for primary care from a mixed-methods study of 157 Coroners&#x2019; reports]]></dc:title>
<prism:publicationDate>2026-09-01</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/09/03/BJGP.2026.0161.short?rss=1">
<title><![CDATA[Primary care quality and secondary healthcare utilisation in patients with multimorbidity: a retrospective cohort study]]></title>
<link>http://bjgp.org/content/early/2026/09/03/BJGP.2026.0161.short?rss=1</link>
<description><![CDATA[Background High-quality primary care can improve multimorbidity management but little evidence is available to understand its impact on secondary care use over time. Aim To assess the concurrent and lagged associations between quality of primary care and planned and unplanned secondary care use, examining the modifying role of frailty. Design and Setting A retrospective cohort study included 468,172 patients with multimorbidity in England from the Discover research platform (April 2022-March 2024). Method We used principal component analysis to combine a set of quality indicators (QIs) and assessed the impacts of QIs on both planned and unplanned care using regression models. Results Generally, patients with higher QI attainment also had higher likelihood of outpatient visits, emergency admissions and ED visits. There was a lower lagged odds of elective hospital admissions in the following 12 months among those with higher attainment of multimorbidity-specific QIs. In the complex multimorbidity cohort (≥3 conditions), multimorbidity-specific QIs were longitudinally associated with lower odds of elective admissions and outpatient visits, while generic QIs were related to lower odds of outpatient non-attendance. Conclusion Attainment of generic and multimorbidity QIs was generally associated with slightly increased planned and unplanned care. However, patients for whom we identified higher attainment of multimorbidity-specific QIs had lower odds of elective admissions and outpatient visits, especially for those with complex multimorbidity. Our research suggests that the quality of primary care may influence patients’ use of secondary care, with the potential to improve care for people with multimorbidity and warrant further investigation into management strategies.]]></description>
<dc:creator><![CDATA[Qian Gao, Benedict WJ Hayhoe, Meryem Cicek, Geva Greenfield, Michaela Otis, Gesthimani Misirli, Ana Luisa Neves, Azeem Majeed, Paul Aylin, Alex Bottle]]></dc:creator>
<dc:date>2026-09-03T08:02:02-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0161</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0161</dc:identifier>
<dc:title><![CDATA[Primary care quality and secondary healthcare utilisation in patients with multimorbidity: a retrospective cohort study]]></dc:title>
<prism:publicationDate>2026-09-03</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/09/06/BJGP.2025.0699.short?rss=1">
<title><![CDATA[Impact of recurrent urinary tract infections on women]]></title>
<link>http://bjgp.org/content/early/2026/09/06/BJGP.2025.0699.short?rss=1</link>
<description><![CDATA[BackgroundMany women experience recurrent urinary tract infections (rUTIs) yet their significance for the women affected is poorly described and understood.AimTo explore women’s experiences of rUTIs and the impact on their lives.Design and settingA qualitative study embedded in a randomised controlled trial (RCT) of D-mannose with women with clinically defined rUTIs in England and Wales.MethodWe conducted semi-structured telephone interviews with 32 women who participated in the RCT. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically.ResultsWomen reported how the experience of rUTIs was burdensome with distressing and debilitating physical symptoms and wider disruptive effects. Women expressed how rUTIs had an impact on different stages of their lives and we identified two types of impact. Internalised impact included the women’s emotional response to rUTIs, dread of a recurrence, and maintaining readiness to manage it. Externalised impact encompassed actions in response to rUTIs, including remaining extremely vigilant about recurrences and seeking help as soon as a recurrence was suspected, and the challenges they faced. The women explained how the responses of healthcare professionals (HCPs) when they sought care affected their help-seeking and their self-esteem, and could leave them with a sense of helplessness.ConclusionExperience of rUTIs has taught women to be vigilant and proactive about the condition but this was not always matched with understanding and validation on the part of HCPs. When women experiencing rUTIs seek care, clinicians could usefully consider the patient’s broader experience of rUTIs, including internalised and externalised impacts.]]></description>
<dc:creator><![CDATA[Margaret Glogowska, Michael Moore, Alastair D Hay, Christopher Butler, Gail Hayward]]></dc:creator>
<dc:date>2026-09-07T07:44:19-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2025.0699</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2025.0699</dc:identifier>
