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Today, we’re speaking to Matt Conroy. Matt is a PhD fellow at the University of Manchester and also works for NHS Greater Manchester (ICB) as the Head of Primary Care Intelligence. Title of paper: Impact of local enhanced incentive schemes on the performance of general practices within the United Kingdom: a systematic review Available at: https://doi.org/10.3399/BJGP.2025.0377 Most local commissioning bodies in England, known as Integrated Care Boards (ICBs), have developed their own additional local pay-for-performance (P4P) incentive schemes alongside the Quality and Outcomes Framework (QOF). To our knowledge this is the first review to date to summarise existing evidence on the scope and effectiveness of local incentive schemes implemented in general practice in the UK with a focus on the indicators and their alignment with national schemes. Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:00.480 - 00:01:01.140 Hi and welcome to BJGP Interviews. I'm Nada Khan and I'm the Senior Research Editor here at the bjgp. Thanks for taking the time today to listen to this podcast. Today we're talking to Matt Conroy. Matt is a PhD fellow based at the University of Manchester and he also works for NHS Greater Manchester ICB as the Head of Primary Care Intelligence. We're here to talk about the paper he's recently published in the bjgp, which is titled the Impact of Local Enhanced Incentive Schemes on the Performance of General Practices within the United A Systematic Review. So, hi, Matt, it's really nice to meet you and to talk about this work and I wonder if, just to start with, if you could explain a bit about what we mean by local incentive schemes in general practice and why you wanted to look at them, and I wonder if you wanted to draw a little bit on your additional role working for the Greater Manchester ICB as well here. Speaker B 00:01:01.220 - 00:01:54.400 Thanks. I guess by a local deep incentive scheme, we mean something that's kind of locally designed or locally commissioned within a ICB footprint to try and address any particular population health challenges or local nuances that go over and above national policy, things like the Quality and Outcomes Framework. I guess what was really insightful for us through doing this piece of work was actually through an FOI that we undertook. Like 90, 98% of ICBs actually have their own local gene for incentive schemes, but we only identified 17 schemes through the published literature, the last one being from 2018. So getting on for 10 years ago, and the fact that we know that so many ICVs are doing these things, but there's not the evidence body there, there's not the learning and sharing of best practice to really inform policy and help ICVs all try and address their local challenges. Speaker A 00:01:55.210 - 00:02:10.650 Yeah. And you've mentioned qof and I guess a lot of people are really familiar with qof, and as you mentioned, there are lots of local schemes sitting alongside it. And I wonder if you have an idea of just what sort of things they're trying to incentivize, just from sort of the background to your work. Speaker B 00:02:11.210 - 00:04:48.850 Yes. So, as part of my day job, I help design and deliver the local GP incentive scheme in Greater Manchester. It's roughly valued about £17 million for this year. And I think what we try to do is use QOF as a bit of a body of evidence, but also look at a lot of our local and national data to really highlight where we think we can make a difference with these local incentive schemes. So, for the 26, 27 financial year, we've done a piece of work to really home in on CBD and diabetes as one area, respiratory as another area, elective care. So we can get the interface between primary and secondary care and also antimicrobial stewardship. I think one of the things that's really fleshed out from that is the impact of non attenders on things like qof. So through qaff, if patients have two or one invites seven days apart, they automatically get exception reported if they don't necessarily attend. But what we found through our local data is actually there's a really strong link between those people and actually poorer CBD control and wide use of healthcare systems. So. So through our local GP insentive scheme, we've really designed almost a narrow cohort that looks at people's individual disease control, looking at things like blood pressure, HbA1c, but also where people haven't attended a review in more than 18 months. So really trying to hone in on specific cohort, acknowledging that those people are really difficult to engage with by proxy. The fact that they've had two invites and not responded. But actually through having a local GP incentive scheme that really highlights these as a specific target cohort group and having dedicated funding alongside it, we can see that from our QOF data, we've had a reduction in exception reporting and actually it's led to these people being targeted and then we can see slow improvements in overall disease control. So whilst it's being funneled through the local GP incentive scheme, there's this wider spillover effect in things like QOF as well. I think that's something that we're looking to evaluate in particular and really draw out, actually, not to say that it's easy to do this exceptional reporting and we know that patients are difficult to engage with, but actually by having a really dedicated piece of work, targets these patients with the body of evidence that these are the people who are more likely to not attend their yearly GP review, but are more likely to end up using emergency care services at that point of contact, that if there's dedicated funding and almost a dedicated cohort, to say these are the people that, as an icb, we've agreed on that we really need to focus on that we can see that those improvements are being yielded and that that is actually having a secondary impact of increasing coif achievement as well. Speaker A 00:04:49.010 - 00:05:03.310 Yeah. So really important work, I guess, being done in local area and this review tried to bring together all of the existing evidence on this, on these different schemes. So what did you find overall in your, in your review? Speaker B 00:05:03.550 - 00:07:48.730 So we found overall that there was 17 schemes that have been reviewed. Of those there was a range of different indicator types, the most of them aligning to the existing indicator types of quaff where they have a lower and upper threshold and achievement scales based on fixed cohort and payment alongside that, which isn't surprising. And I think what surprised me is that so many of the schemes almost piggybacked off QUAFF and just gave more money for existing cough indicators, which was quite surprising in a sense of well, if quaff is already there and as well bodied there was almost that assumption, well, if we provide more money that we're going to get greater achievement on the same indicators that's already there. I think this is the part of the, the push and pull of incentive schemes is that we're all aware that general practice has finite capacity and finite resource and there's almost an assumption that by providing more money you're going to get more outcomes. And it's a bit crude but the analogies, it's a bit like whack a mole and that if you try and do something over here then implicitly means that something there isn't the time and dedicated effort to do something else around the system. I think that's the real challenge with designing these schemes is that acknowledging that where there's already work that's gone in, but how do you address your local challenges and populations and that part of this might be the acceptance, that part of the money is just to give practices the time and the headspace and the workforce to deliver some of this. I think that's one of the things that we've found really locally within our scheme that when we've scaled it up in some areas quite drastically in the first couple of years, you might not see the achievement that you want because there's a lot of time to get around these schemes, to embed them and really employ the workforce to actually start to deliver them. I think the other thing that surprised me is that how little of them actually had an inequalities focus. I think that's partly down to the access to data that's available. I think through undertaking the literature review in a lot of cases people were just using aggregated EMIS extracts that just had a single denominator or numerator for an indicator. And that's something that I think we're really keen to explore throughout the rest of my PhD and that how can we really apply a, a rigorous inequalities lens to some of this and looking at tools like the index of disparity as a way of helping us understand are we in a position where it might look on the surface like achievements going up? And that's great, but is that because we sweep in generalization, are we actually targeting the white British affluent worried well and actually

Today, we’re speaking to Dr Megan Foreman, a GP and NIHR Clinical Lecturer based at the University of East Anglia. Title of paper: Diagnosing in the dark: the childbirth-related post-traumatic stress disorder GP evidence gap Available at: https://doi.org/10.3399/BJGP.2026.0269 Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:00.320 - 00:00:58.460 Hi and welcome to BJGP Interviews. I'm Nada Khan and I'm the Senior Research Editor here at the Journal. Thanks for taking the time today to listen to this podcast. In today's episode, we're speaking to Dr. Megan Forman, who is a GP and NIHR Clinical Lecturer based at the University of East Anglia. We're here to discuss the recent analysis piece that she and her team have published in the September issue of the Journal and it's titled Diagnosing in the Dark the Childbirth Related Post Traumatic Stress Disorder GP Evidence Gap. So, hi, Megan, it's really nice to meet you and thanks again for joining us here to talk about this article. I suppose, to start with, could you explain a little bit more about what you mean by birth trauma and childbirth related PTSD? And I suspect that these are probably terms that GPs are not as familiar with that we should be. Speaker B 00:00:59.310 - 00:01:46.360 Yeah, thank you. So birth trauma is a broader term and that can be. So we're talking here about psychological birth trauma rather than physical birth trauma in the context that we're using it in. We're talking about people who have had a difficult, potentially a pregnancy experience or a birth experience. That's not just looking at birth itself. That can cause ongoing mental health issues and psychological concerns when we talk about PTSD after pregnancy and birth. So what's often referred to as childbirth related ptsd, those are people who meet diagnostic criteria for PTSD as a result of a trauma that was related to their experience from pregnancy or birth. So birth trauma is a broader term and then PTSD is a specific diagnosis. Speaker A 00:01:46.520 - 00:02:14.480 And we were talking just before we started about the wider reach of this work and how, um, it's been picked up more in the mainstream media. But you've also had people telling you about their stories as well. And what I find quite sad in a way is that there have been a number of reviews around inadequate care in women's health. And I'm really struck by some of the poor outcomes that you mentioned in the article, like high suicide rates in women postnatally as well, which is really shocking, actually. Speaker B 00:02:14.880 - 00:03:14.130 Yeah, I mean, you mentioned the people who I've spoken to. So I've had a really involved patient participation group with the work that I've been doing, and they've talked about their own experiences, even in situations where they've had really extreme birth complications. So, for example, a neonatal loss or severe physical injury, even in those circumstances, may have struggled to access support. I've also been contacted by a member of the public since the paper was published and since there was media interest in this, talking about her own experiences of birth almost 30 years ago and difficulty in dealing with that going forward. So it clearly is a big issue. It's also important to say that even if a birth looks straightforward medically on paper, it's still possible to develop birth trauma symptoms and indeed ptsd. So it doesn't have to be a birth with serious complications or a poor outcome for somebody to develop these symptoms. Speaker A 00:03:14.620 - 00:03:37.180 Yeah, and I think that's one of the things that really struck me in the article, is that birth trauma is very subjective and that these issues can happen like, just like you're saying, just after what might appear to have been or appears to be a medically uncomplicated birth. And I think that's probably really important for GPs to understand in terms of what this will look like when women present to their gps as well. Speaker B 00:03:37.260 - 00:04:27.610 Yes. And I think an important consideration is that when women keep referring to women, but I include in that people with other gender identities who have a baby, but when women go into pregnancy, they come to pregnancy with all of their past experiences. And we know that people who have had difficult previous experiences, so for example, intimate partner violence, previous adverse childhood experiences, substance abuse or pre existing mental health problems, these people are particularly at risk of developing PTSD after birth. And it can be something that develops after what looks like a normal birth on paper. So it's really important that we consider birth trauma and PTSD in people, even when it appears that the birth is straightforward and that we still are inquiring about these symptoms to make sure that they're identified. Speaker A 00:04:27.850 - 00:04:40.970 And we'll come back onto sort of inquiring about symptoms. But what might a woman with childbirth related PTSD look like when she presents to her gp? Are there any clues that we should be looking out for, aside from asking questions about it? Speaker B 00:04:40.970 - 00:06:08.320 Well, one of the issues with PTSD is that one of the symptoms that women often experience is avoidance. So people can find that either talking about their birth experience or visiting a healthcare setting can retrigger their symptoms and can be really distressing. So a particular issue with PTSD that isn't necessarily an issue with other perinatal mental health problems is that people can be incredibly reluctant to talk about their experience and that can be with both with family members, friends and healthcare professionals. So it's something that we really need to be vigilant for. But in terms of the symptoms that people describe, essentially there are four symptom clusters. So the first would be hypervigilance so feeling constantly on edge, a constant fear that something bad is going to happen to themselves or the baby. I mentioned the avoidance, avoidance of anything that reminds them of the birth, because it can bring back very extreme, intense physical symptoms. Reliving the birth is another symptom that, that often differentiates it from anxiety and depression. So that can be symptoms like flashbacks and nightmares. And again, the flashbacks can be triggered by reminders of the birth experience. And then the last thing is alterations in mood. So that can be low mood, but it can also be things like disproportionate feelings of guilt. And so mood disturbance is a feature as well. But really, for a diagnosis of ptsd, a person would have to have symptoms from all of those symptom groups. Speaker A 00:06:08.720 - 00:06:35.280 And I suppose in primary care, GPs sometimes can be in a bit of a practice gap. So primary care really has a role in assessing and coordinating this care. But I think that sometimes we're not really sure how to do that, especially when there are other people involved, like the health visitor or the midwives and things. So what do you think that looks like in practice at the moment? So I think probably what you're going to describe is that there's a sense of fragmented care in this area. Speaker B 00:06:35.750 - 00:07:56.120 Yeah, I completely agree. And I mean the guidance. So, for example, the nice guidance on antenatal and postnatal mental health, it suggests that if, if another healthcare professional is concerned about mental health symptoms, that they should be sending people to see their gp. And obviously there's. There's perhaps this expectation that women will also be offered a six to eight week postnatal appointment. So GPs will be seeing women at these points. But absolutely. Care can be fragmented. Sometimes concerns either aren't picked up or aren't passed on. Communication between services can be limited. I know certainly from my own experience, often the information we get in a discharge summary, for example, can be very cursory, which can also make it difficult then to really to preempt you maybe having more problems. Another issue. So we know from research evidence that GPs often mistake postnatal PTSD for depression. So there have been research studies that have demonstrated that this is a common problem. Part of the issue is the overlap with depressive symptoms. So, for example, if you look at the Edinburgh Postnatal Depression Score, it does include symptoms of hypervigilance and mood, so it can easily be mistaken for other conditions. And this can be really problematic because the guidance on the treatment of PTSD and depression are quite different. Speaker A 00:07:56.470 - 00:08:24.550 And I guess just thinking about treatment, so one of the Issues I wondered about was the access to secondary care services, and this isn't always straightforward. And talking about sort of gaps in care, I wonder if some women are falling through a gap here in terms of not potentially fitting criteria for NHS talking therapies because of their symptoms, but not quite at the stage where...

Today, we’re speaking to Dr Ben Walker, a post-doctoral associate based at the University of Calgary, who conducted this work while working at the University of Manchester. Title of paper: Relationships of actual and expected levels of income with GP job satisfaction: repeated cross-sectional study Available at: https://doi.org/10.3399/BJGP.2025.0683 Recruitment and retention of GPs remains an issue for general practice in England. This work examined the relationship between actual income and income expectations with job satisfaction and intentions to quit. Higher actual income was found to be associated with job satisfaction, but there was little evidence to show that it was associated with intentions to quit. A key and novel finding was that higher income expectations were associated with both lower job satisfaction and higher intentions to quit. The findings suggest that policies that help GPs build accurate income expectations, such as increased transparency for incomes for different GP job roles, may be a means of addressing job dissatisfaction caused by discrepancies between expected and actual income for GPs. Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:01.040 - 00:00:58.350 Hello and welcome to BJJP Interviews. I'm Nada Khan and I'm the Senior Research editor at the bjjp. Thanks for taking the time today to listen to this podcast. In today's episode we're talking to Dr. Ben Walker. Ben used to be based as a research fellow at the University of Manchester, but is now working as a postdoctoral associate at the University of Calgary in Canada. We here to talk about the paper he's just published in the BJ GP that's titled Relationships of Actual and Expected Levels of Income with GP Job Satisfaction. A Repeated Cross Sectional Study. So, hi Ben, it's really nice to meet you and to talk about this work and I guess to start us off, I just wanted to talk a little bit about the background to this paper and it's about GP income and job satisfaction, which is clearly a topic that people have plenty of opinions about. But what made you want to look at this question in a bit more detail? Speaker B 00:00:58.590 - 00:02:08.930 So, yeah, it's something we had been discussing internally as a team for a while, obviously, I mean, working in a primary care group, a lot of the driving motivation for a lot of our work is the GP recruitment and retention crisis. And we've always had, we've had this data for a while on GP income from us via our surveys. We've also had this data on GP income expectations and this has been in the survey forever and we've never, we hadn't used anything with it and basically because a lot of us are economists as well as this concept in economics of the Easterland Paradox or the idea that relative income matters more than actual income for happiness. And so we decided that, well, it would be like, like because we are interested in the GP recruitment and retention crisis, it would be interesting to look at the extent to which relative income matters for GP recruitment and retention. So job satisfaction and intentions to quit being two components of recruitment and retention. Speaker A 00:02:09.330 - 00:02:14.290 So you mentioned about a survey. So are you talking about the GP Work Life Survey that was done through Manchester? Speaker B 00:02:14.370 - 00:02:17.130 We are indeed, yeah. So the GP Work Life Survey. Speaker A 00:02:17.130 - 00:02:28.110 Yeah, yeah. So talk us through that just briefly. So what was that all about? I think, I mean there have been a few publications in the BJGP about it, but what. Who are you surveying through that? Speaker B 00:02:28.590 - 00:03:18.400 So the GP Work Life Survey has been going since I believe, 1998. It's been run by Manchester for I believe, all of its history and it's a government funded survey and when we do it we are attempting to a sample of the general GP population to basically ask about various things to do with their work life, including more sort of like formal things like their income and how many hours they're working, but also just how satisfied they are with their jobs, different aspects of their jobs. Yeah, so we collect lots of data on the GP to respond, and, yeah, we aim to get as general a sample of a population as we can. Speaker A 00:03:18.800 - 00:03:40.000 And I think one of the really interesting things about this study is that you're not just asking how much GPs actually earn, but how much they think they should earn. And you mentioned about this paradox that you're interested in in terms of health economics, and I wonder why you think that distinction is important between actual earnings and sort of relative earnings or how much people think they should earn. Speaker B 00:03:40.990 - 00:04:21.630 So I guess with a lot of things in life, and obviously from this economics paradox, a lot of things are not. It's not necessarily what you have. Absolutely. A lot of it is driven by things like peer comparison, or if you're seeing that someone else is getting paid more for doing what you believe is like, similar amount of work or similar quality work to you. So the idea of pure comparison's always just been like, important and there's lots of data out there and lots of studies looking at sort of the effect of absolute income. And this just felt like another relevant dimension to explore, basically. Speaker A 00:04:22.190 - 00:04:33.710 So I guess if we just come on to sort of the big finding. And what did you find when you looked at actual income and GP job satisfaction? What was sort of the main headline here? Speaker B 00:04:34.220 - 00:05:21.850 So, for job satisfaction, we, like, we find absolute income matters quite a lot and it has higher absolute income lead generally associated with higher job satisfaction across most, if not all domains. And for job satisfaction, absolute income matters a lot, but we found that absolute income didn't seem to have any statistically significant association with intentions to quit. So we asked them whether or not they want to leave direct patient care within five years or leave medical work entirely in five years. And we found that absolute income didn't have enough, didn't have a statistically significant association with that. Speaker A 00:05:22.170 - 00:05:41.410 So that's quite interesting, I guess, and it's a bit surprising, really. So higher actual income wasn't really associated with intentions to quit, but paying gps might make them more satisfied, but doesn't make them necessarily mean they'll stay. What do you make of that? It's kind of an interesting finding with. Speaker B 00:05:41.410 - 00:06:00.300 Job satisfaction that's obviously kind of in line with what we would expect. Intentions to quit, maybe it's just. It's a surprising finding. We would have expected it to have an effect on intention to quit, especially given that job satisfaction, intention to quit, go together. So it's a little contrary to what we might expect. Speaker A 00:06:00.940 - 00:06:17.100 I think it's quite an interesting distinction, I guess, because I guess sometimes in workforce discussions, we sometimes think about pay as one answer to recruitment and retention problems. And I think what this work is showing that maybe the picture is a little bit more complicated than that, actually. Speaker B 00:06:17.420 - 00:06:18.540 Yeah, I completely agree. Speaker A 00:06:19.100 - 00:06:27.420 So I wanted just to move on to some of your other findings. So you found something interesting when you looked at expected income. So can you talk us through that as well? Speaker B 00:06:27.920 - 00:07:00.990 So we find that higher expected income is associated with lower job satisfaction, and we actually find that has a small but positive effect on intentions to quit. So higher expected income has a small association with higher intentions to quit. I think there's obviously rationale for this. Obviously it kind of goes along with the economic theory and what studies have found in other domains with things like worse mental health, with higher gaps between actual and expected income. Speaker A 00:07:01.070 - 00:07:15.230 Yeah. So if I'm understanding that. Right, it's not simply that earning less makes you unhappy, it's about the gap between what you earn and what you feel someone else with your experience and career stage ought to be earning. So do you think that's a fair way of thinking about it? Speaker B 00:07:15.230 - 00:07:57.860 I think that's a very fair way of characterizing it, yeah. Basically, if you feel that you should be earning more, even if you're on, like a salary that, say, is pretty good, or they do things like pay the bills, if you feel that you should be earning more for the stage of your career, you're at the training you've had. I mean, gps are, obviously, they have to go through a lot of training through med school, and GP training itself is quite intense. And there's a lot of hours they have to work. So all of this builds into income...

Today, we’re speaking to Dr Jasjot Saund, a public health registrar based in London. Title of paper: Association of the NHS Health Check with all-cause mortality: a longitudinal cohort study in primary care Available at: https://doi.org/10.3399/BJGP.2025.0451 The NHS Health Check (NHS-HC) has been shown to improve detection and management of surrogate markers of health, such as blood pressure and cholesterol. The long-term impact, however, is less evidenced, with mortality reductions seen in a UK Biobank cohort and no mortality reduction seen in a Cochrane review of general health checks, including those outside the UK. The current study added real-world evidence from a diverse UK urban population, and a 15-year study period. Survival analysis of GP electronic health record data shows reduced mortality in those who attended an NHS-HC compared with those who did not. These findings should be interpreted cautiously given the observational nature of the study design. Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:01.440 - 00:00:58.570 Hi and welcome to BJGP Interviews. I'm Nada Khan and I'm the senior research editor of the Journal. Thanks for taking the time today to listen to this podcast. In today's episode, we're talking to Dr. Jazjot Sound, a public health registrar based in London. We're here to discuss the paper she's recently published here in the BJGP titled Association of the NHS Health Check with All Cause Mortality, A Longitudinal Cohort Study in Primary Care. So thanks very much for joining us here today, Jazja. It's really great to talk about this work and I think just before we get into the study itself, we know that NHS health checks are something that most GPs will probably be very familiar with, but maybe we don't always stop and think about the evidence behind them. So, just to start off, I wonder if you can explain to us a little bit about, about what the NHS Health Check program is actually designed to do. Speaker B 00:00:59.050 - 00:02:16.370 Yeah, absolutely. So the NHS Health Check program was rolled out in 2009 and it's essentially a population level preventative initiative, focusing particularly on cardiovascular disease, but potentially wider as well. And so it's specifically targeted at people who are between the ages of 40 and 75 and who don't already have a, a cardiovascular disease or a known cardiovascular disease. And I think that's really important because it's targeting people who are potentially at risk or have undetected disease. And what this means is, so ultimately the health check itself, it consists of a check that's usually undertaken by primary care, so looking at lifestyle factors, modifiable risk factors, biochemical tests, as well as sort of just other general checks. And importantly, this is embedded into primary care pathways. So essentially it's ensuring that these patients are followed up if they are determined to be high risk and potentially put on prescriptions or followed up with lifestyle modifications. So that's generally what the health check is at the moment. Speaker A 00:02:16.690 - 00:02:31.070 Brilliant. Yeah. And I guess the big question behind this paper is, do they actually make a difference? And I wonder what did we actually know about the impact of NHS health checks before you started this work? So what was out there in the literature already? Speaker B 00:02:31.550 - 00:04:07.320 Yeah, so there is a, a huge amount of evidence in different parts of the health check. So you might be aware already that it's a multifaceted intervention. So there's, there's the process bits like uptake and invitation. So there's a big amount of evidence that's been telling us that it's really important that we even just the method of invitation can be really influential on who takes up the health check. But then there's also the specific parts of the check itself. So how we communicate risk to patients, for example, can have an impact on how people go home and take on lifestyle advice. And then there's the body of evidence that's closer to where this paper sits, which is looking at clinical outcomes. And there is a whole body of evidence looking at surrogate markers, so things like does it shift the marker on blood pressure or bmi. And then there's the evidence on mortality, for example, or clinical endpoints such as stroke. And so far the evidence is predominantly positive to say we do see a change in clinical outcomes. And more recently, there was a paper in 2024 which was using a UK Biobank cohort and shows that there was an impact, a positive impact on disease, end stage disease, as well as mortality. But as the paper sort of addresses, there's some gaps in this evidence, which is what we. What we hoped to fill. Speaker A 00:04:07.560 - 00:04:25.280 Yeah. And I guess I wondered if you could just talk us through the data used for this study, because this was a really large real world cohort from an inner city London population, wasn't it? So very different than the kind of population that might, for instance, have taken part in UK Biobank? Speaker B 00:04:26.240 - 00:05:17.420 Yeah, absolutely. So we thought it was really important to look at whether or not the health check was having an impact as it was being delivered in a real world population. And so we were lucky enough to look at a cohort going all the way back to when the health check was implemented in 2009 in Lambeth, which is a really ethnically diverse and socioeconomically diverse cohort. So, for example, we have a population in lambeth that is 40% non white, as opposed to, I think the UK Biobank participants were 96% white. So there's a real difference. And so we wanted to ensure that the population we looked at was representative of some of the inner city boroughs that have particular challenges around NHS health check uptake. Speaker A 00:05:17.660 - 00:05:27.330 Okay, so let's get into what you found. And what was the headline result when you compared people who attended at least one NHS health check with those who didn't? Speaker B 00:05:28.120 - 00:05:53.320 Yeah, so the headline result actually showed that there was a 32% relative risk reduction associated with the health checks on all cause mortality. So that's looking at any cause of death, but shows quite an impressive risk reduction. So that is a relative risk reduction as opposed to absolute. So it's important to note that overall the absolute rate of survival was high,. Speaker A 00:05:53.750 - 00:06:03.670 And that's pretty Striking, actually. So that substantially lower risk of all cause mortality, were you surprised by the size of that association? So 32% is quite big, isn't it? Speaker B 00:06:03.750 - 00:06:33.490 I think initially I was surprised, but then looking back at the evidence and the data that's already out there, it does fall in line with kind of what we were seeing, particularly in the UK Biobank cohort as well. I think there is sort of evidence that potentially looks at general health checks, which has shown a converse picture. But as we discussed in the paper, it's really different to how the NHS health check is delivered here. So that's definitely something to bear in mind. Speaker A 00:06:33.810 - 00:06:45.250 And you also looked at absolute mortality risk over 10 years and the difference seemed to be really pronounced with increasing age. So could you talk us a little bit through what you found there? Speaker B 00:06:45.650 - 00:07:39.440 Yeah, so we found that although the older population had a. A higher absolute risk reduction, they also had a higher absolute baseline risk of death as well. So it's really difficult to distinguish whether or not that finding was related to the health check being more beneficial in older patients or whether or not actually we see a bigger absolute reduction, because in our over 65 population there is a higher baseline risk of, of death. I think we, like, when looking back at the data population who was enrolled in 2009 at the youngest possible age were 40. And even though we had 14 years of follow up, they would only be 57 years old at this point now. So their absolute risk of death is still very low, which might be more difficult to pick up in a study like this. Speaker A 00:07:39.760 - 00:08:10.860 Yeah, fair enough. And I guess, you know, whenever we look at observational research, I suppose the question is whether people who attend an NHS health check are somehow different than people who don't. And that's, you know, in parallel to the studies. For instance, you know, just focusing on UK Biobank, it's sort of a different population really. And I guess people who attend a health check could potentially be more health conscious or more likely to engage with healthcare. Anyway. How did you try to account for that in this work? Speaker B 00:08:11.100 - 00:09:45.530 Yeah, and that's a really important point to pick up and something that's really challenging in observational data in general. But so, yeah, we really wanted to make sure we tried to adjust or account...