<dc:title><![CDATA[Impact of recurrent urinary tract infections on women]]></dc:title>
<prism:publicationDate>2026-05-14</prism:publicationDate>
<prism:section>Research</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/09/06/BJGP.2025.0757.short?rss=1">
<title><![CDATA[Recommended point-of-care tests in out-of-hours primary care]]></title>
<link>http://bjgp.org/content/early/2026/09/06/BJGP.2025.0757.short?rss=1</link>
<description><![CDATA[BackgroundPoint-of-care tests (POCTs) are increasingly used to enhance diagnostic accuracy and facilitate rapid clinical decision making in settings with limited laboratory access. However, there is currently no consensus on which POCTs should be routinely available in out-of-hours (OOH) primary care services.AimTo establish expert consensus on which POCTs should be considered essential or optional in European OOH primary care services.Design and settingA modified Delphi consensus study involving an international panel of experts from 20 European countries, representing diverse clinical and academic backgrounds in OOH primary care.MethodA three-round Delphi process was conducted. Round one assessed current POCT availability via questionnaire. In round two, panellists rated 28 POCTs as essential, optional, or unnecessary. In round three, results were discussed in a structured in-person workshop, followed by anonymous re-voting. Consensus was predefined as ≥66.6% agreement.ResultsSix POCTs achieved consensus as essential: blood glucose, urine dipstick, C-reactive protein, pregnancy testing, electrocardiography, and haemoglobin measurement. Twelve tests were classified as optional, and 10 were deemed unnecessary. Key concerns included inappropriate use, variability in clinician confidence, and patient-driven demand.ConclusionThis study provides, to the authors’ knowledge, the first European consensus on POCT prioritisation in OOH primary care. Implementation of essential POCTs, supported by training and governance, may improve diagnostic efficiency, while optional tests should be tailored to local service needs.]]></description>
<dc:creator><![CDATA[Leon Redek, Rachel Brettell, Rebecca Payne, Linda Huibers, Vesna Homar]]></dc:creator>
<dc:date>2026-09-07T07:44:19-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2025.0757</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2025.0757</dc:identifier>
<dc:title><![CDATA[Recommended point-of-care tests in out-of-hours primary care]]></dc:title>
<prism:publicationDate>2026-06-04</prism:publicationDate>
<prism:section>Research</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/09/10/BJGP.2026.0167.short?rss=1">
<title><![CDATA[Ruling out acute coronary syndrome in primary care: a diagnostic trial (POB-HELP)]]></title>
<link>http://bjgp.org/content/early/2026/09/10/BJGP.2026.0167.short?rss=1</link>
<description><![CDATA[Background Accurate risk stratification of patients with chest pain in primary care may improve patient safety while reducing unnecessary hospital referrals. Aim To evaluate the diagnostic performance of a clinical decision rule (CDR) combining high-sensitivity tro-ponin I (hs-cTnI) and the Marburg Heart Score (MHS) to rule out acute coronary syndrome (ACS), and specifically myocardial infarction (MI), in primary care patients with chest pain, and to compare referral rates with usual care. Design and setting Cluster-randomised diagnostic trial (2:1 intervention:control) conducted in Dutch primary care practices. Method Patients presenting with acute chest pain were assessed using a CDR applied by general practitioners, combining the MHS with a hs-cTnI point-of-care test. General practitioners in the control group provided usual care. Diagnostic performance was evaluated using sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). Secondary endpoints included evaluation of a modified HEART score and single hs-cTnI rule-out strategy. Results In total, 827 participants were included: 740 intervention and 87 controls. The CDR missed one ACS, yielding a sensitivity of 98.3% (95% CI 90.8-100%) and NPV of 99.7% (95% CI 98.0-100%). Specificity was 49.1% (95% CI 45.3-52.9%) and PPV 14.1% (95% CI 13.2-15.1%). For MI, sensitivity and NPV were both 100% (95% CI 92.6-100% and 95% CI 98.9-100%, respectively). Specificity was 48.6% (95% CI 44.8-52.4%), and PPV 11.9% (95% CI 11.1-12.7%). Referral rates did not differ significantly between groups (54.6% vs 47.1%; p=0.39). Conclusion A CDR combining the MHS with a hs-cTnI point-of-care test safely ruled out ACS and MI in(..)]]></description>
<dc:creator><![CDATA[Simone van den Bulk, Annelieke HJ Petrus, Robert Willemsen, Mattijs E Numans, Mark J. Boogers, Maaike PJ. Hermans, Joan G. Meeder, Braim Rahel, Marcel Janssen, Geertjan Dinant, Christa M. Cobbaert, Tobias N Bonten]]></dc:creator>
<dc:date>2026-09-10T06:41:54-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0167</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0167</dc:identifier>