Today, we’re speaking to Dr Emma Ladds, a GP partner and DPhil candidate at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. We’re here today to discuss the recent article she and her colleagues have written for the journal, titled, ‘Ambient scribes in general practice — help or hindrance?’ Title of paper: Ambient scribes in general practice — help or hindrance? Available at: https://doi.org/10.3399/BJGP.2026.0097 Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:00.320 - 00:01:15.600 Hi and welcome back to BJGP interviews after our summer off. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for listening to this podcast today. In today's episode, we're talking to Dr. Emma lads. Emma is a GP partner and a DPHIL candidate at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. We're here today to talk about the recent article that she and her colleagues have written for the analysis section of the Journal. And the article is titled Ambient Scribes in General Practice. Help or Hindrance? So, hi again, Emma. It's lovely to speak to you about this work. And I think one of the reasons we were interested in picking up this article is that it's really highly topical and it's in an area that I think a lot of people are wondering what to do in their day to day practice. And I think that some of the issues that you've highlighted in the article do speak to some of the concerns that people are raising, but also some of the challenges with the implementation in practice. But I guess before we get onto some of the issues that you raise in the paper, can you just explain what we mean by an AI or ambient scribe? Speaker B 00:01:16.160 - 00:01:45.660 Well, it's the technologies based on artificial intelligence that detects conversations, so between the patient and gp, or between GP and other colleagues. And in consultations, it then generates a summary of what's been discussed, but also does some other things as well. So, for example, it might add some coding labels for specific things that are mentioned, and then all of that goes into the patient's electronic health record. Speaker A 00:01:45.980 - 00:02:15.130 And I think that these tools are often presented, at least to some of the GP colleagues that I know and work with, as almost like an obvious win for general practice. So less documentation, more efficiency, and maybe more time with patients. But what made you want to just take a pause and think about some of the assumptions behind some of those quick wins that people might be thinking about, thinking about. Speaker B 00:02:15.450 - 00:03:31.980 And I mean, I think it's interesting, isn't it, because ever since we started to introduce different technologies into the consultations, there's often been an assumption that every new thing would be a quick win. And even since the introduction of the computer, you make for greater efficiency and it will be easier to store data, to retrieve data, to share data, et cetera. And of course, a lot of the time what those technologies do is they drive particular activities. I think it's been interesting just to think about how introduction of different technologies and platforms and digital approaches has driven a much more transactional, quantifiable way of working. And those things that can be recorded and can be captured in technologies or enabled by technologies have been promoted, perhaps at the expense of some of the less quantifiable, more nuanced activity. So suppose it was looking at that journey of technologies and just trying to think about what this next step might also add to that picture. Speaker A 00:03:32.220 - 00:03:41.820 And one of the things you talk about in the article is that AI scribes could create what you call false efficiencies. But can you unpick what you mean by that? Speaker B 00:03:42.300 - 00:04:53.150 I think there's this assumption that actually the summaries and the codes that AI scribes will generate will be very time saving for gps. And no GP ever has enough time. So everybody's looking for, as you put it, the quick wins. And some of the challenges with the outputs from AI inscribes are that they often produce very long transcripts because they're trying to capture a summary of everything that was discussed and that gets entered into the record. And obviously it takes time for subsequent clinicians to look through those kind of summaries. So that could be a fold sufficiency. But also, I mean, it can add false labels or generate errors and that requires checking as well. So it's not that it just produces an accurate summary and then that's out there. Actually, the clinician still has to go back and double check that everything's been done correctly. So even though they don't have to do the actual typing, there's still a level of processing that they have to do of that summary. So it's not necessarily a time saving tool, really. Speaker A 00:04:53.630 - 00:05:15.390 And I think that's one of the interesting things about it because, yeah, there's that interesting point that, you know, GPS might be getting that time back in some other way, but I guess that's highlighting that that might not actually be quite that simple, that the time that you might get back from not having to type out the notes from a consultation is actually being used elsewhere. Speaker B 00:05:15.390 - 00:06:20.920 Actually, I think that's very true. And I think the other thing that's worth thinking about is what's in the notes, the actual information that's there. Yes, it's a summary of the consultation, but actually generating that summary when the clinician does it, there's a level of processing, there's a level of sort of cognitive thinking, of reflection, of thinking about what it was that was happening during the encounter between patient and gp, what was actually being said, or a lot of the time, what was not being said, and the AI scribe won't detect that. And a lot of clinical reasoning sometimes happens for gps, sometimes happens behind the scenes when they're doing that retrospective processing. And as one of my colleagues said, you know, she often thinks about other investigations she'd like to add or things that she might not have made overt to the patient, which perhaps need to be made over to the. So it's those sorts of subtleties that aren't captured in just a very superficial representation of a consultation. That's the content of a consultation. Speaker A 00:06:21.720 - 00:06:53.030 And I think that struck me that taking notes isn't simply an administrative task, it's actually part of clinical thinking. And I certainly, I've tried AI scribes, but how I do my consultations is I write on a piece of paper because I think that's how I process it, and then I move from the paper to the notes and that's part of how I work through the problem. And I guess that's what you're getting at here just in terms of sort of the clinical thinking about actually putting the notes onto the record. Is that what you're saying? Speaker B 00:06:53.350 - 00:08:00.370 Yeah, I think that's right. And I think it's a reflection about how we all develop as individual practitioners as well. I mean, the way you do your consultations may be slightly different to the way that I do my consultations, and the way that you write your notes may be slightly different to the way that I write my notes. But I think often when you've worked together with people for quite a long time, you learn hidden meanings and you pick up that they may phrase things in very particular ways and that conveys a deeper level of meaning to you because of that kind of relational knowledge that you have of your colleagues. So for example, if I write one consultation in my note, my partners know that it was an extremely long consultation that was probably quite circular. We probably didn't come to a very conclusive outcome and probably the patient is going to want to come back and see me again rather than one of them. You know, there are these subtleties in communication that actually at the moment the AI scribes aren't good enough or nuanced enough to be able to detect. And I don't know if they'll ever get to that kind of level of something. Speaker A 00:08:01.130 - 00:08:28.010 But I suppose an AI scribe is never going to really capture clinicians voice, is it? And I think that's what I see when I see some colleagues who are using AI scribes that the. There seems to be quite a lot of detail there which is great, but it doesn't have that clinician's voice in it. So it's hard to really unpick some of the hidden meaning behind sort of what's going on there. And I think that's why I don't use it, because I don't feel it reflects my thought process when I'm going back to look at notes. Speaker B 00:08:28.150 - 00:09:41.210 Yeah, yeah, no, I think that's exactly right. And I think it's extremely good at trans. At sort of capturing transactional interactions and transactional material. And I think that during my detail, I was observing a GP using one of the

In this episode, we look back at the last season of the BJGP podcast and reflect on some of the work we’ve discussed. Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:00.560 - 00:11:08.620 Hi, and welcome to the BJGP podcast. I'm Nada Khan, one of the associate editors of the Journal. And we've reached the end of another podcast season, and before we take a short break for the summer, we thought we'd look back at some of the papers we've covered and pick out a few highlights and common threads between them. And looking back at the different podcasts over this this past season, it seemed that although each conversation started with a completely different research question, by the end we all seemed to be talking about the same thing, and that was, how can general practice work better for patients in today's increasingly complex healthcare system? And although we talked about a wide range of different topics, we covered cancer diagnosis, dementia, women's health, medical education, and we even talked to Garth Funston about artificial intelligence. They all came back to this same underlying challenge. And we know that general practice has always dealt with complexity, and that's not really anything new, but the kind of complexity we're dealing with now feels different. Patients are living longer with multiple conditions. Care is spread even more so across increasing numbers of services than ever before. Technology is changing the way that we work, and somehow, amongst all that, we're still trying to preserve those relationships that have always sat at the heart of general practice. And I think another thing that really struck me was that very few of the papers and researchers were talking about making dramatic changes. And instead we had a lot of discussions about how we could make systems we already have, just work a little bit better. So making it easier to navigate, getting people more connected, more equitable, and more human as well. So one of the first interviews we recorded was with Katharina Savolkul about why medical students choose or don't choose a career in general practice. And on the surface, it's comes across a bit like workforce paper. We know that we need more gps, and understanding career choice is clearly important, but I think we talked about something a little bit bigger, which is, what kind of profession are we asking people to join? And this review highlighted positive GP placements, so good role models and the hidden curriculum as well. And although we often focus on recruitment targets, Katharina reminded us that students choose career because of the experiences they have and the values that they see lived out. And interestingly, continuity of care remains one of the biggest reasons people are still drawn towards becoming GPs, even though many of us worry that that's becoming harder to achieve in practice. And I think that continuity became one of those defining threads that ran through a lot of the interviews that followed. And we had Ewan Lawson join the podcast to speak to Charlotte Morris about dementia care. And what they talked about was that participants weren't really asking for more investigations or different medications. What they wanted to feel was to be known and to have someone who understood who they were before their diagnosis recognize those changes over time and stayed alongside them as their condition progressed. And I guess listening to that interview made me realize that it's not just about seeing the same gp, but it's about patients feeling that someone is carrying the thread of their story over time. And I had a really similar feeling talking to Dr. Tory Ford about recurrent vulvovaginal thrush. And these were two qualitative papers about diagnosis and healthcare experiences. But I think by the end of the interview, we were talking about something much broader. And as clinicians, we think sometimes about those bite sized consultations, but patients don't at all. At least this was the experience that I think that we drew out from Tori's work. And in this work, I think Tori highlighted that people experience illness as a continuous journey. And although in a system where continuity of care might be challenged, clinicians might see episodes of care, but patients live their whole story. And I think that's why sometimes recurrent conditions can feel so frustrating for patients, not because, particularly those individual episodes of care consultations are poor, but because if there's discontinuity, no one's joining those consultations together. And I think the more interviews we recorded, I pulled out another pattern, and that's that whether we're talking about dementia, recurrent thrush, pediatric safety or postnatal care, patients and families were doing a lot of work. So an extraordinary amount of invisible work, they were chasing referrals, following up on test results, explaining the same story repeatedly to different professionals. And although these papers weren't a criticism of general practice, and oftentimes many of the patients talked about how much they valued their GP teams. But I think that it almost made it feel as though patients and families were bridging these gaps together between increasingly fragmented services. And I think that Tom Purchase's work on pediatric patient safety really captured this beautifully. So rather than seeing patients just as recipients of health care, his study showed that they're active contributors to safer care. So they're already preventing harm. Patients and their families are identifying problems and improving systems. And I think he challenged us to think about patients as partners in care, rather than just recipients of care. Another theme that kept surfacing was inequality. And I spoke to Eliza Hutchinson about her work in inflammatory skin disease in People with skin of color. And her participants talked about delayed diagnosis, underrepresentation in medical education, and that impact of dyspigmentation as well in practice. And I think, again, what stayed with me wasn't just the clinical message, which was really helpful, and I'd encourage gps to go back to listen to that, but it's how often people really just wanted their experiences to be recognized. And similarly, I think that Claire MacDonald's work on postnatal care reminded us that women with the greatest social needs are often face the biggest barriers to access and care after birth. And ironically or sadly, this is just as services begin to step back. And I guess these two papers were asking a much broader question was how do we design healthcare systems that work equally well for everyone? And I think one of the papers that I really enjoyed, or one of the people I really enjoyed talking to, was Garth Funston and his work using large language models to analyze free text consultation records, aiming to pick up earlier signals for ovarian cancer. And I think that, you know, we. We talk a lot about artificial intelligence, but actually what we ended up talking about was how we record things in consultations. And as gps, we write huge amounts that really never get coded as read codes in the system or snowbed codes, you know, symptoms, concerns, uncertainty, those details that really make up the richness of a consultation. And I think that what Garth's work showed us was that AI might help us make better use of the information we've already recorded. But I think that actually, you know, it's worth thinking about how we're actually using technology to help recover the stories we've already written in the free text as well. And the last thing that we talked about in this season was something that probably every GP understands instinctively, but few of us have actually been explicitly taught, and that's prioritisation. And we spoke to Andrew McClary about the rapid decisions we make every day. So which patient do we call first? What referral can wait? And crucially, what do we do first? Do we tackle the difficult task or go for the quick wins? And I think that I liked the title of his work, because I suspect every GP probably immediately recognized them themselves somewhere between these two approaches. And I think we also touched upon that prioritisation isn't simply about managing workload, but it's also about managing uncertainty. And I think that if there's one thing I'll take away from this entire season and the different people that we've talked to and the great work that we've listened to, I think it's that general practice has always been about managing complexity. But these conversations reminded me that complexity isn't something we can just eliminate or fix. It's something that it's worth delving into to try to understand a little bit better. And I think, you know, whether we're talking about continuity, inequalities, patient safety, or the workforce force, another common thread I thought that ran through these, these conversations was that connection. So connecting services together, connecting research with everyday practice, and staying connected to patients and the stories that they bring with them through time, really. And I guess for me, really, every interview this season left me thinking a little bit differently about how I, how I consult and practice and about that...

Today, we’re speaking to Andrew McClarey, who works as a GP and Education co-ordinator Lead for General Practice in the Scottish Centre for Simulation and Clinical Human Factors. Title of paper: “Quick wins” vs “eating the frog”: Exploring general practitioners’ prioritisation dilemmas Available at: https://doi.org/10.3399/BJGP.2025.0628 Link to tactical decision making games: https://archive.johs.org.uk/article/doi/10.54531/svvw4195 This is the first study to look at the factors which experienced GPs consider when prioritising their acute workload. Several themes have emerged which highlight the importance of prioritisation training in General Practice. These themes could be used to teach prioritisation decision making to GP registrars or in the creation of continuing professional development resources for experienced GPs. Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A 00:00:00.400 - 00:00:56.560 Hi and welcome to BJ GP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for listening to this podcast today. In today's episode, we're speaking to Dr. Andrew McClary. Andrew is a GP partner and he also works as Education Coordinator, Lead for General Practice in the Scottish Centre for Simulation and Clinical Human Factors. We're here today to discuss the paper that he's recently published in the bjjp. And the paper is titled Quick Wins versus Eating the Frog, Exploring general practitioners Prioritization dilemmas. So, hi, Andrew, it's really nice to meet you. And this paper really stood out to us, I think, because prioritisation is something that gps do every day, but it's not really something that we discuss explicitly. I'm just interested in what made you do this work and made you interested in studying it. Speaker B 00:00:57.200 - 00:02:00.600 It's interesting, I think, that for me, I finished my GP training just after the pandemic and therefore I did a lot of my training during the COVID pandemic. And around then the face of general practice, like most things in life, changed completely overnight. We moved on to telephone consulting and being encouraged to have empty waiting rooms. And I think around the same time we realized that we probably couldn't continue doing what we had been doing, which was being everything to everyone, which brought us on to prioritizing our workload. We have to decide who needs seen, who does not, and when are they seen. And that was a real gap for me in the training that I was provided. And I found myself going into working as a fully qualified GP without really an awareness of how to prioritise in a, in a sensible way. And I think that's where this interest was born out of. Speaker A 00:02:00.760 - 00:02:42.050 And before we get into what you found, it's probably worth saying a little bit about how you approach the study. So this was a qualitative interview study involving gps from a range of practices and career stages. And what you did was you really explored how they prioritized work during the course of a typical surgery. And then I guess through those interviews you looked at sort of the strategies and influences and trade offs that shaped those decisions in everyday general practice. But one of the things I found really interesting was that prioritization wasn't just about clinical urgency. And I wonder if you could talk through some of the other factors that GPs are weighing up quickly, I suppose, when they're deciding what to tackle first. Speaker B 00:02:42.690 - 00:06:17.800 Absolutely. It was very interesting, the themes that emerged from the data and also actually how much agreement There was amongst the gps in the focus groups, as we're not traditionally a group of people who agree about very much. So one thing that GP is particularly interested in, there's five main themes. One is about the system awareness. So we're aware about our own surgeries and where the pressure points are. For example, we're low on particular acute slots today, or there's a certain type of patient that is coming in more frequently at the moment, so we're aware of that. But it's not just having that awareness, it's also being able to adjust how we consult based on the pressures that the system are under. For example, if there are a lot of children or fevers coming in, we want to see them all face to face. We ask the admin team, just bring them all in face to face and we'll see them that way, rather than setting everything up over the phone. So it's not just an awareness of the system, but actually adjusting ourselves to that demand. Another one is the time management. What's the most efficient use of my time? How am I going to get out on time this evening for nursery pickup or whatever else I have to do in the evening? But it's not just our time, it's also the system's time. So what I mean by that is, I know if I try and refer to a hospital service in the afternoon, they'll probably be at capacity. If I do that in the morning, I am much more or first thing, except an afternoon surgery. I'm much more likely to have my patient accepted and managed in a way that I think is most appropriate for them. Also, third theme, familiarity with our patients. We are more familiar with our patients and therefore we don't have to go trawl through their histories. We know, right? I know that patient, I know what that's about. I spoke to them about it last week. Let's just phone them first and move on. That's an easy thing for me to do. Then relationships. Fourth theme, relationships with patients, in that we develop a trusting relationship, particularly if you've been working in a practice for a long period of time. For example, we might be able to have a conversation on the phone saying, well, are you as bad as you were the last time, for example, when you went to hospital with your copd? Is it as bad as that? Well, no, no, Doctor, not as bad as that. And you know these patients and you trust them to tell you the story like it is. But we also not only prioritise relationships with our patients, but also with other staff members. For example, if you're interrupted during a duty doctor session and it's the practice nurse who is needing help with something, that person is there in front of you. They're a valued member of your team and you want to be able to provide input for them in a timely way. And I guess that takes us back to system awareness. We know that that nurse has also got lots of patients to see, and if there's a delay in that, then the whole system is suffering from it. And then lastly, fifth is this idea of personal preferences. Some of us like doing hard things first, so that's eating the frog. Some of us like the quick wins and the endorphin release, of actually seeing all of the columns or all of the slots in the IT system changing a different color, we get a bit of a rush from that. There's no right or wrong answer with this, but actually a lot of it does come down to that. But it's also about looking after ourselves, but also balancing that against good patient care and what needs to be done first from a clinical urgency perspective. Speaker A 00:06:18.360 - 00:06:45.170 And the title of the paper is Quick Wins versus Eating the Frog. And I find that really interesting because from my own clinical practice, sometimes I feel like I'm telling myself off if I'm only taking off the easy tasks, because I know then at the end of the day I'm going to have all the long referral letters, the things that I've really been putting off. And I think, gosh, why did I leave it to this point, really? But I wonder if you can explain what that means a bit more generally, and why it captured something important about GP decision making. Speaker B 00:06:45.570 - 00:08:12.210 I think ultimately, for me, it's about when we are at the trainee stage. We are actually honest about how we approach prioritizing our workload. And I think ultimately that comes down to personality. Some of us like doing the more difficult things first, and then we feel that we've got the wind at our back and we're able to go on about our afternoon knowing that the most difficult thing in that list is done. In fact, the quote goes, eat a live frog first thing in the morning and nothing worse will happen you for the rest of the day. And I think that's probably paraphrasing a little bit, but I think that's the thing. If the worst thing is out of the way, the afternoon suddenly seems much better versus actually some of us need that endorphin release. And the highs, I guess, of actually seeing, feeling that we're going through our afternoon at a Good rate. And we are managing things well and some of us like that. But I think ultimately, if we can have that conversation at the trainee stage to say, look, you're either a frog eater or you're a quick winner and you have to decide which you are. And maybe actually you're at the point in your career where you have the opportunity to actually try these out. Say, right, we'll do the hardest thing first, how does that feel? Versus, you know, take off a few easy things, how does...