<dc:title><![CDATA[Ruling out acute coronary syndrome in primary care: a diagnostic trial (POB-HELP)]]></dc:title>
<prism:publicationDate>2026-09-10</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/06/30/BJGP.2025.0690.short?rss=1">
<title><![CDATA[Co-generating ideas for safer paediatric care with parents and stakeholders: a multi-method UK general practice study]]></title>
<link>http://bjgp.org/content/early/2026/06/30/BJGP.2025.0690.short?rss=1</link>
<description><![CDATA[BackgroundParents play a vital role in protecting their children from healthcare-associated harms, for example, through mitigating safety incidents in general practice. Despite international calls encouraging family involvement in patient safety initiatives, parental perspectives are rarely embedded in the co-design of safety improvements.AimTo co-generate and prioritise ideas for improving paediatric safety in general practice with parents and key stakeholders, and to explore areas of agreement and disagreement between these groups.Design and settingA multi-method study combined qualitative methodology with quality improvement tools involving four parent workshops (between June and July 2024) and one stakeholder workshop (November 2024). Parent participants had experience of accessing general practice services with their children; and stakeholder participants included clinicians, managers, policymakers, primary care leaders and patient advocates.MethodParent participants reviewed national-level safety incident data and used nominal group technique to generate ideas for change. Ideas were collated, refined and presented to key stakeholder participants, who assessed the potential ‘doability’ (can be acheived or performed) and impact of each idea.ResultsParents (n = 33) generated 16 ideas for change targeting communication, access to care records and results, and shared learning and development. Stakeholders (n = 7) prioritised seven ideas, including a campaign to support parents to speak up, having flexible appointments for children and designating a parent advocate. Parents and stakeholders most strongly agreed on the need to proactively seek parent feedback and solutions.ConclusionParents are willing and able to support healthcare teams with their patient safety efforts. Their ideas align with national priorities and offer actionable strategies that general practice teams can adopt or adapt for safer paediatric care in their own populations.]]></description>
<dc:creator><![CDATA[Thomas Purchase, Harriet Quinn-Scoggins, Isobel J McFadzean, Lauren Donovan, Isabel Hope, Eleanor Clarke, Kate J Lifford, Imogen John, Nicholas Hodson, Jillian Beggs, Philippa Rees, Andrew Carson-Stevens]]></dc:creator>
<dc:date>2026-06-30T04:29:33-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2025.0690</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2025.0690</dc:identifier>
<dc:title><![CDATA[Co-generating ideas for safer paediatric care with parents and stakeholders: a multi-method UK general practice study]]></dc:title>
<prism:publicationDate>2026-04-29</prism:publicationDate>
<prism:section>Research</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/09/21/BJGP.2026.0190.short?rss=1">
<title><![CDATA[Moving on from patient safety incidents]]></title>
<link>http://bjgp.org/content/early/2026/09/21/BJGP.2026.0190.short?rss=1</link>
<description><![CDATA[BackgroundPatient safety incidents (PSIs), defined as unintended or unexpected events that could have or did lead to patient harm, can have profound effects on GPs. Understanding how GPs experience and recover from PSIs is important for workforce wellbeing and patient safety in primary care.AimTo explore how GPs experience PSIs, how they move on, and how they use available support.Design and settingQualitative study with GPs in England.MethodSemi-structured interviews were conducted with 22 GPs. Data were analysed using thematic analysis. Participants were eligible if they had been involved in a PSI in general practice, spanning near misses to events resulting in patient harm. Themes were developed inductively and mapped onto the theoretical domains framework to identify cognitive, social, and environmental influences on learning, help seeking, and recovery.ResultsThree themes were generated: personal and professional consequences; recovery and learning processes; and barriers to healing. GPs described emotional responses, including guilt, self-doubt, and fear of reputational or regulatory consequences. Peer support was valued, but access to structured support was limited. Formal investigations were experienced as distressing and compounded the emotional impact. Recovery and learning were facilitated by empathetic, systems-focused cultures, protected time for reflection, and structured opportunities to learn from incidents.ConclusionGPs rely on informal and self-directed strategies to recover from PSIs, with variable access to formal support. Recovery is shaped by individual and organisational factors. Findings highlight the importance of compassionate, non-punitive support systems and psychologically safe environments to enable recovery and promote learning.]]></description>