Today, we’re speaking to Dr Tom Purchase, a GP and Health and Care Research Wales NIHR doctoral fellow. Title of paper: Co-generating ideas for safer paediatric care in general practice with parents and stakeholders Available at: https://doi.org/10.3399/BJGP.2025.0690 Research has highlighted the important role parents play in in paediatric patient safety, for example, through mitigating safety incidents in general practice, yet their perspectives have rarely shaped system-level improvements. This study co-generated and prioritised ideas for change with parents and key stakeholders, identifying feasible and impactful strategies to improve paediatric safety in primary care. These strategies centred around practice communication, accessing care records and results, and fostering a culture of shared learning and development. Parents are willing and able to contribute meaningfully to safety improvement efforts, and their insights align with national patient safety priorities. Clinicians and policy makers can use these findings to strengthen collaboration with families, tailor safety interventions to local needs, and embed parent voices into the design of safer care systems. Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:00.480 - 00:00:49.500 Hello and welcome today to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for listening again to this podcast. In today's episode, we're talking to Dr. Tom Purchase. Tom is a GP and a health and Care Research Wales NIHR Doctoral Fellow. We're here today to talk about the paper he's just published in the bjgp and the paper is titled Co Generating Ideas for Safer Pediatric Care in General Practice with Parents and Stakeholders. So, hi, Tom, it's really great to meet you and to talk about your work, but before we talk about the study itself, I'm interested to know what first got you interested in pediatric patient safety in general practice. Speaker B 00:00:50.060 - 00:02:26.850 Thanks. It's born, I think, out of an extension of the work that we've been doing within the patient safety team within Cardiff University. So a lot of what we do is looking at incident reports, safety incident reports, and trying to pick out what are the, you know, high level key learning points and takeaway messages from those. And then within the team, we started to think about, as well as the types of incidents and the types of harms that are occurring within pediatric incidents. For example, how are parents involved? And it was a bit of a novel approach to what we normally do, trying to have that extra aspect within the incidents and figuring out how parents were either helping to contribute or to mitigate against the incidents, not just looking at the incidents themselves. So that was the starting point, really. And then once we'd started digging into that data and identifying that, actually the majority of the time, which is in one of the papers that was published last year in BJGP, 77% of the reports we were looking at specifically around general practice showed that parents were taking these mitigatory actions that, you know, positive actions that were able to prevent harm or further harm from occurring to their child, for example, chasing results or chasing referrals or importantly, being able to speak up. And then that highlighted, I think, the importance of parents being able to have a voice and advocating on behalf of their child. And that really sparked, I think, the interest, and therefore this part of the. Speaker A 00:02:26.850 - 00:02:46.490 Project, and I think that's a really interesting thing about this paper, is that it focuses on parents and parents not just as observers of care, but as active contributors to safety. And I wonder what your thoughts are about why that's an important shift in how we think about these things. I think you've touched on it a bit, but yeah, I'm interested to know a bit more about that. Speaker B 00:02:46.810 - 00:03:55.980 I think it is a really important aspect of care, but also particularly safety, which maybe is untapped in terms of parents as a resource as to how we can keep children safe. We know that children on the whole are more, maybe not more vulnerable, but certainly are a vulnerable group when it comes to patient care in general and patient safety. And that's because they're so heavily reliant on others to speak on their behalf, to make sure somebody else is looking out for their healthcare needs. And therefore they are probably playing a part within the world of patient safety. And there are good studies from hospital relating to incident reports that show that parents are capable of picking up issues early on. They're able to detect issues that maybe other parts or people within the system aren't detecting. And as I mentioned, our paper from last year specifically looking at general practice showed that parents are able to prevent harms from reaching their children. So they're playing a substantial part already. And from a systems perspective, that is mainly parents figuring out workarounds within a system that really isn't, I don't think, designed to support them as well as it could be. Speaker A 00:03:56.460 - 00:04:33.810 And I guess that's kind of the crux of what you were doing here. So I guess before we get into findings, just, you know, a quick word about the methods because you worked here with groups of parents to develop ideas for improving pediatric patient safety in, in general practice, in primary care, and then you explored those ideas with a wider group of stakeholders and that included clinicians, managers and policymakers, and then brought them all together to co generate ideas for safer care. And it was really interesting because the parents generated 16 different ideas for improving safety. And were there any that particularly surprised you and jumped out at you? Speaker B 00:04:34.450 - 00:05:33.980 I don't think necessarily any were too surprising on the basis that we. I don't think I really had any thoughts going into it as to what they might say. But I guess what did surprise me more was that some of the ideas that we then took forward to the stakeholder group kind of highlighted some disparities or some clear disagreements between the parents who were accessing our services and the people who work within the services. And how we viewed, I suppose, viewed what's actually happening, that kind of work is imagined and how we think things are going and the work is done. I guess what the parents were trying to do to come up with the idea is to bridge that gap unknowingly. I suppose maybe what's surprising is that none of them, I didn't think any of the ideas were necessarily too resource intensive. You know, I think what was quite reassuring is that lots of what the parents were saying were actually relatively simple things that we might be able to enact or at least adopt or adapt, you know, to our own environments. Speaker A 00:05:34.540 - 00:05:47.730 And a lot of the ideas seem to center, I think, around communication, access to records and test results, and actually just helping parents to speak up. And why do you think those themes emerge so strongly? Speaker B 00:05:48.450 - 00:07:24.990 I think that comes back to maybe that difference between how we like to think the system's functioning and how parents think the system's functioning as healthcare professionals and parents. Because we know from a thematic analysis we did, which is also going to be published in bjgp, from these discussions we've had with the parents, that a lot of them said they felt the need to fight in order to be heard. So although within, say, pediatrics and GP training programmes and CBDs and everything we have to do for revalidation, taking ideas, concerns, expectations, collateral histories, making sure we're really considering that the holistic approach is all considered clinically, what you're then getting, I suppose, from the parents is that maybe we're not doing it as well as we could be. And one parent within the workshop said, I know as a parent you are expected to advocate for your child, but what it surprises me is how regularly you have to do it and sometimes it feels like a full time job. And I think that one really struck a chord in terms of really emphasizing how much extra effort and how much work parents are feeling they need to put in. And I think that also implies that the system isn't making it as easy as possible for them to be able to do the right thing. So I can't necessarily explain unfortunately why they feel that those areas needed to be targeted. I guess it's because there are barriers that we are not tackling correctly in order to help parents to speak up more efficiently and certainly to be listened to. Speaker A 00:07:26.840 - 00:07:35.160 And one of the stakeholder priorities was this idea of a designated parent advocate. Can you tell us a bit more about that idea and why it resonated? Speaker B 00:07:35.640 - 00:09:21.810 Yeah, sure. I really liked that one and I thought it was an interesting one because again, it...

Today, we’re speaking to Dr Garth Funston, a GP and Clinical Senior Lecturer in Primary Care Cancer Research at Queen Mary University of London. Title of paper: Using large language models to identify pre-diagnostic clinical features of ovarian cancer from healthcare records: a population-based case-control study Available at: https://doi.org/10.3399/BJGP.2025.0366 Most women with ovarian cancer present with symptoms, but many symptoms are recorded only in free text healthcare records and missed by studies and clinical decision support tools that rely on coded data. We found that using large language models (LLMs) to extract symptoms from free text records substantially increased symptom detection and strengthened associations with ovarian cancer. Incorporating LLM-extracted symptom information into research and clinical decision tools may support identification of women at higher risk of cancer and aid appropriate investigation. Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:00.800 - 00:00:50.940 Hi and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for listening to this podcast today. In today's episode, we're talking to Dr. Garth Funston, who is an academic GP and clinical senior Lecturer in Primary Care Research at Queen Mary University of London. We're here to talk about his recent paper in the BJDP which is titled Using Large Language Models to Identify Pre Diagnostic Clinical Features of Ovarian and Cancer from Healthcare Records. So, Garth, thanks so much for talking to us again today, but I wonder, just before we get into the AI side of this paper, can you briefly explain the clinical problem you're trying to address here with ovarian cancer diagnosis in general practice? Speaker B 00:00:51.500 - 00:01:55.010 So most women with ovarian cancer are diagnosed after they develop symptoms and see their doctor. The challenge is that most symptoms are really non specific. There's no real red flag symptoms for ovarian cancer. That makes it a real clinical challenge for the GP to kind of recognize it and perform tests. So the symptoms are things like abdominal and pelvic pain, persistent bloating, urinary urgency and frequency, things that we see really frequently in gp. So knowing when to consider ovarian cancer is the big challenge. And we know that certainly a proportion of women see their GP multiple times before the diagnosis. Now we're lucky for ovarian cancer in that we have reasonably good triage tests and CA125 and transvaginal ultrasound. So the challenge really is to identify women with these non specific symptoms early so as we can work out who to test and hopefully improve early diagnosis and on outcomes in that way. Speaker A 00:01:55.250 - 00:02:14.530 Yeah, and I'm sure you're well aware of sort of the body work around this area and people like Willie Hamilton, who's done work around early diagnosis of ovarian cancer, along with Claire Bankhead, and they did some really interesting work around things like bloating, didn't they? But that was slightly different, I think, and a little bit that's some time ago now, isn't it? Speaker B 00:02:14.930 - 00:02:39.230 Yeah, it was some time ago. I think all of that is, you know, fundamental and still holds true. And they did a lot of work around things like IBS and in women over, over 50 and things like that that are kind of these subtle signs that we need to be aware of with ovarian cancer. So, yeah, we know there's lots of features that are associated with ovarian cancer, but it's recognizing when to invest to get those features because they're so common. Speaker A 00:02:39.630 - 00:02:49.310 Yeah. And do you think that's why it's described as difficult to diagnose early in general practice? Is it because the symptoms are so common? What are your thoughts on that? Speaker B 00:02:49.390 - 00:03:48.750 I think there's a few reasons. I think ovarian cancer used to be called, certainly in the media, the kind of the silent killer and terminology, which I really, really frustrates me, because we know it's not. We know that most women of symptoms for diagnosis. We actually know that from this paper and other papers that are symptoms in early stage cancer. But that kind of thought around ovarian cancer still holds. Secondly, the symptoms are nonspecific, they're reasonably common. I mean, you know, I probably see a. A patient with abdominal pain most days and it's kind of working out which ones to investigate for ovarian cancer. Yeah. And so I think those are the main things. And thirdly, it's, you know, it's not the most common common cancer. GP will see people probably only encounter a case of ovarian cancer every three to five years, a new case. And that's the extra challenge. It's kind of suspecting it when it's a rare thing in primary care. Speaker A 00:03:49.100 - 00:04:03.500 Yeah. And one thing I found really interesting about this work is that you're using free text clinical records rather than just coded data. So can you tell us a little bit about the data you accessed here and why it was so important to use this free text data? Speaker B 00:04:04.220 - 00:05:09.600 So a lot of the work that we do with primary care data focuses on coded data and certainly within the uk, because that's really the data we can actually access within UK for research purposes. But up to 80% of clinical information is not in that coded format, it's in the free text. And work from people like Sarah Price in the past have shown that often subtle things that we need to pick up are in the free text and GPS don't code that. So it's something I've been really keen to use in research for many years now to try and look at what extra information is there in the free text that could help us in both research and clinical practice and kind of picking up these cancers. And the data we accessed was from the United States, it was from healthcare clinics associated with the University of Washington. And that included kind of coded data, but also the free text medical records of patients which had been anonymized and were accessed in a kind of a safe and appropriate way. Speaker A 00:05:10.000 - 00:05:40.140 Yeah. And I think a lot of clinical staff listening to this will certainly, certainly appreciate that a Lot goes into the notes that we just type in that doesn't really get coded. So it's phenomenal that you're able to access that data. And this paper uses large language models or LLMs, which some people might associate, associate with tools like ChatGPT, but just at a very basic level. Can you just talk us through what actually is a large language model and what sort of it was used for in this, in this study? Speaker B 00:05:40.950 - 00:06:49.130 Large language models, lots of people use them on a daily basis. Absolutely right. Things like ChatGPT, they're essentially a tool for our purposes which we use to extract information from the free text medical records. Now natural language processing approaches have been used actually for many years, kind of rule based approaches. Other models, these require lots of training. You need to lots of highly annotated records and notes to train the models. Advantage of large language models, things like GPT, is they need less annotated notes and we did still do some of that, but they require less and that makes them much easier to apply and use in practice. We use them in this setting to effectively pull out key information on symptoms. We predefined a list of 17 symptoms from the literature which were associated with ovarian cancer and we used the large language models to go through the notes, pull out information on those symptoms that we could use in the study alongside the coded data. Speaker A 00:06:50.090 - 00:07:03.350 And I think that as we've been discussing, these large language models are probably really useful for this kind of data. I think especially because a lot of general practice is narrative and contextual as we've been discussing as well. Speaker B 00:07:03.350 - 00:07:38.940 Yeah, I think, I mean there's two challenges with using free text data. One is access requirements because there's lots of concerns around confidentiality. The other is just the volume of it. You've got these massive records that you know, contain lots of information, lots of writing, go back years. How do you actually process that to find the key information that you need? I think large language models are a really useful tool here because with a bit of training you can use them to actually extract the information that's pertinent to your kind of question. Speaker A 00:07:39.340 - 00:07:48.620 So let's go into what you found and I'm really interested to know about what kind of patterns or features was this model able to identify before an ovarian cancer diagnosis. Speaker B 00:07:49.180 - 00:09:06.690 So we looked at 17, 17 features. We find actually that 14 of the features were more frequently recorded within the free text and coded...

Today, we’re speaking to Dr Clare Macdonald, an Academic Clinical Lecturer in General Practice based at the University of Birmingham. Title of paper: Complex social needs and maternal postnatal care: what can primary care do? Available at: https://doi.org/10.3399/BJGP.2026.0069 Throughout the discussion we use the terms ‘woman’ and ‘women’, but we know that not all those who give birth will identify as women and intend this to mean all those who give birth. Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:00.480 - 00:00:51.740 Hello and welcome to BJ GP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the Journal. Thanks for listening to this podcast today. In today's episode, we're speaking to Dr. Claire MacDonald. Claire is an academic clinical lecturer in general practice, and she's based at the University of Birmingham. We're here today to talk about the editorial she's just published in the May issue of the bjgp, and it's titled Complex Social Needs and Maternal Postnatal Care. What Can Primary Care Do? So, hi, Clare, it's lovely to meet you and to talk about this brilliant editorial, but before we get into the editorial itself, I wonder if you can just talk us through what you actually mean by complex social needs in the context of postnatal care. Speaker B 00:00:51.980 - 00:02:21.290 Yeah. So I think when we talk about social complexity in the postnatal population, we're talking about women who have multiple factors that might be influencing how they can access care or influencing the clinical and social risks that they have. So for most people, the time after they've had a baby results in some social change. Even in the most straightforward, most brilliantly supported, most physically well person, there are big social changes. And that is a period of a complex time to navigate and finding your way and your identity as a family with a new baby and so on. When we talk about complex social needs, we're talking about women who face other aspects of adversity. So it might be that they have housing instability, it might be that they have experienced domestic abuse or they continue to experience domestic abuse, that they have a history of safeguarding issues, safeguarding for themselves or safeguarding concern, concerns about other children or other family members. And when we see women who have overlapping social risk factors that produces this kind of network of complexity that puts them at compounded additional risk and they need additional help in navigating their health needs in that time. Speaker A 00:02:21.450 - 00:02:47.310 And I wonder why you felt that this was an important issue to highlight right now. So is there anything in particular that makes you think that this is the right time to sort of look into this? I know that there's a complex picture in terms of sort of maternal care, and if we look at things like the cost of living crisis, which is compounding a lot of the pressures that people are facing. But talk me through what your impetus was in thinking about this as a now issue. Speaker B 00:02:48.110 - 00:05:26.470 Yeah, that's right. So maternity services are really high profile in the news a lot at the moment, but from a secondary care perspective, and quite rightly, there's a spotlight on the poor care that some women and their families and their babies receive from secondary care. And there are, you know, huge pieces of work being done to improve that, to improve outcomes and to improve people's experiences. But that focus tends to be on intrapartum care. So the care that people receive in hospital around the time of birth, sometimes there's a little bit of focus on antenatal care as well and reducing risk during pregnancy, there's a lot less focus on what looks like the less exciting time of preconception care and then postnatal care. So after women get discharged from maternity services, we know that they're often left feeling a little bit isolated in the healthcare context. Some qualitative research that we've done in the past, looking at women's experiences of postnatal care, women told us that they were surprised about they'd had so many appointments during pregnancy and then so much healthcare retention in the first few days after birth, and then they were just surprised. No, you know, they had a baby and no one was really interested in their health anymore. And that genuinely came as a surprise to them. We know that maternal mortality in the uk, which, thankfully, in absolute numbers, is. Is quite small, but it's certainly higher than it could be and maybe should be, particularly compared to other kind of similar European countries. And there are actually more maternal deaths postnatally, so in the sort of later postnatal period, six weeks to a year after birth, than there are in that sort of antenatal, intrapartum and early postnatal period. And all of the political drive tends to be about reducing maternal mortality in its traditional definition of being up to six weeks after birth. But as GPs, where we can really have an impact is in those late maternal deaths. And of course, very few of us, thankfully, will be involved in the care of a woman who dies in that period, because they are small in absolute numbers. But there are all the women who do not die, but have those risk factors and have that complexity. And the longer they live with those sort of adverse health conditions and adverse social conditions, that is dramatically reducing their quality life course health. And we can really step in, in that postnatal period to look at how we can influence that. Speaker A 00:05:26.870 - 00:05:49.080 Yeah, and you've mentioned about the kind of care that women get in during their pregnancy. And sometimes, I'm sure for some women, the postnatal period can feel already pretty fragmented for those reasons. But how do you think that that fragmentation can become amplified for women with complex social needs? Do you have any thoughts about that? Speaker B 00:05:50.280 - 00:08:25.320 Absolutely. So a Lot of people will know how to contact their gp, right? I think if you ask people, most people have probably got that number saved in their phone or they know where their GP practice is. But after you have a baby, women are then given all these kind of new healthcare professionals who are interested and involved and it's impossible to know how that all fits together. So the midwife will typically follow women up for that kind of, you know, 10 to 14 days postnatally, usually just at the time the midwife is giving you the final sign off appointment. Within a day or two, you have an appointment with the health visitor, which again is somebody new, and then you might have a follow up. For example, if a woman's had a third degree tear or is having some additional hospital follow up because of hypertension or gestational diabetes, then the hospital are involved and then they come back to the GP. And I often feel like, for us as GPs, women, as soon as they're pregnant, they can generally self refer to the midwife and they get kind of lifted out of the primary care system to an extent. We might not see them through their whole pregnancy, then they have a baby, we might or might not get a discharge summary that gives us some details about the birth and then we invite them for their postnatal consultation and in that time, you know, they've had an entire pregnancy, a huge life changing event, and then we get to see them for this one appointment. And it's so complicated. Often for women who are not sure where they're going to get their next meal from, how can they be giving any kind of cognitive time to figuring out if the midwife told the health visitor and if the health visitor told the GP and if they're worried that their bleeding's gone on for a bit too long, do they try and phone the woman who came on Thursday or the woman who came on Monday, or do they come back to their gp? We're asking a lot and we also place a lot of burden on women to retell their story because information transfer is not always timely, it's not always sufficiently detailed. And again, for women who are living in more precarious social situations, that burden then of having to, you know, they're juggling and the, you know, the mental load of everything they're trying to figure out. And then we're asking them, can you remember if your blood pressure was high during your pregnancy? Whereas we should know that we should have that information from those other services. So that fragmentation in services really means that the burden is unduly placed on women to kind of patch that up. And we need to find a better way of dealing with that. Speaker A 00:08:25.640 - 00:08:38.260 One of the things I think that comes through really strongly is that some of the women with the greatest needs often face the biggest barriers, care. And what kind of barriers are we talking about here that these women are facing? Speaker B 00:08:38.980 - 00:10:06.270 The Embrace report, which is well, well worth a look at at least their infographics, I think for every gp, it's just a...

Today, we’re speaking to Dr Eliza Hutchinson, a dermatology registrar and academic clinical fellow based at the Centre for Applied Excellence in Skin and Allergy Research at the University of Bristol. Title of paper: Eczema, acne, and psoriasis in people with skin of colour: a qualitative UK-based study Available at: https://doi.org/10.3399/BJGP.2025.0720 This study is the first, to the authors’ knowledge, to explore the experiences of living with an inflammatory dermatosis specifically in people with skin of colour. We generated eight themes important to participants: delayed or missed diagnosis; preferences regarding healthcare professionals; lack of online information and social media use; misunderstandings in cultural communities; concerns about treatment and lack of research; complementary medicine use; experiences and impact of dyspigmentation; and challenges with structural racism. These findings offer insight into the complex experiences and challenges faced by UK adults with skin of colour living with eczema, acne, and psoriasis. Our practical points for primary care clinicians are a step towards facilitating mutual understanding and improving care for people with skin of colour. Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:00.560 - 00:00:53.150 Hi and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the BJGP. In today's episode, we're speaking to Dr. Eliza Hutchinson. Eliza is a dermatology registrar and an academic clinical fellow and she's based at the Centre for Applied Excellence in Skin and Skin Allergy Research at the University of Bristol. We're here to talk about the paper she's just published in the bjgp and the paper is titled Eczema Acne and Psoriasis in People with Skin of Color. A Qualitative UK based Study. So, Eliza, it's lovely to meet you and thanks again for joining us to talk about this paper. But before we talk about the paper itself, I'm just wondering what made you specifically interested in researching skin conditions in skin of color? Speaker B 00:00:53.550 - 00:01:34.700 Yeah, thank you so much for having me. So I think people with skin of color have been and still are massively underrepresented in kind of medical curricula, learning resources, clinical trials. And I certainly remember when I was at medical school, I don't think I had any teaching on diverse skin tones at all. And so it was as I sort of learned more dermatology, I just became very aware that they are so underrepresented. And I think earlier work in this area, I really tried to improve education for medical students and healthcare professionals around skin of color. That was kind of my starting point. And then I realised actually there's very little, if anything actually on the experiences of people with skin of colour, which is kind of what led me to this project. Speaker A 00:01:35.820 - 00:01:38.380 And you work in dermatology, is that right? Speaker B 00:01:38.460 - 00:01:42.300 Yes, yes, I'm a dermatology registrar based in the Bristol Bath area. Speaker A 00:01:42.540 - 00:02:06.890 Great. So it's wonderful to have your expertise in this especially. And we may get into this sort of about sort of your perspective from secondary care as well, looking back into general practice as well. But this paper focuses on eczema, acne and psoriasis and these are conditions that we see a lot as gps. So why did you feel that this was an important area to look at for people with skin of colour? Speaker B 00:02:07.290 - 00:02:41.470 Yes, I mean, as you said, we know that skin conditions are super common. They make up over 14% of GP consultations and eczema, acne and psoriasis are some of the most common inflammatory skin conditions we see and we know that they have a significant burden on everyone that experiences them. But I think particularly in people with skin of colour, we already know that these people experience kind of increasing things like Dispigmentation, so skin tone getting lighter or darker from their skin condition. And yeah, I think I just wanted to focus on some of the more common conditions that are seen kind of day to day in primary care. Speaker A 00:02:42.110 - 00:02:54.890 And this was a qualitative study and you emphasized that you really wanted to understand the experiences of people here. So talk us through a bit what you did. You spoke to people who had these conditions and had skin of colour? Speaker B 00:02:55.050 - 00:03:26.060 Yes. So we recruited using online methods for a couple of reasons, but really wanted to get kind of diverse range of experiences from across the uk. So we started off with an online survey and that was open to people of all skin tones. And we have written this up as a separate paper which should be out hopefully in the next few months. But based on these responses, we then kind of purposefully recruited people with skin of color to take part in an online one to one interview. And so we spoke to 20 different people with skin of colour as part of this. Speaker A 00:03:26.460 - 00:03:40.300 And I think one of the really interesting things that came out and is running as a strong theme through the paper is that skin conditions can present really differently in skin of colour. Can you explain a bit about what that means in practice as well? Speaker B 00:03:40.700 - 00:04:49.210 Yeah. So we know that skin conditions can look and behave very differently in people with skin of colour compared to white skin. So for example, eczema is typically in a kind of flexural distribution in people with white skin, so like in the elbow creases behind the knees. But in people with skin of colour it might be more likely to be on the extensor surfaces, it might be in a sort of discoid type pattern, so kind of well defined round patches or sort of a follicular pattern is another one we see. So if you look at medical textbooks and what we're taught at medical school, we just don't see pictures of these presentations. And I think another big thing is obviously redness is much less obvious in skin of colour. So that's typically what we would associate with skin inflammation is redness and it is much less obvious. And instead in darker skin tones it might look kind of purpley. Brownie might not be as obvious. And certainly in the interviews we found that patients were aware of this as well. So they were looking at their own skin and not picking up that it was kind of actively inflamed. They didn't know what it was and they'd go and see a GP or another healthcare professional in primary care and they also wouldn't know. And then it's just kind of leading to Delayed diagnosis, misdiagnoses. Speaker A 00:04:50.140 - 00:05:16.780 Yeah, And I think that's certainly something. So the people you spoke to described these delays in diagnosis and also this uncertainty from clinicians. And I do wonder if that is reflected in what we learn and what the wider public understand is what inflammation might look like as well. So I wonder what really stood out to you from these experiences. So how did people and clinicians sort of navigate those delays and uncertainty as well? Speaker B 00:05:17.320 - 00:05:44.760 What was quite shocking was in terms of the misdiagnosis a lot of the time, infection and infestation. So, for example, scabies was a big one that people were misdiagnosed with, and that in some circumstances did lead to kind of stigmatisation, psychological distress, embarrassment, and then people were more afraid to seek help. Further delays in diagnosis. Yeah, I think that was the thing that struck me the most in terms of this problem. Speaker A 00:05:45.240 - 00:06:00.040 And you've mentioned this, you talked about dyspigmentation, and that came through as well very strongly in the interviews. And I think that's probably a problem that's specific to skin of color as well. And can you talk through why that came up as such an important issue for patients in this study? Speaker B 00:06:00.760 - 00:06:46.890 Yeah, of course. So I think we already know that dyspigmentation. So skin tone usually getting darker, but sometimes lighter as a result of skin inflammation, we know that it is more common in darker skin tones just because they've got more melanin there to start with. But the thing that struck me in these interviews was just the profound impact that this can have on patients. So embarrassment, isolation, body dysmorphia. There's a lot of misunderstanding as well, kind of within certain communities about what causes it. And some people experience negative comments from within their own community, from friends and family, which really exacerbated that kind of psychosocial impact even more. And obviously, skin tone is massively tied into kind of identity, and the impact on people's wellbeing was just. Yeah, it was huge. Speaker A 00:06:47.690 - 00:06:58.490 And coming from a general practice perspective, it sometimes feels like the treatment options for dyspigmentation are really...