<dc:creator><![CDATA[James Tawse, Christopher J Armitage, Carolyn A Chew-Graham, Maria Panagioti]]></dc:creator>
<dc:date>2026-09-21T16:30:13-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0190</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0190</dc:identifier>
<dc:title><![CDATA[Moving on from patient safety incidents]]></dc:title>
<prism:publicationDate>2026-06-07</prism:publicationDate>
<prism:section>Research</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/09/22/BJGP.2026.0143.short?rss=1">
<title><![CDATA[Factors influencing implementation of decarbonisation actions in general practice: longitudinal multi-centre case-study]]></title>
<link>http://bjgp.org/content/early/2026/09/22/BJGP.2026.0143.short?rss=1</link>
<description><![CDATA[Background The National Health Service (NHS) aims to reach net zero by 2040. Although recognised as having a key role, little is known about how decarbonisation initiatives are implemented in general practice and how progress can be supported. Aim To explore the institutional, organisational and professional factors that influence implementation of decarbonisation actions in general practice over time. Design and setting Longitudinal qualitative case study in 12 general practices in England. Methods Practices developed a Green Action Plan (GAP) comprising 3-5 measurable actions to be implemented over 12 months. Qualitative data were collected through baseline workshops, 3-monthly follow‑up ‘check-in’ discussions and final focus groups. Topic guides were iteratively developed, informed by Normalisation Process Theory and the Theoretical Domains Framework, and Framework analysis was conducted Results The factors influencing decarbonisation are presented as five themes: systemic barriers; culture and communication; capacity and competing demands; ‘making it work’; and behaviour, attitudes and feelings. Actions aligned with wider NHS priorities or offering time/financial efficiency were easier to embed, whereas those requiring individual behaviour change or reliant on external systems were more challenging. Lack of coordinated policy support and limited control over estates and infrastructure constrained progress. Conclusion At practice level, actions that integrate into routine work and provide efficiency gains are most feasible in enacting change. To support sustained change, directive national policies and coordinated system-level support are required. Individual behaviour change is challenging in an already pressured system, but a supportive culture and team collaboration can facilitate progress.]]></description>
<dc:creator><![CDATA[Helen Twohig, Olivia Geddes, Jeremy Dale, Frederick Dahlmann, Jenny Earle, Abi Eccles, Michael Gregg, Ana Raquel Nunes, Rachel Spencer, Florence Karaba, Nicky Thomas, Helen Atherton]]></dc:creator>
<dc:date>2026-09-22T06:51:54-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0143</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0143</dc:identifier>
<dc:title><![CDATA[Factors influencing implementation of decarbonisation actions in general practice: longitudinal multi-centre case-study]]></dc:title>
<prism:publicationDate>2026-09-22</prism:publicationDate>
<prism:section>Article</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/10/05/BJGP.2026.0175.short?rss=1">
<title><![CDATA[Unpacking barriers to and facilitators for research leadership for Black primary care researchers: a qualitative study]]></title>
<link>http://bjgp.org/content/early/2026/10/05/BJGP.2026.0175.short?rss=1</link>
<description><![CDATA[BackgroundIndividuals of Black heritage comprise 6.2% of the general practice workforce in the UK. Representation is even lower in primary care research. The understanding of why this misrepresentation exists is limited.AimTo explore representation of researchers of Black heritage at various career stages within primary care, alongside factors influencing retention and career advancement.Design and settingQualitative study with 18 researchers of Black heritage and seven primary care senior academic leaders (current or former heads of primary care departments in UK universities).MethodOnline, one-to-one, semi-structured interviews. Interviews were digitally audio-recorded, transcribed, and analysed using thematic analysis.ResultsParticipants recognised significant underrepresentation of researchers of Black heritage in primary care research. Key barriers to career progression and retention included systemic and structural inequities, racism, and exclusionary academic culture. Facilitators included proactive leadership, tailored training and support for researchers (including international scholars), mentorship, sponsorship, and safe networking spaces. Participants offered recommendations to improve representation and career progression: training for leaders to recognise bias, discrimination, and inequity; leadership development opportunities; tailored career support for researchers of Black heritage; and targeted assistance for international researchers navigating UK academic systems. Visibility of Black role models in academic primary care was seen as essential to attracting and inspiring future researchers.ConclusionThese findings highlight key areas for change to foster a more inclusive and equitable research environment in primary care.]]></description>
<dc:creator><![CDATA[Rupinder Kaur Bajwa, Manpreet Bains, Christian D Mallen, Joe Kai, Adwoa F Agyemang-Benneh, Ralph K Akyea]]></dc:creator>
<dc:date>2026-10-05T09:02:08-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0175</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0175</dc:identifier>
<dc:title><![CDATA[Unpacking barriers to and facilitators for research leadership for Black primary care researchers: a qualitative study]]></dc:title>
<prism:publicationDate>2026-07-31</prism:publicationDate>
<prism:section>Research</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/10/05/BJGP.2025.0793.short?rss=1">
<title><![CDATA[Patient, pharmacist, and GP perspectives on identifying and managing polypharmacy: a qualitative study]]></title>
<link>http://bjgp.org/content/early/2026/10/05/BJGP.2025.0793.short?rss=1</link>
<description><![CDATA[BackgroundPolypharmacy is a global priority owing to potential harms, including adverse drug events, hospitalisations, and high treatment burden. Overall, these outcomes have shown little improvement despite numerous interventions, indicating that current approaches to identify and manage polypharmacy remain insufficient.AimTo understand how polypharmacy is identified and managed in everyday primary care from patient, pharmacist, and GP perspectives.Design and settingQualitative semi-structured interviews were conducted with 12 patients and 12 professionals (seven clinical pharmacists and five GPs) across Greater Manchester, UK.MethodReflexive thematic analysis was undertaken, which was supported by normalisation process theory and constant comparison as sensitisation tools.ResultsPolypharmacy was widely seen as important work but, in practice, inconsistent case-finding and unclear purposes for polypharmacy medication reviews were reported. Patients viewed medications as essential tools to sustain biopsychosocial elements of life, contrasting with practitioners’ clinical priorities to mitigate potential harm. Polypharmacy work routinely contained layers of hidden complexity, which was often overwhelming and placed a heavy emotional burden on patients and professionals. Both patients and professionals required training and experience to effectively manage these complexities. Although a protocol-driven approach was sufficient for simple medication issues, only a longer-term approach, predicated on trust, continuity, relationships, and open discussions encouraging healthy conflict, appeared to engage with deeper complexities.ConclusionPolypharmacy work is fraught with complexity and uncertainty, lacking standardised case-finding and clear purpose for both patients and professionals. Better models of care are needed to meet this challenge, encouraging a shift beyond a biomedically dominated protocol-driven approach to a more longitudinal and relational approach.]]></description>
<dc:creator><![CDATA[Jung Yin Tsang, Thomas Blakeman, Matthew Sperrin, Tomazo J Kallis, Rupert A Payne, Darren M Ashcroft]]></dc:creator>
<dc:date>2026-10-05T09:02:08-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2025.0793</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2025.0793</dc:identifier>
<dc:title><![CDATA[Patient, pharmacist, and GP perspectives on identifying and managing polypharmacy: a qualitative study]]></dc:title>
<prism:publicationDate>2026-07-02</prism:publicationDate>
<prism:section>Research</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/10/05/BJGP.2026.0003.short?rss=1">
<title><![CDATA['I have no idea who does the bone thing&#x2019;: a qualitative exploration to improve osteoporosis care]]></title>
<link>http://bjgp.org/content/early/2026/10/05/BJGP.2026.0003.short?rss=1</link>
<description><![CDATA[BackgroundThe Women’s Health Strategy for England highlighted the systemic underrepresentation of older women in health care. Over half of women >80 years are estimated to have osteoporosis, contributing to 180 000 fractures annually in the UK, with substantial personal and economic costs, despite clinically effective treatments and national guidelines being available.AimTo use insights from the experiences of older women and primary healthcare professionals to develop strategies to improve osteoporosis care.Design and settingA community-based qualitative study in England, UK.MethodInterviews were undertaken with 30 community-dwelling older women (aged ≥70 years) diagnosed with osteoporosis and 31 healthcare professionals including GPs, physiotherapists, pharmacists, practice nurses, a healthcare assistant, and a community matron. We reviewed findings iteratively with our coproduction group using a