Today, we’re speaking to Dr Tori Ford, a qualitative researcher based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Title of papers: ‘Accumulative Experiences: Navigating Healthcare for Recurrent Vulvovaginal Thrush from Patient and Clinician Perspectives’ and ‘It’s not just thrush, it’s recurrent thrush’: Patient and Clinician Perspectives on Diagnosing Recurrent Vulvovaginal Candidiasis’. Available at: https://doi.org/10.3399/BJGP.2025.0437 and https://doi.org/10.3399/BJGP.2025.0531 Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:01.280 - 00:01:15.200 Hi, and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the journal. Thanks again for listening to this podcast today. In today's episode, we're speaking to Dr. Tori Ford, who is a qualitative researcher based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. We're going to talk today about two linked papers that she and her team have published here in the bjgp. The first one is titled Accumulative Navigating Healthcare for Recurrent Vulvovaginal Thrush from Patient and Clinician Perspectives. And the second paper is it's not just thrush, it's recurrent thrush. Patient and Clinician Perspectives on Diagnosing Recurrent Vulva Vaginal Candidiasis. So, Tori, thanks very much for joining us here today. And this might come from a slightly unscientific perspective, but my feeling is that I'm seeing a lot more recurrent thrush in practice. And we know that it's incredibly common. I think, despite that, it's not something we hear discussed very often in primary care research. So my first question is, what made you want to study it? Speaker B 00:01:15.520 - 00:01:54.060 So, like you say, recurrent thrush is an increasingly common condition. We know that 1.2 million women in the UK live with it, 6% of people globally, and I just happen to have been one of them. So my paper came out of lived experience of living with recurrent thrush over many years and having a diagnostic journey of, you know, seeing different healthcare professionals looking for answers. And like you say, those feelings of shame and stigma that keep you feeling alone were all too familiar for me. So that's what actually led me into starting my PhD, looking at recurrent thrush and then wanting to hear other patient experiences as well. Speaker A 00:01:54.460 - 00:02:22.220 And we're looking at two of your papers here that were published in the bjgp, and they're both looking at the patient and the clinician perspective. And one thing that comes through really strongly in both papers is that recurrent thrush is often treated as if it's just repeated acute episodes rather than a condition in its own right. Why do you think that that distinction matters to patients and probably to clinicians as well, or should do? Speaker B 00:02:22.380 - 00:03:55.420 I think when we hear about thrush, it's often something that's seen as trivial or mundane, and that's often because it's through this lens of acute, transient, episodic, episod, and most of the time it is right. 75% Of people with Vaginas will have thrush at some point in their life. It's usually self managed over the counter with pharmacy care and symptoms resolved within a few days. But where recurrent thrush differs is when those symptoms keep coming back so that itching, burning pain and irritation becomes sometimes cyclical, sometimes repetitive. And I spoke to three or two patients who all had different durations of heat know, happening every two weeks, every month. And what they often found was because they were accessing fragmented care. So, you know, going to the pharmacy, sometimes going to the gp, sometimes maybe seeing sexual health, it was often seen as again, that mundane, one off, trivial case. And it was really hard to trace those patterns across care, especially due to a lack of continuity. Right. If you're trying to track a pattern but nobody is following you up, it's really difficult to, to capture those. So I think it's a few layers of one. I explore how these sort of social dimensions keep it seen as something maybe less long term, but then also in the ways that sort of care was fragmented made it harder for those patterns to be picked up and then to transition the care moving away from, you know, acute one off prescriptions of an antifungal medication to something that required repeat, repetitive, enduring, you know, testing, treatment, retesting of treatments. Speaker A 00:03:56.060 - 00:04:09.970 Absolutely. And I think what's interesting is that your papers describe recurrent thrush as something that's accumulative and cyclical over time. And you mentioned that it's not just these sort of one off episodes. Can you explain what patients meant by that? Speaker B 00:04:10.210 - 00:05:13.850 Yeah. So often, I think when we talk about healthcare, journeys are presented in a way that's quite linear and straightforward that, you know, you see a healthcare professional, you get treatment, you go home, you start to feel better. But with recurrence, something interesting happens where people aren't, you know, returning to the start. It's not that you go back to a blank page and then restart your healthcare journey every time you're carrying with you everything, everything that's amassed through healthcare encounters, what you've seen online, what you discuss with friends, and that is all carrying through to those consultations. And I think what was really important there was acknowledging that for many people there was a lot to unpack there and often they felt that it wasn't being acknowledged in those clinical spaces. It was seen as, oh, it's just thrush. And that's why in one of the papers the title is, it's not just thrush, it's recurrent thrush. And that's a quote from One of the participants who was speaking about the importance of labeling and distinguishing this condition, especially in terms of the impacts it had on people's lives and also the approaches and pathways that would be needed to properly treat it. Speaker A 00:05:14.330 - 00:05:32.570 And this is an issue that we see across clinical care and women's healthcare. But a lot of participants described feeling dismissed or not listened to. And I wanted to just get your perspective from your wider sort of work in this area is how much of that reflected wider issues in women's health care, do you think? Speaker B 00:05:33.170 - 00:06:46.980 Yeah, I mean, we know there's increasing conversations, right, with the women's health strategy, with the Cumberlage report, about how people's pain is often dismissed based on their gender. And that definitely came across in the studies. But I think what was interesting was that both patients and clinicians were aware of this. And something that is quite interesting was in the diagnostic paper, we look at sort of those moments where there were sort of miscommunication or differing expectations between patients and clinicians, clinicians, where clinicians were, you know, operating on a standard guideline that requires two swabs, two positive swabs for a thrush within a year to diagnose recurrent thrush. But when that wasn't communicated to the patient, of being told we need to accumulate these number of swabs, what the patients thought was happening was, oh, they're swabbing me again, they're not listening to me, they don't believe me. So it was interesting where the dismissal was often in those moments of, you know, it wasn't healthcare professionals saying, this isn't important, or please don't come see me about this. It was really in those sort of small details where patients were operating on one framework and clinicians on another. And there were these gaps in communication. And that's why our papers seek to address some of those gaps with some recommendations as well. Speaker A 00:06:47.620 - 00:07:04.640 Yeah, and as you mentioned, one of the papers is called it's not just thrush, it's recurrent thrush. And I wonder what you felt were the key challenges around actually recognizing recurrence in primary care, as opposed to it just being a, a one off episode. Speaker B 00:07:04.720 - 00:09:30.220 There's multiple layers to this, I think, in terms of the. The papers are sort of split in terms of the diagnostic journey and then the healthcare journey. But that's sort of an artificial split in some ways, because what we saw a lot was, you know, patients trying to seek out continuity of care to get someone to notice the pattern that they were starting to see and assign a label to it and we saw some hesitancy with this in clinicians who said, you know, I'm not going to use the term recurrence because that sounds like it's something serious or sounds like it's chronic. And they saw that being helpful. But then for patients they found that really challenging because they said, you know, they just see it as thrush, they just see it as a one off case, they're not recognizing it when often...

Today, we’re speaking to Dr Charlotte Morris, a GP and academic based at the University of Manchester. Title of paper: Experiences of primary care for people with dementia from socioeconomically disadvantaged areas: a qualitative study Available at: https://doi.org/10.3399/BJGP.2025.0407 Existing national guidance recommends primary care-led dementia health care, but little is known about the experience of this for people living in socioeconomically deprived areas. This study highlights that people with dementia, and their carers, in socioeconomically disadvantaged areas want to maintain identity and understand their decline. Support from healthcare services often diminishes over time, with difficulties accessing and navigating healthcare systems when needed. There was uncertainty about primary care’s role in dementia health care. Clearer communication and proactive support from primary care may improve experiences for these patients. Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:00.320 - 00:00:32.850 Hello and welcome to BJ GP Interviews. I'm Ewan Lawson and I'm the editor of the BJ gp. Thanks for listening to the podcast today. In this episode, we are speaking to Charlotte Morris. Charlotte is a GP and doctoral research fellow at the University of Manchester and we have recently published her paper, Experiences of Primary Care for People with Dementia from Socioeconomically Disadvantaged Areas A Qualitative Study. So, Charlotte, first of all, what I'd like to ask you is how did you come to focus on people with dementia in deprived areas specifically, and what surprised you most in the interviews? Speaker B 00:00:33.170 - 00:02:03.470 Thanks, Ewan. Thanks so much to you and the BJGP for inviting me to do the podcast and publishing the paper. So, I guess my interest in people with dementia started when I finished my foundation training and I did a clinical fellowship year in London where I worked on a ward with people with dementia specifically. And at that time I wanted to be a care of the elderly doctor. But I was struck by how many people kept coming in and out of hospital with dementia regularly. We'd spend ages trying to get them home. They go home for maybe one or two days and then sadly come back on this cycle. And I think in reality, a lot of those people would probably have been better at home, even if that shortened their lives very sadly. And it made me realise I wanted to work in the community with people with dementia, trying to improve healthcare in terms of advanced care planning and kind of planning for progression. So that's where my interest in dementia came in. And I work in a practice in a relatively deprived area of Greater Manchester, and I always had an interest in health equity for kind of various reasons and health equity in terms of various lenses as well. So when I was designing my PhD project, I decided to kind of focus on both aspects, so health inequalities in terms of deprivation and primary care for people with dementia. Speaker A 00:02:03.870 - 00:02:08.270 I mean, I know we're going to touch another on some other stuff, but. Yeah. What surprised you most in the interviews? Speaker B 00:02:09.390 - 00:02:47.530 I think in terms of what surprised me most in the interviews, I think I was actually struck by how much people wanted more health care from their primary care teams. It's not like they felt they were getting the best care or they were really kind of thrilled with what they were getting in lot of times. But they were actually very trusting of their primary care teams and they really, really wanted more of that health care, which kind of struck me, really. And I actually found it kind of quite touching and humbling, as a practicing GP myself, to know that we were really valued and that the care that we provide, people tend to want more of it rather than less. Speaker A 00:02:47.610 - 00:03:21.390 Yeah, so that leads in nicely, because I wanted to ask you about one of the themes in your paper, which was the kind of proactive continuity. And several of your participants described your wanting their GP to take the initiative, you know, to call them, to know them, so just to anchor their sense of self while the dementia progresses. There was a one man who had Alzheimer's who named it Ali. Was a kind of a. Was a striking example. You know, what, what kind of sense? What does that tell us about what primary care needs to be doing? I mean, you mentioned there about how much it was appreciated, but what kind of. What do you think they can do more of? Speaker B 00:03:22.000 - 00:04:42.080 Yeah, I think that kind of theme of proactive continuity splits into two, really. So I think the idea of being proactive is really important and people wanted their GPs not only to know them, but to actively contact them. Sorry, I mean, not just their gps, actually their whole primary care team recognising that we all work together in our practices as well as that proactivity. They wanted somebody who knew them, knew their family, knew their kind of history, knew the kind of outside of their life, rather than just their medical condition or their dementia. And that was really striking and came through kind of very strongly from most people who were interviewed, really. And I interviewed people with dementia and carers and from both sides. That idea of being known by their primary care team did come through very strongly. And I think for me as the interviewer and for me as a practicing gp, I also really like that side. You know, knowing our patients, knowing that person, and being there for the kind of entire journey of a diagnosis to dementia all the way through to that progressing. It's a real privilege and I think it's something really precious for us as, as primary care teams, that continuity. Speaker A 00:04:42.240 - 00:05:02.930 There was a bit of a gap. There wasn't. There's this kind of, oh, you know, there's potential gap in that. And you mentioned this in the paper about the falling away support, that sometimes participants went to the memory clinic, then they were discharged, and then they felt a little bit like they, you know, they weren't picked up necessarily. I wondered if you could tell us a little bit more how that showed up in your interviews. Speaker B 00:05:03.570 - 00:06:27.830 Yeah, yeah, for sure. So I guess everybody, everyone did describe a kind of different journey. And I don't want to just generalize, but the sentiment or the feeling I got from most people was that there was concern around a possible diagnosis, a kind of flurry of activity around when the diagnosis was made, referral to memory clinic, lots of calls. Somebody described a mind boggling array of things being offered around that time of diagnosis and then after that things seeming to kind of fall away. So somebody described the specialist dropped them and they were seen by memory clinic, started on medication and then just left back to the gp. So that idea of kind of there being a flurry of activity and then things gradually dropping away and that being a paradox because actually people felt that their needs generally increased as time went on. So that was very interesting really. And I've also done. It's kind of not a published paper yet and it's still being worked up, but I've done some interviews with primary care providers as well and that seemed to kind of come through as well from them and that there is a flurry of activity around one point around diagnosis. But then as time goes on do things do seem to kind of drop off and change. So it's perhaps felt from both sides as well. Speaker A 00:06:27.830 - 00:07:03.200 Yeah. Let's talk a little bit about when sometimes it doesn't happen so much or people who knew the system. And there was definitely an interesting rather novel finding that came out and I guess it's something we might be aware of, but I haven't seen too many papers that have highlighted it, that if there was someone in the family who knew the system, that was often perceived as crucial and it sort of implies a system rewards social capital or maybe it's just very specific to medical systems. But I wondered if you could, you know, how worried should we be about that? What can primary care do to address it or to flatten those kind of. Those kind of flatten it out. If there is a. If it is an inequality. Speaker B 00:07:04.000 - 00:08:54.200 Yeah, I think a great question and I also thought this was one of the most interesting themes to come out of the paper actually. So just to kind of describe it, a lot of people described how if they had a family member or a friend who knew a little bit about the healthcare system, so if they'd worked in research or if they'd worked in social care, they would be called upon to kind of navigate this complexity of the system and it kind of came through that they would know who to contact, know how much to push, know what strings to pull to get somebody seen. And that insider knowledge, how we termed it, seemed crucial in kind of getting things done. And, and that was described in detail by one...