constructivist grounded theory approach.ResultsHealthcare professionals acknowledged osteoporosis as clinically important but described limited knowledge and understanding. However, older women assumed expertise and proactive engagement from clinicians. Older women normalised symptoms as part of ageing, frequently prioritising other comorbidities. Most were unclear about their diagnosis, prognosis, or treatment plans. Self-management was expected but inadequately supported. There was little routine engagement with the wider primary care team. Digital communication further limited older women’s engagement/re-engagement.ConclusionOsteoporosis remains poorly understood and inadequately managed in older women who face barriers, including multimorbidity, digital exclusion, and low self-efficacy. Many older women accept care gaps owing to limited awareness and lack of meaningful interaction with healthcare professionals. Improved care navigation and greater involvement of the wider primary care team could enhance engagement and support better self-management.]]></description>
<dc:creator><![CDATA[Anne Heaven, Nicola Kime, Shabana Shafiq, Nicola Harrison, Janine Connor, Jessica Faye Johansson, Elizabeth Teale, Christine Sharp]]></dc:creator>
<dc:date>2026-10-05T09:02:09-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0003</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0003</dc:identifier>
<dc:title><![CDATA['I have no idea who does the bone thing&#x2019;: a qualitative exploration to improve osteoporosis care]]></dc:title>
<prism:publicationDate>2026-07-02</prism:publicationDate>
<prism:section>Research</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/10/05/BJGP.2025.0377.short?rss=1">
<title><![CDATA[Impact of local enhanced incentive schemes on the performance of general practices within the UK: a systematic review]]></title>
<link>http://bjgp.org/content/early/2026/10/05/BJGP.2025.0377.short?rss=1</link>
<description><![CDATA[BackgroundTo drive improvements in healthcare quality and to reduce inequalities, pay-for-performance (P4P) schemes have become widespread internationally. In recent years, most local commissioning bodies in the UK have developed their own local general practice incentive schemes.AimTo examine the use and effectiveness of local incentive schemes and their alignment to the national Quality and Outcomes Framework.Design and settingSystematic review of quantitative studies related to local incentive schemes with a P4P structure within UK general practice published after 2004.MethodSearches were conducted via Ovid across the Embase and MEDLINE databases. Risk of bias was assessed using the Cochrane Effective Practice and Organisation of Care criteria and a narrative synthesis was undertaken.ResultsIn total, 17 studies were identified, which were focused on 14 local incentive schemes. All studies were from England, except one from Scotland. Five studies included only tailored indicators, and seven studies included both aligned and tailored indicators. Quality assessment suggested the current evidence was of mixed quality. All studies that reported on process measures (n = 15) demonstrated positive impacts, but health outcome measures were only evaluated in nine studies showing inconsistent findings. Eight studies addressed impact on health inequalities and no studies addressed cost-effectiveness, patient-reported outcomes, or experience measures.ConclusionThere is an emerging evidence base that local incentive schemes in general practice lead to improvements in process measures, although methodological quality of studies is mixed. Future studies should utilise more robust methods to evaluate effectiveness and examine impacts on health inequalities, cost-effectiveness, and variation by practice.]]></description>
<dc:creator><![CDATA[Matthew Conroy, Emma McManus, William Whittaker, Peter Bower, Michael Anderson]]></dc:creator>
<dc:date>2026-10-05T09:02:09-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2025.0377</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2025.0377</dc:identifier>
<dc:title><![CDATA[Impact of local enhanced incentive schemes on the performance of general practices within the UK: a systematic review]]></dc:title>
<prism:publicationDate>2026-07-07</prism:publicationDate>
<prism:section>Research</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/10/05/BJGP.2026.0110.short?rss=1">
<title><![CDATA[Primary care cardiovascular risk reduction after pregnancy complications: a qualitative systematic review]]></title>
<link>http://bjgp.org/content/early/2026/10/05/BJGP.2026.0110.short?rss=1</link>
<description><![CDATA[BackgroundAdverse pregnancy outcomes (APOs) affect approximately 30% of pregnancies and confer lifelong elevated cardiovascular disease (CVD) risk. Behavioural interventions may mitigate this risk.AimTo systematically review qualitative literature on women’s experiences of behavioural change for cardiovascular risk reduction following APOs, with a focus on health equity.Design and settingQualitative systematic review, limited to high-income countries with universal access to health care.MethodA systematic search of PubMed, Embase, and CINAHL from inception to March 2025 identified primary studies. Thematic synthesis followed Thomas and Harden’s three-stage approach. Themes were mapped onto the COM-B (Capability, Opportunity, Motivation-Behaviour) framework to theoretically ground and structure analysis.ResultsEighteen studies involving 339 women met inclusion criteria. Women who were minority ethnic formed the majority in only two studies. Demographic data regarding socioeconomic status, ethnicity, or both were absent from five. Experiences shaping behaviour change aligned with COM-B domains. Delayed physical and psychological recovery after APOs reduced women’s capability to initiate changes. Competing demands, including childcare, household responsibilities, and work, restricted opportunity to focus on long-term cardiovascular health. Opportunities improved when behaviour changes were easily integrated into family life and offered shared benefits. Motivation was strengthened by awareness of increased CVD risk, the responsibilities of parenthood, and personalised advice from healthcare professionals. Tailored, proactive follow-up supported engagement, especially for minority ethnic and socioeconomically disadvantaged groups.ConclusionPrevention of CVD after APOs requires structured, system-level support to prioritise family-based behaviour change. High-risk groups are underrepresented in research; coproducing interventions with these groups may help to avoid widening health inequalities.]]></description>
<dc:creator><![CDATA[Victoria Jane Hodges, Saminah Shareef, Carolyn A Chew&ndash;Graham, Pensee Wu, Modurodoluwa Adetola, Caroline Anne Mitchell]]></dc:creator>
<dc:date>2026-10-05T09:02:09-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2026.0110</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2026.0110</dc:identifier>
<dc:title><![CDATA[Primary care cardiovascular risk reduction after pregnancy complications: a qualitative systematic review]]></dc:title>
<prism:publicationDate>2026-06-01</prism:publicationDate>
<prism:section>Research</prism:section>
</item>
<item rdf:about="http://bjgp.org/content/early/2026/10/05/BJGP.2025.0651.short?rss=1">
<title><![CDATA[Fighting to be heard: a thematic analysis of parent perspectives on safety in UK general practice]]></title>
<link>http://bjgp.org/content/early/2026/10/05/BJGP.2025.0651.short?rss=1</link>
<description><![CDATA[BackgroundChildren are particularly vulnerable to healthcare-associated harm. Parents play a vital but under-recognised protective role in paediatric patient safety. Parent perceptions of and contributions to safety improvement efforts within hospital settings are well documented, but little is known about parent experiences and perspectives in primary care.AimTo explore diverse parental perspectives on paediatric safety in primary care and identify target areas for improvement.Design and settingThis qualitative study in UK primary care was conducted through online (n = 2) and in-person (n = 2) workshops with parents, taking place between 24 June and 8 July 2024.MethodWorkshops were structured around a descriptive analysis of paediatric patient safety incident reports in general practice. Parents discussed and reflected on their own experiences in relation to the findings. Transcripts and field notes were analysed thematically to identify key themes.ResultsParents (n = 33) from varied backgrounds, including under-served communities, participated. Three major themes were identified: responsibility of care, highlighting perceived unclear roles between parents and healthcare teams; navigating the system, where parents described the need to ‘fight’ for care and the challenges of understanding healthcare processes; and communication and language, emphasising the difficulties of being heard, especially among ethnic minority parents and those lacking the confidence to speak up.ConclusionParent perspectives on paediatric safety in primary care have highlighted key areas for practices, researchers, and safety improvement teams to target system change and intervention development. Engaging parents as co-designers in these efforts could enhance trust, reduce risk, and improve safety outcomes for paediatric patients.]]></description>
<dc:creator><![CDATA[Thomas Purchase, Harriet Dorothy Quinn-Scoggins, Isobel J McFadzean, Lauren Donovan, Isabel Hope, Eleanor Clarke, Kate J Lifford, Nicholas Hodson, Jillian Beggs, Philippa Rees, Andrew Carson-Stevens]]></dc:creator>
<dc:date>2026-10-05T09:02:09-07:00</dc:date>
<dc:identifier>info:doi/10.3399/BJGP.2025.0651</dc:identifier>
<dc:identifier>hwp:master-id:bjgp;BJGP.2025.0651</dc:identifier>
<dc:title><![CDATA[Fighting to be heard: a thematic analysis of parent perspectives on safety in UK general practice]]></dc:title>
<prism:publicationDate>2026-06-04</prism:publicationDate>
<prism:section>Research</prism:section>
</item>
</rdf:RDF>