Today, we’re speaking to Catharina Savelkoul, a DPhil student in Health Economics based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Title of paper: Factors Influencing UK Medical Students’ Choice of General Practice: A Systematic Review Available at: https://doi.org/10.3399/BJGP.2025.0226 The UK faces a projected shortage of approximately 15,000 GPs by 2036/37, with a declining proportion of UK medical graduates pursuing general practice. Previous research has identified various contributing factors but lacked a contemporary synthesis within a coherent theoretical framework. This systematic review examines factors influencing UK medical students' career decisions, finding three critical influences: curricula that inadequately represents general practice, a persistent negative hidden curriculum, and the impact of clinical placement quality. Our revised Bland-Meurer model incorporates these findings, providing a comprehensive framework to improve GP recruitment. This systematic review identifies the factors that shape UK medical students’ intentions toward general practice. Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:01.120 - 00:00:59.530 Hi and welcome to BJJP Interviews. I'm Nada Khan, one of the associate editors of the bjjp. Thanks for listening to this podcast today. In today's episode, we're speaking to Katharina Savalcool. Katharina is a DPHIL student in Health Economics based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. We're here today to talk about the paper she's recently published in the BJJP titled Factors Influencing UK Medical Students Choice of General A Systematic Review. So, hi Katharine, it's lovely to meet you and to talk about your work. This is a super interesting area to study because we know that there is a push to increase the number of GPs in practice and I guess that does really start from medical school and people's intentions there. But just to start off, could you talk us through why you decided to do this work and what were you aiming to look at here? Speaker B 00:01:00.050 - 00:03:17.090 Yeah, of course. So the goal of this piece of research, of the systematic review was to synthesize the empirical evidence on the factors that influence medical students, GP, career intention. Because we know that the general practice is what makes the NHS functions. It handles over 300 million consultations annually, manages the long term, most long term conditions, issues over a billion prescriptions per year. And we also know that healthcare systems with a strong, with strong primary care achieve like, better population health in general. But at the same time, right now the projected shortages for the UK are approximately 15,000 GPs by 2036, which is of course a large number and shows like a workforce crisis. And then if we look at the policy response to this, they've been like quite ambitious but also largely unsuccessful. So for instance, Health Education England mandated that 50% of all new medical graduates should enter general practice. And this target has never been met. The same goes for the NHS long term workforce plan to increase GP training places by 50% to 6,000 places in 2031. And the interesting part about this is that the policy responses are all about setting this goal. Right? It's about, you know, we're shifting, we're shifting care to the community, we're expanding training places, more medical students should become a gp. But that's all. Yeah, setting like these, these, these strategies, but at the end it almost seems like the, we're achieving the reverse. So that, that kind of brought me to the question of if we want to, you know, make sure that we have a healthy primary care workforce, that the general practice avoids this large crisis in the future, then maybe Instead of setting these ambitious goals, we should look into the question of what draws medical students to the general practice and also what are some of the reasons why they might not become a gp? And I think if we zoom into those factors at medical school, during medical education, you get a lot more interesting insights that can actually inform more effective policy. I think that's the kind of. That was the reason I conducted this systematic review. Speaker A 00:03:17.970 - 00:03:42.850 That's a great summary of what's been going on with GP recruitment in the past little while in terms of policy and the push to increase the number of gps. And this was, as you mentioned, a systematic review that followed pretty conventional review processes. But I wonder if you could tell us a bit about this bland mirror model. It's a framework used in terms of organizing the results and how this informed how you structured the results. Speaker B 00:03:43.990 - 00:04:47.410 Yeah, I think it's for this specific research question, looking into factors that influence decision making. I decided to look up different theoretical frameworks in order to understand this, because decision making at the end of the days is, of course, something that's influenced by many things at the same time. This model specifically, which was, I think first published in 1995, helped a lot with like, systematically categorizing the findings because it identified three principal domains. One is the student characteristics, such as, like, personal values, maybe personality traits. The second one is the specialty characteristics. So what is the. What are the professional opportunities? And the third one is, like, the influences during medical school. And I think if those are the three kind of domains we saw in this across these, like, 30 years of research, and I think it was the most useful way to kind of theorize these factors. Speaker A 00:04:48.210 - 00:05:01.970 Great. So I guess just talk us through what you found, and I suppose it might be helpful to just talk through the different aspects of that model you've just described. So what were the sort of student characteristics that you found in the literature that influenced and informed specialty choice? Speaker B 00:05:02.640 - 00:06:37.050 Yeah, so I think the findings from this came from different types of studies. I think the largest ones were the ones that used a data set called UK met, which kind of has the data on all UK medical students in such demographic variables, but also more information about their educational performance in medical school. And I think these studies showed us like, the kind of the social, demographic, individual characteristics that are associated with a higher likelihood of pursuing a career in a general practice. And then there's these smaller studies which kind of like looked at personal preferences and personality traits. And I think that that's another really interesting question. Right. Because about this, like, specialty choice and Kind of individual preferences, personality traits. A lot of international research is talking about altruism or do people who enjoy social contact more, are they more likely to become gps? And I think this type of research is quite undeveloped in terms of the UK literature, but it was still interesting to look at it and compare it to different studies. And I think for the demographic factors we saw specifically that female students were more likely to choose gender practice graduates on entry. So age was another one we saw. Yeah, so there's like these different kind of demographic factors or personality traits that seem to predispose you to career in a general practice. Speaker A 00:06:37.290 - 00:06:51.930 And what about the characteristics of the specialty itself or working in general practice specifically that drew some medical students to think about it. So these are potentially medical students looking at gps and thinking, oh, I want that lifestyle or I don't or I want that work. Really? Yeah. Speaker B 00:06:52.150 - 00:07:48.350 On this question, first of all, a lot has changed recently. So I think work life balance was something that was mentioned in like the earlier studies, but right now it has changed so much that that's almost like not something we can, yeah, we can use anymore. But another interesting one, and I think one that we should really take seriously, is that a lot of one of the things that draws students to the general practice is the like, long term patient relationships. So continuity of care. And of course right now with the landscape changing and specifically like the prioritization of access over continuity of care, it might be important to kind of, you know, reconsider those changes in light of the fact that a lot of medical students decide on a career in a general practice because of this like continuity of care aspect that's so unique to primary care. So I think that's another really important one. Speaker A 00:07:48.990 - 00:08:13.560 Yeah, I can definitely relate to that. I think one of the reasons I figured out that general practice was for me was that when I was working in A E, I would flag all the patients I'd seen and clarked in and then wanted to know what happened in their...

Today, we’re going to back at the recent BJGP Research Conference, which was held just last week on the 20st of March 2025 in Bristol. Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:00.960 - 00:00:39.550 Hello and welcome to this BJGP podcast. I'm Nada Khan and I'm one of the Associate Editors of the Journal. Thanks for listening today. In today's episode we're going to look back at the recent BJGP Research Conference which we held just last week on 20th March in Bristol. It was absolutely brilliant to welcome the BJGP team and people who attended to the Southwest. And in today's episode I'm just going to talk about some the highlights and really focus on what the conference is about and maybe have a chat about how to get involved in the future. But first, here's a welcome to the conference from our Editor in Chief, Ewan Lawson. Speaker B 00:00:40.270 - 00:01:16.520 My name's Ewan Lawson, I'm editor of the bjgp. So that means basically I'm the one person that the Journal would probably run without and everyone else does all the work. But I do have to stand up here and say hello to you and I want to offer you the warmest of welcomes to the conference. Been running this for a few years and it's always really nice to get together and just try to help each other, you know, get involved. It's not in a very scholarly way, you know, whether you're involved in research or whether you're interested in putting research into practice. We think we can offer you quite a lot more than just the fact that we publish research at BJGP and BJGP Open. So I hope you have a fantastic day. Speaker A 00:01:17.320 - 00:03:26.850 So this was the seventh run of the BJGP Research Conference and this year we had a particular focus on a few different areas. We took a bit of a deep dive into patient involvement, new and emerging research in general practice, general practice policy and how to get research into impact. And this year, as always, quite a bit around writing and also public speaking in academia. The conference kicked off this year with an absolutely brilliant talk by Professor Martin Marshall, who some of you may know as the Chair of the Nuffield Trust. But he's also Emeritus professor of Healthcare Improvement at UCS and non Exec Director at the Royal Devon University Healthcare trust. And until 2022, Martin was also the Chair of the Royal College of GPs and a GP in New East London. So definitely someone worth listening to about his experiences as well. And Martin really focused in his talk on the relationship between general practice and policy and asked a really important question, which is how good are we as a profession at influencing decision decision makers? And in his talk, Martin reflected on the fact that while the value of general practice is really well established for patients, communities and the wider nhs. It's often still misunderstood or undervalued at a policy level. And in his talk he challenged whether that's purely down to policymakers or whether, as Julian Tudor Hart once put it, there's also an element of political literacy within the profession itself. And what really followed was a thoughtful discussion about how both national leaders and individual clinicians can do more to shape policy, and whether that's through better communication, stronger advocacy, or even engaging more actively with the systems around us. It was a really thought provoking structure of the conference and linked closely to that broader theme of impact that ran throughout the day. Here's just a short snippet of Martin speaking at the conference. Speaker C 00:03:27.570 - 00:04:45.260 I wish I could have my career again and I'd be more influential than I was. I've learned a lot along the way, but this is what I've learned. First of all, as I've described, influencing is about far more than informy. It's not about telling, it's about getting inside people's heads and understanding what's important to them. A lot of influencing is about timing. How do we decide when to influence? I think it's really important. Policy windows is an interesting concept. So sometimes just a window opens that allows you to do something. And a good example of this would be the evidence around Continuity of care, which is actually pretty strong in General practice was largely ignored by policymakers and politicians until the pandemic came along and they were looking for a way of delivering the vaccination program. And we made the case based on evidence that trust is really important to the success of uptake of vaccination programs. And that's why government decided that general practice would deliver their program largely, rather than setting up a separate body to deliver it. So there's an example, another example of ways of change. The NUFRE is doing some really important work around the distribution, the resource distribution formula for general practice, something which the Conservative governments of the past were not interested in, the Labour government is very interested in. So now is our time to push it while we can. Speaker A 00:04:46.460 - 00:11:57.780 So it was a great start to the conference from Martin, which really focused down on how GPs and primary care researchers can get the most impact from their work to effect change. So in addition to the keynote sessions, we had a series of parallel sessions where people presented posters and talks about their work. And what really struck me, listening to different talks and looking at the different posters that were on display, was just how strong the work was across the board, especially from medical students. And early career researchers. There's clearly a lot of exciting work coming through and I wouldn't be surprised to see some of it published in the BJJP in the near future. At the conference, we then had a series of workshops and these looked at patient and public involvement, writing for the BJGP and public speaking in academia. I attended Lucy Potter and the Bridging Gap team's excellent workshop on meaningful patient and public involvement in research. Their team did an absolutely brilliant job at highlighting a familiar but important issue that those with the greatest health needs often face the biggest barriers to care and are probably the least likely to be involved meaningfully in research. And what made this session stand out for me was that it was delivered alongside women with lived experience, which brought, I felt, a real deal, a real depth and authenticity to the discussion. And the workshop was a absolutely powerful reminder of the importance of meaningful involvement and offered some really practical ideas for how we can better include marginalized patients in our work. And going on to one of the regular features of the conference, which is the Right for Life workshop, led by our deputy editor at BJGP Life, Andrew Papaniktis and Tom Round. It's a really engaging session that encourages people to write and reflect on their experiences in general practice. And I often describe JGP Life, the website, as sort of the coffee room of the journal. It's a space for more sort of reflective conversation and debate. And here we're also always keen to receive some submissions from across the GP community, and it's probably worth pointing out that some of these pieces then go on to be published in the print journal too. And finally, the third workshop was led by Professor Graham Easton, who looked at public speaking for academics. And I just want to touch on Graham's really interesting background that he was able to draw upon here. So, Graham was a senior producer for BBC Science Unit for many years and presented Case Notes, which is Radio 4's flagship medical program. He's also a regular contributor to BBC Health Check and has quite a strong interest in the use of narratives and storytelling in medical education, which is a topic he looked at in depth in his doctoral work. So, looking back to his workshop, it focused on something we've all experienced, which is sitting through a talk or presentation where the key message gets lost in really dense slides and you just lose the audience. And Graham's session was all about how to communicate our work more clearly and make it engaging, using things like storytelling, simplifying your core message and using visuals that actually support you're saying, rather than Overwhelming it. It was a really practical session with lots of tips to take away and use straight away. And I think that everyone who attended, who attended learned something new about how to present their research in an engaging and meaningful way. So that's a roundup of the workshops. And finally we had the last keynote speaker of the conference, Dr. Rebecca Payne. And Rebecca really brought together one of the central themes of the conference, which was impact going back to Martin Marshall's talk as well. And Rebecca's talk focused on what happens after publication and challenged the idea that getting a paper accepted as the endpoint. Instead, she kind of framed it as the beginning. So that's the point at which the real work of influencing practice...